Advances in Office Design Improve Practice and Patient Experience
Q&A With Parag Kachalia, DDS
Inside Dentistry interviews Parag Kachalia, DDS, a private practitioner in San Ramon, California
Parag Kachalia, DDS
American College of Dentists
Innovative Dental Concepts
San Ramon, California
Inside Dentistry (ID): Open-concept offices are becoming more popular. Are there equipment elements to consider when designing in this fashion, such as the pros and cons of shared pass-through x-ray units?
Parag Kachalia (PK): I would say a couple of things. I'm not 100% sold on true open-concept offices in the dental setting. Practitioners are starting to prefer a more patient-centered approach to privacy because of the Health Insurance Portability and Accountability Act (HIPAA), but at the same time, they want to optimize their space. Therefore, I would make the argument that more people are moving in the direction of flexible office spaces, which use modular equipment or equipment that can be moved between rooms, than toward truly open-concept offices.
(ID): You mentioned mobile equipment, so I'm assuming that you're talking about intraoral scanners on wheels and that kind of thing. Are there any considerations other than just the mobility of the equipment itself that you're seeing regarding the office design required to accommodate it?
(ID): Whether it's your cone-beam computed tomography machine or your intraoral scanner, you want to have flexibility, not just the ability to roll it from one operatory to the next operatory. If you look at 3Shape's TRIOS® filing system, there's the ability to have one designing area, but the scanner itself is wireless and mobile. In addition, individual operatories are now being connected wirelessly to one another via tablet computers or other mobile devices. You're literally just taking the scanner to where you need it and then firing it up. Your network computer or your network tablet-that's already there. I think mobile equipment impacts an office's actual physical design in that you may have a centralized area that you keep it, but it also needs a place where it "parks" in the operatory, when needed. I do think people want to see less clutter and a cleaner operatory environment. When the equipment is somewhat hidden out of sight, patients experience less anxiety when they walk into the operatory. Therefore, we need to have modular carts that can be brought in as needed but are not always out. In our office, we have a photography cart, a laser cart, and a scanning cart, and depending on the procedure that's occurring, the appropriate cart is brought in so patients don't become overwhelmed by all of the equipment just lying out.
(ID): How about monitors? How many monitors should a modern operatory be equipped with?
(PK): I think there should be a minimum of two monitors and a tablet. To me, it's two fixed monitors of some kind-one for the clinical team and one for the patients' entertainment and education-and a third mobile one, such as a tablet, that you can use to sit knee-to-knee with the patient in the operatory and go through case planning or issues that you're seeing with a screen-replication feature.
(ID): Are handheld x-ray units popular?
(PK): They're becoming more popular, and I think they will continue to do so. I also think that mobile radiography in general will start to increase, and as these units get lighter and smaller, people are going to be much more likely to use them. The biggest hurdle faced by this technology is getting over how people are trained to use traditional x-ray imaging units, where they are required to walk outside of the room during the process, but I do think handheld units will become more and more used.
(ID): What are your thoughts on rear delivery versus over-the-patient?
(PK): That's a tough one because it is influenced by doctor preference, right? Rear delivery is probably the best from a patient perspective because they're not seeing the equipment come directly at them, which can be intimidating. Ergonomically, however, it is probably one of the worst things that we can do. We're rear delivery at my practice, simply because we don't want the patient seeing the equipment. The over-the-patient approach is probably the best ergonomically from the doctor's perspective, but there's a potential to make a patient feel claustrophobic because the equipment is hanging over them during treatment.
(ID): Staying on the topic of ergonomics, what advances in seating and chairs have been made to optimize the ergonomics for both practitioners and patients?
(PK): For the practitioner, I believe that the actual thickness of the chairs has decreased throughout the years, so now we have this slimmer profile that is not as broad from side to side or shoulder to shoulder. This allows us better access to the patient. Regarding patient chairs, during the last 10 years, more and more headrests have been produced with an articulation feature that permits you to actually move the head into more positions than just a static flat board. You can tilt patients' heads back, and it's more comfortable for them. I don't see any issues with patients' chairs in terms of their comfort today, at least with the midrange to higher-end chairs.
(ID): What's the importance of that? Is it really worth it to provide that comfortable of a chair for the patient?
(PK): As a general rule, no one likes going to the dentist, but we can make the experience more tolerable and less intimidating. And so, from that standpoint, I think that this is an investment that makes sense. When patients walk into the room, they see a comfortable piece of equipment that they can sit on, and while they are on it, the comfort improves their treatment from a patient experience standpoint. So to me, within reason, the chair is an important factor to look at and shouldn't be an afterthought.
(ID): Is there anything else on the topic of office design or operatory equipment that you'd like to add?
(PK): I think imaging is going to become a bigger piece for a lot of practices, and imaging includes photography in addition to radiography. One of the regrets that I have at our practice is that we didn't create a dedicated miniature photography studio. I would consider doing that or having the operatory be more flexible in a way that lighting (eg, photographic lighting, different kind of flashes, soft boxes, etc) can be brought into it very simply or drop down from the ceiling. Therefore, in the individual operatory, I think that what we do at the ceiling level is important. Instead of just considering the esthetics, we should also consider what may ultimately need to go up there to be utilized for photography or other diagnostic imaging.