Practice Pointers Your waiting room: Create a first-rate impression

Sit for 15 minutes in your own waiting room. It can be an eye-opening experience. How long has it been since the cleaning service touched the baseboard? Who'd want to touch, never mind read, one of those dog-eared magazines? What's that mysterious carpet stain? Who chose that music? And what's that funny smell?

"Patients form opinions about their doctors based on what they see, hear, and smell when they walk through the office door," says Rosalyn Cama, a healthcare interior designer in New Haven, CT.

"The reception area sets the tone for the visit," says William Soper, an FP in Kansas City. "If patients are uncomfortable, their anxiety extends back into the exam room."

How can you improve that first impression?

Help patients find their way in

A small, welcoming foyer carpeted with thick, durable material greets patients who enter the waiting room of Irwin Berkowitz, a pediatrician in a five-doctor group in Woodcliff Lake, NJ. In the center is his practice logo featuring a juicy red apple reflecting the orchards nearby.

Inviting patients in with a comfortable entrance area like Berkowitz has is the first step in making a good first impression. Making sure they can see the receptionist as soon as they enter is the second step. "From the moment patients arrive, it should be clear where to sign in," says Rosalyn Cama. "And there should always be someone there to greet the patient."

"The receptionist should seem available to incoming patients," advises Tim Griffin, a medical planning consultant with Medical Design International in Atlanta. "If she's behind a cold, glass window that screeches like a haunted house when it's slid open, she doesn't seem available."

Having a receptionist greet a patient immediately and ask for his name makes him feel welcome. Receptionists in Berkowitz's office keep track of the sequence of incoming patients by entering their names into the computer as they arrive, then putting their charts into a rack in chronological order. Privacy screens blur the computer monitors.

One medical office has a concierge greet patients, says Cama. She shows them where to put their coats, escorts them to a chair, then takes their information. All is done quietly and discretely. "Patients are treated as though they're in a fine restaurant," she says.

If your office is big enough, have separate check-in and checkout areas. A new-patient interview area should be away from the reception room, in an alcove or insurance room, for example.

Keep furnishings practical but comfortable

Other aspects of your reception room that help set the tone for patient visits include the following:

Windows. If possible, have at least one window to the outdoors in your reception area.

"A lot of offices have exam rooms with windows, but then the blinds have to be closed—what a waste," says Cama. "Instead, pull patients through the waiting room on an outside wall with access to daylight. Natural scenes reduce stress levels." If you have a southern exposure, cover windows with translucent shades that let in the light yet prevent glare.

Wall coverings. Opt for washable wall coverings in patterns that don't show wear. Irwin Berkowitz and his partners have Lucite panels over strategic locations, such as the check-in area, to protect the wallpaper. His cost for that was $800.

"Decorate your waiting room in a color scheme that's distinguishable from other rooms in the office, so patients don't get lost," advises Tim Griffin. "Highlighting the checkout area and providing exit signs help people find their way out."

Floor coverings. "Carpeting may not be the most practical solution to keeping the floor clean, but it holds the noise level down," says Griffin. "The industrial type in dark patterns that hide stains is most practical." Most doctors should have the reception area carpet cleaned every three months. For areas that get the most wear—right in front of the reception area, for example—consider the "welcome mat" type that pediatrician Berkowitz has in his foyer. Wiping feet at that point keeps the rest of the carpet cleaner.

Lighting. Most designers advise incandescent rather than fluorescent lighting because it's homier, but make sure your room is well lit for safety as well as for comfortable reading. As long as you have diffusers over your fluorescent lights, they shouldn't create a glare. Plug protectors in electrical outlets keep little fingers safe.

Seating. "Most doctors I design for prefer chairs over sofas," says Griffin. "Who wants to sit right next to a coughing, sneezing, or otherwise contagious stranger?" Also, the elderly and infirm often have difficulty getting up from a sofa without the help of two sturdy arms. An argument for one or two sofas is that moms like to have their kids close. It depends on your practice.

"Don't forget to provide seating for your obese patients," says Soper. "Furniture suppliers make extra sturdy, wider chairs, some without arms, that appear no different from ordinary seating." Obese patients often choose a bench with a back and a wide seat, he says. Choose furniture with vinyl or washable, good quality fabric slipcovers.

"Don't give your office an airport look," advises Cama. "Cluster chairs, but no more than five in a group. Whatever you do, don't line furniture around walls. Create seating vignettes as you would in your living room."

Choose diversions that set the right mood

Should you provide TV for your waiting patients? "No," says Soper. "Having a TV or Internet access sends patients the message that they should expect to wait a long time. It says, 'We know we're going to inconvenience you, so we're tossing you this bone.'

"Also, to be heard, TVs have to be loud. Patients in your reception are sick, or worried they might be. They don't need inane chatter."

If you still want a TV, playing educational materials is better than network entertainment, says Tim Griffin. "If you must, run DVDs or a cable news network," he says.

