1 Jun 2021
Coronavirus turned the world upside down in a matter of weeks and it has pretty much kept it there ever since. Many things changed in the veterinary sector over the past 12 months, but, as Alan Robinson explains, the key drivers for practice growth have stayed the same...
Alan Robinson
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Image © Seventyfour / Adobe Stock
During COVID, veterinary consultations are taking longer, and are often rushed and not focused. Typically, vets are already busy and running late, so they rush people or pets in from the car park.
They jump into the clinical exam, try to diagnose as quickly as possible, instigate treatment and diagnostic procedures, and then move on to the next consultation.
Does this add value to the clients’ experience? What opportunities are we missing?
Typically, we have found that areas that have always been an issue for vets have become even more relevant in this COVID-focused world.
Let me tell you the secret to success… the secret is, there is no secret; no new way of working or secret formula. Our circumstances may have changed, but the challenges presenting themselves are still straightforward.
The lack of face-to-face time with our clients simply exasperates and amplifies common challenges:
[1] Discounting professional time – selling yourself at too low a rate and not charging for everything you do.
[2] Not listening to the clients’ concerns with empathy and compassion.
[3] Failure to recommend treatment – not doing the work presented and needed.
[4] Inability to practise suitable protocols and follow up casework appropriately.
The biggest challenge for vets in this new COVID world is recognising that while our professional and personal lives have been turned upside down, actually the best way to balance practice growth, team resilience and clinical quality is one of the few things that hasn’t changed.
All these elements start, and are resolved, in the consulting room. The key to veterinary success is about getting back to basics and understanding how to achieve results – without the human contact we took for granted when expressing ourselves and building relationships in the pre-COVID world.
To optimise the opportunities in each consultation, we need to measure and monitor performance, per practice and per vet, set accurate pricing – including professional time – and have systems to manage the outcomes of any consultation.
Every clinical consultation has four clear outcomes to achieve (Panel 1).
Panel 1. The ‘four Cs’ of consultation[1] Clinical care of the sick animal. Diagnosing and recommending the most appropriate treatment is the vet’s responsibility.
[2] Costs incurred by the recommended treatment is the client’s responsibility – not the vet’s. Vets should charge correctly and offer solutions such as carefree credit where required. If clients cannot afford their vets’ services, vets may have to adjust their clinical input.
[3] Compliance relies on certain things happening at certain times for the benefit of the pet, and managing this balance takes time and careful communication. It is a shared responsibility between vet and pet owner.
[4] Compassion is the emotional content of the consultation for the pet, the client and the vet; another shared responsibility. Clear boundaries on both sides are required, particularly in complex cases and end-of-life decisions.
Recognising this is a considerable challenge in a 15-minute (or even 20-minute) consultation. These four outcomes require a framework and communication to be successful.
Whether a one-off visit or a series of discussions, the client consultation process is at the heart of your client relationships and each pet’s welfare. The importance of honouring the relationship between owners and their pets cannot be overstated.
However, an estimated 55 per cent compliance gap exists between work presented in a consultation room and treated work. This poor clinical compliance from a veterinary perspective is due to:
These challenges are largely based on communication. Whether it is with the client or your team, if you cannot express yourself and communicate your wishes clearly you are unlikely to get the outcome you desire.
Small tweaks in the way you approach a consultation can make a big difference:
When it comes to internal ways of working, in this world of furlough, social distancing and mask wearing, goodwill and team spirit is not enough to make your practice work. Establishing and communicating clear ways of working and set protocols is the only way you can ensure a consistent, quality and caring outcome for your clients, every time they visit you.
The entire veterinary team should be aware of, and follow, set systems and protocols to reach desired resolutions consistently. From receptionist to vet, everyone should know how to approach each case. No one wants to be in the position where vets from the same practice provide different or conflicting advice.
Two types of vet practice exist: those with systems in place and those without. Which is more effective?
Why? Because it takes time, energy and money to dispense.
You can (and should) alleviate (and avoid causing) perceived pain in pets through proper handling and examining, offering a prognosis rather than a diagnosis, showing understanding of the client’s challenges in dealing with the prognosis and (as far as you can) agreeing a clear, fair, and unambiguous price for the treatment being offered.
Clients value compassion – it is fundamental to what we do. Yet, it comes at a cost to the practice, so we should not be afraid to charge to deliver it.
Two types of vet exist: one who makes the “right” diagnosis, and one who sees a clinical and an emotional “challenge” that needs resolution. Which delivers the best value?
