As a pediatric surgeon practicing in Richmond for the past eight years, I have a unique perspective on hospital-based pediatric care in this region. I interact on a routine basis with pediatricians, as well as pediatric sub-specialists in the outpatient clinics, on the inpatient wards, in the intensive care units, as well as in the operating room. My patients range from newborn, premature babies up to children who are adult-sized. And because my partners and I provide essentially all of the general and thoracic pediatric surgery in central Virginia, we care for children both in an academic, teaching hospital and in community hospitals.Having attended medical school and spent the majority of my career in the Richmond area, I have been as excited as anyone about the renewed energy in the community over the past year to build a hospital that is completely dedicated to the care of children. In fact, during my fellowship, I was fortunate to spend time in such a facility, and it certainly is the ideal setting to deliver pediatric care.While previous plans to develop a dedicated facility in Richmond have not yet come to fruition, we have made amazing progress in that direction. Over the past two years, the joining of VCU Medical Center and Children’s Hospital has resulted in unparalleled progress toward dedicated children’s care. Together, investments by the Children’s Hospital Foundation and VCU Medical Center have supported more than half of the 30 newly created positions for pediatric care providers and contributed greater than $160 million worth of facility improvements, including a new state-of-the art neonatal intensive care unit, a new pediatric emergency department and construction of a new pediatric-only ambulatory facility, as well as new programs like the Children’s Trauma Center and the Center for Craniofacial Care.A few months ago, I had the privilege of leading the clinical team responsible for the separation of conjoined twins. This is but one example of the importance of cross-disciplinary health care. The excellent and seamless care provided by countless pediatric and adult specialists, nurses, therapists, staff and ancillary workers made this complex pediatric surgery seem routine. This doesn’t just happen — it is the result of long-term investments in pediatric specialists and clinical staff, research, technology and facilities.Many other miracles have occurred at Children’s Hospital of Richmond at VCU as a result of these investments. Just ask the family members of the little boy who was born weighing just a few pounds without kidney function and has been receiving dialysis since birth. He is now thriving and awaits a kidney transplant. You could ask the parents of another child struck by a vehicle, who is recovering well despite having life-threatening injuries. You also could visit with the mother and father of another young girl who has a rare malignancy that is finally responding to a new course of chemotherapy. They all would agree that the care providers who created these specialized programs saved their children’s lives.VCU Medical Center and Children’s Hospital of Richmond at VCU have a vision to eventually have the people, programs and patients in full-service, dedicated pediatric facilities. Despite the progress that has been made toward this vision, there has been a movement to build a new free-standing children’s hospital for central Virginia, without VCU Medical Center and Children’s Hospital of Richmond at VCU, regardless of how this facility would be sustained, or the possibility that it might fragment the physician and philanthropic communities. While the intent and passion is admirable, a decision to build a children’s hospital facility without full participation and collaboration among all stakeholders would be disruptive and detrimental to the care delivered to our children. If we cannot achieve consensus, collegiality and partnership in the delivery of pediatric services in our community, no structure — no matter how grand — will ensure accessible, coordinated and quality health care for all children in the region.We need to continue engaging in honest and open dialogue to find ways in which all concerned parties can work together to preserve educational programs, support pediatric research and provide high-quality care for all children in our region. I would argue that building upon what we have started at Children’s Hospital of Richmond at VCU, collectively across the community, will be the best and possibly the only way to deliver what our children truly deserve — a unified and comprehensive pediatric health care system.Dr. David A. Lanning is surgeon-in-chief at Children’s Hospital of Richmond at Virginia Commonwealth University Medical Center. Contact him at firstname.lastname@example.org.