Advertisement

Making the most of what you have: improving patient and provider experiences at an eye clinic through interior design

Published:September 02, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.08.002
      Located in Edmonton, Alberta, the Eye Institute of Alberta (EIA) is the hub of ophthalmic care for more than 3 million people in northern Alberta and Canada's northern territories (https://www.albertahealthservices.ca/rah/Page16343.aspx). It includes an eye clinic, several operating rooms, an inpatient ward, a surgical skills laboratory, teaching facilities, and administrative areas. The Outpatient Eye Clinic within the EIA provides care to 45 000 patients per year; the full spectrum of ophthalmic disease is treated at this centre.
      Since being built in 1996, the Outpatient Eye Clinic had greatly outgrown the 15 000 patients a year it was initially built to accommodate. Unfortunately, relocating into a new, larger space is not a realistic option in the foreseeable future; hence we embarked on a journey to update and adapt our existing space with the goals of enhancing patient and provider experiences.
      A beneficiary-centric approach was taken to evaluate the best way to improve patient experience at the Outpatient Eye Clinic. Two hundred and seven consecutive patients were asked to participate by members of Alberta Health Service's Engagement and Patient Experience Team. A standardized paper survey was used to elicit patient feedback about specific areas of possible improvement at the clinic. Similarly, frontline care providers and physicians were also asked to identify opportunities to optimize both patient and provider experiences, including learner experiences. An evaluation by the Alberta Committee of Citizens with Disabilities was done to optimize accessibility of the clinic. Consultants with the Human Factors Team at Alberta Health Services were hired to review the navigation processes at the clinic.
      Similar themes arose from consultation with each of the key stakeholders: wayfinding, aesthetics, and patient education (Fig. 1). Specifically, patients were finding it difficult to navigate to the necessary areas of the clinic using the existing signage and layout. The waiting rooms were lacking in patient education materials and meaningful ways to pass the time, such as reading materials, WiFi, or television. A desire to update the look of the space with plants, artwork, and fresh wall colours was noted as well.
      Fig 1
      Fig. 1Qualitative feedback from patients and providers.
      The clinic underwent renovations to incorporate the recommendations made by patients, providers, and additional consultants. A short video covering these features can be seen at https://www.ualberta.ca/ophthalmology/eye-institute-of-alberta/index.html.
      A routine clinic visit often can require patients to stop at multiple desks, wait in different waiting rooms, and visit separate areas of the clinic. The experience of navigating around the clinic has been streamlined through the addition of colour-coded stripes on the floors that are complemented by the same colour coding in the pods (Fig. 2). This allows patients to identify these areas with ease and from a distance. Additional colour coding around the washrooms and diagnostic imaging areas has made them more prominent.
      Fig 2
      Fig. 2Colour-coded stripes in the hallway aid in wayfinding and navigation around the clinic.
      The signage around the clinic also was updated to have a larger font with a higher-contrast background and reinforced with tactile text and Braille to ensure accessibility. Signs were added to key wayfinding decision points. Reception desks have been reoriented so that they are easier for patients to find and make eye contact with the receptionists (Fig. 3). In the past, the reception desk faced away from the primary hallway, requiring patients to make awkward turns to talk to staff. The washrooms have been renovated to be barrier free and are now easily identified throughout the EIA with colour-coordinated ceiling markers and flooring.
      Fig 3
      Fig. 3Entrance and registration desk after incorporating feedback from providers and patients.
      Improving wayfinding reduces the questions asked of staff that may interrupt their work, increases the efficiency of patient flow through the clinic, and lowers stress and anxiety for patients. The ability of patients to move around easily in the clinic is essential to a positive patient experience and to maximize the numbers of patients seen.
      Improved aesthetics in a space can improve the experiences and perceptions patients of the quality of care they receive and promote a sense of well-being.
      • Gauthey J
      • Tièche R
      • Streit S.
      Interior renovation of a general practitioner office leads to a perceptual bias on patient experience for over one year.
      • Siddiqui ZK
