Designing the optimum office space

Waiting areas require a variety of seating to accommodate your patient demographics, including children.

Following a decade of medical school, residencies, and fellowships, dermatologists are primed to deliver the best in patient care. Often, though, the spaces in which they provide that care don’t measure up. Inefficient offices can not only impede efficiency, but can actually be detrimental to patient and practitioner comfort, convenience…even safety. It seems sensible, then, to invest time and attention in creating and maintaining a space that works for a practice, not against it.

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Some enterprising organizations specialize in recognizing basic requirements and anticipating needs of medical practices, then harnessing insight and creativity to transform ideas into brick and mortar realities. Case in point: Boston-based Margulies Perruzzi Architects at Practice Flow Solutions, in Roswell, Ga.

Hurry up and wait

Jason Costello, AIA, EDAC, a partner at Margulies Perruzzi Architects, says that understanding a client’s program is paramount to designing the optimum office space: “Efficiency is the key to designing an effective outpatient practice,” providing for good patient flow and centralize staff work areas. 

Because dermatologists see a wide range of patients, Mr. Costello likes to see waiting rooms with a mix of seating that accommodates the patient demographics. “It is important to provide a variety of seating options, including integrated spaces for wheelchairs, bariatric seating, long-term and short-term waiting, and children’s areas for family waiting,” he says. And this accommodation goes beyond just the patient: for example, Mr. Costello notes that “Patients’ families often spend a significant time in the waiting area during Mohs procedures,” underscoring the importance of taking those family members’ needs into account.

Planning for the future goes into the design, as well, he says, “Balancing current patient volumes and the space required for the practice today vs. the long-term growth strategy of a physician’s group.”

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Practice Flow Solutions co-founder Larry R. Brooks, AIA, points out that dermatology service is in high demand and that patients do not want to wait. “The number one thing is to eliminate bottlenecks so patients are seen on time and do not have long waits, with little to no wait for getting an appointment and during that appointment. This applies for general dermatology, Mohs and cosmetics.”

To achieve this, Mr. Brooks says, the practice needs to understand the operational aspects of the practice and patient visits, to sync all steps of the visit process. A doctor’s ability to effectively see patients is the key factor to determining the rate at which patients are scheduled. And while this will vary among dermatologist and services provided, what should not hinder this rate, Mr. Brooks says, “is the staffing, operational systems and space available. All those should be setup based on the doctors’ output [patent per hour rate].”

NEXT: Exam efficiency

With a well-positioned computer in the exam room, the clinician need not turn their back on the patient; elevated seating aids the elderly in sitting and standing; and windows provide nature views.

Exam efficiency

Mr. Costello likes to see design based on the practice, not the other way around. “The exam room is a highly repetitive component of the design and should be well thought out, to reflect the individual clinician’s needs, but standardized, to help improve the utilization of the rooms,” he says. Such considerations include:

• Technology - Computer placement and its relationship to the patient and the clinician’s use of technology.

• Storage - What should be stored in the room or stored centrally? Some accountable care organizations now utilize case carts to minimize the cost of built-in casework and streamline individual clinician’s preferences for supplies and equipment.

• Ancillary equipment - Designing in-space requirements for ancillary equipment used in the exam rooms; for example, mobile lasers.

• Patient – Patient considerations can drive the size of the exam room; for example, are multiple family members often in the exam room?

Design should separate dedicated spaces for procedure rooms, Mohs procedures, or photodynamic therapy from centralized work stations, which require visibility to the procedure rooms and proximity in order to improve consults between physicians and increase response time when problems occur during procedures. Accommodations should otherwise be specific to the practice, and might include:

• Surgical lighting

• Washable floor, wall and ceiling materials.

• Adjacent histology lab and microscope review areas.

• Provisions for exhaust hoods, cryostat freezers, lab benches, microscopes, and requisite emergency power beyond what is typically provided standard in office buildings.

NEXT: Comfort and privacy

Semi enclosed spaces cater to work requiring quieter areas and glass maintains good visibility.

