Facilities and Equipment Management for Rehabilitation Businesses

Original Editor - Wanda van Niekerk

Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction

Delivering high-quality rehabilitation care depends on many different elements. Owners of rehabilitation businesses must carefully consider how they design and equip their clinic to ensure effective provision of rehabilitation services. These decisions include equipment procurement, thoughtful design of the clinic space and appropriate infection prevention and control measures.

Equipment Procurement

Rehabilitation practices require various types of equipment for different functions, from administrative tasks (e.g. computers, printers, phones, etc.) to rehabilitation services (e.g. weights, resistance bands, balance boards, exercise balls, treadmills, stationary bikes, etc).

As a business owner, you need to make informed decisions when purchasing equipment, as this directly impacts the financial health of your business. There is always financial risk when starting a business or taking over an existing business, and insufficient research may lead to unnecessary expenses. In fact, many owners of private clinics admit to making substantial investments in major equipment despite feeling uncertain about its potential benefits.

A systematic approach to equipment procurement will help business owners make positive investment decisions. Some factors to consider when purchasing equipment for your business include the purpose and function of the equipment, its quality and durability, safety features, space requirements, initial and maintenance costs, expected lifespan, clinical effectiveness, ease of use, training requirements and its compatibility with existing equipment. Ideally, equipment procurement will be aligned with the specific needs of the clinic. Clinician input is beneficial when making equipment decisions. It helps businesses avoid buying unnecessary, underutilised equipment. It also ensures that the purchased equipment considers and supports therapeutic interventions and patient needs, which may improve patient outcomes and manage costs and expenses.

Equipment Utilisation and Serviceability

Underutilising purchased equipment and ineffective maintenance procedures can negatively impact the operational efficiency of a rehabilitation practice.

Factors contributing to the underutilisation of equipment include improper procurement, inadequate maintenance and insufficient staff training. A lack of training can also lead to therapy errors. Business owners should have procedures and policies in place to get the most use out of their purchased equipment. Competency assessments and comprehensive training programmes support clinicians to fully use equipment in their interventions, which may improve the value of therapy provided to patients.

Rehabilitation equipment must also be well-maintained; improper management can reduce utilisation, delay care and create safety risks. Effective equipment management has been linked to improved patient outcomes and lower operational costs. Business owners should have procedures on how to manage these assets, including equipment lifecycle management policies. Strategic planning is required for when equipment should be retired from use and when equipment should be replaced. Following this strategy can result in fewer disruptions in care, more efficient use of resources and improved patient satisfaction.

Design Considerations for Outpatient Rehabilitation Facilities

Shepley et al. conducted a pilot study on staff, patient and designer perspectives on outpatient rehabilitation therapy environments. Key takeaways from participant interviews are listed below.

Privacy and Social Connection

Private treatment rooms are important to support patient privacy, confidentiality, and treatment needs. Curtains or low partitions do not provide this level of privacy. Personnel value shared workstations in the gym area but also need a private space or area where they can recharge or get administrative work done. Additionally, some patients may feel uncomfortable being watched by other patients or clinicians when exercising in the open rehabilitation space.

Communication in open gym areas can also be difficult due to noise and interruptions. However, the social interaction between patients in a gym area can provide support and hope to patients, motivate them and even be a positive distraction.

Environmental Elements

It is important to ensure a clinic has adequate windows and daylight. Electrical lighting can also be used to create comfortable rehabilitation and treatment spaces. In the waiting area, lower lighting is recommended. Training outdoors can also have positive effects for patients and, if possible, outdoor spaces may be useful for agility drills, sports-specific rehabilitation and “real-world” challenges.

Accessibility

It is important to ensure a clinic has access to sufficient numbers of conveniently located carparks. Clinic entrances and doorways should accommodate people with different mobility needs and, ideally, clinics won't have long hallways. Clear signage is essential to help patients navigate around the clinic space. For clinic staff, movable workstations are an asset and contribute to improved patient flow and workplace satisfaction.

Spaces and Features

Storage: there should be adequate storage for all equipment, from exercise balls to specialised equipment. However, rehabilitation equipment should be easily accessible during treatment sessions. It is also important to ensure there is adequate storage space for patient belongings, like backpacks or coats.

Walls and furniture: walls with mirrors and motivational elements, such as inspiring quotes, can create a positive patient experience. Comfortable waiting room furniture and treatment furniture are also key.

