Patient and staff input is key to meaningful healthcare design.
Medical waiting rooms have a reputation for being sterile and utilitarian, rather than comforting and nurturing. There’s a gap in the research about whether elements such as seating arrangement and seating choice, artwork, and cultural relevancy are important factors in how and if waiting-room design can affect patient and staff satisfaction.
Enter Gensler (gensler.com), a global architecture firm with a highly skilled healthcare design practice; Unity Health Care, Washington, a network of community healthcare centers; and Sunbrella, Glen Raven, NC (sunbrella.com), a textile manufacturer known for innovative, high-performance fabrics.
Through a research-and-design partnership, the trio envisioned a design intervention at Unity’s Brentwood health center in northeast Washington that could test whether community-informed interior design could affect patient satisfaction.
Unity Health Care is the largest federally qualified health center in the Washington region. It serves 106,000 patients each year, which totals roughly one-fifth of the city’s population. Before the design intervention, the waiting room at the Brentwood health center was serviceable in that people knew to check in and sit down. Michael Crawford, chief of staff at Unity Health Care, saw an opportunity to do more for patients and employees.
“When you look at it, it’s quite sterile,” Crawford said about the original waiting room. “It’s not really interactive or dynamic. The colors are not as vibrant as they could be and do not necessarily reflect the character of the community. The furniture could be positioned differently to bolster patient engagement.” Crawford envisioned the waiting room as a dynamic space that could enhance the patient and provider experience and decrease the negative perception of wait times.
Tama Duffy Day, a Gensler principal designer and health-and-wellness-practice area leader, and Bonny Slater, regional health-and-wellness leader at Gensler, spearheaded the design initiative. Duffy Day agreed that while the original waiting room performed well, the design team had an opportunity to provide more comfort and an element of pleasure or joy to patient visits that otherwise could be difficult or stressful. With an emphasis on creating healthy spaces, the team based the research around a simple question: Will a waiting area designed with intention and with community involvement increase patient satisfaction and improve the patient experience?
The team also asked more specific questions about the effects of different design changes. Those included:
• Will a new furniture arrangement affect communication?
• Will community engagement in the design process impact design solutions?
• Will diversity in furniture type influence patient seating choice?
• Is there a preference between woven and vinyl upholstery?
• Does art representative of the community increase staff happiness?
• Will an enhanced waiting room decrease perceived wait time?
• Does art inspired by the community improve the waiting experience?
To understand how the waiting room functioned, the team collected qualitative and quantitative data before and after the redesign. They observed patients using the waiting room, conducted staff surveys, and collected input from patients and staff members during community and staff events. After analyzing the pre-intervention data, three clear priorities emerged: understand and reflect the community, clarify and support key processes in the waiting room (such as check-in and registration), define personal space and encourage communication among patients.
Reflect the Community
The typical waiting room may be distinctive by being nondescript. However, cities are made unique by their communities, so it should perhaps be a given that community-oriented facilities such as a hospital reflect the local character. The design team hypothesized that a more contextual design would result in more positive reports from patients and staff. Researchers sought community engagement in the design process, curious to know if it would noticeably impact design solutions or produce an ordinary waiting room.
During a community event, patients and staff were asked to give feedback on a variety of design elements including colors and patterns as presented on design boards. Guests were asked to mark their preferences with stickers and leave reviews of why they didn’t like certain combinations or patterns. In addition, they could leave more general feedback about what they thought the waiting room needed, such as books and plants, or health-education programming on the television. Overall, the responses indicated an appreciation for bright colors and organic patterns that were interesting, but not too busy or bold. The input directly impacted decisions on color, pattern, art, and activities.
As a result of input, designers incorporated a spring season-inspired palette of blue, green, and yellow; woven fabric upholstery on the furniture; locally inspired macramé art; and a quilted wall that featured poetry generated during the community event.
The effect of the personalized space has been positive for employees and patients. In self-reported post-occupancy surveys, researchers found a 45% increase in employee happiness with the addition of community-inspired art in the waiting area. Patient interviews suggest happiness with the changes, and complaints about wait time decreased by 25%.
“The staff has reported that seeing the quilt wall helps remind them of the joyfulness of why they do what they do,” Duffy Day said of the installation that features poetry written during the community event. “And maybe there’s some discovery happening in the quilt wall or an element of surprise in watching the crystal light reflection in the macramé, but there’s something about the space that improves the patient’s expectation.”
The designers were curious about materiality as well as color for the space. Researchers found woven fabric upholstery is preferred over slick vinyl upholstery. In a post-occupancy survey, woven fabric seats were preferred 8 to 1. Although new materials require education and training for staff in regard to care and cleaning, the woven fabric provides a comfortable, homey feel that can help patients relax. The team chose Sunbrella Contract fabric options for their soft, woven quality and because the high-performance fabrics are bleach cleanable without losing vibrancy, which is crucial for a healthcare environment. Balancing the design with practical measures like sanitation can be a challenge.
“When we design for healthcare settings, there’s always this delicate balance of cleanliness, because obviously we need things to be clean, but also warm and welcoming and safe,” Duffy Day said.
The design team sought to make the waiting room experience more enjoyable for patients. Perhaps obvious, but often overlooked, components of positive experiences and comfort in medical spaces are knowledge and direction. In a waiting room, not knowing where to stand in line, where to do paperwork, or where to wait for a ride home can cause more stress to a patient and upset the flow of daily operations. To support intake and discharge processes, the designers reduced visual clutter and clarified queuing with signage. They arranged the new furniture to provide clear sightlines to call points to minimize confusion.
They also filled the children’s shelves with books, provided tables for work and play, and provided seating in the lobby for those waiting for rides. Ultimately, better flow supports the staff and patient process and has allowed seven more seats to be added to the waiting room.
Define Personal Space
There’s more than one way to organize a waiting room, especially when designing for maximum comfort. Through observation of the original layout, which incorporated a traditional large, rectangular arrangement of chairs, the design team observed that people tended to signal their need for personal space by either occupying the wide bariatric seats or by taking two or three chairs to establish boundaries and comfort in the waiting room. In addition, the researchers noticed it was difficult for families to sit in a group and guests to communicate with one another in the traditional layout.
They hypothesized different seating arrangements would solve the problem of poor communication and a greater need for personal space. The new arrangement includes clusters of varied, hospitality-influenced seating including modular sofas and individual chairs that can be rearranged. By increasing the number of available seats, the spacing between each seat, and the ability to cluster seating, the new layout is more family- and conversation-friendly.
“We know that as patients communicate more, their health outcomes increase,” Duffy Day said. Post-intervention observation showed a 100% increase in communication between patients in the new waiting room.
“The project was a tremendous experience for Unity patients and staff, which culminated in an enhanced experience for the Brentwood health center. We are now exploring ways in which patients, providers, and end users can be intimately involved in future design efforts,” Crawford concluded.
The key takeaway from the experience was the importance of involving the patients and staff in the design process. As Duffy Day said, they are, after all, the inspiration for everything designers do.