Hospitals and health care facilities play a critical role in cities and towns across the country, serving as an employer as well as meeting one of the community’s crucial needs. But over the past decade, that important role has begun to evolve. Spurred in part by requirements under the Affordable Care Act, enacted in 2010, hospitals are expanding their role to focus on health not just for the individual, but also for the wider community, Kaia Nesbitt said during a session at the ULI Spring Meeting in Toronto.

Community Connection

Nesbitt, vice president and leader of the HDR national urban design, planning, and landscape architecture practice, pointed out that where people live can determine their life expectancy. Reports from the U.S. Census Bureau have shown that up to 60 percent of health is determined by a person’s ZIP code.

“What is that saying about the physical environment?” Nesbitt asked. “There’s an opportunity for all of us in the public realm and the real estate industry to have an impact in partnering with hospitals and health care.”

In her recent involvement with hospital developments, Nesbitt has been working to create centers that connect more to the surrounding community. Many hospitals around the country have often been built as standalone developments disconnected from the surrounding community. Engaging in mixed-use development that incorporates retail space, restaurants, and multifamily housing, as well as adding health and wellness features like walking trails, green space, community recreation centers, and grocery stores, helps lift up the health of the community.

But creating such a hospital district is difficult without forming partnerships—an element often missed in health-oriented development, Nesbitt said. “It’s one thing to say hospitals can do better and think about connectivity to nature, but they’re often reliant on partnerships in the communities surrounding them,” Nesbitt said.

Those partnerships can include hospitals teaming up with the local economic development corporation, the private development community, and the local municipality.

New Concepts Taking Shape

A recent project Nesbitt and her firm worked on was a hospital in Coeur d’Alene, Idaho. Like a lot of smaller U.S. cities and towns, Coeur d’Alene experienced intense growth during the pandemic, which put a lot of pressure on the area’s health care system.

The project involves a standalone hospital near downtown with a lot of underused space around it. “The idea and concept was instead of just having a hospital isolated at the center, how might health care be woven into the community as a whole?” Nesbitt said. Through public engagement and brainstorming, the project began to take shape. Connections to new retail development, office space, multifamily housing, and a hotel were all in the mix. Walkability and swapping surface parking for structured parking was an important—though expensive—part of the plan.

The solution for the difficulty of project financing was sharing the cost and the use. “In a community like this, they weren’t used to doing that,” Nesbitt said. City leaders thought that to keep the project moving, they had to think more broadly. Idaho’s Department of Transportation agreed to chip in for parts of the project that included transportation and a bridge, while the city contributed to street and sewer upgrades.

That project is still in the works, and Nesbitt and the stakeholders hope it will live up to the vision they have for it. “We’re creating a heart of the community where people can go—where there’s walkability, green space, a community recreation center,” she said. “It’s a hospital district that supports the hospital and the community itself.”

In another project Nesbitt is working on, in Denver, the team looked to combine wellness, mobility, and technology. At the heart of the project, Pena Station NEXT, is a central park surrounded by retail space, housing, and a grocery store, along with a community wellness center and clinic.

The concept of the project is centered on health and wellness and features such elements as an outdoor climbing wall. “The key question was how might we bring aspirations of the weekend into the week,” Nesbitt said, noting the wealth of outdoor recreation options offered by the surrounding mountains. The development will have healthy retail food options and a running path that weaves through the site and connects to regional trails.

For Nesbitt, the future of hospital design will best serve the community by moving away from traditional models. “The emerging model is a hospital as an anchor for health-promoting communities,” she said. “This is something that requires both the real estate community as well as health care to think differently and look toward each other to find new ways to create.”