Design and Development of Mixed-UseHealth Districts

Okay, good afternoon everybody. Thank you for your patience. Welcome to On the Park Bench, a public square conversation brought to you by the Congress for the new urbanism. On the Park Bench presents interactive conversation with thought leaders in the urbanism and allied fields related to the built environment. Today's topic is design and development of mixed use health districts. We have a panel of experts in mixed use districts who will discuss the many advantages and benefits of including health institutions as part in creating vibrant and safe communities. Eric Leste leaves the region and town planning studio at Tori Gallas and Partner's Washington DC office. During his 29 plus year career he has led award winning planning and design efforts throughout the United States and abroad. For both public and private sector clients. His public sector expertise includes neighborhood plans, corridor plans, foreign based codes, design guidelines, and urban design. His private sector expertise includes transit oriented development. Mixed use sprawl repair. Master. Plan Communities and Urban Design. He also leads teaching peace, healthy communities and hospital oriented development initiatives. Hey, received a bachelor of landscape architecture from Utah State University and is a certified planner. Joanna Lombard is a registered architect of Florida. She's also professor at the University of Miami School of Architecture with a joint appointment in the Department of Public Health Sciences at the Miller School of Medicine. And an AV's faculty scholar in the Leonard and Jane Abbess Center for Ecosystem Science and Policy. She holds a bachelor of architecture from Tulane University. And a master of architecture from Harvard University Graduate School of Design. And Ben Shalman is Memphis Medical District Collaboratives Vice President of Real Estate and Economic Development. In this role, Ben is charged with expanding the ecosystem of developers and businesses working, investing, and building. In Memphis's medical district. Before joining MMDC, he helped build, launch, and voice small change. And equity crowdfunding platform. Focused on impact oriented real estate. Hi Marsha Garcia. I'm the director of education and training for. And today our panel of experts will discuss health districts and their impact on the community social. Physical and economic well-being. Eric will first discuss hospitals and health institutions as community assets that can be leveraged to stitch together. The campuses and communities in which they sit. And then we'll we'll talk with Ben about the efforts to strengthen the connections, communities and campuses in the Memphis Medical District. With the active engagement of the district's and for institution is a majority of which are health institutions. And then we'll have a follow-up discussion with Eric and Ben moderated by Joanna. Finally, we'll have a QA from the audience. So please use the Q&A function of Zoom to ask your questions throughout the webinar. At just whenever they come to mind and we'll address as many as we can toward the end of the hour. So Eric, we're going to kick off with your presentation and ready for you to begin. Thank you. I'm gonna share my screen. Let's see if I can. That to work. So can you see my screen? Hopefully. Perfect. Okay, so. You know, hospitals are very interesting. Some of the learning objectives today that we're going to cover. Or about understanding the outside impact of hospitals. I'm understand the concept of hospital oriented development as a typeology or as a paradigm. Understand the benefits of HOD. Understand the roles that hospitals can play in economic development. And understand a multifaceted approach that really becomes necessary to implement this as an idea. So hospitals employ more than 6.7 million people. And they generate over 900 billion dollars in revenue and they make up close to 5% of the US economy. They're also often the largest employer in an area. That's true in larger cities, but that's especially true in smaller cities and smaller communities. In the Washington DC area where we would expect the federal government to sort of be the largest. But Medstar Health is the largest employer in the Washington DC area and I know that is the largest employer in Northern Virginia. So oftentimes hospitals. Are really overlooked as being an economic anchor. The ability that they have to contribute to economic development. And understanding of what their impacts can be in their sort of conventional setting on the environment. Understanding sort of the distinction between preventative versus critical care, hospitals are typically They're really involved in critical care. Although there's a growing kind of awareness. About preventative care. And the impact or the relationship that they can have with transit oriented development. So, hospitals have like very competitive environment. So they're competing for a shortage of nurses, physicians, technicians. And they have a big interest in trying to attract those people. We have an aging population in the United States that's going to result in about 2.3 million new healthcare workers. And they employ the full range of workers. Everything from very low skilled workers up to highly educated workers. Yeah, this is what we typically find with the hospital. Right. And so the question becomes if this is such an important part of the economy, if it's such a large employer. Can't we do better than this? Can we do better than the building that's the buildings that sit in the middle and the big parking lots or garage that's around their perimeter? And if we sort of change our thinking about these hospitals, we find that they can be an economic development engine. They can have a very strong resilient real estate model. They can be ecologically sound. They can actually promote population health. Not just in sort of critical care, but in preventative care. They can act as community development catalyst. And it can create a competitive environment for talent for the hospitals. So the HIV model is really kind of a simplification and I and a kind of highlighting a set of principles really because hospitals really exist. Exist in many different configurations and hospital systems have many different kinds of elements to them. But the concept is that at the center of this is the hospital. And that it really becomes the economic driver. And the reason for that is because usually accompanying that is a big demand for medical office space and that attracts other office space users as well. But it usually typically happens in a very happenstance way. The other part of that is the residential component. Really bringing residential and close proximity to hospitals in a configuration that's more walkable. Provides an opportunity to people that actually work at the hospital to live near the hospital. And that can be a big attractor to people for employees for a hospital. The other part of this is the attraction with a mixed use center. There hospitals do have Very large, I'll say service requirements. And so learning how to sort of convey, how to take those areas, configure them in a way that functionally works for them, but in a way that they aren't the thing that's most present out towards the rest of the community becomes really important. So at this interface with the 2. Bringing mixed use, bringing retail. And then another very important component is bringing open space. Bring open space integrated into that. All of these elements have to do certainly with good urbanism. But they also have to do with creating healthy communities. Because research has shown that the our physical environment that we designed that we live in. Has a big impact on our behavior. And that behavior has a big impact on our health. And so making sure that the hospital isn't just there for critical