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Start-up Specialty Practice: What to Know Before you Break Ground
Mark Tholen, DDS, MBA
Creating the right design for your dental practice is about more than aesthetics. There are many must-have design elements that can make the practice highly productive while minimizing stress for staff.
Leasing a Dental Office
When looking at leasing space, design considerations include:
Size and Shape of the Office. The first element to evaluate is the size and the shape of the practice’s footprint. In general, 500 square feet of office space per operatory or per dental chair is needed in order to adequately size and place all elements of the office. The space shape should be as close to a square as possible. The more irregular the shape, the more unusual elements in the shape of the footprint, the more difficult it's going to be to create a highly productive floor plan.
Parking. For leased spaces, it’s typical for a landlord to allocate three parking spaces per 1,000 square feet of office space. However, that is inadequate for a dental practice. A minimum of five parking spaces per 1,000 square feet of office space is usually adequate to provide enough space for patients and staff.
Utilities. Before signing a lease, be sure the space has the right utilities, including enough electric service. 400-500 amps of power are necessary for the average dental office.
Style of Building. Ask your leasing agent to scout out class A building space (Class B is more of a business park setting while class C is warehouse space).
Columns and Floor Space. Check out the number and location of columns that will be in the leased space. This information is critical for your architect when they’re drawing up floor plans, to ensure columns don’t interfere with placement of dental chairs or other equipment, or otherwise interfere with the flow of the space. Older buildings have even more columns in a multi-storied configuration, so be sure to take that into consideration. Additionally, columns must be sufficiently distant from the exterior walls in the clinical zone so there is adequate depth for the operatory and the clinical hallway. A general guideline is to add 50 square feet to your floor plan space requirements for every column in your lease space.
Irregular Perimeters**.** Asymmetrical spaces can present some challenges. If the perimeter is irregular, you wouldn’t be able to place all dental chairs equidistant from the wall, as that would result in a staggered configuration. The option would be to line up chairs on a treatment hallway, but that will mean sacrificing some space. A general rule of thumb is to add 50 to 75 square feet to the space requirements per irregularity.
Building Codes. Choose an architect who is well versed in local building codes, especially fire codes. Ensuring code compliance is considered when developing the floor plan will help with securing permits to build out the space. For example, fire codes require an auxiliary exit that is separate and apart from the patient entrance. Some fire codes have additional requirements such as the use of particular building materials and/or a fire sprinkler system.
Signage Availability. It is beneficial to have your leasing agent negotiate to have exterior signage included in the lease, to help increase exposure for your business. An experienced leasing agent is worth their weight in gold. They can look at all aspects of the agreement and negotiate on your behalf.
Purchasing Property
If you’re looking to purchase property instead of leasing space, there are additional considerations, including:
Setbacks. In addition to ensuring the space is adequately sized to support the practice, there needs to be proper setbacks to comply with building codes. As a general rule, you will need a piece of property that is six times the size of the proposed office to accommodate the setbacks. For example, a five-operatory practice would need a 2,500 square foot building. Six times that would mean 15,000 square feet of land to accommodate the building, assuming that the land is relatively square and usable.Stand-Up Consultation Area. Consider allowing space for a stand-up consultation area, which is a powerful means to enhance patient flow. You can treat the patient in the operatory, but converse with them at the stand-up consultation area. This is a short conversation describing the care that has been rendered. This way, the patient feels served and at the same time, the operatory is being turned over.
Designing Specialty Practices
As you would expect, each dental specialty has additional requirements when it comes to office layout. Below are some common areas to consider.
Oral Surgery
Operatory Design. The design of the operatories in oral surgery offices is often determined by the procedure focus and whether or not an anesthesiologist is present.
Recovery Room. For an oral surgery practice, a well-designed recovery area is essential in optimizing patient flow and efficiently monitoring patients. To that end, the nurses’ station should be centrally located right in the recovery room. This way, even when the curtains are drawn, nurses can see and access all patients quickly and easily. It’s common for the recovery room to be at the heart of the surgical component of the clinical zone, and to be located adjacent to the surgical exit. It’s important for the exterior of the surgical exit to have a porte-cochère or a drive-through, so the patient can be placed in a car in a sheltered environment.
Orthodontic and Pediatric Dental Offices
Office Configuration. A pinwheel configuration has become popular for the clinical zone. That is not very helpful at all because the traffic patterns are challenging. You can’t control how children come in and out in a pinwheel configuration. Instead, I would highly recommend a back-to-back configuration.
Game Room. This can also serve as an on-deck sub-waiting room.
Ergonomics. Consider how you are going to configure the dental team around the operatory to reduce strain and improve efficiency. I would highly recommend that all pediatric dentists use four-handed passes, which are critical to being able to increase your speed. And speed is everything in treating pediatric patients. With this approach, the quality of the care is not sacrificed. Only the extraneous repetitive movements are eliminated.
Extending your Brand. Many pediatric practices will develop a marketing theme for their office that carries through the architecture of the facility. The goal is to strike the right balance. It should look inviting, but not silly.
Prosthodontic Practices
Aesthetics and Function. are essential in the delivery of care, so the office appearance should be consistent with the level of care being offered to your patients.
Production Lab. This requires a detailed architectural plan that provides for adequate counter space and utilities inside that space. As a general rule, the production lab is sized according to the number of technician staff that will be in there (150 square feet for the first lab technician, and 50 additional square feet for every successive or subsequent technician). Generally, there are wet and dry areas in a production lab, and they're sized according to the equipment and the workstations to be placed in each of those areas.
Prosthodontic Operatory Configurations. These will vary according to the training, techniques, and focus of the doctor. Cranial facially-oriented practices require a different operatory configuration from that of a standard prosthodontic practice.
Endodontics and Periodontal Offices
Microscopes. Determine where these will be placed within the operatories. These can be wall- or ceiling-mounted or free-standing on stand rollers.
Ergonomics. As with pediatric doctors, endodontists and periodontists benefit from using four-handed passes. Becoming well versed in the choreography of four-handed passes with understanding to where the doctor, assistant, and patient will be, and where the instruments will be placed, will enhance your workflow efficiency.
Consultation Room. Endodontic offices that are performing implant placement should have a consult room. Your architect and interior designer can help you create a space that is consistent with the level of care being provided. They will talk with you about the type of practice you have and work on a design that reflects the quality of the practice in the materials and design of spaces like the consult room.
Recovery Room. If you are using IV sedation, having a recovery room is critical. You don’t want patients occupying the operatory while they’re recovering because that is more expensive real estate.