This article is more than 5 years old. Information may no longer be current.
Deconstructing the office: Accommodating the entire practice
In the previous article, we discussed the exam module: a unit of space a particular doctor needs at his or her disposal every time he or she shows up to see patients. It is based on the doctor’s rate of production, the number and lengths of delegated tasks, and the number of staff who directly support the doctor. In a multi-doctor clinic, different doctors could have different-sized exam modules; these differences in exam module size are frequently seen between anterior and posterior segment ophthalmologists. Their rates and their complement of spaces differ, as well.
The important thing to remember is that once you figure out what a particular doctor needs, that doctor should get the same complement of space every time he or she sees patients. (As was pointed out in an earlier article, this is critical; the doctor’s output must be normalized as much as possible to allow the appointment schedule the possibility of being fairly predictive of the patient flow that doctor will require.)
The final step in defining the “production engine” of the clinical practice is to determine the number of exam modules that the practice will need. First, let us identify the capacity of an exam module. Assuming that doctors work Monday through Friday and can work either a morning session or an afternoon session, each exam module has 10 half-days per week during which it can be utilized.
The next step in the process is to look at all the doctors in your practice. Let us say that you are in a five-doctor practice with the following demands for access to the office for clinic time: Two doctors need 4 half-days per week, two doctors need 6 half-days per week and one doctor needs 8 half-days per week. This totals 28 half-days per week of expected access. Remembering that an exam module can support a doctor for 10 half-days per week, the math is pretty simple: 28 ∕ 10 = 2.8, or three exam modules. In an idealized world, these doctors could meet their practice expectations with three exam modules.
If these five doctors developed a clinic with three exam modules, two of the modules would be used 100% of the time and one module would be used 80% of the time. This is extremely tight scheduling. It allows little capacity for the doctors to get extra time, such as just before or just after vacation, or for new growth. Medical Design International (MDI) prefers to plan initial capacity in a new facility at 80% utilization. This suggests that for a group requiring 28 half-days per week of current access at the facility, the office should be planned to provide at least 35 half-days (28 ∕ 0.8 = 35). This would yield a facility with four exam models.
What if the practice plans to expand? If that five-doctor group plans to grow to seven ophthalmologists in the future, then from a scheduling point of view, those two additional doctors can be anticipated now. If the five original doctors require 28 half-days per week of access, and it can be assumed that the two new doctors will require an additional 12 half-days of access (6 half-days per week per doctor is a fairly common average that MDI sees in ophthalmology practices), then they should plan their facility to accommodate at least 40 half-days of exam time per week. Again, this would require four exam modules. Or they could apply the 80% recommendation — especially if they anticipate their growth will happen sooner rather than later — and master-plan for it, providing five exam modules.
Another, more graphic way to plan to streamline physician access is to actually map out a schedule as in Table 1.
This is the same five-doctor group mentioned above. The advantage of this approach is that it maps out utilization and graphically shows where problems exist. In this case, the problem is Monday. Four doctors intend to show up to see patients; this means the practice needs to provide four exam modules. However, one of those exam modules will not be used again the rest of the week. Additionally, on Tuesday and Thursday another exam module will also sit idle. This is poor utilization of the built environment, not to mention unnecessarily expensive. So, this schedule, with the doctors’ understanding and consent, could be manipulated as in Table 2.
In this case, each doctor still has the same amount of clinical time per week. However, there are never more than three doctors seeing patients at one time. Only three exam modules need be built. This practice configuration has the same economic capacity as the one shown under Current Schedule, but it will require less space to meet the demand. Not only will one less exam module be needed, but the waiting room can have fewer seats and be smaller. Likewise, the clinic can be staffed with fewer technicians and the demand on ancillary testing will be more normalized.
If this same practice intends to grow, a fictitious schedule can be created including future doctors as in Table 3.
The doctors can now graphically see the implications of growth. They can make intelligent decisions as to whether to build more space now or master-plan for it and add it in the future. In either case, the economic engine of the practice has been preserved.
Richard C. Haines Jr. can be reached at Medical Design International, 2526 Mount Vernon Rd., Suite B-405, Atlanta, GA 30338; 770-409-8123; fax: 770-409-8662; e-mail: haines@mdiatlanta.com.
Kurtis Grant can be reached at Medical Design International, 2526 Mount Vernon Rd., Suite B-405, Atlanta, GA 30338; 770-409-8123; fax: 770-409-8662.