The Center For Health Design
Why does this study matter?
Good communication and teamwork among healthcare staff is essential to quality healthcare. “Backstage areas” – or the areas away from patients – can provide privacy for staff discuss patient information, build relationships, and provide training. Conversations often include sensitive information about patients’ health, as well as specific patient needs or circumstances (for instance, letting each other know about a patient who is upset, or a patient who is hard-of-hearing). While there is a great deal of research around visibility in the workplace and team interaction, not many of these studies have focused on the healthcare workplace, and even fewer have looked at visual privacy from patients.
How was the study done?
In order to better understand how having patients in view can affect staff communication, researchers evaluated four team-based primary care clinics with varying levels of visual privacy from patients.
Researchers used observation, interviews with staff, staff surveys, and a visual analysis tool based in a computer aided design platform to examine the visual relationships among patients and staff. The staff interviews and survey focused on questions around privacy concerns, as well as questions on preferred locations for different types of backstage communication. In the visual analysis, patient flow was drawn from the waiting room to all exam rooms, and staff flow was drawn as a grid of points throughout the clinic. The researchers then analyzed the visual exposure level at each location based on the total number of patient points visible at each staff point.
So what do we learn from the study?
As expected, there was a relationship between the level of visibility and the level of staff concern about communication, with clinics where backstage areas had little visual exposure to patients associated with less concern, and more concern in clinics with more visual exposure to patients.
Results from survey show a statistically significant preference for talking in backstage team areas versus more public, visually exposed areas.
But these results around preference were not totally clear cut. In the team areas, there were a mix of spots that staff marked as both preferred and non-preferred locations for communication. The authors suspect this discrepancy may be due to a lack of options for spaces that staff can talk about patients, and that the priority to communicate may override preference for where to communicate.
Lastly, while staff preferred visually private areas, certain design layouts and features seemed to minimize concern in visually open areas. Clinic B was similar to Clinic C in terms of a combination of open and enclosed team areas, Clinic B had the highest communication privacy concerns. The authors suspect the difference was due to the layout, as Clinic B’s team areas were located perpendicular to the patient corridor, with no physical or symbolic barriers, making it easy for patients to see the staff members’ backs and monitors. On the other hand, while Clinic C’s team area faced patient corridors, they also had glass partitions on top of 4-foot walls between the team areas and patient paths.
Can we say the results are definitive?
The authors recognize that this study has several limitations that should be addressed in future research, such as the potential interaction effect that auditory privacy could have. They also mention that the results cannot be generalized beyond primary care, and future studies should consider these issues in inpatient facilities.
What’s the takeaway?
Clinic design dictates the level of visual privacy healthcare staff have during essential teamwork and communication. The results of this study show that staff have a strong preference for the option of visually private backstage areas, but that more open areas can also support comfortable communication – especially when the design provides clear delineation to support adequate visual privacy.
Interested in the topic? Visit The Center for Health Design Knowledge Repository for more.
Summary of:
Lim, L., Kanfer, R., Stroebel, R. J., & Zimring, C. M. (2020). Backstage staff communication: The effects of different levels of visual exposure to patients. HERD: Health Environments Research & Design Journal, 13(3), 54–69. https://doi.org/10.1177/1937586719888903
Our slidecasts are an outcome of the popular Research Matters presentations at the annual Healthcare Design Expo & Conference. Our research team picks papers that have some significance to the healthcare design community and distill the study down into a 5-minute summary of how the study was done, what was learned, the limitations and the takeaway. The slidecasts bring research to you in digestible format. Just five minutes, and you’ll know more.
As a part of The Center's research team, Melissa focuses her efforts on grant-funded research initiatives, as well as supporting ongoing work of The Center, such as the Affiliate+ program, the Knowledge Repository, and the Evidence Based Design Accreditation and Certification (EDAC) program. She examines the impact of the built environment on health through the development of conceptual models that link design and outcomes and by evaluating the effects of evidence-based design innovations and by disseminating research findings through tools, presentations, and publications.
Melissa was previously a senior design researcher for Davis Partnership Architects and prior to that she served as a researcher with the OMNI Institute and the Center for Children, Youth & Environments at the University of Colorado. With a background in both architecture and social science, Melissa describes her research style as “boots on the ground with a knack for rigor.”
Melissa graduated from Cornell University with a Masters of Science, Applied Research in Environmental Psychology and received her Bachelors of Environmental Design, Emphasis in Architecture from University of Colorado, Boulder.