Use and organisation of space: rehabilitation practices are sometimes quite small, which can result in overcrowding, challenges with patient communication and privacy and storage constraints. Rehabilitation spaces will ideally have large open areas for movement-related therapies, as well as distinct zones that support order, collaboration, patient flow and progressions. There should be space for staff in treatment areas to write or type up their patient notes, but also a separate private staff area where clinicians can focus or have meetings with colleagues in private. Waiting areas should be inviting and comfortable, with appropriate lighting to create a positive and welcoming first impression.

Based on the insights from participant interviews, researchers have identified some key design considerations for rehabilitation treatment facilities:

• a mix of private treatment areas and open spaces to accommodate various diagnoses, preferences and cultural backgrounds is useful
• treatment areas should be organised but still flexible
• multipurpose patient treatment rooms should be considered in the design
• every clinician's wellness and ability to work effectively can be considered by ensuring they have private work areas and “restorative respite areas”
• if possible, protected outdoor treatment areas add value to the facility
• access to daylight in the facility is important for both clinicians and patients
• furniture should meet the needs of the patients at the different stages of their rehabilitation journey and also factor in the ergonomic needs of clinicians and other staff members

Infection Prevention and Control

Standard Precautions

"Standard precautions are practices designed to break the chain of infection and achieve a basic level of infection prevention and control " in healthcare settings.

These precautions apply to everyone in the clinic and must be used when there is contact (or potential contact) with blood, body substances or fluids, broken skin and mucous membranes. Elements of standard precautions include hand hygiene, respiratory hygiene, use of personal protective equipment (PPE), handling of sharps, maintaining a safe environment, environmental cleaning, handling of waste and linen and the handling of reusable medical devices or equipment.

A risk management approach to standard precautions is recommended. Clinicians should be prepared for any possible exposures. As a business owner, it is your responsibility to provide the facilities and consumables to prevent unnecessary exposure and to avoid the transmission of infections. The provision of hand hygiene stations, proper PPE, sharps disposal containers and waste receptacles is non-negotiable. Ensuring these items are available enables clinicians to comply with the business's infection prevention and control policies and protects clinicians and patients.

Hand Hygiene

Compliance with correct hand hygiene practices prevents the transmission of potentially pathogenic microorganisms. Research has shown that compliance with and the improvement of hand hygiene practices have resulted in a reduction of healthcare-associated infections. If you'd like, you can refresh your memory about proper hand hygiene practices here.

Respiratory Hygiene and Cough Etiquette

Good respiratory hygiene and cough etiquette aim to prevent the spread of respiratory droplets and exposure to others. It is good practice to implement the following strategies. Cover the nose and mouth when coughing or sneezing to prevent the spread of potentially infectious agents. Use a disposable tissue or cough / sneeze into the inner aspect of the elbow. Always wash hands after contact with any respiratory secretions. It is also important to clean frequently touched surfaces. In times when there is a heightened risk of respiratory infections, it is recommended that the business, contact surfaces and equipment are cleaned even more regularly than usual.

Use of Personal Protective Equipment

Policies and guidelines on the appropriate use of PPE are required in your business, and the appropriate PPE should be provided to employees in your clinic. If you're interested, you can read more about PPE here.

Maintaining a Safe Working Environment

Running a busy rehabilitation practice has its challenges. All team members should be responsible for maintaining a safe working environment and policies and procedures must be in place to ensure a cooperative and coordinated approach to the cleaning and safeguarding of the practice. This includes managing and cleaning linen, disposing of waste, handling sharps, routine cleaning, as well as cleaning, disinfecting and sterilising reusable equipment, medical devices and equipment shared by patients. Patient-shared equipment, such as therapy equipment, is a possible source of cross-contamination. All equipment should be correctly cleaned between each patient.

Templates of infection control and health and safety risk assessment policies can be found here.

If you would like to learn more, please see: Infection Prevention and Control.

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Employer Responsibilities for Standard Precautions

It is your responsibility as a business owner to create and ensure a healthy and safe working environment. All employees should receive the proper orientation, training and guidance on safety procedures in the clinic. Standard operating procedures and guidelines are necessary and should include the latest evidence-based practice on infection prevention and control. This information should be readily available to personnel. Ensure that employees understand the rationale behind your business's infection prevention and control policies and procedures. If employees understand the purpose of these policies, they will be more likely to comply with them. Aim to write your guidelines, policies and procedures clearly to help ensure uniformity and efficiency. Tailor your training on infection prevention control policies and procedures for all staff members. Orientation and in-service training are necessary for all new staff members, as are regular refresher training sessions for existing staff members.