Hospitals as urban anchors/revitalization levers, not usually, but with great potential to serve communities in important ways: Examples are two forthcoming projects by Intermountain Health and University of Utah Health

I have an extensive series of pieces about how DC could have used the reconstruction of a hospital East of the River to create a world class community and public health centric hospital with a complementary medical education and biotechnology research and development initiative.  

-- "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," 2018
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus," 2018
-- "Part three: the potential for donations around an expanded program," 2018
-- "Update on DC's plans to build a new United Medical Center," 2018

I argue that "a building" isn't enough, you have to have a plan to address health inequities in innovative and novel ways.  Plan + program + building.  

And ideally, a "transformational projects action plan" approach to boot.

This set of articles is a bit broader, more about integrating health and wellness planning and hospitals.

-- "Health planning vs. hospital planning redux," 2006
-- "Piling on the hospital issue," 2006
-- "An opportunity for rethinking health and wellness care in the District of Columbia," 2006
-- "Speaking of rethinking how to offer "public services" and medical care," 2007
-- "Community Health Improvement Planning," 2019
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital," 2018
-- "More communities need to integrate health care and public health programming: Prince George's County, DC, etc.," 2020
-- "Rush Medical Center (Chicago) clues us into a gap in state and regional health care planning: planning for disaster and epidemic response," 2020

Even though DC has failed to think big about the new East of the River hospital, that doesn't mean these concepts can't be applied elsewhere.

Salt Lake.  Both Intermountain Health ("Intermountain Health says it wants planned urban hospital to be 'an anchor' in Salt Lake City," KSL-TV) and University of Utah Health ("Here’s the latest on that big hospital coming to WVC — and why it differs from other U. centers," Salt Lake Tribune) are building new hospitals, the former in Central Salt Lake City, the latter in West Valley City to the west of Salt Lake.

The Intermountain hospital will replace a neighborhood-embedded hospital a couple miles away that isn't centrally located and is hard to get to.  The WVC facility for Utah Health will be its first foray into a secondary facility that functions as a hospital.  While they have lots of clinics in the region, Utah Health hasn't bought other hospitals throughout the state the way that other university-affiliated health care systems have in other states.

Both say they want the facilities to be community centric, good neighbors, contribute to the community, etc.  Utah Health say they want the WVC facility to promote jobs and educational opportunities for the Valley's west side.  From the second article:

The goals of the future hospital, he said, are to provide meaningful economic impact to the west side by employing residents who live near the facility, and to improve the health of a city that faces lower life expectancy and higher rates of serious conditions compared with the overall county.

The $800 million complex at 3750 S. 5600 West also represents a chance, Randall said, for the U. to dramatically diversify its workforce.

“If we’re going to have societal impact,” he said, “we have to be engaged in the communities and help them achieve their desires and dreams.”

Revitalization effect, not much.  Financial and employment engines, yes.  The thing is that hospitals, except when they are embedded in neighborhoods--and that's with a big maybe--don't have a lot to offer to revitalization efforts.  Their main effects are financial and as large employers. 

Hospitals are internally focused.  Workers don't have time to eat or shop off campus.  Both patients and visitors are focused on the task at hand, not spending time off campus.  The buildings are big, with lots of employees.  They aren't permeable.  There can be a lot of parking.

I became more focused on this when I was doing some consulting in Pittsburgh.  Allegheny Hospital is a big player in the Northside neighborhood, and West Penn Hospital, affiliated with Allegheny, is located on the main street of the Bloomfield commercial district.  

At the time the Children's Hospital of Pittsburgh was building a new facility in Lawrenceville and everyone was touting its potential for revitalization benefits ("Big move: The new Children's Hospital already has an impact," Pittsburgh Post-Gazette).

But neither the Northside and Bloomfield facilities contributed spillover benefits to business district or neighborhood improvement in substantive ways, at least as customer generators.  And UPMC CHOP is located away from Lawrenceville's commercial centers.

Architecture is tough when you design for the car.  Inga Saffron of the Philadelphia Inquirer makes the point that because hospital planning is in large part focused on accommodating cars in parking, etc., providing high quality people spaces within a hospital complex becomes very difficult ("Penn’s new hospital belatedly recognizes pedestrian space is a public health issue").

