The air in the waiting room is still; it smells like disinfectant and winter boots. The walls are greenish yellow, and everyone who is not staring at their phone is coughing. The people seated on either side of me are packed in tight, like airplane passengers, without enough room to stretch their legs or rest their arms.
In front of me is a huge flat screen playing the same 12 medical device commercials on rotation. Hanging on another wall is a photo of the Eiffel Tower draped in fog, the ’90s equivalent of the ‘Hang In There’ kitten poster. I’m also treated to a perfect view of a bathroom door, where fellow patients wait in line to produce urine samples that, once sealed in plastic tubes, sit in a plastic bucket for all to see.
Who designed this room?
By their nature, medical offices are uneasy places. But do the spaces themselves need to be so uncomfortable and discomforting? So ugly? Research experiments and real-life examples of design-forward healthcare facilities suggest they don’t. There are simple ways (and also more complicated, costlier ways) to upgrade the rooms where we wait to see doctors and actually see doctors. If recent trends in medical-office design prove popular, the difference between going to the doctor now and in the near future will be akin to that of sitting in a bus depot versus relaxing in an airy solarium. At least, that’s the goal.
There’s no exact formula or objective criteria for success in medical office design. As one expert put it, no single space can accommodate every patient’s needs or ease every patient’s anxieties. But designers and design psychologists agree that small changes can help most medical offices feel a little less alienating and a little more human.
Zab Hobart, a designer who specializes in typography, has seen plenty of bad or just lazy design in medical offices. “Too much information in your face is unwelcome when you may be having concerns about your health,” she says, “so it’s important to reduce visual clutter. Calm, orderly, but humane. Paint the walls a bright solid color rather than fill them up with posters.”
For Hobart, “the most common irritants are uncomfortable chairs, and too many of them jammed in together. And excessive sound.”
Sue McCluskey, co-founder of Goods and Services Branding, has worked in healthcare marketing for over two decades, including several years at a downtown Toronto mental health facility. She favors a practical, user-centric design philosophy. “The interior design depends on the needs of the patients, visitors and staff; for instance, in psychiatric intake areas, safety will outrank style every time,” McCluskey says. “You often see a higher level of interior design in more ‘discretionary’ clinics, such as dentists’ offices or dermatology offices. A couple of years ago, I had to see a dermatologist, and the waiting area was gorgeous; it looked and felt like a spa, with a very impressive sense of arrival. Of course, once I got into the exam room, it was the same old room that could have been anywhere.”
If a room’s layout makes patient-provider interactions awkward, ferns and reclaimed oak can’t save it.
Exam rooms are a perennial challenge in medical design. They need to be functional, fully equipped with medical supplies and exceedingly clean — but at the same time, somehow also inviting, discreet and not too sterile. Economic considerations, McCluskey points out, often influence the aesthetic: “Healthcare furniture is really, really expensive because it’s so heavy duty. These items get used and repaired until they fall apart.” As an example, a factor to consider is what’s known as “field-replaceable” parts: Can the chair arms be easily replaced; can the seat cushions be swapped out?”
And context is everything. Medical facilities are unique spaces with unique design needs. “While it’s hard not to judge healthcare interiors against other public spaces like libraries, hotels or restaurants, you have to remember that a hospital or clinic’s priorities are completely different from an organization that appeals to consumer tastes,” McCluskey says. “I think it’s realistic to assume that the ‘style’ component of the design is never the foremost consideration. After you check all of the boxes on the performance and safety requirements, it’s a lot harder to also make the room look pretty.”
Biophilia is the hot buzzword in medical design today. Based on a theory first introduced in the early 1980s by the American naturalist E.O. Wilson, biophilia posits that human beings are instinctively drawn to the natural world and its signifiers. The resulting design principle seeks to incorporate materials, objects and colors derived from forests and fields. Think wood furniture, stone fixtures and a generous appointment of plants.
A New York Times story from 2017, “Bad Hospital Design Is Making Us Sicker,” mentions European studies on biophilic efficacy. Their findings boil down to “the more nature, the better, in any environment.” In practice, however, nature is scarce in medical facilities. How many lush, woodsy waiting rooms have you sat in? How about exam rooms with scenic outdoor views?
Use of biophilic design in medical offices, as Katherine Schwab recently wrote in Fast Company, has “been shown to lower heart rate and blood pressure, as well as engender a sense of calm and tranquility.” Schwab wades even deeper into New Age territory, arguing for healthcare environments that create a sense of movement followed by a sense of completion — what biophilies call “prospect.” Essentially, the patient is supposed to move from a “very alive space” (the waiting room) to one that prompts a “focused and intentional, pure moment” (the examining room). “It’s almost like a rite of passage,” says one adherent.
