Update on DC's plans to build a new United Medical Center
At the end of April I wrote a three-part series about DC's plans to rebuild the United Medical Center, pointing out there is a once in three generations opportunity to create something fabulous.
The three parts covered super innovative public health programs (#1), creating a biomedical and health sciences education initiative in parallel (#2), and landing big name sponsors to help pay for it (#3).
-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River"
-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part Two: Creating a graduate health education and biotechnology research initiative on the St. Elizabeths campus"
-- Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part three: the potential for donations around an expanded program"
But there isn't any public planning process for the project. Although a public planning process isn't guaranteed to produce innovative recommendations.
Nothing particularly innovative is happening with the new hospital in Prince George's County ("Prince George's breaks ground on new Largo hospital," Washington Business Journal). Still one can hope that at least with a public process, the opportunity for innovation is there.
The planning activities for UMC that have been conducted are out of Executive Branch capital improvements planning ("Bowser wants to speed up design, construction of new hospital at St. E's," Washington Business Journal), which isn't a public process (Government of the District of Columbia | FY2019 Proposed Budget and Financial Plan | A FAIR SHOT | Volume 5 | FY2019- FY2024 Capital Improvements Plan).
Instead, it comes up as part of the annual budget approval process, but not with a separate process of hearings and vetting that is public, as is typical of most local governments.
Concerning UMC, the Executive Branch's priority is, not unreasonably, to find a qualified manager, deal with clear operational and accreditation problems, and right the hospital's cratering finances.
In that situation, it's hard to think innovatively.
According to the Washington Post, for me via the Washington Business Journal ("GWU to oversee UMC replacement hospital in Southeast"), George Washington University has been chosen to run the new UMC. Their hospital is owned by GWU and the for profit hospital management company Universal Health Services, and the university has a medical school which will be a good source for cheaper residents.
From the article:
According to the report, GWU and the District will spend the next several months negotiating the precise terms of the partnership. GWU may eventually own the hospital, according to the report, and Bowser and GWU Hospital CEO Kimberly Russo hope to have an agreement finalized before the end of the year with plans to open the new facility on the St. Elizabeths campus in 2023.In the comments on the three articles, I've occasionally added points that I've come across, including additional ideas that are new to me.
City Administrator Rashad Young told the Post the GWU deal is being made “to get the District out of the hospital business.” The District owns UMC, beleaguered, financially challenged facility located on the District’s border with Prince George’s County.
In April, Bowser released a proposal to replace UMC with a $248 million, 106-bed facility on the St. E’s campus — trimming it down from an initial plan for 144 beds. According to the Post’s report, the new hospital is now being planned for between 100 and 125 beds with obstetric and nursery services.
Now wrt post #1 I have these points to add:
-- I recommend that as part of "the hospital," a separate emergency clinic be included, separate from "emergency room" modelled after public health clinics, to help divert regular cases from the emergency room.
-- Using schools and clinics as hubs to create healthy communities: The example of Briya/Mary’s Center, Brookings Institution
-- Like the proposed program at St. Anthony Hospital in Chicago, but different because it is operational, Bon Secours Hospital in West Baltimore has an extensive community social and economic development program, including the construction and operation of various types of affordable housing--they have 700+ units under operation or in construction
-- the Salt Lake County Library runs a "reading room" in a community health clinic in Salt Lake City (which is interesting in itself because the city has a separate library system which I write about a lot; this is probably the only County Library facility specifically within the City) designed to serve the primarily low income, children, and Hispanic demographics of the client population, with the aim of providing free books to children (Byington Reading Room, case study, Urban Libraries Council
Besides my general idea that library branches by hospitals could have dedicated health and wellness collections (in Montgomery County, the Wheaton branch has a special collection on health, and it happens to be somewhat close but not really near to Holy Cross Hospital), it would be possible to create a public library branch, and a dedicated health information program as part of the proposed allied public health clinic listed in point #1.
Conclusion. But I don't expect any of these kinds of innovative ideas to be incorporated into the building of a new UMC.
Another example of the need to formalize and incorporate the Transformational Projects Action Planning framework into master planning. This is definitely an illustration of the value of a regularized process for what I call "Transformational Projects Action Planning" ("Why can't the "Bilbao Effect" be reproduced? | Bilbao as an example of Transformational Projects Action Planning"), where master plans include "big hairy audacious projects" as anchors, and as spurs to broad-ranging community improvement.
Now I believe such a framework needs to be applied at multiple scales.
