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Team Wellbeing

Posted By Administration, Thursday, December 27, 2018
 

There has been a great deal of discussion and concern in the last few years about the mental wellbeing of veterinarians and their team members. Most probably agree that life is tougher than it used to be and most people’s personal and professional lives are at least somewhat intertwined. It is hard to be a star performer at work if your personal life is falling apart and hard to be a loving and supporting family member or friend if your professional live is beating you down. And, of course, hard to take of yourself if either of these is going on!

 

In December 2018 VHMA member managers were asked to share their perspective on the following questions for themselves, as well as their DVM and support team staff. Here is what almost 300 of your colleagues had to say about themselves and their team members (visit the VHMA website to review the full report, VHMA Insiders’ Insight Report, December 2018).

 

·         I am happy at work the majority of the time.

·         My level of stress at work is easy to manage.

·         I have ample opportunity to do work I enjoy.

·         I feel supported professional at work.

·         I feel supported personally at work.

 

Overall, managers seem to be happy with their work situations; about 82% agreed or strongly agreed that they are happy at work the majority of the time. About 70% feel both professionally and personally supported at work. Handling work stress is another matter, 24% of managers stated they could not easily manage stress at work.

 

Managers feel that 75% of DVMs are happy with their work situation. The majority of managers feel DVMs have opportunity to enjoy their work. 80% of managers said their DVMs felt professionally supported at work, and 75% felt DVMs feel personally supported. Handling work stress is perceived to be as difficult for DVMs as for the managers.

 

About 78% of managers agreed or strongly agreed that support team members are happy with their work situation. 73% of managers said support team members have ample opportunity to enjoy their work. The majority of managers also feel support team members feel professionally and personally supported at work. Again, managers feel that support team members find it difficult to manage work stress.

 

There are a large number of seminars and articles in veterinary publications that talk about work satisfaction, mental health in the workplace, work-life balance and things individuals and practices can do to stay mentally healthy and happy with life. One of the most interesting was the Merck Animal Health Veterinary Wellbeing Study, released early in 2018. While this study focused on veterinarians, common sense indicates similar issues impact non-DVMs and many of the recommendations would clearly apply to all veterinary team members. For more information on this study, visit: https://www.merck-animal-health-usa.com/about/us/veterinary-wellbeing-study

 

For additional resources the VHMA is presenting a workshop to help veterinary practice management professionals better understand what wellbeing is, how it impacts the business of the practice, and how to cultivate a positive workplace focused on wellbeing. Visit the VHMA website for more details.

 

 

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Managers Share Sage Advice on Forward Booking

Posted By Administration, Thursday, November 29, 2018
 

Forward booking simply means booking the pet’s next appointment before he/she leaves the practice after the current visit. At the dentist’s office, you can’t get out of the exam room, much less the practice without booking your next appointment. The same goes for your physician’s office, you always book your next annual exam before you leave. Unfortunately, we’ve been slower to adopt this concept in veterinary medicine.

 

VHMA first asked veterinary practice managers about this in 2014 and decided to see what has changed in the four years since then.

 

When respondents were asked “Is your practice “forward booking” (i.e. making an appointment for the next visit before the client leaves the practice) for RECHECKS/MEDICAL PROGRESS EXAMS?” Responses were consistent with the 2014 survey results - 75% of the respondents answered “always” or “most of the time.” No change from 2014 to 2018. No surprises here.

 

When respondents were asked “Is your practice “forward booking” (i.e. making an appointment for the next visit before the client leaves the practice) for ANNUAL/SEMI-ANNUAL WELLNESS OR PREVENTIVE HEALTHCARE EXAMS?” Responses increased a very disappointingly small amount to 15% in 2018 compared to 11% of the respondents who answered “always” or “most of the time” in 2014.

 

Managers shared some of the reasons they said they didn’t forward book preventive care appointments:

  • Forward booking doesn’t fit (ER or walk-in only practice)
  • Clients are reluctant to do so
  • Appointment calendar won’t book that far out
  • DVMs disapproved of the idea
  • Staff reluctant to try forward booking
  • Not a priority with the owner
  • DVM schedules aren’t set that far out
  • Practice tried forward booking previously and it wasn’t successful

 Managers who are already forward booking in their practice shared some sage pieces of advice for those practices that need encouragement. See the full report for those insights.

