Choosing to build your own practice doesn’t have to be a painful operation. Get yourself a second opinion about the best techniques in surgery design. By Kerryn Ramsey
A common mistake when designing a dental practice is to take on the whole kit and caboodle yourself—from finding the location to choosing the interior colour palette. While it’s tempting to project manage a build, an all-in-one package deal can save money and minimise stress. “A professional fit-out can make the surgery more functional and make the patients more relaxed,” says Henry Schein Halas’s Andreas Schulz.
As national sales manager of of Henry Schein’s EQ division, Schulz points out that setting up a new practice is a long-term venture that must take future extensions into account. “You don’t want to have the extra cost of ripping out walls, slicing concrete, reworking the electricals and moving the plumbing in five or 10 years’ time,” he says.
Whether undertaking a new build or a refurbishment, there’s an abundance of council requirements and unforeseen circumstances that can overwhelm even the most renovation-savvy dentist. Despite that, “you’d be surprised how many try and end up having trouble,” says Nathan Reid, national marketing manager of Medifit Design & Construct. “They are fantastic dentists but there’s a whole other level of knowledge that’s needed.”
A dental design service, such as Medifit or Henry Schein Halas design guidance, initially provides a feasibility study, capturing the needs and desires of a practice. Starting from scratch, a dentist should have a clear idea of the size of the surgery, the location and, as Schulz has mentioned, future plans.
Reid says, “We work with the dentist to make sure the potential premises will support that vision for their practice. Regardless of styles, it’s really about the type of dentistry they want to provide and whether the demographic around that area will support the type of practice they are going to build.”
He suggests that a good way to start is to fit out two surgeries in the first stage, then add another two or three later on as the surgery’s patient base expands. “That gives the owner the option of not getting in too deep before they commit to these things,” he says. A dental design service starts the process by finding the ideal premises and negotiating a lease, which could include a rent-free period during the construction time or landlord contributions towards the fit-out.
Schulz explains that fitting out a shell is often the most flexible and cost-effective option but there’s no reason to dismiss other opportunities. He admits, however, there can be unpleasant surprises when converting an old building or residential home into a surgery. It might have to be re-stumped or internal walls might need to be moved to create disability access in hallways and corridors. Heritage issues can also exist in older inner-city areas and may increase the cost of construction.
Legislative bodies in all states are now cracking down on disability access and energy efficiency requirements. “That can be problematic when renovating an older practice,” says Reid, whose Medifit firm has been designing and building dental practices throughout Australia for 11 years now.
Despite the potential risks, he has a similar conviction to Schulz when it comes to refiguring an old dwelling. “Sometimes it works out better in the long run,” he says. Also, in most states, a dentist requries a building licence to be able to conduct fit-out works and the drawings need to comply with the National Construction Codes and Australia Standards.
“This effectively prohibits a dentist in building and project managing their own fit-out,” says Reid.
A surgery build can take from six to 12 months, comprising of interior design, council approvals, issuing of building permits and construction which comprises of supply and installation of all cabinetry, electrical, plumbing, plasterboard walls and ceilings, internal structural wall supports, flooring, painting and loose furniture. Dental design firms provide initial floorplans and renders in the early stages to get the ball rolling. “Once our clients can see 3D renders of the space, they begin to visualise and get excited about the possibilities,” says Reid.
Experienced designers are worth their weight in gold when it comes to ergonomics, traffic flow and getting the right amount of workable space to operate efficiently. “You don’t want staff tripping over themselves, and you need to leave enough room for right- and left-handed chairs,” says Schulz. “Many dentists say they can fit out a practice but they come unstuck when it comes to actually operating in the surgery.”
A dental chair is undoubtedly the centrepiece of the room but there are various aspects to consider. “It’s important to find the right set-up when it comes to placing the bench, getting the perfect distance between the bench and the headrest, and positioning the chair so it looks symmetrical,” says Schulz who’s designed more than 250 practices from Germany to Australia. His design maxim—“space, function, design, hygiene, cleanliness and well feeling”—can be treated as a handy to-do list when putting together a new practice.
Benchtop functionality is key when designing a surgery. “It’s terrible if you open four or five drawers and still don’t find the correct instrument. It doesn’t give patients much confidence,” says Schulz. Illumination also comes into play, with a light intensity around the operation field being between 24,000 and 37,000 lux. When configuring all the lighting and body-protected electrical areas, particularly with the OPG and X-ray unit, there are extra precautions and requirements that need to be followed, so it’s essential to get advice from a specialist.
As well as designing the layout and positioning the equipment, Medifit and the Henry Schein Halas team also work with the dentist when putting together the interior design. Reid, for example, supplies a finishes board with samples of materials, colours and textures, in unison with 3D visualisation. The next stage of design is the detailed documentation, with all trades given implicit direction on how to build the fit-out. For dentists who wish to refurbish an existing practice, they can complete the work in stages, ensuring the integrity of their cash flow is maintained. “Parts of the practice are hoarded off, and the dentist can also work after hours and on weekends to minimise any disruption to the daily operation of the practice,” says Reid.
When it comes to factoring in all the costs of setting up a practice, it’s easy to agree with Reid—“it’s not something to be taken lightly. For a lot of people, it’s the biggest professional choice they’ll make and it needs to be respected,” he says. “We, and others operating in the area, take the stress out of it for dentists. We help them get on with operating their business.”