First Impressions — How to Set the Stage for Success

Your waiting room says more about your practice than you may think. Is it saying what you want it to?

By René Luthe, Senior Associate Editor

When caught between a weak economy and declining reimbursements, a lot of practices may decide their patient waiting rooms are “good enough” as is. After all, you've got some reasonably comfortable seating in there, it's clean and the magazines usually aren't that old; besides, if the choice is between spiffing up a room patients usually don't spend too much time in anyway and a new diagnostic device (or that expensive EHR system you've been delaying), isn't the clinically related item hands-down more important? Well, yes, of course … but maybe the choice isn't quite as easy as you think.

According to interior designer Beulah Chang, principal of Chang Interiors in San Francisco, “An updated waiting room reflects the doctor's technical expertise. This is your first point of internal marketing. It communicates how you go about your practice and it builds trust and comfort and a sense of safety.” So you may want to go sit down in your own waiting room and take a good, hard look around. But fear not — creating a waiting room that sends the message you desire is probably less expensive than you think.

First Things First

Before choosing magazine subscriptions or considering whether to buy a flat screen TV, you will need to decide how many seats your area can comfortably accommodate, how to arrange that seating in a way that facilitates patient flow, and the kind of seating. “Space planning is very important for the room in terms of knowing the number of seats and how many people you expect to have in it, and whether there are adults or any children involved,” Ms. Chang says.

At Dr. Arbisser's practice, the optical shop is integrated with the waiting area, allowing patients to browse and shop before their appointments. COURTESY OF AMIR ARBISSER, MD

Standard chairs measure 22” x 22,” Ms. Chang notes, and seating should be arranged so as to allow patients some visual privacy — they shouldn't be seated face-to-face, more or less having to stare at each other. “There should be some visual distance,” she says.

She also advises orienting the room so that patients are facing the direction from which their names will be called, thus allowing them to pay attention even as they read or work on a laptop computer.

People must be able to circulate in the room easily as well: Two people should be able to cross in either direction at the same time. And given the older population that typically frequents ophthalmology practices, sufficient space for wheel chairs and walkers is another important consideration. Make time on heavily scheduled days to observe how easily patients can circulate, and whether they have sufficient “personal space.”

When it comes to the seats themselves, Ms. Chang says that chairs are preferable to sofas. Here, too, one needs to be cognizant of the older demographic typical of ophthalmology practice. Rather than putting patients with limited mobility in the position of sinking low into a sofa and then struggling to rise from it, Amir Arbisser, MD, founder of a large Midwestern practice based in Bettendorf, Iowa, recommends chairs with armrests on each side. “They help people with limited mobility get up and down,” he explains.

Also helpful in assisting patients with limited mobility, Ms. Chang notes, are chairs with open space beneath the seat so that patients can put their legs under them in order to balance their weight when they rise.

An exception to Ms. Chang's “pro-chair” position is the strategic use of benches. They serve the important function of providing comfortable seating for the “plus-sized” patient more frequently coming into medical offices.

If a large person comes in, you want that patient to be able to find seating without the problem being obvious. “Bench seats are flexible,” Ms. Chang says.

Benches are also a good option for parents with children, allowing them to sit together, and “they help visually break up the room a little bit,” explains Ms. Chang.

Consideration for Their Vision Begins Here

Again, given that many ophthalmology patients are of an older demographic, accommodation for their visual needs should begin in your waiting room. Ms. Chang notes that aging eyes do not see contrast as well as younger ones do. Contrast in colors and their intensity can provide helpful orientation, making doors and steps more visible to them and perhaps helping to avoid accidents. Such contrasts, however, are also offering the pleasure of being visually stimulating as well. And beware of any myths you may have heard. “It isn't true that all elderly people like blue, for instance,” Ms. Chang says. “I think as the eye gets older, the lens yellows a little bit, so sometimes having warmer colors is helpful.”

Dr. Arbisser believes that adequate lighting makes the waiting room more comfortable and appealing, as well. “Having things like lamps makes a difference, so people can read.”

