Creating the “Easy” Experience for Clients Brian Conrad, CVPM Meadow Hills Veterinary Center Kennewick, WA
Year after year we sit and preach to our staff about offering WOW Service and instill into them that they must exceed client expectations every week, every day, at every appointment….How are we doing? I will guarantee we are not doing as well as we think we are. Have you ever taken a moment to consider what it is you are asking them? You tell them: “Go Exceed Expectations”. What in the hell does that mean? First off, do we know what the client expectations are? For a few that can answer that honestly as Yes, then tell me how does the client perceive if the client expectation has been exceeded? If we as the management and leadership team struggle to define this, imagine our poor receptionist who hears time and time again to go exceed expectations. After all, his/her next pay raise could be counting on it. While I am playing devil’s advocate slightly and yes, I truly do believe in incredible client service and exceeding expectations but I have found over the years it is very subjective. We have focused at Meadow Hills Veterinary Center where I manager on “Making it EASY” for the client. If you tell your staff to make it EASY to do business with your clients than they have a much better understanding of their role. After all, we can list out all kinds of ways to make life easy for our clients and their pets. See the difference? In 2010, The Harvard Business Review published results from a study they conducted using over 75,000 consumers to learn more about exceeding expectations vs. making business easy on customers. The first intriguing fact was 84% of those surveyed indicated their expectations had not been met in one of their most recent service interactions. 2 Critical factors came from the study that suggests Delighting Customers does not build loyalty but reducing their effort does. Interesting. So the first finding indicates that if we do more of the work for the client there is a higher probability of them sticking around for next year’s services. Finding number 2 stated Acting deliberately on this insight can help improve service reduce customer service costs, and decrease customer agitation and defection. So in essence, if we have our team members in our veterinary clinics make it easy on our clients such as reminding them 7 days before they are about to run out of a long term medication for their pet than they are going to be much more loyal and the probability of them staying with our clinic is high. Let’s put this in terms we can relate to. Weight loss is a fairly easy concept to understand. If input of calories is less than output of energy in calories (i.e. burn off of calories) then you will lose weight. Obviously the opposite is true with weight gain. If we know this easy equation of eating and exercising a healthy lifestyle, then why is it Americans will spend some 35 billion dollars on weight loss products, pills, powders, additives etc. Why? Because it seems so much easier to take a magical pill than be good about what you eat and hit the gym. Kodak makes incredible cameras yet they are in bankruptcy. We don’t use these incredible camera but instead take the majority of our pictures with our smart phones because it is so convenient and easy. With a touch of a screen we are posting them on social media and texting them to family and friends. We are willing to give up some quality for ease. Relate this back to your veterinary hospital. Are there systems and processes that place too much work on our clients? Are there ways to cut down on the amount of effort which is placed on the client? During a recent lecture on phone call systems in the veterinary office, participants identified clients calling to get updates as one of the top 5 reasons the phone rings. With a focus to lower the effort and anticipate the client’s needs for continual updates, imagine if we texted them as the patient headed into surgery, another text as they exited, and another as the patient woke up safely from anesthesia. This just removed 3 times the client has to attempt to call in to see how their baby is doing from a simple spay or neuter procedure. Don’t assume you are doing all of the work. Ask the client in a survey using a “Customer Effort Score (CES). This is generally expressed on a scale of 1-5. One indicating very little effort was put forth by the client and a five indicating the client felt they had to do more than expected. The question would read: “On a scale of 1-5 how much effort did you have to put forth to have you and your pet’s needs and requests taken care of?” You of course would define what the scale of 1-5 indicating for the answering client. Very interesting information. In fact, a client who gives Meadow Hills Veterinary Centers where I manage a score of 3-5, I am immediately on the phone with them to find out where we went wrong. Take the time to learn more about your clients’ needs and wants. This activity can be a real eye opener. Make sure you are constantly sharing the results with the staff and making changes as necessary. Still not convinced? The study continued on and found of the consumers that indicated effort was low on their part, 94% indicated they would be back for re-purchase of services or products. 88% indicated they would increase their spending. Only 1% noted they would speak negatively about the company. Of the clients that noted a high effort score, 81% said they would speak negatively about the company. Let’s look at a couple of examples of companies in the United States that have put this into action. Chrysler sent a development team to the parking lots of grocery stores across the country. What they found is mom or dad coming out in the middle of the day with kids and arms full of groceries fumbling for the resemblance of the van keys and having a difficult time getting into the car. In came the invention of the auto-slider door on the min-van in efforts of eliminating effort. A big success for the families.
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Lowes Home Improvement store launched “My Lowes” a web-based platform which organizes all of your personal preferences for your home and garden projects. It will keep track of the paint colors for each room of the house, specific annual plants and quantities you use for your garden each year and even remind you to purchase and replace your air filter. In other words, they are doing the work for you to keep your home maintenance organized. It’s working for them too in the way of re-purchase revenues. In 2012, a report was release on grocery store trends. One of the indicators which was measured was the reason a grocery store is selected. 3 out of the top 5 reasons were for reducing effort on the consumer with convenient location, simple to shop, and easy in and out access. It is another indicator this paradigm shift for our veterinary hospitals is real and much needed for us to continue to find success with our clientele. I encourage you to sit down with your staff and make a list of the reasons clients come into your doors. Exams, prescription refills, surgery, dentals, diagnostics, retail purchases, boarding, grooming etc. Make a road map of each reason and steps that have to be taken and list out ways your team can take on more of the effort for the client. Start to survey the Customer Effort Score and make sure the changes are being noticed and recognized by your clients. If they are not, then you need to go back to the drawing board and evaluate where the team is missing the effort connection. Taking a proactive approach will end result in a happier, more loyal, and more profitable clientele.
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Make Your Next Team Meeting Work Brian Conrad, CVPM Meadow Hills Veterinary Center Kennewick, WA
At one point or another each of us discussed the possibility of holding a staff meeting to get everyone together to solve the day to day problems the clinic is currently facing. It seems like a good idea but when I do talk with hospital owners and managers I generally hear the following about their staff meetings: We don’t have the time, we can’t get the staff to attend, they just turn into complaint sessions, or they are so expensive. I agree, with these thoughts I wouldn’t want to have meetings either. In fact, five or six years ago we had similar sentiments about our staff meetings at Meadow Hills Animal Hospitals in Kennewick, WA where I manage. I can remember a meeting that was so dull, boring and unproductive I was ready to give up in the idea of having meetings all together. I am so happy we pushed through those difficult times and now have excellent staff meetings each month. If some of the descriptions above sound like your team meetings it might be time to reevaluate and make some changes. Before we are able to jazz up our meetings we needed to offer some additional structure I like to refer to the who, what, where, and when. Without the structure we have no basis for determining success or failure. Our first goal was to focus on purpose for the meeting. What is it we wanted to walk out at the end of the meeting and be able to say we accomplished? Spending some time a week before hand creating pre-determined objectives set the tone for the meeting. Based on the objectives we were able to create a timeline to run the meeting off of. The timeline and objectives communicates a plan and places importance on the meeting itself. Our objectives are revised each meeting but include housekeeping items, pharmaceutical updates, client comments and concerns, staff education, team building and more. The second goal our management team put in place was consistency for conducting the meetings on a regular basis. Whether you determine your practice needs weekly, monthly, or quarterly meetings it is important to show the staff you are committed to the meetings on a regular basis. We so often speak of creating value for the client but in this case we need to create a perception of value in the team’s eyes. On August 2nd 2016 Meadow Hills Animal Hospital, will conduct their August general staff meeting. While I cannot tell you the exact agenda at this time, it is important the staff understands the importance of these meetings. Meeting dates are schedule out a year in advance and are included on each employee’s schedule to demonstrate that importance. The third roadblock we wanted to overcome at Meadow Hills was a proper environment to hold the meetings at. For many years we used to have our staff meetings in the treatment area of our hospital. As the staff grew so did the problems associated with this incorrect environment. Between the IV pumps beeping, the 6 month old puppy barking and wanting to come out and play, it was hard to get the staff to focus with so many distractions. We even had staff sitting around corners not able to make eye contact with each other. With some thought and investigating we were able to locate several reasonable alternatives. Economically priced hotels such as the Holiday Inn Express or Comfort INNS usually have smaller meeting rooms that can be rented for a reasonable fee. Often times these hotels are willing to negotiate a special rate if you are able to commit to holding your meetings throughout the year. Another idea we found to work for smaller groups is many of these hotel properties have continental breakfast rooms. The rooms have no purpose the rest of the day making them prime picking for holding your staff meeting in them. We also found a pizza parlor down the road that has a meeting room. We are offered the room for free with the purchase of lunch. With some creativity and negotiating we are now able to have our meetings in an effective environment for under $75. A small fee to pay to obtain everyone’s attention during such an important time. Well the next question raised is who is going to take care of our clients as we are off-site for our meetings. The solution we have been using for over five years was hiring a part-time receptionist with her sole job being to answer phones, make appointments, and sell products while we are away. The added benefit is when our full-time receptionist request time-off we are able to use our trained staff meeting receptionist to step in. With the structure in place we are now able to concentrate on the nuts and bolts of the meeting. As I said earlier our first goal is to create objectives you want to accomplish for your own meeting. Below are some examples of activities that you may want to include on your next agenda. Continuing Education for the entire staff plays a vital role to our success here at Meadow Hills. Because of the significance to the training we schedule 30 minutes of the meeting to be dedicated to staff CE. The education sessions may be on medical topics, pharmaceutical supplies, client service, or other business related topics. We select a veterinarian or senior staff member to prepare and present the presentation. We make the presentations client useful. By client useful I mean we concentrate the information to be relevant to questions and concerns clients will have. Our staff doesn’t need to know if a specific antibiotic crosses the blood-brain barrier but they do need to know if the medication needs to be refrigerated and given on a full stomach. I have listed two our recent topics to give you an idea of the information covered.
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Ears, ears, ears One of the number one reasons clients get frustrated and leave a practice is the mismanagement of ear disease. Pus, bacteria, yeast, blood, fungus, mites, foreign bodies, and the list goes on. How do we diagnose but more importantly how do we treat and prevent reoccurrence. Home management and patience are the keys. Are we supporting our clients well during these frustrating times?
Dealing with difficult clients The holiday months bring out the best and worst in all of us. What do we do when a client comes in with an agenda to attack? We know it is not our fault but they are standing in our lobby. What to do….what to do? Sometimes running out of the building is not an option. Pharmaceutical Representatives are excellent resources for additional education for the staff. Take advantage of the opportunity and let the hospital and your clients benefit. When using one of your reps take the time to meet with them and discuss the agenda on what it is you would like covered. There is no sense in discussing a product to the entire staff if this is a product that will never be carried in your hospital. Make sure the pertinent information to be discussed will challenge the entire audience and be useful. We have taught the staff to live and breathe customer/client service. We have spend 10-15 minutes talking about positive and negative personal experiences by staff members with other businesses. When client service is brought on a personal level the desire to improve and exceed expectations is heightened. Staff is encouraged to share a story about an experience they have had in the last month. From there we learn from the experience and relate the experience into the veterinary clinic talking about how it could help or hinder us in a similar situation. Changing pace for an hour can be beneficial to the team in many ways. Once a quarter we try to find a team building activity for the staff to participate in during the staff meeting. It is a time for the staff to switch gears, get to know each other and learn to work with each other better. Below are a couple of examples of successful events. During our February staff meeting a few years ago we had an employee come up with a brilliant idea in keeping with the Valentine themed month. Each team member was given a package of valentine day cartoon cards. The ones you see in stores for the elementary school children to pass out in class. Over the next week staff members took the time to fill one out for each of their co-workers. On the cards they listed out at least one positive trait they admired of their co-workers. At the staff meeting time was taken to hand out everyone’s cards in their own decorated valentine bag. The staff then opened each one and received over 30 separate compliments. In addition the staff went around the room and read one of their cards. What was extra special was each of the staff took the cards home and their families were able to see how appreciated and what vital roles they play for the clinic on a daily basis. Last summer we created a photo scavenger hunt for our 3rd quarter team building exercise. We allowed 1 hour for each team of 5 employees to venture out into the community and look for items listed on a sheet of paper. Each item had a different point value. The team with the most points at the end was deemed the winner. We accomplished our main objective which was to have a fun outing together after a busy summer. Two added benefits was the staff bonding that took place and the strategy and thought process that was used by the teams. I will never forget one of our new receptionists commenting on how fun one of the doctors was as he got to know her better. As our staff meetings positive momentum grew, we wanted to be able to measure how effective our communication was during the meeting. We developed and implemented a consistency quiz to administer to the staff at the conclusion of each meeting. The purpose is to establish consistency and show value for the time and money spent on the meeting. The quizzes are taken on an individual basis. They are reviewed and corrected over the next few days. Any misunderstandings are discussed assuring everyone is on the same page. This tool is a keystone to our success. Questions are pertinent to information discussed at the meeting and usually are 10 questions in length. Celebrating Success is a great way to end your staff meetings. We spend the last 5-10 minutes focusing on what is going right. This may be client retention or compliance rates, it may be someone’s work anniversary of 5 years; it may be a heart felt thank you card from a client. Whatever the case may be we all have success stories in our clinics that need to be celebrated and the staff congratulated on being a part of it. Focusing on this behavior and making a big deal of the clinics accomplishments will only encourage similar behavior. With some creativity and prep work your staff meetings can be revamped into an efficient fun, and productive time. Your goal should be to leave the meeting with you and your staff on the same page, feeling energized know decisions have been made and positive changes are coming. So take the challenge today and see how you may jazz up your next staff meeting.
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Preparing Your Hospital to be Ready for Change Brian Conrad, CVPM Meadow Hills Veterinary Center Kennewick, WA
We all have had some type of success in our practices. Some more than others. But what differentiates ongoing success is for the ability to realize we must continue to be innovative and change to meet the demands, wants, and needs of our clients and future clients. Where we tend to slip up is we see and feel success in our practices and we have a human nature element in all of us to sit back and say “finally, we made it”. I made this mistake at the two practices I manage in Kennewick, Washington. It relates to our client service. We held weekly meetings, we created staff incentives, we solicited client feedback, reviewed other companies out of our industry who we could learn from. The list goes on and on in all of the effort, training and attention we placed on client service. One day the phone rings and we promptly answer it with a welcoming message. It turns out to be a national company that would like to use Meadow Hills Animal hospital and 4 other companies in the United States to create a new training film on customer service. Wow, you can only imagine my excitement along with practice owners. We had done it. We have created the most amazing client service experience for our clients and now others want to duplicate it. A sense of excitement but also relief had swept over me. I could now concentrate on other areas of the hospital because it was obvious we had mastered the experience process and we were done in that avenue. Fast forward 24 months after filming. Our client retention is slipping, new client counts are down, and overall client satisfaction is at its worst levels since the company’s inception. What had happened? We were making the BIG mistake so many companies do. Once you find that magical formula you just sit on it like a sacred cow. A naïve perspective of thinking that once you get there you can sit back and enjoy the fruits of your labor. We now knew that whether it was our client service, our pharmacy sales, or our marketing programs for dentistry that we had to continue to change and evolve to continue that success we wanted for the company. It was a hard lesson to learn but one we try to reflect on often so that we never forget to change, grow, and mature.
Perform a self-evaluation • How would you describe the culture of your veterinary clinic as it relates to change and innovation? • What do you believe is the most unique or distinct feature about your veterinary clinic? • What concerns do you have about your competition or possible competition that would dilute out your uniqueness? • If you had a magic wand and there were no obstacles in your way, what is one thing you would immediately change about your organization? What would you never change? • If your clinic closed its doors for good tomorrow, what would your community and the industry lose? The idea of change is relatively simple. The idea if implementation and accountability is at the heart of innovation. Over the course of the next hour we will look at real life examples of innovation and change implementation. We will look at techniques and systems to get staff excited and on board. The goal of the session is to have concrete objectives to take back your practice and start implementing immediately. But this of course is “subject to change”!
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HR Trends and What to Do Now to Get the Team You Need (Parts 1 and 2) Sheila Grosdidier, BS, RVT Veterinary Management Consultants Evergreen, CO
1. Manage, maintain and monitor • Why we don't fix people • Challenges ahead • New laws • Make a plan now • Understand your options
2. Changes in the labor market Generational influence Millennia Is will represent the largest part of the labor force beginning in 2016. Many more mature members of the workforce are moving swiftly toward retirement and in some cases resulting in a loss of business intelligence in the process, commonly referred to as skills gap. The needs, experience and expectations of the various generations in the workplace influence the management of your practice. Is this being considered and do you have a plan in place to survive this new ground in employee management? WHAT TO DO NOW-Update training to be diversified in how it's delivered, varying the methods to incorporate what will be useful for all team members. Consider special training for managers/supervisors on how to be connected to different generations. Reinforce that diversity of age is an asset to the practice and all team members are valued for their contribution to the success of your business. Succession planning is crucial to the success planning of a practice. Hiring practices The challenge for obtaining qualified candidates for open positions will continue to stretch many practices to the edge of their capability through 2016 and beyond. Job hopping will continue as the usage of smart phones have made it very easy to have instantaneous access to job www.vmc-inc.com I 303.674.8169 I [email protected] 2 0 /6 CVC Convention © 20 16 VMC. Inc. • Page I opportunities. The latest assessment of the labor market identifies that nearly 86% of employees are looking for work at present and are evaluating positions outside of their current job type. WHAT TO DO NOW- Practice must have mobile accessibility to their website/social media along with career information to attract job seekers. Candidates want to apply through their mobile access so having an application online is not just a good idea, it's critical to capturing potential candidates. Consider upgrading to being able to apply online for positions, employee referral programs and aggressively looking for candidates all the time. Assess how successful the interview process has been in finding, and choosing the right candidates. Implement a strong retention program and reduce down the need for hiring. Immigration Executive Order that enables undocumented workers a path to citizenship or permanent status in the US through enhanced work permits and protection from deportation for up to 3 years if they meet an outlined set of requirements. Employers should prepare for individuals who identify that their status to work may be questionable and they now wish to meet the criteria as identified in the executive order. At the point that they are identified, they may be protected under certain state laws, while the employer may be in violation of the federal law for knowingly employing an undocumented worker. WHAT TO DO -Assure that the 1-9 form you are using is the most recent {dated _ ) and implement a policy that indicates penalties to employees found to have falsified their interview information or qualification for employment. Assure this is not a discriminatory claim, as it applies to anyone who would falsify their qualifications, interview information or anything specifically during the hiring and introductory periods of employment with the practice. Social media sites, blog posts and Face book need to have more information about what the culture at the practice is like and why employees work for the practice. Social media is being used advantageously to attract strong talent to a business.
3. Wage and hour law changes States are taking a more active role in the determination of minimum wage, in some cases even cities are declaring a minimum wage for employees within their geographical limits. The Department of Labor has committed to more aggressively pursue employers who in anyway do not comply with rules governing employee wages, this includes penalties/fines, and allows for civil liability as well. In particular, cases where employers were not negligent but were deliberate in their actions, criminal prosecution will be applied. Changes to what is a salaried employee must be paid at minimum is also changing in accordance with the FLSA Act.
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WHAT TO DO NOW-At least yearly, all positions in the practice should undergo review for compliance with state, municipality and federal requirements. Assure all employees are classified correctly and that all mandatory notices on new minimum wage rates are posted.
4. Medical and recreational marijuana- coming to a state near you As Colorado, Alaska, Washington, Washington DC and Oregon are all illustrating to the rest of the country what recreational, not just medicinal marijuana can do for the financial well-being of a state, many more states are strongly considering getting on the "go green" bandwagon. While the states are enacting their own legislation, it's important to note that the federal laws have not changed and are not expected to in the near future. Off work usage and the impact on the workplace are still being studied while employers must decide what is safe for the business, and not invasive on employees off work activities. WHAT TO DO NOW: Drug free workplace policies are becoming paramount in creating safety for employees, clients and patients. Any drug testing policy will need to reflect the updated laws of that state and how to manage any issues where an employee is demonstrating impairment that suggests adverse marijuana usage. All team members should have yearly training to assure they understand the intent and application of the policy. Managers/supervisors need special training in identifying situations where impairment due to marijuana usage may be present. Review your policy regularly as the laws are changing all the time.
5. Employee benefits Paid sick leave -by city, by state, by number of employees Many states have determined that employees should be granted paid sick leave to attend to medical concerns in themselves or immediate family members. The laws often include how the time can be used, how much time is available and who must comply. Compliance is often by the employer's number of employees and the number of employee hours worked. WHAT TO DO NOW-As these laws can be very detailed and shifting, do make sure that your benefits plans, and other policies that might be covering this same topic agree with one another. If sick leave is part of a state law, it is likely that tracking that time separate from PTO is a good practice as well. Employees should be able to identify what time they have available easily either through online access or recording on their paystub. Affordable Care Act- changes for 2016 In 2015, the Affordable Care Act (ACA) outlined a mutual responsibility requirement between the employer and employee on coverage. If the employer has SO or more employees as determined by the formula provided, that employer must provide as least minimum coverage to full time employees. For an assortment of reasons, this was not actually applied to companies of 50-99 employees, but rather in a modified version to employers of over 100 employees. Now, in 2016, businesses with over SO employees will have to offer coverage to over 95% of their employees not to incur a penalty. WHAT TO DO NOW- Be sure to use the formula provided for the ACA to accurately count employees in application of this requirement and perform the count regularly if your employee numbers move in either direction due to seasonality, work load or operational elements. Employers must certify that they have not reduced their workforce to avoid having to comply with the ACA, look carefully and document how decisions are made regarding employee count. Employee vs. practice privacy Many employers are allowing employees to bring their own devices {BYOD) to work and use them for work purposes. This includes access to the business network, internet and applications/software. Questions can arise over privacy, data security and social media access. WHAT TO DO NOW- Update Social Media Policy at least yearly. Track any issues you have during the year to determine what policy changes should be adopted. Have a BYOD specific policy. Maintain the appropriate level of network and internet security, enforce policy consistently among all employees. Employee rights - volunteers and interns- categorize them carefully Growing laws and legislation to protect individuals who should be paid for the contribution in the workplace- California Nevada, Washington DC, Illinois, Oregon and New York have laws in place for 2016. WHAT TO DO NOW- Update your policy to comply with changes. Accommodations for pregnancy and childbirth Upgrades to current pregnancy accommodation regulations are being further defined on the state and on the federal level. Many states have specifically identified accommodations for pregnancy and childbirth along with similar medical conditions to entitle reasonable accommodations that have not been addressed in the past have been clearly outlined. These changes include modifying workplace schedules, redistributing job duties, job function and special seating. WHAT TO DO NOW-do not just have a policy, have a written step by step procedure that all supervisors/managers are trained to use and assure that it is consistently applied. Remember that many of the pregnancy leave regulations include maternity as well as paternity. Follow up regularly with all employees utilizing this policy to assure that they are also informed and can provide feedback on updating on a regular basis. Evaluate current legislation - Family Medical Leave Act, Pregnancy Discrimination ACT, to assure 559
the practice knows what lllws apply and how many employees you have to have to require compliance, each law can vary on what commits you as an employer to have to be in alignment with the regulation. Same sex marriage and rights of individuals regarding LGBT While 2014 marked a landmark change in the allowance of same sex marriage, 2016 will likely show an increasing number of state laws that affect employers than in any prior years- these requirements include availability of benefits, rights of same sex spouses, and protection under the law against workplace discrimination. WHAT TO DO NOW-All supervisors/managers should receive yearly training on assuring a workplace that supports diversity and respects employees as well as clients without discrimination or harassment. Training should include how to investigate claims and how to minimize employer liability. Assure that your benefits policies identify how to apply and assure equality in access to these benefits. Workplace bullying With nearly 75% of all businesses reporting that they are aware of workplace bullying, how to respond to complaints is essential. Bullying can evolve into a wide variety of issues that not only can effect productivity, absenteeism, morale, healthcare costs, and workman's compensation claims, but also enter into harassment, discrimination and civil liability. WHAT TO DO NOW-Don't wait to become part of a statistic, set into place a zero tolerance policy accompanied by yearly team training. Employers should be quick to respond to any report and disciplinary action up to termination. Employees should be encouraged to report any areas of concern without fear of reprisal. Proactivity is key in reducing down occurrence. Domestic violence While domestic violence takes place in the home, it has an impact in the workplace, affecting productivity, attendance and longevity of employment. It is for these reasons that legislation and requirements are being adopted by federal and state agencies. The EEOC particularly has specifically outlined what is considered discriminatory in regard to victims of domestic abuse. WHAT TO DO NOW: Employees are encouraged to report that they have placed restraining orders against spouses or significant others, or if they have concerns about safety that surround their place of employment. A safe environment with a protocol that all team members apply- this includes access of non-employees to private areas of the hospital, how to handle aggressive individuals, and safety in or around the practice. In some states, leave may be part of the state requirement for victims of violence for counseling or legal issues. Ban the box Many states are becoming more concerned that employers are using a rapid screening for criminal convictions as a measure to disqualify potential employees without further consideration. The law has been established in several states to not allow the question of prior criminal convictions to be part of the initial job application. Inquiry into past convictions (not just arrests) can be obtained later in the interview process or when the offer of employment is conditionally extended. WHAT TO DO NOW: If not currently performing pre-employment background checks, it's time to re-evaluate. Remove any questions on employment applications that ask about criminal convictions. Train all team members about what is appropriate and not appropriate to ask during each stage of the interview process. If considering employment for an applicant assess how long ago the offense occurred, the serious nature of the conviction and if it specifically applies to your practice.
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Behind the Camera: What Video in Practices has Taught Us and Will Teach You Sheila Grosdidier, BS, RVT Veterinary Management Consultants Evergreen, CO
Video coaching can be a useful tool for identifying strengths and wealmesses in the consulting room. Sheila Grosdid ier explains the benefits of this style of t raining, what to consider when implement ing it, and what results to expect. Remember the last time you went to veterinary conference and speaker shared with you some great insights about how to improve your practice, enhance your client compliance to recommendations or perhaps just how to assure you were being consistent with your well ness exams? You walked out of that conference room motivated, perhaps even inspired to change your process, encouraged to truly engage your clients to gain their acceptance of your recommendations But somehow, between these great ideas and the opportunity to apply them in the consulting room, there is a distinct disconnect. This is the reality for many within a veterinary practice - doctors, nurses, assistants and receptionists alike. Most are already very competent and experienced at what they do, so in order to make a dramatic change in how a practice conducts a routine activity, they must be compelled to evaluate it from a totally different perspective. Each client's outpatient visit is composed of several different stages: a step by step consulting room protocol, a comprehensive patient physical examination, client discussion regarding health concerns, the veterinarian's recommendations, review of follow-up and the visit's conclusion. Videotaping makes it possible for all team members to review visits, examining all their component parts and identifying how clients respond to recommendations, body language and specific procedures, as well as how they act when alone in the consulting room. This is particularly useful as for most vets it is simply not practical (or possible} to make the same sort of systematic assessment either during the actual consultation of afterwards from memory. This article will cover a number of essential components that should be considered and implement in order to realize the full potential of video coaching in practice.
Is video coaching for you?. Take a moment and ask yourself these questions with regard to your veterinary practice: • Are you certain that clients are being offered a consistent standard of care? • Do team members have the tools and resources to meet the clients' needs? • What future training do you see your team needing to best grow the business? • How does your team best learn? • What training have you specifically done in the past that has targeted client interaction on an individualized basis? While there is little argument that the costs of training practice team members are rising, significant debate does exist over what methods of training will ensure consistency, enable the adoption of new skills, and create an environment that allows team members to coach themselves to achieve greater performance. When done correctly, recording employee/client interactions on video for one-on- one review can be one of the most valuable training tools available to change ineffective behavior into consistently productive client communication.
Communication In 2005, a survey in the US by the American Management Association identified that more than half of employers use video surveillance as a way to reduce theft and violence (Grosdidier 2009}, while only 16 per cent of those businesses used that information for evaluating employee performance (Guerin 2013). While some practices might already be using video technology as a method of monitoring for theft prevention or safety, the ultimate aim of video coaching is obviously very different. Those differences include how the information will be captured, what will be done with the video and how its information can change your practice. Box 1: Benefits of using video for coaching in veterinary practice • Team members can review specific aspects of a real interaction with a client, not simply go on what they remember about it; • They can view and compare videos back-to-back to see improvement over time; • They can review an interaction multiple times, focusing on things such as their body language, word choice, speech volume and cadence, and find something different during each viewing; • They can see a complete visit from the client's perspective, not just their own; They can find out what clients do in your consulting room when they are not present, then think of what they could do to make this a productive time for them and the client. One of the most important factors, and one on which the success of this process will hinge, is clear communication with your team members, assuring them that this will not be a covert operation but rather an openly acknowledged training tool for reviewing staff and client interactions and subsequent coaching for future performance. This is not about looking for mistakes; it's about looking for ways to improve. Each of us has had those moments when we replay a conversation with a client and wonder, 'Could I have done something differently?'. Seeing the entire interaction can provide clear answers. So remember that the team will need to be reassured 561
that the main goal of filming is for those images to help them choose just the right words in order to communicate more effectively with clients in the future. Make it absolutely clear that it is not about policing the practice.
Rules for everyone Because there could be some initial resistance from the team about being recorded on video, it's important to establish clear, steadfast rules that will be outlined and followed so as to reassure the team that this is a training tool to be used in a positive manner. Recording an examination should only proceed after the client has been advised and agreed. A consultation could begin, for example, by saying, 'Ms Jones, we are videotaping today for training purposes. Is that okay with you?'. Usually clients are glad to give consent, but if the client does not approve, then the camera must be turned off. Signs must be posted to alert clients and remind team members that the practice is using video cameras and that it is not a secret activity (Fig 1). While there may be a sense of natural apprehension at the outset of using video, over time, team members will probably have to be reminded that the video is running- it will become part of the landscape. Establish that the video will be used as a tool for training only, not for surveillance. Implement a clear policy that outlines how the video will be recorded and evaluated to ensure maximum benefit to the employees as well as to the practice. To get the most out of the process, this should not be a one-off activity. Plan to evaluate it monthly and set goals with a time line for each team member, which can then be evaluated at a later date. In some respects, this style of coaching is going to be as important for the growth of the entire consulting room team, not just for the individual that you are coaching on a one-to-one basis. Ultimately, this individual will model a change in behavior, creating a ripple-effect for others to follow. A policy example can be found in Box 2. Box 2: Example policies for team video coaching • The practice uses video as an individual staff coaching tool to evaluate interactions with clients exclusively In the consulting room; • Recording will take place in identified rooms on specified dates and times. All consulting room assistants or technicians, receptionists, kennel assistants and vets will be expected to participate, as the entire visit in the room will be recorded. The video camera is to be set up correctly so the entire room will be visible (Fig 2); • All staff who greet clients and guide them into the consulting room are to state that the visit is being recorded and request the client's permission (eg, 'Ms Jones, for training purposes we are recording this on video today. Is that okay?'). If the client declines, the video camera must be turned off; • Team members will have an opportunity to review their video and pick which of the clips they would like to review with their supervisor. Each team member will use an evaluation checklist and submit it to the supervisor before the review; • The supervisor will review the clip one·on·one with the team member and complete the checklist for comparison with the team member's checklist. An agreed goal will be established for the next videotape session; • An incentive could be included, for example, all team members who complete four video reviews in a 12-month period will receive a bonus and be entered into an annual draw for a day off.
