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A National Children's Hospital, The East Coast, U.S.A.

February 2019
EDAC Advocate Firm Project
Insights from Mixed-Methods Implemented During Pre-design, Renderings courtesy of HGA



EBD Goal

To discover the challenges of a new entry portal and determine design decisions to enable clarity for patients, families, and staff. To create an entry that matched the vision of this world-class hospital.


Originally built in the 1980s and expanded over many years, this national children’s hospital needed updating. The entry portal, in particular, had deteriorated in the past year when the “people mover” broke and was no longer repairable. Leadership sought a new entry portal for people arriving in cars— one that embraced their vision of “providing world-class care to the children around them.”


A first site visit revealed multiple issues. The main dropoff area/entry point by car was underground and poorly signed from the main street. This entry is shared by patients/family members and all staff (shuttle buses drop off from nearby Metro stations). Motorcycles and pedestrian bikes also shared this entrance. Many non-English speakers enter at this portal. Cars were triaged if staff were available and not busy with another task. As a first impression, this entry point was uninviting. There was no one to help people and no check-in desk, making it difficult to find the first floor check-in desk.


Because of the project’s complex nature, the HGA research team created a multiple method practice-based research study that involved three researchers, more than 100 on-site hours, and several unique research tools to define the right solutions. These tools examined questions from multiple perspectives—touching on people, processes, and programming.

The first task was a deep dive into the leadership’s perspective of the problem using a DT tool called Flipping Assumptions: a strategic series of questions used during a focus group. For example, leadership used words to describe the existing space as “clutter,” “busy,” and “dark.”

Then, a focus group and questionnaire were used with staff to understand that the entry portal created extra stress for the staff as they arrived to and from work on the shuttles. Staff often felt torn between wanting to help families find their way to their next destination and having to catch the shuttle to get home to their own families. Staff also agreed that the entry point did not represent the prominence of the hospital in their community.

Finally, the team held an open work session for patients and their families to share their insights about the entry sequence. To accomplish this, adults over 18 were offered the opportunity to answer a questionnaire about their experience. Anyone under 12 could participate with signed consent from their parents. Children could also participate through drawings, and families could contribute to the process through Patient Journey Mapping.


Using these tools, the team learned important insights, such as how a family’s stress is directly tied to their child’s stress. And children who utilized the hospital’s services on a continuing basis revealed that they just wanted their lives to be normalized. The findings were themed and described as:

• Spatial issues (low ceiling, poor ventilation, visibility, signage)
• Car congestion and unpredictability
• Lack of organization for car, motorcycle, bicycle, and pedestrian traffic.

• Number of staff being dropped off or picked up at the same time
• People loading or unloading strollers or wheelchairs
• Taxis or car services waiting for pickups
• Staff and patient cross-flow in the P1 lobby
• Broken escalator and overcrowded elevators

• Valet
• Dedication of staff and CNHS to their patients and families
• Sense of arrival at the atrium
• Children’s response to positive distractions, e.g., the people mover and atrium furniture

Research findings were shared with the design team to help inform the next step of design decisions. This phase of the project is currently in progress.

While The Center believes that the information in this resource is valid, it has not fact-checked the information or tested any findings. The Center disclaims any warranties, expressed or implied, regarding this content.