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Young Ophthalmologists
Designing Effective Ophthalmic Medical Space

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Office Design as Efficiency Tool
Efficiency and improved performance are your main motivations behind any capital investment decision. Whether you are considering new equipment or a new or redesigned office, you need to consider how this improvement will help support the practice’s most valuable resource, the physician(s).

A common mistake with new medical facilities is to approach the design as if it were an architectural project. In this mindset, issues like how the building looks, the materials used and the form of the building are major concerns. But while these are important considerations, you must not lose sight of your overall goal — to develop a facility that improves patient flow and helps to capture revenue of ancillary services or products.

When beginning a new facility or renovation project, the approach should be more operational than architectural; the emphasis should be on performance. Once you have defined your space and functional needs, those concepts can be married with architecture to produce a facility design that functions well and is aesthetically pleasing.

Pre-Design: Defining Your Needs
Defining your needs is a very important step. Much like the way diagnostic work and examination help the physician determine a patient treatment plan, diagnostic work and an examination should be performed on the practice to determine the best treatment plan.

Designing medical facilities is specialized, just like the practice of ophthalmology. Your practice should engage a medical facility design firm that knows ophthalmology, understands how ophthalmologists work and the nuances of patient and staff flow. By doing so, your practice will benefit from expert knowledge without wasting your and your physicians’ time educating the designer about how your practice functions.

The pre-design process your practice and the medical facility design firm should go through is:

  1. Define the goals of the practice.
  2. Assess the practice’s current operational systems, staffing mode and productivity.
  3. Forecast future needs/demand; consider realistic growth over the next five to seven years.
  4. Develop improvement plan.

Practice Assessment (History/Diagnostics/Examination)
With the goal of office improvement increasing the number of patients seen by the physician(s), practice assessment should be geared towards what is keeping physicians from this goal. The physicians’ style and staffing model used to support them, as well as use of space and the systems of communication, movement or people and information should all be critiqued. For each component, the question should be:

“What is keeping the physician from being able to go straight to the next patient?”

When physicians can move from patient to patient without distractions or wasted time in between, they will be performing at their optimal, or “natural” rate. It is crucial that a practice know this rate when determining the number of exam lanes needed, the number of staff needed, how the appointment schedule template should be designed and the number of seats in the waiting room.

There are two parts to this type of assessment. The first is gathering historical data on the physicians’ current patient volume. This information should be drawn from actual hours worked and actual patients seen, not the appointment template or schedule.

The second part of the assessment is a time and motion study on the physicians and staff. This determines exactly how much of the physicians’ day is effectively practicing medicine and how much is lost due to inefficient systems, staffing models or space. A summary of one such study is below.

AAOE Executive Update Sept 2007 Staffing model 1

This summary information indicates that i if this physician had a staffing model allowing her or him to delegate non-physician tasks and eliminate wasted time through better systems, she/he would save 14.6 of the 33.1 minutes currently consumed seeing these two patients. When that time is used to see more patients, this physician’s patient-per-hour rate goes from 3.63 now to a potential rate of 6.49 patients per hour.

Along with the list of goals and objectives, this information equips the medical facility designer to develop the space improvement plan. A sample such document is as follows:

Executive Update, Sept 2007, Staffing model, Image 2

This piece and an analysis of your practice’s operational systems should be the first documents developed when a design project is begun. In most cases of a design project run amok, it is because the practice and the architect did not understand the goal of the design improvement project, since the operational assessment documents were never developed.

Designing a New Facility
Once the initial analysis has been completed, the typical design process includes:

  1. Schematic Design (SD) – Initial design
  2. Design Development (DD) – Design further developed
  3. Construction Documents (CD) – Detailed documents to price and build by
  4. This is followed by two further stages, once the design is complete:

  5. Bidding & Negotiations (BN) – Bid and negotiate construction price
  6. Construction Administration (CA) – Construction of the new facility or changes

Up to this point we have focused on the function of the facility, not actual layout and design. But remember that without an evaluation, the design project will in all likelihood not meet the needs of the practice.

In order to avoid such problems, keep in mind the following general concepts when designing your next space:

  1. Patients enter and exit along the same path. This helps patients to stay oriented in the facility and self-exit after the exam. Having patients exit a different way than they came in will only lead to disorientation and require that staff and/or physicians use their valuable time to show patients the exit. The following diagram shows an effective design flow:

    Executive Update Sept 2007, medical office design, image 3

    Unique spaces at the check in, check-out and technicians’ areas are used to create memorable space along the patients’ path and keep them oriented within the facility.
  2. Optical Dispensary adjacent to reception. Your optical dispensary should be in a prominent, well-trafficked location where patients can browse the selection of eye wear while they are waiting.
  3. Exam lanes across from each other. Reduce the number of steps physicians and staff make by positioning the exam lanes a physician uses in a cluster where rooms are across from each other, instead of in a straight line down one side of a hall.
  4. Circulation concept much like street systems. Think of your circulation systems and hallways much like the streets of your town. The “interstates” are the heavily trafficked areas around the check-in and -out stations. These interstates feed the “highways” — the areas around the tech stations and diagnostic areas. The tech stations and diagnostic areas feed the “residential streets” the physicians are in. Just like traffic lanes, the larger the volume of traffic a street or hallway carries, the wider it needs to be.
  5. Shape matters. The shape of your site and building can have a huge impact on how well a plan can be achieved. Your site or building should never be more than twice as long as it is wide.
  6. Allow time in the schedule The scheduled time to completion will vary depending on whether you are planning a minor remodel or a new facility. Typically it takes about five to six months to design and about eight to ten months to build a 15,000 square foot facility. It is recommended that you add some time into the schedule for the unexpected.

Establishing a more efficient and effective medical office space for your physicians requires the key steps outlined above. Get professional specialized help. Analyze your current operational systems and develop new ones where needed to better support your physicians. Design space following the four design concepts above to house the efficient and effective operational concepts.

When you follow this road map, the end result is happier patients thanks to better access and a more efficient process through the facility, more productive physicians and a more successful practice.

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About the author: Larry Brooks is a Senior Medical Planning Consultant with Medical Design International and a member of the AAOE Consultant Directory.