Healthcare design experts say that busy physicians are always seeking ways to deliver better and more efficient care. The layout of their practice can help facilitate this, according to healthcare design experts.
They are now turning to architects firms that design medical offices using Lean workflow concepts and Disney’s On/Off stage design, which benefits both staff and patients.
“The way we practice medicine has changed dramatically because of the design we use now. My colleague and I can get patients in and out quicker and we finish 45 minutes earlier than usual, which allows us to see additional patients. Dr. Kevin Ferentz, MD is the chief physician for family medicine at Owings Mills’ Greater Baltimore Medical Center.
Ferentz claims the design saves him time as his medical assistant is always near — either in the exam area or in an adjoining 5 foot room where they share a workspace. This makes it easier for them to communicate throughout the day, and reduces the amount of time spent waiting.
Robyn Dubick is a principal at CRGA Design Baltimore, who designed Ferentz’s office and another family medicine clinic at GBMC. This saves doctors time and helps them save time.
The exam rooms are also identical in layout and place for supplies and equipment, which saves time and makes it easy to locate them.
Dubick uses Lean principles to improve the patient’s experience by increasing efficiency, reducing waste and improving outcomes.
The exam rooms have been simplified to make it easier for patients. Dubick says that patients can be checked in and out, as well as have diagnostic or lab tests done in their rooms.
She says that GBMC’s patient satisfaction scores have increased from 85% to 93%. The Centers for Medicare & Medicaid Services survey scores of hospitals indicate that they will receive more Medicare reimbursements if they have higher scores.
Ferentz said he learned about Lean management from Virginia Mason Institute in Seattle. This workshop showcased the dramatic transformation of the medical center from a failing hospital into a successful one.
Virginia Mason’s profit margins have increased since 2008 and the number of deaths and medication errors has decreased. Other benefits include a 85% decrease in the time patients wait to receive a lab test result, a 93% rise in productivity and a $1,000,000 reduction in inventory costs.
The new system doesn’t directly save patients money, but it does reduce waiting times, increase safety, and provide more efficient care.
However, not all architects and physicians are fans of the Virginia Mason design. Some people have discovered that certain elements of the Virginia Mason design don’t work in practice. For example, they can’t eliminate all windows and offices.
Ferentz regrets not having a private office. “That was a source for contention within the organization. I think having administrative space for the leader physician would be beneficial, regardless of whether it is to counsel another doctor, or even put in a filing cabinet.
Dubick uses the same “on/off” concept that Virginia Mason used to medical practices. The purpose of segregating patient flow from staff flow is to give patients the “Disney” experience. It keeps patient and staff activity hidden from patients, creating a more peaceful experience. Dubick says that staff can circulate in separate areas to allow them to communicate effectively and quickly without worrying about patient interruptions or HIPAA violations.
Patients can only see their hallways and exam/treatment areas. They enter the rooms from opposite ends of staff members along a U-shaped corridor. Staff and physicians use corridors, meeting rooms and collaborative spaces that aren’t visible to the public.
The “on/off” design. The blue section represents off-stage staff space, while the orange part represents the patient space on-stage.
Scott Eden, MD is the MD who leads Chesapeake Family Medicine, Anne Arundel County. He says that doctors prefer the on/off stage design to the traditional long corridors leading to exam rooms, where patients and doctors converge.
“The most striking thing about the design was how it helped us with HIPAA privacy concerns. Eden says that patients used to be able to hear conversations on their phones about patients while they were passing by, or standing near them. “But that problem was solved with the on/off-stage design.”
Larry Brooks, an architect who is also president of Practice Flow Solutions, an Atlanta architecture firm that renovates and designs medical offices, doesn’t like the idea of on/off stage design. He says he tries hard to convince doctors not to.
It is more space-consuming and can make communication difficult by having separate hallways for clinicians and patients. Doctors and nurses in the back may be able to identify which exam rooms their patients are located in. Nurses often have to cut through exam rooms in order to move from the front to the back. Brooks states that we can create a more efficient flow by using less space.
He prefers to use circulation paths. He compares them to streets in a city. Some lanes have lots of traffic (such the check-in and out areas) while others don’t. (such the hallway leading to the exam pods at each end, which are almost like a cul de sac). He prefers to design congested areas with wide “boulevards” to avoid congestion, as opposed to less congested “two lane highways.”
Practice Flow Solutions, an Atlanta architect firm, created the “circulation paths” design.
Brooks says that clinicians and patients enter the exam rooms through the same hallway. This reduces the square footage and makes it easier for patients to navigate.
Brooks provides private alcoves that doctors can use to make phone calls or speak to other doctors. They are located off the exam pods and not in a separate hallway.
Brooks says that Brooks can’t recall the last time he designed a private office. Brooks suggests that instead of lining the room with five or more desks for five doctors, he recommends putting a small conference room table in the middle. Doctors can flip their desks and take a lunch break or meeting.
According to Dubick, COVID’s social distancing led to a lot more design changes that affected waiting areas.
She says that Lean principles were adopted by more practices, reducing wait times and bringing patients directly to the exam rooms.
Practices had to find safer ways to check in patients than waiting at the reception desk. Brooks says that these options included an electronic kiosk or online patient portal.
Brooks says that COVID has also made it easier to electronically check out patients in an exam room. This is similar to how waitresses are given credit cards at restaurants.
Electronic health records have changed the way doctors interact with patients in the exam rooms. Brooks says that doctors who use EHRs from their desktops frequently turn away patients, which decreases face-to-face time.
The design could include a mobile cart in an exam room and an L-shaped counter to allow doctors to place their computers. It all depends on the practice, he said.
David Zetter is the founder and chief consultant at Zetter HealthCare, Mechanicsburg. He advises clients in the design/renovation phase. These are the steps he recommends to doctors.
Ask yourself this question: What are you looking to achieve? He says that this will determine the type of vendor and permits you need. I have seen clients who have redesigned their homes with only a contractor, while others have hired an architect, patient flow specialists, and designers.
Experts in healthcare understand the workings of medical practices, how nurses and doctors work, and how patients flow. This will save you money and avoid costly errors.
Plan well in advance. Many companies lost employees during the pandemic, and they may need to be backed up.
If you are doing any construction due to supply chain issues, be patient. It took six months for one client to get a new door.
Ferentz was grateful to have been involved in the design process right from the beginning. Dubick states, “It should involve everyone who uses that space including doctors, nurses staff, technicians, and front office staff.”
Costs are determined by square footage. Dubick estimates that construction costs range from $75 to $150 per square foot. Dubick says that this is only the cost of architecture. It does not include design or furniture.
Ferentz estimates that the cost to expand the medical practice from five exam rooms to 18 would be $4.5 million. We were fortunate to receive a donation that fully covered all costs.
Dubick estimates that the average time it takes to complete the project will be 12-14 months.
Ferentz is certain that his new design will bring a return on investment because the practice has already booked patients for the fall.
He doesn’t want to work in a linear layout again. Ferentz says, “I would be very unhappy if I had the opportunity to go back to those long hallways in which I am on one side and the medical assistant on the other.”
Christine Lehmann, MA, Senior Editor and Writer for Medscape Business of Medicine, based in Washington, DC. Her articles have appeared in WebMD News and Psychiatric News. Christine can be reached at clehmann@medscape, or via Twitter @writing_health
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