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Optimizing SpaceImprove Efficiency, Engagement, and Satisfaction for Patients and Providers

Learning Objectives
1. Describe the importance of creating a space with well-designed team stations and clinic examination rooms
2. Identify the impact of positive distractions, within the clinic's surroundings, on the patient
3. List measures one can take to create a spacious and welcoming examination room
4. Recognize the value added to patient experience and engagement through shared computer screens and team documentation
0.5 Credit CME
How will this module help me?

  1. Describes quick and cost-effective techniques to optimize the layout of your clinic's examination rooms and team areas.

  2. Provides information about space design.

  3. Identifies practices that have successfully implemented interior design ideas.

Introduction

The interior design of a practice can significantly influence patient experience as well as team culture. Simple design changes can improve patient–physician interactions, quality of care, workflow efficiency, and team collaboration. These changes impact both patients and the entire care team. Patients often have a higher perception of the quality of care that they receive and have less anxiety when visiting their physician when they find the practice environment attractive.1 These design changes also improve communication skills, mood, alertness, and performance for the entire care team.2

Three STEPS for Optimizing Your Physical Space

  1. Develop Team Stations.

  2. Create an Engaging Environment.

  3. Incorporate Uplifting Designs to Alleviate Patient Anxiety.

Step 1 Develop Team Stations.

Develop team stations that enhance team collaboration. Well-designed team stations or pods can improve practice efficiency and strengthen culture; they can help to improve communication, trust, collegiality, and may result in better patient outcomes and lower health care costs.3 Placing exam rooms close to the team's work area minimizes the space that must be travelled between tasks and allows everyone to communicate easily during and between patient appointments. The proximity of exam and work rooms allows team members to manage patient flow because they are able to physically see which rooms are available for patient use.

A team station or pod should be a quiet space that has natural lighting and access to daylight through outside window views. This type of setting can enhance the team's mood and alertness—allowing them to gain more fulfillment out of their daily work.2

Quiz Ref IDTeam stations should be arranged in a manner that fosters communication. Glass partitions are ideal in this setting as they allow teammates to see and talk to each other while minimizing noise and ensuring privacy. Physicians and team members should be encouraged to use this space for in-person team communications, rather than emails or phone calls. In-person communications result in fewer emails to manage, more prompt completion of tasks, and a cohesive culture.

“We were inconveniencing our patients and creating unnecessary work for ourselves. Focusing on better wayfinding for patients and grouping like services together in the clinic revealed incredible opportunities for us to better deliver a more efficient, patient-centered experience.”

—Morris Gagliardi, MD, MBA; Associate Medical Director, Gouverneur Health, New York, NY
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Q&A

  • How do we create a central work space if we don't have the budget for a major remodel?

    If you do not have the funds for a major remodel, you can create co-locations for physicians, nurses, and medical assistants. Some practices have been able to convert a centrally-located exam room or office into a team space with minimal remodeling. Another option would be to re-purpose existing individual stations into those that could be used for co-location.

  • What if the glass partitions are not enough to prevent distractions?

    Distractions are a natural part of the work day, but it is important to have the ability to reduce distractions and create privacy when needed. Some practices have created a “quiet zone” in the co-located space for team members to use when they need to remove themselves from distractions or need to maintain patient privacy. This can be accomplished through the following:

    • Section off a secluded area and put up signs that indicate that it's a “quiet zone.” List quiet zone rules, such as “please whisper” or “use your quiet voice.”

    • You can use wall and floor materials that are designed to reduce ambient noise.

Step 2 Create an Engaging Environment.

Reconfigure patient examination rooms so that they are welcoming and spacious. The following tips will help your practice create a calm environment that makes your patients feel involved and welcome:

  • Quiz Ref IDUse light, warm-colored paint on the walls to create a calming effect.

  • Consolidate and organize examination materials and supplies on the countertops.

  • Organize patient education materials so they are visible to patients when they are seated.

  • Place examination tables on an angle to use the wall space for additional seating.

The furniture in the patient exam room should be arranged in a way that fosters patient engagement. This can be accomplished by giving the patient the opportunity to sit in a chair seated across from or next to the physician or medical assistant. This seating arrangement increases eye contact during the visit and can positively influence patient engagement.4,5

Patients and clinicians should both have access to the technology that is being used during the visit. Patients who can view what the physician is explaining often feel more involved and motivated to engage in their health care. When using the computer, the monitor should be mounted to the wall or put on a swivel arm. Teams can also use tablets or laptops as they can easily be passed around to involve the patient in the discussion.6

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Q&A

  • What are the benefits of having spacious examination rooms?

