By Bruce Puffer
You’re a physician looking for new space. Perhaps you are opening a second office, or relocating to more advantageous quarters. Building a medical facility “from the ground up” involves hundreds of decisions and details. Whatever your level of involvement in the project, the following suggestions may make your project run smoother and your life a little simpler.
Location, Location, Location
Assuming you prefer the practice of medicine to weekly sightseeing excursions to survey the real estate market, first engage a reputable, commercial broker to locate your new medical site. This broker must understand medical requirements, construction, parking needs and local zoning ordinances.
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 counts, photos, locations of competitors, environmental reports and details on leases and/or purchase options. Professional organizations, such as a realtors’ or business association, can recommend a broker. Experience is key.
Selecting a Contractor
Be similarly prudent in selecting a firm to construct and furnish the facility. Remember, experience counts. Ask for references and case histories of specific medical buildouts that include construction details and costs. Construction of medical offices requires between six and ten weeks, and costs can run from $50 to $75 per square foot. Prices are kept lower when contractors competitively bid each line item.
Get the Right Input
Ask for suggestions. Gather data from anyone who will be working in the new space—physicians, administrators, architects, contractors and real estate experts. Your associates involved in medical specialties may have special facility needs or layout requirements. Others may have seen novel ideas elsewhere worth incorporating.
Weekly meetings throughout the project keep the channels of communication open between the client and contractor, and keep everyone apprised of progress—or any problems that may arise.
Make Every Inch Count
“Managed care” makes it doubly critical that every inch of space be used productively. Up to 28 percent of medical office space is wasted through a series of factors, from the size of dispensary cabinets, to floor plan layout to medical records storage.
Optimum traffic flow is critical. Many medical offices contain both examination rooms and laboratory facilities on the premises. Because some patients will require only lab work and not physician services, it is unwise to locate laboratory facilities at the rear of the building. Yet, it happens. This encourages unnecessary patient traffic through the facility and past the examination rooms. The efficient, practical solution is to situate the clinical support facilities nearer the front of the building to minimize traffic flow.
Putting Your Office in Order
A medical facility should function in its most efficient manner. That happens when rooms are located in a particular order.
Locate the patient holding area closest to the entrance of the building, but make it no larger than necessary. The seeming disadvantage of a small space can be offset by the right combination of lighting, wall coloring and pictures.
This should lead into the greeting/waiting area, where patients are situated who will soon see a physician or laboratory technician. The “right touches” of color, appropriate reading material, windows and lighting can offset smaller space. It should be large enough to be comforting and pleasant, but it need not look like a warehouse.
The clinical support area should be located immediately after the waiting area, while the examination rooms should be located further to the rear of the building.
The layout of the clinical support area should allow it to be accessed by patients requiring laboratory facilities but not physician services, for reasons previously mentioned. The designer’s goal is to make patient “flow and function” run smoothly, with a minimum of disruption and noise.
Individuality Has Its Place
The “cookie cutter” approach best describes how to construct examination rooms. Each should be identical to all other examination rooms in the facility—to the last detail. Equipment should be laid out the same; blood pressure cuffs and opthalmoscopes should be in the same place on the wall in every room, and light switches, equipment and water all in the same place. In this way, a physician will save time and embarrassment by not needing to awkwardly search for supplies or equipment and inadvertently contribute to a patient’s lack of ease.
One pitfall to avoid is “back to back” plumbing between rooms. While this practice may save a few dollars in plumbing costs, it creates a situation where one exam room is a “mirror image” of the other. The moral: spend a little more on plumbing to avoid confusion.
Also, office furniture and equipment in each “universal” examination room should be situated so that physicians may consult “eye to eye” over working surfaces or tables with patients. The layout should consider physicians’ needs so that, for example, the physician can speak with a patient while being able to write and make notes at the same time. Examination tables should be angled away from the entrance way to allow for optimum patient privacy.
Most examination rooms measure 8’ x 10.” Efficient use of space allows this to be a comfortable size.
How Much Storage Do You Really Need?
Many contractors provide medical offices with 24″ of cabinet depth when 18″ will suffice. Remember, that 6″ of space needs to be made up somewhere. If a plan adds 6″ of floor space to an examination room, either another room will suffer, or your square footage will increase and your costs will be driven higher.
Just as cellular phones, calculators and computers have become smaller and more efficient, so has medical storage equipment. The right type of records-filing system can save valuable space. Check to see what is available on the market today.
Choosing the right colors and fabrics can go a long way toward creating an inviting interior decor. Having all the elements on a “color board” helps in the review and decision-making process. Experienced interior designers can help you decide which furniture can be used in the new space, and what is needed to keep the project on budget.
Medical office designers have started to introduce a new and exciting interior design format: “therapeutic environment.” Architects and designers on the west coast maintain that healing and recovery are dramatically affected by colors, finishes, lighting, views, furnishings, open spaces, even sounds and smells. These are referred to as “positive distractions” and have actually been shown to be healing agents. Forward-thinking designers of medical offices and health care facilities are constantly seeking new ideas such as this to implement on behalf of clients.
Even before the construction is complete, arrangements should be made for delivery of furniture, and installation of diagnostic, communications and computer equipment.
A smoothly functioning, efficient facility plays a vital role in improving the delivery of health care. With careful thought and a well-executed plan, your new facility will do just that—and prevent you from needing to take two aspirin before you call a fellow physician in the morning.
Bruce Puffer is president of By Design, a firm with offices in Hingham and Waltham, MA, that specializes in planning and constructing medical offices of all kinds.