Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Description of the Waiting Space
2.3. Architectural Mapping
2.4. Data Analysis
3. Results
3.1. Description of Observations
3.2. Patterns in Seat Occupancy: Direction of Seating
3.3. Patterns in Seat Occupancy: Chair Selection
3.4. Patterns in Seat Occupancy: Time of Day
3.5. Personal Items
3.6. Activities
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Steele, J.R.; Jones, A.K.; Clarke, R.K.; Shoemaker, S. Health Care Delivery Meets Hospitality: A Pilot Study in Radiology. J. Am. Coll. Radiol. 2015, 12, 587–593. [Google Scholar] [CrossRef] [PubMed]
- Morgan, J.R.I. Growing Negative Services. MIT Sloan Manag. Rev. 2006, 47, 69. [Google Scholar]
- Collins, P.B.; Coren, J.S.; Dinzeo, T.J.; Lehrman, S. Improving the Waiting Room Experience. Fam. Pract. Manag. 2020, 27, 14–18. [Google Scholar] [PubMed]
- Arneill, A.B.; Devlin, A.S. Perceived quality of care: The influence of the waiting room environment. J. Environ. Psychol. 2002, 22, 345–360. [Google Scholar] [CrossRef]
- Oostrom, T.; Einav, L.; Finkelstein, A. Outpatient Office Wait Times And Quality Of Care For Medicaid Patients. Health Aff. 2017, 36, 826–832. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cheung, P.T.; Wiler, J.L.; Lowe, R.A.; Ginde, A.A. National study of barriers to timely primary care and emergency department utilization among Medicaid beneficiaries. Ann. Emerg Med. 2012, 60, 4–10. [Google Scholar] [CrossRef]
- Liao, E.N.; Chehab, L.Z.; Neville, K.; Liao, J.; Patel, D.; Sammann, A. Using a Human-Centered, Mixed Methods Approach to Understand the Patient Waiting Experience and Its Impact on Vulnerable Populations. Res. Sq. 2022. [Google Scholar] [CrossRef]
- Healthcare Pain Index 2019. Available online: https://www.qualtrics.com/m/assets/wp-content/uploads/2019/11/Healthcare_PI_Report.pdf. (accessed on 24 February 2022).
- Wright, S. From ‘holding pen’ to ‘a space to breathe’: Affective landscapes in a newly-integrated sexual health clinic. Sociol. Health Illn. 2019, 41, 806–820. [Google Scholar] [CrossRef] [Green Version]
- Chu, H.; Westbrook, R.A.; Njue-Marendes, S.; Giordano, T.P.; Dang, B.N. The psychology of the wait time experience-what clinics can do to manage the waiting experience for patients: A longitudinal, qualitative study. BMC Health Serv. Res. 2019, 19, 1–10. [Google Scholar] [CrossRef] [Green Version]
- Fernandes, C.M.; Daya, M.R.; Barry, S.; Palmer, N. Emergency department patients who leave without seeing a physician: The Toronto Hospital experience. Ann. Emerg Med. 1994, 24, 1092–1096. [Google Scholar] [CrossRef]
- Oche, M.; Adamu, H. Determinants of patient waiting time in the general outpatient department of a tertiary health institution in north Western Nigeria. Ann. Med. Health Sci. Res. 2013, 3, 588–592. [Google Scholar] [CrossRef] [PubMed]
- Becker, F.; Douglass, S. The Ecology of the Patient Visit: Physical Attractiveness, Waiting Times, and Perceived Quality of Care. J. Ambul. Care Manag. 2008, 31, 128–141. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Xuan, X.; Li, Z.; Chen, X.; Cao, Y.; Feng, Z. Study of the Physical Environment of Waiting Areas and Its Effects on Patient Satisfaction, Experience, Perceived Waiting Time, and Behavior in China. HERD 2021, 14, 108–123. [Google Scholar] [CrossRef] [PubMed]
- Gilliam, M.L.; Martins, S.L.; Bartlett, E.; Mistretta, S.Q.; Holl, J.L. Development and testing of an iOS waiting room “app” for contraceptive counseling in a Title X family planning clinic. Am. J. Obstet. Gynecol. 2014, 211, 481.e1–481.e8. [Google Scholar] [CrossRef]
