Urban Design: Health District Planning

― Health District Planning

Creating places that promote health

Contents

Introduction ― 4 Selected Projects ― 10 Our Team ― 34

Left: Baton Rouge Health District, Louisiana

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― Health District Planning

Making healthy plans A health district is a place where investments are targeted to improve health outcomes and inspire healthy behaviors. With you, we are bringing together sustainable healthcare architecture and planning with healthy community design

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Health District Planning

Turning the medical campus inside out

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Our approach to health district planning incorporates our four principles of healthy community design—walkability, livability, sustainability and adaptability— with our depth of knowledge in the planning, design and construction of efficient and sustainable healthcare facilities. Regardless of the size, type or location of the medical facility, our goal remains the same: to generate implementable design and regulatory solutions that enhance patient health outcomes, contribute to staff satisfaction, and support the health and wellbeing of community residents.

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Health District Planning

Balancing the need of the institution with the community A District Planning Approach The Health District Planning Framework combines the strength and expertise of our urban design and medical planning practices.

We use a proprietary Geographic Information System (GIS) based tool set to provide insights that are relevant to our healthcare clients, and that guide them as they retool to meet the challenges of the new value-based healthcare landscape. Health District planning is a suite of advisory and design services that help health systems and their partners establish their strategic priorities. This is particularly important during the current period of rapid change in the business of healthcare.

When we approach a new Health District project, we examine it through four lenses:

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Population Health As healthcare systems evolve to manage population health, our proprietary databased platform graphically displays population health insights within a community catchment area. Specific health factors can be mapped to any level of detail available and correlated with demographic data and the physical features of the community. In this way, we can target specific health issues prevalent in the community and develop strategies addressing the environmental, physical, and social factors that contribute to them.

HEALTHY COMMUNITY DESIGN

HEALTH DISTRICT PLAN

HEALTHCARE PLANNING

resident

community member

patient

employees

FUTURE MODEL FOCUSED ON HEALTH

HEALTHY COMMUNITY DESIGN community plan / vision zoning / guidelines urban design projects public process

HEALTH DISTRICT PLAN

HEALTHCARE PLANNING

shared vision / plan flexible regulations partnership projects

strategic plan / vision operations plan campus master plan acquisitions plan

BALANCING NEEDS OF THE INSTITUTION WITH THE COMMUNITY

HEALTH DISTRICT PLANNING

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Place

Partnerships

Performance

The scientific evidence documenting the influence of the design of the built environment on health and wellness is strong.

As healthcare systems shift to address population health outside of the walls of their facilities and beyond the boundaries of their campuses, the focus should also shift to the quality of the built environment within the community at large. The street level interface between facilities and communities, memorable public place making, and the relationship of a healthcare campus to the community become key drivers.

The traditional diagnostic, treatment, and acute care components of today’s healthcare system are no longer enough if we want to increase health and wellness across a community.

Instead, healthcare institutions must seek a broad coalition of partnerships within their communities in order to create the continuum of care necessary to become accountable care organizations.

In order to improve the health of a population at the district scale we must measure and track health factors over time. Our platform provides the means to catalog health factors and to graphically see how they relate to the geography of the community. But it can also track the effectiveness of the strategies implemented over time. This allows us to track the performance of these strategies, as well as to track changes in the performance of the healthcare organizations using them.

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― Health District Planning

Selected Projects

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Baton Rough Health District Master Plan Baton Rouge, Louisiana Client: Baton Rouge Area Foundation Size: 1,000 acres (404 hectares) Completion Date: 2015

― WHAT IT IS

A place-based health collaborative supporting the vitality, health, and economic development of Baton Rouge and beyond.

We approach Health District planning around two basic principles of wellness – “Diagnosis” (symptoms & assessment), and “Treatment” (prescription & check-up) – that provide structure for the ongoing application and evaluation of design and policy decisions in the District.

Examining the District like a patient.

HEALTHY PLACE

HEALTH EDUCATION + RESEARCH

DIAGNOSIS CHIEF COMPLAINT

Stiff competition from Houston and Birmingham for talent

Acute Congestion On Arterial Roads

1.

2.

3.

4.

KEY SYMPTOMS OBSERVED

Inefficient Transportation Network Weak Alternatives to the Car Poor access to Parks and Open Spaces.

