A mission, vision, and set of core values weave together to create a strong framework for any organization or business. By defining their view of these 3 concepts, a practice can identify a purposeful path forward. With all your staff focused on the same point on the horizon, they can excel at their positions because they understand the contributions they are making to the practice’s goals. This momentum can invigorate everyone and ultimately enhance the care you provide, which benefits your patients and clients.

The inception of many veterinary hospitals starts with a unique driving force or passion that propels the owners to take the risks required to establish a practice. This underlying objective often gets lost in the day-to-day grind or covered up by a long, successful history. Identifying the core mission of any practice can bring the team back to a clear direction.

From a design perspective, one way to keep the focus on your mission is to put it on a statement wall. Painting a fun graphic with the mission, or etching it onto glass or metal, adds visual interest to your space and remind clients and staff every day of the practice’s purpose.

Vision is your dream for the future of your practice

The vision is where the butterflies live. When you think about the future, a dream ideal, what does that look like for your practice? Once you feel those butterflies in your stomach, you’re usually on the right path. The mission articulates the purpose of the practice, but the vision opens the exciting possibilities to come if everyone stays focused on the same goals.

A fun way to incorporate your vision into the physical design of your practice is with artwork. If your vision is to create an enjoyable, approachable environment for your staff, clients, and patients, show it with the pieces you choose for your walls.

Maybe your vision is to train the next generation of veterinarians. You could make the treatment space transparent and open to the rest of facility so that staff, students, and visitors can observe the work firsthand. You also could incorporate a space within your hospital to host trainings and lectures.

Core values are beliefs and ideals that pave the way

The core values are where the personality of your practice can shine. Does everyone love to have fun at the hospital? Is the team adaptable? Are you dedicated to helping everyone have a fulfilling work/life balance? Identify 3 to 7 core values and start shaping the culture of your practice.

Once the core values are established and communicated to the team, they can be utilized throughout your practice, such as in the employee review process, interview process, daily workflow strategies, and hospital design.

If creating low-stress environments for animals and individuals is a core value, make sure your exam rooms are large enough to be comfortable for floor exams and provide space to separate species as much as possible. Good communication might be a core value. This could be achieved by dedicating multiple surfaces to screens that provide live statistics on patients, available exam rooms, or staff on the shift.

If the culture is focused on supporting staff, explore ways to make the staff areas functional and comfortable. Do the doctors need a private, quiet location to make calls? Does the staff need a relaxing place to decompress after a stressful situation? Explore how to create the right spaces for your staff so they can be at their best.

Bring those core values to your architect so they can be integrated into the aesthetics, space planning, and technology of your building. If the hospital embraces your core values, it will be easier for the staff to pick up on them and in turn endorse the culture and your vision.

Maybe one of your core values is to push past current norms. We are seeing teams provide outdoor exam spaces as a supplemental clinical area. If you are exploring new techniques or procedures and this is a practice goal, plan spaces for these activities. If your techniques are always morphing, focus on flexibility. Room dividers, moveable casework, and casters for caging are all options for keeping rooms flexible based on current use.

In the end, it comes down to your organizational goals. By identifying your mission, vision, and core values, you will have a clear path for your practice and a solid foundation for your design conversations. Starting the process with these important concepts will allow your design team to get creative with the aesthetic, programming, and flow. Your hospital then can support the concepts that drive, motivate, and invigorate your day-to-day operations.

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Identifying organizational goals defines a clear path for a practice and lays a solid foundation for design conversations

Establishing a strong framework

The health of humans and animals is tightly interconnected with their environment. In health care, collaboration between care teams and architects is changing the way hospitals are designed and constructed. We believe fostering collaboration between animal care teams and architects will lead to improved hospital and animal care facilities design, enhanced client experience, improved animal welfare and outcomes, and lower costs.

Human, animals, care teams, and the communities where hospitals are located all are part of a complex system that influences the equilibrium between health and disease. Social design refers to the pattern of these relationships, including those that are invisible and intangible.

Social design also addresses the needs of the whole community or society and is reimagining the role hospitals play in the health of inhabitants.

