Increasing practice efficiency: 3 important rules from an experienced practice manager
Communication, protocols and technology are the only things that can improve practice efficiency.
Tanja Mimica B.Sc. MBA an experienced vet nurse, practice manager and operations manager for Greencross and Vetwest Animal Hospitals covers 3 important rules in increasing practice efficiency.
Importance of good communication
I have worked with some practices that are performing very well financially, and others that are struggling to break even. I would go as far as to say that all the differences between them are rooted in communication.
- when vets communicate well with clients, it leads to acceptance of treatment plans;
- when the practice owner or manager communicate their vision and values well with the team, it leads to staff engagement;
- when the staff communicate well with each other, it improves efficiency in the practice, eliminates conflict and creates a more positive work environment.
- when staff members communicate well with clients, the number of client complaints decreases.
It doesn't matter whether you have a fancy new piece of equipment, great marketing material or the best surgeon - if your team is not communicating effectively, your practice is not going to be profitable.
Differentiating the way you practice
Pet owners can really only differentiate practices by the level of customer service they receive rather than veterinary competency. How do you define exceptional customer service?
That is 100% true, but I think some practice owners don't recognize that.
Here's an anecdote: My partner James, who is not from the vet industry, and I took our dog Alex to the vet a few weeks ago. He was really sick, so we saw about 5 vets in 3 hospitals within a period of 36 hours. After each consult, my partner commented on whether he thought the vet was ‘good' or not.
From a medical point of view, they were all great and Alex received excellent treatment.
After I quizzed him a little to find out what he based his opinion on, it was clear that it had nothing to do with judging their professional skills but purely whether he thought the vets ‘seemed like they cared about Alex'. Now, I'm sure they all really did care about the patient, so the only difference was how they communicated.
In our industry, customer service is almost entirely about how well we communicate with clients. Exceptional customer service means letting your clients know you care about their pet.
It's the old saying ‘they don't care how much you know, until they know how much your care' - cliche but true.
Pet owners complain that veterinarians are expensive but really it is just a perception of poor value for money.
Again, it's about communication. It doesn't matter what you have done for Fluffy, if you haven't communicated that to the client and explained the benefits for Fluffy.
Vets and nurses do great work every day that delivers value to clients, but unfortunately clients don't always see that, so we need to get better at communicating. We take patients to the hospital area and call it "out the back” - that term alone diminishes the value of our professional services. We chat to the client about their work while performing a 12 point check, so the client never realizes what you're actually doing for their pet.
A dental cleaning is a good example of this, and I know the uptake of dental prophys is a big challenge for many practices.
The vet looks at Fluffy's teeth and says "He needs a dental cleaning" The client's first question is "How much will it cost?";. So we give the client an estimate of $800, they either refuse on the spot or walk away with the estimate and never book the procedure. In this scenario, the vet has not demonstrated value, they have quoted the cost.
The first thing the client cares about is why their pets needs this - how Fluffy feels now, how he'll feel if the procedure isn't performed, and how he'll feel after it is performed.
The second thing the client cares about is why it ‘costs so much' - especially when they have their own teeth cleaned at the dentist for $100. You have to explain the procedure in order to demonstrate value. Start at the beginning, from admission to pre-meds, to the GA, to post-op monitoring...all the way to the discharge appointment and the revisit.
Demonstrating value is about helping the client understand the benefits of the procedure to their pet and what the procedure involves, while communicating in a way that lets the client know you care.
It sounds really basic, but the reality is that many practices are not doing this.
You can demonstrate value after a routine wellness check by summarizing what you have done (12 point check) and offering digital discharge instructions prior to giving the client the bill or by performing nail clips and anal gland expressions in a consult room with the client present, just to name a few.
Technology can play a key role in improving practice efficiency by reducing the amount of time or effort to perform a task.
When it comes to practice management, I don't think we take advantage of new technology enough. From allowing clients to book appointments online and using new communication tools in the practice such as Slack, to automatically sending client surveys after appointments and using Hootsuite to schedule posts across all social media channels….there is so much we can be doing to reduce time spent on administrative tasks.
When integrating technologuy, give your staff plenty of notice, put together protocols and offer lots of training!