Uncoordinated, Sprawling Development

40,000+ Cars / Day on Major Arterials

1. Silos in Healthcare, Health Education and Research 2. Limits to Growth Of Medical Education and training 3. Untapped Potential for Clinical Research Trials And Industry Connections Only 12% Of LA's Medical Residents Receive their Training in Baton Rouge.

VITAL SIGNS

Only 25 Street Intersections Per Square Mile

ASSESSMENT

Auto-oriented sprawl is bad for business, health, and the business of healthcare.

The Health District's clinical, educational, and research assets are siloed.

Build Midway Boulevard.

Build on Existing Programs to Add Dual Degrees in Medicine.

20% Sidewalk Coverage on District Streets

50% Fewer Clinical Trials than Peer Cities

TREATMENT PLAN PRIORITY INTERVENTIONS PRESCRIPTIONS

FOLLOW-UP TESTS (ANNUAL CHECK UP)

EXPECTED OUTCOME

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Build the Health Loop Trail.

1. Create Connections for Efficient Circulation and Access.

2. Enable People to Walk, Bike, and Take Transit.

3. Connect to Parks and Open Spaces.

4. Establish a District Land Authority to Promote Balanced and Orderly Development.

1. Build a Platform to Advance Collaboration and Partnership Initiatives.

2. Expand Medical Education in The Health District.

3. Expand Clinical Trials in Baton Rouge.

Travel Speed on Arterials

Number of Students and Researchers in the Health District

Pedestrian and Bicyclist Counts

Number of GME Spots In Baton Rouge

Employee Travel Behavior Survey

Number of Industry-Sponsored Clinical Trials

An Efficient, Safe, and Pleasant Place For All

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Active Use of Health Education and Research to Advance Clinical Practice

Baton Rouge Health District Master Plan

→ The future vision for the District centers around access to outdoor amenities and healthy activity for residents, workers, and visitors alike

↑ The District is a coalition as much as it is a place; 13 major health institutions create the physical anchors and the governance body to guide the evolution of the District.

― WHAT MAKES IT COOL

Early efforts in data collection and coalitions have already led to the creation of a neighborhood diabetes clinic.

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Powell-Hood-Hamilton, Gundersen Lutheran Medical Center Joint Neighborhood and Campus Plan La Crosse, Wisconsin Client: City of La Crosse; Gundersen Lutheran Medical Center Size: 600 acres (243 hectares) Completion Date: 2013

― WHAT IT IS

A vision and framework for the long-term sustainable redevelopment of the industrial waterfront and the adjoining medical center campus.

Developed through a series of public meetings and workshops, the Joint Plan provides a comprehensive framework for the long-term sustainable redevelopment of the industrial waterfront and the neighboring medical center campus.

Healthcare Services

Growth Potential

Economic Benefit

Hospital Community Benefits Healthy Built Environment

Local Jobs

Community Resource

ACCOUNTABLE CARE ORGANIZATION (ACO) MODEL (CONTINUUM OF CARE)

COMMUNITY SETTINGS Homes Schools Workplaces Recreation Facilities Places of Worship Wellness Centers Pharmacies ...

Care Delivery

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Focus Areas

END-OF-LIFE CARE

SKILLED NURSING

LONG-TERM CARE

REHAB CARE

INPATIENT CARE

EMERGENCY CARE

TREATMENT ANCILLARIES

DIAGNOSTIC ANCILLARIES

HOSPITALS

HOME CARE

POST-ACUTE CARE

ACUTE CARE

SPECIALIST

URGENT CARE

PRIMARY CARE

New streets and paths, public open spaces, and landscape connections provide greater access to the Mississippi River for local residents, as well as medical center patients, visitors and staff. The Joint Plan has led to the creation of a neighborhood improvement campaign (ReNew), the establishment of a Joint Development Corporation for public realm improvements, and a Community Development Corporation for the revitalization of Powell-Hood-Hamilton.

PREVENTION

PREVENTATIVE CARE

COMMUNITY SETTINGS Homes Senior Housing Assisted Living Nursing Facilities Hospices ...

Urban Design

LA River Urban Agriculture Plan Los Angeles, California Client: Los Angeles River Revitalization Corp.

Size: 660 acres (267 hectares) Completion Date: 2014 Awards: American Architecture Award, The Chicago Athenaeum: Museum of Architecture and Design and The European Centre for Architecture Art Design and Urban Studies, 2016

― WHAT IT IS

A framework to create a healthy, sustainable neighborhood through district-wide and site-specific urban agriculture strategies.