care once you've gotten very sick. But rather that it's located in a place that actually helps you from getting sick in the first place. Is what an HOD model is about. So the benefits here for the community. Is really about focusing investments for the community. You ask yourself, where are we going to spend infrastructure dollars? Where is mass transit going to be located? That is one of the benefits here is that it places it in place that's a big economic engine. A greater density around these would promote mass transit. It provides transportation options for people to get to work. And government hospitals really become cooperating entities that are working together. For the hospital. They're more actively supported as we talked about. They become more competitive. If you can live close by. And certainly in an affordable kind of situation as well, that's a big draw for people, for employees. It in prize, a gracious environment. And it's a district or a community form that combines preventative strategies with critical care. We talked about the health benefits of this type of development, really promoting population health. The open space is an important part of that puzzle too because that improves the psychological health and reduces the case the levels of anxiety and depression rates in the community. But also thinking about chain grocery stores, which research has shown people, consume more fresh fruits and vegetables if that's the case. But it's also a much more responsible form of development for a jurisdiction. Where you look at that and you're focusing your infrastructure dollars of where you're spending and the tax revenues that you're getting. So you have a greater tax revenue per acre. Reduce infrastructure cost. Focusing your limited resources. etc. And then from an environmental perspective, obviously, reducing the amount of sprawl that's out there and rather creating a compact form is an important part of the environmental benefits. I just wanted to point out. That the Eric, you went on mute. Yes, you're back. Am I back? Yes, okay. Okay, sorry about that. So, one of the important things to understand is in the hospital oriented development model what we're really talking about is the full spectrum of hospitals. They come in very many different types and sizes from micro to small to medium to large. And there are many different types. There's acute versus long-term care profit versus nonprofit teaching versus non teaching. Federal versus state versus local, different trauma levels. And so there's a whole set of types that you sort of need to understand. But this model, I think, is something that can apply itself, whether it be to a very large entity or to a small entity. So for example, we're currently working on a mall. Redevelopment project and that mall redevelopment project as one of its primary tenants as a hospital system. And what they're doing is they're creating an ambulatory surgery center. With the next future expansion. Emergency and diagnostics and a micro hospital. So it's not sort of the full blown hospital. Doesn't have a lot of ambulances. It has a few ambulances. But it's a much smaller version that exists in the community. And so that's something that can. More easily integrate, I'll say. With something like a mall redevelopment. So really this is something that can be looked at from a very, you know, the large perspective down to a small perspective. In a way that can fit appropriately into a community at the appropriate scale. There's a very good, documents, by David Zuckerman called hospitals building healthy communities. And what this document is, it's actually really focusing on. How hospitals have been reaching out into the community. And contributing to the betterment of that community. So I just wanted to highlight a few of those categories. If you're interested in this, I would definitely recommend reading this. It's there's a lot of detail that goes that goes into it but just wanted to highlight some of those practices. So there are sustainability practices. Where they've gone out into the community to try to improve the environmental sustainability. They're minority and women own business purchasing programs that have been started. Some hospitals that are an economically distressed community. For example, it's maybe something as simple as all the watch gets shipped out to somebody that's gonna go and do all the laundry, right? But if you focus on capacity building in the community, you may be able to help bring a business up. That can actually be much closer to the hospital. And, create jobs for the community. There has been some housing development, typically having to do with senior housing, affordable housing. Talked about capacity building. Things like local hiring. Community investment and multi institution partnerships. And these are just a few examples. But hospitals. Because of some of the legislation that's out there. Hospitals are either for profit or nonprofit for the nonprofit hospitals. Sometimes people don't realize that they actually have a requirement to make community contributions. And so if you become get a little bit more creative. You can start to say, well, maybe it isn't just all within the walls of the hospital. Maybe that extends out into the community. And you can look at how, what kind of community benefits. Can be generated for the surrounding community. So I think the HG model is a way of looking that and sort of saying it isn't just a single entity, rather it's very much integrated. Just want to do a couple of really quick examples. This is in St. Louis. This is the Barnes Jewish Hospital complex many years ago. It used to actually be the largest hospital complex in the world. It's not anymore, but it's it's on the west end of St. Louis facing, Forest Park, which is kind of like Central Park in New York. It's a large hospital complex. Hard to see here, but it's actually integrated with residential buildings, both new and historic residential buildings, has a nice shopping street that you go down here that has antique shops and restaurants. It has a mass transit that you see this train line that comes through, that was added later. But this is just an example of how. A hospital and even a large hospital complex can integrate with the surrounding community. Some of the moves that they've done recently in some of their new buildings is making sure that the ground floor of one of these buildings that faces the smaller scale retail and restaurants actually has storefronts at the bottom. And that becomes that interface at the hospital with the surrounding neighborhood. Just as example, there's some others here. There's the quarter lane health quarter master plan the Florida Hospital Health Village, Baton Rouge Health District, South Bend, Indiana is currently undergoing studies for the north side of downtown, the University of Maryland, Capital Regional Medical Center. So these are just examples of this mixed use hospital development that's starting to really be considered and implemented. Just as an example. You know, when you're dealing with a hospital, it oftentimes they're already existing. Obviously the The HRD model is an abstraction that has to be adapted to the actual site conditions. So for example here, in this middle piece, there are 2 stream valleys that sort of run down through the site. And so you have to kind of integrate this concept and this idea on these principles. Marrying it with the land, etc. But just wanted to include that to show that obviously you need to sort of integrate that in the best way with an existing. Existing site. So, lastly, I'll say the implementation, can sometimes be a challenge. What I'll say is that I think this starts at multiple, multiple places and multiple levels. Meaning that I think it can start from the government perspective of having this recognition in a comprehensive plan. When you start to