Garrett Ludwig

	I can’t help but speculate that the aversion to performing a feasibility study is as much emotional as it is financial. Clearly, there is a cost factor that may dissuade the fiscally faint of heart-despite its proven worth.

However, my perception is that a feasibility study evokes the emotional equivalent to that of having a colonoscopy. Interestingly, they both produce valuable insight to preventable conditions. So I will temporarily deem the invaluable “feasibility” service to be a “projectoscopy” in an effort to make a point.

To date, the preponderance of my perseveration regarding “projectoscopies” has concentrated on the costs and savings associated with construction, site development and purchase/lease agreements. However, the emphasis of this article is function and usable space.

Survey: What you said matters most when it comes to dental office design

We were asked to design a satellite office for an OB/GYN* practice for which we had designed three other offices. The history is noteworthy because we had gained the confidence of the practitioners to act on their behalf and perform the necessary preplanning due diligence – or “projectoscopy.” Previous projects with this client heightened their awareness regarding the value of this exercise. Their faith in our ability to ferret out mitigating factors was particularly significant because the project was for a suite in a new, yet-to-be-built building-and they had already committed to lease the space. Under similar circumstances, the requisite response former clients have expressed could be paraphrased as, “I don’t need no stinkin’ feasibility study.” “It’s a brand new building. What could go wrong?” The fact is, much!

Logically, by all expectations, there shouldn’t be any issues with a new building. But, as it turns out, there were many. For the sake of focus, I will limit the review to the physical plant and the available space.

The architectural firm that designed the building provided the plans of the subject suite to us. Upon review, we noted that, in addition to the “horseshoe” configuration imposed by the stairwells, lobby and elevator hoistway at the front and rear entrances, the center core of the suite was profoundly encumbered by structural columns, two separate HVAC supply/return ducts and a roof-access ladder.

Related reading: Top things to consider before a dental office remodel

The collective impositions created two factors:                                                                                                      
	1. The usable space, which is calculated by perimeter measurement, did not account for the losses associated with the noted internal obstructions. Additionally, it was determined the advertised square footage of the suite referred to “leasable” space, not “usable” space.  Although this is standard practice, in accordance with 

BOMA (Building Owners and Managers Association)

, it is not always clear to the lessee that “leasable” space includes half the thickness of the perimeter walls. Collectively, the net loss was approximately 200 square feet. So, before we even began the planning process, we were dealing with a deficiency in the perceived “available space”.**

2. The encroachment of these obstructive elements created an enormous challenge for functional use of the suite. The horseshoe condition alone created potential “dead-ended corridors,” a distinct life-safety code violation. This condition was profoundly exacerbated by the encroachment of the respective components on the central core of the suite and the ability to maximize function, flow and life-safety code compliance.

Related reading: ADA releases Practice Guide to Dental Office Design

Without implementing considerable changes, the project was virtually impossible to develop to meet the client’s needs. The referenced challenges are depicted in the “existing conditions” drawing:

Related reading: 5 mistakes dentists make when thinking about office redesign

We first approached the architects and expressed the benefits of relocating the roof-access ladder to the stairwell. They were receptive and agreed to that change. We then met with the mechanical engineer and proposed the noted changes in duct chase locations:

Again, our proposal was met with favor and acceptance. On a side note, with respect for the architect and engineer, I must point out the original layout was based on the expected use of the second floor as two distinctly separate suites. As such, the placement of the respective “chases” was logical for that use. It was simply not accommodating to a women’s health practice on the entire floor.

This project had a successful conclusion, as is evidenced in the finished floor plan:

Related reading: With a new office space, practicing dentistry is no longer a pain in the neck

Due to a modest investment of time and money, we were able to avert a near disaster and develop a functional facility. The message here is that the greater majority of “projectoscopies” (feasibility studies) we have performed have unveiled seriously mitigating issues related to budget, construction and space utilization. The savings in every case has been substantial. But, it is noteworthy to mention that, even if a change is not viable, the discovery of the compelling factors will, at the very least, forecast any implications that the condition might impose on the project budget. In some cases, we have actually determined a facility would not support the needs of the practice. As a result, the clients averted a poor investment in both time and expense. Knowledge is power! Caveat emptor.  

