Ana Zulmira Diniz Badin
The idea of organizing a clinic is certainly fascinating and captivating. However, not only the organizational aspect must be analyzed but the whole context, which includes motivation and favorable and unfavorable conditions.
The size of the physical structure and the team, what to offer, the organizational structure, maintenance and continuity at long term must also be taken into consideration.
The doctor himself/herself is not an entrepreneur and at the moment the clinic has been set up the focus changes completely, with more of the doctor's time being absorbed by administrative matters.
The very first topic to be analyzed is the motivation which leads to this investment (Table 27.1). There are several reasons, such as the need to concentrate work with all its surgical volume in only one place, thus providing time-saving since it will not be necessary to move from hospital to hospital in different parts of the city. Beyond that, the ideal environment for the plastic surgery and its associated services provides a differential in attending, with refinement and details.
Furthermore, the environment where only plastic surgeries are performed avoids both contamination and the possibility of hospital infection. The reduction of hospital costs owing to its smaller structure will also provide a greater viability of surgeries, increasing the work potential.
The idea of a clinic as a highly profitable business involves a concept of association among professionals with larger structures and this is not what we want to take into consideration.
Concentrating all the work in just one place Associated services, differentiated attending Minor risk concerning contamination and hospital infection Reduction in cost Profit
When taking over the organization of your own clinic, you can idealize it according to your concept and professional experience, making it functional, practical, fitting it to your specific needs taking into consideration the way the patient would like to be treated. In other words, personalizing the service of the clinic to our way of being.
Surgeries become more viable with the reduction of costs. There are more vacancies for admitting patients as well as free schedules in the operating rooms and that not only tranquilizes but also makes the doctor's job much easier. Concerning cases of infection, they will present much less danger than those arising in hospital.
The responsibility one takes over on setting up a clinic is not evident at first. It is extremely important that this aspect be analyzed as not only the medical responsibility but also the surgeon's responsibility is at stake. The responsibility is an entity which is connected to the medical responsibility.
The preoccupation with the patient goes beyond the surgical act, involving each organizational detail of the entity, such as employees, equipment, materials, and security. In the case of juridical actions both the doctor and the entity have to take responsibility for them.
The financial aspect has to be taken into consideration concerning the building of a clinic since there is the planning of the physical construction, the purchase of equipment and decoration. Not less important is the maintenance of all this structure, employees, and replacement of equipment and materials on an uninterrupted basis.
If the institution is a private clinic it can be named after the professional; however, a fantasy name disentails the entity from the professional mainly if there are more doctors or other professionals. The designation of the name of the clinic must create a connection between the beauty and the professionalism it intends to offer. Strong names with an aesthetic connotation highlight and give an impact to the brand, such as Nefertiti and Athena, among others.
The physical structure must involve all the sectors of the clinic: the arranging of the appointments, the surgical act itself, the immediate recovery, rooms, and supporting services and associated services.
A space for appointments can be used by one or more professionals of the same specialty or other correlated specialties. It must offer a reception as well as waiting room(s), taking into consideration a proper place for the surgical returns, especially the ones which involve the face so that the patients operated on will not feel embarrassed, neither will the new patients.
According to the volume of work, several attending rooms are advisable for they facilitate the flux of the postsurgical returns, diminishing the waiting time and the patient will receive basic attention from the nurse.
The room for the first appointment can be larger and better decorated, while the return rooms can be more functional. The circulation among the rooms must be restricted to the doctors and their team (Fig. 27.1).
The reception must be exclusive to the hospitable area, not involving the offices. It must have a healthy and clean aspect and it can be formed by several ambient facilities, such as gardens, a television area and some kind of service, such as coffee and water, in order to ease the waiting time (Fig. 27.2).
A special room (a VIP room) is important for special people or for face surgeries, so the patient can have a more private experience
The number of rooms must be in proportion to the intended surgical flux and the number of professionals involved. The physical structure of the number of the rooms must be super-dimensioned so that it will not become precociously insufficient. Plastic surgery has the particularity of presenting the time of finishing as a moment of refinement. That is why it takes so long.
Since the hygiene and cleaning of the room between surgeries as well as the anesthesia procedure take time, more rooms enable us to proceed faster to the following surgeries.
As the surgeon spends a great deal of his/her time on surgical procedures both his/her mental and emotional quality of life must be taken into consideration. The rooms must be large, with windows which permit interaction with nature, preserving his/her emotional balance and keeping him/her in contact with the environment: sun, rain, sky, greenery, etc. Subtle details which preserve sensibility and balance are so very important and necessary in our specialty (Fig. 27.3).
