Consciously Designing Medical Spaces for Every User with Carolyn Boldt of Crossfields

Hello and welcome to this episode of Conscious Design. I'm your host, Ian Peterman, an author of The Conscious Design Book. And today I'm excited to have Carolyn. She is the co-founder of Crossfields Interiors and Architecture, where they help holistic health and wellness businesses be more successful, as well as make them great for clients that are walking into them. Welcome to the show.

Thanks for having me.

Yeah, so I love, I love the design approach that you guys have. It's, I think, very important to think about things the way you guys are. But before we dive into all the design thinking that goes into making awesome medical spaces, let's dive back a little bit. And how did you, how did you get into this space? And, and what got you to really start going through this approach to helping these businesses?

Well, so I'm a commercial interior architect, have a degree from University of Texas, graduated and moved to Atlanta and did all kinds of project work and started working for myself in '92. And my business was word of mouth, large corporate design. And in 2004-ish, my husband decided to leave his corporate job and start working with me. His background is architecture, engineering, and general contracting and development and things. And our— what happened is our largest client, well, started in about 2003 before he actually went on his own, but became Life University, which is a chiropractic college here in Marietta. And Atlanta. I'm in the Atlanta, Georgia area. And at the time, the university was not in a good place. They had lost their current president, and they were actually in between presidents. And my job was to help reduce the facility space, actually. But when the new president came on board, we got involved in helping them revamp. And he very much understood that the quality of your space directly relates to the quality of your success. which was the philosophy of corporate design. If you understand anything about the difference between, to me, residential and corporate design, commercial design would be that commercial design needs to be a return on investment. So, and it's very much focused on what you're creating should actually be able to elevate that bottom line, whether it's in attracting employees, attracting clients, attracting patients. being more efficient, flow, space, etc. So those are the kind of the 2 things you'd focus on in, in commercial design anyway. Saying that, we were working at the university, 2000, like I said, 2003. About 2009, I had the opportunity to help a— and it's a chiropractic college, as I said. I had the opportunity to help a chiropractor personally open his office. And I fell in love with helping the sole entrepreneur, the small business where my background had always been large corporate committees, et cetera.

Right.

So I really fell in love with it. Um, then as it happened in 2010, the university asked us to actually create a course to help chiropractors open their offices. And so we did pure gratis, had a lot of fun doing it, created about a 6-hour weekend type course that we taught. And in the meantime, I had another chiropractor ask us to help open his office, friends of that first one. And it just kind of evolved. It was very organic that after we started teaching these courses, we had the students saying, can you help us? And we're like, well, no, we don't know how to help you because we're used to these big corporate projects. You know, what do we do? At the same time, from a business standpoint, we were really looking at reinventing ourselves to create something that was duplicatable and scalable and transferable and all of those things that we didn't have as our— as we were the lead designers on everything that we did. So it all just kind of evolved together. So in 2011, 2012, we— I started a blog and a Facebook page. on chiropractic office design and created some free lead magnets and started down this journey that I'd never experienced before because everything I'd ever done was local and word of mouth. Now I'm going corporate. I mean, excuse me, now I'm going virtual. I'm going global because there wasn't enough chiropractors in Atlanta to sustain us. So we knew we had to get bigger. So we created this whole different kind of system. And it took off. And we kept feeding it and it took off. And now that's, I guess it was about 4 or 5 years into it, we said, that's all we're going to do. So that's all we do now. And we focus on, we focused on chiropractors for years, but most chiropractors do more than chiropractic.

Right.

And so we, we really now focus on all of holistic health, Let me add the other passion in there. I was already a holistic healthcare patient myself for years and was very passionate about people taking responsibility for their health that they'd have to in wellness and holistic healthcare, etc., and really saw the need to elevate the perception of holistic healthcare to the public. So that it was not— alternative healthcare can be kind of a voodoo word almost, and it's not. So how do you help? How do you help elevate it? And part of help elevating it is what you do in commercial design, which is elevate the image, the package, the package of your product, as we call it.

