By Dr. Mark Tholen
Figure 1
Yes, you will be practicing in the facility and treating patients, but the environment of the office will speak as loudly to the patients as you or any of your staff members. Patients, especially new ones, gauge or determine the level of care they receive by assessing the quality of the office environment. Don't believe it?
Keep this concept in mind the next time you are a new patient to an unfamiliar doctor. Nonverbal communication is very powerful in new or unusual environments. Your office will speak to patients; you have a choice in the statement the office will make to them. Regardless of your clinical ability, your success does not depend on your diagnostic and treatment skills, but rather your perceived competence as viewed from your patients' perspective.
There are two basic tenets advanced in the above paragraph. First, if you accept the concept that the office, among other things, is a communication tool, a giant billboard that all of your patients view each time they are treated, then it should be the personification of your "marketing" program.
In fact, it is the marketing program.
Second, success is dependent upon your patients' perceptions. But what is success? Is it greater production, i.e., dollars, fewer direct patient care hours so that you can spend more time elsewhere, focus on a sub-specialty requiring a certain environment, hiring an associate to alleviate the workload, or increasing your income while maintaining your direct patient care hours? These goals will dictate certain design objectives such as the number of operatories. Often, there exists a great disparity between what doctors believe they need in order to achieve their goals and what is actually required for them to accomplish these goals.
Communicating your goals and dreams
How do you expect the office to assist in reaching your personal goals? Too many times, when questioned about why this new office project is being undertaken the response has been, "I need more chairs or operatories." More operatories are a means to reach your ultimate goal. You must decide how you want your office to look. It is helpful to view your office from your patient's perspective. Would you rather have a quaint, comfortable looking office or a more dramatic presentation that conveys the use of cutting-edge knowledge and technology? Know your goals because they will undoubtedly impact the manner in which your office is designed.
There are two basic office design criteria that should be foremost in your mind as you begin: office function and office image.
Figure 2
After stating your expectations or goals you will be able to gauge the amount of assistance you will require, the amount of work you will do on your own, the financial commitment you will make to the project, and how much time you are willing to commit to it. Doctors' involvement can range from total immersion in the project to completely delegating the design of the office to a staff member, spouse, or more appropriately, the designer or architect. Delegation is ideal for a doctor who wants to devote minimal time and/or effort to the process, but remember that you are the one practicing in the facility for, on average, the next 20 years. Request that the designer or architect confer directly with you at the following key decision points in the design process: (1) your definition of the size and components of the office, which is expressed through the use of a design program questionnaire (supplied by the designer), (2) your final approval of the floor plan, (3) your characterization of the elements of the interior design and, (4) your acceptance of the final detailed design drawings. This sequence of events has the potential to satisfy your goals because modifications are almost always needed to meet individual needs and preferences. If accomplished in an orderly fashion by effective leadership of the designer/architect and yourself, this method of project development will decrease your design costs, reduce your construction costs, and result in the office that you "had in your head" as you began the process.
Defining the character of the office includes establishing a wish list of merchandise and equipment you want to employ and procedures and events that you want to hold in your facility. Make certain that this list is in writing and submitted to the architect. Many architects will typically refer to this document as a design program questionnaire, and some will even have one prepared for you to complete. Without the design program, an architect can always design "something," but this "something" may not coincide with your goals and dreams. If the design program is written as opposed to verbally communicated to an architect or designer, the architect or designer will have a much clearer vision as to what is to be accomplished, and more importantly, they will have your goals and dreams. You and the designer or architect become committed to your ideas by intentionally enumerating your thoughts on paper. This step of (you or the architect) drafting your office design desires is vital to the uniform and daily progress of the project.
Form follows function…right?
There are two basic office design criteria that should be foremost in your mind as you begin: office function and office image. You are designing a dental office, before and above and above everything else, it must function effectively to provide quality treatment to patients while minimizing the physical and emotional stress to the staff. It sounds simple, but there are innumerable things that can impede you from treating patients properly. A very simple formula that is critical to your success is the equation that the functional dollars of the project plus the image dollars will equal the degree of success that you have in reaching your goals and building your practice. Focus and concentrate on the functional aspects of the office design and establish them, then layer the elements of image or aesthetics onto the functional aspects of the office design.
