Imagining the future clinic

Veterinary Economics | HospitalDesign.net

By Wayne Usiak, AIA

At age 10, my friends and I thought we'd be driving flying cars by 2000. We never envisioned laptop computers, the Internet, or virtual reality. Now the flying car seems absurd, and computers are commonplace. There's a lesson here: When predicting the future, practicality always wins.

As you imagine the future of veterinary medicine, don't focus on gadgets. Instead, concentrate on taking your service to a higher level. Consumer surveys show that Americans want value, choices, convenient locations, extended hours, one-stop shopping, no waiting, friendly staff members, and a pleasant environment. In addition, image-conscious clients have made the quality of facilities a priority. To succeed in the next millennium, practices must assess clients' needs and deliver what they want.

As Yogi Berra said, "The future ain't what it used to be." Just as there's no standard "hospital of today," you can't imagine an archetypal hospital of the future. Industry dynamics and evolving practice philosophies will continue to influence hospital design. For example, the decline of such traditional income streams as vaccines forces doctors to rethink their focus. Such advanced technology as telemedicine and laser surgery lets veterinarians offer progressive treatments and services. And as corporate practices continue to grow, new ownership options are affecting practice size and organization. Future facilities will reflect these changes. While there's no clear-cut route to success, identifying trends can help you choose a direction to pursue.

Building value perceptions

As clients' expectations rise, veterinarians must evaluate their professional goals and market conditions to stay competitive. Here are three hospital concepts that help leading-edge doctors make their practices more valuable to clients:

Referral hospitals. Ranging from single-discipline specialists to multispecialist referral centers, these facilities have sprouted up nationwide during the last five years. Referral practices give specialists flexible ownership options and the opportunity to support area practices. By adding critical-care services, some referral hospitals provide 24-hour coverage, maximizing the efficiency of their facilities.

At The Veterinary Referral Center of Colorado in Englewood, Colo., 17 doctors offer cardiology, dermatology, internal medicine, neurology, oncology, ophthalmology, surgery, and emergency services. The 13,000-square-foot main floor contains 15 exam rooms; a two-story reception area; oncology/chemotherapy, endoscopy, ultrasonography, hydrotherapy, radiology, and fluoroscopy suites; a four-room surgical suite with two prep stations; and a six-station treatment room with an eight-doctor workstation area and three recovery/ ICU cages. Two staircases and an elevator lead to the 6,000-square-foot upper level, which features a regional reference lab, 40 offices, a library, a staff lounge, and a 500-square-foot conference and training room.

Pet-care centers. Also called one-stop shops or mega-practices, these facilities feature a full-service veterinary hospital as well as such ancillary services as boarding, grooming, retail sales, training, adoption, holistic and natural therapies, health clubs, and day care. Sayrebrook Veterinary Hospital in Sayreville, N.J., follows the pet-care center model. Besides six exam rooms, two surgery suites, a two-station dental suite, an in-house lab, and a four-table treatment area, the 12,781-square-foot facility features boarding, a bathing room, a grooming studio, cat and dog adoption centers, and a retail area.

Boutique practices. To carve a unique niche, veterinarians can develop expertise in a specific area and cater to clients with special needs. Feline, avian, exotic, and emergency practices are gaining popularity. Some general practices are adding specialists to create new profit centers. A companion animal practitioner may gain recognition as the "hunting dog veterinarian," attracting clients from far outside his or her normal practice radius. Doctors also may develop such special interests as holistic medicine or acupuncture.

Because she covers emergencies two nights a week and works days as a relief veterinarian, Dr. Jill Roberts-Wilson doesn't have a regular practice facility. Nevertheless, she built a loyal clientele by offering a mix of homeopathy, chiropractic care, and Western medicine. To see her clients, Dr. Roberts-Wilson arrives a few hours before her emergency shifts begin at hospitals in the Sacramento Animal Medical Group in Sacramento, Calif., winner of a 1996 Practice of Excellence Award, co-sponsored by Pfizer Animal Health and Veterinary Economics. About 50 pet owners follow her from hospital to hospital and refer friends. Dr. Roberts-Wilson doesn't seek new clients; they pursue her for alternative treatments.

Increasing client comforts

To provide a convenient, comfortable environment that attracts clients, future hospitals will offer more amenities. Concierges who greet clients and offer refreshments may staff reception areas. Play areas will keep children entertained. Exam rooms will enlarge to accommodate more technicians and veterinary assistants and will feature new diagnostic equipment, computers for client education and discharge, and comfortable seating for extended visits. During surgery and treatment, clients will wait for pets in private lounges with viewing galleries. Aquariums, specimens, computer centers, and "Case of the Month" displays will provide "edutainment" for pet owners. To strengthen the human-animal bond, hospitals will include rooms for grieving/euthanasia and visiting hospitalized pets.

As clients' expectations rise, so will staff members'. Large practices will boast child-care facilities to attract and retain key employees. Offering extern apartments can attract veterinary students and contribute to new-staff development. In addition, some states' overnight-care requirements may dictate on-site caretaker facilities. Both types of on-site living quarters will aid hospital security.

