A Pilot Mixed Methods Reimagination of Rural Critical Access Hospital Design Process

Abstract

Purpose

A pilot mixed methods facility environmental evaluation of a rural critical access hospital in Montana coupled with qualitative community interviews to identify areas of convergence and divergence of meaningful design changes to enhance hospital operations, service line offerings, and access.

Background

Montana is the fourth largest state with a population of approximately one million residents. Most Montana residents live in geographically isolated rural or frontier communities with chronic healthcare provider shortages and critical access hospitals closing or at risk of closure. As many rural hospitals undergo renovations, there is a need for a holistic approach to align facility and community needs in an interpretable manner to both design teams and hospital leadership.

Methods

Environmental evaluation was conducted using checklists for seven indicators of facility health: lighting; air quality; noise; infection control/prevention; information security; travel and wayfinding; and supply management. In tandem, qualitative semi-structured community resident interviews were conducted. Findings were synergistically interpreted in partnership with a community advisory board and hospital leadership.

Results

Of the seven environmental indicators, noise and lighting were most significant to local resident perspectives and attitudes to accessing care at the hospital. Residents noted the need for heightened safeguards to support privacy and confidentiality when individuals and family groups are familiar with one another in small towns.

Conclusions

Findings in this study suggest rural healthcare facility design teams may benefit from a mixed methods approach and use of a rural culture-specific guiding conceptual framework to align decision-making with meaningful changes to enhance community engagement.