by Dr. Bradley Dykstra
For more on this topic, go to www.dentaleconomics.com and search using the following key words: Dr. Bradley Dykstra, fire damage, rebuilding after a fire, Benco, Sullivan-Schein.Life is full of ironies and unexpected events. When I left my office on Tuesday, April 8, for New Orleans to speak at the New Orleans Dental Conference, I had no idea I would never see my office again the way I left it. For 30 years, my office has always been in the same state as when I left it, with the only changes being ones planned in advance.
The topic of my seminar was digital radiography, and I planned to briefly mention the safety of digital patient records should a calamity ever strike your office and destroy paper charts and radiographic films. After spending a couple of days in New Orleans and talking with many of the local dentists, I felt the severity of the loss they had suffered when they lost their practice, their home, or both. Katrina was definitely a life-changing event for these wonderful people, and because of their losses they could understand and embrace the benefits of digital patient records.
From New Orleans I traveled to Phoenix to attend a lab advisory board meeting and make a short presentation on the iTero digital impression system. On the afternoon of Friday, April 11, I received a frantic phone call from my office manager asking if I was in town. I told her that I was in Phoenix, but asked what was going on. She proceeded to tell me she was driving past the office and noticed there were several fire trucks and that my office was burning down. One of the ironies is that the fire department is directly across the street from my office.
My associate and staff had worked until 1 p.m. that beautiful spring day in Michigan. The employees in the building next door called in the fire 3.5 hours later. They had their window open and smelled what they thought was burning garbage, but looked out the window and saw what looked like steam coming out of the vents in my office roof. They were not positive it was a fire, but they called 911 to be on the safe side.
It's hard being over 1,000 miles from home and knowing your office is burning and there is little you can do about it. I spent a few hours on the phone changing my flight, and the earliest I could get out was Saturday morning. In the meantime I was in contact with my wife and daughter who were at the scene. When they were able to go into the building, I asked them to retrieve the network server, a couple of laptop computers, and a file cabinet of important documents.
Because the building was relatively new and built to code, the fire was confined to my suite. It did not burn through any of the drywall firewalls. Between the fire, heat, and smoke, 100% of the contents, equipment, supplies, and personal effects were destroyed.
I called the builder and asked him to secure the building by patching the hole in the roof and boarding up the blown-out windows. I had my wife contact the insurance agent of the building and notify him of the fire. The other insurance companies involved were already closed for the weekend. I next called my equipment rep from Benco and told him what had happened, and asked him to start thinking about how he could get the office up and running quickly. We set up an appointment for first thing Monday morning.
Once everything was done that I could accomplish from a distance, I returned to the meeting and told them about the situation. I then gave a brief presentation on the benefits of digital impressions over conventional impression techniques. One of the benefits I mentioned was that in the unlikely event your office is destroyed by fire or other calamities and there are unseated lab cases in the office, it is easy to make a phone call to have the models remilled and the restorations remade. Yes, it is costly, but it does not require the patient or dentist to repeat the impression process.
My immediate concern was being able to see patients in a new location since I knew the devastation was great and the office would not be a quick fix. It is a reality that the longer a practice is closed, the more severe the long-term economic consequences will be. I own the office building I'm in and had an empty suite on the other end of the building previously occupied by a physician group, so it had a lot of rooms we could use as treatment rooms with sinks and cabinets in them. It also had a large reception room, a front desk area, and several restrooms.
On the way home I had time to think and plan how we could get up and running quickly. The most significant thing that gave me hope we could do this quickly was that all of our patient and practice records had been in digital format for the last five years and were all intact. The hard drive on the server was OK, and the external hard drive backups were out of the office. This meant that with a new phone system, a rebuilt server, and a few new computer workstations, the front desk could be in operation very quickly. Sure enough, the front desk was completely functional by Tuesday at noon.
Another decision was who would be the major players in setting the office up quickly and dependably. The decision I made was based on my past experience and what I had learned in business school while earning my MBA. Do not become totally dependent on any one supplier or support system. If an office is dependent, suppliers have the potential to either charge excessive fees or control your decisions. The decision was to have one company, Benco, supply everything from the dental handpieces through all of the major equipment. Sullivan-Schein was chosen for all of the supplies, cassettes, and hand instruments. Several of the equipment and supply items we needed are sold direct, not through a traditional supply house.
Monday morning I met at our new temporary space with the equipment and supply reps from both of the supply houses chosen for the re-equipping process. I clearly stated my decision that the process would be divided between the two companies, and we laid out our action plan. The plan was to have the office up and running by 8 a.m. the following Monday. This would mean there would be only one week of not seeing patients in our own space. Both companies were very capable, ready, willing, and able to do the complete task, and might have been a little disappointed they were not doing it all, but they accepted the decision and performed excellently.
