Since 1922, Shriners Hospitals for Children has provided orthopedic and burn care to children regardless of the family’s ability to pay with 22 hospitals spanning North America and the Pacific Rim. Established in 1923 in the rear wing of the Kauikeolani Children’s Hospital in Liliha, the Shriners Honolulu Hospital is the second oldest and has provided orthopedic healthcare to over 23,000 children from Hawaii and 17 other countries in the Pacific Basin.


In 1930, the Dowsett family donated their 7-acre estate in Honolulu, and Shriners utilized its buildings for their hospital until 1967 when replacement facilities were constructed, consisting of five separate, one-story buildings connected by landscaped courtyards. An expansion and infill project, completed in 1992, connected the buildings but did little to upgrade their infrastructure. By 2004 the Shriners Honolulu Hospital faced systems deterioration, code compliance issues, and lack of adequate space to support the Shriner’s mission and desired model of patient and family care. A feasibility study eventually determined that a full replacement facility of 100,000 gross square feet (gsf) would be the best option for the Hospital.



Shriners’ design directives were to provide a modern, state-of-the-art facility that would support their mission to provide Pediatric Orthopedic Care, Education, and Clinical Research well into the future. The design of their Honolulu Hospital should also be unique from their other system hospitals, reflecting Hawaii, and providing spaces that are comfortable for how people of the Pacific interact.


Closely aligning with Shriners’ mission to care for patients’ family is the Hawaiian value of ‘ohana, which upholds family members’ call to support one another in community. In light of these values the existing Hospital space was rendered inadequate to properly care for patients and their families, as well as to fully accommodate Hospital programs and staff. The design team developed a global functional space program that estimated a total of 137,000 gsf (a 40% increase in net usable floor area) would be needed to adequately address these concerns. The space program included a 24-bed inpatient nursing unit, orthopedic surgery suite including 2 operating rooms and a 6-bed Pre-Op/PACU Unit, inpatient pharmacy, radiology suite including 2 digital x-ray rooms, outpatient clinic including 13 patient exam rooms, rehabilitation suite, hydro therapy pool, recreation therapy, a 10-room family residence facility, conference center accommodating groups up to 100 people, and the necessary support functions including food service, laundry, housekeeping, materials management, facilities services, medical records, care coordination and administration.


Program requirements for the replacement hospital included the following:

  • Acute Care Nursing
  • Pharmacy
  • Surgery
  • Imaging
  • Outpatient Clinics
  • Physical Therapy
  • Plant Services
  • Auditorium
  • Human Resources
  • Administration
  • Fiscal Services
  • Environmental Services
  • Infection Control
  • Medical Media
  • Recreation Therapy
  • Classrooms
  • Telemedicine
  • Care Coordination
  • Materials Management



The priority of upholding a family-focused care model set the design tone to create a healing environment which would help normalize and restore balance to the pediatric patient’s life. The design breaks from the traditional, clinical healthcare setting in order to reduce stress and anxiety by providing elements of positive distraction, promoting daylight and views from patient areas, and including generous areas for family members to aid in the healing process.


Along with fostering a healing environment, Shriners envisioned the Honolulu Hospital as a unique facility that would thoughtfully reflect the community and culture of its patients and their families. From abundant gathering spaces for families and patients to feel “at home,” to ample interior and exterior connections to the natural beauty of the Islands, the new Hospital was to be a place that would be comfortable for Hawaii, both in appearance and design.



The Hospital campus is designed around the Hawaiian kauhale concept, a homestead of houses with specific functions, while respecting the character and feel along Punahou Street, maintaining the green belt and royal palms. The buildings are organized around a central grass court that extends the grassy frontage deeper into the site. Surface parking wraps from the north and west perimeter to buffer the H-1 Freeway. Exterior architecture reflects the Territorial Style of Hawaii with its calm and peaceful character. Large sweeping roof forms plus a well-grounded building mass using cement plaster, inset punched windows and continuous building base display the elegance of the region’s historic past while earth-toned color palettes and natural materials draw upon the beauty of their surroundings.


A protected walkway connects the main hospital building to the adjacent family quarters building, or Family Hale, and the Administration/Education Center. The main hospital building contains critical programs including surgery, inpatient care, outpatient clinic and rehabilitation. The campus design also creates a central courtyard for gathering and celebration complete with a performance mound similar to the traditional pa hula.


The Family Hale provides generous, comfortable living space for families of patients. Mindful of the family value of ‘ohana, this facility was designed at a residential scale in which families can feel at home, and features its own central courtyard where they can gather to support one another in community. A nearby outdoor recreation therapy area features a pavilion where inpatient children and their family members can freely gather and play.



The central Interior Design concept is to recognize the Island’s ties to the natural environment and the healing power of nature. The crown of the Hale form features a skylight which ties us to the heavens and sky while bringing in a large amount of natural daylight. According to ancient Hawaiian mythology, the gods created the Hawaiian Islands from basic elements of land, water and sky. The design team embraced these ties to nature and its associated healing powers through three key themes:


  • Land, the Tropical Landscape
  • Water, the Wonder of the Sea
  • Sky, Views from Above


Each theme inspired interior elements including materials and finishes, furnishings, artwork and water features, each carefully chosen to appeal to patients of all ages with color palettes indigenous to Hawaii and the Polynesian cultures. Along with providing a life-giving respite for patients, the main hospital interiors also serve to welcome and support families with abundant gathering spaces throughout and an overall sense of peace and beauty.


Inpatient rooms incorporate elements of positive distraction for patients and families with colorful, tropical landscape-themed graphics. Each room is large enough to allow families to gather around children, with areas designated for the patient, rooming-in family and caregivers.


Pre-op/post-op units were inspired by the Sky theme, with durable sheet flooring and wall protection products giving patients the feeling of “sleeping in the clouds.” Each unit features six private rooms for acoustical privacy and program flexibility.


Gathering spaces on each floor and throughout the building welcome patients and their families with natural light and outdoor views. Comfort features for visitors within patient, exam, and procedure rooms also uphold ‘ohana.


Artwork inspired by all three themes includes a two-story ceramic mosaic mural at the elevator lobby. Designed and installed by local artist Leah Rigg, it depicts images of the Hawaiian Islands. Suspended below the main lobby’s atrium skylight, a mobile of tropical fish reflects light to welcome visitors with a rainbow of color cast throughout the space.



The design team creatively phased construction in order to construct the new hospital with minimal disruption to the operations of the existing facility, which consisted of sprawling one-story buildings and surface parking occupying much of the available site. The initial phase included a 5,100 gsf renovation of a portion of the existing hospital in conjunction with Shriners’ acquisition of a mobile surgery unit allowing the hospital to consolidate all inpatient nursing, pharmacy and surgery support in temporary space. The next phase consisted of the demolition of a significant portion of the existing hospital to create the building site for the new hospital building. This approach saved the project an estimated $4 million in construction costs and 18 months in schedule over the alternative approach of building Phase 1 in two parts. More than 900 surgery cases were performed in the Temporary Hospital while the replacement project was under construction.



Completed in January 2011, the new project retained 6,600 gsf of existing buildings and added 130,200 gsf of new construction to create a healing environment for pediatric patients and their families with a thoughtful connection to the culture of Hawaii. In every sense, the Honolulu Hospital design allows Shriners to continue their mission of providing innovative pediatric specialty care, world-class research and outstanding medical education serving the keiki of Hawaii and the Pacific Basin.