Choosing the Right Architect

Choosing the Right Architect 

By Kathy Dix

Choosing the right architect for a new ambulatory surgery center (ASC) project is a tricky business. And with such a large number of professionals to choose from, how can a planning committee for a new project, or an ASC looking to expand or redesign, ensure that the right person or firm is selected?

According to the American Institute of Architects (AIA), there are 91,000 architects licensed in the United States. “Licensure is the highest form of professional regulation, and all 50 states require an individual to be licensed in order to call himself or herself an architect. Each state establishes its own professional standards for architect licenses, and architecture registration boards in all 50 states, the District of Columbia, and four U.S. territories, require that candidates satisfy those standards for education, training, and examination,” the institute says.¹

In comparing billings, as reported by AIA members, by client types, 12 percent are from the design of healthcare facilities, the institute adds, referencing the Business of Architecture: The 2003 AIA Firm Survey.

It is wise to go with a firm that has previous experience in healthcare design, specifically design of outpatient facilities, says William R.

Massingill, AIA, NCARB, chief operating of- ficer of Polkinghorn Group Architects, Inc. of Austin, Texas.

“Past experience in the outpatient surgery market is essential for a design consultant,” Massingill says. “While generally offering healthcare services and while generally concerned with fundamental healthcare aspects, ASCs are designed, staffed, and utilized much differently than acute care facilities. In addition, outpatient surgery projects are substantially more complex in nature than physician offices and medical clinics. Thus, an owner must confirm that any and all design consultants retained for a project are experienced in this outpatient industry and have a good track record on similar facilities for other clients. The outpatient surgery industry is a tight circle, and design consultants should be able to provide a prospective client with a number of references that can be contacted regarding their performance on previously-designed projects.”

“Early on, the owner should investigate and draw from the experiences of peers, who can provide referrals, and also from information available from the state’s hospital association or the local office of the American Institute of Architects,” says Sam W. Burnette, AIA, senior project designer/principal at Earl Swensson Associates, Inc. in Nashville.

“For such an important decision, the owner should assign a representative of his/her facility or healthcare group to serve in the due diligence role of selecting three to five capable firms,” Burnette adds. “Information as to whether or not a firm is appropriate or has experience in the design of ASCs can be initially gleaned from Web sites. The size of the firm, large or small, and its existing workload may determine if the owner will get a strong design team or a three-year intern.

“An architectural firm with a full spectrum of healthcare design experience is likely to be more knowledgeable of advancements and best practices in the healthcare industry — which are important to the success of the owner’s project. Key criteria to keep in mind are: the architecture/design team should have knowledge of an ASC’s operational needs. The team should be current on advancements in the ASC industry and have solid experience in the design of ASCs. Look at the track records of firms in designing to budget and in meeting schedules. Ask such tough questions as: ‘What is your track record on errors and omissions as a percentage of construction cost?’ You want the answer to be less than 3 percent. Industry standards we are seeing should allow 1 percent to 2 percent in design contingencies as a realistic benchmark.”

Burnette continues, “We would all like to claim that the design process is a perfect science, but it is not. There is a trend toward owners wanting accelerated issuance of multiple packages, and a reasonable design contingency should be expected. Don’t select a firm that consistently exceeds that benchmark. Instead, a firm should be selected that stays within or beats the standard. In addition to being quali fied and well known, the selected architectural/ design team should be one that will protect the owner’s first costs and long-term operational costs, and have the ability to design an attractive and high-efficiency facility.”

“When choosing members of an ASC design team, there are many factors to consider. However, none are more important than the ability to successfully and seamlessly integrate the architecture with project engineering and construction,” adds Mark Sherwood, director of marketing for The Stellar Group in Jacksonville, Fla. “The ability to overlap and mesh professional services, reduce schedule and maintain budgets has led the increase and use of the design-build approach for the development of ASCs. One can either hire a firm that provides all key services and disciplines in-house, or multiple firms that have come together through a formal joint venture.”

Certain factors indicate that an architecture/ design team should NOT be used. “A firm shouldn’t be selected if it isn’t licensed in the project’s state and hasn’t developed experience there,” Burnette states. “They need to already know the regulations of that particular state and not have to go through a learning process at the owner’s expense. Another type of firm that shouldn’t be used is one that may be popular but has just decided to try healthcare design. Healthcare projects are complex, and the selected design firm needs to understand the intricacies, operational efficiencies and routes for long-range cost savings that contribute to making such projects successful. More than producing a picture-pretty building, they need to know how to design from the inside out.”

“Some reasons that may lead an ASC developer away from a specific architecture/design team are a lack of ASC design experience; if it is a new design firm; if it does not have inhouse or established partnerships with ASCexperienced engineers; if it is not familiar with or does not utilize the design/build method,” Sherwood says.

Selection of the architecture/design team can be the responsibility of one person or a core group of specific people.

“In our company the architects are selected by one individual with approval by the physician partners,” says Peggy Zampetti, RN, senior vice president of facility development at Titan Health Corp. in Sacramento, Calif. “Our performance history with multiple firms enables us to select the best architect for the project. As we develop ASCs nationwide, we have positive relationships with several firms that have a proven track record of successful projects.”

The person or group responsible can vary depending on whether the ASC is funded through private or public funds, Sherwood says. “Private ASCs typically have a review team of real estate and practicing physician investors; however, the primary investor usually makes the final decision,” he adds. “Publicly funded projects go through a state and/or federal process including submissions and short listing of firms through written qualifications, interview presentations, and final proposals.”

“There are three directions in which an owner can go,” adds Burnette. “First, if using a selection committee, the group should be made up of the facility director, representatives of nursing personnel and physicians, the administration, and marketing. There should be representation from all aspects of that facility, but only one person should be tasked with the duty of doing research and putting together the process of requests for proposals. The committee can then fine-tune the process, such as reviewing the proposal. A small hospital, for example, may tap the chief operations officer or facility director to lead the process for the new ASC’s design team selection. The selection or steering committee may also want to have a voice in paring down the list of firms to look at. Second, if time is of the essence, the direction is simply coming up with a short list of three to four firms based upon selective due diligence and interviews.

Going straight to the interview and bypassing a request for proposal saves time and expense for all parties involved. This interview process can be an informal, face-to-face dialogue among the owner’s and design firm’s key representatives who would represent the project. This latter selection process would be the more efficient of the two for design of ASCs. Predetermine a firm’s capabilities and then make the selection with a simple interview. Third, if the make-up of an owner’s staffing doesn’t allow them time to handle the selection process, it can be outsourced with a wide range of project managers who provide this service as an owner’s representative.”

“In my opinion, the selection of the architect is a key component of the project,” stresses Zampetti. “Experience in ambulatory surgery center development is essential. You would not have an orthopedist operate on your eye [instead of an ophthalmic surgeon], yet they are both surgeons. Having worked with architects with limited experience in ASC development, I can tell you it is not optimal and, indeed, may add substantially to the cost of the project.” 

Reference:

1. www.aia.org/press_facts&defPr=1