Collaborative Work Spaces in Healthcare

Healthcare delivery is being redefined to include a team-based approach to patient care with collaboration between clinicians to develop diagnosis and treatment plans.  At Zimmerman Architectural Studios, we design highly functional healthcare spaces for patients and patient care.  We apply that same rigor in the design of workspaces for healthcare staff so they can deliver the best care to their patients.

We design work areas for our clients that promote coordination, collaboration and communication between team members and support the team-based model of care which “strives to meet patient needs and preferences by actively engaging patients as full participants in their care, while encouraging all health care professionals to function to the full extent of their education, certification, and experience.”  Having highly effective workspaces enhances a healthcare facility’s level of patient care.  As more staff return to working in person after a year of working remotely, healthcare organizations can take this time as an opportunity to analyze staff workspaces and ensure that the environment supports collaboration and team-based care.

Features of the Team Work Area

In a recent clinic renovation project for a client, we designed team work spaces where physicians, nurses, medical assistants and non-clinical team members such as interpreters and social workers are collocated in pods.  The furniture layout is flexible and can be changed in the future to meet the needs of the users if the team members change.  The workstations are a standard size and configuration that promotes a feeling of equality in the team.  Mobile tables and shared islands are provided for quick collaboration sessions among team members.

Resources such as printers, copiers, supplies are shared in the work pods.  Sharing common resources is more efficient and also helps promote spontaneous interactions between staff as they move from their desks to the shared resource area.

It is important to recognize that there is still a need to provide heads down, focused work areas and private rooms for telehealth visits, private phone calls and small group meetings.  A variety of work spaces in the team work area gives team members choice and control over their working style.

Excess noise levels can become an issue in open work spaces.  Acoustic control was provided in this project through the selection of interior finish materials.  An acoustic ceiling tile with a high Noise Reduction Coefficient value helped absorb sound along with the use of carpet as the flooring material.

 

Benefits of Collaborative Work Areas

We have long seen the benefits of collaborative work areas in workplace design, now healthcare staff are experiencing the benefits as well.  Working together in teams can help to improve communication, staff satisfaction and provide social connections.

Improved communication

Collaboration areas and having the team collocated in the same area helps promote more frequent communication.  They can gather in small groups for collaboration and impromptu meetings.

“Teams that sit in closer proximity communicate with greater frequency and ease. Questions can rapidly be answered, reducing the time that someone may have to wait before completing a task or responding to a patient. Everyone will be aware of the work that their teammates are doing, enabling easier task-sharing and division of work.”

Staff Satisfaction

A work environment that helps nurses feel like part of a care team improves job satisfaction and reduces staff turnover rates, which in turn reduces hiring costs.

Provide Social Connections

In more traditional healthcare workspace design, physicians had private offices and nurses and medical assistants worked in shared areas.  Physicians were physically and socially separated from the nursing staff.  With a team-based model of care, all care providers are working in the same space.  Along with improved communication, staff can make stronger social connections with their team members which leads to improved performance and satisfaction.

Leveraging Technology

The impact of technology in the healthcare workspace has grown considerably in the past year.  A recent study by JAMA Network Open examined changes in health services among 6.8 million commercially insured individuals in the United States during the first two months of the COVID-19 pandemic. The study revealed that “overall health care use declined by 23% in March 2020 and by 52% in April 2020 relative to existing time trends” however “observed large increases in telemedicine services of “more than 1000% in March 2020 and more than 4000% in April 2020”  Telehealth visits are now part of a typical day for many providers, so providing dedicated space for that work is key.  The need to provide private spaces, within team work areas, where providers can conduct telehealth visits is growing for.

Care teams also need space for small group viewing and instruction, as well as larger spaces for collaboration.  As teams flex and work from various locations, the need for video conferencing ability in all work spaces has become a necessity.  Throughout the past year, we as healthcare designers have seen a large shift in where and how healthcare staff work.  Wireless networks and laptops allow work to be done anywhere, care providers are not restricted to a desk now.

The Future of Collaborative Workspaces

Healthcare systems are reevaluating which workers need private office space, team space or virtual work spaces.  For the clinical staff who do their work in person and provide direct patient care, we see more healthcare organizations moving toward providing work spaces that support team-based care.

