For years, Royal Columbian Hospital in New Westminster, B.C., has sat like Gulliver in Lilliput, an enormous complex overlooking the Fraser River that dwarfs the community around it.
People who run the cluster of small businesses that line East Columbia Street bordering Royal Columbian have done their bit over the years to raise money for the giant next door. But the building and its people always seemed cut off from the historic, working-class neighbourhood.
"Even though there are so many people who work there, we wouldn't see them. It seemed like they would do everything - have lunch, go for coffee - inside the hospital," said a wistful-sounding Gord Hobbs recently, taking a break from serving customers at his bike store, Cap's.
That kind of relationship is set to change in the coming years. Royal Columbian, like many of Canada's urban hospitals built in earlier decades, needs to renew and expand in the middle of a city that has crowded in on all sides.
And, like a small but growing number of those hospitals, it isn't just focusing on how to reorganize its medical facilities. Instead, its leaders are also contemplating how to make the hospital work better with the neighbourhood.
"I'd like to find ways of connecting back into the community," said RCH's director of strategic planning, Andre Kroeger. To that end, the hospital has started a planning process that is looking at everything from how to create a front door that welcomes visitors to better integration with the nearby rapid-transit station, to partnering with the city and local developers to create a district power system.
Not every hospital that expands feels a compulsion to mesh more closely with the community. But more in Canada and the United States are devoting attention to urban design and their fit with city planning for a few reasons. Doing so helps them get community support for denser developments, for one.
Royal Columbian is also pitching its expansion as an overall benefit to the community. The hospital will be a catalyst, said Mr. Kroeger, helping create a medical precinct and drawing well-paid medical staff to the new developments being built around the hospital.
For another, some city planning departments simply demand that hospitals devote some attention to meshing with the larger community. And, for a third, it helps them solve land issues. Royal Columbian, for instance, is squeezed for space and wants to maximize what it can do by encouraging complementary uses nearby.
Mr. Kroeger said the hospital would also like to find partners in the neighbourhood who can offer hospital-related services - anything from medical supplies to food services to certain types of health care - that would work just as well off the medical campus as on.
"We don't want to tie up our site with services that can be offered elsewhere," said Mr. Kroeger, whose institution is planning to expand from its eight-acre site to a possible 13. Royal Columbian is hoping to add 300 patient beds, larger operating-room facilities and a new ambulatory care centre.
Vancouver General Hospital was faced with similar challenges 10 years ago as it worked to reconfigure its sprawling collection of services and buildings in the middle of the city.
"Hospitals now are looking more at how to create themselves as campuses than as large institutional complexes," says Scot Hein, the city of Vancouver senior urban designer who worked with the hospital on its master plan.
Today, VGH's main hospital building remains unchanged. But some buildings around it were taken down to re-expose the historic Heather Pavilion and to create a public commons around it. A new tower was built to the east and the re-organization of other buildings allowed the hospital to open up five sites nearby for speculative medi-tech businesses.
In one particularly nice touch for the community, the hospital built a park over its underground power plant. As people walk through, motion detectors set off steam effects that swirl around them.
Some hospitals have the luxury of surplus land that allows them to give new amenities to the community as they redesign with more compact buildings and underground parking.
"Most hospitals now are on urban sites. They're usually very big and they have large parking areas. But they can be planned in a way that meets the community's needs," says Toronto planning consultant Frank Lewinberg, whose company, Urban Strategies, worked with the Centre for Addiction and Mental Health to redesign its 27-acre site on the west side of Toronto, and with Bridgepoint Health to plan its expansion in the middle of east-side Riverdale.
For CAMH, the plan developed four years ago involved using land for new housing projects, saving trees that the local community loved, and creating new parks. At Bridgepoint, the $1.2-billion redevelopment will mean salvaging some heritage buildings for re-use, including the former Don Jail, putting new roads in its site to make better connections to the neighbourhood, designing its new hospital building to step down to Broadview so it wouldn't be overwhelming for the nearby single-family neighbourhood, and committing to build some affordable housing on land being held for future development.
Like Royal Columbian, Bridgepoint dominates its neighbourhood.
"Because it's on a hill, it's very visible. And it's smack in the middle of a very residential community that has no high-rises," CEO Marian Walsh said recently. "We've been part of this community for 150 years and we thought, if we're going to spend this kind of money, surely we can make a contribution to the health of the community. We had turned our backs on the community, turned away."
The planning process that started four years ago didn't grant every neighbourhood wish, she admits. Some people wanted the current building to be saved, which was just a no-go because of the complications. And it also wasn't an easy process.
"It was very long, it was very arduous and it was very complicated," said Ms. Walsh, whose future hospital is now in the middle of construction, generating a lot of discussion about traffic issues at the ongoing community advisory group. "But I think people love what we're doing."