Improving the physical layout of your practice
One of the benefits of peer learning in the National Demonstration Project (NDP) was seeing how each practice’s physical setup could either benefit or hinder their delivery of care. In most practices, the front office was literally "up front" -- the first area that patients see. Everything else, from the physical size of the office to the layout, varied based on the services offered at each practice. Some practices provided a full complement of ambulatory ancillary services on site. Others outsourced nearly all ancillaries. Most practices admitted they were not happy with their physical layouts. Hardly any of the layouts supported medical home activities.
In changing a medical practice into a medical home, physical layout is important and can dramatically affect communication among team members. Many of the successful practices ensured that team members worked in close proximity to one other. Their offices were arranged in "pods" so that all members of a team -- e.g., receptionist, nurse and physician -- could easily talk with one other during the work day. Hospitals have long done this with the nurses' station, which is the hub from which all patient care flows. This physical proximity of team members helps with the informal communication that is necessary throughout the day to keep care moving forward. The advantage of such a layout argues against grouping "front office" and "back office" in physically separate locations, centralizing off-site appointment scheduling or sequestering physicians in their offices. The medical home is a concept that manages the controlled chaos of a family medicine practice. Physically supporting communication as the chaos unfolds during the day is critical to maintaining a patient-centered focus.
Direct patient care areas require some degree of privacy but are best positioned right off the central "communication hub." Some offices have a wheel-and-spoke model with the communication station at the center and three to five exam rooms surrounding them. Ancillary departments, such as lab and radiology, are best placed centrally so each pod can get to them easily. The fewer steps required for staff (and ill patients), the more efficient the practice will be. (You can read more about design efficiency in TransforMed practices here.)
The penultimate example of physical layout supporting the patient-centered medical home is the "medical neighborhood." Fellow family physician Christopher Crow, MD, in Plano, Texas, has assembled such a layout. He calls it a “medical village.” He has assembled common medical service providers, like mammography and orthopedics, around his clinic. By bringing services conveniently and directly to his patients, he has achieved some of the best quality results in the country.
Changing your office design does not necessarily have to cost a lot of money. Simple steps such as moving scales and desks to a more central location can make a huge difference. However, services that touch patients, such as scheduling and nursing inquiries, should be decentralized and personal. The value of family medicine is the personal touch. If we lose sense of that, we have lost the whole idea of the medical home.
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About the Author
Melissa Gerdes, MD, is a family physician practicing at Methodist Family Health Center – South Arlington in Arlington, Texas, and former president of the Texas Academy of Family Physicians.
Note: This blog is no longer updated; this is archived content.
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