You may think managing your construction project begins when you break the ground. However, this is a serious mistake, leaving you vulnerable to an out-of-control project. The decision to build or renovate must be based on a practice analysis of projected revenues generated based on services offered at a certain level. A percentage of these projected revenues will then be allotted to a mortgage payment, which will establish your initial project budget. This budget determines how much building, site, and equipment you can purchase for your project. Then comes the overall management of your project, which consists of numerous elements occurring in a logical sequence I call the “project schedule.” To help, I’ve organized each step into a series of phases.

In this phase, you will select your project team, establish your project goals and objectives, analyze your needs, finalize your site selection, itemize a budget, and develop a schedule with critical milestones. One of your first decisions is selecting an architect. Based on their level of experience with veterinary facilities, the architect will assist you in gaining your municipal site plan approval, your first “permit." They will develop your preliminary construction budget in more detail, analyze your space needs, and help select your engineering team. You must also investigate and select your financing option and develop your budget for practice-centered expenses like IT systems, signage, furnishings, equipment, and interest carry costs during construction.

A potential deal-breaking decision is site selection. Once you confirm demographics and size, the next hurdle is zoning. Sites not zoned for veterinary use will result in a time- and resource-consuming effort to gain a variance or change. Success is never guaranteed. You must retain a surveyor and civil engineer to develop preliminary site layout drawings, including grading and drainage, building location, setbacks, parking layout, utility connections, trash receptacle location, and any required landscaping, fences, or walls. Concurrent to these efforts, there must be a geotechnical analysis consisting of soil borings and tests to determine the soil's bearing capacity for foundation design. Poor soils result in expensive foundations that can exceed the cost of the site itself. Contingencies placed in your purchase offer can allow you to negate the purchase if any of these conditions are discovered, allowing you to locate an alternative site with minimal losses.

During this phase, your job is to review design solutions from your architect/engineer team and provide direction for them to complete the design to your satisfaction. As you go through the process, remember that your practice’s success has been largely a result of your unique practice culture. You must guard your culture as you make each design decision.

You will also begin a more detailed itemization of every piece of equipment to be integrated into the design. It is critical to make equipment selections early and not change them. Each specific manufacturer has differing dimensions, clearances, and infrastructure requirements. New modifications or waiting too long can increase the chance of installation issues leading to costly change orders.

It’s important to decide now which construction delivery system to use. Each system has different drawings, finance distribution, and contractor involvement requirements from this phase forward. They also have different advantages and disadvantages to consider:

: Often best used in renovations, the architect prepares preliminary design drawings from which selected contractors prepare construction budgets. The owner and architect review them with each contractor, and the contractor deemed best fit is retained. The contractor's job is to remain part of the team as the drawings evolve to completion, offering input to keep the job within their original budget projection.

: The architect and engineers prepare detailed construction/permit drawings and invite contractors to provide competitive bids based on the drawings. Typically, the lowest bidder is selected for construction. You will receive the final construction cost once the design is complete and bids are submitted. Bids over budget may result in project reductions or additional borrowing.

: The architect and contractor are a single team, offering both design and construction for a fixed price set by your budget. For predictable quality results, prior veterinary experience is crucial. A considerable advantage is knowing the construction cost at the project outset.

The architect and engineers will now prepare and submit all required documents and drawings for the building permit to gain final contractor pricing for construction. Your job is to familiarize yourself with all the drawings: architectural, structural, heating/cooling, plumbing, electrical power and lighting, and interior design. Your team should walk you through them. Remember, if it’s not on the drawings, you aren’t getting it. Contractors are only obligated to provide what is in the drawings.

You should also finalize your construction loan. This is an interest-only loan used to pay the contractor as they work on the building. The principal will be rolled into your permanent mortgage at project completion, but interest will be due each month at the current balance of funds distributed. It is critical you budget for this interest expense.

Once you have a contractor retained, your primary responsibilities are to understand and comply with the specific payment terms, review and approve materials/color submittals or substitutions, oversee the timely delivery of owner-furnished equipment, and review monthly contractor pay requests. Here is some key terminology to familiarize yourself with: 

: This is an itemized listing of each item of work, its total contract value, and the amount that has been paid to date.

: This is a bar chart illustrating the entire project duration, including each subcontractor’s time to complete their trade, from start to completion.

: Usually submitted on AIA form G702, an application for payment shows total contract value, payments made to date, and the payment due that month. The contractor, owner, and architect must each sign this document for the bank to issue a payment

 This is an amount of funds (typically 5%) withheld from each pay request until the final payment, for your financial protection.

: Each subcontractor should supply a lien release form with monthly pay requests indicating they have been paid and waive any lien rights for payment disputes.

: Change orders authorize a modification in the contract amount for work to be added or deleted. Change order requests should be preceded by a proposal request from the owner, or the contractor, asking for this change. Once approved, the change order form can be processed and signed by the owner, contractor, and architect.

: When the contractor is substantially complete, the architect prepares a deficiency list of items, or a punch list, to be corrected before final payment.

: Following the passing of all municipal inspections, the municipality will issue a certificate of occupancy allowing use of the building.

Can your practice afford to lose 40% to 60% of your personal productivity in the time it takes to construct your building? To help avoid this revenue loss, delegation is a necessity. If not you, then who should manage the time-consuming day-to-day tasks of managing the project? You could retain an outside construction manager who may bring construction knowledge but will not understand the nuances of you or your practice. This can, and has, resulted in onsite decisions that are not always best for the practice, or the project.

A more favorable option is to delegate project management to someone who understands the practice (eg, practice manager, practice administrator, or head technician). The architect can supplement this project manager’s practice knowledge with their construction knowledge to ensure everything is running smoothly while the practice still operates. This keeps you in production and informed on the project, and you will still be the final decider on all issues. Using your design team and a project manager allows you to maintain the practice and the project at the highest level.

Wayne Usiak founded BDA Architecture in 1986 to specialize exclusively in animal facility design. In 1998, he formed their sister company CMP Construction to offer construction services to their design clients. Over 900 facilities have been completed to date.

Articles

Planning, managing, and staying within your budget during construction can feel overwhelming. Consider these useful tips to help keep you on track for a successful project completion. 

How to manage your construction project while staying in business

As an industry professional, you do your best to keep your clinic sparkling clean. However, there is 1 particular situation that poses a unique challenge—the notorious leg lifters! Everybody knows that accidents happen, but whether the patient is large or small, urine of any kind is still extremely damaging to certain materials. Over the course of this article, we will share knowledge about why urine interacts so negatively with your floors, walls, and other areas. We will also provide tips, tricks, and methods for protecting your clinic from the damages of pet urine. Because let’s face it, when they’ve got to go, they’ve got to go!

Dog urine poses a significant threat because of its chemical makeup. Although all urine is primarily water (with inorganic salts and nitrogen-rich by-products such as uric acid and creatine), dog urine is much more concentrated. Did you know urine can even etch stone? The chemicals present in your pet’s urine are much more destructive.

To make things worse, urine can soak through wall and floor materials and get trapped out of reach of your cleaning efforts. Through absorption, it will penetrate the core of porous surfaces, and that is where the real problem begins. 

As urine breaks down and dries, it becomes more challenging to see, let alone clean. As the remaining water evaporates, a high concentration of ammonia is left behind, and a sulfur-containing chemical is formed, producing unpleasant smells. This high concentration of ammonia is a key reason to never use cleaning products also containing ammonia on affected areas. The scent will be familiar and lead your pet to believe that it is a “safe” place for them to leave their mark. Additionally, the uric acid in dog urine has a crystal-like structure that does not dissolve well in water. The crystals that remain after the liquid dries are why cleaning with soap and water alone will not resolve the issue. Traces of urine will be left behind.

Issues like these have led our architect design team to develop a useful design guideline we call the “pee line,” which is an imaginary line we use to indicate the worst-case scenario height for these leg lifters. It takes into consideration where urine can reach for any size of dogs, from Chihuahua to Great Dane. In our experience, the pee line occurs over 1 m above the floor, and all finishes below it need to be selected, installed, and maintained to be durable and washable enough to withstand damage from urine.

If a furry friend does decide to urinate at an inopportune time and place, there are some products we recommend using for cleanup. A water-based grout residue remover is ideal for keeping tile floors and natural stone looking stain-free and polished. It gets into those hard-to-reach crevices where urine is likely to get trapped and keeps them looking haze-free. These products are ideal for both epoxy and cement-based grouts and will keep the tile itself looking shiny and clean.

