How to Build a Bike-Friendly Hospital

Hospitals are major destinations with unique travel demands. In our auto-centric world, the default assumption is that most people will drive there and that cycling is just not possible. But evidence locally and abroad shows that hospitals can be major cycling destinations – we just need to include the right ingredients.

What makes a hospital unique?

The travel demands of a hospital are certainly different from other land uses like offices, but that doesn’t mean that a significant amount of travel there cannot be accommodated by bicycle. Still, we tend to see hospital travel only through our own experiences, imagining urgent or emergency visits, travelling there in a sick or weakened state, or making long trips to visit loved ones. They’re a lot like airports in that way, where we imagine ourselves travelling with bags of luggage and viscerally conclude that “no one is going to bike there” (forgetting about the thousands of support staff who commute there regularly).

The reality is quite different. Just like offices, hospitals have thousands of regular commuters, and while there are many emergency room visits, the majority of patient visits are for scheduled appointments (many of whom are in relatively healthy condition). Unlike airports, hospitals also tend to be in really central locations, close to the people they serve, making them very accessible to many within a biking distance.

Still, we cannot plan for hospital travel in the way we would for an office or other land use. Here’s a few important traits that make hospital travel unique:

• Many staff work irregular shifts that are longer than a typical workday and may involve starting and/or finishing work during the nighttime, so typical 9-to-5 commuter-oriented transit services may not align with when these people need to travel. Some staff may even travel to different hospitals throughout the day, or have multiple shifts at different hospitals in a given week
• Due to their specialty nature, hospitals draw from a larger catchment area for staff and patient travel (although as mentioned above, they tend to locate very close to residential and developed areas, unlike, for example, an office in an industrial park)
• Some hospital patients are not physically able to ride a bicycle, due to reduced physical mobility
• Hospitals tend to charge a significant parking fee for both visitors and staff, creating a natural incentive for people to consider other options
• Many types of jobs at hospitals are very mentally and physically exhausting and staff may be less interested in a stressful bike ride at the beginning and end of the day
• There is no “typical” visitor for a hospital; staff include highly-paid doctors and low-wave service workers, and patients include people of all ages, ethnicities, abilities, languages, and abilities. Many have access to a car for transportation, but many do not

Why should we care?

A hospital is a massive public investment that generates thousands of trips every day. The new Ottawa hospital, for example, is forecast to have 1,246 beds and 10,439 staff at full build-out, generating 35,400 daily trips by 2048, effectively moving the equivalent of a small town each day. This massive travel generator, combined with public ownership, is a massive opportunity to shape travel and support increased use of transit, walking, and cycling.

On the other hand, a hospital that does not integrate well with other modes requires a massive investment in parking and in the surrounding road network, building giant new parking garages and widening intersections to accommodate all of the vehicle traffic. To use the Ottawa example again, the development team is proposing construction of a 2,500 space parking garage to support automobile travel to the site. At a conservative rate of $50,000 per space, this reflects a $125,000,000 capital cost, to build a structure that will occupy a large portion of the site, with little ability to be repurposed if its capacity is not needed.

So in short, hospitals generate a lot of trips each day, and the travel mode people choose to take these trips has a huge impact on the surrounding city.

Key Ingredients for a Bike-Friendly Hospital

While it should be no surprise that the Dutch have also made hospitals extremely bikeable, we can find great examples in North America too. A survey of a sample of Toronto hospitals found that 3-7% of staff trips and up to 5% of visitor trips were being made by bicycle (depending on the facility) – and these are older facilities in a city that has only recently started to seriously support cycling as a travel mode.

The University Medical Center Groningen (UMCG) is one of the largest hospitals in the Netherlands, located in one of the most bike-friendly cities in the country. Each day, 9,000 staff, 2,000 patients, 1,000 visitors and 2,000 students travel to the campus, forming a massive component of the City’s daily transportation movements. If all of these commuters were expected to drive, the facility would need 14,000 parking spaces; instead just 29% of people either drive or carpool, and an incredible 52% of trips are made by bicycle or electric bicycle.

Key Ingredient #1: Great Bike Parking

Everyone needs a place to put their bikes, but the exact needs vary by user. Consider the comparison of an overnight shift worker who needs to leave their bicycle for 8+ hours in a location they can trust to be secure, versus a patient spending an hour at the hospital for an appointment who just wants to park as close as possible.

Patients and visitors need access to short-term bicycle parking, located as close to building entrances as possible. This should be provided in the form of quality outdoor bicycle racks (ideally covered), provided free of charge, and with easy access to pathways that connect to the rest of the city.

