Placing Users at the Center: Evaluating Exam Room Design for Improved User Experience

Abstract

Objective:

This article proposes a method for evaluating the design affordances of primary care exam rooms from the perspectives of users using functional scenario (FS) analysis.

Goal:

This study aims to develop quantifiable criteria and spatial metrics for evaluating how exam room design supports the needs of different users. These criteria and metrics can be used in the early stages of the design process to choose between alternatives.

Background:

The primary care exam room is an essential space in healthcare, as it is the first point of contact between the healthcare provider and the patient. However, there is a lack of rigorous evaluation metrics for exam room design that supports improved user experiences and better health outcomes.

Method:

A total of nine primary care exam rooms were analyzed using FS analysis. We identified three key user groups involved in the clinical examination process—providers, patients, and care partners—and translated their needs into FSs. We developed spatial metrics for each FS to quantify the extent to which the needs were spatially supported.

Results:

We developed 11 FSs in total: three from the providers’, five from the patients’, and three from the care partners’ perspectives. The results revealed possible design strategies for improved user experiences.

Conclusions:

We quantitatively measured the affordance of primary care exam room design for multiple stakeholders. We expect that the criteria and metrics presented in this article will improve the understanding of different users’ perspectives and provide new design guidance for improved user experiences.

Keywords

design evaluation exam room evidence-based design research methodology user-centered design user experience

The primary care exam room is one of the main care settings, especially in the United States (Vickery et al., 2015). While relatively small, exam rooms are complex spaces with important functions: The exam room is where the first contact between the healthcare provider and the patient takes place and where most of a patient’s clinical experiences occur (Freihoefer et al., 2013; Vickery et al., 2015). It is also a space where patients spend most time directly interacting with providers, and the way the exam room is set up can affect the overall patient experience and satisfaction (Almquist et al., 2009). Furthermore, the exam room has to accommodate various tasks (such as consultation, counseling, information sharing, and education) and a range of users (such as care providers, patients, and care partners) all within a compact and efficient environment (Vickery et al., 2015).

Although the patient-centered model is frequently mentioned as a critical component of high-quality healthcare (IOM, 2001), most research on the built environment and its effects on health outcomes, experiences, and satisfaction has focused on inpatient and emergency room settings. In that regard, outpatient settings, especially the primary care exam room design, have received much less attention (Almquist et al., 2009; Freihoefer et al., 2013). With major changes and advancements in clinical practices and technology, some innovations in exam room design have recently been developed. For instance, three traditional primary care exam rooms were reconfigured into a Jack-and-Jill format in which two consultation rooms shared one inner exam room for improved efficiency (Bodine, 2012); tablets and wall-mounted monitors were used to replace desktop computers in exam rooms (Bluestein, 2016); and exam rooms were designed to provide both on-site and virtual patient care with integrated technology (SMITHGROUP, 2020). However, most exam rooms still have a traditional layout, with patients seated on an exam table, providers occupying a workstation with a computer and screen, and family members sitting on chairs inside the exam room.

The typical exam room has changed little over the last six decades, but there is a lack of rigorous and quantitative spatial metrics for evaluating the affordances of exam room design for the improved experiences of users. This article presents a method for assessing the impact of primary care exam room design on multiple users’ experiences and quantifying how well the exam room layout and configuration meet users’ needs. This approach is expected to enable the evaluation of exam room design according to a clinic’s practice.

This article presents a method for assessing the impact of primary care exam room design on multiple users’ experiences and quantifying how well the exam room layout and configuration meet users’ needs.

Primary Care Exam Room Design and User Experience

According to the Agency for Healthcare Research and Quality, patient-centered primary care is relationship-based and relies on partnering with patients and their families, recognizing them as core team members (Agency for Healthcare Research and Quality, n.d.). In this article, we consider healthcare professionals (those who physically interact with patients, including providers and nurses), patients, and their family members (or, more generally, care partners) the primary users of exam rooms.

In this section, we summarize some of the critical needs of these exam room users relying on previous literature and information gathered in conversations with healthcare professionals in primary care clinics. We acknowledge that there are other critical needs and experiences that this study does not include. Instead, this study focuses on selected user needs that are relevant to the spatial design of exam rooms.

Primary Care Exam Room Design and Work Experience of Healthcare Professionals

We examined the following three main needs of healthcare professionals in this study: (1) the establishment of a quality provider–patient relationship, (2) work efficiency, and (3) personal safety.

