Practice Management News and Views from around the World – December 2017

Pets are Awesome at Sports

New cities mean new options for veterinarians.

From an article by Mark R. Hafen published on his website

For years veterinarians have been told, and have told themselves, that the best or only place to build a veterinary practice was in suburbia. This might have worked in the 1970’s, and even up through the Great Recession of 2008, but it doesn’t work anymore. In the beginning there were few enough vets in suburbia, and there was plenty of land, so that a new aspiring veterinarian could find space and market to support him or her. In suburbia veterinarians would find lots of young families, kids, and of course pets. But the dynamics and the demographics of our cities and suburbia have changed.

Suburbia is no longer the golden goose for veterinarians.

For a while now I’ve been watching the millennials moving into and taking over our inner cities. But I really couldn’t put my finger on the extent and rationale behind what I was seeing and sensing. Now I have the data to back up my feelings.

The Demographics Research Group of the Weldon Cooper Center for Public Service at the University of Virginia recently published a study: The Changing Shape of American Cities.

It’s a well thought out and fully documented explanation of how our cities have changed. On the most basic level the UVA study found that our cities used to be what they called an “old doughnut” where the “hole”, or center, was poverty, minorities, and elderly. Then as you went out from there in ever broadening circles, you found increasing affluence, until you came to the edge and found suburbia.

So it made sense for veterinarians to go to suburbia- that’s where the money, families and pets were.

But now if you look at our cities, you will find the “old doughnut” model of our cities has changed.

Yes, there has been continued growth in what the UVA study calls “outer suburbia”, but outer suburbia is growing less quickly and is more inclined to be older. In fact the “greying” suburbs potentially have less income to spend on pets.

Even more importantly other parts of our cities are taking on more dominant roles.

Millennials with money have moved into the core city center

An exurbia has sprung up beyond outer suburbia

The older inner suburbia has become both denser and dramatically less affluent.

The UVA study calls this the “new doughnut” model.

But regardless of what you call it, and even discounting why it happened, the bottom line is that for veterinarians there are now alternatives to landing in suburbia

Let’s look at the options:

Millennials in the center

All across the US you see millennials moving into the inner city. I don’t blame them, that’s where the action is. The inner city population is growing gigantically. This population values “lifestyle”, is educated and trending toward affluence. They are beginning to grow families, and they are getting pets – small dogs, cats and even exotics.

For veterinarians the inner city is the place to find a small, odd ball lease space, and set up a “fast casual” lifestyle-based neighborhood veterinary clinic.

The inner city is a great place to be and as the millennials age, it will only get better.

Exurbia beyond Outer Suburbia

Beyond “outer suburbia” now lies a new land of “ranchettes” and “mini-estates” often occupied by older Boomers who are willing to drive an hour or more into the city, or younger more affluent “telecommuters” who want to live the “organic” lifestyle. Sitting on mountain tops (in Colorado) or out in the country they have dogs and cats, but they also have horses, llamas, goats, and chickens. They also have money, and they too value “lifestyle”.

For a veterinarians considering a practice in exurbia the only problem is the lack of population density in “exurbia”- there isn’t any! In exurbia it is hard to find enough people in one spot to justify building a veterinary clinic. A simple solution for veterinarians wanting to locate in exurbia is to start a mobile or “house call” practice. Frankly, I think the “house call” clinic is the answer, because without a van you have less overhead, and a “house call” clinic more closely matches the lifestyle of exurbanites.

Inner Suburbia, dense, low income enclaves

Outer suburbia grew because people moved out and away from the new suburbia they had originally located in after World War II. In leaving they left behind neighborhoods that were under appreciated and undervalued. These neighborhoods became a good place to buy a small inexpensive freestanding house. Because of the inexpensive house, many of these neighborhoods attracted less affluent, minority populations.For veterinarians these inner suburban neighborhoods offer a whole new opportunity. These neighborhoods are dense with population. These neighborhoods are also full of extended families, they own (primarily) dogs, and they are dramatically underserved by the veterinary industry.In inner suburbia a low cost, high volume, practice without appointments, primarily dealing in cash (not credit) and geared toward crisis and emergency care will often thrive. A young veterinarian looking to open a practice in the inner suburbia can often find an older, trending downward, existing clinic to buy for very little. The aspiring veterinarian can then revive it and prosper!

