“Never tell people HOW to do things. Tell them WHAT to do and they will surprise you with their ingenuity. – General George S. Patton
When I wrote the text, The Practice Success Prescription: Team-based Veterinary Healthcare Delivery (VIN PRESS 2008), we made it available in the VIN Library for free download. I thought I had made a great contribution to the future of veterinary medicine in the new millennium. I forgot I was dealing with vets trained as control freaks, educated people who only knew case management as their management style; they did not know how to let go, and in fact, missed the key points of the 500 page, with 18 Appendices, thesis as presented.
As we stated in the SYNERGY MODEL, step one is “train to trust”. Once that is accomplished, small outcome-detailed tasks are assigned, and when completed, with accolades (never a BUT), mutual trust will be started. Then we assign program level outcome tasks, and allow the staff member to achieve confidence, with accolades and mentoring as needed. This is where harmony starts to evolve within the staff members. That is when synergy becomes commonplace.
MANAGE BY GETTING OUT OF THEIR WAY
The following are nine steps for how people with high status (vets and managers) can take actions to avoid stifling the ideas and suggestions generated by those who don’t have as much power and prestige (staff members).
- Sometimes the best management is NO management at all. It may be best to describe the WHY and WHAT and just get out of the way, letting trained staff members do their jobs, unilaterally determining the WHO and HOW within their own sphere(s) of influence (practice zones).
- Indifference is as impactful as passion. While passion is an integral part of any successful endeavor, indifference can torpedo the best efforts by passionate, engaged people working within their calling.
- You get what you expect from people. Success measures, and milestones, are clearly defined and the WHEN is jointly agreed upon before any project is started. If your expectations are high AND you provide appropriate support/resources, you will see significant results. If you are cynical and don’t expect much, you will get marginal results at best.
- The best test of a person’s character is how he/she treats those with less power. Watch your doctors, managers, as well as yourself. Make sure you are looking up to your individual staff members and program managers, never down.
- The best people and practices have the attitude of wisdom. They have the courage to act on what they know is right now, and the humility to change when they find better evidence. The ‘control freak’ manager/vet can derail this attribute of excellence.
- Learn how to fight as if you are right and listen as if you were wrong. We all like to be right, and often we are, but sometimes we are just wrong. Without listening, we will never know.
- Avoid pompous jerks whenever possible. They not only make you feel bad about yourself, but chances are you will eventually start acting like them.
- The best single question for testing a practice’s organizational character is, “What happens when people make a mistake?” View mistakes as opportunities for learning or coaching. Repetitive mistakes are opportunities for dehiring – know the difference!
- Leadership is the art of gaining followers through sharing your vision, enhancing their position, and achieving greatness that no one person could achieve alone. The 14 leadership skills can be learned, but they must also be practiced moment-by-moment until they become organic to the new you!
So, these are the nine bullet points, and the above text the cookbook for how to put it all together. The second text we have put into the VIN Library, Promoting the Human-Animal Bond in Veterinary Practice, 2nd edition (VIN Press, March 2009), is also available for FREE download, and the 250 pages include 26 appendices for staff members and practice teams to pursue for enhanced client bonding.
To Survive or Thrive: Up strategies for veterinary practices in a down economy.
When the economy slows it’s tempting to cut prices. Look around. Stores are slashing prices 60 percent to 80 percent and everyone expects a deal. Some are calling this the “frugal future.” But have you noticed the growing number of bankruptcies and going-out-of-business signs that are popping up, too? Both are a common consequence of aggressive price-cutting.
It appears most veterinarians are proceeding with caution when it comes to price cutting. The American Veterinary Medical Association reported that veterinary practitioners saw a slowdown in the last two years. The number of transactions were down but revenue stayed relatively flat. This implies practices either were doing more for each patient or raised their fees to compensate for decreased volume — or a combination of the two. A carefully calculated fee increase for non-quotable services is a good strategy in this kind of environment.
Information gathered at the Economic Crisis Symposium at the North American Veterinary Conference (NAVC) in January suggests that veterinary practices plan to continue at least modest fee increases in the future. Some 45 percent of audience participants at the symposium said they plan an increase of less than 5 percent, while 24 percent expect to raise fees 5 percent or more. Only 6 percent said they don’t plan to hike fees in the coming year. An excited 25 percent said they might selectively reduce some fees for staff delivered well care.
The following 10 ideas can help you implement smart strategies to protect your practice and promote your services:
- Establish a modest fee increase now if you haven’t already for non-quotable services (e.g., flat rate anesthesia fee for the first 30 minutes, plus a per minute fee for everything after 30 minutes – use a double clock timer, available from cooking stores, attached to the gas machine – one clock for anesthesia time and one clock for actual surgery time).
