How Counties are Improving Healthcare Accessibility in Rural Communities

Healthcare is a critical part of our lives, and access to quality care can, in a worst-case scenario, be the differentiating factor between life and death. In the best-case scenario, quality and holistic healthcare keeps us out of the hospital and in the places and activities where we thrive.

In rural communities, barriers such as access and connectivity can affect how and when patients receive care. TreanorHL had the opportunity to recently work with two clients on new rural healthcare facilities to help support their communities with the care they need. With two different geographies, communities, and needs, we wanted to discuss their insights into ways these new critical access healthcare facilities are helping support their patients.

To discuss this topic, TreanorHL Health principals Curtis Hendershott and Mike Hagan join this episode, along with Dr. Timothy Ryan, the public and environmental health director of Clear Creek County in Idaho Springs, Colorado, and Dave Garnas, administrator at the North Central Kansas Medical Center in Concordia, Kansas.

Learn more about the projects referenced in this episode:

• Cloud County North Central Kansas Medical Center
• Clear Creek County Health and Wellness Center

TreanorHL is a national architecture, planning, and design firm located in the United States. The company holds a firm belief in sharing resources and insights with professionals, clients, and building users to shape the space we use to live and grow as people. For more information, visit treanorhl.com.

Transcript

Megan Brock  00:02
Welcome to TreanorHL Talks, a podcast about architecture, planning and design trends as well as current events and noteworthy topics in the field. I am your host, Megan Brock, introducing today's topic, healthcare accessibility in rural areas, and how our clients are raising the bar for their patients and communities.

Megan Brock  00:22
Healthcare is a critical part of our lives and access to quality care can, in a worst-case scenario, be the differentiating factor between life and death. In the best-case scenario and throughout our daily lives, quality and holistic health care keeps us out of the clinic and in the places and activities where we thrive. For Dr. Timothy Ryan, the Public and Environmental Health Director of Clear Creek County in Idaho Springs, Colorado. The key to success lies with holistic health care that prevents the need for emergency medical care.

Tim Ryan  00:53
I differentiate between health care and medical care. I think medical care is what you get in the hospital. It's what you need in an emergency. It's what you need because of long-term chronic illness. Health care is a less expensive, in my opinion, more effective way to address the community. And we don't need a hospital per se in our community because if we have robust health care, and we have robust public health, we can avoid a lot of the quote unquote medical care.

Megan Brock  01:21
For Dave Garnas, administrator at the Cloud County Health Center in Concordia Kansas, holistic healthcare defines your community. In Concordia, 350 community members showed up for the groundbreaking of their new medical center in the fall of 2022, which replaces their current existing hospital.

Dave Garnas  01:39
Even from day one and groundbreaking, you know, we had 350 people show up to a groundbreaking ceremony, which is the most mundane and boring thing you've ever seen. You know, some nice words and you're standing in a bunch of grass going, "there'll be a hospital here someday." But 350 people were so excited, they came out.

Megan Brock  02:01
TreanorHL had the opportunity to work with both Dave and Tim on new rural health care facilities to help support their communities with the care they need. We wanted to discuss with them their insights into rural health care as a practice, a service and ultimately a community building block in their counties. Tim and Dave, along with Curtis Hendershott and Mike Hagan, both principals from TreanorHL's Health studio, have joined me today to talk about what these facilities are accomplishing for their communities. Thank you for joining me today, everyone. Please go ahead and introduce yourselves and share a little bit about your role and background.

Tim Ryan  02:39
My name is Dr. Timothy Ryan, I'm the Public Health Director for Clear Creek County, which is a rural county in Colorado. My primary focus is in public health is on prevention, I think it's equally as important as access to primary care, urgent care as an example, preventing things from happening is far more cost-effective in really what we're trying to promote among our community.

Dave Garnas  03:05
I'm Dave Garnas, I'm the administrator at North Central Kansas Medical Center. And I was I was also the owner's rep. And I've had quite a bit of experience in construction over my career. My background is I grew up in North Dakota and a ton of 250 people in a farming community and went into healthcare administration and my entire career has been put towards rural health care. And that again, I've been a CEO or administrator at rural hospitals my entire career. So again, it's near and dear to my heart. It's where I want to live, where I wanted to raise my family. And it gives me the opportunity to be able to impact the lives of people in a rural community.

