Practice Management News and Views from around the World – February 2019

Dog Rube Goldberg Machine

This video was created as an ad for Purina. I have no commercial link with the company but – just thought it was a clever and well worth sharing

Practising in paradise

Diving into a veterinary practice located on the beautiful Caribbean island of Turks and Caicos

From an article by Phil Zeltzman, published on the Veterinary Practice News website

In 1982, four scuba diving-loving colleagues came up with the crazy idea of setting up a veterinary practice on the beautiful Caribbean island of Turks and Caicos. To that end, they created 52 shares that would be available to other colleagues.

Each partner would spend a two-week “tour” on Providenciales (insiders call it “Provo”), working every other year at what would become Turks and Caicos Veterinary Associates. They’d travel on their dime and work without pay. The clinic’s income would pay the bills for both the practice and lodging. A beautiful, modern house with a stunning ocean view was eventually built for the partners, their family, and their friends to enjoy.

The practice is open in the morning on Mondays, Wednesdays, Thursdays, and Saturdays. The rest of the time, unless there is a (rare) emergency, practitioners can enjoy the beautiful island, its turquoise waters, and white sandy beaches. They also can enjoy snorkeling, scuba diving, horseback riding, amazing restaurants, and day trips to the archipelago’s other islands. There are more than 100 islands, with only a few large ones. Other activities include whale watching, kitesurfing, fishing, and golfing.

The partners were inspired by another practice created with the same philosophy in the Cayman Islands. Sadly, the government shut it down, so it is entirely possible the clinic in Turks and Caicos is the only one of its kind in the world.

The practice offers medical, surgical, and dental care mostly for cats and dogs, and occasionally for exotic patients. There are funny stories floating around, such as the colleague who repaired a torn ACL on a goat. Partners with a desire to serve the community may choose to volunteer to perform spays and neuters at the local shelter, but it is certainly not a requirement.

In Provo, practicing veterinary medicine occurs at a different pace. In other words, relax, you’re on island time! Clients include residents of the island, as well as a large community of expats from all walks of life. They are extremely friendly and thankful for the service offered to them.

Some of the patients include “potcakes,” family-owned or rescued. The name of this very cute local mid-size dog breed comes from the “caked” remnants of overcooked food (often rice and stews) at the bottom of a pan the locals use to feed to their dogs.

Veterinary technician Peggy has been the anchor of the practice since the 1990s. She explains that most partners are from the U.S. and Canada, along with a few colleagues from Norway and Austria.

“Working with a new colleague every other week is challenging, but fascinating, because I learn several ways to treat the same condition,” she explains. “Over the years, I’ve seen their kids grow up and blossom into teenagers, then adults.”

“Some members leave the practice as they retire, and they are replaced with younger colleagues,” Peggy explains. Melinda, the clinic’s other employee, helps out in many ways, mostly with the administrative aspects.

Importing medications is costly because of shipping fees. When medications and supplies are needed, Peggy places an order with the next colleague in line, who brings them in their luggage. The practice then refunds the cost.

Peggy’s story is a love story. She visited Turks in the 1990s with her boss, who was an early partner. Peggy fell in love with the island and after a few tours, she decided to stay there. Her role is now critical. She is a technician, receptionist, anesthesia person, dental technician, laboratory manager, X-ray technician, and expert tour operator.

The clinic has helped countless animals who would have otherwise not received the veterinary care they needed. Turks and Caicos Veterinary Associates is a slice of paradise for the island’s dogs and cats, and the partners who get to practice there.

You can click here to visit the Veterinary Practice News website

You can click here to visit the Veterinarians in Paradise website

Making Sense of Your Waiting Room

From an article by George Bird published in the Veterinarians Money Digest

Both pets and their owners can experience anxiety during veterinary visits. Set them—and your practice—up for success with these tips for your waiting room.

Let’s face it: Most of your patients are less than thrilled to come see you. It’s nothing against you, of course. Visiting the veterinary hospital can be a nerve-racking experience for any dog or cat.

