Designing the right floor plan for your practice
Kats, David J
At one time or another, nearly every chiropractor has the opportunity to move into a new office. Along with the opportunity comes the challenge of creating the best floor plan with the time, space, and finances available. While most chiropractors enjoy the challenge, the potential of overlooking certain benefits is quite large.
As a chiropractic consulting firm, we get many requests for floor plan ideas. We also see doctors make many mistakes. Perhaps the biggest mistake doctors make is designing a floor plan without knowing the actual dimensions of the space they will be leasing. A typical request is, “Will you design me a nice 1,500-square-foot office? I would like three treatment rooms and a therapy bay.” While it is easy to design the floor plan, the chance that it will be used is extremely low since the doctor has no idea of the actual dimensions of the future office. Should we design it as a rectangle, as a square, or will the office space the doctor rents have some unusual footprint? Where will the front door be? Will we end up with a nice bay window in the darkroom? It is nearly impossible to design a floor plan until after the interior dimensions, doors, windows, and existing electrical and plumbing setups are known.
The size of the space to be used is also important. It will dictate to some extent the services that can be offered and the costs associated with the lease, utilities, and structural buildout. Most new doctors start out with 1,200 – 1,500 square feet, although highly efficient offices can have a footprint as small as 700 square feet.
Doctors frequently call with a request for general guidelines for the number of square feet per doctor, number of square feet per patient visit per hour, and other similar building rules of thumb. But in the case of floor space, there are so many variables that it is impossible to create a set of general rules with any value. For example, we find that doctors in high-rent districts, such as New York City or La Hoya, California, tend to lease much less space than the doctor with a similar-size practice in Enid, Oklahoma, or Midland, Texas. Other factors, such as common restrooms, mechanical rooms, and entryways, also change the square footage needed from one location to the next.
Floor Plan Designs
Today, there are three generally accepted floor plans for chiropractic offices. Each chiropractor must decide which design best suits the practice. The traditional design has individual rooms for treatment, exam, x-ray, and private use. But today, even in a traditional floor plan design, many chiropractors make use of a common therapy room (often referred to as a therapy bay) and common rehabilitation area, just as physical therapists do.
Another common floor plan involves combination rooms. These “combo” rooms are large and are designed to function as the doctor’s private office, the treatment room, exam room, and sometimes even the x-ray room. While “combo” rooms may be three times as large as a normal treatment room, they still are quite space-efficient because of the number of procedures that can be done in them. I have seen very efficient office floor plans that incorporate the use of one “combo” room and one other large room for therapy and rehab, with total space of 700 square feet.
While the open floor plan design has been used by physical therapists for years, this third design has become more popular with chiropractors only in the last decade. The open design provides for a large treatment area, sometimes called an arena. This area is used for chiropractic adjustments, physical therapy, rehab, and any other treatment procedures that are normally done in individual rooms but that do not require privacy. The disadvantage of the open design concept is just that-a lack of privacy. The advantage is efficiency in floor space and patient treatment.
Most doctors feel that whatever floor plan they have used in the past suits them best. It has been our experience that if doctors take the time to visit other offices before deciding on a floor plan, they almost always find new ideas that they can incorporate. We encourage doctors to visit several other offices before creating a new floor plan. A book of floor plans does not provide all of the information needed to make decisions on the most efficient use of the new space.
Design from A to Z
We work daily with floor plan designs and tend to answer the same questions repeatedly. As a result, we have come up with a list of ideas to consider whenever designing a new space or remodeling current space.
While not actually part of the floor plan, parking is an important consideration in a new location. Health care professionals usually need more parking per square foot than other businesses. Some building codes require one parking space for every 300 square feet for business use and one parking space for every 225 square feet of building space for use by a health care facility. I have found, however, that because chiropractors generally have smaller offices and have more patient visits, a good rule of thumb for chiropractic offices is one parking place for every 225 square feet of leased space, plus adequate parking for the staff. If you are in an area such as a shopping center or an area that has good onstreet parking, these requirements become less important. Be sure your future location has adequate parking for your practice style.
