Reimagining Rural Healthcare Facilities
by High Plains Architects
The One Health Bighorn Campus in Hardin, MT, is more than just a much-needed new health clinic for the greater Bighorn River Valley area. This integrated health center is an example of a new approach to healthcare design that aims to achieve some lofty goals: to be a platform for community wellness, to be intuitively navigated while surrounded by nature and light supporting patient choice, to be flexible and high performing, and to be a local economic driver.
When One Health engaged High Plains Architects on this project, HPA had not yet designed a healthcare facility. Fortunately, the client did not want a typical healthcare facility, instead, One Health was set on redefining healthcare clinic design. To create something new within the healthcare building typology was an exciting opportunity for our team.
Rather than resorting to the usual industry-standard formulas, HPA and the client were open to stepping back and asking some bigger questions around rural healthcare facilities, such as:
How can this building support the holistic health of the community, including its physical, mental, economic, and spiritual health?
There are a variety of cultural backgrounds in Hardin. How do we create a place that is welcoming to everyone within which everyone can identify?
How can this facility build community identity rather than simply be another box in the middle of a parking lot?
How do we create a place that draws people to it for preventative health services?
Most of the work at a health center is prevention-based and therefore, to a large degree, elective. To remove barriers to the community’s use of those preventive services, we wanted to create a building that had an irresistible quality to it. Unlike most healthcare spaces, we provided views outdoors, lots of daylight in all regularly occupied spaces, and no dropped acoustic ceilings or other elements that scream “Institutional!”. The materials are different than many healthcare facilities for two reasons:
Authenticity: There are no materials designed to look like something they are not; we used simple materials and expressed them. Deep down, we don’t think people like being deceived, even if it is just by materials. We believe that people prefer integrity to artifice. With this in mind, High Plains worked with One Health to select materials that contained natural patterns and textures which weather in a pleasing way.
Environmentally-friendly: There are a staggering number of common-use materials that appear on red lists for their toxicity to people and the planet. We avoided almost all materials that appear on red lists, improving the air quality for all occupants.
In terms of site design, the building fronts Main Street rather than being set back behind a parking lot on the outskirts of town. People are more likely to make use of the health center if the building is a part of the everyday life of the community. The siting of the building also elevates walking and biking as a means of getting to the building—it does not presume that patients arrive by vehicle. It’s important that the front door faces the community, not the parking lot.
Creating a high-performing, flexible building was one of the many goals for this project. A high-performance building provides very comfortable spaces while meeting ambitious energy efficiency and water efficiency targets. This is especially important for a rural healthcare facility because healthcare buildings don’t exist to use energy; they exist to serve the health of the community. We wanted to make sure that the One Health Bighorn Campus annual operating budget went to improving health outcomes for the community rather than paying utility bills.
To achieve optimal energy and water efficiencies, the building team utilized design measures derived from both LEED and WELL building standards. This clinic is designed to have a very low EUI (Energy Use Intensity) because of its energy-efficient features. Renewable energy is also generated on-site with rooftop solar arrays making it nearly a net-zero energy building. Water usage is projected to be 45% lower than the building codes through plumbing fixture efficiency.
Providing daylight in every regularly occupied space, including exam rooms, has benefits beyond reducing energy use. Numerous studies demonstrate that daylit spaces without glare improve productivity, mood, and general well-being. Supporting better productivity and mental health is another way that this is a high-performance building.
Daylighting an essential element of a comfortable productive space is not simply a matter of providing lots of glass. Direct sunlight in the wrong place can be a source of glare that actually reduces productivity and brings undesirable heat gain in the summer. Likewise, too much glass can result in unacceptable heat loss in the winter. The key is to admit the right amount of daylight and distribute it evenly. HPA incorporated right-sized windows with light shelves to direct light to the ceiling, projecting light deeper into the building interior as well as strategically locating operable skylights. The results of the design were tested using computational daylight modeling.
Construction of Phase 1 of the One Health Bighorn Campus was recently completed. The Phase 1 building is designed for flexibility, as it will be converted to both administrative offices and a commercial tenant when the future Phase 2 clinic facility is constructed. Exam rooms can be converted to private offices with daylight from the operable skylights while the staff team areas and waiting rooms will become open office areas with views to outside.
Fronting the main street, Center Ave, and occupying a corner of the future neighborhood masterplanned for One Health’s 26-acre property adjacent to “downtown” Hardin, this new clinic is a welcoming beacon to the city. It also acts as the anchor to a new infill neighborhood, promoting mixed-use development, a more extensive Phase 2 that includes more clinic space and an in-house pharmacy, single- and multi-family housing, light industrial uses, and parks! To learn more about this project, visit: https://www.highplainsarchitects.com/portfolio/big-horn-valley-health.