Children's Hospital New Orleans renovated in place, saving $250M versus a new build

What was changed

Children's Hospital New Orleans, the largest pediatric health services provider in Louisiana, was working out of a building constructed in 1955 that struggled to keep up with current practices and technologies. In 2015 the hospital put three options on the table: build an entirely new hospital, keep the existing one and add a new tower, or renovate.

Building new proved far too expensive. The tower option, though only about half the cost of building from scratch, was still expensive, opposed by neighbors, and did nothing about the outdated existing facilities. The hospital chose to renovate, updating older parts of the campus and building some new facilities to bring itself up to modern standards.

The saving came from renovating while the hospital kept operating: new construction was stacked on top of existing parts of the building, and departments were strategically relocated as new facilities were completed. Architects EYP, who began working with the hospital in 2015, initially scoped 34 phases of construction — 'but it was a lot more than that,' said project director David Deis. Construction began in 2017, deliberately starting with a new ground-floor lobby built as 'the jewel of the project.'

By its designers' account the approach produced a roughly $300 million renovation and expansion about $250 million cheaper than building new. The lobby-first sequencing doubled as change management: giving staff, patients and families an early glimpse of the transformation 'got them on board for the long journey and pain of living through this step-by-step process.'

Why it worked

Building an entirely new hospital was far too expensive; a new tower cost about half as much as new construction, still drew neighbor opposition, and left the outdated facilities in place.

Renovating in place meant Louisiana's largest pediatric provider never stopped treating patients.

Departments moved only as their replacement spaces were finished, so care continued on a permanently working campus.

Building the lobby first gave staff and families visible proof that the disruption was going somewhere.

What can be applied

Renovating while you keep operating is harder but cheaper — sequence the work so people can see the destination early.

Aftermath

Construction began in 2017 and sprawled well beyond the 34 phases first scoped, with departments relocating step by step as new spaces came online. Fast Company's July 2022 account of the EYP-led project put the renovation and expansion at about $300 million and credited the renovate-in-place choice with roughly $250 million of avoided cost versus building a new hospital.