Hello, and welcome to Beauty and the Biz where we talk about the business and marketing side of plastic surgery, and how to avoid build-out mistakes.
I’m your host, Catherine Maley, author of Your Aesthetic Practice – What your patients are saying, as well as consultant to plastic surgeons, to get them more patients and more profits. Now, today’s episode is called “Build-Out Mistakes — with Mohsen Ghoreishi, M.Arch & Marzi Emami Ghoreishi, Ph.D”.
The practice environment you spend 1/3 of your life in, matters. Learn to avoid build-out mistakes.
A great space affects your mood and keeps staff motivated and patients calm. Learn to avoid build-out mistakes.
But it can’t just be attractive. It’s got to be functional, efficient, and well thought-out. Learn to avoid build-out mistakes.
This week’s video is an interview I did with Mohsen Ghoreishi, M.Arch & Marzi Emami Ghoreishi, Ph.D, the managing partners of The Kohan Group — one of the nation’s top architects, designers and builders of gorgeous cosmetic surgical offices. They also know a lot on avoiding build-out mistkes.
Here’s what you’ll discover:
If you are even thinking a little bit about doing a build-out, and wanting to avoid mistakes, you’ll want to watch this.
P.S. I’ve decided to give away my 81-page guide on “plastic surgery marketing and what’s working now” for FREE! Download now to get insights on strategies to stay ahead of the ever-changing process for attracting cosmetic patients.
👁 DON’T MISS THESE INTERVIEWS 👁
Catherine Maley, MBA: Hello and welcome to Beauty and the Biz, where we talk about the business and marketing side of plastic surgery and how to avoid build-out mistakes. I’m your host, Catherine Maley, author of “Your Aesthetic Practice, What Your Patients Are Saying”, as well as consultant to plastic surgeons to get them more patients and more profits. Now, today’s guest is different, but they know a lot about build-out mistakes.
They’re not surgeons, but they certainly work with surgeons and know how to avoid build-out mistakes. So, my special guests are Mohsen and Marzi Ghoreishi, the managing partners of The Kohan Group and one of the nation’s top architectures, designers and builders of gorgeous cosmetic surgical offices, you really have to check them out. They’ve been in business for over 20 years and have been helping surgeons avoid build-out mistakes, and their work is spectacular.
So, we often share the podium at medical conferences. We like we’re on the circuit together. So, that’s how I’ve known them for a long time. And it’s such a hot topic, especially now with everything that happened in the hospitals and doctors just want their own space. They want their own autonomy. They don’t want to book surgery through a hospital anymore or surgery center.
So, I thought that they would be a valuable resource for you. So, we’re going to talk about that today. So, Mohsen and Marzi, welcome to Beauty and the Biz.
Mohsen Ghoreishi, M.Arch: Thank you so much. We appreciate the invite. Thank you very much.
Marzi Emami Ghoreishi, Ph.D: Thank you, Catherine, for the invite. We are so happy to be here.
Catherine Maley, MBA: Absolutely. So, would somebody tell me, where did the name Kohan come from? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: I’ll take that one. How’s that? Kohan is a Persian word, actually. It’s a very small word, but it pertains to quite different words in English. Kohan pertains to something that is an old building, an ancient building, an old culture. It could be a way of life from the past. It could be an old building, like I said, but it still is, actually, still is valid, exists, and it’s a way of life that people still do.
So, literally, anything that pertains to something that’s old and has dignity and everlasting. We consider that to be Kohan, and we figured that would be a great name for architectural firm where when we create something it has everlasting nest to it. It is done with dignity and something in mind that lasts forever for our clients.
And it’s a it’s a lesson from the past, but still valid today and in the future. So, that’s why we selected Kohan.
Catherine Maley, MBA: Terrific. Now, before we get into the, the nitty gritty. What difference does it make to have an okay office versus a gorgeous office? And I will just anecdotally give you, my answer. We are both out of San Francisco. How does this impact or relate to your understanding of build-out mistakes?
I actually left San Francisco. You’re still courageous enough to live in the city, but I’m out. I’m in Sausalito, but I used my very first client 23 years ago was a surgeon in the penthouse of the 450 Sutter street medical building. And that was. Prime real estate and he had gutted it out. It was gorgeous. How does this impact or relate to your understanding of build-out mistakes?
And he, when instead of him taking the office with the breathtaking, you know, 360-degree views, he took a different office and it had his coordinator in the. In the cool office with the views and when you walked in, it had such a psychological effect on people. When the patients would walk in, they were just mesmerized with the views there and how gorgeous it was. How does this impact or relate to your understanding of build-out mistakes?
And they knew it wasn’t going to be cheap. Like it, like it was just, it was so obvious that he, they’re not going to be negotiating with him. This was high end, high class. It was just beautiful. So, I mean, how much of a difference does that make in, in the regular world? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Yeah. I will say something amazing.
Please add. Of course, I think this this is similar to if you go to a restaurant and say, what’s the difference between a very beautiful restaurant with a great ambiance. Forget the service and the food, just the great ambience versus something that like you go to a Waffle House then of course that’s the similar answer to that.
