The dental office as a healing environment

May 1, 2008
Conventional health care settings are rarely therapeutic, and just walking into a dental office can raise the stress level of both patients and staff.

Conventional health care settings are rarely therapeutic, and just walking into a dental office can raise the stress level of both patients and staff. In fact, some people report that their worst health care experience has been in a dental office. But with the advent of the dental spa, there are signs this may be changing.

According to a recent economic report, the dental spa has become an established part of the dental market. In fact, about 5 percent of the American Dental Association's 152,000 members say they use the term "spa" when referring to their office. These numbers are expected to increase as strong growth in the dental spa movement is forecast. Some 75 percent of dental practices in the U.S. are predicted to embrace the dental spa concept.

This is a conundrum for dentists not comfortable with the dental spa concept. Yet a recent article in the magazine Spa Finder called the spa environment the dental office of the future. While the term spa can mean something as simple as a warm pillow or soothing music, to bikini waxes and coiffure services, some dentists may have trouble understanding the value that is added to dental health care when it is delivered in conjunction with a new hairdo or chemical peel.

The dental spa concept brought the understanding that a relaxing dental environment not only adds dollars to the bottom line by attracting more patients, it helps achieve better health care delivery and higher patient satisfaction. This understanding has led to the field of evidence-based health care design, around which we can build a case for improved delivery of dental health care to our patients and a compelling business case for its adoption.

Consider that more than 125 research projects have been conducted in the U.S. and around the world testing the health care designers' use of color, light, noise control, art, privacy, space, and scale. The goal of research in healing design is to create health facilities that reduce patient stress.

Patients at Uppsala Swedish Hospital exposed to views of trees and water suffered less severe pain, as evidenced by the fact that they shifted from strong narcotic pain drugs to moderate strength analgesics faster than other groups. The New England Journal of Medicine reported that in a retrospective study of patients who had undergone cholecystectomy, those assigned to rooms with a view of a natural setting had shorter postoperative stays and took fewer analgesic drugs than those whose rooms looked onto a brick wall.

Other studies have documented the benefits of humor as decreasing the need for tranquilizers and sedatives, lowering blood levels of stress hormones, and decreasing burnout among health care staff. Dental patients who were allowed to look at an aquarium prior to treatment experienced the same benefits as patients who underwent hypnosis. They also required less pain medication.

Converting this evidence into practice is not immediately intuitive because creating a healing environment is not a project or initiative, it's a way of thinking and being. It not only changes the building, it changes the culture so that the perspectives of patients — and what helps them heal — are top of mind. It becomes your practice mission, vision, and philosophy. It embraces a deeper definition of healing and strives to achieve it in all its forms — physical, psychological and spiritual. It means offering services to patients that complement and integrate with traditional dental care. The best part is you can introduce these concepts into your practice without a huge capital investment.

Health care interior designers frequently create a healing environment through feng shui, the ancient Chinese practice of placement and space arrangement to achieve harmony with the environment. Feng shui designers use metal, wood, water, fire and earth, five essential elements found in nature to design, harness, and organize desired results in the built environment.

Isn't there enough for a dental practitioner to worry about than what color the walls are? Yes, but the right physical environment can reduce stress and be psychologically supportive for patients and staff, which lead to better treatment outcomes.

Here are a few simple ideas to create a healing environment. Start with those things that will create an immediate positive first impression. Do this by energizing the entrance to your office with a well-lighted access. Eliminate any clutter, remove wastebaskets from that area, and make sure the entry door swings open completely. Keep in mind that this is the entrance to your productivity and the entrance to new patients. Make sure that signage from your parking lot to your front door is visible. If patients have a hard time finding you, they will have a negative first impression and will probably experience high stress levels even before they are escorted to the treatment area.

Your reception area (avoid using the term waiting room because waiting has a negative connotation) should be furnished with small groups of comfortable chairs arranged in a family room style, not chairs lined up along the wall in institutional fashion. Display fresh flowers or live plants. Have them cared for by a maintenance company if necessary. Dead leaves on the floor give a lifeless impression. Dental office walls should be painted in appropriate colors such as taupe, brown, sage green, tan or light yellows, which are calming colors.

