Dental Office Construction - The Process and Where to Start

Are you contemplating an office renovation or relocation? Feeling overwhelmed about where and how to start? You need to be practicing dentistry - where will you find the time to undertake a project? Fortunately, when involving experienced dental professionals from the start the process can be smooth and even enjoyable.

“For such an enormous project, you helped make the process as stress-free as possible….The detail of your plans eliminated many questions. The general contractor was impressed. My colleagues are wowed!! Most importantly my patients feel very comfortable.”
-Dr. Mark Elice, Hazlet, N.J.

The 10 Step Process:
1. Interview experienced dental office planning and design firms to discuss your goals and spatial requirements in detail. Find a firm experienced in the business, function, and design of dental offices. As your planner and advocate they will represent your interests throughout the project, find someone you trust and will enjoy working with for the next 12-24 months. Also, they can help you build a team of dental specialists such as attorneys, leasing agents/brokers, accountants, and loan officers. Next, your planner will determine an approximate square footage for you to lease, buy, or build based upon your goals. They will prepare a project budget estimate up front so you understand your total investment needs.

2. Take your project budget estimate to your dental lender. The estimate should include all construction costs, dental equipment and cabinetry, furnishings, new office equipment, consultant services, fees, and many other costs. Prequalification will let you know if and how much you can qualify for before make any legal commitments.

3. Using your estimated square footage requirements have a dental leasing agent or broker find suites or buildings that meet your requirements for size and professional appearance. Why do this in step #3 and not #1? If you don't know how much space you need then you could lease a space that won't fit the number of operatories needed to make the practice cash flow. Once you find “the space”, have your agent write and submit a "Letter of Intent", then contact your planner again.

4. Provide your dental planner a "to scale" floor plan of the suite or building. They will develop a preliminary space plan based on your criteria and study if and how you can fit into the suite. If you fit and like the functional flow, have your attorney begin negotiating, review the leasehold or purchase agreement, and then sign.

5. From here your planning/design team will complete a more detailed space plan to ensure that all the functions of your dental practice are integrated for smooth patient, staff, chart, and instrument flow with all functions at your teams’ fingertips and more. This detailed plan is the base for detailed construction drawings (CDs) that should include plans and cabinetry elevations. Thoroughness counts! If it isn't specified or shown in your drawings it won't be in your bid, loan, or the final office. Your planner/designer will create the three dimensional interior architectural design and color scheme selections including carpet, plastic laminates, vinyl or tile flooring, paint, and fabrics. Ideally, you and your team will to be presented a number of color scheme options, based upon what YOU like, for approval. The approved specifications are then added to the CDs.

6. Depending upon the firm, your planner/designer will submit the CDs to the building department for review and permitting. The plan review process can take anywhere from two to twelve weeks, depending on the jurisdiction size. Simultaneously the CDs are sent to the dental contractor for thorough costing, usually a two to three week process. Once the building permit has been issued and a dental contractor has been selected, preparations are made to start construction.

7. The construction of a new or remodeled vacant space usually takes 3 months. Remaining operational through a phased remodel requires some brief closures and two or more phases of construction. This can take as long as 6 months. Your planner will discuss these timelines with you and ideally they will provide project management services during construction to answer contractor questions to keep the project running smoothly so you can focus on dentistry.

8. In the last week of construction dental cabinetry and equipment and furniture and artwork are installed with deliveries coordinated between your designer, general contractor, and subcontractors.

9. Before or in conjunction with move-in, your planner/designer will complete a detailed, room-by-room punchlist and provide copies to you and the contractor. The contractor will complete these items, usually within a month of your move-in, to receive their final contract “retainage” funds.

10. Move in day! This is where taking the time to bring together a experienced team pays off! You, your patients, and your staff can enjoy a well organized, functional, and aesthetically dynamic environment. One you spend the majority of your waking hours in and now it pays you back in a 20-40% increase in profits. You may wonder, "What took me so long?"

Is My Dental Office's Design Impacting My Bottomline?