Rules for everyone Be sure to have your team members assess themselves before their review with their supervisor. It is likely that the team members will readily pick up on how to improve and know what they need to do before the review. This will help them feel more confident and supportive of your coaching over time. Reinforce this action by pointing out what they are doing on their own to improve and how that not only directly impacts the well-being of pets, client satisfaction and the health of the practice, but also enhances their skills. This is where an incentive program can accelerate results. It is fair to expect that the team will be apprehensive when the initial videotaping begins, as it is a new experience and there is a tendency to feel self-conscious. Remember, the videotaping is not going to be taking place in all of the consulting rooms, all of the time. It's at training tool, not a surveillance activity. The goal is to have four or five appointments per team member being coached, which equates to about a few hours in an afternoon or a morning once a week.These should be reviewed about twice a month initially, and then, when the coach and the team member reach the desired results, they can be scheduled on a monthly basis. Want to get started the easy way? Offer a reward to the first team member to try it. One clinic offered an afternoon off for the vet who videotaped the morning of appointments. The practice had no problem getting someone to volunteer, and when the vet told the rest of the team how well the process went, and that they learned good information from the coaching, there wasn't any issue with getting the rest of the team on board.
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Star performers Each year, many veterinary practices spend considerable amounts of money on professionallyproduced videos to train their team. However, practices that start filming and reviewingconsulting room footage find that they start coming across examples of excellent work. Did you just watch a nurse give a perfect explanation of why a pet needs to have a senior profile? Did you see how well a vet responded to an angry client? When you witness these moments in the video, consider creating your own training video. This gives you a tool that highlights the stars you have on your team and which is specific to the standards in your practice. These in-house videos are amazing tools for training new staff. Ask your team members if they would be comfortable sharing their expertise by showing how to perform at that star level in such special videos. Creating a collection of these interactions is incredibly instructive to new employees.
Think positive Your team members will probably be concerned that this will be a negative experience that consists of looking for what they are doing wrong. Demonstrate that it's about building on their current skills a.!W creating positive reinforcement (Joseph 2013). Start the discussion by asking them to identify what they did well and then what they would do differently. Focus on the interaction, not the person. Table 1 (Page 6) gives additional recommendations for making coaching a positive experience.
Summary Veterinary clinics should constantly strive to adopt new and better techniques and videotaping can be a valuable tool that can offer consistency when adopting new methods. How we remember our interactions with clients can vary and videotaping can provided an accurate and effective method of reviewing and evaluating these interactions in order to improve performance. Remember to create a clear framework and team policies for recording videos, coach vets and team members one on one to achieve the best results, and always set goals to make sure that objectives are actually achieved. When clients are asked what was most memorable about visits, what do they say71s it a vet's diagnostic ability or technical knowledge, or is it the connection that was made with the client? Video can dramatically identify what the strengths and weaknesses in the consulting room are and provides an opportunity to closely evaluate them in a way that no other instruction can offer.
References DONNELLY, T. (2010) How to get feedback from employees. www.lnc.com/guldes/2010/08/how-to-get-feedback-fromemployees. html. Accessed January 16, 2014 GARNER, E. (2013) Managers, read these 8 tips on giving the right feedback. http:/lbookboon.comlblog/2013/02/managersreadthese- 8-tips-on- glving-the-rlght-feedback. Accessed January 16, 2014 GROSDIDIER, S. (2009) Should your practice Install video suNelllance?. http://veterlnaryteam.dvm360.com/lirstllne/ artlcle/artlcieDelail.jsp?ld=622344. Accessed January 16, 2014 GUERIN, L. (2013) Workplace cameras and suNelllance: rules for employers. www.nolo.comnegal· encyclopedia/workplacecameras- suNeillance·employer-rules-35730.hlml. Accessed January 16, 2014 JOSEPH, C. (2013) Simple ways to build trust with employees. http://smallbuslness.chron.com/slmple-ways-btJIId-trustempioyees- 11619.html. Accessed January 16, 2014
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2016’s Hottest Tools to Grow Your Practice Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY
Before you begin, a disclaimer. Frequently I find conference audiences interested in quick fixes that can somehow bypass the arduous, complicated work of leadership. There is no such quick fix. Still today’s growth tools, probably more so than ever before, are easy to use and extremely effective. Innovation, experience and technology have all converged to give practices a great shot at growth. Just keep in mind that none of these fly on its own. Every good growth and leadership tool requires a great leader to operate it.
Leadership training Despite a lot of evolution over the past 20 years, the ranks of our industry leaders are still largely comprised of self-made men and women, eager to succeed, but not equipped with the experience, communication, and skills to accomplish every company’s ultimate goal: to get employees to think and act like owners. Before you think about business growth, you should think about leadership. If you had a lemonade stand in Hell, it’s likely that initial business would be great irrespective of your leadership skills, but soon, the supply line of water and lemons to make your product and the number of employees falling ill from pitchfork pricks would erode at profits. Ultimately every business requires some good leader to get things to run smoothly, to get people to get along, and to get people to work passionately. Fortunately, there are a lot of excellent sources of leadership education. Organizations like the CVC and AAHA have embraced the notion that complex concepts are best described using a variety of teaching styles and settings. Attend a conference by one of these organizations and managers may be asked to work in small groups, listen to panel discussions, attend Ted-Talk-like lectures, write essays, or sit in on roundtable discussions. These organizations are drilling down into catchall terms like leadership, communication, coaching and team building and asking both instructors and students, ‘what does this mean?’ The Veterinary Hospital Managers Association has had exponential growth in recent years, not just in membership, but also in the quality of their leadership education and their commitment to it. Both the VHMA and CVC-Advanstar have a wealth of free leadership resources available in digital, print and video format. VHMA also encourages learning through mentorship and has a number of ways for managers to connect with other hospital leaders. Their online member forum is like the VIN of Veterinary Practice Management. It provides great information and support in a daily, ongoing feed. Vendors like Zoetis and Merck know that there is a direct connection between strong leadership and strong sales. These companies have a wealth of free resources available to practices, world-class teachers that can be delivered right to the practice door. They can even outline a plan for how to continue both the professional and business growth after the class has ended. If you and your practice are going to grow, you’re going to grow because of your leader’s efforts and his or her communication and leadership skills. Leadership education is better and more available than ever before. Go to the VHMA and look at the qualifications to become a certified veterinary practice manager. Even if you never sit for the test, the list of qualifications can serve as your own personal syllabus on a journey that you must take if you are going to grow your practice in the long term.
Employing technicians specializing in a field There are more and more options for technicians to expand their knowledge base and grow their skills. This is excellent news for practices interested in retaining quality employees and getting workers to help grow the business as though it were their own. In my work, I see more and more practice’s employing technicians who specialize in dentistry. Since their knowledge and experience can exceed that of the practice’s veterinarians, they can be an enormous asset. They can take over client education at the practice and, because of their credentials, bring a lot of credibility to what they say and teach. They can build out safety protocols for anesthesia and bring an added dimension of oversight to the entire surgery/dental department that ensures that the practice doesn’t just grow, but thrives. Their enthusiasm for what they do can infect the whole team. At the practices with which we work, the ones that employ techs with a specialty in dentistry bring in tens (if not hundreds) of thousands of dollars in dental revenue annually. Some of these techs lead departments that rival the production of the practice’s associate veterinarians. They are a source of inspiration for the rest of the team members. They teach the team that veterinary nursing is a career that comes with a good salary, respect, job enrichment, and lots of opportunities to self-actualize. Along the same lines, companies like Oncura, a business that produces a ‘self aware’ ultrasound machine, can provide associates and technicians certified education on how to accurately perform both abdominal and chest ultrasounds, then watch their work (and if necessary, take over the controls) in real time. It's been an enormous growth opportunity for some practices. By training technicians to do the work, valuable veterinarian time can be channeled in other directions. Live, remote oversight of the ultrasound process by boarded veterinarians ensures that the ultrasound images are diagnostic and interpreted accurately. In some cases, practices are using the Oncura device as part of a senior screening program that catches medical conditions that would otherwise go undiagnosed in the
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traditional annual appointment. The service opens up a whole new level of care for owners eager to keep their pets living long, healthy, active lives and gives small practices an excellent way to compete with larger veterinary groups and specialty practices. ‘Want to be trained as an ultrasound technician?’ How do you think that sounds to an employee that’s been with you for years, proven his or her worth, and who is eager to continue to grow? Do you think such a growth opportunity would help you retain that employee? Could it be a way to have the employee’s earning power keep pace with his or her annual salary increase? The fastest growing hospitals are growing their business by growing their team members.
Expense management tools Our practice managers should be on the floor where they can observe the team in action and trouble shoot efficiency and customer service opportunities. If they’re holed up in their office pouring over the schedule or breaking down invoices into specific expense categories, they’re not making effective use of their time. During the lecture, we’ll talk about online scheduling software that dramatically lowers the amount of time spent working on the employee schedule. This software streamlines an otherwise tedious job, calculates total staff wage, reduces overtime, and helps practice managers to better budget the practice’s payroll. Companies like Henry Schein allow practices to have their inventory invoices separated according to the accounting-expense- category to which the product is assigned. This really streamlines the data entry process. It means that total expenses, by account, can be taken directly from the individual invoices and loaded into the accounting software. The process makes comparing revenue in the POS software to expense in the accounting software straightforward. With just two reports, practice managers can make an immediate, accurate assessment about their inventory management and markup.
Advanced communication services I recently was assigned an article for Firstline Magazine in which I was asked to explore managers’ thoughts on third party communication systems. I was shocked by how many (100%) felt that their communication company was ‘indispensible’. It was not because they were relying on them to handle their reminder cards, but looking to them for help with the small universe of other communication jobs we find ourselves having to do in today’s digital age. Here are few of those jobs and the benefits that they bring to practices. Targeted emails: Communication companies now have a facile way of looking in your software and distinguishing patients by breed, sex, age, time that they’ve been at the practice, services that they’ve received, and so forth. Singling out specific subsets of your patients and targeting them for a service that directly meets their needs means less advertising money spent and a wider conversion rate. Reputation management: Third party communication companies can help you keep track of what’s being said about you online and on which sites it’s being said. They can also help you stay proactive about your reputation by sending out surveys to clients before they turn to sites like Yelp to express their dissatisfaction. Surveys provide you with a more objective look at your practice’s client satisfaction. What’s more, your communication partner can assist you with driving these favorable reviews to more visible sites, like Google, where they are more likely to make a difference in your search engine results and how your prospective clients view your business. Additional services include newsletters; help with social media sites, inactive client conversion campaigns, texting services, and more. With so much available to you, for so little money, relationships with third party communication companies are a sure bet. Be sure to understand fully what they are offering and to stay on top of monitoring their success at delivering it.
Focus on compliance to preventative services More clients think of their pets as family than ever before. Services like dentistry, annual wellness bloods, and more involved services like preventative-health ultrasound screening or radiographs don’t seem like extravagances, but valuable diagnostic tools to keep loved ones remain healthy, active, and feeling good. Companies like Zoetas and Antech have been hard at work building tools to help practices communicate the value of prevention and increase team members’ ability to communicate that value. Portable and self-aware diagnostic tools A growing number of companies are making significant advances in ultrasound machines. Today, practices can purchase machines that are portable (SONIMAGE P3 by Konica Minolta) and that can provide remote, real-time feedback by boarded diagnosticians working off site (the previously mentioned device by Oncura). Portable laser machines can be rented to clients who can be trained to use them on their pets at home thereby decreasing the amount of time spent working on such patients inside the practice, increasing client compliance to treatment, and driving practice revenue.
Payment solutions The past few years have brought in a new wave of payment solutions that put more veterinary services within reach of more clients. Companies like Vetbilling.com manage payment plans for clients off-site. Plans are written by the practice and on the practice’s 565
terms and the hospital collects 100% of the funds. Companies like Care Credit have made it easier for clients to get approved for credit and insurance companies like Trupanion, that offer a certificate for a free 30 days of coverage, help practices sell the value of pet insurance and to drive higher patient coverage rates. We’re living in a fast paced and quickly changing world. Our learning curve is steeper than ever before, but the wave of technology and change has also brought us a host of business-growing solutions. Never before have we had such an opportunity to make an impact on our clients, on the quality of our work, and on our savings and growth. Explore the vendor hall at this year’s CVC and be bold enough to ask for help. It’s essential to these companies’ success that you succeed. Go ahead and farm out some of the responsibility for growing your practice, just don’t forget that you will never be absolved of the responsibility for managing it.
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Build a Receptionist Team that Grows Your Business Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY
Some time ago, receptionists were renamed client care representatives. Likely the name change was someone’s way of reminding all of us that the first people to whom our clients are introduced are tremendously valuable. Trained well, client care representatives have the ability to capture phone shoppers; to catch hundreds of minor, but important client and patient medical chart details; to increase client compliance, and to market services of the practice. In this lecture we’ll talk about the job we want accomplished by these people that we seat at ‘the desk’; talk about how to engage them in what they do; and review the leadership elements that build a great team.
Client care representative job description Your choice to go into business was a kind of commitment. In essence your decision to go out on your own and start your own practice was a statement: ‘I have something unique to offer. I have chosen to provide oversight to the care your pet receives because I want to ensure you quality. The outcome of your pet’s health is so important to me, I want to take full responsibility for every part of the service you receive at this hospital.’ If that’s true then ‘the people at the desk’ have to be more than phone answerers and note takers. They have to be a voice of the practice and really, a voice of you. When they pick up that phone, they should do it the way you would do it. They should pick it up as though they had the desire and power to make a difference. Start to build your veterinary reception team with an understanding of what you want accomplished beyond ‘picking up the phone by the 3rd ring’. Appreciate the value of the job itself. Understanding how important (and hard) it is to manage a room full of clients and pets like a practice owner, to manage a desk load of other responsibilities like a practice owner, and to manage a phone that rings with every kind of question and request like a practice owner is the first step in building a great team. It’s the first step because it teaches you that the person who is willing and capable of doing all of that deserves a good deal of respect.
Start with respect Why is it that this most difficult job is given to those for whom we have the least regard and for whom we provide the least training? Many practice owners will participate in hiring the hospital’s technician, but the client care reps, well, ‘the senior front desk person handles them’. At some practices, doctors won’t even bother learning the front desk team’s names. Their passive dismissal of the group as a whole is what typically fuels our industry-wide front-versus-back war. We silently bless prejudice against a group that has done nothing to win our disfavor except show up to work, receive little to no training for what they do, and quake beneath an intense day of multitasking and demanding clients. When you reach out into the world and request someone to take a client care representative job at your practice, let them know by the ad that you write that this is a job that’s extremely important and valuable. Let them know that you appreciate their interest in applying for the position. When they send in their resume, thank them and show them how glad you are to meet someone who may soon be an extremely valuable and respected member of your team. During the lecture, we’ll review some hiring practices for you to consider when looking for and interviewing a client care representative, but keep in mind this most important point: a great client care representative is an extension of every one of your client service ambitions. Show your gratitude and respect for anyone willing to take on that very big job. When training your front desk team (and everyone in your practice), send the message that client care representatives are just that, client care representatives, not clinic secretaries. If you have a fax to send, send it yourself, don’t throw it to the ‘girls upfront’. They’re not your foot servants, they’re members of your team. Equals. If you need a favor, ask it in the context of a please and thank you.
There’s no getting around your responsibility to train If your practice is like many others, training isn’t training; it’s sitting next to someone who’s been there longer and watching. It’s pick it up as you go. It’s follow along as best you can. The training issue is a frequent source of dismay for me. I regularly go to practices that are quick to point out the flaws of their front desk team, yet can’t produce a single page of a training manual. They can’t even produce an outline of a training manual. If they do have a training manual, they have no record of it ever being used. As I said before, training is typically relegated to someone whose only qualification for the training job is that they were hired first. Don’t train what to do, train how to do it. You don’t just want the phone picked up; you want it picked up in a particular way. You don’t just want people checked into your practice; you want them checked in in a particular way. Use your mission statement as a way of qualifying your training so that your client care representatives understand the spirit of the job, not just the job. 567
Stay realistic Remember that you want client care representatives to answer phones; check in clients; look for charts; manage charts; balance a cash drawer; deal with any number of computer glitches and issues; communicate to clients through email, portals, text messages, social media and so forth; eat their lunch in their laps; and hold their bladder till the ‘other one’ comes back from break. It’s a huge job and it often comes in punishing waves of busyness. What’s more, the only way to do it, is typically to do it all at once. While we always list multitasking as a requirement of the job, we fail to acknowledge that asking someone to multitask is leaving them wide open to make mistakes and consequently to fail.
Conclusion Building a great receptionist team starts with appreciating the value of the job you are trying to get done, with training to do the job that you would like done, and with an exploration of how to adjust the workflow of the job so that it’s doable not just endurable. It’s likely that the rigors of being a client care representative will never go away. The general practice model, with its ‘help all clients at all times’ mission, just won’t allow for it. The person assigned to manage all of the communication and foot traffic coming into the practice will always be challenged. But it’s very likely that we can make an enormous difference in how our client care team performs by showing them respect for what they do, training them how we would like them to do it, helping them to do their work when they need it, and rewarding them and praising them appropriately when they succeed. When someone at the desk calls out sick, team members run away from, not run towards the responsibility of filling in. Why is that? Answer that question correctly and you will have taken your first step in building a client service team that sells your practice.
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Front vs. Back: A Truce and Healing Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY
The Front vs. The Back War increases employee turnover, lowers employee productivity, increases the number of patient and client care mistakes that your practice makes, and is emotionally draining on everyone. So why do we allow it to persist? Let’s consider some of the instigating factors in the battle.
Communication blackout What we don’t know can hurt us, or at the very least can increase our level of frustration and anxiety. Let’s say we need a bag of food from ‘the back’. With a full lobby and a line of people waiting for our help, we pick up the phone, hit the intercom button and call out, “Can I get a 5 pound bag of CD, please?” Nothing. You ask again while an impatient client stares you down. “Hello? Can anyone hear me? Can I get a 5lb bag of CD?” The silence gets you boiled. “How many times have we had a meeting about this?” you rhetorically ask your coworker. “What on earth are those people doing back there?” Those people are actually nowhere near the intercom and can’t hear your call. One is doing the inventory in the basement and the other is outside walking a patient. It’s a perfectly innocent workflow issue, but because you can’t see what’s going on you immediately jump to the worst conclusion. “Lazy good for nothing…I’ll be right back,” you tell the client. “I’ll get it for you myself.” Once in ‘the back’ you really let loose, though there is no one around to hear. “Where in the hell is everybody? Is everyone on break, because we are slammed up front!”? Judy emerges from the basement with a boxful of supplies. “What’s your problem?” she asks on the defensive. “What are you yelling about?” “What does it look like? I’m yelling about you and Joanne! I’m friggin slammed up front and you people are no where to be found!” And so begins The Front versus The Back war of 2016. If only your practice had had a camera system in place, you could have seen Judy in the basement doing her job and Joanne in the dog walk doing hers, but left in the dark, you imagined the worst and the war began. Communication blackouts can frequently be the source of ‘The War’s’ first shot, but another source is more insidious. It’s the underbelly of us all, the need to feel superior to others, to believe that our work is more important, that we’re smarter, that we’re right. A group of technicians huddles around a computer monitor in the back and watches the latest appointment pop into place. The doctor on duty is the first one to comment. “What’s he doing!? He’s putting a vomiting 16 old cat next to a lethargic rabbit? How the hell am I supposed to see that? Someone tell him to fix it.” Marge is only too happy to tell the new guy, Bob, that he messed up. She approaches him from behind and taps him on the shoulder. “Did you just book the vomiting cat?” “Yes.” “Dr. Karen says you need to move it now. She’s extremely pissed. So can you move it, please? Thank you.” Another ‘War’ shot fired. I have a backyard brood of poultry. One day, I’m going to write a book called, Everything I Need to Know About People I Learned from Chickens, because I’m convinced that chickens’ natural inclination to brutally peck each other into a social order, to ostracize, and to form exclusive cliques, is a broader representation of what we humans do more subtly every day. But while some of us work in barnyards, we don’t have to act like we live in them. People who work with others must rise above their basest instincts. Our job’s atmosphere and the standards by which all employees interact is referred to as workplace culture, a term that can be treacle-sweet for many conservative business owners who see goals like revenue, efficiency, care and service as much more important. But when I talk about workplace culture, I’m not advocating for hand holding and Kumbaya; I’m talking about a calculated look at what our employees feel, how they interact, the tone we set in the workplace, and our respect for health and happiness as a way to increase productivity and most importantly to stop fighting, work together well, and feel good about our jobs. A few of you may be saying ‘But we tried to improve our practice’s culture. It didn’t work. People weren’t responsive. We advocated for behavioral guidelines. No one listened’. Failure of workplace culture programs has nothing to do with the merit of trying to improve your employee’s physical and emotional well-being. Don’t let failure to solve the problem convince you that the problem isn’t worth fixing.
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Culture is made possible both by the attention we pay to it as leaders and as a by-product of the business model that embraces the fundamental building blocks of any team: communication, respect, and cooperation to name a few. Leaders should stop thinking about culture as a job perk, and start thinking about it as a necessary component to smooth, productive, long-lived operations. So my recommendation for ending The Front versus The Back War is not to go gunning for the snarkiest individuals at the practice, but to drop an atom bomb of culture on the entire building. The fallout of your actions will have long lasting, glowing effects.
Mission Begin with a articulating your aspirations for workplace culture (that is your aspirations for how it feels to work at your practice and how you expect people to behave) in your mission statement. Choose the words carefully. Mission statements are the real anchor points for all you do and say in your business. Like the foundation of a house, your mission statement must be resolute about what you are trying to accomplish. Here’s a test that I like to try whenever someone wants to share his or her mission with me. Firstly, I don’t allow them to read it. I make them face me and pretend that they’re trying to entice me to take a job at their practice by extolling the same virtues that are expressed in their mission statement. “Mr. Halow, all of our employees are valued. At our practice, everyone is expected to get along and work together well.” “Oh!” I reply because this job is sounding tempting, “if I take a job here, how will I notice that I am valued?” This kind of role play tests the owner and practice’s commitment to the lofty language in the mission and can take a document that feels disconnected from day-to-day operations and make it relevant.
Discuss culture in writing in your employee and training manuals Secondly, articulate your expectations for both behavior and communication in your practice manual. The latest HR trend is to create Workplace Civility Guides in which you outline your expectations with respect to salutations, day- to-day office chitchat, ostracism, name-calling, nicknames, and so forth. It may seem silly. Company policies that insist we say good morning to our coworkers? Laugh if you like, but enough feelings have been hurt by our failure to observe the simplest of social etiquettes that a proactive approach isn’t a bad idea. Outlining how you want people to behave and how you would like them to react is an excellent jumping off point for an interview discussion on the matter, an excellent way to market your practice (who doesn’t want to work for a business that cares about employee feelings?) and an excellent way to begin any coaching session on the subject.
Overtly Advocate for Culture Thirdly, be the practice culture’s advocate. If you observe employees behaving in a manner that is counter productive to the practice’s feel-good culture, address it. Not addressing cultural issues as soon as they arise is more than inaction; it’s passive approval. It’s a passive gesture on the leader’s part that the person on the receiving end of the bad behavior is not important. It’s inaction that could be deadly to your relationship to that individual moving forward. Do not pussyfoot around negative interactions in your building. People that decide to rain on your parade should blow their storm clouds over to someone else’s practice. When I coach team members on this subject, I never shame them. My negative behavior record is probably no better than anyone else’s. But I have recognized the deleterious effects of negative behavior in the workplace and learned to sit on my knee-jerk reactions. I expect others to do the same. As one colleague of mine says, “We can sit here all day long and listen to why you believe it’s okay to behave negatively in the workplace. At the end of the discussion, I’m still not going to allow you to do it.”
Conclusion For any leader concerned that they don’t have the ability or gumption to end The Front versus The Back War, know these things. Showing employees that you respect them, that you believe in them, and that you are eager to see them succeed will not leave you feeling emptier, but fuller. Addressing what everyone understands to be an unpleasant situation will leave you feeling lighter, not heavier. Standing up for kindness and consideration will not leave you short staffed, but will provide you with a remaining group of employees that will invest extra time and energy to help you out. Many of you have tried many things to improve your business. Try working on what you know is most important to you and everyone in your employ: happiness.
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How to Sell the Most Flea and Tick Products Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY
Don’t give up on selling flea tick and heartworm products (FTHW) products in house. Your products, with the assistance of manufacturer incentives, are nearly always competitively priced. As online stores grow in popularity, explore an online store of your own as a way to remain competitive. Despite the ubiquity of online stores and big-box-store loss-leader promotions, there is a future for FTHW sales in your practice. As I previously mentioned, your prices are typically competitive against those of online or discount stores. At your practice you also have the value of convenience and one-stop shopping. At the end of a long workday, your client doesn’t want to have to drive from your practice to the mile-long aisles of Costco to purchase their Frontline just to save a dollar or two. (Besides, won’t they end up spending an additional 40 dollars on junk that they never expected to purchase once they walk through the doors?) People are tired and eager to finish their daylong to-do list. Don’t add to the stops that they have to make on the way home. Sell them the medication that their pets need while they are in the building.
Think about the language you use Learn to inquire about their need for FTHW products in a productive way. “Do you need any more flea product?’ is almost always answered negatively. Instead ask, ‘How many doses of Revolution do you have left at home?’ as a way of starting a discussion on the need for year-round protection. Other practices will ask clients to bring in all their remaining doses (and any other medications) with them in a plastic bag. The request forces everyone to take an exact look at what kind of medication the pet is receiving and how often.
Believe in what you sell Is year-round flea medication really necessary? We say it all the time, but do we believe it? How compliant is your own team (or you for that matter) with year-round protection? If you’re not compliant, ask why. Uncovering your team’s reluctance to follow the same direction that they’ve been giving to clients for years may clue you into more effective messaging for everyone involved.
Switch to orals Many studies have shown that orals are not only more efficacious in stopping all parts of the flea life cycle, but because they are dosed out every three months, their use boosts client compliance.
Explore an online store of Your own. Online stores have come a long way since the old Vetcentric days. Today’s stores are easy to use and do an excellent job at following up with clients and driving compliance. In studies provided by Vets First Choice, clients were three times more likely to be compliant with recommendations to dose their pets year-round with a flea preventative if they purchased their flea product through the online store as opposed to stopping by the clinic to pick it up. Clients were also three times more likely to be more compliant with prescription diet recommendations if they purchased it through the online store’s auto-refill service.
The value of prevention I’ve been working in the veterinary business for nearly 20 years. Each year, at every conference I attend, there is some lecture about the value of year-round FTHW compliance and every year, I’m shocked that the lecture room is packed and sometimes overflowing. But sit in and listen and you’ll find out why. Real data about real disease, once disclosed, is jaw dropping. Dr. Mike Dryden, a frequent speaker at such sessions, is packed with information on the value of prevention based on his first hand experience conducting research on the topic. In fact, fleas, tick and heartworm parasites are everywhere and the primary and secondary impact of an infection by any of them is cause for much of the disease we treat in our practices annually. We eat with our pets, ride in the car with our pets, sleep with our pets, and hug and kiss our pets. Keeping them parasite-free is just smart. It’s better for our pet’s health, better for our health, and better for our wallet. As a team, rediscover the value of the products that you sell and understand the value of buying them through your business as opposed to another source. Talk about year- round protection and regularly evaluate your client’s compliance with your recommendations. These products are still a valuable source of pet health and veterinary practice revenue.
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How to Talk to Clients About Money Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY
It’s rarely pleasant to talk to clients about financial matters. Perhaps it’s because we presume that if the client is unhappy about the price, it means that they are unhappy with who we are as individuals. Then without benefit of training, we find ourselves stumbling through a conversation about money, exacerbating an already uncomfortable situation by talking with our foot in our mouth. To successfully take on a discussion about money with a client, we need to have a set of systems, conditions, and skills in place: • An understanding of our real relevance • Our clients’ trust • A team approach to care • Belief in our pricing • An understanding of how to communicate value • Use of language that underlines both our investment in the outcome and our expertise
An understanding of our real relevance Before you can successfully defend your prices, you have to believe in the value of what it is you’re pricing. Start with the question, ‘Who are we and what do we do that is worthwhile?’ The answer to this question is typically articulated in the mission statement, a document that cites your relevance to clients, patients, employees, veterinary medicine and the community. Too often mission statements are given cursory attention in our industry, a mistake that leaves us most vulnerable to competition. If people have a choice between an Internet answer to their issue or a more time-consuming, expensive stop at your veterinary practice, you better have a very good reason for them to choose the latter. First writing about your value, and then regularly discussing it, not only helps you realize your full potential as a healthcare provider, but it gives you a reservoir of understanding to draw from when faced with the need to talk to clients about your practice’s value.
Our clients’ trust Simply stated, if people don’t trust you, they’re not only circumspect about your pricing, but about your actions and words. The best way to earn trust from your clients is straightforward. If you want to be trusted, be trustworthy. If you tell clients that their concerns about value and price are meaningful to you, then have systems, tools, and training in place, visible to all, to let everyone know that you are walking your talk. Premade estimates, an accurate reminder system, follow through, meaningful callbacks, pet insurance, clear and open accounts-receivable policies, and regular team meetings about service and product worth are all actions that fortify your verbal commitment to care and value. It’s also important that the entire team demonstrates its commitment to client service and patient care. When client issues arise, all team members should be empowered to do whatever needs to be done to satisfy the client. Most practice owners and managers would agree that solving clients’ concerns about value is much more complicated than voiding something from the invoice, which is the knee jerk reaction of those inexperienced with handling client complaints. For this reason, they may be reluctant to allow all team members to take action on behalf of a client without a supervisor’s permission. This is a mistake. Few, if any of your employees have owned a business, and probably don’t fully understand the fine line between satisfying clients’ needs and fiscal responsibility. Without giving them a chance to take full charge of client satisfaction however, they’ll never completely understand how challenging it is to be conciliatory to clients’ concerns and profitable at the same time. Allowing employees to shoulder the full weight of a client complaint, with coaching from you, more deeply involves team members in service, demonstrates your confidence in the employee, gives them some way of ‘making up for’ the service error, and best of all, underlines how important it is to avoid such mistakes in the future.
A team approach to care More impactful than an individual caring about service is an entire team collaborating on service. Focusing on a team approach to service does two things. Firstly, it delivers a more consistent and reliable client experience. Our client service missteps don’t happen so much because we fail to care as individuals, they happen because we fail in communicating client need to one another along the cycle of service. Simply put, it’s not that we don’t run with the ball; it’s that we drop it in the handoff. Secondly, each stride forward you take as a group rallies a sense of team pride and gives employees the sense that their individual effort is part of a larger win. Successful morning huddles and other systems to ensure that all members of the team know who is coming in for the day, what their needs are, and the gender of all pets, improve the value of what you do and your practice’s esprit de corps.
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Meaningful pricing In order to stand up for what you charge, you should believe in the merit of your pricing. Too many veterinary professionals don’t understand the fees behind their services and products. Indeed the system may have little rhyme or reason to it. Sometimes prices are put in place because ‘they seem fair’ or because ‘that’s what the other practices charge.’ Employees may observe owners making up a price for a service without using any kind of formula. They may see managers remove service items from an invoice or giving away money to clients who refer the practice to others. At the end of the day, many of us fail to stand up for our service or product pricing because we believe that it has been created arbitrarily. The best pricing schemes are ones that are logical and straightforward; that take into consideration non-fixed expenses (typically the inventory costs), the fixed expenses (unchanging costs like rent, utilities and labor) and the desired mark up. Veterinary service pricing however, gets much more complicated because we price services and products as loss leaders, as part of packages, as part of wellness plans, and with consideration to what our competitors are charging. These additional variables complicate the pricing formula considerably because in addition to considering the three above-mentioned costs, we have to consider how much profit we are losing on our other pricing schemes. Taking so many variables into consideration is more headache than most managers care to take on. They end up alighting on pricing that ‘feels right’ or what they think clients will accept, rather than taking the time to actually determine if their pricing is profitable. It’s too bad. There are a number of pricing tools available to help managers make sense of prices. Many veterinary practice consultants have developed pricing tools that not only take a lot of the guesswork out of pricing, but also often provide tens of thousands of dollars worth of additional revenue in the first year that they are used. In my experience, the best prices are ones that the entire team have discussed, understand, and market. I regularly visit a diversity of practices in many locales, both affluent and poor. I’ve come to discover a surprising fact. Lower prices do not improve sales, nor do they improve compliance. Wherever I go, compliance is not driven by price, but by team buy-in to the value of the service for the money charged. Lastly, let me say this about pricing. Spending months educating team members and clients about pricing and value, then turning around and giving someone 25 dollars off their bill for referring a client is contradictory to the importance of your practice’s pricing structure. While pricing promotions can have a place in your practice, don’t readily default to them. A bouquet of flowers, a present selected specifically for a client based on their interests, even a handwritten card are more meaningful than money and serve to reiterate to clients and employees alike that you are serious about service and care.
