First interview By Kevin Henry of Pennwell Publishing in a series about office design.
"Kevin Henry of Dental Economics talks with Garrett Ludwig of Diversified Design Technologies about a key component often missing in dental office design"
Monday, December 31, 2012
Tuesday, December 18, 2012
Case Studies
Teaching At Its Very Best
Up To Your Waste In Water
Creative Solution To An Impossible Dream
2000% Return On Investment
Tuesday, December 11, 2012
Testimonials
"Thank you, Garrett, for creating my dream dental
office. I had a vague vision and you made it into existence. Everyone says 'wow' when s/he enters my
dental office & over time I got used to it.
I just went to another dental office open house, and realized how
fortunate I was to have met you, Garrett, at Yankee and timing worked out that
you were able to help me. The other
dental office lacked efficiency, security, and just common sense. Of course it was designed by a dental supply
company who also sold the dentist a lot of unnecessary stuff. Those off-the-rack type cabinets and
stericenter take up so much room, whereas in my office I don't have to move so
much, saving my energy so I can go home to my family refreshed and not burned
out. The sad truth is that I could have
been that other dentist without your help.
I also realized that dental office design is much more than just the
layout of the space. Since we moved into
the new space you created, I and my team have less physical pain, better mood
(we love coming to work!), and therefore better dental work. We have pleasant
work days. We can retain better staff.
The practice revenue increased 50%- so I and all my team members got
raises. I really appreciate your
integrity, honesty, initiatives, and kind smile. I learned so much- about construction but
also how to deal with people, how to manage stress and how to live a better
life from you. In retrospect, the best
thing I did was to have you lead me in all aspects of construction, including
looking at the potential spaces, reading the lease, dealing with all vendors on
my behalf. My one regret is I didn't
listen to you for everything. The things
I said "no, Garrett, this is MY dental office and I want it this
way," well, those things I wish I listened to you. It is so refreshing to know that you put my
best interest at all times, not just make money off of me. And the best part of all is that now I have a
trusted friend who I can call at any time.
Kristen Dority, D.M.D.
Tuesday, December 4, 2012
Absence of Pain Equals Absence of Pathology! Right?
How disturbing is it when a patient refuses routine
diagnostics simply because they have no symptoms and they wish to save money?
How distressing is it to have to treat that patient for a preventable disease
that has finally progressed to a symptomatic, intolerable or critical state? To
make matters worse, how unsettling would it be to have that patient disregard
your treatment plan simply due to their reluctance to expend the time or funds;
despite your assurance of a favorable prognosis?
Although there is no comparison to the element of human
suffering associated with disease, the time and expenses that accompany the
discovery and management of preventable conditions transcends all aspects of
life. Awareness is the key to homeostasis- be it physical health of fiscal
health. We are frequently reminded by utility companies through MC Hammer’s
message, “You can’t touch that…” to be mindful about power-line safety. And the business of “Call
Before You Dig” is inundated with requests from contractors and homeowners
daily to accommodate everything from underground utilities to pet-containment systems.
In kind diagnostic health care testing and outpatient surgical facilities are
cropping up in every community. We are truly the Information Generation.
So, it would be prudent to ask ourselves: Is that a cable or
telephone line- or might it be a power line that could render severe burns or
electrocution; might that shallow ditch penetrate a utility feed and interrupt
service for several days; is that a sebaceous cyst or a malignant growth; is
the new suite harboring any construction challenges or budgetary concerns that
will challenge the success of my project? We live in a “pay now, or pay later”
world.
Prevention, management and the administration of curative
measures will assuredly save you money, and efficient and functional planning
will guarantee a substantial return on investment. As physicians and dentists
you are uniquely aware of the benefits and value of preventative measures and
focused remedies. It is not worth taking a risk when it comes to making the
largest investment of your professional career the creation of a facility that
will support and enhance your ability to deliver your professional services and
support the well-being of your family?
Our mantra regarding responsible design is best summarized
in our Mission Statement: “Our company slogan, “Profit By Design” speaks to the
purpose as well as the effect of design and engenders our philosophy that
responsible design will assure a return on investment. To that end, we are
committed to the creation of an office facility that reflects your professional
image and enhances efficiency and productivity, while stringently managing the cost of its development.”
Wisdom is knowing what to do next. Skill is knowing how to
do it, and virtue is doing it. - David Starr Jordan
Your prescription for design and project management is ready
for you at designrx.biz or call 800-622-5563. It’s painless, and the results
are guaranteed. Garrett Ludwig founded Diversified Design Technologies Inc. in
1971. The company has specialized in the design and construction of private-practice, health-care
facilities since 1975. During that time, he has designed more than 300,000
square feet of professional office space. He has a U.S. patent on his emergency
services “crash cart” design. Ludwig has shared his
experience in dental office design in numerous trade
publications, and continues to lecture on the subject throughout the United States .
He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web
site at http://www.profitbydesign.us.
Tuesday, November 27, 2012
Six Truths About Dental Cabinetry / Millwork
Pre-manufactured dental cabinetry offers superior ergonomic design.
TRUTH:
One would expect that to be true. Unfortunately, that is a profound fallacy! In fact, many of the products designed and produced by those companies necessitate class IV and class V movements for the assistant and clinician to access equipment and materials; thereby necessitating the temporary loss of physical and visual contact with the patient. Some designs actually necessitate that the assistant leave his/her stool and bend or kneel to access storage spaces.
Our designs are based on the ergonomic principles of Four-handed Dentistry and maximize efficiency.
Additionally they are designed to include the efficient use and convenient storage of clinical adjuncts, i.e. electrosurge, airabrasion, intra-oral camera, laser, etc.. The cumulative effect is a work environment that is designed for the user(s) as opposed to the user(s) adapting to a pre-conceived, one-size-fits-all design concept.
MOVEMENT:
I- Fingers only; II- Fingers and wrist; III- Fingers, wrist, elbow; IV- Entire arm and shoulder; V-Torso
THEORY #2:
Pre-manufactured dental cabinetry is superior to others in fit and finish.
TRUTH:
Impossible! There is simply nothing better than “the best”. Therefore all that anyone can claim
is that they are using “the best” materials and techniques. The fact is that the materials that
are available to the dental manufacturers, are available to every designer and fabricator. Please review and
compare the list with anyone who purports that they offer a superior product, and ask them to demonstrate their claim.
THEORY #3:
Pre-manufactured dental cabinetry is better constructed than that of others.
TRUTH:
Impossible! There are only a few techniques that merit distinction as quality cabinet construction. With the exception of “furniture quality” (sophisticated joinery and solid,hardwood construction) there is no difference in the finished product of the carcass (shell) of the cabinet. Screws, dowels, biscuits and adhesives all result in solid construction.
THEORY #4:
Pre-manufactured dental cabinetry offers superior finishes to those of others.
TRUTH:
Again, impossible! Although they are in no way superior, there are two factors that could distinguish those products as “different”.
