For One Hospital, Investing in Livable Streets is Good Business and Good Health


To say 39th Avenue NE was nondescript is romanticizing the past. Handsome, quiet, livable, yes, but unremarkable too. Unless, of course, you are Paulo Nunes-Ueno, Director of Sustainability and Transportation at Seattle Children's Hospital, who saw the street's unbounded potential.

39th Avenue NE was the street he was looking for: an under-valued ribbon of asphalt that connects important neighborhood destinations--elementary schools, middle schools, restaurants, grocery stores, banks and churches, parks and libraries--all on a low-volume street. Best of all, the street ended at the Puget Sound region's bicycling backbone: the Burke-Gilman Trail. It was a street rife with potential, ready to morph from a typical residential street into one of the Seattle's first neighborhood greenways.

The story behind it, and Seattle Children's Hospital's other community projects, is an important case study for how health care organizations are intervening in the built environment. It offers a powerful, replicable model for healthcare organizations to directly affect public health by intervening in the built environment and mitigate development in a positive way for their communities.

Born of a Shapeless Roving Anxiety

Looking to 39th Avenue NE from the Burke-Gilman Trail. (Image via SvR)

The story of 39th Avenue NE's transformation begins in 2006. Seattle Children's Hospital, which is ranked as one of the top 10 pediatric hospitals in the country, decided to embark on a long-range master planning process to understand how its facility needs would grow in the coming decades.

This was a change from how they had done expansion planning. Rather than numerous, consecutive, medium-sized projects, this effort necessarily yielded a larger, more comprehensive look at the hospital's campus needs to keep pace with the growing demands and scope of pediatric healthcare. What they found was that the growth "was stark in terms of the size and number of trips that it was going to generate," remembers Nunes-Ueno.

Upon sharing these initial findings, the hospital noticed a "shapeless roving anxiety" developing in the community about the hospital's expansion plans. This is the point in most stories where collaboration ends and a distrustful, adversarial relationship begins.

But something remarkable happened instead. Rather than hunker down, the hospital undertook a strategy of active, engaged listening. And by listening, they learned something profound. "It's not," according to Nunes-Ueno, "that the community didn't want the neighborhood to change, it's that they wanted it to get better." The hospital was ready to be the change agent to make improvements happen.

From the hospital's culture of triple-bottom line thinking ("we want to be good neighbors, we want to be good stewards of the environment--and that includes health--and we also want to be prudent with our dollars," says Nunes-Ueno), they began to work with the community to consider new possibilities. Eventually, Nunes-Ueno asked, "what if [the hospital] created a fund specifically devoted toward making it safer and more attractive, more fun, easier to understand, for people to get to the places they wanted to get to in their neighborhood by walking, biking or by transit?"

Paulo Nunes-Ueno, Director of Sustainability and Transportation at Seattle Children's Hospital

The community was intrigued.

Thus the Livable Streets Initiative was born: a $4 million investment in the neighborhood to improve the environment, to make it safer, more attractive and easier for people to walk, bike or take transit."

But how to spend those funds? Once again, Children's reached out to the community through a series of design charrettes and conversations. For Sand Point Way, the main arterial running by the hospital, Children's quickly agreed to improve traffic timing and install dynamic message boards. However, understanding how to improve the residential streets presented a different challenge.

The stability that attracts families to residential neighborhoods proved an impediment for the community's collective imagination. What kinds of improvements would have a light enough touch, yet still meet the community's goals? Children's turned to an expert: YouTube.

"To give people a sense of what’s possible, we showed some of the videos that came out from StreetFilms. There was that guy who did research a long time ago about livability of streets: Appleyard. We showed a great video about his work, about the amount of traffic on your street having an impact on the amount of social connections that you have not only on your street but in the world."

"We established three themes: saying let’s look for opportunities to connect the parks and schools to the Burke-Gilman Trail on residential streets through the idea of greenways. Let’s look for opportunities to create safer crossings of Sand Point Way. Let’s improve the connections to the Burke-Gilman Trail. The trail is this amazing thing--a bicycle pedestrian super highway--but the interchanges were never built so it doesn’t create as valuable of a system as it could."

The Children's Hospital Livable Streets charrette was held at the University of Washington.

Kids were invited to design their own livable streets.

"Then we asked folks who came to the charrette, 'If you’re thinking about these three themes and where you live and the places you like to go, what are the projects you’d like to see?' We collected all of those projects and put them all on a map and in a database. With the help of the city, we ranked them on a variety of criteria and took the top ten and asked for the city to do project development on each of them."

"This year we are hopefully going to complete seven of these projects," Nunes-Ueno proudly reports. A Purple Unicorn?

How replicable is the Children's Livable Streets Initiative for peer institutions? In some ways, says Nunes-Ueno, it is a "purple unicorn." He could make the argument that there were unique circumstances, core values and political contexts that made the project successful in ways that it would not be for other communities.

Then he pauses and reassesses. "When organizations take to heart that they’re nestled in a community and that their success needs to happen with the community--not in spite of the community--then these initiatives not only make sense but they become inevitable."

"If you’re giving away free parking to your employees because it helps you to avoid a difficult conversation about how people get work and the impact that has on your neighbors, those choices are really masking a faulty business strategy. It seems like an avoidance that [CEOs] wouldn’t do in other parts of their business: avoiding having a difficult conversation by making a multi-million dollar investment in a car warehouse."

"I think that the question for other institutions that are having big developments is that the development doesn’t happen in a separate sphere than the community they are developing in. Thinking about the impacts of the development on the community will help them in the long run."

The Path Ahead

The new frontage of Children's includes a separated shared-use path and is well-served by transit.

Children's commitment to healthy, safe transportation has recently taken on new forms. In July, the hospital became the first large donor to the Seattle region's new Puget Sound Bike Share, which hopes to launch next year.

Now Paulo is thinking about how to make Children's a "mobility hub" with all manner of sustainable transportation options. On the horizon is a tighter marriage between the hospital's mission, employee care and transportation.

"We have an employee clinic at the hospital called Vera Whole Health. They do a lot of things one of which is to serve primary care for our employees. But they also have all of this coaching and encouragement for lifestyle change, for nutrition and exercise. My vision is that we’d have a bicycle shop attached to that clinic, and one of the drugs we provide most often is a bicycle."

"That would be awesome."