"I've been in so many awful doctor's
offices," says veteran architect and physician productivity
guru Richard C Haines, Jr, president of Medical Design
International in Atlanta. He's worked on practices in
Halifax, Montreal, Calgary and all over the US and he
sees one problem time and time again: designs that prevent
doctors from spending their workday practising medicine.
For one thing, Mr Haines was surprised
at how many Canadian doctors in our recent survey used
only one exam room (33%). "That's woefully low," he
says. "I can't think of a family practitioner I've set
up in the last 20-some years with less than three exam
rooms." He explains why: "We figure if the patient undresses
in the exam room you need to allow about 12 to 15 minutes
to turn that exam room over. If ever there's a doctor
— whose skill is the major resource of any ambulatory
medical practice — out in a hall waiting for a
patient to be ready, then there's a problem."
DESIGN
BY AGENDA
For Mr Haines great design is no silver bullet. You've
got to have good systems in place for a design to work.
He gives the example of a practice with a familiar problem
— an overstuffed waiting room. "We were asked by
an ophthalmologist to add on to his waiting room because
it was overflowing. So we got in there and surveyed
the doctor's production," he recalls. "He was seeing
14 patients an hour, then we looked at the appointment
book — it was bringing in 21 patients an hour.
We told him 'don't change the design of your waiting
room, change the design of your appointment book.' Bring
patients in closer to when they'll actually be seen
and your waiting room problem will go away — and
so will the related parking problem."
SMALL
TALK, BIG PROBLEM
Mr Haines recalls one office where the doctor's exam
rooms were on either side of the checkout counter and
every time he walked past there, a patient would stop
him to chat. "He was seeing 40 patients a day and going
home very tired because he was working so hard to see
that many people," he says. He was able to help this
doctor overcome his dilemma without asking him to change
his genial manner.
"We put him in a new office with
the same number of exam rooms, we just put the checkout
counter away from those rooms — and now he routinely
sees 70 patients and goes home less tired," says Mr
Haines. "That's a substantial increase in production
with no more real estate — just a different configuration."
GRIDIRON
MEDICS
For Mr Haines some of the worst office designs are those
where doctors and nurses literally go great lengths
just to do everyday tasks. "There was this one cardiology
office with a 285-ft walk between the furthest exam
room and the waiting room. That's almost a football
field," he exclaims. "It took the nurse almost five
minutes to go from the exam room up to the waiting room
to bring the person back. Now if you do that 40 times
a day — that's 200 minutes of her time spent doing
nothing but walking. She doesn't get anything done and
she doesn't help the doctor. It's a giant waste of opportunity."
He cites another practice where
the physicians had a brisk one-minute walk whenever
they went between their offices and the examination
corridor. "The doctors were always busy, but that doesn't
mean they were getting stuff done."
HALL
OF SHAME
Why do all theses terrible offices exist? Do doctors
hire otherwise great architects who just don't get medicine?
"Absolutely, all the time," says Mr Haines. "In architectural
school you're taught certain processes and systems and
it becomes part of your psyche after a while that you
can solve any problem with these skills."
"With medicine, the ergonomics
of the flow are so important — more important than
a lawyer's office or an architect's office," he explains.
"A doctor's office is very much like a machine —
you've got input, throughput and output management functions,
and you have to understand all those various links."
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