Please share advice on improving efficiency and organization

I work in the most disorganized and inefficient office ever. It seems no one is in charge and no one knows what they are doing. Our computer system is mostly to blame, but there is so much more to it than that. There are just so many little things that just add to the daily stress. For instance today, several adult patients decided to go outside to smoke instead of waiting in the lobby. This is an ongoing problem because when I go to the lobby to get the patient, it takes up a lot of time having to go find them outside, wait for them to take that one last drag of the cigarette, and then have to walk in the smog that follows them. To make things worse, today the patients who went outside to smoke left their unruly children in our lobby. They were so loud and rambunctous that our front desk staff had to call them down. I suggested the front desk staff let the practice manager handle the situation, but she was not in the office today. The site director was in meeting, so there was no one with any authority to do anything about it.

And another thing that bugs me is our lack of housekeeping. I think someone comes in during the night to empty trash and I hope they clean the toilets, but I see little evidence of anything else being done. The place is filthy. I've always worked in hospitals or nursing facilities with fulltime housekeeping, and I cannot get used to working in a struggling private practice that cannot afford good housekeeping services.

We see approximately 100 patients a day (2 doctors and 8 therapists) but we only have 2 people working medical records and 3 front desk staff.