QUESTION:  Do you have any advice on how to organize clinic and office space?

ANSWER:  Practical layout is vital to both time and cost effective office operations.  It is self-evident that the time you spend getting from room to room and patient to patient, looking for records, processing x-rays, etc., is time not spent providing patient care.  The organization of your office will either save or cost you money and time over the long term.  The more efficient your office plan, the more efficient and time-effective your hours will be. 

It is important to start by thinking through the functions you will need to perform in your model practice, what support staff you will have and where sections of your clinic will best be positioned to minimize steps, maximize efficiency and make the best possible use of the space you have available.  Planning and careful study of actual operational needs is vital because it is very expensive and disruptive to make changes after your physical layout has been built.

Before you start your floor plan, draw a sketch of the space you have available.  Do it to scale as best you can and make accurate measurements of all the equipment you will deploy in your practice, from adjusting tables to filing cabinets.  You may want to mark all fixed or support walls in ink, and all movable, non-support walls in pencil.  Non-support walls can be torn down, moved, etc., to give you the layout you desire within the fixed confined of the non-movable walls. 

Divide your space into major modular uses such as:

Waiting Room

Business office

Examination and consultation room(s)

Adjusting rooms

Private office

X-ray and x-ray report rooms

Here are some important points to consider about the relationship between your fixed stations and traffic requirements:

·         Exams are often followed by X-rays. These rooms should be in the same area.

·         Adjusting rooms should be close together. Place doors close together in some logical pattern.

·         Your CA or X-ray technician can become "lost" having to go to the very rear of the building to take and develop X-rays.  So can you if you are the one taking the films.  Patients find it annoying to walk a long way to have X-rays taken or re-taken, especially if they are gowned.  Try to keep the X-ray room, darkroom and examination and consultations rooms near the front desk and the waiting room.  As your practice grows, this will help make maximum use and effectiveness of your staff and reduce additional staffing needs.

·         Adjustment rooms may be somewhat further from the waiting room, but not so far as to make it an obvious hike.

·         If you get busy, your private office will be the least used room.  Place it in the back; you'll also have more privacy when you need it.

·         You can keep your staff small if your business office flows into the front desk or if your reception area is a window into the business office.  When your staff grows to the point where your business/insurance/records personnel have no duties dealing directly with patients, you may wish to move them to the back or in some other direction away from patient traffic.

·         If you have extended care which will include rehabilitation exercise or other equipment which are low-traffic, low or limited utilization areas, and not staff-intensive, place them away from the waiting room/front desk area.

·         Remember that space close to the waiting room is at a premium.  If a room or equipment station has no logical reason to be in this high-use zone, move it.

Room size is also a key factor.  Here are some points to consider : 

·         Adjusting rooms must be big enough to fit your preferred tables and equipment, with room for you to maneuver around comfortably, with no twists and turns.  There must also be room for two people to sit down without  feeling cramped.

·         The examination room(s) should be big enough for a small desk and two chairs and your exam table, plus room for you to work.

·         The x-ray space must be large enough to house the X-ray equipment, accommodate all required shielding and safety provisions and leave room to move.

·         The darkroom need only be as big as your processor and work surface, plus about ten square feet of space.  In an ideal set-up, the processing can be done with the technician not having to move at all.

·         Hallways should be four to five feet wide to avoid an oppressive tunnel look and avoid congestion between parties moving in opposite directions, or even the same direction.  As a rule, the longer your hall, the wider it should be.  

·         Allow for enough room in your business office and front desk for several people to work together without getting in each other's way. (Remember that you will add staff as your practice grows.)  Do not, however, waste space here.  Carefully think about what you want, what you know will work, and if possible, leave room for future expansion in this area.

·         Your waiting room must be large enough not only for the number of patients you feel you can see in an hour, but also for their families and companions.  In addition, consider that unless you have a separate lecture room (considered a luxury at the early stages of practice growth) you will likely be giving your health talks and patient orientation lectures in the waiting room.  Size and decorate it accordingly.

·         Make your private office out of whatever space you have left over.

·         When you have drawn in your rough ideas of where and how big each room will be, go back and measure each opening, corridor, and corner for barrier concerns. This means that a handicapped person in a wheelchair (3 feet wide) should be able to go through your clinic without problems.  In some states, there are strict barrier free requirements with which you must comply.  Since you will be dealing with sick people and people of all ages, you must take this into consideration.

Do A Mental Walk-Through.

·         Can you move quickly and efficiently between adjusting rooms?

·         Is the area in which your staff will be required to work (business office, exam room, X-ray room, etc.) concentrated enough to make for the efficient movement of the amount of help you will need?

·         Will traffic patterns be clear to patients or will it be a confusing, embarrassing maze?

·         Is your layout spacious enough to avoid a cramped feeling?  At this point you may have to compromise between the number of rooms you want and the constraints of your available space.

·         Have an X-ray dealer whom you trust help you design your X-ray room and darkroom.

In the construction phase, it is vital to remember that it is YOUR clinic.  Be wary of the advice of contractors and be firm about how you want things built.  Watch every phase of the construction carefully and do not let anyone deviate from the plans you have developed.  Remember, you will spend more time here than anywhere else, including your home.