Spatial Influences on Team Awareness and Communication in Two Outpatient Clinics: a Multiple Methods Study

Lisa Lim, Matthew Moore, Jennifer R. DuBose, Bushra Obeidat, Robert Stroebel, Craig M. Zimring

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Healthcare organizations are moving their primary care teams out of private offices into shared workspaces for many reasons, including teamwork improvement and cost reduction. Objective: Identify the specific aspects of layout and design that enable two fundamental processes of high-functioning teams: communication and situation awareness. Design: This was a multi-method study employing qualitative interviews, floor plan analysis, observations, behavior mapping, and surveys. Participants: Two primary care clinics in a large, integrated healthcare system in the upper Midwest, with Clinic S in a suburban location and Clinic A in a rural setting. In the two clinics, a total of 36 staff members were interviewed, 57 (66% response rate) staff members were surveyed, and 2013 individual-points were recorded during 63 behavior mapping observations. Main Measures: Communication encounters, team members’ perception of the environment and teamwork, visibility, distance, functional pathways, and self-reported mode and frequency of staff communication. Key Results: Observations, interviews, and surveys identified environmental factors that predict staff awareness and communication patterns. Visibility impacts situation awareness. Frequency of face-to-face communication increases with visibility and proximity between workstations (e.g., Clinic A nurses’ intra-role communication without workstation proximity vs inter-role communication with workstation proximity: 22.6% [11.4, 33.9] vs 77.4% [66.1, 88.6], p = 0.001) and with staff members’ functional paths. Visual exposure to patients predicts staff’s concerns about their communication (Clinic S: 2.29 ± 0.81 vs Clinic A: 3.20 ± 0.84, p < 0.001). Conclusions: Design and layout of team spaces have important influences on the way that team members work together. The organizational goals of the healthcare system, particularly which staff members need to work together most frequently, should drive the specific design solution.

Original languageEnglish
Pages (from-to)1987-1996
Number of pages10
JournalJournal of General Internal Medicine
Issue number7
StatePublished - Jul 1 2020


  • ambulatory care
  • clinic design
  • communication
  • primary care
  • teamwork


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