Designing the Subspecialty Office:  Key Design Questions

Given that most subspecialists went into medicine to perform surgery, their focus is (and should be) performing procedures and not necessarily on office design and flow. This raises a conundrum: how to build the most functional office space for the physician who is frequently elsewhere?

Several design elements should be considered prior to going to the expense of building out current space or occupying a new office. Here are the important questions to ask yourself when you are ready to make the leap.

What activities go on in the office versus the OR?  Is the space mainly for in-office consults and pre-op appointments, or is it a space for the physician to primarily use to dictate notes?  If the emphasis is on in-office consults, exam room size and placement are paramount. Conversely, if it is largely a place for you to “call home” and to use for dictation and paperwork, is there quiet space away from the hubbub where notes can be dictated with little risk of interruption?

Who will use the space and for what purpose(s)? Who will spend time there and what are their functions that will performed? If this space is primarily assigned to a surgery scheduler, a receptionist and a biller, how do they interact with one another? One should consider if and how their duties and responsibilities may require direct collaboration, which may call for co-located or line-of-sight workspaces. How much sound insulation from front desk staff does the surgery scheduler need if the majority of her work is done by phone? If the work is done largely by computer, does that change the office dynamic?

What areas in the office will be visible to patients? Office space communicates many things to patients just based on where the office is located, how it is decorated, how it is furnished and how much attention is given to detail. Old furniture and dusty fake plants may make your patients question your clinical competence or the likelihood of the surgeon staying up-to-date with clinical advances if your waiting room is stuck in a time warp from decades past.

Conversely, if the carpeting is plush, the furniture luxurious and the artwork expensive, your patients may begin to wonder if your services are costing them more than they feel is fair. It’s always important to keep in mind that patients usually have some out-of-pocket expenses based on their insurance plan deductible, copays, coinsurance or some aspects of your service that may not be reimbursed by their plan. The style, image, décor and furnishings in your office require some nuance. Ideally, you should strive to have clean, attractive and current furnishings of good quality without going overboard.

Take a trip through the front door of your office with a fresh set of eyes as though it was the first time you entered. What message and image is your office appearance communicating to your patients?  What message and image do you want to give to patients? If the answers are not the same, you have work to do.

How much does the location of your office matter? While you may not have considered this question, the location of a surgical practice’s office and proximity to the hospital can also speak volumes. In general, if the hospital in your area enjoys a good reputation, a suite on campus or close to it allows “institutional transference” which will allow you to bask in a bit of the hospital’s standing in the community simply by stating to patients, “We’re located on the St. Ignatius campus.”

The opposite is also true: if the hospital does not have a good reputation, any co-located practice will be painted with that brush as well. What is the reputation of your admitting facility? Is it time to move closer, farther away or even switch? Most physicians give little thought to this once they are established in a community, but frequently, a move to another hospital, while painful at first, can make or break a practice in the long run.

Technology in the office is often an underappreciated element that continues to gain importance in office design. How do you currently use technology? How would you plan to integrate it into your new space? Most exam rooms these days need to be fully wired for computer and other technology support. Should you decide to use laptops, tablets or some other mobile device, you can allocate more space in an exam room for other purposes.

The use of an articulating arm has gained popularity as a more space-efficient way to integrate a PC into an exam room, and articulating arms can also be used successfully in nursing or dictating stations should you add those to your design. Consider below desktop screens with glass panels for minimal desktop clutter and maximum security of patient information in very public areas.

Whether it is an intentional design consideration, like “feng shui” or just an unplanned “feel” that emerges, there is always a subliminal, emotional aspect to any space. We don’t often stop to consider it, but it is palpable in most places.

How do patients and visitors remark about how your space feels? A space can give off a temperature that has nothing to do with the thermostat. In general, would you say your office space is cozy and “warm” or modern and “cool”?

It is important to consider the feel of the space, which includes such important elements as natural light, live plants, artwork and water features. Consider all five senses, not just sight. What do you want your patients to hear when they come in? Soothing music (think spa) or a constantly ringing telephone and the TV in the corner blaring away? What do you want your patients to smell when they come into the office? Pungent, medicinal smells? Dusty, musty smells? Fresh coffee, or perhaps nothing at all? What textures can you introduce that will instill the feeling you want?

In general, many healthcare professionals can agree on the elements of the office and their desire to promote a sense of calm and healing.  Does your existing space do this? If so, how? If not, what will you change?

For more information or guidance on office design and flow, contact one of our consultants at


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