Photographs show interior views of the Gonda Building and the Eugenio Litta Children's Hospital at the Mayo Clinic, Rochester, Minn., campus
Eing a patient is just about the least amount of fun a consumer can buy. What is more stressful, frightening and emotionally draining than being a patient? As an added vulnerability, patients must relinquish control over the service exchange to a provider with a knowledge advantage. In one sense, medical service is like car-repair service; the mechanic knows more than the customer about what's going on under the hood. In another sense, it differs significantly; medical customers have far more at risk than the well-being of a vehicle. In medicine, the stakes are quality of life and life itself.

Medical Service Characteristics

In addition to being complex and important, medical services are intangible, variable, inherently personal and inseparable. Medical services are performances, in that patients buy the efforts of others rather than objects. (Nothing goes in a market basket.) Medical services also are variable because they are so labor- and skill-intensive. The human component of medicine introduces a degree of skill and attitude variability not present in services delivered largely by machines.

Medical services are among the most personal of services, requiring, more than any other service, that consumers bare themselves physically and emotionally. Medical services are one of the most intimate services consumers buy; patients are on an emotional edge. Because medical services are performed directly for the consumer, rather than for the consumer's property, they are produced and consumed simultaneously—the customer must be present to receive the service. This means that the patient experiences what goes on in the service “factory” and experiences the “factory” itself.

The characteristics of medical services, then, suggest some probing questions for those who design and build healthcare facilities. These questions include: How can we make tangible the intangible? How can we strengthen patients' confidence in a complex, variable, high-stakes service? How can we create a setting that conveys intimacy and caring while fostering productive work flow?

The specific characteristics of medical services require a carefully designed form and high functionality from the facilities in which these services are performed. Ideally, the design of a medical facility tells a compelling story about the service that the service cannot tell by itself. The facility communicates a torrent of clues about the service; it is a physical reflection of the core values and quality of care offered by the institution.

Without a Word

Because medical services are so purely intangible and technically complex, patients are especially attentive to what they can see and understand in the physical environment. Service facilities speak loudly to their customers. The question for healthcare executives is not, “Does the facility communicate to customers?”—because it does. The question is, “Do these clues convey the optimal message about our services?” Excellent service organizations orchestrate the tangible clues to tell a particular service story, to enhance the customer's experience, to shape the customer's perceptions and to exceed the customer's expectations.

Importantly, a well-designed, pleasing medical facility not only affects patients directly but also indirectly, because it also influences employees' service attitudes and behaviors. Employees who perform the service spend more time in the facility than customers. This raises still another set of important questions: How can we design a facility that simultaneously pleases patients and employees? How can we design a facility that encourages performers of the service to per-form effectively?

Welcome, Care and Comfort

Mayo Clinic is one among a number of healthcare organizations that adeptly orchestrates the tangible clues of service. It operates from a clearly articulated facility-design philosophy. Mayo Clinic designs facilities to accomplish the following for patients and their families:

Mayo facilities also are designed to be pleasing and comfortable for employees, to foster productive work flows and to enhance the integration of a large, multispecialty medical practice.

Mayo Clinic seeks to counter the imposing nature of large medical buildings with purposeful efforts to soften building interiors through natural light, color, artwork, fountains, pianos and music, as well as other creative design details. The pediatric unit in Mayo's St. Mary's Hospital Emergency Department, for example, transformed artwork by local school children into a colorful arrangement of wall and ceiling tiles. The resuscitation equipment in the examination rooms is hidden behind a large picture (which slides out of the way when the equipment is needed)


In its new 20-story Gonda Building in Rochester, Minn., Mayo used a prized location on the main floor for a large, carpeted, wood-paneled, multimedia Cancer Education Center. It plans to use the same blue stonework from the Cancer Education Center in all of its other cancer facilities. A Mayo administrator explains that the Cancer Education Center is located in such a prime area because “the more visible the Center, the more we take the stigma out of having cancer.”

Mayo Clinic examination rooms are designed uniformly across the system to enable physicians to comfortably use any room. Extra-heavy walls and ceilings deaden background noise and reassure patients about privacy. Patients undress, hang their clothing and dress within a curtained space. The physician's desk is adjacent to a sofa large enough to accommodate the patient and family members. This arrangement removes the desk as a barrier to interaction. The patient also may use the sofa to lie down while waiting for the doctor. Different lighting levels provide background illumination or accommodate physician examinations as appropriate. The examination table is engineered with drawers for linen, gloves and equipment. The rooms are large enough to hold extra people (e.g., family, physician assistants, residents, nurses) without crowding.

Care by Design

As these examples illustrate, attentive healthcare providers prepare for their patients with the same scrupulous attention to detail as a host preparing for guests. Design elements help communicate care, comfort and compassion, showing commitment to patient well-being before a word is spoken. An environment designed for safety, quiet and beauty diminishes patient vulnerability by accommodating personal needs beyond special tests and techniques. It also inspires healthcare professionals to deliver the high quality of care the patient is seeking.

Design plays a significant role in lessening the burden of pain and illness. Facilities designed for optimum care and reassurance say, “Welcome to this place. Your comfort is our first priority.” HD

Distinguished Professor of Marketing Leonard L. Berry, PhD, holds the M.B. Zale Chair of Retailing and Marketing Leadership in the Mays School of Business at Texas A&M University. During the 2001-2002 academic year he was a visiting scientist at Mayo Clinic. He is author of Discovering the Soul of Service and other books. He can be reached at (979) 845-0804 or at