The Promise of the ‘Patient Centered Medical Home Model’ for Tribal Healthcare

By Rebecca Lewis, FAIA, FACHA, CID
Director of Healthcare Design, Principal of DSGW Architects

As architects, we design physical spaces. But as healthcare planners, we also design for human relationships. In clinics and hospitals, the “Patient-Centered Medical Home Model” is not a space at all—but a partnership between patients and their primary healthcare providers. PCMH addresses the whole patient—from their emotions and fears to their lives at home.

The medical home approach to patient care literally “gathers everyone in the same room” to interact with patients and their families. This open exchange insures that no piece of critical information is overlooked. Pharmacists, nurses, and physicians compare notes on the patient’s medications to prevent drug interactions. A social worker may attend to learn more about the family and home conditions when the patient is discharged. A nutritionist may share ideas for diet with the group. Even someone from billing may help families to navigate the maze of insurance and payment systems.

Patients need this reassurance to feel cared for, the human relationships let them be a better patient. The PCMH approach minimizes patient worry over what comes next and who is there to help them. A core strategy is to bring services to the patient rather sending the patient on a journey to individual specialists and departments throughout the facility.

The collaborative care team area at Lac Vieux Desert Health Center is centrally located in the clinic.

A more Personal Approach to Tribal Healthcare
With the Lac Vieux Desert Band of the Lake Superior Chippewa, DSGW worked to apply the medical home model to their new clinic in Watersmeet, Michigan. Their health center has program areas typical of many small clinics: exam rooms, a dental suite, clinical lab, imaging suite and rooms for physical therapy, behavioral health, and family services.

What’s different with the medical home model at Lac Vieux Desert is how these spaces are arranged. For example, meeting rooms are considered not just for their shape and size, but also for their location. They need to be easily accessed by family members and staff for a variety of meetings.

Following a PCMH approach, space and staff time are more efficiently-used. Many rooms serve multiple functions. A community room located adjacent to the staff work area doubles as a patient meeting room. Staff work areas are concentrated at the center of the clinic for team interaction and proximity to patients.

Historical and cultural exhibits in the public areas lend tribal members a sense of belonging and share their traditions with visitors.

Open to the Public
In Bayfield County, on the south shore of Lake Superior, the Red Cliff Community Health Center is one of the few tribal clinics nationwide open to the general public—including the many tourists who visit in the summer.

Before the medical home model, architects generally designed tribal clinics by department. Now, DSGW finds design solutions based on the overall patient experience. In designing clinics like Red Cliff, we consider how patients move through the clinic and how the team cares for them along the way. When patients need to move, the home model makes sure that someone is always with them.

This new thinking marks a shift in how we define “patients”. No longer are they passive players in the hospital experience. Patients and their families are members of the overall team—part of an ongoing system of communication. They are the clients too.

“Customer Service” in this model means that patients don’t need to seek information from multiple sources. The whole team brings information and services to them.  Patients are the focus, as they should be. When you don’t feel well, your team is there for you.