Good design and layout is becoming increasingly important in maximising the potential of your practice. CHRIS GODFREY looks at some standout Australian veterinary hospitals and gets some tips from the experts.

Not many Australian and New Zealand veterinarians practise in their dream hospital. Tradition and economic reality mean vets set up their practice in a small pre-existing facility - perhaps their home.  

If and when the practice expands, they move to more desirable premises.

The issue of the structure is, however, becoming a bigger factor in how the profession works. Most veterinary boards now insist on minimal building features for small animal surgery to be performed. Inspectors will suggest improvements in matters traditionally left to the discretion of the vet - floors may need to be upgraded or a dedicated surgical space created.

The public is also becoming more discerning about the environment their veterinarian practises in and their animals are kept.

Adelaide veterinarian John Hamilton has had a long involvement in practice design. He has worked on about 190 hospitals in the last 15 years and can describe the changes in practice building over those years. "My projects used to be for two or three vet practices, but now I am asked to design for bigger practices with many vets," he says. "There will always be a place for the smaller, local, practice but it seems to me that the larger practice with more facilities is becoming more common."

Dr Hamilton has such a passion for design that he recently sold his Adelaide practice to devote his time exclusively to his consultancy John Hamilton Veterinary Clinic and Hospital Design.

Trends in design

Dr Hamilton identifies several trends in hospital design. The move towards larger numbers of vets in a practice has space implications. Building size has increased from 200-300m² to 300-400m².

"Waiting rooms are also becoming larger," he says. "Large waiting rooms used to be designed for retailing and food sales. Now they are wanted for puppy classes. These rooms will have moveable chairs so space can be cleared. "The buildings need to be bigger for other reasons. With more staff comes more administration and the need for dedicated office space. Some practices are building more consulting rooms because their nurses perform consultations as part of their job."

He has found internal dog runs are becoming the norm. These avoid noise pollution and also have an occupational health and safety impact because staff members do not need to lift big dogs into cages.  Separate dog and cat hospital wards do not seem to be requested by most veterinarians and Dr Hamilton finds the isolation ward traditionally needed for parvovirus is now just as often needed for chemotherapy cases or for day surgery space. Stainless steel cages remain the ideal in most hospitals.

Technical and specialist advances have also had an impact.  "An imaging room - rather than a radiology room - in which radiology and ultrasound is performed is becoming more popular," John says. Another trend is toward the traditional hub of the practice - the treatment room - being replaced by a central 'overview' room.

"Communication with clients is more important now. The centre of the hospital is now an area where veterinarians can phone clients without being interrupted by noise. The room will have viewing windows to the treatment areas of the hospital and access to the public areas. This goes hand in hand with the increased use of glass, light colours and a light, airy ambience in the hospital," he says.

Dr Hamilton's service to veterinarians is based on a client brief, which the veterinarian can present to an architect or builder. This brief is based on the ideas of the client (the veterinarian) but uses Dr Hamilton's specialised skills.

"An architect or designer will not often have a knowledge of the veterinary industry. My service provides a brief - floorplans, materials, odour and sound control, and schedule of doors - which my client can present to the architect," he says. He emphasises several issues in his design work. "A veterinary practice should ideally have the following attributes: firstly, it must look good. Secondly, it shouldn't smell. Thirdly, there should be no intrusive noise and finally, it should provide a good, healthy environment for the staff, patients and clients."

The brief (which usually amounts to about one per cent of the total cost) will give the architect information on veterinary practice specific matters such the control or avoidance of odour and keeping sound from one area of the hospital spreading elsewhere. These details are mundane but important. Dr Hamilton has a sense of where the building fits into the total practice of veterinary medicine. He believes that his designs are dictated by what the veterinary market place and the public want and not his clients desire for an edifice.

"Every hospital has to exist in its context," he says. "Practices in the centre of big cities, for example, have to comes to terms with the cost of real estate and the need to be vertically integrated on more than one floor. There is no single solution for every hospital."

The ASAVA Hospital Accreditation Scheme

The Australian Small Animal Veterinary Association (ASAVA) Hospital Accreditation Scheme has been running since 1975. The aims of accreditation are to "encourage and assist companion animal practices to achieve the highest levels of quality health care and practice management procedures while practising in innovative and state of the art hospital facilities."

In general terms, the scheme is intended to promote good design but also more intangible matters such as quality of care and staff teamwork and morale. Julia Nicholls, the current chairperson of the Accredited Hospitals Committee, sees a direct link between the practice design and quality of care.

"The aims of the scheme encapsulate our two-prong requirement for accreditation. Firstly, modern, up-to-date premises and secondly excellence in patient care," she says. She believes the accreditation process, which may become ongoing and continuous rather than the present once every three years assessment, as having a number of advantages.

"Accreditation is certainly not all about architecture and mega spending on equipment. Something that surprised me was that since my hospital joined the scheme I have had no problem employing vets or nurses," she says.