Another factor that can contribute to a visually soothing environment is artwork, Ms. Chang maintains. Landscapes and seascapes draw people back to a sense of nature. “It's very healing and helps to relax the mind.” Her visits to Kaiser Permanente Hospitals in the San Francisco area, she reports, have revealed the priority the hospitals place on displaying artwork for patients and visitors. “It makes the whole place very uplifting,” she says. “And it adds to the feeling of being well cared for.”

In this patient waiting area, chairs are arranged to allow patients a degree of privacy, with one grouping separated from the other. COURTESY OF CHANG INTERIORS

For practices in areas with high concentrations of a particular ethnic group, artwork can offer an opportunity to demonstrate respect and understanding for their culture, Ms. Chang points out.

Keep It Clean

Another basic tenet of waiting room hospitality is keeping the area scrupulously clean and uncluttered. As Uday Devgan, MD, in private practice in Los Angeles, puts it, “Clean and sparse are good.”

Pamela Willis, a marketing strategist and practice administrator at Jackson Eye in Lake Villa, Ill., agrees. “A medical office should be clean.” To accomplish this, staff maintains the restrooms periodically throughout the day. “Toilet seats are down, there are nice lotions to use if the ladies want to put them on their hands, there's antibacterial soap dispensers that are full, the toilet paper and paper towels are always stocked and regularly checked,” she explains. And patients express their approval.

In the waiting room itself, practices should work at keeping clutter to a minimum. This goes beyond the notorious complaint of outdated magazine issues. Ms. Chang notes that many practices have a lot of pamphlets and signs on display — simply asking yourself which are really necessary is something that's often forgotten as the materials become such a familiar part of office décor that they are virtually invisible to the employees who daily pass them by. Periodic “house-cleanings” should be scheduled, Ms. Chang advises, which should included deciding which materials are no longer current.

Now for the “Extras”

Once you have a patient waiting room that is orderly and clean, with comfortable seating and adequate circulation space, you can move on to considering which extras you may want — or not want — to incorporate in order to make your office's first impression.

• Coffee-table books instead of magazines. In an effort to cut down on the above-mentioned clutter, and to save money, some practices have reduced their magazine subscriptions in favor of coffee-table books on popular subjects obtained at discounters' stores. After all, Time's “Person of the Year” issue very quickly becomes old news, but a large illustrated book on the history of the automobile holds long-term appeal for patients of all ages. “We have books published by National Geographic, entities like that, on airplanes, sea creatures, sports memorabilia, space travel,” explains Mitchell Jackson, MD, in private practice in Lake Villa, Ill. “They are all educational with really great pictures, so kids and adults enjoy them.” And the large size of the books means that they don't easily leave the office with any sticky-fingered patients.

Dr. Arbisser, with five offices in Iowa and Illinois, goes the same route, purchasing oversized books on art and travel, typically for only $5 to $10 each at big-box stores — that's cheaper than many yearly magazine subscriptions, and with no updating required.

Whatever kind of reading material one chooses to offer patients, however, certainly an ophthalmology office should have large-print options available. “Readers' Digest used to offer a large-print version and I believe there's also a large-print weekly New York Times,” Dr. Arbisser says.

• To TV or not to TV? That other popular means of entertaining waiting patients, televisions, are advocated by some practices, but not all. Dr. Devgan and Ms. Chang are not fans of the boob-tube in the waiting room. “I prefer a quieter environment,” Dr. Devgan says. “It's not a huge reception area.” Ms. Chang observes that finding programming satisfactory to all patients isn't easy, and that patients often ignore the educational loops some practices televise. “It's just kind of noisy and boring for them.”

Those in favor of having a big, beautiful flat-screen TV to help patients while away the time before their appointments admit that programming can be difficult. Dr. Jackson stays away from news channels, as reporting on the continued weakness in the US economy makes patients reluctant to open their wallets for anything but the necessities, and coverage of things like violent crimes is unsuitable for any children who might be present. Other daytime programs, too, are not appropriate for that group. “One thing we've learned is to have the control mechanism somewhere other than in the hands of the patient. We don't want children sitting around being subjected to The Days of Our Lives,” says Dr. Arbisser.

Dr. Jackson's practice has solved that problem by going with “warm and fuzzy” programming, as Ms. Willis, his practice administrator, puts it. They set their television to The Food Network, The Travel Channel and Me-TV, which shows “Bonanza, Gomer Pyle — all those types of series. We want relaxed, feel-good programming,” Dr. Jackson says.

