Southwest Washington Medical Center
Vancouver, WA, USA
The Fairbanks-based clinic serves Alaskan Native people from 42 villages situated along the Tanana and Yukon rivers within a 235,000 square-mile region of Alaska; this area comprises the Tanana Chiefs Conference (TCC), a tribal entity and regional member of the Alaska Native Tribal Health Consortium. CAIHAC provides multigenerational healthcare and weaves natural environment, modern healing and community building into a place where cultures come to gather.
To fully comprehend the circumstances of TCC’s tribal members, NBBJ's design team traveled to Koyukuk, a remote native village on the Yukon River accessible only by boat or plane. There they met with village chiefs and community representatives, visited schools and toured the community. After interviewing end users, a list of priorities for healthcare needs and the desired human experience was established. A cultural advisory committee comprised of elders and regional tribal members also worked alongside planners and architects to infuse cultural relevance in the overall design. In addition, the project team drew upon a previous, immersive 18-month study of Alaska-Native tribal cultures that informed their planning and design of the Alaskan Native Medical Center.
Many of CAIHC’s approximately 15,000 patients must travel great distances to visit. The clinic is larger than any space in many of their small villages, so all entry points are low and non-intimidating to make visitors feel welcomed. The building’s flowing form — with clinics adjacent to the river and an exterior landscaping river bed — also provide a culturally familiar aesthetic. A visit to CAIHC often provides an opportunity to socialize with family and friends spanning multiple generations: it is one of few large indoor spaces in the Alaskan interior where Native Alaskans can gather.
To accommodate the close-knit, community-oriented culture, the main lobby and waiting area serves as a larger gathering area that encourages social interaction. Its circular shape, designed to resemble a woven basket, emphasizes the Native way of life and connecting people in spirit. At the center of the gathering area lies a round made of stone and metal inlay that signifies the circle of life and cyclical nature of the seasons. It includes compass directions and seasonal elements of a subsistence lifestyle: trapping, berry picking, moose hunting, fishing and whaling. Smaller waiting rooms, all with southern exposure and views, allow for more intimate gatherings.
Natural forms and Native culture imbue the facility’s interiors with a sense of place and of calm. Native life follows the seasons, so clinic walls bear subtle seasonal shades of green, yellow, orange and blue that indicate different areas for wayfinding. Pathways to specific clinics mimic the winding, braided rivers of the Alaskan Interior, with islands of seating interspersed. The interiors also showcase a substantial art collection that represents all 42 villages.
The most innovative aspect of the clinic’s design is its approach to caring for a patients and families through an integrated-care model that emphasizes wellness over intervention and focuses on family-centered lifestyle changes. In this model, a highly-collaborative team of providers works together in an open space. Such teams — made up of doctors, nurses, medical assistants and specialists — care for entire families. The team learns about a family’s medical and non-medical issues, which ensures comprehensive prenatal to end-of-life care and support on the patient’s journey to optimal wellness.
The building planning and design provides appropriate, effective space for such a partnership. The medical planning works off of a simple diagram that flows east and west from the main lobby to the check-in desk. The design encourages collaborative care at the clinic’s edges. There, providers give care at an appropriate level of intensity in exam, procedure and “talking rooms,” which provide an informal setting for simple care and discussions with patients, family and providers. Care in these rooms is as important as in an exam or procedure room, but the non-clinical setting breaks down the doctor-patient hierarchical relationship to ease conversation between partners. Such collaboration shifts the focus from interventional procedures, medication and acute care towards a more healthful lifestyle.
Like the winding, intertwining rivers that inspired its design, CAIHC’s integrated-care model, medical planning and culturally-inspired design elements come together to create a truly innovative and unique healing environment.
CAIHC is one of few buildings in Alaska to attain LEED Gold certification. The facility consumes 30% less water than average and reduces energy usage nearly 30%. The siting of the building saved more than 50 mature birch and aspen trees, and native plants add to the building’s appeal. Water from rain and snowmelt feeds the landscape, eliminating the need for irrigation.
The heating system uses hot water — which the power utility would have dumped into the Chena River — instead of a gas- or oil-fired burner, eliminating emissions and potential spills. Finally, locally sourced and sustainable materials were used whenever possible, and low-VOC materials and good indoor air-quality practices were employed during construction.
The short building season required a fast-track design and construction process with tight coordination of the structural, core-and-shell, and tenant improvement bid packages. The limited 4-5 month summer building season required long work days to achieve full enclosure by October and ensure a warm, dry space for winter construction. The building also had to be sited to avoid permafrost that covers approximately half the site.
Additionally, design elements were incorporated to make clinic visits more comfortable and safe during extreme weather: canopies cover drop-off areas and straight pathways lead between parking and the front entry, and a fireplace burns in the lobby as symbol of warmth. The sinuous shape of the building maximizes daylighting and minimizes shadows, and the curving façade captures as much sunlight as possible — an absolute necessity in a place that sees only 4-5 hours of sunlight per day during winter months.
Modern Healthcare Design Awards, Honorable Mention
Healthcare Design Awards, Citation of Merit
IIDA NPC InAward, People's Choice
Healthcare Design, “Mirror Image: Alaska Clinic Design Reflects Patient Culture,” September 2013
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