By Joe Ross, ASID Allied Member, Ross Orthodontic, Midlothian, Texas
- Time and motion efficiency in an orthodontic office is only achieved with the elimination of the class IV and V (entire arm and twisting of the body) movements and the reduction of class III movements.
- A designer familiar with the ergonomics of orthodontic-specific patient chairs and delivery systems will position the equipment to eliminate all excess classes of movement. If you are constantly twisting around during procedures, by the end of the day the fatigue will begin to show on your lower back, neck and shoulders.
Turn on the lights in a room; sit down on a stool to work on a patient, with instrumentation at your fingertips. Walk up to a counter and wash your hands. These simple things are the results of the study of ergonomics and anthropometrics.
Anthropometrics, the study of the human body, has given us a set of standards for locating seat heights, counter heights, even the height at which a wall switch should be located.
Ergonomics is the study of how we interact within our work environment. This can and does include many different concepts such as our position, positioning our patients, how we operate the delivery system, work area design, and how all of these factors can impact our health.
There are five classes of movement in ergonomic studies.
Class I – Fingers Only
Class II – Fingers and Wrists
Class III – Fingers, Wrists and Elbows
Class IV – The Entire Arm from the Shoulder
Class V – The Entire Arm and Twisting of the Body
Time and motion efficiency in an orthodontic office is only achieved with the elimination of the class IV and V movements and the reduction of class III movements.
In designing your office, the designer and/or architect will use these ergonomic standards to locate everything from the height of the electrical outlets, to the wall-mounted cabinets, to the art they place on the wall.
Using a designer or architect who is familiar with orthodontics and the study of ergonomics and how they relate to the specific procedures performed in different areas of the office will improve the patient flow, staff flow and instrument flow. When you first walk into an orthodontic office, the reception counter will range from 30 inches up to 42 inches high. Thirty inches is standard desk height as well as handicapped accessible, while 32 inches is standard vanity height for a toothbrushing area. Thirty-six inches in height is the standard for countertop height for most cabinetry. Forty-two inches high is the standard for a check-writing counter.
The designer will ask specific questions to get an idea of how you work in each area of the office. For instance, if you need a sit-down area in the lab, specify a desk work area. If you require additional clearance space over a sterilization counter for a taller sterilizer or the proper venting of a sterilizer, be sure to clarify this with the designer so it is included in the plans.
The largest room in an orthodontic office is the treatment area. It is where you, your staff and most of your patients spend the greatest amount of time. A designer familiar with the ergonomics of orthodontic-specific patient chairs and delivery systems will position the equipment to eliminate all excess classes of movement. If you are constantly twisting around during procedures, by the end of the day the fatigue will begin to show on your lower back, neck and shoulders. After years of working this way, one can only imagine how painful a day at work could be.
Starting with the type of delivery system you will be using in your clinic, the designer should place the additional cabinetry as to not interfere with the procedures performed chairside. The patient chair, the delivery system, the patient and you occupy space in the clinic. Being able to work ergonomically makes you and your staff more efficient and will reduce the stress in an office.
When you first sit down chairside to work on a patient, you might adjust the height of the stool so it feels comfortable to you. Positioned correctly, your legs should be parallel to the floor, your upper legs and backside should be completely supported by the seat with your back firmly against the lumbar support. This gives a natural relaxed position to your spine and helps to reduce the additional twisting and reaching associated with class IV and V movements. After adjusting your stool, you position yourself from a nine o’clock to a twelve o’clock position in order to work on the patient (assuming you are right-handed). Your delivery system, positioned correctly, will be at your fingertips and use only class I and class II movements. Rear delivery and over-the-patient-type delivery systems are primarily designed to be used during a bonding or other four-handed procedures. Both these types of delivery systems cause the additional class III, IV and V movements we don’t want.
The ergonomically correct delivery system will utilize anthropometric standards. Instruments should be positioned at the height of your fingertips and can easily be grasped without reaching over or around any additional instrumentation. Reaching, twisting or turning to get the instruments causes the class of movement to rise. The additional cabinetry in the clinic should be at 36 inches from the floor – any lower causes one to bend at the waist, causing stress on the lower back involved with class V movements.
Since the clinic is the largest room in the office, it is also the first room an inexperienced designer will steal additional space from. Pushing everything closer together restricts your workspace and causes additional reaching and twisting movements. If proper clearance space is not accounted for, this will cause the patients, staff and instrument traffic to collide and will add additional time to treat each patient.
One of the biggest causes of class III, IV and V movements in the clinic is lighting or lack thereof. Twisting your neck or back to try to see inside the patient’s mouth should be unnecessary movements. Starting with a good quality ambient light source will help to eliminate these additional movements. If necessary, add task lighting that can be adjusted easily; this will also eliminate additional movements. An outside light source should not affect the ambient light in your clinic; if anything it should enhance it.
Sterilization and Lab
Using ergonomics in your sterilization area and lab can also be a great benefit and help to enhance the instrument flow. Locating storage for sterile and used instruments at eye level with easy access will permit staff members to reach the instruments without stretching and using the counter space as a storage area. The ultrasonic cleaner should be recessed into the counter top or, if a tabletop ultrasonic cleaner is used, you may want to consider lowering the cabinet it sets on by 12 inches or so. Align the top of the ultrasonic cleaner to the height of the rest of the sterilization counter. This increases the ergonomic efficiency of the instrument flow. Additionally, locating a pull-out work surface within arm’s reach of your sterilizer will also add to the efficiency of instrument flow.
Improving the ergonomics of how you and your staff interact throughout the office will help to enhance productivity, prevent injury, and improve the quality of work.