Ten Essential Elements of a Productive Dental Office Treatment Room

Think your space is productive? Think again; it probably isn't.

Let's face it. Productivity in most dental practices is not very impressive. We may work hard, but we don't get that much done. Heresy, you say! Let's think about it for a minute; a car factory can produce an economy car for $10,000 using hundreds of vendors, thousands of products, and years of planning, and they still can be profitable.

For $10K, what can we do? Make a small handful of crowns? How many computer chips get made in a clean room in an hour? And to think that we complained about masks and gloves slowing us down! I hope to bring to your attention both a handful of broad, basic concepts that relate to productivity and a great number of little, often overlooked items that will make your daily practice more pleasant, productive, and profitable. We'll address many elements of office design as they relate to performance, as well as technology and even scheduling.

With this article, I would like to destroy some preconceptions, and outline some opportunities that will benefit you. Dental office design is all too often overlooked as a source for true productivity improvement. We may think in terms of extra space - perhaps extra operatories - but often, we go ahead and build what is essentially an enlarged version of our last office. That makes no sense.

So what is wrong with the old office? First, your waiting room probably is too large and you don't have enough treatment rooms. What'd you say? My waiting room is packed! Sometimes people have to stand. Our studies have shown that the problem isn't the reception area - it's the lack of efficient treatment space. We all tend to think as if we're still in our dental school cubicles. We're imprinted like baby ducks on their mothers or, more accurately, like hostages to their captors. (Dental school may have taught us an inefficient way to practice but, by George, we're going to suffer for life doing things this way!)

We hated the torment that we received in our cubicles, but then we go buy the same type of setup in our practices, surrounding ourselves with all of our stuff in one favorite room and trying to do certain procedures in specific rooms. Hopefully, you will be encouraged to stop thinking of treatment rooms as complicated, cluttered, technology-crammed spaces. What, you say, take away my technology? Absolutely not! Let's liberate it instead.

1. Cost

Your new operatory shouldn't cost a king's ransom. There is little correlation between total operatory cost and practice productivity. What works in some practice environments may be entirely inappropriate for a different type of practice. Further, your operatory cost is far more than the sum of the equipment purchase costs. To be successful, you must look at total installed cost, which includes the room configuration (plumbing, etc.), plus the installer's expenses and long-term maintenance, in addition to the simple cost of equipment. Careful planning, which minimizes plumbing, electrical, and cabinet expenses, can reduce your costs considerably. Saving money here allows you to make needed improvements to other areas of the practice.

2. Ease of Use

Before all else, your new room must be easy to practice in, day in and day out, patient after patient. Simple, inexpensive choices made in the planning stages will have an enormous impact, saving hundreds of staff hours yearly and freeing your office for more productive activities. Plan your space by considering how you will most rapidly reintroduce sterilized equipment, how you will handle lab cases, and how you will deal with patient records. Build into your system a management plan for all of your practice technologies.

3. All Essential Supplies Must Be Within Fingertip Reach

This simple principle is often overlooked because it is not part of the thought process involved in the purchase of new operatory equipment. Carefully consider how you will rapidly restock every consumable item. Focus on items (such as gloves and cotton goods) with the highest turnover rates and give them priority. Make sure that small, frequently misplaced items like posts can be easily located and put into service. These decisions should be made before your equipment purchase. Your equipment should support your way of doing things, not force you to work around your new purchase. (Figure 1)

FIGURE 1: All supplies should be consolidated within a 90-degree angle reach of your assistant.

4. Make Your New Room Universal

The operatory should be useful for all of the office's primary purposes. Often, doctors will have a tendency to design their new space around the doctor's side. This is understandable because the doctor is researching the purchase (and paying for it!). The unfortunate result is a room that functions only when both doctor and assistant are present. Your new operatory should work well in both two- and four-handed practice. A room that functions well in two- and four-handed use will allow full access to supplies from a single operator's seated position. It will convert from two- to four-handed use in seconds. This important capability also greatly enhances assistant performance when working solo. (Figures 2a and 2b)

FIGURES 2A and 2B: Design should allow for quick conversion from two-handed to four-handed dentistry.

Your new room should also permit right and left-hand use whenever possible. Do not lose the opportunity to employ a talented prospect due to your office's lack of opposite hand-delivery capabilities.

