Profits Abound Behnd Door Number Three

As health care office design specialists, we are commonly engaged to evaluate the efficacy of a space for its use as a health care facility prior to its development. That assessment starts at the perimeter of the site and is influenced by parking, convenience, ambiance and accessibility. Besides the obvious code concerns, the latter includes means of ingress and egress and their respective impact on function and flow within the facility. It is essential that we take a global perspective of the facility’s potential and entertain all options of development; regardless of cost and complexity. Such was the case when I was contracted by orthodontists Dave Reen, D.M.D. and Tom Reen, D.M.D. to assess- and ultimately develop- a space for their third office.

The 3,000 square foot suite is located on the ground floor of an upscale, 20,000 square foot professional office building, which is anchored prominently amidst a large, bustling retail and entertainment complex. The rectangular structure, which measures roughly 55 feet by 130 feet, features parking around its entire perimeter. Front and rear entrances are positioned at the center of the longest dimension, and provide access to the stairs, elevators, public lavatories and ground-floor suites. Intrinsically, these doors presented the most likely of the three optional primary entrances to the suite. However the process of elimination began with the client’s preference for a less obvious alternative.

Option 1:
Parking provisions aside, my clients were enchanted by the fact that their proposed suite featured a private entrance- which shared the same characteristics as the primary building entrances and featured double, smoked-glass entry doors and side lights. It was, therefore my objective to consider a plan that would utilize these doors as the primary entry. Since the building is located in Western Massachusetts, it was imperative that climate-related issues be addressed first. Foremost in that consideration was the inclusion of a vestibule, or weather buffer. It was quickly determined that the enclosure would bisect the available space; thereby encroaching on seating in the waiting area as well as obscure visibility of the waiting area from the reception desk. Those impositions notwithstanding, the concern for demands on heating and cooling were equally daunting. The combined effect of the southern exposure on a highly glazed exterior, and magnified by the anticipated high occupancy of the waiting area, created the likelihood for the inclusion of a third zone in the heating and cooling system. The combined cost to construct the vestibule and upgrade the HVAC was approximated at $5,000 to $6,000 Last, but certainly not least, that section of the suite was determined to be the least hindered by physical obstruction, and offered the most favorable location for the six-chair treatment bay. Consequently, we abandoned that consideration and took the next, most logical course of action by considering the use of the more conspicuous entrance from the public corridor.

Option 2:
Although nicely appointed, the lobby and passageway offered a conventional tenant directory and limited signage on the respective solid-core doors, through which all of the ground floor suites were accessed. Beyond the lackluster entrance to the object suite, lay other encumbrances. The area immediately inside the suite was constrained by the building’s elevator hoist way. That condition was exacerbated by the existence of a structural support column that was positioned seven feet inward from the entry door. The appeal of utilizing that entrance was further compromised by the lack of natural light. Although we could have replaced the existing, solid-core door with a glazed entry, the cost of a fire-rated, single-light door was estimated to range between $1,000 and $3,000- depending on the type of glass and frame used. Lastly, proximal parking was determined to be extremely limited. That was clearly due to the fact that most patrons logically parked as closely as possible to central entrances, as a matter of convenience. Although there was substantial parking available at the distal ends of the building, the compulsory traverse was equally undesirable. Collectively, these factors inspired my clients to have me seek, yet another, alternate means of ingress. 

Option 3:
Surprisingly, the east entrance offered a variety of inherent benefits. First, there was an abundance of parking directly opposite and bilateral to the entrance; which resulted from the parking usage referenced above. It was also evident that the east entrance offered a greater potential to accommodate waiting and reception services, as well as create optimal traffic flow within the suite. Lastly, since the overhead door presented an eyesore on the highly exposed eastern elevation, there was a good chance that the building owners would be receptive to a facelift that would include visible signage. Although all were exceptional advantages, the latent potential for free marketing was by far the most engaging. That was inspired by the fact that the enormous mercantile complex, which surrounded the structure, was bifurcated by a heavily traveled, two-lane access road from which the east end of the building was highly visible in each direction.

The greater majority of patrons of the various amusement and retail establishments are channeled past the site. That qualification was distinctly enhanced by the image that theend of the building could be perceived as a separate and exclusive address. The existing conditions, on the other hand, presented some fiscal, as well a physical, challenges. The former tenant- an insurance agency and claims processing center- had installed the overhead door and hinged utility/egress door on that end of the building to accommodate a drive-in claims adjusting service for their insured. Also, as a result of the topography on the site, the 600 square foot drive-in facility was positioned approximately one-and-one-half feet below the primary grade, with which the main floor of the suite aligned. The two levels were connected internally by poured-in-place concrete stairs. In order to take advantage of the profound benefits, it was imperative that the following be addressed: Removal of the ten-foot overhead door and the three-foot, steel, hinged door; partial enclosure of the remaining openings with matching brick; installation of a new window in the opening formerly occupied by the overhead door; creation of a new penetration for the new glazed entry; installation of same; construction of a handicapped ramp and ambulatory access stair to meet the existing level; poured concrete floor in-line with the main portion of the suite; plus awnings, signage and exterior lighting. Despite the $18,000 price tag, the concept was warmly accepted by the building owner and my clients.

The Bottom Line:
The amortization of the renovation to the eastern elevation of the building over the term of the lease was clearly fractional. One new patient start per month would more than cover that expense. More importantly, the cost/benefit analysis between the actual expense and its marketing value alone was profound. A full-page, weekly ad in the local newspaper or annual Yellow Pages Directory could not compare with the subtle, broad-based impact of the signage. Similarly, the availability of convenient parking- directly outside the private entrance to the practice was particularly appealing, as well. The added benefit of smooth and efficient traffic flow can't be overlooked either- a happy staff stays with a practice and an efficient staff generates revenue. The exuberant feedback from patients and staff has been extremely positive and the clients anticipate unprecedented growth.

ECONOMIC PERSPECTIVE
Our projects have ranged from a very modest $30,000 to over $1,700,000. Regardless of the size and scope of each project, our focus has always been dedicated to function, efficiency and, above all, a calculated return on investment. The most successful of these have been created in concert with clients who have a propitious understanding of the difference between cost and investment; and a willingness to endorse their belief in themselves. The Reen brothers are exemplary in their perception of and commitment to that mindset. Not only did they recognize the value of the investment in the east entrance, they further endorsed the expenditure by including amenities like a vibrant floral display at the building’s threshold and a soothing, wall-hung fountain, in the expansive waiting area. The open, flowing reception desk and the abundantly spacious treatment bay were also requested features that they perceived would augment clinical and administrative services. In the few short months since their opening those perceptions have borne fruit. 

LinkedIn: http://www.linkedin.com/in/garrettludwig

If You Rely On Statistics As A Guide When Planning An Office, You Are Likely To Become One Of Those Very Statistics

This article was inspired by a recent conversation that I had with Linda Miles [Linda Miles & Associates] during which she shared another of her pearls of practice management wisdom. Her client was steadfast in his intent to constrain his overhead to align with the statistical 50% average. In her characteristically direct and succinct manner, she posed the query [paraphrased]: “Would you rather retain 50% of a $500,000 practice or  40% of a $1,000,000 practice?” 

The bottom line is that it’s not how much you spend. It’s how much you make. That postulate is grounded on proven business principles - not statistics. Consider for a moment that department store chains clamor for space in a mall despite the inordinately high lease rates and CAM charges. In some cases they must also pay a percentage of their gross receipts back to the mall. But, as long as their “bottom line” continues to grow, they simply consider the associated expenses as