An understanding of how to communicate value The best client interactions are structured to demonstrate the value of your practice’s services and products. There are three steps to successful client discussions about value, each of which is discussed below.
Identify client need and demonstrate you care The first step in a successful client transaction is determining what the needs of the client are and letting the client know that they matter to you. Show that you comprehend and care by making eye contact, displaying appropriate facial expressions that indicate you are attentive and empathetic, by keeping an open body posture, and by saying things like, ‘I understand how you feel’ or ‘I understand what you are going through’. Even repeating the client’s needs back to them in your own words is very effective at establishing that you both understand and care.
Demonstrate how your service satisfies the client’s needs Next talk about the products and services that you offer and how they will serve to meet the needs of the client and mitigate their pet care issues. It’s important that this isn’t a retrospective of everything you offer, but rather a specific recommendation for a product or service that matches the client’s needs. This is an extremely important distinction. For example, if a client expresses an interest in protecting their pet against fleas, our job is not to list the various products that we sell, rather to assess the situation at hand, and recommend a single solution. Most competitors are marketing a wide selection of products sold at low price. As small businesses, we’ll almost always be outcompeted on both fronts. To be successful, we must play to our biggest strengths, our care and our expertise. That’s why it’s important to limit your advice on veterinary care to one solution that, in your expert opinion, will be the most helpful.
Catalyze a plan of action The last step in this interaction with clients is to invite them to participate in an action plan moving forward. To spend all the time you have getting to know their needs and providing education, then saying something like, ‘it’s up to you’ is not only a waste of your time, it distances you from the client. Someone who is committed to the well being of an individual is not wishy-washy about advice. They have an opinion and they state it! Veterinary professionals who offer a list of options believe that by doing so, they’re avoiding the appearance of being pushy. In fact, their strategy may be more deleterious than they know. Faced with many options, clients often get 573
confused or worse, frustrated. Many don’t perceive a bunch of options as helpful, rather as a sign of the professional’s general disinterest. At the end of the day, each of us wants to know what others think. We call our best friends and family members with questions and the ones who love us most give us their unequivocal thoughts on whatever issue is at hand. Tell the client what to do and let them know it comes from a place of caring and expertise. It’s the best way to forge lasting bonds and loyalty.
Think about the words you choose So you believe in the services and products you offer. Your team collaborates on service and care. You enter into each client interaction ready to listen to their needs, match those needs with your services, and then catalyze an action plan. Still compliance and sales slowly ebb to your larger competitors. What can you do? My advice is to carefully think about each time a client chooses to leave your practice or purchase a product elsewhere and work as a group to think of better ways to communicate who you are and what your practice offers. Here are some ideas to get your started: Client wants a script for a preventative so that they can purchase it elsewhere “Are you sure you don’t want to purchase it from us? With the manufacturer’s promotion, the doses at our hospital are less expensive, yet still come with guarantees that are superior to any other online store or pharmacy outlet. We have time today. If you come in, we can help you select the correct product to match your pet’s life style and show you how to apply it correctly at no additional charge. Mrs. _____, we work hard at getting this kind of support from our vendors because we want to be the sole care provider for your pet.” Client wants to purchase their pet’s chronic medication from an online store. “Are you aware that we have an online store? It’s just as affordable and there is no shipping charge. Additionally, as owner of the store, I have full oversight over it. I can promise you that none of our products are short dated or diverted, a claim I’m not comfortable making with any other online resource for medications. Our client care representatives are free now. I’ll have one pick up and take your order over the phone. She’ll also send you a link to a video demonstrating how to log into and navigate the site. I think you’ll find it helpful for future use.” I regularly need my dog’s Rimadyl filled, but you are too far away. “If I understand you correctly, our practice is out of the way for you and you would like a closer place to purchase your pet’s chronic medication. Why don’t I set you up with an automatic refill and free shipment from our online store? I fully guarantee all the products sold in my store and using our store allows me to remain the sole health care provider for Bingo…a role that I have worked all of my life to achieve.” My bill is too high. “Let’s go into one of the exam rooms and discuss it. From the medical history I see that both the technician and the doctor did a thorough history and it looks like there is a clear reason why each of these services is recommended. May I offer you one of the payment solutions we have for our clients? Each is affordable, will give you the ability to pay your bill, and still give Bingo the care that you and the doctor agree he needs.” I don’t want a payment option. I have too much debt already. “I understand that you don't want to take on more debt and would like to decline the flea product that you and the doctor agree Bingo should have. With your permission, I can set up an automatic shipment of one dose of the product every month from our online store. It reduces your pet’s bill today by 62 dollars, but doesn’t compromise Bingo’s care a bit! I’d also like to give you this handout on a pet insurance that we recommend. Flea products are just one of the many expenses all pet owners face. This is a trusted insurance company. It is affordable and will mitigate those future costs.” You people are the most expensive practice around! “I understand your concern about price. We regularly discuss our pricing as a group and try to find ways to make things as affordable as we can for our clients without compromising care or quality. We don’t want to lose your business and want to remain Kitty’s healthcare provider. Can I suggest this insurance plan? Of all the ones on the market, we believe this one is the best. Insurance means that you don’t have to lower the quality of care Kitty receives by going elsewhere and it will spread the cost of care out over time. Here’s a brochure and a promotional coupon that you can activate today. Is there anything else I can do to be helpful? I hear what you are saying and want to make a difference.” Why do I have to pay for a physical exam? “A full physical exam, along with any diagnostic work that is done, is the best way to fully understand Bingo’s health issue. We do a full physical exam on every patient before it is treated because the risk of making an error is too great otherwise. Physical examinations review every major body system and give the veterinarian more information on how the illness is affecting the body as a whole. It would be unethical to diagnose a pet without a physical exam and a breach in care and safety on our part that the doctor would never risk. He is too dedicated to his role of veterinary care provider for our community to do otherwise.”
Conclusion Your business hinges on your clients’ belief in the value of what it is you do. In my experience, veterinarians are extremely dedicated, ethical individuals. When our concern for clients and pets goes unrecognized, it’s not because it doesn’t exist, it’s because we’ve
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failed to demonstrate it. Taking time to review how you talk about money is a gateway to a clearer practice identity, increased team work, stronger relationships with clients, improved compliance, and a general increase in the health and longevity of your patients.
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Increasing Compliance with Wellness Profiles Bash Halow, LVT, CVPM Halow Tassava Consulting New York, NY
Grow your business on services in which you believe. Don’t choose to grow wellness profile compliance simply because the industry tells you to. The future success of your business doesn’t ride just on revenue, but on your willingness to realize the kind of care and service you know internally is right for the people and pets that you serve. Sell wellness profiles if you believe in the value of the information they provide and if you know how to act on that information in a meaningful way. I recently encountered a veterinarian who expressed concern about the value of 4dx results. “VIN hosts a lively debate on what to do with the results. As a veterinarian, I’m torn. Tests cost my clients nearly 50 dollars. If they show that the patient has been exposed to Lyme, I’m not sure what I do with that information and I think a lot of other veterinarians would agree.” Concerns like these are real and important. As a business owner, your best asset is the trust that exists between you and your clients. If you’re going to take money from them, you should be able to do so knowing that you’re being of genuine service. Practice what you believe in; provide what you know to be of value; care and believe in what you do. That’s where the real revenue from ‘wellness profiles’ or any other service that you provide comes from. If you’re convinced (not if AAHA or the AVMA, or Idexx is convinced) that wellness profiles are beneficial, then I would like you to take that information to your team. Start out with a meeting of your fellow associates and enjoy a discussion on the matter. Emerge from the meeting with an agreement on the value of wellness profiles, to whom they should be recommended, and an understanding of what you’re going to do with the information when you get it. Take the results of the meeting to the whole practice team. Engage your crew in a discussion about what wellness profiles are and why they work. Give real examples of how they’ve helped patients in your practice. Don’t just have one doctor, manager, or owner preach this message, but get the entire veterinarian team on board with helping the team members to understand. Doctors are considered leaders and coming at the group as a united front lends credibility to what you are telling them, underlines the importance of what you are saying, and gets the group enthused. Ask the team for their thoughts on how to promote the profiles to clients. In our work with clients we invite teams to look at the ‘Cycle of Service’, a timeline of every client education juncture (when they find the practice on the web, when they call the practice, when we confirm appointments, when they arrive at the practice, when they are taken into the exam room, etc.). Allow team members to formulate their own ideas of how they would like to communicate the value of wellness profiles to clients. Because they are progenitors of these ‘how to’ protocols, you’ll find that they are invested in the outcome and eager to see them succeed. Often someone in the group will get hung up on the question of value. Do the benefits exceed the costs? It’s an excellent question and one that should never be shamed or dismissed as mere grumbling. Employees that express concern about money are demonstrating their empathy for clients; it’s exactly the quality that you’re looking for in a member of your team. Employees that express concern about money are also picturing themselves in the rooms ‘trying to sell’ clients on wellness profiles. They’re expressing a real concern that they don’t know how to do what you’re asking them to do or that you’re setting them up for failure. Be a good leader. Thank them for taking the wellness-profile-project seriously. Thank them for looking for a way to help you achieve this practice goal. Help them find the answers that they seek. One solution is to work with companies like Antech to put together ‘wellness packages’. In many cases, you’re most likely already doing a stool sample and/or a heartworm test for a patient, ask Antech if they would be willing to create a lab package that includes a wellness profile as a way to save clients money and drive sales. Wellness packages make compliance easier for everyone and streamline the practice’s workflow. Practices that organize their wellness profiles into specific packages based on species and age always grow their laboratory sales, catch more disease in its earliest stages, and decrease the amount of mistakes made internally. After a few weeks of exploring the best ways to communicate your thoughts to clients, you may be ready to develop some marketing materials. Use the following list to stimulate your own thoughts on how best to educate clients. Build Customized Wall Art: These days, word processing software is easy to use and sophisticated. Entreat your doctors and room techs to sit down and sketch out an idea for a wall chart or handout that would be helpful in conveying the value of a wellness profile. Pass the drawing off to someone who is agile with software like Keynote or Pages and build a professional looking poster customized with your practice logo and colors. Print it professionally and invest fifteen dollars in a nice frame. Done. The entire process can take as little as a month. When you’re through, you’ll have a teaching tool that looks great and that everybody eagerly uses. Turn Handouts Into Webpages: Hopefully your website is built in an easy-to-use platform like WordPress. Open up a blank page on the site and transfer content, that you would otherwise have built into a brochure, onto the web. If the document is optimized properly it will increase your practice’s online visibility and serve as a link that you can send to clients following any visit and any discussion that you have had about wellness profiles. It’s a way to keep the dialogue going after the visit and a way to convey that your team is professional and sophisticated.
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Turn success stories into blogs Everyone enjoys a touching story about a dog, cat or other companion animal. The next time your wellness profiles succeed at changing the life of a client or a patient, ask the client for permission and write about it! Don't just talk about the medicine involved; talk about the ‘heart’ of the story and what it means to the relationship of the pet and pet parent. Optimize the blog for search engines, post it to your site, and cross post it to your social media sites. Attend the lecture for more information on this topic or reach out to the author directly for more specific guidance in this area.
Write scripts The key word in this title is ‘write’ not ‘scripts’, since it's the process of writing that helps us to learn what we want to say and how to say it. When I conduct ‘script writing parties’, I gather team members in groups and have them write collectively. After the writing session, they’re asked to read aloud what they’ve written and invited to talk to the rest of the team about why they chose the words that they did. Almost no one leaves the meeting reciting their script at the next client encounter, but they do leave with their mental wheels turning. Having thought about what to write, they are more likely to reflective of what they say and how they say it the next time they are in a position to educate a client. Practices educate clients about the wellness profiles during puppy and kitten visits; as they promote the benefits of pet insurance; as they prepare the patient for their first preventative dentistry (“Since we’ll be doing Fluffy’s first dental cleaning next year, we’ll run a wellness profile this year to get a base line for next year’s blood results”). We’ll discuss these and other ideas in the lecture itself. Remember to regularly talk about the value of wellness profiles and your team’s success with promoting them at your employee meetings. Celebrate success stories and share objective compliance data with the team to stimulate thought and discussion on what everyone needs to do to improve. Make sure that your team understands that their efforts are making a difference in the lives of patients and lengthening/improving important client/pet relationships. There is a direct relationship between preventative medicine and your mission statement. Finding a way for your team members to successfully promote wellness profiles empowers them to teach and gives them a chance to see the enormous positive benefits of their actions.
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Crazy Good Client Compliance: Taming the Beast Every Doctor Chases Laurie Hess, DVM, DABVP (Avian) Veterinary Center for Birds and Exotics Bedford Hills, NY
For years we, as veterinary professionals, have been consumed by increasing compliance. Assuming that most pet owners truly want to care for their pets properly, the issue becomes more about effective education than about desire, technique, or cost. When I can create a good connection with pet owners and am able to deliver my message in a way that they are willing and able to receive, pet owners are more informed and eager to follow my instructions. While it might appear that the surge in communication technology has made this process easier, we have found that there are so many technological options available to the modern practice that communicating with pet owners in the veterinary market can be a very frustrating experience. During this lecture, we will focus on three aspects of modern communication technology: surveys, reviews, and apps, and we will explore how these very efficient channels can help you increase your practice compliance.
Surveys For years, we have been asked our opinions on topics that range from our country’s political system, the taste of a particular soft drink, or the service we received during a phone experience with a major brand. We have grown accustomed to sharing our opinions in hopes that they will incite change, compliment those who are doing a great job, or call out those who are not. Pet owners are no different and are an extremely valuable source for information about your practice and their experiences there. We have adopted a post-appointment survey process at our practice that automatically reaches out to every client via text and/or email after each transaction. Clients are asked questions about their experience and are allowed to submit responses quite easily from their smart phones, tablets, or desktop computers. Our survey content has been custom-created to dive deeper than simply “was this a positive experience?” or “did we exceed your expectations during your last appointment?” by including verbiage that tests the client’s understanding of how they would like our practice to care for their pets. Questions that have proven to be effective at assessing the client’s experience include: • Did the doctor demonstrate that he/she understand your needs by providing solutions that directly relate to the reason for the visit? • Did the staff explain things using easy to understand terms and phrases? • Do you understand the care that was provided in the practice? • Do you understand how to properly care for your pet? • Are the recommendations provided during the visit reasonable and easy to implement? • Do you feel prepared to care for your pet? • Do you feel comfortable contacting the practice with additional questions? Asking the “right” questions is just the beginning of the survey game. You should also consider implementing a consistent process which reaches a large portion of your client base. Resist the temptation to make wide sweeping changes based upon a few comments. Track results until trends become obvious, and then implement change slowly. After processes and procedures are changed, be certain to re-survey those groups that initially made the comments suggesting that change was necessary to gauge effectiveness of the change. Although we will dive deeper into the world of surveys during the lecture, here are a few tips that I have found very important: • Keep the number of questions asked during a survey low. We like 5-7 and find a sharp drop-off in participation when more questions are asked. • Be consistent. Survey repeatedly. Pet owners will develop an expectation of being asked their opinions. • Be willing to change. • When possible, thank pet owners for their participation and suggestions. • Do not survey too much. Many programs allow you to send post-appointment and custom-made surveys without a client appointment. Asking for feedback too frequently can cause a person to stop responding. • Track your results, and use a program that allows you to categorize the responses back to specific aspects of your practice.
Reviews Mobile technologies, websites that have been created to gather and publish people’s opinions on products, services, or brands, and the public’s acceptance of these trends has created an opportunity for veterinary practices to gather data about how they are performing. While many veterinary professionals consider reviews and the entire online review process to be the bane of their existences, I will demonstrate how the review process can be used for your benefit.
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This is a lecture about compliance and using the review concept to gather information that will allow your practice to make change, monitor how well your message is being received, and be a part of the review process. Handling negative reviews is a subject that requires much more attention we can cover during this session. As we discussed earlier in the lecture, we have become accustomed to sharing our opinions. The trend that is online reviewing has changed how today’s savvy consumers select products and brands. For that reason, your practice needs to have an active role in gathering and publishing the most accurate reviews about your practice. One technique is to attach a request for a review to each of the post-appointment surveys you send to clients. While surveys generally gauge a client’s feelings on a scale of better or worse, reviews actually ask for text-based comments, allowing clients to be most specific in their opinions. If your practice has the ability to do so with an internal system, I strongly suggest that you request a survey after each appointment. Should you not have an internal system for gathering survey results, you can direct your clients to public review sites like Yelp, Google Reviews, City Search, or Facebook. Often times, simply demonstrating that reviews are important to the growth of your business is enough to excite clients to participate. One of the very valuable (and most often overlooked) aspects of online reviews is the relationship between the words used in review comments and the words used by those searching online for practices like yours. Think about how you search the Internet. If you were looking for a veterinarian in your area, would you search Google for “veterinary,” or are you more likely to search for phrases like “best veterinarian Any town, Iowa?” More likely it’s the latter. Assuming that is true, let’s consider some of the comments that can be made using reviews. Clients often submit reviews that contain verbiage like “Dr. Smith is the best veterinarian in Any town,” “I live in Any town and love Dr. Smith, “or “Any town loves Dr. Smith and his veterinary team.” Do you see the overlap in content? Please know that the search engines like Google, Yahoo, and Bing can only read text. Properly gathering and positioning valuable content from online reviews on your hospital website is critical for getting your message shared with others searching the web. Although we will dive deeper into the world of reviews during the lecture, here are a few reasons your practice would want to participate in the review process (all of which, by the way, can increase compliance). You can expect to: • Develop a solid base of accurate, very positive reviews and comments that can “cushion” the blow of the less than accurate or blatantly false negative reviews. • Develop a much more engaged audience who not only will feel more loyal to your practice, but also will provide indicators about how well your message is reaching them and ultimately providing them with the information necessary to properly care for their pets in the manner you suggest. • Increase search engine rankings for your practice, if (and only if) the review results are available and properly positioned on your website. • Have your clients understand and be comfortable with the predictable space where they can leave comments. They will feel that they have a voice. The Internet of full of review outlets. If you do not provide a canvas on which they can “paint”, they will paint elsewhere - perhaps in a location with which you are unfamiliar and are not able to monitor.
Practice APPs I am certain that you will agree that smart phones and mobile devices have changed the way we communicate. If you are like most of the population, you utilize your smart phone and the apps installed within it many times throughout the day. These apps are designed to solve problems, provide instant access to information, offer entertainment, build loyalty, increase brand awareness, and generally make the lives of consumers much more convenient. Do you have an app for your practice? I believe that you should, as this is one of the most valuable opportunities today to reach clients. One of the best ways to apply app technology to your practice is to utilize a service that will build and brand an app for your practice. Your practice purchases the app from the developer and provides the app as a free service/benefit to your clients through the Google Play or iTunes APP Store. This opportunity allows you to increase brand awareness by properly positioning your practice logo on what has become the most valuable piece of digital real estate available - your client’s smart phone. If done correctly, your client will consciously or sub-consciously view your logo each time he/she accesses the apps on his/her smart phone. This access opens up an opportunity for communications that has never been available before. A word of caution. There is a trend in the digital world for companies to create “mobile websites” that may “look” like apps when downloaded and saved as “shortcuts” on a client’s smartphone. These mobile sites are NOT apps and offer very limited functionality when compared to a true app that is most commonly delivered via the Google Play or iTunes APP Store. While I will demonstrate the difference during the lecture, the rule of thumb should be how the APP is delivered to your clients. If it is available via Google Play or iTunes, it is an APP. If it is a shortcut on the client’s phone to a mobile website, it is not an APP but rather a dated approach to web design that unfortunately looks like an APP but lacks most (if not all) the features that make APPs such a valuable piece of your digital strategy.
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Although we will dive deeper into the world of APPs during the lecture, here are a few reasons and features of today’s APPs that clearly demonstrate why your practice should immediately implement an APP as part of a digital marketing and compliance strategy: • APPs are inexpensive to build and maintain (usually under $500 to build and $100/month to maintain). • Having your APP and logo on a client’s cell phone promotes brand awareness and allows him/her instant access to your information. • Clients can request appointments, Rx refills, and food refills with the touch of a button. • Practices can “push” messages to everyone that has the APP installed very easily. These messages can be related to specials, reminders to dose pets for heartworm, or any time- sensitive topics. • Clients can call the practice with the touch of a button. • Practices can easily implement technology which allows those clients who have the APP installed to receive messages automatically when they enter the practice. These messages can center around specials, provide welcoming messages, or suggest conversations that the doctor would like to have during the visit. • Loyalty or “compliance-promoting” programs can be developed which gamify the process of compliance and reward clients for caring for their pets in the manner that you recommend. • Photo sharing allows clients to take pictures of their pets and share them (with your logo as branding) across the social channels like Facebook. • Clients can track pet exercise and log activities, symptoms, or behavior for your review during the next visit. Pet exercise can be tracked very accurately using GPS and provide a very accurate idea of how long and how far a pet is walked/exercised. • Clients can access emergency phone numbers and information with the touch of a button.
In summary Today’s world of communication can be very complicated. The many opportunities that are available for you and your practice to communicate with your clients can be overwhelming and missed without a good plan for implementation. This lecture will highlight some of the most valuable digital opportunities and provide examples of how we utilize these resources to excite pet owners to properly care for their pets by complying with the recommendations we make.
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How Any Veterinarian Can Add Revenue with Exotics Laurie Hess, DVM, DABVP (Avian) Veterinary Center for Birds and Exotics Bedford Hills, NY
Treating birds and exotic pets Is it worth it? Are there enough clients to make it worthwhile? Does it generate enough revenue? Done the right way, exotic pet practice can be productive, progressive, and profitable. So, how do you make it this way? You need to take several steps. Start with continuing education on exotics Before you can charge clients for your exotic pet services, you must educate yourself and your staff about exotic pets. Decide which species you will treat. Birds? Small mammals (rabbits, rodents, ferrets)? Reptiles? Amphibians? Less commonly known species like sugar gliders, pot-bellied pigs, opossums, skunks, wallabies, kinkajous, and primates? Start by focusing on wellness care. Learn what’s “normal.” For each species, educate yourself about diet, husbandry, light and temperature requirements, humidity needs, appropriate cage substrate, normal behavior and social structure. Then, learn what’s “abnormal.” Learn to recognize common clinical signs and diseases. Learn basic supportive care and disease-specific treatments, and don’t forget - exotics information is constantly evolving, so you must keep current! How do you get educated about exotic pets? Veterinary schools in the past have taught little to no bird and exotic animal medicine. Many veterinary schools do not have exotic pet departments, so most veterinarians have little to no clinical experience with birds or other exotic pets when they graduate from school. One way to gain experience is through externships that are ideal for “hands-on” experience. Many private practices that treat exotics, zoos, wildlife centers and sanctuaries, and laboratories are great places to gain exotic animal experience. Every veterinary hospital that treats birds and exotic pets should also have a library to cover the care of different species. There are several excellent textbooks, journals, and magazines that review basic bird and exotic pet medicine and surgery. In addition, there are many useful on-line courses through websites such as the Veterinary Information Network that provide great information on exotic pets, as well as numerous list-serves, chat groups, and forums (such as [email protected]) in which practitioners can share information on exotic animal care. Remember, however, as you participate in this on-line networking, that exotic pet care information quickly becomes obsolete as new methods of treatment evolve; there is quite a bit of anecdotal information out there on exotic pets – the “IME, or “In my experience…” - that is not necessarily supported by scientific study and not necessarily all correct. Another place to gain education about bird and exotic pet care is through membership in veterinary associations. The Association of Avian Veterinarians, the Association of Exotic Mammal Veterinarians, the Association of Reptile and Amphibian Veterinarians, and the Association of Zoo Veterinarians, all are great places to learn about exotics and worth the expense of membership if you’re serious about learning. These organizations provide up-to-date information through conference lectures and publications and offer ongoing networking opportunities. Best of all, these groups offer membership not only for you, but also for your colleagues and staff (associates, residents, interns, veterinary technicians, and support staff). Getting set up to treat exotic pets How do you get started? Before you can see any exotic pet, you must acquire some basic equipment tailored to examine these animals. A few essential items include a pediatric/infant stethoscope, small surgical instruments, a few cages with small bar spacing or Plexiglas surrounding them to prevent escapes, and small gauge catheters, needles, and blood tubes. Other basic equipment you will need includes un-cuffed endotracheal tubes for birds (as the standard cuffed tubes used in dogs and cats can cause necrosis of birds’ tracheal walls that are made of cartilage that doesn’t stretch), metal gavage feeding tubes (to force feed birds and reptiles), small bandaging material, and a Gram’s stain kit (to stain stool samples), and an electronic scale that weighs in 1-gram increments to weigh small species. If you are going to be working more seriously with exotic pets, you might consider getting more advanced equipment including a nebulizer to deliver aerosolized medication, a lighted nasal speculum to look in the oral cavities of rabbits and rodents, specialized dental instruments (rasps, burs, etc.) for rabbit and rodent dentistry, Doppler cuffs in small sizes (1mm, 1.5 mm) to measure blood pressure, an intravenous fluid pump to deliver small volumes of fluid slowly, microvascular surgical instruments, a centrifuge to spin small blood tubes, rigid endoscopes (2.7 mm, 1.9 mm, 1 mm) with a light source/camera/video equipment for working inside small pets, an in-house chemistry machine (such as the Abaxis machine) that can calculate hematology results from small blood volumes, a digital x-ray machine capable taking high detail films of very small pets, and an ultrasound machine with a high frequency (12-16 mg Hz) probe for high resolution images of shallow structures. In addition, you need an account with a send- out laboratory capable of processing small exotic pet blood samples, as well as a relationship with a pharmacy that can reliably compound drugs into liquids in volumes appropriate for small exotic pets. Finally, you should also have at least some client education handouts on exotic pet nutrition, housing, and husbandry to cover the most commonly seen exotic pet species. What exotic pet services will you offer? If you’re thinking about incorporating exotics into your practice, you’ll want to consider what services you’ll offer. Will you focus only on preventative medicine and wellness care, or will you see all species for illness, as well? Will you promote annual to bi-annual 581
check-ups for all species with screening blood work? Will you do routine fecal testing and offer deworming? Will you be comfortable gram-staining and performing direct fecal smears on bird stool? If you treat ferrets, will you offer rabies and distemper vaccines, as well as dental prophies? Will you provide surgery for exotic pets such as spays and neuters? Will you offer nail trims for all species, wing trims for birds, and therapeutic beak trims for birds with diseased beaks? Will you be comfortable giving behavior advice for different species? You will, of course, have to be familiar with normal behavior of various exotic pet species to advise clients regarding abnormal behavior. Another factor to consider is whether you will treat exotic pets on an outpatient basis only, or whether will you hospitalize sick exotic animals. If you hospitalize these animals, will you have overnight care? What will you do if you have a critically ill exotic patient? Will you see exotic pets on an emergency basis after-hours? If you are treating exotics during business hours, you must have some provision for after-hours emergency care. Seeing exotic pet emergencies can be a real practice builder, as many exotic animals are not brought to the veterinarian until they are sick. In general, most exotic pets are not brought in for regular check-ups, and many exotic pets are not regularly handled by owners, so many owners don’t realize that their animals are ill until they are really ill. Many exotic animals are prey species that hide their illness, so that they are not eaten by predators, until they are no longer able to. If you are going to treat exotic pet emergencies, you should decide whether you will treat only client-owned pets or whether you will also see non-client owned exotic animals. You may also want to consider having an answering service screen your after-hours emergency calls, as once the word gets out that you are treating exotic pet emergencies, you may be flooded with emergency calls. Another thing to consider if you are going to accept exotic pet emergency calls is to form a relationship with a local 24/7 emergency veterinary center in which you can train the emergency veterinarians in basic, life-supportive exotic pet care, so that you can refer emergency cases to them after your business hours. You can provide them with exotic textbooks, basic drugs, and equipment, and be available to them by phone for exotic pet advice once they are treating the emergency. They can refer emergency calls to you for assessment. Then you can assess these cases on in phone conversations with the clients, and refer them back to the emergency center for temporary “babysitting” care until your hospital reopens. You just need to explain to clients that the emergency center care is care is supportive only, not necessarily diagnostic. The emergency hospital gets business, and you get support plus new clients, so everyone wins. Another factor to consider, once you have gotten more comfortable treating exotic pets, is whether you will provide phone consultations for other veterinarians seeing exotic species. Will you accept referrals? Once your colleagues realize that you are willing to see these animals, you may receive a many referrals from other local veterinarians not willing to see these cases. Once you decide to treat exotic pet species, you should consider whether you will do exotic pet house calls. House calls are convenient for easily-stressed, infrequently handled exotic pets. However, with house calls, you are limited in the diagnostic tests you can do in someone’s home, and these visits may not always be cost effective. If you’re going to do them, you must account for your time, your technician’s time, and travel costs, and you must be sure to keep good records for legal purposes. House calls for exotic pets may be better left for multiple pets that the owner is unable to bring all together to the hospital. A final factor to think about if you decide to treat exotic pets is whether you will work with pet stores and breeders that sell these species. Pet stores throughout the country commonly sell exotic species, and in these stores, the emphasis often on “herd” health, not on the individual pet. This kind of thinking often limits you in what kinds of diagnostic work-ups you are allowed to do, and you are often faced with competing interests of animal vs. the corporation, as well as pre-conceived ideas about what is appropriate exotic pet care. Working with corporations also has certain legal ramifications that are not present when you work on client-owned animals. Working with pet stores, however, can be a great PR move for your practice. What about exotic pet product sales? Just as many veterinary hospitals that treat dogs and cats sell food and other products for these animals, clinics that treat exotic pets often sell products for these patients. If you are going to treat exotic pets, you will want to consider the sale of products for these animals. Often it is difficult for exotic pet owners to find quality items for their animals, so the sale of exotic pet products can be very profitable. Possible items to sell include food, treats, nutritional supplements, cage bedding, toys, grooming tools, pet carriers, and instructional DVDs and books on particular species. Having these items available in your hospital, particularly if you recommend these items to your clients when you examine their pets, provides them with “one-stop-shopping” convenience. Factors to consider when deciding whether to sell certain products include whether you actively recommend these items, whether you have space in your hospital to stock these items, whether you treat enough of a particular species to justify sale of species-specific items, whether you will sell these items before their expiration date, whether they are easily available in stores locally or on-line, and if they are, whether you will be able to sell them at a competitive price. If you sell other items on your hospital website, you might consider selling exotic pet products there, too, to avoid having to stock them in the hospital and to make it convenient for exotic pet owners to get the products they need. Setting fees to treat exotic pets – how much will you charge? Unfortunately, since many exotic pets (i.e. hamsters, budgies) are considered “disposable” or “replaceable” pets and are not valued as much as the beloved family dog or cat, many exotic pet owners shop around to get the lowest prices when it comes to treating their animals. Many small exotics (rodents, rabbits, small birds) have short life spans, and some of these pets may be part of a large
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collection of similar species and are therefore considered less important individually. Ironically, some exotic pets cost less to replace than to treat. The fact that many of these animals are small, very cute, and have a low purchase price makes some exotic pet owners mistakenly think their pet’s care should be inexpensive. Do not undervalue exotic pet care in your practice. Exotic animal care should cost as much as, if not more than, dog and cat care for several reasons. Exotic species are often more time consuming and labor intensive to treat, and they frequently require specialized equipment and training to work with. In addition, they commonly need more frequent monitoring, medicating, and feeding because of their higher metabolic rates. Here is some advice and a few guidelines when it comes to setting fees for exotics. Do not compromise your standards by not offering the best medical care you can provide because of price. Recognize the inability or unwillingness of some exotic pet owners to spend large amounts on their often inexpensive pets, and be willing to work with clients in providing the best care possible within their budgets. Explain your treatment plans thoroughly and in detail, and be sure to review your recommendations in layperson terms. Only doctors (no other staff) should review estimates with clients to ensure they receive an adequate explanation and greater perceived value for services Beware of “shopped prices” - fees owners call around about to comparison shop. Commonly shopped fees include examination fees, the cost for neuter/spay, and the charge for fecal analysis. Compare your fees to those of other colleagues in your area that treat exotic pets, and be sure to keep your initial visit price competitive. Do not set the initial fee too low as to undervalue your services or to reinforce the notion that exotic pets are not as valuable as dogs and cats, but do not set the fee too high as to dissuade people from coming. Get clients in your door, and then justify your fees for other services once they come in. Convincing exotic pet owners to come in the door is sometimes the hardest part. Greater client volume generally outweighs higher fees for fewer clients. How will you advertise your services for exotic pets? “If you build it, they will come” does not always apply. In general, veterinarians are not taught in school to market their services, and many veterinarians do little to no marketing other than a sign or a website. Offering the best medical care is not enough. If you’ve got it, you must flaunt it. But how? There are many ways to advertise the fact that you treat exotic pets. First, you can incorporate exotic animals into your logo on stationary, business cards, etc. You can do this either with a picture or with words (“exotics,” “birds,” rabbits,” etc.), indicating that you treat these species. You can also include exotics in your motto. For example, my exotic animal hospital’s motto is, “Exceptional care for extraordinary pets,” next to our logo which has a bird, a rabbit, a ferret, and a lizard. Branding your practice is essential to any animal hospital’s success, and a picture is worth a thousand words. So, having exotic pets in your hospital’s logo and sign will bring you referrals from people just driving by. Perhaps more than any other place, the Internet is where your advertising dollars should be focused. Start with a prominent Internet presence: a user-friendly website that includes essential key words (bird, rabbit, ferret, reptile, exotics, etc.) so that your site comes up high in an Internet search for species-specific pet care. Exotic pet practice is a niche industry, so key words are important. Be sure to search engine optimize your website using these words! While your ultimate goal should be to come up high in the organic search results for exotic pet terms on search engines, you may want to invest, as well, in some Internet marketing by developing ad campaigns on Google, Yahoo, Bing, Facebook, etc., that focus on a series of key words that are commonly searched when owners are looking for exotic pet care. These ads should link back to your website. This cost-per-click” advertising can become quite expensive if it’s not monitored carefully to ensure it is driving business into your practice. You should start with a limited maximum daily budget for each ad and a moderate cost per click. Monitor your campaign’s progress weekly (via Google Analytics) and make adjustments to key words and cost-per-click accordingly. You should track the number of appointments that result from your ads to determine the return on your investment. As this can be very complicated and time consuming, you may want to seek professional advice. Remember, to make money, you have to spend some money! You should ensure you website, which indicates that you treat exotic pets, is listed in Google’s local business directory. To do this, Visit Google’s “Local Business Center,” and register your business on-line with Google. Google will send you a code via snail mail that you enter on line in their Local Business Center site to confirm your listing. Within 6 weeks, your local listing is posted and is also a place where clients can review your services. While good reviews can be a great source of referrals, remember clients can provide both positive and negative reviews on-line, so be careful to monitor this site closely! Another way to market your exotic pet services is email marketing, which is faster, cheaper, and easier than direct mail. With email marketing, you can easily target thousands of clients, referring vets, pet stores, and pet clubs with just a single click, and you can target specific recipients (species, age groups, geographic locations, etc.). You can base emails on “calls to action,” or things you’d like exotic pet owners to do, such as microchipping and boarding (for all species), and dental prophies and vaccinations (for ferrets). Email marketing can be labor intensive if you have to do the work manually, since a limited number of emails may be sent out at any one time, but many companies will interface with your veterinary software programs to send emails out directly for you.
