When Heartland Health submitted plans to the city of Parkville, Mo., last year for a new clinic, officials rejected them. There wasn't a waiting room in the blueprints. Health system executives had to convince municipal employees that they didn't need one anymore.

Heartland is on a mission to eradicate reception desks and waiting rooms from its outpatient clinics eventually and already has done so in seven new facilities.

"As we were looking through the patients' eyes, one of the things that was just obvious to us was how poorly sometimes we treat patients and their families by sticking them in a waiting room and doing everything on the doctor's schedule or the nurse's schedule," says Mark Laney, M.D., president and CEO of Heartland, a two-hospital network with 50 clinics. "It's not a positive way to get a visit started off, not optimal for anyone. What if we redesigned the patient visit and took the waiting room out?"

As providers look to maximize the patient experience and their patient satisfaction scores, wait times in particular are coming into the crosshairs. Patients spend about 22 minutes waiting to see their doctors at clinics, according to Press Ganey, though that time is sometimes measured in hours. As downtime goes up, patient satisfaction drops, the researcher found. Moreover, the potential exposure to infection climbs.

Efficiency and adequate staffing levels are key to the waiting room-free approach. Heartland has patients settle co-pays online, a navigator, rather than a receptionist, greets them on arrival and hands them a tablet computer preloaded with music and magazines if there's any lag. The goal is to help each patient be in and out of the clinic within about 45 minutes.

Right now, the system is only focusing on new sites, but, eventually, it plans to repurpose waiting rooms at older clinics. How, is uncertain, Laney says, but he knows they'll be used in a patientcentric fashion.

Thus far, visitors, doctors and other caregivers have appreciated the new approach. Nisha Mills, a registered dietitian at one of the clinics, says eliminating waiting rooms made sense as a next step in transforming the patient experience. Still, changing past perceptions about the doctor's office can be difficult.

"Sometimes I will help out [as navigator], and some people walk past me, and I say, 'Oh, I'm here to help you,' but they're just so adamant about trying to find the reception desk," she says with a chuckle.

Eliminating waiting rooms is a small piece of a larger effort at Heartland called Mosaic Life Care. The forward-thinking provider — a 2009 Malcolm Baldrige National Quality Award winner — is working to completely reimagine primary care. Coaches help patients develop life plans that span beyond just their physical health, and chef demonstrations at clinics teach patients how to eat healthfully, among other efforts.

"We really want to be innovators and find new ways to care for people that have more value and are more holistic," Laney says. "So, we're willing to try things; we're willing to sometimes fail. But we're not willing to just keep doing things the same way, because it's pretty obvious to everybody that health care as we provide it today in America is very expensive, it's not very well-organized and it's often not centered around the patients."