Chapter 3: Designing your clinic - make it patient-friendly
|"Always design a thing by considering it in its next larger context—a chair in a room, a room in a house, a house in an environment, an environment in a city plan. "
- Eliel Saarinen
Most doctors starting practice have a limited budget, so your options when constructing your clinic are likely to be limited. However, since this is one of the most important decisions you will make, you need to give it a lot of thought. Don’t hesitate to raise funds or take a loan to buy more space than you think you can afford. Not only will your investment in real estate be sound, you need to leave yourself enough space for expansion for the future as you become busier, since changing your location is so difficult once you are established. Unfortunately, most doctor’s clinics are still very depressing places – and most look just like any other doctor’s clinic.
Spend some time and energy in designing and building a better clinic - after all, you will be spending most of your life here ! If you prefer practicing medicine to going on weekly sightseeing excursions to look at suitable sites, you need to find a reputable, commercial real estate broker to help you find space for your clinic. Based on an evaluation of your needs and budgetary requirements, the broker should produce three to five prime sites in your target area—containing information on traffic, photos, locations of competitors, and details on leases and/or purchase options.
Try to locate your clinic in a site which is close to public transport, so you are easily accessible to patients. Most cities have their equivalent of a "Harley Street” , which is considered to be the "medical heart” of the city where many doctors practice. If you can afford a place here, this is a useful "high-profile’ address to have.
Being located in a busy area will help to attract patients, many of whom prefer doctors who are close to where they live. Practising in a "medical office building” along with a lot of other doctors will help to put you in the heart of all the medical action, facilitating networking with doctors, and getting and providing referrals. Of course, it may also mean that patients may go to your "competition” in the building, rather than to you !
Try to stay as close to your residence if this is possible – commuting can be hell in many cities today. Many young doctors start many clinics all over town, and take as many hospital attachments as possible, in order to attract as many patients as possible. While easy availability is important, often this means that they waste a lot of their time commuting. Not only does this drain their energy, it also is frustrating for patents, who may find it very difficult to get hold of the doctor when they need to. Hospital attachments can be a valuable source of patients , and also allow you the opportunity to network with colleagues and establish yourself professionally. The admission and operating privileges they provide are essential for doctors in surgical branches, who need theatre facilities.
When you start your clinic, make sure you have all the required permissions. For example, not only will you need permission from the society if you practice in a residential building, you will need to make sure this permission is in writing, so you do not have problems in the future.
While purchasing the premises can be expensive, you can look upon this as an investment in real estate, which will usually appreciate in time and is a valuable asset. A less expensive option is to lease or rent a place to start your practice . Young doctors who are just starting practice may not be able to afford a clinic of their own. In such a case, starting practice in a polyclinic is a very useful stepping stone.
Study the owner’s policies and decide whether they are good for you and your patients. Does the polyclinic offer any services apart from a consulting room? Do they have an efficient receptionist? Is the receptionist capable of handling your patients? After how many years will the rent increase? Are the current doctors practicing in the polyclinic happy with the owner ?
Be careful in selecting an architect for designing your clinic. Remember, experience counts. It’s a good idea to actually visit the clinics the architect or interior designer has built in the past, to ensure that his work is reliable. Also, keep an open mind, and friends, doctors and patients for suggestions for your new clinic - they may have seen novel ideas elsewhere which are worth incorporating.
Strategically placed sign boards outside the building are extremely important in helping your patients find your clinic. Illuminated sign boards are even better, since they will increase awareness of your clinic in the community . If you work in a large building, make sure that the entrance to your clinic stands out in the maze of doors and corridors. Keep your building security guards and lift operators happy ( perhaps by providing them with free medical care) , so that they take better care of your patients.
In order that your clinic functions efficiently, rooms should be built to allow optimal traffic flow of patients, and medical and clerical staff The designer’s goal should be to make patient "flow and function" run smoothly, with a minimum of disruption and noise. Space is always at a premium, and you will need a skillful architect to help you make the most of every inch. Your time is precious, and your availability is often the bottleneck in your clinic’s functioning. This is why it may be a good idea to have two or more examination rooms, so that you can examine more patients in a shorter time . Thus, while you are examining one patient, your nurse can help the other patient get ready for you in the other room. A time and motion study has shown that three treatment rooms are the ideal number for a medium-sized practice. Visiting the clinics of senior doctors ( especially those in large cities),as well as the newer 5-star hospitals will also give you lots of ideas as to how you can create a pleasant ambience in your clinic. If you can afford it, go abroad to see the world’s leading clinics, so you can use these as a model when designing yours. Remember to wire your clinic for the future, so that it is ready to accept the newest telephone and computer networks.
Medical clinic designers have started to introduce a new and exciting interior design format called the "therapeutic environment." These designers feel that healing and recovery are dramatically affected by colors, finishes, lighting, views, furnishings, open spaces, and even sounds and smells. These are referred to as "positive distractions" and have actually been shown to be healing agents. The practice décor must project a professional image. Interior designers and decorators are expensive, but if you do not have a good, imaginative sense of colour and design, then you will need the help of a spouse, a friend or a professional. Pictures can be useful assets in addition to the colour scheme, especially in the reception room where patients are waiting, since they provide a talking point with other patients.
