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Archive for the ‘ergonomics’ Category

Accessibility Along the Wine Trail

Posted on: June 18th, 2014 by James Kuester No Comments

This past Memorial Day Weekend I went with friends on a tour of wineries in Western Wisconsin along the Great River Road that runs alongside the Mississippi River. We tasted some good and some not-so-good wine, and we had a great time visiting the shops that are abundant in the small towns all along the trail.

As we toured in and out of the shops and restaurants I couldn’t help noticing the wide variety of interpretations of the American’s with Disabilities Act implementations there were in regards to restroom accessibility. The ADA is fairly straightforward in its guidelines as to what makes for compliant design and what does not. Here are some of my favorites from our trip.

A towel bar doesn't make a good ADA grab bar

A towel bar doesn’t make a good ADA grab bar

One – a towel bar does not a grab bar make.   Towel bars are not the same diameter as grab bars and consequently are not as easy to grip if one needs some added stability. Additionally, towel bars are designed to hold towels, not the weight of a person, so even if this one happened to be installed with proper backing behind the drywall, chances are it would give way if someone actually used it for support.

Two – installing at a diagonal does not count as two bars. The ADA requires both horizontal and vertical supports around a toilet. Additionally, the horizontal support needs to extend down one side and across the back of the toilet. Installing the bar at an angle does not meet the requirement for both horizontal and vertical support. Nice try, but no.




Angled mounting doesn't count for two.

Angled mounting doesn’t count for two.

As in the first example I’m curious as to how well this bar would hold up mounting into the rough stone of an old barn if someone actually needed the support. Neither the mounting bolts nor the bar itself struck me as too stable.

Three – this restroom gets an “A”. Not only have they installed all of the proper bars, they are installed in the proper locations with distances that meet ADA guidelines for spacing from floor to bar and toilet to wall. Of course, they also get brownie points for designing a nice looking restroom while they were at it.



This is how an ADA compliant bathroom is supposed to look.

This is how an ADA compliant bathroom is supposed to look.

When was the last time you were in the public restroom at your dental office? Take a look and see just how whether all of the proper bars are installed and in compliance. Adding bars is a fairly easy thing to do and will make patients with disabilities dental experience much better should they need to use the facilities while there.

Design for Accessibility

Posted on: May 19th, 2014 by James Kuester No Comments
Mom & Dad

Mom & Dad

I recently traveled with my aging parents to my sister’s wedding on Chesapeake Bay. It was a lovely weekend and everyone had a great time, yet while I see my parents every week, living and traveling with them for four days reinforced to me just how much care we, as designers, need to take in designing for accessibility.

My parents are both in their mid-80’s and I think they get around pretty well. They are both in good health, yet do suffer from typical effects of aging such as diminished hearing, vision, balance, and mobility. Consequently, traveling to unfamiliar places poses a challenge. They don’t hear instructions by TSA agents, hotel clerks, and restaurant servers well when there is a lot of background noise. They get tripped up when floors and transitions are not smooth or stairs are of an uneven height. They don’t immediately identify signs and wayfinding clues. Watching my parents navigating unfamiliar terrain made me realize just how much work we have cut out for us in creating designs for our clients that work to diminish these challenges.

The elderly are not the only ones that need good accessibility design. Anyone who has ever broken a leg or ankle or for whatever reason was restricted to crutches or a wheelchair can tell you just how challenging getting around can be. Entrance ramps that are supposed to provide accessibility are often at the wrong angle and require tremendous effort to mount. Restrooms that do not follow ADA accessibility guidelines are next to impossible to navigate alone. Most operatories are designed for the efficiency of the staff and do not take the ability of the patient at all. Good signage in dental offices is almost non-existent. Patients of all ages can benefit from better accessibility design. Our job as dental office designers it to make sure our clients’ practices excel in providing it.

Attention to Details

Posted on: February 7th, 2014 by James Kuester No Comments
The wrong color stands out

The wrong color stands out

We’re working on a dental office design project right now and are struggling to find just the right color match between the floor tiles, countertop, and backsplash tile.  Since the client really loves the floor tile, it is the backsplash tile that is being problematic.  I’m sure, as a dentist you can relate.  When working to build a new crown for a patient getting the enamel color just right so it matches the teeth around it is critical.  If it is a shade or two off the tooth will stand out like a sore thumb and everyone will notice.  The same is true in design.  If something isn’t just right, the overall effect will be marred, and consequently, the impact from the design will be diminished.

