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The Doctor Is In

A hospital in the midst of stores, homes, sidewalks and a bustling community: Is health care the anchor that new urbanists have been seeking?


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PETER BERNARD'S CONVERSION happened on a sunny summer afternoon in Louisville, Ky. It was the mid-1990s, and Bernard, chief executive of Bon Secours Health System in Virginia, had been invited to attend a charrette — a French word for “cart” that doubles in architectural lingo as a crash community-planning session, often open to the public, that's convened to dream up new development in a few days. At the Louisville session the discussions concerned Norton Commons, a proposed housing and retail complex designed by the Miami-based architects and urban planners of Duany Plater-Zyberk and Co.

Architects AndrAcs Duany and Elizabeth Plater-Zyberk are widely credited as founders of the 30-year-old community-planning movement known as new urbanism, which envisions a return to traditional town plans and building proportions of the early 20th century. Before Americans became dependent on automobiles, neighborhoods were more compact, with narrower street grids, smaller yards, plenty of sidewalks and a variety of residential, retail and institutional buildings filling modestly sized blocks. The goal to revive this ideal is epitomized in the candy-colored beachfront town of Seaside, Fla., an 80-acre, self-contained neighborhood designed in the late 1970s by Duany and Plater-Zyberk that's widely touted as the first new urbanist community.

At the Louisville meeting, Bernard recalls being inspired by the concept. “It was innovative,” he says. “It took you back to the European setting where you have these residential areas ingrained in the community, where you could get access to all of your essential needs by walking.”



Peter Bernard, the chief executive of Bon Secours Virginia, envisions this garden behind the chapel at St. Francis Medical Center in Midlothian expanding into a new urbanist residential community.

A nostalgic picture, to be sure, but what does new urbanism have to do with Catholic health care, Peter Bernard's industry of 30 years? In January 2009, Bernard enlisted Duany and Plater-Zyberk to hold a community planning session to discuss expanding St. Francis Medical Center, a 130-bed, $160 million hospital complex in western Chesterfield County. The plan that emerged envisions a full-fledged hospital town, replete with more medical office buildings but also shops, restaurants, green spaces and residential housing, including apartments and townhouses, which line landscaped boulevards and streets.

For Bernard, new urbanism has become part of an ambitious business and mission plan. Historically, hospitals are sterile, bland environments with a singular focus on medical care. Bernard sees something different, more holistic, incorporating into the hospital setting an environment that aids in the healing process. It's also much more than that, extending beyond the hospital's walls into the community — a neighborhood bonded in good health.

As a movement, new urbanism is intended as an antidote for suburban sprawl, a planning panacea for the social isolation, economic segregation and negative health effects that many people attribute to the single-use zoning codes and arterial highways that typify most suburbs across the United States. By creating tightly knit, self-sustaining, walkable communities — places where residents can work, live and shop within short distances — new urbanism aims to eliminate, or drastically reduce, the country's dependence on cars.

So far, the details of the St. Francis master plan are vague. No timetable has been set, and the plan hinges on Bon Secours' ability to purchase additional acres, acquire zoning changes and secure partnerships with developers among other challenges. It could take 20 years or more to complete the vision. But the dream of making St. Francis the heart of a new urbanist neighborhood is bold for a hospital that opened just five years ago and is still new to the suburbs of western Chesterfield.

The St. Francis plan is also, perhaps, a clarion call for a region that's long struggled with poorly planned residential subdivisions and unwieldy regional development. Many urban planners and community observers laud the ideals of new urbanism and its policy-based twin, the smart-growth movement. But challenges exist. The whims of the market can dilute well-meaning principles such as mixed-income housing and the physical hurdles of the region's hierarchical roads and sprawling suburbs, where development is still dictated by road design.

After all, it's no accident that St. Francis is located just west of the recently expanded Route 288 and Powhite Parkway interchange, at the epicenter of western Chesterfield's fastest-growing residential corridor. The hospital is in the belly of suburban sprawl, which begs the question: Will the plans for St. Francis become a blueprint for doing new urbanism the right way, or, in the end, become just another minivan-laden subdivision? 

THE PLANNED EXPANSION of St. Francis Medical Center is the culmination of Bernard's ongoing collaboration with new urbanists. Not long after the Louisville meeting, Bernard, then chief executive of Caritas Health Services in Louisville, hired Joanna Lombard, an architecture professor at the University of Miami and a colleague of Duany and Plater-Zyberk. Lombard, who was studying healing gardens, was consulted to help create “an environment of spirituality” at Caritas, Bernard says.



Joanna Lombard, a professor at the University of Miami's school of architecture, is studying how principles of the planning movement known as new urbanism intersect with health care.

She helped design a nature trail at the hospital campus. The trail became so popular, Bernard recalls, that community residents, not just people within the hospital, began to use it, and lights had to be added to appease demand from the night shift.