1. They could have their own pattern produced in the surface of a plastic laminate. To clarify: Plastic laminate is comprised of several layers of craft paper. The last layer bears a “photograph” of an image (pattern, color, wood grain, etc.). That surface is covered with clear melamine [plastic] to provide a resistant and durable surface- thus the term “plastic laminate”. Anyone can order “custom” laminate- for a price. The fact is that it no better than any of the hundreds of plastic laminates available on the open market.
The exclusivity of a “proprietary finish” actually creates problems for two reasons:
A. It restricts the potential to match any adjunctive millwork that might be Positioned in direct adjacency to
the dental cabinetry;
B. Potential for the same pattern to be available years hence could be a concern if that pattern of color is
phased-out. Should that happen, the ability to replace a door, drawer front or panel with one that would
match the original could be eliminated.
2. They could produce their own injection-molded, door and drawer-front design. That option is, again, available to all designers and manufacturers. It’s simply a matter of investing in the die or mold. Injection-molding is nothing new or innovative. In fact, that method is used commonly by many manufacturers who produce kitchen and bath cabinetry; as sold in all “Big Box” stores. Further, the injection-mold concept is more prevalent in the lower-end lines of cabinetry, due to the obvious cost savings. So a door that appears to be “raised panel” construction is simply formed in that shape.The bottom line is that the integrity of those doors and drawer fronts is comparable to that of all other products. The only distinction is that the design might be unique in appearance. For “a price” those features can readily be replicated or improved-upon. The bottom line is- like the “proprietary laminate”- the mold forms may not be available in subsequent years- a profound example of Planned Obsolescence.
THEORY #5:
Pre-manufactured dental cabinetry is a better value than that of others
TRUTH:
Impossible! Our designs have consistently been constructed by high-end, custom cabinet shops. In the majority of cases, the costs for the same volume of storage as that existent in pre-manufactured, dental cabinetry have been half of the cost of pre-manufactured dental products. When you consider the amount of money that will be invested in cabinetry for treatment, hygiene, sterilization and lab cabinetry, the savings in the physical end products alone is astounding. The ergonomic benefits are virtually limitless.
THEORY # 6:
Pre-manufactured dental cabinetry offers features and functions that are not available anywhere else.
TRUTH:
Not true! We have done it all: Glass doors; LED or low-voltage lighting; pneumatic doors; pneumatic water controls; super-heated “instrument drying” storage space. These “features” provide no distinctive benefit that can’t be accommodated conventionally or creatively- absent extraordinary cost. In kind, the hardware that would support the function of a slide-out, pop-up, pivot or hide-away components is available from numerous hardware manufacturers.
THE BOTTOM LINE:
We live in a world of compromise. Office space selections are commonly based on what is
available and is typically based on- location, size, need, cost and convenience. Therefore, it is
not unusual for there to be physical conditions that compromise the use of pre-designed cabinetry in optimal
orientation that would maximize function and flow. We share these thoughts for consideration:
1. To select or design an office around any product or pre-made assembly of products, would be like designing a house around a 7’-2” distant relative.
2. Angled or curved walls, windows, doors and vital equipment all need to be accommodated. Cabinetry can be custom-designed to maximize the use of the site-specific condition.
Tuesday, November 20, 2012
Five Biggest Pitfalls in Building a Do-It-Yourself Office
By Garrett Ludwig As Seen in DentistryIQ (PennWell Publishing)
Consider for a moment that [technically] anyone with opposable thumbs and fine-motor skills is capable of performing an amalgam restoration. Most people would affirm that postulate. Case in point: As a designer, I attended Columbia University to learn the fundamentals of four-handed dentistry in an effort to enhance my proficiency as a dental office design specialist. During that education I excavated a first molar on a mannequin for an MOD, then filled and deftly [opinion] carved the compound. I would expect that, with a
little practice, I could produce a restoration that would be visually and occlussaly perfect However, without understanding human anatomy, physiology, disease pathology, and the proper treatment of carries, the patient would be at serious risk. Furthermore, the restoration would probably fail in the absence of prescribed technique. The same outcome can be expected when designing and building a dental office without professional guidance.It never ceases to amaze me that, dental processionals- who know and understand that there is no substitute for knowledge, experience and skill- frequently venture into such an extremely complex undertaking as dental office design with reckless abandon. The fact is that design is a “pay now or pay later” business. Invariably, those who are intent on saving money by foregoing professional
guidance ultimately pay substantially more throughout the life of their project, and reap a lesser return on their investment. Unfortunately, most don’t realize it until it’s too late, and they have to live with the result or pay exorbitant professional fees in an effort to salvage their investment.Amidst the minefield of cost-sensitive “time-bombs” that could readily have been circumvented or diffused by a trained professional, there are five that I have witnessed most frequently. I share them with the hope that this insight might avert a bad investment.
Pitfall # 1:
QUANTIFY BEFORE YOU QUALIFY: IT’S THE “MEASURE TWICE, CUT ONCE” APPROACH TO ESTABLISHING SPACIAL NEEDS.
Based on observation and personal experience, it is apparent to me that the process of evaluating thequantity of space needed to support the efficient function of a dental practice is at best challenging. In most cases, I have found that do-it-yourselfers forego or trivialize the pragmatic process of quantifying the cumulative needs for each area and function of the office. The following are common judgments and oversights that result in space insufficiency.
A. The two most common barometers that are used to establish square-footage needs are industry statistics and feedback from professional colleagues. Although both merit consideration, they are often misleading. With the former, “they” may pose the axiom that seating in the waiting area should be based on the quantity of treatment and hygiene rooms. To profess that unequivocally would create the assumption that a general dentist with a family practice would have the same needs as a generalist who concentrates on cosmetic care. Also, since no two practices are equipped, staffed and managed identically, the latter can be equally misleading when establishing the need for space.
B. Accommodation for practice growth is commonly overlooked or short-changed. For example, many choose to add one treatment room for an associate that may join the practice. However, few consider the fact that a single room would limit the production capacity for that individual, and would result in a diminished potential for that person’s growth. As a result, the opportunity for an associate to join the practice is less enticing to that individual.
C. Although most practitioners make reasonable, room-by-room calculations for space, I frequently hear the
statement, “We are currently working in a ‘1,200" square foot space. Therefore, ‘2,200' square feet should
suffice.” Theoretically, that assumption seems plausible. However, many things must be acknowledged,
including changes in building regulations, ADA and HIPAA compliances, growth; as well as many of the
conditions referenced above. It is truly remarkable how quickly 1,000 square feet can be consumed by
“essentials”.
D. In addition to the insufficiencies that are often calculated for the respective areas within the confines of the suite,there are three areas that are consistently overlooked: storage, wall-thicknesses and passage space. Despite the fact that the most common complaint from dental personnel is that there isn’t enough storage space, it is the most frequently overlooked spacial accommodation. The wall-thicknesses and passageway space consumption are visually more subtle. Yet they typically have an even greater impact when ignored. With regard to the passageways- the more complex the space the greater the need for passageway space. So, in most cases, if passageway space has been considered in the overall calculations, the likelihood is that an adequate amount of space has been allocated is slim. Additionally, the consideration that a partition is only four or five inches thick evokes the sense that very little space will be needed for those separations. The fact is that even a small suite may consume 100 to 200 square feet with partitions, alone.
E. Less is not more. I frequently encounter practitioners who base their selection of a space on the cost per-square-foot, rather than the potential for earned revenue; since they are allegedly “throwing the [rent] money away”. Theoretically the perception is that, by reducing overhead, the net revenue will increase. That’s another illusion that is slanted by unfounded statistics “The practice overhead should be....” Nothing could be further from the truth. Dentistry, like any other business will thrive on its enhanced capacity to generate revenue. In addition to heightening function, space creates a feeling of comfort and an image of success. That’s a point worthy of consideration when shopping at Saks or Nordstrom’s .... and CVS. Your perception of those businesses is likely to be the equivalent of your patient’s perception of your practice.
Pitfall # 2:
PROFESSIONAL GUIDANCE IS HIGHLY RECOMMENDED WHEN MAKING A LAND PURCHASE
All too often building sites are determined to be distinctly challenging and or impossible to develop after the
purchase has been made.. Although there are many more, the following are common considerations that are most often overlooked by an inexperienced investor. Point to ponder: I have witnessed many practitioners who have spent more time researching the purchase of an automobile than they did when investing in a land purchase.
A. Health care facilities require more parking than does general business. As a result, it is common to find that the intended size of the building has to be reduced to accommodate parking
B. In a similar context, zoning regulations require definitive building setbacks. Not only does this often impact the size of the building, but the placement of the building, as well. The vision of constructing a dynamic structure with great “curb appeal” can be quickly dashed when it is determined that the building must be located beyond the line-of-sight from the roadway as a result of building setbacks, laneways, screening, and the imposed limitations regarding the allowable amount of paved surface- to name a few.
C. Regardless of the longevity of an undisturbed parcel of land, a soil test should be considered. It is not
uncommon to determine that a site has a high water table,; thereby diminishing or complicating the
development of the site. Similarly, the site could have been used for dumping of incompatible materials or
hazardous waste before environmental records were kept. The remedies for such conditions can be very costly.
D. Clear view of the building aside, any marketing-savvy practitioner is going to want their signage to be highly visible. Although zoning regulations vary from town-to-town, almost all towns regulate the size, style and placement of signage; and typically define the size by square-footage. So, for example, if a two-sided sign is proposed, and the regulations stipulate a maximum square-footage of twelve feet, the likelihood is that you would only be allowed six square feet per side- or a sign measuring approximately two feet by three feet. When you consider borders and logos, there would be very little space left for text.
Pitfall # 3:
PROFESSIONAL GUIDANCE IS HIGHLY RECOMMENDED WHEN EVALUATING A LEASED SPACE FOR USE AS A DENTAL OFFICE**
The lack of review by a trained eye may result in the discovery of many physical encumbrances and restrictive, contractual covenants. The following are a few of those that I have encountered most frequently:
A. First and foremost the majority of property owners list the square-footage of a suite as “leaseable”, in
accordance with BOMA (Building Owners and Managers Association); that includes one-half the thickness of the perimeter walls. This is frequently confused by the lessee as “useable” space. Depending on the overall size of the space and the thickness of the perimeter walls, the “useable” space could measure a few hundred square feet less than the quantity proposed. That calculation grows with a flush-glazed “curtain wall”; since measurements are often made to the glass surface on exterior walls. Flush-glazing is as it sounds. The mitigating factor is that the “leaseable” measurement can increase by the remaining thickness of the exterior wall. We have encountered walls as thick as 24".
B. The area inside the perimeter space may be further compromised by the existence of utility chases, elevator hoistways, roof drains, structural members, roof access ladder, low ceilings, etc.. It may also be necessary to provide space for a water heater, dental utilities and mechanical system storage (HVAC) within the suite. Each of these represents an additional loss in useable space.
C. The useable space may be further diminished by the need for an internal vestibule (or airlock) to protect the waiting area from harsh weather in a facility that has direct access to the exterior. Not only will the vestibule encroach on the useable space, it will also impact the use of the space from the standpoint of functional design.
D. Signage is often limited in a leased space; particularly in professional office buildings, as well as some retail facilities. This isn’t necessarily a “deal breaker”, since some locations are, in and of themselves, distinctive landmarks, and are identifiable and easily accessed. However, visibility and accessibility must be considered as components of the practice marketing program; regardless of the location.
Pitfall # 4:
IF THE “DO-IT-YOURSELF” APPROACH TRULY SAVES MONEY AND PRODUCES A QUALITY PRODUCT, ONE WOULD ASSUME THAT ENDODONTISTS, PERIODONTISTS AND ORAL SURGEONS WOULD BE SERVING A VERY SMALL PATIENT POPULATION.
When it comes to construction, I consider myself to be an inveterate “do-it-yourselfer”; having worked in the building trades for most of my life. Globally, I would comfortably state that I have completed most tasks successfully. However, I have also experienced the need to call in a professional when an unexpected problem arose. In each of those cases it became apparent that, had I engaged the services of these skilled individuals from the beginning, the “dilemma” would not have arisen or would have been readily addressed at a modest cost and in full compliance with building regulations. Most importantly, I would have saved my valuable time to generate revenue in my area of expertise. The perception of cost savings by eliminating a general contractor, construction manager, project manager or superintendent is truly illusionary. In short, a dentist in a restorative practice can generate far more revenue per hour than it would cost to hire the necessary personnel to perform their respective tasks- and those persons know the complexities of the building trades as well as the practitioner knows dentistry. Therefore, if logic prevails, it makes
perfect sense to delegate the responsibilities of design, development and supervision to those who are qualified to provide those services.
A. Bid proposals and construction contracts are a challenge for all of us who work in the field. Beyond the primary considerations of cost, time-frame of completion and the inclusiveness of all trades and services, there are many more subtle factors that will impact our recommendations. To assume that decision-making process in the absence of an inherent knowledge of the construction industry is, in my opinion, financial suicide.
B. I spend a great deal of time each day on the telephone and computer (emails, faxes, transmittals) managing each project. Whether it’s a matter of value-engineering, discovery of a field condition or third-party coordination of services there is an on-going stream of project management activity that must be addressed expediently and must be thoroughly documented- just like dentistry. For a practicing dentist to respond in a timely manner is challenging, at best. Documentation of any sort is even less likely to take place. In the mean time, the “clock is ticking” and you can bet that the contractor has documented the communication; particularly if it involves a change-order that may create an added cost.
