Redesigning an office? Opt for simplicity and comfort
From the July-August ACP Observer, copyright © 2005 by the American College of Physicians.
By Robert Calandra
After several decades and countless patchwork office redesigns, Dean Health System—a multispecialty, integrated health care system in Madison, Wis.—realized it was time to consider a complete office makeover.
Some practices were housed in 40-year-old buildings that simply couldn't handle patient flow, not to mention the growing need for more office and lab space. After weighing the costs and potential benefits, system leaders decided a new facility was in order.
Contracting with a local health care facility planning and construction company, Dean officials oversaw the building of a new 150,000-square-foot facility that opened in January 2004, with offices for 85 physicians, including nine internists. Since opening its new center, the health plan has seen patient satisfaction improve and has been able to bring more physicians on board.
And according to Steve Wilkes, Dean's clinical services administrator, "the fresh look and the fact that 26 different medical and surgical departments are there in one building to support patients' needs" are other big pluses.
Using table lamps instead of overhead lighting makes for a more welcoming waiting room.
Most practices can't opt to build a brand new facility. But in an era of lower reimbursements, emerging technology and new patient privacy concerns, even small groups can use design elements to get a "fresh look" and make their office more comfortable.
"We seem to be getting smaller in space with more docs," said Paul Yanez, the principal designer with Medical Space Planners, based in Morro Bay, Calif. "You need a good, simple, basic design."
Experts say that just about every aspect of medical office design is changing. Private physician offices are out, while shared offices are in. Institutional chairs are giving way to different types of furnishings that make waiting rooms look more like living rooms. The result is a calmer, more welcoming environment for patients—and a more productive space for physicians to work in. (Hospital design is also changing. To see how builders are using specific design elements to enhance patients' safety, comfort and even immune systems. For more information, see "Hospital design: how changing space can help patients heal."
Devising a plan
Whether you're designing a new space or sprucing up an existing office, the first step is to devise a plan. That depends on what you want to accomplish with your new design.
"Are you trying to grow and do you want better efficiency?" asked Jennifer Pliskie, a senior development analyst with Marshall Erdman & Associates, an integrated health care facility planner, designer and builder in Madison, Wis.
Physicians should think about their recruitment plan before tackling an office redesign or renovation.
If you're expanding, do you want to offer a new service or incorporate another specialty? Or do you want to bring in more physicians in the same specialty and accommodate more patients?
"It is wise for physicians to develop a recruitment plan before thinking about renovating or building a new office," said Roger Herritz, a senior project director at Marshall Erdman. "Where are you today, how big are you and how big do you want to get?"
Next, consider your budget. If money is tight, you're probably better off renovating an existing space instead of moving. (See "Office makeovers on a budget." ) If you do decide to move, it may be worth your while to hire a medical designer to help you find and design a new location.
You can often keep hiring costs down by getting a designer at an hourly rate. And hiring a designer can save you money in the long run because they know what to look for in a new location.
"Often, physicians look at one building vs. another and make a decision based on the wrong things," said Jain Malkin, president of Jain Malkin Inc., a medical office design company in San Diego. Physicians focus on geographic location and where an office is located within the building, she said.
But they don't understand how architectural issues—like the distance between a window wall and a public corridor wall—can impact usable space. And they often don't pay attention to the location of mechanical shafts, stairwells and other obstacles. The configuration of space in one building vs. another may yield a much more efficient suite and enable groups to do more with the space.
A designer should spend time at your current office, studying its configuration, interviewing office and nursing staff, watching patient flow, and seeing how well the business office functions. Quite often, Ms. Malkin said, the business and front offices are crammed into very tight quarters—problems that need to be solved with more space.
Designers should give you a plan and a budget with projected costs. Trim expenditures by cutting back on special order items and buying only standard equipment.
Opting for a new location gives you the luxury of designing with your personal wish list in mind. You may want a suite with a back door for employees and physicians, or storage rooms to keep charts out of the reception area. And keep technology needs in mind. Most new office suites are prewired for computers with extra wall plugs, flat-panel monitors in exam rooms and a small locked room for the computer server.
Choosing a layout
When laying out your new space, put private offices in the back, away from patient traffic. That stops patients from popping in with questions and taking up physician time outside the exam room.
To protect patient privacy, waiting room seating is being moved away from the reception area. Unfortunately, Ms. Malkin said, new privacy rules mean that reception areas are going retro, back to the glassed-in era of 20 years ago. Some designers are even using check-in/check-out stalls where patients are separated by panels to prevent information from being overheard.
Front desk and reception areas are now wider, with more room under desks and counters for hard drives and other technology products. Some designers are even forsaking the dual-level desk in favor of one long one.
And designers are placing exam rooms as close to the reception area as possible. To maximize physician productivity, Mr. Yanez of Medical Space Planners said he prefers a "pod" configuration, where exam rooms are arranged so a nurse in a central location can see every exam room door. The physician goes from room to room, working in a continuous circle.
