Siloam Health, a charity-funded, nonprofit healthcare organization focused on serving Nashville’s uninsured and underserved immigrant population, has evolved from a volunteer organization operating from a 1,000-square-foot apartment to one that comprises two-sites, 50 staff members, and 500 volunteers. In its nearly 30-year history, the organization has seen its population base change as well, and today 90 percent of its patients foreign-born and speaking more than 70 languages.

During the session “The Importance of Culturally Inclusive Care,” at HCD Virtual, speakers Dr. Morgan Wills, president and CEO at Siloam Health, and Lori McGillberry, managing principal at Kilter LLC, discussed the organization’s evolution and its newest outreach clinic, opened in spring 2020, to talk about culturally inclusive care and the design strategies that can support it.

Wills said the first element of culturally inclusive care is that “it’s responsive to community needs.” Furthermore, he encouraged people to think of it as a subset of whole-person care, helping to address not just the physical but also the social, emotional, and spiritual wellness of patients. Another key, he said, is that culturally inclusive care creates a hospitable space. “This is done literally in its structure and design elements and figuratively through the provision of services,” he said.

Siloam Health faces several challenges related to delivering care to a culturally diverse population, including language barriers, different medical problems (such as leprosy, Tuberculosis, or infectious diseases not seen in the general population), and cultural dynamics, such as certain populations being less trusting of doctors who ask a lot of questions during the diagnosis process.

In response, Wills said the organization has focused on creating a place “to be seen and heard,” through the hiring of a diverse staff and interpreters to meet different needs and assist during visits, accounting for longer visits, and incorporating décor representing the different homelands and cultures of its patient population. “One thing we’ve learned from our humble beginnings is hospitality is the heart of effective healthcare—but should that really surprise us,” he said.

Discussing how design can help support culturally inclusive care, McGillberry shared some general considerations:

  1. Recognize that most visits have a multidisciplinary purpose. “In the culturally inclusive care model, behavioral health is more integrated into the primary care visit,” she said. To support these efforts and reduce stigma of care, she said environments should help ensure a “warm hand off” between primary care and behavioral health practitioners.
  2. Make room for an interpreter. This person might be a medical professional or volunteer who is there in-person or connecting via phone or video conference. Therefore, designers need to make sure care spaces leave room for technology and/or an additional person in the room. Another important feature is a privacy curtain to shield the patient during medical procedures while still allowing for translating services to occur.
  3. Consider interfamily dynamics. Some patient visits may involve a patient’s entire family, not all of whom know a patient’s background or existing medical issues or past traumas. A solution for the built environment is to include space where the whole family can gather as well as room for one-on-one conversations. Family education spaces should also be considered to support multidisciplinary services and programs.
  4. Recognize the social determinants of health. McGillberry says designers should appreciate other factors that are important to health and treatment, such as access to food or housing.

Three years ago, Siloam Health hit capacity at its main facility and decided to expand with a satellite location rather than renovate. In consideration of it tight budget constraints, the organization decided the new clinic would initially use lean staff levels and be located in leased space, which was provided by a family member of a former patient in an existing office building.

Among the features of the new 3,500-square-foot clinic, designed by Kilter, is a large, welcoming reception and waiting area with different seating arrangements. Colors from Siloam’s logo are incorporated into the seating and artwork to provide pops of color.

In the exam rooms, where designers had to consider how to provide enough space for clinicians, staff, patients, and family, several options for the staff workspace were tested, including fixed millwork and moveable charting tables. The latter was ultimately chosen for its flexibility and ability to be used in different areas.

To support the facility’s multidisciplinary care model, an open workspace was designed is used with a small collaboration space tucked off the corridor where smaller groups of clinicians can gather to discuss a specific case, with an acoustical hanging light fixture added to mitigate sound transmission into the corridor.

McGillberry noted that these projects can be complex, so it’s important to engage the community as well as staff and volunteers early to ensure design solutions are compatible with the organization’s mission and the community’s needs.

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Anne DiNardo is executive editor of Healthcare Design. She can be reached at