Think a waiting room is simply a space with chairs and a few magazines? Think again. A waiting room need not - indeed should not - be a holding pen for patients. Instead, it should be a first glimpse of your "brand," your attention to detail and most importantly, your level of care.
Alison Hood knows all about the vagaries of waiting rooms. Before becoming an interior designer she worked as a pharmaceutical sales rep. "I've been in about 500 hundred waiting rooms, and observed so many things wrong," Hood said. "For example, some rooms had perfectly uniform chairs, with arm rests all the same size. But what happened when bariatric patients came in? They couldn't sit down; there was no seating to accommodate their size. I've been in some rural medical offices set up in home basements with absolutely no concept of a waiting area whatsoever - just a few dining room chairs in an empty space. Many practitioners just don't 'get' that a waiting room is a place to generate income."
Building a Practice with Style
One NP who clearly "gets" it is Cyndee Malowitz, ANP, FNP. When she opened Bay Area Quick Care in Corpus Christi, Texas, 4 years ago, she wanted to get away from the all-white, impersonal urgent-care environment she had worked in for years.
"It was visually so boring," she recalled. With the skill of an artist, affordably secured through nearby Texas A&M University's art department, a mural of a giant sea turtle emerged on one wall of her waiting room (Figure 1). Then came paintings of fish and flora - all nods to Malowitz's interest in sealife. She added whimsical hand-painted, child-scale furniture for pediatric patients. All worries of a blah environment disappeared.
"I also wanted spaces where patients would be comfortable and entertained - especially if they had a long wait," Malowitz said. She installed flatscreen TVs in the waiting area and in all five exam rooms. "The patients absolutely love it."
Just 28 patients came to her practice the first month it was open, Malowitz said. And they liked what they saw. "We had so many comments on the décor. Now 4 years later, we've seen well over 14,000 patients, and we've been named the No. 1 minor emergency center in the area for years. We're doing something right."
Breaking from Tradition
Bradley Rim, director of interiors for Andrew Fredman Architect in New York City, has directed interior design for many healthcare facilities and served on an International Interior Design Association panel that examined how healthcare design can differentiate a brand and create a satisfying patient experience.
"Traditionally, waiting rooms had been stuck in a post-World War I design model: all-white, sterile, institutional walls that simply spoke to safeguarding against infection," he explained. "Waiting rooms were considered purely functional - chairs for sitting. The practitioners may have been great, but their environments weren't."
However, with a robust emergence of strong design in the hospitality industry in the 1990s, consumers started to expect more from a multiplicity of environments - including healthcare.
"Healthcare has been slow to catch on, but now that there is interest in the patient experience and concierge care, all of that is changing. When patients walk into a practice and see a well-designed, organized, comfortable space, they feel a sense of confidence, trust and caring," Rim said. "As NPs assume a greater role in primary, patient-centric care, they can up the ante with waiting rooms that demonstrate to patients they are deserving of comfort and care in a reassuring environment."
Make It Happen
How can you make the magic happen in your own waiting room? The interior design experts we interviewed identified a few pillars of professional décor success:
Basic Layout: Nicole Cocolin, senior interior designer at Stantec in Philadelphia, advised starting with safety. "Every seat should be visible to the registration/reception in case of emergency. This also provides less anxiety for patients; they like to be able to see a person in case they have a question or concern," she said. "Arrange your area with direct flow from entry to reception to exam rooms, so that patients are not walking through rows of seating and stumbling over other patients' feet."
Practical considerations are also important. "Wheelchair accessibility, for example, requires empty waiting spots for patients who remain in their chairs and storage space for those who don't. It should all be thought out."
Dedicate some space to a sick patient area as well as a nook specifically for children. Everyone in the waiting room will be happier.
Colors: Trendy color schemes come and go. Being "on trend" is not as important as understanding the reactions colors evoke, said Marc Wilson, founder of MWD Lifestyles, a New York-based firm specializing in experiential design. "Blue denotes honesty, loyalty, wisdom, confidence, security; green conveys life, calmness, security. The messages are subliminal, but they work," he said.
Other appropriate choices for patient areas include serene neutrals and earth tones (Figure 2). And while white may suggest the aforementioned "blah" stereotype, it can be overcome with color accents, said Trish Adelman, healthcare services director at tvsdesign in Chicago.
"Practitioners want a 'timeless' look; they want longevity from their design investment," she said. "White walls with perhaps one color accent wall can work nicely, because there is still that touch of color and that one wall can be changed easily as time goes on."
One caveat: Beware the red accent. Red can stimulate the senses and raise blood pressure, according to pigment experts at Pantone. It may be best reserved for a private office where work is performed. Research suggests that red backgrounds improve critical thinking skills and attention to details.
