Doing what you do best - improving staff utilization (Proceedings)

Improved staff utilization is a more critical element of successful practices now than ever before. Practices that want to become more profitable can no longer just count on fee increases to achieve this goal. Improved profitability and patient care must come from improved busienss practices. In addition, employees who are allowed to learn and grow and use more skills are generally happier in their jobs and more likely to stay with the practice than those who are only allowed to do less interesting tasks. Effective leveraging of employees is also critical to the productivity of the veterinarians and the practice as a whole. Veterinarians who delegate duties to appropriate staff members are able to see more clients and generate more gross revenue and profits. This increased profitability is essential to providing good quality medicine and surgery and to continual investment in team members in the form of increased salaries and benefits and increased continuing education.

In order to achieve optimal staff utilization, the practice must:

     • Have an owner or practice manager with a strong set of financial, managerial and HR skills—the title isn't enough

     • Have a detailed, understanding of the skills staff members must have to provide outstanding patient care and client service

     • Hire effectively—find and keep the employees with the right skills and attitudes necessary to achieve the practice's goals

     • Provide high quality, effective and ongoing training programs to both new team members as well as those who have been in the practice for awhile

     • Have high levels of employee retention—revolving door employees aren't around long enough to be efficient and effective

     • Design and implement efficient policies, procedures and systems for getting things done

     • Schedule staff, appointments, and surgeries effectively and in synch with each other

     • Delegate effectively—tasks should be done by the lowest level person who can do the job properly

     • Monitor staff activities frequently—in most practices staff are always busy doing something—what they are doing, however, is the key point—is it the most important activity that should be done?

     • Regularly review staff utilization metrics

Some of these key areas are discussed below

Management staff

Financially successful practices are, almost by definition, well-managed practices. It used to be possible to have a successful practice without a great deal of business skills, but this is no longer true. Clients have higher expectations in both the medical and clients service arenas, veterinarians face increased competition, and the complexity of business regulation has increased.

Most people aren't born with a full set of good management skills. Just as it took training and practice to learn to perform an OHE, it takes similar dedication to become a skilled manager. One difficulty in veterinary medicine is that most veterinarians do not graduate from veterinary school with a solid grounding in business skills. Veterinary school curriculums are already strained by the burgeoning amount of veterinary knowledge that needs to be passed on to students and most students didn't take business courses in their undergraduate years. Another difficulty is that many veterinarians aren't inherently interested in business management. They went to veterinary school to learn to practice medicine, not to be a business manager. Many practices have hired practice managers to take on the business side of the practice. However, not all managers have been given the training and resources they need to do their jobs well. Fortunately, these are correctible problems.

Management duties are handled differently in different practices depending on the size of the practice, the interests of the owner veterinarians and the money available to hire managerial help. In some practices, the owner veterinarians do all of the management work either out of necessity or because they enjoy it. In other practices, the owners have hired a full-time, experienced practice manager with the result that the veterinarians primarily practice medicine. The owners make the high-level decisions, but leave day-to-day management to those paid and trained to do it. In other practices, management duties are divided between the owners and other individuals, including support staff, practice managers or associate veterinarians. As practices get bigger and as management duties become more complex, it becomes more necessary to have highly skilled, professional managers in place. Veterinarians will contribute more to the profitability of the clinic through the practice of medicine and surgery than by being managers.

While owners certainly don't have to be involved in the day-to-day management activities of a practice, it is critical that they provide vision and leadership to the business. In addition, they need to set the framework for the decisions to be made, direct and approve the overall activities, and support the management personnel in their responsibilities.

Staff utilization metrics

Analyzing the number of support staff in comparison to the number of veterinarians is useful in determining how efficiently your practice is being run. A greater number of support staff will generally result not only in improved client service, but also in better leveraging of doctor time and skills.

Because the number of hours worked by veterinarians and staff members varies widely amongst practices, they are compared on a full-time-equivalent (FTE) basis. A full-time-equivalent veterinarian is assumed to be one that works 45 hours/week during an entire year. This figure is calculated for each practice by taking the total annual hours worked by veterinarians in the practice divided by 45 hours per week and then dividing that result by 52 weeks. For example, a three-veterinarian practice with an annual total of 6,240 hours worked by veterinarians, the FTE number of veterinarians would be 2.66 (6240 divided by 45 with the result then divided by 52.)

A full-time-equivalent support staff member is assumed to be one that works 40 hours/week during an entire year. This figure is calculated for each practice by taking the total annual hours worked by staff members in the practice divided by 40 and then dividing that result by 52 weeks.

The "right" number of staff people per veterinarian will vary in financially successful practices and must be analyzed closely in conjunction with profitability. It is very easy to increase the number of staff per doctor to a level which allows for an easier work environment but seriously erodes profitability.

