A well-designed facility can help reduce patient stress and create a smoother workflow, allowing for more efficient operations. Photo courtesy CASCO Pet According to the American Animal Hospital Association (AAHA), approximately 30 percent of veterinary practice team members are considering leaving their current clinical practice.1 The estimated cost of this annual turnover is a whopping $1.4 to $5.6 billion. As of May 2024, the average annual turnover rate sits at 23 percent, increasing yearly.2 Unsustainable, these attrition rates have a ripple effect across the industry. The diminished capacity of veterinary teams means pets cannot always get the care they need when they need it, clients are left frustrated, and practice staff have to deal with the fallout, all while grappling with colleagues’ departures and a seemingly ever-increasing workload. The industry is widely recognized as facing challenges related to stress and burnout; 86.7 percent of U.S. veterinarians had Professional Quality of Life Scale (ProQOL) burnout scores in the moderate or high range.3 While workplace culture plays a big role in the well-being, retention, and recruitment of staff, it is important to consider the impact the design of a veterinary practice can have on these factors and overall well-being. A poorly designed facility can have serious ramifications, creating bottlenecks in workflow and efficiency, increasing animal anxiety, and negatively impacting staff morale. Conversely, a practice that employs considered and thoughtful design across the entire space–from floor plan to wall paint, furniture to clinical equipment, and animal housing–can reduce patient stress, create a smoother workflow, and allow for more efficient operations. This, in turn, can improve the quality of life for veterinary teams and workplace culture. Current state of play There is no singular root cause for the veterinary industry's current challenges; the reasoning is complex. While veterinary visits are currently down in prior years, we are still witnessing a growing pet population that is also living longer. Burnout and stress are increasing over time across the profession,4 the former across all veterinary team roles.5 This can affect a veterinarian’s own well-being (and lead to an exodus of talent from the profession) and their ability to attend to patients efficiently and effectively (which can affect a clinic’s reputation and profitability). The physical environment of veterinary settings contains multiple stressors for veterinary teams and their patients. Noise levels in practices can be harmful to human hearing; 68 percent of veterinary professionals reported noise to be a workplace challenge.6 The idiom “negativity breeds further negativity” is true here, even more so considering the issue of understaffing currently plaguing practices. As such, the cycle continues to spiral. Factors to consider These statistics can be overwhelming, as can the urge to implement strategies that focus on employees coping with workplace stressors. However, the onus should not be on individuals; the organization should minimize or eliminate stressors. Interventions to address burnout have been found to be more successful at an organizational level.3 Those that include several types of mechanisms—such as improved communication, optimizing workflows, and delegating special projects—have been found to be most effective. Non-financial offerings, such as support, recognition, psychological safety, and empowerment, can foster job satisfaction and increase a team member’s sense of value. The workplace environment and culture within the practice are also important contributing factors to well-being. A survey of veterinarians in clinical practice that looked at understanding their career transition plans found more than a quarter of respondents (26 percent) may be enticed to retain their current number of clinical hours with improved working conditions.7 Improving working conditions can involve multiple elements, including design and workflow. A poorly designed facility can exact a daily toll on staff and animals, increasing stress and illness, and affecting efficiency and morale.8 As Christine Long, DVM, chief medical officer of Modern Animal, says: “Many of us have worked in places that are noisy, smelly, poorly lit, and poorly ventilated. Spending more than 10 hours a day in a difficult environment like this makes a hard job even harder.” While excellent husbandry can compensate for some deficiencies, an important consideration is how many elements across a practice can be optimized to enhance the quality of life for staff and the quality of care for patients. The impact of environment Picture this: You are working in a clinical room with no windows and harsh overhead lighting. The cabinetry is inadequate for day-to-day needs, and paint is visibly chipping from the wall. The surgical suite is down a narrow hallway, past multiple consult rooms. Requiring an overnight stay, the patient is housed in a kennel where they have direct eyesight of other animals. Dogs are vocalizing loudly, frightening the cats. Your patient does not seem aggressive, but you know the stress of new smells, sights, and sounds can have an effect–it is hard to find someone in your field who has not been bitten or scratched by a patient (or experienced a near miss). You would love to take a moment to yourself in the break room, but said room shares a wall with the kennels–so, really, what is the point? Design, construction, and layout