The benefits of team-based care, for the both care team and the patient, are clear.  “A recent study of 250 primary care practices found that teams provided better care and outcomes than solo providers for patient with diabetes, hyperlipidemia, and hypertension.”  As in-person patient visit volumes return and the need for team-based care increases, we are designing workspaces that respond to the type of work being done.  Flexible furnishings and different work zones promote coordination, collaboration and communication between team members to help them provide high quality patient care.

Lynn Kolb, ASID

Lynn Kolb, ASID

Senior Associate / Senior Interior Designer

lynn.kolb@zastudios.com

Lynn is a highly experienced interior designer who develops interior design concept all the way to finished development.

She has a broad background of interior design solutions delivered to a wide variety clients including healthcare. Lynn collaborates with the design team and engineering disciplines to develop an interior design solution that is “logical, not lavish”. Finding the right colors, materials, finishes and lighting solutions is her specialty.

The New Reality of Healthcare Waiting Experiences

Like many people, my routine medical care appointments in 2020 were delayed and rescheduled.  I have recently had a flurry of appointments to catch up on that care.  As I went to each appointment, I had a different waiting experience.   I also have accompanied a family member to several outpatient appointments and an inpatient stay in the last few weeks.  Each healthcare visit differed in the restrictions placed upon me as the visitor and caregiver, and offered different waiting experiences as well. All of these appointments made me think about what the new reality for the visitor experience and waiting room design should be.  Healthcare providers have implemented new strategies in the past year as a response to Covid-19 to minimize waiting and time spent inside the healthcare facility.  As we move forward in this Covid-19 era, a waiting room is still a necessary space in a healthcare facility even if its use is minimized.

The New Reality
The waiting experience begins before you even leave your house for a medical appointment.  For my recent visits I was able to pre-register online.  I filled out the “paperwork” online and paid the co-pay so that I didn’t have to do that in person at my visit.  Many healthcare systems now offer “e-check in” so that the routine demographic and insurance information is collected before you arrive at the appointment’s physical location.  I think pre-registration strategies will become the standard as patients and providers see the value of online interactions that can make the healthcare experience flow smoother and quicker.

Minimize Waiting
For clinic visits, just in time arrivals are a good strategy to minimize waiting.  Patients are advised to wait in their car until the provider is ready to see them, then they are alerted by a text or phone call to enter the facility.  For patients who arrive in a car, this strategy can work well.  But what about patients who arrive by medical transport, taxi or public transportation?  These patients still need a place to wait until the time of their appointment.  A small waiting area will remain a necessity in outpatient facilities.

Along with just in time arrivals, self-rooming is another strategy that can be used to reduce the need for a large waiting room.  At check-in, a patient is directed to proceed directly to the exam room where they will be seen for their appointment.  This limits the time they spend in the public spaces of the healthcare facilities and limits their contact with other visitors.  Patients feel more satisfied because they perceive less waiting time occurring as well.  One of our healthcare clients has successfully used this strategy on a recent project.  http://www.zastudios.com/aurora-health-center-mount-pleasant/

Social Distancing
Each medical facility I have visited recently had different strategies for social distancing in the waiting room.  Some are effective and attractive, others are not.  Placing chairs in front of a registration desk to enforce social distancing is not welcoming.  I think barriers, like acrylic panels that provide separation and visibility, are an effective way to promote distancing yet provide an aesthetically pleasing solution.  Separating visitors from each other to reduce the risk of virus transmission is here to stay in some form.  Social distancing will continue to be beneficial in waiting areas, especially in high volume sections such as emergency departments.

Reimagine the Waiting Experience
“Nobody liked the waiting room previously, but now it seems inconceivable that people will be willing to sit next to possibly infectious strangers while they wait for an appointment or a loved one’s procedure…All public spaces including waiting rooms, lobbies, and dining facilities will have to be carefully planned and designed to create greater physical separation between people, with appropriate queuing.“ We have seen that waiting space is still necessary in a healthcare facility, even with implementation of new strategies like pre-registration and just in time arrivals.  As architects and designers, our challenge now is to reimagine waiting room design to provide comfort, social distancing and a positive experience.

