Feburary 2010 Premium Practice
Why Office Design Matters
A soothing atmosphere for patients improves the working environment for staff, resulting in enhanced morale, better patient care, and a healing environment that enriches the business and reputation of the premium practice.
It is well accepted that physical environment has important implications for the disease process. We accept that infection, for example, is a battle between microbes and the immune system’s exposure to them via the environment.
Traditional medicine, however, is only now acknowledging the effect on the disease process of less measurable, nonphysical factors such as stress, according to Geimer-Flanders reporting in the Cleveland Clinic Journal of Medicine.1 Many stressors have a bearing on the progression of disease and healing. As a result, experts believe it makes sense to view health care as a comprehensive approach to combating all of the factors that contribute to the disease state. According to Geimer-Flanders, the integration of therapies—peaceful and comforting surroundings, stress reduction, caring health care providers, and evidence-based medicine— creates a healing environment.
Clearly, current trends and research confirm that healing comprises much more than strictly the physical interaction between the doctor and the patient. This concept is a part of what a premium practice is all about—going beyond the basic core service elements of clinical care to deliver an outstanding all-around experience to the patient.
THE ROLE OF THE ENVIRONMENT:
LOW STRESS, HIGH COMFORT
Since the 1990s, physical environment has taken on
new importance in the setting of a consumer-oriented
health care system.2 Specifically, the general appearance
of a medical facility, office, or hospital has an
important effect on patients. A report from The
Journal of Healthcare Management2 noted that the
importance of setting is most thoroughly understood
by those who view their customers as guests, such as
the guest service industry. Myron D. Fottler, PhD, lead
author of the article, wrote, “An excellent healing environment
will reinforce excellent clinical quality, but an
inferior environment can detract from fine clinical
care.” Dr. Fottler is professor and director of Health
Services Administration Programs, College of Health
and Public Affairs, University of Central Florida,
Orlando. He continued: “One of the most important
principles learned by the guest service industry is to
provide the setting customers expect. Another is to
create an environment that meets or exceeds customer
needs for safety, security, support, competence,
and physical and psychological comfort.”
Patients, of course, have different backgrounds and cultures, but a unifying concept is that the design of a medical facility should promote low stress and high comfort (Figure 1). An investigation by the Center for Health Design, a nonprofit research and advocacy organization, showed that the more appealing the environment, the higher the perceived quality of care and the lower the patient’s anxiety.3 The researchers found a significant relationship between perceived waiting times (which are affected by the pleasantness and aesthetics of waiting areas) and perceived quality/perceived anxiety.3 Patients underestimated longer (≥ 30 minutes) actual waiting times and overestimated short (0-5 minutes) actual waiting times. There was no significant relationship between actual waiting times and perceived quality or perceived anxiety. The investigators said these findings suggests that perceived waiting times, which are strongly influenced by the physical design of the environment of care, are a more important determinant of patients’ satisfaction.
Research into the setting of medical care is proliferating, and efforts to promote enhanced health care through design are ongoing at a number of centers. The Pebble Project, for example, is a joint research effort between the Center for Health Design and individual health care providers.3 The project, launched in 2000, is charged with “creating a ripple effect in the health care community to provide research and documented examples of health care facilities whose design has made a difference in the quality of care.”3 It should also be noted that design-related improvements could translate into improved financial success for the institution.3
A related initiative is the Optimal Healing Environments (OHE) Program, a primary research project of the Samueli Institute, a nonprofit medical research organization supporting the scientific investigation of healing processes and their application to health and disease.4 The program seeks to determine how theory about optimal health care translates into real-world clinical practice. An OHE is one in which all aspects of patients’ care—physical, emotional, spiritual, behavioral, and environmental—are optimized to support and stimulate healing. According to the program, building such spaces is one important approach of the OHE Program, launched in 2005.
