Healthcare Design: Your first tribal project was the Wilma P. Mankiller Clinic in Stilwell, Okla., in 1992. How did you approach that job?
James Childers: That was an Indian Health Service facility. And as we went through the IHS program, we figured out that what it produced was the typical Indian clinic you might walk into anywhere: too small, overcrowded, no waiting room, no people amenities. Indian Health Service did a fantastic job of getting the most out of its square footage, but there were really no provisions for waiting areas.

We’re in a very rural area here in Oklahoma; these people might drive 40-50 miles for healthcare. And when they did, they brought Grandpa and Grandma and the kids. Everybody came. As a result, you’d go into these clinics and the corridors would just be lined with people.

The IHS design guidelines dictated that you be within 10 percent of their square footage limitations. So what we ended up doing was reducing the square footage in the mechanical rooms. By selecting the right kind of systems and putting a lot of this equipment on the roof instead of on the floor, I ended up under their program on total square footage.

So what they allowed me to do—after many meetings and discussions—was to take that additional square footage and put it into circulation. We increased the widths of corridors and increased the size of waiting rooms. This was all an effort to get Indian healthcare environments compatible with private care.