How To Renovate / Expand
and Still Stay Open, Efficient, and Effective
As demand for eyecare services continues to grow, practices are having to handle higher volumes of patients by adding more doctors to their practice. This creates a space issue for many practices. To address this, they usually either add a satellite office, relocate the existing office to a larger space, or if they like the location they are in and there is adjacent space/land, they renovate/expand the existing office.
Due to rising construction costs and rents, we are seeing more practices expanding their existing space. But expanding/renovating an existing space brings with it unique challenges compared to building new. The practice must stay open during construction but at the same time create an expanded office that functions efficiently and effectively.
In this scenario, “Construction Phasing” is your friend. This is the process of building out sections in phases while the practice uses what is available, often using a space temporarily for something that it is not ultimately intended to be. This allows the practice to stay open but at the same time think more broadly than just “let’s just add some exam lanes over there,” because just adding exam lanes often leads to a less efficient practice space than it was before the expansion. When a practice is so focused on not renovating, they are only trying to plan the new. That new space tends to be out of the flow of how the original space was planned, therefore causing more walking and less efficient patient and staff movement.
To keep this from happening the practice needs to assess the current space and flow issues to determine what is working well and what is not and then project long-term space and staffing needs. Once that is done, space planning for the entire space, including the new area, can begin while understanding that the practice will stay open during construction.
The following case study illustrates how you can stay open and still be efficient seeing patients while you renovate your entire office.
CASE STUDY: POOR LAYOUT, CRAMPED QUARTERS
This practice had a satellite office in a great location, but the space was poorly laid out and could barely house one doctor at a time. The practice needed to house one MD and one OD simultaneously. The practice also wanted the optical dispensary to “flow” proximate to patient movement to better serve the patients and increase sales.
ASSESSING FLOW AND SPACE NEEDS
The practice assessed practice flow and space needs and determined the following:
- Satellite office needs to house 1 MD and 1 OD simultaneously.
- Not enough exam lanes. Need four lanes for two doctors and three work-up rooms.
- Testing is a bottleneck now with how equipment is shared in same room.
- Lots of walking since testing is on opposite side of office from lanes; must walk through waiting room to get back and forth.
- Hallways are too narrow (only 4 feet wide).
- Not enough waiting seats.
- Needed space to be able to schedule surgeries face-to-face and perform necessary measurements.
Luckily for this practice an adjacent space was available, but it was on the opposite side of existing lanes (Figure 1). If they took the approach “We need to save our current clinic to stay open,” they would end up with lanes on opposite ends of the office. This would create more walking, less efficient techs, and lost productivity.
If they could take a broader approach to design and plan the entire space to best support the practice, they could achieve a high-functioning expanded suite. With the understanding the only two limitations were (1) the patient entry must be one of the three doors along the bottom of the plan and (2) they must be able to stay open during construction, they began planning and implementing construction.
PHASE 1
In Phase 1 a new clinic is constructed in the additional space while the practice operates as usual in the existing space. Once Phase 1 is complete, the manager is temporarily moved to a workstation in the new clinic. A doorway is cut into the rear of that manager’s office to reroute patient flow into the new space. Testing and lane equipment is relocated to the new clinic (Figure 2).
PHASE 2
At this stage, the practice is running one doctor out of the new clinic, still using the existing check-in desk, business office, waiting room, and optical department. Testing has been temporarily moved into rooms in the new section (Figure 3). This frees up the old clinic to be renovated into business office/staff lounge and optical lab, which will then free up space to be converted into more clinic/testing space during phase 3.
PHASE 3
Phase 3 is the most disruptive to the practice because the existing restrooms do not meet ADA standards, so they must be redone. This may mean the practice shuts down for a long weekend to allow the contractor access to both at once. Optical displays will be relocated during this time. A temporary check-in/ out desk is needed since the new reception counter is not very accessible during this phase (Figure 4).
This is key to phasing: Erect temporary walls or plastic “walls” around construction area, freeing temporary space to be used as needed. Evenings and weekends can be designated for the more disruptive renovation that cannot happen during patient hours.
PHASE 4
The final phase, Phase 4, focuses on completing the final work-up room, new testing, and surgery scheduling area.
Note that the patient entry has moved to its final location and testing equipment has been moved around to use rooms that have been completed (Figure 5).
FINAL VS ORIGINAL
The complete renovation/expansion of this office (Figure 6) took it from a poorly performing one-doctor suite to a very productive two-doctor suite while causing little disruption to the practice’s ability to stay open and see patients.
The key to this approach is not being constrained by the thought that to stay open the existing clinic must stay intact.
Originally published on asoa.org
