Community
OralHealth Service
Facility Guideline
Citation: Ministry of Health. 2006. Community Oral Health Service: Facility Guideline. Wellington: Ministry of Health.
Published in August 2006 by the
Ministry of Health
PO Box 5013, Wellington, New Zealand
ISBN 0-478-30037-5 (Book)
ISBN 0-478-30040-9 (Internet)
HP 4292
This document is available on the Ministry of Health’s website:
Acknowledgements
This document reflects advice made to the Ministry from a variety of individuals and organisations. The Ministry would like to acknowledge in particular the input from the following individuals and businesses in the development of this document.
Margaret Binnie, Research Fellow, The Center for Health Assets,Australasia
Bob Buskin, Director, Rider Hunt, Auckland
Darryl Carey, Architect, Chow Hill, Auckland
Atish Jogia, Quantity Surveyor, Rider Hunt, Auckland
Stuart Smith, Technical Director, Beca Carter Hollings & Ferner Limited, Auckland
Garth Whittaker, Director, Ncounter, Auckland
Disclaimer
This report was prepared under contract to the New Zealand Ministry of Health. The copyright in this report is owned by the Crown and administered by the Ministry. The views of the author do not necessarily represent the views or policy of the New Zealand Ministry of Health. The Ministry makes no warranty, express or implied, nor assumes any liability or responsibility for use of or reliance on the contents of this report.
Community Oral Health Service: Facility Guideline1
Community Oral Health Service: Facility Guideline1
Contents
1Introduction
2Description of Facilities
2.1Services provided
2.2Facility design
2.3Target population
2.4Care offered
3Planning Assumptions
3.1Role delineation and level of service
3.2Hours of operation
3.3Type of facility
3.4Alternative contract arrangements
3.5Calculating the number of treatment chairs required
4Operational Policies
4.1Accessing services
4.2Patient management and flow
4.3Anaesthesia
4.4Medical emergencies and patient recovery
4.5Instrument reprocessing
4.6Radiology
4.7Dental records
4.8Supplies
4.9Waste disposal / mercury
4.10Laboratory
4.11Information and communication technology (ICT)
5Facility Location
6Functional Areas and Design
6.1Functional areas
6.2Shared or common areas
6.3Dental surgery design
6.4Dental surgery layout
7Support Areas
7.1Laboratory
7.2X-ray processing room
7.3Staff offices and amenities
7.4Information technology
7.5Car parking
8Infection Control
8.1Environmental
8.2Personal hygiene and protection
8.3Instrument reprocessing area
9Health and Safety
9.1Overview
9.2Sole operator
10Building Services and Environmental Design
10.1Electrical systems
10.2Patient privacy
10.3Security
10.4Acoustics
10.5Lighting
10.6Access and mobility
10.7Information and communication technology (ICT)
10.8Radiation screening
10.9Heating, ventilation and air conditioning
10.10Water
10.11Medical gases
10.12Plant room and supply lines
10.13Interior finishes
10.14Dental surgery joinery
10.15Signage
10.16Fire requirements
11Mobile Dental Units
11.1Overview
11.2Planning considerations
11.3Policy and practice considerations
12Dental Facility Upgrades and Refurbishments
13Components of a Unit
13.1Standard components
13.2Non-standard components
13.3Dental surgery
13.4Instrument reprocessing room
13.5Plant room
13.6Dental laboratory
14Dental Surgery Equipment
15Information and Communication Technology (ICT)
References and Further Reading
1.New Zealand
2Australia
Appendices
Appendix 1: Policy Framework for this Guideline
Appendix 2: Role Delineation and Organisation of Dental Care
Appendix 3: Schedule of Accommodation
Appendix 4: Example Floor Plans
Appendix 5: Quantity Surveyor Costs
List of Tables
Table 1:Essential items of dental equipment where installation must be considered at the design and layout stage
Table 2:Clinical equipment for consideration and installation requirements
Table 3:Items to consider when planning an oral health facility
Table 4:Service characteristics essential for Level 1 service
Table 5:Specific Level 2 characteristics
Table 6:Specific Level 3 characteristics
Table 7:Relationship between models of care and facility types
Community Oral Health Service: Facility Guideline1
1Introduction
Establishing a new public oral health facility – whether it be a unit in a hospital, a community dental clinic or a mobile unit – requires careful planning. A range of factors will influence how well the facility functions, in terms of providing a high-quality service in a safe environment. This Oral Health Facility Guideline has been developed to provide best practice guidance on how to ensure this happens.