You will need profit to build cash reserves to cover leaner months and help with cash flow. December and January months, for instance, usually are slower because families are spending discretionary monies for gifts (or pay off credit cards used for gifts the month before); the back to school month is also slower because families are spending discretionary monies of school clothes and supplies.
Being a good steward of the practice means setting fees to provide a fair profit. The owner deserves a salary based on personal production (~25%), and also a profit or return on investment (ROI) for the money he or she invested in the practice. The practice land and facility, if owned, should be in a family-held trust or LLC, so it can collect a fair occupancy fee plus be protected from inheritance taxes in the case of owner demise.
- CAREFULLY, raise 20-25% of your non-quotable fees quarterly throughout the year to ensure that you are covering your costs. Your suppliers are doing the same. Keep close tabs on inventory, energy and other costs so that you can pass those along to your clients and not hurt the practice.
- Offer clients package prices (it does not have to be a deep discount, and it can be charged against a credit card on file monthly or quarterly). Consider a pre-paid “package fee” for a semi-annual health care consultation (with or without vaccinations). Clients already know 1 dog year is 5-7 people years, and most all women see the OB-GYN at least bi-annually, so this is an anthropomorphic “no brainer”. If clients know what is needed to keep their four footed, furry, family member healthy, it encourages them to take advantage of the offer and come in rather than delay visits because they fear they cannot afford them. The A and B clients will appreciate it, and many practices have had success with a set package price for semi-annual consultations, urine surveillance, blood chemistry, parasite screen and vaccination visits.
- Only the government believes you can be taxed into prosperity; there is no such thing as a smart, or strategic, discount. If your practice has a slow season, you need to plan for semi-annual visit during that time; use of nursing staff can be a great asset for this program, since their services are less costly than a doctor’s consult. The industry “Pets Need Dentistry, Too” campaign is the silliest marketing idea ever to be shared with practices; teeth do not need cleaning only during one month of the year. Sure, you can offer “courtesy dental screens” by your nursing staff during the National dental month, since a majority of animals they see will need some form of additional dental care. Be aware, a rule of thumb is that for every 5 percent discount, you will have to attract 20 percent more workload to make up the loss of profit, so even senior discounts will hurt the average practice. I am not against allowing an “adjustment” on the bottom-line of the invoice as a good Samaritan gesture, but NEVER – EVER – allow a line item discount regardless of your strategic planning – a line item discount prevents a procedure to income check of fee compliance by providers. A bottom-line “adjustment” is actually giving away pure net, so it needs to be tracked by provider so that it stays within the budgeted “good Samaritan” planning limits.
- Offer frequent-buyer programs on products. It’s better for pets if clients purchase their flea, tick, heartworm, NSAIDs, veterinary diets and other prescription products through you. When they do, you can help remind them to give the medication appropriately, help them work through problems, ensure that their pets are getting authentic products and send reminders to help keep their pets protected. To remain competitive with the Internet and retain product business, you may need to offer product deals. Consider working with your pharmaceutical and pet-food representatives to develop loyalty programs. These encourage clients to purchase more products from you, and they build repeat visits. A loyalty program also encourages a partnership between you and the manufacturer that benefits everyone.
- Twice-a-year pet consultations. As discussed above, this is a money maker! By splitting the traditional once-a-year vaccine exam into two six-month consults, you can start laboratory baseline surveillance programs, and have an enhanced communication opportunity with your clients. This is also kinder to your clients’ pocketbooks and should improve pet healthcare services as they age. This way you give clients twice the chance to learn about needed and necessary pet care. It also gives you a way to assuage client fears about vaccine-associated adverse reactions. Twice-yearly appointments also provide the option of giving some vaccines on the pets’ first visit and the rest on the second visit, as well as build visitation habits that will withstand the extended DOI vaccination programs being advertised on the Internet.
- Enhance service with value-added incentives. Now is not the time to scrimp on service. A small thing that means a lot to clients is a free nail clip by the nursing staff after a doctor’s consultation or other procedure. (For pets that require sedation to clip their nails, clients need to understand that the sedation is a separate charge, but the nail clipping is complimentary.) This can build business in a down economy and rewards clients who stay loyal to your practice.
