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Waiting is a fact of life.

We wait to get our food in restaurants. We wait to get on planes or trains in airports and rail stations. We wait to get on rides at theme parks.

We wait for concerts or plays to start. We wait to meet with people for business appointments. And we wait to see the doctor or nurse.

Danville, Pa.-based Geisinger Health System CEO David Feinberg, MD, wants to eliminate the hospital waiting room — especially in the ED, where patients complain about waiting the most.  In a recent LinkedIn post, he wrote:

“Personally, I’d like to eliminate the waiting room and everything it represents. A waiting room means we’re provider-centered — it means the doctor is the most important person and everyone is on their time. We build up inventory for that doctor — that is, the patients sitting in the waiting room.”

Feinberg also makes the point that to be “truly patient-centered, we need to get rid of waiting rooms.”

He suggests that treatment begin immediately upon entering the ED, with current ED waiting rooms becoming more like clinical treatment spaces.

Interesting idea don’t you think?

And while I think it might be possible to get rid of the waiting room in an ED, I’m not so sure it’s possible in a treatment area in a hospital, clinic, or doctor’s office where there isn’t an emergency.

So, if waiting is a fact of life, the focus in healthcare should be to create comfortable waiting areas that support what patients and families do while they are waiting.

What Do People Do While Waiting?

Steelcase Health recently conducted a study where researchers observed and captured more than 75 behavior maps of patients and families waiting in a major academic medical center in the southeastern U.S.  Here’s what people do while they wait:

  1. Interact with family – 24%
  2. Look at their phone or tablet – 23%
  3. Don’t do anything – 21%
  4. Watch TV – 10 %
  5. Interact with others – 7%
  6. Do paperwork – 6%
  7. Read a book – 3%
  8. Sleep – 3%
  9. Do computer work – 1%
  10. Listen to something while wearing headphones – 1%
  11. Talk on the phone – 1%

The most surprising thing to me is that 21% aren’t doing anything. Which means that they might be staring out the window (if there is one) — or at the person sitting across from them. And even though they aren’t watching TV, if it is on, they are hearing it in the background.

A much smaller study observational study of ambulatory, urgent care, and emergency waiting areas conducted by CDH Partners found that even if there was a TV right in front of them, most people weren’t looking at it.  They were looking at their phones or tablets instead.

“Positive waiting experiences and space design are linked with the perception of quality care, a key metric for today’s healthcare organizations,” Steelcase Health stated in its report. “Well-designed waiting experiences that decrease stress and promote active engagement can help improve patient satisfaction scores both during waiting and subsequent care encounters.”

Ken Hutchenrider, President of Methodist Richardson Medical Center in Dallas, Tex., gained a new appreciation of this after opening several renovated waiting spaces in 2014.  “Going into this project, waiting rooms were not something we were focusing on or we thought would be a feature, and that would receive as much praise…Our new waiting rooms are by far one of the best features of our new hospital,” he said to Steelcase Health.

Clearly, it’s time to start looking at waiting spaces as an asset rather than a necessity.

Want More?

Here’s a few other resources with ideas for designing waiting spaces and improving the experience.

“Design Solutions to Improve Waiting” article by Joan Suchomel in Healthcare Design.

“Waiting, Waiting, and More Waiting – Is This Quality Care?” blog post by Susan E. Mazer.

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Leave a comment



Jan Stichler

3 years ago

In theory, eliminating waiting rooms for EDs seems to be a perfect solution to eliminating waiting times. However, EDs, Labor & Delivery units and other similar hospital departments have significant variability as to when patients arrive, and these units have absolutely no control over than variability. Therefore, unless the hospital plans to staff to the peak at all times (financially unreasonable), there will be times when people need to wait while others with more emergent and urgent needs are cared for first. So eliminating the waiting room will simply cause people to wait at the door way, in their cars, hallway or some other location.

Eliminating the physical structure of the waiting room is not the solution to a through-put process problem. The better way to achieve improved outcomes of reduced ED waiting times, is to examine the throughput and process scenarios, and put solutions in place to address these issues. Examine where the blockages and barriers to efficient throughput exist.

