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Physical therapists Ziya Altug and Shirish Sachdeva discuss their article “Why your clinic waiting room may affect patient outcomes.” Ziya and Shirish explore how the ambiance of a medical office significantly impacts patient anxiety and emotional well-being before treatment even begins. They examine evidence-based strategies to transform functional spaces into healing environments using calming music, nature-inspired art, and ergonomic furniture design. The conversation highlights specific needs for pediatric patients and how transparency through technology can build trust between patients and health care providers. Understanding these environmental factors allows clinics to foster a sense of safety and improve the overall care experience through intentional design interventions. Discover how simple changes to a waiting area can set a positive tone for recovery and comfort.

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Transcript

Kevin Pho: Hi. Welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Ziya Altug and Shirish Sachdeva. Both of them are physical therapists. The KevinMD article is “Why your clinic waiting room may affect patient outcomes.” Everybody, welcome back to the show.

Ziya Altug: Thank you, Kevin. Thank you for having us.

Shirish Sachdeva: Thank you. Thank you for having us.

Kevin Pho: All right, Shirish. Why don’t we start with you? Just summarize this latest article that both of you wrote for those who did not get a chance to read it.

Shirish Sachdeva: Well, Kevin, thank you for having us publish this second article with you. I enjoyed writing it as well as I hope your audience likes reading it. The article basically stems from the thought that the first impression that comes in any clinic or hospital comes from a waiting room. People enter the waiting room anxious. That is the thought that this article kind of stemmed from.

Obviously, we went on a search spree finding research articles to see if there is any science behind it. Lo and behold, we found a lot of articles and scientific material that dated all the way back to the times of World War actually. Even until now, we have these recent articles that still come up. So we see this as a current problem. Yes, we talked about different inputs that can affect people’s time when they spend in a waiting room, like music, arts, and different cultural inputs. It is all measurable stuff that we have, and it is well backed up by science. I think it is well worth the read to get an idea about it as we delve deeper into it.

Kevin Pho: All right, so Shirish, for those who did not get a chance to read the article, just give us a high-level overview. What are the various elements in the waiting room experience that may affect patient outcomes? Typically, in waiting rooms, I always see a typical TV turned on to a local news network, but a lot more goes into that. So Shirish, just give us a summary of the various elements we are talking about.

Shirish Sachdeva: I think that is a really fine analysis of it because one thing that we see is news channels running on the TV. I think I am highly on the point of this that news channels should really not be in a waiting room area. They feed into the anxiety that people already step into. We know these waiting rooms are buzzing with lights, cramped-up chairs, and people running across places. Even if you look at an emergency department, it is crazy. But then when you look at outpatient clinics as well, people are heavily busy into it.

So I think the bigger picture synopsis is that we want our waiting rooms to be as calm, as welcoming, and as eased out spaces for people to rest. We want them to understand where they are coming from and what they are going to get as far as the experience is going to be when they are in the clinic or in a hospital for the next couple of hours. That healing process to a certain degree even starts even before the first physical touch has been done by a physician or a nurse practitioner to the patient.

I think that is where this is an important element to bring into it. The psychology of waiting is really stressful. When people are there, they are anxious about their medical problems for sure. The physical and psychological elements kind of intertwine throughout this process. It speaks volumes when people come in with physical injuries, but they do not know if they are going to get better today or is it going to be a long journey for the next eight months or a year. All that process will get addressed step by step in due course when that time passes, but also in that waiting room space, the foundation starts getting laid a little bit.

When we saw these different studies, we looked at studies that talked about the impact of music. We looked at studies that talked about the impact of colors, so even like the colors of your walls and how it impacts people. One of the studies on music was a systematic review where basically we are trying to review studies to answer a scientifically developed question. We look at all these different studies and try to see where that answer comes from out of these different researches.

One of the studies on music talked about reducing anxiety, and this was published in the *Journal of Anesthesia* in 2014. It is not recent, but it showed that 14 studies out of those that were reviewed explicitly stated that just before a medical procedure was done, if people listened to lower calm music, their outcome of the procedure in terms of pain perception and even the quality of the treatment that was received was way higher than those who just received a standard amount of care.