Soper says No even to educational tapes: Too many ads.

"I'd rather have my patients read and look at the fish tank," says Berkowitz. "That better promotes my philosophy." A large saltwater aquarium, maintained by a service, sits in the corner of his waiting room. The setup cost his practice $2,500; maintenance costs $60 every two weeks. The tank is covered to keep his young patients from feeding Gummy Bears to the fish.

Some practices play CDs or a radio station for their patients. Make sure your music is inoffensive—light rock or jazz, the kind of music provided by Muzak for hotels. An alternative is PlayNetwork, which, for about $40 a month, provides a customized selection of music.

"The doctor specifies the mood he wants to convey," says Ryan Risenmay of PlayNetwork in Redmond, WA. "Each month we send a new selection of up to 20 hours of music." A player about the size of a VCR must be purchased or rented, and it works with existing sound systems.

A respectable selection of magazines, including popular ones such as Good Housekeeping, Smithsonian, Sporting News, and Time, should cost about $100 per year. Provide a variety that will appeal to men and women, young and old, but nothing controversial or political. If your staff brings magazines and catalogs from home, make sure they remove the address labels. The important thing is that the issues be recent, clean, and well organized rather than scattered about.

Louis Fabian, a retired dermatologist in Naples, FL, used to place a basket of goodies—samples of soaps, shampoos, sunscreens—in his waiting room. "Everyone likes something for nothing," he says. "When the basket was empty, they'd let us know."

William Soper likes plants in a reception area but has given up trying to keep them alive, so he now uses silk alternatives. "They can act as a room divider and provide privacy."

If you need to provide an area for children, separate it from the rest of the reception area by a half-wall and stock it with quiet toys and books. "Place an adult chair there to indicate that a parent should supervise the area," advises Soper.

Provide a restroom for patients off the waiting area, especially if the building doesn't supply a convenient one, and a storage area for wheelchairs, walkers, and strollers. Patients also appreciate a bulletin board presenting magazine articles about nutrition, notices about counseling sessions, or alerts on toy recalls.

Consider hiring a designer

Do you need a designer to pull it all together? "Yes," says Louis Fabian, who paid $10,000 about 20 years ago for designers' advice, furniture, and wall coverings. "It was money well spent. Patients love the way our color coordination looks—they say it's restful."

Soper, who also hired a designer, agrees: "In the long run, the designer saved me as much money as she charged, if not more."

How does the design process work? "Before either side signs a contract, we meet with the client to discuss budget, scope of services, and schedule," says Rosalyn Cama. "We delineate how long the project should take, and the drawings and documents we'll produce." Her design firm works on either a fixed fee or an hourly rate. As an example, for a five-doctor, multispecialty group in middle America, renovation of a waiting area with no new construction could cost up to $5,000. The hourly rate at Cama's firm is $170 an hour for principal designers, $110 for senior designers, and $80 hour for support staff. The fee includes specifications for furnishings but not the furniture itself; the designer refers the client to an appropriate dealership. The firm charges a retainer of about 10 percent, then bills the doctor monthly for the balance.

"We find out the client's needs and priorities," says Cama. "But part of our job is not to just do what doctors tell us—we try to stretch their thinking."

What if the doctor doesn't like what the designer does? "If by the third go-round you and your designer are still hitting a brick wall, you may be ill-matched," says Cama. "There's a clause in the letter of agreement we use that allows for severing the services." Have a lawyer look at your contract, in any case.

"If the doctor changes the scope of services, the contract must be adjusted, and it may cost more money," she says.

Choose a reliable firm, and don't sign a contract until you have a good idea of what the designer has in mind, advises FP William Soper. Also make sure the designer you talk with is the one who'll actually handle your case.

How large should your waiting room be?

"The size of a waiting room should be based on productivity," says Tim Griffin, a medical planning consultant with Medical Design International in Atlanta.

"If two doctors each see six patients an hour, anticipate 12 patients coming through the door, plus tag-alongs." To allow for patients' family members or friends in a primary care office, Griffin suggests multiplying the number of patients by 1.5 to 2.5. Then subtract the number of people your receptionist ushers into exam rooms. If that number is six, then 12 to 24 people would need places to sit.

Heed local codes

Local building, safety, and accessibility codes typically stipulate that, for physicians' waiting areas:

Pathways must be 44 inches wide.

The turning radius for wheelchairs must be 60 inches.

Doorways must be 36 inches wide.

Reception counters should have an area low enough to accommodate wheelchairs.

Restrooms must be wheelchair-accessible.

"Requirements change from jurisdiction to jurisdiction," says Tim Griffin, a medical planning consultant with Medical Design International in Atlanta. A capable design firm will do code searches for each job.

Dorothy Pennachio. Practice Pointers: Your waiting room--Create a first-rate impression.

Medical Economics

Nov. 7, 2003;80:47.