By Rebecca St. Andrie

Waiting. We don’t like it. In fact, in some cities people pay others just to wait in line for them.

But in health care, waiting is something of a given. In just about every medical office, you’ll find a waiting room. Many of the O&P Almanac’s readers can look outside their offices and see one.

Despite waiting rooms’ reputation as bland, boring and uncomfortable, surveys, experts and even formal research say they don’t have to be. They can, instead, be welcoming and comfortable, creating a great first impression of your business.

If you walk through a waiting room on your way to work, read on. Don’t you want your patients’ experience to be worth the wait?       

Experience it yourself
Many experts on waiting rooms start by giving some common-sense advice: go wait in your own room.
Before or after the workday, take fifteen minutes to sit in the waiting room and observe. What do you see? Is the carpet dirty? The paint chipped? How old are the magazines? And how long can you sit in the chair before you start getting uncomfortable?

Take notes on what you observe. Remember to evaluate receptionists’ counters, entrances and exits from wheelchair level as well.

Follow the guidelines
There are many different guidelines for designing and keeping a waiting room accessible to the disabled. Local and state building codes, as well as civil rights laws such as the Americans with Disabilities Act (ADA), all apply.

Just because there are laws doesn’t mean your building is automatically compliant. Often, there is no approval or permit process for accessibility requirements, and your builder may not have known about all the regulations. The Center for Universal Design, part of North Carolina State University, suggests you check the ADA, the Rehabilitation Act of 1973 and state and local building codes. It also lists some key ADA requirements for waiting rooms:

•    Accessible parking spaces close to entrances
•    Accessible front entrance with ramp and curb cut at appropriate grades and surfaces
•    Interior and exterior doors that are wide and easy to open
•    Accessible route throughout the facility connecting all accessible features and service areas
•    Clear floor space so people, even those using wheelchairs, can get close to and reach all controls and other features
•    Controls, storage facilities and amenities such as magazine and literature racks wheelchair users can reach
•    Low counters, service windows or receptionist stations for transactions with short or seated people
•    Desk-height writing surfaces with knee space for use by wheelchair users and others who cannot stand while transacting business

For reception areas, they suggest that:

•    Large furniture pieces be combined with easy-to-move single chairs to allow multiple seating arrangements
•    Open floor areas be left for wheelchairs or scooters, dispersed throughout seating
•    Adequate space around the door for maneuvering

––“Removing Barriers to Health Care”

These are probably familiar guidelines to you. But review them anyway. A first-hand experience of what it takes to get from the curb to the waiting room will probably expose any obstacles that have crept in since the area was first designed.
    
Soothe the senses
You might also consider what patients hear. For instance, a loud, constantly-ringing telephone can be a major irritant. And everyone has had the experience of being stuck in a place that was playing loud, annoying music. Make sure yours is inoffensive––music without lyrics is probably best––and at a low level.

More and more, patients are asking for TVs to be taken out of waiting rooms. They want someplace quiet, they say. And some design experts feel that installing TVs in the waiting room sends the signal that you are expecting patients to sit and wait for a long time.

What about the other senses? Smell, for instance, is a strong trigger of good (or bad) memories and associations. Strong, sharp or unpleasant odors, such as cleaning fluids or too-strong perfume, may unconsciously color patients’ feelings about your business. If you work there every day, you’ve probably gotten used to them. Ask your patients for feedback or, again, consciously work to register unusual smells once you step in the door.

Finally, anyone who’s worked in an office has heard complaints about the temperature. There’s not an easy solution. One person may be freezing while another can be perfectly fine. Still, check to see if the room has strong drafts or a markedly different temperature from the rest of the building.

Not just the place…the people
But the decor doesn’t matter as much as the people. And the most important person in the waiting room is the receptionist. John Egerton, a retired doctor, wrote a telling story for the magazine Medical Economics about one of his receptionists—a competent, efficient woman who rarely smiled. One morning, a patient named Barry, “a big, cheerful man, invariably full of jokes,” came in.

“Grimly preoccupied with sorting through some papers,” Egerton recounts, “ ‘Sally’ failed to acknowledge Barry’s presence. After a few seconds, he banged his big hand on her desk and proclaimed loudly, ‘Wake up, young lady! Life’s too short to look so miserable!’”

Egerton’s story points out what we already know: patients like to see a smiling face. Many people come into waiting rooms scared, sad or hurting. They appreciate being genuinely welcomed.

“Medical receptionists are charged with a responsibility that may have a lasting impact on the success of an organization: making a good first impression,” says Diana Domeyer, executive director of OfficeTeam, a temporary staffing agency. “Because medical receptionists are often the first professionals a visitor at a medical facility may encounter, they must possess excellent interpersonal skills—being courteous, professional and helpful is critical.”

