Enabling
P R O D U C T I V E WA I T I N G Through Evidence Based Design
Creating an engaging and productive environment in a primary care Setting
N u r t u r e C o l l e g i a t e H e a l t h c a r e D e s i g n C o m p e t i t i o n 2 0 1 1 . Te a m o f 2 S t u d e n t s . A S u b u r b a n P r i m a r y C a r e C l i n i c
PRODUCTIVE WAITING P R O D U C T I V E WA I T I N G EBD PROCESS MODEL
EBD Process Model
GUIDING PRINCIPLE
PATIEND AND FAMILY CENTERED CARE
GOAL: Utilize patient and family time productively.
GOAL: Embrace nature to promote healing.
OBJECTIVES: 1. Decrease patient through-put time.
OBJECTIVES: 1. Reduce patient and family stress and anxiety.
2. Improve patient and family satisfaction with the waiting experience.
2. Improve patient and family satisfaction with the waiting experience.
GOAL: Provide access to information opportunities for cultural identity, entertainment, learning and education. OBJECTIVES: 1. Improve patient and family satisfaction with the waiting experience. 2. Increase community and health awareness.
OBJECTIVES: 1. Reduce patient and family stress and anxiety.
GOAL: Create transformable spaces to accomodate fluctuation in patient and family expectations and needs. OBJECTIVES: 1. Increase productive use of the waiting room.
2. Increase perceived privacy and satisfaction with social support. 3. Reduce noise level.
S1
S2
ARRIVAL SEQUENCE
ENGAGING NATURE
C1.1 Iconic Entrance
C1.2 Approachable Reception
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3. Decrease patient perceived waiting time.
GOAL: Balance privacy and social opportunities.
S4
S5
PRIVACY GRADIENTS
FLEXIBLE AND TRANSFORMABLE SPACES
S3 ENGAGING INFORMATION
C1.3
C1.1
C1.2
C1.1
Way-finding
Daylight
Access to Nature
Technical Innovation
C1.2
C1.1
C1.2
Iconic Art
Visual & Spatial Privacy
Acoustical Privacy
C1.1
C1.2
Flexible Seating
Flexible Infrastructure
C1.3 CrossProgrammable Spaces
P R O D U C T I V E WA I T I N G
Problem Statement
Figure 1
P R O B L E M S TAT E M E N T Waiting has become a boring experience yet stressful as a response to stagnant, unbounded spaces that lack the healing properties of daylight and natural views. These spaces are often crowded, compromising patient privacy with limited personal space. In their research on densely used polyclinic waiting halls, AkalinBaskaya & Yildirim (2007) found that the negative perception of space and the feeling of overcrowding are strongly related to unbounded spatial c o n fi g u r a t i o n s . Patients and visitors are typically r e s t r i c t e d t o w a i t i n g i n fi x e d r o w s o f s e a t ing with limited privacy and few positive distractions, leading to long stressful waits. The static environment is characterized by limited opportunities for respite, positive distractions and stress reduction; the patients ultimately become disassociated with the built environment. Arneill & Devlin (2002) found that waiting areas that were full of positive distractions such as artwork, magazines and pamphlets were rated higher than those without positive distractions. With a less s c i e n t i fi c approach, Kaiser (2009) compares the waiting rooms in healthcare facilities with other industries such as airlines and hospitality; these industries provide varied experiences and a variety of spaces c a t e r e d t o d i ff e r e n t p r e f e r e n c e s w h i l e improving the overall waiting experience. Within the environment of healthcare, where life-challenging and lifet h r e a t e n i n g e v e n t s a r e a m p l i fi e d , t h e p r o nounced focus on individual situations at hand necessitates diversions or distractions to allow those within to manage stress (Smith, 2007). In conclusion waiting in healthcare environments is best characterized as “wasteful waiting” waiting areas lack opportunities to focus on productivity across multiple dimensions: time, nature, information, people and space. Within contemporary society where people are so busy and time is precious, it is imperative people feel like their time is valued.
