February 2009




High quality care ophthalmic practice environment

by Larry Brooks


In today’s healthcare environment your ophthalmic facility has to be many things. It has to be high volume without the appearance of the patient being herded like cattle. It has to be attractive, but not so attractive that the patient thinks you charge too much. It has to be environmentally friendly, but not cost too much. It has to be flexible, but address your unique needs. And most of all it must promote the doctors ability to provide high quality care. So with all these competing agendas where do you start? Healthcare is about doctors caring for people. That means people getting access to doctors, so the design of your ophthalmic facility needs to begin with people, not walls, roofs, bricks and mortar. That is where so many practices and architects go wrong, approaching the design of the ophthalmic office as an architecture project, when it is really a connection project. The focus when designing a new ophthalmic office, or renovation to an existing, should be how the new practice environment will promote the doctors and patients connecting. There are a host of functions and people that are involved in this connection. How these functions and people interact with the office design is termed the Practice Flow. There are three parts of the Practice Flow: the Patient Flow, Staff Flow, and Doctor Flow.

Patient flow

Let’s look at the Patient Flow. When the patient comes to your office, they want to be seen on time, treated with respect, and receive quality ophthalmic care. Your practice has the doctors to provide the quality care; it now needs the office to allow that doctor to deliver that care. This will require the office design to promote an efficient smooth process “upstream” from the doctor so he/she can have patients ready to be seen on time. When developing a concept for successful Patient Flow you start as the patient does, registering and checking in, then follow each step as they progress through the office visit.

Reception area

• Reception desks are often a log jam due to the sheer volume of patients being seen and inefficient systems in place. Practices should promote pre-registration, whether it through packages sent out, phone registration, or website portals to reduce the amount of work that is required at the time of the visit. • The reception desk needs to be designed to be open and located so the receptionist can greet the patient as the patient enters. This will require the receptionist to be at his/her desk at all times. Therefore requiring another system to notify the technician a patient is ready other than the receptionist leaving her/his desk and delivering charts in the paper chart world. Because the reception desk is open and the receptionist is focused on patients entering and in the waiting room, other staff will be required to handle phone duties. This will allow patients to be processed and ready for the technician faster. • The reception area needs to be planned to accommodate self check-in/registration kiosks. This technology is becoming more and more prevalent and in the near future will completely change the way check in is handled. As the patient is processed through the clinic a basic design concept needs to be that the patient can see themselves out after the exam. People’s natural tendency is to exit a facility the same way they entered. Because of this, the idea that a patient should not backtrack is counterproductive. When you try to force a patient to exit a different way than they entered you create work for the staff and doctors having to show the patient the way out. Concepts to follow when developing a Patient Flow pattern through your clinic are:

Patient flow through the clinic

• Place only spaces and staff that have patient contact along the patient’s flow pattern, The more non-patient areas you have the more confusing and elongated the path will be. • Have the checkout counter located so the patient passes it on the way in and have the technician point it out to the patient as the place to go when the visit it over. • Place diagnostic functions along the path as they will logically occur during the visit. • Have a dilating sub-wait within the clinic to eliminate patients having to go back out to the main waiting to dilate. This will keep the technicians closer to their doctor more and cause less confusion in the waiting room.

Staff flow

Staff Flow is the second part of the overall Practice Flow. The focus here is to keep the need to walk to a minimum. This will require the technicians’ area and job description to be organized so they have all they need in a close proximity to the doctors pod they are supporting that session. The only time the technician should have to leave that area is when they are going to the waiting room for a patient. Concepts to follow when developing the Staff Flow are: • Utilize electronic communications to reduce the need to walk to transmit information or instructions as much as possible. Communications that should be planned to be handled electronically are: 1. Notifying the doctor which patient is next. 2. Receptionist notifying the technician a patient has checked in and is ready 3. Notifying the technician or doctor the doctor has a phone call. (This is not to mean using overhead paging.) 4. The doctor calling for a technician to assist or perform follow up work. Systems such as light signaling systems, computer network and printers, and EHRs can be implemented to accomplish this electronic communication. • The technicians station should be located so they can see both their doctors pod hall and the dilating sub-wait. This station should be planned to have a printer/fax/scanner, computer, and if the practice is still on paper charts a place to keep the pre-pulled charts for that session. • Technicians’ stations will need to be planned to accommodate multiple technicians per doctor in seeing patients.

Doctor flow

Doctor Flow is the final part to the Practice Flow and it is the simplest of all three. The doctor simply needs the correct number of exam lanes on a dedicated hall, called a pod that only the doctor, their patients, and staff traverse. This pod, supported by the electronic communications, allows the doctor to cover very little area during her/his exam session. With only that doctor, their patients and team on that hall there will be little distraction during the day, producing a higher volume and calmer more enjoyable practice. In summary, the key to a successful patient friendly, high volume, attractive, so you can deliver quality care ophthalmic practice environment is thinking function and communications first. Then eliminate competing agendas within job descriptions prior to the first line of “design” being drawn. Knowing how you want the new environment to function before the drawing begins will lead to drawings that successfully support an efficient, productive, and successful concept.


Larry Brooks is an architect and expert widely known for improving the flow patterns of medical practices. Larry and Tim Griffin run their own firm, Practice Flow Solutions. He has authored or contributed to articles in publications such as Administrative Eyecare, Journal of Medical Practice Management, Physicians Practice, Practical Neurology, Practical Dermatology, and American Medical News. To contact Larry, please call him at 678-983-0229, e-mail him at brooks@PracticeFlowSoltuions.com or visit www.PracticeFlowSolutions.com.

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Ophthalmology News - EyeWorld Magazine
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