More educational viewing is available as well, of course — the video discs featuring presentations on ophthalmic conditions. Dr. Jackson has opted not to show the video loop, believing patients are already bombarded with such information. Dr. Arbisser's practice is unsure of their value as well. He finds they are something of a mixed blessing. “On one hand, we want patients educated, but on the other, we don't want them anxious and coming in with a whole bunch of questions about issues that aren't theirs — it slows down the flow. So we experiment with that.”

• For your plugged-in patients. One form of electronic communication/entertainment you may want to consider offering patients is free wifi access. With wifi, which allows for wireless Internet connection through a wireless router, your laptop- or iPad-carrying patients can use their downtime in your waiting room to get work done — or simply keep themselves entertained. Drs. Devgan and Jackson both offer patients their office's wifi code. “You already have some kind of Internet connection in your office and you can buy a router for $40 from Amazon,” Dr. Devgan says.

Dr. Arbisser's practice is considering loaning iPads to patients while they wait. An amenity he first saw in high-end hair salons, he believes it could work for practices with the right patient demographic. “A primarily Medicaid practice is probably not going to buy a bunch of iPads. But a heavily LASIK-oriented practice should consider them for the people who come in to either be evaluated or to wait for their procedure. It's a really nice touch,” he says. Another benefit is that iPads offer the ability to enlarge the material to a size compatible with the patients' visual abilities, he points out.

Dr. Jackson decorates his patient waiting room with posters of vintage movies with vision-related titles. COURTESY OF JACKSON EYE

• Personalize your space. Landscapes, of course, are not the only type of decoration you can use to make your waiting room welcoming. Some practices have found creative ways to appeal to patients. Dr. Jackson's features framed classic movie posters with vision-themed titles: Shirley Temple's Bright Eyes, from 1934, and 1949's Looking For a Silver Lining. “The patients who are coming in for cataract often have seen these movies, and they come up and say, ‘You know, every one of these posters has something to do with eyes,'” Ms. Willis laughs. “On our main wall, we have the Bright Eyes poster, and it's about 7' x 5'; it's a huge piece. It's bright and it shows a lot of the color popping out of the walls.”

Dr. Arbisser's practice displays a collection of antique spectacles and sunglasses previously owned by celebrities. “People have to spend some time there, so we try to make things interesting.”

• Have a bragging wall. When Ms. Willis heard patients seeking assurance as to Dr. Jackson's qualifications and experience, she had an idea that would both set their minds at rest and promote the practice: A wall covered with Dr. Jackson's framed diplomas and various certificates. Grouping them together, floor to ceiling, she says, amplifies their effect much more than would scattering one here, another there, throughout the office. “It's a bragging wall, but it proves the point. It shows years and years of specializing, and it shows his commitment to cutting-edge treatments.” No one asks about Dr. Jackson's qualifications any more, Ms. Willis reports.

• Let them eat cake? Many practices choose to offer some sort of refreshments to their patients. The advantages to such a move? Well, everyone likes sweets. Dr. Devgan puts out bowls of candy. “Like an airport lounge, if you're waiting, it helps to have a few things to nibble on. We set out mini-sized KitKats, Snickers, things like that.” His office also stocks a refrigerator with beverages. Sodas such as Diet Coke are hit or miss with patients, Dr. Devgan notes, so he offers universally popular bottled water, in individual-serving sized containers. “Not the bigger bottles, because people usually want just a few sips.”

While high-end coffee is a common offering, Dr. Devgan's practice has opted not to. Things like Keurig coffee makers require supplies and maintenance, he points out, and makes for another mess for staff to clean up. “We have a coffee machine in the back, and if patients ask for coffee, we will get it. But I assure you, one of my top priorities is to stay on time so patients rarely have to wait that long!”

Dr. Jackson's practice has the good fortune of having a staff member who has a cupcake business on the side, and on heavily scheduled surgery days she brings in large, gourmet cupcakes for patients. “They love that delicious, homemade touch, and we have the Jackson Eye logo on the top of them in frosting,” Ms. Willis says. Drinks are not neglected. In addition to coffee, the practice puts out large dispensers of lemonade in summer and apple cider in winter. And there are small boxes of animal crackers.