Relatedly, in 2008, Saffron wrote that the city's newest hospital building was designed for the suburbs, not the city ("Penn got a trophy, not a triumph, in hospital design").  From the article:

After all the promises we heard about how the Perelman Center for Advanced Medicine would bring order to the university's congested hospital district and help forge a more pedestrian-friendly environment, it's hugely disappointing to see that the results are no better than any of the previous trophy medical buildings along Civic Center Boulevard. The Big Driveway rules again.

Perhaps the architects, Rafael Vinoly and Perkins Eastman, were under the mistaken impression they were designing for a suburban office park, rather than a busy West Philadelphia corner. Looking at their contorted hybrid, which pairs a banal low-rise, ribbon-window structure with a towering cube of slick glass, you have the feeling you're witnessing the architectural equivalent of a car crash.

If the screech of incompatible materials and forms isn't dissonant enough, just try walking up to the front door. Instead of a gracious, approachable welcome, we get curlicues of driveway ramps and "Don't Go There"-style planting beds. Pedestrians will have to play dodgeball with cars as they make their way past the building.

Transit adjacency is a plus for employee transportation.  One reason to locate hospitals at high capacity transit stations, is because of there being so many employees. But I haven't seen a good transportation demand management study of hospital workers trip to work.  (In the DC area, the Coalition for Smart Growth was a big proponent of the new Prince George's County Hospital being located at the Largo Metrorail Station, which it was.  But I argued all along that while that was important, it wouldn't have the revitalization impact they touted.)

University of Utah Hospitals have two light rail stops, but the complementary university bus shuttle system needs to be more tightly integrated, at least for the medical campus, to make it easier, especially for patients, to get to health facilities located some distance away from the transit stations.

HealthLine in Cleveland.

In Cleveland, health institutions supported the development of the HealthLine (the name was chosen based on financial sponsorship), a bus rapid transit line serving a number of neighborhoods, including the University Circle district and Cleveland Clinic and the University Hospital system and Downtown.

Hospitals can be strong supporters of community development efforts, but it has to be designed into the program from the outset.  FWIW, Allegheny Hospital in particular is a best practice example in their support of local community development corporations, providing grants to staff towards housing purchases near the hospital, which extends to West Penn in Bloomfield, etc.  

In Philadelphia, Frankford Hospital and Penn Hospitals contribute to local business improvement districts, Penn being a major player in the University City District there.

And some hospitals are refocusing some of their purchasing on local businesses, thereby strengthening the local economy ("When a Steady Paycheck Is Good Medicine" New York Times).

Nationwide Children's Hospital in Columbus ("When a Hospital Plays Housing Developer," CityLab) is leading a neighborhood revitalization effort, probably out of necessity, to preserve the value of its location and the willingness of people with choices to continue to patronize them. 

MetroHealth in Cleveland is doing something similar ("MetroHealth’s new $759 million Glick Center opens Nov. 5, signaling a new era of healthcare," Cleveland Plain Dealer).  They call it "hospital in a park" but Inga Saffron might differ?

In August [2022], the hospital system opened its affordable housing project Vía Sana in Cleveland’s Clark-Fulton neighborhood. Vía Sana – meaning “healthy way” in Spanish -- is the first $15 million investment in MetroHealth’s $60 million mixed-use development aimed at improving both the physical and economic health of the community adjacent to its main campus. ...

Construction of the new $140 million outpatient care facility and administrative building, called the Apex Project, began last year. delivers on MetroHealth’s promise to turn its main campus into a “hospital in a park” and to create a more welcoming neighborhood. The Apex Project includes renovation of the hospital’s Rammelkamp Center for Education and Research and a 700-car parking garage for patients and visitors.

A couple hospitals, like Bon Secours in Baltimore have developed housing to support out-of-hospital patient care and healthy communities.

The potential exception: hospitals that are more neighborhood-embedded.  The current LDS Hospital is in The Avenues neighborhood, less well connected to the city at large.  Theoretically, because it is neighborhood embedded, it could provide more neighborhood-focused services, but I don't think it does.