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Other ways to market your exotic pet services include referrals from other exotic pet owners, pet stores and pet clubs, plus testimonials on species-specific pet care websites. Satisfied clients are a great source of new business, but remember, bad news travels as fast as good news. Therefore, never burn bridges with clients! Pet clubs, such as bird clubs, rabbit societies, reptile groups, etc., often are national with local chapters and can be sources of referrals of both sick and healthy pets. You can stock clubs with business cards and hospital flyers, offer to speak at their meetings, advertise in their newsletters, and provide members-only discounts in return for client referrals. Pet stores can also be a terrific way to gain new business. Many of these stores sell exotic pets and need help with their care. Animals in the store, as well as pets sold to clients, may become new patients, plus many stores will agree to hand out your practice’s business cards and flyers in return for your services. Meet with the store owner or manager, and remind him that the healthier you are able to keep the exotic pet after it is sold, the more business (in supplies, food, etc.) the store will likely get back. Also, keeping in- store pets healthy means these pets are more likely to be purchased, and healthier pets mean happier consumers who are more likely to return to the store for future pet purchases. With stores, however, some animal care decisions may be based on dollars and cents, not on individual pet welfare, so discounting your in-store services in return for client referrals may be a way to gain their business. One thing to remember when you first start treating exotic pets is to not take on cases you’re not comfortable with. Referring cases to a specialist (avian, companion mammal, or any other specialty) is not equivalent to failure. Such a referral may help the patient fastest and may lead to happier, more satisfied clients who ultimately return to your hospital. In sum, you can make treating exotics both fulfilling and profitable. But before you can offer your services for a fee, you must teach yourself the basics. Once you are ready to see exotic patients, get the word out, and market your practice! Exotic pets deserve great care. There are many exotic pets out there but few truly great exotic pet vets. Don’t be afraid of them – be one of them!
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Who’s Treating this Patient? GPs and Specialist Can Practice Better Together Laurie Hess, DVM, DABVP (Avian) Veterinary Center for Birds and Exotics Bedford Hills, NY
What is a referral? • process of referring o the act of referring somebody/something to somebody else, i.e. sending a patient to consult a medical specialist • somebody or something referred o somebody or something that has been referred, especially a patient who has been sent to a medical specialist
Who refers? General practitioner → specialist • Most common; complicated cases beyond GP’s comfort; cases requiring specialized equipment or techniques GP doesn’t have o Specialist → specialist • From one specialty to another, i.e. Internist → Cardiologist; Oncologist → Surgeon
Referrals have occurred forever, but: are they different today? More referrals to specialists? • More specialists are available: 2008-2009 Pfizer study showed @ 9,600 specialists practicing in U.S. • GPs refer to specialists because pets need 24hr care, specialized treatment, advanced diagnostics • There are a greater number of practice specialty categories • Greater acceptance by pet owners of specialized fields in veterinary medicine, as in human medicine
Have referrals been affected by the economy? Fewer referrals to specialists? • More general practitioners are in practice now and more are holding on to clients because they need to earn $ • Fewer clients are willing to spend $ on pets at specialists because of discretionary spending • GPs may feel that with hard economic times, clients may not want to spend $ at specialist so don’t refer
How do vets explain referrals to the client? AAHA referral brochure: Simple, concise, takes burden off GP in explaining referral process to client
Different types of referrals: direct vs. indirect Direct referral • GP provides medical care to a pet (has true doctor-client-patient relationship) up to a certain level • GP is familiar with specialty services of specialist • GP believes specialist can provide a service to that pet that GP cannot • GP refers pet’s owner directly to specialist Indirect referrals - 2 types Doctor-client relationship present • GP provides care to client’s pet (has true client-patient relationship) • Client has another pet that GP doesn’t feel comfortable treating • GP refers client’s second pet to specialist Doctor-client relationship not present • GP receives call from a non-client asking to treat pet that GP is not comfortable treating • GP refers non-client’s pet to specialist
Different types of referrals: active vs. passive Active referral • GP actively explains pet’s case to specialist via phone call, email, fax, letter • Effective communication between GP and specialist is essential to make referral work & results in: o Better feedback to GP from specialist about case, better medical care for pet • It’s all about communication! Tried and true tips for better communication: o Direct vet-to-vet dialogue (eliminate the middle man!) 585
o Phone calls 1st thing in the morning, before crazy day of appointments start o Direct emails from vet-to-vet, not through general clinic email that vet may never see o Personalized letters, addressed directly from vet to vet o Biannual specialist letters to GPs, reminding GPs that specialist is happy to receive referrals o Support staff (practice manager, receptionist, tech) follow-up on communications sent by GP to specialist o Annual token thank you gifts from specialist to GP, thanking for referrals Passive referral • GP takes no direct action to explain details of pet’s case to specialist o GP makes notation in pet’s medical record to “Go see Dr. So-and-So” specialist, or o GP mentions specialist’s name to pet owner, or o GP gives specialist’s contact information/business card to pet owner to make an appointment
Specialist feedback = relay of medical information from specialist back to GP • Is essential for referral process to benefit pet • Is critical if GP wants to continue to receive referrals • May be active or passive • Is often the step where the referral process fails!!
Specialist feedback can be active vs. passive Active feedback • Specialist takes action to relay medical findings and treatment back to GP via call, email, fax, letter, text • GP is continually updated by specialist on pet’s care & status Passive feedback • Specialist doesn’t contact GP directly but filters information about pet back to GP through owner or hospital support staff, or • Specialist gives owner a copy of pet’s medical records to give back to GP • GP misses out on critical information regarding pet’s treatment when specialist fails to actively speak with him/her
When referrals go wrong: the problem - COMMUNICATION BREAKDOWN!!! At several levels: • Failure of GP to communicate pet’s initial medical problem to specialist • Failure of GP to send appropriate medical records to specialist before referral • Failure of specialist to keep GP updated on pet’s medical care & status
What happens when a referral doesn’t work • Once vet-to-vet communication breaks down, medical care may be suboptimal & pet’s treatment suffers • GP’s frustration may make it less likely he/she will refer in the future to specialist • Specialist’s frustration may make him/her less likely to provide feedback to GP in the future • The pet is ultimately the one that suffers
Effective referrals are based on successful communication! • In a 2008-2009 Pfizer study of 20,000 GPs who referred to specialists, most important factors, in addition to quality of medicine, that determined whether GP referred to a specialist were communication-related: o Client service, specialist’s responsiveness, communication between specialist and GP
How referrals should go • For direct referrals (doctor-client-patient relationship present): o GP treats pet; GP decides to refer pet to specialist o GP tells client @ specialist and provides client with specialist’s contact information o GP actively contacts specialist to discuss referral and to tell specialist that he/she wants feedback o Specialist actively refers pet back to GP for further care, if appropriate o GP treats pet & actively/repeatedly updates specialist re: pet’s status throughout treatment o In future, GP is more likely to refer again to specialist, and both vets and pet benefit from collaboration • For indirect referrals (no doctor-client-patient relationship present): o GP receives call from non-client asking to treat pet GP isn’t comfortable treating o GP is familiar with services of specialist o GP refers non-client to specialist by providing pet owner with specialist’s contact information 586
o GP tells specialist that client is not truly GP’s client o Specialist thanks GP for referral o Specialist doesn’t need to provide follow-up back to GP, as pet owner isn’t truly GP’s client
How to streamline the referral process Making referrals faster, smoother, better - implementation of a standardized hospital referral protocol: • For original referral by GP to specialist o GP’s manager/receptionist/technician gives client specialist’s contact information +/- makes appointment for client o GP’s manager/receptionist emails/faxes pet’s medical records to specialist o GP’s manager/receptionist/technician follows up with specialist to ensure records received before pet’s appointment o GP contacts specialist directly to alert @ referral o GP informs specialist of desire for feedback o COMMUNICATION BETWEEN GP & SPECIALIST IS RECORDED IN PET’S MEDICAL RECORD • For specialist’s follow-up with GP o Specialist contacts GP after seeing pet re: findings and treatment, after each visit or every few visits, if >1 o Specialist provides written findings & treatment to GP each time pet is seen, so GP is up-to-date o Essential if pet needs emergency medical treatment by GP o GP’s manager/receptionist ensures that that all documentation re: pet’s care is sent to specialist o Specialist’s manager/ follows up with GP’s hospital to confirm receipt of all documents o COMMUNICATION BETWEEN GP & SPECIALIST IS RECORDED IN PET’S MEDICAL RECORD o Use of pre-made GP referral forms and pre-made specialist follow-up forms: . Minimizes miscommunication/missing information conveyed improperly/illegibly in medical records . Minimizes frustration & wasted time by both GP and specialist in relaying critical medical information . Forms should be part of hospital’s medical software program • So all communication appropriately recorded in patient record • If forms not part of software, forms must be scanned into medical record o Use of pre-made forms with fill-in the blanks: . Referral form for GP to send to specialist . Follow-up form for specialist to send back to GP . Ideally is part of hospital’s software program, so all communication appropriately recorded in patient’s record . If not part of software, must be sent to other vet & scanned into patient’s medical record as forms are used
Forms are the key to streamlined referral success Referral form: GP → specialist Referral form to small animal specialty facility: simple, short, easy for GP to fill out, print & fax, or scan in & email Referral form: GP → specialist Referral form to specialists at a large university: more detailed, longer, downloadable as pdf for GP Referral follow-up form: specialist → GP • Follow-up letter from specialist: o Part of veterinary software program, saved directly into pet’s medical record o Emailed to GP through medical software program o Short, easy to read, digital o Fill out boxes (cut and paste from SOAP) o Print and fax, or print/scan/email, to GP Key points for successful referrals • GP’s responsibilities: o Communicate referral to specialist BEFORE client’s appointment o Ensure appropriate medical records are sent to specialist BEFORE client’s appointment o Indicate to specialist whether client is truly GP’s client and convey to specialist re: desire for feedback 587
• Specialist’s responsibilities: o Thank GP for referral o Provide written feedback to GP after seeing patient . 2008-2009 Pfizer study: GP most concerned about feedback after specialist treats pet, not during treatment o Ensure documentation of patient’s treatment is sent back to GP, each time specialist sees patient o Refer patient back to GP for follow-up care, if appropriate
What happens when referrals are done right • Pet benefits from advanced medical care • GP benefits: owner appreciates that GP did right thing in referring, GP learns from specialist with feedback • Specialist benefits: employs specialized training to help pet, earns GP’s respect & will likely receive future referrals, gains financial compensation for pet’s treatment • Healthy pet, happy owner, satisfied vets – all win!
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Platinum Level Communication and Body Language to Recruit and Retain Exceptional Employees Dani McVety, DVM Lap of Love Lutz, FL
One of my most inspiring business mentors, a woman who grew her start-up into one of the most successful online businesses in the pet industry responded to my question about how to hire good people in this way; she said “Dani, over the past 20 years, I got just a little better at hiring people, much quicker at firing them, but really good at keeping the great ones.” As any business owner knows, personnel can make or break your company. Someone other than you is (hopefully) the one answering the phone, greeting customers, handling payments, and basically doing everything except medicine. These employees must be absolutely amazing, period. So how do you attract, retain, support, and keep these amazing employees with you for years? It’s not just about what you do, but how you do it. It’s not just what you pay them, but how you make them feel. In this talk, we will discuss these Platinum Level Communication tools along with body language techniques you can use that provide the kind of environment that good people want to stay at.
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How to Hire Winners Using Emotional Intelligence Tools Shawn McVey, MA, MSW McVey Management Solutions Austin, TX
Research shows that no more than 25% of one’s overall success is attributable to general intelligence or IQ. A good portion of that remaining 75% is related to emotional intelligence competencies: self-awareness, self-management, social awareness, and relationship management. After this session, you will understand the components of emotional intelligence (EI), understand the importance of EI as a competency in need of measurement when selecting for leaders, assess your own EI in order to have a frame of reference for selecting for EI in others, possess tools to identify ways to improve your own emotional intelligence, and be able to identify EI characteristics of effective leaders to measure in a selection process. You will leave the session with resources or tools for measuring EI, such as interview questions, written exercises, behavioral tools, and EI inventories.
The difference between IQ and EI General intelligence (measured as IQ) is typically focused on analytic reasoning, verbal skills, and spatial ability. It’s a murky concept with many definitions and not the best predictor of work success. Emotional intelligence (EI) is the capacity for recognizing our own feelings and those of others, for motivating ourselves, and for managing emotions well in ourselves and in our relationships. It’s critical that our team members and leaders have emotional intelligence in order to maximize our own personal success and the success of the practice. For every 1% improvement in the service climate, there is a 2% increase in “profit.”
EI and the brain Emotions begin in the limbic area. There is an open loop relying on external cues. The main purpose of the innermost part of the brain is survival. Open loops mean that we affect and are affected by someone else’s emotion (e.g., ICU patients get better if someone is present with them). A leader transmits signals that can alter hormone levels and immune and cardiovascular functioning of others. In fact, after a 15-minute conversation, body rhythms and physiology match—a concept called mirroring. Leaders “manage meaning” for us. About 60% of perceptions about organizational climate can be traced directly to the leader. Workers are more likely to be overtaken by negative emotions (hijacked) after interactions with the boss rather than with peers or clients. Distress from hijacking lowers performance.
The components of EI The four components of EI are self-awareness, self-management, social awareness, and relationship management. Self-awareness includes emotional self-awareness, accurate self-assessment, and self-confidence. Self-management includes emotional self-control, transparency, adaptability, achievement, initiative, and optimism. Social awareness includes empathy, organizational awareness, and service. Relationship management includes inspirational leadership, influence, developing others, change catalyst, conflict management, building bonds, and teamwork and collaboration. When it comes to emotional self-awareness, the inability to notice our true feelings leaves us at their mercy. People with greater self-awareness are better pilots of their lives and are more confident about personal decisions. As a person matures, emotions begin to shape and improve thinking by directing a person’s attention to important changes. For example, a teacher becomes concerned about a lesson that needs to be completed for the next day. The teacher moves on to complete the task before concern takes over enjoyment. You can develop social awareness through empathy. Empathy is the ability to recognize another’s emotional state. In research on married couples, empathy appears to include matching the physiological changes of the other person. Developing empathy leads to greater emotional stability, greater interpersonal sensitivity, and better performance at school, work, volunteer jobs, as well as with family. The art of social relationships involves managing emotions in others. To excel at people skills means having and using the competencies to be an effective friend, negotiator, and leader. One should be able to guide an interaction, inspire others, make others comfortable in social situations, and influence and persuade others. The subtle and complex abilities that underlie people skills are being attuned to others’ emotions, promoting comfort in others through the proper use of display rules, and using your own emotional display to establish a sense of rapport.
Using EI to hire leaders So, now that you understand EI, how do you hire people with an abundance of it so that they and your organization maximize success? First, let’s talk about traditional interviews. Have you ever hired someone who seemed fabulous in the interview and bombed on the job? Why does this happen so often? Interviews fail because we over-rely on our intuition and our “gut feelings.” People just aren’t good at predicting future behavior. If we were, would the divorce rate be 50%? We more often select for general intelligence or technical competencies rather than emotional intelligence.
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When hiring for EI, the successful selection methods include the structured interview, both situational and behavioral; written exercises, written exercises, including reactions to case studies and EI assessment; and behavioral assessments, including presentations and role plays. In structured interviews, types of interviewing questions include:Credentials/Technical: “Why did you pursue the undergraduate degree that you did?” (Self-Awareness) • Experience: “Describe a time when you were presented with a problem about which you did not have all of the information to solve the problem. How did you proceed?” (Social Awareness, Self-Management) • Opinion: “Coming in as a new employee, what would you do to get oriented to the organization?” (Social Awareness, Relationship Management) and “Choose one or the other: I have little trouble taking prudent risks or I am particularly cautious about change. Explain your answer.” (Self-Awareness) • Situational/ Hypothetical: “Assume you are confronted by a donor who is unhappy with something the organization has done. The donor is calling to let you know that they are going to discontinue paying on their pledge. What do you do?” (Relationship Management) • Behavior Description: “Tell me about a time when you felt least effective or were most frustrated in your efforts to deal with a conflict between yourself and a co-worker.” (Self-Management, Relationship Management) In behavior-based interviews, the best predictor of future behavior is past behavior in a similar circumstance. Here are some guidelines: • DON’T ask questions that can clearly be answered by reading the application or the resume. • DO balance the types of questions you ask. • DO make the majority of your questions behavioral description questions. • DO determine the “best” answer BEFORE the interviewing process begins. In written exercises, you want the candidate to identify critical incidents. Use job descriptions, challenges, successes, and essay questions. Develop case studies, or have the candidate write media plans, case statements, or grant proposal outlines. Three types of behavioral exercises are interpersonal role plays, tests of people skills, and knowledge application. Another is having the candidate give a presentation, which assesses communication, public speaking, networking, and training. Yet another behavioral exercise is mock meetings, which assess facilitation skills, leadership ability, teambuilding skills, and group process skills. In order to assess the results of the EI-based exercises, you have to know what the correct “answer” is before you pose the question or elicit behavior. Narrative description is not enough. Match the most desirable answer to the dimensions of EI, including self- awareness, self-management, social awareness, and relationship management. Develop rating or scoring rubrics ahead of time so that you can easily evaluate the responses and compare the candidates.
Examples of EI-based interview questions Here are some examples of EI interview questions that test self-awareness. • Impact on others o Tell me about a time when you were surprised about the positive impact your behavior or words had on a coworker, a customer, or an employee. How did you learn this information? What did you do when you learned this information? o Tell me about a time when you did or said something and it had a negative impact on a coworker, a customer, or an employee. • Emotional and inner awareness o Tell me about a time when you were distracted or preoccupied about something. How did you know? What impact did that have on your performance? What impact did it have on others at work? o Tell me about a time when you were in a good mood at work. How did that affect your performance? What impact did your mood have on others at work? • Accurate self-assessment o Describe a time when you received feedback about your performance and were in agreement. What did you agree with? o Describe a time when you received feedback about your performance and you disagreed with that feedback. What did you disagree with? o Was there ever a time when you initially disagreed with feedback you received and later came to accept it? Tell me about that. Here are some examples of EI interview questions that test self-management. • Emotional expression o Tell me about a time when you were angry with someone at work. What did you do? 591
o Has there ever been a situation at work where you said something and later regretted saying it? Tell me about that. o Describe a situation at work when you were very enthusiastic about something. How did your enthusiasm affect others? • Courage or assertiveness o Tell me about a time when you spoke up about something in the workplace. What was the issue? Why did you speak up about it? What did you say? What did others think? o Has there ever been a situation at work where you wish you had said something in a meeting or encounter but didn’t? Tell me about that. o Describe what you did the last time someone blamed you for something at work that wasn’t your fault. What did you do? • Resilience o Tell me about a time when you felt that you were defeated at work. What did you do? o Tell me about a time when you were distracted by or preoccupied about something. What did you do? o Tell me about a time when you felt like giving up on something. What did you do? • Awareness in the moment o Tell me about a time when you realized that a conversation wasn’t going very well. What did you do? o Tell me about a time when you realized that you weren’t speaking up during a meeting. What did you do? o Tell me about a time when you realized that something was best left unsaid. What did you do? • Planning tone o Tell me about a time when you deliberately planned the tone of a particular conversation. How did you do that? What result did it have? o Tell me about a time when you missed an opportunity to set the tone in a discussion. What happened? Here are some examples of EI interview questions that test relationship management. • Respectful listening o Think about a time when you didn’t understand something in the workplace. What did you do? o Describe a situation when you didn’t understand why someone was acting a certain way or taking a certain position on some issue? What did you do? o Describe a time when you jumped to conclusions. • Feeling the impact on others o Tell me about a situation when you sensed something was bothering a peer or coworker. How did you know? What did you do? o Describe a situation when you knew that something was wrong with a relationship you had with a peer, customer, or supervisor. What did you do? o Relate a situation in which you determined that something that you did or said didn’t go over very well. How did you know? • Service orientation o Tell me about a time when you offered assistance to someone without being asked. What did you do? o Describe a situation when you offered assistance to someone even though it was outside of your job description. What did you do? o Was there ever a time when you resented helping someone at work? Tell me about that. Here are some examples of EI interview questions that test social awareness. • Building relationships o Who are some key people in your organization who you currently must work with on a regular basis to get your work done? Describe your relationship with these people. o Describe your present responsibility for building and maintaining relationships at work. Whom do you build relationships with? How? Why? • Collaboration o Describe a time when you had to solve a problem that involved or affected other people within the company. How did you solve it? o Have you ever implemented an idea or solved a problem and had your solution met with resistance? What do you think you could have done to avoid the resistance? o Describe a time when you sought someone’s ideas or opinions about a project or idea you were working on. • Conflict resolution o Tell me about a dispute with a peer. What was it about? What did you do? How did it end up? 592
o Tell me about a time when someone suggested something that you disagreed with. What did you say? o How have you resolved differences with peers or others? o Tell me about the process you use to resolve your difference. • Organizational savvy o Did you ever have an opportunity to advance a new idea at your last job? How did you go about doing that? o Tell me about a time when you gained support for an idea that you had. How did you do that? Why was this idea important to you? o Describe a time when you couldn’t get support for an idea that you had. What happened? Why was this idea important to you?
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Managing Change: 10 Steps to Get Everyone on the Bus Shawn McVey, MA, MSW McVey Management Solutions Austin, TX
In days past, managers had a goal of stability and predictability. The only thing predictable in today’s environment is that change is coming. Simple or complex, from a new phone protocol to a new facility, you can embrace the change. The learned response to change is caution but caution can lead to paralysis. Today’s acceptable level of performance is tomorrow’s failure. If your practice has a culture with quick reflexes, you can pick up the speed that will protect you in the marketplace. Fast growth necessitates change. To deal with growth, we are really talking about how we handle change in the workplace. Change compels us to get out of complacency.
Reaction to change: Panic or stay cool Because change is scary, panic ensues and kills concentration. Action is important, but impulsive action makes things worse. If you stay cool, you can scramble without getting spastic. You can maintain a sense of urgency but still be steady under fire. Is your practice complacent? • The practice is not losing money; no big threats. • The practice compares itself to the industry average, not the industry leaders. • The typical manager or employee can work for months without encountering resistance or questioning. • There is no highly visible crisis. • The practice measures itself against low standards. • Planning and control systems are rigged (or non-existent) to make it easy for everyone to reach goals. When faced with change, you can wait for instructions or take the initiative. You must figure out what your business needs and be part of the solution. To get change-ready: • Push decision making down to the lowest possible level. • Begin sharing information. • Talk, but listen too. It is a two-way street. • Encourage participation. • Get into the trenches with front-line employees. • Help people see the “why” of change, and work with them to discover “what.” We confuse getting ready with progress. Roll up your sleeves, improvise, and LEARN. Inertia is more crippling than mistakes. Frequent questions asked by those affected by change: • “What is in it for me?” • “Why is this important?” • “How do these people even know what the problems are? They don’t bother to ask us.” • “Do they really think they can change the entire practice at once?” • “How much of our time and their money will they sink into this dry hole?” The first step is to mobilize energy and commitment by sharing values and a clear vision. People do not argue with what they help create. You will get buy-in through participation. The group who will implement change must agree on what the problems are and why they need to change. If change is dictated from the top, people will resist having solutions imposed upon them by individuals who lack familiarity with day-to-day operations. This resistance is expressed through lack of motivation and commitment to the change. You must have top level support--not control. Try harder. • People respond to change by putting out more effort. The greater the change, the more effort to stick with the same habits. • You can’t handle change if you don’t change. • Today’s problems are caused by yesterday’s solutions. Try easier. • Simplify, and search for different solutions. • Get rid of things that are in the way. • Innovate. Bust out of old routines.
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The second step is to develop a shared vision Do you have a mission, vision, and values? Vision must be put into action; owners and key managers must inspire others in the organization toward it. Vision is “what can be seen,” so focus on specifics about how to improve the business and how those changes will benefit the employees, patients, and clients. Components of shared vision • Describe a desirable future. • Be compelling. It should be much BETTER than the current state of things. • Be realistic. Make it within the grasp of the hard-working folks who will make it happen. • Be focused on a manageable set of goals. • Be flexible. • Make it easy to communicate with all levels of employees. You waste time and energy when change creates a culture of complaint and “poor me.” We want the good old days. We fret about the future, and it does not improve a thing. Spend energy on solutions by buckling down and channeling your energy on productive things. Action is better therapy than tears. You can redirect emotions to produce results. The third step is to hire qualified employees. Get the right people on the bus and the rest OFF! Answer the question: What isn’t getting done well? What is holding the practice back? The surest security is a willingness to take risks. You need NERVE. Without risks, there are no breakthroughs. If we don’t move forward without road maps, we will trail the competition. Use your imagination and extend yourself. Put adventure into your work and see how far you can reach. Plan for employee turnover and be cognizant of these issues: • Would the departure of a key employee upset the applecart? • As volume of business increases, some people will not keep up. • Without clearly defined roles, new employees will leave.
Systems are the answer to this problem. Identify the leaders in your practice. Good leaders have three characteristics: • They believe that revitalization and change is the key to competitiveness. • They articulate their conviction in the form of a credible and compelling vision. • They have the people and organizational skills to implement their vision. Rely more heavily on your strengths. You must thrive on pressure and not always rely on strengths. A culture of inflexibility develops if people rely too much on their strengths. Don’t let your strengths become your weaknesses. Keep learning, develop new directions, adapt. Show respect for what works. The fourth step is to focus on results, not activities. If you cannot measure it, you cannot manage it. Operations experience and expertise is critical. You must identify and meet short-term goals, and regularly discuss them. Welcome destruction, change is destructive. It bothers people. Protecting “what is” sabotages “what could be.” Destruction is a condition for survival. It’s messy, makes noise, and people get upset. Reward disturbing the peace. Step five is to implement systems. Establish your infrastructure for growth with HR, project management, and quality control. Create checks and balances for your practice. Reduce stress and make workloads predictable and manageable. This also helps with managing turnover. Change makes people scared. They get jumpy about doing anything that makes them look bad. If we can’t tolerate failure, we don’t develop new competencies. Failure is a master educator. Don’t be careless, but fail quickly and fail often. Success is usually a byproduct of screw-ups. Step six is to start change at the periphery. The likelihood of success is greatest when change is implemented in small, autonomous units. Success breeds success. Change brings out the “so-so” in people. Pressed to keep up, we are tempted to shave standards. We want to get even with the organization for requiring change. Raise your standards and pursue total quality. Instead of accepting less than your best, improve on it. Don’t tolerate so-so performance. Tough times define the culture.
Change and growth: What is in it for me? • Clear advantage over the status quo • Compatibility with people’s desires and values • Requirements that are understandable • Option for people to experience the change model at a small scale first • The possibility of people observing the suggested change in another setting 595
Change triggers survival instincts. Looking out for number-one takes priority over looking out for the client. Focus on the team; there is strength in numbers. Rather than maneuver to protect yourself, focus on protecting the client…the client determines the fate of the organization. Step seven is to train employees, and train again. Invest in training and supervision of the employee. They can’t read your mind. There is a direct correlation between training and productivity. Our goal is continuous improvement and change. This is a process, not an event. Loyalty creates traitors. The organization tries to change, but the culture won’t let it. There is danger in being chained to outdated traditions and ways. Show insensitivity to history to show respect for the future. Break with the past and celebrate achievements that make the organization more competitive. Defending the past cannot protect you from the future. Step eight is to implement technology to support operations. Give people the tools they need to do their jobs. You cannot run a business on a wing and a prayer. Strategically plan and budget for technological improvements. Change is hard on hope because problems cloud our view. We focus on what is wrong instead of possibilities. Bad news drives good news away. Opportunity comes disguised as problems. The way you think influences the way you frame the situation, thus influencing the ability to deal. Believe in opportunities, and you help them appear. Step nine is to improve quality. Deliver a consistent client experience. Develop checklists and scripts to recover from service failures. Increase client satisfaction (value). Listen more than ever to what employees and clients say about their experience with your business. If clients are negatively impacted by a system (or lack of one), fix it quick! Complaints and surveys are a great thing. Increase competitiveness by staying current with: • What is important to your clients • What is happening in the marketplace • What your competition is doing • What your practice is doing well • What you need to do to improve Change creates problems, and we look to blame others. Badmouthing the boss becomes a pastime. None of this slows down change or fixes the problem. Blaming is a devious way of avoiding responsibility. Identify problems with a solution. Get busy doing what you can do instead of second-guessing somebody else’s efforts. Push for a culture of personal responsibility. Step ten is to expand services, not just service. Add new procedures and profit centers. 80/20: Do you know the rule? Adults get bogged down in routine and habit. Grown-ups resent the difficulties of change. Kids embrace change. They thrive on it and treat it like a plaything. Kids insist on variety. Change is what keeps them from boredom. Life is a constant stream of break-throughs. Be curious instead of worried. Maintain positive cash flow and control costs. Don’t “burn” cash. Running out of cash is the most common reason a business fails. Spend cautiously and get paid promptly. The single biggest impediment to growth is the inability of the culture to change with the growth. We are often failures at implementation.
