Equipment–/technology–driven vs. design–driven

Dec. 1, 2009
Last month we addressed two ways dentists design and construct their offices.

Jeff Carter, DDS, Pat Carter, IIDA, and Dave Fazio, AIA

For more on this topic, go to and search using the following key words: dental office design, Dr. Jeff Carter, Pat Carter, Dave Fazio.

Last month we addressed two ways dentists design and construct their offices. We highlighted how this process is satisfactory based on correctly “identifying” yourself as equipment–/technology–driven or design–driven in your project expectations. One or the other of these processes is best based on your defined expectations. Neither is wrong, unless it contradicts your expectations and results in a disappointing outcome. The outcome is the results achieved in the project itself and in your sense of satisfactory participation. In either scenario, an office will be completed, but if the time and money expended wasn’t worth it, then the outcome will be dissatisfactory. A comparison of the types is described as follows ...

Equipment–/technology–driven process outcome —

Equipment supplier (ES) and design/build process (general contractor with imbedded architect/designer)

1) Dentist advocate. The lead “advocate” for your project interests is the equipment specialist. Typically, he/she will recommend and place orders for dental equipment, as well as establish dental “criteria” and oversee construction issues. Based on his/her experience in dental equipment and construction, the dentist advocate will help define and oversee the project with minimal involvement by you, the dentist.

2) Design and documentation process. Design fees associated with this process are minimized. Often such fees are imbedded in the construction cost. Typically, you review and approve the floor plan and finishes, with other design concepts (ceiling, lighting, etc.) directed and defined by others. The resulting documentation (drawings and specifications) will meet minimal permit requirements with additional design decisions deferred until project construction.

3) Project costs and budget control. A primary objective for the E/T driven process is to minimize up–front costs associated with design and documentation as a “savings” to your project. The construction cost accessed to your project is based on the permit drawings. Anything not yet selected will get an allowance and is not included in the initial price. Decisions made during construction are often considered a “change” (or not in your initial pricing) and add to the cost of your project via change orders. Typically these will expand a project’s initial cost by 15% to 20%. This is why lenders add 20% contingencies on loans and why your initial price is never the actual cost of your project.

Design–driven process outcome —

Architect and/or interior designer, equipment supplier (ES), and general contractor

1) Dentist advocate. The lead advocate for your project interests is the architect/interior designer. He/she collaborates with you to define the dental design criteria of your project, including functional and esthetic decisions. Your participation is expanded from minimally involved to helping to define your office vision. The equipment specialist’s project participation is specific to equipment selection and purchase. The architect/interior designer conducts design and construction oversight on your behalf.

2) Design and documentation process. Design fees associated with this project process are identified separately from construction costs. The architect/ID is engaged up–front and typically provides an expanded level of service and assistance to your project beyond what can be practically provided by the equipment specialist or imbedded designer. The documents (drawings and specifications) generated are comprehensive, typically exceeding minimal permit requirements. They are considered a contract with the contractor so they will define your project with minimal additional clarifications during construction. These are referenced during construction and by which your project costs will be managed.

3) Project costs and budget control. A primary objective for the design–driven process is to save your dollars in change orders and added costs during construction. The design–driven process is organized to protect the design intent of your facility. Your design is defined by the function, esthetics, and their associated costs — including furniture, finish materials, lighting, ceilings, dental equipment, technology, etc. Therefore, maintaining the design intent means managing project costs. The goal is for final actual costs to be the same as the initial construction pricing, an inherent benefit of a tightly defined set of drawings.

Identifying what is most important in outcome — whether timeline, cost control, design participation — for your project will cue the project advocate and design/construction process that best addresses your expectations. Ultimately, it is the surest way to a satisfactory project experience.

Jeff Carter, DDS, Pat Carter, IIDA, and Dave Fazio, AIA, are owners of PDGFazio Design Group. Located in Austin, Texas, PDGFazio offers a full range of architectural, interior design, and consulting services to dentists nationwide. For more information, call (800) 511–7110 or visit

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