Healthcare Design - June/July 2017 - 27

TIM BU CHMAN

The patient experience had deteriorated
over time due to the organization's financial struggles as well as the facility's status
as a safety-net hospital, which Cooper says
contributed to a community perception
that quality of care was low. However, when
hospital leaders conducted an assessment
of primary care teams, they found numerous quality measures ranking in top percentiles nationally. So Cooper and his team next
turned their attention to the physical environment. "It was a nice facility in the '80s,
but it was certainly dated. There was nothing
uplifting about it. As a matter of fact, it was
described by the community as being like a
bunker or cave. There wasn't much access to
natural light ... it exacerbated the stress that's
normally associated with a clinical facility,"
Cooper says. It was also based on a providercentric model, with patients held in large
waiting queues and moved linearly through
processes on a first-come-first-served basis.
Hospital leaders decided that a replacement facility was needed where the opposite
environment could be created, ultimately
opening the new Cherokee Indian Hospital
in October 2015. But to get to that point, they
first turned to South Central Foundation, an
Alaska Native-owned healthcare organization in Anchorage, Alaska, for inspiration.
South Central Foundation won a Malcolm
Baldridge National Quality Award in 2011 for
performance excellence and uses a patientcentered medical home model of care.
Cherokee Hospital staff, executives, governing board members, and tribal leaders
flew to Alaska in 2012 to see South Central
Foundation's operational system, the Nuka
System of Care, in action. The system is supported by a design concept that eliminates
physicians' offices and collocates clinical
care teams, including doctors, nurses, and
support staff, in a bullpen where they're in a
state of constant huddle and share access to
specialists such as behavioral health therapists, dieticians, and clinical pharmacists.
"The patient no longer gets a referral to go
across town to enter another linear system.

LEFT: The main entrance is noted
by a 45-diameter oculus that was
inspired by the work of a local
basket weaver. "It's a way of
communicating to the community
that it's their facility, it belongs to
them and is consistent with the
collective culture we have," says
hospital CEO Casey Cooper.
ABOVE: Structural detailing on
the exterior showcases a tree
concept that's applied throughout
the building. BELOW: The facility
features an extensive amount of
glazing in response to community
requests for architecture that
accentuates the beauty of the
natural environment present in the
Great Smoky Mountains locale.
PREVIOUS PAGE: A central spine
connects the various building
components. A "River of Life"
graphic element is introduced in
the terrazzo flooring, conveying the
evolution of the Cherokee through
imagery of local flora and fauna.

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Healthcare Design - June/July 2017

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