Comfort and privacy

In addition to those specifics, Mr. Brooks says some common elements always need to be considered, to address comfort and privacy (for example, sound attenuation).

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For comfort, rooms should be grouped in heating/cooling zones of no more than 1,000 square feet each. The heating/cooling zones need to be organized so there are not too many rooms grouped, and that rooms with varying demands are not grouped, Mr. Brooks says. High heat rooms should be grouped in one zone; likewise, rooms with services producing smells should be grouped by themselves in another zone.

For patient rooms, private conversations need walls that penetrate the ceiling and sound attenuation batt insulation in the walls and above the ceiling. This will help to deaden the sound from one room to the next.

According to Mr. Brooks, other environmental factors that improve patient and staff satisfaction include:

• Access to daylight

• Views to nature

• Not placing junction boxes in adjacent rooms back to back (to reduce sound)

• Installing duct work with sound attenuation in mind

• Gaskets around doors

• Acoustical ceilings

• White noise systems to control sound from one room to the next

Putting the horse before the cart

Picking the new location can be a complex task, but should begin with feasibility studies based on the individual practice’s current and anticipated needs, Mr. Costello explains. Repurposing an existing space must include evaluating the existing structure; heating and air conditioning services; and compliance with department of health requirements, if it is a licensed facility.

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Mr. Costello recommends “investing in LEAN process improvement sessions at the beginning of the project. Dig into the clinical process and procedures in place in your current office design, looking for waste-unnecessary steps, long travel distances, waiting for others, underutilization of assets.” He suggests seeing how the office is currently working and assessing if time is being spent on tasks that provide value to the patient. “A great example of this is a dedicated procedure room for laser treatment,” Mr. Costello says. “If a clinic has the volume to that creates a high utilization rate of a dedicate room, then it makes sense but often it constricts scheduling and limits growth for procedures that utilize the laser. The alternative is enlarging the exam rooms to be able to accommodate the laser, which provides greater flexibility long term.” And don’t forget about the power and ventilation needs of lasers-the procedure can result in an unpleasant odor, and keeping that out of the common spaces is often a priority.

NEXT: Show me the money

Centralized work stations provides less walking for clinician and excellent visibility to exam rooms

Show me the money

Of course, all good things come with a financial impact. Mr. Costello says price will drive a lot of decisions. “At $125-$200 per square foot to build out a suite in an existing office building, you want to make sure that every square foot is accounted for. That is why we focus on efficiency and improving the utilization of space.”

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Mr. Brooks notes that, with overhead increasing and reimbursement not keeping pace, his company sees practices grow by adding mid-level providers and adding cosmetic/retail services. This notwithstanding, he says the price to construct a new office can vary greatly depending on the practice’s budget for finishes.

Mr. Brooks says that “The other factors that affect price are the location of the project and how busy the construction market is in that area. We typically tell clients to allocate budget for nicer finishes in the higher volume spaces such as the entry, reception, and waiting areas and select more durable, yet attractive, finishes in the clinical spaces.”

If you build it (right), they will come

Mr. Brooks says that effective office space design allows practices to be more efficient and productive, providing areas for staff to work effectively and allowing the providers to spend more time with patients. Planning the space to reduce walking, allocate the proper number of exam rooms needed based on the provider’s production capability, locating those exam rooms in pods on dedicated halls to reduce excess traffic … all of these factors improve efficiency.

“When the space is planned poorly, all the above is reversed,” Mr. Brooks says. “Patient flow should be planned to keep patients from being moved too much, as this creates excess work for the staff. The practice performs less optimally, therefore reducing the number of patients the practice can handle.”

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“The primary goal,” Mr. Costello says, is to “focus on our clients’ work and use, to help them work more efficiently and develop spaces that not only look great for the patients and staff, but are designed for the work that takes place in the office.”

Accomplishing these goals is instrumental in providing an office space that supports and complements all the years of a dermatologist’s training and education, and making a practice all that it can be.