Gualala Community Clinic for Redwood Coast Medical Services in northern California.
CHALLENGES IN RURAL AREAS
As the national healthcare dialogue turns toward wellness, healthcare organizations are identifying new strategies to meet the needs of underserved markets. Rural areas, in particular, often lack basic resources taken for granted in urban areas.
For instance, building new facilities can be challenging in rural areas with limited construction equipment, materials, and labor. There are fewer contractors in rural areas and most generally do residential work, not complex healthcare work. The lack of competition drives up construction costs and bids in regions where budgets are tight.
Keeping up with technology and diagnostic equipment also can prove challenging. Broadband services can be spotty, potentially impacting advancements in electronic medical records, telemedicine, teleradiology, and communications. Upgrading diagnostic equipment can be financially prohibitive for small, independent healthcare organizations, and it is often difficult for to comply with current mechanical codes that dictate sophisticated systems for urgent care and other specialized services. Servicing those systems can be problematic due to a dearth in local capabilities.
Many rural areas additionally tend to have high poverty rates and greater disparity between rich and poor. Some rural areas attract affluent retired people living alongside long-time local residents. Retired residents require more health services as they age. Poorer people develop chronic health issues because they cannot afford services or lack access to services.
While these issues impact wellness, population health management and physician/caregiver recruitment, they also offer opportunities.
By researching their markets and identifying population health needs, healthcare organizations can increase services. Many organizations can tap into various government programs geared toward rural and underserved communities to raise funds for capital improvements, including the Patient Centered Medical Home-Facility Improvement (PCMH-FI) Grants under the Affordable Care Act. Additionally, collaboration with larger systems allows smaller organizations to access specialized expertise and resources, such as advances in telemedicine, virtual diagnostics (teleradiology), and even telesurgery. Also, access to helicopter services can support rural clinics that often stabilize patients for transfer to regional medical centers offering a full array of services.
OPPORTUNITIES THROUGH LEAN PLANNING
Lean planning allows rural organizations to do more with less, which converts to a smaller footprint, less square footage, less material, less energy usage. For instance, standardized space planning organizes services around similar activities, with universal spaces designed to flex according to needs. Open workspaces arrange physicians and administrative services within shared spaces, reducing the number of private offices and consultation rooms while promoting collaborative care. Patient self-rooming enhanced with touch-screen technology allows patient to check themselves in, eliminating the need for large waiting rooms. And sustainable operations promote energy-efficient infrastructure and renewable resources, reducing energy costs.
Together, these strategies create a more efficient, cost-effective facility in regions where construction fees are typically higher.
Yet the most important step is to plan a facility that truly reflects the community. Including the community in the planning process builds a sense of ownership. Targeted services ensure community needs are met. Locally harvested materials that reflect the region's architectural heritage create a sense of historic permanence. When the community has ownership, they will use the facility. The facility then is more than just architecture--it is a mission that truly serves the community; it is a community asset and beacon to all, a multiuse platform for wellness, prevention, education and exercise programs, and even a social gathering place for community everts such as the farmer's market.
A CASE STUDY IN QUALITY CARE
Community input certainly guided the planning of Gualala Community Clinic for Redwood Coast Medical Services (RCMS), which fills service gaps in the coastal town of Gualala in Mendocino County, California. The idyllic setting between the Pacific Ocean and the Garcia River Forest is designated a Health Professional Shortage Area and a Rural Frontier Medical Service Area. The diverse population includes high- and low-income patient groups, young families, and retirees.
The planning process focused on several objectives:
- Include the community in the planning process.
- Envision the clinic as a community landmark that is inspired by place and history.
- Celebrate health, wellness, preventive care, and education.
- Foster integrated care via patient-centered medical home model.
- Address population health, experience of care, and per capita cost of care.
- Improve patient throughput, reduce waiting, and enhance patient satisfaction.
- Integrate technology to support virtual exam rooms and connect with specialists via telemedicine.
The planned 23,000 square-foot primary care clinic includes 20 exam rooms, nine urgent care bays, imaging, minor procedure rooms, conference center, and airlift to a nearby hospital for acute care.
The clinic architecturally blends with the rural setting on a 10-acre site. The horizontal massing stretches along the foothills. The undulating roof pattern reflects the undulating mountain range nearby. The durable and resilient fiber cement "skin" resembles wood siding used extensively in the area, and interior finishes recall regional flora, fauna and redwoods in the coastal location. Large windows overlook the forest to one side and ocean to the other. The new clinic is truly a state-of-the-art facility that architecturally belongs to the rural community and is very much a major part of its fabric and history. When completed, the clinic will promote recruitment of top physicians and strengthen quality service in this underserved region.
Ultimately, keeping patients out of hospitals is the overarching goal--and that is achievable through a focus on wellness and better health.