Another study similarly on music was published in the *Journal of Pain Management in Nursing* in 2022. Now this was a little bit more recent where they looked at like 200 patients. This was interesting because what they did was they looked at two separate clinics. One was a clinic where they played the regular music on a speakerphone. The other one had a live music practitioner, a student of music who actually played the flute and sang a little bit and played keyboards in a calm and low-volume environment.

What they saw was that both these clinics flourished with the numbers of stress and anxiety way lower than the standard clinic would have. Then what they also saw was between these two clinics, it was interesting to notice that the clinic that had that live musician playing showed additional lowering of agitation, pain perception, and even nervousness levels. They were all reduced.

Ziya Altug: And may I add a couple of thoughts to that, if that is OK? So, if you are going to create a pleasant waiting room, you can have a television, but maybe have that television on a nature show. A few plants go a long way. Scenic pictures that draw people in and pleasant music that is contemporary and pleasant help. You can have puzzles as a distraction technique. You can have labyrinths where people use their finger to make little labyrinth-type movements. Puzzles are good. Making sure the room is well-ventilated helps. Also kind of having the chairs spaced apart gives people a little bit more breathing room and so forth. So those are some practical tips.

Kevin Pho: So Ziya, how much thought typically goes into the design of a waiting room in a traditional medical practice? Because it sounds like that the relationship that that patient has with their clinician even starts before they meet them. It starts in the waiting room. So Ziya, in your experience, do medical practices put a lot of thought into some of the design choices that you guys are mentioning in the waiting room?

Ziya Altug: I think it depends on a clinic-by-clinic basis. Some of the clinics that I go to at large hospitals or private clinics clearly show that there is effort put in. They have a fish tank in the waiting area, nice music that is soothing, and so forth. Other clinics are just chairs and walls. Basically, the rest of the facility is great, but obviously, they did not want to put too much effort and time and take up too much space from the treatment area.

So I just think it depends on a clinic-by-clinic basis. I know more European clinics are putting an emphasis on clinics or the waiting areas in clinics, and it is making a difference based on the studies that we have seen. I just think that patient care begins in the waiting room. If a person can come in to see the doctor, the nurse, or the therapist a little bit more relaxed, I think that goes a lot further in helping the patient get better.

Kevin Pho: And Ziya, in terms of some of the data that you have researched along with these systematic reviews, what type of outcome measures are we talking about? I heard things like decreased anxiety. How about in terms of the patient experience? Has there been any data showing that it improves patient experience scores and patient outcomes just from design choices in the waiting room?

Ziya Altug: From my point of view, I can say that what we have seen is that it does have a reduction in stress and anxiety and helps elevate the mood. But I will defer to Shirish to see if he has any other thoughts that come to mind.

Shirish Sachdeva: So most of these studies had utilized self-reported questionnaires pre- and post-any kind of intervention. So those surveys were the ones that were coming out with percentages of improvement or scores. Yes, they did show improvement because again the comparison was similar questionnaires being given to people who were in standard clinics. So those scores did vary and surely we saw different improvements.

On the other hand, there were some studies like one that touched on the point of having labyrinths or having some kind of activities in there. There was one study that was a pediatric clinic design, and it was more of an analysis-based study by the organizations themselves reviewing their hospitals. This was in Shenzhen, China, if I am not wrong. This was in 2021, so still recent. They reviewed like three hospital setups. All they did was a qualitative analysis of these places. Ultimately they found out that patients in these hospitals with their experiences would prefer having a better mother and infant room in the hospital. They would like a children’s play area to begin with where children can wait because we know how nerve-wracking it can be for a child to be in such a stimulative environment like a hospital. Even having drinking water easily available was important. As Ziya touched on it, having indoor plants or scenic views from the windows was preferred. So these were more qualitative points that they came down with in this recent study.

But this was more of a qualitative study. There was another analysis that I think was done, and this is more towards how we can help with nowadays technology in the waiting areas. This was particularly wise towards emergency departments because that is kind of at the forefront of the anxiety spaces. What they noticed was that about 63 percent of about 340 patients who were interviewed responded to having some sort of technological input or new technology introduced in there that could have helped in reducing the anxiety. Most of them leaned towards time trackers in emergencies.

