Partnerships between hospitals and fitness facilities enrich communities by offering residents a wider scope of services.

Just a few years ago, many health club owners felt threatened by the rising number of hospitals expanding preventive services by adding wellness centers. Today, many hospitals are moving away from building or managing these facilities, and turning instead to fitness experts. And more and more health clubs-along with park and recreation departments, YMCAs and other groups-are seeing hospitals less as competition and more as potential partners to provide additional services and a wide range of alternative programming.

"Competition is not dead," says Jeff Bensky, managing member of TBG Development, which develops and manages hospital-affiliated fitness centers. "It will never die in this country. It's a question of who your allies are. People are looking for collaborative ventures because they don't want to duplicate services in a community."

These partnerships can create wellness centers that integrate fitness with medically based preventive services, promoting lifestyle and behavior changes all at one location - one-stop shopping for a wide variety of target markets. By integrating health services with fitness, facilities may be more successful in attracting the 80 percent of the population believed not to be doing enough physical activity to maintain optimum health. They may also eliminate the intimidation factor enough to attract three demographic groups-seniors, the deconditioned and the at-risk-that have been growing dynamically in the fitness industry.

Utilizing the hospital's expertise, centers can expand on the medical needs of these populations while providing fitness opportunities. For example, a hospital may provide health assessments, cholesterol and blood-pressure screenings, and eye tests for seniors.

Meanwhile, fitness experts might offer a functional weight-lifting program designed to build strength for daily living, supplemented by Tai Chi or cardiovascular and flexibility exercises. The centers can tap the strengths of each partner to provide much more complete and professional service than was previously available. The YMCA is a perfect example of how these collaborations allow individual organizations to focus on their fortes. Ys provide a number of health-related services, and have worked with hospitals on programming and seminars for at least 25 years, but the services have always been a bit beyond their means.

"The Y offers so many different humanservice programs that many times we spread ourselves too thin," says George Babish, director of business development with the Chicago Metropolitan YMCA. "We're not able to devote the types of resources to some of these wellness programs that are needed to make them successful. We're just not qualified to deliver in some of these areas."

They are qualified, however, to refer members to hospital services or to take referrals from the hospital-as are other fitness professionals. Many jointventure facilities house space for a hospital's physical therapy, rehabilitation, cardiac rehabilitation and arthritis programs. Insurance policies generally only cover a set number of sessions, even though clients are often not entirely ready to stop therapy or rehabilitation. Instead of cutting them off, the centers offer a chance for the client to pass from a therapist to a fitness professional, while exercising in the same setting with the same equipment.

"When patients finish therapy, we actually give them a one-month membership to the health club at no charge," says Joe Cirulli, owner of Gainesville (Fla.) Health and Fitness Center. "They can come into the therapy center once a week to train on these very specific machines. Then, if they become a member of the center, we allow them to come in once every two weeks for the next year at no charge. But the therapy does have to end at some point."

Because of the extent of the rehabilitation equipment available, Gainesville Health and Fitness Center has become a viable wellness resource. While the center has had a rehabilitation area in its facility since 1988, a joint venture formed with the North Florida Regional Medical Center in the mid-'90s helped the facility expand. The center now employs 13 physical therapists and offers a full rehabilitation center with traditional therapy rooms, medical testing equipment, strength-training equipment, treadmills, upright and recumbent bicycles, elliptical trainers and upper-body ergometers. The rehabilitation center also shares exercise equipment, a large swimming pool, a basketball court and lockers with the fitness portion of the facility. Because of these amenities, the center receives referrals from physicians throughout the city, which greatly expands its client base.

"By combining forces, we were able to gain a lot of legitimacy with all the physicians in the city," says Cirulli. "As health care has been changing, in order to be able to even see a patient, you have to work with different insurance companies to be on their approved-provider list. Before the partnership, we were able to get a lot of contracts, but it may be easier to get future contracts with the hospital as a partner."

The center also works with the North Florida Regional Medical Center and Shands Medical Center to offer a wide range of seminars-topics include back pain, cancer, diabetes, incontinence, injury prevention, menopause, osteoporosis and plastic surgery-and health fairs providing flu shots and tests for blood pressure, hearing, heart rate and oxygen.

The key, facility owners say, is to make the center's operation as seamless as possible for the member. Members should be able to move about the facility and enjoy complementary programming from all partners. In Glenview, Ill., the park district wants to create a facility in which people can not only exercise, but also educate themselves about exercise and lifestyle changes that lead to healthier lives.

When completed, the recreation and health facility will offer a fitness center, an aerobics room, an indoor running track, swimming pools, preschool and cultural arts areas, banquet space and a senior center. All of these facilities will be shared through a partnership with Evanston Northwestern Healthcare, which will also offer health education programs, fitness screenings, blood pressure and eye testing, massage therapy, warm-water therapy, alternative therapies (including acupuncture), retail space featuring herbs and supplements, cardiac rehabilitation, and physical, occupational and speech therapy.

"We wanted to have a health-care provider as part of the health center, but not just as an entity that leased space," says Bob Quill, superintendent of leisure services for the city of Glenview. "We wanted someone who would be involved more intimately in our own programming, who would offer a lot of complementary programming and services that would make it much more of a cooperative effort."

While fitness professionals in Glenview will benefit from a greater amount of rehabilitation equipment and health services, the hospital will have increased access to pools, fitness equipment, multipurpose rooms and other facilities that aid its therapies. Such partnerships can also help to fill low-use periods in the schedule. A fitness facility, for example, is generally busiest in the morning, during the noon hour and in the evening; therapy programs can fill the lulls during daytime hours. This idea can even be expanded to include niche activities. MedSport Alliance, which is developing a sportsplex in Detroit, is looking into conducting karate schools in multipurpose rooms to fill open time slots.