Another option is a heavy-duty alkaline floor cleaner that eliminates tough stains and protein-based build-ups, especially on textured surfaces such as epoxy floors. These products are safe to use and go above and beyond to prevent stains from ruining your finishes.

Now that we have covered the cleanup process, we will discuss some material options proven to be reliable and able to withstand urine and liquid stains of all kinds. 

As discussed above, one of the most common problem areas for pet stains is the floor. We recommend using a more durable material, such as epoxy, porcelain tile, or sheet vinyl, especially in high-traffic areas. In addition to choosing the correct materials, it is just as important to seal and install the products correctly. This will lower the absorption rate and make floors more resistant to urine and other fluids, including cleaning supplies.

Keep in mind that the pee line concept extends above the floor, so it is also crucial to consider what is applied on cabinetry and other vertical surfaces. Plastic laminates are a good example of a cleanable material that most hospitals use for exam room cabinetry. When laminates are properly cleaned and protected, uric acid crystals will not be left behind to erode the material and peel away the edges and corners of surfaces. In high traffic or wet areas, metal or hard plastic corner guards can be placed on the edges to shield and better hold the material in place, keeping your area looking new over a longer time period.

There are some materials to avoid using altogether. Porous surfaces like carpet can absorb and trap fluids within the fibers and allow them to spread underneath, producing unwanted odors. Liquids move from wet to dry regions and, perhaps surprisingly, surfaces as seemingly hard as concrete and brick contain pores that confine excess liquids. When these porous materials get wet on one end, the pores begin filling with that liquid and spread throughout. Our recommendation is to stick with nonporous materials, like porcelain tile, solid surface products, or plastic laminate wherever possible.

The world of veterinary design is changing and progressing every day. We hope we can offer insights to help empower you to make the most informed decision for your practice. With an understanding of available materials and how they will perform, it will be easier to keep your clinic looking, lasting, and smelling brand-new for years to come!

Started in 2000 by Rick Renschen, MD Architects has presence from coast to coast with a national portfolio of animal care, human care, and commercial projects. The company is actively registered in 35 states and has a running list of upwards of 180 animal care projects across the country.

Running a clean clinic is the dream, but it can be hard to maintain in a pet-friendly space. Here are a few design strategies to help keep the workplace glistening. 

How to plan for the"pee line” 

I studied chemistry in college and distinctly remember the chemistry building on campus, which was built in the late 1960s, as the nadir of academic building design. This building was brutal, loud, poorly ventilated, and downright inky when the electrical systems failed, which was more frequent than one might imagine. The building had 30-inch hallways and not 1 handicapped-accessible bathroom.

Fortunately, the buildings of today are friendlier than their late modern ancestors. Spaces must accommodate anyone with a physical disability, and they must be healthy to inhabit. They must have windows, code-required ventilation, enough ambient lighting to perform tasks, and fire alarm systems. But there is still a lot of work to do. In honor of horrendous chemistry buildings of the past, let’s explore designs for a more comfortable future when veterinary practices pose far fewer barriers to clients, staff, and doctors.

Architecture used to be a male-dominated profession, and I was the first woman in my office to have a baby. I started a mini baby boom! For a while, 3 mothers were trying to figure out pumping schedules in the single occupancy bathroom, and sometimes, we had to be in there together (which was certainly one way to get to know my coworkers). Perhaps this description is a bit uncomfortable to read, but for those ladies out there who have had to endure absurd accommodations to be both working and nursing mothers, it is time to push for better solutions. Creating a safe, healthy, and family-friendly workspace is one way to retain staff. In fact, lactation areas are now required by law, particularly for practices that employ more than 50 individuals. From a practical standpoint, here are some rules of thumb for providing these types of spaces in veterinary practices:

These spaces do not have to be large, but they do need to be large enough to accommodate a chair and an employee who has a disability.

It is best to provide a refrigerator, so a staff member does not have to put her breastmilk in the break fridge as this is awkward and unsanitary.

If possible, adding a small sink is very important. A sink is essential for handwashing and keeping personal items clean.

The main benefit of gender-neutral bathrooms is that they can accommodate individuals with diverse gender identities. No one should have to think about issues relating to bathrooms when they are attending to professional tasks. Modern plumbing codes allow for different interpretations of how many men’s, women’s, and gender-neutral restrooms are provided. Have an architect talk to the building official about the special requirements of veterinary hospitals and have them pitch interpretations of bathroom designs that make sense. I have never failed in approaching this topic proactively with building inspectors. They will not grant special favors for deleting life-safety requirements such as proper exits or fire alarm systems, but they will listen to reason on bathroom design.

Veterinary medicine is currently one of the least racially diverse professions and many communities of color may have less access to reasonable and affordable veterinary care. The sooner we can talk openly about these concerns, the better we can take care of people and animals for the health and well-being of communities. From an architect’s perspective, here are some of the first steps that can be taken to create open, inclusive, and respectful environments:

Ensure that the architecture feels open and welcoming. For example, a front desk that feels like a barrier will be perceived as such. 

Provide multilingual signage as needed for your community of clients.

Find ways for the building to support the community. Within your budget, provide learning spaces to support children, students, interns, hospital staff, and veterinary colleagues. Partner with schools, churches, and other community groups. A good way to do this without breaking the bank is to provide a space within your lobby that can be converted after hours or on weekends for educational purposes.

I have had the fortunate experience in my life of caring for many older family members, beginning with my grandfather, whom I loved so dearly, and with whom I stayed frequently with while in college. He was a big man and a World War II veteran, and as he aged, there were fewer things we could do together, mostly because buildings were not accommodating to him. Most of them were too harsh, too loud, too startling for a veteran, too cramped, and too hard to move around for individuals like him. Let’s consider designing buildings that are better equipped for folks like my sweet grandpa, as well as for older or more physically constrained veterinary staff members. Here are some ideas:

Enlarge some parking spaces so it’s easier to park and the parking lot is less of a barrier. Deliberately exceed the code if necessary to provide some easy-to-use spaces near the front of the hospital.

Make the front entrance simple. Doors should be wide and easy to operate. You can use a handicapped operator on the doors if you want but use 2 sets of doors that open at different times if you use this feature, so pets do not escape.

Furnishings should be easy to sit on and not too deep or low. 

The ceilings should have a high noise reduction coefficient to reduce reverberation. 

Ensure the restrooms are handicapped accessible with the right type of grab bars. It is very undignified not to be able to get off a toilet. 

Light spaces evenly to reduce shadows and make everything easier to see.

For older veterinarians and staff, consider the following: 

Lift tables to reduce the need to bend and lift. I know an older veterinarian who uses her lowered lift table to sit on so she can be near the floor and pet without sitting on the floor. 

Provide ergonomically adjustable stools and tables. Of particular importance is the dental procedure table, which can be spectacularly hard on a body if it is not adjustable. Therefore, I prefer adjustable dental tables, even though they can be more expensive.

Use good procedure lights. Double lights are important for surgery spaces as they reduce glare and shadows. If your practice is old, consider upgrading your lights; the new LED ones are so much better.

Consider kinder flooring for your staff. A sheet rubber floor is not only softer to stand on, but it is slip-resistant for both your clients and their pets, which is a huge bonus because it helps reduce fear, anxiety, and stress for patients.

As with most brainstorms I start, I have a hard time finding a place to stop. There are so many opportunities to design and build veterinary hospitals that are so much kinder, inclusive, community-oriented, family-friendly, and more accommodating. If we begin with the idea that the hospital building should not be a barrier for anyone, that it should in fact be the opposite, imagine what we can do together for people, pets, and our communities.

Heather Lewis is a principal with Animal Arts Design Studios. In her more than 20 years with the firm, she has designed hundreds of projects for the care of animals, including veterinary hospitals, animal shelters, and service dog facilities.

Break down the barriers of the past and take these design suggestions into consideration to create a more inclusive, community-oriented environment for your staff, clients, and patients

Design without barriers

To say the past year has resulted in major changes in veterinary operations would be a dramatic understatement. Practices have evolved and grown during the COVID-19 pandemic. Although there were likely some growing pains, some changes will also serve veterinary practices well into a more normal future.

Imagine a nearly empty lobby with no scared cats meowing or barking dogs at your reception desk. You’ve learned that people can wait in their cars or outside until you and the exam rooms are ready. Consider adapting the restaurant approach of texting diners when their table is ready and text clients when their exam room is open. Creating more opportunities to keep your lobby calm and stress low will help improve your staff and client interactions. Less crowded lobbies allow for greater species separation too. Whether you are renovating or expanding your practice, look for ways to include exam rooms with outside entrances so clients and patients can enter and exit directly to and from the parking lot or covered, outdoor waiting areas.

Another way to keep your lobbies calm and improve your customer experience is to expand curbside services. Think about minimizing reasons for people to leave their cars, and then consider reducing reasons to enter the lobby. Can you meet people at their vehicles for pharmacy pickup? There may be an opportunity to install a slider window like drive-through restaurants or human pharmacies at your facility, which would make handoffs even easier. Surgery drop-offs don’t always need to involve clients bringing their animals in the front door; it might work better if they meet you at the back of the building if that’s closer to preop and postop holding. Basic oral medications could be given to patients outside. No one enjoys transporting feces through lobbies, so look at outside handoffs for fecal samples. Implementing more curbside or drive-through services will enable you to keep your lobby and public spaces peaceful and less stressful for the pets who do spend time there.

Both human and animal medical fields have grown their telemedicine services over the past year. Although many veterinary services are best provided in person with the animal appearing in front of your team, there are a few areas that can be kept virtual such as: 

Incorporating telemedicine provides the ability to share and potentially downsize offices and charting spaces. Although this may not always be popular, it can be a great strategy if you’re rapidly outgrowing your space. Additionally, virtual consultations can be a good first pass when dealing with fearful or overstimulated animals, especially if they dislike car rides.

It appears the whole world has recently learned how to properly wash their hands. Let’s keep up the handwashing. Don’t ditch your sinks so you can collectively continue to have better hygiene and minimize fomite transmission. If you plan to replace plumbing fixtures, go touchless wherever possible to avoid turning faucets on and off with dirty hands. Soap and paper towel dispensers are also more sanitary when they are touchless. Consider retrofits for doors like foot-operated restroom doors, so people don’t have to touch dirty handles just after washing their hands. You can also retrofit wireless push buttons and automatic openers on doors at key locations in your facility.

Veterinary hospital design has focused on air quality in animal-occupied spaces, ensuring that medical spaces are pressurized properly and that odors in animal zones are properly managed. Over the past year, the world has also learned how important good airflow can be in human spaces too. Indoor-outdoor spaces can be a great asset in many areas. Exam rooms connected to the outdoors can also be more psychologically comfortable for your staff and clients—especially if you open windows and bring in fresh air. 

Try not to neglect your staff spaces either. Connecting break rooms to the outside is beneficial for many reasons. Humans thrive in spaces with natural light, so even if your treatment areas are inside and lack windows, providing break rooms with outdoor access will benefit your team. It’s even better if you can open your break space windows or install sliding doors or a garage door.

Over the past year, everyone has faced incredible challenges and adapted in innumerable ways. Although there are many things we would all like to put behind us, it’s important to reflect on the changes that improved operations and preserve the innovations that worked well so you can continue to grow your veterinary practice. 

Sarah is a principal with Animal Arts Design Studios, an architecture firm dedicated to designing spaces for the care of animals. In her years with the firm, she has worked on dozens of projects.

The pandemic brought abrupt change to the practice of veterinary
medicine. Here’s why and how these adaptations can actually advance
the future of your veterinary practice.

COVID-19 keepers: Practice design changes that should stay

It’s no secret that emergency veterinary cases are highly tense situations, particularly when an ill patient is being rushed through your doors and transported to an appropriate treatment space. Accompanying them at these times are frantic owners, leaving the team dashing around trying to put out all the fires. If the layout of your hospital is insufficient for these hectic scenarios, it can create a very stressful environment for everyone involved. However, by incorporating a few simple design concepts, you can help mitigate these stressors and increase efficiency and productivity for emergency cases.

It starts from the moment a client pulls into the parking lot. Upon entering your site, they should be able to spot and read clear signage that directs them to the correct parking spot for unloading. Remember that owners are often rushing and stressed when their pet needs emergency care and the last thing they want to do is search for the emergency department. The quicker they can read your signs and get to the correct area, the quicker you can begin medical treatment on their pet.