 

Like any cultural change in a practice, it will take time until forward booking becomes “the way we do things here.” There are specific things you can do, however, to make implementation of this change easier and faster; some of these are discussed below:

 

Discuss the benefits with everyone in the practice

Don’t assume everyone in the practice already understands this. It’s important to talk through the advantages of forward booking as a part of your team training.

 

Shift your thinking about what clients will or won’t do

A few pet owners won’t like the change and won’t make their appointments early but this isn’t a reason not to implement forward booking. There isn’t a single thing you recommend in your practice that EVERY client accepts.

 

Words matter

Forward booking preventive care exams works best when the exam room team and the front desk team work in tandem with each other, consistently conveying the same message with their language. Most practices have found that including the doctor in these conversations makes a difference in client willingness to forward book the first time.

 

Reminders are critical!

Set up reminders several weeks and then several days in advance of the next year’s appointment so the client can change or cancel if needed. Don’t forget to consider generational differences and use the type of reminder the client prefers; some clients may want a text, email or phone reminder while others prefer a traditional reminder card.  

 

Resources
VHMA's Preventive Pet Healthcare: Your Guide to Becoming a Practice Champion is a solid, practical, easy to use resource for practice leaders who are seeking to implement forward booking. Check out the Partners for Healthy Pets website for a roadmap, tools, and success stories.

 

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Are Managers Valued?

Posted By Administration, Wednesday, October 31, 2018
 

The utilization of a dedicated professional business manager in a veterinary practice is a relatively new development in veterinary medicine. There have always been a few practices that had a dedicated manager but many did not until perhaps 10-15 years ago. And even now most practice owners struggle to identify the value a manager can bring, the types of activities they should be involved in, and the support and resources they need to do a good job. VHMA’s October 2018 Insiders’ Insight Report explores this topic with managers.

 

Managers were asked: Do you feel your employer provides the tools and resources for you to manage operations effectively?” Fortunately, about ¾ of the survey respondents answered yes to this question; however, there is still room for improvement in the other ¼ of the practices.

 

When asked what tools and resources are not available about ½ of the respondents noted that several very critical resources were missing: the job description, support for their decisions, and access to the owners. It is very difficult to function effectively as a manager without these.

 

When asked why these key resources were not available, managers concluded: lack of urgency regarding business matters, owners can’t give up control, owner has personal loyalties to some poor performers in the practice, lack of vision/direction, owner not around or doesn’t have time to share needed information, and owner not willing to share financial information. Responses from managers in corporate practices indicated information not shared at the practice level, difficult chain of command, and no support from the top. 78% of respondents have had to advocate for the tools and resources they need to perform their job.

 

30% of managers polled stated that they had to convince an employer or potential employer of the value a manager can offer.

 

When asked how they’ve most successfully advocated for their role and for access to the resources, managers stated that demonstrating financial impact, outlining how and what you want will be used, as well as the benefits expected from this resource, and customizing an approach based on your employer’s communication style as the top successful strategies.

 

And finally, respondents were asked to share advice with other managers who are interested in advocating for their role. Over 120 managers submitted some great advice; below are some common themes:

  • Be consistent and transparent in your communications with the practice owner
  • Have a strong backbone; speak up when needed; don’t take things personally
  • Never stop learning
  •   Know what your practice owner wants and make your practice owner’s life easier; this will make your life easier and allow you to do more things
  • Develop both your analytical and technical skills, as well as your interpersonal skills—all are important
  • Work hard but make sure you have some work life balance and a support system outside of work
  • Develop a job description and a list of daily, weekly and monthly tasks—share this with your practice owner; often they don’t really know what you do on a regular basis

 For more information and survey details read VHMA’s October 2018 Insiders’ Insight Report.

 

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PIMS Data: What is Most Important to You?

Posted By Administration, Wednesday, September 26, 2018
 

This month’s Insiders’ Insight Report asked managers about their practice information management software (PIMS), specifically about their reporting habits and needs.

 

Eight reports were selected as “most helpful” by over 50% of the respondents.

  • End of Day/Daily Transactions
  • New Client
  • Production by Veterinarian or Other Provider
  • Revenue/Transaction/Visit/ATC Reports for a particular period
  • Inventory On-Hand
  • Total Accounts Receivable
  • Revenue by Profit Center/Income Category
  • Open Invoice

It is important to note, however, that there is little consistency among PIMS in the names used for their reports or data points or the combination of information included in a particular report; so practices may be pulling some of this info but it is called something different in their system.

 

Managers were also asked “What reports or information do you wish you had that don’t exist on your current PIMS?” Answers fell into three categories. The first category included comments about accuracy or formatting improvements needed on reports already included in the PIMS and about difficulty in accessing this information. Another very small group of respondents noted that their PIMS allows them to search for any info needed and customize their reports; therefore, they can get all the data desired. The third group of respondents listed specific information or reports they would like to be able to generate from their PIMS including the following:

  • Client retention
  • Client compliance
  • Refill notices
  • Which employee entered charges into an invoice
  • Number of visits by visit reason
  • Dashboard style reporting
  • ATC—this was a surprising comment because this is such a common metric but this respondent said they have to calculate it by hand
  • Better and more inventory tracking and reports
  • Reports showing # of clients/appointments by hour to see the busy times of the day
  • Appointment fill rates, lists of no-show, cancelled and rescheduled appointments
  • List of inactive clients
  • Invoice items that are taxable vs. non-taxable
  • Open invoice report
  • More specific referral information such as which RDVMs refer to which specialists

 When asked “What problems or frustrations do you have with the reports generated by your PIMS? almost 40% of the respondents express concerns about the actual accuracy of the reports and that 80% find the lack of customization and poor formatting to be frustrating. A number of the “other” responses indicated no frustrations with their system while others mentioned the following kinds of problems:

  • Default dates change when entering data
  • Inventory issues
  • Can’t drill down on a number to see how/where it came from
  • Difficult to even find the desired report or set up the initial search
  • Takes too much time to generate a report
  • Data is calculated differently across reports in the same software

Managers were also asked about how frequently they run reports, who reviews the reports, and cloud-based programs. Review the full article for more details.

 

 

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Holding On To Employees

Posted By Administration, Thursday, August 30, 2018
 

No matter what other issues we have to deal with in veterinary medicine—pushback against price, declining veterinary visits (again!), and pet owners who believe everything they read on the Internet—finding and keeping great employees has become increasingly difficult and is essential to providing outstanding patient care and client service, practice growth and financial success for the hospital. VHMA’s August 2018 Insiders’ Insights survey focused on some of the issues related to finding and keeping the right employees.

 

For the purpose of this survey employee engagement is defined as the emotional commitment the employee has to the organization and its goals. This emotional commitment means engaged employees actually care about their work and their company.

 

Managers were asked: “What percentage of employees at your practice do you feel are engaged in their work?” Answers ranged from <5% to 91-100% with almost 60% of the respondents saying that 71% or more of their employees were engaged. These are high numbers compared to many other businesses; some of this is no doubt due to the type of businesses we run. It is easier to feel committed to taking care of pets than making widgets. It is critical to not confuse an employee’s engagement and commitment to the profession with engagement and commitment to your practice. If the commitment is more to the profession, the employee could easily leave and find a job in another practice.

 

Managers were then asked: “What percentage of employees at your practice do you feel are disengaged in their work?" About 90% of the respondents said 40% or fewer of their employees were disengaged. Obviously there will be a middle group of people as well who are neither engaged nor disengaged.

 

Employee engagement is a murky and multi-faceted topic. Many owners and managers of small businesses aren’t even sure what employee engagement programs are, much less if and why they are important. There are many different definitions of employee engagement, both academic and more informal in nature but in general they have to do with (as defined above) the employee’s emotional commitment to the organization they work for and its goals. Engagement isn’t the same as employee happiness or work satisfaction. It’s a more active connection—engaged employees do more than they have to. Employee engagement leads to higher quality of service, higher customer satisfaction, increased productivity, and higher levels of profit.

 

Businesses who use engagement programs offensively (i.e. as a strategy) differ from those who use them defensively in the following ways:

  • They believe strongly that a business is a partnership between the company and its employees and that focusing on employees’ long-term financial well-being drives productivity, quality of work and retention
  • They have a strong emphasis on comprehensive health and wellness coverage that goes beyond offering health insurance. Other wellness options include free or reduced cost gym memberships, onsite nutritional counseling, smoking cessation programs, etc.
  • They rely on experts—all work with financial professionals to get the types of programs they need to engage and retain employees
  • They re-evaluate programs regularly, ask employees what they want and tailor them to meet the needs of their workforce—one way to do this is through the use of a cafeteria benefits plan. Some smaller businesses offer flexibility in benefits without a formally structured cafeteria plan; for example, an employee can either have an annual raise or receive more vacation time
  • These companies aren’t offering additional benefits just to be “nice”—they expect their investment to pay off financially through reduced turnover and the ability to attract better employees

The focus on the partnership between companies and employees is as important as the dollar investment. As Andrew Brondel, Director of Administration at Diamond Pet Foods—a company with a strong belief in the power of benefit an engagement programs says: “When employees don’t have to worry about health care or financial issues, they can help us grow our business. They take the initiative to offer and implement new ideas.” 

 

When asked: “What is your practice’s approximate annual employee turnover rate? Answers ranged widely; however almost 85% of respondents said turnover rates were 20% or less and over 50% said they were 10% or less.

 

“What are the top three reasons employees leave your practice?” 49% of managers responded that the reason was "not within our control". 41% said interpersonal issues, and 30% stated compensation was a driver for the employee's departure from the practice.

 

Compensation is obviously an important component of retention and the next question asked “What is your practice’s average annual compensation increase over the past three years (total compensation-all employees)?” Most practices fell in the 2-5% category with a surprising 24% in the 5-10% category.

 

As with most of the important things in life, you get what you pay for with employees. In order to attract and keep quality people, a practice must pay the going wage for a certain job. High raises aren’t enough if the base salaries are too low. Ideally, the practice’s pay scale is in the top 25% of the range for a certain position. In determining market pay, the practice owner or manager must not only look at national averages for compensation and benefits in veterinary clinics, but also must look at local pay scales and look at pay scales for jobs outside of veterinary medicine.

A receptionist can work anywhere—in an insurance office, a law office, at a manufacturing firm, etc. If a practice is paying $2.00 per hour less than the going rate for a receptionist in their area, they aren’t even going to get the good people to answer the ad, much less be able to hire them. If McDonalds is starting inexperienced help at $10.00 per hour, a practice will have trouble hiring kennel help at minimum wage.

 

And if the practice is located in a major metropolitan area, particularly on the east or west coast, national averages of veterinary receptionist or technician pay may not remotely resemble average pay in the city the practice is located in.

 

A starting point for determining pay scales is an understanding of what the veterinary profession pays and surveys such as those done by the VHMA are invaluable in obtaining this information. However, this information has to be supplemented with information about what these jobs pay in the particular city the practice is located in and what alternative jobs pay. Talking to colleagues, friends and relatives who hire people, the local chamber of commerce and looking at help wanted ads in the local paper can all provide valuable information. The College of Veterinary Medicine or technician schools in your area may also have information about the starting salaries of recent graduates. The Internet is also a great resource for salary information for both veterinary specific jobs (such as a technician) and non-veterinary specific jobs (such as a receptionist.) Sites such as Salary.com, CareerOneStop.org and the Bureau of Labor Statistics (BLS.gov) have pay information not just for particular jobs but also within certain cities or other geographic areas.

 

Of course money isn’t the only reason employees work or stay in a particular job. We asked “Why do you think your employees come to work?” No surprise that “passion for helping animals” ranked so high. Most of the answers in the “other” category were a combination of paycheck and passion for helping animals. A few respondents mentioned things about their own practice such as great bosses or a good team.

 

Creating an efficient, productive and polished team starts with the interview process; 80% of employee turnover is attributed to poor hiring. Key techniques leading to effective hiring include behavioral interviewing, and how to make the final selection.

 

Hiring is difficult because the skills that really determine whether a person will be successful in a job are hard to evaluate. Most people focus on determining the quality of an applicant’s technical skills and yet only 11% of employees fail because they don’t have the technical competence to perform the job. Instead, people fail because they aren’t coachable (26%), they lack emotional intelligence (23%), they aren’t motivated (17%) or they lack the temperament needed for the job (15%) (http://www.leadershipiq.com/why-new-hires-fail/) If the hiring process doesn’t focus on non-technical competencies, then it will fail.

