How to choose premises for the practice to pass KHS approval

Legal Requirements: Hygiene First

For example, there must be separate toilets for staff and for patients, hand sanitisers must be available, and a source of drinking water on the premises is a matter of course. Emphasis is also placed on the proper handling of biological waste (e.g., used needles, bandages) and the hygienic handling of medical laundry intended for washing. These requirements are not just on-paper bureaucracy – their goal is to prevent the spread of infection and ensure a safe environment for patients.

For this purpose, hygiene regulations require every healthcare provider to have prepared operating rules for the practice under Section 15 of Act No. 258/2000 Coll. The operating rules are a document that describes in detail the operating conditions of your practice – what procedures you will perform, what equipment you use, how you ensure disinfection and sterilisation, how you handle waste, the staffing of the practice, etc. These operating rules must be approved by the relevant regional public health authority (KHS) before you start your activities. Without approved operating rules, the regional authority will not grant you a licence to provide health services. So, hygiene really does come first – before you see your first patient, you must have the "blessing" of the KHS.

In addition to the Public Health Protection Act, there is also Act No. 372/2011 Coll., on Health Services, which obliges the healthcare provider to ensure the personnel, material, and technical equipment of the practice. The details are set out in Decree No. 92/2012 Coll. on the minimum equipment for healthcare facilities. You do not have to study every decree in detail, but it is good to know that there are official minimum standards – for example, what equipment and aids you must have for a given specialisation, or what minimum space is required.

All these legal regulations pursue a common goal: to ensure that the premises, equipment, and staff of your practice meet the conditions for safe operation. The summary? When choosing and setting up a practice, you must think not only about comfort and design, but mainly about ensuring that the premises comply with the hygiene standards set by laws and decrees under Czech legislation.

The Practice Premises Through the Eyes of the Public Health Authority (KHS)

So, what specifically do public health officers assess when you apply for approval of your practice premises? The KHS focuses on the technical and operational requirements that are intended to make your future "second home" – the practice – hygienically sound. The practice of public health authorities shows several key areas:

• Layout and size of rooms: An outpatient care facility (i.e., a standard practice) should form a self-contained functional unit within the given building. The practice should be located in non-residential premises (not in an apartment) and must meet general building requirements – for example, have sufficient ceiling height, lighting, ventilation, and heating.

The minimum area for a doctor's office is 13 m², which is to ensure that there is enough space in the room for the doctor, nurse, patient, and necessary equipment. Of course, the office does not have to be huge, but if you can barely turn around the examination couch, it is a problem.

The waiting room should be at least 7 m² if it serves only your practice; for a shared waiting room for multiple practices, at least 10 m² is required. In addition to the examination room and waiting room, the regulations also require a toilet for patients and separate facilities for staff – i.e., another toilet and washroom for staff, and possibly a changing room or a rest area for the nurse. Public health officers also check whether, for example, the toilet door opens directly into the office or waiting room (ideally, there should be a small anteroom with a washbasin between the toilet and the waiting room). These layout requirements are often a stumbling block in unsuitable premises.

Hygiene Equipment:

The practice must have a washbasin for hand washing for staff, equipped with running drinking water (cold and hot) and ideally a touchless or lever-operated tap for hygienic hand washing. If you handle biological material or instruments in the practice (e.g., suturing wounds, taking samples, minor surgical procedures), a separate sink for washing and disinfecting used instruments is also required. It is also necessary to have appropriate containers for waste sorting – especially closable containers for infectious and hazardous waste (needles, contaminated material).

The practice should not have unnecessary textiles, carpets, or upholstery that cannot be properly disinfected – floors and work surfaces should have a washable surface that allows for regular cleaning and disinfection procedures. The KHS will also be interested in how you have arranged for hand disinfection (sanitiser dispensers, disposable towels) and possibly other personal protective equipment (gloves, masks, etc.). Do not forget about ventilation – the practice must have either a window or forced ventilation to ensure a supply of fresh air.

Operational Facilities:

The public health authority will examine where and how you will store clean and dirty laundry (e.g., clean sterile drapes vs. used laundry for washing), whether you have a place for disinfection and sterilisation of instruments, or where the steriliser/autoclave is located. Some smaller practices handle sterilisation contractually off-site – this is also possible, but you must state this in the operating rules and document how sterilisation will be ensured. It is also assessed whether there is a cleaning closet in the space or at least a designated place for storing cleaning supplies and a utility sink for pouring out dirty water.