Curtis Hendershott  03:51
I'm Curtis Hendershott with TreanorHL. I'm a principal within our studio. So I grew up in Colorado, Denver specifically, and have had the fortune of working in several remote communities over my career, both in the bigger urban setting hospitals, and then also those critical access facilities and really started gravitating more recently toward the critical access and in rural clinic environment, just because of the people in the connection that we find with those communities.

Mike Hagan  04:31
Michael Hagan with training Rachel, I am a Colorado native. I was born and raised on the western slope in a small-town community here in Colorado. So rural health is important to me in both professional and personal level. I've been with the firm for 17 years practicing healthcare architecture. And really my passion is being part of teams that are integral to providing health services for rural communities. And that really hits home for me.

Megan Brock  05:04
Thank you all for introducing yourselves and for joining us today. I'm going to go ahead and let Curtis start us off with our first question.

Curtis Hendershott  05:13
So what are some of the biggest challenges as a rural health care provider that you are seeing both here currently, and maybe some of your past experiences?

Tim Ryan  05:26
So yeah, even given our proximity, the Clear Creek County and its proximity to Denver metro, although we're only 30 miles away, it may as well be 1,000. For some people, right? They don't have access to transportation, they don't have access to a whole host of things that allow them to access those services. So it's really about trying to provide as much as possible. Within our county, we don't have a hospital in our county, we have a primary care clinic, we have public health, and what public health is in our role is really trying to augment what isn't there and those services and bridge those gaps between what is needed and what we really want to have there. And to be quite candid, what we can financially support, right, we wanted an urgent care facility in our county, but the decision was made that it was not financially viable. So we have a primary care, which is, which is fantastic. It's the first time our counties had primary care. And we're really trying to create a more robust public health system, so that we can bridge those gaps and prevent a lot of the need for those hospital visits. Right. It isn't necessarily that we, the community would very much like them, and the services, but the community isn't large enough, and the infrastructure isn't there to support them. 

Tim Ryan  06:53
One of the things that Clear Creek county is doing in addition to having the primary care clinic and having a robust public health is our EMS, our EMS system has created a community health. So they're going to be even more of a bridge to services like for instance, if you get discharged from the hospital, they're the ones who are going to be going literally to people's homes, to follow up with the patient. So the patient doesn't have to leave, they don't have to go back to the hospital or the doctor's office, they can literally get care in their home. I think it's an incredible model, particularly for communities like ours, where there aren't an abundance of doctors and nurses to help out there aren't in a, you know, hospital that is close by particularly for a lot of individuals. So it's really bringing if you will, bringing the health care to the individuals in their home.

Tim Ryan  07:45
We also recently brought in a mobile dental clinic, not because we don't have a dentist in the community, but that dentist is completely booked this mobile dental clinic, it comes to our clinic. But it can also do home visits, right? We have a lot of individuals who are homebound either by choice or by medical need, right. And so if these individuals still need dental care, I mean, the link between dental care and mental health is huge, right? If you have an aching rotting tooth, your mental health is deteriorating as well. So it's as simple as having a dentist show up and be able to address that tooth issue that will also subsequently address your mental health issue simultaneously. So it's about identifying the needs, and trying to fulfill those needs as best as possible, which is challenging in a lot of these communities, because there aren't resources financially, or otherwise, in addition to resources like doctors and nurses. So it's about identifying who can bridge that gap. And in our case, it's EMS and the paramedics, they are able to actually carry out a lot of what your average doctor could do. Right. And then you tie that into public health as well. And the prevention aspect and it's sort of as complete of a puzzle as we can provide in a community like ours.

 Curtis Hendershott  09:03
Great thoughts there Tim and innovative ideas. hadn't thought about, it really proves you don't need a physical structure to provide good care in the community.

Dave Garnas  09:15
Yeah, you know, I think for us it comes down to, for being a critical access rural hospital, or any hospital health care provider. I think it kind of comes down to four things and a little bit of it is Kansas specific. Number one is financial viability, you know, through the pandemic and coming out of the pandemic into the endemic phase and inflation. Clearly we've seen wages increased dramatically with natural gas, utilities, supplies, all of those types of things. And because we're critical access, yes, Medicare pays that portion, their share of that portion, but none of the other reimbursements have gone up by any other payer. And so, you know, our all of our costs have skyrocketed, but the reimbursement hasn't, does not go with that. Also Kansas-specific, we do not have Medicaid expansion. And so like in Colorado, we had Medicaid expansion. So reimbursement was a lot better than here, we're getting reimbursed on average five cents on every dollar we charge in the state of state of Kansas. So Medicaid is Medicaid expansion is huge. So that's kind of the financial bucket. And those challenges.

