Designing for Every Body: The Most Common Adjustment Is a Chair
By Peter Hall, Managing Director, Agrarian | Veterinary Architecture and Construction Project Management
Key Takeaways
- Three quarters of the 3,411 vets, veterinary nurses and students who took part in the RCVS and BVCIS research reported at least one disability or chronic condition, and around 60 per cent are affected every day [1][2].
- Many people never disclose a condition at work, so a building that only responds to declared need will miss them.
- The most common adjustment people described was simply somewhere to sit. Often the layout leaves no room for one.
- Seating, adjustable heights, well placed staff washrooms, step free routes and a proper quiet room cost little at design stage and a lot to retrofit.
- Adjustments built into the fabric of a practice last. Adjustments that rely on rotas and goodwill tend to disappear when the day gets busy.
The prep team were eating their lunch standing around the tub table. Not because they wanted to, but because there was nowhere else in the building to eat. When I asked them about it, they shrugged and said they were resigned to it and just got on with it.
I've walked a great many practices and hospitals over the years, and that quiet, stoic fortitude runs right through this profession. People adapt to the building because nobody has ever asked the building to adapt to them. That's exactly what I want to change.
After I wrote about co-designing a practice with the team rather than for them, someone at the RCVS very kindly pointed me towards something I hadn't read: the RCVS and BVCIS study of disability and chronic illness in the veterinary professions, carried out by the Institute for Employment Studies [1]. In the spring of 2023, 3,411 vets, veterinary nurses, students and student nurses responded. It's the first study of its kind in the profession, with more than 2,000 conditions disclosed.
Some of the barriers in that research weren't put there by a manager or a colleague, but by the building itself.
In the Designing for Every Mind articles (Part 1 and Part 2), I looked at neurodivergence and sensory load. This article widens the lens. It's about bodies as much as minds: pain, fatigue, joints, digestion, hormones, balance. And it turns out the building has an opinion on all of them.
How many vets and nurses live with a disability or chronic condition?
Three quarters of respondents reported at least one disability or chronic condition. Of those, 87 per cent had more than one, and 15 per cent had four or more. Around 60 per cent said they're affected every day [2].
For a building, what matters isn't the diagnosis, it's the symptom. Here's what respondents reported. I've put them in alphabetical order, because none of these matters more than another to the person living with it [2]:
| Symptom reported | Share of respondents |
|---|---|
| Allergies | Around 17% |
| Balance or vertigo | Just under 12% |
| Concentration difficulties | 34% |
| Dexterity | 18% |
| Digestion | 22% |
| Immune conditions | Around 17% |
| Memory | 28% |
| Menopause related | Around 4% |
| Menstrual and reproductive | 13% |
| Mental health | 45% |
| Mobility | 19% |
| Pain | 36% |
| Respiratory | 12% |
| Sensory processing (smell, sound and light) | 18% |
| Stamina or energy | 32% |
| Urinary or renal | 8% |
Source: RCVS and BVCIS, Disability and Chronic Illness in Veterinary Work and Education, summary report [2].
Read that list again as a schedule of accommodation rather than a health report. Every line has a design consequence, and in a practice of thirty people none of it is an edge case. It's the middle of the team.
Why should practice design work for staff who never disclose?
Around a quarter of respondents felt they'd been treated differently at work or in study, and 45 per cent of those thought disclosing their condition had contributed [1]. Plenty had chosen not to disclose at all, for reasons that are hard to argue with: fear of being judged, worry about fitness to practise being questioned, no formal diagnosis yet, or a previous employer who'd used a disclosure against them.
That rules out the way most of us handle accessibility in a brief. A design that only responds to declared need will systematically miss the people who've decided declaring isn't safe. A recent paper in Veterinary Ophthalmology by Abbondati and colleagues makes a related point about the profession as a whole: an absence of data has too often been mistaken for an absence of need [3]. It's a line every practice owner and designer should sit with. One veterinary student in the RCVS research put it better than I could. It's better to make the whole workplace accessible than to make adjustments only for the individuals who need them.
There's a more prosaic reason too. A building lasts thirty years and a rota lasts a fortnight. It's unlikely anyone on the current staff list will be there for the whole life of the fabric, and conditions may arrive mid career. The person who'll need to sit down in theatre in 2035 probably hasn't even been recruited yet.
Where does the building itself create barriers?
Seating: the most common adjustment
The most common adjustment described in the research was a humble seat. A stool in prep and theatre. A stool in the consult room. A decent supportive chair for desk work. One student described contacting every placement provider in advance to check what could be arranged, then arriving to find that many of them couldn't even provide a chair for a rest break. Think about that for a moment. A chair is about the lowest hanging fruit there is.
Sometimes that's unwillingness. More often, there's physically nowhere to put a stool. A consult room drawn at the tightest dimension that will take a table, a client, a dog and two people standing has no room left for seated working, and a fixed height prep bench with cupboards below can't be used sitting down. Nobody decided to exclude anyone. The plan did the deciding for them.
