There's ample evidence that the design of our health care spaces can help us heal -- but they mostly haven't. Instead, offices have been designed with a focus on staff efficiency -- hence the "cluster" of exam rooms that are almost impossible to exit -- and a cost-effective use of space. Now, the doctor's office -- with its confusing layout, harsh lighting, and disconcerting educational posters -- is about to get an overhaul, for a whole host of reasons.
First is the rising evidence in favor of so-called supportive design, as a technique to create health care environments that promote healing. For patients, supportive design can lower stress, blood pressure, and even pain; for caregivers, it has been linked to reducing stress and lowering absenteeism. Designers and architects who adhere to supportive design use three main principles, all supported by research, to improve patient health.
First are so-called positive distractions, such as window views, and the display of art and nature. "Even designers without health care training got that message," says Ann Devlin, a professor of psychology at Connecticut College. Second is social support -- catering to the needs of people who may not be native English speakers, as well as those who bring friends or family with them to appointments. Third is the issue of perceived control: Do patients have a choice of where to sit? Can they lower the blinds or make the room warmer? It is easy to find their way, or are they likely to get lost leaving the exam room?
In addition to the increased popularity of supportive design, the medical home model of primary care has become more common. That model supposes that health care providers will collaborate to improve patient outcomes -- and in many health care settings, there's no decent space in which they can physically do that.
Last, because of the pandemic and the increasing use of telehealth, doctor's offices suddenly have a new job to do: convincing patients they actually want to be there. "If we're all about preventative care and getting women to invest before something is wrong," says Carolyn Witte, co-founder and CEO of Tia Clinic, a women's health care provider, "how do we make the doctor's office a place women want to go?"
Here's how entrepreneurs and designers are using these elements to build medical offices that are more functional and comfortable for both patients and caregivers.
A Better Waiting Room
The ideal doctor's visit might be one in which a patient never stops in a waiting room at all. Designer Alda Ly, founder and principal of Alda Ly Architecture, says that waiting rooms, as well as other parts of doctor's offices, should take a cue from the hospitality industry. It should be a space to unwind, not to sit interminably. "I totally understand that not everyone can have a sun-drenched space with skylights and a terrace," she says. "But if you walk in off the street, is there a convenient place to wash your hands or grab a tea? Where do you drop the four totebags you've been carrying all day?" The space she designed for Tia incorporates these features, as well as a Covid-19-minded indoor-outdoor waiting room and an attractive lactation room.
HealthQuarters' vision is that of a one-stop shop for health care, with doctors, physical therapists, acupuncturists, dentists, and others all in the same location. If a patient has multiple appointments in one day, it's unlikely that they'd all be scheduled back to back. That means HealthQuarters needed to pay careful attention to the waiting room. There are varying configurations of banquette seating, some cozier than others. And a long table facing the windows, complete with Wi-Fi, is available for those who need to get work done while they wait.
Floor Plans That Make Sense
Even within a smaller clinic, it's easy to get lost. "You come out of a room and you don't know how to get out," says Ly. "You are literally looking for exit signs." Concurs Devlin: "It's a huge problem. Architects don't think about these challenges. Then some signage expert has to come in after the fact and try to fix it."
For some spaces, the solution is simple: exam rooms run along one long hallway, often with a distinctive design feature at either end. The waiting room may have a view to the outside, visible once a patient pops their head out of the exam room, while bold graphics or distinctive artwork mark the other end.
HealthQuarters addresses the navigation problem by designing different "neighborhoods" within its facility. If you're seeing a doctor from affiliated with Mt. Sinai, the accent colors in the rooms and hallways will be dark blue. Tall archways and decorative metal screens signal transitions between new neighborhoods. Acupuncturists and massage therapists occupy a space that is designed with neutral colors more commonly found in a spa.
At larger clinics and hospitals, the hallways themselves can be loud, distracting, unpleasant places, with alarms and monitors going off, and paging overhead. Paging via wearables is part of the solution, and a curved corridor will do more to suppress noise than a straight one. But sound absorption technologies such as acoustic panels wrapped in easy to clean fabric can help as well, says Ryan Hullinger, a partner with global architecture firm NBBJ.
Hullinger's firm is working on a research project with the University of Washington to design a wooden panel that can be carved to absorb specific frequencies of sound, and then tuned to absorb certain frequencies that might be causing trouble in a particular space.
A Less Intimidating, More Functional Exam Room
There are plenty of tweaks that can make an exam room more comfortable for patients. HealthQuarters exam rooms have mini-banquettes, so family members have somewhere comfortable to sit, and patients don't have to wait on the exam table. The lighting is initially set to a relatively warm, dim setting -- both the wall sconces and quality of light are similar to what a you might have at home. A dimmer switch can make the room brighter, but only if it's needed. The fabrics are more similar to those used in residences than in offices: "That's a signal of home, of worth, of comfort," says Danny Orenstein, chief development officer for HealthQuarters, who worked with Ly on the space.
The rooms at Tia have been similarly rethought: There's a patient nook to store clothing, a place to rest a handbag, and seating for a partner or child. There's a vanity area so a patient can fix her hair or makeup before going out to face the world again.
The most important change coming to exam rooms, and one that Tia has made, is also one that patients might not notice right away -- the computer monitor is going away. That might not sound huge, but Anjali Joseph, a professor of architecture at Clemson University and director of the Center for Health Facilities Design and Testing, says the screen can often be a barrier between patient and doctor. If the monitor stays, she says, "The positioning of the monitor is so key, because the clinician needs to be able to make eye contact with the family member and the patient. Doctors actually need to be trained on how to use it."
Making Space for Telehealth
The new demand for telehealth services has put a strain on doctor's offices, which are already short on space. With telehealth growing rapidly because of the pandemic, it's hard to know how many booths any practice will eventually need. That's why NBBJ is designing what it calls a universal exam room that can be converted into two booths, giving clinics the ability to adapt as patient preferences change.
As telehealth evolves, a glorified phone booth may no longer suffice as a telehealth station. It's one thing to use telehealth to connect a patient at home to a doctor. But what if a patient is at a doctor's office, and is using telehealth to consult with a specialist located off-site? "We need good lighting, we need good sound control," says Joseph.
Camera angles are another consideration. Joseph recalls working on one project to equip ambulances with video and audio equipment that would allow a neurologist to diagnose a stroke remotely, while a patient was en route to a hospital, saving precious minutes. But the cameras couldn't quite be positioned to allow the specialist to see the entire patient, specifically their feet. The paramedic would try to describe the patient's ability to move their limbs, but the doctor couldn't quite see it through the monitor, hampering the diagnosis.
Helping Staff Collaborate and Recover
With hospitals and doctors offices so often designed around processes and technology, the effect on the patient can easily take a back seat -- and the well-being of the providers is a distant third. "The respite room is so often a third-class space that feels sort of left over," says Ryan -- and it's not always a decent work space, either.
Part of the solution will be to improve both work spaces and respite rooms, and, where space allows, to keep them separate. Ryan says the respite room of the future will be on the exterior of the building, allowing for daylight and views. "That helps caregivers understand the rhythm of the day a little better," he says -- especially important for those working long hours or overnight.
There will still be tables and places to eat, but the space will be subdivided so that staff can choose to be alone, chat with their colleagues, or use telehealth capabilities to speak privately with a counselor.
Some doctors might still have private offices, but they may also have better spaces to collaborate with others within their same practice. "There is a big push and pull over whether doctors should have a private office or work in a common space," says Joseph, echoing the debate over open-plan workspaces found in so many industries. "The older generation probably want their offices, but there is a trend toward combined spaces."