ask yourself the question, where should development go? What should the land use be surrounding a hospital? These are places and times when that can be influenced. Obviously in the zoning and what can be permitted surrounding hospitals. But also in hospital location decisions for states that have a certificate of need requirement, that could be added as a criteria. That you be located next to transit, you'd be located in a place that has zoning that's appropriate for mixed use. Etc. Certainly for transit planning that hospitals be considered for that. The other one is to actually engage hospitals and systems. That can be a little bit more challenging sometimes. Obviously hospitals are not developers. They have a different mission and different goal. But I think that some more enlightened hospitals. Do look and understand their impact in the, in the community. Developing partnerships with hospitals. Certainly private development. Just private development recognizing the opportunity in the economic engine that hospitals can be. Also infrastructure investments and. And also just prioritization about where infrastructure spending should go. So I think it really requires a multi faceted approach for many different players in order to make this happen. But I think if we do that, we'll make a much better. Much better environment for our communities in that way. So I will conclude with that and turn the time over to Ben. Great. Thank you, Eric. Let me. It's situated here. Okay, you all can see my screen. Perfect. Okay. Okay. So thanks, Eric, and thanks, Marcia, for the introduction. One quick. Addition to my bio many many moons ago. I was also the communications director for the CNU itself. So for those of you out there, they may not recognize me because I have a little less hair. Good to be reacquainted with you. But today we're gonna talk about the Memphis Medical District collaborative and the Memphis Medical District itself. And Eric, I think you've teed up a conversation really well because I think the work that N NDC is engaged in is a really good illustration of how this can spell, how the community building capacity can spill out of the hospital walls and into the communities themselves. So first let's ground the conversation in place, right? The Memphis Medical District, the area that we serve is a 2.6 square mile area that really. Sandwiches the place between Memphis is downtown to the west that hugs the Mississippi River and a constellation of neighborhoods. Both stable residential and commercial pockets known as Midtown, which is just to the east. And these are all enclosed within the George Kestler Design Parkway system, the George Kestler Design Parkway system, a city beautiful gesture that defined the traditional boundaries of the city. Now, one of the things to note about the medical disc is that it is composed itself of 2 point, as I mentioned, 2.6 square miles, but 6 distinct neighborhoods over 10,000 residents, 8,000 students, and on any given day, 30,000 employees moving in and throughout the district. And one of the things that I found it so inspiring about the medical district and what compelled me to move down here and join MDC was how it clicked like an electric this area is. Architecturally, historically, and beyond, there's not many other places in the United States where you get this degree of texture. And if we look back to the 1970, s and that some of the conditions that caused the eventual reason for the formation of MMDC, we can see that a loss of density. Is predominant, right? So in the 1970, s there were over 30,000 residents in the medical district. In 2,014 when the idea for MMDC began percolating we had less than 10,000 residents in this place. Like many other cities across the United States, depopulation and due to vestiges of redlining practices, white flight, this in Memphis, eastward drive towards sprawl was the culprit and Memphis like many other cities as well looked at stabilization through demolition as being a mechanism to control blight, as well as annexation. To keep population numbers either growing, static, and or growing. So there was an attendant disinvestment in the area in the communities. The distinction being of course these 8 anchor institutions that remained in place in the area. And when the idea of MMDC was being thought up. We looked at the historic land uses that were evident, right? So a large institutional presence. 575 acres out of that 2.6 square mile territory. Tons of surface lot parking over 270 acres. I and limited an inconsistent quality of housing even within this robust dense population of institutional uses and individuals who are utilizing those services and are working for those institutions. So the manifestation of this in the city escape take shape in a variety of ways, right? And very,icular, centric auto oriented. Street network, lots of defensive architectural postures, lots of fencing with those tremendously large surface lot parking lots. Eric, you illustrated those as well, essentially acting as disconnection points between the campuses and the communities in which they sit and then disinvestment of the building stock, leading to general conditions of light. So the need for an organization like MMDC was pretty evident, and realizing this need for a coordination of revitalization efforts, the areas major nonprofit, excuse me, anchor hospitals and colleges. Forms our as a nonprofit entity to manage that shared community development. And this is leveraging the outputs of these anchor institutions, right? Knowing that these outputs that include many of the items and bullet points that you see on the right being senters of employment, a destination for students, purchasers of goods and services. Having this tremendous presence in the area could be used as a mechanism to start weaving together and rebuilding the communities. So our mission, is to strengthen connections, communities and campuses within the medical district. So that they are more vibrant, prosperous and equitable. I characterize it in a slightly different way. I always say that MMDC stitches together the social, cultural, economic, and built environment fabrics between the campuses and the communities in which they sit. Very similar, obviously. Mine's a little more wordy. But I think it speaks to the dimensions that we work through. And that makes the question, what is it that we do and how do we do it? Well, in short, we keep our neighborhoods clean and green. We improve parks, public spaces and streets. We support small businesses and real estate development. We program the area and we offer resources to the residents, employees and students who are utilizing these spaces. Again, just grounding us further in place. 6 distinct neighborhoods, all of them have their own unique histories, conditions, and opportunities. It's our responsibility to take our suite of services and resources and to tailor it to each of these communities, knowing that they all have their own stories and needs, right? Now this is. Chuck's supposed against the demographics that we know. Exists within the medical district. Many of the residents, those 10,000 individuals, give or take within our communities are living with the legacy effects of that disinvestment in the population. 