The premises should have a connection to drinking water and hot water – i.e., a functional water supply and water heating; a connection to the sewerage system is also a necessity, of course. The electrical wiring must meet the requirements (electrical inspection, sufficient sockets for medical equipment, etc.). The heating of the practice should ensure thermal comfort for patients even in winter and at the same time not create a dusty environment. The KHS may also be interested in the lighting – the practice should have sufficient daylight or adequate artificial lighting that meets the standards for healthcare workplaces.

Safety and Infection Prevention:

The regional public health authority also checks whether processes are in place for regular cleaning, disinfection, and waste disposal. Part of the approval process is the aforementioned operating rules, where you must describe the frequency of cleaning, the disinfectants used, procedures for cleaning up biological contaminants, etc. Furthermore, the regional public health authority deals with circumstances such as washable wall paint, easy disinfection of surfaces (no cracks, carpets, or dust-catching curtains), and even the possibility of separate patient movement – for example, infectious patients should ideally not sit in the same room with others for a long time (in practice, this is solved by the order of appointments or separate rooms if space allows).

Although the KHS deals with the observance and documentation of hygiene procedures (keeping records of instrument sterilisation, regular cleaning, etc.) more during subsequent operational inspections, they may ask you how you will ensure these things during the approval process. Therefore, it is good to have everything thought out and set up from the start.

Of course, the requirements may vary depending on the specialisation and size of the practice – a dentist will have different equipment than a general practitioner, and for some specialisations (e.g., minor surgical procedures), additional rooms such as a treatment room may be necessary. In general, however, the practice should be designed to be clean, easy to maintain, functional, and safe. If the space you have in mind does not meet these criteria at first glance (e.g., it is a damp basement without windows, an apartment on the fifth floor without a lift, or a small office without the possibility of building a second toilet), it is better to keep looking. The KHS will most likely reject such a proposal.

The Most Common Mistakes When Choosing a Practice Premises

Let's now look at the most common mistakes that doctors make when choosing and setting up their first practice. Some may surprise you – and you may recognise yourself in them. The good news is that you can learn from others' mistakes in time.

1. Choosing a Space with an Inappropriate Occupancy Permit:

A common mistake is to rent premises that are registered as a residential unit or an office and assume that a practice can be operated in them without modifications. Every space has a designated approved use permit. If it was not approved as a healthcare facility (practice), you will face a change of use of the building – a process where you must prove to the building authority that you will modify the space to comply with all regulations for a practice (including a statement from the KHS).

For example, a regular apartment will not have two toilets or barrier-free access. An uninformed doctor may sign a lease agreement and only then find out that they have to invest in construction modifications and paperwork for a change of use approval. The solution? Ask the property owner in advance whether the space can be officially used as a practice, and if so, under what conditions. Ideally, choose premises already approved for healthcare purposes or those where the landlord anticipates modifications and a change of use.

2. Underestimating the Layout and Hygiene Facilities:

Many doctors get excited about the location or rent price and neglect to check the layout. Only later do they find out that, for example, a second toilet for staff is missing, or that the shared waiting room is not the right size. The absence of a washbasin in the office is also a common problem in spaces originally intended for an office – retrofitting water and waste pipes can be structurally demanding, if not impossible. Therefore, before signing a lease, always make sure that the layout at least allows for: an examination room large enough for the necessary equipment, a waiting room, a patient toilet, and facilities for staff.

If something is missing, find out if it can be built (e.g., a second toilet) and who will pay for it. The most common mistake is to rely on one shared toilet – however, hygiene regulations require separate sanitary facilities, unless it is a very small practice with a single employee and a special permit has been granted. Do not count on exceptions; rather, insist on full facilities.

3. Ignoring Accessibility and Access:

Today, emphasis is placed on making healthcare facilities accessible to disabled patients. Newly built practices should have barrier-free access, which means no stairs or at least a lift/ramp. If you rent a space on an upper floor without a lift, you potentially limit a portion of your patients (e.g., the elderly, less mobile). From a regulatory point of view, this may not completely prevent you from opening the practice (if it is an existing building and a lift is technically not feasible, the public health authority may tolerate it), but it is a minus in terms of reputation and operation. A common mistake is not to think about accessibility – until the first patient rings the bell downstairs because they cannot get up. Avoid this and look for spaces that everyone can access. A barrier-free toilet for patients in a general practitioner's office is not always mandatory, but if you have the option to have one, it is a big plus for patient comfort.