Currently characterized by industrial and commercial properties with some residential pockets, the study area is a food desert, has mobility gaps, and likely sits on varying degrees of contaminated soil. However, the area connects to and supports numerous wellestablished yet resource-lacking adjacent neighborhoods and looks forward to a green, connected future vision

LA River Urban Agriculture Plan

― WHAT MAKES IT COOL

The plan explicitly allows urban agriculture in a broad definition that permits cultivation as well as processing and distribution.

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Recommendations •

Leverage underutilized physical conditions, current food-related operations, community desires and newly implemented public policies to improve upon what exists

•

Define urban agriculture in this currently industrial area in a broad sense, including processing and distribution as well as cultivation

•

Reimagine the expansive area within the CASP through a combination of district-wide and site-specific strategies.

•

Bolster the presence and multifunctionality of existing street, bike, and pedestrian networks

•

Identify portions of this network as green infrastructure along with strategically placed detention areas to establish a district-wide stormwater system

•

Create a network of community gardens and educational programs at area elementary and middle schools

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Create synergies by clustering urban agriculture related development adjacent to existing food-related businesses

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Utilize a plant palette that prioritizes edible, low water, and multifunctional landscapes appropriate for the Los Angeles region

UCSF Long Range Development Plan Physical Options Study San Francisco, California Client: University of California, San Francisco Size: Four sites: 173 acres (70 hectares) Completion Date: 2013

UNIVERSITYofOFtheCALIFORNIA, SAN FRANCISCO Comparison five campuses Long San Range Development Plan across Francisco

MA

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The physical options study focused on the character and fit of new UCSF development that will allow the right distribution of services (Medical Education, Research, Clinical Care and Community Facilities) to meet a 2035 vision and a much improved experience for users. Physical options studied range from reuse of historic buildings to sensitive infill with new medical center facilities, to consolidation of outpatient services and attention to new public space. In addition, the study looked at relationships to surrounding neighborhoods, added housing for students and faculty, and anticipation of flexibility in buildings to meet changing research facility configurations.

― WHAT IT IS

AP OF STANFORD CAMPUS

A feasibility study for urban infill at four strategic sites, alongside systemwide strategies for sustainability..

perkinswill.com

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UCSF Long Range Development Plan Physical Options Study

Design options for each site evolved through multiple rounds of analysis with campus stakeholders to demonstrate trade-offs in each scenario and build a consensus around a preferred option. The preferred alternative for each of the campus sites, including documentation, phasing and timelines influences the wider campus LRDP.

Context-sensitive analysis of complex sites Public Realm - Mission Bay

transit + Bike - Mission Bay

Ownership - Mission Bay n

St

St

na

rth

an

ou

Br

Mission Creek Park

SOMA

Mission Creek Park

Kin

China Basin St

China Basin St

Fif th

MUNI

St

Fifth St

w To

s nd

en

d

SMITH CARDIOVASCULAR RESEARCH (17A/B)

CHINA BASIN

ain

Be

SMITH CARDIOVASCULAR RESEARCH (17A/B)

Mission Bay Commons (City)

St

ltr

Ca

Mission Bay Blvd N

Mission Bay Blvd N

Mission Bay Commons (City)

g

St

rry

St

(16B)

MISSION BAY HOUSING (15)

COMMUNITY CENTER GARAGE (21A)

P

P

(14)

THIRD ST GARAGE (23B)

s

ON

en

ST

AD

P

ITU

ST S

TE

S

TE

(25B)

h Se

St

St

ve

THIRD ST GARAGE (23B)

P

(23A)

P

Campus Way BYERS HALL (24C)

GENENTECH HALL (24A/B)

nt h St

Mississippi St

P OWENS STREET GARAGE

MISSION HALL (25A)

P

(25B) GATEWAY MEDICAL BUILDING

Sixteenth St

400’

0’

200’

400’

Visual analysis of campus building massing alternatives Parnassus Heights Site Capacity Study

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Eighteenth St

654 Minnesota Esprit Park

Tennessee St

UCSF-Owned Buildings Potrero Hill UCSF-Leased Space

Indiana St

7

280

Minnesota St

23

Pennsylvania St

Mariposa St

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499 ILLINOIS

CHILDREN’S HOSPITAL

Mariposa St

KT

Texas St

Main Entrances

CHILDREN’S HOSPITAL

Mississippi St

Existing Open Space 200’

