FINDING OUR PLACE
Discovering THE SOUL OF THE NEW AMERICAN CITY
by Scott Keller, Illustrations by Randall Imai and Jon Keller
SNEAK PEAK
Finding Our Place is a book that explores innovative approaches to integrating public health and urban planning in an era where cities are redefining their relevance amidst the shift from manufacturing to a new economy. Through our work developing transformation plans for soon-to-be obsolete hospitals in struggling cities, we offer fresh perspectives on revitalizing urban spaces.
In this book, I discuss our transformative projects in cities such as Lorain, OH; Detroit, MI; Cleveland, OH; Reading, PA; and Takoma Park, MD. As we learned early in our journey and describe in the book, the closure of a factory is a comprehensible event for communities, but when a 150-year-old faith-based hospital shuts its doors, it feels as though a profound, almost spiritual, abandonment is taking place.
Finding Our Place is richly illustrated with easy-to-understand diagrams and renderings by Randall Imai and Jon Keller, two town planners who detail the physical transformations. These illustrations not only reflect the changes in the urban landscapes but also the personal transformations of Jon and Randall. We draw lessons from past projects, conceptualize fundamental urban planning concepts, and apply them to current and future initiatives.
We delve into the evolving understanding of community congregation and how integrated reuse programs—covering primary healthcare, chronic disease management, education and training, senior and workforce housing, social services, and convenience retail—can forge a new sense of community even as traditional factory-based elements decay. For example, in the poorest census tract in Detroit, we observe that "this is not a community built around the Internet, it is bound together by face-to-face encounters. Often, the most productive meetings are unplanned and occur in hallways and on sidewalks."
The book also narrates my personal journey from a Yale graduate focused on investment real estate to someone deeply engaged with public health officials, hospital administrators, religious leaders, community representatives, and colleagues. Each of us, individually and collectively, grapples with the hospital closures and the significant changes surrounding us.
Embedded within the narrative are numerous stories that are both illustrative and entertaining. We share the journeys of others who have been impacted by the transformation of these once-great institutions, including a Baptist preacher, a Brother of the Order of Holy Cross, a member of the Board of Governors of the Joint Commission, several CEOs of large healthcare systems, and more.
This book will appeal to a diverse audience, including healthcare policy and public health professionals, healthcare administrators, physicians, nurses, social workers, architects and planners, educators, inner-city religious leaders, community organizers, and, hopefully, some politicians and statesmen.
Finding Our Place is not a traditional how-to book. Each city is unique, and our reuse strategies are tailored to the specific needs of the communities at the time of our engagement. As people come together to resurrect these withering institutions, new conversations and connections emerge—demonstrating that, indeed, the phoenix can rise from the ashes.
Scott J. Keller
President of Dynamis
In this book, I discuss our transformative projects in cities such as Lorain, OH; Detroit, MI; Cleveland, OH; Reading, PA; and Takoma Park, MD. As we learned early in our journey and describe in the book, the closure of a factory is a comprehensible event for communities, but when a 150-year-old faith-based hospital shuts its doors, it feels as though a profound, almost spiritual, abandonment is taking place.
Finding Our Place is richly illustrated with easy-to-understand diagrams and renderings by Randall Imai and Jon Keller, two town planners who detail the physical transformations. These illustrations not only reflect the changes in the urban landscapes but also the personal transformations of Jon and Randall. We draw lessons from past projects, conceptualize fundamental urban planning concepts, and apply them to current and future initiatives.
We delve into the evolving understanding of community congregation and how integrated reuse programs—covering primary healthcare, chronic disease management, education and training, senior and workforce housing, social services, and convenience retail—can forge a new sense of community even as traditional factory-based elements decay. For example, in the poorest census tract in Detroit, we observe that "this is not a community built around the Internet, it is bound together by face-to-face encounters. Often, the most productive meetings are unplanned and occur in hallways and on sidewalks."
The book also narrates my personal journey from a Yale graduate focused on investment real estate to someone deeply engaged with public health officials, hospital administrators, religious leaders, community representatives, and colleagues. Each of us, individually and collectively, grapples with the hospital closures and the significant changes surrounding us.
Embedded within the narrative are numerous stories that are both illustrative and entertaining. We share the journeys of others who have been impacted by the transformation of these once-great institutions, including a Baptist preacher, a Brother of the Order of Holy Cross, a member of the Board of Governors of the Joint Commission, several CEOs of large healthcare systems, and more.
This book will appeal to a diverse audience, including healthcare policy and public health professionals, healthcare administrators, physicians, nurses, social workers, architects and planners, educators, inner-city religious leaders, community organizers, and, hopefully, some politicians and statesmen.
Finding Our Place is not a traditional how-to book. Each city is unique, and our reuse strategies are tailored to the specific needs of the communities at the time of our engagement. As people come together to resurrect these withering institutions, new conversations and connections emerge—demonstrating that, indeed, the phoenix can rise from the ashes.
Scott J. Keller
President of Dynamis
introduction
The United States is a recognized leader in many areas but our healthcare system has been labeled as “broken” by many policymakers and thought leaders. The time has come to address and we are addressing the longstanding challenges producing unsustainable costs and inadequate health outcomes. A central premise of healthcare transformation is a change in care delivery from silos to a more integrated and coordinated system. Concepts such as patient-centered medical homes, care coordination, shared accountability and value-based payments are gaining momentum to reverse the trends in cost and health outcomes for an aging society.
