Dermatology World July 2011 SUPPLEMENT : Page 7
Cost Considerations Regardless of whether you choose to remodel or relo-cate to a newly built space, there are some key factors to consider, including cost. Dr. Bagel cautioned that building projects always cost more and take longer than expected. The key is minimizing those factors. Dr. Hruza split the costs with another dermatology group. He believes it is more cost effective to build a larger building, which will yield a higher price at some point down the line if they decide to sell it. optimizing your flow Patient flow and work flow are two other significant fac-tors. Dr. Hruza was very involved in planning the layout. He separated the 4,000-square-foot ASC from the remaining 6,000-square-foot office space. Dr. Hruza designed the H-shaped space for two dermatologists working simultaneously, although at this point he is practicing solo. There is a second waiting room on the office side for patients who are in between Mohs stages. The Mohs lab and nursing station are located in the middle, making them accessible from all of the patient rooms. The ASC includes one operating room, one pro-cedure room, three pre-operative rooms, three recovery rooms, a waiting room, and ancillary space. “The flow has worked out very well,” he said. The contractor with whom Dr. Bagel worked pro-posed a design plan that optimized patient flow. Next, the office personnel reviewed it. Obtaining feedback from people who work in the space resulted in some improvements to the layout, said Frida Bagel, Dr. Bagel’s wife who has an interior design background and assisted with the remodeling projects. For example, staff identified some glitches in the floor plan that would have created bottleneck areas. Of course, size is a consideration. Some patients don’t move as fast as others, Dr. Bagel noted. “If you have more rooms, people can flow in and out easier. Plus, the slower patients are not being rushed.” Additionally, it’s harder to attract people to work with you if you have a small space, he said. When planning a new office, Dr. Bagel recommended mak-ing it large enough to last five to six years. His wife believes that it is better to have extra space than tight quarters. “Don’t limit yourself with regard to space,” she advised. “People are more at ease and get along better when they have more space. When employees are bunched together, they will be less patient with patients.” In addition, Dr. Bagel was able to put a histotech lab in a small extra room for which they originally had no purpose. In general, regarding remodeling, Dr. Bagel said, “It’s not something to be fearful of, but it is something to keep your finger on the pulse of, because it’s costly and time consuming.” projeCt management Dr. Hruza says he was fortunate to have a very sharp and detail-oriented office manager who oversaw the project. Without such an individual, it may be worth-while to pay a consultant who could identify some design issues upfront. “When you are asked to sign off on a 100 pages of blueprints at a time, you can miss some things,” he said. An example is the fancy eye wash station that the contractor installed in the Mohs lab because he had installed similar ones in other medical office buildings. “We could have used a $30 squirt bottle for an eye wash station that meets the requirements,” Dr. Hruza noted. It not only cost $2,000, but the eye wash station was poorly installed and caused flooding in the unit one year later, resulting in hundreds of thou-sands of dollars’ worth of damages. Another example is the backup generator that was four times larger than necessary — and four times as expensive. He recently learned that he can reconfigure the ASC to allow for one more procedure room, which would double his capacity, something an experienced con-sultant may have known. Dr. Hruza is currently doing minor remodeling. “Getting there is exciting,” he said. “But it takes a lot longer, more money, and more of your time than you think it will. It requires a real commitment to do this.” Now that the practice is up and running, he believes it was worth the effort. “The building is gorgeous. Patients say that it’s the nicest office they’ve been in. You can’t help but feel good about that.” dw supplement to Dermatology WorlD // July 2011 7
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