O&P Facility Design: A Blueprint for Success

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By Judith Philipps Otto

Times are too tough to frivol away O&P profits in the form of burnt offerings to the god of architecture. But tight budget notwithstanding, today's O&P business owner is faced with the dilemma of keeping up and making progress or getting run off the road to success. Standing still is not an option; that road is nothing more than a conveyor belt that carries you backward if you're not propelling yourself forward at all times

Your facility not only represents your image, it is often the first and sometimes the only factor patients and referrals have to guide them in forming an opinion of your professional capabilities, your efficiency, your attitude toward progressive ideas and new technology, and much more. Do you think people haven't driven past your facility and decided not to come in? Think again. Maybe it's something as simple as congested parking or an entrance that is not sheltered from the weather. Maybe your façade is perceived as too cold and formal, with no trees or "welcoming" influences.

Perhaps there's nothing wrong with the exterior, but once inside, traffic flow is a nightmare, with clients walking through the laboratory to get to a fitting room. Maybe clients are delighted, things are flowing, but your technicians are turning green from fumes.

Maybe there's not a people problem at all, but an information glitch. Perhaps that increasingly vital patient information with its complete documentation is floating around heaven-knows-where instead of under Health Insurance Portability & Accountability Act (HIPAA)-required lock and key. Making yourself a more efficient and economical operation will more than pay for itself, if implemented intelligently.

Facility Design Factors

A List to Get Started

1. Location, Location, Location
You know your community and your competition. You also have a good idea of where you want your office to be. Still, enlist the help of a broker to make sure that you properly consider health and medical requirements, construction options, parking needs, and local zoning ordinances.
2. Choose a Contractor
Select a contractor experienced in health and medical build-outs. Again, you know what you want, and working with someone who is familiar with your needs will make the process that much easier.
3. Gather Input
Your associates, staff, patients, and their family members all "use" your facility and may have great ideas about how to better use your space and set up the flow of the office.
4. Use Your Space Wisely
Every square foot of your facility is priceless real estate. Make sure that you are properly considering storage, central fabrication, and the exam room. Where and why are you placing different components of your facility? This is not only important for maximizing the space available, it is also sets up the office flow for efficiency.

The starting point is obvious: make a careful study of your specific needs for extra space, better flow, more efficient step-saving, etc. Focus on the problem areas in your current facility, and consider alternatives that might provide solutions.

Most who have tackled a facility design or redesign project have done so from the perspective of many years of experience working in less-than-ideal conditions, which not only motivated them to create something better, it also gave them some solid ideas about what constitutes "better."

What will you do to make your "improved" facility work better than the old? What features should you consider with regard to waiting rooms, exam rooms, lab, document security, etc.? Here are some ideas you might borrow:

Ron Manganiello, New England O&P (NEOPS), admits that one of his concerns grew from a pet peeve. "I don't like glass partitions that separate reception staff from clients and visitors. It creates an 'us and them' feeling, which does not put patients at ease. None of our facilities have any glass partitions. Each has a large open area where people can stand at the desk and share the same environment.

"Exam rooms must be large and very clean, nicely furnished with nice pictures," Manganiello notes. "All of our facilities also have a kitchen and refrigerator stocked with sodas, juices, and coffee to help patients feel welcome and at home."

Since NEOPS facilities are partnerships with the owner/managers, specifics of each facility's design are up to the partner/manager. "Several facilities have a separate mastectomy fitting room. Some have fish tanks, which are a good idea-very soothing and very child-friendly. Some have special pediatric rooms, and all have toys and toychests as well as a TV and a video library with favorite children's subjects."

Dan Stachura, lab manager at Baker Orthotics and Prosthetics Inc., Ft. Worth, Texas, describes the challenges and solutions the company encountered in designing an off-site lab.

Otto Bock has fabrication centers in Minneapolis, Minnesota; Orlando, Florida; and Salt Lake City, Utah. Photograph courtesy of Otto Bock HealthCare.
Otto Bock has fabrication centers in Minneapolis, Minnesota; Orlando, Florida; and Salt Lake City, Utah. Photograph courtesy of Otto Bock HealthCare.

"We had the challenge of switching from a facility with office and fabrication in the same building, to separate locations. We have few HIPAA worries, as only employees are allowed in the lab. We tried to do a minimal build-out, using existing walls and doors where possible. Our dust collector, compressor, and vacuum pump are all in the same room at the farthest corner of the building. This reduces noise and keeps the maintenance of the equipment easier to implement."

Next to this room is the machine room, where all grinding and polishing are done, Stachura explains. "Keeping the length of duct-work to a minimum improves the efficiency of the dust-collection system. The routers are placed in front of the windows to take advantage of the natural light. The doors on this room are self-closing, with sealed thresholds to keep the inevitable mess in."

Casting sink, computer station, elevated parallel bars, and storage. Photo courtesy of Mary Free Bed Orthotics and Prosthetics.
Casting sink, computer station, elevated parallel bars, and storage. Photo courtesy of Mary Free Bed Orthotics and Prosthetics.

The technician benches are in a common area, and all of the appropriate tools for modifying, vacuum forming, and laminating are located at each work area. "Nothing is more frustrating than watching people wander around the shop looking for scissors," Stachura says.

