By Deborah Conn

Imagine your O&P practice has been so successful that you've outgrown your quarters. The time has come to build a new facility. How should it be designed? What should it look like? How can it contribute to the efficiency of your operation?

A number of O&P practitioners have grappled with this situation, and their experiences can help you create your "ideal" facility. Of course, the term means different things in different practices, but all good facilities serve similar purposes.

Start on the outside

In designing a new facility, begin by taking the perspective of a patient.

"We literally started with the outside and worked our way in," explained Jonathan Naft, CPO, of his practice's 3-year-old building. "Everything outside is completely flat and on one level. Our front entrance is at the same level as the parking lot; there is no step up and no ramp. All entryways have automatic doors."

"Light doors are important, or even better, sliding doors with automatic sensors," agreed William Hamilton, CP, of Hamilton Prosthetic Center, Phoenix.

William Beiswenger, CPO, FAAOP, has a large, drive-through overhang in front of his facility, Abilities Unlimited Inc., Colorado Springs, to offer protection from snow and rain to patients who are dropped off at the door.

Warm reception

Once patients enter the building, the reception area provides their first impression of the practice. The waiting area should be clean, with good light, comfortable chairs and no odors wafting in from the lab.

Charles Dankmeyer, CPO, said, "This area gives individual practitioners the opportunity to express the personality of their business. Choose colors and install art to reflect who you are."

Naft agreed. "We decorated in a tone that reflects the attitude of the office. We are a professional and conservative group of people, so our décor fits that mold. It's soft, comfortable, clean and open, and it works well for all ages."

"We're really excited about our reception area," said Jonathan Heifetz, CPO, who recently moved from a 5,000-square-foot to a 10,000-square-foot facility.

"Patients enter through a double-door airlock, which is especially important in the Northeast. Once they come in, they are greeted by a half-round reception desk with a brick wall behind it," he explained. "We have bright lighting and earth-tone bricks and stone. It's a very comfortable area."

Heifetz's reception desk is placed in the middle of the room and large windows offer a view of the clerical area, so patients don't feel isolated.

"The reception area should be open," agreed Dankmeyer. "People waiting should never feel like they are alone. And it's important for safety reasons that we are able to see the patients just as easily."

Another consideration is the height of the counter. Naft's facility, Geauga Rehabilitation Engineering Inc., in Chardon, Ohio, has both high and low desks at the sign-in and check-out areas.

"Whether patients are standing or in a wheelchair, they can easily review documents and interact with staff," he noted.

Child-friendly, too

Dankmeyer, whose practice includes children, has set up a diorama with a working model train in his waiting room.

"We change the landscape to match each season," he said. "It's a way for me to express my own personality, and the kids really enjoy running it."

Accommodating children is important even if your practice doesn't focus on pediatrics. Children may accompany their parents to appointments, and a special area with toys and games can both make them more comfortable and minimize disruption for other waiting patients.

The exam room

After the waiting area, the next stop for most patients is an exam room. Once again, comfort and openness are desirable.

"I have a strong feeling about exam rooms," said Dankmeyer. "Privacy doesn't mean being placed in solitary confinement. I hate being put in a four-by-six space with an exam table that barely fits in the room, and I don't expect our patients to feel any different."

In Dankmeyer's facility in Linthicum, Md., eight exam rooms are clustered around a central area with parallel bars. The rooms have walls, but no "lids," so all of them are open to a 12-foot ceiling covering the entire area.

Not only do the rooms feel more open, Dankmeyer feels they are safer as well. "If there's a medical emergency, a patient might not be near the alarm. If they need to shout for help, someone will hear," he explained.

In addition to the eight "roofless" rooms, the facility includes one larger room, 25-by-15 feet, which is self- contained, with a set of parallel bars and its own ceiling. This room is used for patients who are, according to Dankmeyer, "totally and completely uncooperative, such as mentally disturbed individuals or children having a temper tantrum.

"We also use the room for interviews with the media, because it's quiet and more private," he added.

Sizeable exam rooms are important to Beiswenger, as well. His facility includes two, 9-by-13-foot rooms for casting, one 12-by-16-foot room for fitting scoliosis jackets and a 20-by-13-foot gait room—all with 10-foot ceilings.

"Rooms should be of a size that can accommodate everyone who will be there," he advised. "With children, especially, you can have parents, siblings and grandparents accompany them to the office."

It's also a good idea to supply extra seating for family members.

The personality of the practice extends into exam rooms as well. Beiswenger and his staff love natural light, but don't want to have to open and close blinds for privacy. So, patient rooms have elevated windows to let in outside light without exposing what's going on inside.

Other features reflect the way practitioners prefer to work. Naft, a proponent of the paperless office, recommends a computer in patient rooms for notes, record keeping, and CAD.

