Building the rural hospital of the future

July 31, 2010 by David Hamill and Byron Edwards, AIA, ACHA, LEED AP, III
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Reorganizing and reinvesting to bring 21st-century medicine to a rural community
Hampton Regional Medical Center: 2008 image of new hospital concave-shaped front façade and arcade, front door entrance canopy, drop-off to the right, and outdoor dining area to the left. Patient bedrooms are on curved floor above with family lounges at both ends. Metal-clad structure is above dining area
© Warren Lieb

Hampton Regional Medical Center: 2008 image of new hospital concave-shaped front façade and arcade, front door entrance canopy, drop-off to the right, and outdoor dining area to the left. Patient bedrooms are on curved floor above with family lounges at both ends. Metal-clad structure is above dining area

In the 1930s, South Carolina State Senator James Warren, State Representative J. Morrison Tuten, and a number of dedicated citizens embarked on a 20-year dream to secure a hospital for the citizens of Hampton County. Using the 1946 Hill Burton Act Financing and Design Book Criteria, that dream was realized in 1950: Hampton General Hospital was dedicated by the then-governor of South Carolina, Strom Thurmond, at a total construction cost of $283,000.
1950 image of the original Hampton County Hospital shortly after its dedication. Hospital was designed using Hill Burton Act Funding and associated Design Guide
1950 image of the original Hampton County Hospital shortly after its dedication. Hospital was designed using Hill Burton Act Funding and associated Design Guide

Like many rural county-owned hospitals, by the mid-1980s the hospital was showing signs and symptoms of systemic malaise due to the slowing economy, rising costs of healthcare delivery, decreasing reimbursements, antiquated facilities, and a lack of qualified leaders and healthcare professionals. By 1993, it appeared the only practical solution was to close the financially troubled hospital.

Today, Hampton Regional Medical Center (HRMC) is a thriving private, not-for-profit 501(c)3 corporation with new leadership and a brand-new 82,000-square-foot, $23.8-million, state-of-the-art facility (built for a total project cost of $32 million) in rural Varnville, South Carolina. HRMC successfully completed this project and achieved a financial turnaround in spite of the fact that Hampton County is one of the poorest counties in South Carolina, a state with historically low national economic rankings. Moreover, HRMC has continued to grow during the current economic crisis, which has hit rural communities particularly hard. The story of HRMC's remarkable transformation is a model for rural community hospitals across the country that are struggling to achieve a successful outcome. It shows that if a small rural hospital is well-managed and driven by a demand for quality, it can not only survive, it can thrive.

Seven critical lessons

There are seven critical success factors behind the transformation of Hampton General Hospital into a 21st-century healthcare institution:

  • Restructuring as a not-for-profit private corporation

  • Community support for the new organizational structure

  • Strategic planning

  • Physician recruitment

  • Investment in the latest medical technology

  • Effective governance structure comprising a community-based voluntary board of directors

  • Effective financial management

In fact, the single most important step was the legal reorganizing of the hospital from a county-managed facility to a not-for-profit private corporation in 1996.

There are many successful county-owned hospitals. However, it is often the case that the management of small hospitals, say, 50 beds, in small rural communities of 20,000-40,000 people is often highly politicized. In these cases, reorganization of the hospital as a private entity enables the board and administrators to make objective business decisions and manage the hospital to achieve success in today's healthcare environment.

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