DESIGNING THE PREMIUM PRACTICE
Efficient, Flexible Plans
Eckert Wordell in Kalamazoo, Michigan, is an architecture,
engineering, and interior design firm founded in 1984 by Jeff Eckert and Rick Wordell. The firm has
completed a wide range of projects and has vast experience
in health care. It has designed new facilities,
built additions, and created interior and exterior
spaces (Figures 2 through 5). Having completed projects
all across the country, Eckert Wordell focuses on
providing efficient, flexible plans that can adapt to the
changing demands of the health care field while paying
close attention to the atmospheric and emotional
aesthetics of the built space. According to the company’s
Web site, the result is a soothing atmosphere for
patients and an improved working environment for
the staff (see The Four S’s: the Relationship Between
Space and Productivity). In turn, workers’ morale is
boosted, enhancing the quality of patients’ care and
promoting a healing, compassionate environment that
enriches the business and reputation of the premium
practice.
Quality of the Healing Environment
Associate Katie Jacobs, AIA, LEED AP, told “Premium
Practice Today” that Eckert Wordell firmly believes
that the design of a medical facility plays a pivotal role
in the quality of the health care environment.
“Emotional aesthetics define the way you feel when you walk into a space,” Ms. Jacobs said. “We have all been in spaces that make us feel uncomfortable, even though we may not be able to articulate why (that table in the very center of the restaurant, for example). Part of our role as architects and interior designers is to understand this emotion and be able to create spaces that are aesthetically pleasing to the users both visually and emotionally (concepts which go hand in hand). This is especially critical in a health care environment, where people tend to be slightly anxious and may even be quite sick.” (See Action Framework for Creating a Healing Environment.)
“We strive to make the proportions of a space, the materials used, the color palette and a layering of design elements work together to create a comfortable, healing environment,” Ms. Jacobs said.
Wayfinding
Another important aspect of the patient’s comfort
in an office space has to do with “wayfinding”—
knowing where to go and how to get around a building.
“Wayfinding is really important to the patient’s
emotional well-being when they enter a place they are
unfamiliar with,” Ms. Jacobs explained. “Our designs
revolve around clear circulation pathways and intelligent
ordering of spaces, all meant to enhance a
patient’s (and staff ’s) experience.
Premium Experience
The trend toward providing a certain patient population
with a more upscale (premium) experience
began with LASIK, Ms. Jacobs observed. “Separating
LASIK patients from the general clinic population was
often a strategy that our clients wanted to employ to
provide a higher-end experience,” she said. “The levels
of integration between clinic and refractive patients is
always something we discuss when laying out a building.
Some clients want their refractive patients completely
separated when they walked in the door.
Others only wanted them separated on procedure day.
Still others did a blend.”
The development of office-based procedural suites, where surgeons can perform premium IOL procedures, likely lend themselves to this level of attention, she said.
“We have seen greater attention paid to these patients after they have seen the physician and it has been determined that cataract surgery is necessary,” Ms Jacobs said. “Surgery scheduling has become a much longer process, as in some practices the schedulers are responsible for explaining the different IOL options. In our minds this is where the catering can begin, for example, a plush waiting space outside the scheduler’s office, more schedulers to decrease waiting times for patients, etc.”
Depending on the patient base of the practice as well as the sophistication of the client, new high-tech toys and gadgets can be used in patients’ waiting spaces. “High-end plastics suites, the new aesthetic suites, and refractive clinics definitely cater to the ‘techies’ and often have available Wi-Fi, Internet stations, and other gadgets,” Ms. Jacobs said. “We have definitely seen a shift in program need here as the premium IOLs have advanced in popularity. We may also begin to see a trend toward higher-end ophthalmic ambulatory surgery centers as premium IOLs continue to gain popularity.”
USING ARCHITECTURE TO
MAXIMIZE EFFICIENCY
Organization
A poorly organized building can quickly become a
bottleneck to even the most competent staff, said
Ms. Jacobs. She explained that many space-planning
principles can help increase efficiencies in the ophthalmic
setting, including a basic theory of patient
flow known as the linear flow model.