Dr Nicholls believes staff get a sense of achievement in the quality of service offered. She says there is evidence that the value of a practice is increased with accreditation and the public is becoming more aware of quality assurance schemes.  Accreditation involves an inspection of the structures and design of the hospital and also the quality of care offered. This includes an examination of clinical records, procedures and surgical and medical standards. Continuing education of staff is also examined.

A model of good design

John Aspley-Davis's Kippax Veterinary Hospital in Canberra is an entirely well ordered universe.  The practice represents a kind of architectural ideal. It balances the technical and industrial requirements of a veterinary hospital with the needs of the people working in it. It also fits into and uses the environment within which it stands.

"The overriding design factor is one of efficiency," Dr Aspley-Davis says.  "Remove almost all corridors and segregate the areas into front for clients, middle for staff and back for patients. This minimises the time spent in performing a decent and rewarding job. By reducing strain on the limbs, back and eyes, work should be a much more positive experience every day."

The practice sits on a half-acre block on the same road as the original home-based practice he opened in 1977. He moved to the new hospital in 1990 having made a careful study of the practice's demographics.

Nothing, including the surrounds and orientation, has been left to chance. The hospital faces north to maximise natural solar heating in winter. Looking out onto a busy suburban road and a rose garden, a large window on the northern side of the hospital not only lets in light but also promotes the hospital to passing motorists.

Landscaping and greenery, including a garden designed to attract native birds, immediately welcomes clients. They leave their cars in a car park on the same level as the hospital so injured animals can be wheeled on a trolley directly into the practice. All vertical surfaces and posts in the parking area are made of non-absorbent materials, which will not carry a persistent odour from dog urine.

Clients enter the waiting room through wide doors but have the option of waiting outside under a covered area. This and the three large consulting rooms effectively complement the waiting area.  The flooring throughout most of the practice is the requisite hard-wearing vinyl. Its colour is easy on the eye, its surface does not need polishing (a considerable saving on cleaning costs), tends not to show shedded pet hair and is ergonomically correct for a working space.

Ergonomics are important for Dr Aspley-Davis. Consulting room tables are designed to discourage the lifting of heavy animals.  "Seventy-five per cent of our patients weigh less than 15kg, but for larger dogs we have one consulting room with a walk up table," he says. Thus the staff minimise their risk of back injuries. In the other consulting rooms, the veterinarians sit on high chairs with castors. They can work close to the patient with legs under the consulting benches. Yet they can retreat quickly from aggressive animals.

The consulting rooms are designed with the principle of never turning your back on the patients. Doors are at opposite corners and can be entered from the rear passageway.

Strategically placed viewing windows sit in each door to either enable the vet to discreetly see out into the waiting room, or for nurses to check the cleanliness of the room without being seen by clients.  The hospital is architecturally sound on a large scale. It uses "thermally efficient and environment friendly principles". Dr Aspley-Davis sees the building as an envelope, which is warm in winter and cool in summer.

Solid brick walls, double-glazing, concrete floors and thick roof batts have been used. Eight skylights allow for natural lighting for large part of the day. Fifteen extraction fans, vents on the skylights and a positive pressure "Ecoair" conditioning system bring fresh air into the building and the need for air conditioning is restricted, localising its use to a small number of areas.

With such attention to detail it is clear why the hospital won the inaugural ASAVA Hospital of the Year Award in 1993.  Yet what differentiates a practice in which building design has been a key from the start?

"Most vets want a productive and stimulating career," Dr Aspley-Davis says. "By use of a thoughtful design and good quality materials, the artisan can labour many years enriched by a pleasing environment, satisfied staff and agreeable clients - the latter two so often being a result of the former."

Foundations of good design

• Waiting room - the centre of first impressions: Clients are usually anxious about the welfare of their pet so make it soft and welcoming within the constraints that if the materials are below waist height are likely to be clawed or urinated on
• Consulting room - the profit centre: You will be spending much of your professional life in the room so make it comfortable, pleasant and functional
• Treatment room - the centre of the practice: Procedural medicine and surgery are the lifeblood of veterinary work so think ergonomics, natural light and most of all plenty of space to occupy your present and future needs
• Operating theatre - the cleanliness centre: Maintain your invasive surgery standards with easy to clean surfaces, minimum ledges, room to move and all equipment mobile
• Kennel rooms - the neglected centre: Have them open for your clients to visit. As most pets at home would be sleeping in the same room as their owners, be aware of how they feel about seeing their friend caged. Use materials that are easy to clean but soften the impact
• General rules - All rooms should have power points on every wall and in large rooms, on the ceiling as well. Even the cupboards should have one. You can never have too many. If you can, plan for expansion

Source: by CHRIS GODFREY The Veterinarian (Sydney Magazine Publishers Pty Ltd)