6 implementation problems • It takes more time than we thought (76%). • Major problems surface that we did not predict (74%). • Coordination of activities was not effective enough (66%). • Competing activities and crises distracted attention from implementing the strategic decisions (64%). • Capabilities (skills and abilities) of employees involved with change were not sufficient (63%). • Training and instructions were not clear to lower-level employees (63%).
Reaction to change: A sense of loss and anxiety A common reaction to change is a sense of loss and anxiety. The typical employee spends eight hours a day doing, in general, fairly routine tasks, and the completion of those tasks becomes the culture. People will adapt, but there is a predictable series of responses. Stages in reaction to change • Shock • Defensive retreat • Acknowledgement • Acceptance and adaptation 596
People get stuck for a few reasons: • Change is not a single event. • Everyone comes to the table with a different level of experience relative to change, and they have different coping skills. • People who are emotionally fragile are particularly vulnerable during times of change. Minimizing the negatives of change and growth To minimize the negatives of change and growth remember to keep your cool and handle pressure smoothly. Keep your responses non-defensive. Develop creative and innovative solutions to problems. Be willing to take risks and try out new ideas. Be willing to adjust priorities. Demonstrate enthusiasm for long-term goals. Be open and candid. Participate. When a decision needs to be made, make it. Management Development is the process of building the current and potential performance capabilities of an organization’s managers. The focus is on skill development and understanding how to think and behave as managers.
Functions of management development • Enhance management skills. • Shape the corporate culture. • Promote leadership style. • Reward and recognize managers.
Critical dimensions • The person’s concept of their role • The skills demanded by the role • Attitudes and psychological factors
Change in role The fundamental dimension of successful transition involves changing the concept of one’s organizational role from a performing do- er to a managerial role of supervising the work of others. Predicting the future is easy. It’s trying to figure out what is going on now that is difficult.
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Service 101: Building Client Relationships Shawn McVey, MA, MSW McVey Management Solutions Austin, TX
Client focus audit: Rate your key-customer service focus • Why would key potential customers want to do business with you? • What are you doing to ensure that your customers will be with you tomorrow? • Are you fulfilling the promises you make to your customers every day? • Are you respecting your customers’ time in every aspect of the service process? Client focus audit Satisfaction • You treat the pet in a timely manner and within the estimate provided. • You follow through with commitments. • You exceed the client’s expectations within the confines of the treatment plan. Service • You understand the client’s expectations and exceed them. • You pay attention to the client’s changing needs and perceptions. You are proactive! • You focus the BUSINESS on the needs, desires, and wishes of the client. What is customer satisfaction? Customer satisfaction is focusing on the contractual and cultural expectations between the hospital and the client. Service is guided by the understanding of that agreement. Customer service is making an effort to consistently and proactively serve the client; to be of service, not just follow a policy or a rule or an agreement. Implementing customer service • Change must come from owners and veterinarians. They must lead by example. • Employees must be empowered and trained to make good business decisions. • Balance the notion that the customer is always right with what is right for the business. Implementing customer service You can’t afford to fail at this! • Listen carefully to find creative ways to exceed clients’ needs. Do not rely on assumptions. • Focus on the customers’ evolving needs. Is service the same to you at every stage of life? • Eliminate non-value-added mentality: “We’ve always done it this way.” • Provide choices. Instead of “no,” how about, “Let’s explore alternatives.” • Establishing a customer service culture is everyone’s responsibility. • We all must take on the attitude of, “We are in business to take care of our customer!” Back to basics • Pick up the telephone! • Is everyone trained properly? • Do you have performance reviews that enforce client service? • When is the last time you surveyed your clients? Client focus audit • How effectively do you communicate with your customers? • Would your customers agree that you are not just MEETING their expectations but EXCEEDING them? • Do policies in your practice make it easy for customers to do business with you? • What is your USP? (Unique Selling Position) • What do you consider your competitive advantages?
Service or satisfaction? Customer service • Where did you receive excellent customer service? • Why was that service exceptional? • What do customers like least about doing business with your organization?
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Communication style • How important is communication to good customer service? • Does everyone communicate in the same style? • Circle ALL the words that describe you when you are at WORK. • Service 1 Diplomatic 2 Strong-willed Critical Conscientious Pushy Independent Indecisive Serious Impatient Practical Systematic Logical Tough Decisive Picky Orderly Dominating Outspoken Cautious Accurate Competitive Goal-oriented Precise Thorough Brave Persistent Careful Assertive
3 Supportive 4 Ambitious Conforming Respectful Manipulative Extroverted Unsure Considerate Optimistic Enthusiastic Helpful Dependable Talkative Sociable Satisfied Agreeable Reactive Friendly Cooperative Approachable Egotistical Creative Easy-going Loyal Outgoing Charming Patient Convincing
Communication style • Count the circles in each quadrant. • Which quadrant has the most circles? o 1, 2, 3, or 4? My communication style Are you: 1. Analytical 2. Driver 3. Amiable 4. Expressive Read about your style. Does it sound like you? Communication with different styles • High Analytical • High Driver • High Amiable • High Expressive Communication and service • Understanding communication styles can be useful in customer service. • How does communication impact customer service?
Exceptional customer service Benefits of exceptional customer service • Goodwill in the community • Community support when real problems occur • Pride in your agency and your career • Better working environment; internal and external customer service • Increased success with clients What customers value • Tangibles: appearance of equipment and personnel • Reliability: ability to perform the expected service • Responsiveness: willingness to help customers • Assurance: knowledgeable, courteous employees, and their ability to convey trust and confidence • Empathy: caring, individualized attention to customers
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What customers want • Dignity and respect • Services meet expectations • Success • Help with problems • Treated as individuals • Respect their self-image • Respect their time • Someone on their side • Correct information Put a smile in your voice • Turn to the person next to you. • Decide who will be the caller and who will answer. • Turn your back to each other. • With a frown on your face, introduce yourself to your partner. Tell him/her your name and ask if you can do anything to help him/her. • Now with a smile on your face, ask the same. • Can you tell a difference? Tools of the telephone business • Be direct. • Be helpful. • Be courteous when screening calls. • Be careful with transfers. • Be knowledgeable. • Offer an explanation for delay. • Thank the caller. • Take good messages. Customer service barriers • Company policy • Job specialization • Lack of coordination between departments • Remote decision-making power • Arbitrary policies; inflexibility • Top priority is cost-cutting • Indifferent employees • Not enough creative problem-solving • Failure to listen to customers Service recovery • You will make mistakes. What angers customers is when the mistake is handled poorly. • 70% of disgruntled customers will return if the business apologizes for an error. • 95% will return if the frontline employee recovers impressively. What is “service recovery?” • Make it easy and convenient for customers to complain. • Identify unhappy customers before they complain or go away. • Turn mistakes into positive service stories. • Keep track of reasons customers complain so problems can be eliminated. Service recovery steps 1. Apologize. 2. Listen and empathize. 3. Fix the problem. 4. Offer atonement. 5. Keep your promises. 6. Follow up.
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My customer service plan • Plan for improving INTERNAL customer service with my co-workers • Plan for improving EXTERNAL customer service with my customers 3 points to transition • Mastery - Loving what we do and being competent in what we do. It makes our service EASIER. • Chemistry - Building and nurturing strong relationships with others. It makes our service FRIENDLIER. • Delivery - Willingness to meet the needs and exceed the expectations our customers every time. It makes service FASTER. Where are we headed? • Easier - Combines competency and care • Friendlier - Creates a customer-focused culture • Faster - Speeds up processes Mastery • Loving what we do and being competent in what we do. It makes our service EASIER. • Each of us has a right to participate in educational trainings, work-related skill-building workshops, seminars, and instructional opportunities that reinforce our competency and professionalism. Chemistry • Building and nurturing strong relationships with each others. It makes our service FRIENDLIER. • Each of us has the right to enjoy what we do and to have opportunities to build strong, positive interpersonal relationships with coworkers, staff, and customers. Delivery • Willingness to meet the needs and exceed the customers’ expectations every time. It makes service FASTER. • Each of us has a right to provide excellent, swift customer service that has that WOW quality. Are you an influencer? • Has integrity with people • Nurtures other people • Has faith in people • Listens to people • Understands people • Enlarges people • Navigates for other people • Connects with people • Empowers people • Creates and mentors other influencers
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Service 201: How to Focus on the Client Shawn McVey, MA, MSW McVey Management Solutions Austin, TX
Veterinary medicine has gone through a tremendous change and so must our paradigms for delivery of service. It has gone from owner- and medicine-driven to client- and experience-driven. The new consumer is looking for an experience instead of a purchase.
The magic of client enchantment Service magic is a set of learned skills developed through desire and determination. The service magician seeks to delight and stand apart from the crowd. It is not a bag of tricks or an illusion. It is rapport, communication, trust, and credibility. It is the art of crafting awe and wonder and creating pleasant surprises. Service Magic is: • Unexpected • Unpredictable • Valuable • Memorable • Reproducible There are three well-researched approaches. The first is the RATER approach, and acronym for: • Reliability is the ability to provide what was promised dependably and accurately. • Assurance is the knowledge and courtesy of employees, and their ability to convey trust and confidence. • Tangibles are the physical facilities and the equipment, and the appearance of personnel. • Empathy is the degree of caring and individual attention provided to clients. • Responsiveness is the willingness of the staff to help clients and provide prompt service. John Goodman of TARP, a D.C. based customer-service research firm, performed a critical incident study of 1,000 hospitals to find out what behaviors delighted clients and how that affected loyalty. Three top delightful behaviors cited were: • Consistently good service • Proactively provides information • Tells me of new advancements The client is consistently delighted when: • We do what we say we will do. • We regularly communicate. • We provide them with something new. An emotional connection is created between the service deliverers and the delighted client who voluntarily tells love stories about those who serve. This extreme level of satisfaction is called CLIENT TRUST. Service Magic Is Not… • …happenstance or a fluke • …dependent on an extravagant gesture • …a complex set of practices • …boastful or arrogant; rather, it’s confident • …a value-added client service; it is unpredictable and unique • …service with imagination more than service with generosity The Service Magic Method is a two-step process—two very large steps: Opportunity quest and matching technique to opportunity. Opportunity Quest Points of impact and moments of truth where the client: • Observes • Assesses • Evaluates We need a cycle-of-service map or a moment-of-truth assessment.
Opportunities meet 4 criteria The point of contact is necessary but routine • Checking in 602
• Establishing credentials • Placing an order • Listening to instructions The point of contact is annoying or unappealing • Waiting in line • Being kept o hold • Waiting-room experiences • Having to make choices The point of contact is a creaky operation or a perilous process • Getting lost • Misreading instructions • Missing a step • Changing the routine The point of contact is undistinguished or value-add-neutral • Competitors are all doing it the same way. Don’t add magic when • Custom and propriety would be dislocated or disturbed • Clients would view the change as peculiar or puzzling rather than pleasant • Safety or welfare could be compromised • The delivery system is broken Match technique to opportunity • Misdirection or direction: Distract the client’s attention from an unpleasant encounter or contact. • Pattern interruption: Humans always search for patterns to make sense of what they experience. Do something different than what is expected in the moment. • Force: It seems like a fair and free choice, but the outcome has been predetermined. Reframe the choices to make them seem more desirable. Shape the experience. 5 service-management tools • Inclusion • Personalization • Patter • Using confederates • Outs or escapes
Where it happens The three Ps of service magic • Place • Process • Performance Place magic • Environments that delight, support, and enliven • Magical places: venues that attract and please, subtly enhanced by human endeavor Componentsof place magic are • Nature or natural • Signage, direction, and observation • Convenience Know your clients • Understand who will be using your services. • Wear their shoes. • Organize the flow of people and ideas. • Create a focus. • Communicate visually. • Avoid overload. Create turn-on. • For every ounce of treatment, provide a ton of treat. • Keep it up.
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Process magic • Policies, procedures, and routines that make transacting business with an organization, easy, positive, and memorable • Meet client need with experiences of awe and memories of amazement Two types of process • Algorithmic • Heuristics
Algorithms Algorithms are step-by-step processes, kind of like rules of law, that focus on precision, replication, exactness, and dependability • Red Rule algorithm: most effective; tested through trial and error; designed to maximize effectiveness, safety, and predictable outcomes (get it done right) • Blue Rule algorithm: designed to maximize efficiency and sameness (get it done in a predictable manner; rote task) Heuristics • Rules of thumb for doing work, such as, “Greet each client warmly,” or “Treat patients with respect” • Implicit in heuristics is that there is some sort of judgment call that has to be made about good service. • When complex judgment calls are part of the service situation, creating complex guidance seldom results in improved service. Adding magic to heuristics • Never mess with the core expectation of consistency. • Magic is provided by the person implementing the process, not the process itself. • It cannot be too extreme, because the client will know that it is not likely to happen again.
Magic and algorithms Red rule magic (Get it done correctly.) • Make sure the alteration fits the process. • Ask, “Is it reasonable that this brand of magic will not disrupt existing relationships?” • Make sure it is done by the whole team. • Done in matched tones (change the experience, not the process) • Must be subtle • Magic can happen alongside the process. • Must be of the same nature as the core offering Blue rule magic (Get it done in a particular manner.) • Remember you are tampering with trust. • Select a process that clients “must endure.” • Don’t alter the process without looking at the whole experience. • Include props (checklists, job aids, cueing devices) for the service provider in order to enforce consistency.
Restoring magic Service-recovery scripts • Coaching employees to say the right things and recover from service problems • Should match the practice’s mission • Discover what the client values and develop scripts around those issues. • Get input from people who deliver the lines. • Coaching employees to say the right things and recover from service problems • Keep it simple. • It IS a performance. • It is a safety net. Six steps to recovery • It begins off stage. • Clients know best. • Fix the client, then fix the problem. • Offer a fair resolution, then atone for inconvenience. • Give employees responsible freedom. • Follow up.
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Off stage • Create a clear policy for problem solving. • Create a system for measuring and monitoring satisfaction. • Recycle that information back to the staff. The client’s eyes • An expectation of fairness • Personalized treatment • Fix it fast. Don’t let it happen again. Client first, then the problem • We usually jump right to fixing the problem. DON’T! Instead, put the client first. • Psychological repair comes first. • Grovel and apologize. They need… • Information • Recourse • Expertise or know-how Fair resolution/atonement • Apologize and acknowledge. • Listen and empathize: ask open-ended questions. • Fix the problem quickly and fairly. • Offer atonement. • Follow up. • Keep your promises. Involve the client • Clients who participate in the recovery process feel more magic. • Contrary to popular belief, they bring a sense of fairness to the table. Responsible freedom • Give your employees some autonomy. • Create policies that allow them to share in the process. Follow-up • Nothing creates magic more than follow-up. • Some clients fear retaliation and will not voice their concerns when they happen, (especially in health care).
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Service 301: Managing the Client Service Puzzle Shawn McVey, MA, MSW McVey Management Solutions Austin, TX
(From Harvard Business Review’s “The Four Things A Service Business Must Get Right") Best practices aren’t enough • Most managers/owners are waiting for that one great idea or the magic bullet to fix customer service. • Other managers/owners try to implement best practices from other companies or conferences. • But, there is no such thing as a good idea in isolation! There are only good ideas in the CONTEXT of an overall service model/plan. • In other words, what worked for them may not be what works best for you! Service context To consistently and sustainably delivery service excellence, the entire service context has to work together. • What your service offering consists of • How you fund the excellence you want to provide • How you manage employees to deliver quality service • What you do to help customers enhance – not erode - service Service offering • Determine how customers define “excellence” when it comes to your offering. • Your management team must be absolutely clear about which attributes of service the business will compete on. Most business failure is because of trying to design a service model to cover a huge range of customers and remain competitive across them. Successful businesses know what they do well that matters to their customers and choose to focus on that and not over-invest in what they do poorly. Organizations that are superior at all service attributes usually demand a price premium of 50% over their competitors and most industries don’t support that type of premium. You can choose between excellence paired with inferior performance on one hand or mediocrity across all dimensions on the other. Accepting that inferior performance in one dimension fuels superior performance in another is the first step to designing excellent service.
ACTION: Define your attributes Managers need to determine which attributes to target for excellence and which to target for inferior performance – based on the needs of your customers. Discover the relative importance customers place on attributes and then match the investment in excellence with those priorities. “Wal-Mart’s value proposition” • Ambience and sales help are least valued by Wal-Mart’s customers, low prices and wide selection are most valued. • The trade-offs Wal-Mart makes are deliberately informed by these preferences. • They optimize the service offering to cater to their customers’ priorities and REFUSE to over-invest in underappreciated attributes. • Shoppers whose preferences match Wal-Mart’s strengths self-select into its customer base. Commerce Bank’s strategy • Commerce Bank has been able to grow its retail customer base dramatically even though its rates are among the worst in its markets and it has made limited acquisitions. • They focus on the set of customers who care most about the experience of a physical branch. • Customers are varied in demographics (young, first-time bankers, urban professionals, elderly retired folks) but united in priorities (ambience, convenience & friendliness). • They added to ambience with interior elements like high ceilings and natural light and added a fun contraption for redeeming loose change. • For attributes less important to their customers (price, product range), they are willing to cede the battle to competitors.
So, ask your customers What do your customers generally agree constitutes excellent service? Is it convenience? Friendliness? Extended hours? Closer proximity? Ambience? Lower prices? Provide your current customers a list of possible service attributes that you believe your hospital provides well and ask them to prioritize the list in terms of matters most to them. Focus your service offering on the few attributes that matter most.
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List of possible attributes • Ambiance – smell, lighting, comfort of lobby, ease of movement through hospital • Price/cost • Convenience – proximity, hours, availability of appointments, duration of visit • Friendliness – courteous staff, remembers my pet’s name, smiles, etc.
What attributes would you use to describe your practice? Service design audit: The offering • Which service attributes do you target for excellence? • Which ones do you compromise on in order to achieve excellence in other areas? • How do your service attributes match up with your targeted customers’ priorities?
Funding mechanism Consider how you will pay for the increased cost of the excellence you’re seeking to provide through your service offering. • Charge the customer • Create savings & value-added services (win-win) • Spending now to save later • Having customers do the work Charge the customer • Make sure the customer is charged in the most palatable way. • Management should creatively consider what feels fair to its customers. • Often, the least creative solution is to charge more for the particular service feature you are funding.
What are some ways you could creatively & palatably charge customers to fund excellent service? Starbucks’ appeal Starbucks’s appeal is that customers can linger almost indefinitely in a coffeehouse setting. Rather than putting meters next to their overstuff chairs to charge customers for their length of stay, they charge a premium price for the coffee. The higher priced coffee pays for all that goes into creating and maintaining the coffeehouse setting…furniture, staffing, lighting, etc. Commerce Bank convenience They stay open late and on weekends – because their customers care about convenience and ambience of the physical branch. It pays for that service by giving a half percentage point less in interest for deposits. It could fund extra labor hours by charging for evening or weekend visits, but a slightly lower interest rate is more palatable to its customers. Create a win-win Create synergies between operational savings and value-added services. Very clever management teams discover ways to enhance the customer experience even while spending less. Some of these innovations provide only a temporary competitive advantage, as they are quickly recognized and copied – others are surprisingly durable. Progressive’s win-win The Company immediately sends out a van to assist a person involved in an auto accident – often arriving on the scene before the police or tow trucks. Customers love this responsiveness and ranks service highly, even though they wouldn’t be willing to pay more for it. Progressive funds this “excellence” because it allows them to save money on insurance fraud since a representative is sent to the scene – lower fraud loss & lower legal fees. How can you find win-wins? Most managers’ impulse is to imagine what new value could be created for customers and then to ponder how that could be funded through cost-savings. Rather, consider what are your biggest cost buckets? With these in mind, managers can then simultaneously determine how to reduce costs and create a value-added service. Spend now to save later It is possible, if somewhat painful, to make operational investments that will pay off by eventually reducing customers’ needs for auxiliary service in the future. Intuit’s call center They provide free customers support (very uncommon in the software industry), even though call centers are expensive to staff. They have their development people fielding calls so that subsequent versions of its offerings will be informed by direct knowledge of what users are trying to accomplish and how they are being frustrated. This investment drives their feedback-driven improvements for better software with the next offering.
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Have the customer do the work If the goal is service excellence, you must create a situation in which the customer will prefer the do-it-yourself capability over a readily available full-service alternative. If the self-service option is truly preferable, customers should be willing to take on the work for nothing or even pay for the privilege. What work could you transfer to the customer? Airline ticket kiosks Frequent fliers now prefer kiosks because they provide readier access to useful tools like seat maps and often shorter lines.
Service design audit The funding mechanism • Are customers paying as palatably as possible? • Can operational benefits be reaped from service features? • Are there longer-term benefits to current service features? • Are customers happily choosing to perform work (without the lure of a discount) or just trying to avoid more miserable alternatives? Employee management system Ensure that your workforce management activities (recruiting, selection, training, job design) empower employees to deliver the excellence embodied in your service offerings. If your business requires heroism from your employees to keep customers happy, then you have a bad design. Employee self-sacrifice us rarely a sustainable resource. Instead, design a system that allows the average employee to thrive. Employee management system • Ask yourself, what makes our employees reasonably able to achieve excellence? • And, what makes our employees reasonably motivated to achieve excellence? • Thoughtfully considered, the answers will translate into company-specific policies and programs. Commerce Bank’s formula This bank chooses to compete on extended hours and friendly interactions and not on low price or product breadth. Since strategy informs employee management, Commerce decided they don’t need straight-A students to master their limited product set, so they hire for attitude and train for service. Many people are reluctant to acknowledge a trade-off between aptitude and attitude, but failure to accommodate this economic reality in the design of the employee management system is a common culprit in flawed service. Commerce Bank’s team • Managers use simple weed-out criteria like “Does this person smile in a resting state?” rather than trying to maximize across a wider range of positive characteristics. • Because “friendly” people prefer working with other “friendly” folks, the employees are empowered to recruit co- workers. • When they experience great service in another setting, they can hand out a card printed with a compliment and a suggestion to consider working for Commerce. • Because they hire for attitude, they must engineer things so that even lower-aptitude employees will reliably deliver great service. Service design audit: The employee management system • What makes employees reasonably able to produce excellence? • What makes them reasonably motivated to produce excellence? • Have jobs been designed realistically, given employees selection, training and motivation challenges?
Customer management system In a service business, employees AND customers are both part of the value-creation process. Articulate which behaviors customers must demonstrate to get the most value from your service. Then design your service specifically to foster those behaviors. Keep it simple To get customers using the new self-check-in kiosks, airlines ensured that travelers could complete the transactions with far fewer keystrokes than the check-in personnel used to need. By contrast, retail stores that offer self-service checkout machines haven’t made using those machines easy for shoppers. Stores expect shoppers to shoulder responsibility for fraud prevents by weighing bags during check-out, which makes customers anxious to they avoid the machines. Your customer management system Ask yourself, which customers are you focusing on? Which behaviors do you want? And which techniques will most effectively influence behavior? Manage customers in a way that is consistent with the service attributes you’ve chosen to emphasize overall. Influencing customers • Instrumental – incentives and dis-incentives like discounts and late fees 608
• Normative – the use of shame, blame and pride that gets us to return shopping carts and pick up trash when no one is looking • Which methods have you found most effective for influencing your customers’ behavior? Service design audit: The customer management system • Which customers are you incorporating into your operations? • What is their job design? • What have you done to ensure they have the skills to do the job? • What have you done to ensure they want to do the job? • How will you manage any gaps in their performance?
Integrating the elements Successful service companies have a working plan that incorporates all four elements into the service design. Within each of those areas, however, it is hard to spot any best practice. The whole business depends more on the interconnection of the four than any one element. Cleveland clinic • Consistently ranked among America’s most eminent hospitals and a leader in pioneering cardiac care for decades. • No financial rewards tied to doctor productivity, allowing doctors to spend time on innovation. • Organizing centers by disease, rather than by specialization which encourages cross-collaboration. • No clear exact source of their advantage, but the choices made complement one another and come together in a smoothly operating system. Service design audit: The whole service model • Are the decisions you make in one dimension supported by those you’ve made in the others? • Does the service model create long-term value for customers, employees, and shareholders? • How well do extensions to your core business fit with your existing service model? • Are you trying to be all things to all people or be specific things to specific people?
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10 “Must” Things I Would Do in Practice (Parts 1 and 2) Mark Opperman, CVPM Veterinary Management Consultants Everygreen, CO
1. Clearly state to my entire team the mission and vison of my practice. Everyone needs to know who we are, what we are and what I want us to be "when we grow up". I will live that vision in my words and actions. 2. Determine my practices Niche and make sure my practice stays true to that Niche 3. Hire "10" Employees and Develop a training program to insure standards of medicine and customer service. Use video evaluation to "inspect the expect". 4. Incorporate an employee incentive program so that the team has a stake in the success of our practice. 5. Hire "10" associate veterinarians, develop an excellent mentorship program, pay them Pro Sal and after 5 years offer them the option of a percentage buy in to the practice. 6. Use the best in technology; laboratory equipment, digital radiology, VOIP phone system, veterinary software program. 7. Develop an amazing website, be active on social media, be a very high touch, high tech practice. 8. Determine a fair fee schedule, make sure all team members understand our fee schedule and are in support of It and teach the team to show the value of our services to our clients. 9. Hire a "10" practice manager and work with him or her to understand the objectives of our practice and make sure they are being met and hopefully exceeded. 10. Enjoy every day, share that joy with my team as well as the success of the practice. Give back to the community and to those we serve, both clients and patients.
The ten "must" things I would do in my practice 1. Clearly state to my entire team the mission and vision of my practice. Everyone needs to !mow who we are, what we are and what I want us to be "when we grow up". I will live that vision in my words and actions. How to create a "ten" practice I. What is a "Ten" Practice? A. Factors that go into Creating a "Ten" Practice and Others that We Must Overcome When veterinarians first open their practices, the excitement of doing so and also the "fear" due to the economic involvement or indebtedness, are factors that help to make the Initial practice successful and grow. B. When a veterinarian reaches a certain point where he/she is economically more secure, the excitement diminishes and the practice stabilizes. C. A type of "clinical depression" sets in. D. There is a "fear" to incorporate change and, due to this, the practice stabilizes and sometimes levels off or deteriorates. At this point, many veterinarians become disheartened with the practice and the profession. E. Therefore, one must recognize that change is important and one must be willing to take the steps necessary to achieve the attainment of a " ten" practice. F. If you are not on the economic edge and not making it financially, you do not have anything to lose and might as well go for it. G. One must be committed to go through one's fear. If there is anything in your work environment that you do not enjoy, then, you must be willing to change it. If you do not enjoy your environment, your staff and other aspects of your work, then you need to make a change. It takes courage and guts; however we must go through this fear. H. Your practice is a Rorschach of your life. How you run your practice is how you run your life! I. One must commit to change. J. "Life Sickness" can happen. a. Caused by the unwillingness to change when all that which is all around you is changing. b. This is the opportunity we have to really make a difference in our lives. c. This is the only opportunity K. What things in your life add meaning to your life? a. We have the opportunity to have our practices any way we want if we just have the courage to do it. 2. Determine my practice's Niche and make sure my practice stays true to that Niche.
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How to enhance your practice's “perception of value” Make the office visit a pleasurable experience • Warm and Professional Atmosphere o Current reading material o Client education o leash hooks attached to reception desk o -Coffee o Kiddie Corner . Treasure chest of toys, coloring books o Pet carriers o Personalized leashes o Background music o ID collars and tags o Obtaining patient weight during each visit . Microchip o Uniforms and name badges o Being attentive to the client's needs • Internet Pharmacies o What percentage of your income comes from pharmacy sales~ o How to effectively deal with internet pharmacies Exam room report card 3. Hire" I 0" Employees and Develop a t raining program to insure standards of medicine and customer service. Use video evaluation to “inspect the expect".