Figure 3
A common misconception is that a well appointed office costs a great deal more that a relatively plain, simple office. In fact, it is just plain costly to build any technologically driven diagnostic and therapeutic dental office. You are going to make an investment in your professional office, unlike your car or house, because you expect a return on the investment. If properly designed and constructed in an acceptable location, your office will probably yield greater financial return than any other investment made in your life. First of all, there are many rooms confined to a relatively small space. The rooms are smaller and, as a result, there is much more framing, sheet rock labor, technology cabling, vacuum, compressor, and medical gas lines, and many more electrical outlets. A typical five-operatory office has between 80 and 100 outlets whereas a 2500-square foot accounting office might have 20 outlets. This plethora of outlets begets a tremendous amount of electrical work and this, of course, is accompanied by extensive plumbing and the resulting stratospheric costs.
Before the appearance of the office is considered you have already invested a considerable amount in the aforementioned physical elements of the office. The remainder of your financial resources will then determine the office’s image. In order to create a minimally acceptable appearance for the office, it is necessary to invest $10 to $15 per square foot in "image expense" which, in a lease space, might represent between 10 and 15% of the actually building cost. However, if you were to invest $25-30 per square foot you will enjoy an office that emits a strong statement about the quality of care offered at the practice (Fig 1). Many believe that offices with this degree of investment in their image simply have sacrificed something pertaining to function, but this is simply false.
Do not succumb to this fallible reasoning and begin to make imprudent judgements such as "Oh I can’t have that, I don’t want that" or "People in my town won’t like that."
Quality Counts
Why would you not want to make a statement of quality to patients from the instant they walk into your office (Fig. 2)? Marketing surveys have been conducted as to how patients assess the quality of healthcare they receive. In these surveys, patients in a number of facilities were asked to rate the quality of care they would expect to receive, based on a scale from one to ten, according to their observations in a particular healthcare facility. The highest rating any facility received was fifty percent. In other words, patients from a wide spectrum of income levels and facility experiences expected, at best, only mediocre care. It is tragic that people must walk into medical or dental offices and, because of what they see, expect mediocrity.
Patients base their expectations of care on those items they can judge: furniture, artwork, and posters. Message to all practices: Get rid of the posters! Nobody enjoys looking at posters, advertisements, and things lacking in visual appeal. Give the patients something aesthetically placating to view. The patients in these surveys also commented that the furniture in the offices appeared to come from a second hand store or a basement. Clutter was another condition for which the patients voiced disdain; it dramatically lowers the patient’s opinion regarding the level of care they receive. It is important to take notice of these items—because your patients most certainly will.
The key to success of the practice is congruency. You must be congruent in everything you do, say, and display to your patients. The function and esthetics (image) of your office must be consistent with the treatment you propose and deliver to your patients (Fig 3). In other words, your environment must reflect who you are as a practitioner.
Success will follow.
Therefore, posing the question whether your practice can support a new office is not the manner in which the project should be approached. Indeed, the question should be whether a new office will support your practice. The facility must support the practice in order for your life and professional goals to be achieved; it is a vehicle for success. The office must support the growth of the business, the practice, and you as a professional, or it is the wrong design. The office, as the marketing centerpiece, should facilitate the functioning of the practice with a significant increase in productivity.
Green Lights
Are you the type of person who needs all of the spotlights to be green before you will start out on a journey? If so, now is a rare time in which all of the economic green lights are on. Construction (labor and materials) costs are down from 15 to 20 percent on a national average, borrowing costs (interest rates) are at historic lows, and the economy is in its beginning stages of recovery. Remember the admonition, "Buy low, sell high"? It is a very simple strategy which is extremely difficult to execute, but now is the time to buy low. Hopefully, you will seize the opportunity to take your practice to the next level while earning more and feeling better at the end of the day.