If your office is aesthetically out-of-date or poorly functioning, even in a couple core areas, you and your team may be working against your office’s design as well as decreasing patient treatment acceptance. Fortunately, even a micro-remodel has a significant impact on your patient's experience and thus, helps increase your profits. This Catalyst Magazine article about an SEI client, Dr. Christine Kirchner, helps understand how:

“Dr. Kirchner saw a dramatic increase in cosmetic cases after remodeling...(and an) increase in patient referrals and walk-ins. This has continued to grow every month. She also began having an increase in more elective procedures….. (The Staff) are more efficient with their time and production increased 25%....”

Level 1: Christine Kirchner, DDS - Reception Area Before Renovation

Level 2: Christine Kirchner, DDS -Reception Area After Renovation

Your office environment is a patient’s first impression of your practice and an outdated or worn office brings into question whether the equipment, technology, education, and procedures are too. (See the ‘before’ and ‘after’ pictures above in the same suite.)You can be the best dentist with the nicest team-but so is that dentist a half mile away. Your office needs stand out in enhancing the patient’s experience compared with others in your area. The easiest way to understand the impact of staying current and highly functional is through the patient’s eyes.

Working in our offices day-in and day-out it is easy to overlook what the patient sees. So, grab your digital camera and be "the patient". Take pictures of your office starting outside your building or suite and all the way through the office capturing every spot a patient would see. Then bring the images up on your computer monitor; it's easier to be objective when you review the pictures on a large screen. What do your patients see? Make a list of the downsides. I realize you have to work in these rooms so everything cannot be put "away" however, with an effective design there are ways to function well-really well-without a clutter and disorganization in full patient view.

Let's get inside the patient's mind and understand the stories they bring to their appointment. Things like fears of the needle, pain, the unknown, the cost, and memories of childhood dental experiences and even sexual abuse. What would they like? A warm, comfortable, calm, clean (not white), organized, and nicely designed office. While "nice" varies, patients do like to be in offices that are nicer than their home. After all, who among us doesn't enjoy visiting a nicer restaurant or hotel to enjoy the environment? Your investment in meeting your patient’s needs through a functionally designed aesthetic environment that reaches beyond your actual dental care will put them at ease and provide greater confidence in you and your team. Better still, it will attract them to your office rather than that other dentist a half mile away. You will see a direct return on your investment through higher quality patients, greater profit, higher personal enjoyment, and the ease of practicing in a well designed office.

Time and time again our clients tell us their best marketing is the post-renovation word-of-mouth referrals from their patient’s friends and family. The resulting acceptance of both restorative and elective procedures is measurably higher after updating-a great outcome in an uncertain economy!

Now that you “see” your office, to learn more about what to do next go to www.SignatureEnvironments.com. Or send me your pictures and we will discuss the possibilities together.

Chairs We Use and Love

There are days when sitting at work is simply no fun, possibly even painful. Luckily our friends at RGP Dental, especially Michael O'Neil, have a solution we just love to sit on. This Swedish manufacturer has designed some very comfortable, very supportive, and highly adjustable task chairs and it fits all the bodies at Signature Environments. While the chairs were designed as task chairs for the dental industry, with versions for both doctors and assistants, they make an excellent cross over to other sitting intensive industries too! http://www.rgpdental.com/ While we are on the topic, "highly adjustable" is a key term with any general office or dental task seating. Our bodies change depending upon the task "at hand" and our chairs need to adjust with us as well. Commonly we humans sit down in a chair and never adjust it to fit our unique bodies or sitting positions. Unfortunately, this approach can add to repetitive stress injuries at work, such as carpal tunnel syndrome. So, grab your office mate and you can each take a turn at finding the optimal adjustments for your task chairs, even if it isn't an RGP. Here are a few keys to a good ergonomic fit and "rules of thumb":

- Seat height: Adjust your seat height so your feet are flat on the floor when working on your keyboard. Your arms should be roughly horizontal to your keyboard tray.

