Wide Open Spaces: An Iowa DC adopts an open-bay practice model increasing her patient volume and office to 3,000 square feet

Dentists and orthodontists have long enjoyed success employing it, so why not chiropractors? The “it” in question is the open-bay model of practice, wherein patient care is delivered in a communal setting as opposed to private, individual adjusting rooms. Kari Swain, DC, is a fan of open bay. She recently had a stylish and inviting clinic of 3,000 square feet built in her town of Altoona, Iowa, just to take fullest advantage of all the model has to offer.

Kari Swain, DC, (R) and Alicia Sabo, DC, adjust in the family area of the office. The pediatric adjusting table is one of the many draws for younger patients.

“The open model is great,” enthuses Swain, owner of Swain Chiropractic, whose adjusting bay features four adult tables and one pediatric bench. “First, instead of being alone, closeted in an adjusting room until I can get to them, patients are in on the action, listening to the constant flow of patient education, and able to converse with and be emotionally supported by fellow patients and the staff.

“Second, since I’m always—so to speak—on stage, it causes me to concentrate my attention on the processes of adjusting and educating. In my practice, we designate three mornings and four afternoons out of each week for adjusting so I can remain focused with no other distractions. That increases our efficiency and dramatically reduces the time patients spend in our office each visit.”

Swain finds the open-bay model also cuts down on mileage—that is, the amount of walking around she must do within the office in the course of a work day. Less hoofing contributes to increased productivity, allowing more patients to be adjusted in the time allotted.

“The office is designed for simplicity, speed, and efficiency, which lets me remain at peak efficiency during patient hours,” she says. “I don’t have to ping-pong back and forth between rooms; this one to adjust a patient, that one to do an assessment, and another one after that to adjust someone else. The patients I’m going to adjust are all in one room and within easy reach.”

The delight Swain derives from this model of practice appears to be shared by her patients.

“Our patients seem to be quite comfortable with the open model and very few bring up the privacy issue,” she says, adding that consultations and the delivery of reports of findings still are conducted one-on-one in individual rooms. “The entire office is HIPAA compliant.”

Model Solution
The idea to convert to an open model came to Swain after learning of its benefits from other doctors.

“Here was an approach to practice that allowed the doctor to provide natural, holistic health care to more people, to be at his or her best throughout the day, and increase the enjoyment of everyday practice,” she says. “Anything that helps me better serve my patients gets my attention.”

Adopting this particular model caused Swain’s office-visit volume to soar, which, in turn, provided a reason to move from her cramped 800-square-foot facility into one nearly four times as large. It is a facility she owns and had built to her specifications. Among the elements she wanted was a floor plan blending efficiency with eye-appeal and warmth.

“The front desk, for example, is huge and a major focus of the interior design,” she says. “It has separate stations for patients checking in and checking out. There are built-in slots for travel cards, easy access to the computer and a specially constructed sleeve for the oversized appointment book I use.”

The professionally designed interior is done up in elegant hues of green and gold, colors Swain says conjure feelings of serenity for the beholder. The colors carry through into the adjusting area (which has 24 jump seats in addition to the tables).

“The entire adjusting area is made even more pleasant thanks to oversized picture windows that run across the back of the clinic and allow patients to look out at a beautifully landscaped garden,” says Swain.

Comforting views notwithstanding, what counts most at Swain Chiropractic are the things that transpire indoors, Swain reminds.

The staff of Swain Chiropractic (L–R): Amanda Baber, CA, front desk; Michelle Devlin, CA, front desk; Kari Swain, DC; Alicia Sabo, DC; Megan Burdine, CA, billing

“Our office has a purpose, and that is to provide clinically competent, service-oriented, excellent chiropractic care to the individuals and families of my community,” she says. “Helping patients regain and maintain their health is an awesome responsibility, one that we take very seriously.”

Initial assessment at Swain Chiropractic typically entails typically entails a detailed consultation, a basic neurological, orthopedic evaluation, subluxation analysis, x-rays, surface EMG testing, thermography, postural evaluation, and a full chiropractic work-up. From there, individualized recommendations for spinal care and nutritional supplementation are made, “and we develop an appropriate exercise regimen for those patients that we think require such a program,” says Swain. “The important point is that we at Swain Chiropractic promote wellness care and a chiropractic lifestyle above all else. We stress the differences between natural chiropractic care and the traditional medical model. I like to think of myself as more of a health and lifestyle coach.”