Visibilty and Accessibility
Since chiropractors now get many of their patients as a result of being on managed care panels, visibility is not quite as important as it was in the past, but it is still essential if you plan to maximize your practice potential.
Generally speaking, the small, additional amount that you pay for good visibility is recouped several times over during the year. Accessibility, on the other hand, while nice, is not quite as important. Accessibility is important for businesses that provide more spontaneous services, such as fast food restaurants and gas stations. While a customer of a fast food restaurant may drive by because of a street median or bad curb cut, it would be extremely rare for a chiropractic patient to schedule an appointment, drive to the chiropractor’s office, and decide not to go in because of a median or curb cut.
One of the biggest mistakes is underestimating the cost of constructing the interior finish. New construction is frequently leased to the tenant as a “vanilla box.” This means there are no interior walls, doors, or other interior construction. Constructing the interior finish of a building will cost $25 to $30 per square foot. This means that even a modest-sized office of 1,000 square feet will have additional buildout costs of $25,000 to $30,000. If possible, try to find building locations that already have interior construction that can become part of your floor plan. Why spend $30,000 for a buildout in a space that you may occupy for only three years?
If you live in an area where temperatures are extremely hot or cold, you will need to consider a double entryway, sometimes referred to as a weather lock. Without a weather lock, it is difficult to maintain a constant temperature in the reception room and at the front desk. Because of the Americans with Disabilities Act (ADA), entryways, bathrooms, and hallways all take up considerable space in your floor plan. A building that has the double entryway built on the outside of the building is advantageous in that it provides protection from the elements and does not use up your valuable internal floor space.
Reception Room Visibilty
When constructing your floor plan, it is best to locate your receptionist in an area where he/she can view the entire reception room. This reduces the possibility that patients will enter your reception room and sit in an area where they cannot be seen or where they may be forgotten by the receptionist. If the receptionist can see the entire reception room, this also allows for more efficient patient flow.
Ideally, your receptionist can be positioned to see both the entire reception room and the main hallway of the treatment area. This again allows the receptionist more efficiency in routing patients.
Most efficient office designs allow for the grouping of similar activities in the same area. For instance, your front desk and insurance department may function more efficiently if they are close to each other. Other similar activities include having your therapy bay and rehab area adjacent to each other and having all activities performed during the patient’s first visit, such as case history, exam, and x-ray facility, in the same general area. Grouping similar activities into one area provides efficiency, privacy, and convenience for the patients and staff.
The cost of running electrical wiring to x-ray machines and plumbing to bathrooms and darkrooms increases as the distance increases. As a result, try to group your plumbing all in the same area close to the main water and sewer entrance. The same is true with the electrical design. Designing your office so your x-ray equipment is close to your main electrical entrance also saves money.
Using Windows and Walls
It is always nice to have natural daylight in the areas you work in most. Arrange your floor plan so doctors, staff, and patients all have access to natural daylight. On the other hand, exam rooms, x-ray rooms, darkrooms, and storerooms can be located in areas without windows. In addition, positioning your x-ray room against an outside wall sometimes eliminates or reduces the need for lead lining or other radiation protection.
The most common mistake we see in floor plans is simply door placement and swing. Here is an example. If you have two treatment rooms on the same side of the hallway, it is generally best to have the two doors adjacent to each other for ease of movement between the rooms. You must also make sure that the doors swing in the right direction. A door that opens into a hallway frequently reduces efficiency and creates a fire hazard. Another common mistake we see in floor plan design is the use of doorways when a simple opening will suffice. Adding a door will cost approximately $400 when door, labor, and hardware are factored in. If you can replace the door with a simple opening in areas like the entrance to your therapy bay, you have created a more efficient floor plan and saved costs. One other factor should be considered when placing doors. Doorways take up considerable space in your room because you cannot set any furniture directly in front of a doorway. For example, some doctors use small dressing rooms that attach directly to their treatment rooms, frequently called “feeder” rooms. In this case, their treatment rooms may have two or three doors along one wall. This necessitates a much larger treatment room since no treatment tables, chairs, or other furniture can be placed within three feet of the door. If feeder rooms are a good idea for your style of practice, be sure to allow enough extra treatment room space.
