PERIPHERALIA

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It is interesting that we work in outpatients, clinics and 
consulting rooms every day, and hardly give a thought to the 
design of the building. When was the last time you held a 
design meeting in your practice or department? Obviously, 
the choice of design of a unit depends upon many factors, 
such as what you want to achieve and objectives (called 
“attractors” in management “speak”), although many themes 
run parallel in most healthcare delivery systems (known as 
fractal geometry).  

Finding the architect’s plans or blueprints is one of the 
problems of holding a design meeting. No one seems to 
know where they are. This is all easier said than done, and 
I have the feeling that when I ask for the plans, they think  
I want to blow up the building.

The time to hold a meeting is when you get to the “edge of 
chaos” which must have arrived well before last week  with 
the current doctor and nurse shortage. It forces creative 
adaptive ideas. Invite anyone you like to a design meeting as 
it is a neutral topic, and can help with team building. We held 
one once, and a doctor who hardly ever spoke hesitantly said: 
“Why don’t we put a door over there?” It opened up a whole 
new flow system which none of us had previously visualised.

Obviously, different configurations are required for different 
practices and clinics. The private practice model may suit 
small volumes with an insured, middle-class population, 
while other designs suit high-volume care to densely 
populated areas of low- or no-income patients.

There are centres for healthcare design, as well as a healthcare 
design magazine in the USA. They address everything from 
the colour of the paint on the walls to the dying pot plant 

in the waiting room. It is interesting that they now place an 

emphasis on plans for security as well. 

It is a law of the universe that if you wish to change anything, 

you won’t be able to go any further if you don’t have commit-

ment from top management. This requires a “buttering up” 

process.

The doctors themselves also need to be convinced. We don’t 

like to think that we are resistant to change, but resistance to 

change by physicians is well documented. Are you going to 

give up your consulting room just because it is an inefficient, 

slow and outdated form of healthcare delivery?  

The patient’s journey through the healthcare maze can be 

used as a framework in the design meeting. The agenda can 

be signage, parking, entrance, reception and filing. Focus 

can then shift to the flow through to the consulting rooms, 

procedure rooms, other healthcare workers, the pharmacy, 

and then the exits. Lighting, surfaces, steps, ventilation 

and temperature control, the width of the doors, and the 

positioning of the examination beds and instrument trolleys 

can fall under “any other business”.

Let’s consider two questions. Are all the forms you need 

within arm’s reach of your consulting room chair? And 

now take something as seemingly simple at the curtaining 

around your examination bed. How many of you are happy 

with the space you have in which to move around between 

the examination bed and the curtain? I rest my case. 

Chris Ellis, Family Physician, Pietermaritzburg, KwaZulu-Natal 

e-mail: crisotbalellis@gmail.com

The design meeting

“Design is everything. Everything” – Paul Rand