Mariposa Park (City)

Missouri St

Pedestrian Corridor

P

WOMEN’S + CANCER HOSPITALS

WOMEN’S + CANCER HOSPITALS

Connecticut St

Bicycle Parking

ENERGY CENTER

P

Seventeenth St

Mariposa Park (City)

Muni Route + Stop

Landscape Zone 0’

Fourth Street Public Plaza

OWENS STREET GARAGE

280

UCSF Shuttle Stop Bicycle Route

Mariposa St

Design District

ENERGY CENTER

P

Seventeenth St

CHILDREN’S HOSPITAL

MEDICAL CENTER PHASE 2

Bay Front Park

Illinois St

WOMEN’S + CANCER HOSPITALS Texas St

Mariposa Park (City)

ENTRY ZONE

P

Fourth Street Public Plaza

ENERGY CENTER

Pedestrian Path Entry Zone

South Campus

MISSION BAY HOUSING (20)

ROCK HALL (19B)

North Campus

RUTTER CENTER (21B)

Third St

nt

h OWENS STREET GARAGE

MEDICAL CENTER PHASE 2

280

Active Zone

GATEWAY MEDICAL BUILDING

Nelson Rising Lane

South Campus P

Seventeenth St

Retail

P

GL STIT IN

ve

nt

South Campus

Sixteenth St

40

GATEWAY MEDICAL BUILDING

(16)

Gene Friend Way

COMMUNITY CENTER GARAGE (21A)

St s en ONE S Ow ADST UTE

Se

ve

Sixteenth St

P

CHILD CARE (TEMPORARY)

(18A,B)

1500 OWENS

DILLER CANCER RESEARCH (17C)

PRELIMINARY UTILITY PLANT

(15)

SANDLER NEUROSCIENCES CENTER (19A)

280

MISSION HALL (25A)

BYERS HALL (24C)

SMITH CARDIOVASCULAR RESEARCH (17A/B)

Bridgeview Way

St

E IN

ITU

ST

Se

(25B)

China Basin St

Campus Way

GENENTECH HALL (24A/B)

Mission Rock St

Mission Bay Commons (City) (23A)

K oret Qu a d (2 2 )

RUTTER CENTER (21B)

Ow

St

E IN

MISSION HALL (25A)

BYERS HALL (24C)

North Campus

P

GL

s

ON

THIRD ST GARAGE (23B)

MISSION BAY HOUSING (20)

Blvd

Gene Friend Way

Campus Way

ENTRY ZONE GENENTECH HALL (24A/B)

ROCK HALL (19B)

ncois A Fra

(23A)

SANDLER NEUROSCIENCES CENTER (19A)

Terry

Third St

Ko r e t Q uad ( 22)

Fourth St

North Campus

ENTRY ZONE

en

ST

AD

GL

Ow

RUTTER CENTER (21B)

S p orts Field (1 8 C)

BLOCK 18 GARAGE (18B)

1500 OWENS

ENTRY ZONE

P

P

(18A)

Fifth St

MISSION BAY HOUSING (20)

ROCK HALL (19B)

Gene Friend Way

COMMUNITY CENTER GARAGE (21A)

(16B)

Nelson Rising Lane

Fourth St

BLOCK 18 GARAGE (18B)

1500 OWENS

SANDLER NEUROSCIENCES CENTER (19A)

Sports Field (18C)

Mission Creek Park

Third St

P

(18A)

DILLER CANCER RESEARCH (17C)

RESEARCH CUP/ EH+S (16A)

Fourth St

Nelson Rising Lane

Fifth St

MISSION BAY HOUSING (15)

Future San Francisco Unified School District (14)

DILLER CANCER RESEARCH (17C)

RESEARCH CUP/ EH+S (16A)

Sixth St

Sixth St

Future San Francisco Unified School District (14)

Mission Rock (Future)

Channel St

Mission Bay Blvd S

Dogpatch Nineteenth St

Crane Cove Park

0'

350'

700'

― WHAT MAKES IT COOL

A dynamic analysis model melded urban design considerations with functional facilities planning to allow review of more options in less time.

↑ Zoning, land-use, and public realm studies for Mt. Zion site.

