How Design-Assist and Lean 3P Shaped Citizens Medical Center’s New Kansas Hospital

The 171,000-square-foot facility replaces a clinic and critical access hospital to address shifting patient volumes and rural healthcare needs.

Published: June 16, 2026By Robert McCune

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By the time construction began in November 2024 on the new Citizens Medical Center in Colby, Kan., the project had evolved dramatically from its original scope. Over eight years of master planning and design collaboration, what began as a proposed expansion of the existing facility transformed into a replacement greenfield hospital.

The original rural medical center, opened in 1981, comprised two disconnected, space-constrained facilities: a 63,000-square-foot critical access hospital and a 19,000-square-foot health clinic. “We were so out of space as an organization that we’d turned every closet into offices,” says David McCorkle, CEO of Citizens Health (Colby, Kan.), a not-for-profit health system.

A 2016 facilities master plan revealed that the flagship medical center was not only undersized but misaligned with changes in care delivery. Since the 1980s, the facility’s volume had flipped from 80 percent inpatient to 80 percent outpatient, McCorkle says. This surge in outpatient demand was compounded by larger regional hospitals shuttering departments to cut costs. “More and more people from outside of our local community and our region were relying on us,” he says. “In a rural region of Northwest Kansas, sometimes those needs are great. We have patients who will travel to us from over an hour away to deliver a baby because we’re in an obstetrical desert.”

To address these shifting needs, the organization initially focused on expanding the facility’s footprint. Citizens Health hired HFG Architecture (Kansas City, Mo.) to renovate the hospital’s entrance, admissions, and receiving areas in preparation for a future addition that would connect the hospital and health clinic buildings and expand services at both. Completed in 2019, this enabling work became a “turning point,” which would put the project on a different path, according to David Wright, CEO of HFG Architecture and principal in charge of the project.

Why did Citizens Medical Center shift from an expansion to a replacement facility?

Specifically, the modern design of the new entry raised expectations, prompting the hospital’s Board of Trustees members and staff to question why the entire facility couldn’t meet the same standard. Furthermore, as the project team reexamined the client’s future needs, the structural and spatial limitations of the 1981 facility became apparent.

“The floor plan had evolved over decades into a layout that was difficult to navigate; the facility literally had colored lines on the floor to direct patients to different departments,” Wright says. “The existing clinic was too small and difficult to remodel; for example, there was no space for an MRI, which was a critical addition. Every time the team turned a corner, something was not flexible enough to accommodate the client’s new strategic vision.”

Confronted with the limitations of its existing facilities and the evolving needs of its patient population, Citizens Health shifted its strategic focus toward constructing a replacement hospital on open land south of the current campus. The approach would minimize disruptions to ongoing services while accelerating the project timeline. According to McCorkle, the project team estimated that a complex, phased expansion of the existing hospital would take at least four years, whereas a new facility could be completed in roughly half that time.

“There’s a premium that you pay for a new facility, but that has future impacts. For one, you’re not dealing with 40-year-old sewage pipes and some of those things that are difficult to replace under an existing structure,” he says. “We fell in love with the idea of a new facility for a multitude of reasons.”

To finance the new facility, Citizens Health secured a Community Facilities Direct and Guaranteed Loan through the U.S. Department of Agriculture’s (USDA) Critical Access Hospitals (CAH) program, which offers low interest rates for the entire loan and long repayment terms (up to 40 years to repay in some cases). “The USDA has become adept at understanding how critical access reimbursement works,” Wright says, adding that in the rural Midwest, roughly 50-70 percent of CAH loans are paid back through Medicare.

The project marks one of the nation’s largest hospitals funded through the CAH program, which requires a guaranteed maximum price (GMP) because of the unique financial and operational risks associated with critical access hospitals. To meet that requirement, McCarthy Building Companies (Kansas City, Kan.) was selected as the construction manager at risk, assuming responsibility for any cost overruns beyond the GMP. Additional oversight from the USDA reinforced the need for a design-assist delivery approach, which relies on early and ongoing collaboration between the design team and construction manager to control costs and maintain budget alignment. Wright says the design-assist method proved essential, and likely the only viable path forward, given the project’s evolving complexities and significant inflationary pressures that followed COVID-19.

The new medical center opened in January, serving as the only hospital in the more than 300 miles between Hays, Kan., and Denver providing comprehensive family care. The critical access hospital supports 42 medical specialists and includes a full-service emergency department (ED), inpatient beds, a surgery department with an orthopedic focus, clinic, and support services such as dietary, laboratory, radiology, physical therapy, and oncology.