Right. I'm curious how— and you just touched on this, which is It's part of like your communication, right? How people perceive you and how you're communicating. You know, we think of oftentimes we're like, oh, your communication is, you know, the words on the page or the, you know, like how we're speaking right now, right? But there's also this heavily, when you're talking about offices, right? You're gonna walk in, which means everything you see is communicating Yes. Do you find, or have you worked with these companies in helping? Do you find it pairs well with the branding? Do you guys usually come after, or do you— have you been involved earlier? Because I would imagine, you know, you're from a branding perspective, there's a lot of things, but people sometimes ignore the physical part of it. So I'm I'm curious how that all plays and what the ideal is, right? If you were to lie out and say, hey, here's the perfect process to make sure all of those pieces really work together. So you're not having the branding and other experiences not match the actual physical experience.

That is so, yes. If So I could go a lot of different places right there, but let me see if I can kind of hone in on— so part of what our mission is, is to just educate people on the awareness that there is a psychology of space. Okay? So you live in that world already and you understand it.

Yeah.

But if you don't live in it and you don't understand it, a lot of people are not even aware of it. You know, it's the awareness. So our goal is to get the awareness that your space does impact your behavior. It impacts your, your cult— it creates a culture, and it creates a first impression, all of those things. So that's number one. And when you talk about branding, um, you know, that's kind of a word that's really been thrown a lot around a lot in the last few years. But branding, I heard it, branding is your culture. Right? It's the culture that you create. It's not your logo. It's the culture that you're trying to create. So if you think about in design, your first thing that you're doing is what, what you're creating atmospheres that create feelings for people, right? In design.

Mm-hmm.

And so what type of feeling, what kind of culture, what kind of emotion do you want when people are in that space? And then out of that is the elements and the principles of design that, that fall in to create that. So I don't know if that answered you correctly, but to me it starts from the very, very beginning of creating your business plan. You create your business plan with who are you, who are you going to go after, how are you going to show up in the world from a, from the initial standpoint, and those elements Begin to create not only your logo or your the way people show up in the space, but also your environment. So it all starts yes in the very very beginning. In fact, we we take it in the typical design process. We call it programming schematic design, etc. We've actually called them created numbers because once again, it's trying to educate people on something that they don't understand that we have steps. So step number 1 is just determining who you want to be, who, how you want to show up, and who you're going to attract and what your requirements for that design are, including how many square feet you need. Does that help?

Yes. Yes. You always need to know how big the space is going to be. That'll always impact it.

It will.

You in a, and yeah, that explains a lot. When you, if you were to put together the perfect timeline, right? And you're talking about this in the beginning, would it make sense to work with, say, you guys before, like earlier, before you try to create all your logos and stuff and really at the business plan stage to be able to help inform, I want to do this, and then you can, you can really look at it from the space side of things and go, okay, you want to do X, that means you're going to need A, B, C, and D in the space. Like, this is— these are some— you can help create some constraints and guidelines earlier. Is that—

Absolutely.

Absolutely.

So I wasn't probably as clear, but step 1 should happen in the business planning. Our step 1 should happen in the business planning. Yes. Before we one ever goes to even think about looking for space. One, it helps you figure out how many square feet you do need to accomplish your mission and your goal. And, but secondly, it gets you very focused on who you're going to be and how you show up. And that helps you as you go look for spaces to see if these spaces environmentally align with what you're trying to do and who you're trying to be and what you, how that shows up. That along with once, once you can really define how you want to show up, then the, the, um, the branding pieces that we would think of graphically begin to be able to be developed also.

Right.

The logos, the colors, and all those things, just like the environment. But it all starts with what image do you want to have? You know, what do you, what do you want to put out there and what kind of culture do you want to create?

