Setting The Foundation For Healthy Living
Today, a hospital is no longer seen as a destination for the sick. Health systems across the U.S. are transforming their campuses into community hubs for health and wellness. At the same time, healthcare is increasingly delivered in community settings such as schools or homes, where patients are empowered to manage and improve their own health.
The Affordable Care Act requires tax-exempt hospitals to align their services with the true health needs of the communities they serve by completing a Community Health Needs Assessment (CHNA) and implementation strategy every three years. CHNAs have prompted hospitals to make a good-faith effort in addressing population health issues such as obesity and mental health that fall outside of their traditional focus yet have come to significantly affect their financial bottom line.
Forward-looking hospitals and health systems are taking their efforts a step further and tackling issues like walkability and access to healthy foods to improve community health. The most successful cases involve collaborations between a hospital and its community partners and, increasingly, partnerships between competing healthcare organizations. Effective plans look beyond the hospital doors to find opportunities for community integration and partnerships, and one such example is Baton Rouge Health District (BRHD) in Baton Rouge, La.
BRHD is a place-based health collaborative that was formed in 2015 to deliver health and economic development benefits to the city, aiming to foster collaboration among its 15 healthcare, research, and academic partners. The two-year planning effort leading to the district’s formation was supported by the Baton Rouge Area Foundation, which brought competing institutions together to forge a shared vision. Since the public unveiling of the master plan completed by Perkins+Will (available online at http://www.brhealthdistrict.org/), the BRHD has been incorporated as a 501(c)3 nonprofit; hired its first executive director; and taken concrete steps to implement major infrastructure, healthcare, and medical education projects.
Infrastructure for healthy living
Today, the BRHD is an unidentifiable piece of South Baton Rouge sprawl with no shared identity between its three major campuses: Our Lady of the Lake Regional Medical Center, Baton Rouge General Medical Center at Bluebonnet, and the Pennington Biomedical Research Center. The 1,000-acre district is home to world-class healthcare, research, and medical education yet lacks basic and sidewalk infrastructure. Everyone gets stuck in traffic and no one walks anywhere.
The health district vision is based on the premise that a car-centered environment isn’t just bad for health but is also bad for business. The master plan seeks to transform the district from the most congested to the healthiest place in Baton Rouge. A key concept is to turn each hospital inside out, with public open spaces and community- and wellness-oriented uses clustered around the main entrance. A 7.5-mile creek-side trail will link the two hospitals, a future children’s hospital, and the Pennington Biomedical Research Center and provide access to the 440-acre Burden Museum and Gardens. The idea is to make healthy behaviors—such as walking to work, a lunch break, or a nature run—possible and desirable for the thousands of patients, employees, and visitors in the area.
One of the key goals of the BRHD is to support a growing community of students, practitioners, and researchers who will be working to place Baton Rouge on the global map for healthcare innovation. A place-making strategy is aimed to provide the sense of community and quality of life sought by the best talent. Additionally, the plan recommends zoning updates and design guidelines to ensure that each new development contributes positively to the public realm and community character. The district non-profit will coordinate growth, facilitating the sharing of costly new facilities such as parking decks and utility infrastructure between institutions.
Implementation is already underway. With public support for the master plan, the city-parish was able to fast track a $23 million complete street project that will improve traffic flow along two of the district’s most congested corridors by 2019. Long-term infrastructure improvements will increase street connectivity by three-fold, making it easier for everyone to get out of the car. Smaller block sizes are also intended to promote mixed-use redevelopment between the anchor campuses. A web-based dashboard will enable BRHD stakeholders to track progress on district-wide projects and eventually match this progress to increases in healthy behaviors such as walking and biking among district users.
Confronting an epidemic
Another defining characteristic of the BRHD is its location in the “Diabetes Belt,” a cluster of 644 counties in mostly southern states with the highest rates of the disease, which are correlated with rates of obesity. This epidemic of preventable disease costs the Baton Rouge community $1.5 billion per year in healthcare spending.
The district partners saw the need to collaborate to effectively manage and prevent diabetes in the population. They are seeking to establish the Baton Rouge Diabetes and Obesity Center (BRDOC), a community resource that empowers people who have or are at risk of developing diabetes and obesity to take control of their health. The center will provide prescription-based services to patients including one-stop-shop specialty care, personalized health plans, cooking and nutrition workshops, and telehealth (for consults, treatment, and education). It will be integrated into and support existing primary care networks. Investing partners—area payers, hospitals, clinics, and public health organizations—anticipate returns through reductions in unnecessary care.
Beyond streamlining and improving healthcare for patients, BRDOC is set up to advance population health research in Baton Rouge, positioning the district as a center of excellence in the nation and a model for communities across the South. In the short-term, the BRDOC can utilize existing clinical and community facilities at the Pennington Biomedical Research Center and grow as needed. This location provides opportunities for joint-programming at the adjacent Perkins Road Community Park, which draws visitors from across state lines to its active and extreme sports facilities. Telemedicine will enable the center to reach a broader population, including patients in rural areas. If successful, the BRDOC will enable hospitals to shift their chronic disease spending from costly hospital and emergency care towards new technology, services, and facilities focused on prevention and wellness.
Ingredients for success
Overall, the vision for BRHD highlights several key design and planning moves that are relevant beyond Baton Rouge and applicable to health districts nationwide, including:
- Focus on health and wellness. Along with providing healthcare, it’s important to create div
erse programs, uses, and spaces that promote physical activity and support healthy choices.
- Healthy place-making. Sustainable urban design practices can provide a sense of place to hospital campuses, integrating them into the physical and social fabric of their communities. Public open spaces, including beautiful streetscapes with retail amenities, are necessary ingredients for a vibrant destination that attracts new patients and employees.
- Connectivity. A well-connected street and trail network is the foundation of a flexible and efficient healthcare campus that’s walkable and integrated into its community. Streets provide access and offer opportunities for private, mixed-use development that supports a wellness destination.
- Integration. Encouraging interdisciplinary protocols across healthcare, health education, and research is essential and necessary for hospitals seeking to identify and address population health issues in their communities such as diabetes. A holistic approach can reduce unnecessary healthcare utilization, enabling new facility investments that support patient and community wellness.
- Partnerships. Hospitals need to work with community partners and local government to address the socioeconomic and built environment determinants of health. These partnerships are also key to fostering funds for proposed improvements in times of economic uncertainty.
If there’s one thing certain about the future hospital campus, it’s that it won’t look like what we have today. Hospitals and health systems that invest in community-integrated facilities and population health partnerships will attract more patients and achieve better health and financial outcomes. The design community can ensure these outcomes by employing best practices in sustainable urban design and place-making in healthcare campus and facility planning, and by adopting a holistic design approach that addresses the diverse needs of the changing healthcare business.
Basak Alkan, AICP, LEED AP, is a senior urban designer at Perkins+Will in Atlanta. She can be reached at firstname.lastname@example.org. Tatiana Guimaraes, CAU, Assoc. AIA, is a senior associate at Perkins+ Will in Miami. She is a board member and the immediate past president of the AIA Academy of Architecture for Health, a Knowledge Community of the American Institute of Architects. She can be reached at email@example.com.