Sterilization is a money maker! Behind the design @ smilecraft.
Space, efficiency, ergonomics, and patient experience. It all starts with intelligent design.
Intelligent design is the foundation for a successful project. Often times I see projects with plans and layouts that set the project in motion without optimizing space, work flow, or aesthetics. Many in the industry are content with how they have always done things and miss opportunities to improve the patient experience, profitability, and overall flow in an office.
The operatory layout strategy is key from the start. There are essentially 3 main ways to layout the operatories in your practice:
Operatory layouts (in order top to bottom) Single Entry, Dual Entry, Open Bay.
As you can see above this layout decision should be carefully considered to align with the goals of the practice and experience your looking to create for your and your patients. Forget about how you have worked in the past, that is the past and your new future shouldn't be built looking backwards.
Lets take a look at single entry design for its strengths and weaknesses:
Single Entry
# of operatories - In a 65' span with single entry your able to fit an additional operatory into the layout. In larger offices I've seen the ability to add 2 or 3 more operatories into the same space without making them too small and cramped. This is a major advantage for single entry and the future production potential of the office.
Operatory Space - In this example we have lots of usable and open space to give the Dr. and assistant plenty of space to work and walk around the head of the chair. There is 4' of clear space on the Dr. side for free movement and an open feeling. Many other designs don't account for working from 12 o'clock positions at all. The 12 o'clock position is critical for ergonomic treatment on the palatal of the upper jaw with mirror, and the lower jaw with direct vision.
There is also space for patient items and guests as shown in the photos below.
Patient shelf and hook for coats, keys, coffee etc... (See arrow on right side fo image)
Guest chair for family members (See arrow on right side of image)
Sound -The single entry design provides much better sound isolation especially when using suction or handpieces. patients in adjacent operatories cannot hear conversation, or patients talking about health history and other private matters. In the audio file below you can hear suction and some quiet conversation from 3 operatories away. at :20 you hear the door close and the suction along with voices is nearly eliminated making a much more relaxing atmosphere. Notice how the music is no longer muddled with the voice and suction sounds with the door closed.
Privacy - Single entry provides a quiet private space thats safe for patients to talk about health history, relax, or watch Netflix while they wait for the Dr.
Not only will the patients appreciate their privacy the entire team will appreciate the lack of noise pollution and gone are the days of cranking the music to try and drown out clinical sounds and HIPPA regulated conversations.
New technologies and 21st century call systems allow for assistants to stay in the room assisting instead of running out to get supplies etc. The rear cabinet provides and ergonomic access to all the supplies without have to turn around to a side cabinet.
Myth - With traditional non integrated equipment single entry will lead to cords, cable, and clutter trapping the dental assistant. As you can see from the overhead view when advanced equipment allows for full integration design possibilities are different.
Sound pollution can ruin dental patient experience!
Sound is one of the most overlooked aspects of the patient and dental team experience in any dental office. Did you consider this in your new office? I hope so because its hard to fix after the fact.
For years offices have been designed wide open where sound bounces around the entire "open bay" production area. Patients hear:
- suction
- drilling
- patients vomiting (yes I have heard this a few times)
- patents checking out discussing finances
- unhappy patients
- care calls
- patients being scheduled
- Dr's selling treatment to other patients
- children crying (and adults too)
Acoustic design and single entry design with doors can make a world of difference when it comes to patient experience.
Below is a recording from an actual dental office 3 operatories down from where the dentistry is happening. I was recording from inside an operatory with a door open. Then the door is closed at :20 and the stress goes down, music is actually audible instead of mixing in with the suction, drilling, chatting, etc....
Why minimalist design should be incorporated in every dental office. Hint: It’s science!
A study conducted by UCLA concluded that people exposed to cluttered spaces actually have higher levels of the stress hormone cortisol(a). Cortisol disrupts nearly the entire body and negatively impacts heart health and the immune system to name a few according to a research paper conducted at Dartmouth college(b).