And pet stress carries over to their owners like a leaf floats on a breeze.

That’s why even though pets are your primary concern, you cannot forget your clients. Drawing from the experience and expertise of skilled retailers can assist veterinary practices in creating a welcoming and pleasant environment for pets and pet parents alike.

Start at the front of the your practice, and pay attention to which of your senses are impacted. A few will come into play quickly.

Smell

The way a veterinary clinic smells is extremely important, yet an unpleasant odor is one of the most frequent complaints of pet owners. It’s crucial that your staff doesn’t become desensitized to pet-related odors. The best way to address this is to minimize any odors before they spread.

Consider adding an odor-elimination product to your cleaning solution along with a natural cleaner specifically designed to remove the scent of urine. It’s also helpful to invest in natural, pet-sensitive air freshening products that make your clinic smell pleasant and welcoming.

Finally, many practices have added pheromone diffusers in exam rooms to ease stress in their feline patients. For best results, use them in the waiting area, too.

Touch

Something as simple as check-in can be improved greatly with a touch of technology. A tablet or kiosk with a self-check-in option can make the process smoother and more efficient for everyone. And while people may not choose your practice based on the waiting area alone, it will impact their memory of the visit. A comfortable waiting area can enhance their experience and help make them loyal customers.

To start, offer a variety of seating options. Rather than lining a large area with chairs, create a more welcoming atmosphere by placing a cluster of chairs around a small table. Chair clusters also create separate seating areas to minimize animal interaction, which can increase stress in some animals. If possible, create a separate seating area for dog owners and cat owners.

It’s also important to make seating easily mobile, so people can move chairs to be more comfortable.

Sight

Attractive and cheerful waiting rooms reduce anxiety and create a perception of quality care. The same goes for your lobby and front desk, which should be sparkling clean at all times. Many owners worry about exposing their pet to germs during their visit, so be sure to keep entry areas wiped down and clean up all 'accidents' promptly.

When it comes to aesthetics, colors are important. Choose soothing colors such as white, green, or pale blue. Results of a study conducted at Minnesota State University showed that green colors tend to relax the mind while red environments induce stress. Another stress inducer? Abstract art. If you’re looking to decorate with art that soothes, go with landscapes, nature scenes, and photos of adorable puppies and kittens.

In terms of lighting, stay away from fluorescent fixtures, as some studies show they can actually cause headaches, vision issues, and problems with focus. Rather, choose bulbs that offer natural, muted lighting comparable to what you would use in your own home. Allow plenty of natural light into the space, and avoid curtains or window coverings when possible.

Finally, waiting in itself can be irritating and frustrating, especially when the pet owner doesn’t know when it will be their pet’s turn to be seen. Providing a screen with approximate wait times so pet owners can manage their time can make a real difference. This can be particularly helpful if the animal is anxious and would be more relaxed waiting outside the building or taking a short walk if the wait time is long.

Both pets and their owners can experience anxiety during veterinary visits. Set them—and your practice—up for success with these tips for your waiting room.

You can click here to visit the Veterinary Practice News website

Top 3 ways to get the New Year started off right

From an article by Amanada Donnelly and published on her website

If you’re like most people at the start of a new year, you feel a sense of renewal, hope, more energy and a desire to get organized. Don’t let that enthusiasm go to waste. Take the following steps to invigorate your business and make 2019 more successful than last year.

1.Evaluate Key Performance Indicators (KPIs) to develop marketing goals.

Assess 2018 year-end practice management reports and the profit and loss statement to evaluate the financial health of your practice.

Look at these KPIs: new client numbers, number of transactions, doctor productivity, expenses, revenues for different income centers, and the average doctor transaction.

Then establish marketing initiatives based on your KPIs. For instance, do you need to increase new client numbers, increase revenues in a particular profit center or improve pet owner compliance? Set measurable target goals so you can measure your success. Be sure to make staff assignments so everyone knows their role in carrying out your marketing plan tactics. Focus on a few marketing initiatives at a time.