After Bernard joined Bon Secours as chief executive of the nonprofit's Richmond hospitals in 2000, he again turned to Lombard. Prior to Bernard's move, Bon Secours had hired the Richmond architecture firm Odell Associates and local landscape architects Higgins & Gerstenmaier to design St. Francis Medical Center, Bon Secours' first campus south of the James River. It was a symbolic and strategic move in a county dominated by Bon Secours competitor Hospital Corporation of America, or HCA, operator of the Chippenham-Johnston Willis hospitals and, like Bon Secours, a top regional employer.

Odell Associates Chief Executive Jim Snyder says that Bernard balked when he saw existing designs for St. Francis. “We reviewed it with him and he was just not comfortable that it delivered,” Snyder says.

As the story goes, Bernard took advantage of time gained from a legal battle with HCA over St. Francis' certificate of need — HCA was attempting to block Bon Secours from opening south of the river — to launch an overhaul of the St. Francis design, with Lombard's help.

 “Peter connects the environment to his brand,” Snyder says. “He believes that people remember the environment and they relate … the environment of buildings — that experience — with who Bon Secours is.”

“We just came in and totally gutted the original land plan,” says Dave Gerstenmaier, principal and owner of Higgins and Gerstenmaier, the landscape architects, of his work with Lombard.

The St. Francis medical complex, which opened in 2005, sits on about 55 acres and includes the hospital, a cancer treatment center and a day-care center. The campus is lushly designed, landscaped and decorated. It features healing gardens, Umbrian-inspired architecture with red tile rooftops, a stone bell tower, a central courtyard with fountains, and colonnaded pergolas that emanate recorded nature sounds. It also has markers of the hoped-for expansion via its landscaped central boulevard and sidewalks that link buildings and stretch out toward the undeveloped land that surrounds the property.

It's not perfectly new urbanist, Gerstenmaier notes — there's still a massive parking lot set squarely the middle of the campus — but it left room for a new vision.



This Umbrian-inspired bell tower, piazza and pergola surround the entrance to the hospital at St. Francis Medical Center.

THE BON SECOURS executives in charge of the organization's mission have embraced that vision — Bernard's directive to integrate landscape, interior and architectural design with pastoral care. A council of Bon Secours workers and architects meets regularly to talk about the relationship between design and healing. Some employees are so taken with new urbanism and community planning that they've become certified in running community planning sessions through workshops at the National Charrette Institute, a group run by a former employee of new urbanists Duany and Plater-Zyberk. One executive, Bon Secours Richmond's senior vice president for mission, Dougal Hewitt, has undertaken a graduate program in architecture and health care at the University of Miami, where Lombard and Plater-Zyberk teach.

Hewitt and Lombard have researched the history of Catholic health care, linking medieval Catholic monasteries and religiously affiliated hospitals from history as havens that functioned as places for healing, lodging and food. In an article for Health Progress, a Catholic health care publication, Bernard describes the planned St. Francis expansion in language that marries new urbanism with spirituality:

“Everything has been designed to uphold our mission of healing, spirituality and nature. Additionally, the plan encompasses five important principles of good neighborhood design: creating a center and an edge; locating key services and buildings within a quarter-mile radius and a five-minute walk; providing a mix of uses, from hospital and medical services to residences and retail conveniences; a street network for pedestrian comfort; and focal civic places, including churches and schools.”

In the same article, Bernard describes how community planning sessions are a so-called holistic process, characterizing the building of St. Francis as “a calling to mission” and tells of a study commissioned by Bon Secours that will document the positive correlation between the natural light that filters into St. Francis hospital rooms and “enhanced healing and shortening hospital stays.”

“He just sees it,” says new urbanism founder Duany, whose company has been employed by Bernard several times to organize and lead urban planning sessions. Duany calls Bernard a visionary. He and other new urbanists see a natural connection between the movement and hospitals because new urbanism, they say, offers tangible health benefits.



Elizabeth Plater-Zyberk, hailed as one of the founders of the 30-year-old planning movement known as new urbanism, led the January 2009 session that discussed expanding St. Francis Medical Center into a hospital town center.

For example, in a partnership with the University of Miami medical school, Lombard and Plater-Zyberk have contributed academic studies on the relationship between health and the built environment to the American Journal of Community Psychology and the Journal of Gerontology. The former found positive correlations between mixed-use city blocks in a Hispanic neighborhood of Miami and better conduct grades for resident school students; the latter associated exterior architectural features that encouraged more social interaction, such as porches, with feelings of perceived support among Hispanic elderly.

Additionally, a large body of academic research links higher levels of social interaction — something the compact designs of new urbanism hope to encourage — with longer life. For example, a widely cited 1979 study in the American Journal of Epidemiology examined adult residents of Alameda County, Calif. It found that those with weaker social networks — fewer close friends and relatives and less contact with them — were more likely to die during a follow-up period of nine years, regardless of any self-reported health risks.

More broadly, proponents of new urbanism say it stresses the health benefits of more walking, less driving and more socializing — a prescription for the physical and psychological malaise of suburban sprawl, which studies have shown is associated with higher body weight, higher blood pressure and increased likelihood of developing diabetes or being injured or killed in a car accident.

