4 ways to a smaller hospital

This exam room in Upstate Veterinary Specialists' Asheville clinic in Asheville, North Carolina, is small but feels bigger thanks to lighting and openness. It won a 2013 Hospital Design Competition Merit Award. (Yeah, I designed it.)Maybe you've asked yourself: Just how small can a veterinary hospital be? [Editor's note: We did! And 1,400 wasn't too small!]

The answer? Certain veterinary practices can be very small. Maybe even just 900 square feet. [Editor's note: That IS really small.]

It's not easy, and you won't get everything you ever wanted, but you can have the basics, if you work at it. Let's see how it can be done ...

1. One-door exam rooms

I think one of the biggest boondoggles ever foisted on veterinarians was the idea that exam rooms must have two doors. Two-door exam rooms are a relatively new invention in terms of the overall history of veterinary facility design. Before the 1970s, most clinics were smaller, with only one door.

Yes, having a second door out of an exam room can streamline the circulation, but it comes at a cost. If you can eliminate the second door, you also eliminate the hallway behind the exam rooms and can save significant amount of square footage.

2. Smaller wards

Most small practices rarely hospitalize animals overnight. In the rare case when extended hospitalization is required, the norm is now to refer the patient to a local specialty, referral or emergency clinic. For less critical cases, pet owners often want to be involved in the care of their animals and may be willing-and able-to nurse them at home. As such, small clinic shouldn't need much ward space.

That doesn't mean you won't need a large bank of cages in the treatment area for animals treated that day, but I think large holding wards are a thing of the past.

3. Super multipurpose rooms

I once had the opportunity to tour veterinary clinics in Italy. Almost all of them were small, really small-400 to 600 square feet. Most had only two rooms. The first was the waiting room, with an ordinary desk set to one side that was for the receptionist. The second was everything else: exam, office, treatment, surgery and radiography. I'm not sure this would work in the States, where you need a dedicated surgery room and a shielded room for radiography, but to save lots of space you could combine your office, exam and treatment room!

4. Wellness-only

An old friend and architectural client recently wrote to remind me about the 20/80 rule. Namely, that 20 percent of your square footage-the exam room-makes 80 percent of your income. That means 80 percent of a typical clinic's expenses can be traced back to radiography and surgery. If you operate a wellness-only clinic, you can save that 80 percent (and also a bunch of square feet).

My point ...

This brings me to the two most important ideas:

> Don't settle for the status quo. When designing your clinic, push beyond the norm.

> Decide what truly works for your specific needs, not how your neighbor has done it, or the magazines say you should do it.

There are a lot of unwritten rules in veterinary design; for example, exam rooms are 8 x 10 feet or treatment tables are five feet long. But why? Few, if any, of these rules are unbreakable. And in most urban areas, where people are used to spending their days in closer contact with others and enjoying less personal space, you can easily downsize most of the rooms in veterinary practice.

Mark Hafen owns smaller can be better, a veterinary design firm. He is a past partner with the design firm Animal Arts.