Design of Medical Exam Room Can Make a Difference

By Alan Rheault

Amidst all the debate happening in healthcare, one thing that is widely agreed upon is that significant shifts are adding increased complexity to the healthcare system and care environment. There is an increased emphasis on patient satisfaction and health outcomes – a response to the inconsistent outcomes that are challenging healthcare systems today. This is the new reality.

But what about the needs of physicians in all of this change? Without successful and healthy physicians, the system is already flawed before it even embarks on this new era of healthcare.

The role of design in a healthcare setting is often overlooked or underemphasized. There is a significant opportunity to strategically rethink how healthcare spaces can dramatically improve the experiences of everyone involved. The healthcare journey needs to be an integrated one and intentional design of healthcare spaces is one way of making these changes happen more seamlessly.

Investing in a Physician Retreat Space

It’s common for physicians to become so consumed with taking care of patients that they neglect their own wellbeing. In Nurture’s 2013 Clinician Report, we found that risk of patient injury (31%) is a greater concern among surveyed clinicians than risk of personal injury (20%). Despite the fact that 35% of clinicians and nurses report being injured at least once on the job while 24% had to modify activity or movement during at least one shift. Additionally, our research on physician retreat spaces within healthcare facilities found that physicians have no place to decompress, make a personal call, digest food properly or even just take a few minutes to recharge. Many of the physician retreat spaces that do exist, such as small staff kitchens, were given extremely limited real estate, had minimal facilities but were often the most frequented spaces in the entire healthcare facility.

An appealing retreat space, close to the work hub with spaces for recharging, is an important investment in physicians’ physical, mental and emotional health. This is something that should not be underestimated by healthcare leaders. Not only can rested employees perform better and provide better patient care, they are also less prone to burnout or workplace injury. A survey just completed by Nurture by Steelcase, found that one out of every three clinicians who participated in the survey has been injured at least once on the job.

Below is an example of how this type of retreat space could be designed:

Things to note:

• Alone spaces as well as collaborative spaces.
• A designated room for a physician who needs to decompress or make a personal call.
• Efficient kitchenette so as there is a choice to have healthy food.
• A media bar for catch up on paper work or to glance at the news.

Rethinking the Exam Room

Our research also delved into current exam room configurations and found many ways that their limiting factors can be improved to better assist the physician and the patient and, in turn, the changing healthcare landscape.

Specifically, most exam rooms are intimidating environments. They lack spaces for patients to comfortably undress or place their belongings, which can immediately create uneasiness and lead to a perceived lack of quality in care. Exam tables put patients at a different level than the physician, which makes sharing information awkward and impersonal. As physicians also begin to see the role of patient’s shifting from passive to active, these configurations will help foster these new relationship dynamics.

Most exam rooms are designed for only the patient and physician– there is little room for family or a trusted support person. As care is beginning to take a more integrated and holistic approach, this is something that needs to be considered.

Sightlines to information on a computer or handheld device are limited to only the physician, which compromises the powerful potential of technology as a tool for teaching and learning.  Teaching and learning goes both ways – patients and family sharing with physicians, physicians sharing with patients and family, and the configuration of space is fundamental for supporting that. In many exam rooms today, fixed, bulky furniture makes movement difficult, limits in-the-moment reconfiguration, and hinders active learning modes.  Making technology and tools mobile can support a more dynamic flow.

Below is one exam room application that incorporates the insights and opportunities for change that are identified above.

To note:

• Not every appointment requires an exam table. A recliner replaces the exam table, providing “same-level” seating, placing patients in a more empowered posture and encouraging them to participate as co-directors of their health.
• Learning and shared understanding are supported with information displayed on a large monitor, providing equal visibility to educational information or data from a clinician’s device, such as lab or x-ray results. Modular cabinetry provides a mounting surface and cable management, as well as a place for personal belongings.
• Space is allocated for family members, making them equals in the conversation. Seating offers power for technology devices and encourages active learning for all participants.
• A mobile worksurface with drawer storage and magnetic accessories keep exam tools and technology close at hand for physicians. It has a small footprint that moves with the physician – making it easy to adapt the space for the individual needs of each patient.
• Interactions in this room are comfortable and fluid – and a lot gets done.

With all the pressing demands on physicians today, it is understandable that the consideration of how the physical space can have a significant impact on patient behavior, and their own behavior, is dismissed. But reimagining healthcare starts with insights about what people want and need.

Reinvention of space starts with insights that result from rigorous study of what physicians and patients need and want, and what they actually do in a space. When both are married, it can have a significant effect on how fast we move toward a better quality of care for everyone involved in the care continuum.

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Alan Rheault has been Director of Industrial Design for Nurture since 2005. Rheault is among HealthCare Design Magazine’s top 10 product designers of the year (2009). He has more than 17 years of experience with Steelcase.