Healthcare is one of the few industries where designing systems, processes and space are made based primarily on internal considerations. Most medical offices are built with a great deal of planning on the part of the contractor, the administrator and the physicians. The office layout is often based on a current design or how the practice has looked over the past 20 years with some minor modifications.
But designs of the past did not take into account Lean concepts and were mostly carried out by people who cared only about making things work with a concentration on clinical processes. We need to explore how medical office designs of the future must consider the patient as the center of the care model and take advantage of the efficiencies that exist in this ever-changing, technologically driven marketplace.
One of the first considerations health systems and medical practices must make is how many offices they will have in the various markets they serve. Many of my clients are now reducing the number of offices they have within the same ZIP code and taking advantage of technology to connect with patients who may not wish to drive to the office for all their routine and acute care visits.
Understanding that not all patients and medical conditions are appropriate for e-visits or electronic communication, has your practice determined how many of your current visits can be provided without having the patient come to your office? In our current environment where multitasking dominates, many patients do not want to call the office, wait to speak with someone, travel to the office, wait to be seen and spend the better part of their day in the healthcare cycle of inefficiency. If you are not thinking of ways to meet your patients where they are and trying to provide easier care to a generation that is constantly connected to electronic devices, your competitors are.
Electronic capabilities
Most practices and healthcare systems only use a fraction of their EHR and technology capabilities. In a medical practice or hospital, the EHR could also serve as a virtual “status indicator” to show where a given patient is in the flow process (check-in, waiting, exam room, checkout, etc.). The patient portal aspect of the EHR could also allow patients to preregister at home, review their medical record, pay bills, schedule appointments and request prescriptions, as well as facilitate sharing educational and instructional materials related to the visit. These capabilities will go a long way to reduce the staff and patient time spent on these tasks at the facility and potentially lower wait times for other patients.
Your medical practice also can design a room dedicated to e-visits that is equipped for teleconferencing and telemedicine, which would allow for synchronous and asynchronous interactions with patients and their families.
Clinical space
Most clinical space is designed around a hallway with exam rooms on each side and a nurse or medical office assistant located hopefully within earshot of the provider entering or exiting the exam rooms. Nurses may have a small workstation in the hall so they can maintain constant visual connections with the providers and patients. Most medical practices try to dedicate two or three exam rooms per provider seeing patients.
Newer designs create pods that cater to specific specialties or clinicians, containing two or three exam rooms as well as work spaces for clinical and nonclinical staff, so that everyone on the team is physically located within that shared area. This allows for all the patients’ needs to be taken care of within a single space.
Private work areas
While many providers like to have private administrative offices, this happens to be one of the largest areas of waste, inefficiency and unnecessary overhead for a medical practice. On a recent engagement, I visited a 10-provider internal medicine practice that had one private office for each provider. At 100 square feet per provider, this represented 1,000 square feet of office space that the practice was dedicating to non-revenue-producing activities. Not only was this space expensive to design and build, it cost the practice $25 per square foot per month in rent.
A space utilization study found that the offices were used less than 10% of the day, representing an inefficient use of space that could have been better used for clinical needs, such as exam rooms, which would provide opportunity for increased productivity and revenue.
Alternative design concepts include creating a common room (about 400 square feet for this practice) for the providers to use with wall dividers for privacy. This not only saves space and money but allows providers to come together, share ideas and discuss cases. Many providers also like the camaraderie this common area provides. Other providers rarely use an office other than the exam room and can either complete all their work in the exam room, in a common area or outside of the office, thanks to an EHR.
Business and administrative areas
Has your practice determined the utilization and merits of having a large waiting room or areas for check-in, checkout, referrals, triage, etc.? While many of these activities will continue in the near future, technology is helping to streamline the office visit.
Take checkout, for example. Some of my clients are eliminating the checkout area entirely by having most checkout activities, including making copayments and scheduling follow-up appointments, completed in other areas. For example, paying copayments can be completed at check-in, and scheduling follow-up appointments can be done in the exam room and performed at the end of the office visit by the nurse or medical office assistant who already has an excellent rapport with patients.
When creating medical office space, begin by thinking of the patient and borrow a successful strategic concept used by Apple: Try to predict what patients need before they need it. Some of the concepts mentioned in this article should make your office more efficient and effective, and create not just a Lean experience, but a friendly and satisfying experience for patients and their families.
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