Call it the "Pullman car" phenomenon. Tight, long hallways. Doors to the left and right. Decor that hasn't been updated in years.
Other then a cramped waiting room, the classic railroad car is a pretty apt description of far too many chiropractic offices.
Glen David of Davlen Associates, Ltd., the nation's leading chiropractic office design firm, explained just how much of a difference office design can make in your success.
"Patients come to a [DC]with certain expectations that go beyond the quality of care," he said. "If the office looks and feels like a railroad car, you've already created an impression that might not be the most welcoming or friendly. And many patients are a little wary about chiropractic to begin with."
The Ad Hoc Method
Similar to many in the chiropractic profession, Dr. Carmelo F. Caratozzolo sad he tried to just "make it work" when putting together his first office.
"When we were just starting out, we used pre-existing structures for spaces not intended for a practice," he said. "It was like 'what can I use that is already here?' That was inexpensive initially, but costly in the long run."
"Our older office was very narrow and very long, with choke points between the front desk, examination rooms and adjustment areas," said Caratozzolo, who practices in Woodbridge, Va. "And there were definitely times when all the hot seats in reception were filled and people had to stand. We had to do something if we wanted to grow and just having a bigger building wasn't going to be enough."
The answer became obvious: Move to a larger office and redo it from top to bottom.
"If you don't have the right layout, your practice will stagnate," he says. "I wanted to triple my practice. We were at 500 patients, and that wasn't going to happen if we were standing on top of each other."
Common Problems
An effective design can address the two efficiency killers found in poorly constructed office: workflow inefficiencies, an uninviting atmosphere, and poor staff interaction with patients and each other.
"Our old office had a front desk and an 85-foot long hall. There was no 'airlock' foyer, so in the winter it was cold in the reception room," said Dr. Bryce Koelling, who practices in Fulton, Mo. "As we approached our tenth anniversary, we realized that we had peaked out in our old facility. It was painfully obvious that the structure itself was limiting us."
Larger facilities, per se, are not always the answer to a better patient environment. What matters is whether patients and staff can move around efficiently and communicate rapidly in a facility with a clean, welcoming environment, said both Caratozzolo and Koelling.
These same essential concepts also informed the design of Parker College of Chiropractic's under-construction clinic at Parker Square in Flower Mound, Texas.
"We have clinics the size of small hospitals," said Lawrence Stolar, dean of clinics at Parker College. "I had the idea of growing small. So I got permission to create a new clinic of 2,000 square feet to beta-test new ideas in a place where the steps were fewer, the therapy equipment was nearby and where the doctors' offices are close to the action. Within three months of implementation, our patient satisfaction went through the roof, we had improved doctor interaction with them and a decrease in patient treatment time."
The success of what was called "Pod 40" led the school to try the same approach at Parker Square, which will open in the late spring or early summer.
The Big Fix
Re-designing or rebuilding your office begins with two simple questions, said David. "Right off the bat, ask yourself what are the are clinical and business results you want to want to achieve?"
David said that clients who work with his company typically want to increase their practice by an additional 124 to 175 patients weekly. But increasing patient load to that level almost guarantees that the practice will have to add at least one more chiropractic assistant to the staff. Maybe not, said David.
[pb]"If you have the right design that emphasizes efficiency, you won't need to add staff. Good design can dramatically increase staff productivity and that's a key thing to consider when looking at real costs," he said.
While no two projects are alike, David said that doctors can expect that a complete re-design, depending on whether it includes reconstruction or new construction, can range between roughly $30 per square foot to about $50 per square foot.
"Going in, you need to understand that a medical office design firm, an architect or your local contractor, probably doesn't have experience with a chiropractic office. That could result in much higher costs. These don't have to be $200,000 projects, but they can be far more expensive than necessary."
Look and Feel
Dr. Koelling, whose new office opened in April 2009, said his facility is now more like a hub then a rail car.
"The new office flow has helped us, there's no question about it," he said. "When a patient walks in the door, the first thing they see is 'command central'; the front desk module where the CA can coordinate everything from one spot," he said. "She can get to everything quickly with very few steps, to the rehab area, adjusting rooms, and so on."
As part of the design, Koelling's two adjusting rooms have three spacious changing rooms that feed into the work areas. "What the patients love is that when they are ready, they flip on a switch that indicates they are ready, and we see that."
Koelling said electronic patient records are available in the treatment room, reducing staff steps to retrieve them. Digital X-rays are also available in the rooms, yet another step-saver for staffers.
"People come to this office and they're blown away, excited to be there," he said. "The image is professionalism and because we're efficient, the image gives them a confidence in the care. All of it has helped up with retention and referrals."
Caratozzolo said that correcting the workflow problems that were an "impediment" in his old office was a key part of the design.
"All of us had to go way too far into the building to get into an exam room," he said. "Now, it's no more than 10 steps to either an exam room or and adjustment area."
Another problem was that there was too much visibility of areas that were never intended for patient views, specifically the finance billing office.
"It may sound small, but our people can close that door and get work done."
A Real-World Clinic
A major goal of Parker College's new clinic is to give students a "real world" experience. To that end, it incorporates a radical new idea: faculty who work there will eventually be taken off school salaries and earn what they make from providing care. "A campus clinic is not a reality-based experience," Stolar said. "Faculty are on salary, and that doesn't necessarily give students the experience of what they'll find out in the field where you eat what you earn."
One won't find a large numbers of interns in a "normal office," but this particular facility had to accommodate that reality.
"With so many people in the same space workflow patterns are great importance," Stolar said. "You don't want people running into each other or waiting around in large groups. (The facility) had to be operational but without impediments to moving people around quickly."
This required that the rooms in the clinic be multifunctional. For example, the facility will have four different "adjusting pods." These rooms can be rapidly modified to be used for seminars or meeting with patients.
There will also be five multi-purpose private rooms that can be used for patient consultation, follow-up exams, massage therapy and nutritional consultation.
Lively Environments
Efficiency is absolutely crucial to a successful office design, but ambience is just as important. It sets the tone for the entire experience.
Koelling said, "A lot of people says that when they've been in other places, they didn't seem very modern or very clean. In truth, the practice may be very clean, but if it's dark, the impression is negative. And they'll remember that."
[pb]Caratozzolo said, "We put a lot of time and energy into understanding color. The themes are green to connote healing, blue to connote communication and yellow to connote energy."
Adjusting and massage therapy areas have green color schemes, he said. In his office, where patients get consultation and his report of findings, the walls are blue and yellow.
"When they look at me, the wall behind is blue to pick up on the communications vibe."
Group areas, which can be used for lectures, and rehab areas have energetic yellow themes, he said.
David said that basic decorative elements are crucial to the patient's lasting impression of your office:
"Living colors can inspire great confidence, but they cannot be trendy," he said. "There also should be 'life' in the office, like moving water and living plants. And use artwork instead."
When Proper Design Pays Off: The Returns
"When a patient comes to an environment that says 'great service,' and then they get great service in a setting where they feel confident, that's a patient you'll keep," Caratozzolo said.
"And I love coming to work and being here all day."
Warning Signs That You May Need An Office Re-Design
Evaluate your office by looking around and noting everything that is not a reflection of you, your practice or the profession you represent. Look for inefficiencies and Keep one thought uppermost: Does the facility decor reflect the quality of care that you provide? Focus on these areas:
Additional Things to Consider:
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