Financial compliance occurs when the veterinary team “bills and banks” five times the employment cost. Therefore, all procedures need to be:
Clients do not look at your “consultation fees”. Clients have a “go to the vet” expectation threshold in their head, which is probably around £75 to £85 (ish) = consultation + drugs + injection.
If your consultation total cost does not exceed the expectation threshold (more than £75) then you probably do not have to talk about money.
However, If your total consultation cost exceeds this threshold, you must talk about cost or provide an estimate. Do not, I repeat, do not leave this task to the receptionist.
Successful practices focus on maintaining levels of trust and flow in their teams. They enjoy mutual respect and avoid disrupting each other. The right culture is everything; easily lost, difficult to build and even harder to sustain.
The isolation and disruption COVID restrictions have caused has led to many practices now struggling to bring teams back together in a productive and cohesive way.
You need to get back to basics:
Now that is a lot of information to take in. So, taking some of my own advice, I am going to be clear and concise in my consultation with you.
I have 10 tips to improve compliance, maintain team harmony and deliver quality clinical care (Panel 2).
[1] Be willing to calculate and charge a fair price for your professional time.
[2] Always practice good medicine. Aim to be professional and respected first – and liked second.
[3] Learn to live with price queries; it is usually an indication of confusion rather than rejection. Use “the £75 rule”.
[4] Vets need a diagnosis – what is happening now? Clients want a prognosis – what is going to happen next? Offer the option that would achieve the best prognosis.
[5] Don’t assume clients can diagnose and make a prognosis. Follow cases up with a physical or remote examination.
[6] Acknowledge the “illness” as well as the “disease”. Ask open questions to involve the client.
[7] Avoid using jargon only a vet would understand.
[8] Collectively adhere to agreed “best practice” protocols and best products.
[9] Utilise the digital channels to inform, educate and improve client compliance.
[10] Take more time for your work (minimum 15 to 20-minute consults), utilise the skills in your nursing team where possible and take time for yourself, often.
Above all else, know that you are doing a great job in difficult times. By implementing even one or two of the tips, you will be taking positive steps to take control of your business and deliver a better experience to your clients. Well done you.
What we do for our patients, our clients, our team of people, and the financial health of the business are the four equally important and inter-related components of the whole that is veterinary practice management.
This “whole practice lens” is useful when thinking about performance, and setting objectives for practice growth and people development, as well as in day-to-day decision-making.
Where something we do at work resonates across all four areas it is clearly highly powerful for the business as a whole, and should be fostered and embedded into the practice, albeit often each area has demands that compete with demands from the others and we have to make choices.
We should be particularly cognisant of the fact that it’s our people who are the linchpin of practice performance across all four areas, and that the reason why most of our people do what they do is because they want the best for our patients.
Recruiting, motivating and retaining the “right” people for this is challenging, and requires us to ask ourselves: what is so special about this practice? Why should someone work here? Why shouldn’t he or she move somewhere else for more money and fewer hours? And, how do you get the best from the people you have?
The answer lies in how you “engage” your team.
Engagement is not simply “job satisfaction”. It generates passion. It is about having a sense of purpose at work – with a shared vision, values and goals – and where people feel involved in decision-making, appreciated, supported and empowered, and have trust in the practice and what it stands for (for example, MacLeod and Clarke, 2009). It is positively linked to business outcomes such as profitability, productivity, quality, innovation, well-being, patient safety, reduced employee turnover and absenteeism, and customer satisfaction, loyalty and advocacy (for example, Harter et al, 2009).
Developing a mission is a good way of embedding a sense of purpose at work, and the “whole practice lens” can be used for this to help drive engagement by involving the team in developing practice strategy:
[1] Introduce your team to the good old SWOT framework, and ask each to spend some time thinking about the four areas in the “whole practice lens” and note down for each area what each feels the practice is strong on, weak on, what threats it faces and what opportunities it could take, considering also competitors’ offerings.
[2] Then arrange a team meeting to discuss everyone’s ideas and perspectives, and agree what the practice should aspire towards in each of the areas (the vision and mission) and what aspects within each area to focus on (the objectives).
[3] Put a small working group together to distil this into a coherent vision and mission for the practice, the objectives to be achieved and the strategy for achieving these.
[4] Arrange a follow-up meeting with everyone to discuss the proposals and finalise the vision, mission, objectives, strategy and tactics.
[5] Revisit once a year to review progress against the mission, and evolve the strategy as the practice continues to develop and to adapt to changes.This gives ownership of the mission to the team, and considers their different perspectives in getting to a rounded and coherent position.
