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Some practices find extra efficiency with pod design

A column about keeping your practice in good health

By Mike Norbutcovered practice management issues during 2002-06. Posted Feb. 28, 2005.

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The family practice office of Keystone Health Center, a public, nonprofit health care network in Chambersburg, Pa., has 24 exam rooms, but David Hoffmann, DO, uses only six of them.

Instead of crisscrossing the office between patient appointments, he needs to walk just a few feet between exam rooms in his pod. And instead of having to hunt down a nurse who's free to assist a patient, he knows he can count on the ones who are always assigned to him.

With eight physicians, it's a large office, but the pod concept of office design has made it considerably more manageable -- and efficient -- for Dr. Hoffmann and his patients.

"It promotes familiarity," said Dr. Hoffmann, a family physician and director of the HIV program at Keystone Health Center. "Within the pod, you can have specialization. It promotes a team environment."

To minimize unnecessary travel between patient appointments and the lost time spent tracking down information or samples during a visit, some physicians have adopted the pod concept of office design. It's as much an intellectual idea as it is a physical design, and it can help solve everything from patient flow problems to revenue shortfalls.

While it may appear to be an idea for larger groups planning to renovate its space or build a new office, many of the concepts apply to small groups as well. Advocates of the system say you can gain some of the same efficiencies in your practice by changing your organizational structure and allocating staff more in a pod style, where workers are not straying far from their work areas and exam rooms are scheduled consistently.

"I always tell doctors there's no CPT code for walking the hall," said Dick Haines, president of Medical Design International, an architectural firm based in Tucker, Ga., that specializes in medical offices.

The arguments for pods go something like this: Teams are fostered through a decentralized approach to staffing, including assigning nurses and medical assistants to a certain doctor. By keeping everyone in the same pod, work flows more efficiently. It's also contained to one pod, leaving far fewer opportunities to lose time walking to other areas of the office.

"If you put everything you need in the pod, when you go in, you can see the patient and finish the exam before you come out," Dr. Hoffmann said. "That's key."

There is a danger of decentralizing too much of a practice's operations, however. For example, Knoxville Cardiovascular Group had a pod concept design employed in its new office, which it moved into last year. The 13 physicians are divided into three pods, with each pod acting as its own self-sufficient clinic. Each pod even has its own checkout coordinator instead of the traditional design, where a central checkout desk is in place near the waiting room.

The problem, however, is that if one pod suddenly gets busy while another pod is slow, the idle pod coordinator can't pitch in the way workers at a centralized desk can, said Jeff Stovall, administrator for the group. Lunch coverage can also be problematic.

"The pod concept is a very positive and efficient way to work, but with checkout, from a standpoint of utilization of employees, it's very poor," he said. "The pod concept could have still been used if the checkout process had been put in the same [central] area."

While there may always be surprises for physicians who change to the pod concept, the biggest may be how little they have to move to get everything they need. Doctors also were immediately impressed with how much better patient flow was and how quickly the office seemed to calm down, Haines said.

"We've had phenomenal success with it," Haines said. "Our clients report heightened productivity, a much quieter environment, and better work flow and work ethic."

The pod name defines the ideal physical layout of the office. Exam rooms are grouped together, generally with their own hallway away from the centralized part of the office, with perhaps even a separate doorway to the waiting room. The pod, theoretically, would have everything you need within a few steps. The exam rooms are grouped with a nurse's station, where patient files are kept; a doctor's station, where he or she can dictate and take calls on a private phone; and occasionally the physician's office, Haines said.

Pod size would depend on the number of physicians working in it and the most efficient number of rooms needed. A doctor who sees six patients an hour, for example, would need more than three exam rooms to keep patient flow from being hampered.

"You don't want the space to artificially inhibit their ability to be effective," Haines said. "In some offices, you have exam rooms down a long hall, and there's no discernible work environment. There's no consistency from day to day."

Add a lack of consistency to a lot of time spent walking around the office, and you have a recipe for inefficiency. But advocates of the pod system say if you add up the time saved from simply working in the pod, it could mean a few extra patient appointments over the course of the day.

Mike Norbut covered practice management issues during 2002-06.

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