Hospital buildings, much like the patients they house and doctors they develop, have lifespans. After 50 or 60 years, once cutting-edge designs fade into the shadow of newer technologies.
Children’s Medical Center Dallas, which opened in 1967, can’t grow up or out, having expanded to the edge of its plot on the corner of Harry Hines Boulevard and Medical District Drive. The space above the hospital’s ceilings is only 8 inches in some parts, a relic of when medical clinics had fewer machines and fewer wires to run above the rooms.
It’s an unavoidable truth: Once or twice each century, hospital executives have to find the funding, location and capacity to add to existing facilities or construct new ones. Children’s Health and UT Southwestern Medical Center have chosen to start fresh, announcing plans to build a new $5 billion hospital less than 2 miles from the current pediatric facility.
Demand for care is increasing. Dallas-Fort Worth has ballooned in recent years and is projected to hit 8.5 million people by 2028. The pediatric population is nearing 2.5 million, a number that’s expected to double by 2050, Children’s reports. Nationwide, emergency department visits have outpaced population growth for years as more people turn to hospitals for acute medical needs.
The new campus, which includes a 2 million-square-foot hospital with three towers and a connecting bridge to William P. Clements Jr. University Hospital, is a massive undertaking that will take six to seven years to finish. It’s one of the largest hospital construction projects in the country.
“This is beyond my wildest imagination to be able to create a new facility of these component parts and pieces,” said Children’s Health president and CEO Christopher Durovich, who has been in the role since 2003.
The hospital leader has overseen a long list of expansions including the addition of Tower D, a major addition to CMC Dallas. Children’s Plano campus was just an idea when he arrived; the Children’s Research Institute at UT Southwestern, a joint research venture, was merely a “brain cramp.”
“The future that our two organizations are seeking to create will touch the lives of children for the next 50 to 60 years. Those who are alive today, those who are yet unborn, but who will come into the world over that multi-generational period,” Durovich said. “It will serve as a source of community pride.”
The power of hospital design
Karla Esquivel knows how quickly a hospital can become a home.
The Coppell mom realized something was wrong with her son, Carlos Rivera, when he lost weight and stopped jumping around. In early 2020, a cardiologist diagnosed him with restrictive cardiomyopathy, meaning the muscles of his heart had stiffened, stopping the organ’s lower chambers from properly filling with blood.
Carlos would need a heart transplant at the age of 3.
The family drove 40 minutes to Children’s Medical Center Dallas for more testing, not knowing they wouldn’t leave for four months.
“We just kind of moved into the hospital,” Esquivel said. “There was a full crew taking care of Carlos and at the end, I realized that it was the best thing that happened to us.”
Despite a scary diagnosis, the days in the facility felt ordinary. Carlos, now 7, befriended other patients, and Karla found comfort with other parents. They moved rooms and decorated each one with superheroes; Iron Man, a character famous for having heart surgery, was of particular interest.
The art of constructing a hospital requires balancing familiarity with the future. Carlos needed a team of medical experts to carry out his complicated operation in June 2020, which was a success. Carlos’ family needed space and a sense of normalcy.
The family didn’t partake in the listening tours Children’s carried out with patients and staff in the planning process of the replacement hospital, but experiences similar to theirs have informed every part of the new campus, from the colors and art to room and floor layouts.
Around the time Esquivel moved her son into the hospital, Children’s Chief Strategy Officer Lindsey Tyra found herself in a similar position, albeit for a much shorter duration. Her son, Brooks, caught a bad case of the flu that hospitalized him for nearly a week.
“As a mom, leaving my other three kids behind and my newborn so that I could focus my sole attention on him was really scary, and I’m a highly educated health care consumer,” Tyra said. “But I think in that moment, regardless of your education or background, all of that goes out the window.”
In designing the new facility, Tyra and her team implemented areas close to patient rooms for parents and family members and even Children’s staff to take time for themselves.
“If you’re a caregiver, you want to be strong, you want to be positive, you want to be uplifting, but you’re scared,” Tyra said. “You don’t want to let them know that.”
The team paid attention to the view of the child. How would someone the size of a 5-year-old experience the hallways and exam rooms? What textures on the walls and art might engage a toddler versus an elementary student?
