Can a Floor Plan Improve Communication in Healthcare?

Step into any healthcare facility or speak with any provider, and it is evident that changes are – and will continue to be – rapid in the healthcare industry. There is a nationwide shift toward outpatient care. This demand is fueled by several factors, including the following:

• The scientific and technological advancements which streamline procedures, decreasing the need for inpatient care
• The increase in Baby Boomers who use Medicare and comprise the majority of the outpatient population
• The increase of patients with high-deductible plans, resulting in more empowered consumers with choice. The more patients pay out-of-pocket, the more choice they exercise in where and how they spend their dollars.
• The use of the HCHAPS Hospital Survey to evaluate the patient experience.

Given this increased demand, communication will be key in maintaining and improving patient satisfaction and positive outcomes.

Why Is Communication Important in Healthcare?

We partnered with BBH Design, Parkland Health & Hospital System to research the healthcare clinic and how patients interact with their providers. We used 2,872 observations to show where physicians, nurses, and patients spent most of their time while in an outpatient clinic. Furthermore, we studied how doctors and nurses physical locations within the clinic impacted their interactions with patients and colleagues.

While some of the outcomes were quite intuitive, others were surprising. The key findings include the following:

• Patients spent the majority of their time waiting. What patients do while waiting has an impact on their overall experience
• Physicians spent nearly 50% of their time at their workstations on the computer
• Nurses also spent the majority of their time, 34%, on the computer with the remaining time split between patient interactions and interactions with other nurses
• Patients spoke with providers in dedicated care spaces; there was little incidental or natural communication (e.g., at workstations or in hallways)
• Nurses were 99 percent less likely to speak with patients when working at places such as dedicated workstations.
• Nurses were 10 times more likely to speak with another nurse at places such as workstations.
• Nurses act as a “glue” mechanism. They frequently walk around engaging with both patients and physicians. 

Herein lies an opportunity. The outcomes above highlight just how limited face-to-face interactions between patients and healthcare staff can be. Opening the lines of communication will greatly increase the care experience.

How Can We Use a Floor Plan to Improve Patient Outcomes?

What do patients value in their care? How can designers and healthcare providers enhance the care experience?

First, we can look at the frequency of the activities listed above. How can we address the fact that nurses are far less likely to engage with patients when performing computer-related tasks? What can we do to bring that down to at least 80 percent, or even challenge ourselves to bring it down to 65 percent?

Based on our research, we know that design elements have a tremendous impact on physician-to-patient interactions, and more interactions will translate into better patient outcomes and care experiences.

We’ve found that healthcare environments typically have designated spaces where healthcare patients and staff “play their role”. Designing a space that is open and flexible while still maintaining patient privacy can encourage more interaction and collaboration – both formal and informal. When nurse and physician work areas are located in the same area, communication naturally flows. This increase in communication will only lead to more interaction with patients as well.

Here are several space planning ideas to maximize communication: 

• Cluster physician and nurse teaming areas very close to the patient exam rooms.
• Transition into more flexible workstations to increase spontaneous interactions.
• Group team members’ work surfaces in highly visible areas.

We’ll be covering more observations and opportunities for improving clinic design in upcoming blogs, but we encourage you to download KI’s white paper, “The Communication Factor: Observations & Opportunities for Improving Clinic Design”, to learn more about healthcare design.