One of the most important goals of healthcare professionals is to establish rapport with their patients (Beck et al., 2002; Lang, 2012). The design of the exam room impacts the provider–patient relationship and interaction. For instance, depending on their location and spatial relationships with users, computers can take significant time and attention away from patients (Frankel et al., 2005; Makoul et al., 2001; Margalit et al., 2006), acting as a barrier between providers and patients.

The exam room layout also affects the efficiency of providers’ work. The design of the work zone can optimize the workflow by minimizing the unnecessary motion of care providers and thus increasing their efficiency (Hicks et al., 2015). The inability to easily maneuver in the exam room, unnecessary movement, and repetitive motion can cause providers’ musculoskeletal burden and occupational injuries (Dressner & Kissinger, 2018; Hengel et al., 2011; Midmark, 2011). Minimizing walking around the exam room can reduce the possibility of provider fatigue and enhance provider–patient interaction, making it easier for providers to maintain eye contact with the patient (Woodcock, 2003).

Personal safety is another important need of providers. Patient aggression in medical settings has been well-documented, and clinicians face significant risk as targets of patient violence (Dubin & Jagarlamudi, 2010; Morrison et al., 1998; Sansone & Sansone, 2014). Providers have expressed concerns regarding personal safety due to aggressive patients (Anglin et al., 1994; Morrison et al., 1998). The design of the exam room can respond to this concern by providing quick egress for the provider if necessary (e.g., in case of emergency or to obtain assistance).

Primary Care Exam Room Design and Patient Experience

From the perspective of patients, we analyzed the fulfillment of the following needs in relation to the exam room: (1) their relationships with providers, (2) their first encounter with providers, (3) privacy, (4) their relationships with their exam companions, and (5) accessibility within the exam room.

The patient–provider relationship is the “single most important hallmark” of quality care (Council of Accountable Physicians Practices, 2017), and it can be impacted by the exam room design. For instance, a computer monitor can facilitate communication and shared decision making but, as mentioned previously, can also act as a barrier to face-to-face interaction, making the visit feel less personal (Chen et al., 2011; Freihoefer et al., 2013). Additionally, patients’ active engagement, education, and management of their own health and care are essential (Abid et al., 2020). The exam room design can support the engagement of patients and their care partners by allowing access to information and enabling shared decision making. A shared computer screen is also proposed as an effective way to educate patients and care partners (Almquist et al., 2009; Snyder et al., 2011).

The exam room layout needs to address the need of patients to see the care provider entering the room. Establishing eye contact can lead to a more positive first encounter with the provider. At the same time, the exam room design must address patients’ need for visual privacy from activities occurring in the corridor when the door is open (Freihoefer et al., 2013). Needing to disrobe during a physical exam can often make a person feel awkward and vulnerable (Freihoefer et al., 2013; Ofri, 2010), and the patient’s privacy in a healthcare setting is often jeopardized by limitations in the built environment.

Many patients benefit from having a family member or friend accompany them to their medical appointments. Family members’ presence during an examination can favorably influence communication between the patient and the provider (Brown et al., 1998; Main et al., 2001; Schilling et al., 2002), and exam room design can facilitate care partners’ presence and involvement (Davis et al., 2005).

Although the Americans with Disabilities Act (ADA) requires full and equal access to healthcare services and facilities, studies have found that individuals with mobility disabilities frequently report physical barriers in doctors’ offices (Frost et al., 2015; Mudrick et al., 2012; U.S. Department of Justice, & U.S. Department of Health and Human Services, 2010). ADA noncompliance in medical settings can affect the quality of care and contribute to health disparities experienced by people with disabilities (Frost et al., 2015; Mudrick et al., 2012).

Primary Care Exam Room Design and the Care Partner Experience

Family (in general care partners) involvement is a critical component of patient-centered care (Clay & Parsh, 2016; Jazieh et al., 2018). From the perspective of the care partners, it is essential that they can (1) be co-present during the exam, (2) maintain close relationships with patients, and (3) participate in shared decision making.

As noted earlier, the presence of a family member (or companion) can help reduce patient stress and anxiety and improve patient satisfaction (Botelho et al., 1996; The Center for Health Design, 2016). Family members are seen as part of the care team, and they are increasingly engaged in consultation and decision making. This highlights the importance of the spatial relationship among patients, providers, and care partners (Belknap & Lafferty, 2011).