V I S I O N S TAT E M E N T Our vision is that patients and visitors will have a meaningful and stress reducing waiting experience. The quality of the experience will be guided by healing, education, privacy and social support while patients and family utilize their waiting time produc tively. The patient and family fl u c t u a t i n g e x p e c t a t i o n s a n d n e e d s w i l l b e met by providing a transformable space that can adapt as needed. Architectural design solutions and technology will meet in balance to provide changing environments that promote healing, education, entertainment, and community integration. ASSUMPTIONS Type of Facilit y : Pr imar y Care Clinic Size of Facilit y : 35,000 square feet Patient Volume: 30,000 – 40,000 annual visits Operational Context: Primary Care Clinic with rotating specialties OBJECTIVES Decrease patient through-put time and perceived waiting time Improve patient and family satisfaction with the waiting experience Reduce patient and family stress and anxiety Increase community and health awareness Increase perceived privacy and satisfaction with social support Reduce noise level Increase productive use of the waiting room Akalin-Baskaya, A., & Yildirim, K. (2007). Design of circulation axes in densely used polyclinicwaiting halls. Building and Environment, 42(4), 1743-1751. Arneill , A.B., & Devlin, A.S. (2002). Perceived quality of care: t h e i n fl u e n c e o f t h e w a i t i n g r o o m e n v i r o n m e n t . Journal of Environmental Psychology, 22(4), 345-360. K a i s e r, D e n n i s. ( 2 0 0 9 , S e p t e m b e r / O c t o b e r ) . D o n’t w a i t o n t h e waiting room. Medical Construction & Design, 22-26. S m i t h , J . ( 2 0 0 7 ) . H e a l t h a n d n a t u r e : t h e i n fl u e n c e o f n a t u r e o n design of the environment of care. Center for Health Design.
Figure 2
r e t r i e ve d f r o m : h t t p : / / w w w. a i r l i n e r e p o r t e r. c o m
Problem
Staregy/Concept
Proposal
A R R I VA L S E Q U E N C E
Evidence + Strategies Clear arrival sequence and intuitive w a y - fi n d i n g c a n h e l p p a t i e n t s r e a c h t h e i r d e s t i n a t i o n o n t i m e a n d e ff e c tively while minimizing wasteful time and unnecessary stress. Minimizing wasteful time can be achieved by strategically locating check-in kiosks decreasing patient arrival and check-in time. Clear arrival sequencing can be addressed with iconic entrances that guide patients to the facility entry points. Approachable reception areas can be implemented by provision of sculptural reception desks that open towards the visitors entrance pathw a y s . I n t u i t i v e w a y - fi n d i n g a n d a hierarchy of circulation can be achieved by introducing spatial variety, natural light, orienting views outside and connections to nature in as many circulation spaces as possible. Implementation of these design concepts can improve patient and family satisfaction with the overall waiting experience.
Figure 5
Figure 3
retrieved from: http://www.worldarchitec turenews.com/
Figure 4
retrieved from: http://maisarquitetura.com.br
Problem
Evidence + Strategies
Proposal
E N G A G E N AT U R E
Evidence + Strategies Productive waiting can be enhanced with visual and physical access to nature that produces a healing e ff e c t a n d p r o v i d e s a s e n s o r i a l experience. Research has documented that the appropriate use of nature reduces stress ( Tyson, Lamber t & Beattie, 2002); improves health outcomes (Ulrich, 1999); and promotes a sense of overall well-being among patients, v i s i t o r s , a n d s t a ff ( M a c k , 2 0 0 1 ) . I n t e gration of clearstories and placement of skylights aim to illuminate interior spaces while connecting occupants to the outdoors. Interior and Exterior courtyards physically accessible from the waiting area provide optional spaces of respite; while integrating water features they can provide a biophilic or sensory experience with nature that stimulates the senses. The senses are the basic foundations for what individuals consider their sense of self and what they k now as familiar ( Wilson, E.O., 1984; Kellert & Wilson, 1993).
Sky light
Figure 6
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Fiber Optics
Keller t, S.R. and Wilson, E.O., Eds. 1993. The Biophilia Hypothesis. Washington D.C.: Island Press. Mack, L. 2001. New Woodbur y Hospital Uses Natural Ambiance to Assist the Healing Process: Woodwinds Is an Example of Push to M ake Facilities Patient Fr iendly. M i n n e a p o l i s S t a r -Tr i b u n e, J u l y 3 0 , C 1 - 2 . Tyson, G. A., Lamber t, G., & Beattie, L. 2002. The I m p a c t o f Wa rd D e s i g n o n T h e B e h a v i o r, Occupational Satisfaction and Well-Being of Psychiatric Nurses. International Journal of Mental Health Nursing, 11(2), 94-102. U l r i c h , R . S . 1 9 9 9 . E ff e c t s o f G a r d e n s o n H e a l t h O u t c o m e s : Theory and Research. In Cooper Marcus, C. and Barnes, M. (Eds). Healing Gardens’Therapeutic B e n e fi t s a n d D e s i g n R e c o m m e n d a t i o n s . N e w Y o r k : Wiley. Wilson, E.O. (1984). Biophilia. United States of America: Press and Fellows of Harvard College.
