Healthcare Design - August 2014 - 40

R RESEARCH | 08.14
Stepping up collaboration
A post-occupancy evaluation sizes up a new clinic layout that's focused on
improving caregiver workflow and the patient experience through a balance of
design and operations
By Kate Egan

Study guide
To see if the approach worked in what today is the
Yahara Clinic in Monona, Wis., the design team
conducted a post-occupancy evaluation, specifically
studying hypotheses related to the project's goals.
The first hypothesis that informed design was that
creating off-stage ICT work areas would maximize
staff efficiency and increase patient privacy. Yahara
Clinic adopted a patient-centered medical home
model of care that required many caregivers to work
together to oversee the health needs of their patients.
The ICT work areas locate physicians, medical
assistants, nurses, social workers, and other caregivers adjacent to each other to increase collaboration
and allow for real-time conversations. These work
areas are also adjacent to exam rooms, reducing
the distance caregivers travel between workstations
and exam rooms. Off-stage work areas reduce the
opportunity for patients to overhear conversations
about other patients, which increases patient privacy.
The next hypothesis was that utilizing a self-rooming operational model would reduce wait times and
increase patient privacy, patient safety, and staff
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HCDmagazine.com 08.14

efficiency. Using technology to indicate available
exam rooms, patients are immediately directed to
their rooms by a receptionist instead of being seated
in a public waiting area. Receptionists use medical
records software to alert the caregivers that patients
have arrived.
Caregivers receive patients in their exam rooms,
where they're privately weighed, which many patients prefer. By not waiting in a centralized waiting
area, patients aren't exposed to other patients who
might be contagious, and staff no longer needs
to go to the waiting room to retrieve patients. This
saves time and steps, allowing for more time to be
spent on patient care.
Under this model, the waiting area was sized to
be smaller than typical clinics, since only patients
who arrive early or have other people with them
would utilize this space. According to the Advisory
Board Co.'s presentation "Ambulatory Facility of
the Future, Part II, Enhancing Facility Performance
through Design Innovation," the average clinic
accounts for 1.5 seats per exam room, but the Advisory Board cites that an optimal proportion is closer
to 0.5 seats per exam room. In the Yahara Clinic
model, there are 0.45 rarely used seats per exam
room, indicating the waiting room could have been

In the semicircular welcome
center at Yahara Clinic, reception staff initiates the check-in
and self-rooming process by
providing patients with a simple
map and room destination
identification. A smaller-thanaverage waiting area was provided due to the self-rooming
model, saving square footage
for patient care areas.

Kate Egan

When embarking on a new outpatient clinic project,
the University of Wisconsin Medical Foundation
(UWMF) zeroed in on design goals of supporting Lean and efficient operations as well as staff
collaboration and enhanced patient privacy. The
solution was to create an integrated care team (ICT)
space as close as possible to the areas where care
is delivered. A plan was developed that separated
back-of-house ICT space from front-of-house patient
amenity areas and circulation. However, when completely separating front-of-house and back-of-house
functions in a clinic setting, the one place the two
must overlap is in exam rooms.
To address this challenge, the design concept
created dual-access exam rooms with patient entry
from the public corridor and caregiver entry from the
care team collaboration area, maintaining complete
autonomy for both realms. Caregivers would be able
to collaborate within a significantly more efficient and
fully integrated team environment without concerns
for patient privacy or interruptions, and patients
would be provided with a comfortable, hospitable
environment away from the clinical setting.

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Healthcare Design - August 2014

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