Outer Suburbia: grey and static

This leaves us with what used to be the only option- suburbia. Yes, suburbia is still growing, but it is also growing older, and it is turning more into an “empty nest” enclave.

Because so many in outer suburbia will be on fixed or limited incomes disposable income in outer suburbia is trending toward a flatter profile. Outer suburbia is also not growing as fast as it had been growing. Fundamentally, the newer generations don’t want to spend their time commuting.

Suburbia also isn’t where the action is. This doesn’t mean that veterinarians should abandon suburbia. Instead veterinarians should look at “tweaking” their approach to serving suburbia.

Instead of tending toward families, it will increasingly be important to tend to the old: both client and pet.

Many Boomers built practices in the outer suburbia and with time these practices will increasingly be coming up for sale. Young veterinarians should be cautioned to not pay “too much” for a practice in outer suburbia where the demographics are trending toward a flatter curve.As you can see that the veterinary industry, and young veterinarians now have options, either or both.

Probably the most exciting is in the inner city, but the most underserved is in inner suburbia.No matter where in the city veterinarians locate their practices, there are bound to be trade-offs. In fact there is even the possibility that you can mix in the options. You could live in exurbia and have a practice in inner suburbia. The “new doughnut” model of our cities doesn’t mean the end of suburbia, but rather the beginning of a greater diversity of people, and with that more opportunity, and more excitement and options for everybody, including veterinarians.

You can click here to visit Mark Hafen's website

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5 Signs You're Sabotaging Your Work-Life Balance

From an article by Andro Donovan published on the Management Today website

We can be our own worst enemies sometimes. We want fulfilling lives and a work-life balance, but do we ever ask what that means, what really matters to us? Knowing the values that are important to us means we can make the right decisions for our own wellbeing. Not knowing them leaves us at risk of self-sabotage.

This can manifest in various forms, but here are five common ways we spoil our own work-life balance.

1. Not taking a vacation or using your annual leave

This could be because you love your work or worse because you’re a martyr to the cause. You may be not believe things can work well if you’re not there – or perhaps you’re concerned things will run too well. Whatever the reason, taking a proper break from your day job will give you the space to recharge and see the world through a different lens. This in turn can contribute to you coming up with new innovative ideas.

2. Allowing Your Work to Bleed into your Recreation Time

This is both at home or indeed on holiday. You may have physically gone on holiday to a far-off land only to remain plugged in to your office through your phone. Technology addiction is real and it’s affecting our mental health. Dr Mary Aiken, author of The Cyber Effect, believes that the average person checks their phone 200 times a day. You have to get unplugged to fully benefit from your recreational time. If you are constantly checking into your messages and e-mails you are not fully engaged with your hobby, your family or your other half.

3. Prioritisng the Urgent Many over the Vital Few

Work-life balance seems to imply that we need to have equal amounts in both camps. Rather than asking ‘how do I create work-life balance’, perhaps a more valuable question is ‘what lights me up’. What gets you out of bed, what are you doing and with whom when you feel most happy, satisfied and fulfilled? Once we have understood the fundamental aspects of the life we value we can prioritise these vital activities that nourish us at a deeper level, over the many urgent activities that demand our immediate attention but conspire to leave us feeling empty and unfulfilled.

4.Not Having a Plan

If you do not have a plan you are planning to fail. If you want to achieve work-life balance, you need to let go of the old construct of an equal division of time and instead examine all areas of their life (work, family, recreational, health, etc) to decide what it would look like to balance each area so you are living their most effective, present and fulfilling life.

