Role of the Physical Environment on Team-Based Primary Care in the Military Health System

Primary care in the United States has shifted from a physician-centered care approach to a multidisciplinary, team-based care approach. This shift has resulted in many day-to-day changes in the care delivery process including how clinical staff collaborate; interact with patients; and use space, equipment, and various technologies. Team-based approaches, such as the Patient-Centered Medical Home (PCMH) model, are demonstrating improvements in patient health outcomes. The U.S. Military Health System, one of the largest healthcare organizations in the world, has adopted the PCMH model for primary care clinics. To support this new care model, a team-based clinical module is emerging as a spatial concept that colocates the resources staff need for delivering care. Several different design configurations of team-based clinical modules exist in MHS clinics despite the organization’s emphasis on clinic standardization. The purpose of this dissertation is to understand staff perceptions concerning the environmental factors that best support team-based care in the MHS. Using a qualitative approach and a case study research strategy along with ethnographic data collection techniques, this study investigates how six team-based clinical module configurations in three different clinics influence the delivery of team-based care. Data collection included 58 semi-structured interviews with primary care providers, registered nurses, licensed practical nurses, and specialty care providers. Additionally, 11 hours of observations in team rooms provided insight on how the staff use space. Findings were translated into a set of design recommendations for planning team-based clinical modules aimed at improving staff workflow, functionality, and workspaces to facilitate both team collaboration and focused work. This study provides initial evidence that can directly support the MHS in updating design guidance criteria to support team-based primary care