Growing Pains - cdn.ymaws.com
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Where there’s a problemThere’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Satellite and Expansion and Designing the Efficient, Productive ENT Space
Growing Pains:
Tim Griffin, [email protected]
Where there’s a problem.There’s a solution.
2016 AOA Course 303Friday Sept. 9, 2016
9:00-10:00am
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 1
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Growth & Expansion
Reasons for growth
•Adding Doctors
•Adding services
•Current spatial problems
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Growth
Think short term and long term.
“Nothing is as permanent as a temporary solution.”
Growth & Expansion
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Philosophy of Design
Medical Practice Planning
All decisions of the design should center around improving the practice flow.
“Form Follows Function”
If a building/space has a specific function the design should be guided by and support that function.
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 2
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Successful Planning Process
•Assess Current Flow
•Doctor’s Patient Volume Potential
•Project Growth - Future Schedule
•Space Needs Assessment
Pre-Design Phase
•Design Space
Design Phase
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Observe the flow
Magnitude of logjams
Improve
Time Study
Assess Current Flow
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
+No patient ready for provider
+Provider looking for staff, next patient, …
+Provider leaving Exam Pod
+Receptionist away from check-in
+Patients escorted out or lost
Identify – Assess Flow
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 3
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify
Doctor’s Potential
Compare current hourly output with the actual potential for each provider.
Observations / Time Study
Base Space/Staff need on Potential
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify Need
Current Schedule
CURRENT SCHEDULE
Pods 1 2 3 1 2 1 2
AM HK AL MAB CS MB 1 1 1 1 1 5
PM HK AL MAB MB CS 1 0 1 1 1 4
AM AL MB CS MAB HK 0 1 1 1 1 4
PM HK MB CS MAB AL 1 1 0 1 1 4
AM HK CS AL MB MAB 1 1 1 1 1 5
PM HK MB AL MAB CS 1 0 1 1 1 4
AM CS MAB HK AL 1 1 0 0 1 3
PM CS MAB AL HK 0 1 1 0 1 3
AM CS HK AL 1 1 1 0 0 3
PM CS HK AL 1 1 1 0 0 3
Pod Utilization 100% 80% 30% 80% 60% 8 8 8 6 8 38
Monday
Tuesday
Wenesday
Thursday
Friday
Doc # 5
Doc # 4
SATELITE SURGERY
Total Doctor Sessions
MAIN
HK
CS
AL
MB
MAB
Practice A
Doc # 1
Doc # 2
Doc # 3
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify Need
Projected Schedule
PROJECTED SCHEDULE - Long Term
Pods 1 2 3 4 1 2 1 2
AM HK AL MAB dr6 CS MB dr7 1 1 1 1 1 1 0 6
PM HK AL MAB dr6 dr7 MB CS 1 0 1 1 1 1 1 6
AM AL MB dr7 dr6 CS MAB HK 0 1 1 1 1 1 1 6
PM HK MB dr6 CS MAB AL 1 1 0 1 1 1 0 5
AM HK CS AL dr7 MB MAB dr6 1 1 1 1 1 0 1 6
PM HK MB dr7 dr6 AL MAB CS 1 0 1 1 1 1 1 6
AM CS MAB dr6 HK dr7 AL 1 1 0 0 1 1 1 5
PM CS MAB dr6 AL dr7 HK 0 1 1 0 1 1 1 5
AM CS dr7 HK AL dr6 1 1 1 0 0 0 1 4
PM CS dr6 HK AL dr7 1 1 1 0 0 1 0 4
Pod Utilization 100% 100% 70% 60% 100% 100% 100% 8 8 8 6 8 8 7 53
Thursday
Friday
MAB
dr6
dr7
Monday
Tuesday
Wenesday
future doc
future doc
Total D
octor Sessions
MAIN SATELITE SURGERY
HK
CS
AL
MB
Practice A
Doc # 1
Doc # 2
Doc # 3
Doc # 4
Doc # 5
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 4
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify Need
Space Needs AssessmentBASIS OF SPACIAL ALLOCATIONS
Practice Data
Providers in the practice
4 MDs
4 PAs / NPs
Providers seeing patients at once
2 MDs seeing patients at once (pods)
2 PAs/NPs seeing patients at once (pods)
Anticipated Productivity
6 patients seen every hour per MD pod
3 patients seen every hour per PA/NP pod
18 total patients seen by all providers every hour
Clinic Space
3 exam rooms per MD pod
2 exam rooms per PA/NP pod
1 MA station per pod
1 Provider alcove per pod
Front Office
4 minutes on average to check-in patients
4 minutes on average to check-out patients
1.2 check-in staff (total patients x min. check in / 60 min.)
