Session E1b
October 17, 2014
DESIGNING PHYSICAL SPACE FOR
INTEGRATED CARE
Rose Gunn, MA, Research Associate
Collaborative Family Healthcare Association 16th Annual Conference
October 16-18, 2014
Washington, DC U.S.A.
LEARNING OBJECTIVES
AT THE CONCLUSION OF THIS SESSION, THE PARTICIPANT WILL BE ABLE
TO:
 Identify spatial configurations that support collaboration
and coordination of integrated teams.
 Identify spatial configurations that present barriers to
integration.
 Discuss the tension that exists between designing space
that supports teamwork as well as allowing for private,
focused care and describe how sites address these
tensions.
 Discuss how improving physical layout in integrated
settings can address the Triple Aim.
FACULTY DISCLOSURE
We have not had any relevant financial relationships
during the past 12 months.
Bibliography / Reference
1. Bleakley, A. (2013). "The dislocation of medical dominance: making space for
interprofessional care." Journal of Interprofessional Care 27 Suppl 2: 24-30.
2. Gulwadi, G.B., et al. 2009. “Exploring the impact of the physical environment on patient
outcomes in ambulatory care settings.” Health Environments Research and Design
Journal 2(2): 21-41.
3. Gum LF, et al. 2012. “From the nurses' station to the health team hub: how can design
promote interprofessional collaboration?” Journal of Interprofessional Care. 2012
Jan;26(1):21-7.
4. Scharf DM, et al. 2013 “Integrating primary care into community behavioral health
settings: programs and early implementation experiences”. Psychiatr Serv. 2013 Jul
1;64(7):660-5.
5. Lamb G, Shraiky J. 2013 “Designing for competence: spaces that enhance collaboration
readiness in healthcare. J Interprof Care. Sep;27 Suppl 2:14-23.
LEARNING ASSESSMENT
 A learning assessment is required for CE
credit.
 A question and answer period will be
conducted at the end of this presentation.
ACKNOWLEDGMENTS
Much gratitude and respect for our research partners: the 18 practices that
shared their lived experiences with us.
Thank you, as well, to Deborah Cohen, PhD, Melinda Davis, PhD, Jennifer
Hall, MPH, John Heintzman, MD, Ben Miller, PsyD, John Meunch, MD, and
Brianna Smeds, AIA
BACKGROUND
Layout of space in integrated clinics can present challenges to successful
integration or serve to strengthen these models.
Different spatial arrangements can influence team dynamics and share
examples of how primary care practices adapt their spaces to better support
collaboration among professionals.
METHODS
•Sample of 19 integrated primary care practices in the US
•11 were new to integrating care
•8 were considered established integrated clinics
•Research team visited the clinics and observed clinical operations
•8-12 interviews with leaders, providers, and staff at each site
•Data analyzed by a multidisciplinary team using a grounded theory
approach
•Study protocol was approved by the Institutional Review Board at Oregon
Health & Science University
RESULTS
 Examination of physical layout in integrated clinics in
team workspace, clinician offices, and location of
support staff fall in 3 broad categories:

Central medical assistant station with exam rooms and individual office space for primary
care clinicians surrounding this “patient hub.” Behavioral health clinicians are also assigned
private office space, frequently located at a distance from the central patient care areas.

Shared office space for behavioral health and primary care clinicians. Medical assistants and
other support staff may be co-located in this shared space or in a separate office cluster near
the exam rooms.

Integrated pods that allow medical clinicians, behavioral health staff, and medical assistants to
interact fluidly in a central area around a cluster of exam rooms.
RESULTS
• These three spatial arrangements were closely
associated with a team’s ability to easily and fluidly
collaborate and coordinate to provide integrated care.
CLOSE PROXIMITY
 allowed teams to establish situational awareness; an
understanding of the flow and tasks in which other
members of the care team are involved.
 fostered a team dynamic that promoted collaboration
rather than working individually to address patient
needs.
CHALLENGES AND STRATEGIES
 Close proximity also presented challenges for patient
privacy and clinicians finding “private space” to consult or
complete quieter tasks.
 Strategies such as using white noise machines or having
additional exam rooms where private conversations could
occur were employed in these situations.
 While physical layout promoted collaboration among the
clinical teams, sites also implemented communication
strategies to bridge spatial divides, such as inbox messaging,
Vocera communication systems, phones, and internal
messaging systems.
DISCUSSION
• Many practices that aspire to provide integrated
models of care do not often have the luxury of
creating new facilities from the ground up; they have
to make do with the space available to them.
• Observation shows that physical space was
designed to manage a tension between
requirements for private space for patients and
clinicians and the need for shared team
workspace that enables collaboration.
DISCUSSION
• Challenges can be ameliorated by a number of
strategies including designing compact work areas
that allow providers easy access to one another and
close proximity of patient rooms to team
workspace.
• Being intentional and thoughtful about design
and physical layout of work spaces for teams,
individual clinicians, and clinical support staff is
a critical component for implementing integrated
care.
Space, space: architects always talk about space! But creating a space
is not automatically doing architecture. With the same space, you can
make a masterpiece or cause a disaster.
Each new situation requires a new architecture.
-Jean Nouvel
SESSION EVALUATION
Please complete and return the
evaluation form to the classroom monitor before leaving this session.
Thank you!