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How to Prevent No-Shows

How to Prevent No-Shows

Hospital Management

How to Prevent no-shows

His frustration had reached the boiling point. After three no-shows this week, a veterinarian asked me if he should start asking clients to prepay for surgeries. While I empathize with his angst, don’t punish 99.9 percent of good clients for a few bad apples. Imagine you are a client of 12 years who now has to pay before services get delivered. You might get so mad that you leave the practice. Instead, use these proactive techniques to prevent no-shows:

Text or email appointment confirmations immediately after booking.

A client schedules a spay one month from today during her puppy’s last checkup. If you wait until the day before the procedure to remind her of the surgery and fasting instructions, you chance that she may forget or need to reschedule. When she books today, immediately text or email an appointment confirmation that she may add to her calendar. Set up appointment confirmations in your practice-management software or third-party apps. Text: “<Pet name> has a surgical admission appt on <date> at <time>. Reply C to confirm or RS to reschedule.” If a client replies RS, call to have her select a new time and date.  

This double confirmation at the time of booking reiterates the importance of the exam or procedure. My dentist does this. When I booked my next hygiene appointment, I got a text on the elevator ride to the parking garage. I added the appointment to my calendar before I unlocked my car.

Confirm earlier and multiple times. 

Don’t wait until the day before appointments or procedures to remind clients. Set up a series of confirmations and reminders: 1) Upon booking, 2) Four days before the appointment or procedure, 3) Two days ahead, and 4) The day of the appointment, reminding of fasting instructions for procedures or bringing stool samples for checkups. 

Gather new client information during scheduling calls. 

Go beyond collecting a name and phone number. When scheduling, take 2 minutes to enter the client and patient names, address, email, cell number, and patient breed and birthdate. You’ll avoid the negative experience of “clip-boarding” a new client when you hand her a registration form at check-in while she struggles with her Jack Russell terrorist on a retractable leash. You’ll suck away valuable exam time with busy paperwork. Because you have gathered the majority of client contact information during the scheduling call, you’ve established a “know, like, and trust” relationship. 

Perform preanesthetic testing when clients book procedures. 

If you diagnose my cat with dental disease on Wednesday and I schedule treatment for Friday, collect blood and urine samples for preanesthetic screening today. This lets you choose the most cost-effective diagnostics from the reference lab or in-house testing. The client pays for lab tests today, reassuring she will show up two days later for the procedure. Your nursing team also will appreciate one less task to perform the morning of the dental treatment. 

Have clients sign anesthetic and surgical consents before booking. 

Let’s say you diagnose dental disease and explain the need for treatment. The client agrees. Get signatures on the treatment plan and anesthetic consent form today. You’ll dodge the time-suck of paperwork and get written commitment to show up. 

An alternative is use text and email together. When you confirm the surgery two days in advance, text the client: “See you Friday at 8 a.m. for <pet name>’s surgical admission. No food after 10 p.m. Water is OK. We emailed surgical forms to <email>. Reply with questions.” The text prompts the client to check her email, where you can provide detailed fasting instructions and attach consent forms and treatment plans.

Your email message would say, “We will see <pet name> for surgery on Friday at <Your Veterinary Hospital>. Please withhold food after 10 p.m. tonight. Water is OK to drink to prevent dehydration. Your surgical admission begins at 8 a.m. with a nurse, who will spend 15 minutes reviewing the consent form, answering your questions, and getting phone numbers where we may reach you the day of the procedure. I’ve attached your treatment plan and anesthesia consent forms. To speed your admission, please bring these signed forms with you, or we are happy to answer questions during check-in. Please allow at least 15 minutes for <pet name>’s admission to our hospital. If you have questions, call or text 555-555-5555.” 

Text driving directions to new clients. 

When you confirm exams two days in advance, text: “We’re excited to meet you and <pet name> on Friday at 4 p.m. Bring a stool sample that’s fresh within 4 hours. Get driving directions at <link>.” When new clients click the link on their smartphones, map apps will give them estimated travel time along with turn-by-turn directions. You’ll enjoy on-time arrivals and create “wow” first impressions. 

Send a final text or email confirmation the day before appointments and procedures. 

Text the client: “We will see <pet name> tomorrow for an appt with Dr. <Name> beginning at 9 a.m.” The word “beginning” trains the client to be in your lobby at exam time, not down the street at Starbucks (unless she’s fetching you a pumpkin spice latte!). 

Mail thank-you cards after the first visit. 

This is the first date that starts a lifetime relationship. Don’t default to a templated email or text that will get scanned and deleted. People receive hand-written greeting cards in the mail on birthdays, holidays, or anniversaries. Make the new client appointment a standout occasion. Have the doctor and hospital manager sign the card and add a personal message such as “We loved meeting your kitten, <pet name>, and look forward to watching him grow up!”

