Clinic growth isn’t going anywhere, at least not for a while. Deborah Franqui, healthcare market leader at Leo A Daly and coordinator of healthcare design programs at University of Miami School of Architecture (Miami), says the trend is fueled by increasing demand for primary care services. “And that’s going to continue beyond the year 2025, mostly influenced by the growth of the aging population, the growth of the population in general, and the expansion in health insurance coverage,” she says.

That’s why she and Dina Battisto, associate professor at Clemson University (Clemson, S.C.), decided now was an ideal time to conduct a post-occupancy evaluation (POE) with the goal of assessing strengths and weaknesses of different clinic environments in order to create a standardized approach for design. The two will present their work in the session “An Evidence-Based Design Checklist to Inform Clinic Design” (E61) at the 2016 Healthcare Design Expo & Conference.

For the project, which was Franqui’s dissertation, three unnamed primary care clinics designed by award-winning healthcare design firms were analyzed using a methodology developed by Battisto for a similar effort at the military health system, tailoring it for outpatient care. The three sites individually represented the three most common models used in clinic design: a traditional layout with back-to-back exam rooms and staff integrated throughout, onstage/offstage with a dual-side exam room, and onstage with patient and staff circulation in a common corridor with access to exam rooms and a central teaming area.

The POE weighed design strategies against four specific outcomes: operational efficiency, space efficiency, clinical effectiveness, and positive experience. Areas studied in relation to those outcomes included flow, flexibility, functionality, quality of care, safety and infection control, and access and wayfinding. “So if we look at the clinical pods or overall design, what are some design strategies we can implement to improve movement and flow, to improve flexibility, to achieve operational efficiency?” Franqui says. And identifying areas that achieved higher scores than others provided a framework for the checklist.

Among the findings was that all excelled at aesthetics but didn’t do as well with operational efficiency, and a lack of privacy emerged as a common issue. “The more we see clinic design move toward an open staff/team approach, it creates issues with privacy. Even in the onstage/offstage model, it became more critical—since [staff] don’t think patients see them, they tend to be louder,” Franqui says. Another common finding across different layouts was the perception by staff that there were never enough exam rooms, influenced by limited flexible and productive use of rooms and limited visibility across pods preventing awareness of when exam rooms were free.

The findings and checklist will be presented in the session, with the goal of providing a standardized approach to POE for designers to use in measuring the success of their own designs in order to build a database of findings that could shape future building solutions.

“[POEs] are not funded usually and there are limited examples to demonstrate the value or the power of the POE. This is because a lot of times the results of the POE sit on a shelf. … In the end, lessons learned from POEs could help us avoid making the same mistakes over and over,” Battisto says.

Although the project focused on primary care clinics only, Franqui says the results will be applicable across clinic types. The two also caution that their recommendations aren’t prescriptive but rather performance-based and that ideal solutions will always vary based upon organizations and culture.

Jennifer Kovacs Silvis is executive editor of Healthcare Design. She can be reached at