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Premises: Form and function

25 November 2013

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There are many ways to innovate and improve your waitingarea without spending a fortune
The patient experience starts from the initial contact with the GP surgery, whether this is through the website, a phone call or referral. That impression stays with the patient throughout the process. 
Clear communication and understanding of their next step is crucial to making a patient or visitor feel reassured before arrival. Whether this is by highlighting best public transport routes or providing images of the surgery and staff, these steps will start to build a picture of what to expect from their place of diagnosis and treatment. 
Once at the surgery, patients can start to feel quite anxious. There are many ways practice managers can help with reducing this anxiety, from making the sure that the process of finding parking is simple to ensuring entrances and walkways are welcoming and clearly signposted. 
Fresh pair of eyes
First impressions count. Being able to view your surgery through the eyes of someone who has not been there before can be of huge benefit in understanding what the issues are. Actually walking through to the reception from the car park will help you see some of the issues patients might encounter along the way – and they may not be the ones you expect. 
Are badly parked cars obstructing entrance for pushchairs or wheelchairs? Is a locked external door easily mistaken for the surgery entrance? Is it clear how the doors open – and when inside, which way you need to go to visit reception? Is the flooring level? Is the ceiling low? Are the posters and leaflets overwhelming as you walk in? Are the messages that they portray gloomy and negative, or positive and inspiring? Might certain groups be alienated or embarrassed by their content? What can you smell, see and hear when entering the waiting area?
Putting patients at ease
Once into the reception area, the first two or three metres within the doorway is a key area often called a ‘decompression zone’. This is where a patient or visitor will be able to familiarise themselves with the environment and make clear and informed decisions about the next step they need to take. 
This is often to locate the reception counter or seating area. It’s a common misconception that large signs will resolve this initial hurdle; often simple changes and visual cues added to the environment can have a greater effect. For example, people are drawn to lighter areas, so increasing the light around a reception desk will make it clearer for people to locate. This could be as simple as changing some bulbs or adding some spot lights to the counter, another cost effective method would be to paint a contrasting colour panel around the reception desk area.  
As experienced designers within the healthcare sector, more often than not we are called in to look at one area of the environment, but actually discover that it could be something else that may be the issue.
For example, in one major hospital waiting room, we were hired to look at the seating arrangement because some seats were not being utilised. When analysing the space, we quickly realised that the lighting was poor in one particular area, thus not encouraging people to gravitate towards that space. 
A quick fix! 
Another simple method to make it easier for people to understand a space is to remove or move ‘visual clutter’. Again, this is a great example of where a fresh set of eyes can help. By seeing the space with a new perspective you might find that there are communications and objects that are irrelevant, such as bins, misplaced trolleys, posters or leaflets that are surplus to requirement. Having mentioned posters, a quick solution to over-cluttering a space with health related posters is to designate one key area or wall for literature and leaflets. Defining and creating order to the space can reassure and calm patients and allow them to ‘opt in’ to receiving the many messages that a GP surgery, has to convey rather than being bombarded by them.
The first step in the process 
Before you decide to hire a designer to assist you with your waiting room, make a sketch of the areas you think are the problem. It is a useful starting point and allows you to some of the groundwork for no cost.  
Just scribble on a piece of paper the layout of the space. Are there simple things you could do to make it more welcoming and improve operational efficiency? Think about the line of sight from the reception desk – can staff see all areas of the waiting room? If the reception desk is behind a window, often moving it into the room improves communication and creates an approachable, welcoming
environment, providing no compromise is made on patient and staff safety. 
When sitting down, are there clear signs or directions to the toilet and other important facilities? Does the seating arrangement make logical sense compared to where the entrance is and reception desk is located? Although TVs and LCD screens can be useful for communication, advertising and possible entertainment, they can sometime create anxiety and can alienate people with poor sight, hearing or language and communication difficulties.
Choice is key
When going to a restaurant or cafe, one of the first decisions you will make once you have been met and greeted is choosing a table or seating area. Your choice might depend on how you are feeling, whether you want somewhere open plan or discrete, and how many people you have with you. 
Making a decision about where to sit within a waiting area follows the same principles. If, by the nature of how you have set out the seating, you can create group areas but as well as tucked away alcoves, you give the patient or visitor a choice. 
Consider the seating from an ergonomic point of view. It is important to have a range of seating, from beam seating, which can increase seating numbers, to chairs with arms for elderly patients or breastfeeding mothers, while at the same time having a choice of open, more relaxed seating areas for families who want to sit close to each other. 
Creating this variety is vital to comfort and wellbeing while waiting. Seating doesn’t necessarily have to be an expensive outlay; think laterally about the seating stock you have, could you recycle or re-upholster worn and tired seating? Continuity with the colours you use is also key. This doesn’t have to mean matching colours, just using colours that compliment each other – these can be opposite ends of the colour spectrum. Again variety adds interest and makes the seating look less formulaic. Tying in the colours with the graphic branding for signs and stationary also helps.
Nature helps nurture
Natural materials and an associated colour palette have been proven to have a positive effect on calming and relaxing people within built environments. There is a growing body of evidence and a strong movement towards designing spaces that incorporate natural materials and colours, from simple steps such as putting up photos of natural scenes, through to adding fish tanks, or cladding walls within the waiting area in timber.  
“In a study conducted at a Swedish university hospital in 1990, scenes of nature in artwork and murals were shown to reduce anxiety and discomfort in patients staying at the hospital. 
“The patients who were recovering from open heart surgery experienced the least post-operative anxiety when looking at pictures of natural scenes that included water, compared with pictures of abstract art, a control picture, or no picture at all.” (Biophilia: Designing with Nature in Mind).
As with all natural environments, well-designed interior spaces use different textures and contrasting colours to add interest, distraction and provide a focus point for patients within the space. 
Other simple methods to incorporate natural elements things could be to add plants, but again in clearly designated areas otherwise the effect can be lost. Likewise, use of imagery needs to be clear and bold.
Waiting areas are often relatively large spaces compared to a domestic rooms such as a lounge area, so the changes made need to be scaled proportionally.  
Design childsplay
When designing for key audiences in waiting areas, children feature highly. Children’s play areas are a very important area in all waiting rooms and there are some key points to follow when designing them. 
When children play they often seek reassurance from a parent or guardian, which can often be subtle body language. For this to take place, eye contact is important, and we have found in the past that having a separate children’s play room doesn’t work as well as integrated play spaces within waiting rooms, to allow for the all important feedback and communication with parents. 
If a play space is in a separate room, children will have a tendency to remove toys and books and take them into the main waiting area, often causing trip hazards and obstructions within the space.   
Another difficult area within children’s areas is the look and feel, and not isolating age groups by designing for specific age. Themed areas often have a fairly short shelf life; if you design a space with characters from particular cartoon, you will find that within a year the space will feel out-of-date and irrelevant. 
We have found that designs can be kept simple, but if they are slightly abstract in the way they look, then children will use imagination to interpret that space into what they want. 
The final point with regards to designing children’s play areas is don’t assume children would like the same type of furniture as adults, but on a miniature scale. A child will often be much more happier on a soft mat or bean bag (infection control compliant) than they will be on a low chair and table. Thinking like this enables us to create fun spaces on often small budgets.