Being social animals, we humans like to be in the presence of one another, but not in such close or intimately arranged quarters that we feel uncertain about how or where to sit.
If that sounds a bit too singing-bowls-and-jade-eggs to you, design psychologist Sally Augustin is happy to lay out the practical benefits of nontraditional medical office design. Specializing in person-centered design, Augustin is a consulting expert at the University of California, Berkeley’s Interdisciplinary Center for Healthy Workplaces. She has seen — and helped fix — a lot of medical office spaces.
“It’s understandable that people enter medical offices feeling anxious,” Augustin says. “I can’t imagine a moment when you are visiting the doctor in nothing but an upbeat mood. So in principle, you create spaces that calm people down.”
For instance, Augustin explains, it’s important that medical facility seating areas make it clear where each patient’s “territory” begins and ends. Being social animals, we humans like to be in the presence of one another, but not in such close or intimately arranged quarters that we feel uncertain about how or where to sit. “Individual seats with armrests,” she says, “help people to know that for the time they are in the room, they ‘own’ that space.”
Waiting areas should also provide a variety of seating options in different sizes and configurations to meet the needs of people who arrive alone or accompanied, as well as mitigate uncomfortable eye contact between strangers. Once these more primal needs are met, Augustin says the next step is to incorporate elements that at least remind the patient of the outside world: wood-based furnishings with visible grain, walls in deep, vegetal shades of green or muted floral tones. Not too busy, but not isolation-chamber spartan either.
With that said, Augustin warns against overuse of biophilic principles. A patient doesn’t want to see a doctor in a room resembling a log cabin or a greenhouse. “People are always looking around,” Augustin says. “It’s another one of our animal habits. A moderate amount of visual complexity is helpful because it is stimulating but not hard to process. Too much of one design choice is psychologically uncomfortable.”
Exam rooms, Augustin admits, are the toughest spaces to organize, partly because they perform different functions and house such diverse activities. The exam room is equal parts operating theatre and confessional.
Privacy is always a top consideration. Patients need to be able to undress and candidly discuss health issues without worrying about anyone outside hearing or seeing their business. For instance, Augustin says, an exam room door can’t open in a way that inadvertently creates a privacy breach. Hygiene, too, is a non-negotiable priority. “Everything has to be easily cleanable, and that is a big challenge,” Augustin says.
Most studies on medical office design seem to concern the same question: How do you create a space that is sterile but doesn’t look sterile?
Seemingly minor tweaks can help make an exam room a more comfortable setting for uncomfortable, sometimes upsetting, conversations. “Studies show that when clients are surrounded by warm colors, they actually feel warmer,” says Augustin, “which is great when you are sitting in a room with your clothes off. And because the examination room is where you get the bad news, having more curved lines in the room softens the blow.”
There’s also the issue of designing exam rooms to facilitate screen sharing, a patient-care buzzword and increasingly popular topic of research. With electronic health record usage becoming the norm, doctors are spending more time during appointments typing away at computers. Studies say patients feel more empowered to participate in their own care when they can actually see what doctors are typing. This might seem like a secondary concern, but it’s important for exam rooms to enable easy movement and communication, Augustin says. If a room’s layout makes patient-provider interactions awkward, ferns and reclaimed oak can’t save it.
There’s no shortage of opinions on designing healthcare spaces. There’s also no consensus on the right approach. Every idea — putting aquariums in waiting rooms, coating walls in millennial pink, installing desks to signify competence, going desk-free altogether — is up for debate. But most studies on medical office design, and the solutions they propose, seem to concern the same question: How do you create a space that is sterile but doesn’t look sterile?
Augustin recalls seeing an allergist who opted for extreme sterility in their office, in an attempt to assuage fears of allergens. The room fixtures were bare metal and the room had no smell at all, which can be as unnerving as an overpowering scent.
Hobart agrees: “There’s a distinction to be made between sterile-looking and sterile. I’m all for the minimal aesthetic, but the consideration of style must also be consulted.”
The problem, Hobart feels, is the disconnect between designers and patients. “Health is really all about the individual. Yet so many medical spaces seem intent on removing the personal, as if the personal need is the problem, rather the purpose of the visit.”
McCluskey has a different perspective: “You have to remember that what you or I think is a pleasing interior may to someone else seem unprofessional, or intimidating because it’s too ‘high design.’ I prefer healthcare settings to look as sterile as possible.”’
Perhaps the best and most reasonable advice comes from the American Medical Association: Spaces must prioritize basic human needs, such as the need to feel that you’re actively involved in your care and that you’re in the right place for the right reason. Is there any objectively correct way to achieve that goal? Probably not. But I think we can all agree that misty photos of Paris in spring only remind you that you are not in Paris.