When a client or customer walks into a four-star Michelin restaurant with a great ambience, of course, feels and expects different kind of experience but if you go walk into Waffle House, I say Waffle House because it’s everywhere in the country then of course, you expect. Differently, you expect a different experience and also you expect to pay differently.
So, that’s pretty much the same similarity of these, right Marzi?
Marzi Emami Ghoreishi, Ph.D: Yes, absolutely. And also, I would say you know, that’s the proven fact that in few first second when the patient enters to the office, they pass the judgment. Then they see this face before even they meet the staff or they meet the doctor.
And in this competitive environment for all this cosmetic profession and business, The doctor really needs that wow factor first before meet with the patient to be able to set the relationship with the patient rights. And I think that’s the biggest tool they can use in their advantage to make sure the psychology of the patient, the rights.
Today to be able to start a conversation about how great they are in their work. Right. Just to add a little bit mm-hmm. We talked about the patient. This was patient experience. Mm-hmm. , but imagine if you put yourself in a box. All day, eight, ten hours a day and work inside a box. You, me, Marzi, all of us.
Mohsen Ghoreishi, M.Arch: Versus somewhere with a view or somewhere with a great ambience. What is the difference experience we would have as people working at them? And what kind of production we would have if you would have such an environment? Absolutely. So, so it’s not just the patient itself, but also it is. Us, the providers who work inside that space, our team, I think the psychology of a great space, it impacts on everyone inside of it.
Catherine Maley, MBA: I think it made a big difference with the staff as well, because I was hiring people, and when they walked in, they knew we weren’t fooling around, like this was a very high-end practice, and he had high standards of excellence, and it showed, that’s the, that’s the secret though. You’ve got to be consistent with this. How does this impact or relate to your understanding of build-out mistakes?
If you’re going to have a killer website, and then a killer office, But a crappy receptionist, . You can’t, you’ve got to be consistent, you know? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: That’s true. Absolutely. That’s true. The Dr. May be really good, like, like I said, the very first six seconds, anybody walk in that waiting room or that environment, they pass a judgment on.
And I don’t care how good of a surgeon you are, they’re done. I mean, before you even, they even meet you. They, they, they don’t, they either like you or dislike you, and then it goes, of course, who’s always at the kiosk or that front desk if they get up and put a big smile on their face. Of course, that’s.
You know, and that experience continues on and but definitely starts with the physical environment as you walk into any space. It’s amazing what a space can do for you.
Catherine Maley, MBA: For your psyche. So, let’s talk about your services because one thing I didn’t understand when I, because we’ve talked a lot about this on the podcast. How does this impact or relate to your understanding of build-out mistakes?
So, many of the doctors want to build out their own place. And I, I would say like, they would say, I don’t even know how to get started, you know, like, Do you start with an architect? Do you start with it? Find a good contractor first, who then will find you an architect. Do you who’s going to design the thing? How does this impact or relate to your understanding of build-out mistakes?
Like, you know, like what? Aren’t you a full, like one stop shop? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Yes, actually, everyone asked that question and a lot of people stumble around different areas and then sometimes they take a wrong turn. I think the old school is that you start definitely. Of course, you first have to know you have the money and you need to have a budget, right?
How much are you going to spend? So, who are you going to ask how much you need? I think a lot of people pick up the phone and talk to a contract and I have there is lots of pitfalls with that because the contractor will give you what they think that office should be. They don’t really need.
Dissect and dig in to figure out the realistic budget for what kind of vision you have. So, my suggestion would be, if you will, to discuss immediately with an architect. And that’s why if you refer to AIA.org, and I recommend every surgeon who’s planning to build, go there and study as what an architect does, because most people don’t know what an architect does.
If they go there at aia. org and they read, They’ll see the architects have something called pre design and program, where during these two phases. An architect can help the client, the person who’s building, to come up with a realistic budget understand their vision, and realistically understand how long of a building, how long is this building going to last for them, how many square foot it’s going to be, because the budget, construction cost, All of that relates to, and me going to the bank, getting that kind of money relates to this architect trying to figure out the very thing you need to achieve and live with it for the next 20 years.
Catherine Maley, MBA: So, you’re saying start with the architect, because I think a lot of them start with the contractor, quite frankly. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: No, no, no. No, that’s two different worlds. And the contractors are needed to build it, for sure. And a good contractor who is experienced with surgical facility needs to build it. But the contractor…
Does not have those type of expertise and services and architect provides in order to realistically understand what the client is after.
Marzi Emami Ghoreishi, Ph.D: That’s true. Also, I think what is important just to answer back to question about the services. So, clients, the doctor goes to the contractor because the first question they have is how much is going to cost.
And that’s the determining factor for them to be able to move one step ahead. But I would say before asking that dollar number, I need, I need them to know what scope of work we are entering into that. What is the journey? What are the challenges they may face? And what we are going to provide as an architect, per AIA, as Mohsen said, we are going to walk them through the process of design and construction and occupancy.
Then they know what is the Then they can ask the right question. For example, we provided Programming and design as one scope of work. We provide architectural services. We provide engineering services. Also, we provide the interior design services. We help them also go through the construction. These are the services we provide to be able to answer the question every single doctor has.
During the process of buildup. Yeah, for sure. Contractor is a big, big part of that.
