Larry R. Brooks, AIA, of Practice Flow Solutions, presented on the sure-to-intrigue topic, “How to Increase Volume in the Space You Have” at the American Society of Ophthalmic Administrators program during the 2025 annual meeting of the American Society of Cataract and Refractive Surgery.
“Maximizing output is about getting the flow right,” he explained. “Obstacles in the process create bottlenecks.” Components of flow, he said, include physician capacity, staffing model, communication systems, and space layout. To achieve correct flow, practices must address three things:
- Input – The rate at which patients should be scheduled; this depends on physician capacity.
- Throughput — The process of the patient visit, this encompasses everyone and everything that touches the patient during the visit. The number of staff and amount of space are determined by the practice’s input and output goal.
- Output — The number of patients seen. This number is maximized, he says, by maximizing the physician’s time in clinic. “This means to always have a ready patient for the doctor to see when they finish with the previous patient.”
When these three are in sync, he says, it is possible to see more patients in a calm, orderly environment without an expensive remodeling or acquisition of a larger space.
Indications that a practice has a “flow issues” include lines at the reception area, support staff not available when the doctor needs them, doctors who show up late, doctors with no patients to see and a confusing visit path. As is so often the case, the remedy starts with measuring.
“To correct and improve you must time the doctors and staff to see what they do and for how long,” Mr. Brooks said. Although practices often perform studies tracking the patient, he says a time motion study on the doctor will identify areas for improvement.
When timing the doctors to determine their capacity, he recommends looking for things that do not require their knowledge and skill, meaning “things you can engineer out of their day to give them more time for patients.”
Another part of input involves examining the appointment template. Mr. Brooks advised checking if the rate, type, and visits are in sync with the doctor’s output and patient demand.
“The first thing to correct in the weekly doctor schedule is the number of doctors in at once,” he said. “The range from session to session should be as small as it can to normalize the demand on the facility and staff.”
Addressing throughput, or how the space/staff/technology supports the doctor, he advises looking for things that do not support the goal of always having a ready patient for the doctor to see. For instance, are exam lanes or equipment sitting idle when patients are waiting?
Other flow solutions include eliminating unnecessary walking, as well as utilizing electronic communications, EHR and patient tracking systems.
Space, Mr. Brooks said, is the last thing to consider. “It should be a reaction to the operational needs of the doctors, patient volume and staffing need.” He offered tips for planning parking, waiting-room capacity and solutions for what to do if you’ve run out of space.
Non-patient care space such as offices and employee lounges should be out of the patient visit space. As with staff, you want to shorten walking. “A saying I like to use is, ‘If patients don’t need that room, they should not walk past it,’” he said.
“Improving the flow and efficiency of the doctor’s day can increase patient volume substantially, without reducing the amount of effective time the doctor spends with patients.”
Source: Ophthalmology Management