Play Nice: Child-Friendly Business Practices

To be successful in pediatrics, O&P practitioners should be
fun-loving, open to the unexpected, and knowledgeable of children’s
emotional, developmental and health-related issues. An element of that
child-centered atmosphere, however, factors in the child’s parents,
siblings and other family members, who are just as involved in the
patient’s care as the practitioner.

Practitioners must learn to be sensitive to these considerations, and
place themselves in their patients’ — albeit slightly smaller —


Part of this mindset includes knowing that pediatric patients are
inherently different from adult patients in that, as children, they come to the
office as part of a family. Spencer Doty, CPO, MBA, president of Active Life
Inc. in Los Angeles, emphasized the ability to learn to view the family unit as
a whole and to pay attention to the needs of both the individual children and
the family. This begins as soon as they walk through the door.

The most important thing O&P employees can do to put children at
ease is smile and acknowledge them, Ken Vyvlecka, CO, BOCO/P, president and
founder of Family Orthotics & Prosthetics Inc. in Kearney, Neb., said. He
stressed the importance of having outgoing and friendly front-office personnel.
Children are perceptive, he said, and the first impression can convince a
nervous child not to be afraid.

  © 2010

“They often are not sure about the nature of their visit,”
Vyvlecka said. “It helps set the tone when someone is smiling as they
enter. I think that’s critical.”

The first person who greets patients at Family O&P is a
“veteran mom” wearing a perpetual smile, Vyvlecka said.

He also made sure to avoid a stark-white or sterile-looking office and
instead, filled the rooms from floor to ceiling with soft images and tones to
project a calm, friendly vibe for all of his patients.

“Of course a little candy dish on the counter never hurts
either,” he said. “Always ask the parents for permission, but a candy
dish is something that can divert a child’s attention in an instant.”

And Vyvlecka is a man with plenty of firsthand experience regarding
children — he and his wife have nine daughters and two sons, currently
ranging in age from 4 to 26 years, and now have two grandchildren as well.

O&P care

Perhaps the best way to provide the complete O&P experience for
pediatric patients is to staff the practice with orthotists and prosthetists
who are well-versed in pediatric pathologies and pediatric O&P
recommendations, Doty said.

“It’s hard to find that kind of experience, whether it be an
individual or in a company, unless they’re directly involved with some
sort of specialized local pediatric clinic that exposes the practice or the
individuals to all types of pediatric conditions,” he said. “Having
the ability to treat those patients, I think, would be the best tool for
business owners wanting to improve their pediatric care.”

Not to be forgotten in this matter is the issue of the actual
prosthetic, orthotic or pedorthic treatment. Patrick R. Nimphie, BS, CPO,
FAAOP, clinical manager of prosthetics at Mary Free Bed Rehabilitation Hospital
in Grand Rapids, Mich., said that, when appropriate, the practitioners at Mary
Free Bed will offer to incorporate into the device an item that holds meaning
to the child, such as a special fabric or a favorite T-shirt. This material can
be laminated directly into the finish of a prosthesis.

Practitioners also keep in mind options for nontraditional adaptive
terminal devices for the young prosthetic patient’s sports and
recreational activities, he said.

  Child-friendly waiting rooms equipped with toys offer distractions from the task at hand.
  Child-friendly waiting rooms
equipped with toys offer distractions from the task at hand.
  Image: Mary Free Bed
Rehabiloitation Hospital

To complete all of this O&P care with only minimal life
interruptions, practitioners at Mary Free Bed work with the children’s
— and parents’ — schedules, understanding that the majority of
complex projects will need to begin and end during time that coincides with
school vacation days, spring break, holiday breaks and the summer months.

“We try to ensure all our staff is aware of these special
situations and are prepared to work long hours if necessary,” Nimphie
said. “Seeing our kids after school hours during the school year is more
the norm than the exception.”

Play areas

An easy way to win over children is with toys. Doty’s solution for
keeping rambunctious children occupied in the waiting room is simple: ensure
they quickly move to the treatment rooms.

“We don’t get too elaborate,” he said. “We try to
get our patients in and out so they don’t have to spend a lot of time in
the waiting room.”

