Why your practice needs a makeover

The spaces where we live and work can exert both strong and subtle influences on the way our brains function. They can make us anxious, distracted, inefficient or tired, affecting not only our cognitive ability but also our emotional state, mental stability, and physical well-being. Clinical medical practice, like much of life in our society, is tethered to indoor space, so physicians, staff and patients alike are particularly prone to these psychological effects.

The good news is that continued study of the effects of design on our well-being, and of those we work with, has led to better recognition of “trouble” points and ways to improve them. Many of these improvements are easy and inexpensive to accomplish and may lead to a better environment for engagement and healing.

The first step is an honest assessment of the clinical space and the throughput from the focus of the physician, the staff and the patients. Look at the surroundings, listen to the ambient noise, feel the amount of room and the sense of space. Let your staff do the same thing and compare responses. Even consider a simple survey of the patients.

5 design flaws that can hurt your practice

• Lack of space for staff-to-staff interactions
• Lack of “reset” rooms – a place where staff or provider can step away from the practice work and recharge for a couple of minutes. Many clinicians have offices, but their desks are full of distractions. A reset room should be the opposite
• Inefficient and clumsy exam room design
• Lack of natural lighting (or an alternative if the space doesn’t allow windows to the outside)
• Noisy, overly hectic waiting rooms

So what can be done about these and other problem areas in the practice design? The following is a list of suggestions, but the most important factor is a willingness to try changes. Most of these are easily reversible if they don’t work. They are workable even in shared environments (although compromises about stylistic designs may need to be made). Most importantly they will not fundamentally change the organization of the practice, although clinicians should be open even to more drastic changes if necessary. The entire healing system may be in the balance.

8 simple ideas to improve your practice

• Find the clinic’s quiet spaces and use them. Recent guidelines have called for stricter control of blood pressure, but many practices do not even have a quiet spot to measure vital signs. A small comfortable room can be set aside for BP measurement, or even as a “coping” room for patients or staff
• Design the patient (and staff) flow for efficiency and convenience. The goal should be to minimize steps and prevent everyone from having to retrace their steps
• Make the waiting rooms productive spaces. Patients don’t really want the television blaring at all times. Having a usable Wi-Fi, having a small library, presenting informative information, setting up the chairs so people can interact can all go a long way towards minimizing stress and improving the mood and receptivity of the patient.
• Choose colors carefully
• Use the windows for natural lighting whenever possible
• Invest in artwork
• Design the clinic for universal use. Unless the space is dedicated to one age group or type of patient, or if it is truly a solo practice, it is useful to pick colors, furniture, and lighting that will be useful and engaging to a broad range. This doesn’t mean the palette needs to be olive drab
• Develop spaces for education and engagement. The ambulatory care experience is not just about the doctor/patient interaction anymore. It now encompasses teaching, prevention, and resources for making healthful decisions. A resource center (as simple as an orderly selection of booklets or as complicated as video and computer learning stations) can be incorporated into the clinic setting. A small conference area can allow teaching sessions

In summary, the key to making a clinic work better is to first, understand what doesn’t work; second, know what the research suggests; and third, make small incremental changes (or even large ones if necessary) that will put these practices into effect. We as clinicians must understand that the healing process is not just the “laying on of hands.” It is the entire scope of a patent’s experience from the moment they step through the office door.

Diana Anderson is an architect and physician. She is principal, Steffian Bradley Architects, Boston, MA. She can be reached at Dochitect. Keith Mankin is a pediatric orthopaedic surgeon and host, PeerSpectrum Medical Podcast.