Office Efficiency
From the Ground UP
How one O.D. built a state-of-the-art practice with an eye on efficiency -- and in doing so, cleaned up a part of town.
By Karen Rodemich, Senior Associate Editor

What does a state-of-the-art optometric practice look like? In the following pages, you'll learn how efficiency expert Walter S. Ramsey, O.D., F.A.A.O., turned a good old practice into a great new practice by incorporating new ways to see more patients and better ways to ensure patient satisfaction.

No room to grow

Situated on the seventh floor of a high-rise building with 4,200 square feet of space, Dr. Ramsey's old location offered no room for growth. Two other disadvantages to his old office were that patients had to pay for parking and tolerate the inconvenience of going through the building to get to his office.

Needless to say, Dr. Ramsey had many factors to consider when he decided he needed to upgrade his practice. Because he couldn't expand his existing office, he knew he had to relocate.

He found an available corner lot right down the street, and was given a tip that although the area looked seedy at the time, the city was in the process of cleaning it up. The lot had good visibility and traffic flow. As an added boost, construction had just started on a $105 million art center nearby with a planetarium and museum that an estimated 240,000 people would visit every year.

Interestingly, while Dr. Ramsey was located in the bank building, he says his practice was becoming heavily medically oriented. He was writing anywhere from 150 to 175 medical prescriptions per month. His goal in moving to the street level was to get back toward optometry and optical sales. It may seem as though this objective goes against the grain, but he wanted to gain back some of the traditional aspects of optometry.

Because Dr. Ramsey didn't want to move into a business park or too far from his old practice, he looked past the broken whiskey bottles and sleeping alcoholics littering the lot and bought the property.

New office philosophy

Four years and $1.5 million later, Dr. Ramsey's dream finally came true. He explains his overall philosophy for the new, 7,800-square-foot-location: "The business was changing and people wanted convenience," he says. "With managed care and insurance companies getting more into the business, I figured that we had to devote more space specifically for management purposes."

Dr. Ramsey says that offices of the future that want to manage insurance and related issues will need a space to do it. Another aspect he highlights is a meeting place for staff. "It wasn't good enough anymore to pull chairs together in the optical -- a formal meeting place tends to lend more importance to it."

Dr. Ramsey mentioned another detail he wanted to include in his new office. "I also wanted a surgical room in case laser-
assisted in situ keratomileusis (LASIK) moves that way for a mobile laser," he says.

Dr. Ramsey says he went around at meetings and asked other O.D.s what features they wished they had in their practice or that they'd include if they were building a new one. He gleaned many ideas for his own practice this way -- in fact, that's what prompted him to include the conference room.

Help from the experts

"I knew what I wanted, but you can't do it yourself," explains Dr. Ramsey. So he sought the help of designer Larry Funston of Oadbe Associates Ltd. in Ontario, Canada, and Integrated Construction Services, Inc. (ICS) in West Virginia. Mr. Funston helped Dr. Ramsey with the floor plan, traffic flow and various other areas, while ICS provided architectural and engineering services. ICS designed a computerized, animated walk-through and provided 3-D images of different views of the building. ICS also suggested placing skylights in the office and helped Dr. Ramsey custom design the conference room table.

One of the skylights is situated above the technicians' desk in the exam area. The reasoning behind this feature stems from the fact that natural light improves peoples' moods (in this case, both patients and staff).

Exam room reasoning

Dr. Ramsey's exam room area is also unique in that it's set up in a circular, pod design (see the office floor plan on pg. 52 for a better idea of the layout of the exam room and the rest of the office). His rationale for the pod design revolves around the idea of convenience and efficiency.

Currently, Dr. Ramsey is using four similarly equipped exam rooms, compared to the five he ran in his old location. He attributes this cutback to the increased efficiency afforded by the pod-shaped exam area. All four rooms are basic refracting lanes that feature a slit lamp, a phoropter and a sink, among other instruments.

He says, "I wanted them in a pod formation so they'd be convenient and so the medical technicians could see what was going on." He explains that the pod shape saves him time going from one room to the next. It's also beneficial because patients come down one hallway from pre-data to the exam rooms and then through the optical.

