Improving Efficiency

Enter any veterinary practice across North America and you are likely to be faced with a common scene: employees performing tasks for which they are over-qualified, new hires leaking confidence due to a lack of training and tasks being repeated due to a lack of communication.

Reports from the AVMA’s 2021 Veterinary Business and Economic Forum support that this is a common issue — only a very small percentage of small animal veterinary practices are considered to be highly efficient. In a profession dealing with exhaustion, overwork, burnout, retention issues, staffing issues and profitability concerns, wouldn’t improving efficiency go a long way to addressing the challenges that are plaguing veterinary practices? Simple changes and improvements can have a multiplicative impact on practice efficiency.

Rather than focusing on a specific practice, this case report will pull back and address common issues affecting practices around the globe as they lose the struggle against inefficiency.

The Diagnosis

Inefficiency in a veterinary practice comes from many sources:

1. A lack of processes that are used to accomplish repetitive tasks the same way, each time, every time, all the time, without fail
2. Lack of effective onboarding and orientation and subsequent short-term and long-term training
3. Poor and insufficient communication on the issues that cause inefficiency (see 1 and 2 above)
4. Poor delegation and optimization of human resources

Without processes, every task is reinvented every day and, in many cases, performed differently by different people with different and unpredictable outcomes.

Without training, new hires are set afloat without guidelines as to what it takes to be successful, thus setting them up for failure. Additionally, lack of training to the processes means new hires will create another way of doing things that might deviate from expectations.

Without communication, nobody on the team really knows what is working or not. The lack of leadership leads to people doing what they’ve always done and expecting a different result. You know what that defines.

And finally, without delegation, leveraging and optimization, the best person for the task in question is not always the one performing the task. This may lead to high-end people performing low-end processes when they would be better served focusing on what has the highest return on their knowledge and expertise.

The Treatment

Remember these three Ps when addressing inefficiency: Processes, People and Practice.

Have a staff meeting to discuss what processes team members consider inefficient and get them on board to help create solutions. In many cases, they will identify the need for consistency, training and delegation on their own. Once they have defined the problems, the solutions are obvious. Start by creating processes for the 80% of things you do repetitively every day. These include answering the phone, cleaning cages, checking in clients, paying bills, running lab work, etc. You are starting to create a system for how everything is to be done. Identify the people you have or the people that you need to deliver the systems. They may or may not need any veterinary hospital experience if they can learn the processes that you are creating. Using the newly created systems, you have concurrently created training modules for onboarding a new hire.

The most profitable and successful businesses have learned how to leverage their team. Identify the tasks that only doctors should do and the ones only credentialed technicians should do, and then figure out what everybody else can do with the help of training, teaching, coaching and delegation. Let people do what they do best and seek to delegate the rest!

The Implementation

1. Document the major processes that your practice needs to get through every day in the areas of client service, patient service, team experience, management and maintenance. Stop guessing and start recording what you want done and how you want it done.
2. Using the processes created, start training the entire team to perform the tasks as desired. Schedule formal training sessions for new hires and invest in ongoing training of existing staff members.
3. Leadership meetings and staff meetings should be conducted to identify what is working well and to improve on what needs to be fixed.
4. Delegate to those you have trained and to whom you can trust everything and anything that can be handled within your state practice act and your comfort level.
   1. Consider an exam room scribe. In human health care, reports show scribes save doctors two hours of medical recordkeeping per day.
   2. Consider an exam room advocate. In the same way that dentists use their registered dental hygienists and pediatricians use their nurse practitioners, a significant portion of what veterinarians currently do can be done by well-trained non-DVM team members.
   3. Consider hiring a practice manager to do the management tasks that infiltrate your daily efficiencies.
   4. Whenever possible, identify high-tech solutions with high-touch implications. In other words, if there is an app, software or tool that streamlines and saves time while concurrently not dehumanizing the experience, give it a try. These may include apps for online appointment making, controlled substance tracking, automated marketing, and the list goes on.

When it comes to improving efficiency there will be some slowing of the systems initially while ramping up new processes, new tools and improved delegation. But the time climbing the hill will be more than made up with the efficiencies and time savings when you get to the top of the hill and enjoy the ride down.

The Results

Ultimately, with a more efficient practice, you will find:

• More consistency
• More predictability
• Cost savings
• Time savings
• Greater staff satisfaction
• Greater client satisfaction
• You get home for dinner
• You make more money
• You have more fun!

Final Takeaways

In the early 1990s, I read Michael E. Gerber’s “The E-Myth” and “The E-Myth Revisited.” They changed the way that I looked at my practice and looked at my life. The concepts of systems and processes delivering a predictable and consistent client, patient, staff and management experience still resonate with me. The fact that good people with good processes can create great outcomes plays out every day around the globe.

Even with the complexity of a veterinary hospital, simply integrating defined processes will improve productivity. When you add training and delegating, you can create a very well-run machine that is thriving on control instead of wallowing in chaos.