A design that spotlights specialists

By Carolyn Chapman, Special Assignments Editor

General practitioners launching their own practices often start small, hoping to afford a larger space eventually. Not so with specialty/emergency practices, say Drs. Gary Block and Justine Johnson, husband-and-wife owners of Ocean State Veterinary Specialists in East Greenwich, R.I.

"To gain the trust of referring doctors, we needed to build big enough from the outset to house the necessary equipment and specialists," Dr. Johnson explains. The doctors' nearly 13,000-square-foot hospital draws clients from nearby Providence and neighboring states.

Veterinary Economics Hospital Design Competition judges applauded the specialty hospital's well-organized treatment area and wonderful ambience, which is especially important given the often stressful environment. "This plan is great inside and out," remarked one judge.

Meeting a need

Dr. Johnson, a critical care specialist, and Dr. Block, an internal medicine specialist, practiced in several hospitals in the Northeast after they both graduated from Cornell University in 1991 and pursued board certification. In fall 1999, they left their jobs at a Rhode Island practice, and knowing the area lacked a specialty practice, they set out to fill the need. They felt sure their practice vision would fill the niche.

To assemble a team of specialists, Drs. Block and Johnson advertised in medical journals and interviewed residents. Today their team includes a full-time surgeon, dermatologist, and radiologist; five full-time emergency doctors; a part-time avian/exotics specialist; and two interns.

Next, Drs. Johnson and Block hired an accounting firm to create a solid business plan with reasonable projections, and a family history with a local bank helped them secure the necessary funds quickly. As a specialty/emergency hospital, they needed to build a freestanding building with easy access to major roads. "A strip mall location wouldn't promote the singular identity we needed to develop," Dr. Johnson says. Instead, they purchased a 3.6-acre site 10 miles south of Providence at the intersection of two major highways.

After visiting with several architects, the pair hired Brad Rabinowitz of Burlington, Vt. His experience designing veterinary hospitals proved helpful, but they say his willing ears were invaluable. "He really listened to our vision and gave us what we wanted," says Dr. Johnson. "His understanding of working surfaces-floors, paint, counters, and ceiling tiles-helped us create an easy-to-clean and quiet hospital." The doctors shared their basic plan, then worked with Rabinowitz to fit it to their long, narrow site.

Rabinowitz says the specialty focus presented his biggest challenge. "There are more interactive spaces here than in most general practices," he says. "In most general hospitals, critical care is in a small room off surgery; here it's the main focus." To meet the hospital's unique needs, he created an intricate and flexible mechanical system to control odors and prevent contamination, and he reinforced the interior walls to control radiation.

Five environmental zones keep the hospital comfortable and clean, and little to no air recirculates to the working areas of the hospital. A large air-to-air heat exchanger extracts heat from the exhausted air to reduce costs.

Preparing for success

During construction, Dr. Johnson performed limited relief work while Dr. Block practiced full-time in a Connecticut hospital. Dr. Johnson met with the contractor and the architect before each phase to look at the plans and to consider the financial ramifications of on-site changes. "I had no idea how much money we'd eventually spend," she says. Minor problems delayed the project, including resizing the run openings to accommodate doors that didn't fit and moving oxygen ports. "I found it difficult to envision a room until it was built," she says. "In the grand scheme of things those changes didn't cost much money, but I hated paying for something twice."

If you're thinking of taking on a building project, Dr. Johnson warns that you need to reconcile your budget and your dreams. She says their contractor and architect offered ideas to cut the budget, but she knew she wouldn't be happy if they cut corners. "Create a budget for everything you want, and make sure the architect and contractor agree that your project will meet your budget," she says. "Dickering and compromising won't make you happy when you're building your dream."

A year before construction was complete, Dr. Block left his full-time job in Connecticut, and the group of specialty doctors opened the doors for business. "We rented six trailers and linked them together to create a makeshift hospital," Dr. Johnson recalls.

The trailers sat in their contractor's backyard three miles from the construction site. And Dr. Johnson says opening the business before they opened the building was key to their success. By the time the hospital was ready, the team was up and running and the client base had grown to support the large facility.

Creature comforts

Drs. Johnson and Block knew that the serious nature of many of their cases meant they would need to plan a hospital that was both professional and welcoming. So they chose a conservative exterior of brick and stucco to present a professional, high-quality image. Inside, a spacious reception area with large windows greets clients.

On busy days, clients with emergencies may wait up to two hours, so the doctors planned a comfortable reception area to help calm anxious clients. Unique tile patterns break up the long floor space, while blue-paned windows brighten the area and soothe clients. "Our clients expect top-of-the-line medical care here, and we need our first impression to convey that high-end image," Dr. Johnson says. A large blood donor cat area featuring a glass atrium and climbing furniture lies at the end of the reception area. Dr. Johnsons says the cats' visibility improves their chances for adoption and offers them a view of the hospital activity.

Six exam rooms radiate off the reception area, three on each side of the reception desk. Behind each cluster sits a doctors' work station for quick write-ups or call backs. "Those spaces are a life saver," Dr. Johnson says. Conveniently located next to exam rooms, these spaces offer doctors a place to write up records, formulate estimates or record discharge instructions in the computer, enter fees, and make phone calls to referring veterinarians.

Offices, a conference room/library, and the staff lounge occupy the eastern portion of the building. The doctors positioned the lounge away from the main traffic flow to allow staff members an escape from the stressful environment. Dr. Johnson also bought a television for staff members to enjoy during breaks. And the conference space allows for continuing education seminars for referring doctors.

Treatment center stage

Unlike many specialty facilities, where each specialist practices in a separate room or wing, here an open treatment hub supports all doctors. "We didn't want a divisive floor plan," says Dr. Johnson. "We're all on the same team, so we share one large space with nooks for privacy." She says the design fosters cross-consulting on cases and improves patient monitoring. Skylights allow natural light into the working areas.

Behind exam rooms and the reception area sit the lab, pharmacy, and outpatient treatment area. The dermatologist and emergency doctors appreciate the separate outpatient area away from the hustle of the main treatment area.

ICU takes up considerable space and provides continuity to the treatment the team offers, Dr. Johnson says. A large glass wall keeps isolated patients visible. Although the hospital features two wards, Dr. Johnson says the ICU cages are used most frequently for their easy access and monitoring. Two surgery suites, one for orthopedic procedures and one for soft-tissue surgeries, and a supporting prep area radiate off the treatment area.

The central section of the hospital houses such special procedures rooms as radiograph, ultrasound, CT scanning areas, and a small room for treating cats with radioactive iodine. Concrete block walls and leaded drywall contain radiation. With hopes to finish the second floor of the hospital, the doctors installed a concrete slab in the roof, which also blocks harmful waves.

The second story currently houses the owners' offices and storage only. But the five-year plan calls for moving all offices upstairs to make room for additional specialties. The doctors must install an elevator before they can develop hospital rooms on the second floor, so they included an elevator shaft in the plans and filled it with easy-to-remove gravel.

Dr. Johnson says she takes pride in the unique plan and says the new facility fostered the development of a cohesive group of doctors and technicians who are devoted to high-end patient care. "This was our opportunity to build our ideal hospital," she reflects. "We're capable of doing everything we want to do for pets."

Carolyn Chapman, a former Veterinary Economics associate editor, is a freelance writer in Liberty, Mo. Chapman has written for Veterinary Economics since 1994.