Premier Surgeon: The architectural design process

Richard C. Haines Jr.

Sooner or later the time arrives when you have to create the design for your office suite. For most of you, this means hiring a “designer.” The question often arises: “Do I have to have an architect?” The actual answer to this question can vary and depends on the laws of your particular state.

However, if the drawing documents created by your designer will be used to secure a building permit from the local building department, you will need to have your plans developed by an architect who is licensed in your state and who will seal those drawings.

Doctor-architect relationship

It makes a difference who has signed the contract with the architect to provide professional design services. Many doctors going into hospital medical office buildings are provided an architect by the hospital. That architect typically has a contract with the hospital to design the building itself and to work with the doctors to design the tenant improvements that go into that building.

It is important to realize, however, that that architect’s first responsibility is to his or her client — the hospital. It is not uncommon for architects in these relationships to frame options for doctor-tenants within the boundaries established by the hospital. This can work to the doctor’s disadvantage. The same set of relationships also occurs when doctors work with design-builders. The very nature of design-build means that the architect works for the design-builder, not the doctors.

It should also be noted that the hospital’s architects frequently have hospital experience but little understanding of the operational dynamics of clinical practice space. They plan a generic office building in which the hospital can lease space to doctors. Sometimes this space is actually ill-suited to clinical practice design.

The traditional relationship between doctors and architects is one in which the doctor directly employs and has a contract with the architect. That architect represents the doctor, designs the suite and draws the plans. The doctor then enters into a separate agreement with a contractor to build the suite. The architect’s plans are used to not only provide the backbone to the owner-contractor contract, but also to secure the building permit and guide the contractor through construction.

There are three things necessary for an architect to design a space:

• There has to be a defined place in which to put the design, perhaps a discrete piece of land on which to put the building or a particular tenant space in a building within which to put the design.
• There has to be a definitive space program, a comprehensive listing of all the spaces that are needed for your practice and their sizes.
• Someone, hopefully your architect, must have an understanding of the adjacencies required between one space in your space program and another. That person also needs to have a hierarchal understanding of which adjacency relationships should take priority over others

Five-step process

Regardless of whether the architect works for you or someone else, they consistently utilize a five-step process in design. This process reflects the decision-making sequence that a designer goes through as he or she creates the concept of the suite and codifies it for contractors.

Step 1. Schematic design: Schematic design is when the very concept of your project is created. This is when the doctor, patient and staff flows are figured out and the appearance of your building is determined.

Step 2. Design development: Once the schematic design has been refined to meet your needs and expectations, it should be set in stone. During design development, the architect and engineers develop the architectural, structural, mechanical, electrical and plumbing system concepts that your building will need to function properly. The information developed in this phase is layered on top of the decisions that were made during schematic design.

Step 3. Construction documents: Once design development has been put to bed, the contract documents are created. In the past, these have frequently been referred to as working drawings and specifications. They consist of the architectural and engineering plans that will guide the contractor through the construction process. They will also be used to secure the building permit. The information developed in this phase is layered over the decisions that were made during design development. At the end of this phase, all the design documents for your project are complete.

Step 4. Bidding/negotiation: It is during this phase that the price for the construction is determined based on the information contained in the contract documents. Some projects are competitively bid. Others may have a particular contractor selected and the price is negotiated with that contractor.

Step 5. Contract administration: This is the phase in which the building is actually constructed. The architect performs a number of duties while the contractor builds the building. He or she will perform periodic observation of the construction progress, attend contractor job-site meetings, resolve inconsistencies in the contract documents, check shop drawings, help resolve problems that arise in the field, and process change orders and pay requests, in addition to other tasks that may arise.

Each step in the design process adds layers of information to decisions that were made in the prior step. For instance, in schematic design there may be one or two designers working on the project creating the design. At design development, that may grow to six or seven as more decisions are made and more information added. In construction documents, there may be 12 or more professionals working on the design at any one time to make even more decisions and create the documents from which the contractor can build the building. This is why changes late in the process can be so costly; the architect may be forced to back up and go through some of the sequential steps again. And when the project is under construction, the process is much more costly because there are contractor’s costs in addition to architect’s costs.

Understanding the sequence in which decisions are made as you design your suite can help you control your costs, avoid change orders and get the practice environment that you truly want.

• Richard C. Haines Jr. can be reached at Medical Design International, 2526 Mount Vernon Rd., Suite B-405, Atlanta, GA 30338; 770-409-8123; fax: 770-409-8662; email: haines@mdiatlanta.com.