For example, writing about the Purple Line recently, I wrote that thinking about that multi-billion dollar capital investment and the and opportunities for complementary improvements not limited to the transit network, propelled and helped me to scintillate my thinking about "Transformational Projects Action Planning" generally but at different scales too.
- macro ("Comprehensive Plan/Master Plan")
- micro (specific elements such as economic development or transportation within a master plan), and
- individual project (e.g., how do we make this __________ [fill in blank] initiative transformational and innovative).
- the city's health and wellness care system;
- as a part of the city's economic development planning;
- public health planning East of the River;
- revitalization planning for East of the River (using the health and wellness framework along the lines of Medellin style social urbanism, e.g., "'Social urbanism' experiment breathes new life into Colombia's Medellin," Toronto Globe & Mail; "Medellín's 'social urbanism' a model for city transformation," Mail & Guardian, South Africa).
Lack of public capital improvements planning process in DC. It's also an illustration that DC doesn't have a public process for capital improvements planning, instead running it through the executive branch without public review, excepting the very full calendar and agenda of the annual appropriations and budgeting process.
By contrast, other local governments almost universally do capital planning through a public process led by the Office of Planning.
Labels: capital planning and budgeting, change-innovation-transformation, health and wellness planning, hospitals, provision of public services, public health, Transformational Projects Action Planning
posted by Richard Layman @ 1:08 PM&Permanent Link
5 Comments:
I've put that bio of Ed Rendell when he was mayor of philly on my reading list. Not sure if I'll make it -- deep into the history of the grain trade right now.
In terms of this decision...
What i'd like to read is why the capital park commission came up with the first master plan in the 1950s.
Planning can be good - as you well articulate part of the chance to open up -- but you have to give Bowser some credit here.
This might be the best she can do.
And I'd say that is the difference between infrastructure projects -- where you sort of planning (or the 1950 plan) can help -- versus these tactical choices.
I am also working on the history of the prussian army, which made a fetish of being weak and therefore the need for victory in quick tactical strikes, with a corresponding lack of strategic and logistical thought.
It worked well until you invaded Russia.
Basketball versus football. Sometime you just have to make the shot.
Final judgement on details on how bad the city is getting screwed. But like the baseball stadium even a bad deal can be survived.
1950 wasn't the first plan, it was the first plan that acknowledged residents as a constituency for which to plan. Previously the focus was the federal interest specifically. The book by Cameron Logan is probably good -- I have it, but I haven't read it yet.
(Grain trade, ah, back to my CSPI days, the book _Merchants of Grain_ and my interest in Hightower's Agribusiness Accountability Project -- I think that's what it was called. I was surprised recently as I hadn't kept up, that Bunge or one of the biggies merged with someone else.)
What's interesting about the Rendell book (I only read it within the last year or so) is that it really communicates the depth of deindustrialization process, in particular within cities and how difficult it was for cities like Philly (and by extension, Chicago, PGH, NY/Brooklyn, Boston, all the smaller cities in NJ, obviously Detroit, but the process there started so much earlier, St. Louis, etc.). It's really amazing from that standpoint. Who would want to be mayor when you lose on just about every matter?
===
WRT the hospital, first, I definitely agree that DC is trying to extricate itself from a very bad situation. And what they are doing isn't terrible. In fact, it's pretty decent as far as a hospital project goes.
That being said, I still believe a lot more could be done in terms of transformational capability on all those various dimensions.
I'm not saying the city is being screwed at all, $-wise, especially when you look at the future calculations of how much the current situation will cost going forward, if the situation doesn't change.
In fact, it's very much comparable to PG Hospital. By building a new hospital, the county was able to get a new partner and shift the managerial responsibility and a lot of the cost I think, to an entity with much more capacity.
... I have pieces from 10ish years ago that make the point about regionalism and that the problems with DC General, PG Hospital, and UMC (formerly Greater Southeast) were all part of the same whole.
And you could be right that this is the best that the city can do.
... I don't think so though. It's like the baseball stadium. DC didn't have to be a total supplicant, we had something that buyers wanted too, even then. OTOH, it became an important anchor for the waterfront and its revitalization and stoking the improvement there, the velocity of improvement, by maybe 5-8 years, is probably worth it.
(I am becoming so much more equivocal. E.g. Suzanne and I disagree about the special car for the white supremacists on Metrorail -- yes I don't support them, yes they have the right of free speech, and for me, public safety wise, it made sense from WMATA to do what they did. She doesn't believe that the supremacists should have received any accommodations.)