*The majority of my previous contributions on design have focused on various phases and conditions related to dental office design. The fact is that we have had extensive experience with medical specialty practices, as well. They include ophthalmology, otolaryngology, orthopedics and women’s health.

**Space consumed by the duct chases and roof-access ladder created a loss in usable space of 48 square feet. That’s the functional equivalent of a handicapped-accessible lavatory. Similarly, it is common to overlook the difference between “leasable” space and “usable” space. In most cases, the usable space actually ranges anywhere from 100 square feet to 300 square feet less than the leasable space. In this case, the combined loss was approximately 200 square feet.

 and specializes in medical and dental office design. His design expertise is best summarized by his company slogan, “Profit By Design,” which speaks to the purpose and intent of creating functional, efficient and fiscally sound design concepts. He can be reached through 

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 I can’t help but speculate that the aversion to performing a feasibility study is as much emotional as it is financial. Clearly, there is a cost factor that may dissuade the fiscally faint of heart-despite its proven worth.

The top things to consider when planning a new dental office

	Would you ask a patient to invest in veneers before treating their dental pain? Not likely! Nor would you have your car painted if it needed a transmission, brakes, tires and a front-end alignment. So, why would you consider refreshing your office (fit and finish) without first addressing the challenges that have evolved since the days that the carpet was new, the paint was fresh and the wall coverings were in style? 

My sense is that, for most people, it’s difficult to visualize a solution that is outside their respective area of expertise. It is also likely that there might be a perception that any solution would be too costly to resolve. 

In all fairness, it would be prudent to ask yourself if it’s worth spending several thousand dollars to improve the appearance of your office and simply resign yourself to living with the “

” that challenge your every-day existence.

To make matters worse, there is a great likelihood that you will continue to grow- and so will the challenges. At some point you may reach a point of intolerable frustration. However, having spent so much money on those new finishes you might be reluctant to disrupt the office to resolve any new or existent problems. Does any of this sound familiar?

Having helped numerous clients through these practice enhancements, I can honestly say that most challenges have one or more viable solutions, and the cost to implement these solutions is generally modest. The fact is that, the expense should not be the focus. If the design remedy will 

 and make you work more efficiently, your revenue will increase. In fact, in the majority of cases, the return on investment will far out-weigh the costs associated with the improvement.

Take a moment to visualize the “pains” that you experience on a daily basis. Then try to visualize how much more productive you would be if those “pains” were gone. Could you really put a price on that change? Perhaps not. However, you might be able to project how much more dentistry you could produce with the enhanced environment.   

Related reading: The economics of ergonomics 

In closing, I would like to share a recent experience with a client who was facing these very problems. The condition were so daunting, they were considering relocating the practice- at a hefty expense. We evaluated the challenges and proposed the necessary improvements. Their original budget for finishes grew by only 20%. However, one solution alone allowed for the addition of an operative treatment room. The revenue from that investment alone will pay for all of the other remedies and the new finishes.

For the record, we also accommodated the following: resolved a profound HIPAA issue; increased seating in the waiting area and added a refreshment center; created a space for staff lockers and changing; and created space for a 

. Truly, those improvements alone would have been worth the investment. All of this will be completed with one week of down-time, during a pre-scheduled vacation. Worth every penny. 

 and specializes in dental office design. His design expertise is best summarized by his company slogan, “Profit By Design”- which speaks to the purpose and intent of creating functional, efficient and fiscally sound design concepts.

 Would you ask a patient to invest in veneers before treating their dental pain? Not likely! Nor would you have your car painted if it needed a transmission, brakes, tires and a front-end alignment. So, why would you consider refreshing your office (fit and finish) without first addressing the challenges that have evolved since the days that the carpet was new, the paint was fresh and the wall coverings were in style? 

