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What A Difference A Space Makes

611ee5eb26ae440a24441a177ecefb82-huge-06Today on the blog, a family physician who had grown all too accustomed to practicing in a cramped clinic, finds renewed enthusiasm for her work when her practice moves into a new space.

By Anne C. Jones, DO, MPH
The first time I walked into our clinic building, it was a foundation. No walls, only steel rods and markings for where offices and rooms would be. I gathered with my colleagues for the beam-signing ceremony, a ritual in the construction and architecture world that signifies the completion of the foundation and the transition in focus to the interior. Together, my colleagues and I ascended the stairs and walked into what would soon become our clinical care units. The smell of wood, dust and machinery was striking and created a buzz of excitement. There was a feeling of hope and positivity. The anticipation of a new space heightened once we were able to walk through and physically imagine what could be.
Six months later, we arrived for work in our new integrated medical and mental health units. There were cheers, wows, and selfies. The building smelled of fresh paint, packing tape, cardboard boxes, and shrink-wrap from recently unpacked furniture and medical supplies. That new smell continued to fuel our excitement. It reinvigorated us for our work.
And then, the first patient arrived.
We looked at each other all with the same question on our faces: How are we going to see patients here today?  In the old building, we knew what to do. We walked briskly down the halls to keep up the pace, knowing that each room (even broom closets!) was being used for something. We pivoted to the right when crossing paths, without looking up from our screens, knowing that two people could not fit side-by-side in the halls. We placed our laptops on any clean surface, ready at a moment’s notice to pick them up if someone else needed the space. We spoke in whispers behind closed doors to ensure that nothing private seeped through the walls. We worked to see every patient, even though we knew our space could not accommodate the demand of one exam room per clinician. However impractical, we did these things with ease. It was our routine.
How did we manage to see our patients those first few weeks in the new building? I’m not sure if they noticed that we were still searching through boxes to get them what they needed. Our boxes were tightly packed with otoscopes and microscopes, posters and educational materials. The first patients helped us see what we needed to unpack first. They must have sensed our excitement, many hearing that they made history as the first patients seen in the new space.
But we had brought with us so much more than boxes full of supplies. We’d brought the values that formed our foundation as an organization: a health-care system founded upon a strong primary care workforce, with care for the whole person at its core, and a partnership between clinical care and public health that enhances care for the individual and in turn, the community. This is reflected in the new space that allows for collaboration of primary care and mental health care systems to meet the integrated needs of our patients and clients.
A new building has a distinct smell. That smell of newness comes with a sense of hope, possibility and ideals. Over time, the hope turns to gratitude from patients and staff alike for the space that finally matches the quality we strive towards in our service to patients and the community.
But that new smell wears off. Staff and patients get used to new spaces. The experience, however, reminded me what it’s like to feel that newness about my work. It rejuvenated my hope for our health-care system: that it is possible to find ways to keep the excitement and newness - of space, of teams, of technology - in our daily work, and keep our daily work continually open to the new.
In primary care, it is important to create systems that are of high quality for staff and patients. It is equally important to create systems that are resilient and responsive to the needs of an ever-changing population, where the reasons that cause individuals to seek health care are different for everyone and always a bit unexpected. We must be prepared to care for the needs of everyone, but we cannot be too rigid in our thinking. By working together and staying open to the needs of the patient and community, whether on the first or last day of our practice in a particular space, we create systems that are stable in their very ability to transform.
In this time of health-care transformation, the new seems to be ever upon us. What keeps practice feeling new for you? What forms the strength of your foundation? Let us allow these questions to guide us toward the power that exists when we begin to answer them, together.
Anne C. Jones, DO, MPH, is Interim Director of Medical Services at Cornell University’s health service. She practices osteopathic family medicine and public health, serving the integrated needs of patients and the community. She is a graduate of Rowan School of Osteopathic Medicine, Maine Dartmouth Family Medicine Residency, and The Dartmouth Institute for Health Policy and Clinical Practice.

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