Sjöquist Architects, Inc.



Improving productivity by design
by Keith Sjoquist, AIA


Dental office design can help a practice grow by improving operating margins, and increasing productivity and marketability.

Dr. Michael Spencer, a family practitioner in St. Louis Park, Minnesota, says his criteria for choosing an architect for his practice's new building was based on "finding and architect who understood dentistry, and our needs, so we wouldn't have to pay them to learn it."

Dr. Spencer stresses that homework was the key to the success of his design. "We looked at other clinics, asking who had done them, and what criteria they set for the building. Once selected, our architect came in and observed our practice to see how it worked. Then, when we sat down to discuss the new design, the architect could make recommendations on efficiency and systems to make the practice flow more smoothly."

A comprehensive pre-design evaluation of the dental practice is critical to a successful design. The design needs to provide balance for both the clinical and administrative ends of the practice. An imbalance can stall growth. An increase in patient load can be offset by a reduction in administrative efficiency - resulting in confusion and inefficiency.

Areas to be covered in the evaluation are:

  • What type of practice is it? Are special facilities needed for labs or equipment? An overall plan anticipates special needs for electrical, plumbing or gas service, and incorporates them into the design.
  • What is the size of the practice, and what are the future plans to expand it? Is the practice being marketed aggressively, or looking to expand into new markets? Growth will be stalled by a space that doesn't accommodate patients or staff, or equipment for new markets or new techniques.
  • What are the tastes of the dentist? Of the patients? By knowing you own tastes and market, it's a good bet a design will be produced that succeeds for the practice and patients - both in function and aesthetics.
  • Is the practice affiliated with HMOs, or other group coverage plans? The paper work and processing for these dental plans means new pressures on administrative staff, and new design considerations for the administrative space.

The pre-design evaluation will establish a template for the design. Matching this template to the future plans for growth will help identify parameters for size. Dr. Spencer and his partners set criteria for their new space by "knowing what we didn't want. The four of us had practiced in other offices over the years, and had worked with equipment and spaces that didn't work."

Flexibility and mobility are the key, says Dr. Spencer. If the practice is on an aggressive growth track, it is best to oversize the administrative zone in anticipation of growth. It's cheaper and less traumatic to overbuild at the beginning. If the design doesn't plan for growth, the practice risks the disruption of a remodel to accommodate the increased administrative work load. This means down time and lost revenues.

Avoid permanent or built-in office systems, because they limit flexibility and options for growth. Many modern office furniture and filing systems are designed to be modular, with an emphasis on portability, flexibility and function.

There are now available "modular operatories" that are much more flexible than previous installations. This concept allows for efficient growth, optimal use of space and less expensive permanent construction.

For growing practices, new buildings should be designed to minimize load-bearing walls. "We wanted an open, flexible design with walls that could be moved as we grew," says Dr. Spencer.

It is difficult to assign an absolute dollar value to anticipated growth. It is very easy, on the other hand, to assign real dollar values to the costs of oversizing. It costs $10,000-$20,000 to equip and operatory. If the space stands idle, interest expenses can eat into the practice's margins quickly. But a retrofit to accommodate unplanned growth will disrupt a practice, costing money down the road.

In general, an extensive remodel will cost more than a new construction. A $40,000-a-month practice can lose up to 30 percent in billing during a remodeling project. Many dentists, however, are more concerned with the cost of hiring a plumber at union scale than with loss in revenues and disruption to the practice.

The reality is that it is cheaper to schedule contractors and construction at night than to shut down the practice to facilitate daytime construction. A four-month project can cost an average practice as much as $48,000 in lost billing. That kind of money buys a lot of night labor. The idea is to phase the remodel so that disruption to the practice is minimized.

The benefits of an effective and efficient dental facility design can be measured directly. "We produced more in our first month than in any previous month in the old space," says Dr. Spencer. "Even though the staff was still adjusting to the new equipment, and didn't know where everything was."

Productivity improves for a variety of reasons. For one, the practice works better - staff and patients move through the space more efficiently. Also, a new design can change the attitude of the staff. Employees can take pride in the new space. They'll feel better about themselves and their jobs, performing with more efficiently and enthusiasm. And because the office works better, the dentist can concentrate on the quality of care.

An effective design also helps marketing. Says Dr. Spencer, "We get a number of new patients every years just because they see our building. It's visible in the community, and pleasing to the eye. Patients respond favorably to its esthetics and its functions.

Copyright © 1987 by Keith Sjoquist