Eliminating the waiting room to reduce waiting times is like putting your head in the sand when you don’t want to face a problem. Eliminating the waiting room will cause a lot more problems than it will solve.

Sara Marberry

3 years ago

Well said, Jan! Thanks for your insights and comments.

Eric Lautzenheiser, AIA, ACHA

3 years ago

Am certain that there are times that a waiting space addresses spatial or operational challenges that are not adequate for the standard daily throughput. In those circumstances, the waiting room acts as a safety net/catchall…..when renovating or replacing clinical areas that seem to have a bizarre or disproportionate use of waiting, I think it remains part of our role as a professional to tease out the dysfunctions, and do our best, within our role to resolve those and apportion space accordingly. Given increasingly stringent budgets, apportioning space/$$$ is obviously a key concern.

Certainly ED settings are among the most contested…. I note that one institution that I work with implemented a split flow model with “rapid triage” upon point of arrival; this ED has fewer than 20 seats and now has volumes approaching 100,000 visits/year. In my various observations of this ED (at all hours of the day or night) I have never seen it used to capacity. Conversely, at a major urban ED, it was very easy to determine that the use of the waiting space was confounded by its ad-hoc use as a “Results Waiting” environment in addition to “point of arrival”waiting. – One organization has a highly tuned operational process, the other is making the marginally best out of inadequate space.

To respond to the Geisinger CEO’s desire for a “no-wait” ED – I would agree that the ED waiting space can be reshaped for rapid treatment flow, but it will work only if the operational process “buy-in” at all levels of clinical involvement is present. That must be paired by our professional responss. In retuning existing space, we need to make sure that we work with key leadership to achieve space that addresses the average daily/weekly peak volumes, always a compelling issue in ED planning……

In other settings, I do think there needs to be a careful assessment of the role of waiting space in relation to patients and the inevitable “entourage factor” which can be modest or (patient arrives solo), depending upon the community, massive (patient arrives with family, extended family and interested neighbors). That noted, making sure that we attempt to “right size” for flow and a presumed efficient process throughput is essential in planning and design processes… the use of “standard benchmarks” for “key driver room count” to “waiting room seats” is no longer an acceptable or easy solution…

len Berry

3 years ago

We may not be able to eliminate the ED waiting room in all cases, but it is not an unreasonable consideration. Doing so forces the hospital and the ED to get serious about redesigning care processes and eliminating time- and resource-wasting practices. Many hospital emergency departments today post estimated waiting periods and guarantee patients seeing a doctor within 30 minutes. Doing so demands a commitment to improving efficiency. And by the way, a few EDs have in fact eliminated the waiting room. As the source of many hospital admissions, the ED better improve its convenience given the growing competition from urgent care centers, free-standing ERs, and online healthcare delivery. I don’t think Dr. Feinberg’s head is in the sand at all.

Kurt Neubek, FAIA, EDAC, SSBB

3 years ago

Eliminating waiting rooms is mathematically not that difficult–just estimate how many patients would be waiting and add that many exam rooms. But that ignores the other reasons for a waiting room! When a whole family shows up to show their support, where will they go? When the patient needs an exam or procedure and the visitors are asked to step out, where will they go? When a visitor or family member has to take a call or work on their computer for a while, where will they go? Maybe to a lobby or corridor nook or coffee shop, but those are other forms of waiting rooms.
If the goal is to eliminate unnecessary wait times, let’s focus on that and not lose the baby with the bath water.

4 New Healthcare Design Resources You Should Know About, Plus a Few More - Sara Marberry Sara Marberry

3 years ago

[…] Should the Hospital & Clinic Waiting Room Be Eliminated? […]

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Sara Marberry, EDAC, is a healthcare design knowledge expert, thought catalyst, and strategic marketing and business development consultant. The author/editor of three books, Sara writes and speaks frequently about industry trends and evidence-based design. She can be reached at sara@saramarberry.com.

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