4. Unrealistic Timelines:

Another mistake is to think that you will open the practice "as soon as I find a space". The administration and modifications take more time than it seems. Approval of the operating rules by the KHS usually takes a month, and the procedure for obtaining a licence to provide health services at the regional authority takes another one to two months. Add to this the time for any construction modifications, equipping the practice with furniture and equipment, technical inspections, etc. A mistake many doctors make is to underestimate this preparatory phase – for example, to resign from their job with the idea that in a month they will be practising "on their own".

The reality is that from the moment you find the premises to the day you welcome your first patient, it can take four, but easily six or more months. Especially if the KHS finds deficiencies and requires them to be corrected, the process will be prolonged. Therefore: plan with a buffer and be prepared for the fact that the authorities have their deadlines.

5. Trying to Circumvent or Cheat the Rules:

Occasionally, there are those who think: "I'll just fudge this, the main thing is to open as soon as possible." For example, they do not install a second toilet and hope that the public health authority will overlook it, or they start practising before they have all the paperwork in order. This is a very risky approach.

The KHS is not usually lenient during inspections – if it finds that a practice is operating in non-compliant conditions, it can order immediate rectification, impose a penalty, and in extreme cases, even temporarily shut down the operation until the deficiencies are removed. So, taking risks does not pay off. Unfortunately, some doctors get burned – they invest in equipment, pay rent, but are not allowed to practice because they underestimated the formalities.

6. Lack of Professional Help:

Setting up a practice is a complex project involving construction modifications, legal issues, hygiene regulations, dealings with authorities, purchasing equipment, etc. It is a mistake to try to handle everything yourself without consulting experts. An architect or designer can help you design the space modifications to meet regulations (avoiding, for example, a blind corner where the public health authority might want a utility sink). A lawyer specialising in medical law can advise you on paperwork, contracts, and communication with authorities.And feel free to contact the KHS for a preliminary consultation – they often consult on practice plans in advance and will tell you what could be a problem. Many doctors do not take advantage of this and prefer to "shoot in the dark". The result can be a rejected application and a waste of time. So, do not be afraid to ask for advice; preventing problems is always easier than solving them.

Practical Advice for Choosing a Practice Premises

Now that we know what to avoid, let's summarise some practical tips to help you choose the right space for your future practice:

Make a list of requirements before you start looking. Ideally, create a checklist containing all the important items: minimum size of the office and waiting room, number of rooms (office, waiting room, storage, toilets), the need for a water supply in the office, the possibility of installing a second toilet, etc. Then, when you go to view a space, you can check off what it meets. This will save you from disappointment with a space that might otherwise seem attractive but would not meet one key condition.

Prioritise spaces already approved or used for healthcare. If you have a choice, choose a practice in a medical centre, polyclinic, or a building where a healthcare facility has already operated. You have a much higher chance that the layout and technical parameters will be suitable. In contrast, a "raw" space where a practice has never been can hide many obstacles. Sometimes it is also worth negotiating with colleagues – taking over a practice from a doctor who is retiring may mean everything is already approved, and you only need to handle the transfer.

If you are buying or taking over an existing practice, check the up-to-dateness of the operating rules and plan for their update if necessary (a change of doctor, new equipment, etc., require a change in the approval of the operating rules). It is not uncommon for legislation to have changed over the years and for current requirements to be stricter than those in the originally issued hygiene rules.

Check the connections and infrastructure. When inspecting the premises, find out: Where are the water and waste risers (for connecting washbasins)? Are there enough functional sockets in the space, and does the electrical installation meet the needs of the equipment? Do the heating and ventilation work? Is there a shared boiler room or a boiler for hot water in the building? How is the cleaning of common areas handled (if the waiting room is shared, who will clean and disinfect it)? These details will determine whether the operation will be smooth or a nightmare. For example, if you find that there is no water supply in the room at all and the nearest riser is a floor below, it means a major construction intervention. It is better to look for a space where these basic things are already sorted out.

Think about the future. If you are planning to expand the practice with another doctor or services (e.g., a blood collection room, ultrasound, etc.), choose a space with some reserve from the outset. It is better to rent a slightly larger practice than to find out in a few years that you do not fit and have to move elsewhere. At the same time, be aware of the surroundings – is there parking for patients? Will the neighbourhood (e.g., a noisy bar below you) disturb the operation? While the KHS does not primarily deal with these things, they are no less important for you and your patients.

Preliminary consultation with the public health authority. As already mentioned, there is nothing wrong with approaching the regional public health authority before submitting an application. You can present them with a plan of the space, describe how you want to arrange the practice, and ask for their opinion. This will save you the surprise of a rejection. The KHS can point out, for example: "A changing room would need to be added here" or "Be careful, you must have a washbasin in the waiting room if you put a toilet there." This way, you will know what you are getting into.