Mohsen Ghoreishi, M.Arch: Yeah, when you go to contractor and you just pick up the phone and say, how much it costs? Because everybody’s asking the cost. The contractor says, oh, it’s going to be about Well, these days we’ve done another cosmetic surgery down the road.
With two ORs. And it costs us 300 per foot. That’s it. And the doctor is sitting on this side, the contractor is on that side of the phone, and each one of them have a different vision inside their head what that thing looks like. Or what’s inside of that surgery center. Or what kind of certification that surgery center has.
Or how long will this surgery center be going to last for this doctor. I mean, it’s up to your imagination. So, it’s just a very immature. Response to a very difficult question, which really cannot be answered until it’s dig in and dissected and figured out before that realistic budget occurs.
Because it’s just not just not the construction cost, the balls and nuts of the building, but also there is so many soft costs. We have, I have a file that I can go through it. And I can add those soft costs. Sometimes those soft costs are quite, quite high and can break the actually bank, actually. And they, contractors won’t talk about that because your question is how much per square foot can you build it?
But you didn’t ask me. What are the soft costs?
Catherine Maley, MBA: I just think it’s the, the service you offer that this all-encompassing service, I think it’s so brilliant that one person’s responsible for all of this, because if you, it’s like having software in our industry, like a lot of the doctors have three or four different software applications because they’re trying to pull together their lead management process. How does this impact or relate to your understanding of build-out mistakes?
But God, when one thing breaks, nobody can tell, nobody knows who to call, everyone blames everyone else for it. And if you can put it all under one umbrella, I just think that’s less of a headache, quite frankly. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Actually, this is what architects do for a living. And it’s unfortunate. The doctors don’t know about it.
They really don’t know anything about it. The first thing that comes to their mind is contract. It’s just because of the way the world is today. But I suggest definitely, if you really want to do it right, The first time, pick up the phone and call someone, an architect, that has expertise in surgery centers, or whatever the type of building you are building, and require, and if you read on a.
org, all of that is in there, and require all the services that the architect provides. So, you have that quarterback handling your project throughout.
Catherine Maley, MBA: But you really need an, an architect that understands a surgical center, that it needs to be quad A certified. It can’t just be any Joe Schmo, Right. You know, somebody who really understands this. How does this impact or relate to your understanding of build-out mistakes?
Yeah. I’ve, I’ve had surgeons who did a build out and they forgot to add another lobby for the surgical center and they, they had to literally refit the darn thing or they put the HVAC or whatever. They put it on the wrong side of the room and the water flow was somewhere else and it was like a nightmare. How does this impact or relate to your understanding of build-out mistakes?
And if, because nobody knows what they’re doing. How does this impact or relate to your understanding of build-out mistakes?
Marzi Emami Ghoreishi, Ph.D: It is so costly if you want to save costs on the stage of design of the process. And we can discuss more in detail on this subject, but these are all the issues that may happen if you want to cut corners and go with the, you know, Neighbor architect or, you know, brother architect or some familiar person that they can do some drawings that you think that you can get it done.
But the fact is no. Unfortunately, there’s going to be a lot of issues along the road.
Mohsen Ghoreishi, M.Arch: If the doctor’s question and number one priority is the bottom line, dollars, they have to go to an architect. Any other way, they’re going to pay later. That’s my recommendation. Now, whatever your budget ends up being, yes, you have to pay a fee to the architect.
It’s as if, if I want to go to a plastic surgeon, I have to go to a plastic surgeon and pay for it. That’s what professionals are for. You have to pay a fee to actually do it right the first time. But if really you are not even looking for patient experience or you’re not looking for something really off the top or whatever beautiful, you’re looking for something really simple and you want to make it really as affordable as possible.
You have to go to an art. That’s my recommendation.
Catherine Maley, MBA: Yeah. One of the biggest issues is a surgeon goes through this probably once in their lifetime. And then they, and then they’re educated, but they went through the, the ups and downs and the grief of doing it. And now, and now it’s just like a one and done kind of thing. How does this impact or relate to your understanding of build-out mistakes?
So, I highly agree getting some expertise involved early, early on. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: And I can’t tell you how often I have heard I wish I had done it differently. Next time I’ll, I’ll call you. And we’ve had actually referrals from the. Doctors, clients who didn’t go with us, they went with a whole different direction, and then they send us a referral telling the referral person, the very person that go with them first.
So, it’s amazing, we get those kind of referrals now.
Marzi Emami Ghoreishi, Ph.D: Yeah, that’s the interesting point because usually when the doctor wants to establish their practice, if they are young, so I’m sure they have a limited experience about dealing with the different aspects of their business. They are well educated in university and getting degree and a lot of skills to do their surgery.
And they tell everybody, oh, I’m opening a practice and everybody provide the opinion. Okay. No, you don’t need architect. Just go to a builder. And then someone from the family member, they’re trying to help them to put together the colors. And then maybe someone else getting the plan to the permit. So, it’s a lot of pieces that is not in hand of professionals.
And all of these small pieces can go to. A disaster situation, unfortunately, and we’ve seen that and we’ve heard that and we hear stories about that every day and we are not happy about things happening to other to the doctors, but unfortunately trying to get help from their relatives and people they know a little bit of this and that is not a good thing at all.
