Final Thesis

Parsons School of Design, 2018

Amongst the American population of today, one can derive a memory of the sentiment of a traditional doctor’s waiting room as more an unpleasant chore to achieve the goal of receiving healthcare. According to a PBS News hour piece on US healthcare costs, there are fewer physicians per person than in most OECD countries. For example, the US had a ratio of 24 practicing physicians per 1000 people, which is significantly below the OECD average of 31:1000.  It seems likely that average wait times are likely to increase unless this ratio improves proportionally in relation to America’s annual population rise. This thesis attempts to address how to improve the “waiting process” rather than attempting to adjust the time frame of waiting for a doctor visit. This thesis challenges the architectural notion of a traditional waiting room. Whereas the traditional waiting room from an architectural standpoint evokes increased anxiety and unease rather than comfort and reassurance.

                According to Healing the Hospital Environment, “Stress can be reduced by giving people a choice of what they can do when they wait.  Therefore, lieu of a traditional waiting room, which will set forth be defined as “passive waiting,” this thesis examines the possibility of creating “active waiting” whereas there is no clearly definable waiting space. Instead, there is programming that encourages movement and activity whilst “waiting” to see a doctor. The second layer is that the “active waiting” programmatic elements are usable public space by the community that promotes overall preventative wellness. The scope will focus on healthcare related to physical ailments overseen by Osteopathic medicine to test the notion of active waiting in Gowanus, Brooklyn.

                Gowanus, Brooklyn is apart of Community District 6. In the Community Health Survey on community board 6 by NYC DOHMH, 84% of the population self-reported that their own health as “excellent,” “very good” or “good.” Although, in the same survey, a staggering 16% of the adult population lack any type of health insurance.  This is relevant, especially in the concept of physical wellness. It is unlikely that a resident whom, for example, sprains their ankle, will seek a professional opinion on how severe the injury is and if they do not have any form of healthcare, there is an even lower chance they will seek healthcare. Although sometimes an ankle injury can clear up on itself, without proper examination that cannot be known and can lead to permanent damage and future health complications. Alongside the active waiting program, the thesis calls for traditional hospital rotations by Osteopathic Residents in their Neuromuscular and Osteo Manipulative Medicine rotational residencies be placed in this facility. This allows for residents to have first hand experience needed as well as allowing better accessibility by the community to examination of a range of physical injuries at lower or no cost. The concept is that the facility is not located inside a large hospital complex, where they traditionally are. Instead, located along the canal in the heart of Gowanus to encourage community members to access the healthcare they should seek out. The clinic concept would be replicated on this site, that would include a structure of Osteopathic residents attending to patients overseen by a few attending doctors. This increases efficiency while allowing costs to be reduced for the patient in comparison to solely seeing a board-certified doctor rather than a student.

                The active waiting circulation exist on the ground plane and one level up. There are a series of ramps and pathways that guide the user up and down these locations to the other programmatic elements. The large examination rooms exist above the active waiting circulation. The other programmatic elements that are tethered as a part of the major circulation include a café, walk in clinic, holistic pharmacy, lecture auditorium and classroom. The lecture auditorium and classroom are primarily for use by the osteopathic resident students but can be reserved after hours or on weekends by community members. The active waiting circulation also includes multiple moments that allow for active play while waiting to see a doctor in the complex. These include an area for a five minute workout, a section for sedentary exercises, stationary water bikes for aqua resistance exercise, and a stretching area.

                The idea is that these areas offer a user to workout or work on the exercises they might have been given by their doctor in previous visits while they wait to see said doctor. They would also be surrounded by other members of the community also working on overall physical health and preventative care. The active circulation ramps also allow for a user to just walk around leisurely that promotes cardiovascular health that all filters back into the main part of the complex where one would take the elevator cores up to an appointment. The complex in a sense is a proposal to architecturally dissipate the walls of a waiting room and morph it into a usable active machine where the user is the input value and utilized during the time in which they would have spent sitting in a chair in a waiting room.

The overall physical facades are intentionally different degrees of translucent to transparent for users to see other users actively using this machine-like concept. Being able to see others stay active can be an encouragement and visual spark of life into the concept of health. A machine that can allow community members to promote their own wellness in the same location will also promote general community involvement and comradery to create a successful community space for all members.

Endnotes:

1. Phillips, Craig. “The Waiting Room: U.S. Health Insurance Facts & Figures.” PBS, Public Broadcasting Service, 18 Oct. 2013, www.pbs.org/independentlens/blog/waiting-waiting-room-u-s-health-insurance/.

2. Hosking, S., & Haggard, L. (1999). Healing the hospital environment: Design, management and maintenance of healthcare premises. New York, NY: Routedge.

3. NYC Health. Community Health Profiles 2015. NYC Health, 2015, www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-bk6.pdf