There are multiple goals when creating a new design for a dental office:

  • What is the branding message the practice is trying to send?
  • What is the patient experience that the practice wants to be remembered for?
  • How can the practice become more productive and efficient through better space planning and design?
  • How can repetitive use injuries be reduced or avoided through better ergonomic design?
  • How can the practice use energy and water more effectively and efficiency through green design?
  • How can the practice make more productive use of its space through the application of technology?

These are just of a few of the questions that we ask our clients and ourselves on each project we work on. Hitting a homerun on all or most of these requires careful attention to details – just like getting the color right on a patient’s tooth.

Making Your Dental Office More Inclusive

Posted on: November 6th, 2013 by James Kuester No Comments
ADA Compliant Smile Branded Dental Restroom Sign

ADA Compliant Smile Branded Dental Restroom Sign

I just saw the coolest thing while in line at Starbucks.  Starbucks now offers a version of the Starbucks Card in Braille for the visually impaired.  The visually impaired have so many challenges and pulling the right card out of their wallet to buy their coffee should not be one of them.  Nor should navigating their dental office.

Proper interior signage in dental office is often an afterthought during the design process.  So many dentists and staff think that because the office isn’t large and they know where everything is that signage isn’t necessary.  They so often forget about their patients, or future patients, that may be visually impaired.  Even though there are codes on the proper placement of interior signage, they are often not followed, I think more out of ignorance than anything else.  Sadly, the Braille on off-the-shelf signage is often incorrect.  Many large manufacturers don’t have anyone that is visually impaired on their staff to check the signs before they are sent out.

We strongly encourage everyone to make sure the design of their dental office is an inclusive as possible by checking the placement of interior signage and the Braille to make sure everything is correct.

Bring Your A Game

Posted on: May 13th, 2013 by James Kuester No Comments

Yesterday I took my mom out for Mother’s Day.  To start our day we went to brunch at the little local breakfast place that I frequent virtually every Sunday when I’m in Indianapolis.  I know almost the entire staff and often feel more like family than a customer while I’m there.  They have amazingly good food and great customer service.  It doesn’t hurt that I’m also very fond of their clean, contemporary décor.  My mom had never been there so I was really looking forward to sharing one of my favorite places with her.

As yesterday was Mother’s Day, I expected the restaurant to be busy.  Well, it is always busy on Sunday mornings, but busier than normal.  What I didn’t expect was for none of the regular staff to be working.  Chris, the manager, is a really nice guy, but there have incidents in the past that made me question his decision-making skills.  While I can appreciate wanting to reward some of one’s best people with a holiday off with their mom’s, I question the wisdom of having the entire, regular Sunday crew absent.  After all, Mother’s Day is a really big deal in the restaurant biz, and often times the only opportunity a restaurant has to make a good impression.

Now, I’m not saying the replacements did a poor job.  They didn’t.  Actually, if I hadn’t known better I would have said they did a good job.  Unfortunately, I know how spectacular of job the regular crew can do and the replacements haven’t had years of working together to generate that seamless flow that propels one’s performance to World-Class status.  Not their fault, but I was disappointed in the experience Mom received yesterday.  She didn’t get this establishment’s A Game.

In a dental office what is the equivalent of a really high-profile, Mother’s Day holiday event?  Off hand, I can’t think of anything.  The closest is when a new patient comes into your practice for the first time.  Undoubtedly, you and your team want to make a good impression so this new patient will tell all his family and friends about his amazing new dentist and will not find an excuse to cancel his next appointment.  To me a dental office team needs to bring their A Game each and every day.  This is hard.  It is a difficult thing to always be “up” and firing smoothly on all cylinders, but that doesn’t reduce its importance.  So, what do you do, as the team leader to help the staff always put their best game face on?  One thing is to provide a work environment in the form of the dental office design that is conducive to a positive work experience.  Make sure the front office is efficiently laid-out and ergonomically designed to reduce work-place fatigue, frustrations, and bottle-necks.  Make sure there is a clean and comfortable place for staff to escape from the rigors of the day occasionally and vent frustrations away from where patients can see or hear.  There will always be challenging patients and giving staff a place to regroup build camaraderie is critical.  Lastly, make sure the operatories themselves are efficiently and ergonomically designed.  Again, this will reduce fatigue, frustrations, and the likelihood of work-place injuries.