Why then are we still designing cluttered cord and swing arm happy offices? Unfortunately, traditional design has not advanced in the last 20 years since the arrival of the IO cam, digital sensors, apex locators, and all the other table top corded equipment that now inhabits your operatories, cords and all.
If you don’t believe this go into your treatment room and look around 360 degrees. I bet you see:
- “Clean” glove boxes on the wall or cabinet
- Swing arms with many cords, monitors, overhead lights etc
- Bottles of soap and sanitizer on the counter/wall
- Delivery tubing for the Dr and assistant dangling on or above the floor
- Table top equipment with cords galore
- More cords
Operatory with typical clutter resulting from rear delivery and technology not fully integrated
You get the idea. This clutter is very difficult to clean and the mess screams DIRTY to the patients, not to mention it raises the cortisol levels of your team, patients, and Dr’s.
The secret to avoiding this is planning cabinetry and technology integration. These types of operatories can eliminate the mess increase production and efficiency thus rebranding your practice to one that is crisp, clean, and state of the art:
Tip #1 - 3 monitors
Utilizing 3 monitors allows each one to perform a specific function. The rear monitor(1) is for non-patient facing software e.g. scheduling, and charting software. The chair mounted monitor(3) is for patient communication and in-procedure Dr assistance to show X-rays, 3D etc... Finally the ceiling mounted monitor(2) allows for patient entertainment during the procedure.
Operatory with 3 dedicated monitors
Actual yelp review from patient
Tip #2 - Tubs, Casettes, and organized storage
Not only is it inefficient and costly to stock and store inventory in your operatories it clutters things up, slows down procedure changes, and operatory turn overs. An organized storage and tub preparation area can greatly enhance the clean organized feel.
Tub and cassette ready for the procedure with organized Componera rear hub by Kappler
Kappler SOS Consumable Storage Center
Tip #3 - Use a neutral base design and texture
White is as timeless as it gets. When I was a child I had a white shirt and still today I have a white shirt. White is clean crisp and inspires a sense of calm. White is timeless. This doesn’t mean create a sterile operating room feel. In fact just the opposite.
Utilizing different textures and natural materials in similar tones will avoid the cold or bland feel of 100% white or gray.
Avoid choosing dental equipment and cabinetry with speckles, patterns, fake wood, and colors that are not neutral. I often see offices with pink or green cabinets, fake wood all around, and speckles on every surface. Those are not timeless and they are expensive to replace which is why so many offices are just living with their outdated design and cluttered feel.
Minamilistic operatory design with textured wall paper and flooring
Minimalistic design in bedroom showing neutral palette and use of texture
Tip #4 - No side cabients
Side cabients not only make the room feel smaller but they add to the congested and messy feel that we are trying to avoid.
Open space and some breathing room go a long way when it comes to creating the ultimate patient experience.
Open airy operatory with textured drapes and no side cabients
Tip #5 - Integrate your table top devices
Dentsply Sirona Treatment Center’s can eliminate 90% of table top devices like: apex locators, endo motors, implant motors, IO cameras, CAD/CAM scanners, and X-ray sensors coming from the back cabinet amongst many others.
The less is more strategy can enhance your brand, productivity, and even improve the environment and cortisol levels in your practice.
Dentsply Sirona Treatment Center with integrated technology (note the lack of cords, cables and arms)
Actual yelp review from patient
5 Keys to Office Centered design for maximum efficiency and procedure flexibility
1. Implement a centralized storage and inventory intake clean area.
When a box comes in from your dental supplier your centralized storage system should allow for a full unpacking and organizing of the entire box. It’s not efficient to unpack some and then store the box somewhere else.
2. Pre-plan your rooms with supplies (in tubs) for the procedures that will happen that day.
Efficient, accurate work happens when your able to have the tools and materials at hand..
"If the only tool you have is a hammer, you tend to see every problem as a nail."
Abraham Maslow (1908-1970)
3. Utilize technology integration for quick easy procedure switches.
Dentsply Sirona offers full integration of implant systems, intra-oral camera, CAD/CAM, Piezo, and endontic workflows with built in apex locator as shown below. This allows full flexibility and single visit dentistry for the patient. Don’t waste precious time with rolling carts and scattered storage system. Just grab the appropriate tub and switch procedures effortlessly and efficiently.