1.2 check-out staff (total patients x min. check in / 60 min.)
Waiting
1.5 family that accompany each patient
45 total patients and family entering practice every hour
10 exam rooms
14 1/2 of family to exam room
22 waiting chairs
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify Need
WAITING
# of Description of area sf/per
1 vesitbule 100 100 100
22 clinical waiting chairs 20 440 440
1 child play area 100 100 100
1 coffee/water 25 25 25
1 patient toilet 55 55 55
Subtotal 720 720 -
Hallway Factor 30% 216 216 -
WAITING Total 936 936 -
FRONT STAFF
# of Description of area sf/per
2 check-in spaces 65 130 130
1 staff work area 50 50 50
2 check-out spaces 65 130 130
Subtotal 310 310 -
Hallway Factor 30% 93 93 -
FRONT STAFF Total 403 403 -
Total Area
(sf)
First Floor
(sf)
1st floor
Area (sf)
First Floor
(sf)
Attic Space
Storage (sf)
Attic Space
Storage (sf)
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify NeedCLINICAL AREAS
# of Description of area sf/per
2 MD PODs
6 exam rooms 108 648 648
2 MD work station 42 84 84
2 nurse station 65 130 130
-
2 PA PODs -
4 exam rooms 108 432 432
2 PA work station 42 84 84
1 nurse station 65 65 65
-
1 CT 120 120 120
1 photo room 80 80 80
1 samples closet 15 15 15
2 patient toilets 55 110 110
1 clinical storage 36 36 36
1 post-op entry / sub-wait 80 80 80
Subtotal 1,884 1,884 -
Hallway Factor 30% 565 565 -
CLINICAL AREAS Total 2,449 2,449 -
1st floor
Area (sf)
First Floor
(sf)
Attic Space
Storage (sf)
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 5
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify NeedALLERGY
# of Description of area sf/per
10 waiting area seats 20 200 200
1 tech station/reception 100 100 100
1 shot stations - chair 36 36 36
1 shot stations - reclined 56 56 56
2 allergy testing rooms 108 216 216
1 mix lab 120 120 120
1 storage 20 20 20
Subtotal 748 748 -
Hallway Factor 30% 224 224 -
ALLERGY Total 972 972 -
AUDIOLOGY
# of Description of area sf/per
2 audiology booths 120 240 240
1 VNG room 120 120 120
1 hearing aid fitting 90 90 90
1 hearing aid storage 20 20 20
4 sub-waiting 18 72 72
1 audilogist work area 144 144 144
Subtotal 686 686 -
Hallway Factor 30% 206 206 -
AUDIOLOGY Total 892 892 -
1st floor
Area (sf)
First Floor
(sf)
1st floor
Area (sf)
First Floor
(sf)
Attic Space
Storage (sf)
Attic Space
Storage (sf)
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify Need
PROCEDURES SUITE
# of Description of area sf/per
1 prep area 120 120 120
2 procedure room 252 504 504
1 scrub sink area 15 15 15
1 post procedure area 120 120 120
2 patient toilets 55 110 110
1 patient lockers 12 12 12
1 nurse station (pre and post areas) 150 150 150
1 instrument cleaning 65 65 65
1 sterilizer room 80 80 80
1 clean linen storage 20 20 20
1 sterile storage 80 80 80
1 dirty linen 20 20 20
1 bio-hazard waste 20 20 20
Subtotal 1,316 1,316 -
Hallway Factor 40% 526 526 -
PROCEDURES SUITE Total 1,842 1,842 -
1st floor
Area (sf)
First Floor
(sf)
Attic Space
Storage (sf)
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify NeedSPA / COSMETIC AREAS
# of Description of area sf/per
10 waiting seats 25 250 250
1 refreshements 36 36 36
1 cosmetic coordinator 90 90 90
2 treatment rooms 132 264 264
1 product display/store 100 100 100
1 staff work area 80 80 80
1 patient toilet 55 55 55
Subtotal 875 875 -
Hallway Factor 30% 263 263 -
SPA / COSMETIC AREAS Total 1,138 1,138 -
Attic Space
Storage (sf)
1st floor
Area (sf)
First Floor
