Healthcare Design - November 2014 - 22

INTERIORS | 11.14

Reworking the workspace
Recent shifts in care delivery models are inspiring the need to rethink workspaces of old to
support more collaborative, team-based approaches
By Angela Mazzi and Erin Schmidt
Clinic space planning and design are evolving to
support the delivery of an enhanced, outcomefocused patient experience. Key factors driving this
shift include the growing use of technology in care,
the increasing complexity of specialty clinics, and
the emerging medical home model. Additionally,
reimbursement structures geared toward managing
wellness instead of treating illness are driving more
collaboration among caregivers.
The acknowledgement of any one, if not all, of
these factors leads to a new approach to operations, which requires thoughtful consideration of
the workspace itself. Though essential to the function of a clinic space, they're traditionally allocated
to the back-of-house.
A more strategic approach to the location and
configuration of workspaces can add to the efficiency of a practice, impacting patient satisfaction
and outcomes.
Influencers
The use of technology has been evolving in the clinic
setting as electronic records become the norm. With
clinicians more likely to be interfacing with devices
than paper, space efficiencies are being realized.
Thanks to the ease of privacy protection afforded by
electronic storage, areas once dedicated to records
in secluded corners of the clinic space can be
moved into centralized patient hubs.
Meanwhile, as patient needs become more
complex, providers and healthcare systems strive
to respond with highly specialized practices that
can include an array of caregivers beyond the
physician, medical assistant, and nurse. One key
element to the successful delivery of care for cases
with complex profiles lies within the care team's
ability to research and collaborate with other professionals, such as social workers, psychologists,
physical therapists, and pharmacists.
Providing the appropriate setting and opportunity for interaction can lead to a more comprehensive approach to care, with the traditional model
of offices and charting stations not supporting the
breadth of the team, variety of tasks, and the collaborative work required. Responding with spaces
that promote both team-centric and focused work
promotes the ability to deliver highly specialized
care.
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HCDmagazine.com 11.14

The challenge
The Cancer and Blood Diseases Institute (CBDI) clinics at Cincinnati Children's Hospital Medical Center
offer one example of modern patient case management. CBDI patients have complex diseases-e.g.,
a cancer patient may also suffer from neurological
issues or require physical therapy-that must be
monitored and managed by a team of clinicians.

The traditional model of offices and charting
stations doesn't support the breadth of the
team, variety of tasks, and the collaborative
work required.
To operationally improve the clinic, Shawna
Langworthy, the outpatient clinical director for
CBDI, created the position of flow lead, a nurse
responsible for knowing what's happening with a
patient visit at all times. This nurse was stationed
within a workroom that functioned as a touchdown
space for clinic physicians who have offices located
throughout the campus. Each workroom was
dedicated to a specific component of CBDI: oncology, bone marrow transplant, and hematology.
However, they weren't set up to foster a collaborative approach to care.
"We need to keep track of when patients have
arrived, who has seen them, whether they need
labs or prescriptions. We may need to put them in
touch with social services to arrange for transportation. A flow lead typically tracks 10-12 patients at
a time in addition to knowing who's about to arrive
and following up to make sure the post-clinic needs
of the patient are met," Langworthy says.
GBBN Architects (Cincinnati) worked with CBDI
to create a space that supports and fosters this
care model. Design charrettes were held with staff
to review layout concepts that provided a mix of individual work areas and team collaboration spaces.

Angela Mazzi

The solution
The resulting workroom designs deliberately feature
open space over partitions, because of the interactive nature of the work and need for clinicians to see
one another, with sound masking used to mitigate
noise.

Erin Schmidt

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Healthcare Design - November 2014

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