Design Solutions To Improve Waiting In Healthcare
Courtesy of Eckenhoff Saunders Architects, © Mariusz Mizera
Different groupings of seating arrangements at Northwestern Memorial Physicians Group in Chicago, designed by Eckenhoff Saunders Architects, give patients and families choices, with options for more or less privacy.
Courtesy of SOM, © Tom Rossiter
The Cleveland Clinic Egil and Pauline Braathen Center, in Weston, Fla., designed by Skidmore, Owings & Merrill, uses millwork dividers for separating seating areas from each other and from circulation paths.
Courtesy of DSGW Architects, © Rolf Hagberg.
Designed to be part of the care and wellness sequence, this waiting area at Peter Christensen Health Center in Lac du Flambeau, Wis., designed by DSGW Architects, represents the community’s culture by showcasing historic images, materials gathered on-site, and artifacts.
Courtesy of Eckenhoff Saunders Architects, © Barbara Karant
Access to daylight and views of nature make waiting more pleasant and less stressful at Surgical Center of DuPage Medical Group in Lombard, Ill., designed by Eckenhoff Saunders Architects.
Courtesy of SOM, © Tom Rossiter
Televisions can be segregated from other waiting areas and placed in millwork dividers at eye level, as seen here at The Christ Hospital Joint and Spine Center in Cincinnati, Ohio, designed by Skidmore, Owings & Merrill.
With all of the things in healthcare one could worry about, how is it that waiting rooms have risen to a prominent position in the hierarchy of concerns? Yep, waiting rooms.
One of the first spaces patients and families encounter, the waiting room is traditionally considered a necessary element in every hospital and medical facility, yet it rarely drives the planning process and seldom is subjected to a rigorous review. At best, architects and planners typically follow codes and/or guidelines to determine the number of seats per whatever unit of the area it serves, and then try to make it look nice while accommodating the particular physical needs of the population who will use it. Done.
Not so fast.
Waiting is at last being seen from the patient’s point of view. It can be irritating and stressful. By now, we should all be aware that stress is contraindicated for the healing process. Stress while waiting can be a result of many factors, including nervousness or dread about the upcoming appointment or procedure; anxiety about what you’re not doing, but should be doing or would rather be doing, while you are waiting; not knowing what’s going on or when you’ll be called; or being uneasy because of the environment (uncomfortable chairs, crowding, too much noise).
And, to many, waiting is a waste of time. When patients are made to wait, it’s implied that their time is inconsequential compared to the caregiver’s time.
Interestingly, it’s not always the actual wait time that affects a patient’s mood, but the perceived wait time. Once that perceived wait time is too much, patient satisfaction drops. And providers now have an economic motivation for addressing patient wait times, with the introduction of Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), which addresses patients’ experience with individual providers, sites of care, medical groups, or provider networks. This survey asks patients how often they have had to wait 15 minutes or more to see a doctor. Better survey scores mean better reimbursement. So how are healthcare institutions, medical providers, and designers addressing the issues of waiting and waiting rooms? Approaches fall into three basic categories:
- Make waiting more pleasant
- Give patients something useful to do while they wait
- Reduce or eliminate the need for waiting.
Each approach has its own array of solutions, with some solutions easier and less expensive than others.
The waiting game
Make waiting more pleasant. A 2002 study conducted by Allison B. Arneill and Ann Sloan Devlin of the Connecticut College Department of Psychology and published in The Journal of Environmental Psychology found that the physical environment of a physician waiting room related to the perceived quality of care. Subjects believed the quality of care was better when they saw pictures of waiting rooms that were warm in appearance, with nice furnishings and artwork and good lighting, versus ones that were dark and unattractive. Environmental attractiveness also affects the patients’ positive impressions of interactions with staff. The most desired feeling was found to be “calm.”
Positive distractions can help patients while away their time, too. There’s a high degree of evidence that nature-based distractions (views to a garden, landscape art, a tank of colorful fish) help make patients feel calmer and more relaxed, as well as less aware of time ticking away.
But what about televisions? Some patients enjoy being glued to a set; however, many others find that being forced to listen to a TV—particularly when there’s no control over program or volume—can be very stressful and annoying. A design approach that satisfies both needs is to carve waiting spaces into TV viewing areas and TV-free areas. At the Joint and Spine Center of The Christ Hospital in Cincinnati, TVs in waiting rooms aren’t hung high up on the wall but rather are accommodated in millwork that places them at eye level and segregates them from quieter areas.
Seating should be comfortable and arranged to provide options for people to choose whether to wait in a more private area or in family groups. Arms on chairs make it easier for patients to sit down and get up; chair sizes should vary in order to accommodate bariatric users. In patient and family focus groups, the Cleveland Clinic found that people particularly disliked sitting back-to-back with others, when there was a chance that the backs of their heads would come into contact. Easy and abundant access to power is also increasingly appreciated.
Finishes and fabrics should be selected for attractiveness and ease of maintenance; no one wants to sit on a stained or dirty-looking chair. They should also be considered for their contribution to the acoustics of the space, as unwanted noise can cause or exacerbate stress in patients and visitors.
Give patients something useful to do while they wait. Providing access to free services such as a blood pressure test station, a scale, or a lending library can help support patient satisfaction and reduce the perceived waiting time. Free wireless internet will assist patients using their smart phones to access health information; providers can even direct patients to their own educational materials.
At Kaiser Permanente’s newest health centers in California, Thrive Bars, modeled after Apple’s Genius Bars, will allow waiting patients (and others) to get free information from staff on health, exercise, and nutrition. In some facilities, the traditional receptionist is replaced by a life coach, who provides the patient with a tablet computer loaded with information, magazines, and music.
Reduce or eliminate the need for waiting. Virginia Mason Medical Center in Seattle embraced Lean thinking and eliminated the waiting room. In a 2002 visit to Japan, Virginia Mason leaders were embarrassed to explain to a Toyota sensei that the path to patient care included a considerable wait to see the doctor, even though appointments were scheduled. Now, after a decade of attacking waste, the provider’s doctors, nurses, and medical assistants work collaboratively to manage patient flow, with arriving patients going straight to reception and then being sent immediately to an exam room.
Technology can assist, too. Self-service kiosks, such as those used for airport check-in and grocery store checkout, have been around long enough that a large portion of the population is accustomed to them and doesn’t hesitate to use them when they arrive for their medical appointments. Even more sophisticated are smart phone apps that send a notice to a concierge when the patient arrives on-site, so they can be greeted by a staff member with a tablet that has the patient’s file up and running upon entry to the building. There are also a growing number of applications for queuing systems, primarily for urgent care and emergency visits, that allow patients to wait in line at home.
The time is now
There is currently a big drive to reduce or eliminate patient waiting in hospitals and physician offices, or at least to make the experience more pleasant and useful. Each situation should be looked at individually, to define the problem that needs to be solved. Designers and owners have options to employ operations, technology, and design to achieve the most appropriate solutions for waiting and waiting spaces.
Joan Suchomel, AIA, ACHA, EDAC, is the 2016 president of the American Institute of Architects’ Academy of Architecture for Health. She is a principal at Eckenhoff Saunders Architects (Chicago) and can be reached at firstname.lastname@example.org.