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Made to order

A practice owner had a tough decision to make about her growing but cramped hospital: tear up the inside, knock down some walls or move.

Made to order
After: An inviting, comfortable waiting room and clean, well-organized product shelves.
I fielded a call from a client who was trying to decide whether renovating her clinic would make sense. Her caseload was growing, and she had hired another associate veterinarian. Her hospital was in a professional strip center. Adjacent space that was coming available would allow her to expand the clinic by 50 percent. Coincidentally, another open spot at the opposite end of the center would double her square footage. The challenge for her was to decide:
  • Whether she could afford to take on additional rent.
  • How much additional space she truly needed.
  • How much disruption would occur during the work.

Before: The old lobby’s look-but-don’t-touch approach kept therapeutic diets behind the counter.

Little Elbow Room

The clinic was a single-doctor practice when she started 10 years earlier. The three exam rooms were adequate for a long time, but now, with three full-time DVMs on the payroll, a bottleneck had emerged. The rest of the layout was sufficient at the beginning, but the introduction of dental, preventive and wellness services had created a space crunch. In addition, she thought the lobby was too large. An analysis showed she could fit a minimally efficient new layout into the current space but that large areas would have to be reworked. On top of all that, the practice had to remain operational during any face-lift.

Identify the Objective

The goal of every renovation is to increase productivity. At my firm, we consider a clinic to be a business machine. Our job is to make the hospital maximize output through the least amount of energy and expense. A more efficient layout always reduces staff effort and allows for a greater caseload. Veterinary practices need to keep up with advances in not only how medicine is practiced but in areas of increasing importance. This includes being more inviting to feline clients, educating clients on how dental health affects an animal’s well-being, adopting new technology to ensure better outcomes and redefining the customer experience as new generations of pet owners come aboard. These and other trends need to be part of planning a renovation. A practice owner also needs to consider staff satisfaction and retention. It’s not just about landing the perfect associate veterinarian, it’s also about hiring the best nurses, business manager and front desk staff to be the all-important face of a practice. Some veterinarians think that the medicine, and only the medicine, makes for success. Not so. A cursory read of online reviews shows that front desk personnel can make or break the client experience. Pet owners will pick up on how happy employees are in their jobs. For that reason, we focus on both service-related spaces and staff amenities. So, here were the space-challenged veterinarian’s options:

1. Renovate in Place

This choice is always the most disruptive and requires the longest construction schedule. When a practice cannot relocate temporarily (few can) and when it must remain operational during the work, we end up with not one project but a series of small projects. We start with the space that can be easily repurposed. We then proceed through the clinic until all areas needing a fix are completed. This strategy can easily take three to four times longer than a single build. The advantage is that there’s no rent increase. The disadvantages are decreased cash flow due to reduced caseload, and frustration and staff disillusionment with what feels like a never-ending process. This construction option can easily be the most expensive. To a builder, time is money and more time means more money. My client had sufficient space to solve her immediate needs, but she had no options for future improvements. She would have to move in less than five years if her practice continued to grow at the same pace.

2. Expand Next Door

Taking over the adjacent space had its advantages, starting with virtually zero disruption to the practice. The space would be sufficient for a new customer experience. It would mean greeter stations, a comfortable lobby, nine exam rooms, including a comfort room with separate exit, a new laboratory and pharmacy, and a dedicated dental station. The clinical spaces would be adjacent to the practice’s existing treatment room and surgery area. Once the first stage was completed, the practice would move in and openings would connect the clinical spaces with the current treatment and surgery areas. The old space could be renovated without disruption to client and patient flow. The second phase would address staff features such as a lounge with ample seating and exterior space segregated from the parking lot and dog yards. The space would be large enough to hold full staff meetings and support continuing education. In addition, a dedicated business office would provide the doctors with much-needed privacy. The advantages of Option 2 were obvious: a shorter construction schedule and less disruption. The cost was about the same as in Option 1, and the practice would get more clinical and business space and staff satisfaction would be addressed. The biggest advantage was that the expanded clinic could support 10 to 15 years of additional growth. Financial projections showed that the additional revenue would more than offset the higher rent.

3. Start Anew

This “clean slate” option — double the hospital’s size by moving into nearby open space — would allow for an entirely new plan and virtually zero disruption. The location featured prime visibility and access to ample green space. We and the hospital owner had lengthy discussions about this space and the opportunities it afforded, including the possibility of adding an emergency practice and specialty services. The space could become the hospital’s long-term home. It would be a big step up, not only for the direction of the practice but also for its budget and debt load. The thought was both enticing and intimidating. In the end, Option 3 went a step too far, which is another lesson when planning a project. That is, beware of the “might as wells.” It is easy to get caught up in planning and the vision and take matters past a comfort level. The client wanted to retire in about 10 years. Her two associate veterinarians were part of her exit strategy. If they envisioned the practice becoming much larger, Option 3 might have been their choice, but they preferred a manageable, midsized business. This was a clear example of “just because you can does not mean you should.” So, Option 2 was the final decision, one that took into account time, the budget, stress and an efficient, happy workplace. Constructive Criticism columnist Paul Gladysz is the principal architect at BDA Architecture. The Albuquerque, New Mexico, firm specializes in the planning, design and construction of animal care facilities.

After: A new exam room and cushy seating for clients.