It’s not an easy sell on paper: A 100-percent financially self-sustaining, mixed-use campus anchored by a community hospital, in an area on the southwest side of Chicago that struggles with high crime and unemployment.

But if anyone can sell it, it’s Guy A. Medaglia, president and CEO, Chicago Southwest Development Corp. and St. Anthony Hospital. In fact, he already has.

What’s been named the Focal Point campus, designed by HDR Architecture Inc. (Chicago), will combine retail, education, recreation, and healthcare in a nearly 1-million-square-foot complex slated to open by the end of 2017.

It’s a genuinely innovative approach to community care. And it’s a far cry from the situation that existed just five years ago, when St. Anthony Hospital was plagued by mounting debt and plummeting patient volumes.

 

How it all started
Back in 2007, Medaglia came on board with Ascension Health—the former owner of the nonprofit St. Anthony Hospital—by way of a consulting job that required him to oversee its operations. Eventually, he began spending more and more time at the failing hospital, focusing specifically on improving the quality of care provided and opening St. Anthony’s doors to the economically challenged and divided neighborhoods that bordered it.

“We were able to make significant improvement. Our volume went up; our acuity went up … we saw the physician parking lot go from having more than enough spaces to physicians complaining because no parking was available,” Medaglia says.

In the meantime, the hospital also became more involved in community-based initiatives, such as helping employees earn their GEDs, providing Spanish language lessons, and holding a car show where even rivaling gang members came together for a day.

“Despite sitting between two very challenged and racially diverse areas, the hospital has spearheaded a number of programs that are minimizing these divides to bring the community together without violence,” said Peter V. Fazio Jr., chair of the St. Anthony Ministries board, in a press release.

In 2008, Ascension Health had been ready to close the hospital’s doors. In 2009, St. Anthony had completed an about-face that resulted in it becoming an independent institution, now operated by corporate parent St. Anthony Ministries. And Medaglia signed on full time.

What he was able to accomplish got plenty of attention, too. Realizing the hospital was running out of room and wasn’t positioned well to renovate in-place, the city offered St. Anthony Hospital an almost-11-acre lot about a mile-and-a-half from its current location.

But Medaglia was aware of what community and safety net hospitals around the country have come to know all too well: the model isn’t viable—in St. Anthony Hospital’s case, more than 80% of its business was made up of Medicaid and Medicare patients, in addition to managed care and charity care cases. “I said, ‘You just can’t build a new facility and financially sustain it,’” he says.

Then Medaglia turned to his professional past in retail and manufacturing, and considered what it would take to get investors involved. And it struck him: a public-private partnership. The model would allow the new hospital to be financially self-sustaining by building a complex where revenue made from tenants leasing space could be reinvested in St. Anthony’s community programs.

With hospital approval, Medaglia took his idea to the city. And with a little convincing, he got the mayor on board, too. By late 2010, a development plan was submitted to City Council. And while he had a pretty good idea of what the facility needed to be, Medaglia wanted research to back it up.

Finding the evidence
“I was really excited by Guy’s vision for this community, because there was a potential opportunity to do real, robust research around community needs—not necessarily around what the hospital might think the community needs,” says Abigail Clary, regional director, healthcare, HDR. “We were very interested in what this community defined as healthcare.”

The firm approached Medaglia and proposed a research study to validate St. Anthony’s plans. The firm funded the project, forming a team that included faculty and students from the University of Nebraska-Lincoln’s College of Architecture and the University of Nebraska Medical Center, College of Public Health, to conduct community surveys, focus groups, and interviews.

In the end, the definition of healthcare they found was incredibly broad and included themes of wellness, education, and safety, and identified needs like access to healthy foods, daycare, and community space.  

“The community’s reaction to the concept Guy is proposing to do was very good. People were excited, because they felt they were finally being heard and that this will make a difference for their neighborhood and families,” Clary says.

Once the research was done and a clear vision for the new hospital was in place, HDR also bid on the design of Focal Point and won. And for those now assigned to the project, the research has offered a whole new field of reference to use in the design process. 

“It made a lot of design/program moves not subjective. They were based in research,” says Thomas J. Trenolone, vice president, design director-Great Plains Studios, HDR Inc. The research has pushed the creation of a facility where medical services are fused with a variety of other services that keep people healthy. “It’s based on a new paradigm of wellness; it’s not about being an acute care hospital,” he adds.

 

Designing a new approach
With the concept finalized, Medaglia’s vision for what the complex would actually look like was straightforward: “This is going to be the new gateway into this particular community. I want something where people look at it and are in awe. I want something that is green and that is state-of-the-art. I want people to stretch their limits of creativity on this thing,” he says.

While the research shed a great deal of light on what needs could be filled by the complex, it also revealed that community members cared about how it will look, too.

“The aesthetic and the image the campus will project to the neighborhood were exceptionally important,” Clary says.