5. Easy for Your Staff to Work with

Learning how to work in a strange dental environment can be a daunting challenge for new employees. As the labor pool shrinks, it becomes increasingly important to create an easy plan for dental delivery. Tedious memorization must be kept to a minimum. Coordinate your stocking plan with your sterilization and resupply protocol. This is an excellent time to upgrade your entire instrument and supply deployment system. If you have not converted to a tub and cassette system of delivery, this would be an appropriate time to do so. Cassettes greatly reduce instrument handling and related errors, while simultaneously creating a simple system for new employees. This method hastens setup and room turnaround, and you will need less equipment to get the job done. In our next article, we will discuss the next five critical elements: creating a compact operatory, planning for the future, allowing free access, making it easy to re-equip, and not scaring the patient.

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6. Create a Compact Operatory

There are many functional possibilities for a successful design of an operatory. Before creating a physical layout, your first objective is to be able to recognize the difference between clear and concise and chaos and clutter. Bigger is not better. A treatment room overstuffed with low-use equipment is not the goal. Consider how you will use all three room dimensions as you decide upon the overall layout. A compact plan is not only more efficient, it is also more easily worked into your office space, possibly even allowing for additional treatment rooms. (Figures 1A, 1B).

FIGURES 1A, 1B: Two examples of compact, yet highly functional layouts.

7. Plan for the Future

New technologies are a fact of life. They represent great opportunities. Yet, technology often is poorly utilized because the overall office system actually gets in the way of the new capability. Your operatory must make the deployment of new technology effortless. You must have clear egress for mobile units. Cable clutter cannot be tolerated, and bulky equipment should be avoided. You can't always know what your future will include, but you can leave room for it.

8. Allow Free Access

Balancing the need for privacy and access is never easy. A contemporary design must simultaneously respect the patient's unequivocal desire for privacy while allowing the workers convenient access in and out of the treatment environment. Some offices are more willing than others to err on one side or the other of this equation. Some offices use cabinets as room dividers, which are acoustically and even visually porous. This method of division takes up needed space and costs more - don't do it. Offices at the other extreme create treatment rooms with a single entrance door. These alternatives have merit in selected situations - a surgical suite, for example. A private operatory with dual access, though, allows freer range for both doctor and assistant. One type of treatment room often should be different (Figure 2). Contrary to popular wisdom, we will recommend that a general practice apportion 25 to 35 percent of their operatory space to dedicated, single-door hygiene rooms. This design can often be tightly integrated with the doctor rooms. (Figure 2).

FIGURE 2: A doctor treatment room is adjacent to a hygiene treatment room.

9. Easy Re-Equipping

Now that you have designed a productive, ergonomically sound, easy to use, and compact treatment room, don't forget the necessity to disinfect and reset rapidly. Avoid busy equipment with brackets and edges that are difficult to clean. Also avoid plans that make use of extensive cabinetry. Every item of equipment and cabinetry that you purchase is a potential source of contamination that must be permanently maintained. Given this fact, the cost of the equipment that you may have or will purchase for this room pales in comparison to the cost of its care and cleaning (Figures 3A, 3B). Consider this carefully. If you discover that cabinetry is difficult to maintain and is not essential to production, do not hesitate to rid your office of it.

FIGURES 3A, 3B: This area (top, left) is cluttered, is not functional, and features hard-to-clean side cabinetry, as opposed to easily disinfected surfaces (top, right).

FIGURES 4A, 4B: Handpieces are thrust into the face of the patient in the illustration (bottom left), while the patient waits in a compact yet uncluttered environment (bottom right).

10. Don't Scare the Patient

Last, but certainly not least, please remember your patient. With so many ways to outfit an operatory, why choose a layout that places drills and pointy explorers in the patient's face? Since the actual use of handpieces occurs during only 7 to 10 percent of a patient's visit, you might consider this in the overall plan. What are your overall practice objectives? Referrals? Patients that choose elective treatment and volunteer for additional services? Relaxed patients? If those are primary objectives, then you must seriously consider slight modifications in your handpiece placement. If your office is a fee-for-service, independent practice, it is a small concession to make in order to realize your objectives (Figures 4A, 4B).

In summary, the operatory is our place of refuge, the soul of the dental practice, and the engine of its productivity. Careful planning will allow you to exceed your expectations for the practice's quality and productivity while enhancing the practitioners' health and well-being. The plans do not need to be large or expensive in order to reward you with great success.

The preceding is a reprint of an article that was featured in "Dental Economics" titled, "Ten Essential Elements of a Productive Treatment Room" by Dr. David J. Ahearn. All Rights Reserved.

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