TELEMEDICINE A ‘staff-only’ zone Reception Entry Waiting Staff support and meeting rooms
n Consult rooms n Waiting area
n Staff circulation n Patient circulation
Figure 2: This model combines two modes of working – telehealth and in- person consultations – in one integrated public zone.
a very common way of working in health services: ‘I’m in a different space every day. On a Monday I’m in a consultation room in the endoscopy unit – it’s a completely enclosed separate individual consultation room – but on Wednesday I’m in a room that is just separated down the middle by a concertina wall, so it’s not exactly soundproof.’
Type of zoning
In particular, the range of staff using a facility will influence the type of zoning required. Are clinicians working permanently in one department, or moving daily across locations within or beyond the hospital? Will virtual consultations be delivered in blocks of time, or sporadically across the day? Will some staff continue to deliver in-person consultations only? Figure 2 combines two modes of working – telehealth and in-person consultations – in one integrated public zone. Around half of the consultation rooms from ‘Business-as- usual’ are converted to telehealth rooms, which are smaller because no beds or physical examination equipment are necessary. The adjacency of the two different types of spaces allows clinicians to swap easily between delivery modes throughout the day. Staff can circulate behind the consultation rooms to provide some separation from patients, but the spaces are mostly shared by staff and the public. Waiting space is significantly reduced, because fewer patients are required to attend their appointments in person.
Figure 3 goes a step further, delineating a ‘staff-only’ zone for telehealth consultations between the public waiting area and the staff support areas that accommodate administration and ancillary activities. Within this zone there are small booths that seat one person only, as well as larger rooms to accommodate two clinicians, or to allow for exercise demonstrations or equipment. Some work points are enclosed, while others are more open, but protected by privacy screens. This increases the number of consultation work points in the department compared with the ‘Business-as-usual’ layout in Figure 1. It also gives clinicians a range of work settings to choose from, according to tasks and work preferences. Some facilities may refurbish spaces simply by dividing consultation rooms into two smaller spaces, or changing the furniture in consultation rooms to enable multidisciplinary clinician teams for online consultations. Or, the changes may be more wholesale – converting an entire section of a department to telehealth rooms or work points only. As the pandemic subsides, myriad variations on these mixed-mode approaches will appear in hospitals, and each will be developed to suit its own unique circumstances.
Complete transformation – 100 per cent telehealth
Some healthcare systems have already taken a step beyond mixed-mode: whole
Staff support
Entry and reception
Staff support
Staff support
Staff support and meeting rooms
n Telehealth workpoint n Staff circulation
Figure 4: What a different approach to hospital workplaces might look like – re-imagining them as offices, rather than clinical environments. Telehealth work points are spread across a large floor area, interspersed with meeting and administration areas.
Reception Entry
buildings dedicated to telehealth delivery, otherwise known as ‘the hospital without patients’. The Virtual Care Mercy Hospital in Missouri in the US was designed by Forum Architects to accommodate over 300 virtual care staff in mostly open plan space. The staff monitor and consult with patients who are at home or in hospitals around the state.8
This emerging model Waiting
In-person consult zone Staff-only telehealth zone
of care paves the way for a different approach to hospital workplaces, re- imagining them as offices, rather than clinical environments. Figure 4 shows what this might look like, with telehealth work points across a large floor area, interspersed with meeting and administration areas.
A hospital is not an office, of course, and clinicians may be as reluctant, if not more, to give up their traditional work settings as many commercial workers have been in recent years.11
The findings Staff support and meeting rooms
n Consult rooms n Telehealth workpoint n Staff circulation n Waiting area
n Patient circulation
Figure 3: This mode delineates a ‘staff- only’ zone for telehealth consultations between the public waiting area and the staff support areas that accommodate administration and ancillary activities.
of our research certainly support this. Clinicians indicated a strong preference for enclosed workspaces over open areas because of concerns about confidentiality and distractions – and they have a point – nobody wants to compromise patient confidentiality. However, more open workspace doesn’t necessarily mean the dreaded call centre design. The most likely ‘office’ approach may be a standard layout of enclosed telehealth rooms with some open space for administration. Or, as our survey indicated is already happening in some locations in Australia,
October 2021 Health Estate Journal 29
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