CLEVELAND, Ohio — The Cleveland Clinic’s medical performance has made it one of the top hospitals in the U.S. for decades. But when it comes to architecture and planning on its campus, the Clinic looks in many ways like a throwback to the urban renewal era of the 1950s and ‘60s.
Back then, the government and private developers felt the best way to save cities from sprawl and white flight was to build fortress-like buildings and garages designed to attract commuters who would never have to set foot on a sidewalk.
That approach is looking outdated at a time when educational and medical institutions across Cleveland and other U.S. cities — Eds and Meds — are making it part of their mission to remove barriers and embrace revitalization efforts next to their campuses.
With another wave of construction coming soon, including four new buildings and a fifth big garage, residents, city planners, clergy, and other observers are raising perennial questions about whether the Clinic could do more to soften its hard edges and weave retail and neighborhood services into a vast campus that has become a chilly medical monoculture.
In fact, after decades in which the city has largely taken a laissez-faire approach to the Clinic, it’s looking at whether the institution should be rezoned in a way that would require more oversight and collaboration.
“The City is reviewing existing zoning codes in light of zoning innovations that better match with our future vision of the city,’’ Joyce Pan Huang, Cleveland’s planning director, said Friday in an email, responding to a query from cleveland.com and The Plain Dealer.
Huang said: “In the spirit of civic collaboration, we look forward to future conversations about this with the Cleveland Clinic.”
When asked how the Clinic would respond if the city rezoned it, Angela Kiska, the Clinic’s executive director for public and media relations, said in an email: “We are currently looking into the impacts rezoning our campus would have on our operations, but do not have enough information to form an opinion.’’
She also said that “There have been no formal conversations about rezoning.”
The zoning question is related to a long-running civic debate over whether the Clinic is providing adequate benefits to the city in exchange for its tax-exempt status. Poverty and poor health outcomes in the adjacent majority-Black neighborhoods of Hough and Fairfax suggest a deep disconnect between the Clinic and the city.
The Clinic’s posture toward Cleveland also takes physical shape through the use of its property, the design of its buildings, and the public spaces around them. Observers say the Clinic has planned its campus to send subtle and not-so-subtle “keep-out’’ messages to its neighbors.
“They’re oblivious to the fact they’re having an impact on our community,’’ said August Fluker, an architect and a member of the city’s Planning Commission, who lives near the Clinic. “As long as they receive their accolades, it’s all fine and dandy. They could be part of the solution; they could build housing. But they don’t participate. It’s arrogance, in my opinion.”
The question for the Clinic, and Cleveland, is whether the institution’s physical growth can produce a stronger and more equitable city, not just a bigger and better hospital.
Existing conditions at the Clinic show room for improvement. Located between Midtown and University Circle on Cleveland’s East Side, the Clinic is filling up with gigantic, inwardly-oriented medical buildings connected by elevated walkways to massive garages.
While the Clinic has worked hard in recent decades to lead the field of healthcare architecture with light-washed patient rooms and art-filled interiors, its 173-acre campus has become cold, sterile, and lifeless, except for torrents of traffic and employees walking from building to building.
“The fact is that the Clinic certainly had some desires over the years to create an island rather than a connected place,’’ said Robert Brown, a planning consultant, and former Cleveland city planning director. “Hopefully they’re more enlightened these days.”
The 101-year-old institution has hired some of the world’s best architects to design signature buildings including the ziggurat-shaped Crile Building, designed by the late Cesar Pelli, architect of the Key Tower in downtown Cleveland and global landmarks including the Petronas Towers in Kuala Lumpur.
But to make room for growth, the Clinic has also demolished churches and historic buildings and helped remove a once vibrant commercial and entertainment district that included many Black-owned businesses.
“As the Cleveland Clinic enjoyed its rise to the top, it has benefited from systemic racism, gentrification, and redlining’’ said The Rev. Brian Cash, pastor of East Mount Zion Church located at 9990 Euclid Ave. next to the core of the Clinic’s campus.
