Listen up




WHEN MILTON GARDNER unveiled the initial plans for Canada's first new children's hospital in more than 25 years, the response was less than positive.

One kid put it bluntly: It looked like a jail.

They thought the sketches were dull, says Mr. Gardner, principal of Kasian Architecture Interior Design and Planning Ltd. Operating out of offices in Vancouver and Calgary, Canada, the firm was responsible for the hospital's design.

At that moment, the entire concept of the project changed. The team decided to engage children in the hospital's design.

It was a risky move, but it paid off. Today, the C$253 million Alberta Children's Hospital in Calgary is cited as a breakthrough in family-centered healthcare. But to its architects, development team and sponsor, the project served as a revelation about listening-based design.


Most project owners might have been alarmed by such a dismal assessment of their project, but Ken Chiang says he was relieved by the change in plans.

“We all had a sense that we were getting stuck with the design, that we were just regurgitating the same old thing,” says Mr. Chiang, project director for Calgary Health Region, the hospital's governing authority.


Company: Kasian Architecture Interior Design & Planning Ltd. Founded: 1985

Project management approach: Since 1997, Kasian has championed the role of project managers. Just how many work at the firm? “A lot,” says principal Milton Gardner. Why? “Our people thrive when they are part of a team—empowered, appreciated and supported to achieve their career-development goals,” he says. “If someone here wants to be a project manager, and many do, they are supported in that endeavor and they are mentored by some of the best project managers in the business.”

Secret to success: “We listen,” Mr. Gardner says.

Projects currently under way in: Canada, China, India and United Arab Emirates

Many of the area's facilities date back to the 1960s and are “grounded in brick and that solid, institutional look,” he explains. “Healthcare architects typically tend to focus more from the inside out…. You start with function, and you end up with a building's shape. This results in less attention being paid on the aesthetics and feel of the building. And if you keep doing the same institutional building, are you really helping anybody? So, we all just looked at the original design and said, ‘Something is missing.’”

Bob Holmes, senior vice president, planning and capital development, for the Calgary Health Region, viewed the initial lack of enthusiasm as a key turning point in involving the stakeholders—families, children and staff—in the project.

“We were attempting to engage the stakeholders, but there didn't seem to be a lot of traction,” Mr. Holmes says. “So when I heard the news that the children were less than enthusiastic about it, I was actually pleased to hear it. That told me the engagement with the stakeholders had finally taken hold and that there was traction.”

Traction is an understatement. In fact, an inexorable force of nature—the powerful, whimsical visions of children—had been unleashed.

Catherine Morrison, manager of Southern Alberta Child & Youth Health Network, would eventually harness that force into an advisory council that, over the next nine months, would transform the project from the ground up.

“To be perfectly frank, it didn't surprise me that Kasian's perceptions would be way off, because only when you really get close to kids and their families can you appreciate how they really feel about their experience,” she says. “That's what family-centered care is all about. And I'm not sure that architects who haven't gone down this road before could appreciate that aspect and pay attention.”


From left, Oliver Agustin, Jim Ebbels and Milton Gardner of Kasian Architecture Interior Design and Planning Ltd.; Bob Holmes and Ken Chang of Calgary Health Region

From left, Oliver Agustin, Jim Ebbels and Milton Gardner of Kasian Architecture Interior Design and Planning Ltd.; Bob Holmes and Ken Chang of Calgary Health Region

To their credit, the team members at Kasian started paying attention.


Working with The Institute for Family-Centered Care, based in Bethesda, Maryland, USA, Calgary Health Region and Kasian formed a creative consortium to engage children in a collaborative design process. Ranging in age from 8 to 22, the 41 participants included chronically ill patients, siblings, children of hospital staff members and local students recruited from the school system. Most of these kids were then merged into a Southern Alberta Child & Youth Health Network advisory council that's still going strong today.

For two consecutive Saturdays, children worked with the architects and partners to brainstorm ideas for the hospital design. There was the usual discussion, but then the kids were put to work. Putting colored pens to paper, they conjured up their visions for the hospital.

Several universal themes emerged, including vivid color, bigger windows and landscaping that created a fun environment.

“The drawings were pretty extraordinary,” Mr. Gardner says. The architects and designers involved were quick to embrace the ideas—some of which helped to solve long existing issues with the building's design.

“What's interesting is that we had a scale problem with this building. Although it's only four stories on one side and five on the other, it's the same height as about an eight- or 10-story apartment building.”