Partnered with Mills Gymnastics, Dumars Field House and Oakwood Hospital, the sportsplex will fully integrate its shared facilities. Televisions on the fitness floor will broadcast activities in other areas of the facility so parents can work out on the exercise equipment while watching their children-one in gymnastics class and the other playing in-line hockey, perhaps. When members enter the facility, they will be able to see all elements of the center, and directly in front of them will be an informal stage for performances and health-oriented seminars, potentially more attractive to attend in an active, energetic facility than in a hospital. The shared facilities will also increase accessibility to health services, which could be anything from sports medicine to clinical services.

"If an athlete sustains an injury during a basketball game, we can have that athlete see the orthopedic physician upstairs," says Jim Pengelly, executive director of MedSport Alliance, the corporate wellness program for Horizon Enterprises. "We would have the ability to get the patient in to see that orthopedic specialist either that day or the next day." The ideal is to integrate the design so hospital patients and fitness-center members can interact in the same spaces, and so facilities are used to their full potential.

Some facilities install glass walls between the rehabilitation areas and the fitness floors to create a greater sense of openness, and to allow people undergoing therapy to see others working out. Some offer therapy treatments on the fitness floor or in the pools alongside other members. The idea is that therapy patients will be more inspired to recover in a healthy environment, surrounded by activity. And club members themselves may even be more inspired to stay healthy.

"A qualified person from the club and the physical therapist or exercise physiologist from the hospital will be working side by side," says Pengelly. "You could literally be doing personal training on one machine and a physical therapy patient could be working on a machine next to you."

The atmosphere can be further enhanced by using natural lighting or features such as fountains to create warmth and openness. The key is to create a comfortable setting for members. In Louisville, Ky., Baptist Hospital East and Milestone Fitness Center have formed a 50/50 partnership to create a new wellness center. The facility will offer enhanced services such as cardiac rehabilitation, physical therapy, arthritis programs and educational sessions, as well as increased space and parking. But Paul Schmitt, president of Milestone Fitness Center, says his members are concerned that they will lose the close-knit, family atmosphere they have always had at the center. By carefully designing the facility, retaining much of the same staff and remaining on a first-name basis with members, however, that atmosphere can be maintained.

The process of developing a jointventure wellness center begins long before the actual planning with the careful selection of a partner. The prospective partner must have mutual goals and missions, must share a vision for the facility and its services, and should still be interested in the success of the facility years down the road. All partners should receive real benefits from the partnership, and should have strong leaders willing to express their ideas. Perhaps most important, all the partners should be sure they can trust each other.

Establishing trust may mean a great deal of research or a long series of honest, open discussions, but the work will pay off in the long run, says Cirulli. Back in the 1980s, a hospital in town approached him for advice on creating a fitness center for people with disabilities, assuring him it would not compete with his business. Since he couldn't fully serve that population, he offered to help them. For a year, he says, he gave them advice, offered ideas and even showed them around his facility. When the new club opened, however, it was just like his, and its advertising campaign smeared his facility and employees. Eventually, the knockoff club began losing money, and when its owners approached Cirulli to see whether he would take over their business, he was able to convert many of their members into members at his facility. But the fallout could have been much worse, and while this wasn't a true partnership, it is a warning to be sure to know and trust any potential partners.

Before moving into the planning of a facility, it must be decided which partner will be in charge of the management of the facility, and how much hands-on responsibility the other partners will have. A written agreement should spell out the terms of the partnership-but it might take time to hammer out the details or gain a full commitment. When working with a hospital, fitness-center operators should be aware that the process may span two to three years, as dictated by hospital bureaucracies and decision-making channels. And the hospital may have certain expectations, too.

"There is normally an image equity that the hospital would have that the club might not have," says Scott Chovanec, regional director of MediFit Corporate Services, which provides consulting and design services for worksitefocused fitness and wellness facilities.

"Partners have to make sure they're meeting the needs of the hospital. They need critical staff who are educated, degreed professionals. The hospitals are looking for quality in care for any of the patients they would send."

If partners fail to provide the expected quality of service, it could severely hinder the relationship. The partnership can also be threatened by control issues, hazily defined goals, overestimated or changing markets and a failure to gather enough information on the partner before moving forward. Some partnerships have also failed when unrealistic expectations have been made of the other partner.

"Some partners have generally looked to the hospital as the deep pocket," says Judy Sewing, principal of The Benfield Group. "Their expectations are sometimes unrealistic about what the hospital will be willing to do. They want them to bear the financial burden or the financial risk, and hospitals right now are fairly averse to that."

However, some hospitals are willing to make concessions. Many are eager to hand off management duties to fitness professionals who are more familiar with the day-to-day workings of these types of facilities. Moreover, by leaning on the talents of fitness experts, hospitals can provide preventive services that not only reduce the need for more acute care, but develop relationships with potential future customers.

"Like most astute businesses, hospitals are starting to look at the customer differently and wanting to have a customer for life," says Sewing. "They want to develop relationships with people even before they're sick. The wellness center has offered hospitals that opportunity." It has also offered an opportunity to unite an entire community with a plethora of programming and activities to suit any need or desire, from alternative medicine to cardiovascular equipment to educational programming.

"These facilities bring together a wide range of people, whether by age, interest, fitness level or ability," says Quill. "You can have 20 stationary bikes lined up, and you can have everyone from a 16-year-old to an 86-year-old on them and all ages in between. You see interaction between a wide range of people, and that's healthy at a whole other level."