She adds that any receptionist in a medical office must possess discretion. “Medical receptionists gather patients’ personal and financial information and direct them to the proper examination rooms. Therefore, it is essential that they be discreet and maintain patient confidentiality.”

Egerton agrees. In his article, he recounts the story of a nurse who (in the days before HIPAA) would blurt out in “an exceptionally loud voice” sentences like “John Smith has prostatitis again.”

Training the traits
So remind your receptionists what is and is not a violation of patients’ privacy. You might even suggest
specific wording for awkward situations. In addition, the Center for Universal Designs offers “some basic rules of disability etiquette.” You may want to provide receptionists new to O&P these specific guidelines:

•    Offer assistance to a person with a disability if you feel like it, but wait until your offer is accepted before you help, and listen to any instructions the person may want to give about the best way to assist.
•    Any aid or equipment a person may use, such as a wheelchair, guide cane, walker, crutch or assistance animal, is part of that person’s personal space. Do not touch, push, pull or otherwise physically interact with an individual’s body or equipment unless requested to do so.
•    Always ask before you move a person in a wheelchair, out of courtesy, but also to prevent disturbing the person’s balance.

––“Removing Barriers to Health Care”

However, finding a sensitive, efficient, medically savvy receptionist can be difficult. If you’re trying to train these traits into your current receptionist, use the awkward moments as your guide. Egerton said that his eleven principles came about just from discussing incidents that happened. (See sidebar above.)

Often, the offenders would bring up the situations themselves in the practice’s regular office meeting.
“It’s funny how many people are surprised when they are rude to someone and people object, or they are nice to someone and people respond,” Egerton said.

Though the mention would often take the form of “Mrs. X was really so rude to me!” others in the practice would draw out what really happened in the situation. “People felt fairly free to respond to others and say things like, “Well, you do tend to be a little abrupt,’” comments Egerton.

There were also times when Egerton simply had to pull someone aside and say “This is not how we handle things.” A good office manager who could see and hear the reception area helped him keep tabs on what went on.

Finally, Domeyer points out that, depending on the job description, you may want to hire a medical receptionist who has some familiarity with O&P’s particular medical terminology and billing procedures. She suggests asking the following questions during any hiring process:

1.     How would you bill this type of device?
2.     How would you resubmit a claim to the insurance company electronically?
3.     How would you describe the HIPAA law and what it means to an office?
4.     What types of software did you use in the past, and for what purpose?
5.     What is the difference between private and managed-care insurance?

Eliminate waiting entirely
However, no matter what you do, some people are never going to enjoy waiting. In response, some offices are trying to eliminate the waiting room entirely. Susie Creger, education director of the Virginia Mason Production System at Virginia Mason Hospital in Seattle, spoke about how they rethought the waiting room process when designing a new cancer center.

“When we started to look at patient flow and mapped that out, the amount of waiting our patients were doing was just huge,” she says. “They were waiting a good two-thirds of the visit.

“A lot of that waiting was unnecessary waiting––it was for our convenience,” she continued. “We weren’t ready for them. We were backed up.”

The staff decided that had to change. They started tracking how patients spent their time from the moment they came in the door until the time they left. Then they looked at the flow of all the medical professionals in the office.

Next, they brought together one person from each group of people who interacted with patients during a visit: receptionists, medical assistants, doctors, technicians and billing personnel, as well as the patients themselves. Through a series of workshops, they focused on cutting down the wait time. Their ideal was for a patient to step off the elevator, be greeted, and immediately taken back to an exam room where a doctor was waiting.

They’re not to the ideal yet, but the results so far have been dramatic. A patient once needed 40 minutes to complete a visit; now it only takes 19.

Cutting the visit time in half took synchronizing everyone’s activity so that everyone was working on one patient at a time. “What works best is if they have more time with the patients, and if in between Patient A and Patient B they do all the paperwork for Patient A,” says Creger. “So we had to synchronize it with the medical assistants’ work.”

“The doctors love it because they’re home for dinner with their families, not seeing all their panel of patients and then having to do the paperwork until 8:00 at night,” Creger comments. “[Before,] they had to rethink: ‘Do I remember my first patient this morning?’”

Virginia Mason hasn’t eliminated the waiting room entirely. When they tested the process out, they found that patients often brought family members with them, who had to wait. But they did ask for the patients’ input on the waiting room—and found some surprising ideas.

For instance, patients wanted a separate room where they could talk with a medical professional alone. They asked for a coffee bar where they could sit and talk with other cancer patients. And they wanted wood floors so they could easily wheel their IV poles around. When the hospital implemented these suggestions, it changed the room from boring to welcoming.

Common sense…and a little creativity
    In the end, a combination of common sense and creativity can create a pleasant waiting room. It seems the difference is a willingness to look at the waiting room from a patient’s perspective. So take a look at yours. Maybe wait time doesn’t have to be wasted time after all.

Rebecca St. Andrie is managing editor of the O&P Almanac.