4. Dont specialize your rooms.
One common mistake is specializing operatories for hygiene, restorative, crown and bridge etc...
With proper planning organization and digital integrated equipment you won’t need to shuffle or rebook patients. You can perform more single visit dentistry. This makes for happy patients and is a major boost to productivity.
5. Dont waste your money on inventory that sits in drawers and eventually expires.
By utilizing a centralized inventory approach there is no need to inventory massive amounts of material in each room. This lowers overhead costs and improves the time and accuracy of ordering dental supplies from the central storage location.
6 keys to the most efficient operatories
6 keys to the most efficient operatories:
1. Use cabinets with front accessible drawers. If you have to swing out a drawer from the side it's not easy to reach and may block easy access to the operatory restricting work flow.
Standard front accessible drawers are more sturdy and can hold more than swing out drawers.
2. Avoid side cabinets. Side cabinets require turning away from the patient which makes for many more seconds of two handed dentistry. Side cabinets also restrict space for freely moving in the operatory.
From a design standpoint side cabinets and center island cabinets hinder your ability to be different and implement your own design strategy.
3. Use a tub and cassette system that's colored by procedure, and Dr. The operatory can be pre-loaded for a day to half day to make for faster turn overs.
Inventory costs are reduced and time spent tracking inventory and supplies are minimized.
4. Plan an open space free from vertical posts and swinging arms in your work area. These clutter the space and block access to critical items during procedure.
Traditional support arms for monitors and overhead lights have exposed wires, collect dust, and require constant movement around the operatory. Stationary dedicated lights and monitors allow for better design, cleaning, and don’t need to be moved.
5. Use dividers that stay in the cabinet and are easily reachable but then move out of the way. This helps with speed and efficiency but also with infection prevention.
6. Don't store restorative materials in the operatory. It makes ordering and inventory difficult because there are so many locations to check stock. A tub system makes it easy to switch procedures mid stream without having to shuffle through drawers to piece together what you need for that endo. A centralized storage and distribution system makes for less inventory and more efficient set ups. It forces pre-appointment planning.
A good rule of thumb is to have a weeks worth of consumables in the lower accessible portion of your cabinets. The upper should be reserved for your pre-planned procedure tubs. Hu-Friedy makes a great one http://www.hu-friedy.com/products/instrument-management/procedure-tubs/signature-series-complete-tub.html
Where do I put my keys?!?
Patient experience is all about the details. The experience is defined by many small things that ultimately creates the patient impression of a dental office.
One detail often overlooked is where do patients put their personal items such as hats, keys, coats, and most importantly Starbucks cup.
When a patient enters the operatory they often want to set their personal items on a clinical surface. Especially if the operatory has side cabinets on both sides. Not only do clinical side cabinets pose an infection prevention risk with patients putting their items down on those surfaces but they also create a claustrophobic environment without privacy.
Notice the operatory designed below by Kappler. It has a single entrance for patient privacy and personalized spa like experience. Have your ever been to a Dr. or spa that has open bays like many dental offices? I don't think so...
Kappler design knows how to navigate the workflow and how to create an environment that scrutinizes the small details. See their work at www.kapplerdesign.com
Kappler design can greatly improve the patient experience with details that define it. Notice the coat hooks, key shelf and mirror (left). This makes the patient feel at home and becomes a defining design element. Best of all the patient can check out their new dental work and check out their fave before facing the public in the integrated mirror.
A real life story after 2 years - Bacterial contamination and your risk
My Teneo Story; Tija Hunter, CDA, EFDA, CDIA, CDSO, MADAA
We were at CEREC 30 when Dentsply Sirona rolled out the brand new Sirona Treatment Centers, the Teneo and the Intego. As we were already in the market to add a new operatory to our office, we hit the showroom floor and within an hour, we were purchasing our brand new Teneo.