Fig. 27.3. Operating room keeping the surgeon in contact with the environment
The Doctor's Room
Just like the operating room, the doctor's room must be cozy. It does not have to be large, but should be pleasant. This room provides the surgeon with a place to rest and recompose himself/herself (Fig. 27.4).
The number of beds must also be in proportion to the number of rooms and the surgical flux. They also have to be super-dimensioned. They must have equipment to control the recovery of the patient after anesthesia (Fig. 27.5).
Structures correlated to the operating rooms, such as the sterilization area, pharmacy, storehouse and the area for the cleaning material, must be structured on the basis of a practical and functional flux.
(Individual Apartments and Day Apartments)
Apartments or suites must be designed with refinement as they are the places where the patient and his/ her family will be most of the time. The day apartments are designed for surgeries that do not demand hospitalization, such as blepharoplasty, minor lipo-suctions, rhinoplasties, mammaplasty and retouch
Fig. 27.7. Nurse's place ing. They are furnished with more beds for observing the patient after he/she leaves the recovering area of the operating room. In this area a snack can be served so that the anesthesiological criterion can be analyzed in order to release the patient at the end of the day.
This kind of accommodation where the patient stays for a very short period reduces the costs of the procedure and provides us with security on releasing the patient who is recovering perfectly. Not to mention the fast turnover for the clinic (Fig 27.6).
The nurse's place can be only one, that is, they can attend both the day apartments as well as the other apartments (Fig. 27.7).
Support services can be used depending on the cost-benefit to the clinic. They are kitchen, laundry, blood bank and clinical laboratory. Rooms must be allocated for storage, distribution and general maintenance.
In the organizational structure all the functional and administrative hierarchy can be found and differs according to the country (Fig. 27.8).
Associated Services 27.8.1
Other services complement the structure of a plastic surgery clinic. One of the most frequently used is the service of aesthetic physiotherapy, which involves the postsurgical lymphatic drainage, of maintenance and facial aesthetics.
Specialized professionals and in agreement with medical indications execute a specific complementary job clarifying doubts and anxieties of patients. During the preoperative period, services such as relaxing, massage and Reiki can be used (Fig. 27.9).
Ambulatory lasers complement aesthetics treatments such as removal of spots, hair, tattoos, vascular lesions and facial rejuvenation.
Our clinic, The Institute of Laser Treatment - Intralaser - uses lasers for all these treatments, assembling professional dermatologists, plastic surgeons, vascular surgeons and pediatricians. In the case of high-tech equipment, the group of professionals collaborate on the costs of purchasing and maintaining and optimizing the usage of gadgets, avoiding under-use (Fig. 27.10).
The spa permits both pre- and postoperative use, with the uses being most different : day spa, with internment or even health insurance with mediator spas.
When the structure is functioning properly, marketing has an extremely important role for the dream to come true. Several different methods can be applied; however, the most important one is client satisfaction, which nowadays makes all the difference. Businesses multiply, technology develops, health professionals specialize more and more and the client chooses the one who makes the best offer and has the best conditions.
Advertising can be used; however, it must be ethical, subtle and not abusive. A Web site on the Internet as an important tool and it must be used in order to market the clinic, its services and professionals.
Particularly in our clinic we use folders which show the different procedures and a 3 monthly magazine which divulges new techniques and technologies, surgical procedures, dermatological and other correlated specialties. It always presents these in an informative, educational manner, without any sensationalism, taking into consideration its own name Ethics and Aesthetics.
The magazine presents information that is easy and agreeable reading, and it is of great help since the patient arrives at our offices aware of the basic notions and their correct procedures, without the distortions of the media in general (Fig. 27.11).
The Athena Clinic offers different facilities, such as office services, clinic, aesthetic physiotherapy and a laser center (Intralaser), in a structure today called Centro Médico Athena (Medical Center Athena). (Fig. 27.12).
It offers all kinds of plastic surgeries, including microsurgery, but facial rejuvenation minimally invasive surgery is the "most important one" performed by the clinic.
With the description of the videoendoscopic technique in 2001 in Aesthetic Plastic Surgery with temporal access to the medial and inferior face, associated with frontal endoscopy and/or a laser, facial rejuvenation has been the most requested surgery in our clinic (Figs 27.13, 27.14).
Harmonizing Facial Mosaic Stones
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