Dave Garnas  10:26
The other three things that I would say that we focus on and acknowledge as our continual fight or continual top priorities, as far as things that we need to work on the most is workforce availability, daycare, and the last piece is housing. And so in rural America, and I understand the Denver Metro in that type of area, there's lots of houses being built. But in rural America, there's not been very many new homes built in a long time and ages of houses are getting older, and you know, getting to the end of life, and new houses haven't been built. So, you know, we've focused really heavily on workforce, and, you know, pay and recruitment tools and retention tools, which is been very effective for us, we focus on daycare, we don't have our own daycare, but we try to support our local daycare providers in any way that we can to keep them, you know, seeing our employees kids. And then one of the things that we're doing as far as housing is that the hospital here that's been going to be tore down. So we just built the new hospital, the old hospital is going to be demolished. And there's about eight acres of land. And so our board had the foresight, and our city has the foresight that we are donating that land to the city to create a rural housing district. So that basically there are free lots to moderate income homes. And so they'll be able to get the lots for free if they build the house there. And so that that will help educate, you know, teachers, nurses, people at the hospital, people at the other industries in the community, to try to build prosperity and have appropriate housing for the community. So those are probably the four things that we focus on the most.

Mike Hagan  12:22
I think that's very interesting, Dave, about the housing aspect, because not just for the community housing, but I think for our providers, and you know, that recruitment effort of providing the access to affordable livability that is in close proximity. I think, you know, during this pandemic, we've seen this remote nurse scenario play out in it's, it's temporary. So the permanent solution, I do believe is related to that, that housing.

Curtis Hendershott  12:54
Thanks, Mike. So, Tim, what services do you provide at the facility?

Tim Ryan  13:00
Right now we have is still a little bit of room for growth of downstairs in the primary floor. It is a very inviting environment, like your living room upstairs and downstairs when you walk in. Downstairs, we have the primary care clinic, which is run by Centura. We also have another space that is going to be a physical therapy office and practice. If there's one thing about Clear Creek County is the physical aggressiveness of the people who live there and the activities that they seek. So it is a service that is going to be very utilized in this community once it's up and running. There's one thing about physical therapy is when you do need it, it is a daily or weekly thing. So having to travel outside of your community to get that is very much a barrier. One of the major challenges in rural communities like ours, is access to broadband and access to the internet. Right. So our clinic also doubles as our broadband hub. And it's addressing one of the major underlying challenges with rural communities of how do I connect to the internet, because a lot of what we do is we try to connect to people through the internet. And if they don't have access to any of that we're sort of spinning our wheels and not really getting to the people that actually need to be to be reached.

Tim Ryan  14:18
Upstairs, we have a whole host of services. The entire public health team is there. So we have two clinic rooms that we do a whole host of things, including the dental clinic runs out of one of our clinic rooms, one day a month Human Services is there. So these are the folks that connect people to any sort of benefits that they may qualify for. It allows for a warm handoff. So if somebody comes in saying Do I qualify for this program or that program? And it turns out, it's a single mom who just had a baby a year ago, that conversation instantly happens of well, we have a program a WIC program that will allow you to get free food and allow you to provide these other services and they literally will walk down the hall and come to public health and say, Hey, this individual is here, she is looking to see if she qualifies for WIC. And we can almost instantly determine that and get them signed up. It's very satisfying for folks who come in, and suddenly, they came in for what they thought they needed. And they ended up leaving with three or four additional services they didn't know existed, they leave, they're satisfied, more satisfied than they could ever possibly have imagined walking through the door.

