Collaborative care: Boundaryless healthcare design for outpatient clinics

Each module features a standard combination of room types suited to its purpose. Planners can repeat and combine modules in a series across a building floorplan, minimizing the need for custom spaces. We see modular templates used for both “onstage” patient-facing areas like exam rooms and “offstage” support spaces like offices and storage. While adjacent modules might have some connections, they rarely have shared zones intended to foster care team culture. Modules usually function like traditional departments or suites.

Modular and flexible clinical planning projects

We’ve applied a modular approach on several projects with success. We designed UCSF Bakar Precision Cancer Medicine Building in San Francisco, California, so that adjoining clinical clusters shared all offstage spaces in an open team workplace.

What is one way to maximize long-term flexibility and future proof healthcare settings? Movable walls. The design for Jefferson Health’s Honickman Center in Philadelphia, Pennsylvania, features a modular partition system with removable finish panels. It allows Jefferson Health to expand and adjust clinical departments as needed. The idea is that Jefferson Health can reconfigure space, move partition walls, or easily open a wall to upgrade technology services. And they can do it without the expense and disruption of demolition and rebuilding.

Holistic care for the patient

Meanwhile, a new holistic care model has become more fully embraced in healthcare. This model considers the patient as a whole person, not just the ailment. Clinicians, specialists, and caregivers collaborate to address a person’s complex needs. Providers want to break down silos between specialty clinics to foster connections and promote holistic care.

We believe that by combining a modular planning approach with fresh “boundaryless” planning in healthcare design we can unlock more benefits for the provider and the patient. This results in designs suited to holistic care. 

So, what is boundaryless healthcare? And what benefits does it offer to collaborative care?

In a boundaryless healthcare layout, we shape the edges of adjoining clinics without the walls, doors, and corridors that traditionally divide them into distinct suites.

Without those elements, clinicians and specialists have enhanced freedom to move between care spaces, see patients jointly, and interact amongst specialties. Patients need not open and close doors and walk down hallways and visit reception between specialists.

The goal is that in the boundaryless zones, conversation about care flows freely. This results in better teamwork between caregivers and specialists. Ideally, it fosters better health outcomes.

A boundaryless solution

We took a boundaryless approach to the design for the clinics at SUNY Upstate University Hospital Nappi Wellness Institute. It’s a new five-story, 200,000-square-foot outpatient facility. The hospital system had various clinics spread throughout Syracuse, New York. It wanted to expand and unite them in a new wellness institute on the main campus. The new Institute would primarily comprise various clinics—so it was a great fit for us to design around a repeatable clinical module.

The hospital’s top priorities were flexibility and collaborative care. It is committed to using its resources responsibly while serving an ever-changing community. The hospital planners wanted the ability to shrink and grow. They wanted to increase collaboration between clinics. They wanted to foster an integrated healthcare environment and to spend their budget wisely to maximize the dollars available for care. Their needs led us to propose a boundaryless design.

How we designed a boundaryless healthcare facility

The Nappi Wellness Institute embraces the new holistic model of integrated and preventative collaborative care. To foster this integrated approach, the Institute needed a design that could bring all the facets of primary care under one roof.

We wanted extreme flexibility. How could we get there? We collaborated on the design for a module to best serve the patients and caregivers. It allows for their movement back and forth and across corridors. Then we designed the architecture for a purpose-built building around the boundaryless module.

The big idea with boundaryless design is a modular cluster of spaces that repeat across the building. Each cluster has a central work area for the care team, exam rooms, consultation spaces, and staff support areas. The staff nodes are flanked by patient rooms to satisfy the needs of the specific clinic. The edge of the clinics can shift to meet expanding or decreasing needs.

Flexibility on demand

With exam rooms at the edge of the clinical module, neighboring clinics can flex into more rooms as demand peaks. We designed universal spaces that can accommodate a variety of primary and specialty care clinics. Because the rooms are standardized, clinicians from differing practices can easily adjust to the layout as they flex. They can become exam rooms with minimal rework. Clinics can easily expand or shrink to fit future demands.

The idea of collaborative care and shared space drove the architecture. We found the common threads between the departments that were going into the new building. Defining the commonalities and specificities between each department helped us shape a layout to meet their needs. And we consulted closely with the practices during the planning stage to avoid redundancies in space.

We located adult-oriented clinics with similar exam room needs—such as adult medicine and internal medicine—next to one another. This allows each practice to flex from one module to the other as needed. We put the pediatric practice next to family medicine and global health services since they primarily treat pediatric patients. This allowed us to create a much more welcoming pediatric-centered waiting area for all.

Encouraging collaboration

We designed a community table as the “team hub.” On-stage clinicians face each other at the table, which promotes collaborative care. Cross corridors act as highways of teaching, encouraging spontaneous chats by specialists about patient health. Rather than one small break room per module, our design combines program elements in larger communal areas. Gathering people and resources in the space puts the focus on a culture of collaborative care.

Because the emphasis is on onstage collaboration, we minimized the offstage staff area behind the scenes. There are few enclosed offices but plenty of touch-down space for quiet work.

Flexibility and cross collaboration drove the design. But it was important that we design for the integrity of the various clinical modules. Each department needed to see itself in the space. And they need to present a unique specialty face to the patient expecting focused clinical excellence.

Benefits of boundaryless healthcare

SUNY Nappi Wellness Institute will be the first outpatient care facility in the state designed with this unique modular approach. It is the first hospital in New York with a boundaryless design.

Without hard walls or boundaries in the on-stage clinical and off-stage staff areas, the space invites departments to converse and collaborate on patient care. The co-location of services under one roof makes Nappi’s services more accessible to the diverse population. Patients can access more specialties more conveniently. The new facility supports healthcare that treats the whole person with increased collaborative care and access.

Leadership and culture change in hospital design

Often the health facility’s leadership understands the financial benefit of designing for collaborative care. Yet, departments tend to try to preserve their borders and spaces like break rooms and conference rooms. Strong institutional leadership made it possible for us to take a boundaryless approach on the SUNY project. Leadership made a compelling case to its departments for the boundaryless environment as an alternative to departments defined by walls. It had to show departments that they were gaining flexibility and maintaining a presence in the building.

Boundaryless healthcare design supports care for the whole person. We are excited to see how SUNY Nappi Wellness Institute performs in our post-occupancy evaluation. We are confident that we will see the value of erasing the walls reflected in patient outcomes. That’s because boundaryless design supports a culture of “we.”