By Design
Distributors’ experience, credibility are key to office construction and design projects.
John Flucke, D.D.S., had a big project in mind - ground-up construction of a freestanding building in suburban Kansas City, Mo. A self-titled "high-tech guy," Flucke says his building would have to accommodate digital dentistry, intraoral cameras, laser cavity removal systems, Cerec technology, satellite TVs, multimedia patient education and other features.
But life for a solo practitioner (who is currently seeking a second doctor) is busy, and time is limited. He knew he needed help. He turned to Goetze Dental for assistance. "I worked with Goetze from the very beginning, as far as even asking about my land acquisition," he says. "I also employed an architect and construction company, both of whom had worked with Goetze on previous construction projects.
"I had a good idea of how I wanted things laid out clinically, but that was from the operator’s point of view," he continues. "Obviously, there’s a lot that has to happen behind the scenes … to make those designs a reality. Goetze took what I wanted as an end product, and then designed their part of the delivery system to make it a reality. This entailed air, vacuum, cabinetry, sterilization, plumbing - and bringing all of those individual aspects together. Their expertise was invaluable."
Redesigning an office, or building a new one, is unfamiliar, anxiety-provoking ground for most dentists. They have many questions, such as, "How long will the job take?" "How can I incorporate future needs, including staffing and technology, into the design?" "For how long will this project disrupt my practice?" "How much will it cost?" "What if I make a huge mistake that comes back to haunt me in a year or two?"
Flucke’s story illustrates the vital role that dental distributors can play as their customers work through these issues. And while it’s true that design departments and equipment specialists may take center stage, the fact is, the retail rep is an important part of the picture too. "A lot has to do with their relationship with the doctor," says Inga Paul, senior interior designer, Goetze Dental. "The rep is a great bridge to bounce ideas off the doctor, because the doctor trusts him or her." And that rep provides a familiar face when the rep introduces the design specialist to the dentist and his or her staff.
Local knowledge
To be sure, manufacturers can play an important role in office construction and redesign. Midmark Corp.’s designers can do everything from cabinet drawings to complete office layouts, says Bill Zulauf, director of marketing, dental products. Dentists and their staff can travel to the company’s facility in Versailles, Ohio, to look at a 3D office plan and do a virtual walk-through.
That said, distributors with design departments, including Goetze, Henry Schein Dental and others, are in a unique position to help dentists with new construction or design projects, says Zulauf. "They know the local codes, and what the inspectors will be looking for. And they know the contractors in the area who can do dental offices." The distributor’s equipment specialist works with the dentist and staff as the project unfolds, meets with contractors, makes sure the plumbing is right, etc. The specialist knows what the dentist’s imaging options are, and what demands they will place on the design of the office.
The Henry Schein Dental Design Group has 14 design professionals on staff in West Allis, Wis., and several regional designers in other locations. "Our main intent is to design an ergonomic, efficient space and provide specific requirements for the dental equipment," says Jennifer Rhode, national design group manager. "Our design group works in tandem with manufacturers, contractors, architects and our Henry Schein equipment specialists, who assist in ordering the dental equipment, coordinating the installation, and providing onsite guidance to ensure proper placement of the equipment."
Meanwhile, Goetze’s goal is to "help the dentist continue to practice dentistry [during the project] and still have a fruitful experience designing the office," says Paul, who graduated from Kansas State University with a degree in interior design, and just celebrated her 10th year with the company. "We want to help them do what they do best - dentistry. And we do our part to make the office a success. We try to take away their job as general contractor, and keep the team together, so they don’t have to call 32 different people to get things done." Her work calls for some back-and-forth discussions with architects, to make sure the plans make sense from a dental perspective.
Misconceptions
Virtually every design team deals with misconceptions on the part of their dental customers about redesigns. "Probably the biggest thing is space," says Rhode, who was a dental-office designer for eight years before stepping into her current role at Henry Schein Dental two years ago. "Today, the rule of thumb is, 400 to 500 square feet per treatment room, including support areas," she says. Indeed, treatment rooms themselves must measure at least 10 feet by 11 feet or, better yet, 10 feet by 11 1/2 feet, she says.
A problem arises when dentists’ eyes become bigger than their stomachs, or, in this case, their square footage. "They might have 2,000 square feet and want eight operatories," says Rhode. In some areas of the country, where real estate is dear, they will have to make some tough choices. "What areas of the office will be smaller because of that?"
"Everything gets bigger and better," adds Paul. Lasers, computers and monitor-mounts eat up space in an operatory. "But there is such a thing as too big," she says. "The dentist’s world is where his or her arms can reach."
"It’s about ergonomics, and what can they reach [what they need] without straining and turning," adds Zulauf. Cabinetry manufacturers can help by offering a variety of storage configurations. "But it’s up to the dentist and staff - and usually, the staff knows better - to know what they need to use, and how frequently."
The Americans with Disabilities Act has placed its own demands on space. Dental practices must accommodate people with disabilities, and that usually calls for bigger hallways and bathrooms. "Some dentists still don’t understand why they can’t have a little powder room, like they have in their home," says Paul.