C. If one were to assume, hypothetically, that all inquiries were simple and required a brief response, the process would still be challenging. The fact is that many of these inquiries necessitate some level of research. That effort demands three things: the time to perform the task; the knowledge of where to look for the comparative data and knowledge to differentiate the risks and benefits of each.
Pitfall # 5:
FORM, FUNCTION AND FLOW ARE MORE THAN JUST “BUZZ WORDS” FOR DESIGN. THEY EQUATE TO THE ENHANCEMENT OF PROFESSIONAL IMAGE, EFFICIENCY, PRODUCTIVITY AND, ULTIMATELY, PROFITABILITY.
Convenience, comfort, atmosphere and image are all amenities that we seek when selecting a restaurant or
automobile. Let’s be honest, that a fully-equipped Camry would probably suffice as better-than-adequate
transportation. However, for a “modest” difference in cost, the C-Class Mercedes (or better) seems to lead the pack with professionals. In the same context, you can’t find a better meal than one prepared at Momma’s Diner. Nevertheless, the starched white table cloths, impeccable service and great ambiance is
what inspires long lines at Le Dîneur de Maman. And, of course, as a preferred patron, the words, “Dr. Jones. You’re table is ready.” allow you to whisk past the masses who wait patiently to be acknowledged. Even an average meal tastes better when it is served by attentive personnel in a warm and relaxing environment.The fact is that, if there is any group of people that deserves to be treated to the very amenities that we all seek when selecting a provider of superior services, it is your patients. Since it is superior service that you are offering, preferential treatment is truly in order for those who have selected you as their dental professional.With that thought in mind, consider a distinctly tangible example of the “service” philosophy as it equates to investment: Assuming that you are considering offering refreshments to your patients, you might weigh the image presented by a Poland Springs bubbler to that of an attractive cabinet and counter that houses an in-line filter/chiller/water heater. They each provide filtered hot and cold water. However the latter is dispensed by a stainless spigot into a glass bowl. As a “consumer” which would you prefer? An unattractive, commercial-looking plastic dispenser or a classy looking refreshment center. Of course the classy system would win hands-down. So, why do I see so many commercial dispensers in dental offices? Clearly it is expense. So, let’s compare costs. The Poland Springs dispenser will cost a minimum of $35 each month. Over a five-year period, the out-of-pocket expense would be $2,100. That does not include the valuable and costly storage space that the bottles consume (or clutter) or the labor involved to change the five-gallon (40 pound) jugs. On the other hand, the one-time cost for the built-in system might be $1800. That would include: cabinet; counter; bowl; spigot; water heater; water chiller, water filter and drain. The labor consists of re-stocking cups and an annual $20 filter change. Comfort, convenience and enhanced aesthetics- all for a lesser cost. Imagine that?!As is the case with the refreshment center, the value of each element in the overall investment in an new physical plant typically outweighs the costs associated with the inclusion of the respective design efficiencies. I have included a few other areas that are often short-changed due to a mis-perception that the expense would exceed the value.
A. There is no question that efficient design reduces task-related labor. For example, consider the expense of the labor that’s involved to process a wet film or phosphor plate in comparison to the time it takes to process a digital x-ray. No contest! Distractions aside, the time expended and the cost associated with the former, account for an extraordinary and cumulative cost. Consider the fact that the investment in any adjunct that will enhance efficiency is worthy of consideration, since labor is a variable, on-going expense that increases on a periodic basis. So, whether it’s a clinical skill or administrative task, good design maximizes the functionality and productivity of each support staff member, as well as your bottom line.
B. The optimized juxtaposition of support services reduces job-related stress, increases efficiency and enhances revenue production. Consider the last time you attempted to do a home repair and had to retrieve the necessary parts at a Big Box retail outlet. By the time you have defined and located the parts, you are likely to have toured the entire 40,000 square foot facility, and are already exhausted from the stress of the venture before you even start the project. If you equate that experience to your own services, it stands to reason that all support services be positioned in an ergonomic and logical sequence. Since most people are intellectually aware of the value associated with this effort, it amazes me how few invest the time and effort to maximize their efficiency. .
C. Although there are several means by which HIPAA compliance can be achieved, many practitioners overlook these critical measures when planning areas for private communication. Among the methods are: Separation of “public” space from “private” space by barrier (partition, door, glazing); Separation of “public” space from “private” space with space (extended distance between private and public areas); Maximization of acoustical surfaces (carpet, wall-coverings, ceiling tiles); Distortion or masking of communications (introduction of “white noise”, i.e. moving water, music, sound machine). HIPAA regulations may not be pro-actively enforced. However a complaint is likely to result in financial penalties, as well as daunting accommodations- after-the-fact.
D. Good design is also an instrument of “people management”. That’s essentially what professional designers domanage the movement of people within a space. Beyond operational functionality, the accommodation of
comfort and convenience makes a patient’s experience in a professional office pleasurable.
Consider the last time you dealt with a large corporation (insurance company) or municipal agency (motor
vehicle department). What should have been accomplished in five minutes, probably took an hour, and involved several people. It’s simply exhausting! To avoid this experience in your own office, it is essential that the work environment be planned pragmatically to assure the effortless administration of patient services. In addition to the fluid transition that the patient experiences moving from greeting to treatment to departure, they also are comforted by witnessing that same synergy in your office operations. These accommodations are certain to project an image of professionalism and will assuredly produce tangible results. Again, most people understand the tenets of this theory. Those who apply it benefit by it. Those who don’t suffer the consequences of it. Unfortunately, I have witnessed enough of the latter to make this issue noteworthy.
** Above and beyond the physical and developmental concerns, the language and terms of a lease can be
truly significant. However, they are commonly negotiable. The fee to have a lease reviewed and
negotiated by a specialist, whose sole responsibility is lease negotiation, is truly worth the investment.
Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at www.profitbydesign.us.
Tuesday, November 13, 2012
Lose The Jugs
By Garrett Ludwig
Dental offices use a lot of water! Not by volume, but by variety [there are four]: washing/flushing; drinking;
sterilizing; cooling/irrigating- and each has it’s own peculiarities. Three of them require a storage container or “jug”. And the fourth may be subject to the need, as well. In most cases, hand washing, laundering and toilet flushing function effectively from a municipal water supply or well. Notwithstanding, the respective water sources may have a high mineral content or other biological properties that necessitate treatment with a filtration device; potentially, another veritable “jug”. Although the condition is not pervasive; it is always a prudent measure to consider a water test if any trace evidence is found.
Historically, the remaining three water types have been provided by outside vendors or required an after-market, water-treatment product that morph the municipal or well water into the task-specific variation of H/2 O. All are stored in containers or “jugs”, if you will. Since each also requires an on-going expense and an associated labor factor, we have sought an economical and convenient means with which to deliver the respective liquids. Mission accomplished. So, please consider the following rhetorical query:
Jug #1: Drinking Water:
Tap water has long been a reliable source of hydration. Open a spigot for a mere matter of seconds and you’re assured the delivery of a refreshingly cool thirst quencher Be it simply media hype or portability, we as a society have shunned our abundant natural resource for the purity of spring water; or in
many cases simply processed, bottled water. The obsession for refined water has followed us to our homes and offices. Refreshments aside, the provision of a self-contained, potable water source
has also served many as an adequate substitute for the mandated [most locations] drinking fountain. The problem is that these five-gallon units are unattractive, consume valuable storage space; and each jug weighs about 40 pounds. So, add a labor-factor and the risk of muscle strain or more serious injury to the mix, and you have a costly and burdensome accommodation. Since the one-time, upfront costs are modest and the maintenance is virtually nonexistent, why not purify the water “in house”, refrigerate it and serve it “on
tap”?
Jug #2: Distilled Water:
If your office has an autoclave and/or Statim sterilizer, you are faced with two options: 1. Buy and store bottles of distilled water. 2. Purchase a water distiller and produce and store the water in-house. In either case, the water has an associated cost, consumes space and, in the case of the distiller, takes time. Why not treat the water systemically and provide it “on-tap” at the point of use- in your sterilization area?
Jug #3: Dental water-line infection control: If you are like most practices, your syringes and handpieces are fed with a biofilm prevention/management system- which typically includes a one or two
liter bottle attached to the treatment chair or dynamic instrument delivery system. Most often there are two separate systems to serve the clinician and chairside assistant, respectively. Multiply that times the number of operative treatment rooms, add one for each hygiene room, and an average twopractitioner dental practice
will have ten of these water sources. Each reservoir (jug) must be replenished and treated on a daily basis. The process is costly and includes a labor-factor to disassemble, fill, treat and reassemble the reservoir at each location. Would it not be more practical to provide hardplumbed, dedicated water lines that are fed by a systemically treated reservoir that will serve the clinical areas of an entire office?
I expect that the majority response to these questions will be a resounding “Yes!”. So, I will share what I have discovered to be the singular solution and one of the most sensible investments in dental water management:
STERISIL
We have been endorsing the Sterisil system for several years and all of our current clients are now enjoying the reduced cost and stress-free management of the respective water systems; not to mention increased storage, minimized labor and enhanced office aesthetics. Click here to read Sterisil’s Peer to Peer Product Evaluation. And for information and guidance, contact me directly at 800-622-5563 or visit the Sterisil website at Sterisil.com.
Respectfully,
Garrett Ludwig
Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at www.profitbydesign.us.
Dental offices use a lot of water! Not by volume, but by variety [there are four]: washing/flushing; drinking;
sterilizing; cooling/irrigating- and each has it’s own peculiarities. Three of them require a storage container or “jug”. And the fourth may be subject to the need, as well. In most cases, hand washing, laundering and toilet flushing function effectively from a municipal water supply or well. Notwithstanding, the respective water sources may have a high mineral content or other biological properties that necessitate treatment with a filtration device; potentially, another veritable “jug”. Although the condition is not pervasive; it is always a prudent measure to consider a water test if any trace evidence is found.
Historically, the remaining three water types have been provided by outside vendors or required an after-market, water-treatment product that morph the municipal or well water into the task-specific variation of H/2 O. All are stored in containers or “jugs”, if you will. Since each also requires an on-going expense and an associated labor factor, we have sought an economical and convenient means with which to deliver the respective liquids. Mission accomplished. So, please consider the following rhetorical query:
Tap water has long been a reliable source of hydration. Open a spigot for a mere matter of seconds and you’re assured the delivery of a refreshingly cool thirst quencher Be it simply media hype or portability, we as a society have shunned our abundant natural resource for the purity of spring water; or in
many cases simply processed, bottled water. The obsession for refined water has followed us to our homes and offices. Refreshments aside, the provision of a self-contained, potable water source
has also served many as an adequate substitute for the mandated [most locations] drinking fountain. The problem is that these five-gallon units are unattractive, consume valuable storage space; and each jug weighs about 40 pounds. So, add a labor-factor and the risk of muscle strain or more serious injury to the mix, and you have a costly and burdensome accommodation. Since the one-time, upfront costs are modest and the maintenance is virtually nonexistent, why not purify the water “in house”, refrigerate it and serve it “on
tap”?
If your office has an autoclave and/or Statim sterilizer, you are faced with two options: 1. Buy and store bottles of distilled water. 2. Purchase a water distiller and produce and store the water in-house. In either case, the water has an associated cost, consumes space and, in the case of the distiller, takes time. Why not treat the water systemically and provide it “on-tap” at the point of use- in your sterilization area?
liter bottle attached to the treatment chair or dynamic instrument delivery system. Most often there are two separate systems to serve the clinician and chairside assistant, respectively. Multiply that times the number of operative treatment rooms, add one for each hygiene room, and an average twopractitioner dental practice
will have ten of these water sources. Each reservoir (jug) must be replenished and treated on a daily basis. The process is costly and includes a labor-factor to disassemble, fill, treat and reassemble the reservoir at each location. Would it not be more practical to provide hardplumbed, dedicated water lines that are fed by a systemically treated reservoir that will serve the clinical areas of an entire office?
I expect that the majority response to these questions will be a resounding “Yes!”. So, I will share what I have discovered to be the singular solution and one of the most sensible investments in dental water management:
We have been endorsing the Sterisil system for several years and all of our current clients are now enjoying the reduced cost and stress-free management of the respective water systems; not to mention increased storage, minimized labor and enhanced office aesthetics. Click here to read Sterisil’s Peer to Peer Product Evaluation. And for information and guidance, contact me directly at 800-622-5563 or visit the Sterisil website at Sterisil.com.
Respectfully,
Garrett Ludwig
Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at www.profitbydesign.us.
Tuesday, November 6, 2012
Testimonials
"Thank you, Garrett, for creating my dream dental office. I had a vague vision and you made it into existence. Everyone says 'wow' when s/he enters my dental office & over time I got used to it. I just went to another dental office open house, and realized how fortunate I was to have met you, Garrett, at Yankee and timing worked out that you were able to help me. The other dental office lacked efficiency, security, and just common sense. Of course it was designed by a dental supply company who also sold the dentist a lot of unnecessary stuff. Those off-the-rack type cabinets and stericenter take up so much room, whereas in my office I don't have to move so much, saving my energy so I can go home to my family refreshed and not burned out. The sad truth is that I could have been that other dentist without your help. I also realized that dental office design is much more than just the layout of the space. Since we moved into the new space you created, I and my team have less physical pain, better mood (we love coming to work!), and therefore better dental work. We have pleasant work days. We can retain better staff. The practice revenue increased 50%- so I and all my team members got raises. I really appreciate your integrity, honesty, initiatives, and kind smile. I learned so much- about construction but also how to deal with people, how to manage stress and how to live a better life from you. In retrospect, the best thing I did was to have you lead me in all aspects of construction, including looking at the potential spaces, reading the lease, dealing with all vendors on my behalf. My one regret is I didn't listen to you for everything. The things I said "no, Garrett, this is MY dental office and I want it this way," well, those things I wish I listened to you. It is so refreshing to know that you put my best interest at all times, not just make money off of me. And the best part of all is that now I have a trusted friend who I can call at any time.
Kristen Dority, D.M.D.
“I want to take this time to thank you personally for your expertise and exceptional planning of our recent office project. Now that we have been settled into the completion of the project we realize how valuable your services were to making this a success. Our patients are enjoying the practice due to an increase esthetic.”
Pat DeFrancesco, DC
“Your diligence and thorough documentation on the construction plans saved us a substantial amount of time and money. You should be proud of the way it turned-out.”
Rick Short, D.M.D. & Ronni Schnell, D.M.D
“I just want to take a moment to thank you for your help with my new office. Needless to say, the patients are thrilled with it, especially the openness of it. The bigger reception area with the skylights are a huge hit. My staff loves the larger business room (now they are not as crammed as we were before) and the new lounge area. Placing insulation in all the walls to reduce the sound was a good idea. I am glad you talked me into having a consult room. You can feel free to use me as a reference if you need. If you are ever in the area, don’t be a stranger.”
Randy Weiner, D.M.D.
We cherish testimonials from our clients. However, there's something particularly gratifying to receive an accolade from a respected peer. "I had a nice chat with Garrett after I left your office this a.m. and congratulated him on the new office. And, I just wanted to tell you again how nice it was to see your offices and how high you set the bar with the design. Just speaking from a patient's perspective, it's the nicest doctor's office I've been in or seen! To arrive at sidewalk level and see into such an inviting waiting room
Kristen Dority, D.M.D.
“I want to take this time to thank you personally for your expertise and exceptional planning of our recent office project. Now that we have been settled into the completion of the project we realize how valuable your services were to making this a success. Our patients are enjoying the practice due to an increase esthetic.”
Pat DeFrancesco, DC
“Your diligence and thorough documentation on the construction plans saved us a substantial amount of time and money. You should be proud of the way it turned-out.”
Rick Short, D.M.D. & Ronni Schnell, D.M.D
“I just want to take a moment to thank you for your help with my new office. Needless to say, the patients are thrilled with it, especially the openness of it. The bigger reception area with the skylights are a huge hit. My staff loves the larger business room (now they are not as crammed as we were before) and the new lounge area. Placing insulation in all the walls to reduce the sound was a good idea. I am glad you talked me into having a consult room. You can feel free to use me as a reference if you need. If you are ever in the area, don’t be a stranger.”
Randy Weiner, D.M.D.
We cherish testimonials from our clients. However, there's something particularly gratifying to receive an accolade from a respected peer. "I had a nice chat with Garrett after I left your office this a.m. and congratulated him on the new office. And, I just wanted to tell you again how nice it was to see your offices and how high you set the bar with the design. Just speaking from a patient's perspective, it's the nicest doctor's office I've been in or seen! To arrive at sidewalk level and see into such an inviting waiting room
is remarkable; then once inside, even though it's a large office, it doesn't feel like it. I've been in much smaller offices that still feel like an assembly line. The sight changes in finish and detail, furniture and furnishings as you go from room to room are refreshingly thought out, including lighting. And the overall finish level is terrific without being over the top. I also appreciated the seamless integration of technology. From my architect's perspective, it's great to see that there has been such dedication to the design of the working and patient environment. I've seen so many offices, old and new, where there just was no priority for good design. I also wanted to say how nice all of your staff are- they were always very nice of course, but they are clearly delighted with their new surroundings and seemed very grateful that all their staff needs were carefully considered along with everyone else's (looks like Garrett even considered your needs- why the heck did he do that?) You and Garrett really nailed this one- congrats!"
Richard Wies, AIA - (In a message to Robert Golia, D.D.S.)
"Garrett has designed each of my 3 offices and redesigned 2 of them when we chose to remodel and update. He has an unusually keen grasp of office design to improve efficiency, lower costs of operation and increase patient flow, satisfaction and revenue. He is professional, creative and maintains the highest level of integrity. He usually saves more in construction and operational costs that more than covers his professional services."
Jack Monaco, M.D., OB/GYN- Anti-Aging and Functional Medicine
Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at www.profitbydesign.us.
Richard Wies, AIA - (In a message to Robert Golia, D.D.S.)
"Garrett has designed each of my 3 offices and redesigned 2 of them when we chose to remodel and update. He has an unusually keen grasp of office design to improve efficiency, lower costs of operation and increase patient flow, satisfaction and revenue. He is professional, creative and maintains the highest level of integrity. He usually saves more in construction and operational costs that more than covers his professional services."
Jack Monaco, M.D., OB/GYN- Anti-Aging and Functional Medicine
Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at www.profitbydesign.us.
Friday, November 2, 2012
Dental Design Projectoscopy (Feasibility Study)
By Garrett Ludwig
To date, the preponderance of my perseveration regarding projectoscopies has concentrated on the costs and savings associated with construction, site development and purchase/lease agreements. However, the emphasis of this article is function and useable space.
We were asked to design a satellite office for an OB/GYN* practice- for whom we had designed three other offices. The history is noteworthy, since we had gained the confidence of the practitioners to act on their behalf and perform the necessary pre-planning due-diligence- or projectoscopy. Previous projects with this client heightened their awareness regarding the value of this exercise. Their faith in our ability to ferret-out mitigating factors was particularly significant since the project was for a suite in a new (yet-to-be-built) building; and they had already committed to lease the space. Under similar circumstances, the requisite response that former clients have expressed could be paraphrased as, “I don’t need no stinkin’ feasibility study”. “It’s a brand new building. What could go wrong?” The fact is, much!
Logically, by all expectations there shouldn’t’ be any issues with a new building. But as it turns out, there were many. For the sake of focus, I will limit the review to the physical plant and the available space.
The architectural firm that had designed the building provided the attached plans of the subject suite to us. Upon review, we noted that, in addition to the “horseshoe” configuration imposed by the stairwells, lobby and elevator hoistway at the front and rear entrances, the center core of the suite was profoundly encumbered by: structural columns, two separate HVAC supply/return ducts and a roof-access ladder. The collective impositions created two factors.**
1. The useable space, which is calculated by perimeter measurement, did not account for the losses associated with the noted, internal obstructions. Additionally, it was determined that the advertised square-footage of the suite referred to “leaseable” space, not “useable” space. Although this is standard practice, in accordance with BOMA (Building Owners And Managers Association) it is not always clear to the lessee that “leaseable” space includes half the thickness of the perimeter walls. Collectively the net loss was approximately 200 square feet. So, before we even began the planning process, we were dealing with a deficiency in the perceived “available space”.
2. The encroachment of these obstructive elements created an enormous challenge for functional use of the suite. The horseshoe condition alone created potential “dead-ended corridors”- a distinct life-safety code violation. This condition was profoundly exacerbated by the encroachment of the respective components on the central core of the suite, and the ability to maximize function, flow and life-safety code compliance.