Creating a Visitor Lounge
Due the Covid-19 restrictions for a diagnostic procedure, I had to drop off my family member at the hospital’s front door and was told to pick him up in a couple of hours.  Since this hospital is an hour from our home, returning home to wait wasn’t an option.  I also didn’t want to sit in the parking lot so I went to Costco and shopped.  As much as I love Costco, I don’t see retail spaces as a viable long-term option to replace the hospital waiting room.  Waiting in the car for a long period of time is also not a comfortable option in colder climates.

I think it is time to redesign the visitor and waiting experience at hospitals.  Airports have changed the waiting and visitor experience over the years as security requirements have changed.  Healthcare facilities can create a similar experience of unrestricted and restricted waiting zones.  In this new paradigm, caregivers and family members could wait in a lounge in the unrestricted area.  The ideal experience would include individual seating pods to facilitate social distancing and amenities such as a nourishment station and restrooms to provide comfort.  Furniture that provides visual and acoustic privacy and connectivity would allow family members to work remotely while they wait.   Separating the visitor and patient traffic upon entering the facility can reduce the need for visitors to travel into the healthcare facility, much like an airport.

The New Healthcare Waiting Experience
As we have seen in the explosion of growth in telehealth visits in the last year, Covid-19 has required a faster adoption of tools like pre-registration and check in to reduce physical interactions and speed up the in-person healthcare visit.  As we move forward in our new reality, we also need to redesign the waiting room experience in response.  Incorporating social distancing measures in the waiting room is a need that is here to stay.  Another need is creating spaces where caregivers and visitors can wait for their loved ones that provide comfort, infection control and physical separation.

 

Robin Anderson, AIA, LEED AP

Robin Anderson, AIA, LEED AP

Senior Project Architect / Planner

robin.anderson@zastudios.com

Robin is a highly experienced healthcare architect and planner who enjoys developing creative and healing design solutions that enhance the built environment through operational improvements, integration of Lean design concepts and evidence based design.

Over the course of her 22-year career, Robin has accumulated a range of healthcare experience working on projects from tenant suite build outs to replacement hospitals. She provides value to clients through research and understanding market and design trends. Robin’s approach is based in collaboration and building consensus. She is skilled in coordinating and facilitating varied client, user and stakeholder groups to develop creative design solutions that improve the healthcare experience.

Caring for Caregivers – Creating Respite Spaces for Healthcare Staff

Imagine that you are a nurse, subject to incredible mental and emotional stresses as you go about your daily work caring for patients during a pandemic.  You feel like you barely have enough time to eat lunch during a busy shift and are exhausted by the end of it.  Many studies document the rising burnout rates for medical staff.  “According to a national nursing engagement report released in April 2019, of the 2,000+ health care partners responding to the survey, 15.6% of all nurses self-reported feelings of burnout, with emergency room nurses being at a higher risk…burnout negatively affects the physical and emotional health of staff and contributes to rising costs. It also has been shown to have a negative impact on patient satisfaction, worsen patient outcomes or increase rates of safety events, and increase mortality.”

How can healthcare staff be encouraged take a break and get away even for a short time to take care of themselves and avoid burnout?  How do we take care of the health of those who take care of us? How can healthcare organizations counteract the increase in staff turnover?   “NSI Nursing Solutions Inc. reports the average annual cost of turnover for a bedside RN is $44,400. Each percentage change in turnover could cost — or save — a hospital an additional $306,400 a year, on average.”  Developing a culture that encourages staff to take breaks and practice self-care is one piece of a strategy, providing spaces where staff can get away and relax for even a few minutes is another piece.  In the healthcare industry we need to redefine what a break means.  As a client recently told me, a break is not just eating lunch.

Our client Froedtert Health saw a need to create more respite spaces for staff in the last year.  There was an increasing number of staff who needed to get away and refresh from the stress of caring for Covid-19 patients.  “Caring for Covid-19 patients is a very different kind of nursing.  This is stressful and weighs on staff’s minds. It can become overwhelming for them.” states Laurie Salerno, Manager of Clinical Support Resources.  Laurie has worked at Froedtert for 30 years, much of that time as an Emergency Department nurse, so she understands how stressful nursing can be at times and how important respite spaces are for staff.

