At Mercy Medical Center, the addition of conference and event centers allows hospitals to become an integral part of their rural communities

Photograpsher: Jerry Swanson

At Mercy Medical Center, the addition of conference and event centers allows hospitals to become an integral part of their rural communities

Bigger is not always better for interior designers who work on healthcare projects. Small projects can often be more stimulating and fulfilling work for designers than large projects. This is never more evident than working with hospitals in rural parts of the county. Healthcare facilities located in nonmetropolitan areas are not simply smaller versions of their big city counter parts. There are often fundamental and distinct differences that must be taken into account by designers that will affect the success of these environments. Along with distinct challenges are many opportunities for creative designers working on rural facilities.

Existing hospitals that were built during the Hill-Burton era have become aged and many require replacement. The Hill-Burton act of 1946 provided federal grants and loans to improve the nation's hospitals, especially in rural parts of our country. These facilities built during this era are quickly approaching the end of their life and studies show that the cost of their replacement is often less than renovation.

Create a community center

A concern for rural facilities is that they typically serve a larger proportion of elderly as outmigration of younger individuals and families occur. An elderly demographic utilizes Medicare and Medicaid reimbursement as a substitute to traditional insurance. This type of payment hinders rural hospitals from maintaining their already tight budgets. To offset this problem they must find other avenues for economic support. They can do this by becoming a true “Community Center” for their region and incorporate building resources and programs to support involvement by the entire community. These resources can include: fitness programs, conference rooms, event centers, and educational and activity rooms. Providing these amenities can help them take on a leadership role in their community and focus on rural strengths, which include strong social networks, neighborliness, and shared-life experiences by building facilities that help the economic base of the area.

A new hospital in western Colorado is currently under construction on a large addition to provide these types of amenities to its community. It is working in conjunction with their Chamber of Commerce, which will outsource hospital facilities for city use. This program required a community-driven planning process and facility-needs assessment on how to deliver services that would both help the community and also assist the hospital in accessing users that would normally go elsewhere for services. It was determined through this planning, that the community lacked large conferencing and rehabilitation facilities. The interior designers were integral to designing spaces that would attract a wide range of these interest groups. These conferencing spaces can have a distinct corporate look that extends beyond the bounds of a healthcare environment and become a link to the business and social community.

Understand patient profile

To start the design process, the designer needs a comprehensive understanding of the area's patient profile. Unlike a large metropolitan hospital where the patient mix may be diverse, a rural area's patient profile may be more specific. The interior design should reflect the patient profile by specifying familiar and culturally relevant materials that will aid in designing a specific experience for the users.

Heart of the Rockies Medical Center in Salida, Colorado, demonstrates their commitment to the city by commissioning local artists

Photographer: Ron Johnson

Heart of the Rockies Medical Center in Salida, Colorado, demonstrates their commitment to the city by commissioning local artists

At a healthcare district in Wyoming, a new rural facility was just completed. This clinic was built for a community that, in the past, had to send patients two hours away for treatment. The design process with a rural community takes a highly personal approach as citizens were part of the planning process. The community pride was evident during the planning stages as volunteers were integral in planning the interior design of the building. These citizens felt the building should reflect the personality of the entire community. This nontraditional planning approach allows an interior designer to focus on what is important to the users and how the facility can improve a community's image. Through a series of meetings, the public requested a Western vernacular that would express itself in a 21st-century facility. The designer accomplished this by focusing on the bold colors of the landscape and selecting finishes that reflected the West. Many patients are adults who work in the oil fields of Wyoming and the community wanted to welcome them in a way that was as big as their state. This translated into vaulted ceilings with wood trusses and slate surfaces. Skylights punctuate ceilings throughout the facility to let the Wyoming blue sky stream in.

Select furniture for modularity

Furniture selection is very important for rural hospitals. The first issue is availability of product and product standardization. Many designers develop their interior concept by selecting aesthetically coordinated furniture that works together but are not matched too closely. To do this, often designers select furniture from numerous manufacturers. Designers for rural facilities should rethink this concept. They should develop a relationship with one manufacturer that they can count on to help solve issues in a timely manner and access products that can be shipped quickly. Selecting a manufacturer that has numerous collections that span all seating and desk requirements from lobby, to high-use waiting areas, to lounges and patient rooms, is important.

The second issue in furniture selection is modularity. Furniture with modular parts allows components to be replaced and repaired easily without having to take furniture out of commission for long periods of time. Replacement often can be done in-house very quickly, and parts can be inventoried to keep maintenance costs down. Manufacturers offer modular seating that can be incorporated into healthcare environments. Specifying systems furniture in lieu of casegoods is also a good solution to modularity and parts replacement.

