Here's a look at the views of Bruce Komiske, a children's hospital project executive.
"I often make the analogy between a hospital and a prison. At hospitals, we take people, strip their clothes and values, put them in a room with a stranger, give them institutional food. Sounds like a prison, right? It's the most dehumanizing thing we could do to you, and we do it when you're sick, injured and dying, or when a child.
"The philosophy, particularly of a children's hospital, is to blow that up -- to make walking into that hospital totally different, so that it does not look, feel, smell like a hospital. One of the ways to do that is to engage the community, to make it a place people feel very proud of, that is unique to that community. ... Instead of coming in feeling scared or frightened, or intimidated, the children are coming in with school groups just to see the public spaces. And when they come when they are sick, the fear factor is totally different."
Some of Bruce Komiske's previous key projects include: Ann & Robert H. Lurie Children's Hospital of Chicago
Women's and Children's Hospital at Mission Bay, San Francisco
Sidra Medical and Research Center in Doha, Qatar
Maria Fareri Children's Hospital in Westchester, N.Y.
Hasbro Children's Hospital, Providence, R.I.
When Erlanger Health System CEO Kevin Spiegel envisions the Chattanooga skyline as it could look seven years from now, he sees a new building standing among the ranks of city icons like the Tennessee Aquarium, the Creative Discovery Museum and the Hunter Museum of American Art.
"This community deserves a state-of-the-art children's hospital," Spiegel said. "We want a hospital with wide-reaching, regional impact. And really, it needs to happen sooner than later."
Erlanger officials have long wanted to build a stand-alone children's hospital. And for now, the vision is still just that -- a vision.
But Spiegel is ramping up the process to make it a reality, calling for a new women's and children's hospital to be built in the city within five to seven years.
Besides holding small informational forums and sending out surveys to gauge interest, hospital officials have hired a renowned children's hospital project executive to conduct a yearlong assessment of the project's potential.
Bruce Komiske, who has overseen the construction of innovative children's hospitals from Chicago to San Francisco to the Middle East, has literally written the book on children's hospital design, in three volumes.
Spiegel met Komiske while the latter oversaw construction of a children's hospital in Westchester, N.Y., 10 years ago, and first brought him to Chattanooga last summer to talk possibilities.
Komiske, who is spending two weeks of each month in Chattanooga, calls his assessment year a "homework phase." There are still plenty of questions to be answered before the hospital board could consider the potential project.
He needs to establish what kinds of services need to be offered with a new women's and children's hospital, how much it is likely to cost and a recommended location, among other factors.
Komiske has spoken at several forums in recent months, asking Chattanoogans what they feel is the most important building for the city.
"For many, it has been the aquarium," Komiske said. "But in lots of cities, the most important building is the children's hospital. It affects just about everyone, and it's something everyone gets behind. And there is big potential for that in Chattanooga."
T.C. Thompson Children's Hospital was founded by the former Chattanooga mayor of the same name in 1929. It moved to its current facility next to Erlanger in 1975.
Designated as a comprehensive regional pediatric center, Children's boasts physicians in nearly every pediatric subspecialty. The hospital's Level III neonatal intensive care unit provides the region's most high-tech level of care for infants.
But the hospital faces growing competition.
To the west, Vanderbilt has announced it is building an $84 million, four-story in-patient tower atop Monroe Carell Jr. Children's Hospital. The expansion would give Nashville one of the 20 largest pediatric hospitals in the country, The Tennessean newspaper reported.
Le Bonheur, the Memphis system from which Spiegel came to Erlanger last year, finished its 640,000-square-foot children's hospital in 2010.
To the east, Knoxville's East Tennessee Children's Hospital this summer announced a proposal for a $75 million expansion and renovation project.
Children's hospitals have spent $16 billion on expansions over the past decade and project spending billions more in the coming years, a recent examination by Kaiser Family Foundation and McClatchy Company News found.
"Our facilities are already behind. They have been behind for 10 years," Spiegel said. "We cannot afford to be behind for very much longer."
