Healthcare Design - November 2015 - 110

R RESEARCH | 11.15
Configuring for collaboration

A research team digs into what layouts best support new integrated care team
models by identifying staff needs and simulating work processes

Preview

By Jennifer R. DuBose and Ross Westlake
Healthcare is moving away from individual encounters with single clinicians and toward coordinated,
integrated care by high-performing teams. This is
particularly true in the outpatient environment and
for healthcare systems pursuing patient-centered
medical home (PCMH) models of care.
A research team composed of senior researcher
Jennifer DuBose and PhD graduate student Lisa
Lim, both from the Georgia Institute of Technology,
and Ross Westlake of Applied Knowledge and Insights from Herman Miller Healthcare explored the
ability of the outpatient clinic's physical environment
to facilitate or impede collaboration and communication in PCMH care models.
Environmental influences on collaboration were
found to vary across scale and can be categorized
into three levels: the clinic level, the team room
level, and the workstation level. Aspects such as
overall typologies and configurations drive collaboration on a clinic level; however, the research
reveals that smaller design elements in the team
room and workstation levels are also significant
influencers.
An opportunity arose to deepen the research as
well as apply and test the learnings at Mercy Care,
a Federally Qualified Health Center in Atlanta and a
PCMH clinic recognized at the highest level by the
National Committee for Quality Assurance. Mercy
Care was in the process of renovating its clinician
work areas and asked for assistance in redesigning
these spaces.
To understand the needs and work styles at
Mercy Care, field observations were conducted of
the Mercy teams in action. Researchers shadowed
providers and documented behavior through timed
rounds, recording the activities occurring at key
staff work areas and transit locations around the
clinic. Using electronic tablets, the team recorded
the time, location, activity, communication partners,
and items used by each person observed during
shadowing and behavior mapping.
The clinic, as it was laid out at the time of the
research, had separate workspaces for physicians/
nurse practitioners and medical assistants-and
they weren't close, let alone adjacent. Analysis of
the behavioral data points from the observation
confirmed what was suspected: The groups of
clinicians communicated 45-65 percent less with
110

HCDmagazine.com 11.15

staff members who weren't peers and who weren't
closely located than with their peers in their common
workspace.
This strongly reinforced the hypothesis that
traditional clinic staff layouts don't support interprofessional collaboration and communication,
which are both critical for new, integrated care process models.

Traditional clinic staff layouts don't support
interprofessional collaboration and communication,
which are critical for new process models.
Understanding needs
As reported previously in the April 2015 Research
column in Healthcare Design, the researchers identified four ways clinic and team room design might
affect the team and its work processes: culture,
communication, individual work, and coordination
and awareness. Those considerations guided the
work with Mercy Care to design a solution that would
be best for the provider's needs. While the Mercy
Care renovation didn't afford the opportunity to
change much of the overall clinic configuration and
adjacencies, it did allow a new layout for integrated
team workspaces.
In speaking with the staff, differences between
their explicit and tacit needs were also observed.
Explicit needs are often expressed-such as the
ability to see exam room entrances or to have a
space where a caregiver can concentrate with minimal distraction. Tacit needs are those that caregivers
may not be as aware of-such as finding other staff
members or having accessibility to others.
Previous literature and research at various clinic
sites indicated that communication patterns of
similarly functioning teams varied widely in different
built environments. The observed differences supported previous research that, in general, sociofugal
configurations, which promote seclusion by having
the seating facing outward, are less supportive of
unplanned communication than sociopetal configurations, which encourage interaction by having the
seating facing into a group.
Additionally, the research suggested that while an
environment may meet the explicit needs of a team,

Jennifer R. DuBose

Ross Westlake

http://www.HCDmagazine.com

Healthcare Design - November 2015

Table of Contents for the Digital Edition of Healthcare Design - November 2015