Staff considerations were also one of my high priorities. All staff members were asked to meet at my house Monday for lunch for an informational update and a planning session. They had lots of questions, many of which could not yet be answered, but the important ones were answered. Was I going to retire from clinical practice after 30 years and just speak and consult, or rebuild and continue to practice and consult? This was easy to answer: a fire was not going to dictate this decision. What were we going to do, where would we go, and when will this happen? This again had already been decided, and they were told the place and time frame. These decisions allayed the greatest question on everyone's mind — what was their job future?
I then asked the team members to meet by department: front desk/business office, hygiene department, and clinical assistants/sterilization. Each group was given the same mandate: if we are to see patients Monday morning, what do you need in the office to make this happen? They realized that they had to start totally from ground zero — with not one thing salvageable from the old office. This was literally a chance to do things over the way they really wanted them to be. The only limitation was that they could only list what they really needed and used, and anything they purchased would eventually be moved to the rebuilt space. The fact that we would be operating out of three rooms instead of seven would initially affect the number of instruments and supplies we would need.
It was helpful that we had photos and lists on the server of what was in each cassette — operative, endo, cementation, hygiene, etc., which facilitated this process. The staff performed fabulously, and when we opened the following Monday, we had everything we needed for that day. A great team is priceless.
The opportunity to do it all over again: a blessing or a curse? Both, but the initial reality is that it takes a lot of work and extreme amounts of time and energy to rebuild. Although 100% of the contents were totaled, most of the 14-year-old structure was intact, so the basic layout of the office was to remain the same. The office was already very efficient, functional, well equipped, and up-to-date, so this simplified the decision process.
The operatories were to be identical to each other as they were before, allowing for the greatest flexibility in patient treatment and flow. My preference is rear delivery carts with powerwalls and two entrances to each treatment room from behind the patient. Each room would also have two computer monitors and a flat screen TV. The darkroom had already been converted to a storage closet. Minor alterations in the sterilization area would be made. The planning for a Kodak 9000 with 3D capability necessitated a designated room with lead shielding in the walls. This was accomplished by adding the old darkroom to the existing Panorex area.
Equipping the temporary office had two components: the dental chairs, stools, dental units, X-ray generators, and everything else. The chairs and units to become operational were strictly what the dental supply house had available and could quickly move in and set up. Everything else was chosen and ordered to fit into the scheme of the totally new high-tech office. The goal was to have the best diagnostic and treatment modalities possible, while keeping the systems simple and well organized.
As I write this, it is six weeks after the fire and we have been operating in the temporary space for five weeks. It is beginning to feel familiar and is adequately functional. Almost anything we could do in our previous office, we can do in our new office, just not as much of it. The biggest frustration is that with only three treatment rooms, there is no wiggle room if something unexpected arises, and it is tough to stay on schedule. This week a fourth treatment room should go in, which will give us greater flexibility.
To best meet the needs of our patients, we extended our office hours, with me working from 8 a.m. to about 2 p.m., and my associate starting at 2 p.m. and working until 7 p.m. The staff also rotated through these extended hours. Office production is about 50% and 60% of what is was, but new patients, emergencies, urgent work, and preventive recare appointments are taken care of in a timely manner.
Our patients are very supportive of the practice and are flexible and understanding. They verbalize each day three very important thoughts, which I believe sum up what providing quality care is all about. The first is great appreciation that all of the patient records were intact. They know this would not have been the case if the records had not been completely digital. Five years of totally integrated digital clinical charts and 14 years of digital radiographs provided the opportunity to get up and running quickly. The thought that all of the records could have been destroyed is very sobering — the responsibility to safeguard patient records is something often not taken seriously enough.
The next mention of appreciation and even shock was that the office was up and running so quickly. They were comforted to know that if they had a problem, they could be seen quickly. The third major observation was that the staff members were flexible, adaptable, capable, and caring, even in the midst of what many would term chaos. Patients definitely notice the quality and integrity of the team.
Would I ever choose for the fire to happen? Would I recommend this as a way to get a new office? No way in the world. Will we make the best of this situation? Absolutely. Life is full of changes, surprises, and ironies. The best option is to be open and flexible and take advantage of new challenges (opportunities) as they arise. Make the best out of every situation, even if it seems devastating. Take what's been given to you and turn it into something wonderful. Seize the day!
Eighty days after the fire, Dr. Dykstra said practice productivity is steadily coming back. Month one was about 55% of previous goal, month two was 65%, and they are hoping month three will be 85%. Nine weeks after the fire everything was torn down to the studs and chemically treated for the smell. Weeks 10 and 11 began the rough-in of the electrical, plumbing, heating, and cooling. There is not a set move-in date yet.
Dr. Bradley Dykstra is a general dentist in private practice in Hudsonville, Mich., where he employs state-of-the-art dental technology, including digital radiography, dental lasers, intraoral and extraoral cameras, digital imaging, and clinical practice management software. He is a graduate of the University of Michigan's dental school and received his MBA from Grand Valley State University. Dr. Dykstra speaks on digital radiography and integrating technology into the dental office, as well as consulting through his company, Anchor Dental Consulting. Reach him at (616) 669-6600, or by e-mail at [email protected].