Most doctors spend the vast majority of their time looking at the actual footprint of the floor plan design and spend very little time considering the effects of heating, ventilation, and air conditioning. When building, it is important to consider the effects of heat gain through windows and southern exposure. It is often more effective to have zoned heating and cooling. In a recent floor plan we constructed, we Placed a two-ton air conditioner on the north half of the space and a five-ton air conditioner on the south half of the space. Because of the windows and heat gain on the south and the fact that the north wall was a demising wall (a permanent wall that divides the building into two or more tenant spaces) in the building, the energy requirements varied greatly.
The cost of construction can vary greatly depending on the number of cabinets, counters, bookshelves, and other built-in furniture and appliances. It is often less expensive to purchase free-standing desks and bookshelves, opposed to having them built in. This is especially true if you are renting the space and may move to a different facility in the future. Any built-in furniture is usually required to stay with the property, whereas furniture that is free standing can be removed and used in your next office location.
Almost every bid for construction or remodeling provides for certain “allowances.” This means the contractor will allow you a certain amount of money for items such as carpet, tile, baseboard, lighting fixtures, plumbing fixtures, and wall covering. Make very sure that you understand the costs associated with allowances. For example, a flooring allowance of $14 per square yard doesn’t sound bad. You feel confident you can find quality carpet at that price. But you need to be aware that the allowance almost always includes the cost of pad and installation. It also includes the price of any ceramic tile that may be needed in entries or bathrooms and sometimes includes that cost of baseboard. Chiropractors are also misled when they see a “model office” in the office park and assume the floor coverings and lighting fixtures are the same quality as will be allowed for in their space. In addition, contracts will usually provide for painted walls only. Any wall covering-and even window treatments-will be at an additional cost.
To make the best financial decisions, you should have a general idea of what individual costs are for various construction procedures. For instance, if you know that the high walls going in your therapy bay are going to cost $50 a linear foot, you may instead opt for hospital curtains at $20 per linear foot. If you know that the cost of a door is $400, you may instead decide to frame the opening and spend that extra $400 on two ceiling fans with light fixtures. Your builder should be able to give you general ideas as to the cost of individual construction items. Since most chiropractors work on a limited budget, they need to decide which amenities will provide the most desirable effect for the money spent.
Once a building plan and price have been agreed upon, any changes-even minor changes-will usually result in additional costs. These changes are called change orders. They can create major cost over-runs. To reduce the number of change orders, spend more time reviewing your building plans before signing the construction agreement. Don’t just look at the two-dimensional rool layout. Make sure the electrical outlets, computer outlets, lights, and ventilation are situated where you want them. Be sure the sidewalks, landscaping, sprinkler system, gutters, and downspouts are as you want them. The cost to change these items prior to construction can be very little. The cost of change after they have been construtted can be very expensive. Go over all portions of the blueprint. Is the back patio the size you imagined? Is your parking lot well lighted? Can you reduce the need for yard lights in the parking lot simply by having adequate lighting on the outside of your building? Is the striping of the parking lot included? Are your utility meters and boxes placed on the outside of the building in an inconspicuous area? Is the cement pad for your garbage dumpster in an inconspicuous space? Has adequate screening, such as shrubbery or fencing, been created between you and any undesirable neighboring facilities? Adequate planning before construction can save considerable costs.
Unless the chiropractor has used an architect for the floor plan design, there is a big chance that the plan does not include adequate storage. No one likes to pay for storage, but it is necessary. If you look carefully, you can frequently find unused areas that can be used for storage in your floor plan. Dead space at the end of hallways is an excellent place for a closet, and wall space above a countertop is an excellent place for cabinets. Plan your storage wisely.
If you plan in advance, you can run any computer wiring that is needed during the initial stages of construction in your office. If you wait until the office is completed before attempting to wire it for computers, the cost is much greater. Everyong uses computers. You need to plan ahead.
