Th 133598

Plan your office ... then research equipment!

Sept. 1, 2003
I have designed and built five dental offices — including a large group practice — so I feel like I am qualified to pass on some of the information that I have learned from these experiences.

Joseph A. Blaes, DDS

I have designed and built five dental offices — including a large group practice — so I feel like I am qualified to pass on some of the information that I have learned from these experiences. Probably the best office I designed was one that I developed with the help of a sales representative for the DentalEZ® Company. Together with my team of clinical assistants, front-office staff, and hygienists, we put together a very efficient and effective dental office that became a model for many other offices.

In this article, I will tell you how that office was designed, and then give you some principles that will help you systemize your approach to making a decision on equipment for either a new or redesigned office.

18-chair upstairs Sunset Hills group practice floor plan
Click here to enlarge image

In 1974, I was practicing in a group practice that I had put together. I helped design a building with 18 chairs in a circle (it did not rotate) for the six doctors who were in the group. All chairs were equipped exactly the same, with patient flow on the outside of the circle and staff flow on the inside of the circle. The equipment consisted of separate carts for the doctors and the assistants, with very little cabinetry in the treatment rooms. The carts were our solution to the fact that we had three right-handed dentists and three left-handed dentists. Each doctor had three dental chairs, which seemed fine when I designed the office. However, two years later, we had run out of space!

At that time, I had a lot of patients in my practice. My philosophy was one of doing a few procedures on a lot of patients and then keep them coming back (a la Dr. Joe Stevens). I felt very successful, but the practice was rather chaotic. My answer to this problem was to become more efficient in the treatment of my patients. For that reason, I felt the best solution was to add more chairs to treat more patients. The lower level of the building contained 1,400 square feet of space that we had not rented. I informed the group that I was going to take over that space and build a new office to accommodate my larger practice.

My first step was to call the sales rep and tell him what I had in mind. I wanted him to help me with the design of the new equipment that I felt I would need to make this a very efficient office. My clinical staff and I spent a whole day in our treatment room showing him everything we liked and disliked about our present equipment. We tried a lot of other possibilities and either added them to our list or dropped them off of it. There were many questions that started with "What if?" By the end of the day, our sales rep had enough information to begin coming up with the equipment we would need.

6-chair downstairs Sunset Hills group practice floor plan
Click here to enlarge image

About a week later, he returned with a completely new piece of equipment for my five treatment rooms. It was a hybrid of the DentalEZ® Truth System that met all of the qualifications that we had set down for the equipment. It was well received by the rest of the company, and it became known as the Blaes 615 unit. From what I understand, it was a good seller for them. So, I suppose I could say that I actually had a hand in designing a new piece of dental equipment.

We built six treatment rooms in the downstairs area of our facility. Four of the rooms were scheduled rooms, with a fifth room set aside for emergencies and the sixth room designated for the hygienist. The rooms were built in an open space, with the equipment providing the walls of the rooms. The system of treatment was based on a "tub and tray" arrangement,, with plenty of drawer and storage space to keep everything close at hand. Because the dental chairs had a narrow and thin back, the clinical assistant could see everything that I was doing so that she actually became a part of the treatment process. I like to say that we became partners in patient treatment.

The office was everything that I had hoped for. It allowed us to quickly and efficiently serve our patients with the best that dentistry had to offer. But my philosophy of "doing a few things on a lot of people and keep- ing them coming back" was beginning to cause some problems in the office. I had four chairs scheduled, but I would routinely work in treatment on emergency patients. My hygienist was seeing patients on a half-hour schedule and complaining that I never checked her patients on time (hum, I wonder why?!).

The "ah ha' experience!

At this point, I had an "ah ha" experience. I define this as the third time the two-by-four hits you in the head and you say, "Ah ha!" My hygienist and one of my clinical assistants asked to see me at lunch time, announcing then and there that they were quitting. When I asked them why, the hygienist immediately said that she could hardly say hello and goodbye in 30 minutes, much less do anything to change her patient's oral health. She definitely needed more time to see her patients. The clinical assistant told me that our new-patient exams were not comprehensive enough and that I was not really telling my patients what was happening in their mouths.

I convinced them to stay by promising the hygienist more time for each patient. I also promised her that we would start a perio program. I told the clinical assistant that we would develop a better "new-patient experience." This led to a total change in the office philosophy, which eventually evolved into "doing a lot of things on a few people and then maintaining them."

This new philosophy eventually led to my leaving the group practice and returning to solo practice. I then built another office which was even better ... but that's a story for another time!