We are seeing the transformation of the U.S. healthcare delivery system to a system focused upon the patient and driven by value and accountability. As the system transforms to higher accountability, partnerships with traditional and nontraditional entities is a move paramount to success. This transformation will also most likely result in consolidation and innovative collaborations of health systems and others for enhanced collective impact. This new healthcare delivery system, including innovative collaborations, holds the overarching goal of improving outcomes and quality, efficiencies and cost savings and an enhanced patient experience through, more importantly, improved health and wellness for all of us living in our United States.
New models responding to these needed transformations have been enacted such as Accountable Care Organizations and Accountable Care Communities, among others. These models draw on collaboration, integration, and measurable strategies that emphasize shared responsibility for the health of the community including health promotion and disease prevention, access to quality services, and healthcare delivery.
The shift is complex and uproots traditional healthcare institutions including our hospitals. The issue becomes even more complex when it is put into the context of the shift in our economy from a manufacturing to an information and service based economy and the effect this sea change has on our nation’s cities and towns, in which hospitals have been and continue to be key components. Suffice it to say, we are all on a journey and it is not yet clear where we are headed.
Finding Our Place is a story of Scott Keller’s and his colleagues’ journey, trying to understand the future of our cities and their place in them through their unique lens of finding effective community reuse of soon-to-be obsolete inpatient hospitals - institutions that have anchored to what have become our most vulnerable neighborhoods, standing watch if you will, as the manufacturing plants they were originally built to serve have faded away. It is a collection of stories that brings a refreshing and unique perspective as well as hope and optimism -- a testament to our collective human spirit.
The transformation of some of these historical and, in many ways, spiritual places, into what Scott and his colleagues describe as “Healthy Villages” tracks the Accountable Care Community model my colleagues and I pioneered in Akron, Ohio, including concepts such as integrated medical and public health models, delivery of clinical care in conjunction with health promotion and disease prevention, and development of a robust health information technology infrastructure across the continuum of providers, among more. Perhaps it was pure coincidence that our paths crossed or, perhaps as Scott quotes one his healthcare system CEOs, “There are no coincidences.” Whatever the reason, I am certainly pleased our journeys intersected.
Scott’s journey, while still underway, is a reminder to all of us working on different aspects of reinventing our cities and towns that, while we may not be able to see the light yet at the end of tunnel, there is indeed light where we are headed.
Janine E. Janosky, Ph.D.
Dean, College of Education, Health and Human Services
Professor, Department of Health and Human Services
University of Michigan-Dearborn
We are seeing the transformation of the U.S. healthcare delivery system to a system focused upon the patient and driven by value and accountability. As the system transforms to higher accountability, partnerships with traditional and nontraditional entities is a move paramount to success. This transformation will also most likely result in consolidation and innovative collaborations of health systems and others for enhanced collective impact. This new healthcare delivery system, including innovative collaborations, holds the overarching goal of improving outcomes and quality, efficiencies and cost savings and an enhanced patient experience through, more importantly, improved health and wellness for all of us living in our United States.
New models responding to these needed transformations have been enacted such as Accountable Care Organizations and Accountable Care Communities, among others. These models draw on collaboration, integration, and measurable strategies that emphasize shared responsibility for the health of the community including health promotion and disease prevention, access to quality services, and healthcare delivery.
The shift is complex and uproots traditional healthcare institutions including our hospitals. The issue becomes even more complex when it is put into the context of the shift in our economy from a manufacturing to an information and service based economy and the effect this sea change has on our nation’s cities and towns, in which hospitals have been and continue to be key components. Suffice it to say, we are all on a journey and it is not yet clear where we are headed.
Finding Our Place is a story of Scott Keller’s and his colleagues’ journey, trying to understand the future of our cities and their place in them through their unique lens of finding effective community reuse of soon-to-be obsolete inpatient hospitals - institutions that have anchored to what have become our most vulnerable neighborhoods, standing watch if you will, as the manufacturing plants they were originally built to serve have faded away. It is a collection of stories that brings a refreshing and unique perspective as well as hope and optimism -- a testament to our collective human spirit.
The transformation of some of these historical and, in many ways, spiritual places, into what Scott and his colleagues describe as “Healthy Villages” tracks the Accountable Care Community model my colleagues and I pioneered in Akron, Ohio, including concepts such as integrated medical and public health models, delivery of clinical care in conjunction with health promotion and disease prevention, and development of a robust health information technology infrastructure across the continuum of providers, among more. Perhaps it was pure coincidence that our paths crossed or, perhaps as Scott quotes one his healthcare system CEOs, “There are no coincidences.” Whatever the reason, I am certainly pleased our journeys intersected.
Scott’s journey, while still underway, is a reminder to all of us working on different aspects of reinventing our cities and towns that, while we may not be able to see the light yet at the end of tunnel, there is indeed light where we are headed.
Janine E. Janosky, Ph.D.
Dean, College of Education, Health and Human Services
Professor, Department of Health and Human Services
University of Michigan-Dearborn