Over the past couple of decades, and certainly since the passage of the Affordable Care Act (ACA), there has been increasing recognition that environments can aid in healing and speed recovery—or at least not add to patients’ suffering. Whether you’re contemplating a renovation or entirely new office space, there is much you can do to make your patients’ time in your office more enjoyable. Even small tweaks can benefit your practice.
Forces shaping clinical design
The major forces shaping clinical design trends are patient experience, quality, safety and privacy. While patient privacy became a big buzzword with the passage of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the new measures included in the payment reforms of the ACA elevated patient experience to be an important factor in hospital reimbursement. “Patient satisfaction was not a term we used 20 years ago,” says Libby Laguta, principal at Atlanta-based design firm CDH Partners.
Simultaneous increases in patient expectations, combined with a more consumerist approach to health care, have made office environments part of a practice’s competitive advantage. Some have even gone so far in striving for greater hospitality that they offer valet parking, concierge services and coffee bars. But most doctors’ offices aren’t there—yet.
HIPAA and the patient’s right to privacy have driven the trend toward private hospital rooms, concealed sign-in sheets, the assignment of tracking numbers and so forth. Quality and safety measures require prominent handwashing stations and appropriate infection control. But within these seemingly rigid requirements, there is much room for creativity in the creation of welcoming, calming spaces.
“Vascular issues can be chronic,” observes Dorothy Lloyd, director of the health care practice at San Francisco-based architecture firm HOK. She notes that as interventional radiologists offer more longitudinal care, patients will visit their offices many times over a period of months or years. “This means that the patient experience is huge,” she says.
Erica Larson, principal at Pope Architects in St. Paul, Minnesota, says she has seen a lot of renovations of IR suites within hospital settings in her market. She notes that those must follow the same guidelines as surgical suites and that it’s “often difficult to create a sense of warmth due to those regulations.” Even so, some of the trends she’s seen include the increased use of wood; warm tones for walls, fabrics and finishes; patterned flooring; and unique features on ceilings.
“It’s critical to treat the environment like any other part of the patient experience,” she says. “Design touches can help to create continuity and positive distractions.”
As more patient care has moved into community settings, many smaller facilities and buildings are popping up, says Jennifer Silvis, editor-in-chief of Healthcare Design magazine. With increased patient choice comes increased competition, so many medical practices use design as a way to “push patient experience over the edge,” she says.
If you have the opportunity to choose a new office location, be aware of site considerations, Silvis advises. Look for locations that are convenient and offer plenty of parking or proximity to transit. Signage and clear wayfinding can reduce anxiety, she notes.
Also keep the aging patient population in mind. Think about flooring on which wheelchairs can roll, zero thresholds and smooth transitions from one floor type to another, clocks with large numbers, and distances, Silvis advises. “How far is it from the waiting room to the exam table, or the exam table to the restroom?”
Waiting rooms
The patient’s physical encounter with your clinical environment begins in the waiting room. Goals here are natural light and a view to the outdoors, along with some visibility to the clinical areas in the background. “This makes the office seem like less of a mystery,” Silvis says. She also notes that wi-fi is expected.
“Patients and their companions often are taking time off work for medical appointments, so they may need to make waiting time productive. We try to offer a choice of seating options for private work as well as family groups and place the televisions in dedicated viewing areas,” she says.
Laguta and two colleagues from CDH Partners recently conducted research on people’s behaviors in waiting rooms, presenting their findings at the Healthcare Design Expo in Houston last fall. The study, titled, “The Art of Waiting,” aimed to discover where people sat, how long they stayed, whether there were clear preferences along gender lines, how greater density changed where people sat, and mapped such features as the reception desk, televisions, and charging stations. They discovered that, whether in a multipractice office, an urgent care facility or an emergency department, people in medical facility waiting rooms tend to operate in a sociofugal format: that is, they arrange themselves so that they can maintain some privacy.
CDH’s most notable findings:
- People tend to sit facing the reception desk or the door they will be called through.
- Many patients bring along a family member or caregiver (the “guest”), who may stay in the waiting room while the patient goes to the exam room.
- Many patients are in wheelchairs.
- People bring their own electronic devices and tend to ignore the televisions.
- People sit next to their companions, rarely across from them.
- People tend not to sit next to or back-to-back with people they don’t know.
As a result of these findings, Laguta and her team offer this advice to clients:
- Consider the guest.
- Provide a variety of types of seating.
- Plentiful, well-located electrical chargers are critical.
- Work wheelchairs into your layouts.
Larson also notes a trend toward self-registration and self check-in, in which patients are “roomed” almost immediately upon arrival. One of her clients recently wanted to provide an experience similar to that of the Apple Store. Registration is done online in advance. On arriving, patients encounter greeters who help them check in on tablets, then show them directly to exam rooms. Another client opted for a fireplace and a technology bar in the waiting room, as well as comfortable chairs with outlets. Patients can sign in with the receptionist or via kiosks in the waiting area.
Read part 2 of this article, which covers exam rooms, practice workflow and more.
SIR publishes resources and environmental standards
SIR is pleased to announce the publication of a new standards document, “Society of Interventional Radiology: Resource and environment recommended standards for IR (Mark O. Baerlocher, MD, J Vasc Interv Radiol 2017; 28: 513–516). Inadequate health care resources, including staffing and equipment, can have a negative impact on patient outcomes (Fridkin et al 1996, Kane et al 2007, Unruh et al 2007, Clements et al 2008). Previous work demonstrated a lack of formal consensus on staffing guidelines in IR, which led to the IR staffing document (Baerlocher et al 2016). There is a similar absence of guidelines on appropriate resource and space requirements for a successful and safe IR practice. This document provides recommendations for the core requirements necessary to deliver IR services. In centers with a greater proportion of higher complexity cases and/or higher acuity patients (e.g. American Society of Anesthesiologists [ASA] class 3, 4 or 5), there may be additional requirements.
SIR thanks all those responsible for producing these standards documents.