Active Life has a small play area in the waiting room, with an
additional patient room that can be easily converted into a child’s room.
Several toys and other items are stored in a trunk in the room, taken out when
necessary for pediatric patients, and returned to storage after those visits
are complete.

Family O&P stocks its waiting room with kid-sized fun. In one
corner, away from the front door, Vyvlecka built a play area with its own
little wall — which inevitably turns the area into a fort or a house,
depending on the child’s imagination — and a pint-sized desk and
chairs and a little bookcase. To top it off, he solicited some artists from a
nearby college to hand-paint a mural on the wall.

He then stocked this area with age-appropriate toys like car, trucks and
plastic dolls. He also placed a big pink plastic dollhouse in this area, and
both boys and girls take advantage of this structure.

He warned that none of the children’s toys should make noise —
no popper push mowers — to keep them from annoying other patients.

There also are other, simpler options for child-friendly waiting rooms,
even those without designated play areas. These include having children’s
books next to magazines for adults on tables in the waiting room, as well as
coloring books and crayons, which can be thrown away and easily replaced when
they are used. Both are an inexpensive and easy distraction for little ones.

Safety and hygiene

More important than whether the toys are fun for children, however, is
the matter of whether they are safe and clean, and easy to maintain.

Mary Free Bed Rehabilitation Hospital has polices in place concerning
the use of toys from the office’s toy bank or play area, Nimphie told
O&P Business News. The hospital’s clerical staff monitors
the play area to ensure safety.

Vyvlecka’s veteran mom keeps an eye open for any inappropriate toys
in the play area — anything that could be considered a choking item, or
something that is too sharp, is removed immediately.

Play structures should be low to the ground to prevent climbing and
subsequent falls, Doty said.

  Mary Free Bed offers to incorporate into the device something meaningful to patient.
  Mary Free Bed offers to
incorporate into the device something meaningful to patient.
  Image: Mary Free Bed
Rehabilitation Hospital

He also said he considers patient areas just as
potentially hazardous to children. Practitioners should be sure to clean
patient rooms of tools or old devices from other patients before moving
children to those rooms.

Keeping toys clean prevents the spread of germs among children and to
other patients and staff members.

Plastic toys can be cleaned quickly with antibacterial spray or by
soaking in a bucket with a little bleach. Nimphie said the staff at Mary Free
Bed uses a dishwasher to sanitize toys after each use or every day, and
approved cleanser for table tops and other items that cannot be put in the

“We do not allow any unwashable stuffed toys unless they are the
possession of a specific child with the child’s name on the toy,” he

Mary Free Bed also provides hand sanitizer dispensers in
the vicinity adjacent to the toy area.

Vyvlecka suggested stashing emergency backup toys, in case an item is
badly soiled, or to switch out toys that an ill patient has played with.

“Front office staff can wander over when the child leaves, scoop up
those toys and take them out of commission,” he said.

Doty said he recommends cleaning the toys and structures each day to
prevent the spread of germs, and not just for children. Business owners also
must consider the health of other patients in their office. By nature, children
tend to spread germs more readily than adults, and this may be dangerous to
some geriatric or immune-compromised patients.

“Every patient is important so you have to do your best to make
sure all of them are safe, healthy and happy,” Doty said.

And, given the litigious society in which we live, a business owner
cannot be careful enough about the safety and wellbeing of everyone in the

Keep mama happy

Part of the job of working with pediatric patients is dealing with
whatever comes your way — literally. The squeamish need not apply.

“I’m used to the unexpected, and remain calm — getting
thrown up on, drooled in my hair, or something from the diaper — and I
don’t get shaken up about that,” Vyvlecka said.

In fact, he makes sure the office is “little person- and
family-friendly,” and that includes being ready for dirty diapers and
having a place for breastfeeding babies.

“We’ll offer to take a dirty diaper out for them, because the
mom has a baby there and maybe another child,” he said. “Baby’s
cranky? ‘Does he need to be fed? I’ll just step out so you can feed
your baby.’ Never giving an impression that they’re being rushed or
taking up my time. I’m here to serve them.”

