Practice Management News and Views from around the World – September 2010

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Good Listening Makes For Good Management

Steve Wyrostek MBA, BA

Studies have shown that regarding communication activities, humans use listening skills (45%) more than talking (30%) reading (16%) and writing (9%). So why does it seem that everyone talks so much!!!? Since our brain moves four times faster than our mouth the urge is to talk to attempt to keep up with the internal activity. So temporarily stifling our brain waves to listen requires a considerable amount of self control.

In management, mastery of listening skills can turn a mediocre manager into a good one and a good manager into a great one. I suggest it’s because people remember how they feel after they talk with us. And if they feel happy, complete, validated, appreciated, excited, or gratified chances are it’s because they’ve been listened to. And when your employees, customers and suppliers feel like they’ve been heard they’re going to want to keep working with and for you.

Following are some thoughts on practising gentle ears:

Stay in the moment. This means to give your full attention to the speaker. Stop the mind from wondering where it will go. Keep your hands on the desk (not on the keyboard or a writing pad). Observe body language. In fact, stay so focused on the person that their message is all that exists at that moment.

Tune into the rhythm. Did you ever notice that with certain people, the conversational rhythm doesn’t feel right- you’re starting sentences simultaneously, speaking before the other is finished, interrupting, creating awkward pauses, etc? The more you listen the more you can get into the flow of the other speaker’s conversational style and minimize these hiccups.

Refrain from preparing a response. While the other person is speaking is not the time to formulate a response. Having totally absorbed everything said, respond only when the speaker is through. You may be surprised at how articulate you sound after you’ve fully assimilated the entire impact of the conversation.

Assume nothing. This means clarify everything you don’t fully understand. This can be done by saying- “What I’m hearing you say is….” or “Are you saying that…” or “I’m not sure what you mean, would you repeat that?”

Ask. I was involved in a situation once where an employee was very frustrated about a confrontation she got involved in. She clearly had erred in judgment but remained very combative about it. After meeting with her supervisor she was still upset and wanted to see me. After listening to her, I couldn’t understand what she was after because she had admitted she was wrong so I finally asked- “Tell me, what do you want?” Well, I could see that was the question she was waiting for by the relief expressed in her face and
voice. All she wanted was to have her side of the story documented and placed in her file. I hand wrote it on the spot, put it in her file and that was the end of it. She wanted to be heard and I had stumbled across the key to doing that- simply by asking.

Empathize. Sometimes getting into another’s skin can help you better understand where they’re coming from. How are they seeing it? Would you see it the same way if you were in their place? Empathy will help you see the points being made.

Acknowledge feelings. I once went to a boss because I was frustrated at how I was being treated. I felt my contributions were being ignored. I don’t know if I articulated it well but I do know that my boss never said- “I see you’re upset, what I can do to help? or “Tell me why you’re frustrated.” Any acknowledgement would have gone a long way with me.

Feelings permeate our lives. So why would we deny them in the workplace? Let’s be manager enough to acknowledge and deal with them in a caring way.

I don’t think it’s a coincidence that I became a better manager (and father and husband) when I began to shut up and listen. But like breaking up, listening is hard to do and I’ve got not one but two ears (plus some major brain rewiring) to make gentle!

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What’s happening in small animal practice in the UK

Selected data from the MAI consolidated report to April 2010

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News and Views from Boston and Los Angeles

