The importance of patient-centric design in the O&P clinic
he orthotic and prosthetic profession has often been described as clinical care at the intersection of science and art. O&P clinicians must balance the needs of individuals living with limb loss, limb difference, and other mobility challenges with respect to both form and function. The level of customized care offered by many O&P providers imposes unique requirements for the physical space a clinic needs to operate.
Patient-care rooms share walls with labs where prosthetic sockets are fabricated and components are assembled to create a truly custom device. Gait rooms with parallel bars and ramps create a safe space for patients to explore their new mobility. The ultimate delivery of a device is just one aspect of an expansive set of services provided in O&P facilities.
In this article, a diverse group of representatives from O&P practices across the country share their approaches to creating the ideal environment for the provision of O&P care. Each description offers a different take on the idea of a “dream facility,” but all share a common theme: The patient comes first.
4 O&P News | July 2018
PHOTOS: Bulow Orthotic and Prosthetic Solutions
Bulow Orthotic and Prosthetic Solutions
By Michelle Prichard, Director of Patient Services Bulow Orthotic and Prosthetic Solutions (OPS) recently moved into a new 6,000-square-foot O&P patient-care facility. We were fortunate that we had a clean slate and were able to custom-design the clinic exactly how we wanted it. There are six patient-care rooms, including one with 24-foot parallel bars, another with 20-foot parallel bars, and a third with 12-foot bars. There also is a room designed specifically for pediatric care. An additional private room was installed for patients who are here for a long day, such as a cast-to-test fitting day; this space was designed for comfort and includes a TV. The facility features a 1,500-square-foot lab, where we are able to complete all of our fabrication and day-today adjustments and repairs on site.
Bulow OPS—part of BCP Group, which has 30 clinics in eight states—is located in Nashville and surrounding cities. We have 19 employees, including four CPs, two COs, and one CPO.
All of our clinics are patient-centric, primarily in the attitude that our employees take toward our patients and our jobs. We have developed a great culture where we focus on treating patients like special guests on a day-to-day basis. But we also designed the facility to be comfortable for patients; for example, there are TVs in a couple of patient rooms and in the waiting room and a coffee bar in the waiting room. The facility also has multiple large windows in almost every room to let the sunshine in—which is my favorite feature of the space. Outside the building, there is a large, flat parking lot, which garners positive feedback from patient after patient. And finally, we have one wall decorated with words that our team voted on to describe our culture.
The top goals in the design of our facility included the following: 1. Patient comfort and convenience 2. Function: large patient rooms, complete lab/fabrication space
3. Décor to highlight the high-tech and interesting field of O&P.
We have been so pleased with the look and feel of this clinic that we have already designed a new satellite clinic in Murfreesboro, Tennessee, to match. I think we have found our new template.
O&P News | July 2018
By Brandon Sampson, CP, Owner; and Nicole Ver Kuilen, Athlete, Advocate, and Amputee
Brandon Sampson, CP
Nicole Ver Kuilen
Sampson’s Perspective The first Limb Lab location opened in October 2013, and the flagship facility was built in August 2014. The facility is located in a historic building downtown. We hired a local architect and gutted the entire building. All the wood used in the office is from my family farm, Six Mile Grove Woods, so the space has some extremely personal touches.
During the project, we discovered really cool architectural features of the building. What we really do, as prosthetists, is connect people to parts, and that function is mirrored in the physical appearance of our space, including the steel beams that are bolted to exposed cement columns throughout the facility.
We wanted to be inviting and welcoming, and to focus on transparency—not only in how we build limbs but also in how we communicate with our clients and the people passing by. In fact, we have people living with limb loss walk in all the time.
Our goal was to break down emotional barriers by removing physical barriers. We wanted to share what it means to recreate your life after limb loss by taking the stigma of the clinical visit
away and focusing on the collaboration between our patients and practitioners.
One example of this is in how we built both gait rooms to be visible from the main lobby, with frosted glass to preserve privacy. Individuals who are in the lobby often cheer on patients they glimpse walking in the gait room.
When we had the opportunity to design our dream facility, we were intentional about the design choices. We wanted it to feel like a design studio—a creative space—not only for the practitioners and technicians, but also for the clients.
Ver Kuilen’s Perspective Limb Lab! What a cool place. While in Minnesota, I stopped by Limb Lab for a tour. Several years ago, I remember walking in downtown Rochester, Minnesota, and seeing mannequins with prostheses in the window box of the building. I had never seen a mannequin that looked like me! I thought, “What is this place?”
When I turned the corner, I saw straight into the facility’s lab through the windows, where technicians were building legs and arms. It dawned on me that this was a prosthetic clinic. So cool! Most amputees never get the chance to see where the magic happens, and this clinic
PHOTOS: Limb Lab
6 O&P News | July 2018
PHOTOS: Limb Lab
was purposefully making that process open to the public. I thought that was truly visionary and a simple idea to put the patient first. I knew then that I had to someday meet the business owners.
Recently, I reached out to founders Brandon Sampson, CP, and Marty Frana to see if I could come in for a tour. They immediately responded and said they’d been following my Forrest Stump journey and they’d love to have me! And not only that, but I actually had met Brandon back in the day when I was a little girl and he was shadowing as a new prosthetist. It wasn’t until we reconnected that I remembered. How cool is that? They invited me in to share their vision for opening Limb Lab in 2004.
As we chatted, what stuck out to me most was their approach with every patient. They ask: What are the five most important things you want to be able to do with your prosthesis? Then they get to work to see how they will be able to build the appropriate device. Although this might sound simple, putting the patient’s goals first is critical; obviously, we all have different goals and mobility needs in our life. We should never assume that every person wants to do the same thing with his or her arms or legs.