41% of households below the poverty line, 89% renter occupied homes. Majority African American in the neighborhoods that we serve. And this is juxtapose against anchor growth, as you can see on the right. Employees growing a procurement muscle growing and real estate holdings and presence growing as well. We also know that there is a tremendous need for housing across the socioeconomic spectrum in a market study that we conducted all the way back in 2,017. We found that over 2,600 or rather up to 2,635 residential units could be absorbed with everything that has been planned and come on line, we are still about a thousand minutes short of meeting that baseline and 2022 just last year we revisited the market study and found that multifamily properties are incredibly occupied, right? So this is a very tight market. When you add all of this together, right, in terms of what Ndc's goals and vision are, you can boil it down to these 3 lenses, enhancing the public realm, building community wealth, and catalyzing equitable development. And the anchor institutions are our partners in enabling this work to then filter out and through the communities. That takes many different shapes in the programs. And I'm not gonna go into a detail on every program area that an NBC administers, but it is essentially for different, bodies of work and I'm gonna tease out a few of these and go into deeper detail that I think is a particular relevance to this audience. But our anchor programs essentially are the programs that connect most directly the angers themselves with individuals within the communities and our businesses within the region. Our b local program is to increase local spend between the anchor programs, excuse me, anchor institutions and regional businesses. Higher local is a workforce development program that through educational cohorts will help neighborhood residents go through soft skills training and then eventual interviews and potential placement for jobs within the anchors. Live local is a rental and or down payment subsidy program to get people living closer to where they work for employees of the anchor institutions. Our real estate and economic development, team and program is really concerned with expanding the ecosystem of people who are investing building and developing within the. Health district. And we'll go into more detail there momentarily. So I'll skim over right now. Our communications and engagement program works both through digital and physical realms and is really broadcasting the signal of what the medical district is and how we are programming the area. And letting people know the different ways that they can engage, right? This also includes a pretty robust signage and public art component to help alongside our quality public relevant program soften much of the hard scape that is evident in our area. And our quality public realm team works across various dimensions as well. We have a clean and safe streets teams. That is our ambassador program. Those are folks that are performing hospitality. Services on the ground every day maintaining clean streets by beautifying the area and collecting litter. Our place making and mobility efforts are all about creating spaces that have multi modalities and allowing people to have agency over these public spaces. And then our street scapes and landscaping. Is one of the efforts I wanted to go in deeper detail to. So if you can see here some of the work that our quality public realm team has done and I'll use that phrase again to soften hardscape, right? Memphis is a very vicular oriented city. What we want to do is make sure that people recognize that there is the opportunity for them to have agency over space in a way that previously was not there. To take uninviting, unwelcoming, predominantly, predominantly throughput oriented streets and configure them into a way that accommodates multi modes and multi-users. Now, much of our initial streetscape intervention work emanated out from a streetscape improvements playbook that we conducted with LRK and also planning back in 2,016. Looking at where. The big moves could be made to make those interventions in the street and the Manassas could be made to make those interventions in the street. And the Manassas Corridor, which hugs many of the anchor institutions themselves as well as goes through a variety of the neighborhoods that we serve is really where many of these interventions have taken place. What you see here on the right is probably Black Shippers, Signature Signature Street in China that NMDC has conducted to date. And this connects the UTHSC campus University, Tennessee Health Science Center. We have Health Scientists Park. And this just goes into a little bit of further detail. Taking a page out of the tactical urbanism playbook of how you can configure existing roadways into a way that allows for a shared user experience. And what happens when you have that shared user experience? What happens when you can take relatively quick and tactical approach to reframe the perception of place? Well, through that and I'll use that word agency again and you inform the idea of ownership. You had to inform the idea that this is an area that is expressing the inherent value that's embedded within it. That is being primed for development, that is being primed for development that can span the spectrum in terms of program and can't span the spectrum in terms of how we are. Building equity into that equation. So I'm not gonna go into exacting detail in every and all project that MMDC has had its fingerprints on or help support. But taken at large, as I mentioned earlier, but our economic development and real estate team is tasked with is expanding this ecosystem of those who are working developing and investing in the area. That can take shape, many forms. We do a lot of technical and tactical strategic and design assistance. We are a private nonprofit. So we have no jurisdiction to implement plans on our own, but we do a lot of small area neighborhood planning, listen to stakeholders, and then can make recommendations around what would be the most effective and or impactful moves in a given area. We also have a number of financing tools that can help a project, in a given area. We also have a number of financing tools that can help a project come to. We also have a number of financing tools that can help a project come to fruition. Another way of phrasing what we do is that we can act often as an idea bank. We can often act as a land bank and in certain circumstances we can act as a bank This slide illustrates that last note, how that might come to, so we run 2 grant programs and we run 2 loan programs. Very briefly, our initial, you can see here, grant program is what we call the seed fund. Very briefly, our initial, you can see here, Grant program is what we call the seed fund. That provides up to $5,000. I that leads to, 98% of the time. Architectural renderings and a working pro forma. So it development teams can then put their pitch packet together and continue to raise funds for a given project. We also have, you can see here, an improvement program. That is up to $25,000 that's actually intended to be split between both property owners and commercial tenants to be split between both property owners and commercial tenants. So, $12,500 and commercial tenants. So, $12,500 a piece. So, $12,500 a piece. The idea there being that everyone gets equal access to equal amounts to, $12,500 a piece. The idea there being that everyone gets equal access to equal amounts to realize a project. But that can be used for a variety of activities. Anything really to better the experience of a building. Or a space. The 2 loan programs that we administer as well. This is basically we're pick picks up where our see fund leaves off for deeper due diligence and pre development activities even potentially helping with site acquisition. Really anything that's going to get a project shovel ready. Quote on quotes, we can inject up to $250,000 into a project. At very low cost. This is Not to get 2 inside baseball and into terms. But this can be capital that comes into a project anywhere between 2 and a half to 5 and a half percent. And then we partner with a CDIF, a community development financing institution, pathway lending. To administer a 30 million dollar capital debt fund. And this picks up where our grow fund leaves off, right? An investment position anywhere between 250,000 up to 3 million dollars into a project. That's really allows a project to be