The Client as an Asset to Protect

Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate, American College of Healthcare Executives

"Treat the customer as an appreciating asset."

  Tom Peters

Most veterinary practices worry about internal controls for receipts, drugs, and tangible property, as well as cash controls to account for the pennies a day we may lose. But most clients are worth thousands of dollars and practices ignore their protection. The process of selecting a veterinary practice may take place in a matter of minutes or a matter of months for a CLIENT, but the practice bond can be broken in seconds.

The First Step - Awareness

Obviously, before a consumer can become a client, there must be an awareness of the facility's existence and awareness of the need to seek services. This step is often assumed to be accomplished by a yellow page ad or an outdoor sign, yet many pet-owning households in the catchment area may be unaware of all the practices within a 15-minute drive of their home. Once they find a practice, a tour of the facility is seldom offered, so the client is unaware of the high tech-high touch philosophy of the practice. What is your practice's "new client : practice tour" ratio? Have you placed "Behind the Scenes" scrapbooks in each examination room to allow the client to have a picture tour (pictures of people helping animals, not just equipment waiting to be used) while they are waiting? Are pictures labeled with the patient's identification, the procedure being conducted, and staff member's name, then updated regularly to show the new practice programs in action?

Image - The Beginning Of The Bond

The client acquires knowledge about a veterinary practice in a variety of ways, the most common being non-verbal awareness (smells, sounds, sights, etc.) of the environment, followed by the examination room communications. What sets your practice apart from the other practices in the community? What is special? What is different? If the answers are crowded reception, lack of parking, being put on hold every time you call, or other negative factors, your image needs immediate attention. In some communities, image is so important that the media exposure of the practice's role in community leadership can influence a client's decision; worthy causes are the sweetest and most cost effective (since the media coverage is usually free).

The consumer has a set of values fostered by television, magazines, books, and other media sources. and these values drive their image of your practice, either positive or negative. If the practice's perceived image is negative, the consumer will not form a preference for your practice. Word-of-mouth will help maintain this image, as will the environment surrounding your practice, so a concern for the perception of quality needs to permeate all activities of the practice. Step back and look at your practice presentation and the word-of-mouth programs. How are referrals handled? Is appropriate client behavior being rewarded (e.g., outreach thank you programs)?

Knowledge Is Key

Typically, the client develops a process where their veterinary healthcare access commitments are made incrementally. First for preventative care or emergency care, then later for health maintenance care. As clients form a practice loyalty, it is easier to market the full scope of services needed by each pet. Once a preference is formed, the client will act upon it when the need arises. The veterinary practice will share knowledge in many ways, from tailored handouts for the community (a practice directory with contact points for animal control, animal services available, poison control, etc.), to glossy vendor promotions, to audio-visual systems designed to increase their awareness of the scope of services available.

Quality is the most important facet of a practice's image, but the parameters change by region or community. Research by a human healthcare National Research Corporation in 131 major U. S. cities showed a high variability within the six basic quality perceptions, six of those cities are shown in Table 1.

Table 1 - Consumer Perception Of Quality Factors

It is interesting to note that care was seldom a factor unless only the female population was surveyed, and in many of those cases equipment became less important and care became a primary concern in many localities.

Advocation - Becoming A Believer

If the practice experience meets or exceeds expectations, the consumer typically becomes an advocate. They will use the facility for over-the-counter purchases, occasions of concern, or will simply spread positive word-of-mouth recommendations to other potential clients. However, if the experience is negative because of delays, unfriendly staff, an unexpected triple-digit bill, a rushed veterinarian, or a host of other variables, the client will change preferences and a patient or patients will be lost. Consider an implementing a Council of Clients: a dozen clients and their significant other come to a dessert meeting once a quarter and provide the practice with insight on needed services, perceptions of quality or care, and changes needed to increase their utilization of the practice's services. Remember to wear a thick skin and NEVER offer a defense during these "quiet" evenings of feedback.