4. Incorporate an employee incentive program so that the team has a stal VMC team incentive program The problem with most incentive programs We have all read about various employee incentive programs and you may have even tried to implement some of these programs in your own practice. Often, incentive programs reward employees based on a specific goal or metric, such as the number of new patient visits or Increased sales of specific services such as dental services, fecal tests or microchip implants, or sales of specific products, such as heartworm prevention or dental products. Unfortunately, I have found these types of programs are not highly effective in motivating team members. The problem with most of these incentive programs is that not all team members are involved in a particular program, so results are short lived. Also, the amount of additional bookkeeping required to manage such programs tends to become burdensome. In many cases, an ineffective team incentive program can even create back-biting and tension among team members. Naturally, the intent of any incentive program is to reward your team for their dedicated efforts and to let them share in the fruits of their labor. There is a type of team incentive program that accomplishes this goal, and it is one that we have successfully implemented in many of our consulting practices. In the years since we first began using this Incentive program, I have found that, without question, the results are extremely positive and long-lived. This is not the type of incentive program that produces short-term results, nor does it only provide benefits to only a few select employees. Instead, all team members are rewarded based on the quality and quantity of effort they have put into the practice. How this incentive plan works The VMC Team Incentive Program has two components that are critical to its success. The first is the incorporation of a team approach within the practice; the second is effective communication between employer and employee. Simplified, the VMC Team Incentive Program works as follows. First, we calculate the increase in the practice's gross income for one quarter as compared to the same quarter of the previous year. A predetermined percentage of this amount (usually 10%) is set aside in an employee incentive bonus fund. After the end of each quarter, employees are evaluated by the practice manager or the owner of the practice using individual employee evaluation forms. Based on their individual evaluation score and the number of hours worked, each employee receives a proportional amount of the employee incentive fund. The team approach For this incentive program to be successful, employees must work together as a team and each must know what their place is within the team. Every team member must know what exactly he or she can do in order to help increase productivity, efficiency, and profitability within the practice. Therefore, a list of specific tasks and procedures should be presented to each team member. For example, receptionists must be instructed to take a "full service appro regarding past vaccin<~tions and other routine procedures is obtained on all patients entering the practice. Exam room technicians must be instructed how to effectively market the practice's services and to educate clients about topics that pertain to their pet's health, such as preventative procedures, dietary needs, and flea and tick control programs. In this manner, every team member will know exactly what they can do personally to increase the efficiency and profitability of the practice. Open lines of communication The second important component of this incentive system is the performance evaluation. As stated, each team member will be evaluated by the practice manager or the practice owner after the conclusion of each quarter. For part-time employees, the evaluation score obtained will be adjusted based on the number of hours the team member worked during that quarter. This helps to ensure that team members are rewarded based on their time spent in the practice as well as for the quality of their performance. All performance evaluations need to function as an open line of communication between the employer and employee. In addition to having the employer evaluate the team member, the team member also should be asked evaluate his or her own performance using the same evaluation form prior to their performance review. Evaluation forms will then be compared and reviewed with the team member during their review and this exchange will provide a forum for discussion. It is important to keep an open mind during this process. If a team member feels they were judged unfairly in a particular area and can substantiate that claim, then a change may need to be made in his or her evaluation score. By reviewing these evaluations with team members, they will become aware of how their performance is perceived by the practice owner and what they personally need to do in order to improve their evaluation scores. It has been my experience that this incentive system develops "10" employees in a short period of time. As stated, performance reviews should be done quarterly to give team members the opportunity to improve upon their performance and therefore receive a greater proportion of the incentive fund. It should be the goal of the practice that all team members eventually score 100 on their evaluation and are able to share equally in the fund. A program for all- full-time and part-time Once quarterly evaluations have been completed and reviewed with your team, the next step is to adjust the scores based on the average number of hours worked during the evaluation period. As an example; if a team member worked an average of 20 hours a week, their score would need to be cut in half, because 20 hours is half the amount of hours of a full-time employee (40 hours). The score is adjusted based on the average number of hours the team member worked during that quarter as compared to a full-time 40 hour a week employee. The beauty of this program is that there is no discrimination. A kennel assistant may get the same or greater bonus than a receptionist or technician--it all depends upon how well they do their job and the number of hours they work. This is a very important aspect of the incentive program. I truly feel that one person is not more important than another. If someone does well in their job and therefore gets a good evaluation, they have just as much right to receive a bonus as anyone else in the practice. Modifying the program to suit your practice There have been many variations to this program implemented within various practices. In younger practices or in a practice that might have hired a new veterinarian or built a new building, we have reduced the 10% of the increase in gross. The 10% of the increase in gross is the maximum figure I would suggest you use to fund the incentive program, but in many cases it can and should be less. I would also suggest you set a minimum score a team member must receive before the adjustment for hours in order for the team member to receive any money from the incentive program. So, as an example, we might say that an employee must get a score of 70 or 80 (out of 100) on their evaluation if they are to get anything out of the incentive fund. Again, this score would be before the adjustment for hours. Why would we want to give a bonus to a team member whose performance rated only a 50 or 60? Another caveat I normally include in the incentive program is that an employee must have been employed during the entire incentive period. If a team member comes in during or leaves during the quarter, they will not receive anything from the incentive program; it is an all or nothing situation. Give your team an incentive! The VMC Team Incentive Program has had phenomenal success in the practices where it has been introduced. It rewards team members based on their individual performance andcontribution to the practice. It opens up lines of communication and informs the individual teammember what they need to do in order to improve their performance. This program avoids themajor pitfall of other employee incentive programs which is that employees who are not truly dedicated and making a conscientious effort are rewarded along with everyone else on the team. There is nothing more frustrating to a hard-working employee than to have another team member who is marginal and does not put forth that concerted effort still be equally rewarded. That is why we stipulate that team members must receive a 70% or greater on their evaluation, before the adjustment for hours, if they are to receive any funds from the incentive program. I have found that this incentive program creates a "team approach" and has a long·term beneficial effect, not only on the practice's profitability, but also on the employees themselves. 612 We are all well aware that the success of a prac:tic:e depends in a large part on the quality of team within it. Bringing our employees into an incentive program such as thi s, creating a t eam environment, and rewarding team members based on the accomplishment of the practice's goals, is t ruly a win-win si tuation for all involved. In implementing this incentive program, almost any performance evaluation form can be used, just as long as the grading sca le can be converted to a numeric scale of 0 (low) to 100 (high). I would recommend that you utilize evaluation forms th at are not only specific to the veterinary industry, but also customized to each team member's job description within the practice. (VMC, Inc. has many templates for job descriptions that are customized for various positions within a veterinary practice, such as receptionist, technician, veterinary assistant, etc. Contact VMC or visit www.vmc-inc.com for more information.) If you opt to create your own evaluation forms, I would suggest that evaluation forms consist of 20 criteria that will be scored from 0 to 5 points with a maximum of 100 points. Once you have scored performance evaluations, you will then determine the percentage of hours each team member works as compared to a full-time employee. So let's say you determine an employee works an average of 30 hours a week, 30 divided by 40 equals 75%. So you would calculate take 75% of the employee's evaluation score. Once you have adjusted scores based on the hours team members work, the next step is to add up all the adjusted scores and divide each score by the total to figure out what percentage of the incentive fund each team member receives. You will find the calculation sheets and the Excel team incentive worksheet provided with this package will assist you in this process. Keep your team motivated In some cases, practices have found that, after a year or two, the incentive bonus program loses its edge and no longer motivates employees. Team members may even start to see the incentive bonus as an entitlement. If this happens with your program, you may want to consider applying the Dolphin Theory of Management. The Dolphin Theory of Management comes from the dolphin shows we have all seen. How do trainers get a dolphin to jump out of the water and through a hoop? Well, it is a process that is first begun by placing a hoop under the water. The trainer will coach the dolphin to swim through the hoop underwater and, when that happens, the dolphin is rewarded with a fish. After repetition and reward has ingrained this behavior in the dolphin, the trainer will raise the hoop a little and repeat the training. Each time the dolphin learns to go through the hoop, the hoop is raised a little more until eventually the hoop is out of the water and the dolphin is jumping through it. Okay, now let's use that theory and make the analogy that our team members are dolphins and the hoop is the evaluation form. As your team members achieve a score of 90 or 100 on their evaluation form, you must "raise the hoop," or update the evaluation form. Remove some of the criteria they are already performing well on and substitute in new criteria that challenges the team member. Yes, this will be a lot of work, but it is so very necessary. Team members can never feel that their job is a dead-end. They should know that there are always new challenges ahead and that management is going to help them to achieve them. This is the Dolphin Theory of Management and you will find it will help to keep your team motivated and "jumping through the hoop." Quarterly is a must A cornerstone of this program is quarterly performance evaluations. I have known some practices to try to do six month, or even yearly, evaluations and the result was that the program really didn't work. For some reason, quarterly performance evaluations are a must. Yes they are time consuming, but consider this: when you do quarterly evaluations, they don't have to be as in-depth as if you just did yearly evaluations. So you should only have to spend about 30 minutes per employee on the quarterly evaluations. In addition, I would argue that one of the real values of the incentive program is that employees receive feedback on a quarterly basis, which is something they truly desire. In fact, this may be one of the most motivating factors of the incentive program- not be the actual cash reward, but instead, the quarterly feedback on their performance. It is absolutely necessary to the success of this program that you conduct effective quarterly reviews incorporating the Dolphin Theory of Management. Scoreboarding The final key to success with this program is keeping your team informed as to how well the practice is doing. This is a management concept known as scoreboarding. Consider this: how well would a football, baseball or any team do if they did not know the score until the game was over? Well, that is how many of your team members feel. They have no idea of how well the practice is doing and what they might do to help improve the situation. It is not fair to team members to not tell them until after the quarter is ended if there was an increase in gross or not. So, as part of the incentive program, it is imperative that team members be informed of the practice's success. This can be done by simply posting a graph on the wall in your team lounge that shows income from last year, and then having someone updated the current income on a weekly or monthly basis. You may find that, as the end of the month draws near, if the practice has not exceeded its income from the previous year, team members may band together and step up their work in order to increase the income. It is crucial that you let team members in on the "secret" of how well the practice is doing and make sure they know what they personally can do to help. 613 Commonly asked questions • "What should I do if there has been no increase in income between one year and the Next?" If there is no increase between one quarter as compared to the same quarter of the previous year, the practice should still do evaluations on all team members. In fact, you can turn this negative situation into a positive one. During the review, team members can be Informed as to what they can and should do in order to ensure that there is an increase of gross in the next quarter. It may be helpful to analyze exactly which profit centers did not perform well over the past quarter and set some specific goals for the quarter to come. This otherwise negative situation can therefore turn into a very positive one and give added motivation to your team. • "Should I continue to do annual performance evaluations in addition to the quarterly ones I am doing for the incentive program?" One of the quarterly evaluations should also serve as the annual evaluation. I recommend that a practice only conduct four evaluations per year. Naturally, each of these evaluations will be used to determine compensation out of the incentive fund, but the evaluation that falls closest to the anniversary date of employment should be used to determine any adjustments to the employee's base salary or hourly rate. • "How can I use my practice's existing evaluation forms with this program?" Regardless of what evaluation form is used, there must be the possibility of scoring zero to 100 points. A tool to convert individual evaluation scores to this scale is provided in the Excel2014 Team Incentive Workbook, which is included with this packet. You could also perform the calculations manually in order to convert your evaluation form to a 0-100 scale. This method is described below. The simplified formula is as follows: 100 points I No. of Areas (criteria) = Points Per Area Points Per Area I Highest Possible Score = "N" Total Score For All Areas x "N" = Evaluation Score So, let's assume that your evaluation form has a total of 20 different criteria upon which an employee is graded. The grading system is such that scores range from 1 for unsatisfactory to 4 indicating excellence. Then, by dividing 20 into 100 points, you determine that each criterion is worth 5 points. The highest score available for each criterion is 4, so you then divide 5 points by 4. The resulting figure is 1.25. Therefore, once an employee has been evaluated, you should total the scores for all twenty areas and multiply this total by 1.25. The resulting figure will be the score you will use in determining the employee incentive bonus. Again, a perfect score must be 100 points for the purposes of this program. • "Should team members be told how thcit• bonuses were calculated?" The answer is a resounding yes! Team members need to be told what their score WilS and, in fact, during the discussion with the employee, your evaluation as well as their own evaluation of themselves should be reviewed and the final score should be determined. It is not recommended that you share other employees' scores with <1 given employee, however, that is most likely to occur. • "How can I keep my team informed of how well the practice is doing and whether or not there will be a bonus at the end of the incentive quarter?" This may be the most important question of all. Te<~m members need to be continually updated and aware of how well the practice is doing. The concept is known as scoreboarding, as previously described. I would recommend that you post a graph comparing each week's Income to that of the same week of the previous year. If weekly income is not available, then at least post the monthly income as a target figure and, week by week, indicate how well the practice is doing to reach that target. It is extremely important to the success of this incentive program that team members be informed on a continuous basis, not only how well they are doing in regards to their job, but also, the financial success of the practice. Team members need to "know the score," or how well the practice is doing, but equally important is that they know what they can do personally in order to improve the practice. As described previously within this article (see "The Team Approach" on pages 1-2), employees should be given a list of the specific ways they can improve the practice's efficiency and productivity, which will then result in increased gross income. At your team meetings, I suggest you discuss this topic with all team members. Receptionists must know that he or she must provide excellent customer service both over the phone and in person. They should be taught to ask the client if they need any additional products when they are receipting out the client, and to offer to send phone shoppers your hospital brochure. Exam room assistants should make sure they review the pre-exam check list and inform clients of additional preventative procedures the pet might need for optimum wellness. The kennel assistant should be instructed that they must be friendly when admitting a patient, not make the client wait and even help bring the patient to the client's car upon discharge. Everyone plays a critical role in the practice's success, no one person is more important than another and each must know what their role is to help the practice become even more successful. 5. Hire" 10" associate veterinarians, develop an excellent mentorship program, pay them ProSal and after 5 years offer them the option of a percentage buy in to the practice. 614 6. Use the best in technology; laboratory equipment, digital radiology, VOIP phone system, veterinary software program. 7. Develop an amazing website, be active on social media, be a very high touch, high tech practice. 10 reasons to update your website 1. Significant changes have taken place recently with Google Search engines and you may not be getting the traffic you have previously without adapting to these changes. 2. Are you mobile friendly? Your website needs to be easy to access on smartphones, iPads, tablets, etc. 3. Your website should be fresh and inviting. Tired, old websites, say we don't keep up with the needs and interests of clients. 4. Your clients want someone who has good information and will become of their regular community of online resources. 5. Your website should be in alignment with your marketing efforts, pull those efforts through your site. 6. Does your site identify all new services, products and activities you offer? Give viewers a reason to visit you now. 7. Know your bounce rate. Are potential clients coming to your site and then immediately leaving? You need a fresh face to attract and encourage viewers to stay and return. 8. Does it load easy on a mobile device? The site needs to be updated regularly to assure ease of access. 9. Navigation of a website has improved dramatically in the last couple of years, is your site simple to move around? 10. Social media integration is mission critical; your website is the landing page to encourage viewers to see your other social media sites. 8. Determine a fair fee schedule, make sure all team members understand our fee schedule and are in support of it and teach the team to show the value of our services to our clients. How to determine your client fees fairly & accurately 1. “Shopped" and "Exposed" Services 2. Calculate Your Fees Based On: A. Overhead costs per minute B. Direct costs at percent (%) mark-up C. Return on time to the doctor 3. In Hospital Service Fees - Overhead costs per minute A. Calculate overhead costs/minute/DVM B. Formula: ALL expenses- compensation to doctors (both owners & associates) including related costs - inventory costs + number of hours the doctors are scheduled (both office hours & surgery) +60 4. In Hospital Fees - Direct costs A. Direct costs definition: Inventory costs, costs of materials used in the procedure B. Formula: 2x cost due to costs of ordering 5. In Hospital Fees - Return on time to the Doctor A. Return on time to the Doctor definition: Per minute cost of the doctor's time spent on a procedure B. Formula: Cost of DVM's time/minute x # of minutes spent on procedure C. In hospital procedures D. Surgery 1. General/Soft Tissue 2. Orthopedic 9. Hire a" I 0" pr-actice manager and worl< with him or her to understand the objectives of our practice and mal Veterinary practice manager Introduction The purpose of this position is to provide a variety of analytical, evaluative, advisory, coordinating, supervisory and technical functions in support of the (Practice Name]. Areas of responsibility encompass veterinary practice administration, operational plans, training of staff,ordering and stocking supplies and equipment, funds and resource management, data automation, staffing, safety and security, and review/evaluation/analysis of the past performance of the practice. 615 Primary job responsibilties • The fundamental responsibility of the veterinary practice manager is to effectively use all available resources to provide the best possible patient care to animals treated/handled by the hospital, as well as to ensure the profitability of the practice. • Serves as financial manager. Responsible for developing budget estimates and revisions utilizing knowledge of the functions and requirements of hospital. Make recommendations to practitioners for distribution of funds allocated for medical and non·medical equipment and supplies. Advise practitioners on the formulation and development of corrective actions necessary to improve the effectiveness and profitability of the practice. • Consult with the hospital's accountant. Obtain assistance and advice in preparation and review of various analytical reports, unaudited financial statements (profit and loss), departmental profit and loss statements and tax returns. Draw on expertise in determinations on business projection analysis and review, as well as investment assistance. Review statements for trends, bring to the attention of veterinarians any apparent financial problems, and recommend adjustments and corrections. As required, draw on the accountant for assistance in the development of an appropriate accounting system or for advice on the need for updating the existing system. • Establish inventory control system. Assure adequate stocks of supplies are available. Negotiate best prices for all products purchased. • Manage supply activities. Supervise maintenance and proper storage of supplies and equipment. Analyze and monitor the depletion rate of supplies and equipment and provide necessary guidance in the requisition to replenish needed requirements. Responsible for the quality control of supplies and equipment and ensure items are serviceable and readily available for use. • Rectify financial issues that arise between {Practice Name] and its clients. Use a variety of methods in collection of delinquent accounts. Determine when special financial agreements are appropriate; ensure that agreements made are properly followed. • Plan and organize all veterinary administration and personnel activities. Directly assist the practitioners in the management of assigned personnel. Select/promote/separate administrative and paraprofessional team members. Formulate job descriptions, set salaries, prepare payroll. Schedule team members in appropriate areas at all times. 10. Enjoy every day, share that joy with my team as well as the success of the practice. Give back to the community and to those we se1·ve, both clients and patients. Charity account Protocol In order to allow the doctors to provide charity services while, at the same time, controlling this expense, it has been decided that a charity account will be establish for each doctor. This account will allow each doctor a pre·determined dolle~r value to be used in the rendering of medical and surgical services, per their discretion, through the charity account. If a doctor exceeds the amount in his or her charity account, then that doctor would need to "borrow" the funds from another doctor if they wish to render additional charity services. Establishing a charity account is an effective means of allowing a practice to offer charitable services while still maintaining this expense within acceptable norms. The Charity Account is fairly easy to set up. Set up a new client account for each doctor in the practice management software. The new client account should be named "Dr. Name – Charity Account". The rest of the information in the account set up is not important. Then enter a credit of $X,OOO into each of these doctor accounts. This can be done using account adjustment and the reason would be charity account. A suggested annual amount would be $1000 · $2000 per year per doctor. Begin printing the fee exception reports daily. Any time a doctor charges less than the stated fee, it will show on the fee exception report. An account adjustment entry is then made in the "Dr. NameCharity Account" for the amount that was "discounted", with the client's name and invoice number noted. You can also transfer a credit from the charity account to a specific client if the doctor requests it. Once the account is depleted, the doctor should discontinue offering charity services unless they wish to pay for those charges out of their own pocket. NOTE: You cannot "dock" one's pay, but should monitor this behavior so that it does not reoccur. Important guidelines 1. Charity accounts are set up annually. Each doctor is assigned a $X,OOO.OO balance. 2. Charity accounts are to be used for professional services ONLY. 3. Do not use more than the amount credited to each doctor on an annual basis. 4. Doctors can approve use of their account by another doctor. 5. The charity account cannot be used for family members. 616 6. The charity account has to be used for established [Practice Name) clients. 7. The charity account cannot be used for any service for which the clinic will be invoiced. 8. This includes send out lab-work, cremation/burial services, etc. 617 Better Alternatives to Across-the-Board Fee Changes Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH With the rising popularity of dollar stores and thrift shops, it may seem consumers are only concerned about price. Is that also the case for pet owners coming through the doors in America’s veterinary practices? A new study tried to find out. To develop The Nationwide and Purdue University Veterinary Price Index, economists at the Krannert School of Management set out to better understand the pricing of veterinary services from 2009 to 2013. They analyzed millions of veterinary transactions drawing from pet-health insurance claims provided by Nationwide. The analysis revealed that veterinary fees are rising at a slower rate than consumer prices overall and that fees have shown a slight decrease over the study period. These results paint a gloomy picture for pricing power in the profession. Yet some practices – perhaps yours - have increased fees. A comparison from Benchmarks 2013 and 2015 reveals price increases of varying degrees. Service 2015 Fee 2013 Fee % Increase Complete physical exam $52 $50 4.0% Senior exam $53 $52 1.8% Medical progress exam $42 $40 4.8% CBC with chemistry panel $136 $122 10.3% Canine heartworm antigen test $39 $37 5.4% Urinalysis $46 $44 4.5% 4 cm skin tumor removal $155 $149 4.0% Anterior cruciate repair $726 $630 15.2% Six radiographs, digital $87 $85 2.4% How are some high-flying practices increasing fees in a time of consumer price sensitivity? They deliver the value that justifies higher prices. If this sounds like old news, ask yourself, “Am I really doing everything I can to improve my client’s understanding of the level of service I offer?” It isn’t enough to communicate it in the exam room. Clear, consistent value messages need to be communicated by staff, by doctors, by your website, your practice’s appearance and your involvement in the community. The value you offer needs to be reflected in everything you do. Understand the cost of providing a service and a product. Knowing the true cost of something helps with pricing decisions. Products are easy, right? It’s the cost of the inventory item. But wait - don’t forget about labor to prepare and place the order, to unpack and check the shipment and stock the hospital shelves, as well as the overall cost of housing the inventory. Some sources put the true cost of an inventory item as high as the invoice amount plus 40%. Calculating the cost of services presents an even greater challenge. You must factor in labor, the cost of all necessary materials and supplies, facility and equipment costs, and administrative overhead. This exercise might seem like a lot of work for little benefit, yet it provides a huge “reality check” for you and your team on the expense side of the pricing equation. Do your fees truly cover your costs, or are you in the red? Traditional thinking related to setting fees looks like this: Cost Profit Price A fee increase is the easy solution to offset rising costs and maintain a reasonable profit. Yet this strategy might not be feasible if your community is economically-challenged or your fees are the highest for the area. Business in the new normal requires a different pricing approach. A new, healthier model for pricing might be a LEAN strategy. Start with the price the clients will accept and manage your costs to maintain the desired profit margin: Price Cost Cost Minnetonka Animal Hospital in Minnetonka, MN has used LEAN strategies for years to minimize waste. Owner, Dr. Kaaren Howe, is eco-conscious and passionate about protecting finite resources. “By making LEAN changes, we have eliminated waste and are less stressed, more efficient, and more productive. An added bonus - our inventory and staff costs are 4% lower!” Follow Dr. Howe’s lead and reduce waste to manage costs as part of your pricing strategy. 618 Make strategic fee changes. Instead of annual, across-the-board increases, review quarterly and determine which fees to increase, which fees to leave alone, and in some rare cases, which fees you’ll reduce. Monitor the quality of your patient care and client service to ensure both continue to reflect your fee structure (and vice versa). Teach and mentor your staff to boost everyone’s comfort and confidence with talking about money and communicating your value. • Price shopped products and services. A market-based approach is best for price-sensitive services such as vaccinations and elective surgeries. Conduct a Community Survey to gather market data. How do you stack up compared to others? The range of fees in the market place and your target client demographic will guide your pricing decisions. If your goal is to offer the most affordable price in your community, then set your fees at the low end. If you’re targeting a demographic that will pay more for demonstrably better service, then set your fees at the mid-to-high end. You can have the highest fee in the community as long as your quality and reputation supports your pricing. Consider the level of medicine and customer service you offer compared to others. Contrast your number of doctors, practice hours, and the quality of your facility. Do clients believe the value you deliver is greater than the price you charge? • Price inventory items based on cost. The median markup on medication dispensed through the in-house pharmacy is 150%, and through the on-line pharmacy it’s 100%. The median markup on heartworm, flea and tick items is 95% in- house and 80% on-line. Markups on drugs for chronic conditions are 100% in-house and 85% on-line. Apply the markup to the cost, including shipping and sales tax, and add a handling/dispensing fee of $6 to $12. Example: In-house pharmacy cost $10 Markup – 150% $15 Handling fee $10 Final price to client $35 If you make bulk purchases to get a better price, keep the savings versus passing it on to the client. • Employ variable pricing in special situations. There may be times when you want to influence client behavior, reward a client or patient demographic, or increase business during certain times of the day or days of the week with modified pricing. Examples of variable pricing include a discount on dentistry during National Pet Dental Health Month, a discount for senior citizens, Preventive Wellness Plans at a lesser cost than the ala carte price, concessions for humane or rescue organizations, and price concessions during a block of time that is traditionally slow in the practice. Variable pricing can be an effective tool, but carefully consider all the factors and keep your discount under 15%. • Price non-shopped services based on value. A client can see the tangible benefits of your services in a happy, healthy pet. Continue to look for opportunities to influence clients’ perception of value. What’s important to them and keeps them coming back? What’s a turn-off? If you don’t know, ask them. Does your practice facility and level of client service match your price? People think and hear with their eyes, so make sure your image and value match. Consumers want reliable, predictable, familiar service. Be consistent, so clients know what to expect every time. • Reduce a fee if there’s no other solution. For any service or product you hesitate to offer (or don’t charge for) because you think it’s over-priced, consider lowering the fee. Take this approach only after you’ve exhausted all other efforts to change the practice’s internal perception of the value of this item. Talk with your staff to explore why the item is priced at this level, and calculate the true cost of providing it. If you still believe the item is over-priced, then lower it. Reducing the fee might help make your team more comfortable offering the service every time it’s appropriate. Plus, charging something is better than nothing. Get your team on the value bus. If the doctors and staff don’t see the value of your services, it’s time for some refresher CE. The entire team must be knowledgeable about your medical protocols and what’s involved in providing patient care. Receptionists should observe outpatient appointments, dental procedures, and surgical procedures, so they truly understand the quality of care provided start to finish. Every technician and assistant should spend time at the front desk to gain a better appreciation of all that’s involved in delivering stellar customer service. Calculate and share the true cost of your most-common services and products. Ask your highly- skilled communicators to teach less-confident co-workers how to be a more effective patient advocates. For team members who still fail to see the value of your medical care in spite of your robust education and mentorship program, free up their future for something else and get them off your bus. Offer a variety of payment options. Start with cash, check, or credit card. Then consider other options that might be a good fit in your practice. Promote pet insurance for future medical needs. Offer third-party options like CareCredit. Consider pre-arranged auto- deductions from clients’ bank account. Revisit Preventive Care Plans that offer budget-friendly payments. Seek staff input about the payment options clients ask for. Based on your staff’s feedback, ask your practice manager to research the information needed to make a decision about whether that payment option will work for your hospital. Use these recommendations and the worksheet that follows to analyze your pricing and determine if you’re on track or have opportunities to improve. 