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Medical makeover

Amanda Bryan
Med J Aust
Published online: 15 October 2012

Should you renovate your consulting rooms? Here are four key questions to ask before you take the plunge

There are plenty of good reasons to spruce up your place of work, but unless you practise in a top-shelf specialist clinic or holistic healing centre, you probably see these as optional extras.

For the average practice, though, renovation is not about cascading fountains, feature walls or colour swatches.

Natural light, air quality and good design are the key ingredients, say experts, and they can help you boost turnover, add value to the business and attract and retain staff.

Practices with safe, well designed work environments can also reduce medical errors and staff stress, according to Rebirth of a clinic, a design guide created by the Royal Australian College of General Practitioners (RACGP) and RMIT University.

“When we talk about good design, doctors tend to interpret this as a luxury, but it can have big impact on the quality of a practice”, says the guide’s coauthor, Dr Graham Crist.

“People can’t perform optimally in a poorly designed space”, he says. “And given people are the biggest cost in most practices, if we can affect the quality of their environment, this will also affect the bottom line.”

Even so, most practitioners are resistant to the idea that renovation can bring these benefits, says Dr Crist, who is the founding director of architect firm Antarctica and program director, Architecture and Design, RMIT University.

As with any big investment, you first need to evaluate the business case. Here are four key questions to ask before you dive in.

Is it feasible?

Given that the cost of a typical practice renovation will start at around $100,000 and can run into the millions, it’s important to evaluate the feasibility of a renovation project before you sign on the dotted line.

Dr Crist says the cost can be estimated per square metre, and there are large numbers of tools to help estimate this.

This is where an expert can help, he says. He suggests you look for an architect with experience in dealing with medical practices (the RACGP has a list on its website at http://www.racgp.org.au/architects).

Architects can assess the needs of your clinic — the functional needs, patient flows, safety requirements and acoustics — against your budget constraints.

“People are fearful of the design process because it’s unfamiliar”, Dr Crist says. “They are trying to design a building and they don’t know what it’s going to look like yet.”

An architect’s assessment can remove some of the unknowns for doctors. It will include briefing, budgeting and early concept designs. It also allows you to assess your working relationship with the architect.

“A good architect is a good listener and the conversation should be ongoing right throughout the renovation”, he says.

Are you ready?

Are there signs that you are ready to renovate? An obvious sign is when a practice outgrows its physical premises.

According to Rebirth of a clinic, it also helps if you can pinpoint the life stage of your practice. Is it a child (with lots of growing to do), an adolescent (with growing pains), a newlywed (with a recent joining together), a stable mature person in the midst of working life, or an older person looking forward to retirement?

Ian Watts, coauthor of Rebirth of a clinic and an adviser with Antarctica, says it also helps if practices understand the clinical model they are moving towards.

For instance, they may be evolving into a nurse-led, family-focused or multidisciplinary clinic, or they might want to focus more on preventive health, chronic disease management or procedural work.

Knowing this provides some answers to determining the timing, scale and requirements of your renovation, says Mr Watts, who is also a former RACGP national manager.

“Because it’s a 510-year expense, you have to plan where you are going to be in the future, not where you are right now”, he says.

DIY or outsource?

Managing your own renovation project without an architect may be cheaper, but there are other things to consider.

General practitioner Dr Vinh Tran, who has renovated a number of practices (see box), says few doctors would know enough about council requirements, plans and building codes to manage their own projects.

“Most doctors would make more money as a doctor to cover these costs”, he says. “I would not recommend DIY until you have done a few practices.”

If you’re looking for an upmarket result, he suggests you go with a full-service architecture firm. “You just tell them what you want and your vision and give them keys to the building and they take care of the rest”, Dr Tran says.

A middle-ground option is to work with a draftsman to draw up the plans, work with a town planner to get your development approval and then work with a shopfitter who would coordinate tradespeople. Dr Tran says this model is best suited to expanding a practice.

Monica Benavides, director of Innova Design, an interior design company that specialises in the design and construction of medical practice renovations, says renovating a medical practice is highly specialised.

“We’ve seen a lot of clients who thought they could manage a renovation project themselves and they spent a lot of their own time and paid more”, she says.

Should you stay or should you go?

One of the obstacles to renovating your practice is disruption to business. Practices usually face a choice: close down during the building work, move to a new location or continue to operate amid the building work.

Ms Benavides recommends that doctors try to keep the practice running. “You don’t want your patients to go next door”, she says. “This provides a window of opportunity for them to get to know a different doctor.”

She says that to minimise disruption, you can usually leave the noisy work until after hours and make sure areas being upgraded are isolated from the rest of practice.

Dr Crist says that staging the renovation — with one block of rooms kept open while the other block is renovated — can ease disruption.

If you’re able to keep the clinic running during the renovation, there will be less impact on business if the project doesn’t finish on time, he says. If you have closed the business or have moved to another location, a late finish could be catastrophic.

Tips for good design

Mr Ian Watts, of architecture firm Antarctica, has these design tips for medical practices:

  • Think about workflow when planning your design. For instance, don’t locate your treatment room on the other side of the waiting area to your sterilisation room as this could create a safety hazard.
  • Ensure there is plenty of natural light. International literature shows strong links between natural light and staff retention.
  • Allow for a large foyer. A noisy reception desk can interfere with the staff’s concentration and increase the likelihood of error.
  • Be generous with space in your consulting rooms or you may increase the risk of falls, trips, cuts and twisting injuries.
  • Allow plenty of space for the nurses’ room.

Six degrees of renovation

Dr Vinh Tran knows a little about renovating a practice. He co-owns six practices and has been renovating all of them.

He has managed some projects and outsourced others. Some involved a move to a new location; others expanded the existing building. Some projects were large, while others were small.

The renovations at his practice in the Brisbane suburb of Inala, for example, cost $1 million, but the renovation at the clinic in Lakemba, Sydney, is cosmetic.

Expansion has been the main reason for most of the projects, especially those in growing outer-metropolitan areas.

“I know very few [doctors] who renovate to make the practice look better”, Dr Tran says. “Most have growing issues.”

He says the renovations have also enabled them to create more room for practice nurses, and to co-locate pharmacies and pathologists.

“Our strategy has been to start small with low costs, and a year later we put a second doctor in the same location. Once the patients are coming and we have enough cash flow, we look to build a bigger site with six to seven rooms.”

The patients also view the expansion as a positive, he says. “They love it — it’s brand new and bigger, it’s got aircon, and access is easier for people with prams and walkers.”

Dr Tran has opted to keep all his practices open during renovations except for the Lakemba practice, which will close for three weeks next month. The practice has informed patients by mail and has provided contact details of an alternative practice.

Dr Tran says the most unexpected challenge comes in the form of the Building Code of Australia standards, which include specific requirements around fire protection and catering to patients with disabilities. These requirements significantly increase your costs, he says.

  • Amanda Bryan


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