Traditional approaches to team stations on behavioral health inpatient units put these staff spaces at the center of the unit to function as a central point of awareness for staff as well as an interface point between the patients and clinicians. However, as treatment of mental illnesses evolves to become more patient-centric, and as the use of workstations on wheels (WOWs) and tablets allows the clinical team to break the tether of sitting behind a desk, project teams are rethinking their approaches to the physical and operational characteristics of the team station to better align with modern care methods while maintaining a safe environment.
This is making the binary choice of open team station versus enclosed team station an outdated approach to design. Rather, it’s about finding a configuration that allows staff to provide the most optimal care to patients. In some applications, such as child and adolescent units or lower-acuity adult units, there are advantages to eliminating the barrier between patients and staff at the center of the unit to allow the care team to interact with patients in the care environment, encouraging a collaborative approach to recovery. For higher-acuity patient populations, breaking down the barrier between the clinical team and patients may compromise safety to both. In all cases, the design of the team station should balance the goal of aligning to the model of care while ensuring both staff and patient safety.
Furthermore, dissolving the traditional sense of a team station can foster relationships between clinicians and patients while changing the power dynamic on the unit. Here are three examples to consider.
1. Strawberry Hill Behavioral Health Hospital. Opened in August 2019, the 48-bed Strawberry Hill Behavioral Health Hospital for The University of Kansas Health System in Kansas City, Kan., is located in a renovated, four-story office building. The existing building geometry and structural grid presented challenges related to maintaining visibility of the unit from one central team station. The solution was to break down the units at Strawberry Hill into three smaller neighborhoods, each with its own team station strategically located between the daytime (patient activity) zone and nighttime (patient bedroom) zone. As a result, one side of the team station is directly across from the patient bedrooms and the other faces the patient activity rooms, as opposed to a more ideal layout where the team station is surrounded only by patient activity space to maintain a quiet sleeping environment.
To address this situation, the project team decided a hybrid team station would provide the best solution: an open design for the side of the station facing the daytime zones encourages interaction between staff and patients, while the side facing the patient rooms is enclosed with a staggered series of glass panels. During the day, the staff primarily occupy the open side of the team station, completing documentation, interacting with patients, and maintaining supervision of the daily activities. When a private discussion or sensitive call must be made, the enclosed side of the team station is available to do so.
Additionally, should an agitated patient attempt to enter the team station, the staff can quickly move to the enclosed side for safety. During the night, staff primarily utilize the enclosed side of the team center, where they can maintain visibility of the unit for safety and complete tasks without transmitting noise to nearby patient bedrooms.
2. Virginia Treatment Center for Children. For child and adolescent populations, it’s especially important to build and maintain trust between clinicians and patients through personal interactions, as young patients are away from their consistent caregiver, potentially for the first time, and in an unfamiliar environment. For the Virginia Treatment Center for Children in Richmond, Va., the design team focused on using architecture and technology to transform the team station into a collaborative and engaging space.
The unit features a double-sided, open desk where patients and clinicians can sit together, and the staff are provided with tablets for clinical documentation, allowing the center of the unit to be dedicated to human interaction. Additionally, staff can still maintain passive supervision of the unit in its entirety, and children, sitting side-by-side with clinicians, can complete a puzzle or color a picture while chatting about their day. This transforms the center of the unit, typically dedicated to staff, into an additional space where young patients can receive care.
3. Sheppard Pratt Hospital at Elkridge. During design discussions for the new 85-bed Sheppard Pratt Hospital at Elkridge in Elkridge, Md., expected to open in summer 2021, the leadership design team led by CEO Dr. Harsh Trivedi expressed concern that a traditional team station would create a physical barrier between clinicians and patients and undermine the organization’s vision and model of care to closely engage with patients on a regular basis.
Providing the care team with mobile technology in conjunction with that model of care, leadership chose to eliminate the traditional team station in its entirety and dedicate the center of the unit to patient and staff collaboration. Clinicians can still utilize a private charting room located at the interface between patient activity rooms and a staff support zone for sensitive documentation or phone calls. However, most of their day will be spent on the unit, directly providing care to patients.
Additionally, upon entering the unit, patients will not be confronted with a traditional team station, which is often viewed as a symbol of “other” due to the physical delineation and separation, but will encounter an open space full of natural daylight. The decision to eliminate the team station in its entirety is a paradigm shift that puts the patient at the center of the care unit, both literally and figuratively.
Supporting modern care environments
Whether in a renovation or new build, the design of the team station plays a critical role in the overall message the care environment sends to patients receiving care. As discussions evolve from enclosed versus open team stations to include hybrid solutions or approaches where the team station is eliminated in its entirety, this creates an opportunity to align the ideals and vision of individual health systems with the environment in which they deliver care.
In-depth discussions with the care team that has firsthand experience with patients, field observation to record hidden challenges that current designs present, and the use of 3-D virtual technology to refine a solution before it’s constructed can aid in finding the proper design for each unique environment.
Stephanie Vito, AIA, is vice president, architecture, at CannonDesign (Buffalo, N.Y.). She can be reached at email@example.com.