The Clinic responds
The Clinic responds to such critiques by pointing out that it’s spending $52.5 million over five years on lead abatement in Cleveland. It spends $500 million a year on care for Medicaid patients. And, perhaps most importantly, with more than 52,000 employees statewide, it’s Ohio’s biggest employer.
“Whether or not a person has a job is the No. 1 social determinant of health,’’ the Clinic said in a response to questions about its community impact. “Cleveland Clinic is the largest employer in Ohio and in many of the communities we serve.”
Every day the Clinic attracts just over 21,000 employees to the Cleveland campus. It plans to create another 1,000 jobs by 2028 by collaborating on creating a new “innovation district,’’ supported by $265 million in spending by the State of Ohio.
The district, which will include the construction of two new buildings along Cedar Avenue on the Clinic’s campus in 2023, also involves projects to be undertaken by the MetroHealth System, University Hospitals, Case Western Reserve University, and Cleveland State University.
Spillover development related to the Clinic’s growth, including housing, is also benefiting parts of Hough and Fairfax, particularly along the section of East 105th Street south of the Clinic, which doubles as the northern end of Opportunity Corridor.
What neighbors say
Rev. Cash said he sees signs that the Clinic is taking small steps toward becoming a better neighbor but that “it definitely needs to happen on a more strategic level.” He cites the history of his church as an example.
East Mount Zion became the first Black church on the former Millionaire’s Row portion of Euclid Avenue in 1955 when its congregation acquired the distinctive Romanesque Revival building, built in 1908. Today, it’s the last vestige of a once-thriving Black commercial district.
Ten years ago, the Clinic completed a master plan that called for demolishing East Mount Zion to make way for another massive medical building.
After discussing a potential sale to the Clinic, the congregation decided in 2021 under Cash’s leadership to stay put. The church is now raising $1 million to repair its roof as a prelude to a more comprehensive rehab in collaboration with entities including the nonprofit Cleveland Restoration Society.
The Clinic, meanwhile, has agreed to partner with the church on outreach and community service projects that included providing 100 free Thanksgiving meals to residents in need. Such collaboration is encouraging to Cash, but he’s hoping for an even deeper relationship.
“I’ve seen the Clinic make intentional strides to reimagine their image in the community,’’ he said. “We’re in a pivotal time now in which the Clinic understands its responsibility.”
Fluker, the planning commission member, isn’t so sanguine.
In recent meetings of the commission, whose approval is needed for building permits, Fluker criticized the Clinic’s plans for a 177,000-square-foot expansion of the Cole Eye Institute, located on Euclid Avenue a block east of East Mount Zion Church, and a new, 1 million-square-foot Neurology Institute off Carnegie Avenue between East 89th and East 90th streets.
Both building designs merely paid lip service to amenities for pedestrians while continuing the Clinic’s traditional aloofness, he said. The commission approved the plans, but without enthusiasm.
A partial shift in direction
It’s not too late for the Clinic to become more progressive. It still has plenty of undeveloped property, much of it occupied by surface parking lots. It could add amenities for pedestrians, provide street-level retail, and community services in some of its new buildings, and do a better job of screening giant parking garages with apartments or offices.
In interviews over the past six months, Clinic officials said the institution is open to such possibilities.
For example, they pointed to the Clinic’s participation in a private development now under construction at East 105th Street and Cedar Avenue that includes 190 apartments atop a 40,000-square-foot Meijer supermarket.
The project, which occupies land co-owned by the Clinic and the nonprofit Fairfax Renaissance Development Corp., fulfills a promise made by Dr. Tomislav Mihaljevic, the Clinic’s CEO since 2018, to bring healthy options to one of the city’s food deserts.
In a public forum organized by Fairfax Renaissance in May, Pat Rios, the Clinic’s executive director of building and design, said that an 11-acre parcel between East 83rd and East 85th streets at the western edge of its campus could include mixed-use development, not just medical and research facilities.
