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Why Your Front Desk Team Sucks

Why Your Front Desk Team Sucks

Leadership Skills

Do you remember the first time you told a pet owner that her dog was dying?

You were sweating bullets, struggling to find the right words, and tried your best to be honest and compassionate. I’m going to have the same conversation with you. Your front-desk team is in critical condition. If you don’t resuscitate these employees, client relationships will die.

Every client interaction begins and ends with your client-care team.

From the phone call to book an exam to collecting payment at checkout, your front-office staff impacts your hospital’s revenue and client relationships. Here are your team’s ailments and how to cure them:

They don’t know your standards of care.

As a mystery caller, I explained I recently moved from another state and received an email from my previous veterinarian that my dog was due for a checkup. I asked which vaccines would be needed in our new community and the cost. The employee replied, “The shots are always up to you but we usually do leptospirosis, distemper, rabies, and bordetella.” Describe core vaccines with confidence rather than “shots are up to you.”

Miscommunication of basic medical information is commonplace. In another call about a 16-week-old kitten, an employee told me rabies vaccination should be given at six months of age. Another time I explained that I adopted a 12-week-old puppy, shared which vaccines were given, and noted the puppy was treated for “worms” at the shelter. I asked how to prevent my puppy from getting “worms” again. The employee replied, “That would be something you would need to talk to a doctor about. I’m just a receptionist.” As the caller, I heard, “I don’t know anything, and I can’t help you. I just work here.”

Every employee must confidently communicate the preventive standards of care that your veterinarians have set. Create a quick-reference guide of your standards of care for puppies and kittens at 8, 12, and 16 weeks of age, along with adult and senior pets. List questions to ask, services to describe, and prices to quote. This will save significant time during calls and help you consistently and accurately quote services and prices. Protocols would differ for a 16-week-old kitten compared to a 16-year-old cat.

Have doctors conduct a refresher class at least annually, so front-office teammates can discuss commonly asked questions and have consistent messages when describing professional services and products. Have pharmaceutical representatives train your client-care team twice a year on vaccines and parasites, so they know essential product facts.

Too often, client service representatives had never been invited to venture beyond the front desk. As part of new hire orientation, have them rotate through the lab, pharmacy, treatment area, and surgical suite. Letting non-medical personnel observe surgeries will give them confidence when describing services over the phone. Have seasoned front-desk employees watch one surgical and dental procedure at least annually. This hour away from the front desk will have them witness patient care first-hand, seeing every professional service from preanesthetic testing to nursing recovery care. How can you expect them to accurately describe a neuter or dental treatment to callers if they’ve never watched the procedure?

You didn’t teach them manners.

When I approached the check-in counter with my cat in a carrier, your employee was typing on the computer. I waited several minutes for her to acknowledge me. She stared up at me with an exhausted expression and said, “Sorry, I was just entering a prescription refill. How can I help you?” If you have a 10 a.m. appointment for a kitten and I walk through the door at 10 a.m. with a cat carrier, you can easily greet me and my pet by name.

Stand up for service. Your body language communicates you’re ready and eager to help. Say, “Good morning, Wendy. We’re excited to meet your new kitten, Alex! Did you bring his adoption papers and a stool sample for us to test?” After the client responds, show your team is prepared and ready to deliver medical services. Say, “I will let Dr. Lavallee and her technician, Sue, know that you have arrived. I’ll take the stool sample to our lab, where we will begin the test and have results during today’s exam. I’ll add Alex’s vaccine information to his medical record. What questions may I answer before we get started?”

Simple gestures of appreciation such as saying please and thank you, making eye contact, and using “you’re welcome” in place of “no problem” are the difference between ho-hum and five-star service. If Chick-fil-A can teach manners to Millennials, so can you.

You don’t provide ongoing training.

Veterinarians and credentialed technicians must earn continuing-education credits for licensing requirements. Receptionists only expand their knowledge when a sales professional sponsors a lunch-n-learn session at your office. How can you expect employees to improve if you don’t grow their skills?

Your front-desk team must polish and perfect telephone and client-service skills. If your hospital is in Pennsylvania, veterinarians need 30 hours of continuing education every two years while technicians need 16 hours. Have client-care employees earn at least eight hours. Incorporate CE requirements into performance reviews. To be “raise eligible,” staff must complete a specific number of hours of training each year. Learning could include webinars, conferences, in-clinic lunch-n-learns, and sponsored dinners. If employees are constantly growing their skills, they are constantly growing your hospital.

No one directly supervises the front-desk team.

Sure, your hospital manager handles client complaints, sets work schedules, and trouble-shoots questions from frontline teammates. Your receptionists work solo without daily elbow-to-elbow leadership.

Appoint a team leader who also works at the front desk. This manager leads by example, sets work schedules, provides in-the-moment coaching, delivers timely reviews, and creates training plans to elevate the team’s skills. If you don’t have a supervisor candidate yet, have the hospital manager help at the front desk once a week. The manager will see and hear interactions between employees and clients.

You treat them like “receptionists.”

This job description includes being a superior scheduler, multi-task master, problem solver, operator extraordinaire, bill collector, compassionate caretaker, retail marketer, and much more. Treat frontline employees with respect and as equal colleagues if you want them to look and act like professionals. Consider a title change that represents the “I do everything” job description. My favorites are client care coordinator, client service advocate, and client care specialist. Make your team feel like the superheroes they are!

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How Nurses Can Grow Your Revenue

How Nurses Can Grow Your Revenue

Leadership Skills

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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