by Diederik Gelderman DVM

Issues in the USA and Australia are almost identical

  • The recession has hit very hard here — interest rates are at 0 percent or just above (if you want to borrow money)
  • The banks will gladly lend to vets however!
  • Unemployment is at 10%
  • Vets are hurting
  • Lots of staff cuts
  • Many vets have been laid off and so to ‘buy’ a job have opened their own one person practices
  • Lots of one-person practices on every street corner — competing on price and not service.
  • This has really increased the competition. This is a poor trend. Can you identify areas of Australia here?? Gold Coast, Sydney and Melbourne perhaps??
  • Profitability and quality of service suffer
  • The profitable ones are the larger 4-5 vet practices
  • Lots of good staff for hire
  • Apart from the economy. the number one problem (aside from the economy) finding good staff, motivating them and keeping them. Firing here is easy — just say “You are no longer needed thanks — Good Bye”)
  • The number two problem is profitability — net profit here is similar to Australia at about 7% on average
  • The number three problem is lifestyle and work life balance (time with family and time off)
  • There are 40 million people — (approximately), here in California and the whole of Southern California (about 20 million inhabitants) has about the same number of veterinarians as the whole of Australia
  • The economy has been really badly hit — nearly everyone is suffering
  • Generally, the truly good and excellent practices are finding that they are still doing well or very well. It is the less ‘excellent’ practices that are not doing so well. By the way — you see this trend in every ‘recession’ or period of setback — in everycountry in the world. I think that there is a message here. These practices (the ones that are continuing to flourish), are the ones that give truly exemplary and awesome client service and in which the Client is King (or Queen). These practices do well in hard times.
  • In many practices, the number of client visits are down and yet the Average Transaction Fee is up.
  • There is an important message here to — spend more time with your clients — giving them what they truly want for their pet
  • In the excellent practices, both visits and ATF are UP
  • The Southern California Veterinary Medical Association (headed by Peter Weinstein) is a really active and progressive group — if you come to California — make the time and look him and them up. And they are a nice bunch of people too.
  • There are lots of different computer systems over here. There is some open source soft-ware that is very popular as is Cornerstone
  • Their ‘Wellness Care’ — really outstrips ours
  • Their attitude to declawing cats, ear-cropping dogs and tail amputation of dogs is really the antithesis to ours. I sat in on a discussion about the merits or otherwise of these procedures the other night and the consensus was that performed correctly it was not cruel and if the client and community thought it was appropriate then it was the veterinarians’ responsibility to do it. Not many vets actually perform ear cropping — they refer these puppies to someone who does these procedures a lot. However everyone still does tail docks, cat declawing and dewclaw removal.
  • Veterinarians are not nearly as paperless (as a group) as we are (in Australia) and are quite shocked to learn how far we have gone in this regard
  • Veterinary support staff are a much older group then our nurses and receptionists
  • The wages are much lower than ours are and the benefits much less. The average work week is 40 hours
  • Veterinarians come out of ‘school’ with a huge educational debt
  • There are distinct nurses/technicians and receptionists and practice managers — this makes for much better run and functional veterinary businesses.
  • The truly excellent practices with the high client numbers and good profitability do the little things correctly; welcome cards, condolences cards, referral systems, loyalty programs, etc. In other words, they do the little things that the clients truly appreciate and which set them apart from other practices — just so well!
  • Pain relief, pre-operative blood tests and intravenous surgical fluids are mandated by most practitioners that I met — and the client has no say into this. I agree — rarely is the client trained to make medical decisions!
  • And the last point — Yellow Pages are dead! Follow the lead from over here. Stop wasting your money on big ads — spend your investments on referral programs and better web sites.

You can click here to visit Diederik Geldermans website

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A snapshot of veterinary practice in the USA

Extracts from one of the current discussion groups on the VSPN website

What is your veterinarian to technician ratio? What does your DVM expect from their technicians?

  • We recently dropped from 3:1 down to 2:1. The technicians basically do everything allowed to them by law except push induction drugs, intubate, put in charges, and enter the doctors notes. Everything else if fair game for tech duties.
  • We have 2-3 DVM’s working per day along with 2-3 CVT’s & 2-3 assistants (max total of 5 CVT’s & assistants combined). Our CVT’s do everything the law allows: calculating drug doses, administering drugs, inducing anesthesia, intubating, monitoring surgeries, placing IV & urinary catheters, performing cystos, performing fine needle aspirates, skin scrapings, tape preps, dental cleanings, extractions, blood draws, nail trims, anal sac expressions, suture removals, bandage/cast applications, client education talks, recheck calls, UA’s, fecals, cytologies, blood films, etc…
  • We have 1-2 LVT’s’ per day and 1-3 VAs depending on the day. On notoriously slow days we try to schedule 1 tech for 1-2 DVM days; on busier days we always schedule 2 techs and either an entry level tech or experienced VA. We usually have 1-3 VA’s, again depending on the day.
  • Before the recession we usually staffed 1 LVT/DVM and 1-2 VAs/DVM. Hope this helps!
  • I work at a small one doctor practice. I’m the only RVT and am staffed with one assistant who also helps out the receptionist. The assistants and I do blood draws, catheter placement, run in house lab equipment, fecals, ear cytology, take radiographs, do call backs, perform treatments, fill prescriptions. I do all the anesthetic inductions, dental prophylaxis (the vet does most of the extractions herself), bandaging, and make discharge instructions
  • Our techs do everything they are allowed by law to do. It’s rare for a Doc to actual take a radiograph or draw blood. Our appointments are blocked into 10 minutes slots.
  • Most recheck type appointments get 2 slots, new patients get 3 slots etc

What time elements do you see appointments and what length are your appointment slots?