decisions can be fundamental to the productivity and efficiency of veterinary teams, ergonomics, workflows, and safety. Environmental adaptations that limit workplace stressors are a valuable investment for businesses. While a full-scale renovation or rebuild might not always be feasible, there are ways to improve the environment to benefit practice teams, present and future. Clinic aesthetics A well-designed facility is attractive to both staff and clients, aiding in retention of both. Consider the color palette–all-white walls can appear clinical and cold, and is visually jarring shade for animals. Cody Creelman, CEO, and veterinarian at Fen Vet in Airdrie and Calgary, Canada, has incorporated a “relaxing” green color palette to promote a sense of calm; research shows the benefits of softer shades and pastels. Biophilic design elements, such as natural light and live plants, can make a space feel more relaxing. Furnishings Veterinary care teams suffer from high rates of repetitive-motion injuries–lifting heavy patients on and off exam tables, sitting or standing in awkward positions for lengthy amounts of time, and reaching for items or equipment positioned inconveniently. Ergonomic equipment and seating that properly aligns posture can reduce muscular tension and fatigue. Creelman prefers drop-down exam tables for ergonomic efficiency and optimized placement of tables, counters, and equipment, and Long uses ergonomically designed seating for teams. By reducing physical impact and fatigue, stress levels can also be decreased. Noise reduction Noise within kennel wards has routinely measured greater than 100 dBA;9 the opening of a solitary metal cage door can be more than 90 dBA.8 Long cites the echoing effect of metal kennels, amplifying noises created within. Considering that kennel attendants historically have the lowest score of overall mean job satisfaction within veterinary teams, it is an important issue to address.10 Proper design, including construction of animal enclosures, can significantly reduce the level of disruptive noise. Kennels crafted from noise-reducing materials—glass is a key recommendation—have been found to significantly decrease audible stimuli, helping to reduce staff stress levels associated with high-noise areas. For Fen Vet, using glass kennels has created a clean, secure, and aesthetically pleasing environment. It highlights that noise-reducing materials help maintain a calm, low-stress environment for patients and staff alike. Both Creelman and Long agree the right kennels reduce patient stress, with Creelman adding, “Patients recover exceptionally well. Well-rested pets lead to better recovery outcomes, and easier management for the team.” Kennels made with noise-reducing materials can help reduce staff stress. Photo courtesy CASCO Pet Lighting Where possible, bring adequate natural lighting into the space through windows or skylights – ideal for helping regulate the circadian rhythms of patients (and staff). Appropriate overhead lighting (think dimmable LED lighting) can also reduce fatigue and eyestrain. Long says Modern Animal incorporates natural light sources into most treatment rooms, with film to reduce distractions, and that clinic lighting mimics natural light. Uplighting and sconces are used in spaces where softer light is preferable–with fluorescent lighting purposefully excluded. Advances in kennel lighting, such as specialist UV lighting, can improve cleaning protocols. It illuminates organic materials to maximize biosecurity while reducing maintenance time. Such lighting systems can be tailored to the patient’s needs, with “recovery” red lighting allowing for continuous observation without disrupting a patient’s rest; cats and dogs lack cone receptors for the red spectrum. Additionally, the lighting within kennels can create a “warm and aesthetically pleasing” look within wards, according to Long. Red lighting in kennels allows veterinary teams to observe patients without disrupting their rest. Photo courtesy CASCO Pet Storage Psychology research has found that working in cluttered spaces causes stress and anxiety, which can harm mental health and productivity levels.11 If staff members cannot find or access equipment quickly and easily, their ability to provide efficient and proper care is affected. Cabinetry and storage built for strength and longevity, able to withstand the rigors of veterinary demands, are imperative. Not to mention, they also play into the overall aesthetics. As Long has learned, “It’s almost impossible to have too much storage space!” Prioritize accessibility and thoughtful layout and utilize “soft-close” features that prevent additional (stressful) sounds. Color-coded labels, storage bins, and mounted or built-in key equipment can also work to improve efficiency, as well as freeing up spaces and surfaces. Doing so helps keep the practice moving and on schedule; it also makes cleanliness and disease control more manageable. Layout and workflow While layout will vary from practice to practice, there is no denying the significance it can have in terms of improving workflow efficiency. Placing high-use areas (such as exam rooms, treatment areas, and surgical suites) in proximity to one another can reduce the time and effort required to move patients and equipment between them. Sterilization and prep areas should be located nearby to limit how far instruments or staff will need to travel. “Thoughtful exam room positioning improves efficiency without sacrificing client experience,” says