Planning and Planting for Climate Resilience - 48,000 Plants and Trees Take Root

Case study submitted as part of Lancet Commission call for case studies.

Team members / location: Brian Gray/ Baltimore, Maryland, United States

Issue: MedStar Harbor Hospital (MHH) sits on the banks of the Middle Branch section of the Patapsco River covering 25 acres, of which 17 acres were impervious. About 20 million gallons of storm water runoff each year with a storm water fee to Baltimore City of $43,000. Regular flooding and standing water occurred during extreme rain events with no storm water management facilities. Additionally, MHH is part of one of the most historic African American neighborhoods in United States with a long history of public neglect. MHH is subject to urban heat island effect due to low tree cover.

Intervention: The installation of 48,000 plants and trees on prevents five million gallons of storm water runoff, along with the pollution contained therein, from flowing off the MHH property directly into the Patapsco River. Several local small businesses and non-profit organizations supported in the four-step process:

1. Green Infrastructure Master Plan with list of projects along with costs related to design, construction, operations & maintenance, and the estimated impervious surface fee reduction; and created signage to promote health and wellness benefits of GI on campus.
2. Chesapeake bay Trust awarded a grant to create 100% engineering designs.
3. $1.3 million grant from Maryland Department of Natural Resources to implement the project which included planting five rain gardens, four micro-bioretention practices, three bioretention areas, and two bioswales, with plants, almost all of which are native.
4. The hospital took on the maintenance element of this project.

Outcomes:  

• Environmental: The installation of the green infrastructure projects treats 5 million gallons of storm water runoff before it enters the Patapsco River and ultimately the Chesapeake Bay.
• Social impact: MHH’s waterfront attracts large crowds of visitors several times per year during harbor events and the Middle Brach Park bike trail crosses through campus. Educational signage was strategically located throughout the campus, to illustrate the importance of environmental stewardship and responsible storm water management for improved water quality. The Green Team use the outdoor spaces for learning, wellbeing, and hands-on activities. After initially holding an outdoor meditation and aroma therapy session, programs were postponed due to the onset of Covid-19. MHH plans to implement programs that include walking challenges, yoga or bird house making, herb planting. 
• Financial: The annual cost for maintenance of the native gardens and storm water ponds is $40,920 plus $9k for mulching. 
• Clinical:
  • Patient Outcomes: The most important aspects of green infrastructure for a healthcare facility is the positive impact on patient outcomes since being in and seeing the natural world, trees, and plants has been shown to reduce length of stay, reduces patient recovery time after surgery, leads to less of a need for pain or anxiety medication, as well as a decrease in complaints.
  • Population Outcomes: The installation of 48,000 plants and trees on a health care campus aligns with the mission of healthcare in and of itself. Being in nature, even seeing nature and the natural world is good for psychological and mental health -- it boosts focus and memory, enhances happiness and healing, reduces stress and anger, and promotes social behavior.

Key learning point: 

• The biggest learning point is choosing the right builder willing to work closely with the MHH team to obtain upfront maintenance costs. This includes choosing a reputable maintenance vendor who has experience and knowledge working with native perennial gardens and storm water projects, as well as non-hazardous methods to remediate weed growth.