Tim Ryan  15:28
So in addition to human services, we have the veteran services there. So individuals who are veterans can come in and meet with Troy is his name, then he can connect them to all veterans services that they qualify for directly, the Clery county advocates, these are the individuals who really work for the community and work for the individuals who are in situations that they don't want to be in, they're in abusive situations, etc. They're also represented, and are able to interact in that way, again, with the warm handoff. In addition to that, we have a Jefferson Center for Mental Health. So we have counselors on site, there are regularly to there, they have mixed schedules in terms of when they're available. That's another service that somebody can come in and meet with somebody we have, they have walked in as well as scheduled visits. So we have added the food wall, if you will. We also have refrigerators so people can get perishable goods. We've also coupled that with what we call public health and public safety, right, we had 150 bike helmets that we put on the shelf, and literally in two weeks, they were gone.

Tim Ryan  16:32
We also have on the roof. And this is sort of a typical, but we because I 70 runs through the center of our county, which is great for the economy. The problem with it is it is a massive source of pollution. So we have installed on the roof, air quality monitor, we have higher rates of asthma, for instance, in our community and cardiovascular disease. And so how can we collect the data to show that, in fact, the asthma increase in asthma that we're seeing is directly related to the highway that passes right by our entire community. The parking lot itself serves as a great place. For instance, we have a matt van. So individuals who are in recovery, they can come once a week, and they can have services, there's a giant bus that comes in parks in the parking lot. And individuals with great anonymity can go into the bus, talk to whoever they need to talk to get the things that they need to make themselves successful in their road to recovery. And it's about pairing that so it's not just what's in the building. It's about what's available on the on the broader property.

Dave Garnas  17:39
At North Central Kansas Medical Center, we're fairly common critical access hospital with you know, inpatient care, swing bed care, ER, 24-hour ER coverage, radiology services, lab services, etc. We have, I would say areas that we're really have seen growth in and that type of thing has been in our rural health clinic, as well as in therapy, and radiology. So is what did we do through the construction processes, we did add some new services and new modalities. And so we've did fundraising throughout our community. And we paid for with cash, the ability to build a new MRI suite as well as to put a brand new magnet in it. And that's not a service that we've had in the community before. And then also through therapy, we've, we've increased the size of our therapy staff, but we've also, we installed a hydrotherapy pool, and then ground hydrotherapy pool with a lowering floor. So basically, it's just a really nice way for patients to feel safe and confident going into the going into that area. And also with this project, we've also expanded and are in the process of expanding our surgical services, with more days, and also with orthopedics. But we're trying to we're at the point where we're going to work towards expanding orthopedics to hopefully we can do elective knee and hip replacements in the future.

Curtis Hendershott  19:14
And Dave all add to that, one of the things that stood out to me is in with many other facilities that your mission in your care is really moving toward more of a, a health and in catching preventative maintenance type care facility versus emergent type acute care. And so that was really a drive on your end and the beginning is to push for more clinic and preventive maintenance type spaces.

Dave Garnas  19:46
Correct. And clearly, you know, health care anymore is very outpatient-driven. And if you look at the layout of our building, it's all to focus on that outpatient care. Preventative type stuff and those types of things, keep people out of the hospital, and clearly much smaller on the inpatient side, then, you know, be just because that's the trends of healthcare.

Megan Brock  20:12
I'm going to go ahead and bring this back to the TreanorHL team for a moment to talk a bit about design. What were some of the architectural and design considerations we developed alongside Tim and Dave, in support of their goals?

Curtis Hendershott  20:27
So one of the things that we really strive to do, and when we go into a rural community, or frankly, any project and understand early on, you know, some of the things that are extremely important to solve for a rural community. And a lot of those are, are not the normal issues that you would run into in a urban facility. Some of the things that we discussed on the Cloud County project with Dave early on was, how do we bring in different services within that facility that helps support the community. So whether it be the dining area in the kitchen, that is an extension, for different folks to come in and use that space? That was discussed the other discussion early on that that we didn't end up exploring? But do we open up the physical therapy space after hours for the community come in, and that becomes an extension for the community to use. So, again, some of those eyes that ideas that may be unique to a rural setting that would not be normal, in an urban hospital are the things that that we explored. So specific to, again, the cloud County project, we really looked at how do we provide a space that fits into that community and is unique to their situation or their environment, and makes it special for them, we didn't want to just drop in a hospital that was cookie-cutter, or was a copy from another community. So really a lot of exploring of, of the community in terms of the architecture style that exists. And how does that fit into their facility. So as you walk through a lot of color schemes, the murals that you see within that facility are barns, wheat, those types of things that you'll see as you walk through. So that made it more of a special environment and a fit for the community. But again, for the care side of it, we really started moving more to a clinic-based facility, and less on the acute care side, again, to service those areas that Dave said were important to the community.