And the reasons you may not want to offer snacks? Dr. Arbisser's practice used to offer cookies made by the baker-spouse of one of the staff technicians. “The goal was to welcome people, and our waistlines suffered because everyone on staff used to eat the cookies too!” When costs became onerous, though, the cookies were phased out. “Mostly because we were concerned about sanitary issues, but also because as an ophthalmologist, there was something disturbing about serving cookies to patients, many of whom you knew to be diabetics!”

• A room of their own. Dr. Arbisser's may be a “life-to-death” practice, but that doesn't mean he expects all ages to play nicely with others. The more rambunctious pediatric patients have their own space. “It has an entire wall of plexiglass windows, so the adults who accompany the kids can observe them from the adult reception area,” he explains. The children's reception area features toys and games, and a television tuned to cartoons.

A “bragging wall” of the physician's degrees and certificates both assuages patient concerns and livens up waiting room walls. COURTESY OF JACKSON EYE

What About Cost?

For those who do like the idea of creating a welcoming office, these practices say it does not have to be costly. “Nobody has Coca-Cola budgets, so you have to make a big splash with minimal cost,” explains Ms. Willis.

Big-box stores seem to be the way to go. The mini bottles of water Dr. Devgan favors end up costing about 20 cents each at Costco, he says, which also stocks the candy. Ms. Willis favors Sam's Club, where she purchases large containers of lemonade mix “and it lasts you all summer long.” The boxes of animal crackers are also available in bulk at a surprisingly low price. Another recent Sam's Club score was six “gigantic” hydrangeas for $16 each to brighten up the waiting room. As for the gourmet cupcakes that Dr. Jackson's practice serves, Ms. Willis says that they cost only the price of the supplies, plus 25 cents per cupcake to the baker.

“The truth is, to have an office that is nicely decorated and comfortable, costs only, literally, a dollar or two more a square foot than having a purely functional space,” says Dr. Arbisser.

Even going the professional route and hiring an interior designer such as Ms. Chang may not be as costly as you imagine. She says that a good designer will work with a client's budget. “I am doing budgets for people that have tiers to them, so that clients can see how they could do their 18 chairs on one budget, or upgrade them to the next, and that they can work in phases,” she explains. Self-interest aside, Ms. Chang says practices will spend their money more wisely if they work with a coordinated design from the start rather than redecorating sporadically. “There are commercial standards to all this; it's very different from residential work.”

The Not-So-Secret Weapon

Of course, if your staff doesn't know how to welcome patients, pretty artwork and gourmet coffee won't get you very far. “The sale really starts the moment people walk in the door,” says Ms. Willis. Because her practice gets many of its patients from referrals, “their experience from front to back has to be pleasant.” Thus, employees there are trained to do things like offer coffee or water, or offer to help elderly patients with paperwork.

Dr. Devgan trains his staff to simply implement the Golden Rule. “Ultimately, there are two ways of practicing medicine,” he explains. “One is to maximize revenue generation and profits at the expense of other factors, and second is to deliver the kind of care that you would want to receive. In my office, everything is exactly as I would want to receive it if I were the patient. It's the simplest rule possible — the Golden Rule we learned in kindergarten of doing unto others.”

Dr. Arbisser agrees. To ensure that his staff understands what he expects, he periodically sends members to hospitality programs such as the one offered by the Disney Institute, or by regional Chambers of Commerce. One-day and weekend programs are often available, he says. Dr. Arbisser's acquaintance with the owners of what is the largest truck stop in the United States has strengthened his conviction in the need to train employees in good customer service. “They have probably 400-500 employees there and customer service is a de rigueur part of their training before they get to do their jobs — whether it's pumping gas or working in the restaurant, or the truck museum, or anything else; they all have to train and perform well on customer service, or they basically aren't there at the end of the week.”

So impressed is he with how good that training is, he is considering sending new employees to them for instruction. After all, he points out, if the staff is welcoming and attentive, patients tend to be much more tolerant of, for example, a physician who is running late. “I may be the most skilled person in the world at the service I perform, but it's the whole package and people remember and talk about those things.” OM