As Americans try to figure out what changes the Affordable Care Act will bring to their lives and pocketbooks (and politicians continue wrangling over the rollout), here's one that probably missed everyone's radar: the new experience that could be waiting for people in their primary care doctor's waiting room.
Think: library-coffeehouse. That reception area could be redesigned and turned into a place where elite health information is free-flowing along with a few choice and, of course, healthy libations.
Or the space might be used to host live, in-person "chat rooms" for people with the same chronic disease or lunch hour "work the kinks out" exercise sessions for office workers with lower back pain.
None of this exists, yet. It's a vision of the future from the architects and designers in the health care sector at Gensler, where we've been thinking holistically about the doctor's office and how it might be used to transform both the patient's experience and the business of doctoring.
We suspect doctors are doing the same—and especially primary care physicians. Once the unsung generalists in a world of increasing specialization, primary care physicians (a.k.a. internists and general practitioners) have been recast by the health care law as the front line in a new war to keep Americans healthy and out of the hospital. We're moving from a health care system that pays providers a fee for service (encouraging volume of services) to one that rewards good outcomes and value. Those (doctors, hospitals, health care systems) that keep patients well and motivate them to stay healthy are the Affordable Care Act's winners.
And there's a special asterisk on those primary care physicians. Winning for them means running lots faster. Doctors will have to see many more patients during the course of a day, given a slew of new cost pressures and increasing competition from retail clinics, drugstores, and even the big box stores, all of which are already chipping away at the general practitioner's profits by turning basic health care services into a consumer good.
Put all those facts together and what primary care physicians have is a mandate to reinvent themselves. They must get into the business of managing people's health, not their disease. They have to work at the "top of their license" (face time with patients reserved for services that only a doctor can provide). And they have to figure out how to "see" patients in new and different ways.
To do all that, their physical space has to change. Doctors will need to start thinking like merchants and in terms of squeezing profitability out of every square foot. As architects and designers who view "space" as a tool to solve problems and make life better and more interesting, we reimagined the doctor's office as a cross between a vibrant retail space and serious medical office building. What if:
People who may not have anything in common could come together for the experience of partaking health care information. Gone are the rows of chairs and old issues of Golf Digest and Self. Instead, patients hunker down at tables and have easy access (either electronically or via printed materials) to the latest research on cholesterol-lowering medications or on Celiac disease or to home safeguarding techniques that help prevent the elderly from falling, etc.
People with the same agenda would meet to share information or talk to someone at the (doctor's version of Apple's) "Genius Bar"? Perhaps the office hosts (in-person) "chat rooms" for people who suffer from Crohn's disease or diabetes or obesity and makes a nurse or other clinician available to answer questions and facilitate the discussion.
30-minute "unplug" sessions are held during the lunch hour (or after work or after moms drop the kids off at school) and devoted to stress management techniques, deep breathing exercises, posture improvement, gut redux, etc.—and all of them led by a health care professional other than the doctor.
These could be located throughout a metropolitan area or in rural areas so patients didn't have to travel so far. And perhaps, they "see" the doctor via high technology: a video screen and monitors that feed the patient's current health metrics/readings directly to the doctor.
The point is the doctor's office no longer can just sit there as a container for people waiting to be diagnosed. As the new health care law gains traction with its mantra of value, doctors are likely to see the value in their office space and transform it into a dynamic place where patients come not only for a doctor's exam but for access to high-quality health care information and experiences that they can't get anywhere else. That's the value of a primary care physician in America's new health care order.
Horizon Blue Cross Blue Shield of New Jersey, Mount Laurel, NJ. Image courtesy Gensler, photographer: Chris Leonard.