In the empty shell of the old Family Dollar building in downtown Wadena are a series of rooms created out of rigid foam panels. These temporary walls are the mock-up for the inner workings of the future Tri-County Health Care clinic and hospital. This early phase of design is helping hospital staff create the space they need to provide healthcare more efficiently, effectively and with more privacy, according to staff members.

In one room, imagine all the technology needed for a patient room. Each piece of equipment, or at least a representation of that equipment is in place. Is there space for a patient plus family? Will that cart of equipment roll through here? And does that position allow for a great view to the outdoors? Now is the time for every question to be asked and every scenario to be put to the test.

Two people at the heart of those questions are Tri-County Health Care staff Jose Alba, director of ambulatory services and Thomas Pint, director of nursing services. They've have been walking alongside others, providing their guidance and listening to staff and patients to really direct the path of the clinic design.

"It is significant because it's the biggest project we've ever done as an organization, probably one of the biggest projects in the area as far as dollar amount, which we're not ready to share yet, but we will at some point," Alba said. The last replacement project for the Wesley Hospital was in 1974, creating the current hospital.

Pint said hospital staff plan to bring a patient family advisory group to the Family Dollar building later this month to let them see what they've been doing. Few others have seen the work behind the walls.

"We have a really engaged group that's been helping us along the way," Pint said. "We don't want to build the health care facility of the future without our patients being involved."

Together Pint and Alba discussed the conversations that brought the hospital to a layout that's nearing finalization.

"How do you arrange the building in such a way that we still have the most efficient flow for our patients and also efficiencies for staff?" Pint considered. Part of that involved touring a series of clinics throughout Minnesota as well as critical access hospitals in the Midwest to gain understanding of what's out there.

It's not all a free-for-all design. There is a budget. Certainly, there are parts of the hospital that most departments want close access to. There are requirements to follow for much of this building. Certain rooms have to be certain sizes for the equipment needs. Alba looks at the current facility and imagines himself being wheeled around, squeezing through current corridors and around nurse stations. While he emphasized that the current hospital works and is safe for patients, it could be better, he said. One thing they agreed on is that trying to make the current structure work was not feasible.

Certain rooms must be separated from others to offer privacy to patients and staff. Pint referred to certain patient rooms where you can hear your neighbor through the wall. Advances in insulation and sound proofing can help with that. Alba mentioned the visiting specialties is an area they could potentially grow in a new building. But those areas have to be separate, with separate entries. These things take space.

Without sharing the actual design schematics, Alba compared the new hospital design to that of Disney Land. No, not the amusement park side of things, but the behind the scenes portions of the park that allow staff to work out of the view of the public. It's an onstage/backstage design so patients don't have to hear or see all the buzz of the busy clinic. They can travel through just enjoying the ride, or at least passing through knowing their needs are a top priority.

Certain departments can't be too far away from each other for the funding that comes into play. That includes the rehab center, now situated across the street from the hospital. There's a rule that any hospital outpatient department must be within 250 yards of the clinic, Alba explained. So it too will be built within the new complex. The current rehab building will have to find a new use.

“It’s a little bit of a give and take,” said project designer Donovan Nelson of HGA, the architecture firm selected to shape the design of the hospital. Listen to the needs of staff and patients, share designers’ knowledge of healthcare construction, talk with others in the industry to see what works and doesn’t work and hear from patients to see what they want in a hospital experience. “It’s a series of discussions with a lot of people."

Since the announcement of a new Tri-County Health Care hospital plan started moving forward last spring, there’s been a great deal of excitement and curiosity over the reasoning and location of the building billed “the rural healthcare center of the future.” But what goes on behind the scenes now to make this dream a reality is also quite interesting. Nelson said that there’s no prototype or cookie-cutter design to follow to get to the end result.

“There are some rules of thumb about how you locate departments, but there is a nuance,” Nelson said of the unique design.

Hospitals do have similar needs and those needs have a tendency to change, which prompted hospital leaders to move away from the current landlocked facility and move to a site west of town, where there is room to grow and room to adjust.

Nelson brings a portfolio loaded with health care facility projects from the last 14 years and won the 2019 AIA Minnesota Young Architects Award for his specialization in healthcare design and planning. He’s worked on facilities across the country, but mostly in the Midwest, including recent work with the Centracare Long Prairie medical campus and wellness center. His work includes campus master plans, acute care hospitals, outpatient clinics, medical office buildings, long-term care facilities, and behavioral health facilities.

HGA was brought in to do master planning about a year and a half ago, before the push to possibly build new or remodel. Nelson said it was through some of those discovery conversations about the master plan that the decision was made to build a new facility.

Nelson said compared to what the community currently has, this new building will create a more transformative health care experience. He said one thing that was important in speaking with TCHC President and CEO Joel Beiswenger, was a design that’s intuitive to the community needs.

“When you step in, you don’t get more anxious,” Nelson said of the design idea. “It makes you feel comfortable.”

Another aspect key to this project and its location was improving the visibility for the hospital. Early conversations with the public showed that hospitals like Perham Health and Lakewood Health Systems were noticed, while TCHC, in some cases was not on the public's radar, despite being on an a well-traveled road.

“The choice that (Beiswenger) and the team made for the potential site is going to really let the hospital have the visibility that those neighbor hospitals have,” Nelson said. Nelson considers the site, the current farm of Julie and Kelly Taggart, beautiful and said the design will take advantage of the views to help create that peaceful experience.

Another important aspect of the building design is the ability to grow and change. The chosen site has the acreage (76 acres) for growth, but the building itself would also have the ability to be more fluid based on the changes, Nelson explained. TCHC’s big change in recent years is the number of outpatients, far outweighing inpatient intakes. While inpatients accounted for 90% of the activity at the hospital years ago, it's now flipped to only 13% of the activity. If changes like that occur in the future, they'll be able to handle it better in their planned location.

Part of the growth could be in new technologies as there is currently not enough room to bring in some devices that could help them do more. Alba added that while those new things are nice, the goal is not to just have more room for more stuff.

"Really it's more about making sure the services we do provide are top notch," Alba said.

Alba said in looking at the data behind the direction of healthcare, some of the findings were startling.

"In all areas it said we needed less than what we have today, so a lot of that is driven by efficiency," Alba said of the need for change.

Next steps

A big step is near completion, and that is the schematic design, Nelson said. Next up is the design development, which should keep architects drawing through the fall. Then by the end of 2019 into the first part of 2020, the construction documents will be prepared.

Nelson said the design phase still has months and many meetings ahead before a complete drawing is at hand.

Some of those upcoming meetings include conversations with the city and county over annexation and utilities needed at the site. Further conversations with MnDOT are needed to determine access to the site, possibly from Hwy 10 and 11th Street. Talks with wetland organizations and engineers are ongoing. Community relations/marketing director Melinda Vonderahe said testing continues on the site including vibration (related to the railroad) and noise testing (related to the surrounding area businesses) all in an effort to do right on what’s likely a once-in-a-lifetime project.