Spatial Configuration and Staff Experience in Ambulatory Care: A Comparative Analysis of Linear and Onstage/Offstage Clinic Designs

Objective: This study examined staff perceptions of design and patterns of work locations and activities across two different designs, linear design and onstage/offstage clinic design, to inform evidence-based facility design and planning decisions. Background: Healthcare industry trends indicate an increasing focus on outpatient facilities, which currently represent 42% of healthcare construction spending, necessitating research on optimal design approaches for staff efficiency and satisfaction. Method: Three types of data collection and analysis were employed. First, surveys were conducted with nursing, medicine, physician assistants, case managers, and medical assistants/technicians from linear design (N = 48) and onstage/offstage design (N = 50) clinics. Second, focus groups of 24 staff were employed across clinics. Third, staff shadowing utilized tablet-based applications to record patterns of work activities, participants, and locations (N = 6,604 observations; 150 h). Results: Survey results showed Onstage/Offstage clinic staff had significantly more favorable perceptions of Clinic Design Features (p = .000), Design Awareness (p = .001), and Satisfaction with Design (p = .001) than Linear Design staff. Open-ended survey comments provided staff preferences and issues with clinic design. Focus group analysis revealed two themes from Linear Design staff: (1) Distance, and (2) Onstage/Offstage clinic design was superior and one theme from Onstage/Offstage staff: Proximity. Shadowing data revealed distinct workflow patterns, with Onstage/Offstage clinic staff spending significantly more time in direct patient care while Linear Design staff allocated more time to paperwork and patient reception activities. Conclusions: Key implications for clinic designers include prioritizing centralized staff work areas, implementing acoustic privacy solutions with spatial zoning; and redesigning patient interaction points for enhanced privacy compliance.