Redesigned Office and Operatory Increase Efficiency

After a thorough evaluation of traffic flow and work procedures, it was apparent that the layout of my operatories and business office was not providing the efficiencies needed in a busy orthodontic practice. It became essential to restudy my requirements and to redesign work areas.

Having reached that conclusion, I studied the layouts of other orthodontic offices, noting the advantages and disadvantages in each. Visiting the offices of dentists other than orthodontists also proved of great value. Much information on operatory design is available in the literature and this was used in formulating the final design for the new office and operatory area. Design work is time-consuming and fraught with minute details which need careful attention. Making the task somewhat easier was the cooperation of our local dental supply dealer, Walter Dental, who made certain that the plans were sound and practical from the standpoint of equipment installation and servicing.

Office design

Working within a converted general practice dental office in a residence, the first floor area was enlarged and completely modernized to provide what has proven to be a highly efficient and personalized suite of offices and work area (Fig. 1).

The time consumed in planning and studying all available data on dental office design was a good investment. We finally have a traffic flow which allows us to give more personalized attention to each patient and to improve business office procedures.

The basic decision in our planning was to eliminate individual operatories and have a completely open area for our eight treatment centers (Fig. 2).

In the center of the large open work area is a spiral staircase to the laboratory on the floor below (Fig. 3).

Protecting the stairwell from overly curious patients are custom-built cabinets, arranged circularly, which provide ample storage space and scrub sinks convenient to each treatment center.

Operatory equipment

Once the basic room design was decided upon, attention was directed to the equipment. It became apparent that the most important piece of equipment would be the dental chair. So, we compared the various chairs that are currently available. Each chair had its inherent advantages from the stationary lounge chair to the adjustable models. The one word to describe our paramount requirement was "versatility".

Versatility in the adjustment and use of dental chairs is essential in our practice, because we have a range of tall and short personnel who may work in a standing as well as a seated position. Further, there is a wide range of sizes of our patients, including adult patients who are often uncomfortable in a standard "child's chair".

We really were unaware that so many dental chairs are available on the market today, which made the thorough evaluation process a lengthy one. After a long and detailed study, we reached the conclusion that the new Ortho chair from Belmont Equipment Corporation suited our particular needs the best. With it we can comfortably seat any patient, child or adult, for the chair has a headrest extension which can extend the back support or, for our smaller youngsters, it can be removed entirely. The chair allows manual adjustment from an upright to a reclined position. It can be rotated a full 360° which allows flexibility in its use with our customized equipment. Since we do work in a standing as well as a seated position, the chair's motorized base is important for us.

Around the periphery of the operatory are eight stations, each complete within itself (Fig. 4). Each contains a dental chair; cabinet storage for hand instruments, band assortment, cement, wires, etc.; and built-in equipment with three-way syringe, saliva ejector, provisions for spot welder and other instrumentation and equipment. Each treatment area also has a bubbler for patient use and a ceiling mounted operating light.

Patient traffic flow

The traffic flow for patients is working out extremely well. At each station we have a signal which communicates with a control panel at the receptionist's desk. As a chair is ready for seating the next patient, the switch is thrown signaling to the central control station the location, by number, to which the next patient is to be directed. The vacant treatment area is, itself, identified as being available by a signal light at that location.

We have provided a "patient bench" at the entrance into the operatory in case a patient has to wait momentarily before being seated. Patient record charts and files are kept in a rack at each location for ready reference during each visit. Having all instruments and materials constantly at hand in the cabinetry of each work station saves a great deal of time and makes every procedure much more efficient. The investment in duplicate instruments and supplies is minimal compared to time saved.

The x-ray room opens directly into the operatory. It has a new GE panoramic machine, a GE periapical machine, and a Wehmer cephalometer. Having a separate room for x-ray has added efficiency to this phase of our work. Its location, adjacent to the general operatory, fits in well with the patient flow pattern.

In striving to control traffic flow, we began with the reception room where we eliminated the doorknob on the door into the office/operatory area. Patients only are allowed into the work area, and only when personally escorted by our receptionist. If it is necessary to meet with parents, they

also are admitted only by the receptionist who escorts them to the consultation room. We have an additional conference room for use by our business staff when discussing arrangements with parents.

Patient records are filed in the nurses' station (Fig. 5), readily available to the receptionist as she assigns the patient to a particular treatment area. The receptionist communicates with patients in the reception room through a two-way intercom behind a large plate glass window.

This has worked out well in our practice, eliminating unnecessary communication between anxious parents and others and our receptionist, which formerly interfered with her answering the telephone, posting records, seating patients, etc. Acceptance of this arrangement by parents, patients, and others has been extremely good.

Once the patient has been admitted from the reception room, the environment is one of complete openness, from the large open counter facing the nurses' station to the open area of the operatory. The open operatory concept with our eight individual treatment areas has had the broadest possible acceptance from our patients, including the adults.There seems to be an especially good psychological effect on each patient treated in an open operatory arrangement. Being visibly a part of a larger activity than the usual one-to-one confrontation apparently motivates greater cooperation and interest in the orthodontic treatment program. Stereo music is piped throughout the suite, and this seems to add another favorable dimension to the colorful decor of our redesigned operatory and offices.

Conclusion

Redesigning and modernizing a suite of offices and operatories, with a complete change in concept, is a major undertaking in time and financial investment. The rewards of greater production with less effort, highly improved efficiency, better working conditions, and more pleasant surroundings and comfort for our patients make the investment one of the best I've made in my many years of practice.