5. Running on Empty for Too Long

Ignoring the signs of stress can lead to poor mental and physical health. Many of us are so busy leading frenetic, overscheduled lives that we have stopped breathing properly, only using the upper chest area. This is a common stress side-effect which may lead to stiffness in the neck and shoulders, migraine headaches, back aches, stomach issues and anxiety attacks.

Everyone has a choice. If you find yourself neglecting your most important relationships – including with yourself – maybe it’s time to re-evaluate how you are leading your life.

Looking after yourself is a daily choice. It is important to create regular rituals and routines to keep you on track.

You can click here to visit the Management Today website

Don't call it a dental!

From an article by Brendan Howard published on the dvm360.com website

Prioritize preventive care on patients' teeth with a new acronym: COPAT.

The veterinary dental visit is not complete until a discussion is had with the client detailing how to keep their pet's mouth clean and how to minimize recurrence of the disease. A few months ago, two veterinary dentists, a president and a past president of the American Veterinary Dental College, sounded off on their favorite terminology for careful examinations and subsequent treatment.

One of those dentists now wants to make a national pitch for a new acronym to cover it all and put preventive care first: COPAT, or comprehensive oral prevention, assessment and treatment.

After all, argues Jan Bellows, owner of All Pets Dental in Weston, Florida, prevention is already No. 1 for human dentists. He knows that's still not true for many veterinarians, even though he thinks the change is coming.

Client pushback not problem No. 1

Pet owners push back on the need for dental examinations, cleaning and treatment under anesthesia, sometimes for money reasons, sometimes because the value hasn't been explained, sometimes out of fear of anesthesia. But Dr. Bellows thinks the biggest road block to switching from a "treat now, prevent down the road" mentality to a prevention-first mentality is work flow."If dentistry is handled as it should be, the animal has to be anesthetized and probed, and we need radiographs for those 42 little patients in the dog's mouth, and 30 in the cat,"

Dr. Bellows says. "That means veterinarians need to find the time and space to do it."

Many practices have only one table, so where do the two to three dental procedures that need multiple extractions a day go?"We're seeing this problem of not enough space for dental care in practices with veterinarians embracing wellness plans, where preventive dental work is included," he says. "Expense isn't as big a problem as it used to be in those situations, because the routine cleaning is covered—anesthesia, IV, blood work."

So, is there an easy solution to the workflow, staffing and time crunch in revving up more dental work?

"Years ago, we came up with oral ATP—oral assessment, treatment and prevention—which is exactly what we're often doing. We assess the patient and mouth under anesthesia, then we treat, and talk about prevention," Dr. Bellows says. "What many of us are doing today is different than what human dentists are doing.

When our patients come to us, they have halitosis, indicating disease under the gum line already."What he thinks the future could hold, however, is more like the human dentistry model, where patients show up once or twice a year for preventive examinations and cleanings, instead of waiting for problems to develop.

"We see dogs as young as 3 years old with periodontal disease," Dr. Bellows says. "How many people between 25 and 30 start losing their teeth? It doesn't happen, because we brush and floss and go to the dentist to have our teeth cleaned

Ready to put client education out front on prevention with COPAT?

Start brainstorming your favorite client messaging now. “Our dentistry service is now perfectly COPATcetic,” anyone?

You can click here to visit the dvm360.com website

Choosing a Practice Management System…

From an article by Mark Colton published on the VetDynamics website

Given that the career path that led me to Vet Dynamics included 6 years as Head of Operations with Companion Care, Vets4Pets and RxWorks, I suspect it’s hardly surprising that I frequently get asked the same question by our clients, and people across the veterinary profession….“What is the best or most effective Practice Management System (PMS)”, and even, “which Practice Management System will generate me the most revenue”?

Which, in itself, sort of misses the point really.