 

In order to hire the right people, the practice hiring process must be systematic and disciplined. Key steps include:

  • Define the skills and traits valued by the practice and needed for the job
  • Evaluate the candidates’ fit with the current practice team and culture
  • Determine what the pay scale needs to be to get the right people
  • Conduct structured, in depth interviews (telephone screens, in-person, working)
  • Verify outside information (references, degrees, licenses/certifications)
  • Make a careful hiring decision based on the skills and traits needed for the job

The first step in effective hiring is to define both the technical and non-technical competencies valued by the practice and needed for the specific position for which hiring is being done. Once that has been done, the pay scale and the appropriate interview questions can be determined.

 

Interview questions should be designed using the traits and skills the practice has decided are critical to the position—the goal is to use these questions to identify if the job applicants are right for this particular position and practice.

 

Behavioral interviewing is widely recognized as the best technique to use in identifying how prospective employees will behave in certain situations. In behavioral interviewing, the interviewer asks questions about how the job candidate has handled situations in prior jobs that are similar to what they will see in this job. A couple of examples are shown below:

 

Necessary job skill: Must be able to communicate well with clients in often stressful situations.

Interview question: “Give me an example of a time in your last job when a client/customer was angry at you or your business and what you did.”

 

Necessary job skill: Must be able to work well as part of a team.

Interview question: “Give me an example of a time at school or in your last job when you felt one of your colleagues had been unfair to you and what you did.”

 

Not all job candidates will have had some of these situations occur in previous jobs so you can also use hypothetical situations. For example, if the question using a past situation would be: “Tell me about a time in a previous job when your boss yelled at you for something you didn’t do in front of a bunch of clients and other employees,” then the hypothetical situation question would be: “Tell me what you would do if the owner of the practice came out to the front and yelled at you for something you didn’t do in front of a bunch of clients and other staff people.”

 

A critical component of making the final evaluation of a candidate is to make sure you are capturing all the necessary information during the various steps of the hiring process. If you don’t do this, you won’t be able to remember who said what or what your real time impressions were of the candidate. Use a form designed for this purpose and take notes throughout the process—while reviewing the application or resume, during the phone screen, and while conducting in-person interviews. Include the interview questions you ask of everyone on the form and leave room for documenting other questions/comments that come up during the meeting. Using the same interview questions for each candidate will help you better evaluate their answers and compare one to the other. Always check references. Ask as many questions as the person on the other end of the phone will tolerate.

 

Once you’ve gathered all the information about the various applicants, it is time to make a decision about whom to hire. You should have a fair amount of input at this time—information gathered from the job application, cover letter and resume, the telephone screen and working interview (if done), the in-person interview, reference checking and the verification of degrees and licenses/certifications.

 

Often the most difficult task is keeping the candidates straight and remembering who said what. Before you even start the hiring process, set up a standard form to evaluate each candidate and use this throughout the process. Make notes about key strengths and weaknesses noted in the application, resume and correspondence. Do the same for all interviews. List all the interview questions and the answers each candidate gave. Remember, of course, to only include information and observations related to the duties of the job (nothing about the candidates’ age, sex, race, religion, country of birth, disabilities, or other non-job related items.)

 

When making the final evaluation, remember to use the same requirements to judge everyone and make sure the evaluation is based on the competencies needed in the job.  Don’t overemphasize technical competencies; spend as much time evaluating non-technical strengths and weaknesses. Be specific about why a particular candidate is the right person. It’s not enough to say about the best candidate: “I just liked them and thought they’d be a good fit in the job;” this may mean enough time has not been spent evaluating specific skills and attributes and that the candidate is being selected simply because the hiring manager found them easy to talk to. Instead, think through the exact strengths this person has and whether they fit the practice and the job: “This candidate is a certified veterinary technician, has 3 years’ experience in other general practices, was appropriately dressed for the interviews, was friendly and professional on the phone and her references checked out.”

 

Hiring is tough and no practice is going to get it right every time, even when using an effective, structured hiring process. The last thing to remember is that when you do have to terminate someone, analyze carefully what went wrong. Many managers say that, in hindsight, there were clues during the interview process that indicated potential trouble but in a rush to get someone onboard, they were ignored. Learn from your mistakes and the next time will be better.

 

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