Catherine Maley, MBA: Well, I’ll tell you what I’m curious about. A doctor will have a vision in his or her head. And they’re trying to communicate it to you. How in the world do you get from what’s in their head to what happens in real life reality? How do you communicate that? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Ever since we established Cohen, which is 20 years and nine months ago we tried to establish, we tried to have a road map that is quite different than any other firm.
The I have worked before and or it is very hard to know what’s in the client’s head. Right. I mean, I’m sure if you want to buy a house, you have a vision that I want a house look like this and that, or I want a house from outside and inside, both, doesn’t matter, right? And you even see the furniture.
You see, you feel, you can even feel the house if you want to do a house. It’s the same with any building. So, we have a process on our on the website. If you go to the process tab and it has four steps and one of the most interesting steps is creating a Pinterest page. Pinterest page. I mean, we don’t know a lot of these people and the only window through their mind through their, you know, through their mind is by looking at these pictures.
We asked them to put on Pinterest. What we call is likes and dislikes. And so, they may take a picture they like, but they really don’t know why they like. So, we take like 20, 30 pictures of likes and dislikes, and we take about two to three hours just going through each picture, figuring it out. What is it specifically in that picture that triggered the motions in the client’s brains?
It’s sort of psychology, literally, where you realize, okay, this is what really, why really, he or she likes this picture. Not because of all of the other stuff in the picture, but because of that little one green plant putting over here on the table or something, then we cover that plant and say, how do you feel now?
Ooh, that’s different now. Okay, well, no, I really don’t like it. And start the conversation begins. So, when you do this with 20, 30 pictures. We go through their head and see the world through their eyes. And that is the time where we know how they see the world and what is it that puts a smile on their face.
And that’s, that’s a pretty interesting process. That we really take a lot of time to understand our clients before we even draw the first line.
Marzi Emami Ghoreishi, Ph.D: Exactly. And what also we have, we start the process with This step. So, to getting to know that person, but also, we have a lot of different steps during the design to make sure we are in line with the clients every step.
We provide the doctor. So, with different options, we check with them. We go back and forth that based on this and that feedback you had; they provide you this. presentations because we figured out that these are in line with your vision about the space, how you see this space, and how and what kind of space makes you comfortable and relaxed with your brand and your services that you’re going to provide your patients.
So, there’s a lot of check and balance during the design as well.
Catherine Maley, MBA: It just seems so. This sounds so challenging. When you’re a plastic surgeon and you have a patient bring in a photo of themselves or somebody else and say, this is what I want. Does anyone do that? Does the doctor bring in a photo of their friend’s office and say, I want this? How does this impact or relate to your understanding of build-out mistakes?
Because that would be a whole lot easier than going, let me, let me explain my vision to you. I can’t imagine how that, that translates. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: It’s quite tough and that’s what makes our, our, our work quite interesting. Because if you were to design buildings that were all they were all similar, like, you’ve seen cookie cutters before, like, have not driven in developments that all the houses look alike.
That doesn’t take much brain. You do one and you repeat 100 times and you just change the color. Okay, if you were to do that, it would be one. It could be a very boring practice. So, and everybody would get something similar. This way we basically fit the vision to the to the client’s mind.
Marzi Emami Ghoreishi, Ph.D: So, actually, what we’ve seen architecture failed.
One thing I just want to add is some of the architects, they established their own style. And client goes there because they know they do this specific style, but we don’t do that. We are so proud of being able to go through the client mind and making sure we can deliver what they love to see and have.
And that’s why when you go to our website, you see many different. different look and spaces that they are different, but we can proudly say that they are very successful places for the doctor that they be designed for, for them.
Mohsen Ghoreishi, M.Arch: Basically, if the doctor could have been an architect and a creative person, how would they create their own practice if they were to design it?
That’s what we like to do for them.
Catherine Maley, MBA: And how much does the patient journey experience fit into this? Because does a doctor know he wants Only two exam rooms or four exam rooms and he, he just wants a little reception area because he doesn’t plan on keeping people waiting. And does he want a big kitchen or a little kitchen? How does this impact or relate to your understanding of build-out mistakes?
Does he plan on having a conference center where his staff trainings happen or private or is he going to have private events? Who decides all that? Because you have to decide that early on before you even mention anything about price, right? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Again, again, when you go to the process tab on the website, we have examples and it’ll show.
Look, this is the process. It’s a process which has to take place for all of those to be figured out. And that’s called programming. And that during the programming process One thing is to understand client’s vision, which is the Pinterest page. The other part is. Understanding exactly or helping the client to understand what does go inside their building.
So, the size of the waiting room or the size of the sterilization or a clean room or a soil room all determining factor by how many hours you have. Okay. Or what kind of accreditation you’re and we will actually go through that process and help the doctor to figure out the major stuff. And then, by default, we tell them what, what you may, you need to have, how big you may need to have them.
And, of course, that determines the score footage. And that’s oftentimes happens before even the build. We have to do that before we build a building because we don’t know really how many score foot. We need. So, I recommend to figure that out before anything else.