Technology will enhance clients' and staff members' convenience. Computers and telecommunications will probably affect the profession more than medical technology or new procedures. With computers in many clients' homes, hospital Web sites will become increasingly important. Clients will use the Internet to buy pet food, make veterinary appointments, learn about preventive care, and e-mail doctors. Such accessibility will increase most practices' radius beyond the national mean of 5.4 miles. In addition, veterinarians will use telemedicine, teleconferencing, and online continuing education to bring advanced medical procedures and expertise in-house.

Imagining the future

To provide a comprehensive overview of a future hospital, I've imagined a veterinary visit in 2005. Client Bob Johnson finds Woodmont Animal Clinic on the Internet while researching trainers for his two German shorthaired pointers. Practice owner Dr. Ray Cummings shares Johnson's interest in bird hunting and regularly posts tips on the hospital Web site. Johnson takes an online hospital tour, selects an appointment time for his 10-week-old puppy, and chooses a boarding plan for his 1-year-old dog, which he also enrolls in an introductory two-week training program. From Johnson's one-time Web site visit, Dr. Cummings gains two office visits, an ovariohysterectomy for the puppy, training classes, and two weeks of boarding.

While searching the site, Johnson notices a cat icon and clicks it for his wife, Sue, who has two Siamese cats. The Johnsons learn that Dr. Cummings' partner, Dr. Sharon Smith, specializes in cats and birds and posts behavior tips for certain feline breeds. Because Sue Johnson worries about the older male cat's health, she clicks on the query icon and types a question. The next afternoon, Dr. Smith e-mails an answer and invites Sue Johnson to the clinic for a tour. She likes the no-pressure invitation and decides to accompany her husband when he takes the dogs to the hospital.

When the Johnsons arrive with their 6-year-old daughter, Kim, a concierge describes Woodmont Animal Clinic's four lounges and suggests Bob Johnson wait in the Lodge Room, which features photos of hunting dogs, a display of antique decoys, and a touch-screen video of training options, program descriptions, and demonstration tapes. The concierge directs Sue and Kim Johnson to Catland, a cozy nook where they can see Dr. Smith's 20-year collection of cat iconography and view the glass-enclosed cat boarding and play area.

A few minutes later, a technician begins the tour in the hospital's child-care center. A large window lets waiting clients watch children play. The technician introduces Sue Johnson to the full-time child-care professional while her daughter plays with the other clients' and staff members' children.

Meanwhile, in the Lodge room, Bob Johnson's dogs lie by the fireplace while he looks at the photos, antique decoys, and video display. He's almost disappointed when a technician leads him to the exam room before he's seen everything.

The 10-by-10 exam room seems larger because the only cabinetry is the sink cabinet and a bench seat along one wall. A 4-foot-long, wall-mounted folding exam table electrically lowers to the floor or rises to one foot above waist level. The table's rubber-coated surface is durable but gives slightly under weight, preventing pets from sliding. Dr. Cummings raises the table to examine the puppy and then folds it away, preferring to examine the adult dog on the floor. A technician takes digital photos of both dogs from four angles. Throughout each exam, Dr. Cummings explains what he's checking and its condition, and a voice-activated recorder translates his exam notes to the main computer. A technician carries the puppy to the pre-op ward. After Dr. Cummings and Bob Johnson chat about hunting dogs, a technician shows Bob Johnson the training center and Club Suites where the adult dog will board.

Each glass-front suite contains a raised grate floor and window looking outdoors. A light switch changes the glass run door from solid white to clear. Only soft, pleasant music is audible, and the technician explains that special sound-absorbing surfaces coupled with a reverse-frequency white-noise system prevent sound transmission.

The technician escorts Bob Johnson to the transaction desk, where he meets his daughter and wife, who rave about the cat facilities. The receptionist inserts a CD and prints a copy of the exam report cards and the dogs' photos with weights and measurements. Then she hands the Johnsons a binder explaining hospital services. The receptionist tells Bob Johnson he can see the training class, view the dog in its suite, and even watch the puppy's surgery on the hospital's Web site. And staff members post recovery notes on the Web site every two hours. After just one visit, the Johnsons know they've found the best possible care for their four-legged family members.

This combination of high-tech and high-touch services will influence the hospital of the future. Practice owners will respond to clients' higher expectations with new amenities, services, and treatments. Meanwhile, leaps in telecommunications and computer technology make client communication easier than ever. Designing the ideal veterinary hospital of the future is up to you. Explore your special interests, brainstorm ideas, and ask for clients' input to help you create a timeless facility that offers the best medicine.

The author is principal of Wayne Usiak and Associates/BDA Architecture P.C. in Albuquerque, N.M., and a Veterinary Economics Editorial Advisory Board member. He speaks at Veterinary Economics' annual Hospital Design Conference and veterinary conferences nationwide. You can reach him at [email protected]

Summer 1999 Veterinary Economics