Perceptions of psychotherapy waiting rooms: Design recommendations

Why does this study matter?
A major part of the healthcare experience is waiting, and prior research shows that the experience us often stressful and can impact the perception of overall quality of care. The healthcare design literature includes several studies on the design of waiting rooms in hospitals and outpatient facilities; however, there are very few studies that have looked at the experience of waiting in behavioral and mental health settings. When psychotherapy patients arrive for their visit, they may already be feeling anxious, and the design of the waiting room has the potential to set the stage for their overall therapeutic experience.

How was the study done?
In this study, Noble and Devlin looked to prior research to form their hypothesis that certain elements in a behavioral health waiting room – such as positive distractions, sufficient space, privacy, variety, and placement of seating – would be perceived to be more comfortable and related to a higher quality of care. In order to test this idea, they gathered photos of 20 waiting rooms from 12 psychotherapists with a viewpoint from the entrance, and created a photo survey. They asked 250 participants to rate the photos based on the level of comfort they expected they would feel in the rooms, as well as the quality of care they expected they would receive in these offices. They also asked participants to name two features that stood out to them and indicate whether they felt the feature was positive or negative.

So what do we learn from the study?
The researchers used factor analysis to analyze the photo survey data, and were able to identify three types of comfort groups in the waiting room types: (1) cramped and crowded; (2) welcoming and comfy; and (3) large and spacious. They also identified three quality of care factors: (1) old and crowded; (2) homey and comfortable; and (3) large and spacious. 

Waiting rooms that were perceived as “welcoming and comfortable” as well as “large and spacious” received higher ratings for expected quality of care and comfort. The “welcoming and comfortable” rooms received comments like “child-friendly” and “very warm, very well lit” and “homey”. “Large and open” waiting rooms were described as “lots of seating” and “open airy layout”. Waiting rooms that were seen as “large and spacious” were rated highest in terms of comfort and rooms that were perceived to be “homey and comfortable” were rated highest on expected quality of care.

And as one would expect, the “cramped and crowded” rooms were viewed as negative. Comments about the rooms in this category included phrases like “chair packed way to close” and “cheap-looking seating”. Waiting rooms that were seen as “cramped and crowded” received the lowest comfort ratings and rooms that were perceived to be “old and crowded” received the lowest quality ratings.

Can we say the results are definitive?
Photo surveys are a great way to get a sense of how people expect they would feel being in a setting, but a photo is not a replacement for the real thing. This study would need to be repeated in situ to see if the findings hold true. It would also be important to investigate the effect of these environments on actual psychotherapy patients. Participants in this study were recruited from an online marketplace where researchers can advertise studies for payment, and while 45.8% of the participants indicated that they had therapy experience, we can’t know if responses are specific to behavioral health experience or the concept of waiting rooms in general.

What’s the takeaway?
Results point towards certain features that are valued in behavioral health waiting rooms, namely spaciousness, variety of seating type and location, and the importance of privacy. These findings fall in line with prior studies, regarding the need for autonomy, choice and a sense of control over one’s environment, which has been linked to reduced stress. This is important in all healthcare settings, but perhaps even more so in behavioral mental health settings where patients are grappling with anxiety, certain stigmas, and a desire for privacy.

As the authors share in their discussion, the results here tell us far more about what does not work in the design of a behavioral health waiting room, rather than what does work. Waiting rooms that were perceived as “cramped and crowded” or “old and crowded” were associated with a lack of seating, lack of personal space for privacy, bare walls, and little natural light, which the authors propose may give the impression that the practitioner does not care about clients’ wellbeing while waiting.

When designing waiting rooms, we often think of bright, spacious, luxurious waiting rooms we see in trade magazines, but is this reality? Most psychotherapists have small solo practices in offices they rent themselves. How can behavioral health design support the reality of behavioral health settings for a better patient experience?

Noble, L., & Devlin, A. S. (2021). Perceptions of psychotherapy waiting rooms: Design recommendations. HERD: Health Environments Research & Design Journal, in press. https://doi.org/10.1177/19375867211001885

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