Wasted space

Yesterday my wife had a small medical procedure. The actual procedure took less than a minute but we spent about three hours in order to go through the screening at the door of the facility, the paperwork to make sure that insurance reimbursements were in place, the education about the procedure and the consent forms, the preparation for the procedure, the meeting with the Physician’s Assistant and then the meeting with the doctor, waiting for the dismissal paperwork to be completed, etc. etc. In terms of our time, it wasn’t the most efficient of processes. American consumers, however, have become quite adjusted to physician-centered medicine. Most medical facilities have been physically designed with a large percentage of the space consumed by waiting rooms. Line up the patients and have them wait so that the physician doesn’t ever have to wait. As they say, time is money, and the system is terribly inefficient in terms of money, but that is a topic for another day.

As we went through the process, I was feeling fortunate that the facility had recently modified its visitation policies so that I could accompany my wife. At least she had someone to talk with as we waited again and again for various parts of the process. I didn’t have the worry of waiting and waiting for hours when I knew that it was a simple, quick procedure. As we waited, I couldn’t help but think about how the pandemic is already shifting the use of space. If it turns out to be true that the pandemic is the result of an increase in the pace of mutation of viruses and that once treatments and vaccines are developed for this particular virus, other viruses will follow and we need to shift our culture. The dramatic shift in the use of spaces in our regional medical center is already apparent. The center is in the midst of construction of a huge multi-million expansion. Less than 50% of the hospital is patient rooms. The rest is devoted to offices and laboratories and speciality diagnostic tools and hallways and entrances and waiting rooms.

There are a LOT of waiting rooms in a modern hospital. Except waiting rooms are not considered to be a good thing during a pandemic. Here are just a few of the things I observed yesterday:

The facility has two large entrances, not counting the Emergency entrance and various entrances for employees. Both are dramatic with high ceilings and huge walls of glass. Both were designed with multiple waiting areas. There are gift shops, coffee shops and other amenities. All of those waiting areas are currently closed. The gift and coffee shops are closed. The volunteer desks are closed. The chapel is closed. In place of those things, all people coming into the facility through those entrances are met by a screener before they enter the facility. The screener takes temperatures and asks a few questions. Those who do not have essential business are turned away. Then there are more screeners. Most are working standing up behind temporary tables with equipment. Furniture has been grouped together and is being temporarily stored now that no one lingers in the entrances.

Every diagnostic area in the hospital has its own eating room. There is a waiting room for family members of those having surgery. It is closed and not in use. There is a waiting room for those who will receive lab draws. It has half of the furniture removed and the people spread out. The same is true of waiting rooms for infusion, CT scans, Cardiac procedures, and dozens of other diagnostic and treatment areas. Hundreds and hundreds of chairs, designed for people to sit in waiting rooms are in “temporary” storage.

We spent most of our time waiting yesterday in a treatment room. You can isolate people in treatment rooms.

As we went through the process I couldn’t help but think about how a medical facility could be designed to keep people moving through the process of treatment and care without the need for such inefficient use of space. I wonder what percentage of medical facility space is being used for furniture storage in our country today. I suspect that it is fairly high. I wonder how many rooms that used to be waiting rooms are currently simply not being used. Medical buildings are among the most expensive buildings constructed in modern societies. The cost per square foot is higher than almost any other type of construction. In the middle ages the most expensive buildings were cathedrals. These days our “cathedrals” are all hospitals and medical offices.

It would be interesting to chart the flow of people through the regional medical facility. Most enter and exit by the same door. Once inside the facility, with the new regulations, virtually everyone is escorted by a staff member everywhere they go. We spent all of our time on the first two floors of a ten-story structure yesterday an still walked over half a mile. Assuming that our escorts were doubling the mileage, walking one way with no one to escort, that is a lot of mileage. Still, the hallways of the building were nearly empty. Not only is a huge amount of the hospital devoted to waiting rooms, another huge amount of building is devoted to hallways. All of those hallways, even those on floors with no patient treatment rooms, are large enough for two hospital beds to pass without interference. If you figure the lighting, heating and air conditioning, janitorial services and other costs of maintaining space, you begin to understand why the cost of medical care is as high as it is.

In the years to come, architects will be confronted with the challenge of designing more efficient uses of space. Many will be tasked with remodeling existing buildings so that less space is wasted and the flow of people through those spaces is more efficient. For now, however, our model of patient care involves a lot of huge and expensive waste.

Copyright (c) 2020 by Ted E. Huffman. I wrote this. If you would like to share it, please direct your friends to my web site. If you'd like permission to copy, please send me an email. Thanks!