We know that when you are driving by a highway, you will notice that some emergency departments have actually put up how much waiting time there is in their hospital. Similarly, what they said was that if we could have individualized time trackers for patients, it would help. If somebody checks in to an emergency department and they say, “OK, please wait in line or go back to the waiting area and we’ll call you in,” it helps if on their phone or somewhere on the screen in an emergency department they see a little tracker saying, “OK, your number is 265 and you have five minutes waiting time.” If something like that shows up, it also showed decreased anxiety levels and then thereby improved patient outcomes of the whole experience.

I think when you talked about the experience part of it, Kevin, what I think is that patients reply in the end or give a review at the end saying, “When I went to this clinic, I loved my doctor, but this extra outside environment was not congenial.” So they would give full points to their physician or practitioner, but they would not want to go back to that space. That is such a detrimental input to just a brilliantly performed examination by a physician or someone. It is just something that we can so easily pay mind to and improve.

It has a major impact. When I was researching this whole article, I felt like hospitality is not just in the hospitality sector. It forms in all sectors. Primarily when we are dealing with people in their lowest form of their shape of their health, they need the best hospitality that we can provide them. That starts right from the beginning.

Ziya Altug: And you know, it is not just the waiting area. It is also the clinician’s room and the doctor’s office for the examination that could have small touches of plants and pictures on the wall and maybe a lampshade or something to make it look more like a home or living room to kind of ease the patient’s anxiety and stress even in the exam room. So those small things could also be helpful.

Kevin Pho: Right. When it comes to these patient experience scores, it is not just a physician, as both of you are saying. It is everything around the physician. It could be the parking, and of course the waiting room, and so many other factors go into that patient experience outside of that one-on-one encounter with the physician.

So Ziya, in your article both of you mentioned cultural sensitivity when selecting the core music, especially for a diverse clinic. So talk more about the choices that we have to make and be sensitive to the spectrum of cultures that visit our clinics every day.

Ziya Altug: I think music is probably a little bit harder to pinpoint for cultural differences because if you are in a large city, you are going to have many different cultures coming into that clinic and waiting area. So that is where maybe personalized earbuds allow people to listen to their own selection of music. But of course, standards like classical music may transfer to a larger percentage of the population.

I think if you are going to different countries, what works in one country for art may not necessarily work for another country. So I think each clinic needs to probably individualize and personalize their waiting areas for the type of patient population and maybe even get feedback from patients to ask what type of paintings they would like to see or what type of music they would like to see. Getting some feedback helps so that patients have a vested interest in that clinic.

Shirish Sachdeva: Yeah, I think there may go a little bit more thought into it. As Ziya said, if there is a percentage of clientele that we understand, like in one of the clinics I worked in New York City where the 80 percent population was Spanish-speaking, then you can in that case maybe choose more towards Spanish songs.

The core or the baseline that goes towards it is not always the music itself but the core of the music itself. It kind of focuses towards that where the tempo of the music still falls in place. The volume of the music falls in place and those elements kind of strike a common tone in our brain because they are the ones that are calming the brain centers and kind of initiating that parasympathetic response while they are there. That I think tends to strike a common chord across cultures.

Kevin Pho: We are talking to Ziya Altug and Shirish Sachdeva. Both of them are physical therapists. Their KevinMD article is “Why your clinic waiting room may affect patient outcomes.” Now I am going to ask each of you just to share some take-home messages that you want to leave with a KevinMD audience. Ziya, why don’t we start with you?

Ziya Altug: My take-home message is that patient care begins in the waiting room. If we can put a little bit more effort and time into that space, I think the patient outcomes and patient satisfaction scores will improve.

Kevin Pho: And Shirish, we will end with you. Your take-home messages.

Shirish Sachdeva: To tag onto that, I mean environment is a silent clinician. We don’t need expensive renovations. I would say intention kind of beats the budget here so we can lower the blood pressure, reduce fear, and improve engagement with nothing more than thoughtful designs and human-centered choices.

Overall, I think if we want better outcomes, better compliance, and better trust with the clinicians, we have to treat the environment with the same care like we treat our clinical protocols. So healing does begin long before the first exam as Ziya said.

Kevin Pho: Both of you, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Shirish Sachdeva: Thank you.

Ziya Altug: Thank you, Kevin, for having us. Appreciate it.