Catherine Maley, MBA: See, that’s another really good point. How does this impact or relate to your understanding of build-out mistakes?
If they, they don’t know how many square feet they need until there’s a big discussion about it, and you really strategically look at that. And then, then they have to go find a realtor or something or buy a building. Like a lot of them have already found the space. And now they want to retrofit it. Like they’re always in different stages, depending on how far along they are, how, who, how many people they’ve talked to, you know. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Well, they, they ask a lot of questions.
Like a lot of surgeons do have friends, let’s say they have two ORs and a quad ASF certified, and they ask their friends, how many square foot you got? And they say, okay, 5, 000 square foot. So, that, that experience is there. So, they start going with the realtor and ask for 5, 000 square foot. Or talk to a contractor, say, okay, can you build me 5, 000 square foot with two of ours?
And it happens every day. It happens every and that’s fine. We get into the process sometimes maybe a quarter of the way that they’re in it, we get into it, and we help them out. But it is, it would be good to know that first before you look for it.
Marzi Emami Ghoreishi, Ph.D: And not only Forest Grove, but that they need, also there’s a lot of other infrastructure.
That need to be considered to be in place to be able to deliver, for example, to our surgery and if the really that the space has capability of installing the extra stuff, we need for a surgery center. And that’s why we really recommend all the doctors to also consult with an architect prior to going through to end part of the lease.
Although the space may look so fantastic and very, very attractive, but if they cannot put their generator, if they have issue with OR, or, you know, discharging patient and this and that there, so that would be a big problem during the construction.
Mohsen Ghoreishi, M.Arch: I recommend before they sign the agreement, they have an architect to check it out because you don’t want to push the surgery center into an office building that you like.
You got to make sure it fits in there. And as I said, those are very important things. And so, what we can do, we can help them with that. If they found a place that they really love, we can check it out. Or an architect should really check it out to tell them. Okay. Yeah. You know what, doctor, you can have the 2 hours.
That room can be in or that’s good room. We can move the wall and make it an hour and we see enough infrastructure where we can actually adapt this space to a search. Please before you sign dotted line.
Catherine Maley, MBA: That is important. I don’t envy you. I find this to be a monumental project and you haven’t even started yet. How does this impact or relate to your understanding of build-out mistakes?
You know, golly give me the most common mistakes made that this audience can avoid. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Common mistakes is I think we should base on that. One would be. And not to well, I walked into a building last week northeastern portion of our California here and the doctor had to hire the general contractor and a non-licensed general contractor doing the work and his patients. Does a lot of work on, you know, and pays a lot of expense, a lot of money in the office, is doing her into his interior design.
Catherine Maley, MBA: Oh, of course. It’s either her or the wife. Yeah. Yeah. All of a sudden, everyone’s an interior designer. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Exactly. So, so I was like, walking in, we don’t have a licensed contractor. We have a person who’s a patient. Doing interior design and I just walked out. I wasn’t going to, we were going to get mixed into that because that from the very get go, you’re asking for disaster and I am sure they have managed to pay each 1 of these people in a very low, whatever by services or because you don’t have license.
We do the point I’m making. That is one big mistake if you use nonprofessional people to help you. You can’t use your friends, you can use your, you cannot use your uncle. Those are big mistakes, or sister to do this and that. Because this is not the type of work you want those people to really handle.
Marzi Emami Ghoreishi, Ph.D: That’s true. I think one of the other things that we see every day, and that’s not good, and it’s not pleasant to watch people going through these things. A lot of doctors, They fell into a trap of going with the lowest cost, although we do believe that we have to save money for our clients and everybody needs to be budget conscious, but being the less expensive.
It’s not. It doesn’t mean it’s the best. So, our clients paid a lot when they went to the cheapest one. Which they figured out that they have to pay much more to solve the issue that raises from that decision. So, let’s do your due diligence, but don’t fell in the trap of someone tempting you that, Hey, I am the cheapest one.
I can do this job for you with that lowest cost possible that may shock you.
Mohsen Ghoreishi, M.Arch: Honestly, it’s very difficult to assess what an architect does for the doctors, because if you go for a liposuction, you say, okay, my stomach is this much, I’m going to do a lipo, or I’m going to do this, and okay, that’s it. It’s very, very determined what each surgeon does.
But an architect can say, okay, I’ll do your surgery center for you. And you, he can prepare drawings, about eight sheets of drawings, and get a permit for you. And a contractor can take those eight sheets and build it for them, but the same project can be done by another architect instead of seven sheets.
Of drawings, he’ll do 70 sheets of drawings. There is a difference between the two. It’s not that one is dying to draw. No, it’s just one is trying to do the job right the first time and figure everything out into the detail. So, during construction, there are no change orders. There is no time missed because of the change orders.
There is no issue during permit process. So, the permit issue is issued quite fast. And at the end, you have a great product. Yes. And if you’re going to bid that project, people don’t put their hand in their pocket and come up with a bid. They look at the drawings because the drawings are so comprehensive and so detailed that anyone could put a price on it because they know what they’re betting.
They don’t, they can’t, they don’t have to imagine or assume things that goes into the building where all of a sudden, the beds are so different far apart from each other. So, if, if the architect they select is the right architect and do a very comprehensive work, that architect. Should save them a lot of time and money.