Care partners can play a pivotal role in patients’ ability to manage their illness and follow treatment recommendations; this is especially true for elderly patients (Mitnick et al., 2010). The locations and spatial attributes of screens can aid or hinder information sharing with family members during medical examinations. For instance, care partners reported greater levels of dissatisfaction in a standard room where they lacked access to the monitor (Almquist et al., 2009). Similarly, both patients and family members highly preferred exam rooms with a sharable screen, as such a screen supported conversation with the provider, gazing, and information sharing (Zamani & Harper, 2019).

In summary, exam room design plays an integral role in the experiences of healthcare professionals, patients, and their care partners. The room configuration and the spatial layout of exam room equipment and furniture can improve or hinder the fulfillment of various user needs. However, accommodating multiple users’ needs and spatial requirements can be challenging.

The importance of design for the user experience highlights the need for a precise assessment method for quantifying exam room spatial affordances. In addition, visualizing how space accommodates various users’ needs would enable identifying conflicting spatial requirements of different users and pinpointing opportunities for improvement. Evaluating how well the exam room design accommodates different user needs can support designers and decision makers during the design process.

Method

Study Setting and Sample

This article analyzes eight different exam rooms (A–H) in five primary care clinics that provide patient-centered team-based care for adult patients and an additional hypothetical exam room (X) generated by the authors. Due to the confidentiality requirements of the sites in our study, we developed the hypothetical exam room design to compare and visualize the results in a consistent way.

The exam rooms were selected and analyzed as part of a larger study investigating the relationships between layout and user experiences in the five clinics constructed according to the health system’s guidelines. Of the eight selected exam rooms, three were from three different clinics and represented a standardized configuration replicated throughout the clinics. The remaining five rooms were from two clinics where the exam room layouts varied.

The size of the exam rooms was either 10 ft × 10 ft or 12 ft × 10 ft. All rooms had a single entrance, were equipped with standard exam room furniture, and had a staff workstation, an exam table, a sink, and other equipment. However, the spatial relationships among the main architectural elements, furniture, and equipment (e.g., walls, doors, sinks, exam tables, and chairs) varied across rooms, highlighting the need for a systematic evaluation of exam room design and how it affects the user experience. Our analysis did not include other types of exam room designs such as exam rooms without exam tables or two-door models (with separate entrances for staff and patients, opening to the different hallways).

Functional Scenario Analysis

We adopted the functional scenario (FS) analysis method to quantify exam room spatial affordances from users’ perspectives (Denham et al., 2018). Using the FS approach, we developed FSs that highlighted the needs or goals of the main stakeholders that could be achieved through their interactions with specific built environments. This method allows translating spatial users’ needs into quantifiable criteria that can be measured, and the extent to which these needs are met can be compared across design options (Denham et al., 2018). FS analysis has been applied in various healthcare settings such as inpatient and intensive care units (Hadi et al., 2015) and neonatal intensive care units (Denham et al., 2018). This article is the first attempt to apply this method for the evaluation of the primary care exam room design.

We conducted the analysis in the following steps: (1) We developed FSs stating the main needs of primary users. Each need was translated into one FS. The needs were identified through a literature review and informed by visits to the five clinics. (2) We translated the FSs into measurable spatial criteria and developed quantitative metrics. (3) We analyzed and quantified each exam room design affordance using AutoCAD 2018 and DepthmapX (University College London, n.d.). (4) We compared the results of the analysis of nine exam rooms. (5) We identified design attributes that affected the results.

Results

Functional Scenarios and Evaluation of Fulfilment of User Needs

We defined a total of 11 FSs for the three primary user groups: three for care providers, five for patients, and three for care partners (Table 1). For each FS, we defined multiple spatial criteria to determine the extent to which the exam room design met the users’ needs. As these criteria were measurable, they allowed us to compare different exam room layouts. The following section provides examples of the FSs from each user’s perspective. Additionally, we detail four FSs to illustrate the design affordance analysis results.

Table 1.
Functional Scenarios From the Perspectives of Healthcare Professionals, Patients, and Care Partners.