In many respects, Chattanooga is ready for a larger children's hospital, Komiske said. It already has the doctors and the programs. It already has a patient base and a reputation. It has a community that "senses the need."
But there are two big questions. First, is Erlanger financially stable enough to back this effort? The public hospital operated nearly $10 million in the red in the most recent fiscal year, and has been under intense scrutiny since its bond rating was downgraded over the past two years.
And second: Is the Chattanooga support there? The project will hinge on a massive fundraising effort requiring tens of millions of dollars in donations -- potentially more than the Nashville or Knoxville construction projects.
"So far, we've heard nothing but a very positive level of support from the community," Komiske said. "Everyone recognizes that Erlanger is the center of pediatric care in this community. They have great staff, great people, great programs. But the facilities are not up to contemporary standards. They are adequate, but not what you would consider for a world-class hospital."
Komiske said Erlanger is like the parent hospital of Maria Fareri Children's Hospital in Westchester, N.Y. It, too, was the county safety-net hospital. It had a lot of land. Its facilities were functional and safe, but not up to contemporary standards.
After 13-year-old Maria Fareri died of rabies, her parents kick-started a seven-year fundraising effort that the entire community participated in -- from the fire hall to children holding read-a-thons.
The hospital has become world-renowned, Komiske said -- proof that such a project can happen with or without one major donor.
Erlanger officials are trying to get a sense of how much grassroots support they may be able to drum up.
Last month, Erlanger Health Systems Foundations, the fundraising arm of the public hospital, sent a survey to 8,000 community contacts asking about a variety of Erlanger-related issues. She said 400 responses came back.
Asked which project should be the hospital's priority, respondents' preference for a new children's hospital "was by far the largest," said Julie Taylor, the foundation's chief development officer.
"There is definitely an interest in it," said Taylor. "We need to have a new facility if we're going to continue our quality of care. This is something everyone should want to get around."
Kim White, CEO of the River City Co. and a former Erlanger board member, made remarks before one of Komiske's forums last fall, stressing the impact a world-class children's hospital could have on the city's image and business recruitment.
The city rallied behind the aquarium's construction 25 years ago and could do the same for this project, she said.
"I don't know a better thing you could invest in," White said last week. "When we talk to companies about coming here, it's all about schools and health care. It would definitely be a plus for recruiting."
Several potential sites for a new hospital have been floated, including the present campus, an expansion of Erlanger East facilities in East Brainerd, and even the Wheland Foundry-U.S. Pipe site on Chattanooga's Southside.
Perimeter Properties owns the Wheland-U.S. Pipe site. Perimeter partner Mike Mallen said there have been only "very preliminary" discussions to date.
"I have always felt like if Children's saw our site as a viable new location, that we would receive that with open arms," Mallen said. "But I would support it anywhere. It is one of the most meaningful improvements our city could offer our children."
There is also a question of design -- one of the key reasons Spiegel said he tapped Komiske to be the visionary for the initial groundwork.
For Komiske, the hospital building itself needs to be a part of the healing process. When hospitals are uniquely designed to spark imagination and provide comfort, children have less anxiety, he said.
"If you're scared, you're frightened, you've got to overcome those issues before you can really start focusing on the health issues you're dealing with," he said.
And hospitals need to be a "celebration" of the cities in which they are located, he says.
At the Lurie Children's Hospital in Chicago, for example, each of the 23 floors was designed by one of the city's organizations, from the planetarium to the zoo. In the lobby, models of a 30-foot whale and her calf are suspended from the ceiling.
In the Westchester hospital, a steam engine emerges from the wall.
It's too early to tell what he envisions for Chattanooga, Komiske says. There's plenty of inspiration, but there will need to be more definition for people to jump on board.
"In some ways, we're dealing with a chicken-or-egg scenario," said Komiske. "If people don't know what this will look or feel like, they may have a hard time supporting it. We need to define an image, establish some ideas. From there, we can see what people think."
Contact staff writer Kate Harrison at firstname.lastname@example.org or 423-757-6673.