What you need to know to enhance the patient experience and improve the workflow at your office.
A fire crackles in the stone fireplace. The large windows facing the trees that surround the building allow the waning natural light to fall across the cozy seating arranged around the hearth. Someone offers you coffee, tea or water and a magazine while you wait. You settle in and wait for them to call you in for your appointment.
You may think you’re at a spa, but surprisingly, you’re at the dentist’s office. The confusion between the two waiting rooms is no accident: Many dental professionals are designing their practices to encourage a more comfortable atmosphere for patients.
The waiting area is a significant concern for practice design. However, many additional areas are crucial to think about as well. We spoke to a few different experts in the field about what to consider when designing or revamping your dental practice Here’s what they had to say.
1. Why do you want to redesign?
Matthew McLaughlin, territory manager for Midmark, believes the first area a dental professional must consider is why he or she wants to either design a new practice or revamp an existing one. Whether you do a minor remodel or a ground-up build, know that it’s a significant commitment of resources.
“Are you trying to make more money? Are you stressed out because it is inefficient? Are you growing and booked out so far that you can’t see patients fast enough?
Why you are trying to build a new office and what you are trying to accomplish with the new office is the most important thing to start with,” McLaughlin says.
Ciarán Hynes, director of dental furniture product management at A-dec, believes the dental practice design should reflect the personality of the dentist.
Considering how much time the doctor will spend in the practice, he or she will most likely want to include aspects of their personal interests. This translates back into practice design with types of furnishings, equipment and décor.
“It’s really about the primary practitioner and the image they want to portray of themselves, both as a healthcare provider and an individual, by expressing their unique interests and personality. The building décor should reflect their personality, including hobbies and interests, particularly those that may stimulate conversations, reduce patient anxiety and, for the dentist, make them feel they are at home,” Hynes says.
Dr. Jennifer Sanders is a private practice dentist serving families in rural Montana. She’s preparing to start a ground-up build, and she knows why she wants to build a new practice. “We are in a 900-square-foot building that is old and sometimes the basement floods,” she says.
Since the building has too many problems, Dr. Sanders bought the empty lot across the parking lot from her current practice to build a new one. The plan is for the new practice to go in on the other side of the parking lot so that she can stay open during construction.
Dr. Sanders also wants more space for her growing practice. “Right now, we have three operatories. I want to build out with more space with potential for about eight to 10, but we will probably only finish five to begin with,” she says.
2. Where should your practice be located?
McLaughlin says that location is another early and significant consideration. However, many dentists aren’t prepared for all the details that go into selecting the best location for a practice and instead make decisions based on less critical factors.
“Many dentists make the mistake of chasing the most popular areas without considering saturation and demographics. Or they purchase a piece of property that they love the look of without realizing they could never build the correct size building with the necessary parking on it. There are many considerations for location, such as visibility, accessibility, light exposure, etc.” he says.
The NYU College of Dentistry recommends in its online publication “Starting Your Dental Practice”1 that dentists consider several factors for their practice location, including:
1. Personal preference: Explore the area to ensure that it’s a place you want live, work and worship. Consider whether it has the right elements for the life you picture for yourself and your family.
2. Economic potential: The primary consideration with economic potential is whether the community needs another dentist. Many factors help you determine whether the area can support another dentist, from the local economy to the age of established dentists in the area to the employment potential of residents, and even the vacancy rates for the local real estate.
3. Professional desirability: This area addresses whether the surrounding dental community fits with your practice philosophy. From licensing to staff availability to patient care values, the city should be a good fit for your practice goals.
McLaughlin recommends that dental professionals attend a design seminar to help guide them through the process.
“A lot of companies like Midmark host seminars dozens of times a year. It’s only 24 hours of your time and if you are going to invest this much money and energy in the project, and you are going to live with it for 10, 15, 20 years, why not invest 24 hours up front in learning everything from site selection to wall colors?” he asks.
