How health care design supports staff focus

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We often talk about interruptions and distractions in health care, especially when we think about medication errors, but both issues are part of the larger condition of workflow disruption. Research shows that distraction, miscommunication and delayed treatment, all components of disrupted workflow, can lead to adverse events including medical errors and even death. The Center for Health Design’s Knowledge Repository includes dozens of citations for studies focused on how health care design can reduce the likelihood of disruption. Three are highlighted here. 

Disruption to the provision of care can be especially dangerous during an emergency. A study by Mihandoust and colleagues looks at the issue of disruption in the ambulance. 

The research team used simulated telemedicine-based stroke consults in moving ambulances to evaluate the link between the ambulance environment and disruption. They found several hazards that lead to disruptions in the care process, in particular seat size and arrangement, and the location of equipment. It appears that the left ambulance seat zone and head of the patient bed were the most problematic areas for environment-related disruptions. Findings reveal a need to rethink the design of these spaces.

Another recent study looks at end-of-shift handoffs between physicians in emergency departments (EDs). Joshi and colleagues were interested in understanding how workstation design in the ED impacts collaboration during this handoff process. Through observation and a survey of physicians, the researchers compared open workstations to semi-open and enclosed workstations. 

As expected, physicians in the open workstations were interrupted most often, for both clinical and nonclinical reasons. They found that very few physicians felt they experienced frequent interruptions in the enclosed workstation pods, and that the pods seemed to facilitate a sense of collaboration with other colleagues in the workstation during handoff. Interestingly, while there were fewer interruptions in the semi-open workstation compared to the open workstation, the percentage of physicians who perceived frequent interruptions in the semi-open workstation was like that of the open workstation.

While disruption in emergency settings has obvious safety implications, the negative consequences of disruption in other clinical spaces may not be as straightforward. However, disruption in the radiology reading room can have significant effects, such as misdiagnoses. 

A case study by Larsen and colleagues examines the effectiveness of a carefully designed sequence of different radiologist workspaces broken down according to varying levels of interaction ranging from more collaborative to more independent reading space requiring quiet, disruption-free focus. 

This study addresses the stress related to disruption to workflow as part of a larger focus on physician well-being and burnout. Based on findings from a survey and focus groups, the research team developed a floor plan layout that they speculate would optimize distraction-free space for deep reading while preserving separate space for the more collaborative functions involved in radiology. Further research is needed to see how well the design functions in the real world. 

Research used for this column

The following citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• S. Mihandoust et al., “Comparing Sources of Disruptions to Telemedicine-Enabled Stroke Care in an Ambulance,” HERD: Health Environments Research & Design Journal, 2021.
• R. Joshi et al., “Emergency Physicians’ Workstation Design: An Observational Study of Interruptions and Perception of Collaboration during Shift-End Handoffs,” HERD: Health Environments Research & Design Journal 14, no. 4 (2021): 174–93.
• E.P. Larsen, “Optimizing Radiology Reading Room Design: The Eudaimonia Radiology Machine,” Journal of the American College of Radiology 18, no. 1 Pt A (2021): 108–20.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute. It can be accessed at www.healthdesign.org/knowledge-repository.