Influence of Environmental Design on Team Interactions Across Three Family Medicine Clinics: Perceptions of Communication, Efficiency, and Privacy

Abstract

Objective: In this study, we explored how two different primary care clinic physical layouts (onstage/offstage and pod-based [PB] designs) influenced pre- and postvisit team experiences and perceptions. Background: Protocols encourage healthcare team communication before and after primary care visits to support better patient care. Physical clinic environments may influence these behaviors, but limited research has been performed. Method: We conducted observations, three interviews with clinic managers, and six focus groups with 21 providers and staff at three family medicine teaching clinics. Observational data were captured through field notes and spaghetti diagrams. Interviews and focus groups were recorded, transcribed, and analyzed using a grounded theory-based approach to understand how aspects of the clinic environment affected communication, efficiency, and privacy. Results: Variations in communication styles and trade-offs between patient contact and privacy emerged as differences. In the onstage/offstage design, colocated teams had increased verbal communication but perceived being isolated from other clinic teams. In contrast, teams in PB clinics communicated with other clinic teams but had more informal patient contact within care-team stations that imposed privacy risk. Conclusions: Primary care clinic design appears to alter provider–team and patient–provider communication and flow. Organizations should consider aligning environmental design with desired interaction patterns when building new primary care clinics.

Collaborative Care in Primary Care: The Influence of Practice Interior Architecture on Informal Face-to-Face Communication—An Observational Study

“…Direct observation of human behavior reveals insights not accessible from other data collection methods such as self-report (Mays & Pope, 1995). The findings align with previous hospital-based and primary care research showing design factors having an important impact on staff collaboration (Gharaveis et al, 2018; Gunn et al, 2015; Karp et al, 2019; Rashid, 2009). By adopting a circulation/destination/transition zone space categorization, similar to others, we were able to identify design features that facilitate frequent on-the-fly communication (Gunn et al, 2015; Karp et al, 2019; Lyson et al, 2019; Oandasan et al, 2009) and suggest specific features of New Zealand primary care practice design associated with frequent informal staff communication.…”

“…The findings align with previous hospital-based and primary care research showing design factors having an important impact on staff collaboration (Gharaveis et al, 2018;Gunn et al, 2015;Karp et al, 2019;Rashid, 2009). By adopting a circulation/destination/transition zone space categorization, similar to others, we were able to identify design features that facilitate frequent on-the-fly communication (Gunn et al, 2015;Karp et al, 2019;Lyson et al, 2019;Oandasan et al, 2009) and suggest specific features of New Zealand primary care practice design associated with frequent informal staff communication. The importance of informal, face-to-face, onthe-fly communication facilitated through the interior architecture for developing collaborative primary care teams both extends and is consistent with Egan & Jaye's (2009) community of clinical practice concept.…”

The Representational Function of Clinic Design: Staff and Patient Perceptions of Teamwork

“…While openness of team areas was associated with lower teamwork perception by patients, the openness of staff work areas to patients may support patient experiences by allowing more encounters with staff members as Karp et al (2019) described. During our observations, multiple interactions between patients and staff members were observed as a result of staff-patient visual relationships.…”

Beyond Co-location: Visual Connections of Staff Workstations and Staff Communication in Primary Care Clinics

“…Freihoefer et al (2017) reported more frequent communication in an onstage/offstage clinic layout that separates patients from staff compared to the clinic layout with exposed staff work areas. Karp et al (2019) observed more frequent communication within the care team in the onstage/offstage clinic layout compared to the pod-based clinic layout with private provider offices.…”