Have you ever been seated in a large restaurant with your back to the space and your face to the wall? It doesn't feel great. That's why restaurants commonly have four person tables set against the wall with patrons on either side so that no one person is forced to have their back to the main body of the space. On the other hand, further to the center of this dining room are circular tables with patrons facing in all directions, and these are not at all problematic. Clearly, placement in a room matters.
The typical dental treatment room of 10 or 11 feet in length has the patient 3 or 4 feet from the outside wall when using a typical dental patient chair. Quite plainly, it's a very odd place to be sitting in a room and it's odd for other reasons as well.
Dental operatory with insufficient space for patient consultation
There are a few different options to greeting a patient this deep into a room. The doctor can shout an alert at entry - forcing the patient to try and turn around and greet the intruder. Or the doctor can sneak up on, and startle the patient ... or even worse, enter like Kramer in Seinfeld. None of these approaches is acceptable - which leads some doctors to have the new patient met in consultation - thus instituting a forever bottleneck to on time performance!
- First, the patient waits for you.
- Then, you get stuck chatting.
- Little pre-prep gets done because you don't have diagnostic data.
- And so then you have to go to treatment anyway!
So let’s go back to that treatment room geometry - and discuss another challenge it presents. Since the patient chair is centered in the room side-to-side, if the doctor hopes to converse with the patient in a seated (and thus more reassuring and coequal position) the conversation happens in a tiny corner of the room. Dentists get used to this, but think about it for a moment. You've never had this kind of meeting in a house or a normal office environment - jammed into a TINY corner. And so it just doesn't work well for healthy consultation. Quite frankly, it's weird. We as dentists are simply used to it. Patients aren't! Which is exactly why many doctors are used to moving patients to the “consult room” - which patients don’t actually like, and actually reduce consult effectiveness because the change of place causes a change in the patient's mental status.
The good news is that there are a couple of design solutions to this problem that are good methods of remediation in the right circumstance. Later I'll also get the chance to talk about a solution that will work in most treatment rooms that do not use over the patient handpieces. Remember, our goal here is to make treatment rooms comfortable to meet and greet patients.
Toe-entry dental operatory
The first alteration is to change the orientation of the entry door in relation to how the patient chair is oriented. There are two different choices. The first alternative is toe entry. Toe entry permits comfortable greeting between patient and staff and, when in the upright position, allows the patient to be closer to the entry door - but not feel so weird about it. It allows a normal face to face greeting. We'll talk about some disadvantages to this layout later.
Side-entry dental operatory
The second choice is to rotate the room 90° so the rooms can be entered from the side, generally near the toe. This also allows a more natural greeting. While both of these solutions permit a more comfortable interaction with the patient in the upright position, both do create other conflicts. The toe entry room places the patient in an awkward position when in the down state regarding privacy issues, and the rotated room consumes much more hallway length per room, often limiting the number of treatment rooms possible within a given space.
There is another solution that is fairly simple and generally requires a minimal amount of reconstruction or change. This involves the use of a so-called traversing dental chair. In a survey of recent dental graduates we were surprised to find that less than 1% of the students had any awareness of the existence of this chair variant. Thus, we assume that the majority of younger dentists may be unaware of this capability, also.
The traversing chair was actually pioneered over 40 years ago during the highly creative years of the Pelton & Crane company. Examples of the Pelton & Crane Chairman Chair are still in use today - often times having been rebuilt by their second or third generation owners because of their comfort and feature set. The chair was discontinued during the costly acquisition of Pelton by the Siemens corporation - a great failure for all involved and which led to the eventual demise of Pelton & Crane. The expense of potentially building the chair in Europe and then selling it through the dealer network was considered too costly.
What traversing chairs do is to slide front-to-back as the chair-top reclines, thus minimizing the change of position (front-to-back in the operatory) of the patient's head. What this does is subtle but significant. It allows the patient in the upright position to be seated much closer to the center of the room; a position that feels much more natural to them. This placement also creates easier access to the patient by staff members and the doctor in greeting, and allows much more room at the toe of the chair for staff to have initial conversations - face-to-face. When we are treating patients, we have to invade their personal space - it’s an unavoidable function of our usual working distance. But if we can start (and finish) our interactions with a more comfortable, conversational position, the patient will have a much better experience. And a comfortable patient is both easier to treat, and more receptive to discussing care.
As a result, offices that utilize one of these solutions in treatment room design and equipping find that they can much more successfully accommodate both in room consultation and in room check out.
If you have any questions about in-room checkout, case presentation, or room design for success, please reach out at any time to my team at Design Ergonomics.
