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Goal
This evaluation assessed two main clinic module designs—separate versus shared corridors—in the Advocate Aurora Health system. The goal was to identify and assess pros and cons of each module type from the user perspective to help inform and optimize the system’s future ambulatory program and facilities.
Overview
HDR is conducting a multi -site study including 11 ambulatory health clinics in Illinois and Wisconsin. At the time of this study, the newly merged Advocate Aurora Health System planned substanti al growth of outpatient facilities, and the multi-method approach assessed differences in user perspectives about the effectiveness of two typical clinic module designs recently built by Advocate Medical Group and Aurora Health. A key design difference was the inclusion of a separate patient corridor for patients to navigate to exam rooms without entering staff space or having patients and staff share a corridor within the module to access exam rooms.
Challenge
In optimizing its future ambulatory program, the health system set goals including significantly improved construction and operational efficiency, and patient and staff satisfaction. Questions arose about pros and cons of two typical recently deployed core module designs. Searching for relevant evidence, only a comparison between clinics with a core team area versus a linear design with staff located away from exam rooms was found.
The existing evidence was somewhat in favor of a centrally located work area, but was not directly pertinent to the design question about separate patient versus shared corridors in modules with central workspace. Design concepts were clinic core module designs with either separate patient corridors or a shared corridor within the staff area. Although the separate corridor design entails more square footage and thereby somewhat more construction and operational cost, they hypothesized that the separate corridor design would have valuable benefits including higher patient and staff satisfaction.
Solution
The study evaluated provider and staff experience in the two clinic types and preliminarily assessed patient experience using staff proxies. The modular clinic designs represent a previous cycle of the EBD process, and also serve as baseline measures for the next phase of clinic development. These clinics were created to support efficiencies in the design and construction process, to support care team collaboration and high quality patient care, and to allow for ample flexibility and adaptability.
Standardized spaces were deployed where possible, and there was a general focus on facilitating co-located workspaces for care teams—providers, nursing, and medical assistants—where this was culturally acceptable and promoted by local clinic leadership. Both separate patient corridor and shared corridor facilities were built, and allowed for study of this variable. The provider and staff study findings, along with patient satisfaction data, operational data, and construction and operational costs, are being weighed as variables to continue to optimize in new facilities.
Results
Across both core module designs, use of a core team workspace was positively related to increased collaboration around patient care and
consequent perceived higher quality of care. Access to daylight in the core workspace was highly valued by staff.
Noise-related distractions were a problem for providers working in the core area in both clinic types, and providers noted a need for nearby quiet space for confidential phone calls and charting in both designs. Providers also noted a need for more spaces in the core to accommodate all team functions, including nursing and more than one medical assistant for some providers.
The separate patient corridor design offered fewer interruptions and distractions for providers and staff while working, and was perceived to
be more protective of confidential patient data. At clinics that had separate corridors and some degree of patient self-rooming and where tracking technology is currently or planned to be used, there was little waiting room use, and staff reported that clients appreciated lack of exposure to others in the waiting room who might be infectious.
Additional Info
HDR is providing an integrated delivery model for ambulatory master planning, design and construction for Advocate Aurora Health. The
Integrated Lean Project Delivery (ILPD) team serves as the A/E/C and clinical/operational consultant to support excellence in delivery of
ambulatory care. Modular design can also reduce time and cost to implement a major facilities expansion program.