Anyone who has spent any time working with Vet Dynamics over the years will fully understand that the data, although very important, is only part of the story. The real gift is in understanding and interpreting it, then utilising the information to drive sustainable change in capability and behaviour across your team. Thus, delivering the very best standards of animal medicine and subsequently revenue generation, client satisfaction and ultimately client retention and loyalty.

Sadly, there is no ‘magic wand’ or short cut, and it is a ‘cocktail’ of all of the above.

The reality of any PMS system is, that fundamentally, they all do the same thing. They all look a bit different and many people will obviously express a preference for one, rather than another. Some will be cloud based, some will be server based, some will charge a fee at the outset, some will charge you a yearly rate, some are based on your turnover, some on the amount of transactions. But as I say, they all do the same job. Therefore, ultimately the answer to which is the ‘best’ and which is the ‘most effective’ for your practice will be dependent on you choosing the system that is best suited to your needs as a practice, your interface preferences, and the benefits you will get from it.

There really isn’t a right answer, just potentially some very wrong answers for you and your team if you get it wrong. My recommendation is that you ask your prospective new provider to let you have some details of existing clients. Ask for some data on how long their average response time is to calls, how many outstanding ‘tickets’ they have in their queue (a ticket equates to a service call), how often the system releases up-dates, what provision is in place if you need to call them at weekends or outside of office hours, bank holidays etc. And then consider all of this as part of your thought process. In terms of costs, my experience is that they really all cost the same in the long run whichever you decide to choose. Speak to your team, and any contacts that you have in other practices to find out their views on what they have previously used or, are using now. Ultimately the key question is “would you recommend your PMS system to me?”.

Be wary as you contact the sales teams though, as I am sure there will be plenty of special offers and trial periods. Sadly, you know what they say about a free lunch? It is part of the strategic plan of many of the PMS providers that they know the most painful thing you can do in any practice is change your PMS system, and, sadly they hope that you will not be inclined to change and consequently then stick with them.

One of the other things to be wary of is the added on non-essential services or, maybe even data analysis tools that are offered or discussed during your negotiations with your current, or proposed supplier. Will they really add any value to your practice and your ability to measure and drive performance? Some of the options I have seen over the last few years are pitiful, whilst some, at the other end of the scale, suffer from information overload, a sort of ‘analysis paralysis’ if you will? Offering all sorts of data, very little that is of any use, that looks compelling but ultimately is meaningless.

Many of the larger PMS providers will charge you extra for this with a view to then selling on additional “solutions” to you.Many of these systems are built and designed by exceptionally talented code writers or programmers. However, from the PMS system providers solutions, either offered as “free” or as an additional product to purchase, I have still to see one that has been designed and tested extensively by veterinary professionals or teams of people that understand the veterinary profession. In particular the mindset of the people involved, the challenges & opportunities they face, and finally the true ‘Key Performance Indicators’ of the profession. As previously mentioned, many of the PMS provided analysis tools are used as an opportunity for the supplier to further sell in additional services such as marketing.

Ultimately, as you will no doubt appreciate, any data analysis involved needs to be relevant and based on metrics that measure the behaviours that you want your team to exhibit in the consultation room, and those that will ensure the very best animal medicine is delivered in your practice and that your colleagues charge this on properly.

So, what is the answer to getting the Key Information you need from your PMS system? As of today, we are aware of 23 PMS providers in the UK that all deliver the same core function, but, as launched at our conference in September, ‘The Index’, provided by Vet Dynamics, is agile and effective enough to deal with these, and because of the benefits of working with Vet Dynamics we are able to ensure that when we are using benchmarking data we can do so safe in the knowledge that any KPI is being measured accurately, regardless of the PMS system being used.

You will be surprised how difficult it is in any PMS system to measure accurately based on the differing descriptions and spellings used in practice. I have seen one which had 31 different spellings of one breed!

The new architecture of ‘The Index‘ also enables practices, for the first time, to look at individual clinics in multi-site premises, also affording the opportunity to drill down to individuals’ performance, enabling in turn the analysis of poor performance and the ability to identify development opportunities within your team. And this, is where the true ‘gift’ of business performance analysis lays.

