Solving Medical Office Space Challenges

Two years ago, ophthalmologist Dean Arkfeld and two of his partners left their practice in Omaha, Neb., their reasons for leaving a little different than most. They weren't unhappy with their staff, patients, or workload - they were unhappy with their physical office space, and they thought changing it could improve efficiency and patient care. Within a matter of days they opened up a new office, less than 20 blocks away.

"We decided to make this move with the intent of redefining and refocusing the patient care experience," Arkfeld says of their decision to leave. "We had a feeling that we could provide care differently and in a way where it would be a better experience across the board."

Arkfeld's popular new practice, iLumin, boasts state-of-the-art technology, a relaxing reception area, comfortable exam rooms, flat screen televisions, and a new office layout. All of which has led to increased efficiency, patient satisfaction, and patient well-being, he says.

But for many physicians, the concept of medical offices like Arkfeld's seem more dream than reality. Practices across the country are struggling to provide a higher quality and quantity of patient care with fewer resources.

Practices with tight budgets need to find new ways of increasing office efficiency and productivity. A modestly redesigned office space is one way to do that - and it's not as big an undertaking as you might think. Whether your practice is struggling to pay tomorrow's bills or you're one of the few lucky enough to have some extra cash flow at your fingertips, low-cost fixes to your space can improve your work environment and quality of care.

Step 1: Start with a clean slate

First, embrace the "lean philosophy." That's a key recommendation from Joyce Durham, an architect, nurse, and principal at Health Strategies & Solutions, Inc, a healthcare management consulting firm. The "lean philosophy" creates value by eliminating inefficiencies, via methods such as the “5S lean tool”: sorting, straightening, shining (cleaning), standardizing, and sustaining.

Take a look around. Chances are your office is filled with piles of loose papers on counters, teetering stacks of charts on shelves, and excess supplies bursting from closets. The accumulation of clutter is the nature of the profession, Durham says. "For some reason in healthcare, people overstore stuff. They have enough paper towels for the next two years."

Once you've finished cleaning out your space, it's time to grab a label maker and get organized. Medical offices have a high number of staff sharing supplies and working within small areas. Naturally, things get messy. But if everything has a place, marked clearly for everyone to see, organization will come naturally. "Areas that embrace a lean philosophy stay neat and tidy," Durham says. "People put things back in their place and things don't pile up."

Also organize the location of supplies in each exam room, urges Ellen Taylor, an architect and consultant at The Center for Health Design, a healthcare design research and consulting company. Making sure that all supplies are located in the same place in each exam room eliminates the need for staff and physicians running around trying to find things.

Cleaning, eliminating, organizing - it's the easiest way to see what type of storage you need, and how much extra space you have to work with.

Step 2: Self assess

Once your office is clean and organized, it's time to start brainstorming. This may be the most important part of the process, says Laurie Baedke, founder and president of The LIFEworks Healthcare Group, a practice management consulting firm. "It's helpful for practices to get their arms around what they actually need, so that when they do start the design process they do it as efficiently and effectively as possible," Baedke says.

If efficiency is lacking in your office, work flow is probably the cause. Work flow includes everything involved in a patient's visit, from the initial appointment-setting phone call, to the follow-up test results. Take a step back with your colleagues, Baedke suggests, evaluate your processes, and locate the inefficiencies.

Don't be afraid of the "Christmas wish list." Include opportunities for staff input, she says. "If you don't allow that input to be gathered, it's very challenging to get the users' perspective, and hence, design the space most effectively around it."

Finally, assess the quality of care your patients are receiving. Determine what your patients' needs are, and recognize where your practice is coming up short, Taylor says. Consider whether they care about aesthetics, if they have young children, if they have special needs.

Think about your patients - always. If they're not happy, no one is happy.

Step 3: Efficiency improvements

Once your list of needs is finalized, prioritize. It's time to ask yourself, "What would my ideal work flow be?" Taylor says. Form your design process around those ideals.

If you noticed inefficiencies due to room layout, it's time to rearrange. For instance, if one of your physicians is constantly traveling between exam rooms on opposite sides of the office, that's an efficiency problem. Reorganize your office in a more practical way.

Taylor also suggests standardizing the layout of the exam rooms. Place the furniture and equipment in the same place and position, do the same with supplies. This eliminates staff time spent adjusting and rearranging during each appointment. A few minutes saved each visit translates to hours of time saved each month.

The reception area is also a source of inefficiencies, Taylor says. Consider providing patients with as much information as possible before their appointment. This ensures they know when to arrive, what to expect, and what paperwork to complete ahead of time.

The more knowledge you equip patients with beforehand, the more efficient the visit will be.

Step 4: Patient satisfaction

Finally, remember that your office space plays a key role in the way patients measure your quality of care; they look at the whole office visit experience, not just the time spent in the exam room with the physician.

"While the quality of the clinical care experience is the very bottom line of what we are doing, we can't ignore the fact that other influencing factors [like the physical environment] are playing into whether or not a patient feels like the experience in your office was valuable or not," Baedke says.

Researchers at Weill Cornell Medical Center studied the influence office space had on patients' satisfaction and anxiety levels. "The more attractive the environment, the perceived waiting time was lower, the perceived quality of care was better, the perceived communication with the staff was better," Taylor says.

Don't underestimate the influence of aesthetics. Consider adding wall hangings, soft lighting, soothing music, magazines, and books to the waiting room and exam areas. If children visit your practice often, set out small toys and kid-friendly books.

Also consider improving office acoustics. Many exam rooms have thin walls that do little to minimize sound from traveling. This raises patient confidentiality issues, and it also tends to make the patient and the physician uncomfortable. Taylor recommends installing an acoustical ceiling tile. These can cost as little as $30.

"Patient expectations are changing," Baedke says. "We need to be cognizant of that and react to that."

Aubrey Westgate is associate editor at Physicians Practice. She can be reached at aubrey.westgate@ubm.com.

This article originally appeared in the October 2011 issue of Physicians Practice.