There’s a poster I’ve seen a number of times that says, “All I need to know I learned in kindergarten.” It reminds us of a number of life’s basics, starting with “share everything” and “play fair.”

Not only are these good reminders for life, they’re a very good starting point for right-sizing the rural hospital. In particular, the constraints placed on the small rural hospital in terms of size, staff, and budget make “share everything” a critical part of design success.

When done well, sharing resources allows for a better patient experience, improved staff efficiency, and wise use of limited budget resources.

The sequence of welcoming patients and families to the hospital, helping them find the right department, completing registration, and bringing the patient to the point of service is a tough assignment for any hospital. For larger facilities, this sequence will include multiple locations where patients and visitors interact with volunteers and staff.

Efficiency within individual departments means that the optimal situation is for visitors to arrive at the department’s “front door” without staff having to walk patients back from distant locations.

The sequence can quickly become staff intensive, with a poor layout necessitating additional staff to orient visitors. The “right-sized” rural facility cannot afford to add resources when sharing is possible.

The design process for a new rural hospital should include careful attention to how patients are welcomed and directed to a point of service. Opportunities for sharing abound, though they will differ from facility to facility.

Registration positions can be arranged to allow staff to support both ER and outpatient registration.  Welcome desks for laboratory, surgery, and imaging can often be shared.  Gift shops can be configured to allow volunteers to also welcome visitors.

Looking for the best places to “share” is easiest when focusing on the patient side of the hospital experience. For instance, finding one welcome desk is almost always easier for a visitor than sorting through separate locations for multiple departments.

Good design should rely on a smiling, welcoming, face to help orient visitors—and then work to minimize the number of places that this is needed.

From a staff standpoint, finding the right places to share resources can be more difficult. Staffing a shared welcome desk can necessitate more intensive staff cross-training. The location of the shared resources must be as conducive to the efficient operation of the department, as if it were dedicated for the sole use of that department.

Differences in processes between areas must be worked through.  However, the successful navigation of these issues can offer a number of benefits.

The budgetary savings obviously help the entire facility. Sharing architectural resources can do more than produce budget savings, however—it can lead to greater consistency in interacting with the public, simplify case management and quality control processes, and even allow investment in better facilities since fewer need to be developed.  

For any rural facility, budget and practical constraints will make sharing a requirement. For the “right-sized” and well-designed facility, this sharing can be more than just a necessity, it can bring benefits.  Turns out that kindergarten teacher was right!

Michael Speck, AIA, is an architect with Johnson Johnson Crabtree Architects in Nashville, Tennessee and can be reached at