Courtyard
Figure 7
Figure 8
retrieved from: http://www.worldarchitec turenews.com/
Problem
Evidence + Strategies
Proposal
E N G A G E I N F O R M AT I O N
Evidence + Strategies
Productive waiting can be successfully accomplished by engaging patients with purposeful information and entertainment opportunities. “Viewing artwork with appropriate nature content has been seen to reduce stress and pain perception, as measured by physiological outcomes such as blood pressure, heart-rate, and skin conductance� (Hathorn, & Nanda, 2007). Nature images can enhance the healing properties of the space; changing digital displays can provide a continual visual interest while engaging information. W a i t i n g a r e a s a ff o r d a n o p p o r t u n i t y t o educate by providing a comfortable space for the community to gather to learn and collaborate. Through the use of iconic art, architectural design solutions and technical innovations, the waiting area can serve as an engaging and changing environment for patients and family while promoting healing, entertainment, education and community integration. While it is i m p o s s i b l e t o d e fi n e a s i n g l e t y p e o f person that will come to a waiting room, the need for varied experiences and the provision of varied spaces catering to d i ff e r e n t preferences b e c o m e s e s s e n t i a l ( K a i s e r, 2 0 0 9 ) .
Figure 9
retrieved from: http://www.worldarchitec turenews.com/
Figure 10
retrieved from: http://asteriskgroup.com
H a t h o r n , K . , & N a n d a , U . ( 2 0 0 7 , M a y / J u n e ) . H e a l t h c a r e fi n e a r t : what is evidence -based ar t?. Facilit y Care M agazine, 12(3). K a i s e r, D e n n i s. ( 2 0 0 9 , S e p t e m b e r / O c t o b e r ) . D o n’t w a i t o n t h e waiting room. Medical Construction & Design, 22-26.
Figure 7 Figure 11
retrieved from: http://www.vielflieger treff.de
Problem
Evidence + Strategies
Proposal
1.1 1.2 15’
Evidence + Strategies
Creating a balance between privacy and social opportunities can address diverse patient population and patient needs while providing for productive waiting or a restful experience. Typically waiting areas are regimented with seating arranged in a repetitive linear fashion in close p rox i m i t y t o e a c h o t h e r. W h i l e t h e s e arrangements may maximize the occupancy of the waiting area they lack the potential for options of privacy and positive social interactions. Visual and spatial privacy can be accomplished by variable seating groupings, expressed structure and varied ceiling heights. Smaller areas with absorbent ceiling materials and partial walls can also provide a space where patients can engage in private conversations while increasing the acoustical privacy. The physical factors of the space including sound, layout, and the positioning of other patients can improve patient privacy (Scott, Dyas, Middlemass, & Niroshan Siriwardena, 2007).
reception
P R I VAC Y G R A D I E N T S
reception
public
private
1.3
semi-public
reception desk height 3.3
public
12’ 10’
private
furniture arrangement BAD EXAMPLE
BAD EXAMPLE
comfort
detail@children height good example
good example
5’10’’ adult
5’8”
3’8’’ chidren 2’6”
1.2 15’ 12’ raised ceiling height10’
no ceiling height variance
http://www.designandconstruction.ucsfmedicalcenter.org/
private
public
dropcomfort ceiling
Figure 12
1.3
Figure 14
detail@children height
5’10’’ adult
5’8”
3’8’’ chidren 2’6”
S c o t t , K . , D y a s , J. V. , M i d d l e m a s s , J. B. , & N i r o s h a n S i r i w a r d e n a , A . ( 2 0 0 7 ) . C o n fi d e n t i a l i t y i n t h e w a i t i n g r o o m : a n observational study in general practice. British Journal of General Practice, (57), 490-493.
http://www.buildingofamerica.com/news/articles/hc/0510/baylororthoandspinehospital
Problem
Evidence + Strategies
Figure 13
Proposal
ceiling height F L E X I B L E S PA C E S
lobby
Evidence + Strategies
12’
waiting area
exam/ treatment 14’
Flexible and transformable spaces provide optional waiting areas w h e r e p e o p l e c a n e n g a g e i n p r o ducsemi-public public private tive waiting activities.