The CDC recommends that we purge our lines for 20 seconds in between each patient, that we treat our water, and test our water quarterly.
Our office prides itself on our infection control protocols and the training we take to do everything according to CDC guidelines and OSHA standards. So when it came time to test our dental unit water lines, I was skeptical about our new Teneo and how it would fare in the test.
Dental unit water line contamination is something I know about, I wrote a dental continuing education course for it and have given webinars on the subject. Testing your lines is imperative to any practice. If you treat your water, purge your lines when you should and shock your lines, how do you know what you do is working? You test! Unless you are testing, you have no idea if what system you are using, works, you are flying blind.
Standards for safe drinking water quality are established by the Environmental Protection Agency (EPA), the American Public Health Association (APHA), and the American Water Works Association (AWWA). These agencies together have established a heterotrophic bacterial count below 500 Colony Forming Units per milliliter (<500 CFU/ml) as safe for consumption. Maintaining these levels regularly ensures optimal microbiologic equality.
Dental unit water lines have long been a source of discussion and much concern. Dental unit water systems (DUWS) harbor bacterial biofilms, which is a known reservoir for pathogens.
Most of these microbes are from the public water supply and are classified as opportunistic pathogens, meaning they do not usually pose a high risk of disease for healthy person. This fact has direct implications for dentistry because increasing numbers of patients routinely seek dental treatment who have weakened immune systems. With elderly patients living longer and retaining permanent dentition, and children visiting the dentist younger, this exposure creates a heightened risk.
LEGIONNAIRES DISEASE
Legionnaires’ disease as a disease that is caused by a type of bacteria called Legionella. The bacteria got its name in 1976, when many people who went to a Philadelphia convention of the American Legion suffered from an outbreak of this disease, which is a type of pneumonia (lung infection). Although this type of bacteria was around before 1976, more illnesses from Legionnaires’ disease are being detected now. This is because we are now looking for this disease whenever a patient has pneumonia.
In February 2012, the first confirmed case of Legionnaires’ disease associated with dental water lines was reported. The patient, an 82-year-old woman in Rome, Italy, died just two days after she was diagnosed despite heavy antibiotic treatment. In the 2 to 10 days prior to onset of illness, she had left her home only twice, both times for dentist appointments. The Legionella pneumophila strain found in the dental water lines matched what was found in the patient’s body.
Since that time in 2015, we saw two outbreaks of the Legionella bacteria here in the U.S., one in Anaheim California that affected 57 children and later that year in Atlanta Georgia, 20 children were affected and in both cases, the strain of bacteria was traced back to the dental equipment were these children were seen.
OUR TEST
Our test results came back one Thursday morning about 8am, we don’t begin work until 10am on Thursdays. I was shocked when I opened the results. With seven operatories, we passed in all seven rooms, however we failed in six rooms! You see when you test, you must test each air/water syringe, each high speed handpiece line, piezo, and ultrasonic line. So you have multiple test results for each room, in all rooms I passed but in six of them I failed! Six, one room passed all of the test completely and with flying colors.
As I have already established, levels below 500 CFU’s are safe for acceptable drinking water. Our test results showed levels in all ranges. Where we failed, we had levels beyond the acceptable amount, and we needed to change our protocol and now! We successfully shocked our lines that morning before we saw patients.
But I want to talk about our room that passed, every test. And not with just numbers that barely squeaked by, in this room, we passed with numbers that shocked even us. Our Teneo Treatment Center tested out with our air/water tips at 0, a high speed handpiece line at 10, another one at 0 and the Piezo at 0. Thats after 2 years of usage!
Here I was worried sick because I couldn’t control the water supply to that room and I was worried for nothing! The Dentosept that runs through the lines, when done properly, keeps the lines clean and well maintained.
We are in the process of making plans to build a new office, and of course more Sirona Treatment Centers will be installed. When a “chair” can give you that kind of peace of mind for patient protection, why wouldn’t you invest in them? And that’s just one of the many benefits to owning Sirona equipment in your practice.
Sirona = Better, Safer, Faster!