Doing more with less: working more effectively–part 1 (Proceedings)

What Does it Mean to Work "Smarter"?

Everyone knows that veterinary practices are busy places! There is always something going on — the phone is ringing, clients are coming in the door, and beloved pets need our help. The life of a veterinary healthcare team member is hectic.

We have all had the experience of feeling under the gun as our day unfolds in ways we haven't anticipated. It is sometimes difficult to remember that the ringing phone is the reason we come to work every day. So, how can you contribute to a smoother flow of the day's activities? How can you and your team members work smarter, not harder?

As the level of sophistication of the medicine we are able to practice continues to evolve, it means doing more for each patient. It means keeping track of more and more details — medications, IV fluids, physical parameters, etc. Information management alone may seem like an overwhelming task. You will need to do more in your job than ever before. Veterinary practices are just like other businesses in that they must do more with the same size teams.

When the sheer number of tasks performed in a day in a veterinary hospital increases and the sophistication of those tasks also increases, it is critical to take a hard look at how the various pieces fit together. Only by increasing the efficiency of how things are done can we do more for our patients with the same number of team members. Working smarter means consolidating everyone's efforts to get more done. Working smarter means clustering tasks together whenever possible. Working smarter means organizing and managing clinic time better, organizing and managing your own time better, as well as realizing the impact of your time management on other members of the team.

1. Stop trying to be all things to all people.

The 24 – 7 model for veterinary practice is "old news". Once upon a time, veterinarians treated any and all animals that needed them — cattle, horses, pigs, cats, dogs, etc. Those same veterinarians were available every minute of every day for emergencies. There was a time when veterinary medicine was not very sophisticated. Consequently, aiding a particular animal did not take long. The stress level inherent in caring for animals was not nearly as high as it is today.

Now there are nearly as many ways to practice veterinary medicine as there are veterinarians. There are competent, qualified veterinary emergency facilities in most areas of the country, or at least within reasonable access. For those areas that do not have the luxury of emergency rooms for pets, practitioners have the opportunity to band together to share responsibility for after-hours emergencies. We dilute our effectiveness (and our efficiency) when we try to move in too many directions at once.

It is most important for the practice leader(s) to first define personal values, then to define the practice's values. Only then can the practice leader(s) answer the questions, "Why are we here?", "What do we stand for?", and "Where are we going?"

2. Working smarter demands better communication.

As we look at specific ideas for increasing efficiency within a veterinary practice, you will easily identify one common undercurrent — better communication. All aspects of practice operations must be integrated, and the only way that can happen is to ensure that all team members are on the same page. There must be clear, open, and free-flowing communication among the front office staff, the veterinary nurses, the veterinary assistants, the animal handlers, and the doctors. The practice as an organization must establish the means by which communication can remain active among team members.

Take a look around your practice to identify ways that you and your team members can take charge and re-create the ways in which information flows within your clinic. You can be an agent of change. Let's turn our attention to examples of how veterinary practices can foster increased efficiency for working smarter, not harder.

3. Define your daily routine

Every single day in any veterinary practice there are tasks that must be accomplished each and every day. Opening the reception area — turning on computers and phones, preparing to see clients, pulling medical records, turning on the phones. Taking care of the animal patients as well as animals that live in the clinic — out to potty, cleaning litter pans, changing water, feeding. Turning on the laboratory — warm-up cycles, cleanings, calibrations. Restocking examination room drawers, treatment room counters and cabinets, nutrition center shelves.

Identify precisely what these tasks are. Cluster those tasks together that occur in a given area of the clinic. Assign task groups to individuals on the team. Schedule task groups to be done at times when they will not interfere with seeing clients. Depending upon how individual team members are scheduled, these tasks may fall on different people's shoulders on different days of the week. The actual assignments don't matter as much as being certain that all members of the team know what the tasks are and who is responsible for ensuring the job(s) get done.

In addition, define when each team member should be at the practice. Then schedule lunches and breaks in the most appropriate way to maximize efficiency and everyone's ability to serve clients.

4. Create efficient office hours.

Look for ways that your clinic hours can better serve your clients. There is no compelling reason to keep a primary care practice open at all times of the day and night. Should your clinic choose to be open Monday through Friday, closed on the weekend, then it makes sense to provide evening hours at least one or two evenings each week. That way you do not exclude those clients who work a standard 9 – 5 day from taking advantage of your services.

One advantage of not being open on the weekends is a lack of staffing stresses. We do not have any problem filling our shifts because our team members know that they will work hard Monday through Friday, and that they have their weekends to devote to their family members — two-legged and four-legged.

5. Schedule appointments for inpatients and outpatients.

There is no faster way to create chaos than to simply have clients show up whenever they want. Unless you work in an emergency hospital, this is a bad idea for all parties involved. First of all, your clients may have to wait long periods if they come unannounced. Second, if you have no idea why your patients need to see you, team members can't adequately prepare for the upcoming cases. Third, if you are worried about getting this minute's patient through in order to get to the next minute's patient, you will not give any of your patients the attention to detail they deserve.