realized, right? This is for construction financing. If there's a gap. In a capital stack. This is a flexible financing framework. To recognize that there is a need to catalyze development activity in an area of where the market traditionally has looked scans at doing so. And just very quickly want to mention the very unique way in which this fund was structured. So these 3 regional banks contributed 10 million dollars a piece to the fund that allows them to take advantage of their CRA credits without underwriting individual deals. And then the Kreski Foundation and Hyde Family Foundation. We're absolutely instrumental in helping to architect, this fund and allow it to do what it is intended to do. So very quickly. And in conclusion, as we. As we inch towards the conclusion. I want to illustrate some of the projects that we have touched. So we touch projects at any stage at every scale. This is a project that we issued at both pre development as well as improvement grant funding too. We have very little historic building stock in the medical district and there's a very, a very strong need to preserve that historic building stock so we can continue to broadcast the stories that are embedded in this place. The historic terracotta was in disrepair of the Pritchard plumbing building here, we were able to provide improvement grant money for the restoration of such. This is a brand new cocktail lounge that is owned by, a minority entrepreneur who also has a marketing business in the medical district as well. You can see here this was fairly blighted. We provided capital to both the. Inkwell owner who use that grant money for tenant fit out as well as the property owner. Allowing this to be a and now very actively utilized space. The Greyhound has historic bus station, as an adaptive reuse project. It's current use is as storage. Public storage facility as well as a few artist studios as well. This will be converted to over 60 residential units. As well. You can't see it here. There's an annexe and back that's existing that will be a medical facility. So providing much needed housing in the medical district while again preserving historic building stock. And then Orlando is without a doubt the most significant in terms of size development that is occurring in the medical district. Another very unique approach to how ground-up development can occur. This is all property. 10 acres by the university owned by the University of Tennessee Health Sciences Center. That was either vacant parking or underutilized. They partnered with Concat partners and the Henry Turley Company in what is now Orleans Station of 372 units redevelopment. As well as 16,000 square feet of commercial space. That when completes will really pretend to the medical district as having the opportunity to define itself as a 24, over 7 community and rather than a pass through between downtown and Midtown and just a catchment area for the 12 h in which people happen to be working and or studying in the area. And the last project I wanted to show is Malone Park. Commons is a great illustration of missing middle housing that can complement the existing urban fabric while injecting the existing urban fabric while injecting a degree of density into the area. This is led. Development, of missing middle housing that can complement the existing urban fabric while injecting a degree of density into the area. This is lead of team that opened this first phase in July of 2021 11 units that spanned the spectrum of from cottage court studios up to 2 bedroom units. It was immediately sold out. We've injected capital into this project and both phase one and phase 2. We can see construction is happening right now. When fully realized, this will be a 35 unit. Development with 3 commercial units as well. In these mixed structures that our economic development team has had a hand at help and secure tenants, in those. In those spaces as well. So at a very large glance, just some of the activities that we were engaged in last year, you can see it through our building community wealth lenses. We've been able to really increase that by local capacity, a hundred 80 plus individuals served through our workforce development program and catalyzing equitable development, 800 plus new residential units announced not every single one of those units for projects will actually be realized. This is a very difficult time. In a macroeconomic sense, but it still indicates one, the baseline demand that is evident in the medical district and 2, the still increasing drumbeat of investment and opportunity that people see because of the engagement that MMDC has with its anchor institutions and working with the community at large. To really drive and reform and refrain the perception of place and then lastly enhancing the public realm. You can see the continued work that happens on a daily basis. That is what our ambassadors. Are doing each and every day. Really being the face of the And then lastly, it would be remiss of me not to mention as many as you know, our good friend Tommy Cello, a devout new urbanist who is the reason that I am in Memphis, Tennessee. Tommy and I. Had many conversations and he He, to Memphis, run the Hudson Valley in New York to work, with the medical district. Tommy. As many of you know, Tommy unfortunately passed away a few years ago, but the legacy of his work lives on in the medical district every day as well as nationally and spaces that he touch. And the Tommy Paella, please make me fellowship is now open and is open through July 30 first. And have Tommy's friends and family are administering this. If you've got ideas for impact in your city, definitely take a look at what is capable and possible through the place making fellowship. And I will stop there. I think I will turn it over now to show. Thank you very much. Ben and Eric. I think that honestly given the time we're gonna we're gonna move along sort of quickly and I'm gonna focus on one thing but what I would like to point out I think everyone you know just seeing the list of people who are here with us today on the participant list I can see a number of people that are working like, the DPC COVID design group or Kathy, and people who are really trying to make these things happen at the scale that Eric described of individual hospitals seeking to produce benefits for their neighborhoods and to grow in a way that's beneficial to neighborhoods. And then in the case of what Ben showed us, how an entire group of institutions can come together and really address all the interstitial spaces that frankly were pretty bleak. Before they've paid attention to them and desperately need attention to give neighbors and residents and the people that work there a better life. So we saw the scale. Eric, you spoke about how. A small hospital of a hundred people really is a community unto itself and therefore could be a change agent and Ben shown is how the magic that can happen when they come together and Ben shown us how the magic that can happen when they come together and Ben shown us how the magic that can happen when they come together and find financing and can happen when they come together and find financing and can be a kind of supportive. Force for good. So what I wanted to focus on are the 2 questions actually come to this too, because we have a question about the most common zoning tool and we have a question about like how do you really maintain this? Do you have a business improvement district model? Given that we're among new urbanists, I just wonder, A, is there a kind of form based code that really focuses on medical districts and medical when enough medical uses come together. Do they add up to a district? What is the synergy that that takes? Could form base codes be a tool? Is an overlay district a tool? Could you each talk a little bit about that? Because I think that could give a lot of the people in the audience