3. How much space do you need?
The number of treatment rooms, patient accommodations, staff amenities, space limitations and cost per square foot are all vital considerations when deciding how much space your practice will require. Jennifer Rhode, Integrated Design Studio manager for Henry Schein, says the number of treatment rooms dictates the square footage of the practice to a certain extent. Integrated Design Studio budgets around 400-500 square feet per treatment room. So in a practice that wants four operatories, she and her team recommend a dentist have at least a 1,600- to 2,000-square-foot space. As square footage increases (3,000 plus), the overall square footage requirement decreases.
Up next: Organizing the practice workflow
4. How do you want to organize your practice workflow?
Dr. Sanders is still designing her new practice. One of the things that surprised her in the process was how detailed the workflow considerations are in dental office design.
“We have been trying to figure out how to design the office to have a better flow and ergonomics,” she says. “Things like how we go out of the operatory and into the sterilization area and the flow that way or making sure we are not double-stocking things. In the overhead, how much stock should we keep? Also trying to minimize the time the assistants spend running all around the building. It’s little things that I hadn’t thought about that can make a big difference,” she says.
Other experts agree, each with his or her own suggestions on how to improve workflows in the design for dental practices.
Hynes and the team at A-dec work to ensure the dental team’s productivity is maximized, such as with streamlining instrument replenishment with pass-through furniture. The staff can replenish tubs and trays from outside the treatment room through a pass-through cabinet without interrupting procedures going on inside the room. Once inside the room, they have additional innovations to boost productivity both during procedures and in between patients. For instance, trash, sharps disposal and surface disinfection wipes are on one side of the operatory while new barriers and supplies come from other areas.
“We design our furniture around the work being performed,” Hynes explains. “When turning over a treatment room between patients, we want to minimize waste of motion. We dedicate a cabinet to barrier dispensing to ensure the person resetting the room is not searching for different covers and barriers in different locations. Not only is it easier for them to perform the task, it saves time, which can quickly add up.”
Rhode categorizes the practice space into three zones: patient, treatment and private zones. The zone approach allows for staff efficiency and positive patient experiences. The patient zone is located in the front of the space and will include reception, consultation, imaging and restroom facilities. That zone is followed by the treatment zone, which includes the core functions of the practice.
Last is the private zone, which includes the staff areas, mechanicals and offices. “We recommend tucking these spaces away from the main patient spaces to provide added privacy to staff areas, but they can also be easily accessed,” she says.
McLaughlin believes a natural progression with one harmonious design is key to an efficient workflow.
“The whole thing has to work together. It is a holistic thing,” McLaughlin says. “The entire office has to be designed so they get greeted, they get seated and they get treated without ever hitting a bottleneck.”
5. Is it comfortable to work in?
Improving ergonomics is essential to the longevity of dental professionals’ careers. According to dentalcare.com2, sitting is the best position for clinical procedures and choosing the best equipment that facilitates proper posture is vital. From the patient’s chair to the dentist’s and assistant’s stools to the cabinetry, ergonomics in the office design is a crucial consideration.
Hynes feels that dental professionals spend all day “twisting and turning” around patients. “As healthcare professionals, rather than make their patients uncomfortable during procedures, they will often contort themselves for eight or more hours a day. Of course, that doesn’t work long-term” he says.
Drawing a parallel with an aircraft flight deck, Hynes likes to stage consumable supplies, instruments and devices within a Class 3 or Class 4 reach for the team. This ensures they’re not reaching high or low to access frequently used consumables and instruments and never leaving their stool to fetch instruments, supplies or devices from other parts of the building. “Not only does it help the procedures go much more smoothly, but at the end of the day they are less likely to be going home with back pain, headaches or tension,” Hynes explains.
Rhode says when she and her team talk about ergonomics, it comes down to the placement of the doctor’s instrumentation and proper placement of equipment within the room. Whether it’s a younger dentist who wants to develop good habits early on or an established dentist who wants to modify his or her habits to decrease spinal and musculature fatigue experienced throughout the years, helping them understand how they approach dentistry and the oral cavity is a significant factor in designing the treatment space.
“It’s different for everybody, but it’s very important to think about where they are bringing their instrumentation from and how they are going to work and, of course, be aware of how their body is positioned when working on the oral cavity,” Rhode says.
