We will address how these events effect Veterinary Practice, in particular from the physical plant perspective.

Initially we must identify what we need to concentrate our focus on when planning a physical plant upgrade or replacement. It is easy to be distracted by peripheral issues that have little or no bearing on the critical issues. We will begin by identifying the Primary Goals of the Physical Plant Upgrade.

Primary Goals

1. Increase Profitability, Production

Three of the largest contributors to this goal, at least from the physical plant contribution, are the Addition of New Services, Lowering Operation Costs and Increasing Staff Productivity. There is little debate that diagnostic services are the area offering Veterinarians the greatest potential for services expansion. Both imaging and pathology offer numerous opportunities to increase medical revenues and provide more thorough care. Couple this with emerging opportunities for "niche medicine", that allows Veterinarians to offer more specialised services to their clients that they or their associates have a special developed interest. Finally, ancillary services of a non medical variety can allow Veterinarians to serve clients total pet care needs, from nutrition and training to day care and boarding.

Lowering facility operating costs should be a key component in any expansion, remodel or new construction. Energy costs continue to rise and building systems and materials continue to improve, combining for the opportunity to lower operational costs.

Staff costs are the single largest component of any chart of accounts summary. Clearly, elimination of redundant staff can save the salary cost, benefits, and replacement cost of any position saved. Efficient layouts and better material choices can reduce required staffing, and this goes directly to the bottom line. Similarly, more efficient layout makes staff able to produce more, increasing the productivity of the staff that remain. Finally, reducing maintenance impacts both staff productivity, availability for income generating tasks and lowering sub-contracted maintenance costs.

2. Increase Staff Retention, Improve Recruiting

Recent studies of employee concerns regarding job satisfaction show compensation a distant fourth or fifth, to many observers amazement. While we can't underpay and expect loyalty and dedication, there are other factors that concern employees more. These studies have shown employees want to be part of an organisation that has a consistent focus and mission, then walks the talk. They want to believe in and participate, and they want the organisation to support that mission and their efforts. Employees also want opportunity. They want a path for professional growth and advancement in a learning environment. They also desire access to the technology that supports the practice mission and their growth. Consistently among the top three employee concerns was the work environment itself. An organised, healthy and safe workplace place high in employee evaluation of the place they wish to develop, grow and support.

3. Provide the Practice a Marketing Edge

Why invest the time, effort and money in a physical plan expansion if clients and staff aren't wowed with its result? The Practice Image must be supported and enhanced. Clients should be more comfortable and their confidence in your abilities magnified, employee tasks should be easier. The opportunity to provide extended, improved care will make staff more energised, focused and motivated to improve.

FIVE Challenges we must address to achieve the primary goals.

1. Affordability

Every month since 2006, construction costs have risen, often by 1% per month. At this rate, projects that take 18 months to go from preliminary design to construction completion (a typical timeframe for a Veterinary Hospital) increase in cost by almost 20%! For the first time in my 25 years of practice, those increases have primarily been materials based, as opposed to labour. China and India's demand for construction materials has been largely responsible for the inverted supply/demand ration. Energy costs, which have risen exponentially, have impacted both production and operating costs. Material manufacturing consumes energy, so material costs rise. Materials must be transported from the factory and worker to the factory, so both must be compensated by increasing the material cost. Heating, cooling and operating a Veterinary Hospital consumes energy, so operational costs have also increased at that level.

To counteract the increasing energy costs, alternative energy systems can be integrated, but at a higher first cost, increasing the building construction cost. Incorporating more energy efficient building materials and systems is also utilised, once again at a higher initial cost. Two strategies that will likely occur to respond to these increasing construction costs include reducing future hospitals to 800 - 900 square feet per exam room from today's standard 1,000 to 1,200 square feet in order to construct the same income producing facilities without increasing the debt service required. Operational changes will also go hand-in-hand with these reductions. Waiting rooms may get smaller or disappear, exam rooms will do double duty as treatment/procedure rooms, and exam rooms may get smaller or disappear as we now know them. It will take an innovative entrepreneur to prove the concept before any idea goes mainstream. Cost segregation analysis will be part and parcel to every Veterinary project. This strategy, performed by consultants, structures up to one third of the Veterinary Hospital cost under a shorter depreciation schedule, resulting in a large tax savings in the early occupancy years, helping owners gain financial leverage to justify projects. One thing is certain - construction costs may finally stabilise again, but they surely won't go down.

