Improving Patient Care: The Intersection of Culture and Evidence-Based Design

To improve the quality and access to care for Native American communities, the Indian Health Service (IHS) has created two new state-of-the-art healthcare facilities: Kayenta Health Center located in northern Arizona on the Navajo Nation, and Ft. Yuma Health Care Center located on the Arizona-California border to serve the Cocopah and Quechan tribes.

Both facilities prioritize preventative care, contradicting the perceived hierarchy of medicine and inpatient care over outpatient and therapy services. Instead, each facility emphasizes cultural traditions, as well as current trends and theories of health care that put Wellness first. This session, presented at the 2018 PDC Summit in Nashville, considered these two case studies to demonstrate how evidence-based design, a cultural understanding of wellness, and state-of-the-art health care can intersect to improve patient outcomes and support IHS’s mission to keep people healthy.

The Kayenta Health Center embodies Wellness on multiple levels, and couples traditional cultural perspectives of healing with current wellness trends. The 182,000sf hospital serves the local Diné community, integrating the community’s significant cultural perspective of “Hozho iina”, translated as “balanced and good life”, and providing a spectrum of outpatient and inpatient care.

To support the Indian Health Service’s mission to keep people healthy rather than focusing on disease treatment, the Wellness Center, community health, physical therapy, and health education functions are located at the main entrance. This placement emphasizes cultural traditions and current healthcare trends that view staying healthy as the first line of defense.

Similarly focused on a proactive rather than reactive approach to health and disease, the Ft. Yuma Health Care Center is designed to support IHS's chronic care initiative and Lean processes. The new 76,265sf facility provides health care to Tribal members residing in southwest Arizona and southern California, bringing a larger staff, new medical equipment, and services previously unavailable on the reservation.

Because the local population has a high prevalence of chronic disease – including uncontrolled diabetes, hypertension, and hyperlipidemia – the facility leadership adopted a Chronic Care Model that guided the design of the entire outpatient facility, with a 22-exam room outpatient clinic at its core. High priority is given to the proximity and interrelationship of the primary care clinic to the physical therapy and Wellness department in order to boost cross-referrals and enhance physical fitness in the treatment and prevention of chronic diseases.

The east courtyard in the center of the building is also a key feature of the building design. The concept for the courtyard is the river, a common thread for both the Quechan Tribe with its largely agricultural community and the Cocopah Tribe known as the “river people”. The courtyard takes advantage of the climate, offering an excellent opportunity for waiting, gathering, and even therapeutic and administrative functions to take place outside.

To learn more about Dekker/Perich/Sabatini's healthcare projects, see What We Create.

Co-Presented by:
Bill Sabatini, FAIA, FACHA - Principal, Dekker/Perich/Sabatini
Max Parrill, ACHA, LEED AP BD+C, WELL AP - Principal, Dekker/Perich/Sabatini
Deswood Etsitty - Healthcare Facilities Planner, Indian Health Services