Since passage of the Balanced Budget Act (BBA) of 1997 to provide affordable access to healthcare in rural areas, critical access hospitals (CAH) have continued to grow in importance.

CAHs fill a unique niche in our national healthcare system. They share traits with larger urban hospitals—and often some resources and clinical expertise—yet they are tailored to their individual markets on a smaller scale.

Over the next three blogs, I will look at the characteristics of critical access hospitals, focusing on planning, design, and finance. Below are several points to consider in planning.

Community foundation
Critical access hospitals are often the foundation of a community, and architecturally stand alongside the courthouse, fire station and town hall as prominent civic buildings that residents point to with pride. Plan your hospital to be a point of pride.

With 25 inpatient beds per facility and located within a 35-mile radius from the next nearest hospital, CAHs generally are planned as a single-story building that unfolds horizontally on its site. Whether a replacement hospital on a greenfield site or a remodel in a downtown setting, CAHs should be designed with expansion in mind to maintain efficient space flow in the short and long term.    

Because CAHs have a smaller staff, caregivers often are cross-trained at the top of their licensure to multitask as needed. Nurses can be trained to cross departments, such as ED/patient unit, and more universal spaces can flex back and forth, such as flexing prep/recovery rooms with ED/exam rooms. Space sharing means standardizing spaces to allow maximum flexibility from department to department.

Departmental adjacencies
The need for cross-training and flexibility impacts departmental adjacencies. By organizing patients around like experiences and activities, you can plan spaces that logically flow from one to another, such as the emergency department next to radiology next to surgery, for efficiency and discrete patient flow.

Additionally, many CAHs have adjoined clinics, long-term care facilities, or acute rehabilitation centers. Planning with shared resources in mind allows you to support efficiency.

Physician recruitment/retention
“If you build it they will come,” the saying goes. But, in fact, the logic behind planning a CAH is to attract and retain top physicians and caregivers seeking a small-town lifestyle. A well-planned, state-of-the-art hospital allows caregivers to do their best work.