Liz Johnson

Project Leader Elizabeth Johnson, Ph.D., RN
MSU Mark & Robyn Jones College of Nursing
elizabeth.johnson37@montana.edu 

The objective of this research is to conduct a rural hospital infrastructure evaluation and community health care needs assessments for Phillips County Hospital in Malta, northeastern Montana. As 1 in 4 rural Montana hospitals have closed or are at risk of closing due to financial constraints, and 55 of 56 counties are designated as health care provider shortage areas, the Montana Hospital Association has prioritized a critical review of current health care delivery systems in the a) status of the built environment and b) service line congruent to community care needs. The focus of this pilot project is to employ community-based participatory design methods that will examine the influence of built environment with care delivery to align the Phillips County Hospital system of care to the current health care needs of the other 5,000 rural-dwelling residents it serves.

The interdisciplinary team of engineering and nursing experts will utilize eye-tracking glasses (Tobii Glasses 3), screen-based eye-tracking (Spectrum bar), and the Atmos Pro air quality indicator to evaluate the operational functionality of the hospital (Aim 1), which includes cognitive workflow assessments of patients and providers receiving care or delivering care in the current infrastructure. Semi-structured qualitative interviews will be conducted with community members who identify as recipients of care or providers at the hospital to understand current health care needs, barriers to care, and the exploration of the perception of health as a rural-dwelling resident (Aim 2). These methods and approaches are complementary to provide a multi-faceted examination of existing infrastructure and inform recommendations for a future-state renovation or rehabilitation that is responsive to the changing landscape of rural health care delivery. Analysis will include areas of interest derived from eye-tracking and elements of infrastructure inspection (air quality, lighting, wayfinding) for Aim 1, and qualitative content analysis to determine themes across community member interviews for Aim 2.

The proposed work is important because each rural hospital that remains solvent and operates to the needs of the community at-large becomes a means of decreasing the heightened mortality rate associated with lack of health care access or utilization. With 34% of Montana’s population in rural areas and the increase of older adults living in Phillips County, the Phillips County Hospital is an integral institution to support chronic disease management, emergent care, and wellness when aging in place.

Co-investigators on the project include Julie Ruff, Ed.D., Mark & Robyn Jones College of Nursing, and Bernadette McCrory, Ph.D., Department of Mechanical and Industrial Engineering.