    In large, open examination spaces, patients tend to feel less anxious, more comfortable, make more eye contact with the physician and are more likely to disclose sensitive information.79 This response may be related to the actual size of the space, the increased brightness of the space, the ability to see more of the surroundings, increased freedom of movement, and perceived freedom. The more comfortable a patient is in the exam room, the more productive the visit will be.

  • What are the best desk shapes for encouraging patient engagement?

    A moderately sized circular or semi-circular desktop allows the patient and physician shared access to the computer screen while still providing the ability to turn to one another for face-to-face discussion.6,10 Patients and physicians can easily adjust their seating so they can choose to be side-by-side or across from each other. Desktops should be wide enough that a patient sitting across from a physician can choose to keep the physician's face from dominating the view, easily modify personal space boundaries, and share sensitive information without feeling awkward or embarrassed.7

  • What else can we do to facilitate the in-room connection between the patient and physician?

    Quiz Ref IDMany practices have started using a team documentation process, where a nurse, medical assistant, or documentation specialist helps with record keeping.11 This can be done when a nurse or medical assistant sits shoulder-to-shoulder with the physician at the shared desk or stands at a rolling computer station. The key in each configuration is the ability of each person to participate and to read the visual cues of the other.

  • Apart from the desk, does the shape of other furnishings matter?

    Quiz Ref IDRounded, curvilinear chairs, tables, and objects are calming and preferred over angular furnishings.12 This is also safer for children, older adults, and individuals with injuries or disabilities.

  • Does posture and seating height influence the patient encounter?

    Patients are more likely to comprehend information and be satisfied with their visit when their physicians sit at eye-level, lean forward (showing engagement), and make eye contact. Looking down at the patient, leaning backward in a power position, or frequently touching the patient can make the patient feel uncomfortable.13

Step 3 Incorporate Uplifting Designs to Alleviate Patient Anxiety.

Incorporate uplifting designs that help alleviate patient anxiety. Patients will take in your clinic's surroundings, gathering clues about the quality of care they will receive. This will influence their confidence in the practice and their experience throughout their clinic visit.14 Sitting in the waiting area and examining room is stressful for many people; wait times can contribute to patient anxiety and dissatisfaction.15,16 Patients who are anxious can have difficulties comprehending and retaining information from the visit.1719 Positive distractions and uplifting art work can help to divert attention away from stressors to create a positive mood.

Quiz Ref IDWindow views of natural settings and artwork featuring realistic images of natural landscapes have been shown to reduce patients' stress as well as pain.20 These vistas and images should be in direct view of patients while they are waiting; artwork should be of an appropriate size for patients to make out details from where they are seated. Other positive distractions include magazines, informational material, and a flat screen tv that is set to a patient education loop. Plants in the waiting room can also ease patient anxiety and create a more natural, comfortable environment.1,21

Realistic images of landscapes with high visual depth, healthy spring and summer flowers and foliage, low hills, sweeping views of mountains, calm water surfaces, and positive relationships and interactions between people are best. Fish tanks have also been shown to decrease anxiety and lower blood pressure while in the waiting room.22 Avoid abstract artwork as it can increase anxiety.23

Conclusion

The practice space can have a significant impact on the patient experience and team culture. Thoughtful space-optimization solutions can help to improve patient engagement, practice efficiency, and both patient and physician satisfaction.

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Graphic Jump Location
AMA Pearls

AMA Pearls

Learn from small changes

One strategy might be to introduce a specific type of computer or desk in an exam room and evaluate how patient encounters in that space compare to others. Some practices conduct time and motion observations to identify bottlenecks and opportunities for improvement.

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Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

0.5 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;

0.5 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;

0.5 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program; and

0.5 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program;

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Article Information

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this enduring material activity for a maximum of .50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships.

ABMS MOC Statement: Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Maintenance of Certification (“MOC”) Activities, this activity has met the requirements as an MOC Part II CME Activity. Please review the ABMS Continuing Certification Directory to see what ABMS Member Boards have accepted this activity.

Renewal Date: December 10, 2016; October 03, 2019

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