Key steps for determining a practice’s space needs

Here are some tips for improving your office efficiency:

1. Determine the types of rooms you need.

These may be history and physical rooms, procedure rooms, and examining rooms — and they’ll vary by the type of practices.

"In an adult office, you can do anything in an examination room. Pediatricians often prefer that needlesticks be done in a laboratory or a different setting so the scary procedures will be done somewhere else beside the exam room," says Mike Boguszewski, manager for Hamilton HMC, a Minneapolis consulting firm.

2. Categorize your visits by type.

Narrow down the number of types by how long each patient spends in each type of room. Even if you have 20 types of visits, you can reduce it into larger categories. For instance, an obstetrics practice may have three types of check-up visits: regular, high risk, and low risk. But, if each one takes 10 minutes in the room, plus five minutes for a blood draw, they can all be categorized the same way.

3. Add up the number of rooms you need for each activity.

For instance, you may discover that every four examination rooms need to be supported by one procedure room and one history and physician room. It will vary by practice, Boguszewski points out.

4. Determine the amount of time that needs to be spent in a room for each visit on average.

Include the physician’s time plus any time for cleanup and preparation, or other procedures. For instance in an eye clinic, factor in eye dilation time. In an OB/GYN practice, you might include time for the patient to disrobe and get dressed.

5. Determine how the rooms will be configured.

There’s as much variability in the way to configure the rooms in a physician practice is there is in the type of specialty and personality of physicians, he says.

6. Determine who has "ownership" of each room.

On one extreme, each physician would have exclusive use of the set of rooms he or she needs. On the other extreme, every physician in the practice would share every room.

Most practices will come up with something in between. "High-level sharing puts restrictions on physician flexibility The easiest way is for each physician or each sub-team of physicians to have their own rooms," Boguszewski says.

But, if each physician has his or her own set of rooms, the rooms will have more down time, which will increase the cost per room, he adds."It will cost more but what they get in return is ease in scheduling and a greater ability to maintain their own schedules. It is a trade-off."

Another issue is physician preference for instruments, supplies, and equipment. For instance, if some physicians like a particular type of exam chair and others don’t, it may be difficult to get them to share rooms.

7. Cluster the rooms around the physician preferences.

After you figure out how many rooms you need, you need to fit your space into the practice styles of your physicians.

This is where a good facility designer and architect come in.

For instance, the physician may want his or her office in the center of the rooms, or may prefer to have the office on the back hall, away from the patient areas.

Ask the physicians where they want to go for the five minutes of dictation that follows each patient visit. The doctors could prefer to go back to their office or do the dictation at a nearby computer station. Or they may prefer to spend an hour or so at the end of the day in their office to take care of all the dictation at one time.

Boguszewski also recommends practices include cushions of time in room schedules throughout the day. For instance, if Dr. Jones sees 12 patients in 15 room-hours, the patients shouldn’t be scheduled every 20 minutes throughout the day. Instead schedule them every 20 minutes until 11:20 and then leave a 20-minute cushion of time before the next patient is due in the room. Do the same with your afternoon schedule.

Then if a patient is late, the physician gets an emergency call, or a visit takes longer than expected, your rooms won’t be backed up late in the day. "These are recovery points that provide a cushion to keep mid-day appointments and late afternoon appointments on schedule. This way, something that happened early in the morning is not still affecting people at 5 p.m. It’s a way to keep the physicians and the patients happy," Boguszewski says.