“We’re looking to establish a better sense of connectivity with the community and a better sense of entry on the west side of campus,” he said.
The Clinic acquired the property in 2009 from the Cleveland Play House after the theater company moved downtown to Playhouse Square.
Earlier this year, the Clinic announced its controversial decision to demolish the Play House complex, which includes a 1983 expansion designed by Cleveland native Philip Johnson, one of America’s most important 20th-century architects.
Rios and William Peacock III, the Clinic’s chief of operations, said the demolition is a necessary step toward future growth. The site will serve as a construction staging area for the new Neurological Institute to be built nearby, and then as parking.
Kiska said the demolition is now likely within 60 days, but that the Clinic hasn’t determined how long the parking will remain.
Longer term, Rios said at the forum in May, “we’d like to incorporate some street-level amenities so that our neighbors, our patients, and our caregivers can enjoy some of the services that they don’t have access to in the area right now.”
Despite Rios’ statement, an early draft of the plan for the Play House site includes a large utility plant and yet another large garage. The garage may be screened by additional development to hide the raw structure, but similar efforts by the Clinic have produced mixed results.
The east side of a 6-story garage built by the Clinic some 15 years ago at East 93rd Street and Chester Avenue is fully hidden by a layer of offices. At a newer 8-story garage at Cedar Avenue and East 105th Street, the Clinic designed spaces on two sides of the building’s ground floor to accommodate retail shops. But those spaces are now filled by cars, and the Clinic has no plans “at this time” to install those shops, Kiska said.
Drowning in cars
The garages at the Clinic embody the hard reality that in a region dominated by sprawl, cars are the Clinic’s lifeblood. It sluices thousands of automobiles a day through city streets like a giant infusion machine. Adding to the traffic is that much of the Clinic’s campus is bracketed by Chester Avenue to the north and Carnegie Avenue to the south, two of the East Side’s heaviest commuter routes.
As a consequence, much of the Clinic’s public realm is dominated by multi-lane thoroughfares, curb cuts, driveway aprons, valet lanes, surface parking lots, and bland, suburban-style, corporate-campus landscaping, with lawns, berms, rows of slender young trees, and clumps of ornamental grasses. Benches and more welcoming landscaping are rare.
There are exceptions, including the leafy courtyard of Lerner Research Institute, designed by Cesar Pelli, which faces north from the south side of Carnegie Avenue between East 96th and East 100th streets. Elsewhere, blank facades of masonry or reflective glass and long, dull blocks without street-facing entries predominate.
The worst environments include a canyon-like stretch along Carnegie Avenue, where narrow sidewalks squeeze between massive buildings and five lanes of often heavy traffic.
The upcoming Neurological Institute, which includes nearly as much square footage as the Key Tower downtown, will rise 14 stories next to Carnegie Avenue and will likely worsen the canyon effect.
The Clinic has hired the engineering firm of WSP to complete a traffic study by early to mid-2023 so it can better understand how to manage the future of the campus. Kiska said the Clinic will consider releasing the findings publicly.
Big urban medical centers are not known for pedestrian-friendly design. But there are plenty of local examples showing how major institutions, including hospitals, can engage in community revitalization.
They include CWRU’s participation in the Uptown development in University Circle, or the park created along Euclid Avenue by University Hospitals to screen the approach to its emergency department.
Cleveland State University’s new, $650 million master plan builds on a two-decade effort to transform itself from a commuter to a residential school, and to stimulate adjacent private development.
The Cleveland Foundation’s plans for its new headquarters and a related community collaboration center on the southern edge of Hough in Midtown call for numerous ground-floor amenities and community workspaces. The goal is to jumpstart a $400 million, 10-block, high-tech innovation zone for research and manufacturing.
On the city’s West Side, Cuyahoga County’s MetroHealth system is well underway with the $1 billion “hospital in a park’’ transformation of its main campus and related projects including the construction of affordable housing with community services and retail in ground-floor spaces.
