Research links waiting spaces with patient experience
The healthcare industry is continuously evolving, and as part of new value-based care arrangements, hospitals and health systems are receiving portions of reimbursement based on satisfaction performance measures. Combined with an understanding of the relationship between perception of care and the environment, many organizations are overhauling their spaces to cater to today’s healthcare consumers. These efforts have primarily targeted patient rooms and clinical spaces, while transition areas like waiting spaces have taken a backseat in the redesign process.
With this in mind, can hospitals and health systems directly and positively impact patient experience by improving transition areas? Steelcase Health researchers set out to investigate.1
Today’s Waiting Spaces
“Hurry up and wait.” Unfortunately, waiting has become synonymous with the healthcare industry and the often arduous, long process of waiting in a hospital or physician’s office. At their best, waiting spaces are intended to provide patients respite from pain and uncertainty, while offering positive distractions and access to critical information sources. More often than not, however, these spaces feel more like uninviting holding areas instead of warm, welcoming environments for patients and their family members. Lack of privacy and information as well as inadequate space for belongings and limited access to technology are all contributing factors to a stressful waiting experience, which can generate low expectations in the quality of care patients expect to receive from clinicians.
Identifying the Challenges of Waiting
Curious to explore the link between the spatial affordances (what the environment offers and supports), satisfaction with the environment and patient perception of quality care, researchers partnered with a major academic medical center in the southeastern United States to observe and interpret the realities of today’s waiting rooms. This infusion therapy clinic treats nearly 27,000 patients each year. Moreover, these patients tend to spend time in the space a minimum of several times per month, with each wait lasting from 30 minutes to several hours. Their main objective? To discern whether or not more supportive waiting room design would be reflected in measures of patient experience.
Over the course of five days, researchers used established methods and peer-reviewed psychometric instruments to gather more than 75 behavior maps of patients and families and conducted surveys in the existing waiting room setting. They identified four key design mistakes most commonly found in hospital transition areas:
- Too few chairs with a direct line of sight to information sources, e.g. front desk or appointment door
- No room for personal items such as beverages or personal technology devices
- Not enough separation from strangers; no intentional group space for families to gather
- Seating configurations default to large groups, rather than actual groups of 1-2
- Some additional observations that came out of this phase of the research included:
Views and windows were emphasized to the exclusion of information.
Only 80 percent of occupied chairs had people sitting in them; the remaining 20 percent held personal items.
People prefer to be separated from strangers but close to family members.
Researchers’ key takeaway from the baseline assessment was this: like many waiting and transition spaces across the country, the study environment did not support patient and family basic needs for privacy, spatial separation and access to information and positive distractions, all of which are known to mitigate stress. By overhauling these spaces, hospital organizations have the opportunity to better support patients and families and, thereby, improve their care experience.
Transforming Waiting Spaces for Today’s Patients
After observing waiting spaces in the pre-occupancy study, researchers then launched the second phase of the study. Some of the changes researchers instituted during phase two included:
- Wider seats with wider armrests to support placement of belongings and separation from strangers
- Double seats to create social opportunities and encourage family groupings
- Chairs that feature a slight rocking movement and supplemental physical support for post-operative patients
- An enhanced coffee space
- Seating with optimal views to both exterior windows and information
- Plugs in seating areas for easy access to charging and technology
- Tables with space dividers for added privacy
- Easily cleanable surfaces for improved cleanliness
Assessing the Results
In October 2015, the post-occupancy study was completed, and the data collected over the course of both the post and pre-occupancy studies was compared. Results suggested patients preferred the upgraded transition areas based on the following metrics:
- Higher comfort levels
- Greater ability to perform activities
- More space for personal belongings
- Increased, easy access to power and technology
- Additional auditory and visual privacy
- Added pleasantness to the environment as a result of furniture, flooring, lighting, color scheme and pictures
- Improved surface cleanability
But why target transition spaces? It’s clear patients want to receive the best care possible, but it’s usually difficult for them to understand and assess the differences in qualifications and expertise of clinicians and healthcare organizations. Instead, patients rely on their own experiences and judgment, often looking to more subjective measures they understand, like whether they are comfortable and have their needs supported. The changes researchers made to the waiting rooms support both patient and family needs and are very achievable changes to make, while delivering valuable results almost immediately.
What’s Next in Patient Experience?
As the industry continues the shift to value-based care, hospitals and health systems have been tasked with delivering a more patient-centered care experience from start to finish, and forward-thinking organizations are looking for ways to leverage their waiting spaces as a competitive advantage.
With the support of healthcare organizations already exploring the link between waiting room spaces and perceptions of the environment and quality care, facility managers and designers are finally tapping into the hidden potential these transition spaces represent, and seeing positive results in the process.
Michelle Ossmann is a clinician-architectural researcher and director of healthcare environments at Steelcase Health where she is dedicated to improving healthcare quality and safety through design research. While practicing as a staff nurse in the emergency department at Grady Memorial Hospital in Atlanta, Michelle returned to Emory for graduate work and spent the next seven years as a neurocritical care nurse practitioner at Emory University Hospital. It was during the redesign of her own ICU that she saw the need for clinician expertise from within design. At Steelcase Health, Michelle supports product development and directs the research focus in healthcare environment design, leads the application design team and supports the applied research consultancy. Michelle is expected to complete her PhD in Architecture from Georgia Institute of Technology in May 2016.
“New Insight into the Patient Experience.” Available at http://www.steelcase.com/insights/white-papers/new-insight-into-the-patient-experience/