No Parking Here

Design firm IDEO published another thought-provoking blog, Owen Sanderson's To Transform Your Industry, Look At Someone Else's.  It talks about an example of what they call "analogous research;" as Mr. Sanderson describes it: "Analogous research is a form of exploration that takes a team outside of its industry to find inspiration in the ways others have tackled similar challenges."  As may be evident from my prior articles, it is a thought process I love to follow.

The example Mr. Sanderson discussed involved taking some clinicians and healthcare executives to the airport, to see how JetBlue handled customer service.  Personally, I think using any airline for examples of customer service is setting a pretty low bar but, well, healthcare has a hard time even clearing those.  Their clients seemed to get something from the experience. 

I want to try some analogous research too, and I'll pick an even more off-beat topic: parking. 

Jae C. Hong/AP and CityLab

Parking?  Parking is on many people's minds this time of year.  Perhaps you fought the crowds on Black Friday, or tried to avoid them by shopping on Cyber Monday.  Either way, at some point this month most of us will find ourselves trying to park at some shopping destination, searching for the perfect parking space. 

You might, then, be surprised to hear that many experts think we have too much parking, way too much.  CityLab reports we have 2 billion spaces for our 250 million cars.  They quote Donald Shoup, a professor of urban planning at UCLA: "The area of parking per car in the United States is thus larger than the area of housing per human."  That's pretty scary.

CityLab says that we have enough parking spaces not just for busy days like Black Friday but for "multiple" Black Fridays, something that Strong Towns pointed out two years ago.  The latter created #BlackFridayParking to help document the excess parking, "Because, even on a day that is supposed to be one of the biggest shopping events of the year, we've noticed that year after year after year after year, the parking lots are simply never full."

Credit: Sarah Kobos, Strong Towns

Much of this excess parking is actually prescribed by local zoning or retail merchant requirements that are based on, well, who knows what the required ratios of parking to retail/office/housing square footage are based on.  All of that parking, of course, comes with a cost -- not just the cost to build and maintain the parking, but also the lost opportunity costs of how else the land might be used. 

As Sarah Kobos of Strong Towns describes our obsession with parking: "It’s an inefficient system that hits municipalities–and taxpayers–directly in the pocketbook."

We know how we got here.  We started moving to the suburbs, which meant we needed more cars, because we didn't want to walk or take public transit.  Retail stores followed, as did other businesses, all of which then built parking lots -- the more, the better. 

Los Angeles, ironically, is one of the places looking at how it might end the madness.  Architectural form Woods Bagot did a study More LA, asking: "What if L.A.’s miles of parking could be unlocked for more productive urban uses?"  The firm believes converting unnecessary spaces could create housing for up to 1.5 million people while boosting retail spending and creating more green space.

The trouble is not just the current carrying costs of all that parking, but what future trends are telling us.  More people are going online to shop, work, or socialize rather than driving to them.  More people are moving back to more urban areas, fewer people of all ages are getting drivers licenses, and ride-sharing services like Uber or Lyft are on the rise.  In the not-too-distant future, personal ownership of cars may become passe, and much of our lives will be experienced virtually.

We've designed our communities around the car-crazy culture of the 2nd half of the 20th century, but we're now into the 21st century.  We need to rethink what that means for those communities, including but by no means limited to parking lots.

Healthcare has a lot of parking lots -- both literally and figuratively. 

Start with the literal.  All those health care facilities and all those medical office buildings, come with parking.  They have the same problem as the malls and other retail establishments; parking is built for worse-case scenarios, leaving those parking lots often significantly underutilized.  The costs for all that parking, of course, gets built into what we pay for care.

More troubling are the figurative parking lots.  Let's start with the easy one: waiting rooms.  There's almost no one who has had a healthcare encounter who doesn't have their own waiting room story.  The problem is both that we spend too much space on them, and that we make people spend too much time in them. 

Or my favorite example, hospitals.  They are huge capital sink holes, often far from full, and too often housing patients who, with some creative effort, could well be taken care of at home or in the community.  We need to rethink our concept of a "hospital" for the 21st century, not build more of them, much less more parking lots for them. 

Then there is telehealth.  It remains a hot topic, even if currently not widely used (as a recent special Health Affairs highlighted).  That's not going to remain true.  At some point -- as Kaiser Permanente has shown possible -- a majority of visits will be done virtually. 

We need to be planning for a healthcare system where a majority of health care happens virtually or delivered at home, rather than happening in healthcare facilities.  Those parking lots, those waiting rooms, and those hospitals are going to look awfully deserted. 

Urban planners and developers are starting to realize they need to plan for a world that needs less parking.  It will be a big shift, and won't happen overnight, but it will happen. 

Similarly, healthcare executives need to be planning for a healthcare system in which care is delivered very differently -- and where "care" itself will be redefined.  It will also be a big shift, won't happen overnight, but it, too, will happen.

Parking may be the least of healthcare's worries.