a tool that they could begin to use in their work. Eric, you want to start? Sure, I can start. I'm not aware of a specific form based district that's been created for a specific form based district that's been created for a hospital district. I will say that a couple of projects that I've been working on one is in Westchester, New York. Where they have an environmental review process. The zone is the way that our client is a private developer building a J. Central Hospital chose to do it. Is to create a new zoning district. Based on another existing one. Okay. But in there, the language is interesting. The regulating document is in essence the master plan that we created, right? Okay. So it needs to be built consistent with that. And then there are some additional dimensional standards having to do with building heights and having to do with parking requirements and things like that. So that was done because it was the most, expedient, I'll say. And yet the jurisdiction. Can do it based on while you've showed us this master plan as long as you're building consistent with that master plan. Okay. In another location it's really a PUD, really part of a PD. That's where we're introducing a new ambulatory surgery center micro hospital cancer center etc. And that really was just part of a PUD that takes into account. Those elements the medical elements but also the other mixed use elements the retail the residential and all the sort of typical standards. Yeah. So I think, I think you just need to find the tool that works best in that particular setting and for the particular client. Hmm. But ideally, yes, I think that having a form based district that comes from the jurisdiction that sort of identifies in the comprehensive plan and says yes this is where we think we need to focus in a certain way would be the right way to go. Right. Yeah. Thank you. Ben, what do, what do you think about that? And then could you add to that like how many institutions does it take to make up? Something as big as the medical district. Yeah, so there is a medical district overly, a zoning overlay here in Memphis. But it doesn't necessarily prescribe in the same manner that we're speaking. Something particular to the hospitals. And when you think about that an application within the medical district itself. There's a one core area where we have the southern college with optometry regional one and Methodist university. That's Very much medical district central, but there are 5 other institutions scattered across those 2.6 square miles that are situated in very different localized contexts. So the zoning. A form based code that would speak across the board. It would have to be. It would be difficult, I think, for the institutions themselves to come together around one set standard, right? I do think that something that is indicative of these type of thinking in Memphis is, our new relatively new comprehensive plan. Which is 3.0 and that is the first comprehensive plan in over 40 years. It's a few years old now, but it really lays out the framework for Memphis to build up. And not out and taking our queues and directions and knowing that the institutions have such a presence and such a say in how development is dictated in the communities and knowing that that will be available, the city is looking towards increasing density. That helps inform their decisions when they're thinking about redevelopment of parcels that previously we're not under consideration. Right. Now, one of the questions that's come in and this is an interesting one because we've dealt with this here in Miami. The Zachary wants to know they have a level one trauma center. It serves 6 states. Where do you start to engage? A trauma center like that, a major institution like that, like. Who would you go to first? And frankly, this is why I asked you about the overlay district because, having worked in this area for a number of years and it really depends almost on the benevolence of the hospital administration, how they interpret community health needs, how outward facing they want to be, and you know the really outstanding ones I think of like, you know, Rod Hockman at Providence. This is their mission, right? Or in years ago, Peter Bernard upon Sequour, this was their mission to transform, you know, Churchill and Richmond. If that is not in the DNA of the healthcare leader, then it seems like the municipal or county authority. So really. Has to step up. But what would you say? We'll switch it this way. We'll go with Ben first and then you, Eric. Go ahead. It's a really fascinating question because I think you hit the nail on the head Joanna just depends on What's in the DNA of that? Hospital administration and her leader. I will say that for an MDC our board is composed of the CEOs and our presidents of the anchor institutions themselves. So there's almost an inherent buy in. But if you're starting from scratch and there's not necessarily a direct relationship to the head or an organization like NMDC that can act as a conduit. Yeah. That's true. Yes. A director of facilities is actually a really good. Really good entry point. And often that conversation. Right. Because the director of facilities is always thinking about their campus in the context of the surroundings. So that conversation at least initially could lead to a hopefully additional and deeper connections. Yeah, Eric, what do you think? You work directly with those directors of facilities in the healthcare institution. Yeah. Yeah, I'd say it's a little bit tricky, right? I think really it comes down to let me try to understand what is the most important to them. Right. Right? And let me then explain how this can help you. Right. And so in one hospital system in Maryland, what they're looking at right now is How can they make use of land that they currently have that they're not using for residential? Because they understand that they're in a position where they're having difficulty attracting the staff that they need. Right, so I think that's one of the big selling points is to say. How, how would this mixed use development benefit you as a hospital, right? So I think that's how we have to sort of talk about it with them in many cases. And then from the other perspective, if they aren't interested because that's not what they do, right? Right, right. They're not developers. It's not part of their mission. It, then it really is about I think the jurisdiction looking at the land around you. Yeah. And a lot of times with existing hospitals, if you try to think about, oh, how would I start to integrate this? You start to think about it and say, boy, that's really hard. So is there one side of the hospital that we can focus on? Right, right. Right? Where maybe there's some parking lots and that could be the position for 2 medical office buildings. Yeah. Yeah. And then that then interfaces across the street. With a kind of mixed use walkable development. And sort of start to focus on that one interface. Yeah. Well, you've pointed out though, I think a really great portal into this conversation because the need for nursing care, the need for nursing, the need for staff is so great. Retention is such an issue. It costs a fortune to bring someone on. You lose them and you start all over. So, and then working with the medical students here at the University of Miami when they take their residences, they're they're looking for places where they can, I was telling you too when we talked earlier about their resident who went to Minneapolis because she could literally get an apartment across the street from the hospital. So she said to me, I can just roll out of bed and wrap my code on and go to work. So I feel like maybe with the incentive to retain employees and also affordability issues to be able to have employees across the spectrum. Not everybody is getting neurosurgeon salaries, right? That there is an opportunity to say