According to Ms. Jacobs, in traditional ophthalmic flow, the patient is escorted from the reception room into an exam lane, where the technician works up him or her. During this time, the patient’s eyes are dilated, so he or she has to sit in a subwaiting area for the drops to take effect. Then, the patient is escorted back into the exam lane to be seen by the physician.
“This model taxes the exam lanes, resulting in largerthan- necessary, fully equipped yet underutilized rooms,” Ms. Jacobs explained. “It can also create traffic jams and long waiting times as technicians and physicians battle for space. The end result is a limitation on the number of patients that a practitioner can see in the space, due primarily to the arrangement of the physical environment.”
Linear Flow
In the linear flow scenario, the workup functions are
carried out in separate workup rooms.
“The benefit is an increase in the utilization rate of the exam rooms, allowing the physician to see more patients in a given period of time,” Ms. Jacobs said. The linear flow method relies on a linear progression of the various parts of the examination. Together with this should be the layout of the rooms in which these functions take place. “The basic arrangement should progress as follows: reception desk for check-in, waiting room, workup room(s), subwaiting room, exam room,” she said. “The individuality of the practice emerges in the way that special testing, surgical scheduling, and patient education are incorporated into the footprint.” These spaces need to be positioned where they make the most sense for any given practice. She added that, for maximum efficiency, the circulation path linking all of these functions needs to be straightforward: “One significant premise of linear flow is the idea that the physician—not the technician— should be the ‘bottleneck’ of the process.”
According to Ms. Jacobs, the physician should be able to bounce back and forth between two exam lanes (and possibly a third) all day with no waiting time in between.
Efficiency Enhances Patients’ Satisfaction
“Additional benefits of linear flow beyond space and
equipment have to do with patient satisfaction,”
Ms. Jacobs said. “With enough workup rooms, technicians
can very efficiently work up patients and get
them to the subwait areas more quickly, regardless of
whether the physician is running on time or not.” She
noted that patients often wait in the main reception
room for less than 5 minutes before they are called by
the technician, making them feel as if they have begun
their examination. Even though the patients still might
not see the doctor for 40 to 45 minutes, in their minds
they are in the system and the exam process has
begun. She also pointed out that this higher rate of
turnover at the front end of the examination process
will create a needed shift in where the waiting chairs
are located. In this scenario, more chairs would be
placed toward the back of the building, in the area for
dilation, versus the front of the building at the main
reception.
Linear flow can be universally applied in some form or other to almost every subspecialty and every physician mix, including those with an optometric component, Ms. Jacobs asserted. “The practice must be willing to adapt to the new model for it to work properly, but there is no doubt that incorporating this into a practice will yield a more efficient process, resulting in more satisfied patients, staff, and a boost in the bottom line,” she said.
SUMMARY
Healing means different things to different
people (see Steps in Providing a Healing
Environment). Studies that have tried to
determine a definition to the word found
that healing was associated with such
themes as wholeness, narrative, and spirituality.
5 Egnew wrote, “Healing is an intensely
personal, subjective experience involving a
reconciliation of the meaning an individual
ascribes to distressing events with his or her
perception of wholeness as a person.”
A therapeutic relationship between the patient, the physician, the staff, and the environment allows for a purposeful, goal-directed relationship that guides care that is in the patients’ best interest and results in optimal outcomes. The shared medical setting must also reflect the values, beliefs, and philosophies of the patients served. Donna Bednarski, MSN, RN, wrote that specific things in health care environments can reduce stress, including views of nature, natural light, soothing colors, noise levels, privacy, and therapeutic sound.6
Many medical practices that are striving to be premium do not offer an environment such as that described herein. There is no better time than now for premium practices to ensure that they present to patients a setting that integrates peaceful and comforting surroundings, stress reduction, caring health care providers, and evidence-based medicine for optimal wellness and satisfaction.
Katie Jacobs, AIA, LEED AP, may be reached at (269) 388-7313; katiej@eckert-wordell.com.
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