Staff need access to long-term bicycle parking. This parking should be provided in the form of one or more secure bike rooms, capable of holding several hundred bicycles in an organized layout. These facilities should be accessible 24/7 via a key card or credit card, be well-lit, and located in a well-surveilled area to improve personal security, especially at night. The facility should be highly visible and located closer to the main entrance than most vehicle parking facilities, to improve the convenience and awareness of the option.

Ample amounts of power outlets should be made available to accommodate longer-distance e-bike commuters (while the upper limit for a non-electric bike commute may be 5-7km, e-bike commuters can easily travel up to 20km). It’s OK for the facility to charge a small user fee, but it should be cheaper than the cost of car parking. An example for inspiration is the McDonald’s Cycle Center in Chicago, shown below. Note the attractiveness and stylishness of the design, with lots of light and functionality – this is somewhere you would want to leave your bike!

Key Ingredient #2: Complete Bicycle Network

Most people will only cycle if they feel safe and comfortable doing so, and thus a network of safe and connected bicycle routes are needed.

While most of this is the responsibility of the municipality, the hospital development needs to ensure that people cycling can seamlessly connect from surrounding streets through the site and reach bike parking with minimal or no interaction with traffic and with minimal conflicts with people walking.

Off-site, the municipality should ensure that bicycle routes are designed to be winter maintained and lit at night. Ideally, most or all of the main access routes should be located within road right-of-ways to improve passive surveillance when travelling at night (as opposed to a trail winding through the woods). Bicycle paths on and off-site should be enhanced with landscaping to create a pleasant journey – something that high-stress workers will look forward to riding on at the end of a long day.

Below is a video from Bicycle Dutch of Mark Wagenbuur cycling 2.4km to a nearby regional hospital on the edge of town containing 1,120 beds that serves a community of 360,000 people. The experience is seamless and once at the hospital you can see hundreds of bicycles neatly parked next to the front door, all from visitors and patients (a separate secure bike parking facility is provided for staff).

Building a brand new hospital presents a golden opportunity to plan for bicycling from the outset. Construction of a massive new hospital campus is accompanied by upgrades to on-site and surrounding infrastructure, with new roads, new and rebuilt intersections, and on-site pathways, parking, etc.

Key Ingredient #3: Quality Transit Service

We tend to think of transit and cycling as “competing” modes, but having access to both of these modes is essential for giving people a reliable alternative to driving. People who cycle to work may not be able to do so every day, and thus need a transit option in place for days of increment weather or when they’ll have to travel to multiple sites.

While bicycling may be feasible for those living up to 5-7km away (or up to 20km for e-bike users), those who live farther away from the hospital may opt to cycle a few kilometres to a local rapid transit station (express bus, LRT, regional rail), if they can easily connect to the hospital from there.

To make the combination of cycling and transit possible, rapid transit should be available during the full operating hours of the hospital, with quality long-term bike parking facilities at every transit station for those bike-transit commuters (see example from Montreal below). Efforts should be made to allow bicycles to be carried on transit vehicles (at the very least during off-peak hours).

On site, a comfortable, covered walking route between the hospital and the nearest transit station should be provided and this distance should be minimized as much as possible through the site design (or even better, the transit station should be integrated into the hospital building).

This modest bike room holds 78 bikes, is free to use and 90% occupied throughout the year, and is 13x more space efficient than the adjacent car parking spaces. And you'll find it at a suburban train station in Montreal. https://t.co/N1ILwBGJI6 pic.twitter.com/aylFeg6aIu

— Beyond the Automobile (@MattPinder1) June 12, 2021

Let’s Do Better

We need to escape the mindset that a hospital is not a place people will bike to. If a major hospital in Groningen can attract 50% of patient and staff trips by bicycle, in a climate where winters have less than 8 hours of daylight each day and it rains more than a third of the time, we need to be setting our targets and aspirations for cycling higher.

Evidence from elsewhere in the world, and even in Ontario, suggests that, given the right conditions, hospitals can attract a high volume of bike trips. So when we plan transportation for existing and new hospitals with the goal of encouraging active transportation, is a goal of 2% of trips by bicycle really the best we can do?

---

This article was inspired by the ongoing consultation for Ottawa’s new hospital. It is not meant as a critique of the plans, but rather intended as a source of inspiration. Special thanks to Xiaobin Wang for contributing to this piece. Xiaobin is an urban transportation “plangineer” who believes that an integrated multi-modal mobility system is the key to open up healthy and enjoyable lifestyles, She enjoys seeing smiling faces of people cycling and walking she comes across everyday. Xiaobin believes every little change counts and has been taking every project as an opportunity to contribute in shaping and building vibrant and active communities.

---

Want to enjoy more content like this? Join the Beyond the Automobile mailing list to be notified of new posts. Disclaimer: I was not involved in any of the designs discussed in this post.