Adjustable heights for consult, prep and dental work
Height is the same story. Respondents asked for adjustable consult tables and, ideally, adjustable workstations. Electric lift tables, height adjustable prep and dental stations and a properly usable seated position at reception are all straightforward at specification stage and expensive as a retrofit, because by then you're chasing power through finished floors and reinforcing worktops that are already installed.
Staff washrooms
Washrooms get almost no attention in practice design, and the data says they should. With 22 per cent of respondents reporting digestive symptoms, 8 per cent urinary or renal issues, 13 per cent menstrual or reproductive conditions and around 4 per cent managing menopause [2], a single staff WC tucked next to the office, three doors and two lobbies from theatre, is a real barrier dressed up as a space saving. Number, location and provision are cheap to get right on a plan and almost impossible to fix afterwards.
Mobility and step free access
On mobility, one veterinary nurse wrote that in their experience there are no clinical roles where a mobility disability is supported. I'd push back on that gently, not because the experience is wrong but because the conclusion isn't fixed. Hoists, lift tables, trolley heights, turning space, step free routes from the car park to the clinical core, lever hardware that works with limited dexterity, parking close to the entrance, and floor finishes chosen with balance and vertigo in mind are all design decisions. If clinical roles can't accommodate mobility disability, that's at least partly because the buildings have never been asked to.
Concentration and memory
Then the quiet one. A third of respondents reported difficulty concentrating and 28 per cent reported memory symptoms. Consistent room layouts, so the same drawer holds the same thing in every consult room, labelled storage within reach rather than at the top of a tall unit, and wayfinding that doesn't rely on remembering which unmarked door leads where. That isn't an accessibility feature bolted on at the end. It's just a better designed practice, and everyone benefits on a bad day.
Noise, light, temperature and the team room
Noise, light, temperature and the team room all came up too, and I've covered each of them before in The Flickering Light You Can Hear, Let There Be Light and The Building Answers Back. One respondent summed it up: practices should be built to minimise sound, with somewhere private to get away from everything and everyone on a break. Another described a thermostatic radiator valve as a reasonable adjustment [6], which tells you how rarely anybody gets control of their own room.
Why are built-in adjustments better than goodwill?
The reason I think this is a building question and not purely a management one is buried in the comments about adjustments that were agreed, only to quietly disappear later. They're made temporarily, then forgotten when the rota changes, one nurse said, and I don't want to keep having to ask. They say they will, but when it gets busy it isn't adhered to, said a vet.
Every one of those is a well intentioned practice failing to sustain an adjustment under pressure, which is exactly when the person needs it. An adjustment written into a rota lasts as long as the rota. A stool that has somewhere to live, a table that goes up and down, a quiet room and a WC that's close by don't need to be asked for twice, don't depend on this month's manager, and don't evaporate at four o'clock on a Friday when the day has gone sideways.
What does inclusive veterinary practice design cost?
The research makes the point that many environmental changes are quick and inexpensive, and at design stage that's true [2]. More chairs, better lighting, local temperature control and a properly located quiet room cost very little when they're in the drawings from the start. Even in an existing building, a lot of it is refit rather than rebuild: a store cupboard reclaimed as a quiet room, a knee space cut into a run of base units, a lift table in place of a fixed one.
I won't pretend it's all free, though. Larger consult rooms, an extra staff WC, acoustic separation and lift tables in more than one place cost money and floor area, and on a fixed budget they compete directly with the number of consult rooms, which is to say with revenue. What rarely makes it into that meeting is the other side of the ledger: the nurse who leaves, the vet signed off when their back finally gives out, the recruitment fee and the locum cover. I've written before about what one leaver really costs a practice, and it isn't small. Clients are entitled to make that trade with their eyes open. My job is to put it on the table at feasibility, with numbers against both sides, rather than let it surface as a deletion during fit out when nobody remembers why the item was there.
The other honest point is about how the industry briefs. Part M gets a scheme through building control [4], and BS 8300 guides how the public areas work [5]. Neither says much about the clinical core, which still tends to be designed around an assumed body that stands for eight hours, lifts a Labrador, hears the monitor and reads the small print. Most briefs ask about throughput, kennel numbers and workflow. Very few ask which tasks on this team currently hurt. Ask about tasks and postures rather than conditions and you get the same design information without asking anybody to disclose anything.
A five minute walk round for practice owners
If you run a practice, you don't need a design team to start. Walk your building on a quiet afternoon with these questions, ideally alongside a colleague who'll answer honestly:
- Where in prep, theatre and each consult room can someone work sitting down, and is there a stool already there?
- Does the consult table go up and down, or does everyone bend to the same height all day?
- How far is the nearest staff WC from theatre, and how many doors are in the way?
- Is there a room with a solid door and no phone where someone can be alone for ten minutes?
- Who can change the temperature in the room they're working in?