St. Anthony Hospital, Chicago has proposed (they haven't actually done it) a new hospital in a low income area, Lawndale, with community facilities like wellness and recreation facilities built into the campus

From "Chicago safety-net hospitals face uncertain future amid changes to health care system: Area has 20 safety-net hospitals, which are a stop-gap medical system for the poor" in the Chicago Tribune:

When now-CEO Guy Medaglia arrived as a consultant in 2007, the 151-bed hospital was losing millions of dollars annually. Medaglia was tasked by its then owner, Ascension Health, with closing or selling it.

Instead, he emboldened the hospital's board to break away from the chain in 2009 and become independent.  Despite that commercial insurance covers fewer than 1 percent of its patients, St. Anthony has posted operating income nearly every year since.

St. Anthony embarked on its turnaround after assessing the needs of its community and tailoring its services to match. It now functions as a de facto community hub, teaching language classes and hosting courses for people studying to take high-school equivalency tests. It also added health services like dialysis and occupational health and expanded its infusion, pediatric and maternal centers.

"If you're doing what the community needs, you become very valuable to them," Medaglia said. "And to continue to serve them, you really have to think out of the box. You have to think: What can we do that's different, that can service this community at a lower cost and higher quality?"

St. Anthony is pushing forward with plans to build a 1 million-square-foot commercial development at 31st Street and Kedzie Avenue anchored by a 100-bed replacement hospital.

The $430 million Focal Point [Community Campus] development is slated to be built on 11 acres acquired from the city for $1 by a nonprofit affiliated with St. Anthony. The complex is set to include two schools, retail stores, a child-care center, an indoor recreation facility and an athletic field.

How to make a hospital a hub.  The point about the hospital as a community hub makes more sense in a neighborhood where the hospital is more integral and central and where they aim to develop and strengthen hub opportunities.  

The new Intermountain Hospital on the edge of Salt Lake's downtown won't be part of a residential area, but it could offer specialty urban health care programming.  Similarly the University of Utah West Valley Hospital could take its cue from St. Anthony and other programs listed below.

Potential urban health functions at Intermountain. Here are some examples that Intermountain could consider incorporating as a way to provide specially focused services to urban populations.

Church Health, Memphis.  Rather than from a hospital setting like what St. Anthony intends in Chicago, Church Health, an organization founded by churches, provides care to the uninsured in a clinic setting, although they have a comparable and expansive mission.

Services include medical, dental ("Church Health dentists improve patients' smiles, life prospects," Memphis Commercial Appeal), eye, family care and pediatrics, behavioral health, physical therapy, and pharmacy. 

Last year it moved into a consolidated facility of 150,000 s.f.  ("Just what Church Health will do with all its Midtown buildings," MCA; "Church Health Center rebrands in preparation for Crosstown Concourse move," Memphis Business Journal; "Holistic Healthcare for Medically Uninsured: The Church Health Center of Memphis," Ethnicity & Disease Journal).

Wellness programs, also delivered off-site to local churches, include a 25,000 s.f. YMCA facility ("New Church Health Center YMCA opens in Crosstown," MCA) adjacent to the consolidated clinics at Crosstown Concourse Center in Downtown Memphis, which is the adaptive reuse of a former Sears Department Store and catalog distribution center, and a food and nutrition program ("Church Health's Memphis Teaching Kitchen Promotes Healthy Bodies and Communities," Parade Magazine).

HealthOnBroadway: El Rio Community Health Center and Tucson Medical Center.  HealthOn Tucson is a joint program of the community health program and the city's major medical hospital ("New downtown Tucson health clinic offers a different patient experience," Arizona Daily Star).

Not unlike "urgent care clinics" and clinic operations in pharmacies like Walgreen's and CVS, their first venture is the creation of a community wellness and "emergency care center" on Broadway Avenue in Downtown Tucson.  The facility is open six days/week, most nights til 9 pm, and is highly visible. According to the article, these are innovations implemented in the center:

-- high quality and modern design (Photos: BWS Architects)
-- self check-in
-- "Dialogue rooms" where people can talk to health care providers without being in an exam room
-- on site classes, including a conference room that doubles as an exercise room
-- health coaches
-- online appointment booking, including the use of virtual applications functioning like telemedicine
-- hours beyond office hours.

