Ask the Expert
Q&A with Jessica Goodman Lee, CVPM
A graduate of Carleton College, Jessica has worked as a hospital administrator for several large veterinary practices in Minnesota, North Carolina, and Texas over the past 13 years. Her creative approach to client education tools, branding, process streamlining, and superior client service and veterinary care have resulted in great success for those with whom she has worked. Currently, Jessica is the lead practice development consultant with Brakke Consulting, Inc., in addition to being a member of the Veterinary Hospital Managers Association and chairperson of the VetPartners™ membership committee. She is a regular contributor to multiple industry publications and speaks nationally on a variety of practice development topics.
Here, Jessica answers your practice-management questions.
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Featured Question I am the manager of a 4 doctor practice and am having a really tough time trying to institute a new “flow” for our practice. Basically the way our appointments are going does not seem to work well, but I can’t seem to get cooperation from the staff regarding the changes I want to implement! Suggestions?
Jessica’s Response I completely understand your frustration! It can be extremely hard to understand why staff can seem so opposed to change, even when the status quo is not working. Several years ago I dealt with a similar situation in a practice in which clients were being put into exam rooms by receptionists, and remaining there, unacknowledged by technicians for indefinite periods of time. Sometimes clients would return to the front and tell the receptionist, “I think they forgot about me.” Clearly not a good system! I wanted to switch the protocol so that the receptionist would announce the appointment to a technician, who would then greet them and bring the client to an exam room. This way, the client would remain in the lobby so that the receptionists could track wait time and follow up in a timely fashion. Sounds simple, right? That’s what I thought, originally, until I received incredible push-back from the technicians, who felt that it wasn’t part of their “job” to come out front! What I found was that I had to take a step back and focus on the reasons for the refusal to cooperate and then address these in such a way that the staff realized there was a benefit for them. In this case, the benefit was that fewer client complaints and happier clients make their job a whole lot easier. I pointed out how much they hate to go into a room where they know someone has been waiting and is most likely already annoyed, and how a well-cared-for client is far more open to treatment recommendations and compliance. In short, the new flow would not only make their job easier but also more fun! What I didn’t focus on when talking to them was how frustrated I was with them, or that I was stuck having to deal with angry clients, or that the potential loss of clients was affecting the business. I had to put the focus on how the new system would benefit them! I also made sure to ask if they had other solutions to the problem that would work as well, but after presenting it to them in the above fashion they agreed that what I was suggesting was at least worth a try. Here are some other ways to successfully integrate change along with the above:
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- I know that many practices have implemented email reminders with great success—how do I go about getting started on this?
The first thing you have to do is start collecting email addresses from your clients—sounds simple, right? Unfortunately, it can be a bit more difficult than you would expect to get team members on board. While the biggest hurdle is simply that it requires building a new task into their routine, some staff members insist that clients won’t want to give out their email addresses—even though they’ve never asked them.
You are going to have to be diligent and impress upon your front desk staff the importance of asking for email addresses from everyone both new and current clients, every time a client calls or comes in. Take the time to explain to them the tremendous value of collecting these email addresses, as well as the positive impact it can have on business. Also, train them to be comfortable about asking for the information and communicating its purpose to clients. What they will find is that (a) most clients don’t question the request, and (b) if clients do want to know why you are collecting email addresses, once they are told that you are planning to send email reminders, the vast majority is thrilled.
Tip #1: Remember that people often change their email addresses, so it is important to review all of their information every time they come in. Tip #2: Consider introducing the collection of client email addresses by having a contest among receptionists to see who can collect the most in a set period of time. This can be a great incentive to get them going, and it will also help build the habit much more quickly! Tip #3: Once your email database begins to grow, it’s time to consider the growing online opportunities for marketing and client communication, such as e-newsletters, surveys, pet birthday cards, coupons, etc. Be creative! - I know this is a common question, but I am still unsure about how to proceed with fee increases. I’d really like a specific formula to follow—can you provide one?
Unfortunately, there isn’t a “one size fits all” answer to your question. Ultimately, decisions to increase fees must be determined on an individual basis and must be based on real facts such as practice financial data, historical relevance, competition, regional economics, etc. In other words, it’s just not that simple, which I realize is not the answer you were hoping to get!
Take a few minutes to consider the following; I hope it will help you determine the best course of action for your practice.
- Does the system you currently use to implement fee increase work? In other words, are you keeping up with inflation, remaining competitive, and not experiencing an overwhelming push-back from your clients? If so, there is no need to change a thing as long as you remain attuned to client perceptions and continue to monitor client loyalty. Also, it doesn’t hurt to check the pricing on shoppables at other clinics in the area at least once a year.
- If you have not kept up with inflation or increased prices in more than a year, it is highly recommended that you do so, at least on nonshoppables. If you are concerned about client backlash, do several increases of, say, 2% every few months until you are back on track. You can even spread out the increases by category, so that not everything is going up at the same time, if you think that will make it more palatable to clients. Experience has shown that very few clients notice small increases, and as long as prices haven’t gone up every time they walk in the door, most understand that the costs of doing business have increased for everyone.