"Instead of having to leave the room to order something, write up a job or document my encounter with the patient, I can do it right there," he noted. Naft also uses computers to demonstrate devices and techniques.

"A patient getting a new prosthesis can see a video of a patient at the same level using that device," he explained. "Or patients can see how the digitizing and modification process works. The way I like to work is to show them the video while I set up to do the shape capture."

Exam rooms must accomodate the needs of practitioners and patients. "I learned a long time ago that I can't do good work unless I'm comfortable," said Dankmeyer. "All our examination tables are electronic so I can move patients easily into a position where I can work with them."

Respect work flow

In laying out the functional areas of his facility, Presque Isle Orthopedic Laboratory Inc., in Erie, Pa., Heifetz and his staff did a careful analysis of traffic flow.

"We drew a floor plan and did a pretend walk-through as if we were the patient, the clinician, the technician and the clerical worker," he said.

This informed the design of his fitting rooms. Patients enter from the hallway, but each room has a back door for easy access to the lab. This allows practitioners to make minor adjustments without having to traipse across the length of the building.

Naft agreed. "What you don't want is to see a patient in the front of the building and have to walk to the back forty to do a simple adjustment."

Beiswenger addressed the same issue by placing a small adjustment room near the fitting rooms for minor repairs.

Thinking about staff needs is a key part of the process.

"We want the facility to look good for the patient," said Heifetz, "but patients are here for an hour at a time. Staff members are here all day, day in and day out, so it's important they have a building that is comfortable for them as well."

Plan the lab

Planning an efficient laboratory starts, of course, with health and safety concerns. Some practices use separate rooms for specific tasks to minimize toxic fumes and dust.

Beiswenger, for example, has one room for laminating and resins, another for grinding, one with ovens for thermoforming and a different room for modifying casts. Each room has high-powered ventilation systems, which, according to local code, must replace exhausted air with fresh air.

Dankmeyer also uses dedicated rooms to minimize dust and sound, but designed the rest of the lab to be as flexible as possible. "We put a lot of thought into what really needs to be stationary, such as woodworking equipment in the dust room or a place to work on plaster models.

"But otherwise, we use an open floor plan," he continued. "All the technicians have their own workbenches, but they are not bolted to the floor and can be moved to accommodate whatever current production standards need to be.

"When you make prostheses and orthoses, you don't work off a cookie cutter formula," Dankmeyer said. "You need to be creative, to change your methods as you switch into different materials and technologies. As you become more creative, you become more dynamic, and that calls for a flexible workspace."

The lab in Heifetz's facility is set up so technicians can access the machinery they need using as few steps as possible.

"It's a very open area," Heifetz said. "We dedicated rooms to different processes—an oven room, a plastic fabrication room, a machine room—but they all have large windows of tempered glass so people can see what's going on. The windows separate things for sound and cleanliness, but it still feels like an open lab."

Dankmeyer's lab also has a small stock room. "These days, almost any raw component you need is just 24 hours away," he conceded. "But we still keep a stockroom. Some things are handy to have in stock, and we get volume discounts on other items."

(For tips on designing an O&P lab, see Technician's Corner.)

More than you think

Finally, a successful facility includes enough space for office functions.

Dankmeyer advises estimating the amount of space you need and tripling it. "I've learned you need about three times as much space to house all the people it takes to manage the flow of paper, schedule patients and practitioners, and communicate with doctors and insurers."

"Most people think of patient areas and lab space first when designing a facility," said Naft. "But some of the best advice we ever got was to make administrative space larger than we initially planned. As the years roll by, the amount of administration it requires to provide devices just increases."

Coupled with administrative space is the need for storage. Unless your facility has undertaken the scanning of all documents, you probably have accumulated years of patient files and insurance records.

On Beiswenger's "next time" list is to include sufficient storage space.

"We had tons of files and records, and we have to keep them for seven years," he said. "We ran out of places to put them. Eventually, we just built a detached two-car garage for storage. Next time I'll build in larger storage areas."

Dankmeyer believes facilities should also have what he calls a multipurpose room. "We use it to house our technical library and hold staff meetings and in-services," he explained.

"People who are working on a project, like putting together a presentation or developing a policy binder, can go there to spread out," he continued. "And the room has VHS and DVD players and a computer for videos and PowerPoint presentations."

Your ideal facility

There are probably as many "ideal" facilities as there are practitioners to envision them.

That's part of what makes the process so exciting: How do you work? What kind of patients do you see? How many staff members do you have, and what kind of growth do you anticipate?

The better you know your own practice, the closer to "ideal" you can come when it's time to build your new facility.

Deborah Conn is a freelance writer in Falls Church, Va.