Tuesday, January 10, 2012

Three Million Dollar Woman

Sharon Trahan, D.M.D. is not bionically engineered nor has she been genetically enhanced by the infusion of artificial intelligence. She is simply a woman who has, amidst her own career and personal developments, acquired a keen business sense. This deft confluence of vocational achievement and business acumen has positioned her for unprecedented success and prosperity. In the paragraphs that follow I have cited several of- what I believe to be- key elements of business, and how she has applied them.

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.


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

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

Planning A New Office? How would you like to save $40,000 before you start?


Would you like to save $40,000- before you start?

We do this for our clients on a regular basis.

Based on the fact that our client was intending occupancy of a newly-constructed, Class-A office building in a vital and active commercial district, he felt that a feasibility study wasn’t warranted; but reluctantly agreed to proceed. The structure is a two-story, 20,000 square foot (10,000 per floor), “L”-shaped building. At the time, the only occupant was located on the ground floordirectly below the suite that my client had selected [photo similar to client structure]. Admittedly, the angled front of the building was appealing- as was the view of the surrounding business community from the second floor suite. However, hidden in the beauty were two mitigating factors:

1.The highly glazed suite had both a southern and western exposure-, which would have created a “heat-load” on those sections of the building; not tomention the oppressiveness of afternoon sunlight.

2. The acute angles created by the perimeter walls created a challenge for strategic placement and ideal usage of the interior space. Although we pride ourselves with the ability to maximize every square inch of space, there’s only so much you can to with a diminishing dimension.

As compelling as these factors were, they could be managed, and would not be “deal-breakers”. However, a much greater but less visible condition loomed. Clearly, the majority of plumbing and electrical service in a dental suite is run under the floor of the office; which is, of course above the ceiling in the suite below. Since, it would be necessary for the tradespersons to gain access to the lower-level suite, we visited that business to determine if there were any challenges present. We discovered that the ceiling was entirely sheetrocked and was detailed with architectural appointments, like soffits and crown molding. Additionally, all of the lighting fixtures were recessed and/or surface-mounted track lighting. It would have been impossible to penetrate that ceiling and maintain occupancy of the suite. Un-phased by the discovery, my client declared that we would simply elevate the floor in his suite, and run all of the utilities above the existing floor. Having done that for another practice in Boston, I expressed that the floor could be constructed as proposed. However, it would have been an extremely costly endeavor- approximately $40,000 costly. Those expenses included: framing, decking, ramping, railings, etc.

Additionally, the encroachment of the ramp and other architectural barriers compliances would have consumed over 200 square feet of otherwise useable space. Those implications were exacerbated by the position of the suite by virtue of its adjacency to a stairwell and demising wall to the neighboring suite. In short the space was somewhat pie-shaped- the entry being the narrower portion. Since the space was large enough to necessitate two means for egress to comply with life-safety regulations, there were additional design challenges needed to accommodate the ramp. For example, by code, the egresses must be a defined distance apart from each other. Based on that knowledge, we evaluated another suite on the same floor. Not only did that suite offer equivalent amenities (except for the angled walls), it featured a “land-locked” space that was created by a base-building condition. That space was approximately 40 square feet, and could not be defined as leaseable space. But, it certainly could be used for dental equipment and storage. The client had been slated to sign the lease for the angled space on the following day. The lease was signed- for the alternate suite. Our feasibility service was completed in one hour. The lesson here is that there are dozens of mitigating factors that may not be apparent to the un-trained eye. We highly recommend that every opportunity- lease or purchase- be evaluated by a professional. 

Behold: The Construction Contract

Oddly enough, it’s not the fine print to which you are vulnerable

It would require the text equivalent of “Gone With The Wind” to
adequately describe the details necessary to execute an average dental office construction project. As a result, most contracts- including the AIA [American Institute of Architects] document, defer the “description of services” to the respective construction documents, AKA: drawings, plans, etc. The dreaded fine print in the construction contract, although duly worthy of scrutiny and evaluation, is simply additional legalese intended to protect one or both parties in the agreement. Eyes wide open: no harm, no foul.

So if the answer is right there in big bold print: Construction jargon, both large and small print- is only an agreement stating that your contractor will “provide… in accordance with the services to be provided is “‘doc-u-ment: [is] an original or pages containing dream-inducing images of your future office- formerly referred to as benign “plans” or “drawings”- will heretofore to be known as “exhibits of the contractual agreement”. And here’s the kicker: The author of those documents is not a required signatory on the contract.

In most cases there is no agreement. This often results in costly change-orders. Yes, change-orders are sometimes unavoidable. But,
they should be limited to things like unforeseen site conditions- not to be the expected norm. I’ve witnessed projects that grew by as much as 30% in cost overruns- that’s $90,000 on a $300,000 project, and 98% for those costs were predictable, preventable or at least known potentials to be included in the construction cost proposal. No excuses.