- Strengthen relationships with current clients. There is a marketing saying that, “Your next best customer is the one you already have.” Never take current clients for granted. In the quality care practices, about 50-60% of new clients come from word of mouth referral from satisfied clients. While most all veterinary software systems will track the source of clients, less than half use this feature on a regular basis. Consider your appreciation methods for the word-of-mouth referral: a discount on the next visit is DUMB! Discounts are not tax deductible, but a card in the mail is tax deductible; for recurring referrals, adding a pair of matinee movie tickets to the thank you card is also tax deductible. Some practices have tried flowers or candy, but allergies and diets may make that gesture an empty or frustrating gesture. In the holiday season, planning a special event just for the “Golden Clients” or high referral rate clients can be fun for your staff. Perhaps arrange with a local photographer to take pet photographs at the practice for this special event. Or in some cases, practices have opened up the program and sent out a notice inviting all current clients to make photo appointments for their pets. There would be no sitting fee, and the first photo would be free, but the photographer would charge for additional ones (that is where photographers really make their money anyway in this digital era). Photographers should be happy to work with you because it would expose them to a new customer group, and you would handle marketing and provide the location.
- Heighten your community profile and build good will. What community events can your practice support or sponsor? A dog walk to raise money to support cancer research for pets and people? A booth at a community fair? Increasing your visibility in the community is good strategy. Don’t give away free appointments. Instead, donate visible services such as manning the pet ER station during a dog walk to take care of injured pets, heat exhaustion cases and other common pet maladies. At a community fair, consider having a well-mannered, sociable pet there as your “spokes pet” to attract attention. Give away seasonal tips on taking care of pets along with healthy pet treats to build awareness and good will.
- Support pro-bono pet causes. Doing good can do good for the practice, too. As pet shelters struggle to feed and care for abandoned pets, consider holding a simple fundraiser for them. You might ask manufacturers to contribute items for dog and cat gift baskets and sell raffle tickets at the practice to win them. Give fliers to the shelter to help you promote the raffle, and let the local newspaper and radio stations help you spread the word. Participate as a practice team in the RSPCA special events, and if possible, do it in costume to excite your team’s participation.
A Real World Example of Succe$$
In Stockton, California, with the highest foreclosure rate in California, my client dropped from 25% growth to 20% growth . . . he smiled all the way to the bank!
In British Columbia, Canada, with no growth being reported in the local Association (which has an established BC rate guide), my client maintained 22% growth without exceeding the fee guide limits (after we established a written Standards of Care (SOC) for well care products and services, and then using those well care programs delivered by his staff).
In Brisbane, Australia, 16 vets within 10 minutes of front door, community income at $500 per family per week, well care produced a growth rate of 20-25% (still, after four years of added programs), while other practices are bemoaning an on-going loss of income.
Tracking procedures per transactions, AFTER establishing a written standards of care (SOC) for Risk Level 1 animals (young and healthy) – expectation of 110% consistency in offering NEEDED care to clients for their pet, and we want to see improvement each month, NOT leaps and bounds, just IMPROVEMENT in procedures per 100 transactions. If you start with risk level 2 or above, we are into clinical freedom of veterinarian (varies by school), and that is never an easy starting point. After Risk level 1 consistency, then we move to protocols for Risk Level 2 and above (e.g., I.V. TKO (IOFs), minimum pre-anesthetic lab screens, etc.).
BY THE NUMBERS:
– 85% of adult animals come into practice with some form of dental care needed
– 50% of all animals entering the practice have some form of nutritional need
– 30% of long haired cats has PCK syndrome
– JPS candidates need screening at 14-16 weeks of age (Ortolani is 75% accurate, Penn-hip is 86% accurate), and JPS surgery before 18 weeks of age,
– Breed specific PCRs are available for 450 conditions
– 15% to 23% of animals on strategic deworming are still parasitized (per Bayer)
– AAHA reported $639,000 per doctor per year being lost in wellness care/prevention because of POOR practice compliance, and clients NOT AWARE of sense of urgency
– Recommend is NOT sense of urgency => NEED is needed
– Annual is not compatible with the scope of well cares services an animal deserves, so we need to use “NEXT” as the key term when planning visits/contacts
– We moved from 1.9 client visits in July 2004 (roll out of THINK TWO VISITS A YEAR FOR LIFE) to 3.3 client visits after 4 years of semi-annual visit advocacy
– Most effective practices have OPN precede doctor in consult room, doing a 3-5 asymmetry exam, with “Ï have made a note for the doctor to talk to you about this“, and then followed by OPN to do client education as prioritized by doctor
– All visits end with the 4 Rs – assuming an active problem list (recall, revisit, remind, and resolved); planning the next contact is started by doctor, reinforced by OPN, and tracked by client relations/veterinary software – at least one, and usually more.