Laurie reached out to me for assistance in finding rooms that could be repurposed as respite rooms within the existing facility.  “People need a calming, safe place to go and take a mental break. They want a designated space without interruptions” she stated.  To start the design process, Laurie gathered information from staff on features that were important to have in a respite space.  Nature, light, comfortable furniture and private space were all important to them, as well as a location close to the units. However, the overwhelming response Laurie received from staff was “We want to feel like we are not in the hospital, we don’t want to see anything that reminds us of Covid-19 in this room.”  Staff wanted a place to step away from the emotionally charged environment of the ICU.  We worked together and identified 2 conference rooms and an equipment room that could be converted into respite rooms.

After hearing the feedback from staff, the main goal for the room design became creating a space that didn’t feel like a hospital. Using biophilic design features has been shown to reduce stress, so I knew it would be important to include those features in the design solution.  Evidence shows that representational images of natural features such as landscapes, gardens and waterscapes can reduce stress and improve results like pain relief.” I suggested installing a large mountain landscape mural in the respite room that didn’t have an exterior window.  The respite rooms also feature calming wall paint colors and furniture that provides passive movement.

 

The respite rooms have been used by staff now for 3 months.  I recently talked with Laurie to find out what feedback staff have provided on the design and features.  She shared some very candid and insightful responses with me.  Laurie said “One of the quick wins that we had was installing dimmers on the conference room lights. Staff really love being able to control the lights in these rooms.”

LOCATION 

  • Need multiple respite spaces near treatment spaces. Staff do not want to go too far away from their unit.
  • The chapel feels too far away, staff also feel that it is too public.

PRIVACY

  • In the respite space they can totally let down in privacy, that is really important.
  • Adding screens to the larger rooms created more private spaces.

DAYLIGHT

  • Spaces with windows are limited in older, traditionally designed hospitals.
  • Architects need to design more daylighting in new designs in the future.

ARTWORK

  • No posters about being superheroes!
  • Installed a large-scale nature image in room without natural light, staff really like that feature.

LIGHTING

  • Adjustable lighting controls are important, staff want to adjust the level and type of lighting.
  • Staff don’t want harsh medical lighting; string lights make the space feel more relaxing.

SOUNDS

  • Sound machines with calming sounds like waves or chimes are appreciated.
  • Provide a relaxing environment to get away from sounds like phone calls and patient alarms.

SCENTS

  • With all of the hospital smells we decided not to use any fragrances in the rooms.

FURNISHINGS

  • Portable screens give a very warm feel to the room; silk plants add softness to the space.
  • Glider chairs that provide calming movement are a win with staff.

One of my favorite anecdotes that Laurie shared is “We put a lot of battery-operated candles in the rooms. A couple of nurses have just made it their job to go in and change the batteries every few days.”  Staff have taken ownership of the respite spaces and have expressed concerns that they would be repurposed after the number of Covid-19 cases decrease.  Laurie expressed “We don’t want these rooms to go away, we need more of them. This should be done for staff as a standard practice. There’s been a lot of small blessings coming out of Covid-19 and I think this is one of them. It has heightened awareness about the wellness of the employees, nurses and doctors and staff.”

The Zimmerman healthcare team applauds Laurie and Froedtert Health for investing in the well-being of their staff and creating new respite spaces within the existing facility.  Creatively repurposing space within a hospital to provide respite rooms offers the mental getaway that medical staff urgently need.  Investing in their mental health and providing respite spaces to support staff will help to reduce burnout, turnover rates and improve retention rates.  As we begin new design projects with our clients, creating spaces that support medical staff and provide respite opportunities will be a primary driver.

 

Lisa Jansen, ASID

Lisa Jansen, ASID

Vice President | Principal | Director of Interior Design

lisa.jansen@zastudios.com

One of Wisconsin’s leading interior and environmental specialists, Ms. Jansen’s award winning interiors have outstanding sensitivity to the user and function creating an efficient and comfortable space. Healthcare facilities are among her specialties. Ms. Jansen leads the interior design/space planning team. She works closely with the Architect/Manager, design team, and client in the formation of plans to achieve pre-determined goals and objectives. She will also work closely with the project architect in the development of all room finish schedules and review and approve shop drawings for interior finishes.