"Our transfer jigs are near the sink, so we don't have to carry buckets of plaster across the shop," he continues. "The plaster-modifying area is located near the back door, so deliveries are easier, and our techs don't have to carry bags of plaster any higher than the can the opened bags go into."

Stachura says that equipment can be grouped for efficiency based on work flow and how each process affects the next. "For example," he says, "don't have the leather area at one end of the shop and the sewing machine at the other just because it fits in a good space there. Most importantly, don't consider anything to be etched in stone.

"If you can think of a better location or arrangement, change it," he concludes. "Haven't we all had enough grumbling about the way something is set up because it's always been that way?'"

Ted Trower, CPO, A-S-C Orthotics & Prosthetics, Jackson, Michigan, recalls his design experience: "I had to build a lab onto the former physicians' office I purchased in 1993. By accident, that resulted in separate HVAC systems in the clinical and lab areas. It turned out to be a wonderful thing. Noise, dust, and odors don't make it from the back of the building to the front."

David Varnau, CPO, Center for Prosthetics-Orthotics in Seattle, Washington, also drew upon his experience when he custom designed his facility 15 years ago. "I had been in the field for 17 years in four different settings, and I think that helped me to take the best of what I'd experienced and incorporate it into a design. If you've worked in a cramped area or poorly thought out workspace, you have ample opportunities to come up with solutions to problems you've encountered over the years."

Among the features that Varnau particularly likes about his Seattle flagship facility are the recessed floors in the casting room and in the parallel bar rooms, which allow the practitioner to align a patient's prosthesis without bending over and to see a lower-limb prosthesis closer to eye level. "To achieve this, instead of the usual approach of installing ramps to raise the patient walkway, the area of the room adjacent to the parallel bars where the practitioner works is dropped down and requires the prosthetist to step down two steps below normal floor level. Since the second-floor patient-care area was built 14 feet above our parking garage floor, we had plenty of head room in the parking garage to drop the garage ceiling several feet to accommodate the recessed floor above. That, of course, wouldn't be possible in an existing, leased space." When Varnau, who was raised on a dairy farm, originally gave his dad a tour of his new facility, his father commented, "These rooms are just like the milk parlor back on the dairy farm!"

Today, Varnau, is updating his patient rooms in a way that he could not have envisioned when his facility opened. The Center for Prosthetics-Orthotics has just installed computers mounted on movable arms in each patient room to allow practitioners to document measurements and complete patient progress notes while with the patient. "Switching to electronic patient files," Varnau reports, "has represented a paradigm shift in our front office operations and has been costly, but at least all of the cable drops and computer hardware are installed in a space that isn't leased. Finally, Varnau believes in a healthy and attractive environment both for patients as well as for staff. The Center for Prosthetics-Orthotics' patient rooms and reception area feature original sculptures-art that he has pursued as an avocation when away from his office.

Jeff Ashenbrenner, market manager for Otto Bock's facility design service says that one of Otto Bock's specializations is the design and efficient workflow of O&P workshops. "We have been putting this expertise to work on a global basis for over 30 years. We've designed over 1,400 facilities in over 30 countries across six continents. There's no one else out there-even on a global basis-who has this same level of specialization. We're backed by a full department in our home office. More than ten staff members are dedicated to this service.

"We speak to many people who are expanding their operation or starting a new operation and become frustrated with the process," Ashenbrenner says. "They're having difficulty communicating with their architect why a noisy dust-collection system shouldn't be backed up against the wall of a patient room. Or why it's important for the patient room to be next to the fitting room instead of requiring patients to walk from one end of the building to the other through areas that are open to the general public. Our service offering is designed to make the lives of our customers easier. Our customers are focused on patient care; we don't want them to be concerned about if their space is being optimized for efficient workflow."

Ashenbrenner responds to customer inquiries by asking a series of questions to learn more details about their facility and what features they would like to include. He then passes the information on to a design specialist, who creates a design based on the customer's wants and needs.

"Once you get into the design, here's where practitioners can benefit on a financial basis," Ashenbrenner notes. "When their workshop is set up efficiently, they're able to produce devices more quickly, more efficiently, and of higher quality. Consistency is the key for practitioners to be able to save time producing higher quality devices more profitability."

Jeff Grill, the project architect for Mary Free Bed Orthotics and Prosthetics, Grand Rapids, Michigan, points out popular features that excite comment at its $2.1M prosthetics and rehab technology center, with its updated facility.

"We have created 60 individualized mini-lockers-12 x 18 x 36-in.-where all patient projects are stored. This minimizes clutter and confusion," and it also makes HIPAA patient-privacy requirements easier to enforce.

Exam rooms are individualized for the practitioner who uses them regularly. "Everything is at hand," Grill points out. "Tools, computer, patient records. This is a real space saver, since there's no need for a separate clinical charting room."

"Certainly all sorts of financial constraints limit the design," says Varnau. "There's not as much fat on the chicken as there used to be! But the patient's convenience, safety, and comfort need to be top priorities. When that happens, other things fall into place."

You don't need to spend $2.1M on your redesign-an excellent idea survives adaptation and customization and still shines productively. Even if times are tough, you can still afford to dream and perhaps even to carefully and strategically implement those dreams, one facet at a time.

Judith Philipps Otto is a freelance writer who also has assisted with marketing and public relations for various O&P industry clients. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer.