Breathe life into your exam room protocol

Examination room activity is central to the delivery of veterinary services. And the most dangerous hazard of the examination technique is poor communication with the client.

Table 1 An Outpatient System

For if we fail to deliver information to clients in a fashion, manner or style that they can understand, then they have wasted their time and money.

In a perfect world, the veterinarian would be able to see each patient with plenty of time for history collection, examination, assessment of priorities, a nice discussion of the pertinent issues to create and deliver a plan — and then answer questions.

Somewhere in the annals of veterinary medicine, many of us practitioners have come to believe that we must deliver all these steps — from nail trims to open heart surgery.

The problem is that when a veterinarian spends time delivering all the assorted services, professional time and its value is actually diluted.

It is just not feasible to balance all the assorted needs of a busy practice and tack on the responsibilities of a technician, nurse, estimate provider, appointment maker and stenographer.

The economic lifeblood of a practice depends on the effective, smooth and competent delegation of duties to appropriately trained personnel.

Six keys

We must certainly agree that all essential services of the veterinary practice begin in the examination room.

The privacy of the examination room provides the atmosphere for the examination, patient assessment and client communication.

We can also take a lesson from a business model that is undergoing some improvement measures. Just consider your local movie theater.

I often marvel at the cost of a movie theater's snack counter. And they seem to be staffed with employees who generally linger, are slow and mostly inefficient.

The snack bar serves a vitally important role for a movie establishment. It is virtually all profit for the theater. And many lose a lot of profit because of the laziness of its staff.

The more profitable theaters have modified the delivery of snacks via a new paradigm that provides smooth flow of customers to product and cashiers.

The same rules apply to veterinary practices. Attentiveness to a smooth flow of examination room procedures is vitally important.

In the veterinary environment the "rate-limiting step" of the delivery of veterinary goods and services is in the examination room.

Think about it, and consider how you manage your time.

We can see that the more profitable practices have developed a smooth and efficient examination room process. Excellence in examination room procedures opens the doors to excellence in health-care delivery and communications.

The two concepts of profitability and quality are not mutually exclusive, but they do go together. And when the two concepts are fused, long-term excellence can be achieved.

In the short term, inefficient examination room activities can be associated with quality medicine as we can compensate with excess veterinarian time.

Delegation remains critical

At the least, excess veterinarian time in the examination room takes away time that is needed each day for intellectual renewal: studying and reading.

It has been established that income is linear with increasing employees — not with an increasing number of veterinarians.

Often asked is: "How do we go from the national average of 3.5 employees per practitioner to a maximum effective number of say, 12 employees per veterinarian."

Answer: Delegation.

As a practice begins to delegate non-veterinarian duties, like nail trims, written home-care instructions and paperwork — the veterinarian has more time for the next client.

When 12 employees support one veterinarian, we see the economy of scale – larger numbers of clients can receive professional attention at more reasonable prices, while at the same time improving the profits of the practice.

The idea of all dogs getting a bath upon release from a veterinary clinic does not happen when the veterinarian is doing the baths.

The idea of pre-operative tests tends to take a back seat when the veterinarian is handling the chemistry machine.

Clients cannot afford to pay the hourly rate of a veterinarian for "grooming out a mat".

All this comes true as we recognize that when a veterinarian is doing maintenance work, the professional is paid as a maintenance worker. When a veterinarian is working as a technician — the professional is paid as a technician.

The veterinarian that sees 20 patients per day with three support staff has limited time and energy to look up challenging cases. The effective delegation of non-specific veterinary duties provides time for the veterinarian to conserve emotional energy for greater battles, which can include thinking and focusing on the complex medical issues that are present in veterinary practice. To accomplish this goal, we need support staff.

How does one veterinarian assess 40 patients per day?

How does one veterinarian spend appropriate time with 40 patients per day?

How does the client react to these appointment time slots?

How do clients react to paraprofessionals delivering services and information?

The key to scheduling is that the time slots for the clients are not short; in fact they become longer as support staff has plenty of time for each client.

So, a 10-minute veterinary appointment with a client becomes 30 minutes when the practitioner has three client-personalized buddies — one for each of three clients seen this half hour.

Then comes the idea that a support buddy is needed to help the primary buddy do tasks, such as nail trims.

Thus, central to the idea of efficient flow of patients is staff training to ensure staffers know what is happening, and how to answer the volumes of client questions that will pour forth when clients are given the time to ask.

Staff training is essential to the delegation of responsibilities.

Here are some responsibilities to delegate:

• Client education;

• Preventive healthcare steps and information (compliance rises when staff are trained to and then deliver this information);

• Product information;

• Preparation of home-care instructions.

Consider these additional suggestions:

• One buddy is to stay with client/patient from start to finish.

• A second, third or fourth buddy is needed when three clip boards and clients are waiting or admissions are 15 minutes behind schedule.

• Buddy is to stay close and aware of outpatient/veterinarian needs during scheduled times.

• Buddy is to remind and alert veterinarian about the status of call-in appointment conferences.

• Document the bottlenecks to eliminate those in the future.

Many examination room mandates are clearly repeated and repetitious; identify the one's to pass along. Continuity within the staff and between the veterinarians is a critical issue. Thus written protocols for all to see and understand is also essential (See Table).

Dr. Riegger, dipl. ABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him at www.northwestanimalclinic.com, Riegger@aol.com, telephone and fax (505) 898-0407. Find him on AVMA's NOAH as the practice management moderator. Order his books "Management for Results" and "More Management for Results" by calling (505) 898-1491.