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Patient flow is often the key to practice efficiency, which in turn allows increased productivity.
A smooth-running practice not only allows you to see more patients per day, but it also creates a
more pleasant experience for doctors, staff and patients. Perhaps you feel like you would love to
improve flow and increase delegation in your office, but you just don't have the space. Here is
an idea I've used to improve flow in my office and others.
Form and function
Patient flow refers to how well patients move through the office and how many can be seen in a
given timeframe without bottlenecks. One of the fastest ways to increase flow is to increase the
number of pretest rooms and exam rooms. Matching an increase in exam rooms with increased
instrumentation and delegation dramatically increases flow and ultimately, revenue. If you are
able to find a way to remodel your office space, use the opportunity to change how you and your
staff work to delegate more testing and see more patients per day.
Most offices have a single pretest room with all the automated instruments in it. The problem
with this arrangement is that the room is tied up for a long time because there are so many things
to do in there. This creates a facility bottleneck. You may have another technician waiting to
start the next patient, but no room is available. Once a backup occurs in the schedule, it's hard
to correct it.
Whenever multiple instruments share a room, problems can occur with patient flow. One of the most
common examples of this inefficiency is when threshold visual field testing ties up the pretest or
retinal camera room. Perhaps you try to sneak a patient into a room for a test while another
patient is already there. This is not a good arrangement because it distracts both patients from
their procedure at hand and it lacks privacy.
Clearly, you can't have one room for each instrument; it would take too much space and it would be
inefficient in a different way. But there is a happy medium.
The exam niche
I've found that creating a very small room dedicated to just one instrument can alleviate huge flow
problems because it lets multiple tasks happen at once. If the test is long, the niche avoids
bottlenecks, and if the test is quick, the room turns over fast. I call it an exam niche and
you can often take the space from another area that is larger than it needs to be. An exam niche
works well if it is 5 or 6 feet wide and 9 or 10 feet long. This is perfect for an instrument
table, a patient chair and a technician's stool. I set it up so the instrument is against one
wall, allowing the technician to walk around the table to operate it. The patient sits facing
the instrument with his back to the doorway. A table or counter can be placed in the rear of the
niche for technician supplies. A visual field instrument is operated from the side, so it can be
placed up against the rear wall.
Exam niches are perfect for special tests that:
- Take a long time, like fields.
- Need special lighting, like retinal photos.
- Are not done on every patient, like a GDx.
- Are done on many patients but there is only one instrument, like corneal topography.
A carpenter can easily construct a partition wall from lumber and simply set in place so it just
butts up to the suspended ceiling without even changing the ceiling grid. The carpenter can also
break through an existing wall and create a new doorway, effectively making two rooms out of one.
Give some thought as to whether an actual door is needed; some tests need true darkness and
isolation from sounds, but it's nice to have no door on a small room. If there is no door, you
may not need a heating/air vent. If the testing runs a long time (like fields) you can have a
furnace contractor add a duct and vent above the ceiling.
An exam niche may not need any lighting or wall switch, since the instrument often provides enough
light and many tests are done in semi-darkness. A floor lamp or night-light may be used if needed.
You obviously need electrical outlets, but rooms generally have these on all walls, so there is
probably one that will remain in the new niche.
Are your exam rooms too big?
I used to think 20-foot long exam rooms were ideal, but times have changed and they are actually
a waste of valuable space. Mirrored exam rooms work perfectly and are actually easier to refract
in. I find exam rooms that are 9 or 10 feet wide by 12 to 14 feet long are a very comfortable and
they allow room for all the equipment, a refraction desk and sink, room for a technician and a
guest chair. If you have 20-foot exam rooms, consider lopping off six feet from one end and
creating an extra room.
To find potential office design changes, I find it helpful to look at an office floor plan on
paper first, and then walk through the space when there is no one in the office. Think beyond
the existing walls and look for wasted space. Think "What if?" and be creative.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
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Dr. Gailmard offers consulting services to eye care professionals through Prima Eye Group; information is available at www.primaeyegroup.com.
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