Gunn, R., Davis, M. M., Hall, J., Heintzman, J., Muench, J., Smeds, B., … Cohen, D. J. (2015). Designing Clinical Space for the Delivery of Integrated Behavioral Health and Primary Care. J Am Board Fam Med, 28(Sup.), 52-62.
Purpose: This study sought to describe features of the physical space in which practices integrating primary care and behavioral health care work and to identify the arrangements that enable integration of care.
Methods: We conducted an observational study of 19 diverse practices located across the United States. Practice-level data included field notes from 2–4-day site visits, transcripts from semistructured interviews with clinicians and clinical staff, online implementation diary posts, and facility photographs. A multidisciplinary team used a 4-stage, systematic approach to analyze data and identify how physical layout enabled the work of integrated care teams.
Results: Two dominant spatial layouts emerged across practices: type-1 layouts were characterized by having primary care clinicians (PCCs) and behavioral health clinicians (BHCs) located in separate work areas, and type-2 layouts had BHCs and PCCs sharing work space. We describe these layouts and the influence they have on situational awareness, interprofessional “bumpability,” and opportunities for on-the-fly communication. We observed BHCs and PCCs engaging in more face-to-face methods for coordinating integrated care for patients in type 2 layouts (41.5% of observed encounters vs 11.7%; P <.05). We show that practices needed to strike a balance between professional proximity and private work areas to accomplish job tasks. Private workspace was needed for focused work, to see patients, and for consults between clinicians and clinical staff. We describe the ways practices modified and built new space and provide 2 recommended layouts for practices integrating care based on study findings.
Conclusion: Physical layout and positioning of professionals’ workspace is an important consideration in practices implementing integrated care. Clinicians, researchers, and health-care administrators are encouraged to consider the role of professional proximity and private working space when creating new facilities or redesigning existing space to foster delivery of integrated behavioral health and primary care.
Rose Gunn, MA, Research Associate
Department of Family Medicine
Oregon Health & Science University
Rose Gunn is a Research Associate in the Department of Family Medicine at Oregon Health & Science University in Portland, Oregon. She is involved on a number of federally-funded grants looking at health systems innovation and re-design. Utilizing qualitative research methods, Rose investigates practical ways clinics can improve care for patients. Rose received a Master of Arts in Anthropology from San Francisco State University.
Shandra Brown Levey, PhD,
Director of Integrated Clinical Behavioral Services
Department of Family Medicine
University of Colorado, School of Medicine
Dr. Brown Levey received her PhD in Clinical Psychology from Illinois Institute of Technology in Chicago, Illinois. She completed her 2-year post-doctoral fellowship at the University of Colorado Department of Family Medicine where she currently serves as the Director of Integrated Clinical Behavioral Sciences. Through her work, Dr. Brown Levey strives to implement integrated programs and support their development over time with regard to clinical, educational, research, policy, and financial needs for growth and sustainability.
Sheila Bosch, PhD, LEED AP, EDAC
University of Florida
Dr. Sheila J. Bosch is an assistant professor in the Department of Interior Design at the University of Florida and an accomplished evidence-based design researcher. In 2014, she was named top researcher by Healthcare Design magazine's HCD10 awards for her significant contributions to healthcare design. Before coming to the University of Florida, Sheila served as the Director of Research for Gresham, Smith and Partners, an international architecture, engineering and interior design firm, where she supported planners and designers in enhancing quality, safety and efficiency in healthcare settings. At UF, Sheila continues to direct original, empirical research to advance our understanding of the role of the built environment in improving occupant well-being. Her healthcare design research focuses on a variety of healthcare settings, including behavioral health, neonatal intensive care units, emergency departments, patient-centered medical homes, and environments for older adults. Additionally, Sheila is interested in how the design of learning environments may improve teaching and learning outcomes. Sheila is a member of the Center for Health Design's Research Coalition and serves as an ad-hoc reviewer for several peer-reviewed publications, including Health Environments Research and Design journal and the Journal of Interior Design.