- Habermehl, N.; Diekroger, E.; Lazebnik, R.; Kim, G. Injury Prevention Education in the Waiting Room of an Underserved Pediatric Primary Care Clinic. Clin. Pediatr. 2019, 58, 73–78. [Google Scholar] [CrossRef]
- Henize, A.W.; Beck, A.F.; Klein, M.D.; Morehous, J.; Kahn, R.S. Transformation of a Pediatric Primary Care Waiting Room: Creating a Bridge to Community Resources. Matern. Child. Health J. 2018, 22, 779–785. [Google Scholar] [CrossRef]
- Khan, M.A.; Shah, S.; Grudzien, A.; Onyejekwe, N.; Banskota, P.; Karim, S.; Jin, J.; Kim, Y.; Gerber, B.S. A diabetes education multimedia program in the waiting room setting. Diabetes Ther. 2011, 2, 178–188. [Google Scholar] [CrossRef] [Green Version]
- Patel, D.; Sarlati, S.; Martin-Tuite, P.; Feler, J.; Chehab, L.; Texada, M.; Marquez, R.; Orellana, J.F.; Henderson, T.; Nwabuo, A.; et al. Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study. JMIR Mhealth Uhealth 2020, 8, e15866. [Google Scholar] [CrossRef]
- Fenko, A.; Loock, C. The influence of ambient scent and music on patients’ anxiety in a waiting room of a plastic surgeon. HERD 2014, 7, 38–59. [Google Scholar] [CrossRef]
- Joseph, A. The Impact of Light on Outcomes in Healthcare Settings; The Center for Health Design: Concord, CA, USA, 1 March 2022. [Google Scholar]
- López-Tarruella, J.; Llinares Millán, C.; Serra Lluch, J.; Iñarra Abad, S.; Wijk, H. Influence of Color in a Lactation Room on Users’ Affective Impressions and Preferences. HERD 2019, 12, 55–70. [Google Scholar] [CrossRef]
- Minckley, B.B. A study of noise and its relationship to patient discomfort in the recovery room. Nurs Res. 1968, 17, 247–250. [Google Scholar] [CrossRef] [PubMed]
- Frederic, E.; Johan, S.; Rolf, W.; Cyrille, D.; Alain, G.; Christian, L. Improving Patients Experience in Peadiatric Emergency Waiting Room. Stud. Health Technol. Inform. 2016, 1, 535–539. [Google Scholar] [CrossRef]
- Rondeau, K.V. Managing the clinic wait: An important quality of care challenge. J. Nurs. Care Qual. 1998, 13, 11–20. [Google Scholar] [CrossRef] [PubMed]
- Spechbach, H.; Rochat, J.; Gaspoz, J.M.; Lovis, C.; Ehrler, F. Patients’ time perception in the waiting room of an ambulatory emergency unit: A cross-sectional study. BMC Emerg. Med. 2019, 19, 41. [Google Scholar] [CrossRef]
- Taylor, B.W.; Wilcox, A.; Morrison, K.; Hiltz, M.A.; Campbell, M.; MacPhee, E.; Wentzell, M.; Gujar, S. Implementation of a Game-based Information System and e-Therapeutic Platform in a Pediatric Emergency Department Waiting Room: Preliminary Evidence of Benefit. Procedia Comput. Sci. 2015, 63, 332–339. [Google Scholar] [CrossRef] [Green Version]
- Biddiss, E.; McPherson, A.; Shea, G.; McKeever, P. The design and testing of interactive hospital spaces to meet the needs of waiting children. HERD 2013, 6, 49–68. [Google Scholar] [CrossRef]
- Devlin, A.S.; Anderson, A.; Hession-Kunz, S.; Kelly, M.; Noble, L.; Zou, A. Magnitude Matters: Art Image Size and Waiting Time Impact Perceived Quality of Care. HERD 2020, 13, 140–153. [Google Scholar] [CrossRef]
- McLaughlan, R.; Sadek, A.; Willis, J. Attractions to Fuel the Imagination: Reframing Understandings of the Role of Distraction Relative to Well-Being in the Pediatric Hospital. HERD Health Environ. Res. Des. J. 2019, 12, 130–146. [Google Scholar] [CrossRef] [Green Version]
