With the final move to take place in May 2009, the $625-million campus will include a new nine-story, 296-bed hospital with overnight accommodations for family members; a 41-bed emergency and trauma unit; 79 beds in three critical care units; and 13 operating suites, six of which will be equipped with minimally invasive equipment. The project also includes construction of the John G. Rangos Sr. Research Center, which will provide open research laboratories for researchers, visualization and imaging suites, and a 270-person conference center. The new campus will be in close proximity to the University of Pittsburgh Medical Center and the Hillman Cancer Research Institute.

“The paradigm that we have built in Pittsburgh focuses on creating excellence,” says Dr. Raphael Hirsch, chief of the Division of Pediatric Rheumatology. “We believe that if you create excellence, the revenue will follow.”

The success of the Pediatric Rheumatology program is largely attributed to having a critical mass of people interacting with each other in a collaborative environment. The expansion of the Pediatric Rheumatology Division in 2002 marked the beginning of a transformation in administrative thinking, planning processes, and facility infrastructure to deliver better patient care and to create new financial opportunities through public/private partnerships and an intellectual property program. The extensive construction project was based on those same principles.

Pediatric Rheumatology is a small specialty with only about 230 pediatric rheumatologists in the United States. While many of the programs in the country are losing money, Pittsburgh’s program got off to a good start six years ago with the hiring of Dr. David Perlmutter, physician-in-chief, scientific director, chair of the Department of Pediatrics and Vira I. Heinz Professor of Pediatrics.  His vision was to bring in leaders who could create a center of excellence by providing not only clinical care, but also research, training, and education. Perlmutter, in turn, recruited Hirsch and together they worked with hospital administrators to hire the best clinical investigators in the world.

Today, the Pediatric Rheumatology program is one of only two in the country to receive a National Institutes of Health training grant. The Pediatric Rheumatology Division attracts top international doctors and is one of the largest centers in the United States in patient volume. In 2007, more than 4,000 patients were treated.

The research technology has resulted in the start-up of a company, Cartesia Dx, as a collaborative effort with the Robotics Institute at Carnegie Mellon University in Pittsburgh and the University of Pittsburgh. The Pittsburgh Life Sciences Greenhouse provided funding to launch the company in 2006. Cartesia Dx provides three-dimensional thermal imaging, which helps to provide a more quantifiable diagnosis of arthritis. The two defining characteristics of arthritic inflammation are swelling and heat. The technology uses two different types of cameras: a three-dimensional camera to measure the shape of the hand and a thermal camera to measure temperature.

The realignment initiatives that made the Pediatric Rheumatology program a success are being used to ensure that the new hospital and research facility are also effective, productive, and beneficial to patients. Realignment is taking place at the organizational, infrastructural, and cultural levels.

Planning Framework

In 2007, the Richard King Mellon Foundation awarded Children’s Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine a $23-million grant to establish a pediatric research institute to be housed in the Rangos Research Center. The funding will enable Children’s Hospital to foster high-risk, high-impact research projects.

Key characteristics of medical centers, such as that in Pittsburgh, include the ability to form institutes, the capability to create integrated public/private partnerships, the ability to cross-train and utilize skilled workers, and the capacity to align their visions and affinities.

There also are four development scenarios that are typical for academic medical centers, according to John Scott, a principal at CUH2A.

The first is the spin-off scenario where new facilities are built around institutes of like-minded scientists, while the second is the managed or nest-egg scenario, which focuses on resources. The third is the magnet scenario where the clinical and translational sciences institute is used as a mechanism to train clinical researchers and to attract industry into a particular area.

Children’s Hospital of Pittsburgh of UPMC falls into the fourth category, or the integrated scenario, which aligns leadership and creates centers of excellence.

The new hospital and the research center are being brought together on a 10-acre campus. The buildings will be linked by an enclosed third-story walkway, enhancing the opportunity for interactivity between medical researchers and clinicians. The hospital will include a family resource center, libraries, an activity center, a healing garden, and playrooms. The hospital also will offer the latest technology with a paperless information management systems and decentralization of the medication dispensing process. Nurses will be equipped with wireless, silent notification monitoring systems and phones for constant contact with patients.

