Waiting space: Exploring public hospital non-clinical areas through a user-focused design approach

Background: For most people, going to a hospital is time-consuming and can even become exhausting. This occurs due to a high number of patients in both clinical (clinics, wards, patient bedrooms) and non-clinical areas (waiting areas, hospital cafeterias, hospital parking garages). Many public hospitals are facing overcrowding situations, and their functions are becoming obsolescence or out-of-date.

The motivation of this PhD stemmed from my own experiences of going to Thai public hospitals, where the ‘overcrowding’ situation is viewed as a typical day at the hospital. My curiosity of this phenomenon developed into an ambition to investigate what has caused an overcrowding situation in Thai public hospitals and how with an architect background, I can help alleviate the situation, especially the overcrowding situation and poor physical conditions of public hospital waiting areas. In the past 30 years, there has been a rise of a new paradigm in hospital design, where the focus of hospital design has shifted from medical treatments to patients’ needs.

The paradigm shift of hospital design occurred due to the emergence of the evidence-based design (EBD) theory. The theory emphasises that hospital physical environments can have effects on patient health outcomes. The EBD theory has created a movement among hospital designers, planners and facility managers, who aim to amend the physical environments of hospitals.

One technique that can lead to the successful implementation of the EBD in hospital buildings is to involve users in the design process. Therefore, the terms ‘user-involvement’, ‘user-focused’ design approaches and ‘usability’ are often used and are major strategies among healthcare designers, facility managers and related professions to create an effective hospital physical environment.

Objective and aims: The purpose of this PhD study was to investigate Thai public hospitals and to identify the underlying issues causing the overcrowding situation. Moreover, the aim was to observe and to compare public hospital non-clinical areas as well as end-users’ experiences to provide insights that can be used to optimise the physical conditions of hospital waiting areas.

The investigation was guided by two main research questions;(1) What characterises public hospital non-clinical areas?(2) How can the experiences and perceptions of Thai/Danish patients and medical staff optimise the design of waiting areas and patient waiting experiences with the aim to integrate a user-focused approach? Methodology: The investigation was based on five public hospitals represented by the primary and secondary case studies.

The primary case studies are Maharaj Chiang Mai Hospital -Thailand and Rigshospitalet -Denmark. The secondary cases are St Olavs hospital - Norway, Khoo Teck Puat hospital - Singapore and Chulalongkorn hospital - Thailand. The study was conducted through evaluate and to compare non-clinical areas, focusing on the waiting areas of these public hospitals and interviews with patients and staff from primary case studies.

Findings: The results are presented in five scientific papers in which four core findings were extracted (chapter 6 answers the research questions): (1) Six core components that govern the characteristics of hospitals' non-clinical areas which are: structure and organisation of the healthcare systems, hospital management system and services, patients’ needs and patient-focused approaches, hospital space management and planning, the physical environment of waiting areas, social structure and cultural setting(2) The implementation and the impact of the new paradigm of hospital design(3) User-focused and user-involvement approaches during the design process through the specific design guidelines, leading to positive design outcomes.(4) A comparison of the differences and similarities of the six core components to provide insights that Thai and Danish hospitals can exchange.

This study contributes to limited knowledge on the impact of hospital waiting areas on patients’ experiences. First, not only do the hospital’s physical environment and the design of waiting areas have effects on patients’ waiting experiences, but the six core-components also have impacts on patients’ waiting experiences and care journeys.

Second, the findings from the investigation and observations of public hospital waiting areas allowed for developing a waiting area typology of seven types of waiting areas: (1) a large waiting area, (1a) a large waiting area without zoning, (1b) a large waiting area providing zones, (2) a long corridor waiting room with chairs, (3) a small area beside a corridor, (4) a waiting space nextto a window, (5) outdoor waiting areas, (6) food places and canteens and (7) an unplanned waiting area.

Third, user-involvement is a highly recommended technique that could lead to a high level of usability; however, involvement during the design process should be carried out while being managed properly through structured guidelines.