Rebuilding Place in the Urban Space

"A community’s physical form, rather than its land uses, is its most intrinsic and enduring characteristic." [Katz, EPA] This blog focuses on place and placemaking and all that makes it work--historic preservation, urban design, transportation, asset-based community development, arts & cultural development, commercial district revitalization, tourism & destination development, and quality of life advocacy--along with doses of civic engagement and good governance watchdogging.

Friday, August 10, 2018

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.

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.
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.

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.

One model is the community health clinics run by Mary's Center that are co-located within the Briya Charter Schools--I mean to write about this--but set up to divert non-emergency care cases from the "hospital" and to set up wellness and chronic disease management programs through that entity.

-- 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 UMC program and the lack of a public process for it and likely missed opportunity to create an innovative hospital and program has helped me to see that Transformational Projects Action Planning is an organizing structure for planning at various and different scales. In this case maybe four scales:
Office of Land Use versus an Office of Planning.  It's also an illustration that DC's Office of Planning is more an office of land use, rather than a focused on a full range of urban planning activities.

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.

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At 5:11 PM, Anonymous charlie said...

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.

At 12:37 PM, Blogger Richard Layman said...

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.

At 10:00 AM, Anonymous charlie said...

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.

At 4:17 PM, Blogger Richard Layman said...

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...


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