- On the other end of the spectrum, if you are concerned that the pricing at your practice is causing client defection, and you have actual proof that your prices are not in line with others providing similar services in the area, it is time to consider your options. To avoid further client loss, you may need to adjust pricing structures, which may include lowering some fees (yes, you heard me correctly!). The most important question to keep in mind is whether lowering a fee will increase sales, and if so, will those increased sales generate more profit and provide better care to more patients. If the answer is “yes,” then lowering fees is the way to go.
Keep in mind, though, that no matter what your prices, there will always be clients that will comment that you are “too expensive.” This doesn’t necessarily mean you are priced higher than the animal hospital down the road. Often, it just means that money is tight, and there is really no price that would be low enough. Be sympathetic, but don’t make changes based on these comments without doing your homework.
Here are a couple of final tips:
- Make sure you are passing on product and medication price increases immediately or ahead of time, when possible. In other words, choosing not to raise prices when costs increase had better be a decision made purposely and not by accident. Even a few days of increased costs without increased revenue can add up, especially considering the recent fluctuation on many pharmaceuticals. Watch your mail for price lists and check all invoices immediately! Using your management software’s inventory capabilities will also make it a lot simpler to keep on top of this.
- Consider the presentation of your fees and cut out the “fat.” There was a time when having a line item for every single thing was recommended, but that is no longer the case. When invoices are simplified, there is less opportunity for client misperception.
- Do you have any suggestions for imparting to doctors the importance of motivating and mentoring when dealing with staff members—not just correcting a behavior?
Address your practice culture first. If you have established a business environment that nurtures growth for each employee, kennel worker and veterinarian, then mentoring is just a part of each person’s job description. If you have a culture that is a more independent business model, where people “work for” the veterinarians, you will never get the veterinarian’s buy-in for mentoring a staff member.
Mentoring support has to come from the top down, and I don’t mean from just the veterinarians. All staff members are responsible for helping each other learn the ropes, and mentoring should be a specific part of each person’s job description. When you teach every staff member more, then they produce more and everybody wins!
Remember though, that not everyone has the skills to be a mentor. When you’re thinking about whether or not someone would make a good candidate, there are several things to consider. Are they personable? Are they organized? Do they have any teaching experience? Any management training? Are they motivated to help or are they just doing it because they are being told to?
Asking people to do things they are uncomfortable with is not a terrible thing; just make sure you can support them so you can make it a win for both sides.
- Do you know if there is any way to copy discharge instructions? For example, if you have two puppies in for visits on the same day and both got spayed, is there a way to copy the discharge instructions entered for one puppy to the other’s medical chart? Or, is there a way to copy charge estimates made for one client if another client is having the same procedures done?
You can copy discharge instructions by copying the information from the patient’s medical note and pasting it into a new medical note template. The bookmarks will not carry over, but the information can be easily modified to fit the existing patient’s needs.
Unfortunately, it’s not possible to copy charge estimates. If the estimates have been set up in Cornerstone™ with group codes, then you can just enter that group code for spay or neuter, etc. We set up a group code for pet sterilization with Smart Codes as well. (Cornerstone customer support can help you set this up.) Smart Codes allow Cornerstone to automatically choose preset items, such as pain medications and induction medication, according to the patient’s species, sex and weight. This is a clear case for calling support! They don’t bite either.
- We have a problem with staff turnover in our clinic. It takes so much time to train new staff members on our equipment, processes and protocols and then they decides to leave the practice six months later. Any ideas on how to decrease staff turnover or improve the training process?
There are few things that make my heart sink more than when I hear we have a turnover situation. Regardless of whether the turnover was initiated by you or the employee, you still have work ahead of you. If at all possible, do an exit interview to determine if there are issues with your practice that may have caused the turnover. Be honest with yourself when it comes to accepting the criticism that comes from an exit interview. They can be most enlightening!
Hire right! Sounds so easy—but it’s so hard. You must commit to hiring only the best people, not just warm bodies.
We approach hiring as a team project. We identify a candidate, bring them in for the initial interview and then have them work for us for an entire day. The candidate is put to WORK! Actual responsibility! Of course, we have a team member there to assist, but we want to see them actually working. Can they draw blood? Do they have good animal handling skills? Do they know how to monitor anesthesia? Can they talk to clients? Do they have basic computer skills? And after all that, the TEAM decides. If they like the candidate, then we hire him or her. If there are some reservations, we wait! Don’t just fill a spot with a warm body...it always costs you in the end. Trust me...we know!!
- How do you keep track of reference lab test orders in your practice? We have a log book, but I suspect not everything gets written down and sometimes we forget to charge for tests.
Outside reference labs provide a great opportunity for your clinic to standardize your lab request policy. ANY and ALL lab tests should always start with a lab request in Cornerstone™ or the practice management system you use. By starting with a lab request, we ensure that the charges always go to the Patient Visit List (PVL) in Cornerstone and then to the invoice.
We used to think that we could get by without a lab request or the outside lab tests. We found that we were losing up to $100 per month in tests we didn’t charge for. So we set up all of our outside labs within Cornerstone. Our new policy is that ANY and ALL lab tests start with a lab request.