Right. Which is very important. And yeah, I think it's, I think it's great you're doing that education piece because it's even, even with physical products, because that's what I deal with mostly is people, it's kind of an after, like, oh, it'll, the product will just look what it looks like. And it's like, yes, but do you know what people will think or feel when they're looking at your product or in your space, right? And part of, part of the product, I, I think of medical, especially that kind of thing, is you're gonna be sitting in that space. You know, if you have an hour-long appointment, that's an hour of your day. That's a significant portion of your, your waking hours that day. You're gonna sit in that space. So it's gonna make an impact.

Yeah.

And thinking about it's important.

It is. It is. So when you think about product design and things, it's all psychology. It's all psychology. So it's what psychology do you want it to be and being intentional about it and not just, you said that people just have a product and it just kind of evolves into there it is. It's like, yeah.

I prefer being intentional. It lets us really set what you want to have happen. You mentioned a few different areas, right? And some of the difference, because people are a little more familiar with like residential interior design, people will be like, oh, it's the color of the walls and the supply, right? And it's all about making the person who lives there obviously enjoy their space, which is like one metric of how you go through Design, but on the corporate side, you mentioned a few others and I'd love to just dive a little bit into that and how all that plays because this is something most people don't really think about. You mentioned bottom line, obviously being able to make that better, but also efficiency, making your attracting employees, you know, team members, things like that. What Do you have a hierarchy of most important in general, or is it really— do you base it on the goals? How do you go through the more variables that you have and sort it down into making the most sense for a space?

So we follow 100% of the time form follows function.

Okay.

So you know that very well. What that means to us is that form and function are connected. So you can't just create the function and then try to make it pretty. You gotta think of it cohesively, right? Just like when you're dealing with product design or anything, it's, it's a, it's connected to each other. But if it doesn't function well, it doesn't really work. It doesn't matter how pretty it is. Because if it doesn't— so let me just— we're talking residential design for just a minute, and I'll equate it to a kitchen. Everyone knows that really people that are really into good cooking and, and being chefs, and that's real important to them, that flow and that efficiency of how everything comes together becomes extremely important. So if you think about— and we deal with doctors' offices. The patient volume is part of their bottom line, how many patients they can go through without those patients feeling like they're herded through, right? But how many patients can they function through so that patients aren't waiting a long time so that patients get, get in and out? They don't want to sit there for an hour, you know, unless they're being treated for an hour. That's a whole nother thing.

But right.

So creating efficiencies around patient flow, creating efficiencies around the staff flow so the staff are Not overusing energy, walking back and forth and things. You know, there's just that. And especially the doctors, you know, the doctors being able to easily get from one place to the other. So that type of flow efficiency, as well as, you know, where all the equipment is, just like in a kitchen. So that has to work first. And the other piece of it is that— so we call it maximize space and flow.

Mm-hmm.

So maximizing the space, if you start out with a clean slate and you know how many, in our situation, how many exam rooms you need, how many treatment rooms you need, and what's happening in each one of those exam and treatment rooms, then you can determine the exact ideal square footage for each one of them so that you're efficient within the space. Because if it's too small, you won't be efficient. You'll be bottlenecked and If it's too big, you're wasting money on rent that you don't need to be wasting. So finding that perfect amount is maximizing the space, and then the flow is how it's all connected together. So that has to happen first. That's the function. But as one is thinking about the function, or as a designer thinks about the function, you're thinking about how patients are going to feel as they go through the space and how they're going to what the impressions and what they're gonna see when they walk in. And so we have a first impression and then we have the culture that's created. So first impression would be similar to retail design where when you walk into the space in a retail design establishment, if, if what that space feels like and the product that you're looking for don't— are not congruent, then you'll have a disconnect and it'll lower your sales. And it's pretty much been proven that way, whether it's a Walmart that intentionally is created that way or whether it's a really high-end designer store. That impression should marry with and be cohesive with the product that you're promoting. So the same thing in any kind of corporate doctors, especially doctors, especially where you have clients, a brick and mortar that you have people coming in and making a decision to spend money or not.