Dr. Ramsey performs an average of 3,800 refractions a year. He achieves this high number by scheduling patients every 10 minutes. This time span is easily met with his new exam room layout.

Aside from the four exam rooms he's currently using, Dr. Ramsey has 2 more, which he's reserving for when he finds the right future associate, who will occupy the private office (which also boasts a skylight) across from those rooms.

Being the efficiency expert that he is, Dr. Ramsey has incorporated other time-saving techniques into his practice. The following areas are examples of steps he took to increase flow in the office.

• "One of the things we do is check every patient's insurance the day before his appointment," he explains. Dr. Ramsey has one full-time employee who handles this, as well as the telemarketing aspect of the practice, which we'll talk about next.
  This staffer also sends history forms to patients through the mail so the patient's chart is prepared and his history is completed when he walks in the door. This arrangement speeds up the diagnosis and work-up of the patient, says Dr. Ramsey.

• To increase efficiency even further in the exam area, Dr. Ramsey even has color-coded prescription pads, which list the specific drugs in a certain category that he can check off for each individual patient. The colored prescription pads (including red for eyeglasses, green for allergy and white for standard prescriptions) are in the exam room.
  For example, if he's in an exam room with a patient who has allergies, he'll just grab the green prescription pad, check off the drug he chooses to best fit the needs of this patient, and hand it to him to take to the pharmacy.

• Dr. Ramsey also has a drug database that runs all patients' drug profiles and calls up any potential interactions a medicine he prescribes for them may have with one prescribed from their cardiologist, for example.

Features for patient satisfaction

Other interesting features include a large, two-way window next to each exam room door. With these in place, patients can see outside the room without feeling claustrophobic, but they don't feel as though they're on stage either because they can't be clearly seen from outside.

Each exam room also contains a television for patients to watch while waiting for Dr. Ramsey. He uses a remote control to switch off the television when he enters the room.

Dr. Ramsey's practice isn't just efficient for his benefit, but also for his patients. He says that the technicians in the exam area are directly linked to the Internet. "Of the lenses we dispense, 80% to 90% are shipped directly to the patient via Internet ordering," he says. This way, patients don't have to return to the office days or weeks later to pick up their lenses.

The new optical

"I wanted an optical that was truly different than any other in the United States," says Dr. Ramsey. He wanted the feel of a very fine jewelry store. And achieving that wasn't easy, either. "Everything I saw from all of the display suppliers looked the same. They couldn't offer me anything unique," he explains. So Mr. Funston helped him design his own display, which was built in Canada and assembled in Charleston by ICS.

Halogen lights create a glimmering atmosphere when they reflect off the frames on the glass shelves, which are suspended by aircraft cables. "This allows us to use point-of-sale items that manufacturers provide, and they help," says Dr. Ramsey.

Regarding the layout of the optical, Dr. Ramsey says, "I wanted the optical and the lab next to each other. I wanted people to see the optical from the street," he says. But people do more than just look at his optical from the street. Patients from other practices come to his office to get their frames, and this is obviously an area that Dr. Ramsey plans to keep growing.

"We increased our frame inventory from 800 in the old office to about 2,000 in this new location," he maintains. "We have exclusive lines of frames not available to our competitors, so they're not price-sensitive."

Dr. Ramsey planned for the contact lens insertion and removal room to be near the optical because he wants patients to buy sunglasses too. He explains, "Studies show that 90% to 95% of contact lens patients will purchase their sunglasses withing the first day after they get their contact lenses." So the contact lens room is next to the sunglasses to make the double sale.

Dr. Ramsey says that he's installing computers in the optical area with a program that lets patients view their own faces in different frames. "This gives us a high-tech look and separates us from the competition," he says.

Regardless of the reason why the patient is in the office, every one of them walks through the optical on the way out. Dr. Ramsey says that many times, a patient will stop and buy a pair of frames even if her prescription hasn't changed.

Telemarketing and administration

As mentioned earlier, Dr. Ramsey has one full-time staffer who takes care of both insurance verification and telemarketing, although he says they have enough work to have someone full time doing the telemarketing. He'll consider hiring a full-timer for this position in the future. According to Dr. Ramsey, the telemarketer currently only calls existing patients, but she doesn't only call those who have medical conditions -- she makes calls to all patients. "All charts are color-coded with stickers," says Dr. Ramsey. The colors help the telemarketer easily identify a patient's diagnosis so she knows why she's calling a patient to schedule a visit. Dr. Ramsey explains that the telemarketer is trained beyond simple patient recall skills. She can discuss charts and diagnoses with patients, and she's involved with special promotions.

