A small practice renovation
that paid off big time

When the doctors and the practice nurse got tired of running up and down stairs they decided to do something about it. Toilets and greenhouses

By Ed Rumford

Four years ago a two-doctor general practice in an Ontario university town decided the time had come to 're-engineer' their practice. Re-engineering, you'll recall, was a watchword in the late 90s. In the corporate world it was often used as a euphemism for reducing staff but in the physicians' case what they really wanted was a more efficient operation.

The practice was housed in a small converted two-storey house owned jointly by the physicians. The reception area and patient files were located in the semi-basement and each of the doctors had a floor above to him and herself.

Patients entered through a side door and went down a couple of steps into to a low ceilinged, dingy � the doctors called it cozy � reception area and then were shown into an adjacent waiting room. A narrow stairway lead to the first floor with the home's original stairway taking patients to the second floor.

GET OUT OF HERE
The first thing the designers suggested was that the doctors look for new quarters. They pointed out that it was usually cheaper to start afresh than to convert an existing space.

Though the physicians recognized the wisdom of beginning over somewhere else, they considered the location, which was close to the university, essential. About half of practice revenue came from treating students referred by the university health centre. The female partner was particularly involved in issues surrounding women's health and lectured two days a week on the subject. She simply didn't want to move. After a cursory look at other spaces the doctors decided to stay put.

The design team, a local couple, took a deep breath and then spent the next week at the practice observing the operation and making notes. They paid particular attention to patient flow and to record keeping. Three weeks later they met with the family doctors to present their findings and make suggestions on how the practice could be improved.

They began with what, for the physicians, was a shocker. They suggested the reception area, waiting rooms and record keeping be relocated to the first floor and that one of the MDs move to the semi-basement. After a long silence, the male FP said somberly, "I guess that means me."

For the next two hours the team outlined the plan. By placing record keeping, in particular, at the centre of the practice, much time and many steps could be saved. They noted that records tended to pile up on the doctors' desks and in the examination area and risked being misplaced. Another benefit would be smoother patient flow. They suggested that after each visit the patient be given his or her completed record and return it to the reception area for filing.

The next bombshell was that the pair hire an additional practice nurse so that each physician would have his or her own medical staff member � at the time the physicians shared a single nurse. The first reason was a practical one, once the doctors were two floors apart, one nurse simply couldn't handle both practices. The second was more important. The designer believed that by adding an additional examination room to each office, increased patient loads would easily cover the nurse's salary and related expenses.

Next they returned to the relocation of the ground floor partner to the basement. To make the case, they'd prepared some drawings of how the remodelled basement office might look. The key element of the proposal was a small green house to be added at the back of the office to let in light and to give the space an 'outdoor' feel; this would be accomplished by extending the basement at the back by five feet and glassing it in above ground level. The result would be a larger and much brighter office space.

After thinking it over for a couple of days, the doctors bought into the plan � even reluctantly agreeing to 'consider' an additional staff member. The next issue was what to do while the renovations were underway.

The solution turned out to be an elegant one. The university health clinic had some extra space they were willing to let out during the six months that construction was underway. The practice setup would be less than perfect but it would be convenient for patients � especially those connected to the university.

In the end, construction took eight months, partly because of some refinements the physicians added: principally upgraded floor and window treatments; new furniture and fixtures; a semi-bathroom on the second floor; the replacement off all the plumbing; and three skylights in the roof to brighten the second floor office and make up for the greenhouse the other partner was getting in the basement office.

THE WORK WORKED
It's been almost three years since the doctors moved into the renovated quarters and they couldn't be happier. Says the female physician, "for me, the best part of this was hiring another staff member. Having my own nurse has made a tremendous difference. She's wonderful with patients. She's taken over a lot of the routine tasks and I'm actually seeing more patients and enjoying it more. Who would have believed it?"

The satisfaction level in the basement is equally high, though for a different reason. "Once we moved back what I realized was the amount of time I'd wasted shuffling records back and forth. The new central system is a godsend. Looking at efficiency I realized I was wasting time myself. We've really streamlined procedures. I've made an effort to put things where they'll be close at hand both in the office and the new examination room. It's made a big difference, I'm actually less exhausted at the end of the day."

The only downside: they'd originally budgeted $60,000 for the renovations, the final tally was closer to $85,000. Both doctors are satisfied, though, that they got value for money.