Change is hard and it's scary. No one likes change. When change involves new technology, it can be particularly difficult for team members to adapt because it generally requires changing habits that have been formed over time, and learning an unfamiliar software.
The overall process you would follow is similar to the one I described earlier about implementing follow up calls. Explain why, involve the staff in the process, document protocols, offer training, review, encourage feedback and be prepared to amend procedures.
When implementing new technology, it's particularly important that you document the new protocol in a written policy and procedure. That way, team members can refer back to it if they are having difficulties.
You may also need to inform clients of the change, or let them know that your staff are learning a new program, and thank them for their patience.
Prepare your staff for hiccups along the way. This means setting realistic expectations that they may experience frustrations with using the new technology. That way, when things do go wrong, you can say "great, this is what I was talking about, we knew this would happen, let's find a solution and move forward”
One other thing comes to mind that relates specifically to VetCheck and client handouts: get rid of the printed handouts once you start using the digital version. When people are given the opportunity to go back to the old, familiar way of doing things, they will use it. If they have no alternative but to use VetCheck, they will eventually form new habits.
Finally, make it easy. If using the new technology involves 7 steps, yet the old method involved only 3, it's difficult to justify why the new way is better.
Implementing new protocols
Whether it be follow up calls, forward booking appointments, sharing important health information or discharge instructions, practice owners and managers have to get the team to buy-in to each new protocol, policy or procedure.
Far too many managers simply tell their staff what they have to do. "Book follow up calls after every surgery" - without explaining why follow up calls are important. Vet nurses care about animals and they want to do the right thing for their patient. If you explain 'the why', offer training and tools to perform the duty, they will do it.
If you as a practice owner or manager are complaining your staff aren't doing something - take a look in the mirror: you have to change your approach.
Techniques to increase team compliance
It's best to involve the team in the design of the new protocol.
To continue with the example of follow up calls, the manager would hold a team meeting and explain why follow up calls are important, from a patient care point of view. This is really important - bring everything back to patient care, that's what we're all here for.
The team could then brainstorm together on the best time of day to conduct the calls, who is going to be responsible for doing them each day, what is going to be said over the phone, how it will be recorded in the patient history and so on.
The manager should then use this information to create a written policy for follow up calls, and roll it out to every single team member.
But it doesn't end there - you can't just 'set and forget' - the manager needs to identify if any team members require further training in this area, and follow up with the team after a reasonable period of time, say one or two months. Team meetings are a great time to review policies, identify issues and amend protocols.
You have to create a practice culture that is inclusive and allows each team member to voice their opinion and contribute. As a vet and practice owner, you may think that it's a good idea for the receptionist to do follow up calls in the morning. But if you don't include the receptionist in the feedback loop, you'll never find out that the receptionist is slammed in the morning with admissions and clients are too busy to talk because they are getting their kids off to school. There it is again - communication!
The Practice Manager's Role
Practice managers and consultants can bring an enormous amount of value to the practice. I think there are a number of barriers practice owners face when thinking about whether to get help running their practices.
Cost is one of those barriers.
The bottom line is, a good manager will pay for their wages twice over...at least. Whether it be through improving client retention, increasing the number of active clients, training your team, improving practice efficiency or reducing staff turnover - a good manager is an investment with an excellent return.
Many practice owners, once they decide to hire a manager, promote their head nurse. This isn't always a bad idea, but it shouldn't be the most obvious choice. In fact, in most scenarios it doesn't make sense - if you have a great surgical nurse, why take her off those duties and move her to a completely different position, one that doesn't even utilize her technical skills?
We also have a real problem in the industry with overworked practice owners who are running underperforming practices and not doing anything about it. We have a high rate of depression and suicide, as well as young vets exiting the profession.
It doesn't have to be this way. Vets are high achievers, so it makes sense that they think they should be excellent business owners. But they are two completely different professions, and it's near impossible to be the best in both. So, practice owners either need to get someone to help them run their business, or hire another vet while they work on the business.
About Tanja Mimica B.Sc. MBA
Tanja has almost 15 years experience in the vet industry, having worked as a vet nurse, practice manager, and more recently as business operations manager at Greencross and Vetwest Animal Hospitals.