We have put up the pictures of some of the test tube babies which have been born in our clinic, and many patients enjoy looking at these, since it gives them hope that they can succeed to. You can put up patient educational posters; as well as a bulletin board, which has articles on medical topics your patients will find of interest. Attractive information signs are extremely useful since they help direct the patient and save a lot of questions. Many signs are mass produced by firms, or you can have them custom designed. Such examples include: No smoking; Details of clinic timings; and payment schedules.
A good way of finding out how your patients feel when they arrive in your office, is for you to sit in your own waiting room ! Are you comfortable ? Would you be happy to wait in this room ? Design your clinic by always keeping the patients viewpoint in mind, so that you can build an office that maximizes your productivity without losing the warm human touch that characterizes the best practices. Many physicians now have TVs in their waiting rooms, so that their patients don’t mind waiting.
Provide for a welcoming atmosphere by positioning your receptionist with direct eye contact with anyone coming through the door. To make the reception area seem more "friendly," don’t place the receptionist behind a wall or behind glass. Pictures of you receiving awards, and photos with famous personalities and celebrity patients can reassure your patients ( and their family members) that you are a competent doctor. Putting up your medical diplomas and certificates will also help to reinforce your credentials , ability and learning. You might also want to put a file which contains testimonials from patients about your services. A press cutting file which contains articles by and about you is also impressive. Keep your practice brochures and patient education pamphlets in your reception area. Encourage your patients to read these– and to take them home – this is an excellent way of marketing !
Patients expect the clinic to be clean, and you need to be obsessive about this. Make sure all the cleaning is completed by the time the first patient arrives. If you fail to find anybody to do the cleaning, you will have to do it yourself ! The ambience of your reception area creates clues for people about what they should realistically expect from the care and service in your practice. Too elaborate an area may send a message that care will be expensive, while an overcrowded room full of grouchy looking people signals a long wait and a rushed physician. The seating and the size of your reception area must be adequate, not only for the patients, but also for the relatives and friends they frequently bring with them. As a rule of thumb, if you see four patients in an hour, you should have twelve seating spaces ( three times the seating capacity for the number of individuals you have scheduled to see in the hour) .
A telephone line should be available for the patients use, as they may wish to ring their office or home. The best option is to install a pay-phone service, to ensure the phone facilities are not misused. A rack or table carrying an adequate supply of general interest magazines is essential. Do not let your magazines become dusty, torn and two or three years out of date. Flowers and plants in tasteful arrangements have a welcoming effect. Silk flowers and plants are a good way of avoiding continual worry about watering, providing they are not allowed to become drab and dusty. Background music is popular and can provide a pleasant and relaxing atmosphere for patients who are sometimes tense when they arrive. Have a supply of tea, coffee , biscuits , sweets and soft drinks for your patients and visitors. A supply of drinking water should always be available, as should toilet facilities. The toilet is often the best indicator of a facilities’ focus on cleanliness and hygiene – make sure yours is spotless and kept clean . It’s a good idea to use it frequently yourself to ensure this is done ! A collection of small toys and childrens books is a good idea to prevent boredom.
If you can afford it, airconditioning your clinic is one of the best investments you can make. A comfortable environment will not only keep your patients happy, it will also dramatically enhance the productivity of your staff ! Carpets have become more affordable, and offer a touch of class to your clinic.
If you use assistants in your clinic, try to provide a private seating area for them, where they can talk to patients in private. Patients must have a small private area in which to change. A simple curtained-off space in one corner is adequate; or screens may be used if curtaining is not possible. Some very busy doctors try to improve their efficiency by seeing more than one patient at one time. This is terrible, and should be avoided. The least you can provide your patients is your undivided attention – even if it is only for a few minutes. Patients understandably hate talking about their problems in front of other patients !
Your front office is your public face but just having a comfortable reception is not enough. Your staff is vitally important, and they can literally make you or break you. It’s a good idea to provide uniforms for your staff. Not only does this help your clinic look much more professional, it also helps your patients identify your staff members. Staff should wear name badges; and having pictures of the staff with their names and designations on your bulletin board can help to enhance their self-esteem, because it sends a message that every person on staff is a respected member of the team. It also makes it easier for patients to approach a staff member when they can recall the persons name. The best feature of a good reception area is an immediate acknowledgment of people as they arrive. A warm welcome creates a positive expectation about the care and service that will follow and builds trust and rapport. You need to constantly motivate your staff to present your practice in a positive light. Staff-patient interactions are crucial because the reality is that your staff spends much more time with your patients than you do –an average patient spends 45 minutes to one hour in the office and only five to 10 minutes with you. Every interaction that patients have with the practice has to be managed and made positive. Investing in good employees involves more than wages — you also need to provide them with the best tools for the job, including computers and Xerox machines, depending upon your practice needs.
It’s a good idea to create an office manual which describes commonly performed office procedures, such as answering the telephone . It is useful to have "cheat sheets” and reference pages, which summarise the common queries patients have . While establishing these systems may seem like a lot of trouble , having a defined system will help your practice to grow. The primary responsibility of the front office is to greet patients— period. Remember that you never have a second chance to make a first impression, so make sure you make the most of your space, funds and staff to make the best impression possible !