Start no-show strategies today.

A dog owner may spend nearly $700 for a checkup that includes an exam, vaccines, diagnostics, and 12 months of flea/tick and heartworm preventatives. Surgical and dental procedures may have even higher dollar values to your practice. Stop the anxiety of whether clients will show up as promised. Reclaim the confidence that you’ll have long-term, loyal relationships with these approaches.

Author: Wendy S. Myers, CVJ, Communication Solutions for Veterinarians

 

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Avoid a Meltdown When Dr. Popular Isn’t Available

Avoid a Meltdown When Dr. Popular Isn’t Available

Hospital Management

A longtime client calls and requests an appointment with Dr. Popular. While this veterinarian is blessed to be busy, you don’t want clients to have meltdowns when they can’t see their preferred doctor. What should you do? 

 

focus on what you can do.

Don’t tell the pet owner that the doctor is booked three weeks out because it will create a negative impression and could incite an argument. Say, “Dr. Popular’s next available appointment is Aug. 30 at 9 a.m. If your pet needs to be seen sooner, Dr. Next could see you tomorrow at 4 p.m. Which do you prefer?” 

practice forward booking.

When clients want their first choice of time, day, and doctor, have them book the next appointment during today’s exam. Use forward booking for progress exams, checkups, and disease-management exams for pets with chronic health conditions.  

When wrapping up today’s exam, Dr. Popular should introduce the concept of forward booking. If you have computers in exams rooms, he should schedule it now (Yes, the veterinarian needs to know how to use the scheduling tool in your practice-management software). Here are two examples of client conversations: 

 For a disease-management exam, explain the “why” behind the change in the frequency of exams and use benefit statements. Dr. Popular would say, “Because Molly was diagnosed with arthritis today and will begin long-term medication, I will need to see her every six months to manage her arthritis and check blood work in case we need to adjust medication dosages. Booking her next exam now will let you get your first choice of a time and date with me. Six months from today would be Jan. 9. I could see Molly at 10 a.m. or 4 p.m. Which do you prefer?” 

For a checkup, lead the client to book the next six- or 12-month exam. If the receptionist is scheduling the exam during checkout, she would say, “Just as your dentist has you schedule your next appointment at checkout, we do the same to proactively manage your pet’s health. Let’s book your pet’s next checkup for this same day and time next year. We will confirm two weeks before the exam, so if you need to change the appointment it will be easy. By scheduling today, you will get your first choice with Dr. Popular. He could see your pet at 10 a.m. on Wednesday, Aug. 12 or 3 p.m. on Friday, Aug. 14. Which do you prefer?” The first choice is the same day of the week and time as today’s appointment. The second choice is a different day of the week and time of day (morning vs. afternoon). Get scheduling techniques in my article on “Four Ways to Use Forward Booking” (https://www.veterinarypracticenews.com/four-ways-to-use-forward-booking/).   

be persistent when pets require progress exams.

Because Dr. Popular is booking weeks in advance, the entire healthcare team must be dogged and communicate the importance of scheduling follow-up care today. After explaining how to clean a dog’s ears and apply ointment for an ear infection, the nurse would say, “Dr. Popular needs to perform a follow-up exam in two weeks for your dog’s ear infection. We strive to book follow-up care with the same doctor because Dr. Popular wants to see the condition successfully resolved. This will be a 15-minute appointment to examine your dog’s ears and determine if additional treatment will be needed. Dr. Popular could see your dog on Thursday, Aug. 28 at 10 a.m. or Friday, Aug. 29 at 2 p.m. Which do you prefer?” 

If the client procrastinates and waits to call your hospital in two weeks when care is due, Dr. Popular won’t be available. Booking with the same veterinarian helps you achieve exam efficiency. If Dr. Next will see Dr. Popular’s patient for follow-up care, he will need to spend more time reviewing the medical record to get up-to-date on the diagnosis, treatment, and prescribed medications. The follow-up visit may take twice as long if a different doctor sees the patient.  

add more urgent care slots to dr. popular’s schedule.  

I advise receptionists to block three urgent-care slots per doctor per day for same-day sick patients. Because clients will call every morning with sick patients that must be seen today, plan for them in your daily schedule. You may need more urgent care slots on Mondays, Fridays, and Saturdays, when hospitals typically see higher volumes of sick patients.  

To determine how many urgent care slots Dr. Popular will need, create a spreadsheet that totals the number of exams he sees by day of the week. Let’s say he saw 22 patients on Thursday. Approximately 20 percent of patients are same-day sick appointments. Based on this formula, Dr. Popular would need seven urgent-care slots on Thursdays. Block an urgent-care slot at the top of each hour in Dr. Popular’s schedule on Thursdays. Get more insight in my YouTube video on “Overbooked and Can’t See Sick Pets? Here’s the Solution” at https://www.youtube.com/watch?v=j_oWxml2qyc&t=9s.  

Talk up other doctors.  

You want clients to feel confident and comfortable with every doctor in your practice. Dr. Popular, nurses, and the client-care team need to praise the skills and knowledge of other veterinarians in your hospital. When a client sighs after hearing Dr. Popular isn’t immediately available, promote Dr. Next. The receptionist would say, “Dr. Popular’s next availability is Aug. 30 at 9 a.m. I could schedule you with Dr. Next. He has a special interest in feline medicine and would love to meet Alex. I’m confident you’ll be satisfied with the quality of his medicine. Dr. Next could see Alex tomorrow at 4 p.m. Shall I schedule this exam?”

During his appointments, Dr. Popular also can share praises of his colleague, Dr. Next. Afterall, Dr. Popular may be the practice owner and hired Dr. Next. To transfer the client’s trust to another veterinarian, Dr. Popular might say, “Dr. Next has been part of my medical team for five years. We went to the same veterinary college and share similar medical interests and philosophies. If I’m unable to promptly see your pet, I’m confident that Dr. Next will do an exceptional job.” 

Because Dr. Popular will take vacations or may sell the practice one day, you must build trust in every veterinarian. Have your team discuss ways to equally distribute appointments amongst all doctors because the hospital’s goal is to have every veterinarian fully booked every day.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Stop Clients’ Bad Habits of Emergency Refills

Stop Clients’ Bad Habits of Emergency Refills

Hospital Management

The habit is predictable. Every day, multiple clients call your veterinary clinic within minutes of closing time to request prescription refills. “My dog took his last pill this morning, and I need a refill today. I’m on the way to your hospital now. Could you wait for me?” pleads the pet owner.

You both want the dog to get timely medication, but why did the client wait until the last dose was gone before contacting you? To avoid the stress of urgent refills, take a preventive approach with these strategies:

Alert clients when refills are coming due.

My cat, Caymus, takes benazepril daily. I refill his medication every three months. When you dispense his next prescription, create a refill reminder for 11 weeks, when one week of doses would remain. Alerts could be phone calls, emails, texts or app messages. Send alerts through your practice-management software or third-party providers.

At Blue Sky Animal Clinic in Loveland, Colo., Practice Manager Chrystal Bell wanted to be able to call and text from the same phone number her clients knew. Zipwhip lets you use your existing business phone number to send and receive texts. Now clients text refill requests to Blue Sky Animal Clinic’s main phone number. Employees reply when messages pop up on the desktop screen.

Push notifications also let you tell clients when they need to repurchase. A VitusVet call study found the average client service representative (CSR) answers 600 calls per week at a veterinary hospital.1 While more than 60 percent of calls generate revenue through appointments and prescription refills, the average veterinary hospital is missing $123,000 of gross revenue due to inefficiencies in phone-based customer service. (*1)

Links in your emails, texts or app can let clients request prescription refills electronically. Clients will enjoy the satisfaction of one-click refills, while your client service team will be overjoyed when you reduce call volume by 20 or more calls each day.

 

Enter the number of refills available.

If the veterinarian wants to perform a blood test every six months and the technician is filling a one-month supply, five refills of 30 tablets would remain. The number of refills will print on each prescription label, letting the client see the countdown of 5, 4, 3, 2 and 1 refill left.

While I agree that veterinarians will need to approve each prescription refill, don’t punish clients with long hold times on the phone. Note the number of refills that are available in medical records, avoiding the find-the-doctor game each time clients call with refill requests. Tell the pet owner, “<Client name>, I see that you have five refills available. What time would you like to pick up your pet’s medication? I will have the doctor confirm the refill. I will only call you if the doctor has any questions or concerns. Otherwise, we will see you at <time>.” After speaking with the caller, the CSR could ask the veterinarian to approve the prescription and note the requested pickup time for the technician who will fill the medication.

 

Set up reminders for drug-monitoring tests.

Clients may become outraged when you decline their emergency refill request because blood work is due. To avoid confrontation, your medical team needs to proactively remind clients when future testing will be due. Veterinarians should set protocols for the frequency of blood tests for long-term drugs such as phenobarbital, non-steroidal anti-inflammatories (NSAIDs), thyroid medication and others.

