Today's Veterinary Business

FEB 2019

Today’s Veterinary Business provides information and resources designed to help veterinarians and office management improve the financial performance of their practices, allowing them to increase the level of patient care and client service.

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23 February/March 2019 • TODAYSVETERINARYBUSINESS.COM grossing factor has gone from 25 percent to as much as 40 per- cent! Not very efficient at all. As for cost savings, yes, we cut the roof and foundation areas in half. Offsetting that is the structural system for the added 4,000-square- foot second level, so the savings are not as large as one might guess. Between offsetting costs and increased gross size, building skyward is rarely less expensive. Know Your Labor Costs Factors beyond construction costs need to be considered. In addition to intelligent space utilization, modern hospital design focuses on staff efficiency. The single biggest expense over a building's 30-year functional lifespan is not the initial construction but the staff- ing. Construction averages about 10 percent of the 30-year total while personnel represents about 40 percent. Putting the greatest effort into leveraging your most expensive asset makes sense. How do you do that? By focus- ing on staff efficiency. A rule of thumb says that for a person of average fitness, 50 to 60 feet of horizontal travel takes the same perceived effort and time as climbing one flight of stairs. If a staff member's duties can be con- tained within a 50-foot path of trav- el, remaining on one floor would be more efficient than making the person reg- ularly negotiate stairs. Of course, the scenario changes a bit when an elevator is included. Then the limiting factor becomes lift wait times. Working with hundreds of practices over the years, my firm has found that, when possible, keeping all clinical functions on the ground floor is best. This observation usually relates to hospitals at the smaller end of the spectrum — about 10,000 square feet or less. If conditions are such that the entire program cannot fit on the lower level, some adminis- trative spaces work reasonably well upstairs: management offices, phone recep- tion, the breakroom, an IT closet, storage areas, and heating, ventilation and air conditioning equipment, for example. Keep in mind that if the upper level holds a unique space that a staff member needs for her duties or is entitled to, like a break room, an ADA-compliant vertical access likely would be required. You cannot intentionally construct a building that would prohibit hiring a disabled person or keep her from doing her job. Larger projects might need to have clinical spaces on multiple floors. In those cases, an elevator is certainly necessary. I try to limit client access to the ground floor, primarily the entry and reception areas, the waiting room, and exam rooms. Client elevator access be- comes a non-issue this way, and the elevator can be located in a spot dedicated to staff and patient use. After that, laying out a large hospital depends on the service mix. Large equipment rooms can be very expensive to place above ground level. MRI and CT machines and linear accelerators are heavy. Placing them on the second floor or higher creates a number of other expensive problems. Know Your Limits To the greatest extent possible, my firm tries to eliminate redundan- cies. If the main treatment room is on the ground floor but the surgery suite is upstairs, you might need an X-ray unit on both floors. Beyond the cost of added equipment is the probability of more staffing. Like the building, the cost of equipment operators eclips- es the equipment expense. In larger specialty or referral hospitals that house separate departments, extra staffing might not be a problem, but we find that centralized support services tend to increase a building's utilization and reduce its size. Occasionally, a practice owner requests multiple stories to im- prove the building's street pres- ence and create a more noticeable landmark. A taller building con- tributes to that feel, but there are other ways to achieve the effect. One needs to check local zoning constraints, but a building's exteri- or massing can be quite impressive and even appear to conceal multi- ple stories without the challenges and expense of adding floors. With the occasional exception of incidental second-story space, like a pitched roof attic, all in all the preference is to construct a single story whenever possible. 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. This multistory hospital has a staircase at one end for vertical circulation and to provide an emergency exit. Tall spaces make this single-story emergency hospital appear larger. The additional height improves its street presence and visibility. Occasionally, a practice owner requests multiple stories to improve the building's street presence and create a more noticeable landmark.

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