We were recently asked to review plans that were prepared by another firm. The results of that review, although daunting, are immaterial. But, I will note that the first sheet in the set of drawings contained a large text table listing services, dates and trades- for change-orders*. Talk about your “red flags”. Also, visible in blazingly bold print were disclaimers exempting the designer from the responsibility of anything from building and life-safety code
compliance to construction detail- deferring them to be addressed in the field or “by others”; thereby placing the bulk of responsibility on the contractor. But, despite this complete communication and budgetary disconnect, the client was prepared to sign a construction contract that left them vulnerable to extensive additional costs. Close call.

Analogously, construction is much like dentistry. Both will have a superior result when thoroughly prepared and detailed. So, I would like to site an example of the deficiencies that are quite common in construction documents. The drawings referenced above did note that a backflow preventer should be installed “per code”. That would be perceived by many lay people as having met the obligations associated with compliance and inclusion as a budgetary line item. The fact is that the directive did not include: location [at water source/inline to defined locations]; whole-house or dedicated run; size; manufacturer; model number; associated plumbing specifications [hard-plumbed/air gap/vacuum breaker]; testable/non-testable; also some towns require more than one. The cost differential could easily span costs of predictable, and preventable, cost overrun. Professional design fees are fractional by comparison.

Besides construction details like those noted above, it is vital that all materials be defined in advance. This is necessary for two budget-related reasons: 1. The cost of the products have an obvious impact on the budget; 2. The labor associated with the installation of different products can vary significantly. This information is typically provided on the drawings and are referred to as construction lighting and finishes, at the very least. This data takes the guesswork out of construction cost estimating, and aids in the process of value-engineering (substituting a similar product of a lower cost) if needed. For example, a door schedule will contain the following: height; width; thickness, detail (flush/raised panel/inlay/glazed) construction (hollow-core/solid-core) species; stain/finish; lights (glass- full/partial, divided); type of frame (wood/metal/etc.); direction of swing, type and finish of hardware; rating (fire protection). The cost differentials can range in the thousands of dollars. You may have wanted cherry or maple doors with a distinctive grain. But, the budget may only allow for standard Douglas fir. Imagine first-class dentistry in an average facility. Oh! That’s what you’re moving from.

So, that brings about another irretrievable forfeiture- quality.

Besides accommodation for growth and improved operational function, the most desired result is the achievement of an enhanced professional image- The “wow” factor. If you plan and budget for a granite transaction counter (as opposed to plastic laminate) it is likely that the cost would be quite manageable; particularly if other products and services provided in the contract are valueengineered [if necessary] to make that accommodation.

Clearly your attorney will protect you from the potentially harmful legal vernacular of the contract with the general contractor or construction manager. But, who is governing the content of the construction documents for the actual services that the contractor has agreed to perform? No one. But, all costs are yours to absorb- because you agreed to pay for them; whether by definition or by tacit acceptance of the designer’s documents. In a nutshell, you
have given the designer a blank check to spend as they see fit with no accountability or remorse. There is very good reason and practicality to hire a professional. They are the only ones who are capable of actually defining and managing your project and the associated costs of development.

A footnote to hiring a professional designer- make certain that they are not deferring any services like MEP (mechanical, electrical and plumbing) to a third party. It is essential that the designer have a full and articulable understanding of all equipment and associated construction materials and services. Without that knowledge, they will be unable to effectively control and manage the project.

Please note that most of the contractors with whom we have worked are honest, hard-working and accommodating people. Regardless, they are in business to make a living, and can’t perform their services for free. Consequently, if additional work is required as a result of missing or insufficient information, they are entitled to be compensated for that work. That’s the good news. For that small percentage of unscrupulous contractors- caveat emptor!

Lastly, the contract to which your attorney’s attention should be directed is the one between you and your designer. Paramount within that agreement are two major concerns: 1. Beware of disclaimers- professionals “own’ their work. 2. Request verification that they are capable of providing the necessary construction details that will allow you to establish and adhere to a budget. Take heed, and God-speed. schedules; which includes door, window, plumbing,

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, Garrett 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.dentaldesign.pro/. or LinkedIn: http://www.linkedin.com/in/garrettludwigcontractual fine print is essentially harmless, you might ask how you might otherwise be vulnerable. TheDocuments. The signed contract itself- replete with its legalconstruction documents” and you will “pay…”[and pay, and pay]. As such, the actual contract for thecontained in the Construction Documents. To wit, according to Merriam Webster aofficial paper relied on as the basis, proof, or support of something.” Those prettythree-party communication (client, contractor, designer) prior to the signing of the twopartyseveral hundred dollars. That’s just one small, but costly, example of a very

Behold: The Construction Contract