When a technician fills a long-term prescription, enter two reminders: 1) drug-monitoring test and 2) Prescription refill. Let’s say your veterinarians want to perform blood work every six months for dogs taking NSAIDs. Set the reminder for 30 days before testing is due, which will trigger postal, email, text and/or app notices to the client. Your reminder should explain the reason for testing and lead the client to schedule now. The reminder would state, “Drug monitoring is necessary for <pet name> to continue to safely take medication and is required before the next refill. Please schedule your pet’s blood test before <date> so we may provide prompt refills.” If an exam also is due, schedule the appointment with a veterinarian. If the blood test is the only service due, make a technician appointment for the blood draw.

If clients haven’t responded to reminders, technicians would call one week before testing is due. Say, “This is <technician name> from <Your Veterinary Hospital>. We saw <pet name> six months ago, and Dr. <Name> needs to monitor his thyroid level. During a technician appointment, we’ll collect a blood sample and run the thyroid test. Drug monitoring is necessary for <pet name> to continue to safely take his thyroid medicine and is required before the next refill. <Pet name> will be out of thyroid medication next week. We could see you Monday at 10 a.m. or Tuesday at 5 p.m. Which choice is convenient for you?” Use the two-yes-options technique to guide pet owners to schedule.

 

Place a sticker on the vial when one refill remains.

When blood work will be due before the next refill, put a label on the prescription vial such as “Blood test required before next refill.” The prescription label also will note that zero refills remain. Use a bright-colored sticker rather than typing “Blood test required before next refill” on the label. Few clients re-read labels for chronic medications when dosing instructions remain the same.

The sticker alerts both clients and employees. When the client arrives to pick up medication, the CSR would see the sticker and say, “I see that this is your last refill before blood work is due. Let’s schedule a 15-minute technician appointment for the blood draw. We could see your pet next Tuesday at 1 p.m. or Wednesday at 11 a.m. Which choice works for you?” Schedule first before collecting payment for the medication because an appointment reminder will print on today’s receipt. In addition to using stickers on chronic medications, also put the “Blood test required before next refill” sticker on heartworm preventatives when a heartworm test will be due.

 

Set up auto refills.

Retail pharmacies such as grocery stores, Walgreens and CVS Health use text alerts when prescriptions are ready. Research conducted by the CVS Health Research Institute found that pharmacy customers enrolled in digital and online programs have better medication adherence and reduced healthcare costs. (*2)

Your veterinary hospital could use an auto-refill strategy for over-the-counter and prescription drugs. If a client buys six months of heartworm preventatives, set up one auto refill in five months when one dose will remain. Alert the client when the medication has been refilled with calls, emails, texts or app messages such as “Your pet’s heartworm preventative has been refilled and is ready for pickup. One dose remains, and we want to provide ongoing protection from deadly heartworms.” An auto-refill strategy would increase compliance for 12-month dispensing. Because a heartworm test would be due at the completion of one automatic refill, you would send reminders for the physical exam, heartworm test, prescription renewal and other services included in a preventive checkup.

An over-the-counter flea/tick product also could be set up on auto refill. Let’s say the brand has a “buy six, get two free” promotion. At month 7 when one dose remains, you would alert the client, “Your auto refill of <brand name> to protect your pet from fleas and ticks has been filled and is ready for pick up. Your purchase is eligible for two free doses, a value of $___, which we have included with your refill.”

Midwest Veterinary Supply’s partnership with MyVetStoreOnline.com lets clients set up recurring orders of any product, from food to medication (www.midwestvet.net/practice-solutions/home-delivery-solutions/mvso.html). The “Easy Dose It!” program sends clients a single preventative dose in the mail each month with free shipping.

 

Send dosing alerts.

During exams, show clients how to set up alerts on the day of the month that they need to give flea, tick and heartworm preventatives. Provide instructions through email blasts, e-newsletters and social media posts, too.

 

Offer refills through your online store.

When clients get refill notices, offer the convenience of online or app ordering. Ask your veterinary distributor about setting up your own online store. Clients get home delivery of medications and diets with auto-ship benefits and reminder emails. You set the price of all products. Clients pay your hospital’s retail price plus shipping, handling and applicable taxes.

Make this a hassle-free year of managing prescriptions. These strategies can graduate beyond prescription drugs. Think of every consumable product your hospital sells—diets, dental chews, preventatives, pet toothpaste—and create refill push notifications. You’ll improve client loyalty, patient care and the financial health of your pharmacy.

Reference:

*1 – DiFazio M. Veterinary front desk workers are heroes too and here are the numbers to prove it. Published June 28, 2016. Accessed December 20, 2016 at http://content.vitusvet.com/blog/veterinary-front-desk-workers-are-heros-too-and-here-are-the-numbers-to-prove-it.