Your marketing plan doesn’t have to be long and complicated to be successful. In fact, simple is often better. 

2. Improve team meetings.

If your meetings are awesome skip to #3. If not take action to improve team engagement and have more productive meetings. Here are 3 ways to improve meetings:

Define the purpose; don’t have a meeting just to make routine or nagging announcements. Brainstorming, problem solving, education and team building are excellent reasons for a meeting.

Make sure the meeting leader knows how to facilitate. They should keep the team focused and move to an action plan for each topic

Improve engagement by requesting team feedback. Be sure to engage all team members, not just the vocal few.

3. Give clients what they want.

What can you do this year to raise the level of service? Don’t be complacent. Here are a few ideas of what clients want:

  • Excellent digital communication. Must-haves include a mobile app branded to your hospital with multiple features including a client loyalty program. Another is lots of texting capability!
  • A team empowered to help them
  • Convenient patient admissions and prescription refill protocols
  • Reminders for all medications and access to an online pharmacy
  • Written take-home instructions

You can click here to visit Amanada Donnellys website

6 Tips for Improving Billing and Payments

From a blog on the DVMelite.com website

It’s nearly impossible for a veterinary practice to achieve sustainable success without sufficient cash flow. Your employees still need to get paid and you’ve got overhead and ongoing upkeep of your clinic to worry about. If you are performing services but find yourself having to chase after clients to be compensated, or are struggling to get your finances out of the red, chances are you could benefit from tightening up and optimizing your billing processes. Let’s take a look at a few strategies to help you improve in this area.

Set a policy and stick with it.

If you’ve been prone to making exceptions for clients in the past, now’s the time to buckle down and lay some ground rules. First and foremost, you need to create and document a formal payment policy. Ideally, we would recommend requiring payment in full at the time services are rendered, as this is standard practice in the veterinary industry. If you do offer other options, make sure you’re clear on what those entail and that your clients are fully aware before moving forward.

Communicate openly and frequently.

Never just assume your clients know what your payment and billing policies are. Communicate them regularly. Post a “Payment Basics” flyer right near the front desk and include a disclaimer along with any paperwork you have your clients sign. Remember – you cannot adequately enforce a policy that isn’t well-documented and clearly communicated, so leave no ambiguity.

Offer a variety of payment options.

If you find that requiring payment upfront is a struggle for some of your clients, you might consider offering a few other options. For instance, you might decide to work with a pet insurance company. This enables your clients to defray some of their out-of-pocket costs for veterinary care while also ensuring that you still receive timely payment for your services. Another option would be to accept pet-specific credit plans, such as CareCredit. Offering several options can relieve the burden from your clients, improve cash flow for your practice and contribute to happier, healthier pets overall.

Educate your staff.

It may sound elementary, but many practices struggle with cash flow simply because their employees aren’t doing their jobs adequately. For instance, if your front desk agent isn’t well-versed on your time-of-service payment policy, he or she might erroneously give a client the option of being billed. This undermines your ability to collect in a timely manner. To avoid this, make sure that everyone on your team is educated, both on the policies and procedures as well as how to speak with clients about payments.

Make receivables a priority.

If you already find yourself in a hole with regards to a backlog of payments, don’t let your collections efforts simmer on the back burner – no matter how uncomfortable a task it might be. Veterinary medicine may be primarily about building relationships, but at the end of the day, it’s still a business. Be compassionate but firm when it comes to your accounts receivable. And recognize that a client who is consistently late and/or reluctant to pay may not be someone you want to continue doing business with anyway.

Designate a go-to person.

If finding the time to work on billing is becoming more and more challenging, be proactive in assigning the task to someone else on your team that you trust. Not only will this take the weight off of your shoulders and free you up to focus on growing your practice, but it will give everyone in the clinic a point person and subject-matter expert to whom they can turn whenever there’s an issue. This will enable your practice to run much more smoothly, which isn’t just better for you and your team, but for your clients and patients as well.