Okay.

So that's that first impression, retail design. And then hospitality design is more of the culture that's created. So if you think about when you choose to go out to dinner, yes, you think about the food, but you're thinking about that atmosphere and what you want to experience while you're in that atmosphere. So it's that idea that in doctors' offices, especially in holistic healthcare, because patients come more often to holistic healthcare, Chiropractors, physical therapists, et cetera. It's not a once a year thing. It's a more often. So that culture that's created makes them want to keep coming, keep coming back. So that's the attract and retain patient, which is directly related to your bottom line.

Hey, it's Ian here. So glad you're enjoying this episode of Conscious Design. If you want the full scoop on Conscious Design, what it is, how we do it, how you can do it, Then check out our book. We wrote it so creative entrepreneurs like you can code social and environmental responsibility right into your brand's DNA. You can download the first chapter for free. Link is in the description. Enjoy the rest of the episode. Don't forget to like, subscribe, and share. Right. Obviously, cuz you're, if you're spending, it's better to have a client that keeps coming back than to go have to find another one every single time.

Yes.

One of the things I think maybe we, you and I mentioned it at some point, but one of the things that comes to mind too is it's a little bit, and maybe you can talk about the difference, right? If you are, especially in the medical side, right? If you are a doctor's office that's more insurance focused, that's one kind of flow, right? Because people aren't coming in and spending. $200 they're spending, you know, whatever their copay is, which is as small as we want it to be, right? Whereas like holistic is a lot more and there's even, you know, different dental offices and things like that that are, we do cash. So it's a lot. You're now, you're talking about cash payments out of pocket. No, no, not using insurance. Does that, does that play that per— because those are 2 different kinds of purchases, right? One is almost not you don't think about it, right? Because the insurance just does their thing. The doctor's biller takes care of all of that. And the other one is you're handing over money at the time. Does that play a factor into how you do this, or is it— are those small, smaller nuances less impacted by that?

They are. I don't know if it's as much insurance versus cash as it is the amount of cash. Does that make sense what I'm trying to say?

Yeah, yeah, yeah. Okay.

So, um, there are cash practices that are really low dollar versus cash practices that are much higher dollar. So if you've got a service that you're expecting to get, you know, $20 a visit for, or you don't expect— the person that walks in doesn't expect as much. You're in Walmart, you're going to get a deal, right? But if you walk into a designer department store and you're going to put over $2,000 for a handbag, you're expecting a whole different experience. And so that is— that's the pieces that need to line up with what we were kind of talking about, that first impression from the retail store. You are correct in that insurance is kind of like the lower price because it's what people are putting out of their pocket. So, if insurance is going to cover a lot of it, then you don't really— you can tolerate less visual quality. Does that make sense what I'm saying?

Yeah.

As opposed to if you're going to be putting a lot of money out of your pocket, You—it just needs to. It just needs to line up. You don't need to walk into a space that I know I'm—I'll just share with you—I've been going to physical therapy, which I have never really done before, but I'm doing it. And—and I'll just share with you this: that I'm on Medicare now. I'm 65 now, so I'm on Medicare, and I don't have to pay anything. I mean, it's such a, such a, and I don't care what the space looks like. You know what I'm saying?

Right, right.

As opposed to me going to my massage therapist where I'm choosing to pay for that wellness treatment out of my pocket and, and it lines up differently or just that, that whole everything that's happening. So you have to, so the biggest thing you have to know when you're designing any kind of corporate space is who are you trying to attract? What are their demographics? What are their psychographics? Who are they? The word avatar, you've heard, may have heard that. Who's the avatar? You know, who is that person? And if you design to that person and all of the aspects of that person, then you tend to have, you know, you, you hit it right in the middle and then it kind of allows that space on each side of that person to be receiving also.