Top things to consider before a dental office remodel

	In part three of Dental Product Report's three-part series on ergonomics, 

, explains how ergonomics can increase a practice's efficiency and productivity-all while saving money.

 of the series for more insight into ergonomic practices and benefits.

	 	 	Although the nature of our work as designers obligates us to understand the bio-mechanics of ergonomic function, I will reserve commentary regarding healthy practices and prevention of occupational injury to experts like Bethany Valachi. Rather, I will focus on the economics of 

We humans are an odd lot. We can absorb, intellectualize and proselytize about all of the things that are good for us. But, more often than not, we don’t practice what we preach- until we have an “Aha” moment. Although there are many more factors to consider, it is my hope that, what follows will inspire such a revelation, resulting in change.

Related reading: Part two: The biggest ergonomic mistakes dental professionals make

As remarkable as it may seem, the number one cause of reduced efficiency and productivity [that I have witnessed in clinical practice] is lack of consistency in the orientation of clinical adjuncts. Perhaps it is a result of incremental practice growth and like-product availability.

But, I constantly see practices with profound variations in everything from patient chairs, doctor’s/assistant’s stools, to dynamic and hand instrument delivery. That includes adjuncts like, intra-oral lights, trituators, curing lights and impression materials. 

Beyond the stresses associated with the dysfunction that results from these inconsistencies, these conditions rob you of valuable production time. Gross movement aside, the uniform orientation of instruments and adjuncts will shave calculable amounts of time off of production.

Besides the evident increase in revenue, achievement of this goal will be truly realized when the only distinguishing factor between rooms is the view out the window.   

 training program during its early development in the late 70’s. At that time, the prescribed recommendation for movement* by the clinician was limited to Class II. Correlatively, trans-thoracic handpiece delivery was the “rule” and the passing of instruments and handpie

ces, left the clinician’s hands in a perpetual carpal-tunnel-provoking position; bi-lateral to the oral cavity. Ergonomic research has resulted in advancements in clinical practice, which are now more user-friendly. To wit the recommendations regarding range-of-motion include Class III and occasional Class IV movements [such as adjusting an intra-oral light] for clinician and assistant.

Related reading: How to handle daily pain in the dental office before it becomes chronic [VIDEO]

I believe that most dentists follow those principles. However, I often observe chair-side assistants, whose range-of-motion pushes the limits of Class IV movement, and often extends to Class V movement; including having to stand and/or bend to access equipment and supplies. Not only do these movements consume time and retard function due to superfluous motion, there is a loss of visual access to the oral cavity and the reasonable ability to suction, retract and irrigate during a procedure. As a result, efficiency and productivity are compromised.

For the sake of discussion, please assume the following: 

1. The average space consumed by patient and exam chair is approximately 24 inches.

2. A comfortable distance between the patient chair and lateral work surfaces for both clinician and assistant is approximately 30 inches.

3.  Based on the postulate that form follows function, and the axiom that the human anatomy will perform most efficiently in a defined field of movement, an ideal space accommodation of seven feet should suffice between support surfaces. To reach beyond this work zone would defeat the goal of ergonomic adjacency.

As a result, the determination of total treatment room width will ultimately be defined by the lateral work surfaces themselves; call them “power-wall” systems or simply cabinets and counters.

Theoretically, if a 15” deep counter would adequately accommodate a sink and work surface, then a room width of 9 feet, 6 inches should suffice. Why then would any design professional propose treatment rooms that are ten feet or ten-and-one-half feet wide? Effective use of that redundant space would equate to a savings of three feet to six feet of that could be valuably utilized by other clinical or administrative areas. Waste not, want not. 

 In part three of Dental Product Report's three-part series on ergonomics, Garrett Ludwig, president of Diversified Design Technologies, explains how ergonomics can increase a practice's efficiency and productivity-all while saving money. Check out Part 1 and Part 2 of the series for more insight into ergonomic practices and benefits.   