Affording you the opportunity to ensure:

  • That all your clients are getting a consistent message in the consult rooms
  • That all your patients are receiving the very best levels of care that they deserve
  • That you maximise the profitability of your business

There are a number of potential outcomes once you start to analyse and manage performance of individuals in your practice. Generally, these fall into one of two strands; capability or attitude, and there is a degree of inevitability that as soon as you start to measure and compare performance, you find yourself in a position where you need to address poor performance. This should never be a reason to avoid reviewing performance, and remember, your coach will always be able to assist you on the best way forward. It is generally my experience that unless you already have concerns about someone’s attitude, then anything ‘uncovered’, through any kind of benchmarking amongst your team will be a ‘development’ opportunity that will improve capability, as well as improve financial performance.

You can see it’s easy to spend a lot of time pondering and thinking about what is the best PMS system for your practice, and like many big purchases, it can be a costly mistake.

Going back to my original questions, “what is the best PMS?”, ultimately that is a question that only you and your team can answer. You need to determine that it will enable you to feel comfortable that you are being able to offer the best levels of care for your patients and generate the levels of revenue your business requires to meet your profit plans.

Remember, fundamentally they all do the same job. It’s using the system to get the results that you want that counts the most, rather than expecting the system to solve all of your challenges!

You can click here to visit the VetDynamics website 

6 Ways to Empower Your Veterinary Team

From an article by Mark Opperman published on his website

It’s Monday morning and as your clinic comes into sight, you see that the parking lot is full. Inside you see a lobby full of clients and pets. Whether you are the receptionist, the technician, the veterinarian, or the hospital manager – you know that need to hit the ground running.

Now imagine two distinct scenarios...

Scenario #1:

You start to get anxious knowing that you are going to be the one picking up all of the slack, doing everyone’s job, and have an exhausting day that will extend well beyond your scheduled shift.

Or:

Scenario #2:

You are excited for an action-packed day; you can’t wait to get into the clinic and lend a hand. Time will fly and before you know it you’ll be heading home, satisfied that you had a productive day.

Scenario 2 is the well-managed practice, where each member of the team plays an integral role in keeping the hospital moving in a positive direction.

An important element of this model is empowerment.

  • 1. Make sure each team member knows exactly what is expected of them. This includes a detailed job description and a comprehensive phase training program. Check back with employees frequently to ensure they have the tools and equipment needed to do the job.
  • 2. Communicate with your team on a regular basis. Monthly staff meetings keep everyone informed about clinic updates. Hold training sessions, create monthly newsletters and keep an up-to-date hospital policies and procedures manual. Communication becomes especially important when there are changes on the horizon.
  • 3. Get your employees involved in planning and decision-making, when individuals are engaged in the processes they are more likely to take responsibility. Start by letting them make small day-to-day decisions and see how much more invested and productive they are in their responsibilities.
  • 4. Give your team members frequent feedback. Give positive feedback soon after they have performed well and, if an area needs improvement, it should be discussed right away. Make sure you say ‘thank you’ for a job well done and recognize a team member who has surpassed expectations.
  • 5. Be fair and respectful to your team. Being thoughtful in challenging situations and resolving conflict creates a supportive environment for your entire team. If you have erred, own up to your mistake and apologize – your team will appreciate your honesty, better relate to you, and respect you that much more.
  • 6. Learn to trust your team. You need to create a culture of support and trust. Allow your team the freedom to do their job without continual micromanagement – but be sure to check in and ensure everything is running smoothly.

Creating a positive, supportive and fun work environment, where your employees feel valued and heard, will lead to empowerment and result in clinic success. When your team is empowered, your clients receive quality services, your patients get the best care, your clinic prospers, and your days run smoothly.

You can click here to visit the Veterinary Management Consultation website