← Overall site comparisons; massing studies for Parnassus Heights Site.

→ Site strategy for Parnassus Heights.

Vivacity Health District at Valley Ranch Master Plan Houston, Texas Client: The Signorelli Group Size: 200 acres (81 hectares) Completion Date: 2016

VISION | BIRDS' EYE VIEW

― WHAT IT IS

A vibrant district of hospitals and state-ofthe-art medical office buildings alongside healthy restaurants, hotels, and highdensity residential. .

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VIVACITY | HEALTH DISTRICT AT VALLEY RANCH |

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Vivacity Health District at Valley Ranch Master Plan

― WHAT MAKES IT COOL

With its own heartbeat, this place of balance reflects where healthcare is headed—more personal and connected.

The central park and plaza are the heart of social life and wellbeing in the district; streets and sidewalks are designed for maximum safety and comfort, with active uses framing the park.

Wyckoff Heights Medical Center Health Improvement District Brooklyn & Queens, New York Client: Wyckoff Heights Medical Center Size: 1,920 acre (777 hectare) catchment area Completion Date: Ongoing ― WHAT IT IS

A data and mapping initiative to predict areas of highest community need and realign investment priorities in the catchment area..

THE WYCKOFF HEALTH IMPROVEMENT DISTRICT

Health Improvement District

Health Improvement District

Asthma Heat Map

Community Partners

EXPANDED OUTPATIENT SERVICES WITH INTEGRATED BEHAVIORAL HEALTH

UPDATED AND MORE ATTRACTIVE LABOR & DELIVERY

NEW MAIN ENTRANCE PAVILION

WOMEN’S HEALTH CENTER

NEW MORE WELCOMING FRONT FACADE

ROOF GARDEN

NEW PARKING DECK WITH INTEGRATED SERVICE LEVEL LOGISTICS MIXED USE SUPPORTIVE HOUSING DEVELOPMENT WITH INTEGRATED HEALTH SERVICES

EXPANDED EMERGENCY DEPARTMENT WITH INTEGRATED URGENT CARE NEW ED DROPOFF ENTRANCE

Wyckoff’s transformation is planned at three scales: within the hospital, on Wyckoff’s campus, and in the district that is Wyckoff’s primary catchment area. By defining itself at the center of a Health Improvement District, Wyckoff is refocusing its efforts from traditional downstream healthcare services to prevention and improvement of population health in its community.

← Detailed mapping of health record data identifies hot spots of poor health and develops evidencebased strategies to address them.

By continuously measuring these health factors, Wyckoff can track the effectiveness of its population health improvement strategies over time..

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St. John Medical Center Health District Plan & MX-I Zoning Tulsa, Oklahoma Client: St. John Medical Center Size: 33 acres (13.5 hectares) Completion Date: 2014

HEALTH DISTRICT PLAN /

― WHAT IT IS

A District plan and zoning update targeting future growth that supports community health as well as the health system’s patientcentered mission.

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Existing conditions

Possible growth scenario

Current zoning allowed growth

Balanced development envelope

�

Facilitated conversations between the health system, the City of Tulsa, neighborhood stakeholders, and preservation advocates helped build consensus on a shared future vision for the public Small Area Plan.

↑ The new Mixed-Use Institutional (MX-I) zoning category enables flexible growth for institutional campuses in harmony with residential and historic neighborhoods.

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Our Team

David Green

Basak Alkan

Geeti Silwal

Stephen Coulston

Robin Guenther

Ingrid Stromberg

LET’S COLLABORATE

Have a health district planning need?

UrbanDesign@perkinswill.com

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Since 1935, we’ve believed that design has the power to make the world a better, more beautiful place.

That’s why clients and community members on nearly every continent partner with us to design healthy, happy places in which to live, learn, work, play, and heal. We’re passionate about human-centered design, and how design can impact our lives through sustainability, resilience, well-being, diversity and inclusion, and mobility. And we’re committed to advancing design through research. As a matter of fact, in 2018, Fast Company named us one of the World’s Most Innovative Companies in Architecture. Our team of 2,500 professionals provides worldwide interdisciplinary services in architecture, interior design, branded environments, urban design, landscape architecture, and more, and includes our partners Portland, Nelson\Nygaard, Genesis Planning, and Pierre-Yves Rochon (PYR).

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For more information, contact: UrbanDesign@perkinswill.com