When I was handed my first prosthesis as a kid, it wasn’t waterproof or meant for running—even though water and running activities were the two most important things in my life, and still
are to this day! My first leg had a foam covering to look like a leg. But to me, that wasn’t as important as being able to wade in the water with my friends or run without my foot breaking! Because the leg was made to look like a leg, we had to sacrifice functionality. And at the end of the day, that wasn’t what I wanted.
Brandon and Marty put the patient first, and it’s clear in the design of their lab. They were intentional about making it feel like a community you can enjoy being part of. The rooms are still private, but with translucent walls so you can see shadows of people walking, to promote mobility to all patients.
In addition, Limb Lab shared with me what they are doing to help create a better future for amputees. One example is how they are collecting data related to socket design.
One of the most difficult—and most important—parts of building a prosthesis is the socket. It doesn’t matter what fancy feet or technology you have; if the socket doesn’t fit, you aren’t going to wear it. It can take many appointments to get the right fit, which is why the process for making a prosthesis is so expensive. It’s time consuming. Sockets are made by hand. Each prosthetist wraps your leg in plaster and then hand molds what will eventually become your socket.
So, Brandon is doing something pretty cool to start taking the guesswork out of this process. He’s scanning every
step of that “by hand” process to create a duplicate 3-D model via technology invented by Standard Cyborg. Why? To gather data! By creating a scanned model during every step of the process, Brandon is capturing subtle changes between the residual limb, his plaster hand cast, and edits to the socket to gather valuable data that we can then aggregate and interpret to understand how a socket is made. He’s been collecting this information for every patient he works on. Think about the power of all that data!
I love what Brandon and Marty are doing, and I look forward to keeping in touch with them and seeing all the innovative work they come up with. They are truly helping to revolutionize the patient experience with prosthetics.
O&P News | July 2018
Scott Sabolich Prosthetics and Research
By Scott Sabolich, CP, Owner
Our Oklahoma City facility was built in 2004 and has 35 employees. Our Dallas facility was built in 2012 and has 10 employees.
Because we only work with prosthetic clients, our practitioners have really been able to hone their skills as prosthetists. We hope by focusing solely on prosthetics we can provide the most specialized prosthetic care experience. Often this results in us being a destination facility for clients who are difficult to fit.
Our family has been in the field of prosthetics in Oklahoma since
1947. In Oklahoma City, we built a 21,000-square-foot facility from the ground up, solely for prosthetic development and research. We did this with the patient in mind. This set-up helped enable every aspect of the facility to be built around the needs of the patient and to enable staff to provide care for the patient. We maintain strong relationships with referral sources as well as clients.
We have worked very diligently to develop and implement the patents that we hold in socket design. This has enabled us to work with clients that are difficult to fit and face challenges in being fit locally in their own communities. We also work closely with many of the rehab facilities in Oklahoma City and Dallas. We work closely with the University of Oklahoma Medical Center, Oklahoma and Dallas Departments of Veterans Affairs, and many more. The combination of history, construction, and relationships makes our facilities unique.
Our master hallway in Oklahoma City is more than 250 feet long. It is perfect for indoor running trials. I also love our nine-acre campus. It includes a lake and walking trails to test different slopes and surfaces for our clients. Some clients comment on the two-story lobby with integrated training stairs, which has an outlook tower over the campus. We also have a 9,000-square-foot lab on site that allows us to turn around and deliver prostheses at an extremely fast but controllable pace for our clients. These are a few favorite aspects of our patient-centric model.
In thinking about design, we knew our facility needed to be large enough to meet current needs, have space to grow or rework internally without building additions, and ultimately function as a hub for future satellite facilities.
Our Dallas facility, which is 12,000 square feet with a fully functioning lab, opened in 2012. We are in the process of evaluating other potential locations for our next satellite facility.
PHOTOS: Scott Sabolich Prosthetics and Research
8 O&P News | July 2018
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By Ben Clark, CPO, Owner
Eastside Orthotics and Prosthetics was started in September 1980. It has always been at the same location in East Portland, Oregon. We occupy approximately 2,000 square feet in a small strip mall next to a bar and a tax service company. It has not been updated besides some small improvements, like the bathroom, since 1980. I am the third owner of Eastside and just purchased the company in March 2018.
We are a small group of five on staff: two CPOs, two office administrators, and one lab manager/technician. We are growing fast and will need another patient-centric prosthetist soon.
PHOTO: Eastside O&P
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10 O&P News | July 2018
The main reason I wanted to be a part of the Eastside team was that the culture was already patient-centric. When I first arrived, this culture was not being represented well by the physical appearance of the office, but the communication and clinical experience was always patient first. This office uniquely works with a high volume of transfemoral amputees and has historically been an advocate for treating patients with the best technology for the individual. My goal is to extend the patient-centric culture further into every area of the patient experience.
I have asked many Eastside patients what they like most about our facility. The answer I keep hearing is that
Eastside feels like home; it is unassuming and comfortable; and they feel like their care is not rushed and that we are listening. For me, my favorite space in the facility is the gait room, which is very functional, with parallel bars that extend into a steep ramp and stairs.
We are currently remodeling the office to increase the patient-first feeling. I was unhappy when I first noticed the waiting room window that separates the front office from the patient is chest high and very small. We are opening up the wall so it will be wheelchair height and allow for easy communication with our team. We are restructuring our lab and moving the dangerous equipment and tools so there is more room for
patients to move around the office and not feel they are confined to patient rooms.
Right now, I am more concerned in fostering the support of the peerto-peer relationships that could be happening within this community of amputees. We are planning to start a women’s amputee group at the office in the next couple of months. The goal is to introduce these amazing and inspiring amputees to one another so they can share how they overcame everyday challenges and learn from each other. These opportunities can be as simple as an office barbecue that is open to the patients, to encourage the community to come together.