User Group Functional Scenarios (FSs)

Healthcare professional perspective FS 1. Healthcare professional needs to access the patient’s chart and talk with the patient while maintaining eye contact

FS 2. Healthcare professional needs to move around the exam room to complete tasks without too much walking

FS 3. Healthcare professional needs to have the possibility of fast egress from the exam room in the case of emergency (from the default location of the charting desk/station)

Patient perspective FS 4. Patient needs to see the provider entering the exam room

FS 5. Patient needs to establish direct eye contact with the provider while seated on the exam table and access the information on the screen

FS 6. Patient seated on the exam table needs to be shielded from a direct view from the corridor when the door is open

FS 7. Patient needs to engage with care partners to receive support while sitting on the exam table

FS 8. Patients with mobility disabilities need to have an accessible route through the exam room

Care partner perspective FS 9. Care partners need to be able to stay in the exam room during the patient–provider encounter

FS 10. Care partners need to be able to sit close enough to provide emotional and physical support for the patient and maintain the direct eye contact with them

FS 11. Care partners need to have access to a computer screen in order to be engaged in consultation and decision making

Provider needs

The identified FSs from the provider perspective focus on (1) the provider–patient relationship (FS 1), (2) the provider’s work efficiency (FS 2), and (3) the provider’s safety (FS 3). For instance, to determine whether the exam room’s spatial configuration supports provider–patient interaction (FS 1), we measured the angle at which the provider needed to shift their view from the screen to establish direct eye contact with the patient seated on the exam table. The human field of view is the observable open area a person can see and expands to approximately 180° (angle degrees), including peripheral vision (Hammoud, 2008). The patient seated at the exam table is not in the provider’s 120° field of view facing the computer screen. The provider needs to turn their head 100° to maintain eye contact with the patient (Figure 1). This layout requires additional efforts for the provider to interact with the patient while viewing the computer screen.

Figure 1.
Design evaluation results of Exam Room X for the healthcare professional and patient relationship from the healthcare professional’s perspective.

We assessed the efficiency of the exam room layout (FS 2) by measuring the compactness of the care provider’s working zone, defined by the provider’s primary touchpoints (exam table, sink, monitor, and door). We used two spatial metrics: (1) the summed walking distance between the provider’s primary touchpoints (in feet) and (2) the ratio of the total area of the provider’s zone (polygon between the touchpoints) and the total floor area of the exam room (Figure 2). Exam Room X has a relatively compact provider zone that makes up 16.7% of the total room area (Figure 2); in comparison, for Exam Rooms D and E, these values are 20.8% and 25.8%, respectively.

Figure 2.
Design evaluation results of Exam Room X for healthcare professionals’ work efficiency

Patient needs

Even for a routine check, a doctor’s visit is often uncomfortable and can cause stress and anxiety for patients (Cobos et al., 2015). Care delivery should focus on ensuring both the physical comfort and emotional well-being of patients. As described in Table 1, patients need to (1) have awareness that the provider is entering the room during the first encounter (FS 4), (2) establish a quality relationship with the provider during information-intensive encounters (FS 5), (3) have visual privacy (FS 6), (4) have emotional and physical support from care partners (FS 7), and (5) have a fully accessible exam room (FS 8).

For FS 5, which defines the provider–patient communication and relationship, we identified three spatial criteria: (1) the angle at which a patient needs to turn to have direct eye contact with the provider, (2) the distance between the patient and the provider, and (3) the angle at which a patient needs to turn to see the screen while seated on the exam table (Figure 3). The layout of Exam Room X allows the patient to see the provider by turning their head only 10°, while to see the information displayed on the screen, the patient needs to turn their head 29°. The provider sits at a distance of 46 in. from the exam table, which is, according to Hall (1966), within the zone of personal space where subjects of personal interest can be discussed (18–48 in.).

Figure 3.
Design evaluation results of Exam Room X for the healthcare professional and patient relationship during information-intensive encounters

Care partner needs

The needs of care partners during the medical examination are summarized in the following three FSs: (1) the exam room should include adequate space and seating for at least one family member or care partner (FS 9), (2) care partners need to be able to sit close enough to provide emotional and physical support to the patient and maintain direct eye contact with them (FS 10), and (3) care partners need to have access to the medical information on the screen to better engage in consultation and decision making (FS 11).

The exam room layout needs to support effective and inclusive communication and medical information sharing with family members, as stated in FS 11. For instance, as shown in Figure 4, the room design can allow care partners direct visual access to the computer screen from their dedicated seat (the angle at which a care partner needs to turn their head to see the screen is 3° in Exam Room X).

Figure 4.
Design evaluation results of Exam Room X for care partners’ information access and engagement.

