Like many O&P business owners, Jeffrey Brandt, CPO, of Ability Prosthetics and Orthotics, didn’t originally intend to work in the field. When he entered college, he intended to become a meteorologist, but a chance opportunity to volunteer in a rehab facility changed his plans.
He realized the O&P field offered a unique mix of science, psychology, technology and business that was a good fit for his skill set. He was determined not only have his own office, but to ensure the experience of O&P care for the patient was exemplary. Brandt now has 11 different patient care facilities to show for it.
The facility in Exton, Pa., is the fourth of Ability’s offices. He chose the location because the western suburbs of Philadelphia were underserviced. The Exton branch showcases the attention to detail that Brandt brings from the extensive research he has done in facilities design.
The Ability P&O experience is unique, both for the practitioner and the patient, in that work is outsourced, but all offices are equipped for on-site modifications. This business structure is time-efficient, cost-effective and allows for a greener, safer work environment.
Brandt took O&P Business News on a tour of the facility and pointed out some of the ways he tried to think out of the box in terms of design and function. Images by 3 Roads Communications.
The conference room serves multiple functions. Brandt chose a glass wall, which allows in natural light so patients or staff would not feel closed in. The room is often used for initial evaluations, instead of an exam or casting room.
“We wanted a comfortable room to bring people in to talk about their device, their pathology, and their treatment plan. It’s nice for upper extremity fittings because you’re not sitting in exam room, perched up against the counter. You can get patients’ knees under the table, and they can practice picking up marbles and completing other tasks with an i-Limb.”
The multi-purpose room is also used for staff and practitioner meetings, as well as to entertain third-party payers and vendors and for continuing education sessions. It has a large video monitor that is used to show training videos to patients and practitioners.
The reception area is spacious, with plenty of room for wheelchair access. The reception counter is large and open; there is no sliding glass window separating the office staff from the patients. “No trying to avoid eye contact,” Brandt said. Article reprints are displayed on the walls and on the reception counter, and are rotated periodically. A pass-through to the main hallway is large enough to accommodate an oversized wheelchair. The hallway is open and large enough to walk patients through.
All exam rooms have water, voice and data accessibility so practitioners can use their laptops. Every photo and poster is framed. “Nothing with push pins,” Brandt said. He thinks push pins are tacky.
Each facility has two exams rooms; in one room, they scan for cranial helmets. “For a company that outsources, we can have a cranial helmet in 2 days,” Brandt said. “You can scan the cranium in about 2 minutes; it’s quick and painless. The child doesn’t even know what’s going on. Before mom is out of the parking lot the image is emailed to the vendor for processing a positive foam model of the cranium. Both the positive and the negative are shipped in 2 days.”
Brandt also gives parents educational laminated charts of different conditions, such as plagiocephaly and brachycephaly. “We put emphasis on the presentation and quality. We know we’re going to provide good care, that’s our mission, but this is a little extra step that sets us apart. People are going to make judgments about that, so it’s important to look good. We do this for all products and devices we offer.”
The casting room is oversized by design. “When I was in a rehab institute in Chicago, the first week into my residency they jammed me in a room that was 4 feet x 8 feet to cast twins. There’s a stroller, mom, dad, the two babies, me, and the equipment all packed into the room … that creates unnecessary stress.
“With an oversize room, you can fit a wheelchair, family members … you can put the patient in the middle of the room and circle 360· around them. It’s big on purpose, very functional, with room to breathe.”
Because Ability outsources, the lab is smaller but still equipped for all necessary modifications, adjustments or refurbishments.
“We outsource everything, but we’re still prosthetists and orthotists; we still have to modify, repair and adjust devices. We have everything we need in here to do fittings and follow-up appointments.”
Outsourcing the fabrication gives practitioners more time to manage the patient’s care, including education, design and pathology.
“We are concerned with efficiency and outcomes. I am not aware of data that suggests fabricating “in-house” increases outcomes. And, judging by the politics and operational hazards that plague many labs in O&P facilities, I am not convinced they are efficient either. Most of our referral sources are not only unaware where the devices are fabricated, but would question our ability to provide fabrication given the context in which we interact with them. I don’t want my dentist fabricating my dentures.”
Brandt described an instance in which he crafted an insert for a physician, who questioned his method of doing business.
“I just go in the back room and I heat up my heat gun and make the adjustment. And he said, ‘oh, you’re doing the Walter Reed model. Those guys are managing the patient care. They’re designing it but they’re not making it.’ And I said, ‘Exactly, if that’s the Walter Reed model, then great!’
“Outsourcing also allows us to run a cleaner, healthier facility for my employees,” Brandt said. “The materials used in laminating are toxic; we do no lamination so there are no fumes. We are not heating plastic to its melting point.” He said too many practitioners in the industry in their mid to late 60s have health and lung issues he believes are attributable to their work environment. “Standing here grinding all the time…the toxic fumes from molding toxic plastics…we have never done this since we opened. That facet of the industry is best suited for a facility that is dedicated to central fabrication. We are focused on patient care and the design of the device. It is also better for our patients’ health, and our facilities have a much more pleasant smell!”
The gait room, where patients test their prosthetic legs, is 29 feet long. “What makes this room unique is that there are 18-foot parallel bars, which you don’t see a lot; usually they are 9 feet. There is room for the practitioner at the end of the run. The patient can come into the room in a wheelchair, spin completely around and start walking,” Brandt said. A mirror at the end allows patients to see themselves walk.
Brandt pointed to the computer and large monitors in the room. “A lot of the devices we deal with are Bluetooth enabled — microprocessor knees, the WalkAide unit, the i-Limb hand — they all have software that accompanies them. All the software from all the devices we fit are on this computer. The monitors are flexible; we can turn the screen so patients can watch themselves with the web cam. If we’re fitting a device and we need help from the manufacturer, we can conference them in on the web cam. They can watch the fitting.”
To Brandt, a clock displayed prominently on the wall helps practitioners keep track of time better than with their smartphones or a watch.
“I wanted clocks in all the rooms, so as practitioners, we’re cognizant of the time. So the patient can say ‘Hey, he said he’d be back in 10 minutes…and he was!’ It forces us to commit to our patients and to stay on schedule.”
The back office is set up for two practitioners. Tall metal racks house current work. Once an item has arrived from a manufacturer, it is placed on a shelf with a practitioner reminder and an appointment is scheduled. “Everything is accounted for in OPIE so timelines can keep moving. Timelines can note glitches and delays from one manufacturer delivery to another,” Brandt said.
The coffee area does not encourage leisurely sitting around. Although staff may bring a cup of coffee to patients, patients are not permitted into the coffee area.
Each of Ability’s offices is equipped with the same types of phones, printers, scanners and computer monitors. This reduces technology questions so employees can theoretically work in any office. Voice over IP allows easy calls between branches.
“We use it across the company like an intercom for easy communication between employees, and to route calls from one office to another. If a patient calls today, they’re going to get a body. And that’s because of our phone system and culture.”
Over all branches, Ability has more than 20,000 patients. OPIE software allows any employee in any branch to access a patient’s records for seamless care. “We don’t take up space with huge paper charts and the risks of exposing secure information are very low. This is another way Ability strives to be green, efficient and effective.” — by Carey Cowles