For example, at a recent sales meeting, Rhode watched a demo from a manufacturer showing the pivot of their headrest. By making a minor change, the dentist’s ergonomics improved in a significant way.
“They were able to treat the patient in a much more upright position. It was very interesting to see how making this little adjustment improved their positioning,” Rhode says.
Rhode adds that it’s also important to make sure that the support systems are appropriately located. “When sizing a treatment room, it’s important to consider equipment requirements, placement and overall function of the space to ensure proper ergonomics, accessible clearances and adjacencies,” she explains.
From an operatory design layout, it’s ergonomics first, McLaughlin says. Where is the doctor working? Where is he or she sitting? What is he or she using? He and his team design the space so that the doctor can stay in an excellent ergonomic seated position and access anything without standing up bending down or turning a shoulder.
“You are spending hundreds of thousands of dollars and thousands of hours to perfect your craft and become a clinician and then put your body into positions that could end your career. You have invested so much time and energy, it doesn’t make sense to let your body break down due to poor quality equipment or design,” McLaughlin says.
McLaughlin extends the same concern about ergonomics to the entire team so that team members can access instrumentation or any support materials necessary without movements that are going to cause problems. He also considers how the patient and staff are getting in and out of the operatory.
There are many ways to arrange the treatment room and options for how the equipment can be mounted to facilitate these goals. McLaughlin encourages doctors to come into a showroom to see examples and invest in their long-term wellness.
“It doesn’t do you any good if you save $50,000 on your office design and lose five years of working,” McLaughlin says. “It’s not a good trade-off.”
Up next: Creating a centralized location for infection control
6. Do you have a centralized location for infection control?
Sterilization centers are a crucial part of the dental practice. Not only do they facilitate infection control but they also increase efficiency for instrument reprocessing and room turnover. Our experts all emphasize the significance of the location and layout of the sterilization center for dental office design.
Rhode and her team seek to streamline function in the sterilization center with a dirty to clean linear flow. They also avoid doors in this working space. However, the way they position the entrance and exit of the sterilization room depends on the location of it.
“If there are treatment rooms on both sides of the space, then we have sterile in between and access to both hallways. Sometimes we have treatment rooms in an L-shape, so we want access to both hallways there too,” she explains.
Regardless of the layout of the room, Rhode says she likes to have the sterilization center no more than 30 feet from a treatment room, so team members don’t have far to travel to get to it. She also likes separation between the sterilization room and the lab. Labs are dustier, noisier, dirtier and not suitable for sharing space with sterilization, Rhode says. She likes to tuck the lab off the beaten path and put a door on it. “It’s not an area you are showcasing,” she explains.
McLaughlin likes the sterilization area to flow well to facilitate efficiency and productivity. “If you can turn a room over in half the time, then you can see another patient quicker,” he says.
Sterilization is a bottleneck in many practices, causing some dentists to have up to 50 percent more instruments than needed. “They can’t get their instruments through sterilization fast enough because the room is poorly designed, so they are buying more instruments and instruments aren’t cheap,” McLaughlin explains.
McLaughlin says many times this occurs because dentists try to fit instrument processing into an area that wasn’t designed for it. He would like to see dentists develop the sterilization center from the ground up rather than forcing it into an area as an afterthought.
Hynes emphasizes the importance of choosing appropriate surface materials for the sterilization center. Traditional, contractor-built cabinets made from residential-grade materials will not last with the steam, splashing water and chemicals that are present in the instrument reprocessing flow.
“Materials have to be appropriate for the aggressive nature of sterilization processes and equipment. We don’t want the surfaces to deteriorate in these areas when exposed to splashing and steam. Industrial-grade cabinet materials, including powder-coated metal sub bases and non-porous countertops, are essential,” he says.
With the emphasis on infection control in today’s dental environment, dentists want to display their sterilization centers for patients. However, when designed with inappropriate materials that won’t hold up over time, it can make a poor impression.
