The idea that the built environment can have a positive effect on health outcomes is a generally accepted truth today. Research has proven the benefits of providing natural light and views to nature, configuring spaces to prevent falls, and more.

But what about the community outside a hospital’s walls? What effect can a healthcare campus have on the health and wellness of its surrounding area?

Connecting design to population health overall is a topic that Jason Harper, senior medical planner and associate principal at Perkins+Will (New York), says has been percolating for 20 years, especially in light of the past decade’s alarming rise in lifestyle-related chronic conditions like obesity and diabetes. “People have been looking at that on a variety of scales, from the materials we specify to the energy efficiency of the buildings we design,” he says.

Harper adds, though, that medical planning hasn’t traditionally played a role in this conversation. Looking at how hospitals and medical centers have historically been built, they tend to be monolithic structures set off from roads and engulfed by parking lots, offering few reasons for local residents to enter when they’re not sick or injured.

But times are changing and organizations around the country are reconsidering the campus planning of old in favor of models that place their facilities as anchors of communities rather than outliers, opening doors to neighbors and supporting healthy initiatives—all in an effort to keep people well rather than treat illness.


Design drivers
There are a number of factors influencing the shift. The first is a trend toward urbanization: For the first time in history, the majority of the world’s population lives in urban areas. Here in the U.S., the urban population increased 12 percent between 2000 and 2010, outpacing the nation’s overall growth rate of 9.7 percent, according to the U.S. Census Bureau.

The path of suburban sprawl is reversing. “This whole new trend of urbanization is thinking about a live/work/play environment. It’s a paradigm shift in how people want to live,” says Yogi Patil, practice leader of healthcare urbanism at HKS Architects Inc. (Dallas).

At the same time, as a culture we’re embracing wellness more than ever, from wearing self-monitoring devices like Fitbits to eating locally sourced food. “It’s just looking at [wellness] from a new perspective, because we stopped looking at it for the last 1,500 years of the Industrial Revolution. Now we’re realizing we need to go back to the basics and do things right in the first place,” Patil says.

And doing things right in the first place is exactly the course the healthcare industry is on, too. Thanks to reform and new reimbursement models that reward hospitals for value over volume, the idea of prevention as a business model is connecting the latest trend to providers’ bottom lines.

While one solution to this new challenge is seen in providers expanding reach and access to preventive care through ambulatory sites, another piece is the reinvention of the healthcare campus. Frequently dubbed health districts or health villages, the concept of a healthcare component serving as a community anchor that influences an overall wellness-focused lifestyle is picking up plenty of steam.

What exactly that means in execution, though, can vary greatly. “It’s a facility or an environment that’s an extrovert rather than being an introvert,” Patil says. “It’s not working in isolation; it’s engaging the community and city in context and making it a part of the future. It’s not just a place where you go when you break your hand or are having a heart attack, or where you’re living the most stressful moments of your life. It’s a place where you can be engaged in day-to-day activity. In what fashion and in which way, that’s still being defined.”


From the ground up
Though still somewhat rare, new-build healthcare village models in progress are garnering plenty of national attention. Either healthcare system-driven or developer-driven, they include mixed-use components like retail and housing in addition to healthcare pieces like hospitals, medical office buildings, or ambulatory centers. The idea is to create that live/work/play urban environment that’s so desirable today and to do so in a setting that’s driven by wellness.

Eight years ago, Florida Hospital began to look closely at land it had acquired over time, determining that an idea to develop a health community with a hospital center was worth exploring, says Jody Barry, administrative director of strategic development for Florida Hospital and Adventist Health System’s Florida Division (Orlando).

For inspiration, the provider turned to its own history. Parent organization Adventist Health was founded on the belief that a healthy diet, a sensible amount of exercise, and good relationships with friends and family translate to a healthy life. “Here we are 100-some years later, and science says healthy lifestyle is the best way to a healthy and fulfilled life,” Barry says. So when identifying design drivers for an integrated community development, Florida Hospital homed in on such components as a pedestrian-friendly environment, parks and recreational spaces, and plenty of healthy eating options.

“What we think we can do is create a panache and magnetism, a reason to engage in healthy activities when you’re healthy,” Barry says. “There are a lot of things we can do. We can have healthy cooking classes, we can have stop-smoking seminars, we can have fun walks, and we can provide gyms.”

While its planning came well ahead of healthcare reform, Florida Hospital Health Village, about 40 percent complete today, brings with it a fitting model for modern healthcare. “We’re financially incentivized to reduce utilization, and the only way to do that is to elevate the health of the community so they don’t need you as much. The big trick is to figure out how to be paid to elevate people’s health,” Barry says.

Indeed, at the heart of these developments are financial drivers, too. In the case of Florida Hospital, the organization is partnering with developers that have expertise in myriad niches (from residential housing to biomedical research) and purchase land from the hospital to build village components that fall within the overall direction created for the community.

Likewise, the planned Union Village in Henderson, Nev., is on its way to becoming reality thanks to a provider signing on to build a 214-bed hospital, which subsequently sparked interest from hotel, office, housing, and senior living providers seeing a reason to be there, too, says Rex Carpenter, associate principal and senior vice president at HKS (Denver), which has spent the past three years master planning the project.