Inspired by the drawings, the architects discovered that by using residential-style, four-paned windows that were two stories tall, they could actually create the illusion from a distance of a smaller building with fewer floors. “That gave the place a sense of home, as well as a sense of scale,” Mr. Gardner says.

It would also turn out to help patient healing. “In the old hospital, the kids would lose their day-night cycles because there were so few windows,” says Lois Ward, administrative director of the child and women's health portfolio for Calgary Health Region.


Drawings by the children led to several design innovations, including an area where patients can receive visits from all the members of the family—even the four-legged ones. “All of the pictures had pets running around,” says Milton Gardner, Kasian Architecture Interior Design and Planning Ltd. “As a result, we ended up adding a pet visitation vestibule to the hospital, because we heard the children say their pets were important members of the family. It's a good example of listening-based design.”

The children also inspired the designers to create a vibrant color palette, a central gathering space in the lobby that features a retractable stage for theater performances, a sunroom and an art studio. And a revamped landscaping plan includes elevated wooden walkways, elevated wooden bridges, gardens, treehouses, birdhouses, an orchard, and an End of Life Garden for terminally ill patients to visit with their families.


1990s A series of studies by Calgary Health Region determines the need for a new Alberta Children's Hospital to replace an existing series of buildings dating back to 1952.

1999 Government of Alberta, Canada commits to development of the new hospital.

March 2001 Design contract awarded to Kasian Architecture Interior Design and Planning Ltd.

August 2001 Kasian begins master planning and creation of functional schematics.

May 2002 Initial schematic concept of hospital's exterior is presented to a family advisory group—and rejected by children as too institutional. As a result, a Child and Youth Advisory Council is created to provide feedback to Kasian and Calgary Health Region.

July 2002-March 2003 A series of creative workshops and ongoing collaborations are held with the Child and Youth Advisory Council.

July 2003 Construction begins. August 2006 Construction completed on budget and three months ahead of schedule.

September 2006 Dubbed “the Lego building” because it resembles colorful building blocks, the hospital opens to critical and community acclaim.

All of these changes in design, however, brought about another challenge: how to build the hospital the kids envisioned without it costing a lot more time and money.

But in fact, the revolutionary process would bring the project in on budget and three months ahead of schedule.

The solution came in what Mr. Gardner found to be a refreshingly innovative process.

“We sat around a table with the major building trades and the construction manager to make design decisions together—and we made decisions to suit the construction manager's priorities,” he says. “As a result, major design construction and cost decisions were made very quickly, in the same room, by all who influenced those decisions. This cut design time, eliminated constructability issues and improved the building schedule.”

With the added budget and schedule pressures brought on by the revisions, Kasian and Calgary Health Region learned another vital lesson: the value of collaboration. To ensure everyone was working toward a common goal, Mr. Gardner and other principals and associates at the firm met regularly with a core team that included the construction manager, the building trades, interior designers and engineers.



“I always liked big windows.”

At 10 years old, Carmela Desireau answered an ad in the Calgary Herald and became a member of the Alberta Children's Hospital Child and Youth Advisory Council. “My idea was the big windows,” says Ms. Desireau, now 15. “If I were in the hospital, I'd want big windows, so I could see outside even if I couldn't go outside.” For the architects, Ms. Desireau's contribution had a more significant impact: It visually downsized the exterior scale of the building.

“We just wanted something pretty.”

For years, Leah Sullivan, now 20, had visited her two chronically ill brothers in the old facility. “I hated that hospital,” she says. At 14, she and her peers envisioned a place with cheerful landscaping. “We just wanted something pretty,” Ms. Sullivan says. “When you went out of the old hospital, it was pretty grubby. We wanted a nice, peaceful place. It's like a fun jungle gym incorporated into the landscape.”

“Too often, there's an ‘us’ and ‘them’ mentality,” Mr. Gardner says. “Everybody stakes out their turf and they do battle. I'm the architect, you're the contractor, you're the engineer and that's the way it is. Being able to blur those distinctions by saying, ‘Okay, we're all professionals trying to get this built, so what do we do next?’ really was a great experience. We listened and we cooperated. Too often, architects are prima donnas. With this project, the kids transformed much of the way our firm thinks.” PM


There was the usual discussion, but then the kids were put to work. Putting colored pens to paper, they conjured up their visions for the hospital.




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