Comparison of the Analysis Results and Identification of Design Strategies

The analysis results for the four FSs (FSs 1, 2, 5, and 11) are summarized in Table 2. After analyzing each layout, we compared the results for all nine exam rooms and examined what design elements affected the results in each of the FSs. We found that the location of the workstation and exam tables in relation to the entrance are key design factors that affect the experiences of users in the analyzed sample of primary care exam rooms.

Table 2.
Examples of Functional Scenario Analysis Results of the Nine Exam Rooms.

Exam Room Type

Exam Room A B C D E F G H X

Healthcare professional perspective

FS 1 Healthcare professional–patient relationship

C1. Degrees between healthcare professional’s monitor and patient from healthcare professional’s seat (degree) 178 85 85 135 160 175 41 90 100

FS 2 Healthcare professional work efficiency

C1. Sum of the distances between caregiver points: exam table, sink, monitor, door (feet) 31 31 37 40 40 38 34 25 32

C2. Ratio of total area of polygon between caregiver points and total floor area of the exam room (area of polygon, sq. ft) 16.3% (5.94) 17.2% (16.98) 21.2% (21.06) 20.8% (23.04) 25.8% (28.58) 19.0% (23.13) 20.1% (23.29) 10.4% (11.80) 16.7% (20.04)

Patient perspective

FS 5 Healthcare professional and patient relationship during information-intensive encounters

C1. Degrees a patient needs to turn to have direct eye contact with healthcare professional (degree) 65 82 67 92 111 31 5 2 10

C2. Distance between patient and healthcare professional (inch) 44 70 74 45 71 23 43 22 46

C3. Degrees a patient needs to turn to see the edge of the screen (degree) 55 100 83 65 112 23 N/A 34 29

Care partner perspective

FS 11 Care partners’ information access and engagement

C1. Degrees a care partner needs to turn to see the edge of the screen (degree) 33 N/A N/A 83 80 30 N/A 90 3

For instance, the results for F1 and F5 suggest that the location and position of the provider’s workstation (especially the computer) and exam table are the most critical factors in patient–provider encounters. FS1 and FS5 are seemingly similar, but one is from the patients’ perspective while the other is from the providers’ perspective, resulting in somewhat conflicting design strategies. While those needs occur simultaneously during the patient–provider encounter, the built environment that each stakeholder interacts with is different, thus creating distinct spatial needs for each stakeholder. As stated in FS 1, the care provider needs to chart and talk with the patient while maintaining eye contact (Figure 1). This is best achieved when the provider sits in front of the computer screen while the patient is in the provider’s field of vision, such as in Exam Room G, where healthcare professionals need to shift their view only 41° from the monitor to the patient. This setup allows providers to alternate their attention between the screen and the patient, as they do not have to turn their back on a patient when using the computer. On the other hand, the patient needs to establish direct eye contact with the provider and access the information presented on the screen (Figure 3). As shown in Table 2, the patient seated on the exam table in Exam Room G can easily see the provider but cannot access the monitor during the encounter. As stated earlier, patients’ active engagement facilitated by access to information on the screen is one of the cornerstones of the patient-centered care model and a shared goal of all users—patients, providers, and care partners.

In comparison, layouts where the exam table is perpendicular to the workstation (e.g., Exam Rooms H and X or Exam Rooms B and C) seem to support the needs of both users. In Exam Room X, the healthcare professional and the patient can sit close to each other and can both easily shift their view to see each other and the computer screen (Figures 1 and 3).

Discussion

Primary care exam rooms are the cornerstone of the healthcare experience for patients, family members, and healthcare professionals. In this article, we demonstrated a method for evaluating the design affordances of exam rooms from the perspectives of users using FS analysis. The analysis results revealed whether and which exam room designs supported the needs of multiple users, showed where environmental conflicts arise, and helped us identify key design features affecting users’ experiences. Designers and decision makers can use this method to assess and choose between alternatives while designing a new clinic but also improve the performance of existing layouts and pinpoint where these layouts fall short in meeting users’ needs. Additionally, we developed a set of measurable criteria and spatial metrics that are by no means a final list but represent a step toward a quantitative assessment of exam room design and the extent to which users’ needs are met spatially.

