man walks dog along a path outside


Decentralization, Healthcare and the 15-Minute City

A hot new urbanism topic, the “15-minute city” concept suggests that cities should be designed or redesigned so that daily urban necessities—work, home, food, education, healthcare, parks and so on—are within a 15-minute reach via foot or by bike. In short, the 15-minute city means reconnecting people by decentralizing city life and services.

Much has been written about the 15-minute city’s potential effect on the way we live, work and socialize. But what impact might this decentralization have on the future of healthcare delivery in our cities? Gresham Smith recently sat down with Jim Langlois, the firm’s executive vice president of Healthcare, to explore this question.


Do the current planning trends of healthcare systems align with the premise of a 15-minute City?


Jim Langlois: There is alignment. For many years, the concentration of healthcare has been at the medical center or hospital. So, when architects have been designing for healthcare, many times it’s within the medical center model where care services are centrally located.

By doing this, however, the evolution of the medical center has created a greater isolation from the community it serves. Over time, much of the adjacent neighborhoods become service providers back to that medical center, creating yet another ring of isolation. Access to the hospital is most often by car. And, once out of the car, the pedestrian is confronted with confusing circulation choices. For many, the hospital can be an intimidating place.

The concept of the 15-minute city is something very different in that it’s a decentralized city, and we’ve been seeing healthcare systems go in this direction by relocating care programs off the medical center campus. And it’s for many reasons; one of them being the cost for any infrastructure improvement on a medical center campus, which involves multiple phases, extended time and complex construction requirements.

Additionally, there are disruption issues to the campus occupants. Therefore, in many cases, we’re seeing healthcare decentralizing by pulling non-acute care functions out of the medical center, where these care services can be more easily accessed.

When we talk about the 15-minute city and easier access, as well as creating more of a village vernacular of different services, healthcare fits right into that model. I see the healthcare trends for us as planners and architects continuing in this direction—where we’re extracting elements out of the medical center and putting them alongside other community services.


Has COVID-19 accelerated these planning trends?


Jim: What we’ve observed over the last 10 months is that many people are apprehensive about going to medical centers and hospitals. And it’s much easier to access primary and secondary care when it’s outside the acute care setting. Consequently, many of our healthcare clients have said they’re going to proceed with facility improvement projects, especially when these projects are outside the medical campus model and create some decompression of the hospitals themselves.

COVID-19 has pushed this trend along—the whole notion of providing more accessible care within community-based spaces rather than within the medical center is again in alignment with the premise of a 15-minute city.

building exterior with water and bridge

Leader or Follower? Which is healthcare’s role in the urban development notion of a 15-minute city?


Jim: It’s an interesting question. Healthcare probably will follow only because these changes are disruptive, costly and time-consuming for healthcare systems. They’ll see the opportunity and they’ll go with it. Right now, the investments they have in major medical centers and hospitals are significant. Nonetheless, I believe that wellness, primary and secondary care will all be a key part of 15-minute cities.


If healthcare does become a key component of the 15-minute city, what becomes of the major medical center?


Jim: First of all, when you start pulling these care services out of the major medical centers, there’s some decompression for the facility. Space is needed within most hospitals. It’s complex and disruptive to expand within a medical center. It just creates lots of problems. So, by moving some of the non-acute care functions out of the medical center and putting them into the 15-minute city, the medical center benefits. Bottom line is the medical centers will remain an important community asset. However, it will change some aspects of the medical center characteristics.

It’s important to note that some countries, such as Israel, already have models like the 15-minute city. I traveled to Israel two years ago to see their medical system models. The country’s primary and secondary care facilities are located within the communities. Major medical—acute care/tertiary care—are government-run hospitals. As a result, they have a real division between primary and secondary care.

two-story lobby with multiple patient registration desks

Some key aspects of the “Future City” are wellness and healthier environments, reduced dependency on the automobile and a greater sense of community. How is healthcare adapting or contributing to these changes now?


Jim: By developing wellness, primary and secondary care facilities outside the medical center campus, the people who use these facilities will look to the immediate community for their lunches, fitness clubs and parking. They will no longer have to depend on the medical center as a self-contained entity to provide these types of services.

A hospital has a large workforce, and rather than leaving the campus to grab a lunchtime meal, cafeterias and eating venues are part of the hospital. But if more healthcare is located within the 15-minute city, walking to the local sandwich shop, fitness center or Starbucks is just around the corner and run by another business, not the hospital.

There are big changes ahead with healthcare, and wellness is going to be a major part of that change. Ultimately, we’re trying to keep people healthy, and the wellness component has a greater emphasis in our healthcare clients’ planning. The big question they’re asking is: How can we provide easier community access to wellness, primary and some secondary care?  Part of the answer may well lie in the 15-minute city.