*2 – CVS Health introduces new digital pharmacy tools to help make medication adherence easier and more convenient. CVS Health, Nov. 18, 2015. Accessed Dec. 19, 2016 at https://cvshealth.com/newsroom/press-releases/cvs-health-introduces-new-digital-pharmacy-tools-help-make-medication.

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How to See More Patients

How to See More Patients

Hospital Management

Seeing patients every 30 minutes doesn’t work. If Dr. Smith has outpatient exams from 8 a.m. to 5 p.m. with an hour for lunch, he will see 16 patients. His daily production will be $3,072 to $3,360 based on a $60 exam fee and average doctor transaction of 3.2 to 3.5 times the exam fee.  (*1) Tweaking scheduling techniques will let Dr. Smith see eight more patients each day, increasing income $4,608 to $5,040. Let’s start making more money:

Step 1: Schedule exam time based on the reason for the visit.

Don’t put every appointment in a 30-minute slot because a progress exam will take less time while a sick-patient visit may take longer.

Veterinarians and receptionists will work together to create scheduling guidelines. Don’t force this significant change on employees without their input—or it’s guaranteed to fail. Talk about what works and doesn’t work with your current schedule, how nurses support doctors in exams, and which scheduling tweaks will have the greatest impact. When making any change in your hospital, answer:

  1. How will this change improve client experiences?
  2. How will this change improve patient care?
  3. How will this change grow revenue?

Teamwork will help everyone understand the “why” behind scheduling renovations and get buy-in to follow guidelines consistently. Receptionists and doctors will need to define appointment lengths such as:

  • 10 minutes: Booster vaccines without exams, Level 1 progress exams for minor problems such as ear infections, and surgical discharges when a doctor needs to provide instructions.
  • 20 minutes: Adult preventive checkups, complicated medical/surgical discharges, Level 2 progress exams for complex problems, disease-management exams for chronic conditions, and second, third, and fourth puppy/kitten exams.
  • 30 minutes: Sick and urgent care exams, senior preventive exams, new clients, limping or symptoms that may require radiographs, skin cases, ophthalmic exams, second opinions, quality of life consults, and unattended euthanasia.
  • 40 minutes: Patients with vomiting and/or diarrhea, first puppy/kitten exams, attended euthanasia, and exotic pets.

Expand this list based on the types of appointments you see. Keep the quick-reference chart of scheduling guidelines on reception computers or laminated cards so tips become habit-forming. Your practice-management software also lets you designate appointment types, which would automatically block the correct length based on the exam type.

 

Step 2: Think in 60-minute blocks.

Your goal is to book every minute of each hour, avoiding gaps in the schedule. A 60-minute block could include a 10-minute progress exam, a 20-minute preventive checkup, and a 30-minute sick-patient exam. The next 60 minutes might consist of a new client appointment followed by a disease-management exam. Both choices had you successfully fill each hour.

 

Step 3: Book sick-patient exams next to checkups.

If you schedule three sick patients in a row, you risk running behind and creating an avalanche of late exams. Preventive checkups are more predictable and likely to stay on time. If you sandwich a sick-patient exam between two checkups, your schedule could stay on track.

 

Step 4: Leverage nurses.

Evaluate which appointments could shift from the schedule of veterinarians to nurses, such as giving booster vaccines that don’t require an exam, expressing anal glands, changing bandages, administering fluids, trimming nails, collecting samples for drug monitoring, and more.

 

Step 5: Evaluate as you go.

You’ll need two to four weeks to transition to the new scheduling system because you may have forward-booked appointments for progress exams. Everyone will need training on how the new scheduling system will work and what their roles are in executing it. Set a transition date to switch from the old to new scheduling method. The transition is best made quickly and completely.

During the first 90 days of implementation, have a doctor and receptionist supervisor meet weekly to see what worked well in the schedule’s flow and identify tweaks to make. Fine-tuning during the first 90 days will help you define your perfect exam flow.

 

Step 6: Track results.

Measure before-and-after progress. Create a spreadsheet on the number of appointments and revenue for 30 days before changes were implemented, and then 30, 60, and 90 days after the new schedule began. You should see up to 33 percent growth.

 

Share results.

During staff meetings and invite employees to share feedback. When employees see results and know they were part of making it happen, your practice will thrive.

References:

*1 – Tumblin D. Problem: Your Average Doctor Transition Is Low. Veterinary Team Brief, January/February 2018. Available at: www.veterinaryteambrief.com/article/problem-your-average-doctor-transaction-low. Accessed on March 10, 2019.

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How Nurses Can Grow Your Revenue

How Nurses Can Grow Your Revenue

Hospital Management

What is the difference between an under- and top-performing healthcare team?