619 Comparing your value-based fees Compare your value-based fees with Well-Managed Practices® using this worksheet. Enter your exam fee in the spaces provided and apply the following factors to determine your new fee. Source: Benchmarks 2015 – A Study of Well-Managed Practices® by Wutchiett Tumblin and Associates and Veterinary Economics. Percent of exam fee Your exam fee New fee PROFESSIONAL SERVICES Complete physical exam ($50; 20 minutes) Medical progress exam 79.8% $______x 0.798 $______Extended exam 125.7% $______x 1.257 $______Hospitalized patient exam 71.8% $______x 0.718 $______ DIAGNOSTIC SERVICES Blood pressure evaluation 71.8% $______x 0.718 $______ECG; 4 lead in-house 138.0% $______x 1.380 $______Tonometry 72.0% $______x 0.720 $______ DIAGNOSTIC IMAGING (includes image and interpretation) Abdominal ultrasound 478.8% $______x 4.788 $______Digital Radiograph (two views, 8x10) 288.3% $______x 2.883 $______Digital Radiograph add’l (one view, 8x10 ) 115.7% $______x 1.157 $______ LAB WORK (includes lab, interpret. & collection) BUN 59.8% $______x 0.598 $______CBC with chemistry panel (Alb, Alkp, Alt, Amy, Ca, Chol, Crea, Glu, Phos, TBil, TP, BUN, electrolytes, [Na, Cl, K]) 239.4% $______x 2.394 $______Cytology (fine needle aspirate) 109.7% $______x 1.097 $______Feline leukemia, FIV, heartworm antibody test 116.7% $______x 1.167 $______Giardia ELISA 107.7% $______x 1.077 $______Canine Heartworm 3DX test 73.8% $______x 0.738 $______(Heartworm, Lyme, Ehrlichia canis) Immunity titer test 229.4% $______x 2.294 $______Thyroid panel (T4,T3, free T4, T4, autoantibody, T3 autoantibody, CTSH, thyroglobulin autoantibody) 325.2% $______x 3.252 $______ ONELECTIVE PROCEDURES Doctor surgical services soft tissue (per hour) 780.0% $______x 7.800 $______Laser (additional fee) 104.1% $______x 1.041 $______Endoscopy, upper GI 698.2% $______x 6.982 $______Laparoscopy 724.6% $______x 7.246 $______ ANESTHESIA (incl. intubation) Anesthetic monitoring (electronic) 55.9% $______x 0.559 $______Gas anesthetic, sevoflurane 209.5% $______x 2.095 $______(30 min, 60-lb canine) Gas anesthetic, isoflurane 207.5% $______x 2.075 $______(30 min, 60-lb canine) HOSPITALIZATION – LEVEL II (with IV) Overnight, excl. exam & inpatient services 10-lb. feline 142.6% $______x 1.426 $______60-lb canine 149.6% $______x 1.496 $______ 620 How Associates Earn More by Producing More Without Selling their Souls Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH Revenue production comes into play whether a doctor’s compensation is tied to individual production, or he or she receives a fixed salary. Yet maintaining a “patient first” focus is imperative for continued success. Patients drive the medicine in your practice, and the medicine drives the business. Yet, paying attention to the business is crucial to your ability to continue to elevate patient care, invest in new technology, and invest in the doctors and staff. A practice-wide focus on enhancing patient-care, brainstorming ideas for growing services, and sharing information about the costs of running the practice helps associates better understand the patient-medicine-business connection. Mine your data On your journey to enhance patient care and grow revenue, make your practice management software your very first stop. A wealth of information lies within, just waiting to help you shine a spotlight on opportunities to jump-start growth. You’ve likely heard various versions of Peter Drucker’s credo, “What gets measured gets managed,” or Robin Sharma’s version, “What gets measured gets improved.” So, measuring is your first step. Your second step is a plan of action to accomplish your goals. Determine what to measure Perhaps your goal is to increase the number of patients who are in harmony with your medical protocols. The practice sets the following group goals: • Goal: Increase the number of thyroid panels by 25 percent • Goal: Increase the number of heartworm tests by 25 percent • Goal: Increase the number of fecal tests by 35 percent • Goal: Increase the number of feline wellness examinations by 35 percent Run a report from your practice management software for the number of the above items completed last year. Brainstorm ideas for how to hit your targets Is everyone confident discussing the patient benefits of these services? Ask your most effective communicators to share communication tips with less-confident co-workers, and then practice. Do your client educational materials need an overhaul? Ask for volunteers to update your handouts to better communicate the message. Are you using visual aids to help communicate the importance of these services? We think and hear in pictures, so visual aids during appointments can help clients see the light. Post results where the team can see and report your progress Visuals work for team members too. Graphs are a quick and easy way to see results and patterns in the results. Learn from your successes and your failures. If you’re not hitting your targets, what do you need to do differently? Fine-tune your approach to ensure success. If you’re exceeding your targets, celebrate your success! Then, aim higher Sustain the gains John E. Jones said, “What gets measured gets done. What gets measured and fed back gets done well. What gets rewarded gets repeated.” Reward your team for accomplishing their goals. Have a pizza and salad party. Bring an ice cream truck to the practice for a fun staff break. Go roller blading, hiking, bowling or whatever your staff likes to do for fun. Once you’ve hit your targets in these areas, choose three or four new areas to spotlight. Additional patient-care ideas • Designate 2015 (and 2016, 2017, and beyond) the “Year of the Cat”. Implement feline life-stage guidelines. Become a Cat-Friendly Practice. Implement Fear-Free guidelines. • Revitalize your team’s approach to dentistry. Make sure every staff member observes a dentistry procedure start to finish, so they can speak truthfully and passionately about the value of those procedures with clients. Be mindful of the words you use to describe periodontal services to clients. Boarded dentist Dr. Cindy Charlier, frequently reminds practices to “Consider not the cost to the client but the cost to the patient if the client doesn’t accept your recommendation.” • Take a fresh look at preventive-care plans. Implementing wellness or preventive-care plans might be sitting on your “to-do” list. Or perhaps you decided the considerable time and effort required to implement a program wasn’t worth it. Regardless of the reason you’re not offering them, it’s time to revisit this option. New data from the American Animal 621 Hospital Association and IDEXX reported that 8 out of 10 pet owners indicated an interest in preventive-care payment plans. And their interest level wasn’t determined by income. • Rejuvenate your nutrition mojo. The latest statistics from the Association for Pet Obesity Prevention are that 54 percent of dogs and cats in the US. Are overweight or obese and that 90 percent or more of pet owners don’t recognize that their pets are overweight. As the pet advocate, you have a special opportunity to provide nutritional education to clients that’s essential to rewrite those statistics. • Spark growth with a new service. Adding new services to your repertoire creases fresh energy and enthusiasm for the entire team. New services are another opportunity to differentiate your practice (and for a doctor to differentiate him or herself), expand the offerings for existing patients and attract new clients. Let’s talk compensation and benefits The majority of practices now pay their doctors some form of incentive-based compensation. About 26% pay purely based on production. Another 50% pay doctors a guaranteed base plus a percentage of production over a required minimum. The remaining 24% pay their doctors a fixed salary. Practices who use a blended rate – i.e., one percentage applies to all medical service and product production – typically pay their doctors between 16% and 21%. Where they fall in the range is dependent upon the practice’s staff-to-doctor ratio. The more staff the practice provides to assist the doctors, the lower the percentage paid to the doctors. The additional staff members allow the doctors to produce at a higher level, which increases doctor compensation. The practice also has an added layer of overhead because of the additional staff members, which the doctors must help support. Practices who use a split-rate – that is, one percentage applies to medical service production, and a different percentage applies to medical product production – typically pay their doctors between 22% and 26% for services, and 4% and 8% for products. The service/product split –that is, how much of medical revenue comes from services and how much from product sales - and the staff-to- doctor ratio will both impact where you end up in the stated ranges. To make any percentage-based compensation system work, every team member must understand what is and isn’t credited to the doctor’s individual production. Doctors receive credit for all medical service revenue provided during an outpatient appointment, in- hospital treatment, or dental and surgical procedures. Doctors also receive credit for medications and therapeutic foods dispensed during an outpatient appointment, during in-hospital treatment, or at the end of a patient’s hospital stay. Prescription refills and additional food or product purchases that don’t involve a doctor are credited to a hospital provider. The doctor receives credit for the refill only if it requires his or her time to review the record, assess if the medication or dosage needs to change, and give direction to the staff member who will fill the prescription. Doctors never receive credit for boarding, grooming, or retail purchases. When multiple doctors collaborate to treat a patient, the doctor who provides each point of care receives credit. For example, if Doctor A examines and admits a patient to the hospital on Day 1, and Doctor B provides or supervises the hospital treatment on Day 2, Doctor A gets credit for everything on Day 1, and Doctor B gets credit for Day 2. Doctors who lead with what is in the best interest of the patient can earn more. Maintain a patient-first mentality that always, always remembers it’s about the medicine, not the money. With a patient-first approach, the money follows the medicine. Figure 1 – Starting salaries for employed veterinarians Years of 75th Experience Median Percentile Less than 1 year $70,000 $70,000 1 to 2.9 years $73,500 $75,000 3.0 to 5.9 years $76,800 $80,000 6.0 to 10.9 years $85,000 $85,000 11.0 to 15.9 years $85,000 $87,500 16.0 to 19.9 years $87,000 $89,800 20+ years $87,500 $90,000 Figure 2 – Benefits in well-managed practices® Retirement Simple IRA - 3% match Health Insurance 65% of premium OR $258/month Continuing education $2,000 to $2,600 Paid time off 0 – 3.9 years 10 days 4 – 9.9 years 14 days 10+ years 17 days Source: Benchmarks 2015 – A Study of Well-Managed Practices® by Wutchiett Tumblin and Associates and Veterinary Economics. 622 How to Get 16% ROI on Your Practice Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH As a practice owner, you’re well-versed in the risks and rewards of owning a business. You may even have days when it feels like the risks and hassles outweigh the rewards by a large margin. Owners of Well-Managed Practices tell us their biggest challenges are maintaining efficiency, productivity and profitability. If you’re nodding your head in agreement, read on. It’s a fact: Downward pressure on profit continues. Well-Managed Practices now have an average owner return (ROI) of 12 percent. That’s what’s left for the owner after all operating expenses are paid, including variable expenses, fixed expenses, staff compensation, facility costs, associate and owner doctor compensation and owner management compensation. That’s low. Declines in profitability impact your ability to pay the bills, offer competitive wages and benefits, buy new equipment and protect the investment value of your veterinary practice. It’s time to improve profit. Aim for an ROI 2 to 4 percent higher than last year. Aim for a 16 to 20 percent ROI within the next three to four years. See Figure 1 – How to Get to 16% ROI. Seem impossible? Suspend your disbelief just for a moment and stick with me. Instead of, “We can’t do . . .” or “That will never work because . . .,” open your mind and explore the possibility of, “What if we could do . . .” or “How can we make a change in . . .?” A profitability turn-around takes planning, focused attention and changes to your processes to boost efficiency and productivity. Some of the required changes may be painful. You’ll possibly encounter resistance along the way. Persevere and encourage your staff to hang in there because the results will benefit everyone. Watching what you spend may come naturally in your practice. You work with a practice budget, compare your numbers to the WellMP benchmarks, and adjust your spending when necessary. If so, kudos to you and your staff! But if you’re not quite where you’d like to be when it comes to taking charge of your expenses, now’s the time to put your expenses on a diet. Rather than adopting the “starvation” approach to accumulate the extra cash, start with these Five Easy Slim Downs and these benchmarks to help you pinpoint where your spending is a little heavy. Then get started with your practice slim down to save that extra $10,000 to $20,000 and boost your ROI to 16% or above. 1. Pare down your drug inventory. If your shelves are looking a bit bloated, it’s time to eliminate the excess. Veterinarians have many wonderful drugs to choose from to treat patients. But carrying every wonderful medication that’s available ties up a lot of cash and creates confusion for the staff and for clients. Doctors – unite! Create a list of the medications that you believe in the most. Conduct a scientific comparison of the duplicate products you have on your shelf. Consider the pros and cons, safety, and efficacy of each. Make your case scientifically and medically and come to a consensus among the doctors about what’s your best and second choice. Then eliminate any other redundant items from your shelves. a. Tip: Stock $10,000 to $16,000 of drugs and medical supplies per full-time equivalent doctor, or about one month’s supply. This includes heartworm, flea and tick products and excludes diets. b. Tip: Spend 8% to 9% of revenue on drugs and medical supplies. Spend 4% to 6% of revenue on heartworm, flea and tick products. c. Tip: Move infrequently-used medications to your on-line store. 2. Evaluate your labor cost. What one or more things could you do differently to increase efficiency and productivity in your hospital? It’s not unusual for different practices to have the same level of staff support, but significantly different levels of doctor production. I’m currently working with two practices, each with a 4 to 1 staff-to-doctor ratio; one generates about $440,000 of medical revenue per FTE doctor and the other generates $670,000 per FTE doctor. What accounts for the $230,000 difference? Explore the following opportunities to rev up your practice’s productivity. a. Do more with less. Bump your pay scale to attract more skilled and efficient employees. We’ve all experienced the employee who seems to get twice as much done in half the time as two other employees combined. You might find that an employee who merits $18 an hour could easily complete the work of two, less productive $12 an hour employees. The result: an annual savings of $10,000 to $12,000 depending on the benefit package. b. Streamline your processes. It’s easy to get into the routine of “that’s the way we’ve always done it.” Take a fresh look at your protocols – are you doing things the easiest, most efficient way, or could you streamline the process? Are staff members duplicating efforts? Eliminate the redundancies. Are you taking extra time to track information that no one is using? Then stop. c. Tip: Hold a contest for your staff. Ask each staff member to submit one or two ideas to improve efficiency throughout the hospital (reception, exam rooms, treatment, surgery, boarding, etc.). Give awards for the top four ideas (first, second, and third place, and honorable mention). Be sure your awards are meaningful and 623 compelling. For example, first prize gets a paid day off; second prize gets a gift certificate for a local spa; third prize a gift certificate for a favorite local restaurant; and honorable mention gets tickets to the movie of their choice. Or, you could let the winners choose which award they would like out of your offerings. d. Get organized. Clutter and untidy work stations add to the chaos of busy days. Spend a day eliminating the mess. Move frequently used items to more accessible parts of the hospital to eliminate wasted steps. Move rarely used items to storage. Get rid of items in storage that you haven’t used for a year or more. Adopt the creed: reduce, reuse, recycle. The hospital will look better, and the doctors and staff will feel better and be more productive! e. Convert under-utilized space to a medical purpose. Some hospitals have idle or under-used space that’s begging for use as a medical area. For example, convert a food storage space to another exam room. Convert an under-utilized retail space to a patient discharge room. Convert an under-utilized storage space adjacent to treatment to a dental suite or a procedures room. f. Tip: Hold a contest for your staff to solicit their ideas about under-utilized areas of the hospital that could be converted to medical use. Give awards for the top ideas (see suggested prizes above). 3. Bump up your use of technology. Update and/or replace hardware to reduce wasted time waiting for the computer to process or recovering from a crash because the system can’t handle the hospital’s current needs. Update your software to the latest version. Replace your software if the company hasn’t provided updates for years or their support is poor. Convert to electronic medical records to eliminate wasted time searching for lost or misplaced records. Technology saves time and reduces frustration when used well. a. Tip: Hire a trainer from your practice management software company to spend a day with your staff teaching them more about your software’s capability. Staff members know the basics. But they may not be aware of all the shortcuts that help streamline their work, or the options that help enhance client service and patient care. The return you’ll receive will be much greater than the cost of the training. Example: One veterinary practice estimated that the knowledge they gained from the training saved three staff members an hour a day, which amounted to an annual labor savings of about $15,000. 4. Revisit your administrative costs. It’s easy for fixed overhead spending to creep up without realizing it. Don’t let the word “fixed” change your mind about giving these expenses another look. a. Use e-mail for reminders, newsletters, educational materials, and other client correspondence instead of the U.S. postal service. Postage adds up and clients may actually prefer to receive information via e-mail. b. Take stock of your office supplies. Organize your inventory in one central location so everyone knows what you have on hand before requesting and ordering more. Change reorder points to minimize the amount of inventory you have on the shelf before placing a new order. c. Evaluate employee health insurance. Talk with your insurance agent about health insurance policies with higher deductibles and co-pays. Sometimes the premium savings is greater than the difference in the deductible, so you can offer to pay part or all of the difference in the deductible and still lower the practice’s cost. Ask your agent to research other policies with lower premiums and similar coverage options. Consider having employees cover part of their health care. d. Assess your Workers’ Compensation Insurance rates. Coverage managed by a private insurance company, if an option in your area, might offer better rates than a fund managed by your state. e. Conduct an energy audit in your practice. A professional energy audit gives you a clear picture of where your practice is losing energy and what you can do to save money. Possible resources to conduct the audit include your state or local government energy or weatherization office or your electric or gas utility company. Per www.energy.gov, you can save 5% to 30% on your energy bill by making the recommended upgrades. Visit www.greenyour.com for an energy audit checklist. f. Investigate the possibility of refinancing your debt. If you’ve got any high-rate loans, act now to see what your options are for getting into a more favorable rate. 5. Think twice before investing in equipment. Do the math to determine if the equipment purchases you’re planning will pay for themselves in a reasonable timeframe. Investing in equipment helps you enhance patient care and client service, and grow your practice. But fabulous equipment rarely used, is a poor investment. Take the time to evaluate how often you’ll use the equipment and the revenue potential before taking the plunge. 624 Figure 1 – How to get to 16% ROI Gross Revenue 100% Variable Expenses 23% Fixed Expenses 8% Staff Compensation 22% Facility Expenses 8% Total operating expenses (61%) Amount Available for Associates and Owner 39% Doctor Compensation 20% Owner Management Compensation 3% Total Doctor Compensation (23%) Owner Return on Investment 16% Reinvestment – Equipment 3% Remaining Amount Available to Owner 13% Compare your expenses to these benchmarks Variable Expenses (as a percentage of total revenue) Drugs and medical supplies (includes radiology, surgery and hospital supplies but excludes food, shampoos, etc.) 9.9% Heartworm, flea, and tick products 4.3% Laboratory 4.1% Diets (therapeutic and retail) 3.0% Over-the-counter retail products (e.g. toys, collars, shampoo) 0.4% Credit card fees 1.6% Bad debt, collection fees 0.1% Cremation, care of remains 0.6% Sales and use tax 0.7% Medical waste disposal/radiation badget monitoring 0.1% Practice vehicle expense 0.1% On-line pharmacy-drug cost 0.1% On-line store-food cost 0.1% Total 25.1% 625 Fixed expenses (as a percentage of total revenue) Accounting services 0.3% Advertising and promotion 0.8% Bank charges (monthly maintenance fees) 0.1% Business consulting services 0.4% Business gifts and flowers 0.1% Business meetings 0.1% Charitable contributions 0.1% Continuing education, meetings, and travel 0.6% Entertainment 0.1% Equipment repairs, maintenance, and support contracts 0.5% Franchise tax and other taxes 0.1% Health insurance 1.8% Laundry and uniforms 0.1% Legal 0.1% Liability insurance 0.1% Licenses and permits 0.2% Miscellaneous 0.2% Office and computer supplies 0.9% Payroll service costs, retirement plan administration fees 0.2% Personal property tax 0.2% Postage, freight, and delivery 0.2% Printing 0.1% Professional dues and subscriptions 0.3% Technical (IT) support contracts 0.4% Telephone, answering service, internet connection 0.5% Workers’ compensation insurance 0.6% Total 9.1% Non-doctor Staff Compensation (Gross W2 wages as a percentage of total revenue) Wages 21.6% Payroll taxes 2.5% Retirement contributions 0.6% Total 24.7% Facility Expenses (as a percentage of total revenue) Annual rent or mortgage payments (excluding property taxes, insurance & utilities) 5.1% Utilities (gas, water, electric) 0.9% Janitorial, housekeeping, and garbage 0.4% Facility repairs, maintenance, lawn care, and security monitoring 0.8% Property insurance 0.3% Real estate taxes 0.5% Total 8.0% Reinvestment Medical equipment 0.8% Computer equipment 0.4% Facility improvements 0.8% Total 2.0% 626 Mine Your Data: Medical and Financial Payoffs Just Waiting to Happen Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH Productivity and efficiency often top the list of practice owners’ concerns, and all eyes are fixed on revenue growth. We asked the 2015 Benchmarks participants to name one change that would have the most significant positive impact on their practice. The top responses were: 1. Expand or renovate the facility 2. Strengthen the skills of the practice manager and healthcare team 3. Expand services 4. Hire a new associate – for some, an additional doctor; for others, a replacement Patients drive the medicine in your practice, and the medicine drives the business. Yet, paying attention to the business is crucial to your ability to continue to elevate patient care, invest in new technology, and invest in the doctors and staff. A practice-wide focus on enhancing patient-care, brainstorming ideas for growing services, and sharing information about the costs of running the practice helps the doctors and staff better understand the patient-medicine-business connection. Mine your data On your journey to enhance patient care and grow revenue, make your practice management software your very first stop. A wealth of information lies within, just waiting to help you shine a spotlight on opportunities to jump-start growth. You’ve likely heard various versions of Peter Drucker’s credo, “What gets measured gets managed,” or Robin Sharma’s version, “What gets measured gets improved.” So, measuring is your first step. Your second step is a plan of action to accomplish your goals. Determine what to measure Perhaps your goal is to increase the number of patients who are in harmony with your medical protocols. The practice sets the following group goals: • Goal: Increase the number of thyroid panels by 25 percent • Goal: Increase the number of heartworm tests by 25 percent • Goal: Increase the number of fecal tests by 35 percent • Goal: Increase the number of feline wellness examinations by 35 percent Run a report from your practice management software for the number of the above items completed last year. Brainstorm ideas for how to hit your targets Is everyone confident discussing the patient benefits of these services? Ask your most effective communicators to share communication tips with less-confident co-workers, and then practice. Do your client educational materials need an overhaul? Ask for volunteers to update your handouts to better communicate the message. Are you using visual aids to help communicate the importance of these services? We think and hear in pictures, so visual aids during appointments can help clients see the light. Post results where the team can see and report your progress Visuals work for team members too. Graphs are a quick and easy way to see results and patterns in the results. Learn from your successes and your failures. If you’re not hitting your targets, what do you need to do differently? Fine-tune your approach to ensure success. If you’re exceeding your targets, celebrate your success! Then, aim higher Sustain the gains John E. Jones said, “What gets measured gets done. What gets measured and fed back gets done well. What gets rewarded gets repeated.” Reward your team for accomplishing their goals. Have a pizza and salad party. Bring an ice cream truck to the practice for a fun staff break. Go roller blading, hiking, bowling or whatever your staff likes to do for fun. Once you’ve hit your targets in these areas, choose three or four new areas to spotlight. Re-energize your practice’s compliance efforts If your team has run out of steam on compliance, perhaps it’s time to change your vocabulary. Could “client compliance” become “patients receiving the healthcare necessary to ensure a long, healthy life in harmony with your medical protocols”? Yes, it’s long- winded compared to compliance, yet much more patient-centric and may resonate more with your team. In the book If Disney Ran Your Hospital, author Fred Lee describes four levels of motivation. The first is compliance, and it’s defined as “doing what someone makes me do,” which isn’t very motivating. The author suggests we instead need to move through 627 the other levels of motivation – willpower (doing what I believe I should do), imagination (doing what I want to because I feel like it) and habit (doing what comes naturally) – to get to real nurturing, uplifting motivation. So let’s change what we call “compliance” to move clients (and the practice team) to the “habit” level of motivation. Additional patient-care ideas • Designate 2015 (and 2016, 2017, and beyond) the “Year of the Cat”. Implement feline life-stage guidelines. Become a Cat-Friendly Practice. Implement Fear-Free guidelines. • Revitalize your team’s approach to dentistry. Make sure every staff member observes a dentistry procedure start to finish, so they can speak truthfully and passionately about the value of those procedures with clients. Be mindful of the words you use to describe periodontal services to clients. Boarded dentist Dr. Cindy Charlier, frequently reminds practices to “Consider not the cost to the client but the cost to the patient if the client doesn’t accept your recommendation.” • Take a fresh look at preventive-care plans. Implementing wellness or preventive-care plans might be sitting on your “to-do” list. Or perhaps you decided the considerable time and effort required to implement a program wasn’t worth it. Regardless of the reason you’re not offering them, it’s time to revisit this option. New data from the American Animal Hospital Association and IDEXX reported that 8 out of 10 pet owners indicated an interest in preventive-care payment plans. And their interest level wasn’t determined by income. • Rejuvenate your nutrition mojo. The latest statistics from the Association for Pet Obesity Prevention are that 54 percent of dogs and cats in the US. Are overweight or obese and that 90 percent or more of pet owners don’t recognize that their pets are overweight. As the pet advocate, you have a special opportunity to provide nutritional education to clients that’s essential to rewrite those statistics. • Spark growth with a new service. Adding new services to your repertoire creases fresh energy and enthusiasm for the entire team. New services are another opportunity to differentiate your practice (and for a doctor to differentiate him or herself), expand the offerings for existing patients and attract new clients. The past two years, rehabilitative therapy topped the list for Well-Managed Practice participants, followed closely by laser therapy. Behavior counseling made the list of future additions for the next two years. So take a look at your own “services to add” list – and finally add one! Revenue metrics – How the puzzle pieces fit The key to revenue growth is to understand all the pieces and identify the opportunities for growth. Shown below are the 12 critical components of revenue and comparisons from Well-Managed Practices®. Measure your practice’s results against these benchmarks to identify your opportunities for growth. 628 Revenue Your WellMPSM Practice All revenue $648,200/Doctor $______Medical revenue $582,000/Doctor $______Other revenue $ 66,200/Doctor $______ Average doctor transactions (ADT) Transactions Your Your WellMPSM Practice WellMPSM Practice ADT $184 $____ All transactions 5,300/Dr. _____ Exam $ 52 $____ Medical transactions 2,900/Dr. _____ Other $ 67 $____ Other transactions 2,400 Dr. _____ Fees Services Active Clients Visitation The overall fee structure and Your Your the service/product mix are WellMPSM Practice WellMPSM Practice the two main determinants 931/Dr. ______Medical 3.1/yr. _____ of a hospital’s ADT. Other 2.6/yr. _____ Accounts Receivable New Clients Retention Your Your Your WellMPSM Practice WellMPSM Practice WellMPSM Practice 1.5% _____ Stable 18/Mth/Dr. _____ 4.4 Yrs. _____ Transitional 35/Mth/Dr. _____ 2.4 Yrs. _____ Awareness Visits Scheduled Age of Active Patients How well known is your Your Your practice in the community? WellMPSM Practice WellMPSM Practice 70% _____ < 1 yr 9% _____ 1.1 - 3 yrs 20% _____ 3.1 - 6 yrs 23% _____ 6.1 – 9 yrs 22% _____ > 6 yrs. 26% _____ 629 The “LEAN” System: Be More Efficient Without Cutting Corners Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH Products made in Japan 50 years ago evoked images of mass-produced, low-quality goods. Today Japanese brand names such as Toyota, Lexus, and Honda signify quality and durability. How were the Japanese automakers able to improve quality and reduce cost? Did they just get lucky? No, they got Lean! While Lean started in manufacturing, Lean processes translate to service industries too. There are tremendous opportunities for the use of Lean in healthcare. A study of human healthcare facilities concluded that the facilities spent 75% of their time on non-patient tasks related to communicating, coordinating, and documenting care. In addition, a 2003 report by the New England Journal of Medicine reported a 45% defect rate in human healthcare. The overall goal of applying Lean strategies in healthcare is to initiate a process of continuous improvement to improve patient outcomes while lowering costs. Several human healthcare facilities have used these statistics as a lever for implementing Lean. The results are impressive. ThedaCare, a Wisconsin-based health system, reduced inpatient total cost of care by 25% while improving patient satisfaction to nearly 100%. Seattle Children’s new surgery center reduced nonoperative time by 50% versus the main campus surgery center. Lean defines waste as any activity clients view as not adding value to their experience and not meeting their needs. By focusing on activities which meet the needs of the client, you will realize benefits such as: • Improved patient care • Improved client satisfaction • Improved staff satisfaction • Reduced inventory • Improved flow of patient care • Reduced expenses Waste goes beyond expired medications. Lean identifies seven areas of waste. • Unnecessary services. Are you doing things that don’t need to be done, such as inadequate patient work-ups (running lab test A when you needed lab test B)? • Mistakes. Does your staff regularly need to redo work and correct errors? • Delays. Do equipment failures and wait times for charts or medications happen frequently? • Unnecessary motion. Could you increase efficiency by moving equipment or supplies to reduce or eliminate wasted effort? • Over-processing. Review your protocols and processes on a regular basis to determine if they are still relevant and provide value. • Excess inventory. This goes beyond the products stocked for retail sale and doctor use. For example, too many files leads to the need for more cabinets and more floor space. Do you have files and equipment you have not used for months cluttering your work area? • Excess transport. Do you juggle patients and clients among rooms? Wasting the creative and technical skills of your employees is an additional area that practice owners may not consider. Let your staff shine! Look for opportunities to tap their skill sets. Ask your team to identify opportunities to eliminate waste and present plans to implement their ideas. The traditional top-down management style places stress on the owner to lead initiatives and ensure implementation. Lean processes empower employees to inspect their own work and redesign processes and protocols to maximize efficiency. The result: staff members have newfound enthusiasm for their work and more time to practice medicine. One of the strengths of Lean is its focus on action. You can get started right away with a small project, see immediate results that excite you and your staff, and leverage this momentum to take on a larger project. The first step - designate a Change Agent. The leader of your Lean initiative must have an open mind about change and be able to make things happen. He or she can seize upon a frustrating experience and turn it into an opportunity to start a Lean project. For example, a staff member may struggle to find needed medical equipment in a storage area. The Change Agent can use this experience as an opportunity to rearrange the storage area in a way that makes items easy to find and reduces frustration and wasted time. The Change Agent begins the Lean project by implementing the 5S System for the targeted area of improvement. While originally 5S was used as a tool for maintaining clean work areas, it has evolved into a systematic method for reducing costs, improving work flow, and empowering employees to assist in reducing waste. The staff members closest to the service now have the authority and tools needed to improve work processes or work areas. 630 Once the first Lean project has been identified, begin by taking photographs or video of the area of focus. Before and after pictures are a powerful tool for showing staff members the benefits derived from Lean initiatives. Next, utilize the 5S steps. 1. Sort a. Eliminate unneeded items within the target area. Dispose of items that aren’t needed. Fight the urge to hold onto items because you might need them in the future. 2. Set-In-Order a. Current State. During this step, document the location of each item and the current work flow. Create a map of the area to outline it, identify the large items, and map the flow of patients, clients, employees, and paperwork. Label all significant items, so they are easily identifiable to staff members. This process, called mapping a value stream, creates a one page picture or flow chart of the current process, and helps identify redundant steps and unnecessary motion. b. Future State. With the current state mapped, now create a future state value stream map. How can you eliminate waste identified in the current state value stream map? What is the ideal flow for completing a task? Brainstorm with your staff to create an area which has great flow, is well ordered, and reduces unnecessary movement. Items are now well-labeled and anything can be found within seconds. Everything has a place and there is a place for everything. 3. Shine a. Inspect, clean, organize, and de-clutter the area and items within the area. Repair or replace frayed cords, bad bulbs and batteries, and worn-out parts. 4. Standardize a. Create standards and visual controls such as signs and checklists to improve efficiency and reduce errors. Signboards and color code indicators provide important information at a glance. 5. Sustain a. Teach employees your Lean processes and protocols, so everyone understands the benefits. Continue to evaluate additional Lean opportunities. As with any change, you may encounter staff resistance. People may not understand the need for change, may fear it will lead to more work, or may not understand that they will be playing a key role in determining the changes. Commit to the program, explain the need for the changes, and address the fears of the resistors. Unfortunately, about 10% of the workforce might remain resistant to the change and leave. But those who embrace Lean will enjoy improved safety, work flow, and reduced costs that lead to increased customer satisfaction, employee engagement, and practice profitability. Don’t wait to realize the benefits of Lean. Implement Lean in your practice now! 631 What Team Members Today Want: How to Get it and Give it Denise Tumblin, CPA Wutchiett Tumblin and Associates Columbus, OH Practices must stay on top of current trends in staff compensation and benefits to remain competitive and attract efficient, effective and productive employees. Pay scales must also reflect the level of education, experience, skill and personal attributes employees bring to the table. Yet there’s more to keep in mind when it comes to keeping employees happy, satisfied in their position, and with the practice. Staff members tell us that competitive wages, appreciation for a job well done, and growth/career opportunities are the top three things that are most important to them as an employee. How does your practice rate in delivering the top three for your staff? Begin with compensation and benefits Results from Benchmarks 2015 show that Well-Managed Practices™ spend between 21% and 25% of revenue on staff compensation, payroll taxes, and retirement contributions. This includes all non-doctor staff positions; hospital administrators, practice managers, bookkeepers, receptionists, credentialed technicians, veterinary assistants, kennel/ward attendants, and groomers are in this number. Where you fall in this range will depend on the cost of living in your area, the skill set of your staff, and your staff-to-doctor ratio. See Figures 1 and 2 for the latest pay scale and benefits offerings. If your staff costs are high, start by evaluating productivity. Often the issue isn’t over-spending, but rather lower-than-expected productivity. Low productivity has a variety of reasons. Sometimes it’s caused by giving away or significantly discounting care that the practice provides. Sometimes it’s related to a lower-than-warranted fee structure. Sometimes it’s due to a lack of skills or inefficient processes. And, sometimes a practice employs people who are a poor fit and who put a damper on the morale of the other team members. Before you start thinking of ways to cut staff expenses, first determine why your cost is high. Show appreciation Showing appreciation actually starts with communication. Staff members tell us that the number one thing that would most increase their job satisfaction is better communication with co-workers. Enhanced training and continuing education is a close second – and communication is integral to an effective training and education program. The staff also tells us the number one change that would have the most significant positive impact on the practice is improved internal communication. Effective communication is crucial for business success. Getting everyone on the same page enhances efficiency and productivity, reduces stress and frustration, eliminates wasted efforts, and cultivates teamwork – all of which results in lower costs and higher profit. It’s also important to recognize your staff members respond to a variety of communication “styles”. Here’s how to interact with people with different personalities kindly, sensitively, and effectively (excerpts from Benchmarks 2015). The director Personality Characteristics: To effectively communicate with: Competitive, ambitious Be brief, direct and concise Goal/results-oriented Avoid unnecessary details Task-oriented Focus on results and return on investment Confident and independent Provide options The mediator Personality Characteristics: To effectively communicate with: Introverted Be patient and logical Calm and supportive Friendly and neutral tone Loyal and team-oriented Steady, low-key approach Great teacher, trainer, mentor Involve in planning process and idea generation The socializer Personality Characteristics: To effectively communicate with: Charismatic and outgoing Allow time for social interaction Talkative and very social Avoid harsh or aggressive tone Self-assured and sensitive Put details in writing Creative, visual learner Use a whiteboard for discussions The analyzer Personality Characteristics: To effectively communicate with: Introverted Be organized and logical Meticulous and organized Support position with facts Detail- and task-oriented Ensure each point is understood Fear of work being criticized Understand motivated by quality of output/data 632 Orientation, training, and mentorship While the orientation and training provided to new employees is often considered mentoring, a true mentorship program goes beyond day-to-day training and focuses on accelerating the mentee’s professional development. A mentor shares knowledge and experience, points out other resources and networks that may be helpful to the mentee, provides critical feedback related to the mentee’s communication skills, interpersonal relationships, technical abilities and leadership skills, and challenges the mentee to move outside his or her comfort zone. Employers who offer mentorship programs are more attractive to potential employees and enjoy better staff retention. Employees are more productive and satisfied in their position. Turnover, and its resultant cost, is lower. Informal mentoring occurs all the time and is very effective. Yet a formal mentoring program, done well, will give an added leg up. In a formal mentoring program, both the practice and the mentee set specific goals and measure the results. Mentorship is available to all employees who meet the program criteria. Participants are paired up based on compatibility, and mentors receive training. Management promotes the mentorship program internally, so everyone sees the benefits of participating. One key to an effective mentorship program is identifying the skills the mentee wants to build and the practice’s goals for the program. A mentee must visualize his or her future- where does he want his career to develop? Will she have a special interest niche in the practice, such as acupuncture, avian, rehab or surgery? Will he be the go-to person for internal staff CE? Will she begin on a path to practice ownership? A key success factor for a mentorship program is the mentee knowing what success looks like and what he or she wants to accomplish, and having a sense for the kind of guidance that would be most beneficial. Likewise, the practice must set clear objectives for the program. How do you visualize the future of the mentee in the practice? What areas of professional development are most important to you? Do you want to expand a doctor’s medical training to add new services to the practice? Strengthen the veterinarian’s communication skills? Expand the associate’s understanding of the costs of running the practice? Set staff members up for success Managers need to put team members in situations where they’ll thrive. This process starts as early as the first interview. Ask candidates what they love to do, not just their past work experience. Working in your area of passion leads to happier and more efficient employees. Here are