× You are not currently logged in. To receive all the benefits our site has to offer, we encourage you to log in now.

EBD Journal Club: Setting the Stage: A Comparative Analysis of an Onstage-Offstage and Linear Clinic Modules

When: January 17, 2018
Time: 11:00am Pacific
Price: FREE

The purpose of this study was to understand how two different ambulatory design modules—traditional and onstage/offstage—impact operational efficiency, patient throughput, staff collaboration, and patient privacy.

Delivery of healthcare is greatly shifting to ambulatory settings because of rapid advancement of medicine and technology, resulting in more day procedures and follow-up care occurring outside of hospitals. It is anticipated that outpatient services will grow roughly 15–23% within the next 10 years (Sg2, 2014). Nonetheless, there is limited research that evaluates how the built environment impacts care delivery and patient outcomes.

This cross-sectional, comparative study consisted of a mixed-method approach that included shadowing clinic staff and observing and surveying patients. The linear module had shared corridors and publicly exposed workstations, whereas the onstage/offstage module separates patient/visitors from staff with dedicated patient corridors leading to exam rooms (onstage) and enclosed staff work cores (offstage). Roughly 35 hours of clinic staff shadowing and 55 hours of patient observations occurred. A total of 269 questionnaires were completed by patients/visitors.

The results demonstrate that the onstage/offstage module significantly improved staff workflow, reduced travel distances, increased communication in private areas, and significantly reduced patient throughput and wait times. However, patients’ perception of privacy did not change among the two modules.


Location Information


Presenting Faculty


Kara Freihoefer, PhD
Senior Associate Research Specialist
HGA Architects and Engineers

Kara focuses on utilizing evidence-based design principles to inform and educate healthcare clients and colleagues on design decisions. Furthermore, Kara serves as the co-chair of the Research Council where she helps spearheads research initiatives across all disciplines firm-wide.

Throughout her tenure at HGA, Kara has authored several research articles. Her most recent publication is entitled “Making the Case for Practice-based Research and the Imperative Role of Design Practitioners” in Health Environments, Research and Design Journal. She has also presented research findings at various national research conferences such as Healthcare Design and Environmental Design Research Association (EDRA). This year, she was awarded EDRA’s Certificate of Research Excellence (CORE) for an investigation that explored staff communication, efficiency and patient privacy of an on-stage/off-stage clinic module.

In 2012, she received a PhD in design research from the University of Minnesota. Her doctoral research evaluated the relationship between indoor environmental quality of sustainability facilities and user perceptions. Kara also received a Master’s of Science in Design degree from Arizona State University in 2009, and a Bachelor’s of Science from the University of Wisconsin-Stevens Point in Interior Architecture and Design in 2004.


Dennis Vonasek, AIA, ACHA, CID
Vice President/Principal
HGA Architects and Engineers

Dennis' expertise includes medical planning, project management and design for diverse healthcare projects and scales nationally and internationally. He previously has presented healthcare planning topics at major industry conferences, including Healthcare Design Expo + Conference, Healthcare Facilities Symposium, ASHE PDC, and ACE Summit and Reverse Expo. He has a Bachelor of Architecture and Bachelor of Arts and Environmental Design from North Dakota State University.