All Access: How Universal Design Can Improve Your Practice

Universal design allows users of all ages and abilities to thrive within a space. A practice that incorporates these concepts can better serve patients, families, and even employees. 

Just say no to doorknobs.

At least that’s what is happening in Vancouver, British Columbia; in March, the city banned the use of round doorknobs on new buildings and homes. Doors on those edifices now must have levers. That’s universal design (UD). It might seem like a tiny detail, but the doorknob-to-lever switch is a good example of the kind of thinking needed to make more spaces accessible to more people.

In his final speech in 1998, Ron Mace, the architect who coined the term “universal design,” differentiated it from “assistive technology,” “ADA regulations,” and “building codes” this way: “Universal design is design for the built environment and consumer products for a very broad definition of user that encourages attractive, marketable products that are more usable by everyone.”

This consumer-centered approach will allow you to work in a space that will accommodate most individuals — which can be good for you, your staff and patients, and your bottom line.

All Aboard

If you’re following ADA guidelines, you’re already doing a lot to meet patients’ needs, but these are “minimum standards,” says Danise Levine, a registered architect and assistant director of the Inclusive Design and Environmental Access (IDEA) Center at the University of Buffalo, N.Y. “And these rules are mainly for wheelchair users. In a doctor’s office, you’re dealing with people with a wide range of abilities and disabilities. You’re dealing with patients and also with whoever is bringing the patient.”

Thinking in broad terms about who might be using your space — young, old, tall, short, infirm, or not — will help you see the benefits of UD. “[Its] biggest contribution is that it keeps people in charge of their own health,” says Cynthia Leibrock, designer, lecturer, and founder of “They will be able to make their own decisions and not have to constantly ask for help. ‘I can’t open the door, go through this space, reach this.’ It supports their healing.”

There are no hard and fast rules for UD. For example, ADA may require 32 inches of clearance for a doorway. If your doorway is 31 ½ inches, it’s not compliant. You can answer “yes” or “no” for everything in the ADA code. With UD, Levine says, “I can give you a checklist of 30 things you can do to make your space more accessible. You can choose to do ffve of them or two of them. But there’s no requirement that’s prescriptive. You can start slowly, and, as you can, do more.”

Be aware that along with ADA rules, you also have particular building codes to follow, and those two things may be contradictory, says Newton, Mass., architect Deborah Pierce, author of Accessible Home: Designing for All Ages and Abilities. For example, the Massachusetts building code says you need to have a grab bar behind a toilet that is 42 inches long; the ADA says 36 inches.

Beyond the Parking Lot

It’s easier to work UD principles (see box, p. 26) into a new build, but you can do many of these things in a retrofit or remodel. Check out the websites of the National Association of the Remodeling Industry (, the National Association of Home Builders (, the American Institute of Architects ( (all of which certify professionals in universal design), or the American Society of Interior Designers ( to find qualified, UD-trained professionals.

A lot of UD is just common sense, but it can get overwhelming when thinking about accommodating every possibility for the widest range of people and enhancing every aspect of your space from the acoustics and lighting to your entryway to individual exam rooms to bathrooms and reception areas. Below are a few suggestions, but your design professional will likely have a checklist and spend a lot of time speaking with you about the needs of your patient population and staff.

Accessible route

Remove barriers for easy access for walkers and those using mobility devices. A no-step entry is ideal. “It’s nice if everyone can come in and leave the same way instead of having some come in the front door and others have to go around the side,” Levine says.

The bottoms of vision panels — windows or side lights on conference rooms or office spaces — should be no more than 36 inches off the ground, Leibrock says, to accommodate those who are shorter or are in a wheelchair. “As people go by they can see the room and use them for ‘way finding’: ‘I turn left at the break room,’ for instance.”


Levine suggests having at least one facility that’s family style, if it’s possible, so a caregiver could have the space to help someone needing assistance.

Controls and Doors

Things like doorknobs and cabinet pulls shouldn’t require a twisting or grasping motion, according to the ADA rules. Leibrock suggests testing controls “with a closed fist or draped hand” to see how difficult they might be to operate. “Even a lamp might be difficult to turn on. It’s better to have a touch switch on a cord — which is just a $5 item.”

Reception/Waiting room

This area should be well-lit and designed to make people feel less anxious.

Make sure it’s laid out so that not only is there enough maneuvering space between furniture, but that those in a wheelchair who are with a care provider can sit together and not be in the path of circulation. There should be a variety of seat sizes so heavier people, pregnant women, or shorter people can get in and out of them easily. Chairs should have arms well forward and have space underneath them so they’re easy to get into and out of.

Counter heights in public spaces are often too high. Have at least one lower counter, maybe 30 inches to 33 inches in height so shorter people, a child, or a wheelchair user could easily pay a bill or speak with a staff member.

Pierce suggests using color to make your space feel comforting. “Generally, blues and greens are soothing. Reds and oranges are energizing,” she says. “But blues can be gloomy as well as soothing. It’s important to get both color and shade right.

Place large-print magazines on a lower rack for people with low vision. Vary materials, colors, and textures in flooring so people can differentiate between spaces.

Exam rooms

Depending on your patient population, it might be worth investing in an adjustable-height exam table. “Transferring is just not safe,” Levine says, and caregivers, nurses, and doctors will all benefit from this kind of table.

And think about what it might be like to look up while lying on the exam table, says Pierce. Low-hanging acoustic tile might be needed to cover wires and ducts, but maybe lights could be softer so they’re not glaring in a patient’s eyes.

Bottom Line

Unless you’re going to be moving walls or installing new plumbing, UD does not have to be costly and can be done in phases over time. Your practice will reap the benefits by attracting more patients. “Anyone who wants to be competitive in their industry wants to be sure they’re serving a wide spectrum of the population, so universal design is good thinking,” Pierce says.

It can be used as a marketing tool. “It speaks to professionalism and builds trust,” Leibrock says. “If I were in a wheelchair, I wouldn’t trust a doctor who didn’t make me feel comfortable in his or her space.”

— Stacey Freed is a writer based in Rochester, N.Y. She
has received a variety of awards for her coverage of the
design, remodeling, and construction industries.

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