TY - JOUR
T1 - Spatial Influences on Team Awareness and Communication in Two Outpatient Clinics
T2 - a Multiple Methods Study
AU - Lim, Lisa
AU - Moore, Matthew
AU - DuBose, Jennifer R.
AU - Obeidat, Bushra
AU - Stroebel, Robert
AU - Zimring, Craig M.
N1 - Funding Information:
The authors would like to thank Lori Baumbach and Deb Cholewa, operational leaders for the two clinics featured in this paper, and the many staff members of these clinics who generously gave their time and effort to the study. We would also like to thank Aaron Biedermann for his efforts enabling the collaboration between Georgia Tech and Mayo Clinic.
Funding Information:
The project described was supported by Funding Opportunity Number 1L1CMS31449-01 from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. Acknowledgments
Publisher Copyright:
© 2020, Society of General Internal Medicine.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - 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.
AB - 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.
KW - ambulatory care
KW - clinic design
KW - communication
KW - primary care
KW - teamwork
UR - http://www.scopus.com/inward/record.url?scp=85085154007&partnerID=8YFLogxK
U2 - 10.1007/s11606-020-05790-6
DO - 10.1007/s11606-020-05790-6
M3 - Article
C2 - 32367392
AN - SCOPUS:85085154007
VL - 35
SP - 1987
EP - 1996
JO - Journal of General Internal Medicine
JF - Journal of General Internal Medicine
SN - 0884-8734
IS - 7
ER -