Three types of floor planning mistakes

Three types of Orthodontic Office floor planning mistakes: omissions, ergonomics and flow

Submitted by Susanne Slizynski, Managing Partner by

This is a 2,600 square foot orthodontic office in Brooklyn, NY. Construction on this project has started, the concrete has been cut, trenching is done, pluming, air and vacuum lines have been installed to a total of $47,000. In our initial conversations with the doctor he expressed frustration that his critiques of the floor plan were being cast aside and were not being addressed by the local team. When he met with the cabinet manufacturer, he expressed his concerns and they  referred him to our team to work out the bugs.  We have been hired to do a thorough review of the plan and report back to the doctor.  We started out by having the doctor complete our comprehensive orthodontic office planning questionnaire.

three-types-of-floor-planning-mistakes  Green Curve Studio


1-Entrance: Missing Vestibule, this office is located on the ground floor and requires a vestibule to reduce energy costs and to provide a walk off area to reduce tracking in snow. This was requested by the doctor from the start. 2-3-4 Reception/Aquarium/Front Desk/Check-in: The office is located in a religious community where separation of male and females is the norm, the equipment/architect plan is in compliance on this aspect. The goal of having an aquarium in the space was for it to be a focal point, viewable by parents, male and female patients, but it has been positioned up against a wall in the female section, males would have to cross over into the female area to view enjoy the aquarium.  Tooth Brushing is secluded off the female reception area, requiring male patients to cross over, the area is very tight, the sinks are too close, patients would be elbow to elbow and there is no room for tooth brushes, paper towels or waste chutes. There is a coat closet in the brush area but it’s too tight for access, I imagine would be extremely uncomfortable for patients to access, it’s likely that it would only be used by one patient at a time. The brush station is not in the proper flow, it should never be located in a secluded area with access through a reception room. There are two side by side check in stations with chairs for patients to sit down and check themselves in, this detail shows that the designer does not know what they are doing as self check-in is meant to be expedient where the patient stands in front of a touch screen monitor and taps their name.
5&6-Front Desk/Business Office: Equipment suppliers constantly make the mistake of positioning a door between check-in/check-out, with one staff at front desk. This works fine in a dental office where the patient volume is low, but for an orthodontic office it causes congestion and back up at the front desk.  Afternoons often have a flow of 75 to 150 patients so this layout is “anti flow” where patients coming and going will stack back at the front desk, congestion areas give parents the impression that your practice is disorganized and too busy.  The other problem with this layout is that business office is mixed in with the front desk, it’s likely to be messy and strewn with office equipment, it doesn’t provide the privacy necessary to focus on business tasks and private conversations with patients. You also have a patient washroom directly across from this area, unpleasant for staff and  patients. 
7-Staff Room: The thought is that locating staff room upfront will allow the business manager to supervise, so staff doesn’t congregate. The parking structure is located off the doctor’s office so all staff will traffic in and out of the doctors private office to get into the space. 
8-Private Treatment: There are three rooms on the plan labeled “Private Treatment”, these rooms are set up as though they are surgical rooms with four handed dentistry, and they are meant to double function as a NPE or TC Room.  The rooms are too tight for any of these tasks to be performed and they are over loaded with dental equipment that is not required for an orthodontist. The guest chair is awkwardly positioned right next to a hand washing sink, this does not make a good impression on parents paying thousands of dollars for orthodontic treatment.  
9-Photo room: A significant portion of space has been dedicated to a Photo room, this is typically a back lit panel. Ideally there should be 2-3 back lit photo areas as photos are taken throughout the day by more than one staff member. 
10-Doctors Office/Private Washroom: This is set up for one staff member, but the orthodontist plans to share the office with his administrator.  The layout uses up a lot of space but doesn’t really provide much functional work space. The private washroom is non functional, the doctor will have difficulty getting into the room as the door swing doesn’t allow for adequate clearance. 
11-Private Treatment: This is the third multifunctional room that again, is too tight to function and again over loaded with dental equipment. 
12 -Column/On Deck Seating:  The structural column is not incorporated into the design so it’s creating a blind spot. On-deck seating is  separated, male and female, but they are directly across from each other in a narrow hallway, in the middle of the busiest and most congested area in the office, staff and patients trafficking through need to squeeze by patients sitting at on-deck.    
13&14 -Male/Female TBays:   Let’s take a look.  First of all with this layout if you have 6 female patients and 2 male patients, you can’t mix them together, instead of treating patients you have to spend your time organizing the flow of male and female patients.  Both Treatment Bays are equally 100% failure for layout, flow and ergonomics, there’s $47k of plumbing already installed.  The rear hand washing cabinets have two computer stations, but not enough room for staff to stand at the counter and allow for doctor, staff or patients to get in and out of the space.  The hand washing sinks are at the far end of the rear cabinet where they can only be  accessed by staff at the end treatment chairs.  The treatment chair at area “14” is so close to the wall the patient can’t get in, they would have to approach on the right hand side and crawl into the chair.  But before the patients and assistant even get to either of the end chairs they have to navigate around staff and doctor treating patients, the staff and doctor will need to skoosh in every time someone passes behind them. How is any one going to be able to open drawers or cabinet doors to access supplies? 
15-Lab/Sterile Area: This area is very tight, you can imagine trying to open doors & drawers, there’s just not enough room for lab and sterile staff to function at all.  Labs are noisy and dusty, a door is required to close off the noise from the rest of the office.  There’s not enough counter space to layout the needed equipment; double wide model trimmer, whip mix, lathe, a sit down area for adjustment, essex retainer-wet lab/dry lab function, 3D printer, double stack auto claves, breakdown/set up, ultra sonic, drawers, supplies.  This is likely when the cabinet manufacturer realized that the orthodontist needed immediate help. 
three-types-of-floor-planning-mistakes-after  Green Curve Studio


