Leaders at Gouverneur Health, part of the New York City Health and Hospitals Corp., knew there must be a better way for its two primary care practices to use their current clinic space. The practice teams had few places to interact, which impeded their ability to get work done and added to long wait times for the 250 patients seen daily.
Gouverneur teamed up with a local design school to figure out how they could maximize the space for physicians, nurses, staff and patients. They mapped the patient flow from arrival to departure; reviewed literature to see what peer-reviewed research showed; inventoried how the space was being used and whether it matched the intent; and analyzed how many spaces there were in the building and whether the spaces were visible and accessible.
Some of the recommended changes are similar to ideas outlined in an AMA STEPS Forward™ module that highlights five ways physicians can maximize their offices' physical space, such as developing team stations to enhance interactions and adding positive distractions to alleviate patient anxiety. Among the recommended changes the design team had for Gouverneur after reviewing the space:
- Programmable LED lighting to enhance wayfinding in the long corridors.
- Art on the walls to ease patient anxiety and enhance the patient’s experience.
- Standardized furnishing and equipment positions, including computer screens that move or swivel so physician-patient interactions could be face to face.
- Patient-driven movement through the clinic; for example, “self-rooming,” in which the patient is assigned an examination or consultation space when they enter the clinic. The patient then goes to that room to wait instead of waiting with others in a designated waiting area.
- Visual cues, such as lights or flags, to indicate if a room is occupied.
- More outlets in waiting areas so patients can be connected and occupied.
- Repurposed underused—and less visible—exam rooms as team rooms or alternative work spaces for practice team members.
- Team spaces that are close to—and, ideally, can be seen from—exam rooms.
Gouverneur leaders say the changes made have resulted in a more efficient, patient-centered experience. “Our recently updated facility provides a nurturing, safe environment to deliver cutting-edge care,” said Kenneth J. Feldman, Gouverneur Health’s associate executive director.
The STEPS Forward module offers some quick and cost-effective ways to optimize layouts in your clinic’s examination rooms and team areas. It also answers some common questions about space design and provides a closer look at how practices in Boston, North Carolina and Dallas have redesigned their spaces.
The module may be completed for continuing medical education credit. The AMA’s STEPS Forward collection features 43 practice-improvement modules. Several come thanks to a grant from, and collaboration with, the Transforming Clinical Practices Initiative.