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How a Well-Designed Doctor's Office Could Help Patients

John Bartelstone
Jeffrey Berman Architect
Will doctor's offices look more like this in the near future? Some say the natural design elements can help patients.
Design elements such as single-bed rooms, lower noise levels, lighting and layout can reduce medical errors and lower stress.

Doctor's offices and hospitals may not always be stunning examples of architecture, but both architects and doctors are thinking of how designs can put patients at ease and help them heal.

There has already been research on how to design hospitals better, and a recent exhibit at the Connecticut Institute for Primary Care Innovation, and an upcoming book, focuses on applying what we know about hospitals to design better doctor's offices.

Building a Better Hospital

Researchers from the Georgia Institute of Technology and Texas A&M University, along with the Center for Health Design, reviewed hundreds of studies on hospital design and how it affects the staff and the patients. They found that design elements such as single-bed rooms, lower noise levels, better ventilation, lighting and layout can reduce medical errors, lower stress levels among staff and patients, and promote faster healing with fewer infections, less pain and less reliance on drugs.

In 2007, the Agency for Healthcare Research and Quality, which falls under the U.S. Department of Health and Human Services, released a DVD showing how to incorporate the evidence from research into hospital designs. In 2009, the Robert Wood Johnson Foundation published a 350-page book with case studies.

Turning to 'An Often Overlooked Location for Care'

The Robert Wood Johnson Foundation also noted that "health care executives were often uninformed about how a hospital's physical design can affect patients and staff."

At least there's research, said Ann Devlin, a professor psychology at Connecticut College with a forthcoming book about how to use the existing evidence to design a better doctor's office."My interest," she said, "is in translating and adapting that research into what I consider to be an overlooked location for care. That is the doctor's office, where you generally go to have your annual health check. ...The quality of care is paramount, but I think what health care providers often fail to understand is that the first impressions that we have of doctors often set the stage for the kind of relationship that will ensue."

Inspiration From Nature and Spas

As an example, Devlin points to a widely-cited study from the journal Science in 1984 showing that among patients who just had gall bladder surgery, those who stayed in a room where they could see trees had shorter stays in the hospital and took less painkillers compared to patients who had a view of a brick wall. There has since been more research that using nature, or even just representations of nature like landscape paintings can work as a "positive distraction." Devlin says doctors should take note of that when it comes to designing walls or murals for their waiting rooms.

Credit John Bartelstone / Jeffrey Berman Architect
Jeffrey Berman Architect
The Farber Center for Radiation Oncology features a lot of wood paneling, among other natural design elements. Architects say it's become somewhat of a trend among designs for health care facilities.
"If you have a really large waiting room, you're probably not running your business correctly."
Bashir Zivari

In fact, taking design cues from natural settings has become something of a trend when it comes to healthcare facilities, said BashirZivari, an architect for a firm specializing in medical facilities.

"[Architects for medical facilities are] trying to get inspired by using a lot of icons from nature, whether it's wood grain or stone or even the color palates, they're much more in tune with natural settings," Zivari said.

As an example, Zivari pointed to the firm's designs for the Farber Center for Radiation Oncology in New York, which prominently features wooden floors and furniture, plants, and a large fish tank in the waiting room. He said architects are also looking at places like spas for ideas on what design elements can help people relax.

Zivari also said design isn't all there is to it. "It's all about how the patient runs through this whole maze of different places," Zivari said. "We have this constant conversation with our clients in that if you have a really large waiting room, you're probably not running your business correctly."

Redesign the Primary Care Process

Gregory Makoul, the chief innovation officer at St. Francis Hospital, and a professor of medicine at the University of Connecticut Health Center, has been thinking about waiting rooms along with the rest of his team. On average, the waiting time to see a doctor is about 20 minutes so far this year, according to national data from the doctor-rating site Vitals.com.

Credit Alan Yu/WNPR
Instead of a waiting room where patients sit and watch TV, the Primary Care Office of the Future Exhibit has iPads where patients can fill out health information while they wait. The software is created by former videogame designers, with the hope of making the task of filling out forms less of a chore.

Makoul and his team decided that time could be used for something more useful, and so in their Primary Care Office of the Future Exhibit, they put iPads in the waiting room so patients can do screening questionnaires and intake forms using an interface made by former videogame designers, so a doctor will already know what to expect when the wait time is over. The staff behind the exhibit also paired this with software to pull electronic health records of patients so staff don't have to spend as much time looking up prescriptions or doing clerical work.

"The idea is to get everybody working to the top of their license," Makoul said. "One of the things that the group has heard me say a lot is...if you can offload the 50 percent of work that primary care doctors are doing that another member of the team could do, or that technology could help get done, you just doubled your supply of primary care doctors."

Spend More Time Facing Patients

Another feature that the exhibit changes is the exam table. Instead of having a full table that takes up a lot of space in the room, the staff put a reclining chair that can be laid flat as a table, but can otherwise serve as a chair where the patient can sit at the same level as the doctor.

The proposed workspace also includes a large screen hanging on a wall, so when a doctor is typing something into a patient's electronic records, the patient can see what the doctor is typing and the doctor doesn't need to have his back to the patient.

Credit Alan Yu/WNPR
Another major change is the use of a reclining chair instead of a fixed exam table, a large screen so patients can see what a doctor is typing, and a chair where the doctor sits at the same level as the patient.

Michael Todd, a former primary care doctor who is now the global medical director for General Electric Capital, actually tried this out at his former office. He said the patients were very satisfied and the office still uses this new layout. He also said ideas like these are important, even if not every doctor's office can put them into practice right away.

"As a primary care physician myself, I think those kinds of things would make and encourage me as a young physician to continue in the practice of medicine," Todd said.

Of course, installing large screens, buying new chairs and software is expensive, which is why Makoul said these ideas will probably take a few years before they become mainstream.

But there are smaller things that doctors can do to make an impact, said Ann Devlin of Connecticut College. She pointed to research showing that blood donors were more stressedwhen watching TV in the clinic, and said maybe doctors should consider giving patients magazines to read rather than installing TVs. She also said instead of putting chairs in a rectangle around the walls of a waiting room, doctors should consider putting the chairs in groups so people can sit with their families, friends or whoever they like. She said that gives patients "perceived control" and thus relieves stress, in an environment where they know they are not the experts.

This isn't even an entirely novel concept: a 1989 article from the Canadian Medical Association Journal noted that "poor design may cost you patients."

"It does matter that physicians have thought about patients," Devlin said. "The arrival, the reception, the waiting, all of those things, the care with those are implemented, says something about the doctor's considerations of the patients and I think that that couldn't be stressed enough."

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