Small town culture and big city care merge fluidly at the newest incarnation of Norwood's Uncompahgre Medical Center. Just over a year ago, the clinic opened the doors to its new, state-of-the-art facility, a significant leap from the center's 1939 beginning and long stint on Grand Avenue. Under the direction of Michelle Haynes, the center has not only moved into a top-quality building, but it has become financially stable while expanding care for its patients.

"The building is serving us beyond what I could have foreseen," said Haynes. "The emergency landing facility for the helicopter is greatly improved, our X-ray capacity is improved thanks to a grant from the Telluride Foundation and we have expanded our ability to host specialists while still carrying a full clinic. Patient flow and confidentiality are better, and we are able to house complimentary providers. We've also been able to facilitate more health-related community meetings with our new conference room."

Haynes, as well as health care providers Dr. Hillard Zallen and Michael Adams, P.A., enthusiastically tout the amenities at the clinic, especially Adams, who spent six years at the old building before last year's move.

"This facility offers us the opportunity to serve people better in a more conducive atmosphere," Adams said. "It's easier to manage patients when you can depend on the heat in the winter and plug things in without sparks. The other clinic was just an old building that was designed and built for a different time. This clinic meets all the state standards for accessibility and is better designed."

A tour through the new clinic, with its centralized nursing station, isolated emergency room and various sizes of patient rooms, creates a feeling of space for the patient and easy accessibility for the practitioners. The facility, though, is just the skeleton; the real heart of the clinic lives in its staff and administration.

"It's a well-done building and a comfortable place to work, but that was only part of my decision to come here," said Zallen, a Denver-area native who signed on with the clinic following his residency in Boise, Idaho. "My family and I were looking for both a community we liked and a clinic, and this is the perfect combination. It's a well-run, stable clinic with a good patient base and strong standing in the community. It's really exceptional for a rural health care facility."

The clinic has not always enjoyed such stability. When Haynes came to the clinic, it was in the aftermath of a few significant changes that severely impacted its financial health. For Haynes, it was a return to the area (husband Randy grew up in the region) after working in a community mental health facility in Denver and earning her M.B.A. Her first challenge as director was to stabilize the situation.

"We first had to make the clinic financially viable, which demanded we set out a strict budget and go from there," she said. "We had the overwhelming support of the community, which has continued all along almost no matter what the situation is. We also have been fortunate to attract top quality providers who are not only good providers for here, but as good as you can get anywhere. As we became more stable, the Bureau of Primary Health Care was willing to invest more money. Then we started looking at other programs, like partnering with providers. We've done large surveys to identify needs, and then we try to meet them."

Patients see little of the behind-the-scenes business at the clinic, but the financial stability cannot be understated. Haynes has actively pursued funding from every source imaginable, and she is aided in this pursuit by the large number of under- and uninsured patients the clinic sees.

"We are a frontier area with about 65 percent low-to-moderate income patients, so grants help sustain about 40 percent of our budget," she said. "Plus we have other ways to help, like Kathy Reed, who is a patient advocate and can help uninsured patients find funding programs. The clinic itself manages the Neighbor-to-Neighbor Fund, where board members and locals donate to help in smaller ways, like funding prescriptions for a month."

Haynes is quick to include the clinic board in the success story. She cites the community based board as one that focuses on identifying community needs and facility and program development, but leaves the day-to-day operations to its highly qualified staff.

"Our board is so great to work with," she said. "They are there when we need them and provide the support we need to keep things running smoothly."

And that is no small accomplishment. The clinic offers a dizzying array of services to local patients, easing the exhaustion of traveling for medical care. In addition to in-house dental, physical therapy and mental health care, orthopedic and podiatry specialists visit regularly, and the clinic has added Telluride practitioner McLean Cherry to the staff to assist Zallen in expanding women's and children's care. One service it doesn't offer is after-hours care.

"Many years ago on-call services were available, and it was very challenging and expensive," said Adams. "Instead, Michelle (Haynes) wrote an EMS grant to boost support for our excellent emergency services, and that money paid for new equipment and training. We have found a balance."

Zallen, too, sees the downside of extended care in rural areas where medical professionals can find themselves trying to fill too big of a hole.

"One of the problems community health centers face is the desire for long-term continuity with caregivers," he said. "And if there is extensive after-hours care, doctors will get burnt out; I've seen it with fellow doctors. Physicians don't like to say no, but that kind of work is difficult to sustain."

To insure sustainability at the Uncompahgre Medical Center, Haynes has a multi-pronged approach. She has worked to reduce debt: less than 10 percent of the cost of the new clinic is owed, and she is very committed to pursuing grant funding and other health-care cost reduction programs. She also recognizes the value of staff stability and strives to hire people she believes will be happy in the modest, often inconvenient lifestyle of Norwood.

"Finding a provider can be difficult, and when we are recruiting, we are sure to invite the family," she said. "The provider might be happy here, but the family might not, and that can be a weight on them. We are also careful not to burn them out."

Looking ahead to the future, Haynes plans to stay the course that has served them so well: responding to the needs of their community.

"Right now our vision is to continue providing the best service we can," Haynes said. "We just negotiated a new lab contract to provide really good service at a lower cost. Dr. Zallen would like to see more specialist providers come in. We want to let people know that they don't have to go to Montrose for good health care. Our providers are very capable of caring for our patients and our communities."