The Center for Health Design recently hosted a webinar on a topic that we don’t cover nearly as often as we should: designing for rural healthcare settings. Based on the large attendance we saw for the live event and continued on-demand views it’s still receiving, this industry agrees.

The webinar focuses on a unique, exploratory approach to applying evidence-based design (EBD) principles to rural healthcare settings. The speaker, Chris Haddox, an assistant professor of sustainable design at West Virginia University, was awarded a grant to develop a partnership with health design colleagues at Texas Tech University to examine how the delivery of healthcare in his rural native West Virginia might be improved by using an EBD process in designing and remodeling local healthcare facilities and if it could positively impact patient engagement. He conducted a research project that examined the barriers of providing care in these settings and, through that process, engaged stakeholders to help gather data and bring the project to life.

Haddox is not an architect or engineer, but he grew up in a healthcare family and was familiar with the challenges in providing healthcare in West Virginia and similar rural areas. He started his work asking three questions of healthcare systems and design professionals in his area: (1) Who is researching EBD in rural locations? (2) Can EBD influence health outcomes in these settings? (3) What are the barriers to promoting EBD in these settings?

These questions led Haddox to design a qualitative study and publish a paper in the Health Environments Research & Design (HERD) Journal on the “Impact of Design on Patient Participation in Healthcare in a Rural Health Clinic in Appalachia: A Qualitative Pilot Study.”

His research found that rural facilities were largely unaware that building design could impact patient outcomes and staff turnover and, as such, leaders weren’t seeking EBD interventions. The study also found that many firms with significant healthcare design expertise weren’t looking to small rural projects for additional work, further limiting the probability of new ideas and proven design interventions being introduced in rural facilities.

In one case (that’s likely indicative of many), a small clinic project was being designed and built by the local contractor, who had no exposure to the latest developments in healthcare design or EBD practices.

Haddox is continuing to look for funding to build out his research, including looking at issues around ADA accessibility and facility-related barriers to healthcare for people on the autism spectrum.

But larger questions for our industry remain: How do we build bridges to these rural areas and provide expertise at critical times, when money is being spent to build and remodel current healthcare buildings? How do we expose those who design, build, and operate rural healthcare facilities to EBD principles and make sure they know about the tools and resources available to support them?

This industry has a wealth of knowledge and a willingness to share ideas and solutions to help the greater good, but it’s time to expand the conversation. At The Center, we plan to work with Haddox to help find the answers.

Debra Levin is president and CEO of The Center for Health Design. She can be reached at