Time is also money and get a project done really right. Unfortunately, people oftentimes don’t think of that because they see the fee of an architect really low, but they really don’t know what that means. They come say, well, we got this architect is going to do it for. Say this amount, but you are three times more expensive.
How is that? It’s permit is permit. That’s where they don’t really know and cannot assess the difference in work. And that is where I tell our clients. Please, let me show you an example of a work, and then the next, when you go through an interview with other architects, have a look and see for the same 5, 000 square foot, you know, surgery suite, what are the drawings and deliverables
are, and then determine if, what you really want to do, and also understand and talk to the owner of the surgery center, say, it’s. How much is change order? How much, how long did it take for you to go through permit process? How many changes did you have during construction? Because those things happen when you do something quick and fast and dirty.
You, you leave a lot of things without unanswered and then you have to pick them up somewhere during construction, which that takes time. That means it elongates the construction time. That means money. And nobody knows, nobody really, I hate to see. The clients go through that kind of horrible experience because they just don’t know the domino effect.
Marzi Emami Ghoreishi, Ph.D: And also, when it comes to the time of bedding, if they receive the bed, and sometimes you know, some of the bed, they’re slow enough to be so attractive. And some of our client, unfortunately, despite the fact that we asked them not to do that, they went with the lowest price because the contractor, you know, didn’t have the experience in surgery center or other things.
So, they went there with the lowest price and unfortunately, due to the construction, they had to pay much more money they could have saved if they go with a much more qualified contractor. So, that’s the whole. Are top gathering the whole team together.
Catherine Maley, MBA: And a lot of the doctors never heard that term change order until they got into this process. How does this impact or relate to your understanding of build-out mistakes?
So, talk about a change order because that changes everything. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: You know, that’s true. When that change order comes, they are, they are in the middle of construction. They have no way back to get back out because They can’t, it’s just more costly to get out of that contract. So, they are subject to come up and pay and eat up the time and do it.
Those are those are some of the things we see that it’s a mistake. That the clients do, and we also have some of our own mistakes that we have done. And some of them is to, one of them is that, like Marzi said, we realize the owner is picking the least expensive. Contractor who has never done a surgery.
So, we realized it’s not really a good fit and still remain in the contract. So, what we do, we realized remaining or keeping ourselves into that contractual agreement. It’s going to have an eventually it’s going to be a bad product and we’re going to get hurt by it as well. So, we now have something in our agreement that we actually have the right to get out because we know is not, is not going to happen because, because we want a project with minimum risk, because any risk that comes upon the client, it is our own.
What are your top, what are your top red flags? Top red flags are like if I see the owner is looking at the bottom, bottom line only, because if you are, if your client goes to that surgeon and that client of that surgeon thinks the same way, that surgeon will not do the surgery.
Marzi Emami Ghoreishi, Ph.D: Imagine the patient goes to a doctor and says, do my cheek or my face with the lowest price possible without looking at the, you know, before and after or result of the work.
Mohsen Ghoreishi, M.Arch: So, that’s the biggest red flag. Another red flag is when a client decides to be the contractor or the architect or project manager. That or we, we, that is one of the, that’s the upfront number one red flag where we recommend if you are going to an architect, trust the architect, like when your patient trusts you.
When you do a lipo, you put that patient to sleep. That means they’re totally vulnerable, vulnerable and trusted you on that table, right? You need to be the same way to an architect. You have to pick somebody that you totally trust and let them do it. Go every day to the project site. Go check things out.
You want to change something? Talk to the architect. You want to move something? Talk to the architect. Do not talk to the contractor. Do not express yourself.
Marzi Emami Ghoreishi, Ph.D: Do not talk to subcontractors. Some of them.
Mohsen Ghoreishi, M.Arch: That is, that is number one problem because the moment client starts engaging with the subcontractors and contractors, that’s where everything goes wrong.
I suggest that interaction should be up front with the architect during design process. And then when the design process is very comprehensive and you don’t leave anything out, you’ve spent enough time to build the project on paper. Therefore, there is nothing going to be afterthought. Okay? So, everything is figured out.
You’re done. Now it’s time for this contractor to build it. And you have your architect as your quarterback during construction, who’s watching your back. Watching every step. This contractor is doing. You need to acquire that service from your architect to be involved in construction. But for us, the moment we realized the country, the owner is going to be a project manager or a designer and also help during construction.
We’re out. We don’t take that part because if you don’t take that project. That should say something to the surgeon. It’s like two surgeons want to do one surgery at the same time. And one of them is not really a surgeon.
Catherine Maley, MBA: So, we have to talk about permits because it seems to me that’s one of the biggest delays. How does this impact or relate to your understanding of build-out mistakes?
By the way, so when you’re, when you come on board and you all have figured out a budget. Is there wiggle room there, especially for, obviously, change orders, but the permit situation, the time delays, how do you figure all that out? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Well, everything is somewhat based on we can control the time that we design for a project.
That is under our control. We cannot, nobody can control permit. And so, we put a timeline together and say, okay, we design it for, let’s say, eight weeks or two months or three months design time. But then we allocate, let’s say, two months for permits, depending on what project it is, what complexity it has, what city or county it is.