By engaging patients living in rural Wyoming, the interior designer was able to fully understand and integrate the community's authentic vision for its facility, the Pinedale Clinic

Photographer: Ron Johnson

By engaging patients living in rural Wyoming, the interior designer was able to fully understand and integrate the community's authentic vision for its facility, the Pinedale Clinic

A designer can specify two different fabrics that blend on one chair. The back and arms of a modular chair can be a different fabric from the seat. If this concept is used throughout a facility, when a fabric is out of stock or is discontinued, it is easy to change to a different fabric on a damaged seat or arms without looking like the chair was repaired. Mixing and matching of fabrics will allow greater flexibility and can also offer a more diverse interior palette.

Initiate community art programs

A further difference between metropolitan hospitals and rural facilities is the process for integration of artwork into the interiors. The typical process for a large city hospital is to retain an art consultant who does the selection of the art or artists, and final pieces are approved through an art committee made up of hospital staff and volunteers. Smaller rural facilities typically do not follow this process due to consultant costs and lack of proximity to art consultants. An example of a different process is the artwork selection by a rural hospital in southern Colorado. This facility made a commitment to the citizens of its city to advertise for art submittals from area artists only, for integration into the new hospital.

Staff determined the locations of where they wanted to showcase permanent artwork and also selected one corridor that would become a revolving art gallery for all area artists to show their work. They even opened up the building as a showcase for school children to hang their school projects on a continuing basis.

Instead of hanging permanent art in patient rooms, there is an opportunity to develop a collection of art pieces that are stored on rolling carts, and when patients check in, a volunteer meets them in their room and allows them to select the artwork they want hung in their room for the duration of their stay.

History displays are especially important for rural hospitals. Their demonstration of past, present, and future history can strengthen the bond between the hospital and the community. The way these displays are presented are of particular importance.

This opens the way for the interior designer to play a large role in the design and facilitation of the art program. The designer can help make decisions on where the selected art should go and make sure the finishes, colors, lighting, and signage will accent this location, not deter from the art. The interior designer can also develop the submittal process and act as an in-house consultant for the hospital to aid in selecting and placing the art. The interior designer is particularly important in helping to determine the scale of the art for the spaces.

By using artists that live and work in the area, a hospital can further its outreach mission to the community and the facility can instill a sense of public pride whereby citizens want to visit the hospital to view the artwork, even when not visiting a patient.
The use of regional materials in a Grand River Medical Center in western Colorado provides a more comfortable and inviting experience for local patients

Photographer: Ed Lacasse

The use of regional materials in a Grand River Medical Center in western Colorado provides a more comfortable and inviting experience for local patients

Advocate for sustainable finishes

When selecting finishes, interior designers can be an environmental proponent and educate their rural clients on sustainable interior products. At most rural facilities, the environmental services department is part of the facilities group. This group needs to understand the benefits of using green products. The facility department's advocacy for these products is essential to get the product specified in the project. A major stumbling block to specifying sustainable products is the uncertainty about initial costs, return of the investment, and overall maintenance. One strategy to overcome these obstacles is to work with the environmental staff and have the manufacturers provide mock-ups of the products for the staff to see and work with. They will then understand the products' maintenance and how the products could change the approach the staff takes to cleaning and maintaining the facility. This change in maintenance will benefit the facility and will demonstrate that sustainable products provide a better environment for patients and staff by supporting a healing environment.

Many rural facilities want to procure product from only suppliers in their area to support the economy. Often this is in direct conflict with the general contractor who wants to bid products out to many dealers, often those from a larger city for the best bottom-line cost.

Smaller dealers may not get the same pricing as larger dealers. Interior designers need to determine who will purchase the product and verify what products the area dealers can access for the best discounts. Once that is determined, they can work with the manufacturer's representatives to verify the area dealers will be able to get the same discount as the larger dealers. Again, this will help the hospital in its mission by investing in its community resources and will also assure the designer that his/her specifications will be purchased for the project and not changed due to cost constraints.

The ultimate mission for all healthcare interior designers is to design a building that is a healing environment. This mission should be no different for designers that work on smaller rural projects. Understanding the regional culture is integral to creating a center for community that translates into the client's vision and ultimately reflects the values, beliefs, and philosophies of the people the facility serves. HD

Janette Ray, ASID, is senior associate at Davis Partnership Architects in Denver, Colorado. For more information, e-mail janette.ray@davispartnership.com.
Healthcare Design 2009 June;9(6):12-18