June 11, 2019

Planning Ambulatory Centers for Highest and Best Use – Part 2


As highlighted in part 1 of this blog, rigorous analyses are performed by the Haskell operations team to inform the right architectural elements to incorporate when designing a new ambulatory center space. While in some cases these analyses mean adding a specific type of space, more often it means eliminating certain types of spaces altogether and focusing on implementing efficient processes instead. Let’s explore a few examples, from access, treatment, and post care.


One of our recent clients utilized a registration process that required patients to check in at both a main registration desk and then again at their specialist clinic during each visit to a facility. This process has distinct disadvantages:

  • Each visit required an additional 5-10 minutes of registration for tasks that may be duplicative.
  • Square footage at each specialty was used for registration rather than for additional treatment space.
  • Most patients viewed the extra steps as cumbersome, tedious, and confusing.

Haskell proposed that the clinic or physician practice preregister as many patients as possible over the phone, by mail, or via a patient electronic portal. Then during each visit, a patient would proceed directly to their doctor’s office and simply validate information already collected. As a result, more space could be dedicated to treatment functions and additional patients could be accommodated. In this case, specific space was eliminated in favor of another kind of space.

If a centralized registration space is needed due to the type of care provided, Haskell has also tested numerous registration configurations to see which resulted in the shortest patient wait times. Using computer simulation modeling to test multiple scenarios, we could test which worked without having to actually implement them.

Additionally, we studied different numbers of registrars for a medical office building client, including the number of registrars dedicated to each specialty, whether specialties shared registration staff, and combinations thereof. For this client our testing affirmed that the most successful configuration involved one centralized registration area at the main entrance, with all registrars capable of registering any patient regardless of specialty.

Physician Clinics

It will come as no surprise that extending hours of operation enables a clinic to treat more patients. To best manage expected volumes, studying use patterns of the demographic being served can inform what the right hours of operation may be to meet patient needs. For example, an urgent care may need to be open well into evening hours to allow patients or mothers with children to arrive after work. Primary care offices may also offer evening hours for either primary or urgent care.

Using patient event data can also help target whether hours are appropriate. It’s possible that a health system’s nearby emergency department experiences an uptick in non-urgent volume, or local physician practices receive a surge in sick calls in the hour or two following an urgent care’s or clinic’s closing.

Operational patterns are important to study. Often patients find it can be challenging to get an appointment with their physician, sometimes waiting months for a new patient visit, or not finding open time for a sick visit at the time it’s needed. Meanwhile, many patients fail to show up; nationally, no-show rates are between 15% and 30%. While an organization needs to work proactively to reduce its no-show rate, it may also need to provide additional flexible capacity to accommodate quick-turnaround visits.

Group practices may offer first-come, first-served open sick visit time for a few hours in the morning and afternoon to manage some patients’ need to be expedited, with either their primary care physician or another available doctor or midlevel provider within that practice, and not necessarily at the “home” location. Planning occupancy targets to accommodate this practice model is important for not under-sizing a future building. Detailed data review will be necessary to be as accurate as possible.


Ambulatory centers may offer screening and diagnostic imaging modalities, such as CT, X-ray, ultrasound, or MRI. Although use of these modalities can vary by patient type, many support spaces could be shared to reduce space allocation and improve workflow. Examples include registration areas, waiting spaces, and dressing areas. Providing separate changing and waiting areas for each modality could result in uneven utilization. An analogy may be the queue waiting for a series of cashiers at a fast food joint or grocery store. Think of the times you may find yourself in a slow checkout lane that holds up not just you but everyone behind you (“I always choose the wrong line!”); some fast food companies provide one queue to wait for multiple check-out stations and improve availability for everyone waiting. The shared dressing room areas mitigate similar bottlenecks, where one area may be overutilized and another underutilized.

Improving Patient Experience Improves Patient Satisfaction

For many providers, improving the patient experience represents a significant opportunity in saving space and improving satisfaction. In working with providers throughout the country, Haskell staff have helped clients alleviate a wide range of difficult challenges affecting the patient experience by completing detailed and comprehensive data analysis and implementing operational process improvements to achieve reduced wait times and efficient office visits.

Haskell delivers $2± billion annually in Architecture, Engineering, Construction (AEC) and Consulting solutions to assure certainty of outcome for complex capital projects worldwide. Haskell is a global, fully integrated, single-source design-build and EPC firm with over 2,200 highly specialized, in-house design, construction and administrative professionals across industrial and commercial markets. With 20+ office locations around the globe, Haskell is a trusted partner for global and emerging clients.

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