It is amazing how often we receive floor plans from clients with room sizes that are totally inadequate or out of proportion. We have literally seen floor plans that had treatment rooms four feet wide when drawn to scale. One easy way to compare room sizes is by counting ceiling tile. Most, but not all, chiropractic offices have a suspended ceiling. Most ceiling tiles are two feet square or two feet by four feet. Next time you are in an office whose layout and dimensions you like, start counting ceiling tile. It won’t take long until you have good idea of the size and shape of the rooms you will need for your new office.
Another common mistake we see from doctors who design their floor plans without the help of an architect or draftsman is a design whose rooms cannot be accessed directly from the hallway. The most common example is a dark room that can be accessed only by walking through the x-ray room. We call those rooms “landlocked.” Be sure to make use of lateral hallways and other arrangements that assure easy access.
Have you ever walked into a reception room of a health care practice that was exceptionally small and, to make matters worse, the receptionist could be seen only through a small sliding glass window? You immediately get the feeling that you are in a small practice and that they want to hide what goes on in the office. This cramped feeling can be avoided by removing the wall between the reception room and the receptionist. A counter is sufficient and allows incoming patients to view the reception room and receptionist area as one larger room. It creates an open feeling. Other techniques, such as skylights, natural light from windows, wider hallways, and lighter colors for wall and floor covering all add to a feeling of spaciousness. Good lighting can have the same effect.
Design and Appearance
In reviewing hundreds of floor plans, I have noticed that chiropractors who design their own space almost always use straight lines and 900 angles to complete their floor plans. Professional designers, on the other hand, take advantage of curved walls and other geometric shapes to create ambience. Examine your floor plan to determine if bending a few of those lines would be an improvement.
Lighting and Electrical
I like a bright, friendly atmosphere. Some doctors like a more relaxed, soothing atmosphere. Proper lighting is a major factor in creating the atmosphere you want. Fluorescent ceiling lights with a minimum of grid reflection create a brighter atmosphere. Incandescent lights and indirect lighting create a more soothing atmosphere. Three years ago, we moved into a new facility. I thought we had ordered bright, direct lighting, but the lamp deflectors created the feeling of indirect lighting and, in fact, cast shadows on the upper half of the walls. We are now in the final stages of building a larger office. In discussing the new lighting with our architect, I found that the lighting in our current building was not only the type I dislike, but it was also more expensive than the lighting needed to create a brighter atmosphere. Proper lighting helps create the proper atmosphere. Design it carefully.
Regardless of where you build, you will probably have business neighbors. While choosing your neighbors isn’t part of office design, it is certainly important in creating a pleasant working environment. By determining your office zoning, you can often determine your neighbors. “Office” zoning usually precludes retail sales, which, in turn, allows you to avoid certain businesses. We have also had clients who complained of odors from adjacent nail salons, sounds of animals from adjacent veterinary clinics, and unruly people from nearby bars and lounges. Pick your neighbors carefully.
If possible, your floor plans should provide for a private entrance for the doctors and staff. It creates a more professional atmosphere.
It seems there are always some unexpected expenses when moving to a new location. Your building may not look quite like the office model that you saw-the one with the expensive wall coverings and fancy window treatments. There will always be unexpected costs. Towel bars are needed in the restrooms. Signs are needed for all of the doors. Anticipate as many of the extras as possible to avoid last-minute surprises.
Occasionally, we will see a doctor pore over his floor plans and note every tiny discrepancy, but fail to notice the things that have been totally omitted from the building plans. One of our clients had to spend thousands of extra dollars because his building plans didn’t call for guttering and downspouts. Another found that there was no computer wiring, and a third found that the artist’s drawing showed green grass and trees, neither of which was included in the actual bid. Study your building plans to be sure that each item is included. Ask your builder for any specific items not shown on the building plan that will need to be provided as “extras” at your expense. In other words, look at the total building project, not just the floor plan.
Designing a new office is a difficult task, but the more time you spend studying blueprints and building plans before construction starts, the more prepared you will be to deal with the inevitable changes and decisions that will confront you during the building process. A proper building design and floor plan are an important portion of your business success.
Dr. Kats is owner/manager of Kats Management, a chiropractic consulting company in Linoln, Nebraska.
Copyright American Chiropractic Association Dec 2000
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