we can incorporate housing into these facilities and maybe do you think that kind of combination of focusing on their workforce might be a portal into expanding outside the walls. We can start with you, Eric, and then go to Ben. Sorry, could you repeat the last part? Yeah, if you think that's a really, I'm thinking about people out there trying to make this case and their communities as they work. Yeah. Do you think the workforce retention? We know, I guess I should back up to say there's an enormous amount of research, which is my own personal focus on the benefits in terms of lower patient errors and greater productivity as well as health outcomes for patients. But if we send all that aside and we say an economic incentive seems to be at the top of the scale of what people care about. Yeah. Do you think the workforce retention and caring for that workforce? Where is the good the desire to do good for the community may not have immediately come to the front of the brain the desire to retain a powerful workforce might be an a kind of motivator. Oh, absolutely. Yeah, I think that's absolutely a motivator and I think it's something that I'm thing more of as time goes by, right, as we start to get in the situation with many, many more people retiring and getting older and aging population. Right. And recognizing their needs that they're gonna have in the future also. I think is very much so probably a good starting point, right? It's all about self-interest. How does how does it benefit the hospital? Right? And so I think that's a great place to start. Right. Yeah. Ben, were you gonna say something on that? Yeah, I would just echo and say it is essential when we think. Some of our anchors who are undergoing expansions right now. Yeah. Their ability to attract. Talent is completely tied up with the availability of housing. And if there's not housing available. Yeah. They are at a disadvantage. As these jobs are so scarce across the country. So one of the things that we are trying to do is look at how that happens at different scales. We don't. Directly work. On developing any hospital owned property. But we obviously work very closely with the respective anchors on advising what can possibly be done. Right. And sometimes that takes the form of larger scale developments. Owns that land. It's on a 60 year. Lease with the development team. So it's a great opportunity for them to create the housing that they know that their student body and their workforce. Is in need of and they will need to attract that. And then they at the end of 60 years that land reverts back to the University of Tennessee. Yeah. Yeah. Right. That can happen with some of the other anchor institutions which has holdings of their size but there are also many incremental lots as well. And what we have been doing is working with developers to essentially create the a standardized way of looking at the incremental lot. And in filling in that fashion and then working with the anchor institutions to think, okay, we can do it at large scale and the small scale. Yeah. Right. You really need both. And you really need to accommodate the spectrum of employees that they are trying to attract. Yeah, exactly. Yeah. And that's really. How you make that connection and get the mix of incomes for mixed communities as well. So I realize we're at the hour and, maybe we should, we, I mean, we could, we have lots to talk about. Ward said, let's get down to the nitty gritty of the design because he's a hundred percent right. For those of you who are urbanist. There may be people on the call or health care architects and there's some amazing health care architects who are grappling with these. If you happen to run into a project where you're working with one of them who isn't, then you have. You know, there's a lot more tools that we need to add to the palette than what we've just kind of lost over today. So I guess Marsha, we could just do a whole seminar on how to and we could go the scale from the small clinic all the way through. The hospital scale to the large district and we could basically change the world today. But knowing that that isn't going to happen, I think maybe we could let everybody go and then Marsha, did you say if Eric and Ben want to stay on for a minute or 2? We could address words question if he has time to stay. Yeah, we, you know, want to remind everyone else that this webinar is being recorded. So if you do have to drop off, thanks for coming, but we can. Mainly because I've delayed us by a few minutes. In the beginning with some technical difficulties we can One for a few more minutes, so happy to get to some of those questions that we haven't. Been able to address this yet. Okay, well if it's okay, Ben and Eric, I would like to address what Ward is saying because I know I think everybody who's done any work in this area can tell you they've been in a room where someone has said, well, no, you can't do this and you can't do that because this needs to be next to this. And this needs to be that. And there's a kind of framework for all how a hospital looks. If you wanted to fit in, for example, with the architecture of a community, you might get pushed back to say, well, actually, we think that if we need to look kind of shiny and high tech for patients to believe that we do the latest medicine. So do you have some advice for the designers out there trying to push this kind of work. And I think I'm gonna direct this right to you, Eric, because you have these hanging on your wall. Sure. You know, I think that the larger the hospital gets, the bigger the challenges are, right? In terms of the service servicing needs, the number of bays for the trucks and the trash in the cleaning and the emergency and the high visibility to the emergency sign and entry and all that, right? Those become bigger and bigger drivers. Also how How each of the how the internal layout of the hospital, right? Right. If each of the departments interfaces with each other is so important. So I think as as it gets bigger, some of the biggest opportunities for integrating actually has to do with like the medical office buildings. Oh, that's a good point. Yeah. That you typically find in the campus and really trying to trying to figure out where to position them in a way. Yeah. That creates an interface with the surrounding community. So I think that that's one. The second one, I think, has to do with parking, right? Yes, right. One of our favorite topics. And that has to do with. You know, a hospital may start out with surface parking and eventually move into structured parking. So I think in some cases, It's about really having a master plan that looks long term. That in the short term, maybe it is going to be service parking. Yeah. Right. Maybe there is only one interface at 1 point. But in the future you position and know where the garages are and where the next kind of medical office buildings are going. Yeah. So I kind of feel like those are the easier places to sort of interface with the surrounding community. And then the third thing I would say is sometimes Getting the better interface is really about the sides or the back of the hospital. It's what happens right off the property. Right. In other words, instead of having the street right there, maybe that's actually the back of development. Right. So that you're in essence have a street. Building. And then hospital, service functions. Right. Right. Right, so you kind of share that service with another use that has a front face. Right. And to the parking issue. Ben if you deal with this in the district. One of the I thought clever ideas that, Javier. The glaciers and Liz did for a hospital in St. Enrichment was to design the layout so that each parking unit could be a future block. That and that could be designed eventually to have front facing structured buildings with structured parking. The reluctance for structure