Creelman. “Additionally, open-concept treatment areas with large observation windows allow clients to see what’s happening, building trust and reinforcing value.” There should be enough through-traffic space within the suites and in hallways to move patients around; good flow feels less physically stressful. Prioritizing employee well-being One of the most important factors in employee well-being is safety. While physical safety is important, so, too, is psychological safety. The veterinary industry has a known problem with perfectionism, and there needs to be an avenue for the team to express curiosity, ask questions, and admit mistakes without fear of retribution.12 While design considerations can contribute to this, building separate spaces where veterinary staff can retreat to can also be beneficial. You might include a separate, private space in addition to a break room where team members can take a moment to decompress and deal with emotional labor or compassion fatigue in private.13 Consider a dedicated mental health space, positioned away from high-traffic and high-noise areas, with comfort-focused design, sensory and relaxation tools, biophilic elements, and mental health resources. Creating a calmer environment for patients will help lead to better recovery outcomes and easiermanagement for the team. Photo courtesy CASCO Pet Conclusion The stats are sobering. A projected 74,000 individuals are planning to leave their clinical practice within a year; 25,500 veterinarian providers plan to exit the profession permanently.1 A multi-faceted issue, the physical environment of a clinic plays a significant role in a team’s overall working experience. Considered design–from aesthetics to equipment, kennels to storage, layout to “safe spaces”–truly does have an impact. A calmer environment makes for calmer patients and an improved experience for all. Smoother, streamlined workflows benefit staff and practice profitability; more efficient operations can return hours to time-poor teams, reducing overtime worked and helping towards a better work-life balance. Additionally, pride in a clinic environment directly contributes to staff morale and engagement, reinforcing a positive workplace culture. Consider, too, the design of a facility can play into the recruitment process, potentially becoming a deciding factor for prospective employees. As a final thought, incorporating team members from every remit when discussing potential design changes and plans can help ensure the needs of staff are met, and assist with future-proofing the practice for continued success. Matthew Bubear is CEO of CASCO Pet, a manufacturer of animal habitats and veterinary kenneling. Bubear has more than 30 years of experience in the industry. References American Animal Hospital Association. 2024. “Stay, Please. A Challenge to the veterinary profession to Improve Employee Retention.” AAHA. https://24051120.fs1.hubspotusercontent-na1.net/hubfs/24051120/Stay_Please_AAHA_Retention_Study_2024_02182024.pdf?hsCtaAttrib=156715755565 Lederhouse, C. 2024. “Study: Fair pay, appreciation for work top factors in employee retention.” AVMA News. https://www.avma.org/news/study-fair-pay-appreciation-work-top-factors-employee-retention Neill, C. L., Hansen, C. R. & Salois, M. 2022 “The Economic Cost of Burnout in Veterinary Medicine.” Frontiers in Veterinary Science 9. https://doi.org/10.3389/fvets.2022.814104 HealthforAnimals. 2022. “Global State of Pet Care.” HealthforAnimals. https://healthforanimals.org/wp-content/uploads/2022/07/Global-State-of-Pet-Care.pdf Chapman, A. J., Rohlf, V. I., Moser, A. Y. & Bennett, P. C. 2024. “Organizational Factors Affecting Burnout in Veterinary Nurses: A Systematic Review.” Anthrozoös 37(4). https://doi.org/10.1080/08927936.2024.2333161 CASCO Pet. 2024. “Stainless steel cages pose ‘excessive noise’ challenge.” CASCO Pet, News & Blogs. https://cascopet.com/uk/the-world-of-casco-pet/our-blog/stainless-steel-cages-pose-excessive-noise-challenge/ Kogan, L. R. & Rishniw, M. 2024. “Career transition plans of veterinarians in clinical practice.” Frontiers in Veterinary Science 11. https://doi.org/10.3389/fvets.2024.1433891 University of Wisconsin Madison. 2023. “Facility Design and Animal Housing.” Resource Library. https://sheltermedicine.wisc.edu/library/resources/facility-design-and-animal-housing Scheifele, Peter, Doug Martin, John Greer Clark, Debra Kemper, and Jennifer Wells." Effect of kennel noise on hearing in dogs," American Journal of Veterinary Research. 2012 73, 4): 482-489. https://doi.org/10.2460/ajvr.73.4.482 Moore, I. C., Coe, J. B., Adams, C. L., Conlon, P. D. & Sargeant., J. M. 2014. “The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics.” Journal of the American Veterinary Medical Association 245(5). https://doi.org/10.2460/javma.245.5.513 Mills, K. host & Dn. Ferrari, J. interviewee. 2023. “Why clutter stresses us out, with Dn. Joseph Ferrari, PhD.” Speaking of Psychology (podcast). https://www.apa.org/news/podcasts/speaking-of-psychology/clutter Dr. Berlin, K. host & Doherty, C. interview. 2022. “Past Platitudes to Real Results: Making Psychological Safety Standard in Veterinary Practices”. Central Line: The AAHA Podcast (podcast). https://www.youtube.com/watch?v=upn0UvqJlI4 American Animal Hospital Association. 2017. “The Link Between Healthy Workplace Culture and Optimal Personal Wellbeing.” AAHA Culture Roundtable. https://www.aaha.org/wp-content/uploads/globalassets/04-practice-resources/practice-culture/aaha_culture_roundtable.pdf
