• Health reform
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Series
• Writers
• Other years

• Search tips
• Email alert
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

• AMA Wire
• CPT
• DMPHP
• JAMA
• JAMA&Archives
• news@JAMA
• Virtual Mentor
• Physician jobs

Comfortable investment: Making your office more patient-friendly

Some physicians are banking on the idea that designing a pleasant and easy-to-navigate office can increase patient satisfaction -- and their bottom lines.

By Larry Stevens, amednews correspondent. March 17, 2003.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE
•  

When thinking about how you can squeeze more income out of your practice, take a moment to consider where your office toilets are located, and whether your waiting-room chairs have stains on them.

Toilets and chairs may not be an obvious place to look for relief from tight reimbursements. But some physicians are looking at every part of their facility's environment to determine how office design and organization can create a practice that is more efficient, thereby allowing them to earn extra money by seeing more patients in a day.

These same improvements can be made without making patients feel like they're being herded through an assembly line, but instead making patients feel like they are getting more attention and better service.

When five-doctor Mystic Valley Urology in Stoneham, Mass., decided to ditch its outgrown digs and create a new office from a gutted building, Peter Tiffany, MD, one of the doctors in the group, knew he was taking a serious financial risk, so he needed to investigate how the new building could help pay for itself.

In this case, necessity was both the child and the mother of invention. The new building was designed in a way that could play an important part in realizing increased efficiencies that could help generate some of the needed cash to pay for it.

Mystic Valley hired Larry Brooks, principal of Medical Design International in Tucker, Ga., to design the new facility. The doctors obviously wanted a good-looking office. But even more important, Dr. Tiffany says, "We wanted [the building] to contribute to efficiency and patient satisfaction." Both factors would eventually result in improved revenue, Dr. Tiffany figured.

It was difficult to use Mystic Valley's old offices as a guide. It had grown incrementally and now was housed in three offices in the same building.

But Brooks did find a number of problems that could be avoided in the new office.

For one thing, there was no order to the rooms relative to order in which patients would use them. Patients had to walk down a hall to the rest room to provide a urine sample, which doctors often had to retrieve themselves because nurses were in another end of the office. "There was a lot of unnecessary shuffling and moving around," Brooks says.

In the new facility, patients go to the rest room first, place their urine cup in a small door in the rest room that opens on the nursing station on the other side. A nurse retrieves the sample and carries it while escorting the patient to the exam room.

The nurse is then in position to perform the information-taking responsibilities.

Another time-saver results from each of the seven exam rooms being exact replications of each other. Literally every item -- tables, sink, chair, tube of lubricant, tissue box, prescription pad -- is in the exact same location. "When you know without having to think about it where everything is, you're more efficient and your stress level is much lower," Dr. Tiffany says.

Dr. Tiffany doesn't measure the improved efficiency in the office design in hours, but in seconds and minutes. When doctors don't have to carry the urine cup, they save 30 seconds per patient. Not having to look for rubber gloves, prescription pad or other things may save another 15 seconds. And because of a flashing-light signal outside each door, the doctors don't have to find nurses to see who's ready to be seen next, saving another 30 to 40 seconds. All told, the savings may equal one or two more patients a day for each doctor.

Understanding office layout

Most doctors will not be able to acquire the skills needed to design a complete office from scratch. But an understanding of the basic concepts of designing for increased efficiency and patient satisfaction can be a big help when discussing layout with an office design professional.

At the very least, it should help the doctor determine if the space planner is savvy about the unique requirements of medical offices. In addition, even doctors who are not moving can do some relatively simple and inexpensive design-related activities that can play a role in improving the office environment.

Certainly, the larger the group, the more people milling around, the more important the office design is to work flow. But the need for efficient design is not confined to groups. Solo doctors, especially those who perform complex procedures, also can improve their work flow though good layout.

For example, reproductive endocrinologist David Smotrich, MD, of La Jolla, Calif., says when he planned his new facility, he was very concerned about patient flow and patient safety. Among the design features health care designer Jain Malkin incorporated in Dr. Smotrich's new office was to put the nurse station in the middle of the office complex, so if someone is having a problem she doesn't have to call down the hall for a nurse.