Let’s say you schedule appointments every 30 minutes. In an eight-hour workday, one doctor sees 14 patients and has an average transaction of $160, generating $2,240 in revenue. Your average doctor transaction should be 3.2 to 3.5 times your exam fee, according to the Well-Managed Practice Benchmarks Study.(*1) If you leverage your nursing team and schedule time based on the reason for the visit, you could see 21 patients per day, producing $3,360 per veterinarian and averaging three patients per hour. Revenue rises when you add dental income that nurses deliver.

How can nurses help you grow revenue? Follow these steps:

Check your staff-to-doctor ratio.

Every employee feels the hospital is short-staffed. Chances are, you may have the right number of employees but are not efficiently using them. Aim for staff-to-doctor ratios of 4.7 team members per full-time veterinarian, according to WTA Consultants in Columbus, Ohio. (*2) This support staff includes two nurses, one veterinary assistant, one receptionist, and 0.7 managers.

Assign doctor-nurse teams.

Designate daily which staff will be outpatient nurses (exams) and inpatient nurses (treatment area). Pair two nurses or assistants with each veterinarian. This medical team of three works together the entire day. Define roles and tasks each support employee will perform. Doctors need support from the right person with the right skills at the right time.

Veterinarians should focus on three medical responsibilities:

  1. Diagnose health conditions
  2. Share treatment solutions
  3. Perform surgery and procedures

Nurses do everything else. Think of nurses and assistants as “staff extenders” to perform non-doctor functions such as client education, technical skills, and medical-record management. This approach lets you see 30 percent to 40 percent more appointments in the same amount of time. (*3)

Here are examples of outpatient and inpatient nursing duties:

Outpatient nurse duties

Inpatient nurse duties

Get patients’ vital signs

Collect samples for diagnostic testing prior to doctor entering the exam room

Take brief histories

Run lab work

Educate clients

Take x-rays

Fill medications

Perform dentistry

Be a transcriptionist, writing in medical records while the doctor explains exam findings and diagnoses

Place catheters

Review medication and treatment instructions with clients

Run and monitor anesthesia

Admit and discharge surgical and dental patients

Monitor hospitalized patients

Provide discharge and medication instructions

Administer medications and treatments to hospitalized patients per doctor instructions

Handle nurse appointments

Assist with surgery

(Expand and tailor this list of duties for your hospital.)

State laws vary on which duties credentialed veterinary nurses are allowed to perform. Check your state’s practice act here. You will use three types of nursing teams:

Outpatient nursing team:

You may use two credentialed nurses, one nurse and one assistant, or two assistants. For a 20-minute checkup, Nurse #1 spends the first five minutes gathering a brief history, getting the patient’s vital signs, and explaining services and products that will be delivered today. Confirm the reason for the visit at the beginning of each exam. Say, “I’m <name>, the nurse who will assist Dr. <Name>. For your pet’s checkup, we will do a nose-to-tail exam, vaccines, heartworm/tick screen, intestinal parasite screen, and refill preventatives. I will take a brief history, collect samples for testing, and get your pet’s vital signs. Then the doctor will begin the exam. Does your pet have any health or behavior concerns you want to discuss with the doctor?” If the client shares a concern, this becomes the chief complaint that the veterinarian will address before delivering preventive care. Watch my video on “The #1 Question to Ask to Keep Exams on Time”. Nurse #1 takes the patient to the treatment area where an inpatient nurse or assistant will help collect samples.

When the patient returns to the exam room, the doctor is ready to begin. The veterinarian will spend the middle 10 minutes of the appointment performing the exam, vaccinating the pet, discussing exam findings and test results, and answering the client’s questions. Nurse #1 stays to assist the doctor with the physical exam.

Meanwhile, Nurse #2 is starting the next appointment, allowing the doctor to consecutively work two exam rooms. Nurse #1 closes the first appointment, reviewing preventative or medication instructions and providing client education. This exam work flow lets your team see three or more patients per hour, significantly increasing productivity and income.

Surgical nursing team:

The veterinarian prioritizes today’s surgical cases. A nurse and two assistants support the surgical doctor. The nurse anesthetizes patients, places catheters, monitors patients, assists the veterinarian during surgery, and updates medical records. In the afternoon, the same nurse may discharge patients. Assistant #1 preps patients and moves them into the surgical suite. Assistant #2 recovers surgical patients. The veterinarian changes gloves and follows sterile surgical protocols between each patient. The nursing team calls, emails, or texts clients as each patient is recovered and confirms discharge appointments.

 

Dental nursing team:

By age 3, most dogs and cats have periodontal disease. (*4) Because doctors will diagnose dental disease daily and advise treatment, you want to schedule dental procedures Monday through Friday to meet the demand. The veterinarian performs pre-surgical exams, sets anesthetic protocols, oversees cases, and does oral surgery.

