These startups are reshaping the doctor’s office
There is many proofs that the design of our healthcare spaces can help us heal – but it usually doesn’t. Instead, the offices were designed with an emphasis on staff efficiency – hence the “cluster” of exam rooms that are almost impossible to get out – and cost-effective use of the office. space. Now, the doctor’s office – with its confusing layout, harsh lighting, and bewildering educational posters – is on the verge of a revamp, for a whole host of reasons.
The first is the growing evidence in favor of the so-called supportive design, as a technique for creating health care environments that promote healing. For patients, a supportive design can reduce stress, blood pressure, and even pain; for caregivers, it has been linked to stress reduction and absenteeism. Designers and architects who adhere to Design Support use three main principles, all backed by research, to improve patient health.
First, there are the so-called positive distractions, such as window views and the display of art and nature. “Even designers without health care training get this message,” says Ann Devlin, professor of psychology at Connecticut College. Second, social support – meeting the needs of people who may not be native English speakers, as well as those who bring friends or family with them to their dates. Third, the issue of perceived control: do patients have a choice to sit? Can they lower the blinds or make the room warmer? Is it easy to find your way or are they likely to get lost when leaving the exam room?
In addition to the growing popularity of the supportive design, the primary home care model has become more mainstream. This model assumes that healthcare providers will work together to improve patient outcomes – and in many healthcare settings, there is no decent space in which they can do this physically.
Finally, with the pandemic and the growing use of telehealth, physician offices suddenly have a new job to do: convincing patients that they really want to be there. “If we are all about preventative care and getting women to invest before something goes wrong,” says Carolyn Witte, co-founder and CEO of Tia Clinic, a women’s health care provider, “how do you make the doctor’s office a place where women want to go?”
Here’s how contractors and designers are using these elements to build more functional and comfortable medical practices for 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 director of Architecture of Alda Ly, says waiting rooms, as well as other parts of doctor’s offices, should take inspiration from the hospitality industry. It should be a place to relax, not to sit endlessly. “I totally understand that not everyone can have a sunny space with skylights and a patio,” she says. “But if you go off the street, is there a convenient place to wash your hands or have a tea? Where do you put the four tote bags you carry all day?” The space she designed for Tia incorporates these features, along with a Covid-19 oriented indoor-outdoor waiting room and attractive lactation room.
HealthQuarters“The vision is one-stop-shop for health care, with doctors, physiotherapists, acupuncturists, dentists and others in one place. If a patient has multiple appointments in a day, it is unlikely that they will all be scheduled one after the other. This meant that HealthQuarters had to pay special attention to the waiting room. There are different seating configurations, some more comfortable than others. And a long table facing the windows, equipped with wifi, is available for those who need to work while they wait.
Floor plans that make sense
Even in a small clinic, it’s easy to get lost. “You come out of a room and you don’t know how to get out,” Ly said. “You are literally looking for exit signs.” In Devlin’s opinion: “This is a huge problem. Architects don’t think about these challenges. Then a signage expert has to come after the fact and try to solve it.”
For some spaces, the solution is simple: examination rooms extend along a long corridor, often with a distinctive design at each end. The waiting room can have an outward view, visible once a patient exits their head from the examination room, while bold graphics or distinctive artwork mark the other end.
HealthQuarters tackles the navigation problem by designing different “neighborhoods” within its establishment. If you see a Mt. Sinai affiliate doctor, the accent colors in the rooms and hallways will be dark blue. High arcades and decorative metal screens mark the transitions between the new neighborhoods. Acupuncturists and massage therapists occupy a space designed with neutral colors that are most often found in a spa.
In large clinics and hospitals, the hallways themselves can be noisy, distracting, and unpleasant places, with alarms and monitors going off and paging overhead. Paging through portable devices is part of the solution, and a curved lane will do more to suppress noise than a straight lane. But sound-absorbing technologies such as acoustic panels wrapped in easy-to-clean fabric can also help, says Ryan Hullinger, partner of the global architecture firm. NBBJ.
Hullinger’s company is working on a research project with the University of Washington to design a wooden panel that can be carved to absorb specific sound frequencies, then tuned to absorb certain frequencies that could cause problems in a particular space.
A less intimidating and more functional exam room
There are many adjustments that can make an exam room more comfortable for patients. HealthQuarters examination rooms have mini benches, so family members have a comfortable place to sit and patients do not have to wait on the examination table. The lighting is initially set to a relatively warm and low setting – the wall scones and light quality are similar to what you might have at home. A dimmer can make the room brighter, but only if it’s necessary. The fabrics are closer to those used in residences than in offices: “It’s a sign of home, of value, of comfort,” says Danny Orenstein, Director of Development at HealthQuarters.
Tia’s bedrooms have been redesigned in the same way: there is a patient corner to store clothes, a place to rest a handbag and seats for a partner or a child. There is a dressing table for a patient to do their hair or make up before stepping out to face the world again.
The most important change coming to the exam rooms, and the one Tia has made, is also a change that patients might not notice right away: the computer screen disappears. It may not sound like a lot, but Anjali Joseph, 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 important because the clinician must be able to make eye contact with the family member and the patient. Physicians actually need to be trained in its position. use.”
Make room for telehealth
The new demand for telehealth services has put a strain on doctors’ offices, which are already under space. With the rapid growth of telehealth due to the pandemic, it is difficult to know how many kiosks a practice will eventually need. That’s why the NBBJ is designing what it calls a universal examination room that can be converted into two cabins, giving clinics the ability to adapt to changing patient preferences.
As telehealth evolves, a glorified phone booth may no longer suffice as a telehealth station. It is one thing to use telehealth to connect a patient at home to a doctor. But what if a patient is in a doctor’s office and uses telehealth to see a specialist offsite? “We need good lighting, we need good sound control,” says Joseph.
Camera angles are another consideration. Joseph recalls working on a project to equip ambulances with video and audio equipment that would allow a neurologist to diagnose a stroke remotely, while a patient was on his way to the hospital, saving precious minutes. But the cameras could not quite be positioned to allow the specialist to see the whole patient, especially his feet. The paramedic would try to describe the patient’s ability to move their limbs, but the doctor couldn’t quite see him through the monitor, hampering the diagnosis.
Help staff collaborate and recover
With hospitals and doctors’ offices so often designed around process and technology, the effect on the patient can easily take a back seat – and the well-being of providers is a distant third. “The respite room is often a third-class space that kind of feels left out,” says Ryan – and it’s not always a decent workspace, either.
Part of the solution will be to improve both workspaces and respite rooms and, where space allows, to separate them. Ryan says the respite room of the future will be outside the building, allowing daylight and a view. “It helps caregivers understand the rhythm of the day a little better,” he says, which is especially important for those who work long hours or all night.
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 colleagues, or use telehealth capabilities to speak privately with a counselor.
Some doctors may still have private offices, but they may also have better spaces to collaborate with others within their same practice. “There is great pressure on whether physicians should have a private office or work in a common space,” Joseph says, echoing the debate over open workspaces that are found in so many industries. “The older generation probably wants their desks, but there is a trend towards combined spaces.”