  • We see appointments from 2 Pm until closing daily. Surgery drop off time is from 7 Am – 8:30 Am. Techs arrive at 8:30. Surgery begins promptly at 9 Am. Techs must have the complete setup (including IVCs and blood work) done by 9 Am. We do surgery between 9 Am – 12 Pm. Our average numbers are 8 surgeries of various types during that three hours.
  • Our doctors appointments are 1/2 hour long. We are not the cheapest, but not the most expensive on the block. A half hour is good value for the price. We don’t try and squish two or three animals into a single 1/2 hour appointment. A single owner bringing in three animals will purchase 1 1/2 hours of the doctors time. So long as they are buying it, they might as well use it. Sometimes we may only see three clients in one day, but, they all have multiple animals.
  • We are open 8-6 Monday – Friday and see appts starting at 9am with our last AM appt at 11:30. We then start appointments again at 2pm and see our last appointment at 5:00. Saturdays we are open 8-12. We see our first appt at 8am and our last one at 11:30. Almost all of our appointments are 30 minutes.
  • Doctor appointments are 30 minutes and tech appointments are 15 min
  • Our appointments are blocked into 10 minutes slots. Most recheck type appts get 2 slots, new patients get 3 slots, etc.

You can click here to visit the VSPN website and read or contribute to other current discussions

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Vet Help Direct

with acknowledgement to the Society of Practising Veterinary Surgeons Journal

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Launched in early 2006, Vet Help Direct is a web based, interactive triage system for pet owners, horse owners and farmers. The system helps owners to understand when their animal needs veterinary attention and to decide how urgent the problem is:

Owners answer a series of step-by-step questions and are given a clour coded priority rating

Over 95% of answers recommend going to the vet, the variable part of the answer is the time scale

Customised first aid advice assists owners until they get to the vets

The interactive style encourages good compliance with the advice to seek veterinary attention

The system can be integrated into your practice website, personalising it for your clients. Vet Help will liaise directly with your web developer to customise the content for your website and match the colours to your website theme

If you register for any of the Vet Help services, they will create a complimentary bespoke graphic for your website home page with a link to the public site or to the appropriate page in your website if you choose to incorporate the questions and answers on your own site

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Leading Outside the Lines

by Jon Katzenbach and Zia Khan

From a review in the Gifted Leaders website

In every company, there are really two organizations at work: the formal and the informal.

The formal organization is the rational construct that runs on rules, operates through hierarchies and programs, and evaluates performance by the numbers. Tactics of the formal domain include: deploying tangible factors like job descriptions, organization charts, process flows, and scorecards.

The informal organization, by contrast, is an agglomeration of all the human aspects of the company: the values, emotions, behaviors, myths, cultural norms, and uncharted networks. The power of the informal is visible in every organization every day – it is an undeniable, emotionally resonant force.

  • Organizations that sustain high performance over time have learned how to mobilize their informal organizations while maintaining and adding formal structures, each in synch with each other.
  • In sports, great coaches pay just as much attention to the emotional aspects of the game as they do to the skills involved. In business, the informal organization is most successfully mobilized when there is also a sharp focus on performance. People want to know how their informal collaboration will lead to an improvement in results.
  • It’s difficult for any manager, even one who has a predilection for the informal, to understand exactly how to lead outside the lines. There is, after all, no universal recipe book: the right balance of formal and informal measures will look very different depending on the company, the business, and the circumstances. In business, leaders who are well versed primarily in formal measures may feel less comfortable dealing with what they see as the “fuzzier” aspects of the organization.
  • If you are interested in creating balance for your organization, one good place to start is with performance goals and metrics. If you can get a feasible approach to metrics under way that does not constrain the organization through the misuse of formal controls, then you can not only accelerate higher performance, but provide employees with a much greater understanding of the results that matter and why they are important.

Guidelines for designing and using metrics that matter and motivate:

  • Remember that shared values drive performance. Start with a broad and inclusive dialogue process designed to discover the shared values that really matter to employees. Good metrics serve as an indicator that shared values are being honored.
  • Make your metrics both tangible and meaningful. This kind of measure allows people to get excited when they see the numbers moving up. Creating personal connections to the work helps build and maintain a high level of performance.
  • Choose metrics that allow everyone to feel connected. The metric should help people coordinate and work together as a team.
  • Don’t go overboard, less is more when it comes to metrics. You want a small number of metrics to create focus. The teams that win are the ones who figure out the short list of metrics that matter the most.
  • Communicate, communicate, communicate! Once your key metrics have been selected, it’s crucial that communication about them is visible and clear. Employees need regular, if not continual, access to the metrics and they should be clear about what they can do to positively impact a metric if it is lagging.

“Leading Outside the Lines” – integrating formal metrics and informal communication – can lead to new levels of performance.

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