Like other rural facilities across the county, Ty Cobb Healthcare System (Royston, Ga.) felt the pressures of providing rural healthcare in a modern age: rising costs, funding shortages, increasing competition, and a shrinking medical staff population.

According to the National Rural Health Association, only about 10 percent of physicians practice in rural America despite the fact that nearly one-fourth of the population lives in these areas. Faced with these challenges, many rural healthcare facilities decide to close their doors or consider affiliating themselves with a larger system.

In Georgia’s northeast counties, residents were being served by two regional hospitals: the 71-bed Cobb Memorial Hospital covering Franklin County, and Hart County Hospital, an 82-bed facility, which started as an independent facility until its board signed a lease and management agreement with Ty Cobb Healthcare System.

By 2008, these two competing facilities, which were both operated by Ty Cobb Healthcare System, were losing a combined $6 million a year.

The operator hired a financial firm that concluded that the facilities, with duplicate services, could better serve the population—and be profitable—by consolidating into one. Earl Architects (Greenville, S.C.) was brought in to do master planning and found the outdated buildings and their remote sites too costly to renovate. “It was pretty obvious to us that they needed a new hospital,” says Rick Earl, president, Earl Architects.

But that wasn’t the only obstacle. The hospitals were losing physicians, particularly specialists, which was driving more patients to seek care at outlying urban facilities. Recruiting physicians back to the rural hospital was going to be costly, so the hospital board eventually decided to try to sell or partner with another organization. However, medical development company MPA of Georgia (Atlanta), proposed another solution: creating a partnership model that included a physician ownership group serving as the majority owners of the new facility. Ty Cobb Healthcare System would own the certificate of need and license for the Ty Cobb Regional Medical Center (the operating company and tenant).

Larry Unger, CEO of MPA of Georgia, says the ownership model solved a number of issues, starting with the lack of available funding when the project was getting off the ground in 2009. Having doctors buy into the hospital and serve in the market, rather than the hospital hire them, created the needed equity for project financing and brought specialists back to the area.

The physicians also financed an adjacent medical office building (MOB), Ty Cobb Physicians Center 1. “We made that entire medical office building and a portion of the hospital business occupancy, so it operates at a lower cost than the core hospital,” Unger says. “It looks like it’s all part of the integrated hospital, but that entire section of that building complex is separated.”

A third business, Clear Creek Investors, was created so the physician group could also buy 25 acres of ancillary land on the site. This saved money during Phase 1 by allowing the minimum amount of land to be purchased for the present-day construction project, while looking ahead to future growth.

Construction began in 2010 and the new Ty Cobb Regional Medical Center was completed in July 2012, in Lavonia, Ga. The facility includes a 56-bed, 155,000-square-foot hospital and a 35,000-square-foot MOB, which houses a dining room, wellness center, and administrative services on the first floor.

Home base for community care

From the start, the design team focused on creating a place for community that would become a destination for healing, as well as wellness and learning. “That’s the future as it relates to the community hospital,” Earl says. “It’s not just a place for people to go when they get sick.”

That message is apparent right from the building approach, where designers preserved an existing ravine and created a tree-lined boulevard entrance on the 39 acres of former pasture land. The facility is situated at the highest point on the property, and has a curvilinear shape and glass façade that allows views and natural light to filter into patient rooms and common spaces.

Scott McFadden, vice president and director of design, Maregatti Interiors (Indianapolis), says the glass structure also helps blur the line between the interior and exterior, creating a great connection to the outdoors. “We wanted to make sure that it has an overall comfortable feeling,” he says.

In the two-story glass lobby, finishes and materials reflect the rural area while two large-scale, backlit panels filled with images of Georgia’s natural surroundings introduce the facility’s color palette and graphic imagery. Each area of the hospital has its own identifying color palette for artwork, furnishings, and related imagery, including blue and green in the two medical/surgery units, violet in the women’s health center, and amber tones in the first-floor ICU.

Within these departments, complementary paint and textured wallcoverings are used on the interior corridors, which are set up in a racetrack layout, with the more saturated colors on the interior wall. “It’s a subtle way to make you look toward the inside wall, as opposed to looking inside patient doors, and provide patient privacy,” McFadden says.

The design team also introduced all-private, acuity-adaptable patient rooms. The use of inboard toilet rooms allows space for floor-to-ceiling windows to further blur the line between exterior and interior while creating views to the outdoors and bringing in natural light.

Team effort delivers artwork

Working with art consultant Interior Design Concepts (Hopewell, Ga.), the design team sent out a call for local photography submissions, with several hundred images chosen to be framed and hung inside the hospital and MOB. In addition, a local artist used an assortment of found objects, including wood and metals, to reference the area’s local lakes through two fish sculptures for the main lobby.

“Those are the things that can ease anxiety and make you feel a little more comfortable,” McFadden says. “A lot of people will seek out art pieces, or stumble across one from someone they know, and that might give them some comfort.”

The piece that makes the biggest statement, however, is the one that pays homage to the hospital’s namesake. Toward the end of his life, Ty Cobb made a $100,000 donation on his parents’ behalf to build the original 24-bed Cobb Memorial Hospital in Royston, Ga., which operated for nearly 60 years. “We wanted to make certain that [the reference] was a major feature, but we didn’t think it felt appropriate to bring it into the patient units,” says McFadden.

The solution was a 30-foot-long-by-16-foot-wide digital wall graphic that hangs in the dining room and is visible as you approach the building via a wall of windows. The sepia-tone piece incorporates images of Cobb himself, supplied by the Ty Cobb Museum, along with his autograph and quotes that carry a healthcare-related theme: “I regret to this day that I never went to college. I feel I should have been a doctor.”

“It becomes a bit historic in nature in that way,” McFadden says.

Focus on the future

Unger says more than 80 physician partners have invested in the facility, showing its viability as a strategy for rural healthcare going fo

“It demonstrates that rural communities can turn themselves around and have a future, not based on handouts but based on public/private collaboration and never-give-up ingenuity,” he says.

In the past year, the Lavonia City Council has also voted to rezone an area around Ty Cobb Regional Medical Center as a medical campus district in the hope of attracting more specialists and medical-related businesses to the area.


“For a source list relating to this project, see “Ty Cobb Regional Medical Center: Project Breakdown.”

Anne DiNardo is senior editor of Healthcare Design. She can be reached at