One’s dental office design cannot ensure that one’s dental team always brings their A Game to their job each and every day, leadership and coaching play a big role in that, too. However, having a great place to work certainly helps.  If you question this, just think about the demand for newer and better stadiums and arenas at all levels across the country.

Creating a Positive Experience for Disabled Patients

Posted on: December 12th, 2012 by James Kuester No Comments

Bathroom design that fails ADA standards

We are always amazed when we find bathrooms that are not compliant with the Americans with Disabilities codes.  These codes provide for universal accessibility and safety for everyone, whether they are experience a permanent disability or a temporary one from an accident.

In this bathroom we visited recently there were several issues, but two of the most glaring were the height of the counter and the pipes underneath.  The counters are not to be more than 34” above the floor with the faucet set back from the edge by no more than 19”.  This particular bath fails on both these measurements.

As far as the pipes underneath, they must either be thermal wrapped or covered by a barrier so one will not burn their knees when rolled up to the counter.

These seem like really simple things to protect one’s patients from harm and make their time at the dental office more pleasant, but as we’ve said, we continue to be amazed at how often these little things fall through the cracks.

Sharing the Sidewalk

Posted on: June 11th, 2012 by James Kuester No Comments

Dental Office Reception Counter with area for Wheelchair Accomodation

Last night I’m walking along on my way to meet friends for dinner when I’m approached by a man in a motorized wheelchair coming up the sidewalk toward me.  While I tend to walk to the right side of the sidewalk anyway as a general rule – just like I was driving a car – as the man came closer rather than hugging the opposite side of the sidewalk he actually steered directly at me until I had to step into the street to keep from being hit.  We were the only two people on the sidewalk and it is a wide walk, so there was no obvious reason why he felt the need to run me off the sidewalk.

At the grocery where I normally shop there is a woman that I see often that is confined to a motorized wheelchair.  She has a bike horn attached to her chair and if you are standing looking at something on a shelf and she wants past she starts blowing her bike horn at you.  I’ve been the object of her horn blowing before and I’ve witnessed this several times.  Most of the times there is plenty of room for her to go around the person that is shopping but she doesn’t.  She wants them to get out of her way.

When I was in high school there was a fellow student that was confined to a motorized wheelchair.  He, too, had a bike horn attached to his chair; however, he rarely used it.  Instead, he’d just run into other students that were in his way going down the hall.  He also tended to run his chair at full speed through the crowded halls.

So, why does there seem to be a general rudeness amongst individuals confined to motorized wheelchairs?

I believe that this stems from a frustration with just how difficult it is to maneuver in a world designed for the walking.  While the Americans with Disabilities Act set standards for how spaces are to be designed to accommodate those with disabilities these are only minimum thresholds.  To be truly accommodating one needs to strive to live like someone confined to a wheelchair and incorporate as many features as possible into a space so as to make it as easy to work, live, and play in as it is for those with no disabilities – to truly make a space universal in its design rather than just accommodating.

Test out your dental office and see how accommodating it is.  Borrow or rent a wheelchair sometime and try to maneuver through the office like you were a patient.  Start from the parking lot and go through the entire process of checking in, getting from the chair into an exam chair, back out of the operatory to the restroom, and back to check out.  Have each member of your staff do this, too.  Compare notes at the end and see the experience from the eyes of a disabled patient.  Now, what if a member of the staff was confined to a wheelchair?  Would that person be able to do his or her job?  The entire exercise can be very eye opening as to just how unfriendly our work spaces are to those that cannot walk.

Perhaps if the world was just a little more compassionate and accommodating to those with disabilities I’d stop being run off the sidewalk on my way to dinner.

