How can you serve the community with a new health and wellness center in a safe and comfortable environment?

Opening a health and wellness center or practice during a pandemic provides a unique set of challenges, as public health information fluctuates. But health care offices and gyms and restaurants — many businesses — have opened their doors again or are working hard to keep their doors open as they navigate our new and changing environment.

What are they doing well? How can you replicate that in your own business?

The health and safety of everyone who may be on the premises is the No. 1 priority. You want to serve members of your community and provide them with the care they need. How can we do that in a safe and comfortable environment?

Health and wellness center: considerations checklist

For chiropractic offices, there are multiple areas to consider, including:

• Pre-screening before a patient visits
• Masks and social distancing while a patient is on-site
• Cleaning and disinfecting, especially high-touch areas, after a patient leaves

Staying ahead of the curve means constantly monitoring and accommodating federal, state and local guidelines. These change as new information and rapidly changing data shape the way public health officials respond.

Guidance for opening (or re-opening) is available through your county, your state and the Centers for Disease Control (CDC). It’s important to know what the requirements are for your own county or state, and to follow whichever requirements are stricter.

How one health center handled a re-opening

Early in the pandemic the Life West Health Center temporarily closed to consider operations and procedures that were needed to remain open. The San Francisco Bay Area Life West Health Center, where senior students at Life Chiropractic College West practice their craft and work with the community, was already meeting with faculty and staff when the shelter-in-place order came. This area of the country has continued with stricter protocols than many areas, and as of November was still reopening very slowly.

However, reopening as quickly as possible and as safely as possible immediately became the No. 1 goal for the health center.

“We quickly determined that we can’t stay open without making accommodations, but we can’t shut down and not serve our patients and interns,” said Scott Donaldson, DC, vice president of clinical operations. “If we can see non-COVID patients and keep them out of the emergency room and other doctor offices, we’re providing an important service.”

Developing new protocols

The next question was: How to do that safely and effectively?

A team of staff and faculty began to work on developing new protocols, even before the order to do so came. The team included everyone from faculty doctors to staff working at the front desk. “All those perspectives came together for a good plan,” Donaldson said, although he stressed that what works for a large educational institution may not work for a smaller office.

The health center was able to reopen a week later. The new protocols went above and beyond what the county was requiring. Later, when public health requirements changed, Donaldson said the health center was already taking the recommended extra precautions.

Patient scheduling

The team started by assessing how many people could be in the facility at once, but restricted the initial population in the building to less than what was recommended. That gave the health center time to test any protocols before an expanded population would be allowed inside.

For example, when the health center first reopened, only five patients were allowed inside per floor at any given time. That meant making changes to the way patients were scheduled, as well as adjusting the schedule of the interns who were seeing them. The health center now allows up to 15 patient visits per floor at a time.

Initially, the screener who was also stationed at the door used a handheld thermometer, but Donaldson said this led to longer lines as people waited to be screened and have their temperature taken. Now the health center uses an automated thermal scanner that takes the temperature of everyone walking in, then sounds an alarm if it detects an elevated temperature. That has eliminated some of the lines while still providing a temperature check along with the screening process.

Reopening safely for the health center primarily meant limiting physical exchanges, but there were other components as well.

New protocols included:

• Pre-screening questionnaire available online
• Temperature scan at the door
• Masks required for all
• New cleaning protocols, including sanitizing stations in between patients
• Rescheduling appointments so that there are fewer people in a space at a time
• Sanitizing stations set up throughout the space
• Signs and directional arrows to help control pedestrian traffic and maintain social distancing
• Exits and entrances blocked to manage the number of people in a space at any given time
• Cash and check payments no longer accepted at the front desk

Scheduling process changes

Schedule processing changes were very restrictive at first, Donaldson said, allowing only 30 minutes per patient.

“We’re still sticking to that, with a few exceptions,” he added. They opened a family room where people who already cohabitate can be seen together.

Patients in the family room have an hour with an intern.

“That’s worked well and we will probably keep that,” he said.

One of the benefits of changing the scheduling is that the health center estimates it has a 25-30% greater volume of patients than pre-COVID. Donaldson said that before the pandemic the health center would see about 180-200 patient visits per day. Now they are averaging between 200-260 per day.

The key is how patients are scheduled. No more than 15 patient visits are allowed per floor at a time. But with more rigid scheduling, patients are able to spread out more evenly across the day, which has the added benefit of accommodating more patients. Before, interns scheduled their own patients, so health center spaces became crowded around noon and at 5 p.m., when the interns had a natural break in their day.

Donaldson said the health center has a different call-back procedure now as well. Instead of calling to reschedule, the health center has instituted more of a check-in process with patients while they are sheltering in place.

“We check in, see how they’re doing, keep that communications channel going so people who are sheltering in place can gauge when they might feel comfortable coming back in,” he said. “And for patients who hadn’t been coming in, some of them came back after we checked in with them.”

Staying in compliance

All these pieces made a difference in the larger reopening plan that came together, Donaldson said. “It’s still a team effort.”

The health center hasn’t had issues with compliance and continues to issue regular reminders on masks, hand- washing and social distancing as part of their process.

“There was a very strong message from the team that these protocols must be in place if you want to see patients,” Donaldson said. Patients, staff, faculty and interns have all taken the responses to the pandemic seriously.

“This is what works for us,” he added. “We’re a large educational facility, and our discussion started with what is the responsible thing for us to do.”

Kathy Miedema is a member of the marketing team at Life Chiropractic College West and the managing editor of the Life West Chiropractic Magazine.