Grand designs

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For speed, Moorfields has clustered its exam rooms.

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Reception desks should be visible from the front door.

Medical facilities have a less than glowing history when it comes to design. Until relatively recently, hospitals were immediately identifiable by their monotonous corridors, sterile white walls, and heavy-handed use of concrete. The design backlash seen in the US in recent years has yet to fully hit the Middle East, where 'patient-friendly design' still typically translates to liberal use of scatter cushions and design features that drop off sharply once patients exit the waiting area. But it's an oversight that could be costing practices money.

It's not too strong a statement, notes Larry Brooks, senior design consultant for Medical Design International, to say that how you practice medicine is dictated by your clinic's design. Tip: it's not about the colour swatches.

"Physicians typically don't understand the link between how productive they can be, and the space around them," Brooks admits.

Physician and patient workflows are shaped by design, he explains, which can have a significant impact on your practice's productivity. If your clinic's design is flawed, you'll see the impact on your bottom line.

"A pretty building that is ineffective will lose you money. It's about designing workflow processes that are efficient, and wrapping the building around those; plan the function and then the aesthetic."

Physicians are typically slow to grasp this link, mainly because most designing a practice have never done so before, and probably never will again. And while some may baulk at putting aside budget for expert consultation, Brooks says, good design will pay for itself.

"Efficient workflows can increase revenue by 50-60%, which isn't unusual," he reveals. "Physicians often don't understand the economics of what their time is worth."

Shape of things to come

The cornerstone of good design, says Dr Tasnim Khan, partner at the American Family Clinic, Dubai, is deciding what you want to achieve with your clinic.

"From a physician's perspective, you want revenue, you want to keep your expenses down and you want patients happy," she suggests. "By looking at processes to improve the total patient experience, at the same time you're going to be able to minimise your costs."

Brooks asks physicians to determine the future goals of their practice. "How many providers do you want to plan for, and what services do you want to provide to your patients?" he asks. "That helps us understand where they want to get to rather than what they're doing now."

For first-time buyers, Brooks suggests taking a second look at the shape of the building before signing on the dotted line. "You don't want any space, or room or any piece of property that is more than twice as long as it is wide," he stresses. "The squarer the better, when it comes to the shape of your building. A long, skinny piece of property elongates the flow-patterns for the practice, which means you walk further to get the same work done. It's much less efficient."

This is a particular problem in the United Arab Emirates, suggests Simon Varghese of Dubai-based Evolve Interiors, as the property flurry has seen the number of available clinic spaces drop.

"Demand for space is outstripping supply, so tenants who get space are ready to get the money and sign on the dotted line," he says. "Then they find the building can't meet their requirements.

"It's the biggest problem in Dubai right now, so new tenants should really study space before signing up."

Architect Fareena Dawood has recently completed work on the American Family Clinic. To create a clinic that works for you, rather than against you, she advises heading back to the drawing board to establish your working patterns.

"Bubble diagrams are something we typically do for any project," she explains. "You identify spaces, such as exam rooms and the waiting area, and explore the relationship between them. Based on the priority between these relationships, you either put them together or further apart to ensure the functional aspect of the design is correct.

"Circulation is everything with a clinic."

Function versus form

For existing practices, there is a range of ways to map out workflows. Brooks, for example, stands in the hallway of practices and times physicians to identify how much of their day is spent in clinical practice, and how much spent searching for a nurse, walking the halls, or waiting for a patient to be brought through. The aim is to identify possible bottlenecks, and see how workflow could be streamlined by more supportive design.

The results are divided into three categories, Brooks explains; tasks only the doctor can do, tasks that could be delegated to another member of staff, such as collecting medications, and wasted time spent in the hall or waiting for a room to be set up.

"We see how the space is negatively impacting their ability to be productive," he notes. "When we show this to doctors, we say, ‘in the environment you're in; you're seeing four patients an hour, but if you eliminated this wasted time and delegated effectively, you could see six.'"

Few Middle Eastern design firms have healthcare-specific experience, Khan adds, so physicians should plot these workflows before bringing professionals on board. She recommends carrying out a patient-cycle audit to identify any snags in your average patient's visit. Just note the time taken to complete each stage on the patient's chart.

"For example, if a patient checked in at 3pm, we would note that check-in took four minutes. Then we'd mark down waiting time, time taken to transfer to the exam room, amount of time spent with the doctor and so on.

"It really gives you feedback, and it's an objective measure."

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