Swain was influenced to see her role as such by what she was taught at chiropractic school, of course. But much of this view had been instilled in her long before then. Credit for that goes to the chiropractor under whose care she was placed as a child back in her hometown of Storm Lake, Iowa, about a 2-hour drive from Altoona.

“Growing up, our family chiropractor taught us that chiropractic helps maintain wellness for a lifetime,” she remembers. “He constantly stressed that the nervous system controls every function on the body and that the nervous system must be in total balance for people to be healthy. This philosophy was reinforced every time we went to see him, whether for wellness care or the treatment of an injury.”

Back then, Swain was barely old enough to tie her own shoes and already she was exhibiting the traits of a good chiropractor.

“My mom,” she says, “would take the entire family to the chiropractor and all of us would get adjusted. When we returned home, we’d all lay on the floor and rest a while so that the adjustment would hold better, just as the doctor told us to do. But, instead of resting, I’d go from one sibling to the next and recheck them, pretending I was the chiropractor. I must have been maybe 3 or 4 at the time.”

With proto-chiropractic tendencies so strong at so tender an age, it was only natural that Swain would decide before reaching her teens to become a chiropractor—a choice from which she never wavered. After high school, she enrolled at Iowa State University in the city of Ames. Three years later, she matriculated into the Palmer College of Chiropractic bachelor of science program to complete her undergraduate studies. In 1991, Swain officially entered the chiropractic program at Palmer. She earned her doctor of chiropractic degree in 1995.

That same year, Swain moved to Altoona to enter practice. “My husband and I wanted to stay in Iowa; we love this state and wanted to stay near our families,” she explains, pointing out that Altoona is a small community not far from the big Iowan metropolis of Des Moines. “We didn’t want to be in a major city. We were both raised in a small town and that’s the environment we felt most comfortable in.”

Active Practice
Today, Swain Chiropractic is a thriving practice. Income derives from a combination of cash and insurance.

“In the future, I fully intend in to phase out, or at least greatly diminish, the portion that belongs to insurance,” she says. “Insurance is a lot of work. It’s such a battle to collect from insurance companies and no one is ever happy with the process or with the reimbursement. We want to be an office of people, not paper.”

Helped by an associate, Alicia Sabo, DC, a 2003 graduate of Palmer College, Swain offers services to children, adults, and the elderly.

Regardless of age or sex, “we encourage our patients to be goal oriented when it comes to their health,” Swain says. “And, from day one, we let patients know what we expect from them. Among our expectations is that they become fully engaged in helping us help them regain their health. We ask them to comply with all recommendations, attend our health care orientation, keep their appointments and refer others.”

As for referrals, Swain insists that what’s key is not how many new patients show up but how many of those keep coming back.

“Many chiropractic offices live and die by the need to increase new patients from one year to the next, but not us,” she says. “Most important to us is patient retention so that the patient not only gets rid of their symptoms, but has a spinal correction and a wellness option. That’s what we really focus on.”

She also encourages retention of patients through a commitment to super service.

“I define super service as making every effort to give patients what they want and need,” she says. “And what most want is a neat, clean, beautiful office to come to, along with a fabulously trained, warm, and truly sincere staff working in support of doctors who are passionate about chiropractic, motivated and clinically competent.

“If you can provide all that, the patients will as if by magic come, stay, pay and refer.” CP

Deep Focus

Kari Swain, DC, is earnest about her role as a chiropractor, just as she is about her role as a wife and mother. However, being tops in those jobs is never easy, especially when it comes to striking a healthy balance between the demands of each. “To have harmony, you first of all have to focus just on what you’re doing at that moment,” says Swain, owner of Swain Chiropractic in Altoona, Iowa. “If you’re at the office, don’t be thinking about things dealing with your family—think only about practice. When you’re at home, think only about your family, not the practice. When you’re at play, be 100% focused on play. It takes self-discipline to stay focused, but the results are more than worth the effort. Concentrate on one task at a time, one patient at a time and the completion of one goal at a time. “Harmony comes from practicing what’s preached about living the chiropractic lifestyle. I do all the things I tell my patients to do; I get adjusted regularly, I eat healthy foods, drink a lot of water, exercise, and get plenty of rest. The chiropractic lifestyle makes a lot of sense and it is my personal goal to positively influence others, chiropractors and patients so they can enjoy the health, success and happiness that I have been so fortunate to achieve.”

Rich Smith is a contributing writer for Chiropractic Products.