The key to successful healthcare design is putting people first, and at EUA, we strive to elevate the human experience. One of the first discussions we have with a client is understanding their model of care and how we can help them improve their process. Recently, we have seen more and more of our clients transitioning from a traditional, linear model of care to an on-stage/off-stage approach which better separates patient from caregiver spaces.
The on-stage/off-stage model borrows its terminology from theatre design, only making visible those spaces that you want your audience to see. On-stage areas in healthcare design consist of those spaces that are accessible to the public and used primarily by patients and visitors, such as reception/waiting, exam rooms, lab and other ancillary patient care areas. The off-stage areas are those areas that are ideally not seen by a visitor, including core staff areas such as nurse stations, break rooms, offices and storage spaces. Additionally, off-stage circulation areas allow materials to be transported out of public view.
Traditional vs. On-stage/Off-stage Clinical Model
A typical on-stage/off-stage clinic design will include dual access exam rooms which feature two entrances – one for patients coming from the waiting area and entering from a public corridor and another where staff enter from an off-stage collaborative team space. Provider offices and support spaces are located off-stage, on the perimeter, adjacent to the collaboration area.
This model ensures staff have private touchdown points, but still have visibility and proximity to patients. Moving a step further, this model can also be adapted for “self-rooming,” where the patient is assigned an exam room when they check-in and escort themselves to the appropriate room without a staff member. On the staff side, the reduction or elimination of private offices can allow for more patient care or staff collaboration areas.
Dual Access Exam Room
Benefits
Separating on-stage and off-stage areas allows for more efficiency in care, leading to increased patient and staff satisfaction. Separating the flow of visitors from staff enhances the experience for both parties through simplified wayfinding for patients and minimized footsteps for staff, contributing to reduced wait times for patients. In addition, the shift away from private offices to team spaces creates more opportunities for the staff to collaborate. Collectively these factors help to improve patient access to care.
When recently working with a fifty-bed community hospital, the primary driver was creating separate on-stage/off-stage staff areas. We understood this concept supported the owner’s goal of maximizing the patient and family experience and thereby increasing satisfaction scores. This specific strategy involved the division of staff charting and work areas into nurse “perches” close to patients’ bedside and establishing out-of-sight “collaboration” areas. The former provides a place for the care team to monitor patients and to be easily accessible to family, while the latter provides a more private work space for conversation and consultation.
Nurse Perch/Collaboration Area
Another client, that was building a series of outpatient clinics ranging in size from 10 exam rooms to over 50, implemented the on-stage/off-stage model using dual access exam rooms, a central staff work space with dedicated support/storage spaces for each pod and shared provider offices to improve space planning efficiency.
Central staff work space and dual access exam room
Bottom Line
The on-stage/off-stage care model improves the flow for patients and staff and greatly affects efficiency and privacy which has a large impact on the perception of and access to healthcare. Staff and patients have differing motivators and factors that matter to them so when implementing a care model, it’s important to understand what works best for your audience and needs. Is registration easily navigable for patients? Are staff members ducking into storage rooms to have a private conversation? Put yourself in the shoes of your users – how does your model of care support patients and caregivers?
Emily McNamara, AIA, LEED AP BD+C
Senior Project Architect
