Dental and medical office build-outs: the mistakes that push back the first patient

Most delays start before the first wall goes up

The biggest mistakes in a dental or medical office build-out are signing a lease before checking whether the plumbing can reach every treatment room, bringing the equipment vendor in after the drawings are done, underestimating power and data, treating accessibility as a final-inspection detail, and setting an opening date with no room for inspections. Each one is avoidable if the right people look at the space and the drawings early.

At Harrison Construction we build medical and dental office finish-outs, including work for Brident Dental, under the same quality control, safety and close-out process we use on our restaurant projects. The two kinds of work have more in common than people expect. Both pack a lot of plumbing, electrical and equipment into a tight footprint, both depend on vendors outside the construction contract, and both have an opening date that matters to the business. Here are the mistakes I would most want a practice owner to avoid.

Signing the lease before anyone checks the plumbing

A dental operatory or an exam room with a sink needs water and a drain, and a dental office usually needs several of them spread across the floor plan. In a typical retail or office space, the plumbing is concentrated near the restrooms. Reaching every room can mean cutting and trenching the slab across much of the space and connecting to a sewer line that may be shallow, far away or in the wrong direction.

Before you sign, find out where the sewer line runs and how deep it is, whether the slab can be trenched and whether the landlord allows it. A space that looks ideal for patients can be expensive to plumb. A builder walking the space can tell you whether your layout fits the plumbing or fights it.

The same walk should cover the other utilities a practice depends on. Ask what electrical service the landlord delivers, whether the rooftop units can handle the added load, where a compressor and vacuum pump could go with enough ventilation and sound separation, and whether the landlord's rules allow the slab and roof work you will need.

• Sewer line location and depth
• Whether the slab may be cut and trenched
• Electrical service size and panel space
• Rooftop HVAC capacity and age
• A ventilated room for compressor and vacuum equipment
• Landlord rules on roof and slab work

Bringing the equipment vendor in too late

Dental chairs, delivery units, compressors, vacuum systems, sterilization equipment and imaging each need specific utility connections in specific places: water, drains, air, vacuum, power and data, often at exact heights and locations. Medical practices have their own version of this with exam tables, lab equipment and imaging. The equipment dealer usually provides the utility requirements, and those requirements have to be on the drawings before the walls are framed.

When the vendor arrives after the drawings are finished, or worse, after the slab is closed, the result is rework: walls opened, conduit moved, floor cut again. Involve your equipment vendor at the same time as your architect, ask for utility templates for every piece of equipment, and make sure your contractor coordinates directly with the vendor's installers on delivery and connection dates. Imaging equipment may carry its own room and regulatory requirements, so ask your vendor early what yours needs.

Forgetting the wiring nobody sees

Practices run on technology: practice management software, digital imaging, phones, security cameras, intercoms and patient Wi-Fi. That means a network cabinet, data drops in every room, dedicated circuits for equipment and enough electrical capacity for all of it. Low-voltage cabling is often left out of the construction contract and handled by a separate vendor, which works fine only if someone plans it before the ceilings close.

Think about the front desk and the hallways as well as the treatment rooms. Check-in screens, payment terminals, printers, nurse call or intercom systems and cameras all need power and data at specific spots, and each one forgotten becomes an exposed cord or a wall opened after painting. A walk through the floor plan with your office manager, room by room, usually catches what the drawings missed.

Bring your IT provider into the design early so the data locations, the network room and its cooling are on the drawings. If you are still choosing who will support the practice's technology after opening, Anthony Omini's guide on what a small office actually needs from IT support is a useful starting point.

Leaving accessibility to the final inspection

Medical and dental offices serve the public, and patients include people using wheelchairs and walkers. Accessibility affects the entrance, the reception counter, the restrooms, the corridors and the treatment rooms, so it has to be designed in from the start. In Texas, the Texas Department of Licensing and Regulation states that projects with costs of $50,000 or more must submit a full set of construction documents for review under the Texas Accessibility Standards, and that projects below that amount still have to comply.

Remodels carry a rule that surprises many owners. Under the federal ADA regulations, when an alteration affects an area containing a primary function, the path of travel to the altered area and the restrooms, telephones and drinking fountains serving it must be made accessible to the maximum extent feasible, unless the cost is disproportionate. The regulation treats the cost as disproportionate when it exceeds 20 percent of the cost of the alteration to the primary function area. This is general information; your architect and accessibility reviewer will apply the rules to your space, and a good contractor will price that work up front rather than discover it at inspection.

Rooms that leak sound and air

Patients notice when they can hear the conversation in the next room. Standard office partitions that stop at the ceiling grid let sound travel freely over the top. For consultation, exam and treatment rooms, plan walls that extend higher, insulation in the walls, solid-core doors and attention to ductwork that can carry sound between rooms. These details are inexpensive during framing and expensive afterward.

Air is the other half. Sterilization areas, labs, equipment rooms and network closets generate heat, and a single thermostat for the whole suite rarely keeps everyone comfortable. Ask your mechanical engineer and contractor to zone the system around how the practice actually works, and plan exhaust where the equipment requires it.

Finishes chosen for the brochure, not the cleaning routine

A practice is cleaned and disinfected constantly, and the finishes have to stand up to it. Carpet in clinical areas, porous countertops, textured wall coverings and seams in the wrong places look fine on opening day and wear badly. In treatment and sterilization areas, choose smooth, durable, cleanable surfaces and ask your designer how each material handles the products your staff will use.

Lead time matters too. A particular tile or countertop chosen late can hold up the whole finish phase. Make selections early, approve samples quickly, and keep a backup option in mind for anything with an uncertain delivery date.

An opening date with no room for inspections

Practice owners often set the opening date by working backward from the day their current lease ends or the day an associate starts. The construction schedule then has to fit that date, and the parts nobody controls get squeezed: permit review, utility work, equipment delivery and inspections. A failed inspection a week before opening can push patient appointments, and rescheduling patients costs more than rent.

Build the schedule forward from today, with realistic time for permits, accessibility review, inspections and the certificate of occupancy, and then compare it with your preferred date. If the two do not match, you have time to adjust. Many of the same steps apply to any commercial space, and I describe how they stack up in the permits and approvals behind a build-out.

Remodeling while patients keep coming

If you are expanding or updating an operating practice, the construction has to work around patients and staff. That means planning the work in phases, keeping exits and accessible routes open, controlling dust and noise, and scheduling the loudest or most disruptive tasks for evenings or days the office is closed. It also means agreeing in advance which rooms will be out of service and when, so the front desk can schedule around them.

Phased work takes longer overall and costs more than building in an empty space, but it keeps revenue coming in. The key is a contractor who plans the phases with the practice, not around it, and who communicates every change to the plan before it happens.

How we take on a practice build-out

We start where the mistakes start: with the space and the people. We walk the space with you, look at the plumbing, power and HVAC, and pull your architect, equipment vendor and IT provider into the same conversation early. Pre-construction gives you a budget, a schedule that includes the approvals and a list of decisions you need to make and by when. During construction you get regular progress meetings and written reports, and at the end, a close-out with the inspections, certificate of occupancy and documentation complete.

If you are planning a dental or medical office anywhere in Dallas–Fort Worth, or a multi-location rollout in one of the other states where we are licensed, we are glad to look at what you have. And if you are comparing contractors, use the questions to ask a commercial contractor before hiring with every one of them, including us.

Questions people ask me