(sf)
PROVIDER PRIVATE AREAS
# of Description of area sf/per
4 doctor office spaces 120 480 480
1 doctor lounge 120 120 120
1 doctor toilet/shower 100 100 100
1 PA/NP shared office 120 120 120
Subtotal 820 820 -
Hallway Factor 30% 246 246 -
PROVIDER PRIVATE AREAS Total 1,066 1,066 -
1st floor
Area (sf)
First Floor
(sf)
Attic Space
Storage (sf)
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 6
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify NeedBUILDING SUPPORT AREAS
# of Description of area sf/per
1 conference room 240 240 240
1 staff lounge 150 150 150
2 staff toilets 55 110 110
1 laundry room 80 80 80
1 janitor closet 36 36 25
1 electrical room 48 48 48
1 computer server room 36 36 36
1 bulk storage room 120 120 120
1 stair to attic 60 60 50
Subtotal 880 739 120
Hallway Factor 30% 264 222 36
BUILDING SUPPORT AREAS Total 1,144 961 156
SUBTOTAL USEABLE AREA 11,578 11,332 218
Secondary Circulation 5% 579 567
TOTAL USEABLE AREA 12,157 11,899
Exterior wall factor 5% 608 595
TOTAL GROSS AREA 12,765 12,494
1st floor
Area (sf)
First Floor
(sf)
Attic Space
Storage (sf)
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Identify NeedPARKING SUMMARY
Description of area TOTAL
Clinic Patients 25
Clinic Staff / Providers 30
Spa (patient and staff) 8
Sleep Lab
Total Parking Spots 63
LAND SUMMARY
Description of area TOTAL
Building Pad 12,756
Parking 350 sf / car 63 cars 22,050
Subtotal Gross Area / Floor 34,806
Land Coverage Factor 50% 17,403
Total Gross Area (sf) 52,209
Total Gross Area (acres) 1.60
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Find Space
Work with a realtor
•Location•Geometry•Parking•Due Diligence
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 7
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Find Space
Due Diligence
•Proper Parking•Proper Zoning•Building Integrity•Building Systems•Fare Rent•Landlord Reputation•LOI•Attorneys and Realtors
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Find/ Assess Space
Geometry – too long and narrow
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Geometry – effectively long an narrow
Core
Find / Assess Space
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 8
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Geometry – Good
Find / Assess Space
Core
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Find / Assess
Identify Entrances
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Find / Assess
Identify Entrances
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 9
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Design
Exam Pod Layout
E E E EMD
+/- 40’
“Straight Line”
• Too much walking
• Too much traffic on exam hall
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Design
Exam Pod Layout
E E
E EMD
+/- 20’
“Nested”
Hall cut in half
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Design
Exam Pod Layout
E E
E EMD
+/- 20’
“Nested”
Hall cut in half
Private hall
Connection at MD
E
E EE
MD
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 10
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
303 Growing Pains –Designing the Efficient, Productive ENT Space
Tim Griffin, AIAPractice Flow Solutions
www.PracticeFlowSolutions.com Page 11
AOA Course # 303Friday, Sept. 9, 20169:00am – 10:00 am
Where there’s a problem. There’s a solution.Copyright PFS 2016 PracticeFlowSolutions.com
Where there’s a problem. There’s a solution.
Tim Griffin, [email protected]
678-982-2965