Visible Results by Dr. Jeff and Pat Carter

Categories: Office Design;
Visible Results 

When you compete on the experience, not price, when designing a practice, the payoff is more than just aesthetic

by Dr. Jeff and Pat Carter

The vast majority of constructed dental facilities are design-build process outcomes, which minimize the design-phase interaction between professional designers (architects, interior designers and engineers) and the end-user dentists. They also minimize project documentation and specification, which can make it difficult to control project costs once into construction. Perhaps you currently practice in a design-build facility that you originated or acquired from another dentist or dental specialist.

Why is the design-build process so prevalent in dentistry? Typically, the primary rationale is saving the doctor money; however, this idea is based on the assumption that investing time, money or both into a dental facility has minimal impact on the ultimate financial success and quality of life of the dentist and team members who occupy it. This approach also assumes that dentists don’t benefit significantly from working closely with trained design professionals to optimize the ergonomics, workflow and aesthetics of their facilities.

Nearly 100% of start-up dental facilities are design-build outcomes, and current dental specialty lending programs do not support soft costs for professional designers outside the design-build process. Yet, the No. 1 complaint of dentists designing and constructing a startup facility, as documented by those same dental specialty lenders, is regretting not investing more into the design of the facility. A year or two into a new design-build facility, dentists believe the minimized aesthetic and disparate function of their office is often a detriment to attracting new patients and quality staff.

The alternative is a dentist/professional design collaboration, which involves working more closely with dental-specific designers to optimize your facility. This is a design process we have promoted for years, sourcing the dentist on the design of their own facility. And we have witnessed the impact the investment of time in the design phase has had on their ultimate practice growth; we recently framed this as a contrast between a facility designed to compete on price versus one designed to compete on experience.

A cheap start leads to costly upgrades
We categorize the design-build process as “competing on the price” because the primary goal is to minimize costs and design time so the project can move into construction relatively quickly. Typically, a general contractor provides any additional “design” that would be required to take a dental supplier floor plan to a permit set of drawings and advances the project directly into construction. As noted above, this is promoted as saving the dentist money and time.

Competing on the price is a valid approach for simple, less detailed types of projects, such as big box stores like Walmart. However, we’d argue that it is not the best approach on a more complicated type of project such as a dental facility—and here’s why.

What’s not well understood or explained to dentists is that “savings” on the design phase typically leads to a minimized aesthetic and greatly increased cost risk during construction. Because in-depth design discussions are truncated or minimized, any desired aesthetic details or technical specifics aren’t defined in the drawings—and anything not defined in the drawings becomes the general contractor’s prerogative (assumption) in the pricing and construction of the project. In the “competing on the price” model of design-build, the allowances built in the construction cost are typically builder’s-grade selections with minimal appeal to dentists who want to create a distinctive aesthetic, and any upgrades or changes become a change order or cost overrun (which is a testament to statistics that show most design-build dental offices have cost overruns of 20% or more). Finalizing your facility design during the construction process is a costly and ill-advised decision.

By contrast, a professional designer/ dentist design collaboration, working with a dental-experienced general contractor, is a “competing on the experience” design process. The design drivers optimize the experience of the practicing dentist, team members and patients with the aesthetics and function of the facility, and then managing the project’s costs through a well-defined set of drawings during construction. The goal is for the process of design and construction to be a positive experience with a project outcome that is overwhelmingly positive.

More investment … but more return, too
To create that overwhelmingly positive dental facility takes more time and a higher investment level by the dentist—an average 15%–25% more than design-build projects, we estimate.

Is it worth it? As a cash flow/profitability/ business model, you can make compelling arguments for both competing on the price and competing on the experience. The savings up front on the design-build process is arguably appealing! However, in our experience, the impact of the professional collaboration facility is undeniable: Over the years, many of our dentist clients have had astronomical increases in practice growth and production.

Is it all the facility? Of course not. Many of those dentists are dynamic clinicians who place a high value on the “quality of life” for themselves, their team members and the patients treated in their facility, so for them, competing on the experience is just part of their personality structure, and spending more time and money optimizing the design of their facility is a desired and enjoyable process.

And while we believe strongly in the benefit of this collaboration process and have promoted the impact it can have on a practice, “proving” this benefit has been limited to anecdotal stories and testimonials by dentists over the years. fi at said, there is no better example of this contrast than a project we recently completed with a husband and wife dental team.

Finding the right partners
Dr. A (husband) and Dr. C (wife) wanted to upgrade the “design-build” facility they had acquired from a dentist relative. While their office was workable, neat and clean, and their practice was growing, they longed for a facility that was unique and distinguished them from other practices in the highly competitive area.

