Mark Opperman
CVPM
Practice Smarter columnist Mark Opperman is the president and founder of Veterinary Management Consultation Inc., director of veterinary practice management at Mission Veterinary Partners, and founder of the Veterinary Hospital Managers Association. His column won first place in the Florida Magazine Association’s 2020 Charlie Awards.
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Here’s an interesting question for you: How do you know if you and your veterinary hospital are efficient? According to one definition I found, efficient means “achieving maximum productivity with minimum wasted effort or expense.” What does that mean in a veterinary environment? Let’s identify specific areas in which you can evaluate efficiency.
Goal Achievement
Definition: The ability to consistently accomplish tasks and objectives effectively and on time.
Do you set goals for yourself and others and then monitor the progress? Many experts say goal planning is the key to success. However, how will you know if you achieved a goal if you never identified it?
One way some hospital managers and owners establish goals for their practices is to hold an annual employee retreat. It’s typically done off-site so the entire team can focus on the hospital and work together to develop reasonable goals.
Every day and weekly, you should have a checklist of tasks to be completed in the practice and set the goals you want to be accomplished during the week or month.
When establishing goals, make them SMART, an acronym for specific, measurable, actionable, realistic and time-bound. Saying you want a more profitable clinic is admirable, but it isn’t a SMART goal. Instead, your goal should be specific and measurable, such as “Increase average client transactions by $10 in the next 30 days to improve practice profitability.” Those details constitute a SMART goal and hopefully are achievable.
Waiting Time
Definition: How long before clients and patients receive attention.
This area is a good one for evaluating veterinary practice efficiency. You can break waiting time into three categories: client service representatives, technicians and doctors.
When looking at the reception area, monitor the time taken to admit or discharge patients. Many practices track it by noting on the check-in report when clients arrive and their appointment times. Then they record when a client and patient are escorted to the exam room.
Next, monitor the time spent before the exam room assistant or technician initiates the visit. Many practices place a timer outside the door to record the statistic. The timer starts when the pet owner and patient are placed in the room, and the exam room assistant can see how long they have been waiting.
I also suggest measuring how long the assistant or technician spends with the client. If you schedule a 20-minute appointment and the assistant takes up 15 minutes, the doctor doesn’t have much time left. A good rule of thumb is the assistant should consume no more than one-third to one-half of the time allotted for the appointment.
Next, we need to evaluate the efficiency of the doctors. How much time passes between the assistant leaving the room and the doctor entering? Then comes the question, how long is the doctor in the exam room? Once again, if we have a 20-minute appointment and the entire visit takes an hour, we have an efficiency problem, along with upset clients and team members.
Many practices have found that 10-minute flex scheduling helps resolve such a problem. Instead of having all appointments scheduled for a set period, like 30 minutes, flex the schedule to fit different types of cases. You might plan 10 minutes for a medical progress exam, 20 minutes for a wellness comprehensive physical exam and 30 minutes for a sick patient visit. You also might set 40 minutes for a second opinion. This method makes much more sense than trying to fit every appointment into 20 or 30 minutes.
Staff Productivity
Definition: Monitor the productivity of veterinarians and support staff and evaluate the efficient utilization of their skills and time.
This one is big. How productive are your doctors and team members, and how do you gauge it? One way is to monitor a veterinarian’s professional client transactions (PCT), or revenue directly attributable to the doctor. Don’t include food sales and boarding and grooming income in the calculation because the doctor must be directly involved in a service to receive credit.
When looking at a doctor’s PCT, compare it to other doctors at your practice and national averages. A slight boost in PCT can significantly improve a practice’s profitability. For example, if a doctor increases the PCT by $20 and invoices 3,000 cases yearly, revenue jumps by $60,000.
How can you help a doctor become more efficient and, thus, more productive? Through better leveraging of the team. Leveraging refers to the ratio of full-time employees to full-time veterinarians. The typical ratio is 3-to-1, but it could be 5-to-1 or more in a highly leveraged practice.
In a highly leveraged practice, the doctor would not place an IV catheter, take radiographs or flush an ear. Instead, a technician or veterinary assistant would do those tasks.
Understand that leveraging isn’t simply a matter of adding staff members. The team must be well trained, and employee competency needs to be commensurate.
Teamwork and Communication
Definition: Efficient hospitals foster clear communication among team members, leading to better coordination and improved patient care.
I doubt that many people would disagree that communication and teamwork increase efficiency. However, what are you doing to improve communication in your hospital? Many practices have morning huddles. A 24-hour hospital might hold meetings at shift change. The time spent huddling is rewarded through greater efficiency.
All team members should participate in huddles when possible. During the session, go over, for example, the day’s anticipated activities, appointments, surgeries and dental cleanings. Any policy changes or updates can be shared then, leaving everyone better informed.
I should add that writing and updating job descriptions is critical for effective communication. Team members need to know what you expect of them, and they should receive adequate training. Performance reviews are vital in providing feedback to employees. Conduct detailed reviews at least once a year. Some practices find that quarterly reviews significantly improve team member communication and morale.
Client Satisfaction
Definition: Is the hospital meeting client needs?
Feedback from pet owners provides valuable insights into a hospital’s efficiency. You might think your clinic provides excellent customer service and medical care, but what do your clients think? Getting their feedback is essential.
Actively seek client feedback instead of waiting for a negative online review. Consider texting or emailing pet owners after a visit to solicit their input. Don’t worry if you only get a 20% or 30% response. You will hear the good and the bad, helping you keep a finger on the pulse of your practice.
FAMILY GET-TOGETHERS
Team meetings foster effective communication. I recommend that veterinary practices hold an all-hospital meeting at least once a month. The best time to assemble is when nearly everyone can attend. Many practices do it over lunch. Consider scheduling recurring meetings for a specific day of the week, say the first Wednesday of each month. That way, team members can arrange their schedules well in advance. The discussion should have an agenda and not last longer than 90 minutes. For historical accuracy, keep meeting minutes. Many practices record meetings on video and require anyone who misses a session to watch it within 24 hours when possible.