Today's SurgiCenter - Selecting the Right Architect

Selecting the Right Architect

By Wade C. Taylor, AIA

I just heard a tragic story from a surgical center planning consultant a few weeks ago, and I hear it all too often. The facts have been changed but the message is the same. This is how it went: “We are planning an outpatient surgical facility in Wyoming. We just started the preliminary analysis and should be ready to engage the architect very soon. Unfortunately, we have no input as to the selection of the architect, and in spite of our strong lobbying efforts with the hospital, the chief surgeon’s distant brother-in-law will be hired. He has dabbled in healthcare over the years — that is, if you count assisted-living facilities as healthcare architecture. I spoke with him the other day. Now I am really concerned. He asked me if I had ever heard of ‘Construction Guidelines for Healthcare Facilities.’ Adding, in his 20-odd years, he had never heard of it.”

I was not surprised, as I have heard this story before. The best advice I can give to anyone trying to build an ambulatory surgery center (ASC) is this: find an architectural firm that specializes in ASC design. There are some architects who devote their careers to designing and developing surgery centers. They charge about the same as other general practice architects, maybe 1 percent or 2 percent more. If you don’t have one in your city, don’t be afraid to search the country for the best talent. After all, this is a major investment of time and capital, one that could put you out of business if you fail.

I am often asked about my fee during an initial conversation. This is natural, but hardly the most important component to evaluate. Putting the architectural and engineering fee in perspective allows you to focus your attention on the more important attributes of the process. For example, if we assume an average construction cost of $3 million for a new ASC, the architect’s fee will be in the range of 8.5 percent to 10.5 percent. Anomalies exist, as always, but this is a fair representation of the range to look for. At 10 percent, the A/E fee would be $300,000. This would include all architectural and engineering components required for the building and the site.

Now calculate the remaining capital costs, as well as other soft costs that include the land purchase, medical equipment, instruments, computers, software, furnishings, etc. An average cost for this model is roughly $1.5 million, assuming it’s a free-standing, multi-specialty facility and the land purchase is reasonable. Factor in your annual operating costs for 20 years, including utilities, staffing, etc. Recent experience shows annual operating costs of about $1.4 million for a well-designed facility. Add it all up and you have a grand total of nearly $34 million. The architect’s one-time fee, in a proper perspective that includes 20-year operating costs, is one-tenth of 1 percent, or one-one thousandth of your grand total.

I called a previous client recently, and asked him about the fee we charged in 2001. First of all, he could not remember what it was (which says volumes.) Then, when we went through the previous exercise, he laughed and dismissed the early fee concern as marginal at best. His comments confirmed this recommendation — select your architect based on his or her experience, reputation and capacity to interpret your project needs. I cannot overemphasize this final criterion.

Going back to our example of inexperience in Wyoming, consider this first: 26 states have adopted the “Construction Guidelines for Healthcare Facilities” as the basis for Medicare and state licensure. Secondly, few states perform a preliminary Medicare compliance- based review of the architect’s drawings prior to construction. On occasion, the state representative will visit the site, but the first and essential audit occurs after construction is complete. To illustrate my point, let’s use a common but costly example of code ignorance.

The average architect is aware of the Life Safety Code, (adopted by CMS in CFR 42 at the federal level) because it is used for many building types. But unless the architect is informed by a third party, he will not apply the “Construction Guidelines for Healthcare Facilities” code (individually adopted at some state levels). The differences are numerous.

Minimum corridor-width requirements, according to the Life Safety Code, can be as narrow as three feet to eight feet in some areas, based on occupancy and egress calculations.

Imagine the state representative who walks through the completed facility, places a tape measure on the floor and says, “This corridor is too narrow, it needs to be a minimum of five feet wide (again, based on the “Construction Guidelines for Healthcare Facilities” code.) You just spent $3 million in construction costs, invested 18 months of time and effort, and your facility is deficient before opening.

In fact, there is a very good chance that your facility opening will be delayed weeks, if not months. This is one mistake you just can’t afford. Just imagine, the construction is complete, and you need a wider corridor!

In speaking with a consultant a few months ago, I asked him what kind of questions he would ask of a potential architect and, surprisingly, this is what he said. “I don’t ask the architect how many successful projects he has completed, I simply ask for an example of his worst project. I am not trying to eliminate him from my short list, but to understand his problem- solving skills. What matters is how he solved the issues when they occurred.” I agree. Any architect you meet who denies having a bad project or making any mistakes is either lying or has not had the experience he needs to do your project. The best experience is firsthand experience.

I used to think the healthcare community in America was so vast that establishing a good reputation for recurring commissions was futile. Quite the contrary exists. Today, there are many resources available to surgeons and investors alike that quickly identify the better architects and planners. I say “better” because there are unique programs and client requests; and perfect solutions for them do not exist. You know yourself and your group; one architect will fit better than another based on your personalities and group profile. Think about it; the relationship will last as much as two years, being tested many times during that period. Do you want to wake up each day looking forward to the process or dreading it? You have a choice, so the right fit is important.

You can generally gauge the strength of a firm in a particular industry by their marketing strategy. Like most things in life, the more focused and the more passionate you are about one particular thing, the better you are at it. If, for example, a firm’s Web site displays nothing but gas stations, then you can assume they are pretty good at it. If a firm displays medical, retail and worship facilities, then they practice general architecture (less focused.) In the case of a large firm, you need to ask about the experience of the lead architect who will work on your project. It’s really that simple. From this author’s perspective, the size of the firm is not nearly as important as the credentials of the individual assigned to your project.

Something else to consider — a good firm will be covered by at least $1 million in errors and omissions insurance. This is similar to malpractice insurance. You can even ask the architectural firm to take out insurance that names your project specifically on their policy.

If you desire a successful project, start by hiring the right architect. Know that the fee is marginal when put in perspective, that some architects focus their complete attention on surgery center design, that individual experience is more important than firm experience; that the best firms carry errors and omissions insurance, and that reputation transcends all of the above.