Backstage Staff Communication: The Effects of Different Levels of Visual Exposure to Patients

Objective: This article examines how visual exposure to patients predicts patient-related communication among staff members. Background: Communication among healthcare professionals private from patients, or backstage communication, is critical for staff teamwork and patient care. While patients and visitors are a core group of users in healthcare settings, not much attention has been given to how patients' presence impacts staff communication. Furthermore, many healthcare facilities provide team spaces for improved staff teamwork, but the privacy levels of team areas significantly vary. Method: This article presents an empirical study of four team-based primary care clinics where staff communication and teamwork are important. Visual exposure levels of the clinics were analyzed, and their relationships to staff members' concerns for having backstage communication, including preferred and nonpreferred locations for backstage communication, were investigated. Results: Staff members in clinics with less visual exposure to patients reported lower concerns about having backstage communication. Staff members preferred talking in team areas that were visually less exposed to patients in the clinic, but, within team areas, the level of visual exposure did not matter. On the other hand, staff members did not prefer talking in visually exposed areas such as corridors in the clinic and visually exposed areas within team spaces. Conclusions: Staff members preferred talking in team areas, and they did not prefer talking in visually exposed areas. These findings identified visually exposed team areas as a potentially uncomfortable environment, with a lack of agreement between staff members' preferences toward where they had patient-related communication

The Representational Function of Clinic Design: Staff and Patient Perceptions of Teamwork

This study empirically investigates the relationships between visibility attributes and both patients’ and staff members’ teamwork experiences. Teamwork among healthcare professionals is critical for the safety and quality of patient care. While a patient-centered, team-based care approach is promoted in primary care clinics, little is known about how clinic layouts can support the teamwork experiences of staff and patients in team-based primary clinics

Does pre-ordering tests enhance the value of the periodic examination? Study Design - Process implementation with retrospective chart review

<p>Abstract</p> <p>Background</p> <p>To evaluate the value of a pre-ordering process for the pro-active scheduling and completion of appropriate preventive and chronic disease monitoring tests prior to a periodic health examination (PHE).</p> <p>Methods</p> <p>A standardized template was developed and used by our nursing staff to identify and schedule appropriate tests prior to the patients PHE. Chart reviews were completed on all 602 PHE visits for a 3-month interval in a primary care setting. A patient satisfaction survey was administered to a convenience sample of the PHE patients.</p> <p>Results</p> <p>Of all the patients with tests pre-ordered, 87.8% completed the tests. All providers in the division used the process, but some evolved from one template to another over time. Most patients (61%) preferred to get their tests done prior to their PHE appointment. Many of our patients had abnormal test results. With this process, patients were able to benefit from face-to-face discussion of these results directly with their provider.</p> <p>Conclusions</p> <p>A pre-order process was successfully implemented to improve the value of the PHE visit in an internal medicine primary care practice using a standardized approach that allowed for provider autonomy. The process was accepted by patients and providers and resulted in improved office efficiency through reduced message handling. Completion of routine tests before the PHE office visit can help facilitate face-to-face discussions about abnormal results and subsequent management that otherwise may only occur by telephone.</p

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

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 communi-cation, 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 un-derstanding 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 considera-tions 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

Beyond Co-location: Visual Connections of Staff Workstations and Staff Communication in Primary Care Clinics

The importance of communication among healthcare providers has been long recognized, and many healthcare organizations are implementing team-based care, with emphasis on staff communication. While previous empirical studies in various settings illustrate the role of built environments in user communication, there is a lack of quantified interpersonal spatial metrics to predict interactions. This study investigates how interpersonal spatial metrics at different scales predict staff communication patterns by empirically studying four primary care clinics that provide team-based care. We found that staff members in clinics with higher visual connections among staff members reported more timely and frequent communication. We also found that staff members talked to each other more frequently when their workstations were visually connected. The findings of this study are expected to help designers and facility managers provide well-designed team-based clinic layouts, beyond just shared work spaces for team members, for improved staff communication

Primary care patient and provider preferences for diabetes care managers

Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients&amp;rsquo; and providers&amp;rsquo; preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4%) patient responders and 28 (66%) provider responders. The majority of patients (&amp;gt;70%) and providers (89%) expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes car

Does Behavioral Bootstrapping Boost Weight Control Confidence?: A Pilot Study

Background: Since confidence is an important predictor of ability to lose weight, methods for increasing weight-control confidence are important. The purpose of this study was to test the relationship between short-term behavior changes (`behavioral bootstrapping') and change in weight-control confidence in a small prospective weight-loss project. Methods: Data were available from 38 patients who received an initial motivational interview and a follow-up visit. Body mass index at baseline ranged from 25.5 kg/m2 to 50.4 kg/m2 (mean_=_35.8, median_=_34.4). Independent variables were change in weight (measured in kilograms in the clinic), self-reported change in minutes of physical activity, age, sex, and marital status. Minutes of physical activity were assessed at baseline and after 30 days, using the following question, _How many minutes do you exercise per week (e.g. fast walking, biking, treadmill)?_ Weights were measured in the clinic. Results: Weight change was inversely correlated with change in confidence (p_=_0.01). An increase in physical activity was associated with an increase in confidence (p_=_0.01). Age, sex, and marital status were not related to change in confidence. Independent effects of weight change and physical activity were estimated using multiple linear regression analysis: b_=_-0.44, p_=_0.04 for change in weight, and b_=_0.02, p_=_0.03 for change in physical activity (r2_=_0.28). Conclusions: Short-term changes in behavior (losing weight and exercising more) lead to increased weight-control confidence in primary-care patients.Exercise, Obesity, Weight-loss