Designing for Effective and Safe Multidisciplinary Primary Care Teamwork: Using the Time of COVID-19 as a Case Study

Abstract

Effective medical teamwork can improve the effectiveness and experience of care for staff and patients, including safety. Healthcare organizations, and especially primary care clinics, have sought to improve medical teamwork through improved layout and design, moving staff into shared multidisciplinary team rooms. While co-locating staff has been shown to increase communication, successful designs balance four teamwork needs: face-to-face communications; situational awareness; heads-down work; perception of teamness. However, precautions for COVID-19 make it more difficult to conduct face-to-face communications. In this paper we describe a model for understanding how layout affects these four teamwork needs and describe how the perception of teamwork by staff changed after COVID-19 precautions were put in place. Observations, interviews and two standard surveys were conducted in two primary care clinics before COVID-19 and again in 2021 after a year of precautions. In general, staff felt more isolated and found it more difficult to conduct brief consults, though these perceptions varied by role. RNs, who spent more time on the phone, found it convenient to work part time-from home, while medical assistants found it more difficult to find providers in the distanced clinics. These cases suggest some important considerations for future clinic designs, including greater physical transparency that also allow for physical separation and more spaces for informal communication that are distanced from workstations.

Clinic Design for Safety During the Pandemic: Safety or Teamwork, Can We Only Pick One?

“…They also performed telehealth consultations from these rooms. Such separation provided physical isolation and distance to the providers; however, it hindered teamwork and communication with other team members due to a lack of situational awareness, as noted in a previous study (Lim et al, 2021).…”

“…Not surprisingly, a recent study confirmed that staff members' teamwork and communication experiences decreased during the pandemic in primary care clinics (Lim et al, 2021). For instance, providers in one clinic reported significantly lower communication scores in 2020 (3.01 + 0.10) compared to the prepandemic scores in 2017 (3.47 + 0.11).…”

“…Design for interactions. Communication among team members is key for effective teamwork (Ellingson, 2002;Leonard et al, 2004), while it became challenging during the pandemic (Lim et al, 2021). The transition to off-site work (e.g., at-home work) for some of the team members increased the need for virtual communication and replaced on-site face-to-face communications.…”

“…Furthermore, social gatherings and interactions among healthcare workers support their teamwork as well, and the lack of social aspects of work can negatively affect their joy and satisfaction at work (Lim et al, 2021). Thus, designing physical spaces, such as indoor and outdoor break areas, where healthcare workers can safely share social time together during the pandemic, would support the teamwork and safety of healthcare workers during challenging times.…”

Current approaches for preventing environment-associated contamination in healthcare facilities: a systematic literature review by open access database

“…The article of Lim et al (2021) [ 48 ] shows how changes and adaptations in the physical environment of healthcare, especially in primary care, have influenced communication, situational awareness, heads-down work, social support and activities, and asynchronous information exchanges. Using two case studies, they show how design changes can either improve or hinder teamwork.…”