We worked closely together, mapping out the floor plan to meet the clinical objectives, optimizing the flow of patients and staff, accommodating all the current and future technology, and developing the upgraded aesthetics and finish selections. During this design phase, we initiated the selection of the general contractor. We interviewed four candidates whose responsibility would be to deliver a facility based on a comprehensive set of drawings generated by the dentist and designers. They would submit a fixed-sum construction contract based on these drawings, and the design team would collaborate with them during construction to address questions and manage any cost issues on the dentist’s behalf.

Three of the interviewed general contractors were familiar with this collaboration process and understood the benefit to the client and the project. However, the fourth believed the project didn’t warrant this approach. As Dr. C explains:
He said, “It’s just a dental office. No one cares about how it looks. These details are ridiculous. Patients just want it clean and to get in and out as quickly as possible.” But to my husband and me, this is our home, and our team and patients are our family. We wanted every inch of our practice to be a testament to how passionate we are about the details of our dentistry.

We take pride in treating our team and our patients like family. What better way to show our appreciation than to create a comfortable, clean (not to mention cool-looking) high-tech environment for a place that most people dread going to?

In the design-build approach, the contractor drives the design of the project, and this general contractor decided the dentists didn’t need (or deserve?) a thoughtfully designed, aesthetically upscaled facility that fulfilled their vision for how they wanted to practice. Rather, he would drive the project’s design—and it would no longer be their vision but his (based on the money he would “save” them).

As dentists, we aren’t experienced in the construction of a dental office, so this approach and attitude is received as, “He knows better than I do about what my office should be.” We also struggle to overcome the “I hate going to the dentist” mentality of our patients, as echoed by this contractor. What is lost in this approach, however, is that part of overcoming that negative reaction is to offer an environment that doesn’t look and feel like the typical high-fear medicinal dental office. Our point: You don’t have to give up your voice or your involvement in designing your own office.

The “no-frills” general contractor was not selected. The one who was enthusiastically welcomed the challenge of a functionally complex and aesthetically upscaled facility unique to the vision of the dentists, and he became a key collaborator in making that happen.

A before-and-after example
In Figs. 1 and 2, you can see the dentists’ previous practice was aesthetically simple, neat and clean—it was evident the doctors cared about the office’s appearance.
Fig. 1
Fig. 2

However, the new office was designed to compete on the experience. We introduced more compelling spaces—better flow and sizes of rooms, floating soffits, beams, uplighting, upgraded finish materials—all designed to create a uniquely positive dental experience.

Additionally (and significant to note), the fixed-sum cost negotiated at the start of this project was the actual, final cost of the project by its conclusion. The general contractor posted photos on social media and was proud of the excellent work his construction team provided (Figs. 3 and 4).
Fig. 3
Fig. 4

From a design perspective, this was a challenging space to deliver a “competing on the experience” outcome. With most retail center lease-space options, window exposure allowing natural light into the core of the facility is limited. Ceilings and architectural details elevated beyond the standard 9 feet often require extensive rework of existing HVAC systems and ductwork.

The completed project (Figs. 5–11) displays multiple features consistent with the “competing on the experience” philosophy of dental office design and construction.

Nine months into the new facility, Dr. A and Dr. C have been overwhelmed with new patients and positive feedback from both team members and existing patients. Patients report they feel like they’re in the lobby of a five-star hotel or spending the day at a luxurious spa—a stark contrast to that “patients just want it clean” comment! To further amplify our point, their new facility sits only about 800 feet from their previous office, and within the same retail center. There’s no change in patient demographics to account for this sudden explosion in new patients and overall practice growth.

Why are they suddenly experiencing an overwhelming positive response to the new facility? Loyal patients of record are now being much more proactive in recommending their dentists to family and friends, telling others, “Hey, you should go to my dentists! They are great—and you’re going to love their new office.”

The positive response of a “competing on the experience” office seems obvious to us. When it comes to their health, many patients are sensitive to their environment and surroundings and are looking for a positive experience, taking cues from the spaces within which they are treated.

Dental offices that are well organized, pleasingly aesthetic and uniquely detailed signal a commitment to quality—and in the case of a dental office, highly skilled dental care. That attracts patients. It also attracts patient referrals. Patients want to refer those they care about to a practice that can provide quality and skilled dental care; their referral to a quality practice and facility is a positive reflection on them.

As the dentist, investing your time in thoughtful design and “sourcing” your own unique practice facility for yourself, your team members and patients can have a remarkable impact on your practice. That is our experience, that is what many dentists have accomplished and that may be precisely what you desire for your own practice. Understanding and choosing the design and construction process that delivers that outcome is key.

Author Bio
Jeff and Pat Carter Jeff Carter, DDS, and Pat Carter, IIDA, are owners of Practice Design Group, a Texas-based agency that offers a full range of design and consulting services to dentists nationwide. Information: or 512-787–2501.

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