- Is everything people reach for every day stored between hip and shoulder height?
If more than a couple of those answers make you wince, you've found your brief.
How Agrarian builds this into every brief
None of this is new to us, and it isn't a reaction to the research. It's how we already brief a project, and the research simply confirms why. Our briefing conversations include a seated working position in every clinical space, and adjustable height as the default rather than an upgrade in prep, dentals and consult rooms. They include one properly quiet room that isn't the staff room, staff washrooms sized on headcount and placed near where people actually work, local temperature control, acoustic performance written into the specification and measured at handover, and lighting that's dimmable and flicker free throughout. And early on, a task and posture exercise with the whole team, framed so that nobody has to explain why they're answering.
Asking about tasks works. We always try to listen to every member of the team and build in their recommendations wherever we can. One simple example came from the team who do the laundry. We looked at the task in depth and worked out that with slightly larger machines and auto dosing, they could put more through in fewer loads and use less cleaning product. A win for the team, and a win for the practice's bottom line. Sometimes it's just a matter of stopping to ask why a task is done that way, and whether we can make it easier. When I revisited the practice, I made a point of speaking to the nurses who handle the laundry. They were still all smiles, not only because the job was easier, but because someone had been prepared to listen.
My sincere thanks to my contact at the RCVS for pointing me to the research, and to the RCVS, BVCIS and IES for compiling it, which is no mean feat. Almost half of respondents said they'd take part in further work on the subject, which strikes me as an open door. I'd love to be part of that conversation, particularly on the role the building has to play.
Planning a build or refurbishment?
If you're planning a build or a refurbishment and would like these questions in the brief rather than on the snagging list, I'm always happy to talk it through, and equally happy if the timing isn't right just now. You can reach me at peter.hall@agrarian-uk.com.
Which task in your practice currently hurts, and could the building be carrying that load instead? I'd genuinely like to know.
Frequently asked questions
What is the most common workplace adjustment in veterinary practice?
Seating. In the RCVS and BVCIS research on disability and chronic illness, the adjustment respondents described most often was somewhere to sit: stools in prep, theatre and consult rooms, and supportive chairs for desk work. It is one of the cheapest adjustments to make, provided the layout leaves room for it.
How many vets and veterinary nurses have a disability or chronic condition?
In a 2023 survey of 3,411 vets, veterinary nurses and students carried out by the Institute for Employment Studies for the RCVS and BVCIS, 75 per cent reported at least one disability or chronic condition, and around 60 per cent said they were affected every day.
Does Part M of the Building Regulations cover veterinary staff areas?
Part M sets minimum standards for access to and use of buildings, and BS 8300 gives more detailed guidance on inclusive design. Neither says much about the clinical core of a veterinary practice, such as prep, theatre and consult rooms, so staff needs have to be raised in the brief.
Is it cheaper to build accessibility in at design stage or retrofit it?
Design stage is far cheaper. Height adjustable benches, lift tables, knee spaces and well placed staff WCs cost little when they are in the drawings. Added later, they can mean chasing power through finished floors and rebuilding worktops already installed.
How can a practice owner check their building for accessibility today?
Walk the building with a colleague and ask: where can someone work sitting down, does the consult table adjust, how far is the nearest staff WC from theatre, is there a private quiet room with no phone, who controls the temperature, and is daily kit stored between hip and shoulder height?
References
- RCVS (29 July 2024). RCVS and BVCIS call for greater understanding of equality law and reasonable adjustments with landmark research reports. rcvs.org.uk
- Plowden Roberts, C., Robinson, D. and Rosolin, B. (2024). Disability and Chronic Illness in Veterinary Work and Education: summary report. Institute for Employment Studies for the Royal College of Veterinary Surgeons and British Veterinary Chronic Illness Support. Fieldwork May to June 2023, 3,411 responses. Summary report (PDF)
- Abbondati, E. et al. (2026). Neurodiversity in Veterinary Medicine: Does Lack of Data Mean Lack of Awareness, Understanding and Support? Veterinary Ophthalmology. doi.org/10.1111/vop.70070
- HM Government. The Building Regulations 2010, Approved Document M: Access to and use of buildings, Volume 2: Buildings other than dwellings. gov.uk
- British Standards Institution (2018). BS 8300-2:2018 Design of an accessible and inclusive built environment. Buildings. Code of practice. bsigroup.com
- Equality Act 2010, section 20: Duty to make adjustments. legislation.gov.uk
About the author
Peter Hall is Managing Director of Agrarian, specialists in veterinary architecture and construction project management. He has spent more than twenty five years designing, refurbishing and delivering veterinary practices, referral hospitals and multi site clinical developments across the UK.
Written By
Peter Hall, Managing Director
Peter Hall specialises in veterinary facility design and project delivery, working on referral hospitals, multi-site practices and clinical developments. For more than twenty years he has designed, refurbished and audited hundreds of veterinary buildings.
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