The Guideline will be of most use to:
- health service personnel involved in the planning and design of oral health facilities
- architects, planners, engineers and others who are engaged to plan and design oral health facilities
- personnel whose role it is to oversee and monitor such projects.
Although the levels of service provided will vary across District Health Boards (DHBs),all provide oral health services to similar populations of eligible clients within the public health sector, and their aims and objectives are similar, with the emphasis on prevention. This Guideline is aimed at ensuring a consistent approach to the design of publicly funded oral health facilities to meet both the needs of the patients, and also the needs of the staff who work in the public sector.
Before any facility planning occurs, an Oral Health Service Plan for the District Health Board (DHB) region should have been developed. This will detail the level of service to be provided, the number of dental chairs and workforce requirements, and the type of oral health facility required. It is essential that community oral health facilities are planned within the wider strategic planning for DHB oral health services, and within Ministry of Health guidelines and requirements for service coverage.[1]
Although standards and requirements will change over time, non-compliance with this Guideline when redeveloping or reinvesting in facilities will need to be justified to gain approval for the proposed non-compliant components.
2Description of Facilities
2.1Services provided
Most publicly funded oral health facilities will provide predominantly community-based outpatient services, but there may need to be some inpatient access in hospital-based units. Dentists may need access to operating or day procedure facilities for dental and oral surgery that cannot be undertaken in a community facility, particularly for children and people with special needs. However, this Guideline focuses on primary care delivered from community-based oral health facilities.
Oral health facilities may support some or all of the following services:
- dental therapy services for children and adolescents
- general and emergency dental services for all ages
- specialist services – paediatric dentistry, oral surgery, orthodontics, periodontics, oral medicine, prosthodontics, endodontics
- teaching and training
- community education programmes.
An example Schedule of Accommodation is set out in Appendix 3 of this Guideline. The schedule is not intended to be prescriptive, but rather aims to provide the basis on which an oral health facility suitable for its stated purpose can be developed. In short, it provides the information necessary to plan and design oral health facilities of varying sizes and complexity.
Sample layout drawings for one, two, four and six chair facilities and costs are provided in Appendix 3. DHBs will be required to commission detailed drawings for their agreed facilities, however it should be noted that there should be an opportunity for a collaborative approach for procurement of final facility drawings.
2.2Facility design
The Oral Health Facility Design Guidelines produced by Queensland Health (2004) identifies some of the issues which should be taken into account when planning a facility in New Zealand as many of the issues experienced in Queensland are replicated in the New Zealand oral health sector. We therefore think that the Queensland guideline is relevant and make reference to their suggested design criteria below.
Oral health facilities should support the effective and efficient provision of oral health services to eligible clients. In order to do this, the following outcomes should be achieved by facility designs:
- capacity to comply with relevant laws, by-laws and standards
- safe, hygienic buildings
- capacity to achieve accreditation to an appropriate level
- innovative, stimulating and responsive environment for patients and staff
- flexibility to allow for future change
- maximum energy efficiency
- accessibility for disabled persons
- capacity to support the development and retention of high quality staff to meet the needs of patients.
2.3Target population
The target population for publicly funded oral health facilities includes:
- pre-school and school-aged children and adolescents
- people with special needs who are unable to access dental care from private dental practices
- adults on low incomes who are entitled to a Community Services Card
- communities with high needs
- clients in remote and rural areas.
