Efficiency

Increase efficiency through space planning

By developing efficient workflow patterns, your practice can run like a well-oiled machine.

BY LARRY R. BROOKS, AIA

Did you ever wonder why a space or room in your practice is not located in a place that maintains the efficient flow of patients, staff, and doctors? Oftentimes, the architect places these locations as they fit in the space, not as they fit within the operational flow of the practice. Your ophthalmology practice has many moving parts that all need to work together to create an efficient, completed office visit, much like a manufacturing plant has to work in sync to efficiently and cost-effectively make products.

Louis Sullivan, a famous architect, coined the phrase “form follows function.” That phrase can be turned around to state, “function follows form.” Or, the physical environment in which your practice operates will affect practice flow, either positively or negatively.

When you plan new practice space, think in terms of efficient workflow patterns and then wrap architecture around them. In the pre-design phase identify:

• What you are trying to achieve

• Future growth of the practice

• Current flow issues that need to be corrected.

Pre-design is where general architects and practices often get off track. They start drawing before they understand what the practice needs to run efficiently. By taking time to determine efficient workflow processes, the design will follow a path that allows everyone’s time to be used as wisely as possible, leaving more time to care for patients. And remember: At the end of the day, what you have is a business of selling time, and the most valuable time is that of the physicians who dispense their knowledge and skill. So, your first priority should be to achieve an efficient workflow for your physicians.

Because the physician-patient connection is the reason for the practice, start planning the facility around the physicians, then work outwards from there. To do so, first you must determine how many lanes each doctor needs. This is a function of their average patient-per-hour rate, plus the amount of time needed for the staff to finish with the last patient and prepare the next, or turnaround.

Figure 1 demonstrates that the doctor needs enough lanes to manage each patient effectively — that is, without waiting for turnaround — so that when the doctor comes back to the first lane, the patient in that lane is ready. It is detrimental to have too few lanes (physician waiting due to turnaround) or too many (patient waiting in lane too long). Once you identify the correct number for every physician, use this number as the basic building block for planning your new space. Based on your pre-design work in determining practice make-up and growth, you know how many exam pods you need in your new facility.

Figure 1. In this diagram, each patient encounter requires 7 minutes and 30 seconds of doctor time and 10 minutes of staff turnaround time. With two lanes, the doctor must wait 2 minutes and 30 seconds (the difference between turnaround time and doctor time) for the next lane to become available. With three lanes, as shown, the doctor can move from the first lane to second to the third and then back to the first without waiting for the staff to turnaround the lane, while the patient wait is minimal.

The next step in expanding on the building block of your planning is to identify how refraction will take place. Determine when diagnostic equipment is needed during the patient visit process. If the technicians perform manual refraction, then you must decide whether they will use a full lane or tech-only work-up rooms. These work-up rooms are typically located close to the doctor in case the doctor needs to see the patient in that room. If you plan to use a refraction system, then history rooms are needed, which changes the flow. You will want to locate the refraction system rooms closer to the waiting area as one of the first stops. To reduce overall patient time, the staff can dilate the patient while getting the patient’s history. Often a staff is dedicated to these refraction systems.

Figure 2 illustrates traditional manual refraction where a lane or two is added to the exam pod to allow time for refraction. When the additional non-physician time is factored into the workflow, each doctor’s exam pod numbers five lanes for both the physician and techs. One exam pod for the optometrist consists of three lanes.

Figure 2. In the diagram above, manual refraction is performed in the exam lane. To maintain efficient flow, each pod consists of five exam lanes for both the doctor and the techs.

Notice that each pod has its own hall to limit excess traffic in the physician’s area. Patients pass diagnostics and surgery counseling on the way in and out. All patients enter and exit along same path, which is key to keeping patients oriented in the space. The hallways should run wider in higher traffic areas, much like roads in a city.

In Figure 3, an example of a refraction system layout, the patient goes from waiting (in the green area) to refraction system, diagnostics, and history/dilate (all in the blue area) then the exam lane (the orange area).

Figure 3. The diagram above shows a plan where refraction systems are used outside the exam lane (shown in two of the blue rooms marked EPIC), which reduces the number of lanes in the physician’s exam pod from five to three.

In this approach, because the refraction system is used, the number of lanes in the physician’s exam pod is reduced to three. Therefore, the physicians’ walking distance is shorter thereby making more efficient use of their time.

In both examples, the physicians have work stations near the rear of the exam pod to allow them a private area to take calls, review information, etc. This saves the doctors the time of walking to their offices, which might be located a good bit away from their exam pods.

Although each of the two examples uses a different practice flow concept, the same basic principles are followed: Patients pass check out on their way to the clinical area; diagnostic and counseling areas are located between waiting and clinic; and physicians use independent halls in their pods to reduce distractions.

The final pieces to getting your new practice space to work efficiently is the input portion of your practice. Your appointment template should schedule patients at the correct rate, and your staffing model should eliminate conflicting staff duties. With those in sync with the physicians’ output, you should have a practice space working like a well-oiled machine. OP

Mr. Brooks is the principal of Practice Flow Solutions, Roswell Ga., a niche firm that focuses on helping medical practice achieve efficiencies by identifying and solving problems in patient, staff and doctor flow. Contact Mr. Brooks at brooks@PracticeFlowSolutions.com.