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.

Keywords: medical office buildings; primary care redesign; primary healthcare; qualitative research; team-based care.

Figure 1.

Photograph of onstage/offstage (OS/OS) closed work area showing perspective from within the OS/OS care-team station showing a shared work area. On the left side of the image is a door to an examination room. The patient entry/exit is not visible from this area and is on the other side of the examination room. Dotted area indicates busy areas where the most interactions occurred during the observations.

Figure 2.

Onstage/offstage clinic (left) and pod-based clinic (right) design showing work area in relation to patient areas and care-team station in detail. Dotted area indicates busy areas where the most interactions occurred during the observations.

Figure 3.

Photograph of pod-based open work area showing perspective from within the PB care-team station showing an open shared work area. Behind the viewer and in the back of the photograph, examination room doors are shown in hallways shared by patients and teams.