Nurses lead your dental profit center. The dental team includes one nurse and one assistant. The nurse anesthetizes patients, places catheters, and checks the assistant’s work. The assistant takes dental x-rays, cleans and polishes teeth, recovers patients, and updates clients.3 The veterinarian reviews x-rays and performs extractions and oral surgery. While employees will always help teammates when needed, the key to maximum production is simple: Nurses don’t do assistants’ work, and doctors don’t do nurses’ work.3

 

Schedule nurse appointments.

Use nurse appointments for admissions, discharges, and outpatient services that support staff perform. When clients walk in for nail trims and bandage changes, these unscheduled services may put additional stress on your nursing team and cause clients to wait when employees aren’t immediately available. To bring structure to walk-in chaos, create a column for nurse appointments in your schedule just as you have rows for doctor exams. Concentrate blocks of nurse appointments during afternoons and evenings such as 1:30 to 3:00 p.m. and 5:30 to 7:00 p.m.

Avoid nurse appointments for outpatient services during mornings, when your nursing team is preparing for surgical and dental procedures and checking hospitalized patients. Morning nurse appointments are limited to surgical and dental admissions. Let’s say you have six procedures today. Schedule admission appointments every 10 minutes from 7 to 8 a.m. Because doctor exams haven’t started, the assistant will admit patients in the privacy of exam rooms, where clients may comfortably ask medical and financial questions.

Set guidelines for nurse appointments so receptionists properly budget time:

  • 10-minute nurse appointments: Express anal glands, collect blood samples for drug monitoring or follow-up testing, perform intestinal parasite screens, insert microchips, provide Level 1 nail trims (cooperative patients), remove sutures, booster vaccines that don’t require a doctor’s exam, and check the weight of pets on weight-management programs.
  • 20-minute nurse appointments: Change bandages, clean ears, Level 2 nail trim (patient requires two or more nurses), administer subcutaneous fluids, collect urine, and perform laser therapy.
  • 30-minute nurse appointments: Take scheduled follow-up radiographs, provide grooming services for birds, and deliver services for multi-pet nurse appointments.

In my online course, “Be Efficient in the Exam Room,” I share flex-10 and high-density scheduling concepts along with exam flow by job type. Have your medical team evaluate every step of delivering outpatient and inpatient services. Ask, “Why do we do it this way?” and “How could we be more efficient?” When you leverage your nursing team, you can deliver more patient care, better manage your workday for less stress, and enjoy increased revenue.

References:

*1 – Tumblin D. Problem: Your Average Doctor Transition Is Low. Clinicians Brief, January/February 2018. Available at: www.cliniciansbrief.com/article/problem-your-average-doctor-transaction-low. Accessed Feb. 4, 2019.

*2 – DVM360.com staff. Benchmarks 2016 Shows Strong Revenue Growth, Higher Staff Levels. Veterinary Economics; Sept. 7, 2016. Available at: http://veterinarybusiness.dvm360.com/benchmarks-2016-shows-strong-revenue-growth-higher-staff-levels. Accessed Feb. 4, 2019.

*3 –  Catanzaro T. Veterinary Healthcare Services: Options in Delivery. Iowa State University Press, 2000:23-25, 52.

*4 –  American Veterinary Dental College. Periodontal Disease: Information for Pet Owners page. Available at: www.avdc.org/periodontaldisease.html. Accessed Feb. 4, 2019.

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Can You Compete With $12 Per Hour at Chick-Fil-A?

Can You Compete With $12 Per Hour at Chick-Fil-A?

Hospital Management

My neighborhood Chick-Fil-A restaurant has a banner advertising jobs starting at $12 per hour. The fast-food franchise boasts a family culture, college scholarships, career paths to management or ownership, and work-free Sundays. Chick-Fil-A ranks among the top 100 in the 2018 Best Places to Work from The Glassdoor Employees’ Choice Awards. (*1) Selling more than chicken, Chick-Fil-A joins other top employers, including Facebook, Google, Apple, Southwest Airlines, Nestle Purina, and more.

I pulled into the ever-present drive-thru line to see what kind of service $12-per-hour workers deliver. Two employees with mobile devices were taking orders to reduce wait time. A Millennial greeted me, asked my name and what they could get started for me. As I drove to the window for my sandwich, the cashier welcomed me by name. When I thanked her, she replied, “It’s my pleasure” rather than the commonplace “no problem.”

