Optimizing Space Case Report: Parkland Health & Hospital System

Parkland Health & Hospital System redesigned their outpatient clinics considering the patient and team experience from check-in to the exam room, to the team station and check out. The design team observed patients, nurses and physicians as they moved through their day, including how they interacted with each other. Computer use and an isolated “home base” were identified as barriers that limited communication. Enhancing communication and collaboration emerged as key themes and the “connected clinic” design evolved from these discussions.

The team found that shared work stations increase collaboration and opportunities for interaction with physicians. The team stations were most effective when located on a corner, where they were:

• Highly visible

• Easy to reach

• Had enough space for any team member to accomplish work

Parkland Health & Hospital System found that patients were more likely to talk with nurses at an open, highly visible nurses' station (blue area in Figure 1) rather than in more closed areas (red area in Figure 1). Patient engagement also increased when a staff member was standing at their station, rather than sitting. In addition, Parkland Health found that nurses were almost 20 times more likely to speak with physicians when co-located at interdisciplinary team stations rather than in separate spaces.

Figure 1.

In an outpatient oncology clinic at Parkland Health & Hospital System, an interdisciplinary team station with high accessibility and high visibility off of the main corridor and located at a corner is more likely to be used by care providers. The blue team space has more desirable visibility than the red team space, increasing opportunities for staff-patient communication. Image courtesy of BBH Design.

A team of nurses worked with designers on their ideal clinic layouts, workstations and examination rooms. Design ideas included:

• Hybrid work areas with modular furnishing and seating

• Transparent and translucent partitions/half walls with privacy gradients (see Figure 2)

• Multiple interaction points within the exam room (see Figure 3)

• Shared and portable technologies (e.g., screens that pivot and tablet arms)

• Exam rooms that can double as education/teaching areas

Figure 2.

The “onion” layout designed by a group of nurses at Parkland Health has an inner ring that can function as an independent practice or, when combined with an outer ring, can flex into a multi-provider practice. Image courtesy of BBH Design.

Figure 3.

In this “around-the-clock” exam room layout, care delivery revolves around the patient much like the hands of a clock. Image courtesy of BBH Design.