Children require different kinds of care tailored to their level of development. Pediatric cardiologists, pulmonologists and gastroenterologists train to recognize diseases and administer treatments that are unique to kids.
“An infant communicates with us differently than a toddler, preschooler, an elementary-aged child, a tweener, a teenager or a young adult,” Durovich said.
Doctors, nurses and other health providers also had a say in the design. The hospital constructed mock rooms made of styrofoam and ran simulations to see how big the space needed to be and where each outlet should be placed. It’s a tool that Children’s Healthcare of Atlanta used in the construction of a new hospital set to open later this year.
Children’s staff toured pediatric facilities in Georgia, Pennsylvania, Massachusetts and Colorado to learn what they want to include, and what they don’t. They pulled inspiration from unlikely sources as well: Durovich saw a salad vending machine in Boston Logan International Airport and a robotic arm that serves coffee during a trip to San Francisco.
“All of those things and more are how we create an environment that kids and families are comfortable with,” Durovich said.
A joint venture
The relationship between Children’s and UT Southwestern, a public academic medical center, stretches decades. Almost immediately after the two health care giants reaffirmed their master agreement in 2019, talks of a new and improved children’s hospital in Dallas began.
“We appreciated that the Children’s Medical Center, as much as it was a place where great care was given, still was an old and aging facility,” said UT Southwestern President Dr. Daniel Podolsky. “It was clearly limited in capacity as the number of children seeking care continued to increase.”
The new hospital, Podolsky said, will be a boon to recruitment efforts for doctors and other health care providers. North Texas is designated as a critical health care professional shortage area for both family medicine and pediatrics. The region is projected to need 1,972 pediatricians in 2032 but a supply of only 1,239, meeting less than 63% of demand, according to the 2022 Dallas County Community Needs Assessment.
One month before COVID-19 brought life to a screeching halt, the Children’s board approved the replacement campus. It was the beginning of a long road: Both Children’s and the governing bodies of the UT System would need to sign off on the plans. UT Southwestern provides most doctors for CMC Dallas.
The hospital’s original proposal and the final product look different, in part because of the pandemic. The project was originally reported to be half the cost and with fewer beds than the current $5 billion, 552-bed total.
Increasing interest rates and construction costs are to blame for the skyrocketing price tags on a number of hospital projects nationwide.
“It’s more expensive to build anything nowadays than it was two or three years ago,” said Mike Hargrave, principal at medical real estate data firm Revista in Maryland. “And that’s because of inflation of materials like steel and concrete.”
Texas ranked first in hospital construction in 2023, with 35 properties and 8.7 million square feet in progress. Dallas ranked sixth for hospital construction out of the nation’s top cities, just behind Houston. Indianapolis, which is building a new IU Health hospital, ranked first, according to Revista.
Hospital and outpatient construction start volumes are generally down compared to pre-pandemic.
In the fall of 2023, three years after Children’s gave the OK on the new hospital, Durovich and Podolsky had a standing meeting in the UT Southwestern president’s office. Podolsky was prepared to take the plan, all $5 billion of it, to the UT Board of Regents.
“Holy cow,” Durovich thought. “This is going to happen.”
Looking to the future
As the dust settles after Wednesday’s announcement, the physical work of creating the campus from scratch will commence. Children’s and UT Southwestern will break ground on the new facility, located on land that formerly housed the Bass Center buildings, in the second half of this year.
The hospital will require excavating 800,000 cubic yards of dirt and rock, equivalent to 245 Olympic-size swimming pools. It will need 37,000 tons of rebar, or about 16,820 mid-size cars worth, and 376,000 cubic yards of concrete, which equals the weight of around 3,390 Statues of Liberty.
It’ll be six or seven years before the new facility welcomes patients. In the meantime, Children’s Medical Center Dallas will remain in operation. Children’s and UT Southwestern have yet to decide what to do with the old hospital once the new one opens.
Karla Esquivel and her son Carlos return to Children’s every few months for check-ups, and likely will for years to come. The visits are happy — Carlos’ recovery has been smooth — but the family feels prepared for a day when Carlos requires more intensive treatment. The idea of the new hospital is a source of comfort, Esquivel said.
“It’s a big thing for families like mine, for families in that situation already, that they will have more research and more options,” Esquivel said. “It gives me hope.”