Rachel Flynn, Richmond's director of community development, says the pattern of suburban development that occurred in the last century, reliant on the invention of the automobile and eventually typified by far-flung suburbs, has been a deviation from centuries of successful city planning, and that “we've really had to learn the hard way what the downside” is. Flynn lauds Bon Secours' efforts to bring new urbanism to Chesterfield.

STILL, FOR ALL the enthusiasm new urbanism and smart growth engender, the challenges of building new urbanist neighborhoods in the midst of Richmond's suburban sprawl are numerous.

Take West Broad Village, a massive development being built on West Broad Street that its Web site bills as a lifestyle destination rooted in new urbanism: “A community of people who live, work, shop and recreate within an urban setting they call home …. from the neighborhoods, to the ‘Main Street,' to the public spaces and even to the adjacent school and park.”

But with residential units billed as luxury, pedestrian paths ultimately hemmed in by heavily traveled Broad Street and Three Chopt Road, and the closest grocery store being a pricey Whole Foods, West Broad Village appears to fall short.

“New urbanism can sometimes become watered down,” says Sheila Sheppard, coordinator of the Partnership for Smarter Growth. Sheppard commends any efforts to incorporate new urbanist or smart-growth principles into planning. But considering the development around Short Pump, she notes a lack of crosswalks and green space and the absence of truly mixed-income houses.



A rendering by Duany Plater-Zyberk and Co. depicts a future neighborhood that might surround St. Francis Medical Center. Below left, an expanded version of the existing hospital.

John Accordino, an associate professor of urban planning at Virginia Commonwealth University, says new urbanist ideals run up against big challenges in the suburbs, where a hierarchical system of roads — highway to retail corridor to neighborhood street to cul de sac — create barriers that can trip up the integrated goals of new urbanism. “As you get further and further into the residential area,” Accordino says, “you get ultimately to a dead end.”

Even new urbanist developments that have been deemed successful — creating the longed-for destination-based “place-making” that new urbanists seek to recreate — are potentially problematic, Accordino says, because eager, less-mindful developments can crop up around them. “So you may have created a nice little oasis of walkability,” he says, “but … you [also] may have created more sprawl.”

Stauncher critics of new urbanism, including Dorn C. McGrath, emeritus chair of the urban planning program at George Washington University, point to what they believe are more damning pitfalls. “It's a current fad used to sell projects,” McGrath says. “If you claim new urbanism for almost anything that you do, somehow everybody looks at each other and they nod uncomprehendingly, but you've used the right term.”

McGrath says he's watched the Kentlands development in Montgomery County, Md., hailed as a new urbanist success, evolve into an “additional far-flung suburb,” and casts doubt on the ability of such projects to remain truly mixed-income. “It's supposed to be,” he says. “Except the market dictates who will live there.” The houses in Seaside, Fla. — lampooned as a fake dystopia in the film “The Truman Show” — famously sold as lots for $15,000 and with houses in the $100,000 range in the 1980s; now most Seaside residences sell in the millions, often as vacation homes. A Seaside lot currently on the market lists for $499,000.

New urbanists are keenly aware of the movement's criticisms — and the proposed expansion of St. Francis Medical Center, in its infant stages, may provide the opportunity to address them.

Lombard, the University of Miami architecture professor who worked on the master plan for the St. Francis expansion, says the hoped-for neighborhood surrounding the hospital is built on the idea that every hospital worker — from the custodian to the cardiac surgeon — can afford to live and work in the same place. For Bon Secours executives and planners, the employees of St. Francis would provide an automatic critical mass for residential units and retail shops.

As for transportation — St. Francis is banded by Powhite Parkway, Route 288 and Charter Colony Parkway, with no access to public transportation — supporters say it's a challenge, but that even small inroads count. “All these highways have been built, and so if we're going to keep expanding, let's try and do it in this new way,” says Flynn, the city's community planning director.

Of course, it's not an approach every Richmond region hospital will take. Margaret Lewis, president of HCA's capital division, points out that all hospitals are economic drivers and “a part of the fabric of every community.” As for a hospital town center, Lewis points to HCA's Reston Hospital Center in Northern Virginia but says “you don't see it much in Richmond” and that “it's not essential.”

For a vision that could take between 20 and 50 years to complete, the challenges of regional coordination will persist. Although no formal market research has been done to test the plan produced at the St. Francis meetings, Bernard says talks with developers about expanding St. Francis Boulevard, the main street of the current campus, are in the works, and that any development will be “complementary of the mission and vision of the Sisters of Bon Secours along with our values.”

In other words, it's still a vision. But it's getting attention, and under Bernard's helm, spans the hospitals of Bon Secours. A November meeting discussed a new urbanist vision for St. Mary's, the Bon Secours hospital that straddles the city and Henrico County, and another concerning Richmond Community Hospital in the urban East End is planned for June. As for St. Francis, Bernard says, “We are now massaging the product that we received from [Duany Plater-Zyberk] and we're prioritizing.”

Correction: In earlier print and online versions, Style misidentified Sheila Sheppard, coordinator of the Partnership for Smarter Growth. We regret the error.


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