- Mihandoust, S.; Joseph, A.; Kennedy, S.; Macnaughton, P.; Woo, M. Exploring the Relationship between Window View Quantity, Quality, and Ratings of Care in the Hospital. Int. J. Environ. Res. Public Health 2021, 18, 10677. [Google Scholar] [CrossRef]
- Nanda, U.; Chanaud, C.; Nelson, M.; Zhu, X.; Bajema, R.; Jansen, B.H. Impact of Visual Art on Patient Behavior in the Emergency Department Waiting Room. J. Emerg. Med. 2012, 43, 172–181. [Google Scholar] [CrossRef]
- Barlas, D.; Sama, A.E.; Ward, M.F.; Lesser, M.L. Comparison of the auditory and visual privacy of emergency department treatment areas with curtains versus those with solid walls. Ann. Emerg. Med. 2001, 38, 135–139. [Google Scholar] [CrossRef]
- Jiang, S.; Powers, M.; Allison, D.; Vincent, E. Informing Healthcare Waiting Area Design Using Transparency Attributes: A Comparative Preference Study. HERD 2017, 10, 49–63. [Google Scholar] [CrossRef] [PubMed]
- Zeisel, J. Observing Environmental Behavior-Chapter 8. In Inquiry by Design: Tools for Environment-Behavior Research; CUP Archive: Cambridge, UK, 2016. [Google Scholar]
- Behavioral Mapping and Tracking-Research Methods for Environmental Psychology-Wiley Online Library. Available online: https://onlinelibrary.wiley.com/doi/10.1002/9781119162124.ch3 (accessed on 17 June 2022).
- Behavioral Mapping of Children’s Physical Activities and Social Behaviors in an Indoor Preschool Facility: Methodological Challenges in Revealing the Influence of Space in Play. International Journal of Health Geographics. Available online: https://ij-healthgeographics.biomedcentral.com/articles/10.1186/s12942-019-0191-y (accessed on 17 June 2022).
- Qi, Y.; Yan, Y.; Lau, S.S.; Tao, Y. Evidence-Based Design for Waiting Space Environment of Pediatric Clinics-Three Hospitals in Shenzhen as Case Studies. Int. J. Environ. Res. Public Health 2021, 18, 11804. [Google Scholar] [CrossRef]
- Jafarifiroozabadi, R.; Joshi, R.; Joseph, A.; Wingler, D. Perceived Usability of Seating in an Outpatient Waiting Area: A Combined Approach Utilizing Virtual Reality and Actual Seating Prototypes. HERD Health Environ. Res. Des. J. 2022, 15, 248–261. [Google Scholar] [CrossRef] [PubMed]
- Abraído-Lanza, A.F.; Céspedes, A.; Daya, S.; Flórez, K.R.; White, K. Satisfaction with health care among Latinas. J. Health Care Poor Underserved 2011, 22, 491–505. [Google Scholar] [CrossRef] [Green Version]
- Gotlieb, E.G.; Rhodes, K.V.; Candon, M.K. Disparities in Primary Care Wait Times in Medicaid versus Commercial Insurance. J. Am. Board Fam. Med. 2021, 34, 571–578. [Google Scholar] [CrossRef]
- Huq, F.; Nakamura, M.; Black, K.; Chubb, H.; Helfrich, Y. Association of dermatology wait times with insurance coverage in Michigan. Am. J. Manag. Care 2020, 26, 432–437. [Google Scholar] [CrossRef]
- Monstad, K.; Engesaeter, L.B.; Espehaug, B. Waiting time and socioeconomic status—An individual-level analysis. Health Econ. 2014, 23, 446–461. [Google Scholar] [CrossRef] [Green Version]
- Siciliani, L.; Verzulli, R. Waiting times and socioeconomic status among elderly Europeans: Evidence from SHARE. Health Econ. 2009, 18, 1295–1306. [Google Scholar] [CrossRef]
- Zakare-Fagbamila, R.T.; Park, C.; Dickson, W.; Cheng, T.Z.; Gottfried, O.N. The true penalty of the waiting room: The role of wait time in patient satisfaction in a busy spine practice. J. Neurosurg. Spine 2020, 33, 95–105. [Google Scholar] [CrossRef] [PubMed]
- DOTT-Home. Available online: https://www.dott-tool.com/ (accessed on 6 April 2022).
