Visalia’s Measure H failure last year leads to master plan, new partnership

Kaweah Delta hires master planning firm, studies Sierra View Medical Center partnership


VISALIA – Hospitals need to meet California’s earthquake standards by 2030. While some hospitals managed to finance the expensive infrastructural cost through bonds, Kaweah Delta needs to find another way after the failure of Measure H last year.

Now, Kaweah Delta, with input from the community, is taking steps to meet the changing health care needs of the region today and into the future.

Kaweah Delta’s board of directors has formally engaged with a master planning firm that in the next year will help develop solutions to replace the building that houses 221 inpatient hospital beds that cannot be used beyond 2030 because it does not meet California’s earthquake standards. Additionally, the firm will propose new facilities for Kaweah Delta to care for the community, including ways to add new services, increase access, and improve areas that are currently a challenge, such as parking.

“This is a very exciting time for us as we continue to seek ways to partner with others and plan for how we will care for our community in the future,” said Gary Herbst, Kaweah Delta’s CEO, who has found silver linings in the 2016 defeat of Measure H, the general obligation bond intended to help fund Kaweah Delta’s initial proposal for a “new acute care hospital” to partially replace a sizable portion of the seismically-non-compliant acute care beds located in Kaweah Delta’s Mineral King Wing. “Working with the community has been a phenomenal experience, to say, ‘okay, community, we have got to figure this out a different way,’ and in the long run, we are going to end up with a better solution from doing that.”

Also this month, the board will explore a partnership through creation of a Joint Powers Agreement and Joint Powers Authority (JPA) with Sierra View Medical Center in Porterville, a partnership designed to help lower the cost of health care for both hospitals and help them better care for people in the region.

Master Plan

The master planning firm, RBB Architects, was unanimously selected by the board with input from members of Kaweah Delta’s “Hospital of the Future” Community Advisory Committee, one of five community groups totaling approximately 200 people that have offered Kaweah Delta input on a variety of topics. Members of the “Hospital of the Future” Committee were there when RBB, one of four leading architectural and engineering firms, presented proposals after Kaweah Delta reached out to 10 firms, none of whom were involved in the master facility plan developed for Kaweah Delta in 2015. The final four proposals are available at

For nearly a year, the Hospital of the Future committee, along with key City of Visalia officials, has searched for solutions to Kaweah Delta’s 2030 deadline to bring the older part of its hospital into compliance with state earthquake standards. “The more we learn, the more it seems that we will have to replace the 221 inpatient beds because the structure in which they are located does not meet seismic compliance. Whenever feasible, we plan to adopt an incremental approach to building new facilities to lessen the financial impact to Kaweah Delta and the community that supports it,” Herbst said.

Founded in 1952, RBB is based in Los Angeles and has completed over 10,000 health care and other master planning projects throughout the U.S. and overseas. The board and committee members were impressed with RBB’s experience, its ability to maximize cost savings for others, including Dignity Health Mercy Merced’s replacement hospital in 2010, and its No. 1 architectural firm ranking from the Office of Statewide Health Planning and Development (OSHPD). The group liked RBB’s design philosophy, which includes elements that improve quality of care for patients and reduce costs. An example is elimination of wasted space to reduce the number of steps a nurse takes from a work station to a patient’s bedside. RBB is also the architect behind Kaweah Delta’s Emergency Department expansion.

Hospital Partnership

Both Kaweah Delta and Sierra View’s respective boards of directors will separately meet Nov. 27 to consider a partnership that could allow both entities to lower the cost of health care and further their goals of caring for people in the region. This would involve the establishment of a JPA, something that public agencies including cities, counties, schools and health care districts are allowed to do. If the hospitals move forward with this agreement, they would look for things they both currently offer independently and bring them together to provide the same service at a lower cost to each hospital. For example, they could work together on projects such as: the joint establishment of a clinic, the joint recruitment of physicians/staff, or the alignment of pharmaceutical/supply purchases. If the hospitals were to make joint purchases, both hospitals should incur the savings that come from buying in larger quantities. If both boards approve moving forward, the JPA could be operational in early 2019.

JPAs allow hospitals to achieve the benefits of consolidation, while remaining independent. Under this arrangement, employees would remain with their current hospital, both hospitals would continue to be governed by separate boards and management teams, and each hospital would maintain a separate medical staff. Another benefit of a JPA is that they allow for growth, so both hospitals can potentially reach out to other partners to join, said Donna Hefner, president and CEO of Sierra View Medical Center. “A partnership with Kaweah Delta is something that Sierra View has been hoping to achieve for some time. It aligns with our mission, vision and values which focuses on partnerships and collaboration. This collaboration will allow us to continue to meet the health needs and strengthen the quality of life for our community,” she said.

In health care, JPAs are becoming the norm, Herbst said. “Hospitals are no longer called to just care for people who are the sickest, they are asked to take care of the health of an entire population. To do that effectively, you have to have broad geographic coverage and that is where affiliations and partnerships are becoming norms of change,” he said. “From the consumer, patient and community point of view, this is a good thing.”

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