Do not skimp in the wrong places. We understand that the budget of a start-up practice is tight. Nevertheless, there are places where saving money does not pay off. For example, quality flooring and washable wall paints – it may be tempting to keep the older paint, but hygiene regulations are clear, and cleaning will be easier. Also, quality medical furniture (examination couch, worktops) with a certificate of washability and resistance to disinfectants is a better choice than domestic furniture. Realise that the KHS will also assess details such as the condition of the washbasin, the surface of the walls, and the like. If you equip the practice correctly from the start, you will avoid future problems during inspections and extend the life of the equipment.

Prepare your documents and be patient. Once you have the space, a round of permits awaits you. Draw up the operating rules (or have them prepared by an expert) in accordance with Decree 306/2012 Coll. and submit them to the KHS for approval. Prepare all the attachments – e.g., a site plan and description of the premises, documentation for the equipment (confirmation of their safety), contracts for the disposal of hazardous waste, etc., because the public health authority may want to look into these things as well.

After the operating rules are approved, submit an application to the regional authority for a licence to provide health services – you will document your professional competence, personnel provision, and, most importantly, the KHS decision on the approval of the operation. In the meantime, you can deal with contracts with insurance companies, liability insurance, and other formalities. Be patient – the authorities have their deadlines, and it is common for the entire process of establishing a practice to take several months. The important thing is not to forget anything; any addition of documents means a delay.

Consequences of Non-Approval of Premises and Why Not to Underestimate It

What happens if the KHS does not approve your premises? Ideally, the public health authority will give you a list of deficiencies to be rectified and a chance to correct them. However, this means an inevitable delay in opening the practice – for example, you may have to redo the floors, add a washbasin, or amend the operating rules and reapply. You lose time and, of course, money (the rent is running, but you cannot practice and earn). If you were to try to practice illegally without a licence, you risk immediate intervention by the authorities.

The KHS has the authority to order the closure of an establishment that does not meet hygiene conditions, and your actions would be classified as an administrative offence under the Public Health Protection Act. The penalties can be very substantial – according to Act No. 258/2000 Coll., fines for a healthcare provider range up to hundreds of thousands or even millions of Czech crowns, depending on the nature of the offence. For example, operating a healthcare facility in violation of hygiene regulations or without approved operating rules can result in a fine of up to CZK 1,000,000.

Another consequence is that without approval of the premises, you will not get contracts with health insurance companies. The regional authority will not issue you a licence to provide health services until you have everything in compliance with hygiene regulations.

Unapproved or non-compliant premises also mean an increased risk for patients. The hygiene rules are not there to bother doctors, but to protect the health of everyone involved. If, for example, you were to practice in an environment where it is not possible to properly sterilise instruments or where operations are mixed with infectious waste, you would be endangering patients and potentially facing lawsuits or other legal repercussions in the event of harm caused.

The summary is simple: do not underestimate the hygiene requirements or the "paperwork" with the KHS. Every crown and hour invested in the proper selection and preparation of the premises will pay you back in peace of mind and a smooth start to your practice. If you were to ignore hygiene standards, you risk delaying the opening of your practice by months, unnecessary expenses for remodelling, fines, and in the worst-case scenario, the closure of an already running practice until you rectify the situation. These are all scenarios that can be prevented with thorough preparation and cooperation with experts.

Final Recommendation

Opening your own practice is an exciting milestone in a doctor's career. However, to prevent the dream from turning into a nightmare, it is necessary to pay attention to the legal and hygienic aspects of the operation from the very beginning. If you proceed systematically – from selecting the right premises, through consultations with the public health authority, to carefully fulfilling all requirements – you do not have to fear the KHS approval process. View the public health authority as a partner who will help you set up your operation safely, rather than as a bureaucratic bogeyman.

If you are unsure, do not hesitate to contact professionals. Our Prague-based law firm has extensive experience with the agenda of establishing medical practices and we will be happy to advise you or help with communication with the authorities. Similarly, architects, designers, or specialised companies can ensure that your practice is compliant in all respects. An investment in expert advice pays off – you gain the certainty that no important detail will be missed, and you will be able to focus on what is essential, namely caring for your patients.

Finally, we wish you the best of luck in building your new practice. If you do not underestimate the hygiene requirements and have the right advisors by your side, a successful start without unnecessary complications awaits you. Your future patients and colleagues will certainly appreciate that you run a practice that is safe, professionally managed, and in compliance with all regulations. And you can sleep peacefully knowing that you have done your best to achieve it. Good luck!