- Pati, D.; Nanda, U. Influence of Positive Distractions on Children in Two Clinic Waiting Areas. HERD Health Environ. Res. Des. J. 2011, 4, 124–140. [Google Scholar] [CrossRef] [PubMed]
- McKinnon, K.; Crofts, P.D.; Edwards, R.; Campion, P.D.; Edwards, R.H. The outpatient experience: Results of a patient feedback survey. Int. J. Health Care Qual. Assur. Inc. Leadersh Health Serv. 1998, 11, 156–160. [Google Scholar] [CrossRef] [PubMed]
- Ibrahim, F.; Harun, W.M.W.; Samad, M.H.A. The Waiting Space Environment: Perception by Design. Am. J. Eng. Appl. Sci. 2010, 3, 569–575. [Google Scholar] [CrossRef] [Green Version]
- Kutash, M.; Northrop, L. Family members’ experiences of the intensive care unit waiting room. J. Adv. Nurs. 2007, 60, 384–388. [Google Scholar] [CrossRef] [PubMed]
- Sommer, R. The Ecology of Privacy. Libr. Q. 1966, 36, 234–248. [Google Scholar] [CrossRef]
- Ossmann, M. Sommer Revisited: Seating Patterns in a Hospital Waiting Room. In Proceedings of the 43rd Environmental Design Research Association, Seattl, WA, USA, 30 May–2 June 2012; p. 214. [Google Scholar]
Demographics | Patients Seen (n = 17,632) No. (%) |
---|---|
Age, average (standard deviation), years | 52.5 (15.3) |
Gender | |
- Female | 22,614 (34.8) |
- Male | 11,412 (64.7) |
- Unknown | 221 (0.3) |
Race/Ethnicity | |
- Hispanic | 1153 (6.5) |
- Non-Hispanic Black | 3053 (17.3) |
- Non-Hispanic Asian | 3285 (18.6) |
- Non-Hispanic White | 4535 (25.7) |
- Non-Hispanic Other | 5280 (30.0) |
- Unknown or Decline to States | 326 (1.8) |
Primary language | |
- English | 11,695 (66.3) |
- Spanish | 3303 (18.7) |
- Cantonese | 1320 (7.5) |
- Other language | 1166 (6.6) |
- Unknown | 148 (0.84) |
Family size | |
- One member | 14,305 (81.1) |
- Two members | 1807 (10.3) |
- Three members | 678 (3.9) |
- Four members | 521 (3.0) |
- Greater than four members | 321 (1.8) |
Income source | |
- Professional/technical * | 343 (2.0) |
- Labor/production ^ | 1144 (6.5) |
- Service/sales | 2148 (12.2) |
- Retirement income | 336 (1.9) |
- Disability income | 822 (4.7) |
- General or public assistance | 1023 (5.8) |
- Other ** | 1049 (6.0) |
- None | 10,767 (61.1) |
Description | Frequency n (%) |
---|---|
Observations Involving People (n = 536) | |
Patient | 408 (76) |
Family Members | 125 (23) |
Staff Members | 3 (1) |
Observations Involving Personal Items (n = 179) | |
Mobility related items (wheelchair, crutches, cast, walker, baby stroller) | 72 (40) |
Purse or bag | 71 (40) |
Miscellaneous (e.g., food, clothing) | 36 (2) |