Incorporating Universal Design

Posted on: April 20th, 2012 by James Kuester No Comments

I came across this inspirational story of a courageous woman and her struggles to maintain an independent and fulfilling life after a horrible event rendered her paralyzed.  While the story focuses on redesigning her home for independence, many of the principals she touches on are critical in dental office design for ensuring a quality patient experience.  Not all of your patients have permanent disabilities.  Some are only in a wheelchair or on crutches for a short time.  While the Americans with Disabilities Act dictates design standards for commercial offices, they don’t require retroactive changes and we visit offices all the time that are out of compliance with these basic guidelines.  Additionally, how often does a member of your team miss work due to a “weekend warrior” injury?  Would they be better able to continue to be productive if your dental office was designed in such a way that is was more accessible?

Many thanks to the Universal Design Living Laboratory for bringing us this inspirational story.

A National Demonstration Home in Columbus, Ohio:  The Story Behind the Project

On June 13, 1998 my husband, Mark Leder, and I decided to celebrate our anniversary by going on a bicycle ride. It was a beautiful day with a clear blue sky, perfect biking weather. I was riding down the path ahead of Mark, when he heard a loud crack and yelled, “Look over there something is falling!” I glanced back at him and suddenly a 3 1/2 ton tree came crushing down on me, leaving me injured on the bike path. My life was changed in that instant! I was paralyzed from the waist down with a spinal cord injury.

As I lay in the hospital, I was angry, scared and mad at the world.  more

Cool New Award Winning Design!

Posted on: March 16th, 2012 by James Kuester No Comments

Red Dot Award winning dental loupes design by Evident

Not all great dental design is restricted to that of the office.  Thanks to our friends at Dentistry.co.uk for bringing us this great story on these award winning loupes.  Evident’s new ExamVision Sports Frames have recently won the Red Dot Design Award for outstanding design quality and trendsetting.

This is not the first time Evident’s great loupes design.  In 2010 the Red Dot jury awarded the ExamVision HD TTL 2.3x for its high quality design and outstanding optical qualities.

Congratulations for Evident and thanks to Dentistry.co.uk for breaking this story!

The Open Floor Space is there for a Reason

Posted on: February 26th, 2012 by James Kuester No Comments

While we’ve discussed this issue before, it is one of such importance, especially to those with disabilities, that we just can’t help from discussing it again when we see just flagrant violations of the accessibility code of the Americans with Disabilities Act (ADA).  Under the ADA areas, such as restrooms must have minimum clear floor spaces so that those in wheelchairs can readily maneuver in the space. It used to be that these clear floor spaces could overlap, but recent revisions to the codes have changed this so that each clear floor space must stand on its own and provide for free maneuvering in the space.  If one thinks about this, it makes sense as it is difficult enough to maneuver a wheelchair in tight spaces, especially if one is using a wheelchair only temporarily due to an accident or injury.

Bench has been placed in clear floor space designed for accessibility

These free floor spaces causes restrooms, especially, to have quite a bit of open floor space, and people without disabilities tend to think they need to fill this space up to keep it from feeling cold or empty.  In dental offices what we see is that a storage cabinet is placed in the restroom in this free floor space in order to increase storage capacity.  Here is an example of a restroom where a decorative bench was placed in the restroom to eliminate this open floor space.  While this might make the restroom feel more cozy and comfortable, both which are attributes we discuss frequently in designing one’s dental office, it completely destroys the maneuverability of the space.

We might suggest that you conduct a test of your dental office by renting or borrowing a wheelchair and pushing yourself from room-to-room to see how accessible your space really is.  Try entering the restroom, turning around, wheeling up to the lavatory and washing your hands and then turning to throw the towel away.  Can you do this easily and comfortably? How about hanging up your coat or placing a hand bag somewhere while you are doing this so it is up off the floor?  Especially, for someone that is just confined to a wheelchair for a short period, this can be an extremely challenging activity.  Just think how frustrating your patients must get.  If they are permanently confined to a wheelchair I’m sure that they’ve developed tricks and a certain skill level at maneuvering in less than ideal conditions, but should they really have to?  Don’t you think they’d rather visit a dentist that has an office designed to make their lives easier? I know I certainly would.