Designing for low-cost community veterinary services

Flatbush Veterinary Clinic (Images courtesy of Tim Murphy | Foto Imagery)

Lack of access to veterinary care is one of the major risk factors for pet relinquishment to animal shelters around the United States and Canada. According to a 2020 American Veterinary Medical Association report, approximately 27% of pets did not see veterinarians routinely in 2016.¹

Many veterinarians and animal welfare groups are working hard to address access to care through multiple avenues. One such avenue is the proliferation of low-cost community veterinary clinics. Some of these clinics use for-profit funding, whereas others are nonprofit. Regardless, they all tend to rely on streamlined services and high-volume models.

With a high-volume model, it is critically important to maintain quality of care and veterinary care best practices. Care should be provided in an ethical manner that is good for the patients, clients, and care providers. As veterinary architects, we worked with many more of these high-volume, high-quality, low-cost care clinics in recent years. Through this, we learned a lot about how they function, how they need to be designed, and how to keep the costs of construction to a minimum. We will use Flatbush Veterinary Clinic in Brooklyn, New York, to discuss the design of a low-cost care clinic. If a low-cost care model works in Brooklyn, it can work in most locations in the United States, where real estate and construction costs are likely lower.

Assembling the right team

It is important to visit and talk with other low-cost care clinics, as well as to assemble a team of advisers and designers who are both familiar with and sensitive to the needs of these clinics.

Spending money where it counts

If you are building a business model based on a lower cost of care, the cost of construction must be less than in a typical clinic. Here are some design and construction priorities, as well as areas where clinics can potentially save money.

Must-have priorities

Sterile is sterile.

When performing surgery at high volume, it is even more important to align with best practices. Do not skimp on surgical facilities. Follow the American Animal Hospital Association’s best practices for surgical facilities, as well as the following guidelines:

• Do not replace handwashing with waterless scrubbing, as handwashing removes soiling. Waterless scrubbing can be used in addition to handwashing, but handwashing is still a best practice.
• The surgery room is only for surgery. Large benches and recovery areas should be located outside surgery suites. Sinks, pack and prep, and all other functions should also be outside surgery suites.

Flatbush Veterinary Clinic Surgery Suite (Photo Courtesy of Tim Murphy | Foto Imagery)

• Use active gas scavenging for staff safety and follow safety requirements for oxygen delivery to patients.
• Keep patients warm during surgery and recovery. Provide enough HVAC to overcome warming devices, lighting, and other heat loads in surgery and recovery spaces.
• Design an aseptic environment with seamless finishes.
• Provide good lighting and ergonomics so the veterinarians working in high-volume care can do their best work.
• Provide enough spaces for staff and volunteers to properly monitor patients during recovery.
• Clean and sterilize all instruments properly and provide a good layout for pack and prep with a dirty-to-clean flow.

Reduce fear, anxiety, and stress.

In a high-volume practice, it is important to reduce stressors. Pet families are already stressed and relying on your help. Thus, we like to see separate flow for dogs and cats, as much separation of species as possible, noise reduction, and areas for staff to take a break so they can continue to provide the best care.

Use good equipment.

Do not skimp by using that 1995 x-ray machine that you got for free; it is not worth it. A team member or patient will get hurt using old or antiquated equipment. We often take the approach that these types of clinics must spend more money on equipment than other infrastructure. They often have no money for other nice things, but quality equipment will keep everyone working carefully and safely. Equipment also provides an accounting advantage over fixed cabinetry and custom-built items, as it depreciates each year.

Saving money

Do not prioritize the following:

Fancy real estate.

Low-cost clinics are best placed in communities where the care is needed most. Expensive locations are probably not accessible to these communities, and expensive buildings will not support the creation of functional business models for low-cost care. Therefore, funky locations are probably fine—just make sure the clinic is on public transportation routes, is easy to get to, and feels safe during the day and at night.

Fancy architecture.

Flatbush Veterinary Clinic Lobby (Photo courtesy of Tim Murphy | Foto Imagery)

You simply do not need it, and fancy architecture can be disrespectful to the clients served and the model being promoted. We keep things simple, clean, and professional. At Flatbush Cats, a photo wall personalizes an otherwise simple lobby space. Although the desk looks nice—if not fancy—we worked hard to select the most inexpensive materials that still provided a nice, professional look.

Expensive finishes.

We often will make decisions such as using plastic paneling in heavy-use rooms instead of tile and using colorful paint instead of expensive wall coverings.

• For flooring, luxury vinyl tile or sealed concrete floors can be fine in client areas. In medical zones, we tend to use sheet vinyl, which is both low cost and cleanable.

Custom cabinetry.

Do not be afraid to be scrappy. Cabinets and chairs instead of built-in benches from IKEA? Fine.

Flatbush Veterinary Clinic Cat Holding (Photo Courtesy of Tim Murphy | Foto Imagery)

Built-in items.

Use cages on wheels rather than built-in versions, as they cost less and are more flexible. You can also use rolling shelf units rather than built-in shelves.

Other unique requirements of high-volume, low-cost clinics

Managing clients.

Many low-cost care clinics do not take appointments, whereas others do take appointments but mostly for drop-offs. In either case, there can be large crowds of people showing up at the same time. We have seen people stand in heat of 90 ^oF for hours with their pets while waiting for $11 vaccines. The number of people who arrive needing care can be astonishing.

• Design for crowd control. If possible, have outdoor waiting options. Consider in/ out flow of clients at busy times of the day. Possibly use a crowd management option to limit the number of people in the lobby at any given time. Use examination rooms to move clients in and out of lobby spaces to control flow, even if the pet is taken back to treatment for care. In a perfect model, we would love to collocate a low-cost care clinic adjacent to a large classroom not only for outreach options but also crowd control (within the classroom) for large events such as vaccine clinics.

Considering a drive-through model.

Although this would not have been possible at Flatbush in Brooklyn, drive-through drop-off/ pick-up models can be useful in other parts of the country. It would be possible to manage crowds via a Jiffy Lube–style design, where spay/neuter clients could pull through enclosed garage bays to drop off their pets.

Optimizing surgery flow.

Surgery must be set up for patient monitoring and high-volume services. We design the following features into these surgical zones:

• A direct line between induction table and the surgery room, for direct flow into the surgical spaces, without having to turn or maneuver patients.
• Patients should be visible to technicians and doctors from the surgery and surgical prep areas.
• Benches and other recovery zones must be abundant, as many patients might be recovering at the same time.

Prioritizing safety.

Because low-cost clinics tend to be crowded, monitoring client behavior can become difficult. Ensure that there is a secure back-of-house zone that the clients cannot enter. Keep drugs securely locked up and out of view, including both scheduled drugs per law and expensive pharmaceuticals, such as flea and tick medications. Ensure that the lobby is designed for incidents, includes panic buttons for calling police, and has quick escape routes for customer service staff and clients.

Building a joyful space

Overall, helping pets whose families cannot afford care can be incredibly rewarding and important work. Spread your message and tell your story, just as Flatbush has done via its social media and design of their space. Bring in light, color, imagery, playful graphics, and other simple and inexpensive design elements to create a welcoming, inclusive atmosphere. Build the space with joy and spend less money during design and construction.

References
1. Burns K. Pet ownership stable, veterinary care variable. American Veterinary Medical Association. December 31, 2018. Accessed July 2, 2024. https://www.avma.org/javma-news/2019-01-15/pet-ownership-stable-veterinary-care-variable#:~:text=Americans%20still%20love%20their%20pets,visit%20the%20veterinarian%20in%202016.