New Medical Staffing Procedures Call For Design Solutions
The hybrid medical professional—physician-writer, physician-researcher, physician-educator, and the physician-editor—is often mentioned in literature and popular press. As a self-labeled “dochitect,” I propose a new hybrid model, the physician-architect, with the intent of bridging the gap between architecture and medicine through the field of healthcare design.
An architect now working as a resident physician, I maintain two notebooks in my white coat pocket: one for medical facts, a common finding amongst trainees, and the other for design notes and sketches.
The observations collected are shaped by my unique perspective: for example, seeing the design implications associated with changing medical practices.
According to a 2012 Johns Hopkins and University of Maryland study, medical interns spend a minority of their time directly caring for patients—12 percent in direct patient care, 64 percent in indirect patient care, 15 percent in educational activities, and 9 percent in miscellaneous activities.
Computer use occupies 40 percent of interns' time. Compared with studies prior to 2003, interns spend less time in direct patient care and more time talking with other providers and documenting.
Because of mandated reduced work hours in the setting of increasing complexity of medical inpatients, growing volume of patient data, and increased supervision, the amount of time we have with patients is limited. How does this changing practice impact staff space needs for effective care delivery?
It surprised me that so much time is spent on order-entry and charting at the computer, in rooms often without art, natural light, or acoustic control. Physicians are frequently separated from the nursing and ancillary staff, requiring multiple telephone calls for communication rather than discussing patient care face-to-face.
Space is generally limited for daily multidisciplinary rounds, which allow for efficient medical care delivery and planning for safe patient discharges.
No doctor can work constantly, so cross-coverage is essential. Night float is the product of reforms in medical education, which limits the number of hours that doctors in training can work. Residents assigned to work the night shift allows for other residents to sleep but also promotes frequent patient handoffs, which can result in the transfer of inadequate information.
It’s interesting to consider this change in hours on our work culture and use of space. Many hospitals continue to rely on interns signing out verbally to each other, often at busy and noisy nurses’ stations, potentially inviting error. Designers may soon need to consider designated spaces and technology for these handoffs to take place.
Recently in my hospital, we developed a plan to renovate our resident lounge and provide a separate space for our white coats and personal belongings. The administration came to assess the space and our proposed plans but recommended we turn one of our neighboring overnight on-call rooms into our coat room. “With the new work hour restrictions, residents shouldn’t need sleeping quarters anymore,” they remarked.
Ask any doctor-in-training working night shifts, and they’ll endorse that a place to rest is still required. Working a 12-hour night shift is not the same as a 12-hour day shift, especially with a constant switch between day and night schedules that can cause extreme fatigue and destroy circadian rhythms.
With this conversion to the shift work model, I wonder whether on-call rooms will remain part of departmental space programs, or will planners need to develop innovative areas for short naps and additional forms of rest and rejuvenation?
The changing face of medical training and practice will likely require the integration of additional spaces for multidisciplinary discussion, areas for short periods of rest for trainees, and quiet areas for safe and efficient handoffs to take place.
Diana Anderson will share more ideas at the Healthcare Design Conference, Nov. 16-18 in Orlando, during the session “When Drafting meets Doctoring: An architect’s view of health design as a resident physician." For more details, visit www.healthcaredesignmagazine.com/conference/.