Architecture, College of


Date of this Version

Spring 5-3-2021

Document Type



Coughlin, John P., "Accessible Health- An Evidence Based Approach to Improve User Experience and Clinical Sustainability Within Rural Healthcare" (2021). Theses from the Architecture Program.


A Design Thesis Presented to the Faculty of The College of Architecture and the College of Graduate Studies at the University of Nebraska In Partial Fulfillment of the Requirements For the Degree of Master of Architecture, Major: Architecture, and For the Degree of Master of Community Regional Planning, Major: Community Regional Planning, Under the Supervision of Professors: Lloyd (Bud) Shenefelt, Yunwoo Nam, Steve Hardy, & Gordon Scholz. Lincoln, Nebraska: May 2021

Copyright © 2021 John Phillip Coughlin


The manner through which health care is provided evolves through advances in medical knowledge as well as improvements in supporting infrastructure and processes. The rate at which this change is made possible is increasingly driven by non-medical factors. These factors include, but are not limited to, the necessity to operate safely in a COVID-19 pandemic while simultaneously operating with economically sustainable processes and infrastructure. This is especially true for underserved populations in rural communities. Acknowledging and understanding these changing environments allows one to better optimize the sometimes competing interests of user experience with sustainable clinical practices. Healthcare is vital to the economic viability and wellbeing of rural communities. This study explores existing research and precedents focused on promoting access and delivery of primary care to underserved populations while supporting sustainable operations for medical facilities. Minimizing the distance between patients and their providers while maintaining a high quality of care at each clinic will make healthcare more accessible and relevant for people living in rural communities. This Tyranny of Distance influences user access to necessary healthcare services while concurrently shaping available options for sustainable clinical support. What are the best practices to extend care delivery and optimize clinical operations to improve the healthcare experience in these areas? This study identified best practices and implemented an evidence based approach capable of creating and supporting accessible, adaptable patient care settings. The patient experience and their willingness to accept new approaches, such as virtual care, must always be at the forefront of care and include eficient, efective, high quality care. A broad comprehensive literature review was employed to understand challenges in healthcare as well as identify what are driving the trends we see in the primary care designs today. From the extensive literature review, over 110 articles were reviewed all of which were applicable to topics related to rural healthcare objectives. Primary research was completed through interviewing design professionals, health providers, and facilities managers associated with healthcare in Nebraska. The extensive research was used to identify and develop a framework for which various drivers, trends, and data streams can be synthesized to generate a flexible framework for rural healthcare delivery.

Advisors: Lloyd (Bud) Shenefelt, Yunwoo Nam, Steve Hardy, & Gordon Scholz