2.4Care offered
The care most commonly offered in community-based facilities includes:
- oral examination and diagnosis (including radiographic diagnosis)
- preventive care, including fissure sealing and fluoride applications
- general dental care, including restorative dental care at a non-specialist level
- extraction ofteeth and oral surgery
- treatment of periodontal disease
- referral of patients (as required).
Community-based dental facilities may also be used to provide dental services beyond those traditionally offered in school-based facilities, such as:
- fitting and adjusting dentures and removable prosthetic care
- specialist care (eg, orthodontic, outpatient oral surgery or paediatric dentist treatment).
Facilities should be planned bearing in mind the extended scopes of practice that may be offered by a dental team – including dentists, dental therapists, dental hygienists or clinical dental technicians – in the context of each DHB’s oral health service planning.[2] Community-based dental facilities may also be the base or hub for outreach health promotion and community link services offered by the oral health service or allied health providers. Suitable accommodation will be required for these staff if they are part of the oral health service plans.
In hospital-based units, services may be provided to patients requiring specialist treatment or advice beyond the scope for general dental practice.
3Planning Assumptions
3.1Role delineation and level of service
Role delineation is a process that determines the facilities, staff profile and other requirements that ensure oral health services are provided at an appropriate level and in a facility that is appropriately supported. The level of service describes the complexity of the clinical activity undertaken by that service, and is chiefly determined by the presence of dental and other health care personnel who hold qualifications compatible with the defined level of care.
This Guideline recommends a role delineation and organisation system with a hierarchy of levels of care, from less complex to more complex, with appropriate consideration given to local needs, resources, cultural diversity and geographical constraints. It is based on the American Society of Anaesthesiologists (ASA) Physical Status Classification System, and considers the physical states of the patients to be managed and the services to be delivered from the facility to define four levels of facility, as follows.
- Level 1: access is limited to examination and preventive oral health care for normal healthy patients with mild systemic disease, delivered from a fixed (purpose- and non-purpose built) or mobile dental facility in a community setting.
- Level 2: examination and treatment oral health services for normal healthy patients with mild systemic disease are delivered from fixed or mobile community facilities.
- Level 3: examination and treatment oral health services, with the ability to offer sedation services for normal healthy patients or patients with mild systemic disease, are delivered from community- or hospital-based facilities.
- Level 4: examination and treatment services, with the ability to offer sedation services for normal healthy patients and examination and treatment services for patients with mild or severe systemic disease, are delivered from a hospital-based facility.
For more detail on role delineation and level of service, see Appendix 2.
3.2Hours of operation
Oral health facilities will usually operate during business hours, Monday to Friday. However, some may operate outside these hours and this may have particular implications for access, security and safety of practice that need to be considered during the planning and design stages.
3.3Type of facility
Offering a community-based and population-focused oral health service requires a mixture of oral health facilities appropriate to the needs of each community and the needs of the population. It is anticipated that community oral health facilities will be either:
- stand-alone and community-based in a metropolitan or rural area
- community-based and part of a school, community health centre or other multi-purpose community-based centre
- a mobile unit in an outreach location made available for dental care
- a hospital-based unit.
The District Health Board New Zealand (DHBNZ) School Dental Service Review Final Report, December 2004 proposed reconfiguring oral health facilities based on the ‘hub and spoke’ model. This configuration usually consists of a strategically sited ‘hub’ clinic, with mobile clinics constituting the ‘spokes’. A hub clinic will generally accommodate two, four or six dental chairs, although in high-density communities or where training facilities are required, larger clinics accommodating eight or more chairs are a potential option.
For the purpose of the following discussion a distinction is made between fixed, mobile and hospital facilities.
Fixed community-based facility
We anticipate that a full range of dental examination and treatment services would be provided from a fixed community-based facility; which is to say, facilities delivering at least Level 2 services and offering ‘hub’ services in a hub-and-spoke model.