Despite the current controversy over allegedly unauthorized bonuses paid to Dr. Akram Boutros, who was fired as MetroHealth’s CEO in November, the partially completed transformation is an exemplary project that should be continued under new CEO Airica Steed.
The city’s role
Clinic officials said that in planning their campus, they’re playing by rules set by the city and that they haven’t done anything wrong. But for decades, the city has been reluctant to regulate the design of the hospital more closely because of an apparently tacit understanding that it’s lucky to have such a big employer in its midst and shouldn’t ask for too much.
Robert Brown, the former city planning director, said it was a rare exception in the middle 2000s when then-mayor Frank Jackson pushed the Clinic to allow the Greater Cleveland Regional Transit Authority to extend its Euclid Avenue bus rapid transit HealthLine through the campus after the Clinic balked at the idea.
By considering the zoning for the Clinic, the city now appears ready to ask more of its biggest employer.
Most of the Clinic is now mapped under the relatively permissive General Retail chapter of the zoning code. The city could shift the Clinic to Institutional Research, a relatively new chapter of the code under which the city could request an institution to complete and share a new master plan, and then stick to it.
The city and MetroHealth used the new code in 2019 to collaborate on plans for the “hospital in a park” along West 25th Street. Today, only a small portion of the Clinic is zoned for Institutional Research.
The city could also include the Clinic in a Design Review District, a designation that would require it to reveal more about how it plans to use land made available by demolishing buildings. The Clinic is under no such obligation now.
It’s possible, however, that the Clinic could resist efforts to impose new regulatory sticks and carrots. When asked about being included in a Design Review district, Peacock said, “I’m not sure there’s value in adding a layer.’’
Revisiting a master plan
Regardless of zoning, the Clinic should revise its 2012 master plan, which, among other things, called for removing East Mount Zion Church.
The plan was devised by Lord Norman Foster of London, one of the world’s most famous architects and designer of the sleek and massive Samson Pavilion at the Health Education Campus at East 93rd Street and Euclid Avenue, a joint project with CWRU.
Foster envisioned a “green spine’’ as the centerpiece of his plan for the Clinic. It was to be a nearly continuous procession of cloister-like spaces extending east-west across the interior of the campus, sandwiched between Clinic buildings facing out to Euclid and Carnegie avenues.
In reality, the green spine is too broken up by buildings, surface parking, and a below-grade truck yard to read as a coherent idea, at least for now.
The Clinic also appears to be chipping away at the concept. At the new Neurological Institute, for example, visitors will have to walk across six traffic lanes and a median on the north side of the building to reach the landscaped spine envisioned by Foster.
Another big idea in Foster’s 2012 master plan was that of a “grande allée,’’ a tree-lined reflecting pool running the length of East 93rd Street from Chester Avenue to Euclid Avenue.
But the allée, designed by San Francisco landscape architect Peter Walker, is meant to be looked at, primarily from passing cars, not to be actively enjoyed. Its extensive lawn areas lack benches or footpaths.
Opening up a process
The Clinic could certainly do more to humanize its campus, connect it to the surrounding city, and tame the impact of traffic. It could also engage the public in a more open conversation about plans for the future.
Clinic officials have said Dr. Mihaljevic has engaged in conversations with neighboring community groups and with the city. The Clinic shared plans for its upcoming buildings briefly at the Fairfax Renaissance public forum in May, and again in city planning commission meetings this fall that focused narrowly on individual buildings.
But there’s been no transparent, public, big-picture discussion about the Clinic’s future in which all interested parties could join, including residents of Hough and Fairfax. There should be. And the Clinic should view that possibility not as an onerous obligation but as an exciting opportunity.
The Clinic could add to its laurels by becoming the No. 1 medical center in the U.S. in healing neighborhoods damaged by redlining and racism.
As one of Ohio’s top brain trusts, the Clinic absolutely has what it takes to meet such a challenge head-on. From a great institution, nothing less should be expected.