This article concludes a feature that appeared in the spring 2017 IRQ. Part 1 of the article, which explored the forces shaping clinical practice design, trends in waiting room design and more, can be found at bit.ly/irdesign.
Exam rooms
Twenty years ago, doctors met with patients in their offices, then went to clinical exam rooms to perform examinations, then returned to the office to discuss the results. “There are too many patients and not enough time for that any longer,” observes Dorothy Lloyd, director of the health care practice at San Francisco-based architecture firm HOK.
Exam rooms are increasingly designed to facilitate dialogue between provider and patient, says Jennifer Silvis, editor-in-chief of Healthcare Design magazine. “There is not necessarily an exam being conducted, but the patient seated on the table feels vulnerable.”
According to Erica Larson, principal at Pope Architects in St. Paul, Minnesota, more clients are opting for desks and chairs in exam rooms, as well as modular furniture and sliding doors for greater flexibility. These dedicated consultation rooms help to achieve parity between patient and provider, says Silvis, as they are seated at the table together. There are fewer supplies in the rooms and increased use of rolling carts, says Lloyd. She notes that a 100-square-foot space can hold three to four people. As patients become more involved, wanting to see their scans or test results and asking questions, these conversations are becoming more common and often involve multiple caregivers or family members.
Providers need information at their fingertips and engage in real-time recordkeeping, which is done via a computer or tablet, but the technology can be intrusive. “It can seem as if the doctor is talking to the computer rather than the patient,” Lloyd says. She notes that there has been much experimentation with different kinds of technology placement, but that “effective results aren’t there yet.”
Workstream redesign
Design of clinical space and design of clinical workstreams can be a chicken-and-egg proposition. Even so, “It’s important to redesign workstreams along with the physical space. We always look at different ways of organizing activity,” says Lloyd. “As a real sense of connection with the patient and their health develops, we are trying to tease activities out from the workarounds.”
Silvis notes an increasing awareness of “onstage” and “offstage” activities in clinical design. Closely tied to patient privacy and satisfaction, practices are going for a wholesale separation of staff operations areas and patient treatment areas, often using corridors as buffer zones. Although the goal here is to make the office quieter and less disruptive, Silvis reports that recent research showed that staff actually became louder because they couldn’t see patients.
Generating evidence
It won’t be long before clinical workspace design will be subject to the same evidence-based evaluation as medical procedures and treatments, says Michael Murphy, co-founder and executive director of MASS Design Group in Boston. “Doctors are trained to expect evidence,” he says. “We are at year zero of what will be a 50-year effort to demonstrate that design interventions are having measurable patient outcomes,” he says. A lot of evidence-based design research has been at the familiar scale of the patient room, he says, noting that there are “many controls that can be calibrated, and the placement of various elements assessed.” Although research on the scale of a clinical unit or hospital floor has had less investigation, MASS is currently working with researchers at Ariadne Labs to discover what effect, if any, labor-and-delivery unit layout and design has on C-section rates.
Looking to the future
Although there is much that is creative and innovative in clinical workspace design, a possible future is health care without walls, says Susan Dentzer, president and CEO of the Network for Excellence in Healthcare Innovation. Driven by advancements in technology and increased patient demand, health care is becoming more distributed and is taking place outside of conventional institutions.
“There is a clear recognition that what is really involved in most office visits is the exchange of information, which can be taken out of the institutional setting,” she says. “Certainly, much care could be delivered in less intensive settings.”
Dentzer urges interventional radiologists to consider: All things being equal, and knowing that technology is getting better and more distributed, how can we deliver care outside our walls? With low-cost, portable or handheld devices that in many cases are more powerful than those installed in hospitals, what does the future of health care look like? Might you dispatch a radiology assistant in an Uber to perform necessary scans at the patient’s location?
“Nothing needs to be invented; all of the technology exists,” Dentzer says. “We haven’t seen the limits of this approach. It’s just a matter of imagining.”