Right. What, what else, you, I guess you mentioned a little bit, but if you could dive into, because the, the flow and the flow is interesting to me because there's, there's a lot, there's a lot of flows happening, right? And there's, there's multiple, right? With a, with residential design, right? There's usually one, you know, user, so to speak. It's the family, whoever lives there, right?

Yes.

It's not gonna be 30 people or 100 people a day going through it. But when you have an office like this, you have, I kind of feel like it's 3, maybe correct me if I'm wrong, but you have the employees.

Yes.

But you have also the business or the owners, doctors, right? And then you have the customers and they're all expecting something very different out of the space. At the same time, how do you, how do you start to address that complexity of flow? Because there's always one user is easy. I feel like as soon as you do multi-user something, it's all of a sudden becomes very easy. Like, how do you address that? And is there, I guess, what are any, some considerations that you put in to help make sure you can get 3 different things out of the same space in a non, non-combative way from the users.

Well, I'm gonna say something. There's always compromises, and we have to, we have to know the priorities of compromises, right? So, but the goal is to start off with understanding that, that priority, and then design accordingly. So when we design doctors' offices, we look at— there's typically 3 different flows we look at. The first one is the new patient flow. So the new patient flow, um, is a little bit more about that first impression, and it's going to typically be escorted through the office, you know, as the first time that they go through, especially in health and wellness. Okay. Um, because you're coming so often, once again, the patients come so often. So it has to be non-confusing and it has to be appealing, but it's not like they have to find their own way through it. So the wayfinding is not what's important. So they'll typically go in, you know, they'll typically go to an exam room and a consult room as opposed to right to the treatment rooms and things of that sort. In the second flow would be your existing patient flow. And once again, in health and wellness, you tend to have patients that have been there and they're familiar and they can almost escort themselves around, you know, especially in chiropractic. A lot of times you'll have— they'll go to a pre-adjusting area themselves just to get prepared for adjusting. Or in physical therapy, the same thing. You know, it's like go over to the bike and start walking or riding or something.

Right.

So that flow needs to be really easy for that patient to see. So you need to think about, are we going to confuse them in any form or way? So a lot of times you'll have certain things up front so they don't have to go wind themselves back versus the escorted things can be farther in the back. That's just a simplistic way to kind of manage it. But then we put on top of it the layer of the staff, which includes your doctors and includes your assistants and, and includes your admin. And you almost have to look at each one of those and what their job duties are.

Okay.

Because in some situations, that front desk person may never leave their front desk. Do you know? And in some situations, that front desk person may escort that patient all day long back to the back and front and things. So you have to just understand the business model and think about that flow of each person as best you, as best you know it without, without bottling yourself in. And obviously the bigger the space, the more impactful it becomes. Do you know what I'm saying? So when you get into a really large space, you tend to start thinking in zones. Like, um, because you typically don't have one person, one staff that's going to manage the whole space in a big space. They're going to have a certain area that they're focused on. Like you'll have a nurse's station and that'll be the part of the space that that nurse's station will handle.

Right.

So it's just, it's digging into the business operations and understanding it to come up with the flow.

Yeah, I love, I love that. It keeps always just pointing back to it. You have to think about this at the beginning. And it's part of, and I love that you mentioned it as part of your operations. And I, you know, people think about operations and like, oh, it's just how you do stuff. Like, but I love you keep bringing this back. Yeah. And the space will impact how How you do that. I feel like, you know, industry, like industrial businesses really understand this, like worker flow, material flow, like there's whole systems and tools all about it. It's very, you know, think about an Amazon warehouse, right? It's very dialed in.

Yes.

But, and we don't have to make it, right? They're not trying to make customers happy when they walk in. It's They ignore that. So you can add that component and still have pull in some of that efficiency though and bring it in and then also make it a great experience for your customer. So this is—

Yeah.