2. An Entitled Society

Our 24/7/365 society has aided the growth and success of emergency and specialist hospitals. At the same time, it creates an atmosphere of escalating expectations that make it difficult to please anyone. This can be both client and employee based. Generation Next is largely built on a "What, me work?" mentality. Good young talent with a strong work ethic is in short supply. Expect to pay a premium. Americans suffer from the Robin Leach factor. They all want lifestyle of the rich and famous, or at least be treated that way. They have become accustomed to the finer things. They won't give up their Lexus, designer clothes or Hyatt Hotel room easily. There is a bright side for us though. They also want luxury boarding, doggy day care and the best specialist care for their four legged family member.

3. Technology

Information technology needs have inundated the Veterinary facility in the last five years. The computer network in the facility is the major component of the IT system, but ancillary needs are clamouring for more of the attention. Wireless networks still have not proven robust enough to reliably handle files like radiographs, so complex hard wired systems remain the standard. Server numbers have increased as various systems each require dedicated units. This results in racks with multiple units and dedicated rooms with their own air conditioning system, as A/C is needed year-round. More complex systems and increased needs require an IT consultant at least, and oftentimes, a dedicated employee. Additional needs like website hosting and data mining for practice management increase system requirements. It is not unusual to have a computer station in every room, many with more than one, and monitors for clients in Waiting and Exam Rooms. Practice management software support, imagining system support, websites, webcams, weblinks, appointing, diagnostic/technical support, communications and alarm systems all require individual attention, software, and hardware. Are you prepared to accommodate these needs? Add to this the medical technologies and their space, training and support needs. Imaging systems, surgical/treatment support and diagnostic/pathology technologies advance every year. It is critical that leading edge practices keep current, and that their facilities plan supports the mission.

4. Sustainable Design

Research indicates that by 2030, 75% of the building stock in the US will be replaced or rebuilt. Couple this with 2030 Challenge adopted by American Institute of Architects, which vows to design all buildings 100% carbon-neutral by 2030. This will be achieved by reducing their fossil fuel, greenhouse gas emitting consumption in increments to 50% by 2010 and 100% by 2030. These combined events are causing concerted efforts in energy conservation, water recycling, reduced daylighting, building materials with low or no emissions, and the promotion of healthy built environments. Several opportunities exist for Veterinary buildings to participate in these efforts, including

·         Collecting storm water for irrigation of landscape

·         Integrating photovoltaics and solar hot water heat

·         Integrating finishes with high content of recyclables

·         Using engineered wood products

·         Using materials and systems with high durability and long lifetime

·         Using fresh air economisers on air conditioning units

·         Integrating natural daylight

·         Utilising green cleaning products

·         Increasing insulation levels and lowering infiltration loss

·         Utilising locally produced materials

·         Integrating low voc emitting materials

·         Utilising automated lighting controls

5. Evidence Based Design

The Centre of Health Design has led the way as the clearinghouse for researching how the built environment influences healing, productivity, attitude, stress reduction, and personal satisfaction in addition to other criteria. In the Veterinary Hospital, both patients and staff can benefit from integrating these principals. Research has proven increased healing rate, increased recovery speed and lower nosocomial infection rate in hospitals integrating daylighting, views, colour and quality indoor air.

On the human side, staff have demonstrated lower turnover, reduced dispersing errors, lower time at task (increased productivity), reduced fatigue and improved diagnostic capacity under similarly improved conditions. Other research findings included better client retention, improved protocol acceptance, and reduced operating costs in both labour and energy. What's not to like about using this research to our advantage?

Making it Happen

Selecting a veterinary experienced team is the best advice from Practice Management Consultants, Architects, Engineers and Contractors to Information Technology consultants. Should any one of these critical team members fall short, your project success will surely suffer and potential failure becomes a real issue. Each team member needs to be focused specifically on the veterinary business as their business focus. In this way their relationships with vendors, manufacturers, and suppliers coupled with the intimate, specific knowledge of veterinary business protocols, service delivery, staffing, and business needs ensures their solutions are specific to your business success. Your business needs are specific, particularly in the physical plant, and particularly because of emerging challenges that are necessary to address to position you not only for current but future success.

Source: Wayne Usiak Hospital Design Conference 2009