The Rangos Research Center, expected to be completed in the fall of 2008, is designed for the 21st Century and beyond. It includes an open-lab concept and a layout that fosters the sharing of information and equipment. Core laboratories will be shared among researchers. Open break rooms on alternating floors will provide an opportunity for researchers to interact in a social setting that offers a breathtaking view of the city.

Hospital Leadership

“It’s not often that an academic hospital has the ability to reinvent itself, but we had that opportunity,” notes Roger Oxendale, chief executive officer of Children’s Hospital of Pittsburgh of UPMC and president of the Children’s Hospital of Pittsburgh Foundation. “The real strength of a children’s hospital, or any academic medical center, is not the bricks and mortar, but rather the rich, productive environment that unites science and research with patient care and a teaching mission. Science and research are the drivers in that equation.”

The goal of the pediatric hospital’s leadership is to create a comprehensive campus, which achieves positive patient outcomes by focusing on perfecting patient safety and quality of care in a family-centered environment of health and healing. The leadership has adopted a philosophy of transforming patients from sickness to health and providing employees with work that offers meaning to their lives.

One of the first decisions to jumpstart the vision for the new hospital was the merger of Children’s Hospital with the University of Pittsburgh Medical Center in 2001. The construction of a new children’s facility was critical to replace an existing hospital. As part of the merger, UPMC provided an initial $250 million to begin the project.

Primary goals of the project are to create a research infrastructure that inspires physicians and scientists to excel at their work and face challenges with distinction. Achieving these goals meant locating the research facility and the hospital on the same campus. A conference center will be located in the research building to facilitate collaboration between clinicians and researchers. Integration and connectivity will be evident throughout the entire campus, which will boast 1.5 million sf of facility space.

“Children’s Hospital has a long history of excellence in pediatric healthcare,” says Oxendale. “For example, the polio vaccine was part of the University of Pittsburgh and Children’s Hospital research enterprise and we were also the first pediatric transplant center in the country. We’ve expanded exemplary programs in not only rheumatology, but also cardiology and endocrinology.”

Economic incentives also served as a driver in prompting the hospital’s leadership to proceed with the new campus. For instance, collaborative partnerships can be formed with public and private investors to help meet long-range financial objectives. Science, research, and technology enterprises can also be forged.

New Horizons: Payoffs

The focus on excellence is paying off for patients and families at Children’s Hospital. Specialists are continually seeing a larger number of patients, and children are often seen by a doctor within two days after the appointment is made—something Oxendale says is unusual for an academic medical center. These factors improve the overall satisfaction of families and result in an enhanced reputation of excellence through referrals and word-of-mouth praise.

Science, research, and technology work together at Children’s Hospital to create clinical brilliance. In fact, diabetes researchers are close to finding a cure for Type 1 diabetes and the scientists in the Pediatric Pulmonology laboratory have created a vaccine platform designed to prevent viral illnesses in individuals with immunosuppressed systems.

“We have one of the oldest pediatric research centers in the country,” says Oxendale. “Under the leadership of Dr. Perlmutter, one of the top chairs of pediatrics, we stand out as the fastest growing pediatric research center in the country as defined by funding from the National Institutes of Health. Our researchers continue to attract millions of dollars in public and private funds.”

The paradigm of public/private partnership allows the hospital to train scientists for the future to collaborate on research, enables initiatives to be brought to market quickly and efficiently, and helps attract top researchers. Providing quality patient care, quality teaching, and quality research requires the hospital to be fiscally prudent in the operation of the organization.

The overall project is expected to have a significant impact on the local economy, providing more than 850 new full-time jobs at the new hospital and up to 800 new jobs at existing or start-up research companies.

Lessons Learned

Realizing that patient care drives revenue is a critical aspect of Children’s Hospital’s project. Likewise, research plays an invaluable role in patient care. The Division of Pediatric Rheumatology is a primary driver in bringing patients to the hospital, where other specialists may also become involved in caring for the children.

“The Rheumatology program is enabling us to drive the excellence of the hospital,” says Oxendale.

To ensure the successful completion and operation of a project, it is also important to take advantage of other resources and partnerships that may be available in the local region. Leadership must also be committed to the project for the long term.

“We are blessed to have the opportunity to build this vision of excellence in pediatric medicine,” says Oxendale. “We continue to build on a vision of excellence in pediatric medicine, which makes us realize what the bottom line really is: giving patients and their families hope for a fair start in life and a healthy future.”

By Tracy Carbasho

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