The Hidden Design Behind Observational Care

By Rebecca J. Lewis, FAIA, FACHA, CID
Principal, Director of Healthcare Design

We’ve all done the small-talk shuffle. That walk from waiting area to exam room at our local clinic where we chat with the nurse about the weather, the kids, the upcoming weekend. But what most of us never realize is that, while we’re walking, the appointment has already begun.

From the moment a patient has their first interaction with a nurse or doctor, there is diagnostic work being done. The healthcare staff is observing your gait, balance and skin tone. They are asking you questions to gauge your mental state, your clarity of thought and your recall.

It’s a concept we call “observational care” and it’s something we consider in every healthcare facility we design. Since many patients experience anxiety over visits to the doctor, this type of observational care is crucial. Anxiety levels are lower during the time spent waiting for the appointment to “begin.” The escorted walk from waiting room to exam room may feel like small talk, but it’s actually a vital part of a healthcare assessment.

When we design spaces, we look for ways to encourage these types of informal, diagnostic work. The tribal clinics and micro hospitals we design, for instance, have a waiting room that functions as a kind of community center, which becomes an ideal way to foster observational care. And small decisions, such as the location of a nursing station at one end of a hallway, can provide ample opportunity to observe a patient visually.

There’s a great deal of priority being placed on efficiency in modern medicine, as it’s often a primary way to lower costs. But, the clients we work with know that you have to do both, have a facility that is efficient, while still be arranged for these types of observational care opportunities.

With every healthcare facility we design, we have two goals in mind: Design a space for maximum productivity and efficiency, while leaving plenty of room for the magic of small talk. Because small talk isn’t small at all. It’s the heart of observational care.