Importance of spatial design to team-based learning and care

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We shape our buildings and afterwards our buildings shape us.

                                                                                               Sir Winston Churchill

Collaborative team-based care has been shown to address the Quintuple Aim,1 and it offers solutions to the primary care crisis. In December I wrote about the importance of relationships as a foundation for team-based care.2 In February I expanded on the support needed for its successful implementation and sustainability, and in April I examined compensation models and how they can help or hinder team-based care.3,4 This month I focus on spatial design as another essential component of effective team-based care. Until recently, little attention had been paid to the physical workspace and how it affects team function, learning, and practice.

In the literature, 2 areas of focus related to sustainable team-based primary care have emerged: how spaces influence wellness and health, and how design considerations contribute to collaboration and innovation.

Design features that enhance wellness include natural colour schemes; greenery, art, and ambient music; windows and natural light; and open social spaces, all intended to connect people to the outside world, decrease anxiety, brighten the work environment, improve well-being, and maintain health.5,6 Small changes such as half walls, frosted glass, potted plants, and a new coat of paint can contribute positively to team wellness.

To bolster collaborative team-based educational opportunities and care, clinic spaces should include onstage (publicly visible) and offstage (behind-the-scenes) elements.7 These 2 types of space stimulate the flow of information, support collaborative care, improve patient care,8 and offer better patient and provider experiences.

Integrating both onstage and offstage spaces balances meeting the requirements of patient care (including privacy)7 with meeting the needs of teams to discuss, strategize, plan, and innovate. Individual or one-on-one spaces are essential for tasks such as providing feedback to learners and offering virtual care. These spaces are not individually allocated offices but rather shared space near group work areas that can be booked for personal blocks. Designing flexible spaces ensures efficient use of limited square footage. Further, the concept of shared space and resources reduces disciplinary hierarchies that can hinder interprofessional learning and practice. Most clinic space should be open and flexible to accommodate multipurpose use such as group teaching, group visits, and integrated patient care.

Spatial design features that nurture team-based practice include offstage interaction areas8 or bump zones,5 such as the clinic laboratory and workstations where informal exchanges of information happen. Students and clinicians from different disciplines can work side by side to review cases, chart, monitor patient appointments, and address administrative tasks. Such co-location of disciplines improves communication and supports collaborative practice, much like exchanges that occur in corridors of health care facilities.

Social spaces such as lunchrooms or water cooler areas can cultivate relationships and collaboration. In buildings with multiple clinics or units, creating social spaces accessible to all staff can increase awareness of different services, which fosters efficiencies in patient care and builds a broader sense of community.

Since patients do not access the offstage areas of a clinic, it is important to develop another common area that includes patients to promote a sense of belonging; the reception and waiting area is often the logical choice. The waiting area can be open, warm, and inviting. Creating and using a main entrance to the clinic, where everyone passes through the same doors to enter and exit, serves to connect patients, staff, students, and providers. It can improve communication and generate a sense of transparency that boosts team trust.

Interprofessional collaborative practice is developing rapidly worldwide. As models of team-based care are implemented across Canada, it will be vital to consider how spatial design can support optimal team function.

Copyright © 2023 the College of Family Physicians of Canada

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