Your veterinary hospital may be competing for the same entry-level workers. Indeed, a top job website, reports an average of $12.43 per hour for veterinary receptionists with typical tenure of one to three years. (*2) Job ads offered hourly wages from $13.22 to $20. Now the largest U.S. generation, Millennials rank compensation as the sixth quality they look for in employers. In a Harvard Business Review survey, Millennial job candidates want the opportunity to learn and grow, quality management, interest in the type of work, and opportunity for advancement. (*3)

 

To compete for entry-level workers, your veterinary hospital needs to:

1. Offer competitive wages.

Low unemployment rates in your community demand higher compensation. Profit sharing and bonuses can increase what employees take home. Give performance reviews to new hires at 30, 60 and 90 days. Once they complete the 90-day introductory period, include salary reviews with performance appraisals. You might hire candidates at $13 per hour, and then tell them a raise to $14 awaits if they complete the training program and earn a positive review.

 

2. Create a supportive culture.

Northfield Veterinary Hospital in Denver complements great pay with a great work environment. Perks include amusement park days, monthly staff dinners, a supportive team environment, and no staying late. “I’m an owner at the hospital and having a certified veterinary technician who has worked in the trenches for many years is appealing to staff,” says Jen Weston, CVT, manager and co-owner. “We have a great staff who are willing to train, answer questions and be supportive.”  At Trinity Animal Hospital in Holly Springs, N.C., the team goes bowling and plays laser tag, which its vendors sponsor.

American Animal Hospital in Omaha, Neb., conducts working interviews to prove its culture is the best in town. “We show candidates our friendly, positive work environment,” says Tabitha Show, LVT and practice manager. “Without a strong culture, you have nothing.”

 

3. Train up.

The staff of 30 at Roanoke Animal Hospital in Roanoke, Texas, has an average longevity of 8 years, with several employees staying longer than 10 years. “If you work in the kennel and have a desire to progress in this field, we will train you,” says Liz Hill Bird, hospital administrator. Teaching kennel workers to become veterinary assistants leads to job satisfaction and career paths.

 

4. Create clear career paths.

At Adobe Veterinary Center in Tucson, Ariz., Dr. Christine Staten designed tiered positions for receptionists and technicians. Employees get a list of skills to master for each level with test-outs. Pay increases as team members graduate to higher tiers.

 

5. Provide continuing-education opportunities.

Conferences are awesome perks, but few practices can spend thousands for every employee. Start a journal club where you share and discuss client-service and management articles. Use webinars for staff meetings. Go to community events that distributor and pharmaceutical representatives host. Join a local practice managers group. Have doctors present what they learned at conferences and which ideas your team could implement.

 

6. Delegate projects.

Employees may be interested in marketing the practice on social media, making YouTube videos, designing educational bulletin boards, managing inventory, establishing an angel fund, and other projects that could grow your business. “Train them for new skills,” advises Nikki Richardson, hospital administrator at Trinity Animal Hospital. “Team member retention and low turnover will make you more money in the long run.”

 

7. Offer flexible schedules.

If your practice is open 8 a.m. to 6 p.m. Monday through Friday, you need staffing for 10 business hours each day. Consider allowing employees to work four 10-hour shifts for a total of 40 hours per week. One receptionist works Monday through Thursday while another covers Tuesday to Friday. Organize shifts so you have appropriate daily staffing coverage while letting employees enjoy four-day workweeks.

 

8. Provide veterinary care savings.

Follow IRS guidelines of no more than a 20 percent discount, or you risk audit and tax consequences. Define limits on the number of personal pets covered and have a manager enter charges to prevent abuse of the benefit. Some practices pay employees’ pet insurance premiums in lieu of discounted professional services.

 

9. Have uniforms.

Employees represent your brand. Set standards of appearance for uniforms, name tags, jewelry and personal grooming. The employee handbook at Taco Bell explains, “It’s important to be proud of the way you look every day. When you look good, Taco Bell looks good.” (*4)

 

While helping pets and people leads to tremendous job satisfaction, altruism won’t pay the bills. A combination of competitive wages and great perks will help your veterinary hospital attract and retain the best candidates.

References:

*1 – 2018 Best Places to Work: Employees’ Choice. Glassdoor. Accessed March 16, 2019 at www.glassdoor.com/Award/Best-Places-to-Work-LST_KQ0,19.htm.

*2 – Veterinary receptionist salaries in the United States. Updated Feb. 17, 2018. Accessed Feb. 19, 2018 at www.indeed.com/salaries/Veterinary-Receptionist-Salaries.

*3 – Rigoni, B. and Adkins, A. What Millennials Want from a New Job. Harvard Business Review. Published May 11, 2016. Accessed Feb. 19, 2018 at https://hbr.org/2016/05/what-millennials-want-from-a-new-job.

*4 – Taco Bell Handbook. Published October 2015. Accessed Feb. 19, 2018 at www.hralliance.net/cofiles/38305_c6131950/files/Taco%20Bell%20Handbook(1).pdf.

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