Prior to the pandemic, Gensler began development of an extensive nationwide survey on outpatient care and design. The study was prompted by continued growth in outpatient services and consumerism among outpatients.

Other motivations included a lack of research that captured consumers’ experiences with outpatient design and digital health solutions and the desire to create a survey that could be repeated in the future to map trends over time.

The Gensler Outpatient Experience Index (O-EXI) was deployed from May to October 2020 to a nationwide panel representative of the U.S. population. The survey was maintained by a third-party panel provider.

Respondents were randomly selected to participate in the survey and balanced with the U.S. Census.  Qualifying respondents experienced an in-person outpatient visit within the last two years or a virtual health consult since the start of the pandemic.

By including outpatients with in-person visits either before or after the onset of the pandemic, the study could account for the influence of COVID-19 in subsequent statistical analyses. All participants answered questions relative to their last outpatient experience.

In total, 2,992 survey respondents had an in-person outpatient visit. Five hundred and seventy-eight respondents experienced a virtual health session for their last outpatient experience.

This article focuses on statistical results from analyses of the 2,992 in-person outpatient respondents and provides some takeaways for the industry going forward.

The Gensler Outpatient Index

In partnership with a third-party academic design researcher, Gensler used the O-EXI to capture the sentiment and behaviors of outpatient consumers across the broader American healthcare landscape. It drills down on several key dimensions of the outpatient consumer’s most recent visit with a medical physician, either in an outpatient setting or virtual health session.

The O-EXI also captures how those visits related to a wide variety of outcomes including satisfaction with the experience, judgments of the outpatient facility, spending or loyalty behaviors, and health outcomes.

For example, it became apparent that trust in healthcare providers, desire to make changes to a healthcare provider, loyalty, physical and mental health status, and engagement in one’s care were important outpatient consumer outcomes.

These outcomes also provided the larger context within which to frame later and targeted explorations of the data.

For example, if outpatient consumers experienced extensive wait times but in well-designed waiting rooms, would they be more likely to go somewhere else in the future for their care? In other words, would they exhibit disloyalty? Or would the design offset the negative experiences?

Surprisingly, researchers found that accounting for all other influences and considering the entire national dataset, overall impressions of waiting areas had little influence on outpatient consumers’ outcomes such as loyalty.

Similarly, a good parking experience had little influence. This is contrary to what is often heard during focus groups and interviews. However, what came to the forefront as crucial to outpatient consumers were modern and welcoming exteriors and exam rooms and more intuitive and private registration experiences.

Exceptional outpatient experiences

A big-picture finding of the O-EXI study was that exceptional experiences with design and digital solutions can capture healthcare’s greatest currency: consumer trust.

Outpatient consumers gage trust in their healthcare providers as a key indicator of value. A majority of outpatient consumers do not have expertise in medicine and, therefore, an objective knowledge of the value of the services they are consuming.

The O-EXI found that anxiety, depression, and post-traumatic stress disorder symptoms exacerbated by the pandemic further dampened trust with physicians and the American healthcare system. However, the study also found that with lowered trust, consumers were open to making changes to their healthcare.

These included a location change in where care is received and health insurance. While consumers are open to considering their options, healthcare design can be a differentiator that turns the corner on diminishing trust and captures this market share.

Impact of outpatient design

According to the study, upwards of 70 percent of outpatient consumer spending intentions and loyalty were explained by experiences with design elements and interactions with the physician.

Important design elements included the facility’s appearance from the outside, registration options and seating for registration activities, and exam and consult space design and layout. Those who felt positive about these design elements felt they received value for what they paid for, the visit exceeded expectations, they’d recommend the location to others, and would return in the future.

The facility exterior and exam room are a power pairing and together have a large impact on the outpatient experience. According to the study, if the exterior and exam room design were both highly rated, an outpatient consumer would be more likely to:

  • know what actions to take about their health
  • feel in control of their health
  • understand how to prevent problems with their health
  • feel a sense of purpose
  • feel more optimistic about their future, among other important outcomes.

However, consumers who reported poor ratings—either for the exterior or exam room—were lower on these important outcomes. In other words, consumers may rely on successive and consistent design cues from branding and materials when journeying from exteriors to exam rooms.

The consistency may confirm expectations or, ideally, broaden and build their expectations for what is coming next.

Successful outpatient design

Analyses of the respondents’ data revealed that for an outpatient facility exterior to be rated highly, it needed to appear modern, high-tech, inspiring, and welcoming. If the online impression of the facility did not match the actual impression upon arrival, the experience was compromised.

Clearly delineated exam and consult zones, wall-mounted screens, and shared and round-shaped tabletops were statistically associated with easily accessible information and consumers’ control over their surroundings.

Moreover, patients’ use of personal devices to document or share information during an in-person consult was associated with a stronger therapeutic alliance with the physician—and overall higher engagement with their own health.

This would suggest that designers should be mindful of interactions initiated by consumers with digital technology during a consult just as much as those initiated by care providers.

Furthermore, the O-EXI revealed that the entry experience has become confusing, crowded, and offers few cues on what to do, especially regarding the registration process.

Respondents said lines to the front desk and crammed seating were disturbing when trying to complete digital forms or use a personal device in privacy. Whether the consumer was registering at a kiosk, on a tablet, or in the exam room, the presence of staff was crucial.

Inefficiencies and dissatisfiers such as increased wait times and feeling lost resulted when consumers registered without staff as a nearby resource.

Virtual health

Virtual health is showing promise. About one-half of respondents who used it said a virtual consult was as good as an in-person visit.

The healthcare design industry needs a targeted approach identifying when, where, and for whom virtual health visits may be most effective. For example, the study found women and ethnic minorities value the convenience of virtual health.

Overall, the O-EXI found that physicians’ virtual healthcare settings need to immediately cue credibility . For example, participants reported that effective virtual consults had the physician’s credentials immediately evident.

Additionally, the physician’s setting needed to appear orderly and consistent with what would be seen and expected when visiting the physician in person. This would suggest that consumers are looking for their physicians to be conducting virtual consults from the well-branded offices and exam and consult spaces they have found familiar from in-person visits.

Future of outpatient environments

As the O-EXI demonstrates, research can help providers anticipate consumers’ preferences and elicit dignity, confidence, empathy, and delight.

Current and future advances in the spatialization of data, sensor data, machine learning, and artificial intelligence will further support the design of environments that are responsive to consumers’ needs at any given moment—both in person and virtually.

Future iterations of the Gensler O-EXI will be monitoring these developments.

Nicholas Watkins, PhD, global health sector research lead at Gensler (New York). He can be reached at April Spivack, PhD, is associate professor at Hanken School of Economics (Helsinki, Uusimaa, Finland). She can be reached at Kyle Sellers is research communications strategist at Gensler. He can be reached at 

Additional details on the O-EXI findings and methods can be found at