These types of partnerships also provide nontraditional solutions to reduce providers’ financial strain through opportunities to off-load some nonmedical services. For example, rather than build and operate an in-house conference space, providers could attract a hotel to its village model and rent its conference facility when necessary. “I’ve seen a shift over the last three years in hospitals’ willingness to consider those types of relationships, and I think it’s purely because of financial pressures,” Carpenter says.


Look outside
While these developed communities are dotting design boards, another approach to population health and wellness doesn’t involve a greenfield site at all. “Some of the biggest low-hanging fruits are existing hospitals in urban environments that have gentrified over time,” Carpenter says.

Perkins+Will’s Harper is involved in nonprofit Congress for the New Urbanism’s Health Districts Initiative, which aims to help hospitals take part in creating livable, walkable neighborhoods. The approach, he says, is about looking at a healthcare system or facility and making sure it’s designed in a way that’s not contributing to the poor health of its surrounding community—thinking about it programmatically to draw in a mix of uses with a focus on the community interface.

“Many are starting to think about how they do that. Do they bring the farmers’ market onto their property? Do they put in walking trails? What are the right ways to turn things around in their sphere of influence? You need to have a larger sphere of influence; you need to take a stake,” Harper says.

And, as opposed to the new-build models that essentially create communities from scratch, this type of approach instead evaluates existing neighborhoods, specifically what urban components exist and what need improved upon.

On Chicago’s southwest side, for example, St. Anthony Hospital is in the process of building a new hospital and mixed-use campus in an effort to revitalize an existing economically challenged community. The hospital-anchored development offers wellness-inspired programming that the area was lacking, from soccer fields to healthy food options to public transportation.

HDR Architecture Inc., which is designing the St. Anthony Focal Point project, is also trying to take the concept to critical-access care, thinking about how even a small town hospital can be a part of its town’s revitalization, says Tom Trenolone, vice president and design director for HDR’s Great Plains Studios (Omaha, Neb.). “I think these are true hallmarks of where things are going. The missions of hospitals have always been about that, but for some reason we’ve built them in a way that they’re on the periphery,” he says.

The Cleveland Clinic has made strides in working with its surrounding community over the years, partnering with local stakeholder organizations to develop transit lines in the area of its downtown campus, which has bolstered business and residential offerings. It also turned to its internal common spaces to bring the community in through events like farmers’ markets and health fairs, says Bill Peacock, chief of operations for Cleveland Clinic.

Basing its facilities projects on government-mandated community needs assessments, internal data, and conversations with civic leaders, the organization has also re-evaluated existing spaces for better uses.

For example, Peacock says, though the closing of its Huron Hospital in 2011 was hotly contested locally, the system found that replacing it with the new Stephanie Tubbs Jones Health Center better served the disease profiles of the community, allowing the offering of healthy cooking classes, cancer management programming, and post-surgery rehab. “That facility, I think, is an example of how going forward healthcare has to flex and be responsive. Systems have to think about how they can best serve,” Peacock says.


Opportunity knocks
While models for expanding support of population health through healthcare campus planning exist, there’s no one-size-fits-all approach. “What you need in each project will be different based on what’s driving that project,” HKS’s Patil says.

For Florida Hospital, Barry says he turns to his planning and design partners to bring his health village’s drivers to life. “What are the objectives? Do you want to develop a community that’s inviting and feels good, and has vibrancy to it? You come up with these words like ‘vibrancy’ and give it to the planners and say, ‘Here’s what we want, here are the words that describe the project. Now what does it look like in concrete and steel?’” he says.

However, there are plenty of providers that have yet to pursue this initiative. To start to effect change, Harper says it will be critical for designers to be involved earlier than their traditional inclusion when a program has been chosen or a site has been purchased. “We’re not far enough upstream to have that conversation about how you need to think about all of your facilities within the community as a comprehensive whole, what your interface is, who your collaborators are, and what can be affected due to the overall scale healthcare systems operate at,” Harper says.

HKS’s Carpenter suggests architects initiate those conversations. “Reaching out to clients, it can make a difference. Architects can be agents of change and champion those causes ourselves,” he says. Colleague Patil agrees: “A lot of times we’re educating our clients, asking hard questions, or instigating some of these thoughts with our clients. It’s not limited to putting buildings on a campus; it’s about thinking of a bigger picture, a bigger vision, and providing leadership.”

It’s a transition Harper thinks will happen naturally, too, as providers start thinking more about influencing the behavior of the populations they serve. “It’s so crucial for them to find a way to reduce costs. They don’t quite have the incentive to do that; most are still chasing where the reimbursement dollars are, where the money is, where the most return on investment is. It’s going to take a while to get there, but I think it will accelerate as the incentives start to change, because people will see the economic benefit of investing in that way, rather than in the next MRI,” Harper says.

Jennifer Kovacs Silvis is managing editor of Healthcare Design. She can be reached at

For more on first steps to begin planning a campus to promote community wellness, see "Starting Point: First Steps To Supporting Wellness By Design."