The Waiting Game

A few days ago ProPublica had a headline I wished I'd written: If It Needs A Sign, It's Probably Bad Design.  Although the article started with a health care example (EpiPen of course, citing Joyce Lee's brilliant post), it wasn't focused on health care -- but it might as well have been.   Health care is full of bad design, and of signs.

Take, for example, the waiting room.

When most patients enter a provider's office or facility, the first thing they are likely to see is a waiting room.  The waiting room probably has other would-be patients already waiting there, each full of their own health concerns.  In some instances, the initial waiting room is merely a staging area; once processed, patients may be sent to yet another waiting room to wait some more.  And, of course, once they eventually do reach an exam room, they'll probably endure some more waiting, no matter how long their wait has already been.

It is no coincidence that in health care those of us not providing the care are called patients.

We're expected to be patient.  After all, our providers are very busy.  They have other patients.  Their time is apparently more precious than ours; if you don't think so, contrast what happens if you are late with what happens when they are late.  If they're late to our appointment, we're led to believe, it is because they've been spending quality time with other patients, and we can hope we'll get the same consideration.

Of course, they have all those other patients, and not enough time to keep them all on schedule, because that's how the day was scheduled.  It's not like the patient load couldn't have been predicted.  No one is forcing them to schedule us in unreasonably narrow increments.  It's simply a matter of generating the desired revenue.    

Speaking of revenue, the other thing patients are likely to see when entering an office are signs about payment -- have insurance cards ready, payment are expected at time of service, etc.  Between those financial reminders and the waiting room, it is not exactly a welcoming experience.  

Health care providers are certainly paying some attention to the problem.  The Upstate Business Journal reports on how some local physician office and hospitals are moving to a more "at-home appeal," with more natural light and better furnishings (including plants and artwork).  The waiting areas are "moving in the direction of a more collaborative, inviting space," including "having more technology with televisions and iPad stations that keep patients interested and occupied while they wait."

Similarly, FastCompany profiled the winners of the American Institute of Archtects (AIA) National Healthcare Design Awards, seven medical centers with some innovative designs.  The designs aren't not just aesthetics.  As an AIA spokesperson said: "There's much higher awareness now of how healthy environments help patients heal.  That is, in turn, related to evidence-based design studies that actually prove that—so it's not just intuitive, it's actually been proven in many instances."

Evidence-based design is, in fact, a real thing.  AIA has guidelines for healthcare building that try to take these into account, such as moving away from semi-private rooms.  These have been incorporated into law in over 35 states.  We've all seen the boom is healthcare building; consulting firm FMI estimates some $42b in 2016, and hopefully some good portion of that is based on these design principles.    

That's all well and good.  Making health care settings more comfortable and easier on the eye is a good thing, right?  But those may be missing the point.  Designers can try to make a doctor's office feel more like home, or a hospital seem more like a hotel, but we're not stupid.  We'll still know we're not at home or in a hotel.

We're focusing on the wrong design problem.  As Tom Goodwin wrote recently in TechCrunch: "We’ve got the questions wrong. It shouldn’t be how are you innovating or which project is doing new things, but why are you doing it and on what level."  He was talking about innovation generally, not just in design, but the point still applies.

Instead of paying designers to try to make waiting more comfortable, maybe we should spend the money on industrial engineers to identity why we're waiting at all, and address those root issues.  It is the wait that is the problem, not the waiting area.

Instead of pouring money to make hospitals more like hotels, maybe we should be spending the money on programs that allow people to remain at home.  Hospital patients often leave more disabled than when they arrive because they spend too much time in bed, because hospital design and processes revolve around beds.  We can make better beds in nicer rooms, but they're still not good for us.

The design problems are pervasive.  Health care is, after all, an industry that incents physicians to use EHRs they use but don't like; that has patient portals that patients don't even use, whose bills are so notoriously poorly designed that HHS holds contests to find ways to improve them, and whose terminology is so confusing that U.S. Department of Education says only 10% of us have a proficient level of health literacy.  Bad design abounds.

We can put up all the signs we want, we can architect nicer buildings and offices, but they won't address the underlying design issues.  Design needs to focus not on how to make health care settings prettier but how to make our encounters more efficient and our care more effective.  It needs to focus on us and our health.  We need to start asking the right questions and solving the right design problems.

If we're waiting long enough that we even notice the waiting area, that's a design problem.