Mike Hagan  22:58
Yeah, absolutely. It's interesting, there's a lot of commonalities in these two projects we're talking about even though they're, you could say drastically different, right. One is a hospital. One is a clinic. One is in Kansas, one is in Colorado, but what it comes down to really is the community and it's designing for the community. It's partnering with the stakeholders. As Tim mentioned, you know, this is Idaho Springs, Clear Creek County project was nine years in the making, right? So it was, it was a partnership from day one for the design team to learn or immerse ourselves within this community so that we could then provide ideas of solutions on what the next level of care would be. And in this case, you know, there wasn't a whole lot of healthcare in Idaho Springs. Previously, it was this small, less than 1200 square foot residential house that we renovated a couple of years before this project, just to have one physician and a couple exam rooms, and provide care. And when we did that, it was amazing, because it was overwhelmed immediately. And you could see that that community need was there. So that that really helps that that next stage of thought process of what can we provide?

Mike Hagan  24:18
And Tim said it many times, you know, listening to the community, what do you guys want? What do you guys need, as community members really informed this building? You know, it's a beautiful building from the exterior, it fits in the setting. We also had to be careful of creating a perception that this building was not part of the community because it was brand new and it's big, you know, it's not a little house. It's a two-story 12,000-square-foot building. So we didn't want the community to feel intimidated by this. We wanted it to be welcoming. So I think there were certain design aspects that we tried to offer to the community on this, you know, Minor Street is the main street that goes through Idaho Springs and when he created this porch and a residential feel to this industrial or commercial building that's providing different healthcare services, so that it is inviting. People can come into the main lobby on the first and second floor and it has a fireplace, it's warm, it's screening, it's not institutional, it doesn't have that stigma of mental health or public health or, you know, primary or emergent care. It's just a building that people can be proud of, and feel like they can go to for the services they need and not be ashamed, but be proud of what is offered there.

Mike Hagan  25:39The multidisciplinary services provided in the building was very unique, challenging, but it was spot on for what the community needed. So when we first talked about this, it was going to be oh, we need urgent care. That's what we thought we needed was urgent care. And that's all we needed. But it turns out, we provided everything but urgent care. And I think it was successful in the fact that we listened to hear what else the community needed, not just we need somewhere to go. But we need somewhere to go for X, Y, and Z. And we provided as much as we could, for that. So I think the multidisciplinary services provided was really the most successful, and the design kind of followed suit to that it provided a collaborative environment for the caregivers, and providers in that space. So they can go to primary care, and they get referred upstairs for these other services. And then they could do all that within, you know, a two hour duration versus two months of back and forth to different types of facilities. So I think the program really offered a lot of benefits to helping inform the design.

Mike Hagan  26:46
And that kind of ties into the next question about you guys talked a little bit about the backgrounds of your facilities, and what the need is, and how you support the communities. What is the feedback from your communities say, you know, Tim, we had a very small, you know, residential clinic as, as best cares, we couldn't Idaho Springs. Now we have a kind of a robust collaborative care center. Dave, you know, you have a replacement hospital. So how was that received from your community?

Dave Garnas  27:15
Sure, you know, when I came four and a half years ago, the reputation that the perception of the existing facility was directly reflected towards, you know, the, the physical environment. And, you know, my message from day one, when I arrived here is that the facility doesn't define the quality of care we give, it's the people inside of it. And so, you know, we really hammered home that mantra, and we started to see turns, we started to be more involved in the community more involved in our college and our high schools and that type of thing. And without a new facility, we really started to turn that tide. 