For example, Dr. Ramsey will soon be running an ad in the local newspaper asking people to call the telemarketer for more information about the practice.

The telemarketer works in a corporate workstation area near the conference room and the bookkeeper and office manager's shared office. There are four cubes here (one for Internet ordering, one for telemarketing, one for insurance and one extra, which will probably go to another telemarketer in the future).

Regarding administrative personnel, the bookkeeper and the office manager, as mentioned, share an office. Their office has a big window overlooking the main waiting room and entrance to foster visual communication between these two key staffers and those working at the front desk. They can also keep an eye on things out in the foyer and main waiting area. Dr. Ramsey's optical manager even has an office of her own.

Other amenities

The following is a short list of other amenities featured in Dr. Ramsey's new office location.

• Separate staff parking. In addition to the 30 spaces of patient parking, Dr. Ramsey's office has a separate lot for his staff to park. He's even considering individualized name plates for the parking spots in the future because he thinks that would add to staff morale.

• Staff entrance. Dr. Ramsey's staff members also have their own entrance to the office with a tilted floor to meet disability guidelines.

• Kitchenette. Dr. Ramsey and his staff sit down to lunch every day in a cozy little kitchenette where the rule is to avoid business conversation.

• Conference room. "It's amazing how much we use this room," says Dr. Ramsey. "We use it a lot for three- and four-people meetings and it's so much more intimate." The conference room features pop-up boards with Internet access, telephones and electricity so you can do a PowerPoint presentation right from the Internet onto the screen near the door.
  "The room will have many uses even when I'm not here," Dr. Ramsey points out. "Pharmaceutical companies will present lectures to the staff, as will I, continuing education for the optical staff or the medical assistants will also take place here, as will sales training."

• Waiting rooms. In the first of the office's three waiting areas, patients are greeted when they enter the office. It's set to the left side of the entrance so patients are away from the action.
  Yet another waiting area is located in the exam area. "This," says Dr. Ramsey, "serves two purposes. If the technicians are ahead of me, then the overflow can wait right here. We also put patients who are dilating back here and sometimes family members accompany other people, so they wait here as well."
  Patients find another waiting room after they leave the exam area, before the optical, where they'll wait for an optician to help them with frame selection.

• Control room. In the middle of Dr. Ramsey's office is a control room, which houses the security system, the main telephone system and and the main computer server that controls the entire office. "We also keep personnel files and records here," says Dr. Ramsey. He adds that only he and the office manager have a key to access that room.

• Soundproofing. The walls between the examination rooms and in the conference room and the private offices are all soundproofed, at Dr. Ramsey's request.

• Symbolic sign. Although Dr. Ramsey's office sign isn't exactly an amenity, it does deserve mention because, as with everything else, he put a lot of thought behind even the material used.
  He says, "I chose granite because it symbolizes permanence and stability. I had it imported from South Africa to match the brick of the building."

Future plans

Dr. Ramsey plans to have private frame showings in the evenings for patients who appreciate fine eyewear and who want multiple pairs of eyeglasses. His office keeps a list of patients who fall into this category and they will mail them invitations when new frames lines debut.

As his office's first year anniversary approaches, Dr. Ramsey plans to put a time capsule in the building, including pictures and other memorabilia -- including this article. He'll have a ceremony inviting patients to commemorate the occasion.

Definitely worth the effort

Although Dr. Ramsey kids that the project almost killed him, he says it's worth everything he went through. He now offers his patients many more services than before, and it's paying off. Dr. Ramsey hasn't been in his new location for a year quite yet, but his current patient base is around 15,000 to 20,000, and he says this is growing. Overall, he expects a 15% growth of total business for the new office.

So despite the fact that Dr. Ramsey didn't get the rooftop garden he was hoping for, he did end up with an efficient, state-of-the-art practice -- and he certainly can't complain about that. And that's exactly what you should expect when you put enough time and effort forth in planning and coordinating something you really want.