But the facility is more than just a place to drop in for a flu shot, as they have a broader focus on working with the patient over time such as with health coaches, offering free wellness programming, etc. 

University of Houston College of Medicine Direct Primary Care Clinic ("Monthly subscription for low-cost healthcare is now available through University of Houston clinic," KHOU-TV).  This clinic is offering low cost basic health care access to people who couldn't otherwise afford it, for $60 per month.
Houston has the highest rate of uninsured residents in the nation, according to a press release from UH.

Startup costs for the pilot clinic were funded by a $1 million gift from The Cullen Trust for Health Care.

In Fort Worth, Texas ("His insulin would have been $1,000 per month. At Fort Worth hospital, he pays $10," Fort Worth Star-Telegram) the Texas Resources Hospital system has a program operating in 9 hospitals, to provide focused care of chronic health conditions for the uninsured.  

The initiative, the Healthy Education Lifestyles Program, offers low-cost health care to anyone 18 and older who is uninsured and has diabetes, hypertension, high cholesterol or congestive heart failure. For $10 a month, patients get a monthly check-up from a nurse or other health care provider, education on how to manage their disease, and help navigating the complex health system to find prescriptions that are affordable.

Continuum of care programs (relevant to both).  "Penn receives record $125 million to offer free tuition to nurse practitioners to work in underserved communities." Philadelphia Inquirer.

Jackson County Michigan has a "community integrated paramedicine" program where EMS personnel are utilized as a way to provide "continuity of care" between hospital release and home, with the aim of increasing care compliance and reducing readmissions.  Regions Hospital in Minnesota also has a community paramedicine program.

Potential community hub functions at West Valley: Social determinants of health.   The basic idea is addressing what are called the "social determinants of health" ("An Effective Way to Tackle the Social Causes of Poor Health," Harvard Business Review).  According to the St. David's Healthcare system in Austin, Texas:

20% of health care outcomes to do with access to care; the other 80% dependent on family structure, where you live, access to food, parks, etc.

I don't know much about the West Valley City location that University Health is building on.  But through the University Neighborhood Partners program ("University of Utah University Neighborhood Partners program and community revitalization in West side Salt Lake City/County") the University of Utah is focusing on that part of the Valley.

I do think that they should study carefully the St. Anthony Focal Point Community Campus initiative.  And there are other examples listed below.  These kinds of programs could be great components of a community health outreach initiative on the west side.

 
Latino Health Access, Orange County, California.   Focused on providing health care to the Latino community, which has traditionally been underserved, the organization focuses on education, prevention and participation, training a cadre--many thousands over the years--of paraprofessionals and volunteers working in and already part of the community, to deliver health education, focused on chronic diseases, such as diabetes.

The organization was featured in a four-part HBO documentary “The Weight of the Nation,” on addressing obesity.

The organization sponsors an annual health walk, has built a park and community center in an impoverished neighborhood that lacked such facilities ("Residents Bring First-Ever Park to California’s 92701 Zip Code," Salud America!), and the organizations main clinic has a community room with space for exercise classes, fitness equipment, and space, a "Youth Room," for adolescents.

LHA has published a workbook, Recruiting the Heart, Training the Brain: The Work of Latino Health Access, discussing what they do, how they built the organization, and their care model.

Other programs.  As part of medical school programming, Columbia University has opened the "Community Wellness Center" in Upper Manhattan which provides health services, and some free services, and also "trains residents of Harlem and the surrounding area to serve as community health advocates."

But outside of certain screenings, like for blood pressure and cholesterol, they don't provide medical services.

Share Cancer Support, a Manhattan-based breast- and ovarian-cancer nonprofit, has an African-American Ambassador program providing education and training sessions in communities of color ("A cancer survivor does outreach in communities of color," Crain's New York Business). 

3rd Street Youth Center and Clinic in the Bayview Hunters Point neighborhood, San Francisco, offers an interesting ladder of programming to develop youth self-knowledge about health issues.  And a year long program involving various institutions introducing youth to health careers.

