25 ways to untangle your veterinary practice snarls

Not long ago I received a cry for help on my voice mail: "Dr. Rothstein, we spoke a long time ago when I opened my practice. You advised me on some management issues, but 10 years later my clinic is still dysfunctional. Can you help? Please?"

I returned the call, but the doctor never called back. My guess, however, is that he's not the only practice owner or manager who feels desperate about internal operations, wondering how to get things organized and flowing smoothly. Disorganization always causes problems. Some practices grow so quickly that they overwhelm the veterinary team and start shedding employees and clients. More mature, stable practices experience problems because they're missing essential organizational systems.

If you, like my caller, feel that your practice is a knotted mess whose strands are in danger or fraying—or snapping—I've got 25 ways for you to smooth things out. These systems are distilled from my 10-plus years of managing a group of veterinary hospitals. You don't have to reinvent the wheel to turn around your hospital operations, but you must provide the essential leadership to make it happen.

1 Medical exam report cards

Report cards help doctors conduct complete exams at every patient visit. They also remind clients of your recommendations and personalize otherwise generic information. Have a computer in your exam room? You can fill out the form immediately as part of your electronic medical notes and then print a copy for the client as a take-home. And because you're revealing the results of the full physical exam, report cards also cut down on front-desk complaints about exam fees.

2 Computer diagnostic codes

Use diagnostic codes in your computer system so you can quickly pull up a master problem list for any patient. This list of past and current health issues saves you time and helps associates who may not have seen the pet before—no more scouring records for past problems. After each visit, enter the diagnostic codes from the physical exam so your list for the patient is complete. This takes a few minutes, but it's worth the effort.

3 Client education handouts

You should be ready to hand an information sheet to a client each time you make a diagnosis. Start by creating educational handouts for your top 10 to 20 diagnoses and then add forms for less-common conditions over time. Link the forms to diagnostic codes in your computer so that they automatically print when clients check out. Clients need to understand their pets' health conditions thoroughly, even when doctors and team members don't do a perfect job communicating the details. Client handouts help keep pet owners well-informed. Plus, they educate family members who weren't at the visit.

4 Patient drop-off forms

Letting clients drop off pets for exams and procedures decreases stress on team members, especially on days with lots of walk-ins, last-minute appointments, or cases requiring extensive workups. Your team members can continue with regular appointments and complete other workups in their downtime. To facilitate this process, create a drop-off form that includes patient history and owner contact information for the day.

5 Discharge forms

With surgical discharge forms, you can print out or modify take-home instructions for clients so that they leave well-informed about the pet's condition. A good form saves time and decreases client stress. Clients tend to assume procedures have been done correctly, so you and your team are often judged on how well you handle the discharge.

6 Dental discharge forms

These forms diagram teeth that were removed, summarize the condition of teeth after a cleaning, and describe other procedures that you've performed or will need to perform. In my hospitals, we attach before-and-after pictures of the oral cavity so clients can see the difference a cleaning makes.

7 Consent forms

These forms can protect you from liability and help ensure that clients understand the risks involved in surgical and anesthetic procedures. It's still important to review the form with clients and ask them for any questions or concerns.

8 Hospitalized-patient flow sheets

Doctors write up these treatment plans to help the team provide complete care throughout a pet's stay in your clinic. The forms should be easy for team members to understand and include boxes for checking off treatments as they're performed.

9 Dental and weight grading systems

Grade teeth and provide body weight scores during every physical exam and provide corresponding forms that explain the grades. Grading the condition of a pet's teeth improves dental care compliance. Using body scores and reviewing what the scores mean highlights the importance of weight control in pets and gives you the chance to discuss weight-related issues and solutions.

10 Travel sheets

Travel sheets are an important communication tool at my clinics, where we use them to circle all procedures, medications, and other items associated with a pet's care. In fact, our travel sheets double as to-do lists for team members. Technicians take one copy to do their work, while the front-desk team gets another copy to enter charges and prepare medications. A comprehensive, well-organized travel sheet can minimize mistakes, missed charges, and sometimes missed medical care.

11 Standardized treatment plans

Writing treatment plans on the fly is time-consuming and error-prone. Instead, incorporate all the elements you recommend as standards of care in estimate format in your veterinary software program. These plans work great for common services like neuters, spays, and dental procedures. They also work nicely for hospitalized patients and surgical cases, though you'll often need to tweak them depending on the case.

12 Precounted drugs

We all strive to get clients in and out of the clinic in less time, but that's a challenge when visits include more than a wellness exam. For instance, in the pharmacy, it can take 15 to 20 minutes just to write up and prepare a pet's prescriptions. A nice shortcut to help alleviate this problem is to precount commonly prescribed medications.

13 Point system for scheduling surgeries

Booking the right amount of time for a surgical procedure can be difficult. You can end the guessing game by using a point system. Take the time to figure your doctors' individual averages, then give this point system a try. As an example, for a speedy doctor and support team, one point may be worth 10 minutes: a cat neuter. A dog neuter might be worth 2 points or 20 minutes, and a dog spay 3 or 4 points. For a slower team, 15 minutes per point may be more realistic. Keep in mind you have to include setup time.

