How to conquer clutter in your physician office

Medical practices are unlikely to be so cluttered as to end up on a reality TV show about hoarding, but clutter can still make an office look bad and lead patients to question the quality of care they receive.

"Even though a place might be clean and there are no infection-control issues, if the patient sees a bunch of clutter, they will think the place is not clean," said Kristin Baird, RN, CEO of the Baird Group in Fort Atkinson, Wis., which advises practices on issues related to the patient experience. "They will think, 'Do I have to worry about catching something here?' They start to not trust you."

The cleanliness of an office is one of the questions Healthgrades.com asks patients when rating doctors, and clutter is sometimes mentioned in negative reviews on Yelp.com and other websites. Clutter also can affect workplace productivity and morale. A survey of 1,000 office workers, although not necessarily in the medical setting, released Jan. 25, 2011, by OfficeMax found that 77% said unorganized clutter negatively affected productivity. About 53% said clutter damaged motivation.

"Clutter really is a ... decision that is still waiting to be made," said Angela Wallace, president of the National Assn. of Professional Organizers.

Tackling clutter, however, does not just mean a weekly cleanup. Every practice needs to develop its own systems and solutions that may include policies about waiting room reading material, work space personalization, patient charts, office signage and out-of-date equipment.

"The most important thing is to have good business systems in place," said Wallace, who also is a professional organizer based in Novato, Calif.

Experts suggest that medical practices take several steps to prevent or address clutter. The first is for staff to take a step back and try to see the office as a patient does.

"People become so accustomed that they do not realize how it looks to other people," Baird said. "But you need to be able to experience the practice through the eye of the patient. Partner with somebody else to do a walk-through and give you some feedback."

Patients can be turned off by stacks of old magazines in disarray in the waiting room. Charts, for various reasons, may be piling up. Paper signs that once seemed terribly important may no longer be so, and may be accumulating.

"Staff may have had a situation one day where somebody asked a question once too often so they slap up a paper sign, and if one sign is good, two are better," Baird said. "Some paper signs are not only tacky-looking, the messages are downright scary."

Equipment no longer used may be taking up valuable space. The desks of front-office staff could be so heavily personalized that they look unprofessional.

Questions to consider when attempting to address or prevent clutter: Is it really necessary to have so many magazines in the waiting room? Do the magazines reflect the interests of the practice's patient population? Can the waiting room be organized so it can stay neat with patients coming through? Should tidying the waiting room regularly be a particular staffer's duty or one that rotates among employees?

"Physicians will just ask their staff to bring in their old magazines for the waiting room. That's always a bad idea," said Johnny Hagerman, corporate assistant vice president of marketing for MedStar Health, a regional health system based in Columbia, Md. "People don't like to walk into a department store that is disheveled. They feel much the same way about medical practices."

Practices may want to consider how personalized a staffer's desk can be, particularly if patients can see it. Experts recommend against a total ban on personalization. Rather, practices should consider what policies would reduce the perception that the space is cluttered. For example, what is the maximum number of family photos that can be affixed to a computer? How many framed photos can sit on a desk? Are personal screen savers allowed?

"Everybody personalizes their desk space, but personalization can be seen as clutter," Hagerman said. "Staff may think they are giving the impression that the office is a homey place to be. Unfortunately, too much stuff doesn't make patients feel at home most of the time. It makes them feel the place is disorganized and not well managed."

To get staff buy-in and maintain morale, experts advise that employees work together to develop policies on personalization.

Other issues are deciding what equipment needs to be in a patient exam room and what has to sit in the hallway. How does the signage look? Can written messages be consolidated in any way? Are charts piling up? Can you reduce or eliminate that pileup?

If the office is disorganized, an electronic medical record may not solve the problem. The office may need to set up an annual, quarterly or even monthly purge of paper, electronic materials and just plain stuff. Rules should establish what must be deleted, discarded or donated to charity.

Additional policies to consider: How long should patient medical records be kept? What papers need to be disposed of securely? Can some be scanned and stored electronically? Are there any items that need to be kept but don't need to be in the office? Would it make sense for the practice to rent storage space to make the office look better?

"You need to make it everybody's responsibility," Baird said. "It's got to be everybody's job."