From physical layout to spatial experience: Understanding the impact of visual interfaces on teamwork in primary care clinics

Teamwork among healthcare providers is critical for the safety and quality of patient care. Multiple national strategies and programs have been developed and recommended for implementation of a team-based approach to primary care, and many healthcare organizations are adopting team-based primary care clinics. However, little is known about how clinic layouts can support the teamwork of staff members in team-based primary clinics. To date, there has been little agreement on how clinic layouts should be designed to support the teamwork experiences of staff members and patients. Thus, different healthcare organizations advocate for unique and significantly different types of team-based clinic layouts. This study looked at four team-based primary care clinics to empirically investigate the relationships between visibility metrics and both patients’ and staff members’ teamwork experience. The results of the study showed that the visual interfaces between staff members and patients, as well as between different groups of staff members, were found to have significant associations with awareness, communication, backstage communication, and overall perception of teamwork. While no specific differences in awareness perceptions were reported between clinics, some negative consequences resulting from the lack of staff’s ability to see the clinic area and other staff members were observed. Staff members had to spend additional time searching for each other and had their patient care process obstructed when they could not see the clinic area or other staff workstations. The visual interface between staff workstations also significantly predicted staff communication patterns. Clinics providing more visual connections between staff workstations reported stronger perceptions of timely and frequent communication, and staff members talked frequently to other staff members whose workstations were visually and physically connected with their own workstations. Furthermore, clinics providing more visual connections between staff workstations reported higher teamwork perception. Surprisingly, more visual connections between patients and staff workstations were associated with lower teamwork perceptions from the patients’ perspective. The visual connections between patients and staff workstations (visual exposure to patients) also negatively affected staff backstage communication patterns. Clinics with higher visual exposure levels reported higher levels of concern for privacy while communicating patient information, and the staff members across all four clinics preferred not to talk about patients at visually exposed areas, even if the locations were inside team areas. The findings of the study support designing team-based primary care clinics to enhance the teamwork experience of both staff members and patients. It is worth noting that this study investigates the teamwork experience of not only staff members but also patients, who are critical entities of teamwork for patient-centered care in primary care clinics. The design implications are expected to be applicable for the teamwork of other settings, especially for strong programs where both inhabitants and visitors exist as main user groups of the spaces.Ph.D