Dave Garnas  27:54
One of the other things that we did was to open up a walk-in clinic. So basically, you don't have to have an appointment, you show up between the hours of 8:30 and 6:00 p.m. Without an appointment, we're going to see you so we have a dedicated provider every day to do a walk-in clinic. And that made a huge impact. And we started to gain our patients back that have maybe gone to another community, but specifically to the facility. Now that we're open, and we're in, you know, having been out here virtually every day of construction, you know, you see people driving by, driving around the new hospital and being looky-loos. And so you know, it's amazing, because people are just getting excited in the community everywhere I go. During construction, the community members were excited. And when we did our open house, we had between 700 and 800 people show up for a ribbon cutting and tours, and the streets were lined back to our highway 81. Man, it was an amazing day to see that level of support. We've had people who have not normally, you know, been donors, you know, we added on an MRI unit to our hospitals kind of an ad alternate. And we need to raise about $470,000 And we started in February, and by August, we had it we had exceeded it by about $400,000. So the amount of excitement that hey, this is finally getting done. We're not doing it with taxpayer money. And the amount of excitement and well wishes just people perception of the quality now takes a giant leap forward. So we're really excited about it. And it's been a very heartwarming process to go through.

Tim Ryan  29:47
In Clear Creek County, prior to the current building that we have. There was a primary care office there and today's point it's not the quality of the building. It's really the services and the people in there that are really defining that, I would say that the current building in the concept behind it really is nine years in the making. My predecessor is really the one who drove this for nine years. And her vision was this is simply put, bring as many services as humanly possible into one building that provide serve different services for the community. So that one, individuals don't have to go to different locations to get different services, they can start at a one-stop shop, and get all of their needs taken care of. But beyond that, it's how do we bring people in? Right? How do we get people to the building? One of the big issues, particularly in a community like ours, which is a roughly 10,000 individuals is around mental health, right? People don't want to be seen in the parking lot, or their car doesn't want to be seen in the parking lot of a mental health facility, because there's stigma associated with that. So it's how can we create a place where nobody's going to have any idea why you're there, there's so many different services provided there from dental and mental health and physical health and different services of all sorts, that it doesn't really matter why you're there, you're there getting something.

Tim Ryan  31:20
In the first year of being open, we have had over 100, or over 1,000, unique individuals come into our building, whether it be for the primary care downstairs, or for the myriad of services that we provide upstairs. So in a community of 10,000, having 1,000 unique individuals, which is a tenth of our population in the first year, to me speaks to the success, we have had a number of individuals say to us, this is absolutely fantastic. I used to have to go to three different places to get these different things. Now it's all in one place. And we very much obviously appreciate those compliments. But more importantly, we're asking those individuals, what else can we do? What other service would you like to see here that we could potentially provide. And again, because we're a tiny community, and finances are an ongoing issue. We're trying to identify those things like for instance, a mobile dental clinic, it costs the county nothing to engage in and create a memorandum of understanding with this mobile dental unit to create or provide this service in the community. The mammogram, van, same thing, it comes in parks in the parking lot twice a year, it's available to the broader community, we obviously facilitate the scheduling of it and the scheduling of patients to go there. But it's bringing things to us in our community that aren't already there that are greatly needed that require no financial commitment on the part of the county. And it's so identifying those sorts of things. And really the way we identify those is engaging the community. What would you like to see here? What can we provide that would be valuable to the broader community beyond what we're already doing. So the feedback has been great from your average individual who walks through the door, all the way up through management in the county commissioners, etc. They're all hearing positive things. The biggest challenge in any of these communities, though, I would say is getting the word out. We've tried every avenue you can possibly imagine from social media, to the old school, we're going to send a flyer postcard to your house three times a year, listing all of the services that continue to grow at this facility. But we still have people who come in and say, I didn't even know this place was here. What services you provide? It's like, well, yeah, sure. Here we are, what can we do to help you? And how can we continue to grow what it is that we're doing?

Mike Hagan  33:48
Yeah, absolutely. So the next question is, what would you like the community to know about the facility that they may or may not already know?

Tim Ryan  33:57
Well, I think the first and foremost is that this building is the communities. It isn't public health. It isn't the commissioners, it isn't the counties, it's the people's building. Right. And it serves the purpose that the community sees it needs to serve. Understanding and growing, what we have in there driven by the community is the other piece, right? We are regularly trying to promote all the other things that are in the building. But more importantly, asking that very important question of what would you like to see here? What do you think is a need out in the community that we aren't aware of or haven't heard yet? Once we start to hear themes, and once we reach out to broader the broader community to understand is that really a need? Obviously we do our, our due diligence, making sure that what need has been expressed is truly a need, and more importantly, how can we fulfill that need? What I would like the community to know is that we have a variety of services from basic health care needs in the primary care clinic downstairs to vaccines and family planning. We just got title 10 funding from the state because we don't have family planning in our community. In a county of 10,000, we need family planning. And so it's about providing as many services is possible that community needs and wants. This isn't a fixed thing, right? It we have the ability to grow. And we have the ability to provide other services. We understand were physically limited by space. But we are not limited by our imagination in our needs, right? Those we don't set limitations on those sorts of things have no idea is too crazy until it is sort of thing. And we will we will entertain things and go down that path if we determined it's viable. And it's actually needed.

