Published on April 15, 2014 by Anne DiNardo, Senior Editor Healthcare Design
The patient experience is taking on a whole new level of importance for providers, as the industry shifts to a value-based service model, where outcomes and satisfaction drive reimbursements.
“Most hospitals have been focused on the back-of-house operations, where everything was about volume and efficiency,” says Michael Lied, director of healthcare, principal, GBBN Architects (Cincinnati). “Now the value is shifting to the front of the house and the customer service aspect.”
To that end, the waiting room and the overall waiting experience have fallen under new scrutiny, particularly the traditionally stale environments where patients and visitors might pass what feels like excruciatingly long periods of time. Providers are engaging designers to create spaces that make patients and visitors feel comfortable, appreciated, and valued for their time while setting their organization apart from others.
This shift is driving changes in the design approach, from the right-sizing of these spaces to the aesthetics, furnishings, and technologies that are being put to use.
“We’re putting a lot of thought into creating a look and feel of the institution,” Lied says. “The finishes and imagery we use all tie in together and help differentiate them from others.”
Spaces in transition
Most designers agree that the days of large waiting rooms with row after row of chairs are over. Instead, suggests David Grandy, director of innovation and senior healthcare strategist at HDR, Inc. (Omaha, Neb.), organizations are taking one of two points of view on these spaces.
“Providers are looking to add value by designing more patient- and family-friendly spaces,” he says, with solutions taking the form of added amenities, educational opportunities, flexible layouts that can be reconfigured for after-hours group appointments or classes, and a variety of seating arrangements.
On the other hand, he says, some organizations are downsizing waiting spaces and shifting the waiting experience to exam rooms instead, oftentimes involving a self-rooming operational model.
Other designers acknowledge that clients are considering adoption of check-in kiosks and self-registration, but not everyone’s on board yet.
“I think there’s still a lot of belief that having a person to welcome you and to answer any questions is comforting to many people,” says Christine Guzzo Vickery, vice president and senior interior healthcare designer with HGA Architects and Engineers (Minneapolis).
Marc Margulies, co-founder of Margulies Perruzzi Architects (MPA; Boston), says he’s seeing a shift to smaller, department-specific waiting spaces that are more hospitality oriented, with residential-type furniture and places to plug in electronic devices. “People don’t want to feel like they’re being shuffled in and out too mechanically,” he says.
In the case of inpatient settings, Vickery says the rise in private patient rooms that are large enough to accommodate family members is also contributing to the downsizing of waiting rooms. But in some departments, like an OR, she says waiting rooms are still very busy—and very necessary—to accommodate families waiting for updates about patients and their procedures.
In ambulatory care settings, GBBN’s Lied says he’s seeing growing adoption of central reception and waiting areas. “All the information you need is in one space to help with wayfinding and clarity,” he says. “It also helps [facilities] identify their brand by the appearance of that area when you walk in.”
Better places to spend time
Across facility types, efforts are being made to improve the waiting experience through the use of more consumer-friendly features.
Amy Mees, senior medical planner, interior design, at GBBN Architects, says her clients have a strong desire for retail-inspired furniture arrangements. “Everyone wants to have this Starbucks look and feel with a variety of table and seating options,” she says.
Steph Shroyer, interior designer at GBBN, says creating a variety of niches, from spaces for parents to sit down with their kids to worktables for those arriving with laptops and iPads, helps patients and visitors craft an experience that’s right for them.
“We’re trying to have different areas and activity zones so that your wait doesn’t feel like a wait anymore,” she says.
And while patients and visitors are still looking for activities to help pass the time, they’re looking beyond a TV broadcasting daytime dramas and talk shows. In fact, in a pilot study conducted by Vickery’s firm on waiting room activities in 2011, 95 percent of the roughly 230 respondents said “reading” was the activity they most wanted, followed by “use of a mobile phone” (57 percent), and “watching TV” (41 percent).
To accommodate these preferences and keep a TV from being a distraction, Vickery says she uses dividers to create waiting zones and plans the space so that everyone’s not waiting in one continuous area.
“The TV’s are then strategically placed within one or two of the dividers so that the sound is contained,” she says. “Those wishing to read quietly or watch a fireplace or aquarium can sit near dividers that contain those amenities.”
Certain design features can also help prevent patients and visitors from feeling isolated from what’s happening behind the scenes, whether they’re waiting for their own appointment or the results of a family member’s surgery.
During a project for Reliant Medical Group (Worcester, Mass.), Margulies says MPA installed a door with a glass pane between the waiting room and the back-of-the-house area.
“If you have to wait, it’s very frustrating to be sitting there and feel like nothing’s going on,” he says. “But if you see people coming and going, and staff moving around in the clinical area, then you feel there’s something happening and that they’ll get to you.”
The visual sightline also helps patients leaving an exam room find the reception area and know which way to exit a facility.
The operations of waiting
Though waiting in healthcare spaces isn’t likely to go away, Rosalyn Cama, president and principal interior designer of Cama Inc. (New Haven, Conn.), says improving the experience overall starts with understanding the expectations patients have from the get-go. What are they being told before a visit? How will they arrive? What do they perceive to be necessary on-site amenities?
“In this new model of care, design teams are looking for knowledge about how the built environment impacts the psychology of meeting expectations and how it influences consumers’ basis for reporting on services,” she says.
Cama says she’d like to see technology utilized to improve flow and help communicate with patients, even before and during their arrival. For example, if a patient is early or if a doctor is running late, then a notice or message could be sent to the person so they could seek alternative ways to spend their wait time, such as using on-site amenities or outdoor spaces.
HGA’s Vickery says interactive screens or kiosks can also be used to give patients a better sense of what their wait will be like—how many patients are ahead of them in line and how much time those visits will take.
Cama cites airlines’ use of gate announcements of flight status or the Ritz Carlton’s use of headsets at curbside valet to notify departments, such as reception, registration, and housekeeping, that a guest has arrived, as sources of ideas for healthcare on improving the time between patient arrival and registration.
“These models exist and should be scrutinized, not copied, to reveal new ways that allow making the arrival sequence to a medical visit patient-centric,” she says.
Waiting for the future
Thanks to technology advancements, healthcare reform changes, and the drive to be patient-centric, the already evolving waiting experience may look very different just five years from now.
Vickery says that in addition to a smaller size for open spaces overall, she’d also like to see private spaces incorporated where visitors can make a call or get work done.
“Just having more places where people can tuck in and work on their computer, make a call, or do what they need to do and still have some privacy and hear their name called for an appointment,” she says.
“The main things that matter are making sure someone knows they’re there, that they haven’t been forgotten, that they have privacy and it’s comfortable,” she says.
GBBN’s Shroyer says she’d like the experience to become more personalized, mimicking a spa-like approach where there’s a small reception area to register patients before allowing them to select an appropriate space for their wait, such as a kid-friendly area for families or a cozy lounge for adults.
Lied says adding new amenities, such as dry cleaning services, could be another way to fill wait time with constructive activities. “All of a sudden you’re getting things done, and you have a better experience,” he says.
For more on waiting room design, check out “Aesthetics Of A Successful Wailing Room.”
Anne DiNardo is senior editor of Healthcare Design. She can be reached at firstname.lastname@example.org.