The new much needed Naytahwaush Health Center will increase access to health care for the Tribal members while fostering efficient and highly utilized services. Prior to this facility, Tribal members would have to travel in order to receive access to healthcare. The unique nature of this project as an I.H.S. Joint Venture required the blending of DSGW’s traditional design development process with that required by I.H.S. Our process included a matrix of design, operational, sustainability, and value decision making events. The Tribal Community of the White Earth Reservation now has access to modern healthcare close to home.