How we approach a community or practice population is dependent on practice philosophy, profession interrelationships, and the target population (elderly, multiple cat households, owners of geriatric dogs, etc.). Regardless of which targeting strategies are used or which target population is in the primary catchment area, the promotional messages must be carefully developed. This is another reason the whole team must be involved in their development. As a matter of marketing principle and awareness of human nature, a smart practice will strive for multiple client visits per year, spreading out the costs but increasing the total access to practice services.

Segregation Of Function

One of the most critical elements of any internal control program is the segregation of function. This simply means, one person does not have total control of an asset. Take for example the person counting the money at the end of the day is different than the person closing out the computer record, the two totals are then compared by the two people. The same goes for the client as an asset; no one person must control that asset. The client must encounter a team of caring providers, from the receptionist, to the outpatient nurse (technician), to the veterinarian who recommends an internal referral, to the other practice doctor for collaboration on more involved cases. Even the use of external specialists indicate a team approach--a practice desire to deliver the best care possible. Regardless of the Monday morning syndrome, in most veterinary practices, the phone is an underutilized client communication (defined as the getting and giving of information) system waiting to be implemented.

When a client misses an appointment, who should call them, and how soon? The message can be simple, such as, "The doctor and I missed you and FLUFFY today (yesterday, this week, this month, etc.) is everything okay at your house?" Consider also vaccination reminders, which we believe should start at the 11th month AND not list specific lettered needs, rather they should state the client actions need- if a practice really cared, a non-response to the vaccination reminders would be called within 72 hours of the expiration (by the receptionist).

The nursing staff (some people call them "technicians," but clients better understand the term "nurse") has an important role also. In the case of a post-surgery, the nurse anesthetist (technician) would call the client when the animal recovered from anesthesia and ensure the client also understood the discharge planning coordination. This would be followed by another call, by the same surgical nurse (technician), in three to four days with the message, "We know you and Fluffy will be in next week for the suture removal, but the doctor and I just wanted to reassure you that if any of your family members had any questions about Fluffy's procedure or recovery process, we are here for you."

The outpatient nurse calls clients two weeks after a flea control program is initiated because that is the next time a treatment cycle is indicated. A nutritional counselor calls a client after 20 cans of a case are utilized to offer to order another case of prescription diet before it runs out. The dental hygiene nurse calls in three weeks after a dental care "deferral" to check on gum condition (red = pain, we must get it out). An outpatient technician calls ten days into a 21-day cystitis treatment with a caring message, such as, "We know Fluffy is only half way through the treatment program we prescribed, and that you and Fluffy will be in next week for the recheck, but the doctor and I just wanted to reassure you that if any of your family members had any questions about Fluffy's treatment or recovery process, we are here for you." If some of these narratives sound familiar, it is simply because caring is a consistent message we want to convey. We know it requires from six to sixteen contacts (variable based on client awareness, belief, and knowledge) to make clients respond on a new healthcare need.

The doctor will retain 20 to 30% of the primary call-backs, due to specialized interests or client-promised diagnostic feedback requirements. The team approach will help diversify the handling of incoming client calls, since they become used to the team approach in healthcare monitoring and the telephone follow-ups. Any practice with more than two doctors on duty should consider the use of a telephone receptionist to increase the routing of the incoming calls to the appropriate person, increase the responsiveness of making appointments and calling missed appointments, and decrease the disruptions for the front desk team who should be receiving clients with a helpful smile.

The veterinary practice client is an appreciating asset, so you must appreciate them and let them know how much! American clients hate to be "sold" anything, but they usually enjoy the opportunity to "buy" something. Therefore, always offer two "yes" alternatives rather than just a "yes or no" demand. A "caring veterinary practice team" ONLY sells peace of mind, everything else the client is allowed to buy. Clients do not just "belong to the doctor," they are practice assets! Clients are stewards of living creatures and deserve a caring and knowledgeable veterinary healthcare team to be available to help them in this commitment. Clients will become better assets as they are nurtured by the team, and better clients are seen more often. Clients who are seen multiple times per year will seldom "follow the newspaper ad" or "go to the discount clinic," unless the practice bond is broken by an uncaring team. If the caring veterinary practice team provides the peace of mind the client will appreciate the feeling, and appreciative clients will return. This is how an appreciating asset is developed - try it, your team will like it and so will your clients.