Adds Zulauf, "The most difficult situation is when the dentist goes to the architect first and designs the office from the outside in, rather than from the inside out. They should really think about how many people will work there; how many dentists, hygienists and others; and then build off that space."
Lack of foresight can affect the way the practice operates, he continues. "You can get your folks jammed into a little [sterilization] spot if you don’t think about how many people will work there or how many operatories you’ll have."
Another common misconception is the amount of time a project will take. "A lot of dentists think it will go a lot quicker than it does," says Paul. But any number of things can happen to slow down a project. "I get a lot of drawings from doctors who think, ‘This will fit,’" she says. "But they might not take into account [the Americans with Disabilities Act] or the placement of walls. They have a vision for this space, but it won’t work … Those conversations can get a little difficult."
Planning for the future
Regardless of whether the project is a redesign or totally new construction, the dentist and design teams must proceed with the future in mind. "The dentist has to plan for things that don’t exist," says Zulauf. For example, they might run extra-wide conduit simply in anticipation of future equipment needs. "There’s a lot of planning for the unknown."
Advances in imaging and IT have already changed the way offices are designed. For example, some practices have decided to go paperless, but they still want a file cabinet or two around during the transition, says Rhode. "This affects the design of the business office," she says.
Offices that have panoramic imaging units today but are considering a cone beam unit in the future need to do some planning, she adds. Cone beam units require more space than the panoramic units, because of radiation concerns. That’s why the conversion to cone beam might involve converting a large closet or consult room.
Needless to say, digital radiography has eliminated the need for a darkroom, says Paul. But it places new demands on the treatment room itself. Many rooms now have two monitors, one behind the patient’s head, for the use of the doctor and hygienist; and another in front of the patient, so the doctor can discuss - and illustrate - treatment options (as well as allow the patient to watch TV during treatment).
Nod to efficiency
Good design not only looks good, but it can facilitate efficiency and productivity in the office. That’s one reason designers are placing sterilization areas near the middle of the office instead of at one end or the other, says Zulauf. This way, people don’t have to walk from one end of the office to the other to attend to sterilization duties.
Adds Rhode, "We typically suggest a galley-style sterilization area," that is, one with a counter on one side for dirty items, another on the other side for clean. And she suggests designing two entrances, so that people aren’t walking over each other entering and exiting the area.
Paul recommends placing the sterilization area - as well as the lab and panoramic unit - in a central area, to save on time and steps. She also recommends segregating, if possible, the public area of the office - e.g., reception area, operatories, consultation room - from the "staff-only" area. "This way, if team members need to sit down or make a phone call, they’re not in the middle of patients walking around," says Paul. In addition, well-thought-out offices can reduce the interruptions dentists face from chatty patients. "Dentists want to be in the mix, but being a little bit off the beaten path will serve them better," she says.
Another nod toward efficiency in today’s office is the multipurpose operatory, as opposed to dentist-only and hygienist-only rooms. The reason, in a word, is flexibility. This way, if the hygienist discovers a problem that must be treated by the dentist, the dentist can pop in and take care of it, instead of asking the patient to move to another room or come back for a second visit. "They don’t want to inconvenience their patients," says Zulauf.
Rhode advocates a similar approach, but adds that when possible, offices should include an overflow room, so that patients aren’t left sitting in the waiting room an inordinate length of time.
Image-building
Speaking of waiting rooms, it’s there that the dental experience begins - for better or worse. A redesign project allows the dentist to make a good first impression. "You’re seeing more things upfront," says Rhode. "When you walk into the office, you want it to look soft, so there’s soothing lighting, maybe a waterfall. We’re seeing coffee stations, Internet stations, things to keep people occupied."
The "soft" look should extend through the hallways to the treatment rooms, she says. That might mean wall sconces in the hallway.
But every designer knows that lighting is a personal decision, adds Paul. "You can suggest wall sconces to one dentist, and he or she thinks it’s great," she says. "But another person is more traditional and wants all lighting on the ceiling. I try to give them a couple of suggestions, but I find that too many suggestions muddle things."
There’s a bit of public relations in office design. That’s why there is something to be said for placing high-tech equipment in highly visible areas. "Patients now ‘expect’ state-of-the-art care," says Flucke. "They are better informed than ever before, thanks to the Internet, and they are seeking practices that meet their needs."
"Patients have a tendency to go to the office that has new technology," says Rhode. They want to see computers, large-screen plasma TVs in the operatories, and maybe even a high-tech milling machine.
It doesn’t hurt to showcase sterilization equipment either, adds Paul. "Practices want their patients to know they’re taking the steps necessary to keep their instruments sterile and to maintain a healthy office."
In addition to all the other factors, dentists need to keep in mind their staff during the whole process. "I always put a lounge in my plans, unless I am specifically asked not to," says Paul. Such lounges provide a place for the staff to congregate, leave their personal belongings and eat lunch. In its own way, it can help keep things running smoothly, because the staff doesn’t always have to eat out at lunch. "If you keep your team happy, everything runs smoother," she says.
"Most doctors only want to go through this process once in their careers," says Flucke, referring to new construction. "It definitely pays to have someone who does this process multiple times a year to offer guidance and advice."
That’s where a distributor can help.
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