The central station also allows the nurses to oversee more rooms, reducing the need for overstaffing. "Patients have sense of privacy and confidence that they're being taken care of, and because of the design we can give them that without adding a lot of extra people," Dr. Smotrich says.

The sense of privacy also was enhanced by placing a toilet between two exam rooms with doors leading directly to the exam rooms. This eliminates the need for patients to leave their rooms to use the toilet.

Malkin points out that providing a sense of privacy is one of the most important ways design can improve patient satisfaction. For example, when building a new facility, always insulate between exam rooms. "One of the most disconcerting things for patients is to hear the doctor and patient when they're next door," says Malkin, also the author of Medical and Dental Space Planning.

Another way to improve privacy as well as patient flow is to have separate check-in and checkout areas. This relieves the front desk bottleneck and may move patients into the system more quickly.

The sliding glass door has been a traditional way to improve privacy because it allows staff and doctors to discuss patients without being overheard by people in the waiting area. Some doctors prefer the more open and friendly feel resulting from having no barriers between the receptionist and patients. But the downside is that the receptionist has to retreat to another room to discuss a patient or to make certain calls.

Nancy Bounds, a health care designer with NB Interiors Inc. in Metairie, La., contends that the sliding glass door doesn't necessarily have to be a symbol of unfriendliness. But people have to be trained how to use it.

"The door should never be a barrier," Bounds says. "If at all possible, it should be opened as soon as a patient approaches, even if just to say, 'Just one minute.' " She also strongly suggests a clear glass door so patients know they have been seen. And it should be as big as possible so that patients and receptionist don't have to poke their heads in to communicate.

Waiting room

After check-in, the next patient experience is usually the waiting room. This is an area ripe for improvement, many experts say.

There are, of course, very expensive and elegant solutions. Dr. Smotrich says after designing his office, he found he was left with a long narrow waiting room. To make it seem less like a subway car, he employed a sinuous design in the carpet and ceiling.

Other designers go even further in terms of elegance. Designer Page Rutledge in Carolina Beach, N.C., once created a waiting room whose floor tiles were actually photographs of shimmering water. Patients get the feeling of walking on a lake. And fish sculpture, seeming to dive into the floor, provided additional interest.

But Rutledge is quick to point out that while these fancy rooms -- beyond the budgets of many practices -- certainly present a rich appearance, they have only a limited effect on overall patient satisfaction. Patients are primarily interested in whether their doctor is competent, but most can't judge that directly. So they seek clues.

When it comes to office design, they're more interested in neatness and currency than glitz and glamour. "If doctors knew how much patients are turned off by old, dog-eared magazines, stained chairs and ragged carpet, they'd take care of those things immediately," Rutledge says.

She points out that many doctors have not been in their waiting room for years. She suggests taking a look around, and trying to see it from the point of view of a patient coming in for the first time. "What does the office say about you?" she asks.

Besides neatness and cleanliness, waiting rooms can be redesigned relatively inexpensively to be a more comfortable place to wait. The more comfortable, the less time patients think they have waited -- and, designers and physicians say, the easier it is to get patients to open up about their conditions once they're back in the exam room.

Color is important. Since many patients may have a touch of white-coat syndrome, the cool hues can be relaxing, designers say. Malkin points out that studies have shown that cool colors tend to cause time to be underestimated. But if your practice has a lot of older patients, don't be too understated: many with vision problems may not be able to distinguish pastels.

Incandescent lamp lighting may seem more homey than stark overhead florescence. And individual chairs are often preferred over couches, which many people don't like to share with strangers.

Music, ubiquitous in medical offices, is not actually necessary, many experts say, unless it is used to provide privacy for people at the reception desk. A television can help pass the time, but it's best to position a TV so that people have an option of viewing it or not. In any case, the broadcast should be monitored by staff to avoid shows that may be offensive to some viewers. The morning news programs quickly give way to questionable daytime programs.

There's a lot to think about when designing or even just sprucing up an office. Many doctors won't have the time or the resources to consider a major overhaul. But just an awareness of the importance of the office environment may lead doctors to find areas for improvement. And the overall effect of the enhancements can well be increased efficiency and patient satisfaction.

Back to top

 ADDITIONAL INFORMATION: