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The hard facts of evidence-based veterinary hospital design


Statistical analysis across many industries shows the benefits of letting nature in.

Many of you have probably heard of evidence-based design from one of my earlier articles, or maybe you've attended a lecture about it. It took millions of dollars and a bunch of high-priced consultants to discover the idea that good design is a good investment. For the most part, evidence-based design has to do with driving down stress by bringing daylight into human hospitals with windows and skylights. And it works. But now I want to tell you about the newest, new thing: biophilia.

No, it's not a new version of West Nile, nor is it what grows in the back of the vegetable crisper in your refrigerator. The term biophilia was coined by social psychologist Erich Fromm, but the concept really came to light with Edward O. Wilson in his 1984 book The Biophilia Hypothesis. It's the theory that human beings carry an innate human attraction to nature. “Biophilia,” as Wilson describes it, “is the innately emotional affiliation of human beings to other living organisms.” The concept holds that humans have a biological need for connection with nature on physical, mental, and social levels and this connection affects our wellbeing, productivity, and our interpersonal relationships. This concept goes back to us as hunter-gatherers and supposes that we are genetically predisposed to the natural environment.

Besides being an inherently attractive concept, it has actually been proven to be true. For example, when subjects were hooked up to an EEG and shown images of nature versus urban scenes or townscapes, the subjects were more wakefully relaxed when viewing the images of nature. The fractal patterns commonly found in nature are most likely to hold our attention and induce this relaxed response. One study performed measured the production of salivary cortisol (a stress hormone) produced by individuals walking through the woods versus the same individual walking through an urban area. While walking through the woods, 15.8 percent less cortisol was produced than through the urban area.

This all may seem pretty esoteric, but there are studies more applicable to the veterinary environment that can translate into dollars in your pocket. For example, employees with views of trees and landscape took an average of 57 hours of sick leave per year, versus 68 hours for employees with no view. Additionally this study went on to investigate the impact of urban versus natural views, orientation, and the amount of sunlight being admitted. The study also found that the quality of the view was the primary predictor of absenteeism. In another more prime example of the impact of the work environment on employees, the ING Bank built a new headquarters in Amsterdam that included lots of natural light, organic art, and even water features. In this case, absenteeism decreased by 15 percent.

The other side of absenteeism is presenteeism, or the effectiveness of an employee while he or she is at work. In looking at a municipal call center, researchers discovered that the number of calls per hour handled by employees with a view of the outdoors was as much as 7 percent greater than employees without a view. Switching to the human health industry, in 1984 Roger Ulrich conducted a study of patients with nature views versus those without views. On average, the patients whose windows overlooked a scene of nature were released after 7.96 days versus 8.71 days, or approximately 8.5 percent earlier.

In another study, researchers found that patients exposed to more sunlight perceived less pain and took 22 percent less analgesic medications per hour. A study of retail customers showed that those exposed to images of a greener retail setting were willing to pay as much as 25 percent more for a selected item. And the most dramatic findings related to retail sales showed that when non-skylit stores added skylights, there was a 40 percent increase in gross sales. In schools, studies have shown that as much as a 20 percent to 26 percent increase in the rate of learning and a 5 percent to 14 percent increase in test scores when students attended classes in a sunlit environment.

What the studies are saying makes practical sense. And for you as a practicing veterinarian, these numbers can translate into dollars and cents. Let's look at a theoretical practice that is grossing $1 million a year and see what kind of impact these numbers could mean in round figures. In terms of staff effectiveness, if you had 12 full-time equivalent employees and you could decrease absenteeism by 6 percent and increase presenteeism by 7 percent, you could have a combined increase in effectiveness of nearly 13 percent. That would mean for the same amount of dollars expended in salary, you could effectively have an additional employee. If the money spent on salaries constitutes 50 percent of your gross income, this increase in effectiveness would translate into 13 percent of 50 percent of your gross, or $65,000.

In terms of patients, if you could shorten recuperation time by 8 percent, it's possible that you could then treat or house 8 percent more animals. If medical care and treatment represented 80 percent of your gross income, then 8 percent of 80 percent is $64,000. If your retail sales represented 10 percent of your gross income and you were able to increase that by 40 percent, that would be 40 percent of 10 percent or $40,000. These three things together could represent an increase in your gross effective income of almost $169,000. As much as I would love to believe that, let's dial this down to a more reasonable number. If we cut the potential effectiveness by half that would still represent an increase of 8.5 percent. But, these increases are not without cost.

In a new building, it's going to cost you something to increase the amount of daylight that is brought into the building. And while it's nearly impossible to set a specific dollar value for these upgrades, I could predict that it might represent an increase in construction cost of 5 percent to 10 percent. On a new building that costs $200 a square foot, that could translate to an increase cost of $10 to $20 a square foot. More importantly, it could increase your mortgage by the same amount. For example, if your mortgage represents 7 percent of your gross income, the mortgage cost would increase to 7.7 percent. That's not pennies, but if you could increase your gross income by 8.5 percent by increasing your costs by 7.7 percent, that is still nearly a 1 percent spread (i.e., money in your pocket).

Before you all rush out to punch new windows into your existing building in the hopes of striking it rich, let's back up just a couple more steps. There is more to your working environment than sunlight, and there is more to what you gain from having sunlight than dollars. Sunlight and work environments that reduce stress potentially make your quality of life better on many levels. Some of you may be practicing in windowless veterinary hospitals. How much more likely would you want to go to your hospital on a beautiful sunny day if you could see outside? And what about your staff? And wouldn't your patients be happier too?

Even if you don't buy into the idea that you could increase your gross by a little bit, you have learned a new term. So the next time you are standing around at a backyard barbeque you can impress those attending by saying, “That bad biophilia was killing me, so we popped in some windows and wow, I sure feel better!” And then those around you can ask you, what the heck is biophilia anyway?

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