Renovating a HOF practice: the order of decisions

Renovating a practice usually starts with the dream: wall color, chairs, lighting, a beautiful reception. And it usually ends in a blown budget, stalled works and the health authority asking for adjustments nobody foresaw. The reason is almost always the same: the order of decisions is backwards. The finish is chosen before defining what the room needs to do, and the layout is defined before checking what the code requires.

This page proposes an order of decisions for renovating an orofacial harmonization practice: first function, then code, then layout, then budget, then schedule, then finishes. It does not replace an architect's design, the opinion of the technical manager or the guidance of the health authority, which depend on the municipality and the type of establishment. The goal is to avoid rework and protect your cash.

Why the order matters

Each decision constrains the next ones. A low ceiling limits the lighting. The position of the sink limits where the treatment table goes. The floor you pick limits cleaning and biosafety. Whoever decides backwards finds the conflict after already paying.

First: what the practice does in each room

Before calling any construction professional, write on one page:

• which procedures will be performed and how often;
• how many simultaneous appointments the practice expects;
• which equipment goes in the room and what each piece requires in power, ventilation and space;
• what the reception, the waiting area and the patient's path will look like;
• which support areas are needed: storage, sanitizing, supply cabinet, kitchenette, restroom;
• who works there and how many people use the room per shift.

That page is the brief for the works. The clearer it is, the fewer changes midway, which are the ones that cost the most. The care routine described in scheduling and time per procedure and the HOF clinic environment help you think through the space.

Second: check the code before the design

Practices and healthcare clinics are subject to sanitary requirements that vary with the type of service, the size and the municipality. They can cover minimum room types, washable floors and walls, sinks, supply flow, waste, ventilation and accessibility. What applies to you depends on how you are classified.

Ask, in writing whenever possible:

1. Does the renovation require prior notice or approval of the design?
2. Does a change of layout affect the license or require new licensing?
3. Which rooms and finishes are required for the type of care?
4. What should the flow of clean supplies, dirty supplies and waste look like?
5. Are there accessibility and signage requirements?

Keep the answers. They protect the practice in an inspection and guide the architect. The health inspection checklist and the biosafety checklist help you build the list.

Third: workflow and layout

With function and code defined, draw the flows before the walls:

• Patient flow: entrance, reception, waiting, treatment, exit, payment.
• Supply flow: receiving, storage, use, disposal of sharps and waste. See PGRSS at the HOF clinic and sharps disposal and PGRSS.
• Team flow: where people put on protective gear, sanitize their hands, store belongings and take breaks.
• Data and privacy flow: where the patient can talk about prices and health without being overheard, and where records and computers are kept.

The procedure room deserves its own attention: an accessible sink, a support counter, proper lighting, room for the professional to move and ergonomics. See ergonomics for the HOF professional, lighting in the HOF practice and procedure room checklist.

Fourth: budget and priorities

A renovation budget usually blows up for three reasons: forgotten items, changes during the works and delays. Structure it by priority:

Add a contingency reserve to the budget, defined with the professional running the works. Renovations in older buildings hide surprises behind walls and ceilings. And remember that the cost of the works does not include the money the practice fails to earn on the closed days.

Schedule and appointments during the works

The works need a start date, an end date and a care plan for the closed days. A few precautions:

Define who handles urgent cases and follow-ups during the closure: a temporarily rented space, a partner colleague or a clear contact channel. Rented room or own clinic and the page on working at more than one clinic help with the alternatives. Notify patients in advance and keep in touch. See automatic reminders for patients.

Equipment, stock and documents during the move

During the works, the practice needs to protect supplies and documents:

• Temperature-sensitive products: decide where they are kept at the correct temperature. See storing botulinum toxin.
• Patient records and files: protect them from dust, moisture and improper access. See data security at the HOF clinic.
• Equipment: cover it, switch it off and check it after the works.
• Stock: take inventory before and after. See injectables stock.

The renovation and the patient's first impression

The space communicates care, and it is worth thinking about how the patient experiences the consultation. The planning conversation, for example, calls for a quiet place with soft light and privacy. Harmy helps at this stage: presentation mode puts the phone in full screen, with only the slider, so you can turn it toward the patient, and the magnifier enlarges the treated area. Think of the conversation space (two chairs, a small table) as part of the project.

Renovating well means deciding in the right order. With a clear function, the code checked, the workflow drawn and the cash protected, the finish stops being the riskiest part of the works and becomes, as it should be, the last and most enjoyable.