The Eastern Band of Cherokee Indians has occupied its existing healthcare facility for 45 years. In 2002, the tribe took full ownership of healthcare operations from the Indian Health Service and by late 2013 began an ambitious program to replace an existing facility and significantly improve and expand services for its population located in the remote mountains of western North Carolina.

Ownership was determined to pursue innovative methodologies in operations, design, and construction and decided to contractually unite the owner, architect DesignStrategies, and builder Robins & Morton through an integrated project delivery contract. Simultaneously, the owner wished to adhere to evidence-based design principles and established tools to measure the outcomes upon completion of the project and post-occupancy.

The new Cherokee Indian Medical Center consists of a 150,000-square-foot ambulatory care facility and 20-bed inpatient facility. The first floor provides for a Level II trauma center/emergency department, a radiology department, a physical therapy area with orthopedics and wound care treatment areas, and ample conference/training space.

Of particular importance to the Cherokee is the pharmacy, which is designed with drive-through capability; however, it’s the outpatient clinic that was the key design driver. After touring innovative Native American hospitals in Alaska and Oklahoma, the administration committed itself to the concept of integrated care teams (ICTs) in lieu of a traditional department structure.

The Cherokee are both the patients and the owners of the hospital, so the commitment to improve the health of a defined group of patients has very real consequences to the mountain nation. The ICTs are housed in open office areas consisting of physicians, nurses, social workers, educators, and various specialists distributed through 12 ICT teams. Each ICT is responsible for a specified cohort of patients whom they’ll follow from cradle to grave.

The second floor houses a laboratory; eye clinic; complementary medicine (including message therapy and acupuncture); a 20-station, full service dental clinic; central sterile; administration; and a two-room procedure suite. The second level also features 20 inpatient beds and includes flexibility for two hospice rooms.

The inpatient rooms have sweeping views of the mountain peaks, which are a crucial part of Cherokee life and culture. A garden level provides a cafeteria and kitchen, a cooking demonstration area, and outdoor dining, also oriented to the optimum mountain views. Support services and mechanical/electrical systems are located on this level, as well.

A motto is displayed throughout the existing hospital in the Cherokee language for all the community to see. The saying says: “It belongs to you.” The new replacement hospital intends to inspire the Native American community to fully identify with this center of health and healing as truly their own.