Designing for Health: Caregiver’s Workplace In A Multidiscipline Collaborative Teaming Work Environment

Perkins + Will -Auditorium settings. Sickeler 2017

Can the healthcare work environment assist in supporting a collaborative multidisciplinary work environment? 

In our experience as designers, we are seeing a trend of more clients requesting collaboration and multidisciplinary teaming areas within buildings that deliver healthcare and health education. The goal and stated need being better outcomes and happier inhabitants in these environments, spaces, buildings, and communities. In healthcare, it is generally believed that collaborative efforts yield better health services and outcomes for the populations that are served. This culture of collaborative teaming causes a layer of complexity in day-to-day work that demands the caregiver’s workplace to be designed supportively, physically, ergonomically, and socially for proper communication to take place.

What is a multidisciplinary team approach and how do we support teaming activities with design? Hinshaw, an author and researcher on collaboration describes a multidisciplinary approach as professionals from different training disciplines working together towards a common goal. Webster’s Dictionary defines communication as “the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs.” The World Health Organization (WHO) describes interprofessional collaborative practices as multiple health workers from different professional backgrounds providing comprehensive services by working with patients, their families, careers, and communities to deliver the highest quality of care across settings. According to Wikipedia, teamwork in healthcare is "a dynamic process involving two or more healthcare professionals with complementary backgrounds and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care. "In healthcare, teamwork is "a dynamic process involving two or more healthcare professionals with complementary background and skills, sharing common health goals and exercising concerted physical and mental effort in assessing, planning, or evaluating patient care."

As the world continues to move towards a high level of collaboration and a multidisciplinary teaming approach, the healthcare profession will continue to depend on a multidisciplinary teaming structure. According to Paul M. Shyve of The Joint Commission, “repeatedly, information management in healthcare involves communication from one participant to another.  From the clinician’s first solicitation of information from the patient, to the sharing of information about the patient between the clinicians and other staff, to the final education and instructions provided to the patient about his or her illness and treatment, and how to remain well.” The complexity of the ways medical teams interact and collaborate as well as how these processes are translated to the patient seamlessly and with ease is the desire of a patient-focused environment of care designer.

Rosenstein documented in his research “that traditional medical education emphasizes the importance of error-free practice, utilizing intense peer pressure to achieve perfection during both diagnosis and treatment. Errors are therefore perceived normatively as an expression of failure. This atmosphere creates an environment that precludes the fair, open discussion of mistakes required if organizational learning is to take place.” In the early 1990s, Donald Berwick wrote about patients needing an open communication system instead of experiencing adverse events stemming from communication failures. More than a decade later, this concept still has profound implications on our method of healthcare delivery. Team collaboration in helping to reduce medical errors and increase patient safety.

Looking to our higher education projects over the years can give us clues to how our new physicians, caregivers, nurses, and researchers are being trained, and what they expect from their work environment in the real world. Figure 1 shows a translation of auditorium / lecture hall settings that we, as designers, have provided over the past years.  Lecture halls have changed in the past, from a lecturer speaking at you while seated stationary, to a one-sided table lecturer, and more currently to a team approach with a panel of instructors in which students sit face-to-face around a flexible table to solve a problem together.  Believing that results and opportunities will be far superior, many of these students from the best schools will expect this type of arrangement within the care arena within a hospital, clinic, or research lab.

 

It is important to consider that communication is not just verbal in form. Studies such as Rosenstein’s state that high percentages of communication are more affected by body language, attitude, eye contact, and tone, leaving only small percentages of the meaning to be based on the actual words said. The meaning of a spoken word can take on a different significance depending by the style of delivery; the way speakers stand, speak, and look at a person. However, critical information is often transmitted via handwritten notes, e-mails, or text messages, which can lead to serious consequences if there is miscommunication. It makes sense that the proper use of technology, ergonomics, and eye-to-eye contact may aid in clear communications within a multidisciplinary work environment.

In the care environment, traditional millwork nurse stations or care centers have been built as tall counters and barriers where collaboration is not supported. Team centers with distinct programmatic areas for collaboration and work tasks are appearing in many of our programs and clients are requesting them to be centrally located. In Figure 2, a planning diagram shows a central team approach within an outpatient clinic.  In addition, the planning diagram shows collaboration spaces organized for differing activities. There is a front, an on-stage zone for interactions with patients, as well as a back, off-stage zone for teams to collaborate and learn from one another in a private environment. 


Figure 3 shows an image of a multidisciplinary space where talking face to face in an environment that supports conversations required in order to provide innovative solutions is a possibility for a very simple multi use solution in Healthcare.


All of us have been and will be patients at one time or another. We know how important it is to receive instructions for care and wellness in a simple and understandable manner. The translation within the exam room or patient room dictates that there be a space to sit and to be able to share information with not only the patient but also the family, and to provide a space where a collaborative team approach is heard or seen by the patient and that it is understood.

Figure 4 shows an exam room with a half round table and articulating large screen monitors on the side walls around the exam table as well as an adjustable monitor to the patient  for those in wheelchairs or if positioned horizontally around the half round table. Healthcare providers, architects and designers are working on perfecting the interface between the caregiver team and the patient and family. Providing a space for the complexities of a Multidisciplinary collaborative team environment and the prescription for healing to be seamlessly translated to a fragile patient and their family is less difficult with the proper attention to the arrangement of the rooms and all that goes into it. Our clients are asking to provide safe spaces for eye-to-eye contact and communication and for collaborative areas so that they can increase their positive outcomes. Designers must artfully yet functionally coordinate the use of furniture, ergonomic accessories and technology to first do no harm and then to help in the curing and healing process.    

 

References

D'Amour D, Ferrada-Videla M. San Martin Rodriguez L, Beaulieu MD. The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks. J Interprof Care. 2005;((suppl 1)):116–131.
 Hinshaw A.S.(1995).  Towards achieving multidisciplinary professional collaboration.  Research and practice, 115-116

 O’Daniel M, Rosenstein AH. Professional Communication and Team Collaboration. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 33.  www.ncbi.nlm.nih.gov/books/NBK2637/

World Health Organization. Framework for Action on Interprofessional Education and Collaborative Practice. Geneva: World Health Organization; 2010.

Bart N Green, DC, MSEd and Clair D Johnson, DC, MSEd, Interprofessional collaboration in research, education and clinical practice: working together for a better future.  2015

Shyve, Paul M. Senior Vice President, The Joint commission. Communication: The Bond to Patient Safety. 2017

O’Daniel M, Rosenstein AH. Professional Communication and Team Collaboration. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 31 www.ncbi.nlm.nih.gov/books/NBK2637/

Berwick DM. Seeking systemness. Healthcare Forum J March/April. 1992;35:22–8. [PubMed: 10117125]

Allesandra T, O’connor M. The platinum rule:  discover the four basic business personalities and how they lead you to success.  New York: Warner Books; 1966

Joint Commisiion on Accreditation of Healthcare Organizations.  The joint commission guide to improving staff communication. Oakbrook Terrace, IL: Joint Commission Resources; 2005.

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