The site, at the corner of 31st Street and Kedzie Avenue, is an urban location that sits along an industrial corridor, with proximity to housing, but not quite adjacent to it. A major requirement of the project was the introduction of green space to the barren locale.

“Half the campus is outdoor space, so how do you build up the rest of the 1 million square feet, including the parking deck, in 5 acres? It’s definitely a challenge,” Clary says.

In the end, though, the solution was to go up, which in turn creates an icon for the community’s skyline.

The exterior will reflect what’s already around it, with a red base representative of nearby brick bungalows and the trussing of its pedestrian bridges similar to that of Chicago’s own bridges and the Hancock Building. The light, airy geometric shape of the building shell is inspired by the city’s skyline.

“It’s going to be a beautiful, glowing box on a community-level base, so when you’re next to the building, it brings the con
text to a human scale,” Clary says.

The hospital also required that the design for the new facility be flexible for the future, so it can easily assimilate into a predominantly outpatient environment without having to make a significant investment to its acute care spaces.

“We’re building a 151-bed facility. I want it to be convertible, not something that can’t be adjusted when the needs of the community change. This building has to last 100 years, and as inpatient services start to shrink, we’ve got to be able to make modifications to that hospital to accommodate the change in healthcare,” Medaglia says.

 

Separate but together
In an overall campus plan that includes such a variety of elements, circulation, too, has become key. “How do you navigate through these buildings, taking care to support the retail components and not overlapping circulation patterns with the healthcare components?” Clary says.

On-stage and off-stage areas will be created, keeping the mixed-use components away from the healthcare space, to allow the hospital to function as it needs to without crossover or confusion.

Tronolone describes the elevator system alone as similar to designing a public transit line, with red line elevators for service, blue for medical, and yellow for the public.

The campus is laid out so the blocking around the base of the building is mostly retail, with healthcare components, like the emergency room, that need to be on the ground level placed there, as well. Above that will be community/education space, with the medical center taking up the highest floors. Parking will be located in a standalone structure that will house retail, too.

In fact, the design team has worked hard to not waste any space and achieve a design that’s as efficient as possible.

“Guy has been very specific about making sure we hit certain targets, because of the model they’ve built and what they need to be able to do to operate and stay profitable. We had to make it Lean, so basically everything that comes in—outside of covering their operations costs—goes right back into the community and their services,” Tronolone says.

For example, one creative use of space is found in the pedestrian sky bridges. As visitors cross from the garage, there are retail and community elements along the walkway on the approach to the medical center. “We’re trying to squeeze every single ounce of space and use it for an appropriate method,” he says.

Once visitors reach the building, it’s designed with vertical separations. For example, on the third floor is a two-level concourse where the pedestrian bridges are integrated into the facility. Below that, a medical component is completely separate and independent, with a bed tower above.

“The bed tower sits on top of that walkway, and we’re connecting it via elevators and lifts, but there’s no direct interaction between the community components or the retail components with the medical environment,” he says.

With a year under their belts already, including the research piece and pre-design, full design work is expected to start soon. In January, the city approved transfer of the land. And meanwhile, Medaglia is busy meeting with retailers and signing on tenants, such as a charter school and culinary school, and sharing his concept for community healthcare as much as he can, with plans to continue to gather research to gauge the model’s success.

“I’m not just selling 31st and Kedzie. This thing needs to be pushed. This will work in Brooklyn; it will work in East L.A.; it will work in Cleveland. The extra research and any type of information gathering that we can have will only help see this thing move forward,” he says.

Jennifer Kovacs Silvis is managing editor of Healthcare Design. She can be reached at jsilvis@vendomegrp.com.

 

SIDEBAR: Research-based design
Current plans for the Focal Point campus were shaped by the research funded by HDR Architecture Inc. and conducted by faculty and students from the University of Nebraska-Lincoln, College of Architecture and the University of Nebraska Medical Center, College of Public Health. The “St. Anthony Hospital: Final Research Report” concludes that recognizing a broad definition of the word “health” will help the new hospital be engaged in the overall well-being of the diverse community where it will be built. Here’s a look at what the community campus will include, answering the specific needs identified by residents through the research study:

• The new St. Anthony Hospital will continue to provide emergency and medical care, regardless of one’s ability to pay
• An outpatient and specialty clinic for rehabilitation and health maintenance
• Retail tenants, providing the community with access to food, clothing, and household items
• A hospitality center for community use
• A daycare center
• An education center offering preventive health programs
• A recreation center with a basketball court and half Olympic-sized pool
• A variety of wellness programs on topics including healthy food preparation and parenting skills 

St. Anthony Focal Point program breakdown

• 375,000-square-foot medical center
• 75,000-square-foot ambulatory center
• 160,000-square-foot education center
• 50,000-square-foot hospitality center
• 12,000-square-foot daycare center
• 384,000-square-foot parking garage
• 233,000-square-foot retail area
• 32,000-square-foot common space area