Don't put the cart before the horse

I have observed the equipment-buying habits of dentists at dental shows for years. Many dentists are unprepared for the task. They have not given adequate thought and preparation to the development of a plan to make the office the best it can be. Now don't get me wrong here! I don't want you to go out and just throw money at a project. The idea of having a plan is to get what you want, not what some salesman thinks you should have!

It is extremely important to get your clinical staff involved at this stage. How else can you know how your hygienist practices or what her needs are in terms of storage space? Does she need little drawers or big ones? What type of delivery system would work best for her? What would your clinical assistant like to see changed? What are her wants and needs? How does she prefer to work? Can she really see what is going on in the patient's mouth ... or does she just "suck spit?"

Begin to develop a list. A good way to start this process is by brainstorming together. Get everyone involved — even the front-office staff! If you could have the ideal office, what would you do? Remember, there are no wrong ideas! Nothing at this point is too outrageous! Write everyone's ideas down. Then, go back and talk about how you could implement these ideas. This is where you begin to get practical and weed out some ideas. It is probably best to do this in separate sessions. We posted our brainstorming sheets and studied them between sessions.

Now begin developing your actual plan for your new or remodeled office. Begin to build some systems around the plan. How will you get people from the reception room to the treatment room? Is there enough room for all the technical equipment that you want to put in it? What purpose does each piece of equipment have? How will it be used? Develop a system for each treatment room.

Recently, I visited the Midmark Corporation in Versailles, Ohio. This company was founded in 1915, and is committed to developing quality products, services, and technologies that allow health-care providers to increase effectiveness in their practices. The company is well-known in the medical-office field, even though it entered the dental-office-equipment arena less than 10 years ago. During my visit, I was impressed by the company's attention to detail in the development of its line of dental equipment. The company has been known for some unorthodox marketing methods, so we had a long discussion about the needs and wants of dentists and dental equipment.

I took a lot of notes, and came up with a list of five steps you should take before talking to anyone about new equipment.

1. Be prepared. The old Boy Scout motto really is pertinent here! Dentists should be proactive in their purchase decisions. Take the plan you developed and begin checking out which equipment will help you achieve your goals. Get a list of the companies that manufacture dental equipment by calling the Dental Manufacturers Association at (215) 731-9975 or the American Dental Trade Association at (703) 379-7755. A good way to look at equipment is on the exhibit floor of a major dental meeting. But you also can begin by going to a company's Web site and studying the options it offers. If you have time before a dental trade show, request literature from equipment companies. Make a list of the ones that you would like to visit. Prepare a budget so you will know how much you want to spend on equipment. Use the show guide to locate company exhibits instead of wandering up and down every aisle of the exhibit hall.

2. Choose the right dealer. It is important to choose the dealer with whom you want to make your equipment investment. The dealer-selection decision should be made well in advance of the show. Your concentration at the show must be on the proper equipment to fulfill the needs of your office, not on which dealer to use. The most important aspect of any dealer selection should not be the pricing, but the support that the dealer will offer. Does the dealer offer service with local, qualified (factory-trained) service technicians? Does the dealer offer design services? Does the dealer offer equipment-specification services? Does the dealer sell consumable products? Will the dealer respond quickly to your needs? Is there a requirement to purchase consumable products ito get service from the dealer?

3. Know what to look for. If you have done everything you should in Steps 1 and 2, you will be prepared. You will already know what you are looking for and what you need to see. Share this information with the dealer you have chosen, so the dealer's representative can be effective in helping with your selection. Ask your dealer if there is an advantage to placing your order at the meeting. Is there any advantage to buying the vendor's complete line? It is extremely important to include your clinical-team members when you go to the meeting. They will help you decide if the equipment meets the goals that you established.

4. Stay focused. Don't get caught up in the hype, and don't be rushed into a hasty decision. It makes more sense to me to delay the decision so that you can study exactly the equipment you want with the options that you want. Be sure to get all of your questions answered to your satisfaction! Don't take "no problem" as an answer. Remember that long lines at the booth, lectures, and lunch dates can create distractions.

5. Know how you want to practice. You should understand how you want to practice. Do you prefer rear delivery, chair-mounted delivery, side delivery, or an assistant cart? If you are not sure, visit some new dental offices in your area and check out how these practices operate.

Perhaps you could arrange to try the treatment rooms at lunch or after hours. You should make a decision on the type of delivery system you want before you visit the trade show. Discussing the various delivery-system options takes away valuable time from evaluating the equipment.

Most dentists will purchase three complete dental offices in their careers. The equipment itself is constantly changing. Each major equipment investment should begin with a complete presentation and end with all questions answered. The goal is to create an incredible experience for your patient in a relaxed atmosphere that allows you and your team to be the best you can be. When this all comes together, dentistry is both fun and rewarding!

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