On the drawings for their new medical offices, it said "lab".

"In my mind, if you have experience in building medical labs, you know you need space to sit down and draw blood," says Danielle Brown, practice administrator for Advanced Surgeons. They were moving to the new Grandview Physicians Plaza on Highway 280. "But when I walked in as they were building the lab, it was solid counters. There was no room for a chair.

It turns out that the architects had done plenty of labs, but those had been research labs, not ones for medical practices. "And the only way I found out was I physically showed up during the build and saw it," Brown says.

"If you're not trained to look at architectural plans like a designer, it's very hard to understand even the cabinetry and the wiring," Brown says. "And no one teaches practice administrators or physicians how to read designs."

This was just one of the skills Brown has picked up in her 30 years in healthcare administration, which has included relocating practices more than six times. This latest move had already been in the works when she walked in the clinic her first day on the job. "The plans had been approved and the build was underway," she says.

The minutiae of detail to oversee in planning a medical practice never ends, she says. "You have to think about where you're going to sit in each office and where the computer is going to be," Brown says, because having to move a desk and the accompanying wiring can run hundreds of dollars.

Danielle Brown

"You have to think about the functionality of how your office is going to operate and the flow of your system," Brown says. Before the move or in the design phase, the placement of machines and their wiring must be decided, like faxes, copiers, phones and printers, along with the medical equipment that needs wiring and has to be mobile. "Don't assume the architect knows what's functional for you," she says.

The most obvious things can be overlooked by the architect or leasing company. "Like how do they key your office?" Brown says. She has no grandmaster key at the new location. "I have 10 different keys now, and to rekey it would be cost prohibitive," she says. "Those are the things you take for granted until you get in."

Even simple fixtures, such as faucets, can create havoc. The placement of the sinks in the new exam rooms positioned the faucets right behind the physicians as they interacted with patients. Not a problem normally, except these faucets were motion-activated. "The water kept coming on," Brown says. "They had to turn down the sensitivity of the faucets to fix that, so now you have to wag your arms like you're going to take flight to get it to go on."

Cleaning services, security, fire extinguisher inspections and infectious disposal waste disposal can all change as part of a lease. To use the cleaning service in some buildings, the paper towel and toilet paper dispensers may need to match whatever type of paper products that service provides, such as rolls or sheets.

"Look at your lease to be sure you can sublease, too," Brown says. Otherwise, that can block the possibility of generating revenue from sharing offices with medical professionals looking to lease part-time space to practice at a different hospital a few days a week.

Thermostat positions are also easily overlooked, but crucial. In Brown's new office, the only place to put the copier ended up right below the thermostat controlling three offices. The copier put out irregular bouts of heat, so everyone was regularly freezing. Moving the copier to the hallway resulted in the offices being too warm, because the flow of air in the hallway kept it naturally cooler. "It cost $400 to move the copier," Brown says, because of relocating the wiring around firewalls.

Other things Brown cautions administrators to look for include ensuring exiting patients flow past a check-out the window, verifying the design of all the doors -- "they had put windows in the exam room doors!"-- and planning the storage of old medical records for warehousing or destruction. "You'll need at least a two-week lead for that one," she says.

For the actual move, Brown rented plastic moving boxes for just over $100 from Bungo Box. "Best thing since sliced bread," she says. "You're not dealing with cardboard boxes ripping or breaking down." They moved the entire office on a Friday and opened for business on a Tuesday. "We worked all weekend to unbox."

As a golden rule of moving and planning a practice, Brown suggests, "any change you make, think hard about what that will impact after you change it." She adds that practice administrators should realize they did not go to school to be an architect. "So if you don't know what you're looking at on the design,never be ashamed to ask." The stress and costs avoided could be enormous.