If you have a patient that needs a work-up that will take extra time, consider admitting that animal in order for the evaluation to be done around the scheduled appointments. If you have a client call for an appointment and you do not have an appointment slot that works, consider admitting that animal for the day (or part of the day) and actually schedule that animal's exam during an existing appointment slot in the schedule. If there are patients that must be seen on a day that you focus on surgery instead of outpatients, consider a day admission in order to work the patient and its work up in among the tasks surrounding the surgery patients.

6. Cluster surgery and dentistry cases together on the same day(s) of the week.

It takes the same amount of time to set up for 2 surgical or dental cases as it does for 12. Increase your team's efficiency by setting up for (and mentally preparing for) clusters of cases on one or two days a week. If you are conducting general anaesthesia as it should be done, there will be monitors, IV pumps, medications, catheters, etc. that must be set out to be at the ready. Mentally preparing for surgical/dental cases allows the entire team to be on the same page. Do surgery all day those days, rather than trying to shift gears and see out patients later the same day. If you have a particularly light surgical day, you still have the flexibility to open up appointments once the cases are complete.

7. Create job descriptions for each team position.

Job descriptions allow your team members to know what is expected of them. Creating expectations is not the same as limiting what team members are capable of learning or contributing to the practice's operations. Job descriptions allow everyone on the team to understand how their teammates spend their time during the workday. It gives people insight into how hard everyone must work to make a veterinary hospital operate smoothly.

8. Cross-train the members of your team.

Cross training allows all team members to fill in when there is a gap in the practice's coverage. Teaching veterinary nurses to work with the computer, answer the telephone appropriately, and complete transactions does not mean that these individuals will work in your clinic as receptionists. But it does mean that when you are short-staffed, client service does not suffer. Obviously, the receptionists in your practice cannot be expected to do the veterinary nurses' jobs, but even in their arena there is some overlap.

9. Create a protocol notebook.

Why reinvent the wheel with each case that walks through the door? A notebook of written protocols and procedures allows standardization of how things are done in your veterinary hospital. These protocols should include such things as the steps that are taken to turn on the laboratory equipment in the morning and how to turn it all off properly at night. Think about writing procedures/protocols about any regularly scheduled event that happens in the clinic. Likewise, thing about drafting a written protocol for preparing anaesthesia patients, setting up for an anaesthetic event, how to calculate and deliver constant rate infusion (CRI) drugs, or handling a cat abscess.

Protocol notebooks standardize procedures, ensure that things are done the same way each time (roughly), and they greatly speed up the training process for new hires. Written protocols also work well to refresh everyone's understanding of how things should be done — of how the practice leader wants things done. Protocol notebooks are dynamic documents that should evolve as the practice evolves in the level of care it provides. Revisit them regularly.

10. Consider flex hours or job-sharing for team members.

When you have a position to fill, consider options beyond the usual hiring of a single person for a full-time job. What about having 2 people share one full-time position? Another creative option is to allow team members who choose it to work fewer, longer workdays instead of the standard 40-hour stint. Obviously this will only work if there are enough people on the team willing to give it a try!

11. Outsource what you can to better utilize your internal resources.

"The Paw Street Journal" provides a slick, well-made quarterly newsletter for your clients. A web-site hosting service gives you access to your clients (and them to you) with services provided by experts. A cleaning service for keeping your hospital clean, fresh, and sparkling is worth every penny. Your veterinary nurses are way overqualified to do your cleaning work. Outsource your payroll. With changes and updates in tax law, it is nearly impossible for someone outside the accounting profession to keep up. Also, by having payroll calculations done outside the practice, you create an easy system of checks and balances, thus lowering the risks for embezzlement or other improprieties.

12. Consider a telephone person away from reception.

Many practices are moving their incoming calls to a place away from the reception area. If receptionists are focused only on the clients in front of them — the clients in the examination room and people who walk in for food products or medication refills — they will quickly and easily complete the transactions at hand. Incoming calls take them away from the client in the clinic. Incoming calls interrupt the flow of the transactions at hand.

A "remote" telephone person can devote 100% of his or her time to the clients calling the practice for information or in order to schedule an appointment. There are no distractions for that person, and he or she can really choreograph the flow of patient care in the practice.

13. Print business cards for all team members — bond clients to the team, not the doctor.

When clients bring their pets for care or treatment, they may see 3 or 4 different members of our team. It is important that we create awareness of precisely who these people are. If a team member can hand a business card to a client and create a connection, the client has a point of contact with the practice other than the doctor. This saves the doctor time in terms of answering client questions by telephone. It saves the clients time because their questions may actually be answered in a more timely fashion than if they must wait for a callback from the doctor.

Another advantage to your team members having business cards is that they are instant ambassadors for your practice. At any time they have the opportunity to speak about the clinic and refer a potential client. Also, at CE training, it gives your people the opportunity to network with peers and colleagues. There are few networking tools as effective as business cards!

14. Think about a dishwasher for pet bowls (and people, too).

Automatic dishwashers not only save team members lots of time, they allow you to sanitize pet food dishes for enhanced safety of your patients. Remember to use a button on the front of the dishwasher that reverses — "Clean" on one side and "Dirty" on the other — so that everyone in the practice can tell what is in the machine. You'll never go back to hand washing!