Space matters: Increasing employee engagement and efficiency through office redesign

Studies of occupational stress pay little attention to features of the physical environment in which the actual work is performed. Yet evidence is accumulating that the physical environment of work affects both job performance and job satisfaction.¹ 

Provider burnout shows consistent negative relationships with perceived quality (including patient satisfaction), quality indicators and perceptions of safety.² Conversely, nurses who perceive their work units are patient-centered were significantly more satisfied with their jobs than those who do not.³ 

All of these factors led to the creation of more collaborative workspaces at Concord Surgical Associates, Concord, N.H., for clinical support staff in the outpatient medical practice setting. 

Methods 

Press Ganey surveys all of the clinical providers and staff at Concord Surgical Associates on a biannual basis to determine the level of engagement of the overall institution and each department. The survey results to the question, “My job makes good use of my skills and abilities,” was identified as an area needing improvement in the general surgery department, which included eight surgeons, 11 advanced practitioners (APRN, PA-C), three medical assistants (MAs), three registered nurses (RNs) and five patient care coordinators (PCCs). In response, this department redesigned clinical area workstations to create a more collaborative workspace for clinical support staff and thereby improve employee engagement.  

Pre-redesign 

Before the office redesign, the workspace setup was not ideal for the specialized care of patients requiring clinical assessment and guidance, and was not patient-centric for care delivery (see Figure 1). The close proximity between the clinical and administrative staff led to blurred role definitions, in that MAs often provided backup to the administrative team by doing tasks that did not require clinical competency or medical decision-making: faxing documents, handling medical record requests and leave of absence paperwork, covering the check-in and checkout processes, and scanning documents into the patient medical record.  

Due to their close proximity, many MAs also performed duties of a PCC, which were more administrative than clinical. 

Before the office redesign, the workspace setup was not ideal for the specialized care of patients requiring clinical assessment and guidance, and was not patient-centric for care delivery (see Figure 1). The close proximity between the clinical and administrative staff led to blurred role definitions, in that MAs often provided backup to the administrative team by doing tasks that did not require clinical competency or medical decision-making: faxing documents, handling medical record requests and leave of absence paperwork, covering the check-in and checkout processes, and scanning documents into the patient medical record.  

Due to their close proximity, many MAs also performed duties of a PCC, which were more administrative than clinical. 

Office redesign  

In June 2015, the office was redesigned to increase efficiency and clinical workflows (see Figure 2). As part of this process, RNs, MAs and PCCs worked with practice leadership to review the details of their job descriptions and expectations, and redefine the clinical roles of the team with more clarity. Tasks that were administrative and did not require clinical expertise were better performed by front-end users. Those tasks were systematically identified and reassigned to PCCs. MAs continued to room patients but eliminated the administrative responsibilities of scanning, answering calls and scheduling appointments, which were shifted back to the PCCs.  

Workstations were renovated so that each MA was placed with an RN in the central area of the office. This workspace, referred to as the “clinical fishbowl,” has been identified as “one-stop shopping” for physicians and advanced providers looking for RN or MA help, making workflows more efficient. Clinical staff members were empowered to refer administrative responsibilities to PCCs in the front office. This change provided more time for clinical support staff to complete tasks that were within their scope and that were more professionally satisfying. For example, nurses provided pre-operative patient education and nurse office visits, which resulted in increased patient volume and revenue. This also allocated time to complete classes and required competencies for their clinical practice and development. 

Results

• Rearranging office space to enhance team functioning and efficiency improved morale within the office and increased revenue. Press Ganey survey results on the question, “My job makes good use of my skills and abilities,” increased by 6%.  
• The explicit partnership between the MA and the RN resulted in MAs improving their clinical knowledge: 66% of MAs moved forward with certification and considered a return to school to further their clinical development. 
• Turnover among administrative support staff increased to 60% during the redesign process, which allowed for new hires to come in with a clear definition of role expectations and responsibilities.  
• More than 700 additional patients were seen in fiscal year (FY) 2016 compared to FY 2014, and total surgeries increased by 300 for the same period. From FY 2015 to FY 2016, total charges increased by $1.93 million. 

 When expectations are clear, responsible parties are held to duties required by their certification or license, and roles are physically arranged in a space that encourages collaborative learning, coaching and mentoring. The result is an increase in employee engagement scores and increased patient volume and revenue.   

Notes: 

1. Vischer J. “The effects of the physical environment on job performance: Towards a theoretical model of workspace stress.” Stress & Health. 2007; 23: 175-184. 
2. Salyers M.P., Bonfils K.A., Luther L., et al. “The relationship between professional burnout and quality and safety in healthcare: A meta-analysis.” J Gen Intern Med. 2017; 32: 475-482. 
3. Rathert C. and May D.R. “Healthcare work environments, employee satisfaction and patient safety: Care provider perspectives.” Health Care Management Review. 2007; 32: 2-11.