Efficient design and key adjacencies in facility layout

To achieve efficiency in the design of the greenfield project, the team undertook a Lean 3P process that engaged end-users, including Citizens Health doctors and nurses. Before construction began, the team worked collaboratively to build full-scale mockups of critical clinical spaces, enabling stakeholders to test layouts, adjust room adjacencies, and refine workflows in real time. This participatory approach ensured the finished design was grounded in actual staff needs and patient flow.

“We took giant sheets of cardboard and sticky notes and built full-size, three-dimensional mock-ups of various spaces, such as exam rooms, patient rooms, the ORs, trauma rooms, even the entire emergency department,” says Project Architect Amy Helman, healthcare architect at HFG.

The project team also used the models to run patient drills, McCorkle adds. For example, staff simulated transporting patients to and from various departments for treatment to measure the steps and time required.

The modeling efforts directly influenced a shift from a single-story footprint to a 2-story clinic on the building’s front west side, intentionally clustering outpatient services for maximum efficiency. The first floor houses high-traffic offerings such as a physical therapy gym, urgent care, lab, and retail pharmacy, while the second floor accommodates outpatient surgery, wound care, infusion, and oncology.

Meanwhile, the single-story east side is dedicated to inpatient services with 25 private patient rooms and a labor and delivery suite twice the size of its predecessor. At the back of the building, the emergency department benefits from its own entrance and direct connectivity to the surgery and imaging departments.

How can building design support hospital navigation?

Prioritizing key departmental adjacencies—such as radiology’s connection to surgery—drove a layout centered on a distinctive concave spine. This curvilinear design optimizes operational flow and visually breaks down the 171,000-square-foot facility, which is more than double the size of the original buildings.

To ensure the expansive new medical center feels welcoming, the curved space between the wings is designed to evoke a “warm embrace,” says Katie Pruser, interior designer at HFG.

Inside, intuitive wayfinding assigns each department a color represented through locally inspired biophilic art, such as combine harvester imagery in shades of yellow for physical therapy. “That imagery is how people create attachment to those spaces and how they remember where they’re supposed to go,” she says.

The building shape also establishes a flexible framework for future growth, which was a priority established by the client. “From a planning standpoint, the curved form creates natural zones along its length, giving each department a clear address along the spine while allowing future wings or expansions to extend outward from the main circulation path,” Wright says.

Ultimately, the dynamic architecture embodies Citizens Health’s commitment to adaptable, patient-centered care. As McCorkle notes, “Years from now, the people leading this organization are going to say, ‘That was really forward-thinking to be able to design a space that has the ability to change when it needs to.’”

Why use design-assist on healthcare projects?

Early in the project inception, HFG selected McCarthy Building Companies (Kansas City, Kan.) as construction manager at risk to help accelerate delivery of the new Citizens Medical Center in Colby, Kan.

Leveraging a design-assist approach, the team brought the construction manager onboard early in preconstruction, allowing for real-time cost estimation, in-depth design reviews, and value engineering proposals that optimized speed and project outcomes.

The design-assist delivery method proved critical for navigating steep inflationary pressures, which drove construction costs to fluctuate by up to 20 percent, according to David Wright, CEO of HFG (Kansas City, Mo.) and principal in charge of the project. By involving the construction manager early, the team could respond to real-time budget challenges, swiftly implementing layout efficiencies that reduced the overall building size from 190,000 to 171,000 square feet.

For example, reconfiguring the surgery department’s pre-op and post-op spaces and designing a central sterile equipment core accessible to all four operating rooms streamlined workflows. The move also cut that department’s footprint by around 20 percent, directly supporting cost control without sacrificing operational effectiveness.

Early integration of the construction manager also enabled the project team to develop multiple construction packages for bidding and procurement before design documents were fully complete, streamlining the overall schedule.

Josh Jazwick, project manager at McCarthy (Overland Park, Kan.), says securing trade partners’ buy-ins and locking in equipment and materials ahead of construction significantly accelerated project delivery. “Being able to plan our resources out and make sure we’re getting material set aside and qualified people on site when we need them meant none of that was going to be a sticking point later,” he says.

Robert McCune is senior editor of Healthcare Design and can be reached at [email protected].

Citizens Medical Center project details

Location: Colby, Kan.

Completion date: December 2025

Owner: Citizens Health

Total building area: 171,000 sq. ft.

Architect: HFG Architecture

General contractor: McCarthy Building Companies, Inc.

Engineer: Farris Engineering, BHC Engineering, Apex Engineering

Medical equipment planner: McCarthy Equip

Project details are provided by the design team and not vetted by Healthcare Design.

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Caption: The main entry of Citizens Health Medical Center features a broad metal canopy supported by wood tone-accented columns, floor-to-ceiling curtainwall glazing, and a curved stone façade with signage, creating a clear, weather-protected arrival zone for patients and visitors.