After Orthodontic Office Plan by Green Curve Studio, inc.
1-Vestibule: The vestibule that the doctor  requested is now in place, this provides an airlock that tempers the outside air which will reduce energy costs. It also provides a walk off area to reduce snow and debris from tracking into the space.
2-Female Reception/Aquarium: We’ve relocated the aquarium so that it’s a focal point upon entrance and easily viewed by all. We’ve relocated tooth brushing out of the reception area.
3-Front Desk: We’ve reshaped the front desk and moved it out of the men’s reception area, we’ve created two works spaces and opened up the flow, we’ve created a logo wall to identity the practice.
4-Business Office: Separating the Manager and Business Office from the Front Desk allows parents, staff and doctor an area to sit for private conversations with plenty of work space and room for office equipment.
5-Hallway: We’ve widened the hallway to allow for single and double wide baby carriages, high peak hours where staff, patients and doctor will traffic through this area. The med/gas closet has been removed since this is not needed for an orthodontic office.
6-Exam/Consult/Records: The Exam/Consult/Records room is across from the Business office, the room allows for parents and siblings to huddle on one side of the desk, or sit on the bench area, we’ve provided a records chair for the exam, room for a scanner, and we’ve provided a back lit panel to take patient photos.
7-Exam/Consults/Records/Private Treatment: We’ve enlarged this multifunctional room, moved the parent seating across from the sink area, so we have a clear separation of parents side on the left, staff/doctors work area on the right, so the orthodontist has a direct eye contact with the parent. We’ve added another back lit panel for a second area to take patient photos with out taking up any extra space, and of course room for a scanner. 
8-Tooth Brushing: We’ve relocated tooth brushing with a separation between the sinks so male and female can brush their teeth at the same time, it’s in the proper flow and in the open area.
9-On-Deck: On-deck is now moved out of the heavy traffic area, with separated male and female seating.
10-Staff Lounge: The the staff lounge is now right off the parking garage entrance so the staff doesn’t have to traffic through the doctors office or through the front end of the office.
11-Dr’s. Office: The orthodontist private office now has plenty of privacy, work space and an easily accessible washroom. We’ve eliminated two of the non functional exam rooms to allow for more functional staff support areas.
12 Lab: The partial ortho lab has been separated from Sterile and now has adequate wet/dry/sit down work area for two works stations and all the necessary equipment.
13: Xray: X-ray has been moved out of heavy traffic areas and placed more central to the Treatment bay for new and mid case x-rays.
14-Sterile: The centrally located galley style Sterile Room separates tray breakdown/sterile and tray prep areas.
15-Treatment: The U-shaped ortho treatment layout provides 3 semi private treatment zones with partitions to separate male and female patients, the partitions remove the need to track male and female patients, allowing for maximum efficiency and patient volume. Each treatment area has a fixed cabinet to the right for supplies, delivery is over the patient with a rinsing sink on the left which was requested by the orthodontist, this allows the patient to enter the chair on the right hand side. There is enough clearance at the head of the ortho treatment chair for staff and patients to traffic in and out of the Tbay area.

Q & A:

When should I have my orthodontic office floor plan reviewed by an industry recognized design team?
We practice an open door policy where we offer floor plan critique and review, often plans don’t look as bad as this one, but can still have critical problems that will become apparent to the doctor at some point. If you sign off on the floor plan and the design team starts working drawings like electrical, ceiling design, lighting design then you’re already into construction drawings, so costs will start to snow ball out of control.  You’re likely to get push back from the “on board” “design team as they’ve likely spent weeks on the layout and are not able to send you a progressive invoice until you sign off on the floor plan.  Not only that but the equipment supplier and contractor can’t progress with invoicing and contracts, so there is a turf struggle.  It’s difficult to tell an onboard consultant, that you may value in many other ways, that you don’t have confidence in their floor planning abilities, especially when you see the errors and aren’t able to articulate to the team how to make the improvements. So having a thorough critique will justify your decision. 
I’ve worked very closely with the local team on the layout and I feel pretty confident that it’s good to go. Why should I bother to get a critique?