We will put that number according to our experience. Okay. And the, the bed environment and how busy the construction time is. So, we will put that assumption in there is assumed. There is nothing else we can do. And then we assess how much time it takes for back and forth with the county until the permit is ready.
So, we give a pretty much a. Not a rosy picture, a pretty tough picture to the client. Right. And tell him, Bob, you need to accept this. It’s going to take you two years. Oh, no. I was told by a local architect it’s going to take three months. That right there is another red flag. It’s a big red flag. You know you cannot talk to this client any further because they are going to hurt themselves like there is no tomorrow.
Anybody who says that. They just want to take that project, involve themselves with the project, and after that it’s too late to exit.
Marzi Emami Ghoreishi, Ph.D: And let me tell you one example exactly with regards to that. We had a project, potential project, that they asked us, we want to give you this project, but our condition is you finish and get the permit before December 2020.
Exactly that timeline. We looked at the project. We looked at the jurisdiction and we said to the doctor and landlord that this is not possible. This is not realistic. We can do whatever we can in regards to our part. What we cannot promise you, you get and obtain the permit, but that’s it. Imagine what the project is still in the process.
They went to another architect. They signed the project. They signed the contract with another project. You know, the architect and they just started all the design phase. The project is still in the process from 2020. And that was a small TI. Very small project. Be realistic. That’s the whole point. I have a city that they can get back to us in one month.
I I’m working with the city that they haven’t issued the first round of comments after six months. So, crazy. We have to have plan B always. Always we have to talk to our clients at the beginning of the project. We said, let’s, let’s plan for good situation. Let’s plan for the worst scenario.
Mohsen Ghoreishi, M.Arch: Another red flag is clients, doctors who they’re going to buy the tile from their friend who’s going to give him a discount tile.
They’re going to bring an electrician to buy their friend who they’re going to buy the light ceiling lights from their friend over there. And guess what happens. It complicates the project. The bids are going to be higher because the contractor knows he’s not going to have a full project with full profit.
So, he jacks up the price and the doctor at the middle of the construction who has been promised to get those lights is not able to get the lights. And the tile is not coming because the right tile is discontinued and now, he has to change. It is so bad. It is so bad. So, because everyone wants to cut cost, I suggest cut cost.
But cut cost within time. That you will be spending constructing this project because everything you don’t have, you’re already for you. That’s the amount you have to pay to operate in a hospital.
Catherine Maley, MBA: Well, and often they also have an office that they have to pay for, or they’re going to get kicked out in a month. How does this impact or relate to your understanding of build-out mistakes?
And now they have to go somewhere else and scrambling.
Marzi Emami Ghoreishi, Ph.D: That’s true. And a lot of stress.
Mohsen Ghoreishi, M.Arch: We have a lot of stories. We have a lot of stories where, in fact doctors have done work without permit. And the building was sold to a new management, the old management was okay with it because the owner was a doctor to in the dark or owner was agreeing with that.
They sold it to a new management; they take over the lease. And the new management realized that thing was done without a permit, which it was against the covenant of the lease agreement. They kick them out. They had a demo the entire space. It was 800, 000 later, after costs for architects, lawyers.
demolition of the existing building and getting something interim to go to the new space. 800, 000 later they went to their new home. So, please don’t do anything, any work without a permit. Just do it right. Just do it right the first time.
Catherine Maley, MBA: Because you’re probably not going to ever do it again. So, you might as well do it right and not have to worry about it. How does this impact or relate to your understanding of build-out mistakes?
I know somebody who had the friend that had the wood planking, like the planking flooring. And, and so they, they did that like to save some money. And sure enough, it was very poor quality. So, every time the laser fell or like the laser handle fell, like there’d be a divot in the floor and it was just a nightmare. How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Yeah. Of course, using the right material for these type of environments is a plot. It’s an important fact. How do you
Catherine Maley, MBA: know? How do you know when you’re just chatting? Like if you’re a doctor and you and they’re saying, oh yeah, and we have this quality material we’re using, how do you know? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Well, who’s telling them?
Who’s telling them? Are you saying the contractor would say something like that, that we have quality material? Oh, well, you, you need to trust the professional. So, if an architect tells you that and they don’t deliver it, then they’re liable for it. Because for a surgery suite, you have to use, or any medical practice, if you will, healthcare material is required.
And the pathogens microbial bacterial in the, in the air, all of that. I mean, especially postcode, people are really, really conscientious about that. You have to trust the professionals. So, if they tell you that they have to provide there is a specifications on the materials, how long they last was the warranty.
Same as the pattern and the color, there are other specifications. If there are sustainable materials, if there are green materials, if, you know, what kind of materials are we using? It’s from the wood and the cavernous to glue that is in the back of the, if you will you know, planks, if you will, if you use vinyl planks or they are all, they all have specifications and you can read it.
You can study it. If the architect, architect must submit those to you. So, as a contract, so the way it works is if you have an architect on board before contract architect specifies in a pretty nice booklet, and that’s how the contractor bids the project. But prior to installation, the contractor sent what’s called submittal to the architect said it tells the architect I am buying this.
