Tri-County Health Care staff announced Wednesday they are looking at options to either expand their current 45-year-old facility in Wadena or build a new hospital, as soon as spring of 2020.

TCHC President and CEO Joel Beiswenger said both options are on the table, but in able to both serve patients today and into the future, he feels a new hospital in a new location, with room to grow, would be the best option.

"We find ourselves in a position, a little similar to the mid-80s, where we are pushing the boundaries on our building," Beiswenger said.

Much like the building is now landlocked, departments within the building are seeing changes in how they care for patients, and while they may need to change, they too are landlocked in their spaces.

He shared how the concept of coordinated care, involves a different way patients are cared for. More patients, too, are larger, more obese than in years past. Surgery equipment made for higher ceilings are in suites with lower than desired ceilings. The options of going up and out are just not there, Beiswenger noted.

"We are short on ceiling height and that's the virtually impossible remodel to do," Beiswenger said.

In a press release Wednesday, the hospital shared that the decision behind the change involved several factors, a big one being the patient needs.

" ... its patients deserve a facility that is as strong as the community in which it is located and reflects the quality of care they receive. However, the current facility in Wadena does not meet these expectations," according to the press release. "Tri-County has reached a crossroads. The current facility is outdated, cramped, inefficient and cannot accommodate growing services or keep up with changing healthcare needs. The options? Either cut back on services or make an investment in a new or remodeled facility and be a strong entity in Wadena and surrounding communities for years to come."

It's been about a year and a half of engaging with groups and analyzing the needs of the patients and staff to get to this point. In the fall, the Board of Directors approved an investment in a new or remodeled clinic and hospital.

Beiswenger said in comparing this journey to a 1,000 steps, he said they are on step 50.

Upgrade now or cut back

The current hospital faces obstacles such as an inefficient layout, operating rooms that are costly to update, hidden location, poor energy efficiency, lack of parking and limited room for expansion in its current location. These make it difficult to offer the most advanced procedures and services while upholding safe, high-quality care.

Health care itself is rapidly changing. For instance, when the current building was built 45 years ago in Wadena, patients who stayed in the hospital (inpatients) made up 90 percent of the care provided, and it was designed with that need in mind. Now, however, inpatients only make up 13 percent of its business, and outpatients represent its greatest growth opportunity.

In addition, the growing trend of patient-centered, multi-disciplinary continuity of care requires more departments to be available for outpatients. The current building does not provide enough space for outpatient needs or for the growth of care coordination services.

Both the hospital and Wesley building have been remodeled throughout the years, but they have limited options for expansion and updates. It is also expensive to update old facilities and difficult to remodel without causing major interruptions to patient services. Tri-County's early research has found that it will cost almost as much to update the current facility as it would to build a new clinic and hospital.

"The cost is within 20 percent," Beiswenger said of the difference between remodeling and building new, building new being slightly more expensive.

If the hospital were to add on, they would likely find themselves with a larger facility than they need. A new building would likely be smaller than the current footprint, but the space would be much more efficient.

Beiswenger said TCHC is working with HGA Architects as well as Kraus-Anderson Construction to create a plan of what a new building might look like as well as what it might cost. The cost is not something Beiswenger is quite ready to share in these early stages.

Where to build

As was announced Tuesday, a joint meeting of Wadena City Council, Wadena County Commissioners, Ag Society members and TCHC staff will meet at 7 p.m. April 2 at Karvonen Funeral Home to discuss the idea of the hospital building going where the current Wadena County Fairgrounds now sit, just to the west of town on Hwy 10.

Beiswenger added that it's just one of 15 properties that the hospital has identified.

The research showed that Hwy 10 traffic is more than twice that of Hwy 71.

"It's surprising, unless you are in Wadena or in the immediate region, how many people don't know we exist," Beiswenger said.

One patient that spoke up, who grew up in Perham, traveled past Wadena on Hwy 10 for years. She never knew TCHC even existed. That plays into a decision to focus on a property on Hwy 10.

The remaining buildings

If a new hospital is built, it begs the question of what about the current hospital and the Wesley Hospital, buildings on either side of Hwy 71 in Wadena.

Beiswenger said conversations have been started on what these buildings could be used for. He said both would be utilized by the hospital even with a new hospital, but only by non-patient care staff. All patient-care services would be housed in one place, but the support service personnel would remain in the old buildings.

"We will be the ones running around, not the patients," Beiswenger said.

But that's probably closer to step 635, Beiswenger adds.

He's sensitive to the need to make use of the huge buildings.

"We know we don't want to end up with an albatross here in the community with an abandoned building," Beiswenger said.

He said the hospital will work to find reuse or work to create a redevelopment plan for the buildings if that becomes the need.

Design considerations

The plan would have a focus of one entry. An accessible entry that also adds to the safety of patients and staff.

The look and feel would be warmer, more comfortable. Creating an environment that's less institutional.

Another consideration is that patients are looking for more of a hotel-like environment.

"To some extent it is a business retention perspective for us," Beiswenger said.

He said, unfortunately, many people often make a hospital decision based on the look and feel, verses the care delivered and quality staff.

Beiswenger said the current hospital's ability to give patients what they need is in place, but he knows there are ways they could serve the next generation better.

"Even though we have the highest technology available for a facility of our size scope, there is some perception that we don't because of the age of our building," Beiswenger said.

"Right now we don't think our building is representing the quality of services we are delivering."

Tri-County Health Care has remained independent in a world where healthcare mergers and acquisitions are happening across the industry. Almost 70 percent of hospitals in America are part of a large health system, according to The Business of Healthcare. And at a time when competing facilities are attracting patients to their newly constructed facilities, Tri-County needs to remain competitive.

"Our strength as a healthcare institution, charged with delivering care that is critical to the wellbeing of our cities, is driven by our communities. It is our reason to exist," said Beiswenger.

Beiswenger started his career at TCHC in 1986 in the finance department. He had the chance to return to TCHC in 1998 and has served at the president/CEO since 2008.

He recalls the changes and expansions the hospital has seen in years on board.

With the last major expansions, the current hospital has been land locked on the south, east and west. In 1998, there was some consideration of a new hospital, but at that point the building was only 25 years old, he said.

"It would have been potentially deinvesting in a facility that still had much useful life left," Beiswenger said. "So it was not the right answer at that point, that's when we ended up adding on."

That add-on involved the site pharmacy, second-story specialty clinic, entry area, waiting area, roughly a 10,000 square foot expansion, opened in 2002. That was a highly-disruptive, long-term, multi-million dollar project.

If all fell into place, a new facility could be constructed over the course of about 28 months, or a fall 2022 ribbon cutting.

"It's just an extremely exciting time," Beiswenger said. "We want to make sure we continue to thrive and can do everything that we're doing today and more into the future. Our fear is if we stay in this facility as it is today, we might have the opposite effect."

That effect would not be healthy for patients, the community or TCHC as an organization, he said.