UO Magazine > Real Estate > Renovate Your Space 2

The key to starting and completing a successful remodeling project, Allen says, is information, information, information. He says architects, in particular, like to collect every detail possible before they start to plan. In the world of remodeling and construction, no one likes surprises—particularly after the project has begun. Frequent changes also can drive up costs.

“Architects like a lot of information up front,” Allen says. “And NONE later.”

Allen hastens to add, however, that flexibility can be built into any plan, and customers can ask for alternate plans for scenarios such as tight funding. Certain aspects of work can be earmarked for postponement until a later date, if necessary.

“But I would recommend as few alternates as possible, especially since the architect will need to be specially compensated for each one that will need to be designed and engineered as separate pieces,” he says.

Depending on the type of planned construction and the basic soundness of the structure, physicians need not shy away from older buildings.

Farmington, New Mexico, contractor Lonny Rutherford, who also is the vice chairman of the Remodelers Council of the National Association of Home Builders, undertook the remodeling and expansion of a 900-square foot adobe house, originally built in the early 1900s, for family practitioner Margaret Cassidy, MD.

The project was completed several years ago through Rutherford’s business, Legacy Construction, Inc. The end result was so stunning that the remodeled doctor’s office created from a nearly century-old home was featured on the cover of a commercial construction magazine.

When the project first started, workers discovered that the charming adobe hacienda had its own 12-by-8 foot round cistern—a relic of its earlier years. While certain elements of the original house were preserved, Rutherford says other portions of the house were too damaged to retain.

“It still has some of its old hardwood floors, but we had to tear out some of the others because they were damaged,” Rutherford says. “But we did keep a lot of the quaintness with some of the wooden floors. When we tore off some of the old lean-to porches, that’s when we discovered the cistern. The lobby, waiting room, and offices are mainly in that existing structure. All of the exam rooms and break area are part of a new structure.”

The location was ideally suited for a medical practice, because it fit in with a small commercial community (including a dermatologist’s office up the street) that had been established within an old residential area. Yet, the office is quietly tucked two blocks off the main street and within 10 minutes’ drive of a hospital.

The structure needed to accommodate about 10 staff members, as well as meet codes for accessibility that include a wheelchair ramp with railings. While the house is historic, it is not officially in a historic district—so there were no tax breaks. But being inside a historic district can include restrictions, such as special permits requiring you to conform to certain standards during a remodel to maintain a neighborhood’s appearance.

One historic touch in the former adobe home can be seen out front, where a WPA emblem is stamped in colored concrete on the sidewalk. WPA stands for Work Projects Administration, a federal program created in 1935 as part of President Franklin Roosevelt’s “New Deal” program, aimed, in part, at relieving unemployment.

Rutherford says there are ways to add crucial modern touches to an old structure, even one made of adobe, through techniques such as running wiring along exterior walls by chiseling in grooves and then patching. “We upgraded everything with new (electrical) panels because of the need for computers, data systems, and phone systems,” he says. “But we tried to retain some of the historical aspects of the house.”

In modern structures, once-sterile medical office interiors are being replaced with warmer colors and intimate surroundings, some of which match trends toward “boutique” or “concierge” medical practices designed to offer more personal services for fewer patients.

In early 2007, Garrison Bliss, MD, and his partners in Seattle Medical Associates were preparing to embark on a remodeling project that involved establishing a 6,000-square foot clinic in an old downtown medical building. His practice is part of a growing number of medical offices that now charge a type of “retainer” fee for a select number of patients willing to pay extra in exchange for less waiting and more time spent on their medical care. So the new Seattle facility will have a much smaller waiting room than might be usual in a clinic, and more exam rooms so patients get in and out quickly.

“I would say that in any building project, physicians should think harder not about what they want but about what patients want,” Bliss says.

In addition to what patients want, physicians also need to consider work flow needs of staff as they go about their daily routines, says Leslie Cooper, RN. Cooper drew on previous experience working for public schools on designs and renovations of health office facilities to create an article on the topic for The Journal of School Nursing (June 2005). Cooper now directs the family nurse practitioner program at the University of Cincinnati College of Nursing.

“Talk to the medical assistants who are doing the urinalysis,” she says. “Talk to the nurse who does the initial assessment of the patient. Find out if it is really going to be more efficient if the equipment you need is mounted on the wall in each room, or if it would be more cost effective and more convenient to have a couple of sets of equipment on a rolling stand.”

Medical practices, in particular, are vulnerable to unexpected problems when it comes to making sure a structure conforms to mandated standards aimed at protecting a patient’s privacy. Guidelines accompanying the Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996, state that structural changes do not need to include soundproofing in walls, private rooms for conversations, or encryption for communications through telephone or other means.

Privacy safeguards are needed, but can be accomplished in reasonable ways through methods such as “use of cubicles, dividers, shields, curtains, or similar barriers.” But even when it seems privacy safeguards are met, there can be unexpected setbacks. Cooper recounts one incident where a school health office was structured with low dividing “half” walls separating cots, with enough spacing to make sure school privacy standards, similar to HIPAA, were met.

But there was one problem.

This school was for the hearing impaired, and sign language used to communicate with patients could be seen and “heard” by anyone in the room. So old-fashioned curtains had to be installed for patient privacy after all.

In a few instances involving several expensive “do-overs,” Cooper says designers and contractors just couldn’t quite manage to merge the special needs of tiny elementary school-sized patients with those of the adult nurses. Miniature toilets and sinks for the children required back-breaking postures for the nurses each time they washed their hands.

“Change orders are expensive,” Cooper says. “The whole point is that, the more time you put into planning, the better your product eventually

will be.”