Healthcare Design - May 2016 - 102

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the area who use Highway 1 for routine travel.
Operate self-sufficiently
Remote locations often come with unpredictable
weather conditions and limited connections to
the outside world, requiring buildings to be as
self-sufficient as possible. This includes being
conservative in energy usage and having reliable,
independent back-up sources of energy.
For instance, Kiowa County Memorial Hospital
in Greensburg, Kan., was the first CAH to receive
LEED Platinum certification in 2010, serving as an
example of how rural facilities can operate effectively while employing a variety of environmental
features, such as a wind turbine, water conservation measures, and a heat recovery system. Newbuild CAH Peace Island Medical Center also uses
many sustainable features, including generating
energy from a geothermal system and collecting
water for designated rain gardens to minimize demands on the small available staff. The hospital's
use of a variety of environmentally sustainable
features provided additional operational savings in
maintenance of the facility.
Standardized and adaptable clinical spaces
The limited number of working healthcare providers in medically underserved areas influences
the need for standard design and universal room
modules in clinical layouts-exam rooms that are
assigned for primary care and can support urgent
care overflow, as needed, for example.
Design standards also help providers jumping
between locations. Fort Providence Health Centre
uses this concept for clinicians rotating through its
health system. Each facility organizes the patient
and provider areas with similar dimensions, casework and furnishings, and equipment.
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Clinic design must also be flexible for changing regulations, services, and patient volumes.
Universal rooms can fluctuate between purposes
as service demands change. To that end, Fort
Providence uses a single multipurpose screening
room for all imaging and small procedures. The
room contains a mobile X-ray unit and radiolucent
stretcher and can accommodate telemedicine,
observation, patient holding, general exam, and
dialysis. A 12-by-12-foot room dimension (as
opposed to a more standard 10-by-12-foot
universal exam room size) accommodates the
extra equipment in the space.
Maximize staff connectivity
Rural facilities are often run with minimal staff
who may need to move easily between greeting
people as they arrive, providing patient care, and
coordinating with one another. To ease this process, plan departments around centralized work
spaces and open clinical pods.
Clinical circulation that connects staff work areas
with adjacent clinical space is also useful. The
planning should include a central core support area
with connection to the clinician zone without interruption from public circulation. Ely-Bloomenson
Community Hospital, for example, was renovated in
2009 with a central staff area that supports emergency and inpatient care and is connected as one
work zone. Core support spaces are designed to
keep visual and physical connection between staff
and minimize redundancy.
A look ahead
These are just a few guidelines to help launch design work on rural projects and support the unique
operational goals of CAHs. Rural healthcare is
moving away from acute care and increasing
appropriate primary care components, such as
mental health services and specialty telehealth

Top: This diagram of Glenallen,
Alaska, shows the location of
the Cross Road Medical Center
site within the town and its
accessibility via major roadways
for those who come into town
for services. Above: The staff
work area at Ely-Bloomenson
Community Hospital in Ely,
Minn., designed by DSGW
Architects in 2009, provides a
flexible support area between
the emergency department and
the inpatient department to
allow staff to view both departments without interruption.

KIRSTEN STALOCH

essential services in a community. Frontier areas
typically have great distances between towns that
are often only connected by a two-lane primary
road. Clinic locations along these critical transportation arteries optimize navigation to the facilities
for patients as well as providers and suppliers.
Remote regions that attract high volumes of visitors should locate health centers on main axis
roads.
For example, the frontier town of Glennallen,
Alaska, was selected as a site for a clinic on local
Highway 1, which is the only vital connection between the regional city of Palmer and the western
Alaskan frontier. Palmer is home to the closest
hospital, which is 136 miles away from Glennallen,
making the Cross Road Medical Center location
a convenient destination for those seeking care in

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Healthcare Design - May 2016

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