Since patients are uncomfortable and nervous upon arrival, the best energy is calming energy. A clean, well-maintained aquarium produces soothing sounds and vibrant colors. The provision of basic needs such as a meticulous and convenient bathroom and a selection of drinks and healthy snacks are very welcoming. The room temperature should not be too cold or warm, and noise should be kept to a minimum.

Use art and wall décor to create a healing space. Modern art is not relaxing. On the other hand, pictures of natural scenes can be very soothing and relaxing. Family pictures can be very distracting, so limit them to either a small grouping or a collage in one frame. Replace noise with relaxing music or sounds from nature such as a bubbling fountain or aquarium.

Consider natural lighting where possible through windows and skylights. If this isn't possible, consider professional lighting that can meet clinical needs while providing a more soothing atmosphere. Make sure chairs are comfortable and pillows are available. An open environment that still offers privacy can be achieved by the creative use of half or three-quarter walls. In the treatment room provide views of nature by using appropriate art work or DVDs. Clutter in a treatment room is never a good idea, so eliminate it. It is a turn-off for patients and can lead to clinical errors and wasted supplies, and it is not a good infection control practice.

While the physical environment is tangible and easy to grasp, the psychological component of the healing environment is not. The psychological element addresses the relationship we form with patients, with healing in mind. This environment engenders feelings of peace, hope, reflection, and spiritual connection, and provides opportunities for relaxation, education, humor, and whimsy. It includes the relationships between staff members, their level of caring for the patient, the timeliness and availability of services, and the patient's access to information.

In a self-contained setting like a dental office, anger, hostility, or frustration between staff members can be easily transferred to patients either directly or indirectly. The importance of a good hire that fits in the dental office takes on new meaning when it's thought of in terms of improving the healing process.

Even more important than the interactions staff members have with each other is the quality of their interactions with patients. Do they view the patient as a necessary evil, a nuisance, a source of revenue, or someone, or someone with legitimate health care concerns who trusts the doctor and staff to address this concern?

Simple things go a long way, such as addressing the patient by name, speaking in a soothing voice, asking permission to put a call from a patient on-hold, explaining to the patient what is going on with his or her treatment, saying please and thank you, or protecting a patient's privacy. While these suggestions are no-brainers on paper, we often fail to deliver them in reality.

Long wait times also create stress. Patients should expect and receive timely care. Nobody enjoys long waits in a reception area, regardless of its healing environment qualities. Staff should stay focused on delivering timely care. Patients will view the office as not respectful if no one cares how long he or she waits. Staff should never make a phone call where patients can directly observe them. It is disrespectful. The reception area should never be closed from the treatment area or front desk by a closed, sliding window. It says, "I'll get you when I need to," and makes patients feel neglected.

Lack of information is a stressor that can be avoided by answering questions and explaining treatment or financial options to patients. Patients should know how long a procedure will take and how much discomfort they will feel, and they should receive updates along the way. In all cases patients should have enough information to make intelligent treatment or financial decisions. This gives them confidence in our ability to provide professional care.

Finally, we often forget that patients bring certain things with them that impact the healing process. Things like their outlook on life, their psychological state, their willingness to take self-responsibility, their acceptance of themselves, their beliefs and values, and their coping and problem-solving skills. While we cannot change these spiritual dimensions, a little empathy can go a long way. From an altruistic perspective, successfully implementing these practices will lead to faster recovery, better pain management, lower infection rates, and greater patient satisfaction, and will enable your practice to attract more patients and improve the quality of dental care, leading to better patient outcomes.

Likewise, from a business perspective, these practices can decrease employee frustration, improve job satisfaction and lead to higher retention, attract better staff, reduce absenteeism, and enhance operational efficiency and productivity. This has a positive impact on the bottom line, which means you take home more money and the value of your practice increases.

Michael Kurtz is president of Provident Practice Group, LLC, a health-care consulting firm that provides planning, management and business solutions to the dental community throughout the United States.

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