      • Zuccarelli R
      • Durkin N
      • Wu AW
      • Brotman DJ.
      Changes in patient satisfaction related to hospital renovation: experience with a new clinical building.
      • Swan JE
      • Richardson LD
      • Hutton JD.
      Do appealing hospital rooms increase patient evaluations of physicians, nurses and hospital services?.
      • Tièche R
      • da Costa BR
      • Striet S.
      Patient satisfaction is biased by renovations to the interior of a primary care office: a pretest-posttest assessment.
      • Mastandrea S
      • Fagioli S
      • Biasi V.
      Art and psychological well-being: linking the brain to the aesthetic emotion.
      A new cohesive colour theme not only served as a practical tool in wayfinding but also created a brighter, calming, and more welcoming space. New donated artwork now adorns the walls in each of the waiting rooms. The new chairs in the waiting room are not only of varying sizes and depths to fit a diverse patient population, including the elderly and bariatric patients, but also complement the natural ambiance of the space. Large windows in the waiting rooms let in natural light to help brighten the space. These changes to the interior design of the space capitalize on the therapeutic potential of art and architecture.
      As a result of feedback from the survey, televisions with educational programming and logistical information have been installed in each of the waiting rooms. Phone charging stations also have been built into the waiting rooms. WiFi guest access is available throughout the clinic, and the clinic's website is routinely updated with news from the departments.
      The renovation also allowed for improvements in the experience of staff at the clinic. For instance, the addition of a new staff lounge has allowed for a touchdown space for staff to socialize with each other during breaks. The Outpatient Eye Clinic serves as the primary teaching site for the residency program; to facilitate resident learning, observer tubes were added to slit lamps and lasers, and designated spaces within each of the pods were created to allow for private discussion. Computers were added in touchdown spaces to enable better connectivity and pave the way for future electronic medical record implementation.
      The $2.3 million required for the renovation was raised by the Royal Alexandra Hospital Foundation. The foundation coordinated a fundraising team that mobilized community support for the renovation (please go to https://www.royalalex.org/eye-institute-of-alberta for details). Alberta Health Services personnel helped to coordinate a proposal for design and construction. We are grateful to all those involved in supporting our renovations.
      Ultimately, although the renovations were able to address much of the feedback from patients and providers, there still remains additional work to be done. For instance, the renovations did not focus on patient flow. However, we are concurrently working on those aspects by engaging consultants through Alberta Health Services Improvement Way who have provided suggestions on how to improve physician and diagnostic templates, cycle time, and so on. These changes are a work in progress.
      We have reworked our current space to improve flow and patient experiences. Although these changes don't obviate our eventual need to grow into a bigger space, they have helped the space reflect the clinic's value of patient-focused care and make the most of our existing environment. The new space puts the patient voice at its centre and will help us provide outstanding and compassionate care in the future.

      Footnotes and Disclosure

      The authors have no proprietary or commercial interest in any materials discussed in this article.

      References

        • Gauthey J
        • Tièche R
        • Streit S.
        Interior renovation of a general practitioner office leads to a perceptual bias on patient experience for over one year.
        PLoS One. 2018; 13e0193221
        • Siddiqui ZK
        • Zuccarelli R
        • Durkin N
        • Wu AW
        • Brotman DJ.
        Changes in patient satisfaction related to hospital renovation: experience with a new clinical building.
        J Hosp Med. 2015; 10: 165-171
        • Swan JE
        • Richardson LD
        • Hutton JD.
        Do appealing hospital rooms increase patient evaluations of physicians, nurses and hospital services?.
        Health Care Manage Rev. 2003; 28: 254-264
        • Tièche R
        • da Costa BR
        • Striet S.
        Patient satisfaction is biased by renovations to the interior of a primary care office: a pretest-posttest assessment.
        BMC Health Serv Res. 2016; 16: 373
        • Mastandrea S
        • Fagioli S
        • Biasi V.
        Art and psychological well-being: linking the brain to the aesthetic emotion.
        Front Psychol. 2019; 10: 739