Wide open spaces

A consistently bad local economy and extended practice hours made staffing a headache for the doctors at Town and Country Veterinary Hospital in Warren, Ohio. Operating out of an old gas station and bursting at the seams, the owners knew they needed to make some changes to the design of their hospital. But they wanted to make sure they did it right, and that takes time.

Leave the light on: The overhang and drive-through entrance allow clients to feel safe when entering this extended hours facility at night. It also protects clients from the brutal winter weather in Ohio. (Photos by William Webb, Infinity Studio Photography)

"Our practice faces constant financial pressure from local steel mill closures, manufacturing plant bankruptcies, and a declining domestic automobile industry," says practice co-owner Dr. Charles Moxley. "During my first trip to the Veterinary Economics Hospital Design Conference, it became immediately obvious that careful attention to design would allow a hospital to operate efficiently with a minimum of staff members."

Floor Plan Town and Country

Dr. Moxley and his team decided to stay put in the short term, devising a plan that allows them to operate extended hours with only eight veterinarians and two to three fewer staff members than a normal hospital of this size would need. This allowed the practice to save money while planning for a future facility. In addition, the team had the framework for operating on this schedule in place before moving into a larger facility—a key to their success, Dr. Moxley says.

Treatment: The heart of the hospital, the treatment area was given special consideration by the hospital's owners, who planned for separate functions while maintaining ease of communication. Visual contact between the treatment area and the surgical center (below) helps the team maintain communication.

But eventually it became clear that their small, outdated building wouldn't cut it. So Dr. Moxley and his co-owners ramped up the planning process for building a new facility. The entire project took 10 years from start to finish, but when all was said and done, Town and Country Veterinary Hospital had a large, inviting place to call home.

Surgery: The surgical center was grouped with prep, radiology, and recovery areas to prevent the overlap of outpatient services within the treatment area. This helps to maximize the open feeling of the hospital's floor plan and reduces the number of doors the doctors and team members must pass through.

Maximizing space, minimizing steps

A key part of Town and Country's strategy for using fewer staff members is that everyone is able to see everyone else at any time. With the open floor plan, visual contact is possible from practically everywhere in the hospital. "If we have needs in a certain area, staff members can move to those needs rather than be sequestered," Dr. Moxley says. "Now when I have time on my hands in back, I can see where I'm needed and move there. From dead center of the hospital, we're only about eight steps from anywhere."

Waiting area: Receptionists have full visual command of client-accessible areas, including client hallways, while maintaining direct communication with the heart of the hospital. There are virtually no points in the building, except in the exam rooms, where clients encounter the doctors.

Specific design features support this plan. For example, the doctors' hallway, created in a wide L-shape behind the open reception area, doubles as the pharmacy. Doctors have easy access to the exam rooms, pharmacy, and treatment areas behind the hallway, as well as direct access to receptionists—without needing to pass through client areas en route. In addition, staff members can see across the treatment area, from exam rooms and pharmacy all the way to the surgery suite and radiology room, making their trips more efficient and allowing them to draw on other team members for help as needed.

A look at the numbers

One of the best parts of the move, Dr. Moxley says, is that the team didn't feel the growing pains that many teams feel in new facilities. As Dr. Moxley puts it, "We built the practice before we built the facility." "We did what most people do, only backwards," he says. "Our decisions were based on economics, so we finished on time and under budget. How many people can say that?"

Exam room with ultrasound: This exam room functions as a multipurpose room, facilitating routine outpatient appointments, surgical admissions and releases, and ultrasounds.

Planning for profit

Dr. Moxley and the hospital's co-owners are happy to report that focusing on their in-house laboratory and crematory has paid off handsomely. Because the hospital sees a high number of emergencies and referral clients, the doctors chose to focus on in-house lab services.

Euthanasia and special exam room: This quiet exam room is often where euthanasias are performed. The exit allows grieving clients to leave the hospital without walking back through the reception area.

With the move, the doctors have expanded their microscope facilities, improved their chemistry machinery, and added a higher-capacity CBC machine. The open floor plan and pass-through design allow a single technician to manage hospitalized- patient samples, surgery samples, exam rooms, and drop-off samples.

Staff break room: In the break room, team members and doctors can take a break for lunch or just relax. The space can comfortably accommodate a large group for team meetings or get-togethers.

"Our lab represents 13 percent of our gross revenue," says Dr. Moxley. "We suspected we would be doing more in-house services when we moved and we have. In 2006, the lab generated more than $255,000. We keep two or three staff members employed off of this revenue alone. Because of this success, the lab earned a central place in our design."

Staff patio: Out here team members can enjoy a nice day and eat lunch. An overhang protects the space from the elements.

The crematory business has also fared well, with an average of 100 cremations per month. The hospital generates more than $40,000 in yearly revenue from the crematory business, which nets more than 50 percent after equipment costs. Town and Country Veterinary Hospital features the only in-house crematory in the area, and clients appreciate the service.

"Our decision to capture the crematory business was part of the construction plan," says Dr. Moxley. "We're now able to give our clients peace of mind that their pet's remains will be cared for with respect."

Involving the team

Town and Country Veterinary Hospital eventually became the hospital it needed to be. But it wouldn't have been nearly so great without the involvement of all team members. "My biggest piece of advice to those who are building a new hospital is to be smart enough to know that you don't know everything," says Dr. Moxley. "Your technicians, receptionists, and other staff members have something to teach you, and you need to listen."

In this spirit, Dr. Moxley posted a draft of the floor plan in the lunch room at the old building. He asked staff members to make changes and suggestions. What resulted was an abundance of great ideas: three communication terminals for receptionists, a view of reception from the office, cage design suggestions, the layout for the surgical suite, and placing laundry facilities next to the isolation area so dirty laundry from isolation would never cross through other care areas.

"In our practice, form definitely follows function," says Dr. Moxley. "I think that makes our practice so efficient. My hope is that other practitioners can see our practice and say, 'That's how I want my practice to work.'".

Sarah Moser is a freelance writer and editor in Lenexa, Kan. Please send questions or comments to ve@advanstar.com.