Primary care exam rooms are the cornerstone of the healthcare experience for patients, family members, and healthcare professionals

Although performed on a limited sample of exam rooms, our analysis begins to reveal specific design strategies that can support a better user experience in a primary care exam room. For instance, we found that ensuring patient privacy while simultaneously allowing them to see staff entering the room is a challenging task, and neither of the layouts we analyzed met both requirements. However, this goal can be achieved by placing the exam table in the back of the room, orienting it so the foot end is facing the entrance, and having the door swing toward the exam table, which was not the case in any of the examples we analyzed. Making the provider’s working zone more compact by placing the sink, workstation, and exam table at close distances allows providers to efficiently deliver care and avoid unnecessary movement. Furthermore, positioning the provider’s zone near the entrance enables providers to quickly exit or obtain assistance in the case of an emergency. The thoughtful placement of workstations in relation to the exam table can support both patients and healthcare professionals during the encounter. While some design strategies require significant retrofitting or new construction, many can be incorporated in the existing exam rooms at low or no cost. Examples include reorienting the exam table to allow patient privacy, adding a chair for a companion, placing the exam table on an angle to free up wall space for additional seating, or reorienting the screen to facilitate information sharing.

Furthermore, we found that some spatial configurations work better for one user group than others. For instance, Exam Room H presents the best overall layout from the provider’s perspective. The provider’s zone is small and compact, making this layout very efficient because it does not require too much movement between the primary points of work (FS 2). The exam table does not obstruct the provider’s line of egress, which allows the provider to exit the room swiftly and may contribute to their safety (FS 3). Finally, the provider’s desk and screen position in relation to the exam table permits providers to alternate their attention between the screen and the patient, as they do not have to turn their back on the patient when using the computer (FS 1). However, Exam Room H only partially responds to the patient’s needs, as illustrated in Table 2. This layout supports the patient–provider relationship, as a patient seated on the exam table can see the provider entering the room (FS 4), can have direct eye contact with the provider during the examination (FS 5), and can be seated at a convenient distance for discussion (FS 5). Additionally, patients can see the information displayed on the screen (FS 5). However, while this placement of the exam table allows visual contact between the provider and patient, it compromises the patient’s privacy (FS 6).

Another important finding of this study is the identification of users’ spatially conflicting needs and activities, even when the goals are shared (e.g., increasing patients’ active engagement by providing them with information). Examples include ensuring that the patient and provider can always see each other without turning their head and at the same time be able to directly see the monitor (FS 1 and FS 5). Addressing the patient’s need for visual privacy from corridors (FS 6) and the patient’s desire to see the exam room door to be aware of staff entering (FS 4), ensuring the compactness of the provider zone (FS 2), and creating an accessible route through the exam room for patients with mobility impairments (FS 8) can generate conflicting design decisions and require tradeoffs.

As we design the exam room to balance different users’ wants and needs, we must be aware of the tradeoffs. These trade-offs will depend on priorities, and we might choose different approaches for distinct types of exam room visits and consider patient demographics, provider specialties, and other factors. For example, in an orthopedic exam room, it is desirable to have 360° clearance around the exam table, while the exam tables in pediatric exam rooms are usually placed against a wall to help prevent younger children from falling off (Freihoefer et al., 2013). Similarly, when the provider zone and the exam table placement in relation to the entrance have to balance healthcare professionals’ work efficiency and safety, safety may supersede work efficiency in settings such as behavioral health clinics. The orientation of the exam table should allow the patient to see persons entering the exam room directly; however, in obstetrics and gynecology (OB/GYN) or similar settings, the patient facing away from the door is of primary importance.

As we design the exam room to balance different users’ wants and needs, we must be aware of the tradeoffs.

This study has several limitations, in terms of both its sample and methods, that should be addressed in future research. First, the FS analysis method has limitations in generating guidelines for designing or optimizing layouts. The analysis examined the spatial affordances of the identified FSs from the perspectives of selected key stakeholders and sites rather than considering all different requirements of the specified setting. Second, our analysis included a limited number and type of primary care exam rooms. We did not consider specialized exam rooms (such as OB/GYN), exam rooms with separate entrances for patients and staff, exam rooms with windows and natural light, exam rooms without exam tables, or with additional sharable monitors (such as wall-mounted monitors). Therefore, this study’s findings and design recommendations cannot be broadly generalized to other settings. Future studies with larger sample sizes and broader scopes are expected to provide further insights for supporting users’ needs and addressing requirements that result in environmental conflicts for users in different roles and call for opposing design solutions.

Implications for Practice

Healthcare designers can use the developed list of functional statements, quantifiable criteria, and spatial metrics during the early design stage to evaluate and improve the primary care exam room design and choose between options.

Healthcare practitioners and researchers can use the proposed quantifiable criteria and spatial metrics to evaluate the affordances of their current exam room designs and the extent to which they meet the spatial needs of users.