Per your specification, have a look and confirm if I’m buying the right thing. Then the architect looks at these specs and says, oh yes, you’re buying the right thing, go buy it. Then he goes and buys it and installs it. So, there is a check and balance through the entire construction. If you eliminate the architect during construction, You don’t know what you’re going to get.
So, the architect must start from conception to occupancy, through occupancy.
Catherine Maley, MBA: I think that is the overall theme here. Start with the architect and use A to Z, the architect, who’s going to manage all of this. The surgeon, you stay out of it. You be the surgeon and let them be the project manager, but I would think you’re communicating a lot. How does this impact or relate to your understanding of build-out mistakes?
Just make sure everyone stays on the same page. Boy, I can just see things going sideways halfway through this project and the doctor saying, that’s not what I wanted. I want this instead, you know? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: Absolutely. There’s a two full communication should be between the architect and you know, it’s like Of course, like, for instance, when we start a project, I do a lot of work with the programming.
We look at operational analysis, how to streamline the operations, and we do diagrams, expositions of parts and pieces and figure out the score footage and all of that, and then I hand it over to Margie. She will be the, she’s the project architect or principal architect. She puts all of that together, and she comes up with a floor plan, and then during the entire process, We have the client involved and they have to be involved and approve every step of it.
And so, they will be very involved through, especially our front work. And once, once all the legwork is done and it goes to production, then they don’t really have to be involved because it’s just production of those drawings for permit, if you will.
Marzi Emami Ghoreishi, Ph.D: I would say communication is the key. And documentation.
So, we are so adamant about documentation through the process of design and construction. And that was interesting experience that I want to share with you. These documentation, even not with the owner or client, also with other parties, like consultants, like landlord, like this and the other, saved our clients a lot of money.
We had a project that landlord promised. The client to install new HVAC system, and they had it in email. We archived that and we kept it in our server. And a few years later, the client, after we finished the project, they came back to us and they said they had the issue with the landlord about the renewing the lease.
And we send them this previous email because your landlord promised you have this email. And then they could They could get what they deserve from the landlord, what has been promised in their days.
Mohsen Ghoreishi, M.Arch: It was about 25, 000 simple HVAC system that the landlord originally did not change as they had promised.
And now they had to, they had asked the tenant to buy a new one, and… That was a no, no. So, we just kept that had that email kept and when we send that, they accepted it was done.
Marzi Emami Ghoreishi, Ph.D: We are golden because our because our clients always in the loop that hey, doctor, we talked to this and this and the other. And that’s the result of our conversation.
So, it’s not about only materials or, you know, the other. So, it’s everything related to the project. They need to know. And as much as they know more, We are better off.
Mohsen Ghoreishi, M.Arch: Like I said, we architects should be the quarterback for the project. There are a lot of people involved in design and building a surgery center or medical school.
There are a lot of people involved and there is one client with limited budget and a big dream. And, and somebody got to be the quarterback, and that’s what architects are trained for to do, but unfortunately, the medical world don’t use the entire services an architect should provide oftentimes.
Architects are in the background behind the contract.
Catherine Maley, MBA: All right, with that we’re going to wrap it up, but this is really interesting. I hope everyone’s getting a lot out of this. The detail that goes into this, I had, I knew it was a lot, but this is really a lot. So, I highly recommend you go to www.KohanInc.com. How does this impact or relate to your understanding of build-out mistakes?
com. You’ve got to check out their gallery of photos. The designs are just beautiful. The offices are gorgeous. You really do great work. Is there anything, any way they can get ahold of you? What’s the easiest way to get ahold of you if they want to chat? How does this impact or relate to your understanding of build-out mistakes?
Mohsen Ghoreishi, M.Arch: If they go to www.KohanInc.Com, there is a, a complimentary talk we can have for about 30 minutes.
Yes. And, or you can call me on my cell phone or Marzi, either, or we’d be happy to. Answer. I think I always say talent is easy to find, but reliability is hard to acquire. So, we’re available. So, just call us on the cell phone. If you go on the online, there is our mobile number. Everything is there. You can call us.
You can reach us and schedule a time to talk.
Catherine Maley, MBA: And by the way, I’m now offering my free copy of an 81-page guide I did called “Plastic Surgery Marketing, What’s Working Now”.
I decided to give it away for free. full of patient attraction strategies. And you can get that at www.CatherineMaley.com/Free.
Everybody that’s going to wrap it up for us today, a Beauty and the Biz and this episode on how to avoid build-out mistakes.
A big thanks to The Kohan Group for sharing their tips on avoiding build-out mistakes.
And if you have any questions or feedback for me, you can go ahead and leave them at my website at www.CatherineMaley.com, or you can certainly DM me on Instagram @CatherineMaleyMBA.
If you’ve enjoyed this episode on Beauty and the Biz, please head over to Apple Podcasts and give me a review and subscribe to Beauty and the Biz so, you don’t miss any episodes. And of course, please share this with your staff and colleagues.
And we will talk to you again soon. Take care.
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-End transcript for “Build-Out Mistakes — with Mohsen Ghoreishi, M.Arch & Marzi Emami Ghoreishi, Ph.D”.
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