Community-based facilities may be developed at many different locations, including school-based clinics, stand-alone facilities within or close to community hub locations, and co-located as part of community health centres or other community-based centres.
Mobile facility
Mobile facilities would frequently be used to offer ‘spoke’ services in a hub-and-spoke model. There are a number of trailer and self-propelled/self-drive mobile dental unit options. Before embarking on the construction and use of mobile dental facilities, however, the purpose of the unit must be clearly identified, including the population to be served, the level of service (examination only or full treatment), the service sites to be used, and the workforce mix.
Single-chair mobile units may be developed for either a comprehensive examination and preventive service or a full treatment service. Mobile units with more than one chair would generally be recommended for full treatment services in preference to an examination and preventive service.
Hospital-based facility
The main role of hospital-based dental facilities is to provide outpatient care. However, services are also provided to inpatients who require urgent dental care or dental care as part of an inpatient admission. Not all hospitals are expected to have a dental unit, but DHBs must make provision for dental care for inpatients, and for outpatients requiring dental care that cannot reasonably be provided from community-based facilities (including the private sector).
3.4Alternative contract arrangements
District Health Boards may also want to consider utilising private dental practice providers, or investing in the community-based facilities of other primary health care providers (eg, primary health organisations or Māori oral health providers). Publicly funded dental facilities operated in conjunction with a DHB-funded contract would be expected to conform to the standards outlined in this Guideline. Contracting with private dental practices should be considered, particularly where investment in public dental facilities would not lead to a productive facility, and where access to an appropriate workforce or service coverage may be better achieved in conjunction with a private dental practice provider.
3.5Calculating the number of treatment chairs required
The decision whether to invest in a public dental facility and the size of that facility is affected by many factors, and this Guideline is provided to assist in planning a facility to ensure it meets the needs of a particular population. DHBs should consider the productivity anticipated from new clinical facilities, and this should be based on the productivity anticipated from the dental chair.
But while dental chair productivity is important, it is not the only factor. Other considerations are the demand for dental services, the level of oral health need in that population, and the proportion of the overall service that it is anticipated will be delivered from the publicly funded facility.
The following formula may be used to assess the number of chairs required. Based on the total number of days available, calculate the actual hours available by subtracting the number of non-clinical hours from the total hours available. Then, assuming half-hour appointments, multiply the actual number of available hours by two. This gives the number of patient appointments per year each chair can support. This is illustrated in the following example, which works through the steps, based on a number of assumptions.
1.Assume total days available=47 weeks x 5 days = 235 days.
2.Therefore, total hours available=235 days x 8 hours/day = 1880 hours.
(This excludes public holidays and an annual closedown period = 5 weeks.)
To calculate the non-clinical time:
3.Assume chairside cleaning allowance = one hour/day (half hour between and after sessions = 235 hours.
4.Assume 80% occupancy = 376 hours (this allows for meetings, training and allowance for managing the work patterns of part-time staff, etc).
5.Therefore, total non-clinical hours = 611.
6.Available hours = 1880 hours per annum– 611 (total non-clinical) = 1269 hours per annum(or 5.4 hours/day).
7.Assume a predicted 12,000 appointments per year.
8.Based on half-hour appointments, each dental chair has the capacity to support 11 patient appointments per day, or 2585 patient appointments per year.
9.Therefore, 12,000 appointments per year require 4.6 chairs.
District Health Boards should carefully consider the critical assumptions in this planning (eg, 30-minute appointments, number of days available) and assess whether differing productivity and efficiency assumptions are more realistic for the DHBs actual situation.
On the basis of this information, DHBs need to consider full-time equivalent output/productivity levels, appointment not kept rates (which may be higher in the public sector), and facility configuration options to achieve an optimum staffing mix and maximum efficiencies.
4Operational Policies
There are a wide range of national, regional and local regulations and policies relevant to the planning and delivery of oral health services and facilities. For details on these, refer to the ‘References and Further Reading’ at the back of this Guideline.