- Seat back: Have your office mate adjust the back height so it comfortable hits and supports the lumbar area of your lower back. Then sit back--yes BACK--against it. It is time to officially end "perching" on your task chair and let the back support you. (Ladies, we are the worst about the whole perching thing and it is really hard on our lower backs and hip joints.)

- Seat tilt: If your seat has tilt adjustment it may be more comfortable to tilt it forward or even backward, or better yet be "free flowing" to follow your body in motion. (No, this doesn't mean your back can leave its new connection with the back of the chair, it means it will be supported properly while you work though). Happily for us the RGP has the "free flowing" function too, depending upon the use mode chosen.

- Keyboards are best located under your countertop. On top of the counter is too high and may lead to carpal tunnel syndrome. There are some well made options with height-adjustable rise and fall and they will tilt too. Invest in a keyboard roll-out as a high priority!

- When changing from keyboarding to working on your countertop adjust your seat height up to allow your arms to be parallel with the task at hand. (I know, sounds like a hassle but it's the best habit to learn, your body will thank you). When your elbows are low and wrists resting on the countertop edge or keyboard edge you may find yourself losing circulation-this is NOT a good thing.

- Foot stools: When your seat goes up so do your feet and to keep your touché firmly planted against the back of your chair you may need to invest in a foot stool under your desk. These can be found in your office supply catalog and vary from cheap to spendy. The goal—keep your back against the seat back and your bottom firmly planted—not perched.

- Lastly, the mouse. That little critter can be the cause of shoulder pain and needs to be sitting directly beside your keyboard (down on that new keyboard roll-out you will be buying). Check yourself to make sure your arm isn't extending out to the side or causing you to tilt forward. Pull your mouse pad closer and snug it up happily next to your keyboard--everyone will be happier!

Suggestions for future entries? Pains you have from work? Contact me at Janice@SEIseattle.com, I am happy to help!

Celebrating 12 Years of Creating Signature Dental Environments

Oh so far back, in 1996, Signature Environments was created out of the belief that dental planning and design could be so much better. My long time colleague, Kristin Harleman, and I met and had designed a combined 75 dental offices at another design firm. We had observed the need for general dentists and specialists to rise from a Level 1 (entry), to a Level 2 (mature) practice wasn’t fully being met. We realized dentists needed signature environments that clearly differentiated their Level 2 practice from others in their town, city, and, at times, their state. On September 1, 1996 Signature Environments was founded to do just that.

We had learned that dental practice success strongly depends on the patient’s experience in the practice. The more focused on the patient the entire dental team can be, the better the patients’ experience becomes. In any business, the best marketing is word-of-mouth. And, if the patient loves you, your team, and the care you provide for them, they tell everyone they know all about it- for free! We knew the way to create the best patient experience was to develop optimal function first. Function creates the best patient care by keeping the team focused on the patient and generates elevated income and profits. However, we also knew function was not alone in the equation. A practice’s visual signature is also essential to creating a lasting and positive memory. A visual, verbal, and functional presentation of your entire dental team is conveyed to your patients through your interior architecture, the warmth of the environment, amenities, and a seamless, yet caring operation. By developing both aspects in tandem, our clients experienced a significant increase in new patients and profits.

During our experiences, we’ve also observed how it overwhelms clients who were simultaneously working in their current, stressful office and trying to address all the aspects of planning a new office. As your team leader, Signature Environments manages the project from inception to completion by doing what we do best, so in turn our clients can continue to do what they do best--practice dentistry. We bring our expertise and resources to your project along with the most knowledgeable dental equipment specialists, dental contractors, dental bankers, leasing and real estate agents, and other top dental business consultants. Through our detailed construction drawings and thoroughness our clients go to the bank knowing they can also meet their business goals within their budget.

Our business plan was ambitious, and our growing client list and positive feedback has confirmed we were on to something better. Now in our 12th year (my 18th), I plan on sharing solutions, common pitfalls, great products, and funny stories. Please join me, and make yours a great practice!





Janice M. Thayer, President
Signature Environments, Inc.