Jenni Eschner, Associate Principal at architecture firm Kahler Slater
To succeed as population managers, the most progressive health care organizations understand they must migrate from a physician-centric clinical model toward top-of-license, team-based care. At the foundation of this new multidisciplinary approach is collaboration. Team collaboration is no longer a “nice to have” for health care organizations—it’s an essential component for realizing the promise of higher quality, more efficient care in the future.
While often overlooked, facility design can support and enhance team-based care by encouraging in-person communication, breaking down delivery system silos, and bridging barriers created by the physical space.
What are the most promising approaches for rethinking the configuration of the built environment to facilitate collaboration? We spoke with architecture and design firm Kahler Slater to discuss three easy strategies your organization can take in your next building project to strengthen team-based care:
Eliminate private physician offices
While private offices may seem convenient for physicians, many providers have recognized the advantages of shifting toward a central touchdown space to foster better coordination among clinical staff within the ambulatory environment. For example, University of Wisconsin Health's Yahara Clinic, an ambulatory care setting offering primary care services and imaging and diagnostics, invested in an Integrated Care Team (ICT) space to increase collaboration among physicians and the broader care team. Piedmont Healthcare in Atlanta did the same in their newly renovated inpatient area, adding behind the scenes care team collaboration zones. Today, physicians stand shoulder-to-shoulder with mid-level providers, including physician practitioners, nurses and medical assistants, to discuss patient treatment plans for high-risk populations.
Providers have also recognized that private physician offices represent expensive real estate that too often may go unused. With physicians splitting their time between both clinic and hospital settings, as well as connecting from home through electronic medical records, dedicated office space in multiple locations can lead to inefficient duplication. In addition, younger practitioners that have become acclimated to a more integrated practice model may be less likely to regularly use dedicated offices.
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As a result, organizations should consider repurposing private physician office space for patient care functions. For example, square footage that was previously allocated to physician offices can accommodate exam room expansion, group patient education spaces, consult rooms, and larger treatment rooms, all which help support complex chronic care management and patient engagement in primary care practices. This not only yields benefits in terms of better patient outcomes, but can ultimately improve the financial picture for a health care organization by expanding the revenue-producing components of the practice.
However, if eliminating all physician offices in a culture that is accustomed to private offices isn’t something your organization can support, consider the strategy employed by Meriter-UnityPoint Health in their newest Monona Clinic and DeForest Clinic. In this scenario, shared multi-provider work zones (group offices) are provided immediately adjacent to the care team areas for enhanced collaboration and a more efficient use of space.
View examples of Kahler Slater's work in this slideshow.
Plan for unassigned work spaces
Your facility design should provide multiple informal and unassigned work areas that serve smaller groups of 2-3 people. This supports how most collaboration actually occurs—within short, informal interactions between only a few clinical staff members. For example, Centegra Hospital Huntley included smaller work stations in the design of their emergency department, creating a care coordination hub for staff with small group work areas. These smaller work areas allow room for “team huddles”, where physicians can connect with support staff daily to review the work at hand and anticipate the needs of patients and families.
Unassigned spaces can also serve as hoteling stations for private phone conversations, dictation, focused work that requires a quieter environment, or to supplement privacy needs for physicians who are no longer in private offices. To accommodate different clinicians’ practice styles, design these meeting areas with varying work surface heights, partition heights, and levels of visual and acoustical privacy.
Create 'off-stage' staff break space
Consider off-stage team-building zones outside clinical work areas and the delivery of patient care. At Holy Redeemer Healthcare at Bensalem and Martha Jefferson Hospital, off-stage lounges offer an additional alternative to shared touchdown spaces to foster staff communication. These organizations have found that break areas have not only proved to be an invaluable support for team-building, they can also help reduce the amount of noise within clinical spaces, creating a quieter environment for providers and patients alike. An off-stage area may help avoid potential HIPAA compliance concerns by ensuring that private patient care conversations between staff aren’t inappropriately overheard in patient and visitor areas.
Of course, an off-stage break space shouldn’t be located too far away from clinical areas. Although evidence-based design research shows that getting away from work areas provides much needed respite and a chance to reinvigorate for clinicians so they can perform at their highest level, caregivers prefer - and are more likely to use - a space that is adjacent to their immediate practice area.
It’s no secret that strengthening collaboration is essential for providers as they move toward new team-based delivery models. This means that clinicians need the ability to interact with a larger, integrated care team that includes mid-level providers, interdisciplinary allied health team members and administrative staff to share information related to patient care. While you’re working to put in the right clinical processes in place to achieve success, don’t overlook the role of the built environment. The right facility design can make all the difference in your care team’s ability to deliver seamlessly coordinated patient care.
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