By Michelle Ossmann, MSN, Ph.D.
From the May/June 2016 Issue
Across the country, people are waiting. Whether standing in line at the grocery store, sitting in traffic, or on hold during a phone call, they are waiting. What is another reason for this common activity? It is seeking—and ultimately waiting for—care in a healthcare facility because of an illness, scheduled doctor’s appointment, or other health related matter. As the entry point to hospitals, physicians’ offices, or urgent care centers, waiting rooms are among the most highly trafficked areas in a healthcare facility. So why aren’t healthcare waiting rooms more accommodating?
As the healthcare industry continues to move toward an emphasis on quality and “patient as consumer,” many facilities are overhauling clinical spaces to enhance the patient experience. Commonly overlooked, however, are other opportunities to support and improve the patient journey, including modifying waiting and transition spaces.
Current State Of Healthcare Waiting Rooms
Most everyone has spent time in a healthcare facility, whether as a patient or a caregiver, and the waiting experience was likely less than enjoyable. Harshly lit, sparsely decorated, and with little support for privacy or physical frailties, healthcare waiting rooms are generally designed for utility and volume, devoid of comfort for the people who spend time there. And although staff members typically wish to help ease the stress of the unknown, the environment doesn’t support easy information transfer.
At their best, waiting spaces provide respite from pain and stress, access to critical information sources, and a seamless transition throughout the care experience. All too often, though, these spaces are unpleasant and they leave people needing—needing more information and privacy, needing more space, and yes, needing access to power for their devices. These are all factors that, together, create a less than satisfactory waiting experience.
Observing The Space, Three Common Problems
To explore the link between more supportive waiting room design and an improved patient experience, researchers partnered with a major academic medical center in the southeastern United States to examine patient and family behavior in today’s healthcare waiting rooms. Specifically, they sought to:
- identify individual seat choice, grouping patterns, and family group sizes;
- analyze the connection between environmental variables and the patient experience; and
- understand the needs and expectations of families to determine if and what furniture and process changes were needed.
After five days of observations and documenting more than 75 behavior maps (diagrams that detailed how occupants chose to sit), researchers noted three especially common shortcomings.
- Too few chairs with a view to information sources, like the front desk or appointment door
- Not enough personal space for belongings
- Too little privacy from other people; not enough space for families to gather
Researchers also noted that one-third of the seating was situated facing windows, which in the study setting negated a view to the desk or doors. However, based on the observations, patients greatly preferred a view to information sources, choosing those seats more frequently. Additionally, roughly 20% of the waiting room chairs were occupied with personal items, whether as a means of spatial separation from other groups or lack of designated space for these items.
Transforming The Space
As a result of these observations, the researchers noted the opportunity to transform these usually dull transition spaces into welcoming ones by updating the existing waiting room design in the second phase of the study. The aim was to create a more engaging and supportive space. In addition to new furnishings, the upgraded layout featured:
- Wider seats and armrests to provide separation from strangers and allow more room for personal belongings
- Seating designed for family groupings and social interactions, where desired
- Ergonomic chairs for a facility’s post-operative patients
- A coffee space
- More seating with views of both information sources and exterior windows
- Outlet plugs near or integrated into seating for easy access to power for devices
- Communal table to support activity requiring a surface
- Wipeable surfaces in order to foster improved cleanliness
Assessing Feedback, Four Guiding Principles
From the two phases of the study, researchers identified four guiding principles that should influence healthcare design as hospitals and health systems start to rethink their approach to waiting spaces.
- Balancing sight lines
- Rethinking density in seating arrangements
- Creating choice for separation and togetherness
- Attention to perceived cleanliness
When the pre- and post-occupancy studies were compared, these simple modifications showed a positive trend across various experience measures.
As is the case with waiting spaces throughout the United States, the pre-transformation waiting space in this research did not support the basic needs of patients and their family members, like privacy, proximity to information sources and positive distractions, or spatial separation.
Patient and family response to the new design, however, showed that supportive transition spaces could indeed provide the much needed spatial separation, sense of privacy, and access to information that people crave in these types of settings. Moreover, although not the focus of this study, patients and families overwhelmingly and frequently commented on the improved cleanliness of the furnishings, noting the now wipeable cushions.
In the end, the study results suggested what researchers expected: patients preferred the updated waiting room design more than the original waiting area based on the following findings:
- Improved comfort levels
- Increased ability to perform activities such as work, rest, etc.
- Improved space for personal belongings
- Easier access to power plugs
- Additional privacy
- Improved scores based on pleasantness of furniture, flooring, lighting, color scheme, and imagery
- Anecdotally improved perceived cleanliness
Healthcare organizations looking to improve patient experience within their facilities should design healthcare waiting rooms that accommodate a range of activity and privacy preferences, thereby affording a supportive environment. By transforming time spent waiting into productive (or at the very least, distracted) time, the entire healthcare experience becomes less stressful for patients and their companions. While this research setting was healthcare-specific, the findings can be leveraged and applied beyond these environments.
Consumer interests continue to be top of mind across all industry sectors, with many business leaders considering or incorporating the needs of individuals into their organizational strategy. Healthcare is no different and facility managers can take this and other environmental psychology research into consideration as they look to reinvent their waiting spaces and provide a better consumer experience overall.
Ossmann is a clinician-architectural researcher and director of healthcare environments at Steelcase Health, which leverages a portfolio of healthcare applications, furnishings, products, and services to support connected care. While practicing as a staff nurse in the emergency department at Grady Memorial Hospital in Atlanta, GA, Ossmann returned to Emory for graduate work and spent seven years as a neurocritical care nurse practitioner at Emory University Hospital. She later earned a Ph.D. in Architecture from the Georgia Institute of Technology.
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Thank you for this thoughtful analysis of healthcare waiting room design. One of the defining features of major metropolitan hospitals is their reliance on deep plan buildings. Unfortunately, this type of design creates large areas of enclosed interiors. Given that the most sought-after feature in any architecture is a visual connection to nature: how do you imbue isolated waiting rooms with a sight line that turns high density spaces into relaxing environments? Interestingly enough, by culturing an understanding of neuroscience and the healing attributes of illusions, it is possible to design a simulated architectural portal to open skies. Using research-verified virtual skylights, it is possible to imbue enclosed clinical interiors with a visceral, organic connection to perceived open space—clear, blue skies and green vistas. Providing this restorative, environmental context in our highly artificial healthcare spaces has been well documented to reduce patient acute stress, anxiety, and restore emotional balance; precisely the key physiological factors that affect our well patients heal. Thanks!
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