Seat Orientation | Seat Number | Occupation Frequency, % (n) |
---|---|---|
Facing the door | 2 | 10.9% (53) |
Facing the door | 3 | 10.5% (51) |
Facing the door | 4 | 9.7% (47) |
Facing the TV | 6 | 9.7% (47) |
Facing the TV | 7 | 9.0% (44) |
Facing the door | 1 | 8.4% (41) |
Facing the TV | 8 | 7.8% (38) |
Facing the window | 12 | 7.8% (38) |
Facing the window | 11 | 6.2% (30) |
Facing the window | 9 | 5.7% (28) |
Facing the window | 10 | 5.7% (28) |
Facing the door | 5 | 3.9% (19) |
In the hallway | 13 | 2.9% (14) |
In the hallway | 14 | 1.0% (5) |
In the hallway | 15 | 0.8% (4) |
In the hallway | 16 | 0% (0) |
Seat Number | Seat Orientation | Occupation Frequency by Patients (%, n) | Occupation Frequency by Family Members, % (n) |
---|---|---|---|
1 | Facing the door | 7.8% (29) | 10.5% (12) |
2 | Facing the door | 10.8% (40) | 11.4% (13) |
3 | Facing the door | 10.2% (38) | 11.4% (13) |
4 | Facing the door | 10.0% (37) | 8.8% (10) |
5 | Facing the door | 3.8% (14) | 4.4% (5) |
6 | Facing the TV | 10.5% (39) | 7.0% (8) |
7 | Facing the TV | 10.0% (37) | 6.1% (7) |
8 | Facing the TV | 6.2% (23) | 12.3% (14) |
9 | Facing the window | 7.6% (28) | 0% (0) |
10 | Facing the window | 5.7% (21) | 7.1% (7) |
11 | Facing the window | 5.4% (20) | 8.8% (10) |
12 | Facing the window | 8.1% (30) | 7.0% (8) |
13 | In the hallway | 2.4% (9) | 3.5% (4) |
14 | In the hallway | 0.5% (2) | 1.8% (2) |
15 | In the hallway | 1.1% (4) | 1.0% (1) |
16 | In the hallway | 0% (0) | 0% (0) |
Chair Type | Morning Clinic n (%) | Afternoon Clinic n (%) |
---|---|---|
Chairs facing the door | 119 (45) | 88 (45) |
Chairs facing the TV | 69 (26) | 50 (25) |
Chairs facing the window | 69 (26) | 48 (23) |
Chairs facing the hallway | 8 (3) | 14 (7) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Liao, E.N.; Chehab, L.Z.; Ossmann, M.; Alpers, B.; Patel, D.; Sammann, A. Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital. Int. J. Environ. Res. Public Health 2022, 19, 13870. https://doi.org/10.3390/ijerph192113870
Liao EN, Chehab LZ, Ossmann M, Alpers B, Patel D, Sammann A. Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital. International Journal of Environmental Research and Public Health. 2022; 19(21):13870. https://doi.org/10.3390/ijerph192113870
Chicago/Turabian StyleLiao, Elizabeth N., Lara Z. Chehab, Michelle Ossmann, Benjamin Alpers, Devika Patel, and Amanda Sammann. 2022. "Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital" International Journal of Environmental Research and Public Health 19, no. 21: 13870. https://doi.org/10.3390/ijerph192113870