Building for tomorrow

Here's the good news: With careful planning, it's still possible to design an affordable hospital that stays ahead of industry expectations. But it's also true that some societal trends are putting new pressure on the veterinary industry. And these trends translate into new facility needs. For example, you may want to consider these issues:

• Whole-life care. Today's pet owners consider their pets to be companions and participants in their everyday lives. Future veterinary hospitals will offer "cradle-to-grave" services such as adoption, wellness care, behavior training and counseling, daycare, nutritional counseling, rehabilitation therapy, geriatric care, euthanasia, and grief counseling.

• Technology that meets client expectations. Wiring your building for maximum efficiency means anticipating the ways equipment in different parts of your building could work together. For instance, you may want your radiography and lab equipment to drop data directly into electronic medical files.

• Consumer differentiation. As consumers look for products and services that speak to their specific needs and values, practices will diversify to meet these needs. So, it'll be increasingly important to form a practice philosophy that differentiates you from your competition. And your specialized approach to care may change your facility requirements.

Technology tip

For example, let's say you decided to develop a strong reputation in the fast-growing areas of therapy and rehabilitation. You might build rooms that help you address these needs.

• Emphasis on diagnostics. The next generation of practices will increasingly emphasize diagnostics over treatment. As diagnostic imaging becomes more sophisticated, more teams will choose to include diagnostic centers. And when you build, you should try to include the wiring and space you'll need to adopt new and improved diagnostic equipment in the future.

• Specialty, referral, and emergency. We're seeing a strong emerging trend toward centralized services and facilities with the proliferation of specialty, referral, and emergency practices. As this trend picks up speed, more practitioners are shying away from providing all available medical services to their clients. Instead, they're combining resources to provide some specialty services.

• Boarding and daycare. Modern pet owners stay on the move. And while many take their pets on vacation, others choose to leave pets at boarding resorts. We're also seeing increased consumer demand for pet daycare.

In the trenches: Factors affecting costs

To appeal to these mobile pet owners, you may want to offer spa and resort services for pets. Apartment-like animal housing, up-scale grooming, and landscaped outdoor recreation areas all appeal to this crowd. Some hospitals also choose to include high-end retail to give clients the convenience of one-stop pet supply shopping.

Squeezing more in

Balancing the tug-of-war between your wallet and your dreams can be as simple as coming up with strategic design solutions. The following strategies seek to reduce circulation, incorporate multi-use spaces, and increase efficiency.

• The pod concept. Many human medical facilities group sets of three or four exam rooms to make a pod, and it works for veterinary practices that focus on outpatient care, too. The pod configuration lets a doctor and technician team work several exam rooms simultaneously. And these one-door exam rooms significantly save on square-footage because you don't need an access hall on both sides of the room.

• Multi-task exam room. In many veterinary hospitals, exam rooms aren't used at full capacity during the middle hours of the day. If you install a folding wall in the back of the room, you can use the space as an exam room in the morning and evening rush hours and as additional treatment space during the day.

• Open exam room. Some veterinary hospitals add exam space and advertise their high-quality care by creating a place to perform exams in an open area off the waiting room.

• Ready room. The ready room's a mini-treatment room adjacent to the exam rooms. This space works well with the pod concept and high-density scheduling. A technician can do minor procedures in the ready room, which lets the doctor move on to the next exam room. At the same time, a team member can escort the client back to the waiting room, freeing the exam room for another patient.

• Resource room. Ideally, you'd make this multi-purpose room accessible to the waiting and treatment areas, and doctors' offices. Furnished with a conference table, shelves, and desks around the perimeter, you can use this room as a library, gathering space for meetings and continuing education, or an additional workspace.

• Express check in/checkout. You've dropped your bags curbside or with the hotel concierge, right? Well, it's the same idea. Your team would meet clients at the curb and start their visit quickly and efficiently. You'd check clients out in a more private setting, such as an exam room, rather than the reception desk. This could be a great way to provide a higher level of service without increasing square footage.

• The greeter's station. A greeter's station replaces the traditional reception desk and lets one team member focus on addressing clients' immediate needs without needing to answer the phone or attend to other business.

Advances in technology make this change possible. As wireless computer networks become more prevalent, you can conduct business transactions anywhere in the practice. Checkout can occur in exam rooms. Your team can schedule appointments from anywhere. You can enter data in records anywhere anytime. All this means you no longer need to chain basic business functions to your reception desk.