some ways to get team buy-in: Ask employees I reviews which of their skills are under-utilized. Find ways to use these talents to benefit the practice. Ask employees to submit a personal SWOT analysis prior to their performance review, and use it to supplement their evaluation. Pay close attention to the strengths and weaknesses the employee pinpointed. Tailor the employee’s goals for the coming year based on the SWOT to help foster buy-in and accountability for the goals. Figure 1 – Pay ranges by position Median Position <3 yrs. 3 – 5.9 yrs. 6+ yrs. Hospital Administrator No response No response $23.00 Practice Manager $18.60 $22.00 $20.00 Office Manager $19.50 $16.00 $18.75 Bookkeeper No response $14.75 $16.60 CSR/Receptionist $11.50 $12.50 $14.25 CVT/RVT $15.00 $16.00 $18.00 Veterinary Assistant $11.50 $12.25 $13.25 Kennel $9.00 $11.00 $11.50 Groomer $9.25 $14.00 $24.25 75th Percentile Position <3 yrs. 3 – 5.9 yrs. 6+ yrs. Hospital Administrator No response No response $23.40 Practice Manager $18.90 $22.00 $22.25 Office Manager $19.50 $19.60 $20.00 Bookkeeper No response $15.00 $20.20 CSR/Receptionist $12.60 $13.40 $16.80 CVT/RVT $16.00 $17.20 $20.00 Veterinary Assistant $13.00 $13.50 $15.00 Kennel $10.00 $12.00 $13.50 Groomer $9.25 $14.00 $24.25 633 Figure 2 – Benefits in well-managed practices® Retirement Simple IRA - 3% match Health Insurance 65% of premium OR $258/month Continuing education (per employee, per year) Managers $1,000 - $1,500 Client Services Representatives $ 350 - $ 500 Technicians $ 500 - $ 950 Veterinary Assistants $ 340 - $ 500 Kennel $ 250 - $ 390 Paid time off 0 – 3.9 years 10 days 4 – 9.9 years 14 days 10+ years 17 days Source: Benchmarks 2015 – A Study of Well-Managed Practices® by Wutchiett Tumblin and Associates and Veterinary Economics. Resources to help evaluate your compensation and benefits Benchmarks 2015 – A Study of Well-Managed Practices® Compensation and Benefits by AAHA Press On-line sources such as www.salary.com or www.payscale.com 634 5 Physical Exam Hacks to Improve Diagnostic Accuracy and Communication Effectiveness Ernie Ward, DVM, CVFT Seaside Animal Care Calabash, NC Most veterinarians don’t allow a meager 1800 seconds to perform an examination. That’s 30 minutes to welcome, examine, diagnose, offer advice, obtain products, review usage and follow-up, invoice the client, and schedule da return visit. Good luck. Why are we so stingy with the time offered to our patients and clients? Time won’t solve all our professional problems, but it highlights where our priorities are. I can’t force you to spend a mere 30 minutes per appointment, but I can suggest some compelling tactics to make each second of your exams more meaningful. Connect hearts, minds, and paws First impressions count every time. This means whether you’re meeting a client on the first or fortieth occasion, those first few seconds set the tone for the rest of the visit. Regardless of how hurried, distracted, or overwhelmed you may be, your success with the current appointment is determined by how present you are in that moment. If the client perceives you’re distracted, disinterested, or disconnected in any way, things typically don’t go well. I’d also add that I’ve found if an animal senses you’re not thrilled to be there, they’re less agreeable and often downright nippy. Before you begin each appointment, know client and pet names, gender, age, pertinent medical history and reason for visit. Being prepared allows you to focus on faces instead of charts. Enter the exam room smiling, relaxed, confident, and grateful for the opportunity to practice your art. Extend a warm handshake, pet the patient, and sit down. I recommend sitting whenever possible to eliminate any potential intimidation, foster intimate communication, and aid attention. Deliberately focus on listening. Too often, veterinarians have diagnosed and decided before asking and examining. I find when I approach exams unbiased, I’m a better diagnostician. As the conversation continues, pay close attention to the client and patient’s body language. Do they understand what you’re saying and doing? Do they agree? Are they comfortable? If your compliance rates aren’t what you’d wish, chances are your clients aren’t connecting with your advice. Ask questions such as, “Does that make sense?” “What do you think about that?” “Do you think Rover will be okay trying that?” Staying connected means actively engaging and ensuring clients agree with our recommendations. Make comfort a priority Managing veterinary appointments is tricky because we’ve got to accommodate both human and animal needs. What pleases people may not comfort canines and what comforts canines probably won’t make Himalayans happy. When considering my consultations, I ask, “Is everyone as comfortable as we can make them?” Train your staff to evaluate animal and human body language as soon as they enter your hospital. Are they stressed, nervous, or angry? If so, have protocols for easing apprehension. Many times a warm smile, gracious greeting, comfortable seating, and offering water, tea or treats can allay most worries. Teach your team to engage in conversation, introduce clients to one another while waiting, and pay attention to the energy and attitudes of clients. Make it your goal to lift spirits instead of avoiding anxiety. When you interact with your pet patients, critically analyze your movements. Aim to use minimal restraint, be exceedingly generous with treats and distractions, and intensely focus on the pet’s responses. You’ve probably only got about 600 seconds of hands-on contact; make them as pleasant as humanly possible. Compliance insurance You’ve got less than 1800 seconds to connect, comfort, and practice medicine during a standard appointment. Some veterinarians fear if they emphasize communication they may minimize medicine. Not true, if you’re tactical. To help keep my team centered on my patient’s medical needs, we use a variety of single-page examination reports. These reports are divided into the medical history, physical examination, and a checklist of meds, supplies, and services we recommend. The medical history includes the most common questions we have for wellness visits by species and age, queries for frequently seen medical conditions, and more extensive behavioral assessments. The exam portion highlights our standard physical examination findings by anatomy and organ system, and the checklist ensures clients leave with what they need. Provide a copy of the report to your client during discharge. Review the pertinent details and highlight areas that need further attention. At the completion of the appointment, make sure to answer, “When will we see you again?” Don’t be afraid to schedule an appointment six months or more in advance. The client can always change it if necessary. Booking future appointments today is an excellent way to encourage follow-up and routine visits. I’m constantly amazed at how powerful this tactic is in practice. Advance scheduling works because most people honor their commitments. 635 1800 seconds spent wisely on each appointment can be incredibly valuable. Don’t waste them waiting in the lobby or consultation room. Don’t squander them performing a meandering meaningless exam. Don’t fritter them away creating stress and anxiety. Every second we have is priceless. Create daily tactics that guarantee you’re making the most of your most valuable resource – time. 636 Kittens and 10 Million Deaths: Talking to Clients and Staff about Antimicrobial Resistance Ernie Ward, DVM, CVFT Seaside Animal Care Calabash, NC It’s baffling to comprehend how a sniffling kitten in your clinic could contribute to killing an extra 10 million people every year by 2050. Yet that’s exactly what’s at stake according to the World Health Organization (WHO), World Alliance Against Antibiotic Resistance (WAAAR), and nearly every government on the planet. Antibiotic resistance has become such a global concern that in January 2016 at the World Economic Forum in Davos, Switzerland, an emergency agreement was commissioned and signed by 85 companies and nine medical industry associations from 18 countries pledging to combat the growing superbug threat. The recently discovered MCR-1 gene, a mutation capable of creating bacteria resistance from our most powerful antibiotics, has spread from China to the U.K. and beyond. This terrifying gene is believed to have sprung from the overuse of antibiotics in livestock. If the experts are correct, we could be facing an antibiotic Armageddon in 20 to 30 years. So what’s this got to do with the snotty-nosed kitten you’re examining? Everything. When I graduated from veterinary medical school nearly 25 years ago, we were taught to use antibiotics in most patients. The rationale was viral infections were often accompanied or quickly followed by bacterial infections. “Mixed bag infection” was a term thrown around to justify penning a prescription for runny eyes, sneezing, coughing, and malaise. It seemed to work just fine. I was pleased with my clinical outcomes, clients were happy to have something to do, and, let’s be honest, the extra revenue antibiotics generated was welcome. What harm could a few extra antimicrobials cause in my tiny rural practice, anyway? For another fifteen years I happily prescribed antibiotics without much thought. An old axiom I picked up in veterinary school was, “60% will get better no matter what you do, 20% because of what you do, and 20% despite you.” I know it was meant as a joke, but there was truth buried within those words. About the same time, veterinary and human medical organizations were urging practitioners to use fewer antibiotics. The science was clear; most upper respiratory infections in pets were due to a virus, not bacteria. Why did I feel the need to prescribe antibiotics for nearly every sniffling patient if perhaps 80% didn’t really need them? Clients expect a pill The reality is many pet owners expect a prescription medication whenever they bring a sick pet to the veterinarian. They’ve invested time and energy, struggled with a reluctant dog or cat, and probably consulted the internet and tried a home remedy. You’re the professional with the prescription pad. Use it. It’s often simply easier for veterinarians to avoid an altercation and dispense drugs. Clinical doubt creeps in and you begin to wonder what if it’s more than the standard sniffles? Will the client be angry if we wait and they’re forced to return? Another lesson I’ve learned is that easier isn’t always right. Step away from the prescription pad The first step toward steering the client away from a programmed pharmaceutical response is to perform better examinations. Articulate every step of your exam. “The ears look clear and healthy,” “the lungs sound great, no congestion,” or “no discharge from the eyes.” You’re building a case for not prescribing an unnecessary antibiotic and affirming the importance of the visit. Next, if you think it might be a bacterial infection, perform a culture and sensitivity test. You probably won’t. For what it’s worth, many human hospitals will reprimand a physician for prescribing antibiotics without requesting a culture. Regardless, if you somehow conclude the pet doesn’t need an antibiotic, change your communication. “Mrs. Jones, here are three things you can do to help Fluffers feel better. She doesn’t need an antibiotic because it won’t work against a viral infection.” I’ll write these instructions on a prescription pad. The Centers for Disease Control (CDC) offers a sample written prescription for human doctors to use to reinforce safe antibiotic usage. Continually use terms such as “viral upper respiratory infection” to emphasize that antimicrobials won’t help. You need to develop an arsenal of antibiotic alternatives. I routinely recommend immune-boosting supplements and vitamins, soothing salves, cough suppressants and NSAIDs. Vaporizers to open airways, warm compresses to comfort runny eyes and noses, and plenty of fresh, whole foods to nourish a sick pet (I especially like chicken broth and smelly sardines or tuna for cats suffering from upper respiratory illness). Choose treatments you believe in. I try to give pet owners something to do two to three times a day. This allows them to detect any changes in their pet’s condition and reinforces their caretaker role. Give specific advice. Don’t say, “give vitamins;” provide a specific brand, dosage, and duration. I show clients vitamins and supplements I personally use for my pets. “Go pick up this,” is powerful medicine. Some clients will still demand a prescription drug. An interesting observation I’ve made is that many U.S. pet owners are worried about vaccine adverse events but never consider the risks of antibiotics. I explain the risks of antibiotics to pushy people along with the bacterial resistance issue. Perhaps half will agree. For the other obstinate half, I use an economic incentive: If the pet isn’t better 637 within two to four days or worsens, I’ll either prescribe a medication or recheck the patient at no charge. Even though this isn’t ideal, I believe this tactic has helped me retain many clients and avoid complaints and negative reviews. I’ve also found that most patients get better within the prescribed period. I’ve even had a handful of clients apologize for being a pain. I know this strategy may be controversial and is certainly debatable; my goal in sharing is to encourage you to develop your own approach to antibiotic stewardship. Antibiotic stewardship begins with you Veterinarians need to create antibiotic usage guidelines for their teams. First, examine the scientific literature and determine which antibiotics make sense for the specific conditions you commonly diagnose. Many doctors fall into bad habits and dispense the same old drugs for the same old things. We must do better for future generations. If antibiotics are needed, draft protocols to ensure your doctors use the right drug, for the right time, at the right dose, for the right duration. That’s what they teach in veterinary school these days. Start treatment immediately. Consider administering the first dose in your clinic. Short course and single-dose drugs are being advocated to boost compliance. Call clients after a couple of days on antibiotics to confirm the pet is improving. If not, you may need to change antibiotic or treatment. If you need another round of antibiotics, do not use the same antibiotic class as in the previous 90 days. Prolonged use and improper low dosing are key drivers of antimicrobial resistance. Next, evaluate your team’s infection control protocols. Make sure everyone is washing their hands after handling every patient. Do you routinely disinfect your stethoscope, bandage scissors, and pens? Do you change your lab coat or scrub top? Numerous studies conclude that if the clinic team uses or wears it, it’s contaminated. What about cleaning table tops, door handles, cages, and floors? Develop written protocols and systems to ensure your facility and personnel are as sterile as possible. Power with the people Ultimately, widespread public awareness of the dangers of veterinary antibiotic overuse is needed. We need governmental and professional organizations to actively campaign about bacterial resistance. Pet owners need to clearly comprehend the link between inappropriate antimicrobial use in animals to human health risks. Resistance is a moving target. We need everyone on board if we’re going to preserve antibiotics and protect millions of humans and animals. So the next time you see a sneezing kitten, think of the lives you’ll save by properly prescribing antibiotics only when needed. And break out that vaporizer. 638 Make Your Peace between Profit and Charity in Practice Ernie Ward, DVM, CVFT Seaside Animal Care Calabash, NC • “You care more about my money than my pet!” • “I wish you could be my doctor.” In my 26 years of veterinary practice, I’ve heard those words on countless occasions, sometimes from the same client. Those sentiments highlight the struggle we have within our profession: Why do veterinarians have an agonizing association with money? Where do we draw the line between profit and compassion? How can we do good for animal welfare while doing well financially in our practices? The answers may be both simpler and more complicated than you think. How did we get in this mess? Veterinarians were revered in ancient times because we cared for our tribe’s food animals. Our roots intertwined with commerce as livestock attained economic value. During the previous two hundred years, the limits on our compensation became based on the “replacement cost” of the animal. In other words, we could only charge commiserate to the value of the patient we were treating. The limitation on our fees had the unintended consequence of hampering primary medical progress in veterinary science. For most of modern veterinary medicine’s history, we’ve been consigned to scrounging for human medical research scraps. It’s only been in the past fifty years that major pharmaceutical companies have recognized animal health as a profitable sector worthy of their resources. And that gets to the real reason of how we got in the mess. Our limiting legacy It wasn’t until the 1970’s that small animal veterinary medicine as we know it today came into existence. Prior to that, a farm-call veterinarian would administer the occasional vaccine or offer basic treatment for a dog or cat. Why? Because there wasn’t any inherent financial value in pets. The farmer could justify spending £50 on a cow he could sell or milk but not on a dog with a broken leg. While his family dearly loved the dog, he just couldn't rationalize paying much for treatment. It was in this environment that early small animal veterinarians established the money-guilt we experience today. The first pricing schedules were grounded in the legacy of “replacement cost” and arbitrary mark-ups based on what veterinarians thought clients would pay. Feeling uncomfortable raising their fees for examinations and professional services (it was only a cat, after all), many veterinarians expanded their offerings into areas they weren’t entirely at-ease. The battle between “selling” and “serving” commenced. There were a multitude of paths our profession could’ve, and probably should’ve, chosen to elude our current quandary. Despite all of this, I believe part of our predicament can be traced back a few more decades to a beloved icon. Blame it on Herriot I also blame James Herriot for our profession’s money-guilt. Herriot set the “veterinary virtuosity bar” unreachable by most of us by accepting a few eggs in exchange for years of specialized education, investing in expensive equipment and medications, driving in dangerous conditions, leaving our families, and then staying up all night curing an ailing animal. I can’t match that. Many veterinarians swayed by his chivalry cringe when conversing about currency for our services. “That’s okay, a handful of eggs will be sufficient.” His memoir, “It Shouldn’t Happen to a Vet,” takes on an entirely new meaning now, doesn’t it? We carry this ethos in our DNA today. Even as pets have risen in prominence and incomes allowed owners to demand high-tech tests and treatments, we still harbor hesitancy about money. Some of our colleagues consider anything more than a few eggs is too much to charge. Others are convinced that financially successful veterinarians are greedy, uncaring, or probably both. In my experience, there’s room for both eggs and elitism in the veterinary profession. Making peace with profit and philanthropy Businesses exist to produce profit. As long as an enterprise pursues profit in an ethical manner, making money can benefit society. For example, if my practice revenue grows, I am able to hire additional staff members and pay a fair wage, invest in helpful technology, and give back to my community. Or not, if I’m a greedy louse. I can’t do either if my practice isn’t profitable. Whenever the debate of should veterinarians do more … (fill in the blank with the cause of your choice), I typically say, “Yes!” I say this because we should be doing more. More community outreach and involvement, more political engagement, and more personal development. In my experience, the best businesspeople aren’t greedy, they’re giving. Most truly successful people I know understand to sustain success they must invest in their staff, contribute to their neighborhoods, and retain high standards, ethics, and morals. I’m incredibly proud to call myself a veterinarian and just as proud of my entrepreneurial accomplishments. 639 Roadmap to peace The first step toward reconciling the pull between wealth and charity is to define yourself and your practice objectives. What does it mean to be a veterinarian to you? What are your metrics for personal and practice success? How do you know if you’re achieving your goals? Too often we allow others to determine who we are and how we practice. This creates tension, frustration, and, ultimately, disillusion. Burnout is the result of dissatisfaction with an undefined journey. Self-reflection is essential because I feel most money-guilt is anchored in poor professional self-confidence. Blame it on our history, the economy, or Herriot. The fact remains that many veterinarians would rather swig anal gland juice than talk about money with clients. Maybe it’s because I started my first practice without any full-time employees in a poor, rural setting, but I became comfortable looking clients in the eye, telling them how much money they owed me, and saying, “Thank you.” I became “money- calm” because I’m convinced I provide a valuable service. That’s not arrogance; that’s self-confidence and it can help you relax around remuneration. The next step is giving back. I’ve always focused on one or two major fundraisers for my clinics each year. Most of our philanthropy involves animal and children’s charities. We also created a fund within our business to raise monies to aid financially distressed families with their veterinary bills. I’ve discovered that whenever your staff witnesses you giving back to charities and needy clients, they’re better handling the inevitable, “All you want is my money!” complaints. Inserting yourself into animal welfare issues is another stride toward being proud of your profit. One of the chief responsibilities of success is applying your influence to causes you’re passionate about. Being financially fruitful often opens opportunities for change you’d never access form the cheap seats. Movements and charities need disciplined, ambitious, and bold leaders. These attributes are most often associated with successful businesspeople. Use your power to fight for better treatment for animals. Falling off the tightrope Treading this tightrope isn’t easy. I can’t adequately explain nor resolve this issue in a few hundred words. Clients will still say ugly things to you and about you and stress doesn’t evaporate overnight. You’re going to want to quit and take the eggs. Don’t. Not only is our profession counting on you, your career and happiness are at stake. It gets better the more confident you become. Absolving yourself from the guilt of receiving money for your expertise is crucial for professional peace of mind. Self-confidence helps shields you from the sting of criticisms and allows you to develop into the veterinarian you dreamed. For that, I thank Dr. Herriot. His writings shaped who I am today and instilled in me the power and sanctity of the human-animal bond. It’s up to each of us to turn yesterday’s basket of eggs into today’s credit cards and cash. Perhaps no other profession can do as much good while doing well. I’m proud to be Ernie Ward, Veterinarian. 640 Introverts Unite…Separately: 10 Tips to Survive and Thrive in an Extroverted Profession Sarah Wooten, DVM Sheep Draw Veterinary Hospital Greeley, CO With jungle gym careers, increased competition for jobs, more complicated customer interactions (social media, yelp, and google reviews, anyone?), veterinarians have to establish critical relationships and communicate important messages to their clients and colleagues. In a business world that largely relies upon extroverted strengths, finding space to be heard can be a challenge for the introverted veterinarian. Fortunately, extrovert-centric self-promotion is so last decade. Today - influencers will stand out if they can build other people up and commit to listening over talking. Before we can talk about the strengths of introversion, it’s important to understand what introversion is. An introvert is someone who seeks solitude to recharge energy. Introverts draw energy from within themselves. Introversion is not shy. Shy is behavior or behaviors caused by anxiety in social settings. Characteristics include needing and desiring time alone, tendency to think before speaking, prefer to dig deep vs. small talk, may be less likely to express emotion and can be difficult to read, enjoy writing over talking, and can be private, quiet, and reserved. In the American workplace, there can be barriers that prevent introverts from becoming influential leaders. These can include an emphasis on team approaches that can be draining and stifling to the creativity of an introvert, a tendency to shie away from self- promotion, pressures within the American business culture to behave like an extrovert, feeling talked over by extroverts, pressures to make decisions quickly, and the stress that goes with these barriers. It is important for introverts to know that they are not alone in feeling frustrated by these perceived barriers, and that being an introvert is not a weakness. In order for introverts to establish professional success, we must first stop trying to behave like extroverts, and instead, focus on the strengths that come with an introverted nature. Introverts must schedule quiet time to recharge, prepare, find creativity and solutions, and not burn out. Preparation and ability to focus is a strength of introverts, but they must have time alone to exploit this strength. Quiet time allows preparation by visualization, and increases the likelihood of success of professional encounters with clients and staff. Even a few minutes of solo concentration can help an introvert increase focus and influence. How do you find your quiet time? How can you prioritize this sacred time and use it to your best advantage? Where can you go without distraction? What activity (or activities) provide you with recharging quiet time? Think about a challenge that you are currently facing. How can taking some quiet time help you with influencing change? A second strength of introverts is preparation: Introverts are game-changing strategists. We hate to wing it. We like a game plan, and rehearsal, and all details ironed out well before its game time. This allows an introvert to present himself or herself as the expert on the topic at hand, and increases confidence of both the veterinarian and the client. Another area of strength includes intentional and attentive listening to clients, an ability to read body language, and tuned-in empathy, which encourages clients to share feelings and questions more readily. It also gives an ability to help clients make hard decisions. Introverts tend to display tremendous listening skills, which is critical to patient management and successful practice. Introverts can use this ability to gain credibility and achieve better compliance, especially through the use of open-ended questions and focused conversation to really understand the problem before provided customized treatment and diagnostic plans. Introverts also display a penchant for writing, and writing for influence, whether, through one-on-one interactions with clients, via veterinary or pet publications, or through thoughtful use of social media is yet another way introverts can influence and lead our profession. 641 Say This, Not That: How to Get Clients to Say “Yes” More Sarah Wooten, DVM Sheep Draw Veterinary Hospital Greeley, CO When communicating with clients, there are subtle changes you can make in your delivery that can have big payoffs in increased compliance, better client retention, and increased new clients. If you use the right words, the word gets around. In this session, we are going to identify simple communication tweaks that will strengthen your confidence, reduce confusion in the client, and instill a sense of goodwill between client and veterinarian. In this session, we will go through two ways to communicate an idea, the pros and cons of each, and how changing what you say or how you say it might get more ‘yes’ from your clients. 1. ‘I recommend’ vs. ‘your pet needs’ 2. ‘We need to run a cbc, chem, T4, urinalysis, etc.’ vs. ‘We need to get some blood and urine for some tests.’ SIMPLIFY 3. Silent physical exam vs. talking your client through the physical exam. 4. ‘I noticed the following abnormalities on your pet’s physical exam – list them’ vs. 5. ‘First let’s talk about what is good. Your pet’s heart sounds good, no murmurs 6. ‘Do you have any questions?’ vs. ‘Does that make sense?’ Sometimes clients are too overwhelmed to respond to an open-ended question, and asking a simply yes/no question is more appropriate and easier for them to process. 7. ‘I’ve been looking on the internet and I found…’ eye roll, pursed lips, gusty sigh and fill-in-the-blank immediate negative reaction vs. ‘great job researching. I can tell you really care about your pet. Here is what I know…’ 8. ‘I feed blue buffalo’ – what are your responses? What is successful? What is not? CROWDSOURCING! What I’ve found: in our clinic we have abnormal gut flora, increased urine pH with increased numbers of urinary stones. Here are some other diets that you can try… 9. ‘I don’t want to heartworm test, my pet doesn’t go outside.’ What do you try? 10. ‘your pet needs a dental, here have a giant estimate’ vs. ‘things look pretty good today, however I am concerned about your pet’s dental health. See this tooth? It’s infected, and that bacteria goes into the bloodstream every time your pet chews, which puts additional wear and tear on the internal organs. 11. ‘your pet is fat, cut back calories 20%’ vs. ‘I’ve noticed an upward trend in your pet’s weight. Have you? This additional weight puts your pet at risk for all the same issues that overweight humans have (make it relevant). Here is the exact amount of calories per day to feed of EVERYTHING THAT GOES IN YOUR PET’S MOUTH to prevent unhealthy weight gain. (give written instructions) 12. ‘I recommend a lepto vaccine’ vs. ‘leptosporosis is a growing human and pet health concern in our area. We’ve diagnosed some cases, and in order for you to know about the risk, I’ve been super intentional with counseling pet owners on the risk to both you and your pet. It is a simple two booster vaccine and requires a yearly booster. Do you want to do that today? It will save you some time and money vs. coming back later to do it. 13. ‘restrict your pet’s exercise after surgery to prevent surgical complications’ vs. ‘in a pet’s mind they are either fixed or broken. If they feel ‘fixed’ they will overdo it, and that could cause big problems for healing. Protect your investment in this surgery, and keep your pet in a kennel/on a leash at all times/for a specified amount of time. Then ask for clarification. Are the exercise restriction instructions clear?’ 14. ‘coconut oil/apple cider vinegar/cesar milan’s alpha roll/fill in the blank questionable-internet recommendation will not fix the problem’ vs. ‘it sounds like you have been trying some things at home that aren’t working. Let’s work together to try and figure this problem out. I believe I can help you.’ In conclusion • Make sure the client understands what you are saying. Finish with ‘does this make sense?’ • Say ‘your pet needs’ vs. ‘I recommend’ • Draw parallels to human health issues to make the issue relevant and better understandable for the client. • Encourage the client when they make the effort to do research, even if it erroneous. • Give positive reinforcement when the client asks hard questions: ‘that is a good question’ • Make sure you address the reason the client came in. Ask ‘did we address your concerns today?’ If you end up having to fix something else before addressing the client’s primary problem, address that as well. ‘I know you came in because your cat is urinating on your bed. I believe the pain that your cat is experiencing from dental disease is contributing to this problem, so we fix that, and hopefully the problem will stop. If it doesn’t, I need to know.’ • Utilize fear free tactics when possible, humor works really well to break the ice and lower your client’s anxiety levels. 642 Tips from the Trenches: Subtle Ways You Sabotage Client Relations Sarah Wooten, DVM Sheep Draw Veterinary Hospital Greeley, CO Often times we as veterinarians are unaware of how we are impacting our clients mentally and emotionally, and how that might open doors or create barriers to care. In this session, we will go over several subtle ways in which we can break down client relations, and what to do instead. Possible barriers to productive veterinarian-client relationships: 1. Not acknowledging the difficulty of the situation right away – establishes empathy and instills loyalty. a. Emergency – I’m sure you wanted to be at the veterinary hospital today, right? This was part of the plan for the day. b. Poor prognosis: this is hard. I’m really sorry. 2. Refusing to compromise on a diagnostic or treatment plan, i.e. only offer the best, and if the client declines, don’t give them a second option that may be more palatable to them. 3. Using big words. 4. Not using discharge instructions and handouts. 5. Not giving explicit and easy to understand reasons for follow-up. 6. Not being sympathetic to client concerns for high estimates. The struggle is real! 7. Not developing your best euthanasia best-side manner. ‘no one cries alone’ – a good end inspires incredible client loyalty, and for good reason. This is hard. 8. Not asking for clarification on the part of the client after you explain something. “Does this make sense?” 9. Assuming that every client wants an in depth explanation. Learn to read your client. Some clients want to know everything about their pet’s condition – they will geek out on everything you give them. They thrive on explanations like ‘your pet has gastroenteritis secondary to dietary indiscretion. We are going to give an injection of maripotant to reduce vomiting and gut inflammation, and then this is an antibiotic called metronidazole that is designed to…on and on.’ Other clients are what I call ‘going to the mechanic client’ – they don’t care about the disease process, they just want it fixed and not to happen again. They get overwhelmed easily with information. They are happy with ‘Your pet has diarrhea. Give this and if it doesn’t clear up in 24-28 hours, call me.” Start with basic explanations, and then offer more information if the client seems interested. 10. Assuming that the client is not doing his/her best. Not giving praise for a job well-done. 11. Using closed body language, not maintaining eye contact, and not giving your undivided attention to the client in the room. 12. Using adjectives like ‘kinda’ when describing your recommendations, response to therapy, etc. ‘after surgery, your pet will be kinda groggy’ or ‘I kinda recommend a urinalysis’ etc. Using ‘kinda’ can be like ‘um’ – a space filler when you aren’t feeling confident in your communication. Think before you speak, so you can be intentional, clear, and what you say can have the greatest impact. 13. Not understanding your client’s level of anxiety. Asking “how are you?” can go a long way. Smiling, using humor when appropriate, and meeting your client where they are will all break down barriers to care and establish trust and rapport. 14. Not understanding or addressing your patient’s anxiety and fear. Not utilizing fear-free tactics. Letting the client know that you understand their pet is nervous and that it is natural. I draw parallels to how I look when I visit the dentist. 15. Trying to convince a reticent client. They are either going to listen, or they are not. You lay out the facts to the best of your ability – that is your job. If you have a good relationship with the client, you can try this: “Ok. I definitely hear you. I think it would help me to help you and your pet the best if you explain to me your reasons behind your decision.” What the client does with it is their decision, not yours, and if you are too pushy, you can piss them off. When they don’t do what you say, document it. Sometimes, the answer is initially no, but if you show respect to the client, respect their decision, and maintain the relationship, sometimes the answer changes over time to ‘yes’. 643 How to be Happy in Veterinary Medicine (Parts 1 and 2) Kimberly Pope-Robinson, DVM, CCFP 1 Life Connected Consulting San Clemente, CA 1. Feelings are not to be judged, or ignored. I believe that feelings are our passion connecting with our physical self and becoming numb and/or cynical does not lead to a content or sustainable career in veterinary medicine. 2. Wellbeing overview – Learn to recognize the water line, sinkers, and balloons. 3. Water line is the “fear of failure” or our own personal shame. “Shame is the intensely painful feeling or experience of believe we are flawed and therefore unworthy of acceptance and belonging!”. Brene Brown 4. Know the difference between guilt and shame- shame is who we are, guilt is our behaviors. I find we tend to jump to shame versus guilt as a profession. “Recognizing we made a mistake is far different than believing we are a mistake.” Brene Brown. 5. Understand and learn your “why”, this is the core to shame resilience. Find how to remember your “why” (filling your balloons) when things become challenging. 6. When you feel negative (sinking under the water line)– write down 3 positive things that speak to your “why”. 7. Define perceived threats (Red and Blue trains) – Book reference “Riding the Blue Train”. Learn to recognize which train you are on and accepting that it is okay to have brown gauze moments. 8. We come into the industry all on blue trains, however industry dynamics promote red train stations; long hours, physically and mentally demanding, deal with the public in emotional situations, having no options for pets (not just money concerns), and have no insurance buffer for the financial conversations. 9. It is not only Compassion Fatigue that is driving people out of vet med. Defined how Engagement, Perfectionism, and Compassion Fatigue show up in the profession. 10. Subway story, think of one justifiable reason for others actions will help to find peace in forgiveness so as to not take things personally. 11. Empathy is the antidote to shame, 4 attributes to empathy. a. To be able to see the world as others see it. b. To be non judgmental. c. To understand another person’s feelings. d. To communicate your understanding of that person’s feelings. 12. To have empathy for others, we must be able to be empathetic to ourselves. 13. “Self Forgiveness is the foundation to a sustainable career in the veterinary industry.” 14. 4 key summary points; a. You control your response b. You create your environment c. Work through emotions d. Find self forgiveness. 644 How to Manage Emotions in Tough Conversations Kimberly Pope-Robinson, DVM, CCFP 1 Life Connected Consulting San Clemente, CA 1. Feeling like you are trapped between a rock and a hard place with these discussions is not an isolated feeling. 2. Medically trained, technically trained, and communication training not generally the primary problem. I have found the highest anxiety in having these conversations is related to our emotions. 3. Remembering why we entered the profession, it can sink us, but it also floats us. 4. Money is not our driver, however profit is slim. 5. Provide a definition of high-level view of “compassion fatigue” in the profession. 6. Top personality traits I have observed to those entering the profession; analytical, compassionate, people pleasers, Type A, Introverts, workaholics, and perfectionism (high achievers). These are great traits to get into and through vet school, not so great for a sustainable career. 7. Remembering the value that you bring can be difficult and often we fall into traps early on in the career to avoid these conversations. 8. The traps; a. I’m new and learning b. I own that window c. Discounting prejudice d. Make a client for life e. Skipping recommendations. 9. Burden to carry as a profession – grocery store clerk analogy. 10. Then we have those moments of clarity, cases we will never forget. No matter how much we share with a client, it will not remove all legality concerns. 11. 13) The answer is in partnership; set expectations. Preparing for sticker shock is not leading the conversation with money. 12. Reflective listening and providing structure/direction are critical as often dealing with emotional situation. 13. A reflective statement does not mean that you agree with the individual. Being heard can be extremely powerful in letting people move forward. 14. If the client can’t afford having a next step in mind, remember that there is a right and wrong way to the multiple estimate approach. 15. How to not take it personal – remember this is a partnership. a. What we know- i. Medical needs ii. Financial requirements iii. General prognosis iv. Emotional expectations v. Home care needs. b. What they know- i. Financial capabilities ii. Attachment to pet iii. Emotional capabilities iv. Home care follow through abilities. 16. The right path is not always because of financial or medical drivers, how to learn to accept all outcomes. Learning to let it go is key! 17. “Self forgiveness is the foundation to a sustainable career in veterinary medicine.” 18. 4 key summary points; a. You control your response b. You create your environment c. Work through emotions d. Find self forgiveness. 645