Another more specific measure of staff and veterinarian productivity and efficiency is the average number of staff and doctor hours per transaction. Average staff hours per transaction are calculated by dividing the total number of hours worked by all support staff members during a certain time period by the number of transactions incurred in that same time period. Average doctor hours per transaction are calculated by dividing the total number of hours worked by all doctors during the same period by the number of transactions incurred in that period. Average total hours per transaction are calculated by adding staff hours per transaction to doctor hours per transaction. As the name of the metric states, these results are averages for all transactions from the simplest sale of a bag of dog food to a long and complicated surgery. However, comparing these figures from period to period in your practice and to other practices can be very useful in determining areas for improvement.

Staff training

A good training program takes time to design and implement, but the benefits will far outweigh the costs. Not only do staff members need training in multiple areas—medical topics, client service topics and the specifics of their job duties, but they also need training in how to prioritize their job duties and in working efficiently. This training gives employees the ability to provide better client service and allows veterinarians to delegate more tasks and concentrate on doing what they were trained to do—diagnose and treat cases. Equally importantly, staff training keeps employees interested and motivated. The more an employee knows how to do, the more interesting their job is and the more pride they have in the practice and confidence in themselves and what they do. And employees who have a greater range of skill and knowledge can be more efficiently utilized resulting in greater income to the practice. Review your training program to make sure you are addressing all of the steps below:

     • Decide what kinds of training you need. Most practices need a new-hire training and orientation program (for both doctors and support staff) as well as an on-going training program. The new-hire program will usually have a standard content whereas on-going training programs are generally more flexible depending on the needs of the practice.

     • Designate a veterinarian or senior support staff member as the Training Manager. Give them the time and the tools necessary to set up and manage an on-going training program.

     • Make sure you have current written job descriptions to aid staff and doctors in understanding the parameters and expectations of each position.

     • Decide on the critical topis. New-hire training generally consists of an orientation to the practice's employee policies and procedures, introduction to all staff members, computer system training, OSHA training, time spent in each area of the clinic and finally, specific training in the new employee's position. On-going training programs are generally split between business and client service topics (good telephone skills or dealing with clients' grief) and medical topics (vaccination programs, catheter placement, etc)

     • Decide which topics are important to which employee groups. Some topics (computer system use, good telephone skills) should be taught to everyone whereas receptionists generally don't need to know how to intubate a dog.

     • Get input from everyone in the practice as to what training is currently needed. Have a doctors' meeting and see what skills they think are lacking in the support staff. Ask the support staff what lack of knowledge or skills is impeding their progress. Ask recent new hires what would have made their jobs easier had it been included in the orientation program.

     • Decide on the timing of the training. Some kind of training should occur every week. Some sessions will include all staff members and others will only include one department (i.e. receptionists.) There is no ideal time for training, but pick one that is least disruptive to the practice. Many practices use the lunch hour for staff meetings and training sessions but this is often inefficient because it is difficult to start on time and there are frequent interruptions. Early morning works well for many practices. For example staff meetings and training are scheduled every Wednesday morning from 7am-9am. Either the practice doesn't open until 9am that day or one person is designated to deal with the unavoidable walk-ins or emergencies. If the practice is open during this time, no scheduling of appointments, drop-offs, etc should occur and the phone should be forwarded to the answering service or machine.

     • Vary the subject matter and the type of training session. Some will be traditional classroom style; others may include role-playing or hands-on practice sessions.

     • Take advantage of the many resources already available in the form of books, tapes, etc. from the AVMA, AAHA and other organizations.

     • Involve everyone in your practice. If you have a technician who is particularly skilled in catheter placement, have them help the less experienced staff members. If one of your doctors has a special interest in orthopedics, ask them to teach a session. Bring in outside speakers—drug company reps will often talk on topics related to their products. Someone in the practice may have a friend who works in a related area (for ex. a psychologist who can talk about grief counseling or a marketing guru who can lead a discussion on attracting more clients to the practice.)

     • Share knowledge gained at outside meetings. Each participant (doctor or staff member) should discuss the most useful things learned with the rest of the practice.

Delegation

Delegation is critical to good staff utilization; however it must be done right to be effective. This doesn't mean just dumping any task on the first employee you can find and expecting it to be done perfectly.

Think through first, why do you want to delegate tasks? This will help you decide what to delegate and to who. Common reasons include:

     • Redistribution of the workload as the clinic grows

     • Reduce higher level employee work (and stress) load

     • Provide employees with more interesting tasks and opportunities

     • Obtain new insights in how to accomplish tasks

Effective delegation is an art, not a science. These steps are critical:

     • The potential delagator must get over the idea that they alone can correctly perform the task

     • Determine trust level with employees before delegating

     • Decide what tasks to delegate

     • Match tasks with the appropriate employee

     • Allocate time to do the task to the employee who is now in charge of it

     • Provide correct level of control and authority

     • Follow-up periodically

     • Offer the right reward and recognition for jobs well done

In general tasks should be done by the lowest level person who can do the task correctly. However, in spite of this rule, some tasks should not be delegated. These include sensitive interpersonal communications, critical client matters, tasks that, by law, a veterinarian must do, the dissemination of good news, the releasing of critical information, and disciplinary tasks.