Understanding users’ perspectives and needs can help healthcare systems know the impacts of the exam room design on the primary users (providers, patients, and care partners) and help organizations optimize the environment for an improved experience.

User Group	Functional Scenarios (FSs)
Healthcare professional perspective	FS 1. Healthcare professional needs to access the patient’s chart and talk with the patient while maintaining eye contact
FS 2. Healthcare professional needs to move around the exam room to complete tasks without too much walking
FS 3. Healthcare professional needs to have the possibility of fast egress from the exam room in the case of emergency (from the default location of the charting desk/station)
Patient perspective	FS 4. Patient needs to see the provider entering the exam room
FS 5. Patient needs to establish direct eye contact with the provider while seated on the exam table and access the information on the screen
FS 6. Patient seated on the exam table needs to be shielded from a direct view from the corridor when the door is open
FS 7. Patient needs to engage with care partners to receive support while sitting on the exam table
FS 8. Patients with mobility disabilities need to have an accessible route through the exam room
Care partner perspective	FS 9. Care partners need to be able to stay in the exam room during the patient–provider encounter
FS 10. Care partners need to be able to sit close enough to provide emotional and physical support for the patient and maintain the direct eye contact with them
FS 11. Care partners need to have access to a computer screen in order to be engaged in consultation and decision making

Exam Room Type
Healthcare professional perspective
FS 1 Healthcare professional–patient relationship
C1. Degrees between healthcare professional’s monitor and patient from healthcare professional’s seat (degree)	178	85	85	135	160	175	41	90	100
FS 2 Healthcare professional work efficiency
C1. Sum of the distances between caregiver points: exam table, sink, monitor, door (feet)	31	31	37	40	40	38	34	25	32
C2. Ratio of total area of polygon between caregiver points and total floor area of the exam room (area of polygon, sq. ft)	16.3% (5.94)	17.2% (16.98)	21.2% (21.06)	20.8% (23.04)	25.8% (28.58)	19.0% (23.13)	20.1% (23.29)	10.4% (11.80)	16.7% (20.04)
Patient perspective
FS 5 Healthcare professional and patient relationship during information-intensive encounters
C1. Degrees a patient needs to turn to have direct eye contact with healthcare professional (degree)	65	82	67	92	111	31	5	2	10
C2. Distance between patient and healthcare professional (inch)	44	70	74	45	71	23	43	22	46
C3. Degrees a patient needs to turn to see the edge of the screen (degree)	55	100	83	65	112	23	N/A	34	29
Care partner perspective
FS 11 Care partners’ information access and engagement
C1. Degrees a care partner needs to turn to see the edge of the screen (degree)	33	N/A	N/A	83	80	30	N/A	90	3

Footnotes

Acknowledgments

The authors thank Maria Fernanda Wong Sala and Jennifer R. DuBose for their support and contribution.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Zorana Matić, PhD

Lisa Lim, PhD

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Exam Room Type
Exam Room	A	B	C	D	E	F	G	H	X
Healthcare professional perspective
FS 1 Healthcare professional–patient relationship
C1. Degrees between healthcare professional’s monitor and patient from healthcare professional’s seat (degree)	178	85	85	135	160	175	41	90	100
FS 2 Healthcare professional work efficiency
C1. Sum of the distances between caregiver points: exam table, sink, monitor, door (feet)	31	31	37	40	40	38	34	25	32
C2. Ratio of total area of polygon between caregiver points and total floor area of the exam room (area of polygon, sq. ft)	16.3% (5.94)	17.2% (16.98)	21.2% (21.06)	20.8% (23.04)	25.8% (28.58)	19.0% (23.13)	20.1% (23.29)	10.4% (11.80)	16.7% (20.04)
Patient perspective
FS 5 Healthcare professional and patient relationship during information-intensive encounters
C1. Degrees a patient needs to turn to have direct eye contact with healthcare professional (degree)	65	82	67	92	111	31	5	2	10
C2. Distance between patient and healthcare professional (inch)	44	70	74	45	71	23	43	22	46
C3. Degrees a patient needs to turn to see the edge of the screen (degree)	55	100	83	65	112	23	N/A	34	29
Care partner perspective
FS 11 Care partners’ information access and engagement
C1. Degrees a care partner needs to turn to see the edge of the screen (degree)	33	N/A	N/A	83	80	30	N/A	90	3