Healthcare Design - June/July 2017 - 30

The final design of the 150,000-square-foot,
$57 million project organizes a comprehensive
service platform for the community. Although
primary care is the heart of the facility, Cherokee Hospital also supports 25 inpatient beds,
four of which are also used for hospice-all in a
linear building layout that answers another specific request from the community: more light.

The team pursued a design that breaks the facility into separate pieces,
which allowed natural light to permeate throughout, with glazing used extensively on the exterior.
Once the team decided on this approach, the next critical step was creating a connection between the various structures. The solution was using a
central concourse as a connecting spine along which the numerous entry doors are located. And while the approach resulted in a perimeter
wall that was 25 percent larger than a traditional rectangular structure
would have required, it also allowed Cherokee Hospital to separate its
hospital occupancy spaces from its outpatient occupancy spaces while
still tying them via the spine. "From the patient's perspective, it's seamless-you wouldn't know any different. But from a design and construction perspective, it was very important because we saved money by not
having the whole building burdened by a certain construction cost,"
Rook says.
To reduce patient and visitor anxiety, the building operations are based
on an onstage/offstage model, with circulation routes for materials, linens, food service, patient transfer, etc., kept out of sight. The emergency
department (ED) entrance is on the opposite side of the campus from the
other entry points so flashing ambulance lights aren't visible. Waiting
areas are open and flow into the central concourse, with ample space for
families as well as fireplaces and other residential design-inspired elements used to deinstitutionalize the space.
The Cherokee interpretation of the Nuka System of Care includes the
elimination of private physicians' offices and collocation of care team
members in the primary care area, with 12 total teams located in an open
environment with specialists assigned to every three teams. On the acute
care side, integrated care teams are also collocated and the layout introduces "talking rooms," where family members can be educated on how to
care for patients after they return home (a common practice to avoid patient transfers to larger medical centers).
"Once we made it through medical programming, we did extensive
programming of cultural elements," Rook says. As part of the process,
Cooper arranged for the design team to visit with various members of
the tribe, including the head of a local museum who put into terms how

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I N T H E D E TA I L S

J U N E /J U LY 2 01 7

Integrated care
teams are collocated
in a patient-centered
medical home model
of care that was
inspired by South
Central Foundation,
an Alaska Nativeowned healthcare
organization in
Anchorage, Alaska,
and its Nuka System
of Care.

TIM BU CHMAN

project," says Phil Yance, vice president of Robins & Morton (Birmingham, Ala.).
In fact, meeting those expectations became a
critical piece of the IPD contract itself, specifically a bonus structure that included a financial
incentive established for the team members
if the directive was achieved. "[We said,] 'We
don't just want you to build us a building; we
want you to build us a beautiful building that the
community absolutely loves, that they claim as
their own, and that helps promote greater engagement from them. And as a matter of fact,
we want to reward you for that,'" Cooper says.
"'It matters less that you're on schedule and, of
course, we want you to be on budget. But what
really matters is the community has to love it.'
And that was the primary driver."
To achieve that, Rook drove a community engagement process that included more than 30
meetings across every township in the tribe's
geographic area during which the team worked
to glean as many details as possible on existing
hassles and stressors associated with the existing campus and barriers to patient engagement,
such as poor parking conditions and limited
access points to the building. And if answering
such requests came at the detriment of operational efficiency or an increased price tag-and
it did-Cooper was OK with that. "We have more
registration desks than we've ever had, more
entrances to the building than we ever have,"
he says. "But we did it because the community
said they wanted to be able to have ground-level
parking close to the entrance that is approximate to the service they want, and they didn't
want to snake through the building to get there."
Part of the community engagement process
also included bringing on numerous local subcontractors to contribute to the project, with
Robins & Morton teaming smaller companies
together to qualify for the job and carving out
pieces of the project for each of them. "Not only
do you have community involvement in [giving]
input on what it's going to look like and the feel
of the project, but also they're the ones who built
the project," Yance says.
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