14 Follow-up calls

Follow-up phone calls are a great way to enhance medical care and customer service. Although different practices hold different philosophies on whom to call and when, here's mine: Call all new clients the next day, call owners of surgery patients one to three days after a procedure, and call owners of medical patients in a time frame you determine. For example, you might call the owner of a dog with vomiting or diarrhea three days after the visit, a skin case in seven days, and a lameness case in 10 days. In my practices, well-trained front-desk team members call during slow periods and route complex questions to technicians or doctors. At other practices, only technicians or doctors make the calls.

15 Emergency slots

Managing doctor schedules is tricky. Some doctors ask to be double- or triple-booked, while others stress out at the very thought. To take some of the heat off overbooking, try using emergency slots. How many emergency slots do you include? One every other hour per doctor is reasonable, but you know your schedule best. The key is to monitor the emergency slots and adjust as needed. The goal is to fill them during the day. You don't want to go overboard and lose 25 percent or more of your appointments to unused emergency slots.

16 Practice or office manager

The first rule of human resources for veterinarians is to let someone else do it, if you can. Hiring an effective manager lets the doctors—including owners—focus on the medicine. Veterinarians earn more and cost less providing medical care than running the office, even in a small clinic of four to six people. You need to provide some level of oversight (see the next tip), but try not to get overly involved.

17 Management checklist

In my practices, we use a one-page master checklist that asks managers to verify that certain functions have been completed on a timely basis. Ask your manager to sign off on the checklist weekly—or use it yourself—and you'll feel more comfortable that no one's dropping the ball when it comes to facility maintenance, payroll verification, tracking missed charges, sending reminders, and so on.

18 Policy manual

A manual simplifies everyone's life at the clinic. It doesn't leave gray areas open to discussion or misinterpretation. For example, if team members are sick, can they send a text message to a manager, or do they need to call in? What about cell phones—can team members take personal calls on duty? Outlining these issues in the manual prevents problems, because the team knows the rules.

19 Job descriptions

Create a job description for every team member, and update these job descriptions as needed. They're a fundamental communication tool that lets employees know your expectations for their positions. They're also an invaluable benchmark when you need to guide a team member back on track.

20 Phased training program

If you want your clinic to run smoothly, you need to put in the time to properly train new and existing team members on the systems, protocols, and medical and customer-service philosophy at your clinic. Phased training can help. Phased programs follow a schedule of teaching tasks and functions week to week, typically finishing in one to two months. Phased training works well for everyone—from receptionists to associates.

21 Performance evaluations

Performance evaluations are a crucial part of veterinary practice. Annual reviews are OK, but twice a year or more often is better. Reviews are a chance for team members to express how they're feeling about work and the job they're doing. They're also a chance for you to share what's working well and not so well.

22 Staff meetings

If you're not holding team meetings at least once a month, yours is not a well-run clinic. Many folks hate meetings until they attend a good one and see how beneficial they can be. For maximum effectiveness, start and end meetings on time, keep them relevant and positive, and make sure to involve the whole team. Ask team members beforehand for topics they'd like to discuss. Throw in contests or trivia games. Mix a staff meeting with a lunch-and-learn presentation from a vendor for even more educational value.

23 Practice statistics spreadsheet

In the same way we look at blood work to see whether pets' organs are working properly, we need to examine a set of numbers to learn about our practices' health and growth. Key numbers should be monitored weekly and monthly. The most significant are gross revenue (total payments), number of new clients, number of appointments, average client transaction, payroll expense as a percentage of revenue, and inventory cost as a percentage of revenue. At my hospitals, we also track the number of surgeries, dental cleanings, ear cytologies, and intestinal parasite exams performed. The numbers are compared to last year's and posted each week. We use contests to reach certain goals, and bonuses and financial incentives keep the team involved and motivate them to reach new heights.

24 Payroll and inventory spreadsheets

Looking at your payroll and inventory expenses as a percentage of gross revenue can be sobering, but it forces you to adjust payroll hours quickly—before you're in serious trouble. If your inventory is particularly high, adopt an inventory control system using your practice software or with colored dots to date inventory items.

25 Work schedule spreadsheet

This document shows managers how many hours they've scheduled for each staff member for the week and at the same time calculates total scheduled staff hours for the week. So if you've examined the budget and determined that, for example, you have $4,000 for staff payroll or roughly 300 hours of labor, you can tweak your schedule appropriately. This isn't an exact science, but overstaffing is lost money that can't be recouped.

Now you can see why my mystery caller was stressing. Lots of work goes into running a practice, and it's no wonder that we get overwhelmed keeping operations running smoothly. But keep it in perspective: Great practices aren't built overnight. Practices with most of these 25 tips in place have done it over a number of years. So start with a few of these ideas and build from there. And here's the most important take-away: Clients most value consistent service and reasonable wait time. Organize your practice operations, and you'll win on both those fronts. The result? More revenue, happier team members, and more satisfied clients.

Extra credit

Want to go the extra mile in boosting customer satisfaction at your well-run hospital? Consider the following:

> New client welcome letters

> New client folders with informative handouts

> New puppy or kitten owner folders

> Branded collars for boarding and hospitalized pets

> In-house lab results sheets

> Controlled substance log book

> Employee bonus pay programs

> Skills training lists for veterinary assistants

> Facility maintenance or to-do lists for all areas of hospital

> New client forms requesting e-mail addresses

> Client referral program

Veterinary Economics Editorial Advisory Board member Dr. Jeff Rothstein, MBA, is president of Progressive Pet Animal Hospitals in Michigan. Please send ­comments to ve@advanstar.com.