And speaking of bad deals, as long as Congress won't step in and legislate some controls, local jurisdictions do as well as they can do, given how much pressure there is by the citizenry to keep a team, not pay out, and the pressure from the team to get $.
e.g., very interesting that the Redskins finally realize they can't be a**holes if they want money from a locality for the next generation stadium.
Yep, that the one -- merchant of grain.
ABCD; D is of course Elaine from Seinfeld.
A was Andre, they went under during the last Argentine crisis (01). Now when people say A they mean ADM.
ADM is rumored to being buying bunge.
More soybeans and corn these days (for ethanol) but my theory is why ABCD has been hurting for 10 years (farmers get the same information as they do) that will change with soybean tariffs, and you need to "clean" US beans for Chinese sales.
Also funny from CSPI -- look up their position on gene editing and CALYXT -- another speculation.
My personal theory is rather than re-colonize East Africa for soybeans the chinese may use algae to grow soy oil. Theory!
Very off topic.
Logan's book was the one at the talk this year? Need to read it.
Yep. I read his dissertation back in the day. It was quite good. The thing that gets me about people like him is the quality of the writing. I am a decent writer but hardly lyrical. The book by Suleiman Osman on Brooklyn, _Negotiated Landscape_ about the SF waterfront... they paralyze me when I judge myself against that standard.
I guess I didn't remember Andre. Definitely ADM and Cargill and Bunge. I can't remember what I was reading, about someone who worked for one of those firms in Europe...
algae and oil, gosh, I am feeling un-creative...
I guess I missed this article from last year.
https://www.washingtonpost.com/dc-md-va/2022/02/17/bowser-hospital-cedar-hill-dc/
In nod to mission, new D.C. hospital takes name from Frederick Douglass’s estate
Mayor Muriel E. Bowser (D) and health-care leaders on Thursday broke ground on the city-funded $375 million, 136-bed facility and unveiled the nod to Cedar Hill, a national historic site less than two miles from the campus, as part of a mission to target health disparities in the surrounding underserved, predominantly Black communities.
... The new hospital, set to open in late 2024, will replace United Medical Center, the public hospital beset by financial problems and mismanagement for decades. The lack of access to adequate services, including obstetrics care, has contributed to the disproportionately high mortality rates and poor health outcomes highlighted and exacerbated by the pandemic, Turnage said. He stressed that UMC will not close until Cedar Hill is open.
... “Over the years, the residents of Wards 7 and 8 have paid the price of a public hospital run by a government,” Turnage said. “Without question, the lack of convenient access to the care they need to address their health conditions has been a major factor in perpetuating these major health inequities for these residents.”
Universal Health Services, which runs George Washington University Hospital, will operate Cedar Hill at St. Elizabeths East campus for 75 years and contribute $75 million over 10 years, Turnage said.
======
wtf, UMC was not run by the government.
======
Kimberly Russo, vice president of the D.C. region for Universal Health Services and chief executive officer of GW Hospital in Foggy Bottom, said the health system will work to reverse long-standing inequities.
“This is simply unacceptable,” she said at the event. “We must do better and together we will.”
Physicians and graduate medical students from George Washington University Medical Faculty Associates and George Washington University School of Medicine and Health Sciences, Children’s National Hospital and community physicians will provide care to patients.
In addition to the inpatient facility, the first to open in D.C. in more than 20 years, the hospital will have an ambulatory pavilion for physician offices, clinics and community space, a 500-car garage and a helipad for emergency transports, according to the mayor’s office.
======
Still, my plan was better.
Interestingly, some departments will be run by other hospitals.
======
Children’s National, which serves 30,000 children in the pediatric emergency department at United Medical Center, will move its operation to Cedar Hill.
The D.C. pediatric hospital, where the neonatology program is ranked first in the nation by U.S. News & World Report, will also operate a six-bed neonatal intensive care unit at the new hospital. Officials expect more than 2,500 babies to be delivered at the new hospital in its first year.
The adult emergency department, which will not have the volume to support a Level 1 trauma center, will be equipped to handle 90 percent of severe trauma cases as a Level 3 trauma center, including gunshot wounds, stab wounds, car accidents and head trauma, Turnage said.
Sixteen inpatient beds will be designated to treat voluntary and involuntary behavioral health patients. The campus will feature outpatient services, including physical therapy, dialysis and chemotherapy, and specialty offices for orthopedic, liver, heart, kidney, brain, bones and joint care, according to the mayor’s office.
Post a Comment
<< Home