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Tuesday Jun 20, 2017

Putting Patients at the Center of My 'Clinic of the Future'

Editor's Note: If you are looking for more ideas on how to modernize your practice, the popular Office of the Future exhibit will be returning to this year's Family Medicine Experience, which is scheduled for Sept. 12-16 in San Antonio.

About one year ago, I realized that my practice had reached its limits within the space we then occupied. Although my clinic had suited our needs for more than five years, I had built my practice panel to more than 600 patients, and that location would not allow us to grow into a multi-physician operation -- which is my goal -- or to add other services.

I was proud of my original clinic space. It was not like most doctors' offices with beige walls and cramped exam rooms. We got great feedback from new patients. Many patients remarked that it was "comfortable," "cool" or "funky." (From what I'm told, that latter designation is a compliment and not related to foul odors). I gave interviews about it(www.youtube.com), and I shared a video tour(www.youtube.com) of it on our website. Eventually it become clear, however, that my image of what a clinic could be had been limited by the shoestring budget common to virtually any start-up clinic a doctor opens shortly after graduating from residency.

Here I am listening to a patient at my new clinic. The consultation room is designed to improve communication, as well as patient comfort.

It took me a while to find a space that would be suitable for our new clinic. Luckily, the building owners at our new location were agreeable to our doing a major renovation to suit my grand vision.

My model of practice, direct primary care (DPC), allows for a lean operation -- low overhead and minimal staff requirements. As a solo DPC physician, I only need to employ one full-time nurse. I have zero administrative, clerical or billing staff. That clinician-to-staff ratio will remain the same with this expansion. This simplicity allows us to get creative and focus to a much greater degree on the patient experience.

Creating Comfort With a Purpose
Other service-oriented businesses obsess about customer experience from the moment a person enters the door. Physician offices should be no different.

I'm not suggesting marble countertops and chandeliers designed to impress people. Although style preferences are diverse, promoting comfort and conversation is possible in several ways. Enhanced seating arrangements are perhaps the most important factor in that effort, and fostering greater clinician-patient eye contact should be the first consideration. That's certainly not possible when doctors are busy looking at a computer screen facing a wall. For many years, my primary setup for interviewing patients was across-the-desk with my trusty iMac on a swivel stand. However, there were times when the desk seemed to be an obstacle to engagement. Given that more than half of my visits do not require an extensive exam or supplies, I decided to create a consultation room that was more of a living room than an office.

In my new consult room, I placed a full-size sofa for patients next to a matching chair and laptop table for me. I have had only a few visits with new patients, but I could immediately see that patients seemed to enjoy the causal setup.

In my old clinic, a few random items were frequently referenced -- none more than the red Craftsman tool chest in my primary office and exam room. I purchased it because I thought it was a practical way to store my procedure supplies. Dozens of female patients have told me, "I think even my husband would like this place!" because of that tool chest. I also enjoy doodling anatomy and other concepts for patients, so I had placed an enormous chalkboard in my office. I quickly learned that kids enjoyed using it almost as much as I did.

Needless to say, my tool chest and chalkboard definitely made the journey to the new clinic.

Building a Place of Community
I wanted a welcoming lobby that was more than just a waiting room. (In fact, my average wait time is probably a net negative. Patients often arrive five to 10 minutes early and are seen before their scheduled appointment times.) Although I had done some group activities -- educational and community-based -- in our old small lobby, it was cramped for more than eight people. I wanted our new lobby to be designed with that specific purpose in mind.

So although we have only seven comfortable chairs in that area during regular clinic hours, we have enough space to fit 20-25 people when needed. I also hung a large TV in that space to be used for slides or videos. It should be a perfect setup for group education, community meetings, demonstrations and any other crazy ideas we dream up.

Our new kitchen is large and open. We placed booth seating along a wall that can easily seat six people. Whenever we grow the practice to include multiple physicians, it will be a great location for team huddles. After all, who doesn't enjoy hanging out in the kitchen? Also, we plan to use the kitchen for cooking demonstrations when teaching patients about nutrition.

Integrating Technology
Being member-supported (not paid per visit), we embrace the opportunity to provide care remotely utilizing technology. But I also recognize the importance of having our physical space when patients need to be seen in person. The convergence of technology and physical space is a challenge that every service industry faces, but nowhere has it been more fraught with problems than health care.

Unfortunately, implementing technology in our clinics has often wreaked havoc with physicians' workflow and patient encounters. I have heard many doctors lament the hours spent hunched over a keyboard. Patients miss the full attention of their physicians if they are pecking away trying to keep up with documentation requirements. In a relationship-centered business, it's understandable why people express frustration. This does not need to be the case.

In front of our consult room sofa is a large TV that will allow me to share my laptop or tablet screen for patients who want to view their medical record (notes, results and images) or anything else I would like to share. I am hoping this will encourage patients to become active participants in their health records and care plan.

Studies have shown that open notes improve patient engagement(catalyst.nejm.org), and there is no better way to promote that process than during a clinic visit. Our other rooms will be designed around this idea of collaboration and patient face time, as well.

Looking to the Future
With all the other challenges facing doctors and patients, it might seem that matters of design are the least of our worries, but I would disagree with that sentiment. If we aren't improving the real-world experience of health care for patients, we aren't changing much that matters at all.

Ryan Neuhofel, D.O., M.P.H., owns a direct primary care practice in Lawrence, Kan. You can follow him on Twitter @NeuCare(twitter.com).

Posted at 03:58PM Jun 20, 2017 by Ryan Neuhofel

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