Healthcare Design - September 2016 - 84

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ALL TOGETHER NOW

Post-occupancy evaluations conducted on four
different Patient-Centered Medical Home clinic
designs yield insights into what works best
By Tom Clark
iorists. In order to support PCMH and Lean
goals, at least two successful typologies are
emerging-open team centers and on-stage/
off-stage approaches, both of which colocate
more comprehensive care teams to optimize
coordination, collaboration, and efficiency.
Healthcare design firm Clark/Kjos Architects
(Portland, Ore.) performed post-occupancy
evaluations of four clinics designed by the firm
using the open team center model, each with a
different approach, to learn what specific design
strategies are most successful in meeting the
PCMH and Lean goals. They are all similar in
size, with 18 to 21 exam rooms. Clinic staff completed online surveys with their judgments related to both care team communications and efficiency factors related to walking distance. The
four clinics evaluated are:

84

SEPTEMBER 2016

The Clinic A team center
(above and below) uses
open workstations for
medical assistants and
other ancillary staff that
surround semi-enclosed
provider workstations.

The post-occupancy surveys yielded some
clear lessons for designers who are working with
the open team center model.
WA L K I N G D I S T A N C E

Patient rooming: patient (patient travel from clinic entrance to exam room). The distance from the
clinic entrance to the exam room ranged from
170 to 243 feet (median for each clinic). The surprising difference between the clinics studied
is the added walking distance created by some
waiting room sizes and shapes. As a result, the
designers recommend placing the waiting room
as close as possible to the exam room cluster,
as well as minimizing the distances within the
waiting room, which is especially important for
those with disabilities.

HCDMAGAZINE.COM

NATHANIEL WILSON

T

many new outpatient clinics are
designed to support the Patient-Centered Medical
Home (PCMH) model, a concept that was codified by
four major physician associations in the "Joint Principles of the Patient-Centered Medical Home" white
paper in 2007. Principles include care coordination,
physician-directed teams, and whole-person orientation, among others. In addition, many clinic planners
have adopted some form of Lean planning to improve various patient care outcomes and create
staff efficiencies through eliminating wasteful
steps from their operation.
Traditional clinic planning typologies pose
challenges to meeting these goals, because
they often separate care teams (physician offices in separate locations from medical assistant stations), limiting team coordination and
increasing walking distances (waste); also,
these plans usually don't support collaboration with care coordinators and ancillary care
professionals like nutritionists and behavHE OPERATIONS OF

* Clinic A: Open team center with provider stations partially enclosed with patterned glass
* Clinic B: Open team center with provider
stations partially enclosed with solid walls
* Clinic C: Racetrack plan with provider stations partially enclosed with solid walls
* Clinic D: Open team center with provider
stations enclosed with glass, frosted at sitting height.
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Healthcare Design - September 2016

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