Cater to the Children

Several practitioners and business owners
offered their suggestions for making each pediatric visit a positive and fun

  Practitioners and business owners agree that a child-friendly environment can win over patients and parents alike.
  Practitioners and
business owners agree that a child-friendly environment can win over patients
and parents alike.
  Image: Family
Orthotics & Prosthetics Inc.

Jennifer Klein, CPO at Gillette Children’s Specialty

  • Have plenty of items for distracting the child during the
    appointment, like toys, books, games, snacks and movies that are
    age-appropriate. Make the visit as fun as possible with positive interactions
    from every staff member.
  • Empower the child whenever possible. Let him or her make
    decisions about decals or strap colors. Present the child with
    ‘either-or’ choices to help them feel in control.
  • Listen to the parents and ask for their opinions. They
    know their child better than anyone, plus they are the ones that actually have
    to put the assistive device on their child each day. Parents also know what
    tactics work with their children and what their tolerance level is.
  • It also is nice to have a ‘prize’ at the end of
    the appointment — like a small toy or sticker — to use as an
    incentive for good behavior or cooperation.

Spencer Doty, CPO, MBA, president of Active Life Inc.:

  • For children, the physical environment is key to winning
    them over, whether they or their parents are receiving treatment. Even for
    treating adult patients, it is that much more difficult to treat a patient when
    a child is running around the treatment room, seeking attention. …
    Distracting the child with toys or books improves the entire patient

Ken Vyvlecka, CO, BOCO/P, president and founder of Family
Orthotics & Prosthetics Inc.:

  • Put mom, dad and child at ease, be
    personable, and smile.
  • Encourage children to bring toys in with them. If the
    child is playing with something, get down on the floor with them so you do not
    take them away from their toy, or put the child and the toy up on the table.
  • Chest” with new
    inexpensive toys that the children can dig into after an appointment. This has
    always been a big hit with the children and their parents.

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These are small gestures, but all add up to the patient — and the
patient’s family — feeling welcome in the office. People only visit
an O&P office because they have a need, or something has gone wrong, and
being part of their solution goes a long way in patient care, Vyvlecka said. He
works hard to put them at ease and improve their situation.

“The saying, ‘If mama ain’t happy, ain’t nobody
happy,’ is true. If you take your kids to a [practitioner] and the
man’s insensitive and inconsiderate, you’re not going back,” he
said. “If mom is happy after your visit, then you will come back, and may
even tell someone about the visit.”

According to the U.S. Small Business Administration, the Customer
Service Institute found that it costs five times more to find a new customer
than it does to keep an existing one satisfied, and that translates directly to
the health care profession.

The treatment experience that O&P practitioners offer their patients
is the main component of what sets them apart from other facilities. Children
can become patients for life, and the opportunity to keep those patients happy
can make or break a business.

Business aspects

Therein lies the no-nonsense, down-to-business reason to enter the field
of pediatrics: it is lucrative. Putting aside the cute-and-cuddly incentive
that it warms the heart to help a child and watch him or her grow, it also
serves as a consistent stream of patients and income, which means staying in

“If an O&P business can handle pediatric care, then it could be
a great way to secure steady and profitable work,” Doty said. “For
the most part, it’s a secure demographic that’s available to us that
can produce a great financial reward, in addition to the patient experience

The ability to bill for O&P devices twice a year, vs. once every 3
years, obviously makes a difference financially, he said.

The same factors that make pediatrics a profitable business source,
however, also make it more challenging. While billing for components and device
upkeep a few times a year brings in significant income, it also creates more
work for practitioners and more time spent on paperwork to secure those

Additionally, children often have state-funded health care, and the
reimbursement can be lower than with private third-party payers, Nimphie said.
Part of Mary Free Bed’s mission as a nonprofit entity is to care for
patients in its service area, regardless of their ability to pay.

He does not see these issues as a detriment, however, when considering
the ultimate reward.

“All of us [at Mary Free Bed] are thankful we are in a situation
that we can work with the children. It is a special opportunity in the O&P
industry to work in a facility that has a large number of pediatric
patients,” Nimphie said. “Two of our practitioners have been working
with individual patients for more than 30 years. Knowing that they saw these
children take their first steps and continue their care until they have
children of their own is a special feeling you can’t get many other
places.” — by Stephanie Z. Pavlou

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