parking seems to basically be a cost factor. More than anything else. Do you think Ben in the district, is that a strategy that you're trying to do where you kind of design it for a future city and imagine it eventually. Being in compass and structures. Yeah. Well, I'm smoking because parking. Is the 1 million dollar question right So have those specific designs been broached? The short answer is no. Have ideas about structured parking and concentrating parking to then free up this land that is held. Hostage in other ways. Has that been thought of? Absolutely. You know, we work very, very closely with the downtown Memphis Commission, which is a sister. You can see, very different. They are quasi governmental and while most of the medical district was within the seabed they serve a much larger area and obviously with the concentration of down in downtown. The reason I bring that up is actually next week that will be the ground opening up the downtown. Mobility center. And this is essentially what we are discussing. It is a facility that has a structured parking. It has a EV share, it has bike share, it has shower facilities. Right. And it is attempting to. Both be the nitty gritty of concentrating activity and building a physical space where you can then free up land for other better uses. But it's also the, and I use this phrase earlier, it's also a reframing device as well. And rethinking how we can use spaces and what the primacy of the vehicle is and what you need to accommodate it. Right, right. And to that end, if I may share something real quick. This is something that we did not. H the presentation, but. It is a way in which we gauge and assess. Appropriateness of it a potential investment into a given project. Hmm. And we call this our impact assessment tool. What we do is we take the outcomes of our mission statement of vibrancy, equity and prosperity and look at that as something that is measurable. And the idea here is that the more marks that a given project hits, potentially the higher investment we would be able to extend. But you're willing to make. I see. The correct but really the idea here is to offer this up as an open source tool to both our anchor partners as well as any development entity that comes to us that you're thinking should be aligned or going through these lenses. Yeah, yeah, exactly. And if it's not, let's help you to do so, right? And when it comes to parking, this is This is part of the equation. Right. This is part of the conversation that has had so people are thinking primarily, particularly in a city like Memphis, where parking is a given. Yeah. Right. That there are ways of looking at the value of one slant. Right. And maybe, yeah, go ahead, Eric. Sorry. Yeah. I guess. Okay, one more thing out and when we talk about hospitals and hospital systems, right? Yes. It's again that question of where are you on the spectrum? Are you a large research hospital or are you in size or small size, right? Yes. At the small size, we're looking at one project right now, which is the ambulatory surgery center at a micro hospital. Okay. Hmm And actually looking at sharing parking. In other words, building a garage because your peak times are gonna be very different. Right. Right. With your residential and very different with your retail. So. In some cases, there might be an opportunity to share, right? In the larger hospitals. Probably not the case right as much but Right, right. Yeah. Because they're so 24 7. Yeah. What do you think about, Ward, I have to say, I have to meet board because where does like targeting all the really important ideas as to how you really do this. Words like, okay, what about hotels? And that's true. I mean, even smaller, hospitals when they are the major hospital in their region and people drive several hours there for care and family members need a place to stay. Hotels, hotels matter. And so hospitals do those kind of hospitality houses, but what do you think about the hotel as a possible parking share kind of? Potential. Well, I think it's a good use. I think you'd have to look at the kind of timing of the parking for that, right? The timing, okay, yeah. Yeah. And so it might not always work out that way with the hotel. But certainly if it's worth looking into. But I think that, And do you have them as part of your TOD, Eric? Your HOD. Yeah, yeah, that's that's the idea, right? It's especially if you get to the kind of research hospital right scale. Right. Yeah. Then there's kind of a bigger need for having place for people to come and stay before they come and do their procedure or after even right as the costs are so expensive to keep a patient in a hospital room. Right. But you might a doctor may want to sort of have them be nearby. And so having that hotel. Right. Or like Ben has, Yeah. Ben has with St. Jul, right, where families might come for children. Okay. Was there any last tips you'd want to leave for the designers? Because I think this is inspiring work and it's really important and it changes cities and it also changes the way we deliver health care. So I'm very grateful to be here with you. All talking about this. Do you have any final words of advice for our participants? Then you want to go first and we'll close with Eric. Well, I would, my final word would simply be, it can be daunting because these are significant systems, right? And significant sites by the nature of what a hospital system requires. But start small, right? Just Keep in mind that incremental level. And whether that is more of a conversation. Or whether it is a demonstration project, because I think there is a desire for all of the reasons we have to discuss, the attraction and prevention of employees. Reducing. Recidivism in terms of individuals who are experiencing homelessness is using an emergency room as a proxy shelter. And hospitals as being better integrated into their communities and better neighbors. There are so many dimensions on why hospitals, are now thinking about themselves. And I'll steal your phrase again, Eric, but beyond the gate. And That first domino really is to think incrementally. So I'll leave with that. Yeah. Okay. Yeah, and I agree with you, Ben, that you don't know it is daunting sometimes, right? They're difficult. It's an institution. The decision making is more difficult in a hospital, right, with the board than in some other types of projects. But I would kind of look at it and say the whole new urbanism movement, right? If they If we sort of think back at the beginning. That's true. A lot of what we did was education. Right, it was about explaining and illustrating to people why this was better and how you did things differently. To the point where we are today, where those conversations are much easier. And so I think that really it just starts with let's start taking in the first steps. Let's start educating. And the takes commitment. And a little bit of stubbornness, I think. Yes. A lot of kindness and then Stephanie Buffalo, out good food. She gave the example of the hotels around the Cleveland Clinic, but it's true. I mean, can you imagine? Gourmet food in a hospital because they have a community garden and it grows its own produce. Some of them are doing that. So so many opportunities to do great things. Thank you for inspiring. Us today and for giving us the tools. And Marcia, this is. Telling me somehow we should put this together and by the way, let's come up with that form base code while we're headed. Great to see you guys. I agree, Joanna. Yeah, I'll add that to the list. Well, I think we've all learned a lot over the past hour plus. So thank you, Eric, Ben and Joanna for a really fantastic session. As I mentioned earlier, a recording of this webinar will be available on the CNU website in the next day or 2. So thank you everyone out there for joining us today and we'll see you next time on the Park Bench. Thank you so much. Hey, Carol