The signage should also be well lit and bright in both daytime and nighttime settings. It should be easy to read with large letters and clear, concise messages. The color of the sign should be bright and bold, and contrast with whatever background you’re using. The most common design typically includes a red sign with white letters that says, “EMERGENCY.” The color red itself has psychological associations with feeling high risk and needing urgent attention.

Finally, the placement of the sign is important. It should be highly visible and clear of obstructions so that clients don’t miss it. A couple of good placement options for signs are either up high on the building or a monument-type sign as people drive in.

Allocating a designated drop-off area for emergency cases is essential for emergency practices. It gives clients a place to stop and unload that is conveniently located near the entrance to the hospital, and it prevents people from having to park far away and potentially carry a large, immobile animal from their car to your front door.

Drop-off spaces can be as simple as 1 or 2 designated parking stalls near the entrance, or they can be as extensive as a porte cochere covered drive-through right by the front door (like a hotel where people temporarily park while they check in to their rooms), where clients can temporarily park while they bring their pet inside. Again, whichever you choose should be clearly labeled with easy-to-read signage.

If possible, designate a workspace for staff members to greet emergency cases as they arrive. For many of my emergency hospital projects, I often design larger than normal entry vestibules to allow greeters to be stationed just inside the first set of entry doors. These greeters will often have a small kiosk or desk that they can sit or stand at in between drop-offs, and large windows surrounding them to clearly see as clients pull up. There is also a space for a gurney to be parked nearby that greeters can quickly grab when they need to run out and help a client with their pet.

Emergency greeters are often perceived as an added level of care to pet owners who might not know what to do in emergency drop-off situations. The greeters are there to immediately respond to the pet owner, helping their pet get the attention they need, answering questions they might have, and directing them to the correct place to go before they’ve even entered the front doors. It’s a hospitality-type service that goes a long way in making pet owners feel more comfortable and taken care of.

Once an emergency case has entered the hospital’s front doors, it’s imperative to get them to a treatment space as quickly as possible. The path from the front door to the treatment area should be straight and direct. If the path to a treatment space is inconvenient or too long, it can cause unnecessary delays. There should be minimal corners and turns to navigate, as well as minimal doors to open and close. The width of the hallway should be wide enough to allow for a gurney and 2 people on either side to easily pass through; 5 to 7 feet wide is typically a good rule of thumb. Some other beneficial features to include in emergency hallways are automatic door openers to quickly and easily open doors when passing through and wall guards or bumpers to protect the hallway walls from rushing gurneys.

Triage exam rooms are the first response station in emergency hospitals. They are essentially a special-use exam room that serves as the first stop for emergency care. Clients will often accompany their pets into a triage exam room along with a doctor. These rooms give the doctor a private space to evaluate the severity of the situation, provide immediate medical treatment if needed to stabilize a patient, and discuss options with the client for how to move forward.

The difference between triage exam rooms and standard exam rooms has to do with the way they are outfitted. For example, triage exam rooms generally need more cabinetry than standard exam rooms because they need more storage for treatment supplies like intravenous equipment, syringes, bandages, and more. They also typically have a gurney or rolling table as the exam surface instead of a fixed or folding exam table to allow for mobility, and there is often more open floor space for emergency-type equipment such as crash carts. Some veterinarians also choose to incorporate medical gases into triage exam spaces such as oxygen.

Obviously, getting an animal from a client’s car to a medical space is just the beginning of emergency veterinary care, but it’s arguably one of the most important steps to ensure successful treatment and satisfied clientele. If you can ease the stress of those first few moments in emergency cases, you can set the tone for the entire emergency experience.

As the Director of Design with BDA Architecture, Becky Gasser has more than 10 years of experience designing animal care facilities across the United States. Passionate for both animals and architecture, she has been the lead designer on several award-winning veterinary hospitals.

Curtail stressors, increase staff productivity, and enable smoother transitions from the client's car to treatment spaces using these design concepts.

Hospital Design360 June 2021

How to manage your construction project while staying in business

How to plan for the"pee line”

Design without barriers

COVID-19 keepers: Practice design changes that should stay

Designing for emergency cases

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