Dental Office Planning is a Blend of Science, Art, and Finance
Twenty years ago most dental offices were designed over lunch on a napkin. At that time revenue was a dirty word to any healthcare professional and building regulations were limited and casually enforced. But today, with the combined effects of rigidly enforced mandates by numerous regulatory agencies, the influences of managed care and increased operational expenses, dental office planning has become a demanding blend of science, art and finance.
I chose “profit by design” as my company slogan because it speaks to both aspects of the definition of design. The first, and more obvious of the two, is the effect that good design will have on your image and, ultimately, your bottom line. Harry Demaree, DDS, did a superb job of imparting the philosophy of the former in the last issue of DE&S. So, I’ll say nothing more than that I share his viewpoint.
The latter, and more subtle, is the purposeful execution of responsible design or, in simple terms, “problem” prevention. And, since I was asked to write about common problems in dental-office planning, it also is the circuitous focus of this article.
While reviewing the extensive list of difficulties that I had witnessed or experienced in the past 25 years, it became clear that most “problems” are, in fact, not problems at all: simply inconveniences. However, with the proper guidance, they can be avoided or eliminated. In the paragraphs that follow, I have highlighted a few “problems” that should never have arisen or had simple solutions.
Managed Design = Cost Containment
First and foremost, a good designer must be able to manage your investment. After all, if you are developing a 2,000 square foot office at $60 per square foot, you are, in essence, handing the designer $120,000 of your hard-earned money to invest as they see fit. The very least they must do is to keep expenses within your budget.
Since the single, most-common “budget buster” is lack of information on the construction drawings, it is imperative that a designer have an articulable knowledge of construction, profound familiarity with building regulations and the ability to communicate and manage the integration of the two.
Construction cost estimation is a contractor’s playground. Although there are a lot of honest and forthright contractors who will warn you about missing information and advise you to provide more details, you are more likely to face one who is more opportunistic. There are two basic types. The first will “pad” the cost of each trade that lacks detailed information, in an effort to cover the expenses that he anticipates might develop. The second will underbid the individual trades – knowing full well that the related costs will become extras later in the project.
Invariably, the contractor who has padded his bid will not reduce his fee if the actual cost of each trade is below his projected fee. As a result, he will dance his way to the bank with your money. However, regardless of the added expense, this contractor still is the better of the two, since you know your costs up front.
The contractor who underbids in anticipation of profiting from the “extras” often will use deceptive wording in their bid. Typically, they will identify a line item as being included in the project; knowing that it doesn’t meet the necessary requirements.
For example, the following line item sounds as if it is complete in its coverage. “All wiring to dental equipment is included.” However, it does not reference hospital-grade wiring, which is required now in most states in treatment areas. So, if that information is missing on the construction drawings, the contractor has no obligation to include it in his bid. And since the mandate is relatively new, he can just say he didn’t know about it. Bottom line, these would-be “problems” can be prevented easily by ensuring that the construction data is detailed and comprehensive.
When you realize that “extras” typically will cost 20 to 30 percent more than they would if it were included in the original bid, it sheds a new light on who is managing your construction dollars. I actually witnessed a contractor who escalated the cost of extras by almost 100 percent – and got away with it.
Sizing Up the Space
You would think that establishing the size of the office would be simple – approximate the needs of each room, add up the number of rooms and multiply the combined length by the width and you’ve got your answer. Unfortunately, I continue to see practices that have outgrown their physical plant before they even take occupancy. Can you imagine how it must feel to have spent thousands of dollars on a great-looking new office, only to find that you’re cramped and can’t function optimally?
Again, this “problem” is avoidable. The most common oversight is an underestimation of how much space the corridors and walls consume. For example, if you have 500 lineal feet of partitions, they will consume close to 200 square feet of space. Typically, I will factor in as much as 25 percent of extra space for walls and corridors.
Room approximation is another area where an experienced designer will elicit the information needed to make a sensible determination of need. For the time-being, let’s focus on a simple area like the waiting room and ignore the complexities of the clinical and administrative space. A series of practical questions will easily determine your seating needs. A few basics include: “Do you generally stay on schedule?”: “Do you usually schedule long or short visits?”: Do you treat the very young or the very old and are most of your patients accompanied by a driver and/or other family members?” A few more questions and a determination of need can be established.
It is imperative that your design team has a working knowledge of each and every aspect of your clinical and administrative needs – including staffing, equipment and projected growth.
Can’t Get There from Here
In the past year I have inherited several projects from other design firms. Why? Because the plans that were proposed did not meet building regulations. In one office plan, the designer had proposed expanding the building in two directions. For all intents and purposes, the plan was quite creative. However, it was clear that the designer never researched the zoning regulations. The building already was positioned as close to the building line as was allowed by the town. Therefore, an entire section of the proposed expansion could not be added.
On another project, numerous general building codes had been overlooked. As a result, the building department rejected the plans. Besides the fact that a great deal of time and money was wasted in the planning process, the “problems” were discovered at the last minute. The repercussions included project delay, additional expenses (rent etc.) and a volume of inconveniences and frustrations.
I’m not suggesting that all professional designers know everything there is to know about zoning and building regulations. But, they should know the types of things to look for and where to find the answers.
Uh, oh! What Do We Do Now?
Despite practicing the due diligence of researching the standards that are expected in a construction project, all designers will occasionally be thrown a curve. Again, with a little resourcefulness, these conditions also can be remedied without conflict.
A recent project posed an unusual and completely unexpected problem. I had anticipated that some potential life-safety issues might arise from the building department due to the unique combination of commercial and residential space and the fact that we were expanding the office into a second level. In an effort to minimize any design revisions, I submitted the preliminary plan to the building department for review.
The one thing I never expected was an issue with handicapped accessibility: since the plans for the lower level were completely compliant with ADA requirements. However, to my frustration, the architectural barrier’s consultant for the town requested that we install a full-service elevator to enable access to the upper level by non-ambulatory patients.
Given the $100,000 budget for the entire project, a $65,000 elevator was out of the question. So, after hours of planning, we were faced with the possibility of not being able to expand the office.
We brought our case to the state building commissioner and cited numerous exceptions to the code. Although the process took a few weeks, our efforts paid off. We were granted permission to build the facility as proposed as long as we maintained full handicapped access on the lower level.
As much as I am pleased with the result, I do not share this experience to “toot my own horn.” The fact is any competent design professional could have accomplished the same task. But, I do want to emphasize the fact that professional design services offer more profound value than the esthetic amenity – the ability to get the job done.