Focus on your dream

Veterinary practices have changed dramatically in the last 50 years to meet increasingly specialized market demands. You've proven you can adapt to a clientele that continues to place higher value on the health and well-being of companion animals.

Future hospitals will continue to provide settings for the industry's highest level of care. And they'll become more dynamic so you can squeeze more services and functions into less space. To find the right creative solutions for you, set aside your notions of what a traditional hospital does. Focus instead on what you know yours could do.

Lawrence A. Gates is a senior partner of Animal Arts/Gates Hafen Cochrane in Boulder, Colo. Heather E. Lewis is also a partner with the firm, which has designed more than 300 veterinary hospitals and more than 40 animal shelters and has won 28 awards in the Veterinary Economics Hospital Design Competition. Lewis will speak on animal housing and functional flooring at the 2006 Veterinary Economics Hospital Design Conference, Aug. 23 to 25 in Kansas City, Mo. For more information, visit www.thecvc.com/hd.

Lawrence A. Gates

Heather E. Lewis

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Evolving exam rooms

Exam rooms generate the most profit per square foot of any area in your practice, and they determine the number of clients you can see at any given time. Use these strategies to make the most of this critical space.

Varied-height counter tops at Magrane Animal Hospital in Mishawaka, Ind.

By Wayne Usiak, AIA

Years ago, a veterinary hospital was a single room for reception, examination, diagnosis, and treatment. Medical advances, client demands, competition, computerization, and increased business skills all inspired change. Now, exam rooms serve as a center for doctor-client interaction.

Clients spend most of their visit in the exam room. The experience influences their opinion of you, your practice, and the value of your service. It's where you consult, deliver your medical diagnosis, educate, and learn about their pet's place in their life. The bottom line: You enhance your bond with the client in the exam room, so set the right stage.

How many and where

While the standard for many years was 1.5 exam rooms per on-duty veterinarian, today most progressive hospitals build nearer to three. Five is usually the maximum for an in-line arrangement. If you have more, consider L-shaped, U-shaped, or pod groupings for efficiency. You also need to decide between one-door and two-door exam rooms. With two doors, you minimize congestion by splitting client and team traffic patterns. But one-door exam rooms save space, and may allow an exterior window, if placed along an exterior wall.

All in the name of comfort

To make everyone comfortable, you want to provide adequate space and comfortable seating. How many people does your exam room need to accommodate? Consider assistants and clients' family members. Multiple occupants generate more heat, and exam rooms overheat quickly, so make sure there's also adequate ventilation and exhaust. Other issues:

• Does the room accommodate elderly and disabled clients?

• Does the cabinetry and exam-table layout allow simultaneous patient exam and restraint, note taking, and client conversation?

• Is the lighting sufficient for both general and specific tasks? Do you wish to dim or brighten the lighting?

• Does the space accommodate ideal technology? Desktops, laptops, and tablets require different setups. For example, to share computerized information with clients, they need to see the monitor easily.

• Does the room offer adequate writing space? While a 36-inch-high surface works, 42 inches is ideal for standing and writing.

• Do you need a sink? Either distance or a counter-height change should separate the sink from the note-taking area.

Also think about how you'll incorporate a trash receptacle, pharmaceutical and supply storage, sharps disposal, model space, retail display, and built-ins like otoscopes with chargers.

Get more from your rooms

Many hospitals today provide special features in one or more exam rooms so that rooms can do double duty. Consider these strategies to provide services beyond a typical wellness exam in your rooms.

• Offer additional services, such as ophthalmology, dentistry, or rehabilitation and equip your exam rooms appropriately.

• Provide client education. Install computers or video equipment to facilitate education sessions.

• Add a lift table. You can choose from several styles of lift tables with different positioning and effect on the layout of the room.

From floor to ceiling, and doorknobs to light fixtures, all the pieces and parts of the exam room affect clients' perception of your practice and their comfort and confidence in you. In addition, a well-designed room means a better working situation for you and your team members. So give this critical space some extra thought, and make sure you've made the most of your opportunities.

Wayne Usiak, AIA, NCARB

Veterinary Economics Editorial Advisory Board member Wayne Usiak, AIA, NCARB, is a senior partner with BDA Architecture in Albuquerque, N.M. He'll talk about design trends, integrating equipment, and building a hospital on a budget at the 2006 Veterinary Economics Hospital Design Conference, Aug. 23 to 25 in Kansas City, Mo.