For example, we designed an office for an eleven-chair prosthetics practice. Their lab space was four times that of most statistical averages, and was equipped comparatively to that of any commercial lab. Ten years later, the practice is thriving and the space and equipment continue to serve the needs of the practice. The additional upfront expense has long-since been amortized and the associated day-to-day costs remain negligible. On a less costly and more subtle level, space was allocated in the very center of the suite of that practice for a future panoramic x-ray. This “prime real estate” sat “wastefully” idle in the center of the suite for over four years. Currently, their state-of-the-art, digital panorex is positioned for optimal function and flow - both of which serve to reduce overhead and enhance revenue. So, study the statistics, and - if possible - research the results. It is likely that you will discover that- to follow the words of the of soothsayers will only serve to limit your potential. In the words of Albert Einstein, the definition of insanity is, “Doing the same thing over and over again expecting different results”. Don’t become a statistic.

LinkedIn: http://www.linkedin.com/in/garrettludwig the cost of doing business. The same holds true when planning a dental office. That’s not to say that you should spend recklessly. But keep in mind that “under-spending” can ultimately be more costly than “over-spending”. All investment decisions must be predicated on an expected Return On Investment (ROI). To that end, you must establish and adhere to a budget. But each line item needs to be weighed individually to determine their respective value.

They Made Us Do It!

Plea: But, but… we are simply “facilitators of our client’s dreams”. They made us do it. Honest! 







Defense: Our designs are predicated on the following: 

1. Function
2. Flow
3. Space utilization
4. Efficiency
5. Productivity
6. Client tastes
7. Budget*

Value Engineering:
Since most projects are influenced by budgetary constraints, it is imperative that our clients have the opportunity to select finishes and architectural appointments that will be representative of their
quality of care- yet financially manageable.  This is accomplished by value engineering- or cost/quality comparatives.  For example, counter surfaces can be constructed with plastic laminate, solid surface (i.e. Corian) or stone.  All will look great.  But, more often than not the more costly products and details are chosen.


EXAMPLE ONE: 
The facility on this project only offered windows on one side of the building.  With good sense, the client chose to have the treatment rooms face in that direction.  Since we also needed to provide privacy between the treatment rooms and the reception area,  the only way that we could provide natural light to the internal 
space would be through  an interior window in an fixed partition; known as a “borrowed lite”.  Among the variety of options were the vinyl-clad, acrylic “glass block” show in the photos.  The “glass” measures ½’ think.  However, from each side the windows look like conventional glass block.  With the inclusion of radiused corners, the windows look great.  However the cost was a fraction of the cost to construct a glass block separation, and the windows served as a perfect sound barrier.

EXAMPLE 2:
It is a fact that based on first impressions; the expectation of the initial impression will persist, if supported with a similar tone. Since the featured project included land purchase, a new building with leasable space and equipment, we had to be conservative in our proposal to create a first-class image.  Although the reception/
greeting area is nicely appointed, it was created economically.  For example, the etched glass is actually an applied film on clear glass- un-discernable to the eye.  Also, what appears to be a “raised panel” façade is simply two sheets of stained plywood with square-edged wood trim.  That detail is carried onto the counter surface.  The ceiling features recessed cove lighting in a boxed soffit.  But with the inclusion of a conventional, recessed ceiling, the 
access to framing and lighting is simple. Therefore the construction costs were quite reasonable. 

Having created a favorable “first impression”, we simply had to create a similar vision throughout the rest of the office.  The transaction counter in the departure features a plastic laminate surface.  But, since it blends all of the surrounding finishes, it looks first-class.  We also created a “stepped soffit” on a “shoe-string” by simply layering the drywall.  The effect is as dynamic as if it were framed and sheetrocked at distinctly different heights.  

EXAMPLE 3:
By admission, we do create “high-end” offices… on request.  The photo shows a serpentine, wood veneer reception desk with inlaid glass tiles and solid surface transaction counter.  Those contours are 
mirrored by curvilinear, drywall soffit with recessed cove lighting. We are simply “facilitators of our client’s dreams”.  What’s your preference? 

Conclusion:
The majority of our clients choose the finer appointments.  Perhaps that is why they are among the most successful dentists in the United States.  We are very proud of our contribution to those statistics