Mental Health Center of Denver in the Park Hill neighborhood will marry a family health clinic with farm and greenhouse. The overall redevelopment of a shopping center site includes senior housing, affordable housing, and a family health clinic. The Mental Health clinic will include a community space, community gym facility, teaching kitchen, and dental clinic also ("Community input shaped new mental health clinic in Denver’s Park Hill," Denver Post).

Community engagement facilities.  The University of Maryland Baltimore, a health-focused campus, built a 20,000 s.f. community engagement center in the neighborhood adjacent to its campus ("UMB breaks ground on community center in West Baltimore," Baltimore Business Journal).  From the article:

Programs offered at the new center will include workforce training, a legal clinic, weekly markets with fresh fruits and vegetables, computer access and exercise and yoga classes.

The expanded center will add a new UMB Health Alliance, a faculty and student-led program that will focus on preventative health education for asthma, hypertension, diabetes and mental health. It will also offer academic programs for middle and high school students and house UMB's Police Athletics-Activities League for youth.

Athletic fields are being installed as part of a new health campus in Greater Pittsburgh ("Allegheny Health Network serves notice to its rivals with Coraopolis athletic, outpatient center," PPG).

Sure Start and similar initiatives.  Sure Start centers in the UK have been decimated by the Conservatives, but were created to provide extra services to impoverished families preceding childbirth til 4 years of age ("Sure Start saved NHS millions," Guardian).   

A Boston Globe article, "The ‘fourth trimester’ and plight of new mothers during a pandemic," calls this period the "fourth trimester." 

The Sisters in Birth clinic in Jackson Mississippi, focused on assisting women of color in pregnancy, as black mothers die nearly 3x more often than whites of pregnancy related causes ("Sisters in Birth, Standing by Expecting Mothers," Jackson Free Press).

From the Pittsburgh Post-Gazette story, "Allegheny Health Network launches new effort to tackle Black infant mortality":

In Pittsburgh, Black infants are more than four times as likely than white babies to die before they reach their first birthday.

This grim gap is the reason for a new initiative launched by Allegheny Health Network called First Steps and Beyond. The program aims to monitor the health and well-being of African American parents and their babies through the first year of life by expanding prenatal, perinatal, birthing and fatherhood services to residents. In doing so, it hopes to slash infant mortality of Black babies by at least 28% over the next five years.

Separately, "Leeds only major UK city to see a drop in child obesity," Guardian.  It's attributed to the HENRY program: Health, Exercise, Nutrition for the Really Young.

Finland has a best practice program wrt childhood obesity ("The Fit Children of Seinäjoki," Der Spiegel). 

Reading room.  The Salt Lake County Library system runs a library "reading room" in the South Main Public Health Clinic in Salt Lake City, which serves a predominately low income population. A big element of the service is providing free books to children ("Clinic's reading room making a big difference for low-income kids," KSL-TV)

Some library systems have special health and wellness collections.  Why not create one as part of a community-serving hospital? 

Teaching Kitchens.  The Teaching Kitchen Collaborative supports hospitals and public health clinics offering nutrition and cooking programming.  Boston Hospital has a Teaching Kitchen ("At Boston Medical Center, cooking classes aim to restore health after addiction," AP).

The ProMedica health system in Toledo (1) created the Ebeid Institute for Population Health as a way to serve underserved communities and (2) on the ground floor of the building created a 65000 s.f. "Market on the Green" nonprofit supermarket. A hospital nutritionist does programming, cooking glasses and store tours.  (3) there is a Financial Opportunity Center program too, GED classes, etc.

The workforce development program of Ebeid is integrated with the staffing program for the supermarket.

CVS Health Hub concept.  According to Drug Store News ("CVS Health debuts first Health Hub Location"):

During a ribbon-cutting event at the company's HealthHUB location at 687 Johnson Ferry Rd. in Marietta, Ga. the community celebrated the new, innovative store format that features a broader range of health care services to help patients better manage chronic conditions, more products and services focused on overall health and wellness, and personalized care.