Reworking The Healthcare Workspace
Clinic space planning and design are evolving to support the delivery of an enhanced, outcome-focused patient experience. Key factors driving this shift include the growing use of technology in care, the increasing complexity of specialty clinics, and the emerging medical home model. Additionally, reimbursement structures geared toward managing wellness instead of treating illness are driving more collaboration among caregivers.
The acknowledgement of any one, if not all, of these factors leads to a new approach to operations, which requires thoughtful consideration of the workspace itself. Though essential to the function of a clinic space, they’re traditionally allocated to the back-of-house.
A more strategic approach to the location and configuration of workspaces can add to the efficiency of a practice, impacting patient satisfaction and outcomes.
The use of technology has been evolving in the clinic setting as electronic records become the norm. With clinicians more likely to be interfacing with devices than paper, space efficiencies are being realized. Thanks to the ease of privacy protection afforded by electronic storage, areas once dedicated to records in secluded corners of the clinic space can be moved into centralized patient hubs.
Meanwhile, as patient needs become more complex, providers and healthcare systems strive to respond with highly specialized practices that can include an array of caregivers beyond the physician, medical assistant, and nurse. One key element to the successful delivery of care for cases with complex profiles lies within the care team’s ability to research and collaborate with other professionals, such as social workers, psychologists, physical therapists, and pharmacists.
Providing the appropriate setting and opportunity for interaction can lead to a more comprehensive approach to care, with the traditional model of a doctor’s office and charting stations not supporting the breadth of the team, variety of tasks, and the collaborative work required. Responding with spaces that promote both team-centric and focused work promotes the ability to deliver highly specialized care.
The Cancer and Blood Diseases Institute (CBDI) clinics at Cincinnati Children’s Hospital Medical Center offer one example of modern patient case management. CBDI patients have complex diseases—e.g., a cancer patient may also suffer from neurological issues or require physical therapy—that must be monitored and managed by a team of clinicians.
To operationally improve the clinic, Shawna Langworthy, the outpatient clinical director for CBDI, created the position of flow lead, a nurse responsible for knowing what’s happening with a patient visit at all times. This nurse was stationed within a workroom that functioned as a touchdown space for clinic physicians who have offices located throughout the campus. Each workroom was dedicated to a specific component of CBDI: oncology, bone marrow transplant, and hematology. However, they weren’t set up to foster a collaborative approach to care.
“We need to keep track of when patients have arrived, who has seen them, whether they need labs or prescriptions. We may need to put them in touch with social services to arrange for transportation. A flow lead typically tracks 10-12 patients at a time in addition to knowing who’s about to arrive and following up to make sure the post-clinic needs of the patient are met,” Langworthy says.
GBBN Architects (Cincinnati) worked with CBDI to create a space that supports and fosters this care model. Design charrettes were held with staff to review layout concepts that provided a mix of individual work areas and team collaboration spaces.
The resulting workroom designs deliberately feature open space over partitions, because of the interactive nature of the work and need for clinicians to see one another, with sound masking used to mitigate noise.
“Having a large room where everyone can work together outweighs any problems we have with associated noise. Cubicles or a series of rooms would not work for us. The flow lead is able to visualize the whole room and help manage a patient’s visit,” says Dr. Rajaram Nagarajan, associate director of oncology clinical operations at CBDI.
A number of mock-up stations were trialed with staff, with the resulting layout designed for flexibility. For example, islands are used as team zones or individual touchdown stations, as needed. Smaller workstations with additional ergonomic tools and smaller-scale chairs that offered mobility were chosen.
In order to achieve this, the workstations were designed to support only the functions necessary and to accommodate high volumes of providers who would be coming and going multiple times a day. Storage wasn’t a concern, which allowed for a narrow footprint. Depth was also kept to a minimum through the use of dual articulating monitor arms and under-mount processor holders. This setup not only keeps technology out of the way but allows a team to share images by swiveling monitors.
Since seated time is minimal, the smaller chairs that provide short-term comfort were provided to respond to both the size of the workstation and allow for easy mobility when care teams choose to gather together. Each workroom also contains huddle spaces, with large wall mounted monitors and work surface for several team members to view patient records together.
The clinics opened in January 2013, and the design team has followed the project post-occupancy to assess how well the space is performing.
One dramatic change fostered by the new design was the ability to collocate all staff related to a clinic into a single workroom, instead of a space being available for physicians only. “All practitioners that need to be involved are in one space while still being able to cluster by groups to collaborate. A face-to-face arrangement of seating allows us to work in a more interactive way,” Nagarajan says.
Overall, it’s been found that the efficiencies in work style, collaboration, and workflow have led to the desire of employees to remain in workrooms, even when collaboration isn’t required. Knowing where everyone is and keeping this backbone function central but out of sight of patients and families has created a better patient experience, too.
What’s to come?
As demand for a more comprehensive approach to managing both disease and wellness emerges, space needs are demanding solutions that support this process. This focus on integrated, team-centric care highlights the polarity between traditional private offices and open workstations.
Siloing perpetuated by private offices or isolated workstations is no longer a viable condition for many organizations. As a more collaborative care platform evolves, workspaces must evolve, as well.
Strategic collaboration and less hierarchical environments will be required to effectively meet the demands of today’s primary care teams. Although an off-stage function, the spaces where clinicians and staff work are becoming a key part of creating an optimal patient experience and improving care delivery.
Angela Mazzi, AIA, ACHA, EDAC, is an associate and medical planner at GBBN Architects. She can be reached at firstname.lastname@example.org. Erin Schmidt, IIDA, LEEP AP, is an interior designer at GBBN Architects. She can be reached at email@example.com.