Mike Hagan  35:53
Yeah, I think, you know, to close, we've talked about the projects we've just completed where we're at today, what do we see an expected change in delivery, in healthcare in rural healthcare specifically? Moving forward, you know, the next three to five to 10 years? Do you see anything? Where do we see this, this going, what you're providing to your communities?

Dave Garnas  36:18
Well, specific to healthcare, I think that we're going to have to do more with less people. Workforce is a huge challenge, no matter what industry you're in right now, from construction to healthcare to fast food, it doesn't matter workforce is an issue. And so from our perspective, it's just great timing, because, as Curtis knows, through the whole design process, we want we want a modern medical facility. But we also want to have some really strong adjacencies. For our departments, we wanted to have a lot of efficiencies for our staff. And so with those two things in mind, we're going to have to do more with less probably in the future, because there's fewer and fewer healthcare workers anymore. And so, so doing more with less means that we've got to make it easier for people to do their jobs and more efficient for them to do it. And I think that's what we're going to be faced with in the next, you know, 10, five to 10 years. And then also, you know, we also need to have a more efficient building, which we do with LEDs and, you know, energy efficient everything. Because let's face it, reimbursements are going down from insurance companies and Medicare and everyone else. And so we've got to make our fixed expenses, just that much, much more reasonable, if you will.

Tim Ryan  37:41
I think focusing on health care, as opposed to medical care, I think will have a lasting impact for generations to come right. And making sure that they collectively we understand as a community, the importance of health care, I think for our community, in particular growing, what we services we provide in the in the facility that we have inside and out is our future and making sure that we are addressing the needs of the broader community. And so it's making sure that we're investing in our community in a way that is fully supporting and fully creating the infrastructure for them to hold up the community. That's where I see our future. As Clear Creek County, in a number of counties surrounding us, right, a lot of my peers that I talked to regularly subscribe to the same sort of philosophy of let's connect these people to the services they need, and the help they need and the support they need. And we will make a difference out in this community.

Mike Hagan  38:43
It's such an interesting point, you keep mentioning that medical care versus health care. That's an important distinction. And I think connecting the community to health care is the future, right? It's no secret that large hospitals are no longer the future. We always will need hospitals, but the outpatient ambulatory care experiences growing. And I think even more so the whole health and community health is that next wave of the future, and especially for the non-urban settings that need to really focus on that preventative aspect. I really appreciate those thoughts, Tim.

Curtis Hendershott  39:23
Great thoughts there, Tim. Thank you.

Megan Brock  39:27
Well, thank you and great insights, everyone. It was fantastic to get to hear from you. Thank you for joining me today on this episode.

Megan Brock  39:36
At TreanorHL, we work with rural healthcare clients all over the country. We support our clients with this critical work by combining niche expertise with practical innovation that advances change in areas less densely populated. We understand the unique needs of our rural healthcare clients and the patients they serve. We support them step by step with evidence-based design strategies they can rely on. 

Megan Brock  40:00
Saving lives and keeping our communities healthy is serious business and it drives us to work with passionate clients like Tim and Dave. We'd like to give a huge shout-out for their hard work and dedication to the communities of Cloud County and Clear Creek County and for visiting with us today on the podcast. If you want to learn more about cloud counties, north central Kansas Medical Center, and Clear Creek County's Health and Wellness Center, see the show notes for links and more information. You can also visit treanorhl.com To learn more about how we've helped our clients with healthcare space solutions that fit their unique needs. Until next time, thank you for joining us on this episode of TreanorHL Talks. TreanorHL is a national architecture planning and design firm located in the United States. We hold a firm belief in sharing compelling stories and data-driven insights with professionals clients, and building users to help design the world we want to live in. For more information visit treanorhl.com That's t-r-e-a-n-o-r-h-l.com.