Without implementing considerable changes, the project was virtually impossible to develop to meet the client’s needs. The referenced challenges are depicted in the “existing conditions” drawing below.
We first approached the architects and expressed the benefits of relocating the roof-access ladder to the stairwell. They were receptive and agreed to that change. We then met with the mechanical engineer and proposed the noted changes in duct chase locations, as shown below. Again, our proposal was met with favor and acceptance. On a side note, with respect for the architect and engineer, I must point out that the original layout was based on the expected use of the second floor as two distinctly separate suites. As such, the placement of the respective “chases” was logical for that use. It was simply not accommodating to a women’s health practice on the entire floor.
This project had a successful conclusion, as is evidenced in the finished floor plan (below). Due to a modest
investment of time and money, we were able to avert a near-disaster and develop a functional facility. The message here is that the greater majority of “projectoscopies” (feasibility studies) that we have performed have unveiled seriously mitigating issues related to budget, construction and space utilization. The savings in every case has been substantial. But, it is noteworthy to mention that, even if a change is not viable, the discovery of the compelling factors will, at the very least, forecast any implications that the condition might impose on the project budget. In some cases we have actually determined that a facility would not support the needs of the practice. As a result, the clients averted a poor investment in both time and expense. Knowledge is power! Caveat emptor.
*The majority of my previous contributions on design have focused on various phases and conditions related to dental office design. The fact is that we have had extensive experience with medical specialty practices, as
well. They include ophthalmology, otolaryngology, orthopedics, and women’s health.
** Space consumed by the duct chases and roof-access ladder created a loss in useable space of 48 square
feet. That’s the functional equivalent of a handicapped accessible lavatory. Similarly, it is common to overlook the difference between “leaseable” space and “useable” space. In most cases the useable space actually ranges anywhere from 100 square feet to 300 square feet less than the leaseable space. In this case the combined loss was approximately 200 square feet.
Garrett Ludwig founded Diversified Design Technologies Inc. in 1971. The company has specialized in the design and construction of private-practice, health-care facilities since 1975. During that time, he has designed more than 300,000 square feet of professional office space. He has a U.S. patent on his emergency services “crash cart” design. Ludwig has shared his experience in dental office design in numerous trade publications, and continues to lecture on the subject throughout the United States. He can be reached at (800) 622-5563 and garrett@designrx.biz. Visit his Web site at www.profitbydesign.us.
Tuesday, January 10, 2012
Three Million Dollar Woman
Notwithstanding, this article is focused on Dr. Trahan as a woman dentist and senior partner in a practice, which she purchased and revitalized. From a personal perspective, she also became our primary contact during the development of the new physical plant; whereby I garnered the most visceral insight to her remarkable intuition. For those reasons her partner, Donald Pierce, D.D.S. will receive less direct recognition for many of the accolades that follow. However, it should be acknowledged that theirs is a highly functional and interdependent professional partnership and Dr. Pierce is equally deserving of recognition for his synergistic and congruent role in the success of a practice which has emanated from their profound due diligence.
My association with Dr. Trahan began in March of 2001, when my business associate, and I were hired to design a facility for Dental Associates- a burgeoning family dental practice in Attleboro, Massachusetts. It is important to note that, in an effort to assess the needs of a practice, we provide a rudimentary check list of needs; the answers to which aid in establishing sizes and quantities of space, as well as the general short and long-term goals of the practice. However, since many responses to that practice data survey read like an ad in a personal column, I have learned that attentive observation is the key to discerning the core objectives and the client’s commitment to bring those aspirations to fruition. It was evident from the very beginning that Sharon Trahan was a woman who said what she meant and meant what she said. I can honestly say that she is one of the most focused businesspersons I have ever encountered- while remaining socially conscious and genuinely congenial.
Although I will cite many other more distinctive examples of her adroitness, I have been most impressed with the more subtle endorsements that I observed. When she expressed her appreciation for her dedicated staff, as most do, it was brought to my attention that she actually made the effort to negotiate the lease of space in the basement of an adjacent multi-family home to afford her deserving staff a refuge from their respective office duties. The basement had been used as a staff lounge by founding dentist, Dr. Gerry Rosenthal, who owned the property at that time. When the house was sold to a private party, subsequent to Dr. Rosenthal’s passing, Sharon tactfully facilitated an agreement to lease the space for continued occupancy as a staff lounge. What is particularly distinctive about that effort is that most of the same staff have remained with the practice and are now enjoying an abundant lounge replete with kitchen, private lavatory and changing area. This is, of course, is a small factor in the overall appreciation that she fosters. But the message remains the same- A happy staff stays and the staggering alternative induces the need to advertise for, train and acclimate patients to new staff members and is dauntingly costly and non-productive. Although her efforts are profoundly sincere, this is business savvy at it’s best.
Interestingly, these expressions of appreciation would never surface without earned effort. Therefore the opportunity for achievement must first be established. That can only be created by the discriminating delegation of responsibility, which, in turn, can only be achieved with an absence of ego and an instinctual and unwavering trust. Sharon Trahan has effectively combined those characteristics with her exceptional ability to attract and select people who mirror her own dedication to the respective tasks at hand. Besides her discerning decision to single-out Don Pierce as her partner in clinical practice, the most visible and notable examples of her extension of her own manner was through her retention of Dr. Rosenthal’s former chairside assistant Dale Koehler, and office administrator, Lynn Robinson. Besides being extremely personable and charming, Dale is, as Sharon states- “... the glue that keeps the clinical practice together.” Having been with the practice since 1984, she brings a wealth of knowledge about the evolution of the practice and has been instrumental in the effective assimilation of clinical innovations and new technologies; not to mention the symbiotic and seamless integration of the growing clinical staff. In Sharon’s words, “I feel extremely fortunate to have her on my team and working without her would not feel right.”
Lynn, who joined the practice in 1992, is a diminutive dynamo who brings energy and vitality to the practice with an unmistakably sincere warmth and personality. However, she is also tactfully tenacious when the need arises. If there’s a job to do, she gets it done, with the authority that was imparted to her by Dr. Trahan- there’s no room for micro-management. Therefore, if that includes diplomatically but assertively righting an injustice, she gets the job done with authority. Essentially, she’s a mirror of Sharon Trahan’s discriminating and measured approach to effective people management. So, for starters, Sharon has mastered a few of the most vital skills of business administration: She’s insightful, trusting, delegates well and demonstrates appreciation for those in whom she has entrusted a responsibility. I speak, first-hand by observation as well as through personal experience, in my role as a design professional. Clearly, our best work has evolved in an environment of trust, with an open line of communication. Intrinsically, Sharon knew this, made her goals understood, and allowed us the liberty to create what she envisioned. Besides understanding the precepts associated with the delegation of responsibility, she also knows that her time is better spent doing what she knows and loves- dentistry. Professional passion aside, she also recognizes the value of “chair time” in contrast to performing a non-revenue-producing task or to intervene unnecessarily with responsibilities that she has assigned to others. Now, let me see- was her appellation, “D.M.D.” or “M.B.A.”?