Lighting: Because "95% of patients will be sitting in a waiting area longer than they will be seeing their NP, a bright and cheery environment is crucial," Wilson said. He suggested flooding the room with as much natural sunlight as possible, softened by curtains or shades.
Adelman concurs that light - and the quality of that light - is one of the most important aspects in the design of a space. She said different bulbs provide different light - some yellowish, some bluish; it's best to keep them consistent.
Rim said certain LED bulbs keep electrical output way down but the illumination levels way up. "They don't make patients look green or ghostlike," he said. "These LEDs [not to be confused with the new squiggly shaped bulbs] are more expensive to buy, but they last 50 years, take very little energy, and the color rendering is beautiful."
Walls: If your office is bound within existing walls (i.e., not new construction), concentrate on a finish that is both attractive and maintenance-friendly. Rim advised paper over paint, "because paper finishes are easier to maintain and more wipeable. They also allow you to introduce some subtle pattern, texture and visual interest." Paint may be more realistic for a start-up budget, in which case a washable paint surface is critical.
If you have the luxury of a custom build in your practice area, prefab walls deserve consideration, said Kristin Moore, director of healthcare at DIRTT, a manufacturer of customized prefabricated interior constructions (Figure 3).
"We manufacture walls down to a 1/100 of an inch increment," Moore said of the custom walls. She noted that advantages include the fact that "everything that needs to run in that wall - med gases, electricals, technologies , whatever - are already embedded and ready to go." And since the walls are built modularly, inclusions can be configured in an infinite number of ways to fit specific needs. Outer-facing modules can hold "built-in" dispensers, glove boxes and supplies - even art panels. All components can be moved and repositioned when necessary.
Flooring: Flooring is often one of the largest expenditures in any waiting room. Rim suggested using large 24x24-inch tile blocks, rather than the standard 12x12, because they look contemporary and require less grout, which gets dirty over time. If your clientele includes older patients, it's best to have light-colored floors that allow them to see contrasts and steps more easily than darker surfaces.
Adelman agreed. "Consider visual cues in floors. Lines or patterns in materials can be confusing or promote vertigo. Stay away from patterns that are too active and stripes across a corridor that might cause a patient to think it is step. It can be confusing."
Rim also cautioned against carpets. They rip, tear, wear, soil, and they present problems when body fluids inevitably come in contact with them. When carpet is chosen, use carpet tiles so soiled areas can be swapped out.
Furniture. Seating is the most important aspect of a waiting room, according to the designers interviewed. "Patients interact with the seating and they want to feel comfortable - not pricked by a fabric or stuck to a surface on a humid day," said Rim, who favors faux leather because it's "easy to clean, elegant and holds up well."
Adelman noted that the issue of body fluids is also relevant with seating. "A chair fabric should be tested to hold up against urine, chemicals, blood, vomit, Betadine, all of it." Many of today's textiles can be treated with synthetic molecular coatings that are much more advanced - and practice-friendly - than the standby Scotch Guard. These newer coatings make liquids bead up on the surface. Adelman also suggested considering chairs with a clean-out space between the back and seat for easy cleaning of food, crumbs or body fluids.
Remember that seating should include chairs with hand rests - helpful for those who have trouble standing - as well as chairs with open sides for larger patients, and tested to hold 500 to 700 pounds.
Positive distractions: Additional features to relax or comfort waiting patients can run the gamut from a striking work of art to a calming water feature. TVs are no longer a universal choice. "They are disappearing a bit now," said Adelman, noting that television programming can be anxiety-inducing and distracting. She prefers music, reading material and the newest offering - power strips to allow patients time on their handheld devices.
Not to be overlooked is the calming presence of greenery and floral arrangements. BloomNation.com florist Ken Denaburg, owner of York Flowers in Washington, DC, and Annapolis, Md., routinely services medical offices. "Using flowers shows an added layer of care and concern about patients' well-being," Denaburg said. "Seeing something beautiful while waiting can help relieve patient anxiety and change their focus." He advised consulting a florist about plant choices to avoid heavy fragrances and common allergens.
"Plants breathe a sense of life into room," Wilson said. Consider purchasing a small decorative plant for the reception desk - perhaps an elegant orchid. "It shows that you care about your patients' environment and how they are treated. It shows you are taking an extra step," he said.
Waiting rooms are portrayals of your brand, and the unique space you create for patients can be a vital building block for your practice. "I honestly believe we've gotten a lot of our business because of the environment we created," Malowitz said. "Patients can see that we want them to have a good experience. And once they experience the level of care, they return." ■
Valerie Neff Newitt is a staff writer. Contact: firstname.lastname@example.org.