"The nurse is the key, not the doctor," Mr. Yanez said. When a patient leaves a room, the nurse provides him or her with the doctor's instructions, cleans the room, moves a new patient in and places the chart outside the door. The doctor simply looks for the chart.
Some designers also recommend using what's known as the "next available room" arrangement, in which individual physicians do not have dedicated exam rooms.
"The whole idea is sharing vs. dedication," said Ms. Pliskie. "Taking away 'ownership' makes the space use as efficient as possible." Practices that use the "next available room" arrangement can get by with fewer exam rooms.
And the design of exam rooms is changing. One obvious addition is computer screens and keyboards. In a nod to patient privacy, exam tables are now being placed away from the door, so patients can't be seen when the door opens.
To comply with HIPAA regulations, designers suggest soundproofing exam rooms with solid-core doors, walls that extend one foot above the finished ceiling and insulating the walls. And there's a controversial new trend in exam room design: removing the sink.
"Some practices don't place a sink in each exam room," said Norman Lazerine, a medical office designer based in Los Angeles. "Instead, they're installing a smaller number of sinks at centrally located nursing stations that serve the exam room area."
The arrangement saves plumbing costs and allows for more counter space in exam rooms. "This is somewhat non-traditional," he added, "and may not be appropriate for every specialty."
Other designers, like Margo Komplin, Marshall Erdman's manager of interior design, say that sinks in exam rooms are still preferred by many practices.
"Patients expect sinks in the exam room and expect to see doctors wash their hands," she said. "The patient needs to see it. It is a visual cue."
Decorating for comfort
When redesigning your waiting room, think comfort. Groups are now decorating waiting rooms to project a more homey, relaxed image.
"One style of chair may not be comfortable for many people," said Ms. Malkin, who wrote the 2002 "The Design of Medical and Dental Facilities: A Comprehensive Guide to Design, Equipment and Clinical Procedures." Instead, "different styles of seating will appeal to different people. Furnish a waiting room more like a living room, with a variety of furniture pieces."
The right lighting will also make the waiting room feel warmer. Designers recommend replacing overhead lighting in public areas with table lamps and using wall sconces in hallways.
They're also adding another cozy feature: carpeting. While some designers prefer tile or vinyl floors, carpeting has become a popular alternative. Besides boosting the comfort level, carpeting cuts down on office noise.
And "if you can, bring in nature with colors and plants," said Marshall Erdman's Ms. Komplin. "Use an aquarium, a bouquet of flowers and other visual cues that put people at ease. Ask yourself, does it feel like I'm walking into a hotel lobby or into an institution?"
Robert Calandra is a freelance writer based in Wyndmoor, Pa.
Hospital construction is booming in the United States—and many new hospitals are using research to inform design decisions, a trend known as "evidence-based design."
That concept is being spearheaded by the Center for Health Design Research, a nonprofit organization based in Concord, Calif., that studies how environments can affect patients' safety, comfort and even immune systems. According to Jain Malkin, a San Diego-based designer and a center board member, more than 600 studies currently link the hospital environment to clinical outcomes.
One center report funded by the Robert Wood Johnson Foundation and released last year found the following:
Patient falls at a hospital in Indianapolis decreased 75% in a cardiac critical care unit where nurses' stations were spread out and placed closer to patients' rooms.
The rate of hospital-acquired infections in Michigan fell 11% in new patient pavilions that used private rooms and specially located sinks.
Medical errors in Detroit dropped 30% in oncology inpatient units that used acoustical panels to lower noise levels, reorganized medical supplies and dedicated more space to medication rooms.
The center's report is online.
Redesigning on a budget
What can you do if you're not moving and don't have a big budget for a major makeover? Plenty, medical office designers say. Start by walking through your waiting room and checking out your furniture, floor, artwork and magazines.
Make sure your upholstery is professionally cleaned every six months," said Jain Malkin, a medical office designer based in San Diego. Throw out dead plants and update your magazine subscriptions. Use different lighting options and consider new carpet for an inexpensive new look.
"Changing flooring material and color can make a significant impact on updating a facility's appearance," said Norman Lazerine, a Los Angeles-based medical office designer.
Paul Yanez, the principal designer with Medical Space Planners based in Morro Bay, Calif., recommends painting walls a basic light color. He uses a chalky-white with a blue tint on the walls, a frosty white for doors and a snow white for the doorframes. By staying with basic colors, he said, you can dramatically update your office look by just changing pictures on the wall.
Removing clutter is another frugal way to freshen an office. A bad filing system spilling down the hallway doesn't make for a pleasant environment. Ms. Malkin suggested another clutter-buster: Have reception staff limit the number of personal items they keep in the front office.
And cutting down on office noise makes a big difference. If possible, don't have receptionists answering the telephone.
"Their sole responsibility is checking patients in, and patients shouldn't be competing with telephones for attention," said Jennifer Pliskie, a senior development analyst with Marshall Erdman & Associates, an integrated health care facility planner, designer and builder in Madison, Wis. To further cut down on office noise, Ms. Malkin suggested placing the telephone nurse in an enclosed room.
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