Institutional expansion, community relations, and the hospital next door

Abstract

Hospitals play many roles in a city: alternately, they may be caretakers of the sick, economic engines, intellectual hubs, major employers, and neighbors. This last role has evolved greatly over the last 45 years. The relationship between hospitals and the communities in which they are located has been affected by constantly changing economic, political, and social factors. During the early days of urban renewal in the 1950s and early 1960s, large teaching hospitals in Boston experienced a surge of political and economic power that allowed them to expand with few constraints, often to the detriment of their residential neighbors. Today, the same hospitals must broker complex deals with their neighbors if they wish to expand, offering up a host of community benefits. The process by which the hospital-community power dynamic has evolved has been shaped by the mediating entity of the Boston Redevelopment Agency, which is in turn influenced by the Mayor's Office in Boston. Despite their many roles in the city, it is their sheer physical presence that drives hospitals' relationships with their neighbors. The health care and employment benefits they can provide are not major bargaining chips in disputes over expansion; the important considerations are the tangible elements of power - money and land. The primacy of physical presence as a relationship driver can be illustrated by the differences in the negotiation process that hospitals directly bordering residential communities and extending into them experience, as opposed to hospitals that are not directly on the residential fringe.