Yes, it's good. Hopefully everyone who listens to this who's a chiropractor or other medical will talk to you. Hopefully we can make some offices a little bit better. While we're kind of just to wrap up here, I'd love anything else you want to mention in your process, your design thinking that we didn't touch on. I know you have your approach to this, or anything that you want people to know really at the beginning, like when's a good time to come talk to you? Obviously at the beginning, but—

At the beginning, the sooner the better. The sooner the better. Yeah, because if we, if we can talk to you in the very beginning when you're creating your business plan, one, it helps you figure out how many square feet you need, which you need to know for financial reasons and before you ever go search for space. And secondly, it helps you hone in on those questions of your operations and helps you hone in on the ones you still need to discover. And then the other piece of it is part of your marketing. It's really part of your marketing. So you think about, I, I, I talk about your environment and I may have mentioned this earlier, but your office space is like the package of your product. So when people walk in, it's just like having a lot of packages on the shelf.

Right.

The website, the website is too. The website is too. Now the website is the front page, right?

Right.

But if the website and the interior of your space do not emulate what you're trying to communicate to those people on the inside, if it's confusing or if it's disconnected from—

Right.

From what you're trying to sell, just like I was talking earlier, if you're selling a Walmart-priced product, you don't need a Louis Vuitton interior.

Right.

You know what I'm saying? You gotta have— and vice versa. And vice versa, you know. So we see some, some of our doctors that want to go up in their price, but their office looks like it's a Goodwill. So, you know what I'm saying? It's like it, it just, the people, it disconnects. And we've seen 20% increase, you know, when people actually do this, whether it's a renovation. We do renovations also, whether it's a renovation or whether it's a new build. That they can actually—

I love, I love that description that your, your space is the packaging to it. You know, your service is the product and your, your space is the packaging, which I think is, it's a perfect, perfect metaphor. And I think that'll hopefully everybody heard that part because that, that is right. Because we do think about packaging, right? We think about it's what you're delivering. And services sometimes are so hard for people to wrap their heads around because product is, you know, easy. It's like, here's the product, here's the packaging, you know, very clear, you know, you can hold it in your hand easy where services kind of oftentimes feel a little more etheric in that it's, there's no tangible, right? You're receiving something, it is worth money and it's valuable and you It's a good exchange, but it's not like, you know, take it in a box and take it, take it home with you. You experience— it's an experience that you're receiving as well. So I, yeah, that's a— I love that analogy. I'm gonna have to use that.

There's so many— there's, and I can't quote them, but I've read them, studies on products that they change their packaging and their whole, their whole sales change. the same idea. You know, the same idea.

Amazing. Well, I really appreciate you being on, on this episode and being able to share what, what you're doing and continue doing it. Hopefully more and more people just keep learning this. And for anybody that wants to get ahold of you guys, find you guys, what's the best social media website? What's the best place to find you guys?

Well, our website is crossfieldsdesign.com. And, um, if, because we've been in the chiropractic world forever, just Googling chiropractic design, we typically come up. Um, we're working on the holistic design being coming up that, that often too. But, uh, crossfieldsdesign.com. We do have a, a free resource for your listeners, which are, I've mentioned, um, renovations. But we have a 5-point designer checklist that would be the first 5 things that as designers we would look at if somebody needs a, what we call a facelift, if they're considering, okay, does my space match up with who I'm trying to be? So they can get to that from crossfieldsdesign.com/listeners. And so that's just a free resource that they can get to us.

Perfect.

And then, yeah, our website, our website has a plethora of information. Yes, we're on Facebook, and yes, we're on Instagram, and yes, we're huge on Pinterest.

I can imagine. Design usually is.

Design usually is. So, but all of those things are accessible from our website.

So amazing. Well, and I will, for everyone listening, those, all those links will be put in the show notes so you can just click them as well. Again, I really appreciate you being on, on the show. Love talking about design, and thank you so much.

Thank you for having me. I appreciate it.