“As consumers are becoming more informed and are more frequently asking to see the sterilization area prior to signing up as a patient, the importance of choosing an industrial-grade manufactured sterilization center is essential,” Hynes explains. “Not only does it need to maintain its functional integrity, it must also maintain its visual design integrity for the life of the practice.”
7. How will your practice deliver an exemplary patient and employee experience?
Patient experience is a term bandied about with more frequency in the dental industry. While most doctors are concerned with the quality of patient care first, they’re not always aware of how they make patients feel when they deliver that care. How patients feel about their experience, however, is more critical than many doctors may think.
Colin Shaw founded Beyond Philosophy, a global customer experience consultancy company. While he works with many industries worldwide, ranging from insurance to mobile phones to international shipping, he has also consulted in the healthcare industry on patient experience.
“A customer experience has differences from patient experience, to be sure, but for what dental office design has to do with patient experience, our regular customer experience definition applies,” he explains.
Shaw defines a patient experience this way:
“A patient experience is an interaction between an organization and a patient as perceived through a patient’s conscious and subconscious mind. It is a blend of an organization’s rational performance, the senses stimulated, and emotions evoked and intuitively measured against the patient’s expectations across all moments of contact.”
Shaw explains that a patient’s subconscious is partially responsible for what he calls the emotional part of any experience, what he refers to also as the irrational side. There are conscious emotions too and they play into how patients feel as well. So how things look, sound, smell, taste and feel are all bits of information the subconscious mind is processing. The information is then subject to the patient’s interpretation and related emotional response.
For example, if the patient hears a handpiece whirring away in an operatory, it can trigger an emotional response, usually discomfort or anxiety. Also, if the waiting room looks shabby or the magazines are all torn and old, it sends a signal of neglect and lack of concern for esthetics, which can have negative implications to the patient experience as well.
“On the flip side of that, however, a warm, comfortable setting that resembles a spa or a living room triggers a different emotional response,” Shaw says. “It gives patients a different set of emotions to draw from, which reflect favorably on their experience at the practice.”
Hynes and his team work to minimize patient anxiety. “When entering the treatment room, we want the patient to see a professional and calming space. We design our furniture to conceal devices that may add to their anxiety.
Once supine and perhaps engaged in entertainment, we want to unfold behind them the instrumentation, consumables and devices out of their line of sight,” he says.
To improve patient perception of the practice, Rhode encourages dental professionals to showcase their technology. Her team likes to use glass panels instead of walls to give patients a look at the CAD/CAM setup or newly refurbished steri-center.
“Infection control has been very big in the news and it’s something the patients think about, so showcasing that area is really important,” Rhode says.
McLaughlin says much of the patient experience is driven by interaction at the front of the office. He encourages his clients to have a closed space for the business manager for consultations or collections so that check in and check out are separate.
“No one wants to be walking up and trying to sign in for his or her hygiene cleaning and have to hear a conversation about someone’s outstanding bill and vice versa,” he says.
The waiting area is the patient’s first experience with the brand, so he also wants dentists to “secret-shop” themselves. “Walk in the front door from time to time and take an honest look around to see if you were a patient what would your thoughts on that brand be,” he says.
Another area to consider is the employee experience. Do your staff members have a place to be when they aren’t with patients? Is there an area for the team to take a break? In Dr. Sanders’ small space, the practice doesn’t have a doctor’s office or breakroom. When the staff finishes with patients, her team leaves because they don’t have any place to sit down. She intends to add a break room, a laundry area, a meeting space and maybe even a bathroom with a shower.
“Those little extra touches go a long way to make it a little more comfortable for everyone to be there,” she says.
1. “Starting Your Dental Practice: A Complete Guide.” New York University College of Dentistry nyu.edu. pg. 32-34. From Pdf: Web. 1 August 2018. http://www.nyu.edu/dental/careers/stud ents/startingyourdentalpractice/chapter4.pdf.
2. “Ergonomics: Working to be more comfortable.” www.dentalcare.com. Web. 2 August 2018. https://www.dentalcare.com/en-us/professional-education/ce-courses/ce508/ergonomics.