In a hospital environment, the building and spaces in which patients seek care have a significant effect on clinical outcomes, the experience, and costs of care. Infectious disease prevention is one area where improving design has a significant effect in decreasing health care–associated infections, thus improving outcomes and decreasing costs. This holds true for veterinary hospitals as well, where nosocomial infections can negatively affect revenue, clients’ confidence and outcomes, public image, and staff morale. By implementing a layered set of strategies based on overall hospital layout, improving the flow of staff and patients, and adding natural ventilation and air decontamination systems, infectious disease transmission risk can be minimized.

Although the relationships between environment and health are complex, constructing a functional hospital is not difficult. Some strategies matter more than others in creating a healthy environment. They include the following:

 The location and type of sinks and automatic hand sanitizer dispensers can improve hand hygiene and lower the spread of hospital-acquired infections. Hand sinks must be convenient and well-designed to be effective. Consider new touchless technologies.

 A hospital’s level of clutter is tied to its ability to maintain health and well-being for patients. Not only does clutter interfere with cleaning and increase the number of potential fomites, it can affect staff’s mental well-being, decrease the ability to find things quickly, and affect the ability to provide proper care. Declutter and invest in efficient storage around the hospital to free up spaces and surfaces, hence improving disease control.

 More water is not always better for a hospital, as water can degrade finishes. However, some areas such as dog wards have to be easy to keep clean. Individual drains are better than trench drains because they prevent cross-contamination. Drains should be placed at the back of animal enclosures so staff members can stand outside the enclosures to clean them.

 Cleaning before disinfecting is key. Using the correct disinfectant at the right dilution and contact time will improve efficacy and lower disease prevalence in the hospital. Accelerated hydrogen peroxide disinfectant is most effective. It is less caustic than bleach, safer to handle, and effective against pathogens. Its foaming action makes it a good cleaner as well.

 Proper lighting supports good cleaning. It is easier to see soiling on surfaces in well-lit spaces. Well-designed lighting can improve the well-being of patients and staff, particularly in critical-care settings. Appropriate lighting reduces fatigue and eye strain and task-related errors. We recommend LED lighting technologies, dimmable in all patient areas to reduce stress.

 Reducing noise is critical to patients’ quality of care. All animals are stressed by loud noises in hospital settings, with cats being the most affected. Noise can prevent rest for critical patients, impairing their ability to recover. Creating a quieter environment will decrease animals’ stress and anxiety, as well as improve the working conditions for the animal care team. Noise reduction can be achieved by the following:

equipment selection (eg, quiet casters on chairs to reduce noise)

 Indoor air quality doesn’t need to be complicated. In a typical general practice, we use 3 tools: boosted air exchange and air filtration, exhaust systems in animal wards, and differential pressurization of air to prevent the spread of odors and contamination. These tools are best applied to new construction. In existing buildings, it may be more difficult to remediate air quality concerns. Help from an animal care architect may be required.

Looking at the big picture, consider key social design principles that can be adapted to any built environment where health care is delivered, including veterinary medicine:

Design buildings to deliver more health, not more health care. Human hospitals usually measure success in terms of bed occupancy, leading to the design of small private rooms with little space for walking. Recovery is improved when patients are able to get up and walk. This also translates to companion animal medicine. For example, the design should include an area where animals can go out to walk during their hospital stay.

Seek input from a variety of individuals, from the medical team caring for the animals to the receptionist to the maintenance person, pet owners, and architects. They all have unique perspectives and objectives for hospital design.

Make the invisible visible. During the planning process, make maps and draw the systems at work in the hospital. Shifting from verbal language to visual spurs innovative thinking and ideas. It is important to think of flow patterns, animal housing placement and layout, location of an isolation room, exam room design, outdoor areas, etc.

Never stop experimenting. Cross-collaboration among the care team, architects, clients, and business professionals encourages constant innovation.

This is important because planning today does not account for changes that occur in the constantly evolving field of veterinary care. Therefore, planning alone stifles innovation until the next planning cycle. Balance long-term planning through constant experimentation by gathering information from small prototype experiments, listening to feedback from the care team, and communicating with the design team. For example, no one planned for the current disruption of a global pandemic. However veterinary hospitals adapted by experimenting with different ways to care for patients, the team, and clients. Some of these experiments will likely stick, such as innovations in indoor air quality design. Others may pass as the pandemic recedes, such as curbside drop-off.

The ultimate objective in improving care is to improve heath, and the careful design of veterinary hospitals can work toward this goal. In short, hospitals should be designed to reduce stress and promote healing. They should be pleasant, comfortable, and supportive for animals and humans.

Functional and healthy facilities dramatically improve clinical outcomes

 Facility design can reduce stress, enhance healing

When deciding whether you’re going to be building a new veterinary hospital, it is important to develop a preliminary budget as early in the process as possible. Not only a construction budget but also a total project budget. By the time all is said and done, there will be many people that need to dip into your project funding to make it happen.

The purpose of establishing a budget early on is to make solid decisions, balancing what you prefer to spend against what the potential costs are going to be to achieve what you want. Let’s start with breaking down the different categories that relate to a total construction budget. When we establish a total budget for a project, the 4 major categories include soft costs, builder’s budget, owner’s managed budget, and contingencies.

Soft costs are typically expenses for design and engineering, which should include architect, plumbing, electrical, mechanical, structural, and civil engineering. Depending on the type of project you have, you may also need other consultants such as surveyors, geotechnical engineering, hazardous materials or environmental studies, fire protection or sprinklers systems, traffic studies, and other potential municipal studies and submittals.

You should be able to determine an approximate cost by either contacting each individual entity or contacting an established architect or design/builder that has experience in these types of projects to help you allocate funds for this first part of your budget.

Typically, builders’ budgets are the most expensive portion of the overall budget. This is the cost of constructing your new facility, not only the building but also site costs associated with your project. There are many factors that make these budgets fluctuate. Some of these factors are the type of construction. Is it going to wood, steel-framed, or concrete block? How elaborate is the design? If money were no object, then champagne taste carries a champagne price. Try to balance your style of architecture and amenities with your budget. Another factor is the geographic location of your project. Middle America is still comparatively economical to build. As you get closer to the East Coast or West Coast, costs go up.

The COVID-19 pandemic has had a major impact on costs. Interest rates are still low, which is good for your loans; a lot of people are taking advantage of this, and contractors, in general, have not slowed down. If anything, they have become busier, which typically drives up the cost. Material costs have also escalated for wood, steel, and petroleum-based products, as well as copper and other base materials. Shortages and long lead times for some material also have an effect on costs. A lot of suppliers are unwilling to hold pricing for more than 10 days. This makes it more difficult to establish a budget 9 to 12 months before construction is ready to start. You should make an accommodation in your budget for escalation of cost somewhere between 5% and 15%.

There are several areas where you can obtain information regarding basic costs for construction. We have developed a database of average costs of previous projects throughout the United States that can be used as a base point. You will just need to factor in inflation from when that project was built to today’s market. Another would be to invest in a construction cost data book that breaks down individual components and square-foot averages. These books will give standard construction cost but may not indicate the specialty components in veterinary hospitals such as oxygen and anesthesia evacuation systems. Three other sources of information would be from veterinary-experienced architects and contractors, as well as veterinary-specific lending companies.

Owners’ managed budgets are items that are solely the responsibility of the owner. These can be broken down into 6 categories: business systems (ie, furniture, fixtures, and equipment [FF&E]) and financing (ie, legal and practice management, project development, and occupancy costs).

Business systems include phone systems, computer systems and cabling, as well as safety systems such as fire and intrusion alarms, monument and building signs—all of which could impact the total cost.

FF&E are all items that are necessary to open your doors when your construction is complete. Are you going to reuse existing items? Or are you going to purchase all new? The costs can be large, especially when you’re purchasing big-ticket items such as CTs and MRI units. FF&E could be a separate line-item budget in itself to be added to the overall total budget.

Financing costs can include closing costs on your loan, loan interest, appraisals, banking fees, and inspection costs. The best source for information on these items can be obtained from an experienced veterinary-specific lending company.

Yes, you will probably need an attorney and their fees to guide you in contracts, closing documents, and advise you on other legal issues. Do you have a practice management consultant or software? If not, you may need 1 or the other, if not both.

Land acquisition cost could be a substantial expense to your total budget and should be accounted for. Other project development costs can include impact fees, utilities, and meter fees established by your local jurisdiction. Additionally, there may be project management fees. If you hire a third party to act as your liaison between you and the architect and contractor for the duration of the project, this could add an additional cost.

Items in this category should include installation of equipment and furniture you purchased such as cages, run desks, etc. One thing many people forget until the end is the cost associated with moving into your new facility: labor, rentals, and the expenses associated with printing and revising existing websites or developing new ones.

The last of the major considerations are contingencies. You and your lending company should always establish a contingency for your project. In the past, we have used somewhere between 5% and 10% of the total construction cost. These contingencies will help with things you may add during the project process or to help offset some of the potential escalation in material costs. Unused contingencies can go toward purchasing that new piece of equipment you have been wanting. Your lending company will help you establish a percentage of a dollar amount for this.

As you can see, there are a lot of items that should be taken into consideration when developing a total project budget. The more information you can obtain early in the process, the less likely there will be costly surprises toward the end. This should reduce or eliminate going back to your lending company and asking for more money or coming out of pocket.

CMP, Inc, has developed a standard spread sheet that can be utilized in producing a budget that can be added to or modified, which can help establish a total project budget. For a copy or more information, please email the author at Sean@cmp-inc.net.

 is a shareholder, president, and a founder of CMP, Inc.

Potential expenses from 4 major categories should be considered to determine overall cost

Total project budgeting

With a puzzle, you open the box and dump the pieces all over the dining room table. But where do you start? Group the pieces with similar colors together? Find the edge and corner pieces first? As with a jigsaw puzzle, there are best practices to help you assemble your hospital, such as identifying clear zones, establishing efficient traffic flow, and capitalizing on your general rules. But unlike a jigsaw puzzle, there is more than 1 way to fit the pieces of your hospital together.

After establishing your program and listing the spaces you want in the facility, start grouping these program elements into zones. Client, staff, and support zones are the 3 main ones.

 encompass exam areas, the lobby, public restrooms, and any treatment areas that clients can access, such as a wet or dry rehabilitation area.

 include medical spaces and break rooms, staff restrooms, and spaces that transition to the client zone, such as exam rooms.

 include all of the spaces that help you complete day-to-day tasks, including medical gas rooms, shipping and receiving areas, mop closets, morgue, and technology/data rooms.

Although medical spaces are critical to the success of your practice, not thinking through a plan for the support zone can lead to major issues with the layout and success of your hospital.

Best practices for traffic control involve analyzing how individuals, supplies, and equipment will move through the building. After identifying your zones with program groupings, determine where these spaces should overlap to minimize travel distances and decrease the time it takes to grab a supply item. The goal is to create the most direct flow possible while thinking about the specific needs of a medical procedure.

Often overlooked is the movement of bodies after euthanasia. Although we would rather not spend time thinking about this, it is important for the service that you provide your clients. It can be very stressful for a medical team member if there is not a clear and private way to move a body from an exam room to the morgue. Two-door exam rooms are very useful for this purpose. Additionally, provide a private pickup area by locating your exterior pickup door in a nonpublic location. Preferably this would be as far away from the front door of your hospital as possible.

Other traffic flow considerations involve the movement of patients in and out of your facility. Locate dog walking areas close to the building and within proximity to your animal housing areas. Identify where you want suspected isolation patients to enter in order to minimize infecting others. When possible, locate isolation rooms on the exterior of a building with access to a nearby exam room. Ideally, this isolation room also would be directly adjacent to your main treatment space or an area that allows staff to keep their eyes on these patients. An additional way to optimize traffic flow would be to allow clients to come directly into an exam room. The more you can minimize cross traffic and congestion in your lobby, the more efficient your operations will be.

Another piece of the puzzle is knowing how large to make your spaces and what is needed spatially to carry out day-to-day tasks. Start by measuring the existing spaces in your current hospital. Some clinicians feel comfortable in an exam room that is 8 × 10 feet, whereas others prefer more space to allow for longer exams and more time engaging with clients and pets. In general, we find that 8 × 10 feet works well for single-door exam rooms, but 2-door exam rooms require more length to get proper orientation with the client (eg, not turning your back on them when typing on the computer).

Surgery rooms range in size depending on the type of procedures that will be performed. A good starting point for most general practices is 12 × 15 feet, whereas specialty hospitals will need more space for orthopedic proce- dures, closer to 15 × 15 feet.

Circulation space defines not only the width of your hallways but also the space for someone to move around inside a room. The best general rule is that an individual with a dog on a leash takes up a 5-foot diameter circle. If your clients like to extend leashes, then this 5-foot radius can grow quickly. Back-up counters in a treatment area or the space from the side of a treatment table to the front of a cage bank should be no more than 4 feet away. Think efficiency and minimize how many steps you need to take to move an animal or grab an instrument from a counter.

Like working to complete a jigsaw puzzle, good hospital design takes time and organization.

Identifying the zones needed; how individuals, animals, and supplies move through them; and where items are located within your hospital will help piece your spaces together. There is no 1 solution for all hospital designs. Analyzing your operational needs and recognizing the importance of traffic flow will set you on the right track.

 is a certified veterinary technician and veterinary architect at Animal Arts in Boulder, Colorado. She also speaks at the Veterinary Economics Hospital Design Conference.

Designing your veterinary hospital can feel like putting together a 1000-piece jigsaw puzzle. For some, this can be an easy task, but for most of us, it’s daunting.

Building a hospital: A jigsaw puzzle with more than 1 solution

The American Animal Hospital Association (AAHA) expanding its reach with its first accreditation outside North America. Recognizing the importance of veterinary care best practices across the globe, AAHA announced Daktari Animal Hospital in Tokyo, Japan, as the first overseas practice to earn accreditation from the organization.

The hospital, founded in 1964 and led by veterinary trailblazer Dr Gen Kato, is known for its state-of-the-art technology, patient care and dedication to the human-animal bond, according to an organizational release. Kato has been a longtime and active member of AAHA.

“We are committed to partnering with veterinary organizations worldwide to raise the global standard of veterinary care,” says Garth Jordan, CEO of AAHA, in the release. “AAHA standards are readily adopted locally with appropriate adaptations, providing a common language and ‘North Star’ for all veterinary practices regardless of their location.”

Daktari Animal Hospital, which has 3 facilities in Tokyo and affiliate locations throughout Japan, offers a variety of services that include wellness and preventative care, 24-hour emergency care, and cancer treatment. Additionally, Daktari’s Tokyo Medical Center also houses the CT Center that is available for use by other area veterinary hospitals.

As with typical AAHA accreditations, a large portion of Daktari Animal Hospital’s evaluation was performed on-site. An AAHA leadership team recently visited Tokyo to conduct the hospital’s assessment and meet with Kato and his staff. Having found that international accreditation comes with its own unique set of challenges, the AAHA trained Japan-based veterinary professionals to serve as agents for the organization in Japan, to help support the accreditation efforts there.

“Certain things incorporated into North American standards simply aren’t feasible for practices in other countries,” said Anthony Merkle, CVT and regional manager for member experience at AAHA, who led the process, in the organizational release. “For example, our standards dictate a certain type of [personal protection equipment] that may not be available in another country, so we needed to make adjustments for that.”

Other considerations for adapting AAHA standards may include North American government regulations that don’t mesh with other countries’ regulations or the price of certain equipment that makes aligning with a given standard cost prohibitive.

Once a practice is accredited, AAHA provides ongoing support and recommendations for maintaining and exceeding the standard of care established, according to the organization. For international practices, this is especially important as they may be among the first accredited in their geographic location and can benefit from the connection to other organizations following the same standards.

For Jordan and the AAHA team, the accreditation process has been educational and eye opening. “The level of detail that goes into accreditation is amplified when it’s translated to another culture,” said Jordan. “It’s been a great reminder of how dedicated AAHA accredited members are to the standard of care they provide to their patients. We are extremely proud of the work we’re doing at AAHA to help our members simplify the journey toward excellence in their daily practice.”

American Animal Hospital Association expands care standards to Japan. News release. AAHA. July 14, 2022. Accessed July 14, 2022. 

https://www.aaha.org/about-aaha/media-room/press-release-list/aaha-expands-care-standards-to-japan/

The first Japanese practice earns accreditation, paving the way for others

Hospital Design360 August 2022

Establishing a strong framework

Facility design can reduce stress, enhance healing

Total project budgeting

Building a hospital: A jigsaw puzzle with more than 1 solution

AAHA expands care standards to Asia

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