How Many Exam Rooms Do You Need?


Mark's note: When I first started in healthcare, I worked for a team called ValuMetrix Services, a part of Johnson & Johnson that did consulting for labs and healthcare organizations. During that time, I got to work with Tony Milian. While I came from manufacturing outside of J&J, Tony had moved over from other parts of J&J. It's been great to re-connect with him recently, to learn more about his consulting that's focused on eye clinics and other clinic settings. What he wrote, originally part of his email newsletter, applies to all sorts of medical office settings. Visit Tony's firm's website and their blog.

tonyBy Tony Milian:

I commonly hear Optometrists say, “If I only had more exam rooms, I could see more patients.” Well, how many exam rooms is the right number? Do you need two, three, or even four to see patients efficiently throughout the day? The number might surprise you. It's two, and here's why.

Efficiency, from an Optometrist's perspective, usually means that you want to be able to move fluidly from one room to another seeing patients all day long without interruption. If you are waiting outside in the hallway for the next patient to be worked up before you can proceed, this is an interruption and hence, not efficient.

With this perspective on efficiency, it's easy to see why more exam rooms are better. If you have three or four exam rooms full of patients waiting for you then you don't have to stop. You can just keep moving all day long without interruption, right?

That's true, but you are forgetting about the most important thing in your practice: the customer (your patient). Efficiency has to be a balance between working without interruption and giving the customer what they need, when they need it, with minimal waiting. This is called productivity, it's different than efficiency.

A well-synchronized practice should run productively with no more than two exam rooms per physician, with a third exam room, if available, being used for overflow cases where exceptions are managed. More than two exam rooms used consistently per doctor means that one patient is being seen by the doctor, the other is being worked up by a tech, and the third is waiting.

The extra room just becomes a storage closet.

Of course, successfully running with just two exam rooms per physician means that you need a well-synchronized and choreographed work up process. This means two things.

First, your average time in the room with a patient cannot exceed how much time you allot on the schedule. You can't have a 20-minute slot on the schedule and a 24-minute exam. If this happens, you are going to fall behind, no matter how many exam rooms you have.

In fact, you should shoot for a goal of ensuring that your average time in the room with a patient is no more than about 80% to 85% of the time allotted on the schedule. For example, if your schedule says you have 20 minutes per patient, your average time in the room with a patient should not exceed 16 or 17 minutes.

Second, the amount of work your techs do versus the amount of work you do in the exam room has to be balanced. If they can outpace you and fill exam rooms faster than you can see patients, it's a sign that you need to delegate more work to them. The same, but opposite, is true if you are consistently standing outside the hallway waiting for patients to be worked up.

Other factors play into how successful you are at running with two exam rooms. Being strategic about how you schedule patients so you don't overload your clinical resources is one critical factor. Another factor is how and when you dilate patients. We will save those, perhaps, for a later discussion.

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Tony Milian
Throughout a 12-year career at multiple Johnson & Johnson operating companies, Tony learned how to successfully apply Lean Management concepts to improve the delivery and quality of health care in numerous sectors. As an entrepreneur, Tony has utilized Lean Management concepts to help foster a culture of employee driven continuous improvement at more than 400 Eye Care practices across the United States and Canada. His approach has generated significant revenue growth, cost reductions, and operational efficiency within these practices, while also improving staff accountability and engagement.


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