So, how did Sharon Trahan earn my esteem as businesswoman extraordinaire? Philosophically most of us comprehend the tenets of good business and many of us apply them with some consistency. However, very few will hold to their convictions when the chips are down and the costs go up- particularly the latter.
If I may digress, I would like to share an experience that I had with a motivational speaker who offered a simple challenge: Place a $10 bill at the end of a 12" wide wooden plank that was supported on each end by 8" concrete blocks. The task was to simply walk across the plank, pick-up the bill and walk back. Not a single person balked at the challenge. The offer was then enhanced with a $1000 bill. However, the plank was proposed to be suspended end to end between two buildings six stories above the ground. There were no takers. The element of risk increased exponentially, and abruptly leveled the playing field. Theoretically, Sharon Trahan approaches business with an unfettered focus on the goal. She’s not reckless, and is intellectually aware of the risks. However, metaphorically, “If the board was an adequate means of conveyance to retrieve the $10 bill, it will work as well to seize the larger prize.”. We can all perform those low-risk tasks under ideal circumstances; particularly with a predetermined outcome. However it takes an unusual individual to maintain the same composure and unfaltering commitment when the equation is compromised by uncertainty intensified by risk or clouded by cost. These are the factors that separate the “talkers” from the “walkers. Sharon Trahan is clearly a “walker”.
Case-in-point: When we began the planning process to transform a former single-family home into professional office space for the rapidly-growing practice of Dental Associates, we familiarized ourselves with the needs and objectives of the proposed practice relocation. It became apparent that a portion of the cramped conditions in the existing space was self-imposed. Clearly, Dr. Trahan had purchased an aging practice in a physically encumbered, bi-level structure with limited parking and no room for growth. However, despite these conditions, she had hired cosmetic
dentist, Don Pierce, D.M.D. while retaining Lynn Robinson in her position as administrator. As a result, she and Don were each relegated to the use of one operative treatment room and resilient Lynn was confined to a ‘closet”, which she shared with multi-function phone, fax, scanner, copier, printer. Some would question the rationale of these decisions. However, in my mind, any true businessperson would deem this to be insightful decision-making, and another prototypical trademark of a true entrepreneur.
Certainly, Sharon could have generated a comfortable living working out of two rooms, hired a bookkeeper and remained status quo. After all, one must consider that the new salaries impacted the revenue stream, as well as diminished her own chair-side production. However she had greater aspirations- not the least of which was to create a facility that projected a professional image that reflected the high level of dental treatment and the “whole patient” philosophy of her patient’s dental health. In brief, she accepted the challenge of a short-term compromise in an effort to achieve a longterm goal. This is a huge key to her personal success as well as that of the practice itself. In any case, a property was selected for development, approximately one mile from the existing office. Our research determined that the site was abundantly sufficient to support the practice, as well as the required parking. We, therefore, immediately began the design process. I won’t wax on in detail; but after two years of design revisions requested by a myopic group of local bureaucrats who repeatedly “raised the bar”, following the review of each “appeasement” that was submitted, it was clearly time to walk away or engage in a potentially endless legal battle. Despite expending $12,000 on design fees and $4,000 on fees associated with the numerous public hearings, the decision was made to cut their losses and move on. Time and money had been spent and the clock was still ticking. Yet Sharon [and Don] never broke stride, and patiently and methodically spent the following months searching for another site that offered greater potential.
As the opportunity arose to develop a facility at the present location in Attleboro Falls [an affluent suburb of North Attleboro, Massachusetts], numerous gut-wrenching decisions had to be made; the greatest of which was the selection of the contractor to develop the site and construct the building. In short, there remained a $135,000 discrepancy between the low and high bidders. Again, Sharon’s business logic took over. She [and Don] opted for the higher fee simply for the reason that the contractor of choice had a proven track record of being on time, and had promised completion within nine months. The low bidder had proposed an eighteen-month period of development. Besides realizing a savings in interest from the lender, the hastened occupancy of the facility promised a greater potential to generate revenue. True to form, the projected increase in production and enhanced efficiency would prove to comfortably offset the cost differential. So, if I had to select one factor that sets Sharon Trahan apart from her peers and colleagues, it is her innate ability to assess a challenge, discern its positive and negative values and decisively and unwaveringly strategize its resolution.
Perhaps Kenny Rogers had Dr. Trahan’s methodology in mind when he wrote the lyrics espousing the benefit of, “...knowing when to hold ‘em and knowing went to fold ‘em...’ So, one year later in a new, stand-alone building, with the help of a new associate and two part-time specialists, Attleboro Falls Family Dentistry turned a profit and Sharon earned her “wings” as a reluctant and unassuming business prophet.
True to form, it is noteworthy that Sharon’s sagacious business sense transcends general enterprise. As a staunch advocate for continuing education, Sharon recently sought training with Joseph Carrick, D.D.S., a noted dental specialist from Houston, Texas. When she reviewed the time, travel and expense associated with attending his training session in Texas, she contacted Dr. Carrick and asked him to quote a fee to hold another session at her office in Attleboro Falls. She then weighed the costs and benefits, and engaged the specialist for a hands-on training session in her own office. Sometimes it pays to bring “the mountain to Mohammed”- another noted prophet.
The bulk of effort that Sharon puts forth is pointedly proactive, and that requires forethought and decisiveness. However, she wields as much power under circumstances in which she must be reactive. Above and beyond the hold-‘em / fold-‘em theory, there’s a point where one has to accept that there is a price to pay for everything- money, time, emotion, etc.. It’s simply a matter of refusing to allow these “obstacles” to stand in the way of your success. Above all else, Sharon has mastered the art of letting go.
If I may digress once more, I would like to share a story about a friend of mine- a self-made businessman- who by his fortieth birthday had earned a million dollars. As a dedicated family man he proudly shared his achievement with his mother-in-law; who was an accomplished businesswoman herself. She lovingly told him that; “You’re nothing until you owe a million dollars.” Although humored by the response, he appeared a little deflated by her audacity and obvious disregard for his achievement. I ran into him a few years later, as he was constructing a new building to house his evergrowing business. He beamed as he told me that he finally pleased his mother-in-law. He now owed over two million dollars. With sincere respect for Sharon Trahan’s business acuity I would like to close with a quote (author unknown) that epitomizes her demeanor, “Work like you don’t need the money, love like you’ve never been hurt and dance like you do when nobody’s watching:” .... all the way to the bank.
LinkedIn: http://www.linkedin.com/in/garrettludwig
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.
If You Rely On Statistics As A Guide When Planning An Office, You Are Likely To Become One Of Those Very Statistics
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.
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