You can click here to visit the DVMelite.com website

When Veterinarians Make Mistakes

From an article by Dr Patty Khuly and published on her website

Veterinary medicine is a profoundly human science. So much so that it perfectly mirrors the many deficiencies, uncertainties and flaws that characterize our human experience. It is, by its very nature, shockingly imperfect.

But that’s not what anyone wants to hear when they bring their pets to the vet ...

... They want to believe that a) their veterinarian has paid her dues and graduated at the top of her class, b) that she’s spent at least twenty years acquiring the skills only experience can burnish to perfection, and c) that she never, ever makes any mistakes.

It’s clearly impossible to supply a veterinarian who can offer c), much less all three. Not only does everyone, without fail, make mistakes, but not everyone can graduate at the top of their class, and (guess what?) it takes twenty years to acquire twenty years of experience.

So it is that when you walk into that after hours animal ER facility and encounter your very first fresh-faced intern when you most believe you need the absolute best, most experienced clinician … you’ll come face-to-face with the most visible reminder of the reality of the allied medical professions: They are imperfect. And sometimes you just have to live with it.

That was the case last month when our hospital hosted one of the worst clinical disasters of my career. As the result of a simple misunderstanding, a staff member gave ten times(!) the normal dose of a subcutaneous medication to a post-operative patient.

Thankfully, I double-checked on my team, read the recorded dose, and flipped out in time to do something about it. But, unfortunately, this was not an antibiotic or one of any number of drugs for which an antidote is available. To fix my mistake I had to surgically excise the area and pump this seven-pound kitten full of a fat-binding solution to help clear his body of the toxin.

Three days later I knew we were in the clear. But can you imagine the owner’s shock as I’d explained the mistake? What would you have done during those three days of stressful waiting? You’d have been right to blame me. (I did, for sure.) You would have a right to expect your veterinarian to pay for all treatments. (We did, of course.) And you would have been justified in feeling angry and harmed.

But here’s the thing: It might not have been fair if you’d condemned me roundly or perceived my act as a betrayal of trust. This was a mistake. An honest one. One that was caught in the course of the checks and balances medicine has to employ by way of mitigating risks we know we take each time we suck medicine into a syringe and administer it to a patient. Because almost everything we do carries risks.

After losing exactly one patient to an anesthetic complication in only twenty years of practice, I was starting to feel rather charmed. (So you know, one to four out of every thousand anesthetic procedures yields a significant anesthetic complication.) But if you practice medicine long enough, things will happen. Good things and bad things. I choose to believe it’s how you react to them that counts.

Here’s where I’ll blatantly appropriate a quote by my favorite medical writer, human surgeon Atul Gawande, from his seminal book, Complications: A Surgeon's Notes on an Imperfect Science:

“[Veterinary] medicine is, I have found, a strange and in many ways disturbing business. The stakes are high, the liberties taken tremendous. We drug [pets], put needles and tubes into them, manipulate their chemistry, biology and physics, lay them unconscious and open their bodies up to the world. We do so out of an abiding confidence in our know-how as a profession. What you find when you get in close, however –– close enough to see the furrowed brows, the doubts and missteps, the failures as well as the successes –– is how messy, uncertain and also surprising [veterinary] medicine turns out to be.”

Atul Gawande is no James Herriot, of course, but in this book he uses stories to make many of the same points Dr. Herriot so charmingly made in his All Creatures series of books: Medicine, even veterinary medicine, can get messy. Very messy. And that's as it should be. To err is human ...

Thankfully, as Gawande and Herriot teach us, it is in the midst of all that mess that we learn and progress. Indeed, it’s often by making mistakes that we learn the most. After all, though it won’t make most pet owners (or patients) happy to hear it said aloud, they don’t call medicine a “practice” for nothing.

You can click here to visit Patty Khulys website