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Your programming process begins with categorizing each space you will require into these three areas. This exercise will assist your design professional in grasping a better understanding of how your space is to be composed. Document your thoughts in a spreadsheet to allow for easy change and distribution to all parties in a neat, organized fashion. Your architect will use the information you gathered in the programming phase as a basis of the design. The preparation of this information is not a duplication of effort but a required exercise you must undergo to better understand your needs. Think outside the box, considering all the possibilities and options for perform- ing the same task in a different or more efficient way. Once you have established your program, you are ready to begin the process of selecting an architect. Select Your Design Professional First and foremost, the firm you select must have a diverse and documented suc- cessful healthcare design background. This experience is critically important to the suc- cess of the project. The architect must have a good understanding of the medical field and, more importantly, your specific type of practice. Although architects are regarded as talented problem-solvers, the architect must specifically understand patient flow, be respectful of confidentiality issues, conform the design to meet a multitude of building codes, be aware of infection control concerns, and have an appreciation for the use of healing environment design meth- ods within the project. Additionally, your design professional must have a working knowledge of today's state-of-the-art medical equipment and the unique requirements they present, i.e., imaging equipment that requires lead lining, processing equipment that needs special plumbing or electrical requirements and sinks, and a casting room that needs plaster traps. These things must be second nature to your architect, as you cannot afford to have your project serve as a classroom for learning. The second requirement that must be met prior to the hiring of your design profes- sional is the review of client references. It is imperative that you contact the owner's representative of a few recently completed projects and discuss with them their experi- ences. In the big picture, how did the firm fair? Did the firm do everything its owners said they would? Did it meet the project budget and schedule? How well did the firm interact with the physicians and staff? Was its team made up of good listeners, or did they mandate how work should be done? Architects are compensated in a variety of ways. The most common is a fixed fee method, based upon a defined scope of ser- vices. Total fees for a project can range from a low of 7 percent to as high as 12 percent of the total construction cost, depending upon the level of services provided. Ask for a detailed proposal that will outline the scope of services and provide you with a breakdown of the fee. It is typical for the architect's direct expenses — such as travel, document reproduction, testing or other similar project costs — to be billed to you as reimbursable expenses. The initial schematic design phase of the project may be completed on an hourly, applied time basis. Ask to see a rate schedule. Lastly, membership in the American Institute of Architects (AIA credentialing) gives credibility to your architect. This is a national organization founded in 1857 that promotes professionalism of its members and public awareness of architecture by requiring each member to be licensed by his or her state and requires continuing educa- tion development throughout the career path. Be aware of the brother-in-law-type, non-licensed "designer" or "draftsman" who is willing to give you cut-rate services and provide you with everything you need. Remember, you get what you pay for. Get Ready for the Budget Just as critical as an accurate, well- thought-out program and the retention of a design professional is the development of a realistic project budget. You should be mentally and fiscally prepared for the costs of a renovation or new construction project. Renovation costs for the typical medical office may range from $50–150 or more per square foot of floor area. These costs depend upon many factors that include the condition and arrangement of the existing space(s), demolition required, the level of finishes to be used, and the percentage mix of clinical, staff and support spaces. Be aware that the risk for additional work or change orders with renovation work is much greater than that of new construction. A project contingency of a minimum of 10 percent is strongly recommended to offset any unforeseen conditions. New construction costs can be much more predictable and may range from $150–250 and higher per square foot, again depending upon the type of finishes, build- ing location, urban or rural setting, site work required, etc. These figures never include land costs or other soft costs such as profes- sional fees or other development expenses. As part of the standard architectural services provided to you, your architect will be able to prepare an overall budget for your project. It will reflect local labor rates, existing conditions, and other data specific to your project. Remember to include budget line items for office furniture and both large and small medical equipment purchases. A well-designed office requires a defined program that begins by analyzing how you perform your daily work tasks and recognizing the unique functional requirements of the healthcare setting. The selection of an architect specializing in the healthcare design field is critical to the successful outcome of the project. Be informed and realistic about your overall project budget. Above all, consider the consumer, your patient, along every step of the design process. Greg A. Chianis, AIA, is a graduate of the University of Texas at Austin and an active member of the American Institute of Architects. Chianis has 21 years of healthcare design experience with a wide variety of medical specific projects. He is a founding partner in the firm of Chianis + Anderson Architects, PLLC, located in upstate New York. Chianis + Anderson Architects, PLLC is a 14-person firm specializing in the creation of quality, well- designed healthcare environments for a variety of clients in the Northeastern United States. Chianis can be reached via email at gchianis@ chianisanderson.com or standard mail at Chianis + Anderson Architects, PLLC, 84 Court Street, 7th Floor, Binghamton, NY 13901. ■ M D N E W S . CO M ■ MD NEWS Central New York | 2 1