A fl e x i b l e i n f r a s t r u c t u r e s u c h a s m o v e a b l e w a l l s c a n o ff e r o p p o r t u n i t i e sarrangement to adapt the waiting space layout urniture a s n e e d f o r c h a n g e m a y a r i s e i n fl u e n c e d b y BAD d i vEXAMPLE erse patient populations, PLE changes in clinical practices, and implementation of new technologies. Flexible and transformable waiting areas will provide opportunities for community, s t a ff and educational activities. The waiting area can be transformed into smaller or larger areas hosting local art exhibits, book fairs, entertainment, and educational p r o g r a m s e n c o u good r a g i nexample g health awarele ness and addressing the needs of the c o m m u n i t y o r a s a s t a ff t r a i n i n g a r e a . The waiting area, a crossprogrammable space will be used during and after clinical hours as needed; it can therefore eliminate the duplicity of training and community rooms which are typically used after clinical hours and empty spaces during the day. This transformable space will be provided with state of the art technology to meet its varied uses while engaging the community, s t a ff , p a t i e n t s a n d v i s i t o r s i n m u l t i p l e purposeful activities.
Figure 7 Figure 16
Figure 17
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retrieved from: http://www.worldarchitec turenews.com/
Figure 18
Figure 19
retrieved from: http://www.movable-wall.com
Problem
Evidence + Strategies
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
Productive Areas
Work Area Leisure Area
Check-in 2 3 5
Arrival
4
6
work area
leisure area
play area
1
Play Area
outdoor area
View Portal
7
Outdoor Area Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
1. Arrival
Visible Entrance Provides patient with an intuitive entry point
Landscaped Entry Provides patient with sense of welcome and relaxation
Check-in Kiosks Provides touchpoint check-in immediately upon entry
Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
2. Check- in Skylights Provide controlled natural light deep inside waiting area
Drop Ceiling Provides a sense of privacy for patients who desire less social interaction
Iconic Reception/Help Desk Provides patient an obvious location for face to face check-in
Check-in Kiosks Provides touchpoint check-in immediately upon entry
Biomimicry Wall Provides entertainment by reacting to people around it. Movable Screen Provides a sense of privacy for patients who desire less social interaction
Modular Furniture Enables the space to be reconfigured based on desired activities
Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
3. Work Area Skylights Provide controlled natural light deep inside waiting area
Varied Cieling Heights Provides a sense of privacy for patients who desire less social interaction
Clerestory Provides controlled access to natural light
Movable Screen Provides a sense of privacy for patients who desire less social interaction
Modular Furniture Enables the space to be reconfigured based on desired activities
Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
4. View Portal Clerestory Provides controlled access to natural light
View Portal Provides framed view to landscaped patio and water wall
Water Wall Provides a relaxing sound and keeps the patio cool
Wall Side Bench Provides personal seating
Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
5. Leisure Area
Skylights Provide controlled natural light deep inside waiting area
Clerestory Provides controled access to natural light
Multi-Touch Wall Provides an interactive interface for medical education or entertainment
Backlit Wall Panels Provides a soothing wall surface that mimics nature Various Seating Provides oportunities for various levels of social interactions
Modular Furniture Enables the space to be reconfigured based on desired activities
Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
6. Play Area Digital Wall Provides a medium for education or entertainment
Children’s Nook Provides a playful space for children while they wait
Multi-Touch Wall Provides an interactive interface for medical education or entertainment
Modular Furniture Enables the space to be reconfigured based on desired activities
Backlit Wall Panels Provides a playful wall surface that encourages social interaction
Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
7. Outdoor Area Landscaped Patio Provides patients with relaxing outdoor environment
Water Wall Provides a relaxing sound and keeps the patio cool durring warm days
Movable Seating Provides patients with choices depending on their needs and desires
Green Wall Elimates the edges of the exterior facade creating a more relaxing envronment
Overflow Space Provides overflow space for various activities.
Problem
Staregy/Concept
Proposal
P R O D U C T I V E WA I T I N G
Proposed Concepts
8.Living Wall Elevation
Children’s Nook Provides a playful space for children while they wait
Skylights Provide controlled natural light deep inside waiting area
Clerestory Provides controlled access to natural light
Multi-Touch Wall Provides an interactive interface for education or entertainment
Problem
Landscaped Patio Provides patients the choice to be outdoors
Staregy/Concept
View Portal Provides specific view to landscaped patio and water wall
Proposal