I recently reviewed a layout where the doctor had worked closely with the architect on his 3,000 square foot layout, I was distracted by how the architect fit all those rooms into 3,000 sf, it was impressive, I thought for a second these guys are good. I sent the plan over to our design team and it measured off at 3,800 square feet, the doctor one hundred percent understood that the layout was within 3,000 square feet, and didn’t want to lease any more space.  Other than that I easily spotted few problems with the layout, there wasn’t enough in the room in the reception area between the front desk and seating, it was way too tight, a parent in the reception room could easily put their feet on the front desk, but reworking this area meant reworking many other areas. The brush station was secluded, the mechanical room was up right against the front desk where noise and vibrations would transfer through the wall. The doctor told me that local architect demanded that he explain why he needed an outside specialist, he sent them our critique and proceeded to hire us to rework the layout and design the entire space. The final layout doesn’t look “anything” like the original plan.  

How much does a layout critique cost and what can I expect from it?

 A thorough Floor Plan Critiques range from $500 to $1,200 depending on the size of the space and how much improvement is needed. The service includes a consultation and marking up a PDF of the layout pinpointing problematic areas, it does not include sketches to revise the layout.  Many orthodontist already know the plans don’t work and after a brief conversation with our team decide to contract with us with out the need for a paid review.  Some doctors will take comments back to the local team and have them make revisions accordingly, most of the revisions are as bad or worse than the first draft.  Orthodontist love working one on one with the design team where workable options are discussed on the on screen share, rather than having an equipment supplier rep or an architects rep pass the information onto the drafting team where a lot gets lost in translation.  But if the drafting team doesn’t have much if any experience in dental office design it’s likely it won’t make much of a difference. With an experienced team such as hour ideas can fly off the pages, giving you a lot of options. 

How much does it cost if I hire your team to provide the layout?

Often doctors know there are problems with the layout, after a brief review discussing areas of concern they decide to hire us to rework the floor plan, many of them have spent weeks and countless hours working on the layout with their design professional, paying premium fees, they are ready to move on.  Our “Floor Planning Only” design service ranges from $1 to $3 dollars per square foot for a fully detailed layout. Once you send us the PDF layout of your space we can firm up a quote and scope of work.  Remember that all A, D & E costs (architect, design, engineering) are reimbursed by the bank as part of the construction loan, so you can afford to hire the best team. 

Why wouldn’t obtaining an “experts opinion” be viewed as a “positive?”

This is rather a loaded question and there could be many reasons: – Money is most likely the number one reason for a local design or equipment resource to“control the turf”. They may be worried an outsider would take control of the project and they may lose potential sales, and that you might not be loyal to keeping them on as the equipment supplier.  Pride is a second strongest factor is resisting outside assistance, no one wants to be “made a fool of”, they don’t want to lose the doctors confidence, pride is a very powerful emotional motivator.  And they also be worried about project delays and how that impacts your timeline and construction budget, especially if they don’t know the design team and the expertise they provide. However having an experienced and talented team on board actually expedites the design process so the project moves faster, as the doctor has confidence in the design. 

What if I’m well underway with design, does it make sense to secure a review?
You should secure a review right away to make sure you’re not throwing hundreds of thousands of dollars of construction money at a design you might regret. On this project it was up to the doctor to decide whether to trash part or all of the $47,000 of installed plumbing or to continue construction on a critically flawed layout spending from $400 to $600k.  On other projects we’ve been able to save most of the completed work, but that was just skill and luck. 
What gave the doctor the confidence to start over was how much he loved the new layout, he could visualize it, it was his dream office so  the decision was made to restart the entire design.  
Many doctors worry about the money they’ve already spent on design and worry it will cost too much to get out of a signed design contract, however unresolved flaws will only get more expensive, then the anxiety you have about paying too much for good design will turn into anxiety about inflated field change orders, it can come back to haunt you in a big way. 
What can I expect from Green Curve?
At Green Curve our goal is to provide you with a layout that will have a 10, 20, 30 year life cycle, depending on the size of your space and pace of growth.  What you need to know is that terrible floor planning by local equipment suppliers, architects, designers, is prevalent, it’s the norm. 
When we’re designing a project we’ll likely get input from many participants; doctor, staff, spouse, equipment suppliers, consultants, contractor and more. Our team has the experience to demonstrate which options actually work, if this project had come to us in 2005 I wouldn’t have had the hutzpah to step in as a gate keeper between the doctor and contractor/equipment supplier to reset the project on a successful course.    
There can be a turf struggle between different design entities, but you have to decide which team is going to provide a best outcome for a new orthodontic office launch.  We are happy to help!
Susanne Slizynski
Managing Partner
Green Curve Studio inc. 

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