To improve the quality of care and access to care for Native American communities, the Indian Health Service (IHS) has created two new state-of-the-art healthcare facilities: Kayenta Health Center located in northern Arizona on the Navajo Nation, and Fort Yuma Health Care Center located on the Arizona-California border to serve the Cocopah and Quechan tribes. Both facilities prioritize preventative care, contradicting the perceived hierarchy of medicine and inpatient care over outpatient and therapy services. Instead, each facility emphasizes cultural traditions as well as current trends and theories of healthcare that put Wellness first. This session was presented at the 2018 PDC Summit and considered two case studies to demonstrate how evidence-based design, a cultural understanding of wellness, and state-of-the-art healthcare can intersect to improve patient outcomes and support IHS’s proactive mission to keep people healthy. Learn more at https://www.dpsdesign.org/blog/improving-patient-care-culture-and-evidence-based-design.

1. Improving Patient Care:
The Intersection of Culture and
Evidence-Based Design

2. Project Team

3. Bill Sabatini
FAIA, FACHA
Principal | Architect
Dekker/Perich/Sabatini
Max Parrill
ACHA, LEED AP BD+C, WELL AP
Principal | Architect
Dekker/Perich/Sabatini
Deswood Etsitty
Healthcare Facilities Planner
Indian Health Services
Innova Group

4. Introduction
• Population health initiative
• Increasing rural health care access
• Consideration of cultural traditions in health care delivery
• Wellness services in addition to normal clinical care
• Integrating People, Place, and Program

5. Fundamental Project Goal

6. Indian Health Service
• The Indian Health Service (IHS), an agency within the Department of Health and Human
Services, is responsible for providing federal health services to American Indians and
Alaska Natives.
• Our Mission: to raise the physical, mental, social, and spiritual health of American Indians
and Alaska Natives to the highest level.
• Our Goal: to assure that comprehensive, culturally acceptable personal and public health
services are available and accessible to American Indian and Alaska Native people.
• Our Foundation: to uphold the Federal Government's obligation to promote healthy
American Indian and Alaska Native people, communities, and cultures and to honor and
protect the inherent sovereign rights of Tribes.

7. • IHS 2016 PROFILE (Based on 2000-2016 data -- Numbers are approximate)
• Indian Health Service (IHS) direct health care services: Services are administered through a
system of 12 Area offices and 170 IHS and tribally managed service units.
• Population Served:
• Members of 567 federally recognized Tribes
• 2.2 million American Indians and Alaska Natives
Indian Health Service

8. The American Indian and Alaska Native (AI/AN) people have long experienced lower health
status when compared with other Americans.
 Lower life expectancy and disproportionate disease burden exist perhaps because of
inadequate education, disproportionate poverty, discrimination in the delivery of health
services, and cultural differences, due to adverse socio-economic conditions.
 Diseases of the heart, malignant neoplasm, unintentional injuries, and diabetes are leading
causes of AI/AN deaths (2008-2010).
 AI/AN born today have a life expectancy that is 4.4 years less than the U.S. all races
population (73.7 years to 78.1 years, respectively).
 AI/AN continue to die at higher rates than other Americans in many categories, including
chronic liver disease and cirrhosis, diabetes mellitus, unintentional injuries,
assault/homicide, intentional self-harm/suicide, and chronic lower respiratory diseases.
Disparities

9. Kayenta Health Center

11. The Place

12. The People

14. Defining an Appropriate Healing Environment
• Cultural Identity and History
• Dine Healing Practices and Dine Wellness
• Indian Health Services (IHS) Mission and Initiatives
• Creating a Culturally-Based Environment of Care

15. Healing Way of Life for the Mind, Body,
and Spirit, for Illness and Wellness

16. Kinaalda – Ceremony for Growth,
Wellness, and Maturity of young women

17. The Process

18. Kayenta Program
Inpatient:
• 10 inpatient & 3 birthing
beds
• Emergency department
• Diagnostic imaging &
laboratory
• Ambulatory surgery
• Pharmacy with drive through
• Traditional healing
Outpatient:
• 36 primary care exam rooms
• 30 dental chairs
• Behavioral health
• Physical therapy
• Wellness gymnasium
• Community health &
wellness outreach
Support:
• Lobby reception
• Administration
• Facility management

21. Concept

24. Site Plan

26. Plans

36. Outcomes

37. Ft. Yuma Health Center

40. The Place

45. The Program