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Critical Access Hospitals: Re-imagining the Care Delivery Model

Jennifer Klund, AIA, ACHA, Healthcare Planner, HGA Architects and Engineers

Critical Access Hospitals traditionally have been the foundation of rural communities as they provide affordable access to healthcare, generate economic development, and offer well-paying professional jobs. Yet many CAH's find themselves navigating change as they expand their roles as healthcare leaders. As with many larger urban hospitals, Critical Access Hospitals are evolving with industry-wide changes in healthcare delivery methods, technology and demographics. While Critical Access Hospitals share traits with urban hospitals, they are tailored to their individual markets on a smaller scale.

Below are three guidelines Critical Access Hospitals should consider to improve patient access, increase operational efficiencies, and meet growing market needs within an integrated "one-stop-shop" care model.

Within smaller communities, CAH's are seen as one of the major civic institutions. The buildings often are centrally located, standing alongside the courthouse, fire station and town hall as prominent civic buildings. Many newer CAH's are designed as points-of-pride, reflecting the town's architectural heritage and projecting a sense of welcome.

Orange City Replacement Hospital for Orange City Area Health System in Iowa, for instance, architecturally draws inspiration from its pastoral 37-acre setting with curving glass wall and cultured-stone exterior, light-filled interior lobby, and gourmet-inspired cafeteria. The design grew out of series of community meetings and reflects the community's desire for a contemporary, forward-looking design that nonetheless ties into the region's agricultural economy and Dutch heritage. 
At night, local residents are drawn by the flickering water feature and illuminated interior shining like a beacon through the curving glass wall. As a point-of-pride, Orange City, as with similar CAH's, sends a clear message that it is invested in the community, reinforcing its market position.

Critical Access Hospitals often are planned as integrated medical centers combing emergency, acute care, procedure, inpatient care, and clinic services. Flexible planning allows CAH's to share resources with multiple healthcare providers and expand easily with evolving programming. Because Critical Access Hospitals have smaller staff, caregivers often are cross-trained at the top of their licensure to multitask. Standardized space planning organizes services around like experiences and activities, with universal spaces designed to flex according to needs, such as prep/recovery rooms or ED/exam rooms.

The recently opened Sioux Center Community Replacement Hospital and Health Center in Sioux Center, Iowa, groups common spaces--from registration and waiting lounges to gift shops and chapel--within a centrally located Town Center, from which all programming radiates. The integrated medical center includes a 17-bed inpatient hospital, emergency department, OR, primary care clinic, and four specialty clinics for orthopedics, cardiology, dermatology, and neurology.

The efficient plan allows Sioux Center to cost-effectively streamline workflows. For instance, by integrating physician clinics with hospital functions, Sioux Center avoids duplicating imaging and lab costs. Additionally, the plan maximizes workflows through strategic placement of adjacencies. The laboratory is next to outpatient clinics at one end of the plan to streamline patient flow from exam room to lab, while ED, imaging and surgery are adjacent to each other on the other end of the plan to accommodate the most likely patient/caregiver flow. Likewise, specialty clinics are adjacent to surgery to address efficient patient/caregiver flow, while ED, birthing and patient units flex back and forth.

The challenge for many healthcare owners is maintaining facilities that support the on-going healthcare evolution--which means remodeling outdated hospitals or building new. But a new hospital does not necessarily mean business as usual. Healthcare owners are rethinking their business model and financial outlook to compete with larger urban hospitals so area residents can retain the hometown choice as the best healthcare choice.

Critical Access Hospitals have four key revenue-generating departments: Emergency Department, Procedure /Surgical, Imaging/Diagnostics, and Clinic. When planning a facility upgrade, owners should first consider how to optimize department productivity within a sustainable business model.

Schoolcraft Memorial Hospital in Manistique, Michigan, rethought its healthcare delivery process when planning a replacement hospital. Serving 9,000 residents, the 62,130-square-foot hospital includes 12 private patient rooms, emergency department, two operating suites, and integrated rural health clinic.

With more than 200 healthcare professionals and staff, the hospital incorporated a number of innovations, including transforming the older inpatient model to a leaner, more cost-effective outpatient model that emphasizes preventive care and wellness aligned with integrated diagnostic and clinic services. Rather than upping square footage, the hospital reduced inpatient space from 24 beds to 12 beds. Flexibly designed adjacencies further promote efficiencies, allowing such spaces as the ED/inpatient unit to flex back and forth. Many caregivers are cross-trained across disciplines to deliver the care as needed within this flexible plan.

Realigning the care model can lead to a more efficient delivery and improved patient outcomes, but making the paradigm shift is not always easy. Planning a Critical Access Hospitals is a community-wide effort, in which healthcare leadership, caregivers, staff, community members and medical designers rethink the healthcare delivery process to create a more streamlined hospital. Planning a state-of-the-art CAH also has the added benefit of attracting and retaining top physicians and caregivers who may be seeking a small-town lifestyle. From Orange City to Sioux Center to Schoolcraft, today's Critical Access Hospitals are leading the way in defining new models to deliver world-class care.

Jennifer Klund, AIA, ACHA is a healthcare Planner at HGA Architects and Engineers.

Jennifer Klund at HFSE 2014...

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