The Dumb Things We Do: A Critical Look at the Way We Practice

Philip J. Seibert, Jr. CVT
Veterinary Practice Consultants
(423) 336-1925

Introduction

One can hardly pick up a newspaper or listen to radio or television and avoid the news that another company is "right-sizing" or reorganizing or "down-sizing" or whatever the current term is to reflect this phenomenon. The thing that all of these companies have realized is that things have changed in today's business world and only those businesses that adapt to the new environment will thrive. Today's customers are demanding more (product, service, attention, value) for less. Combined with exponentially increasing technological advances, these new expectations are making even the smallest business reassess their methods of manufacturing and delivering their product or service.

It is almost impossible to get someone to agree to the statement, "I want to deliver mediocre customer service." Every business wants to deliver exceptional customer service, but few really do. In a monopoly, restrictive policies, inefficient service and "take it or leave it" attitudes are tolerated for obvious reasons. However, faced with the opportunity to seek satisfaction elsewhere, the customer will complain with their checkbook - in other words they will go elsewhere looking for their definition of exceptional customer service. That is called competition.

Time Enough To Do It All?

As a profession we have a long history of providing the best possible care for our patients in some less than ideal conditions. This sometimes turns into a "make do" attitude toward the requests of the client. But in this new veterinary marketplace, the customer is now king! There is a strong parallel between the veterinary practices that not only survive, but thrive in the midst of competition and their philosophy of delivering the hospital's services. That's right, the philosophy in delivering services and not the philosophy in delivering healthcare.

For years we have explored time management and organizational structure. We have analyzed data and set goals for performance and production. These are wise moves for any business, but today we need to move into the next dimension - logic. Although there are many college classes and forums available to discuss the theories of logic, it is a process that eludes many.

In today's business environment, we can not afford to spend precious time on inefficient or outdated procedures. Faced with the challenges of competition we must continually strive to provide a better product for less cost. The most logical way to reduce the cost of a product or procedure (and to make the job easier) is to streamline the process.

Barriers

So what's the big secret about providing a good service at a fair price? There's nothing wrong with that philosophy; it only needs one additional component. You have to make it easy for the customer to obtain your services or products. This is known as Form Follows Function.

Over the years we have erected barriers between our clients and our services. When the client has to wait in line at 5pm to get the receptionists attention, request a bag of dog food, wait while their medical record is "located", get the third degree about "do you still live at..., and your phone number is ...?", wait for someone to bring the food from the back, then between phone interruptions wait to pay for the food, is it any wonder why the client goes to PetsMart to buy their dog food.

Are we more concerned about our personal habits than service to the client? Recently, I witnessed the following episode:

Sign on the veterinary hospital door: "Hours: 8am-12pm and 2pm-6pm. Appointments preferred, but not required."

The time is 11:45. A client walks in and requests a consultation with the doctor and the conversation goes something like this:

Receptionist:  "I'm sorry Mrs. Jones, but the doctor is not available until this afternoon."

Client:  "I was told by someone on the phone the other day that I didn't need an appointment."

Receptionist:  "The doctor has blocked off this morning for a very important meeting. Can you come back after two o'clock?"

Client:  "Yes, but it would be very inconvenient. I thought you were available for walk-in appointments until noon."

Receptionist:  "We normally are, however, today is an exception."

Do you think this hospital is building a bond with this client? Or do you think this hospital has just erected a barrier to its services. Yes, one would argue that things happen and this is the first time the doctor has ever done this. Let's look at it from the client's perspective. If this is a first visit, it's not a very service-oriented impression that was given. If it was not a first visit, the client probably believes that the doctor has gotten too big, or too busy to give them the personal service that they used to get. They may accept the situation and remain a client, but they may just as well find another hospital that sticks to it's posted schedule.

Here are some examples of other practice-erected barriers to excellent customer service:

1.  When the lab test is done in house, but the results are not available immediately because the tests are "batched." When the client has to wait unnecessarily for information, it is an inconvenience to the client and therefore a barrier to excellent service.

2.  The practice is closed during lunch. You may say that everyone deserves lunch -even you and your staff! Maybe that's the only time you can get surgeries done. For the client who works all day that's VERY inconvenient. When a client has a choice of practices they usually migrate towards the ones with longer hours and open during lunch. Client satisfaction surveys done by individual practices reinforce this premise. One hospital in New Orleans was focusing on upgrading medical equipment and increasing the boarding capacity as their client service improvements, but their survey (done by an outside company) told them that 74% of their clients wanted longer hours. The clients didn't necessarily want longer appointment hours, just longer hours to be able to make an appointment, talk to a person about a problem, or just to stop by and purchase something. By the way, they were already open until 7pm on three nights during the week!

3.  Being open is not enough - you must be staffed appropriately. One of the biggest barriers to excellent customer service is under-staffing during peak times. Having only one receptionist to cover the desk of a three doctor practice during lunch, early mornings or late afternoons is definitely a hassle for the clients. It's not enough for the client to get through on the phone if they have to be put on hold before you find out what the problem is; it's certainly not excellent customer service to make the client who is standing in front of you wait while you help the one on the phone! Many supermarkets and retail outlets are recognizing this fact and some even have a written guarantee that if there are more than three people in line at the register, they'll open another register within 3 minutes or you get a free product for your inconvenience.

Everyone would agree that keeping the customer happy is the best policy to have in any business, but it's alarming how many times the company's policies are designed to prevent employees from delivering excellent customer service. If you or your staff have ever used the phrase "I'm sorry, it's against our policy to ..., " then you have just erected another barrier to excellent customer service.

Assumptions

1.  Zero defects is not realistic. When defects (mistakes) happen - apologize for the inconvenience and then fix it, but don't automatically institute a laborious check and balance system for a problem that happens very infrequently. At the same time, don't ignore a common problem and keep "chalking it up to experience."

2.  Find the balance between the benefit (or savings) and the cost. You have to find the balance between amount of work expelled and amount of work saved that best suits the situation.

3.  Over the years we have pieced together "patches" for all the small problems that have come up; sometimes you have to just reorganize the whole system.

4.  What has worked for 10 or 20 years is no longer adequate for the fast-paced business world today.

5.  Sometimes you gotta 'nuke the system!

Concepts

Look at the big picture. Don't focus on just the task at hand. Don't be afraid to dream!

Don't just rearrange or straighten - ORGANIZE. Think about the steps in the process and organize the materials, paperwork, layout, flow, etc to support the task. If something needs to be moved, MOVE IT! Think about an assembly line operation - that's the most organized, logical operations in the world and we can do the same thing!

Process

1.  Take a lesson from a small child; keep asking "Why 'ya doin' that?" If the best answer you can come up with is "Because we've always done it like that," then proceed directly to step 5.

2.  Now ask "Do we need to do that?"

3.  Next ask "What would happen if we stopped doing that?"

4.  If after steps 1-3, you find that the task is necessary, start asking "Is there a better way?" Consider things like:

-  are elements of this task repeated in other tasks?

-  if so, can we combine them into one task to simplify things and still accomplish the same objectives?

-  is this step really necessary after all?

5.  If the procedure, process, step or task is not essential then stop doing it! If it can be combined with others, then create the new organized way to do it and implement the changes. Make sure to train all others to do the new method. Do NOT maintain dual "systems" until you get comfortable with the new method. This is only a crutch and will hinder the formation of the new habits.

Every day examples of working harder not smarter:

Maintaining a manual index of client file numbers or phone numbers for the times when the "computer is not on-line?" Why not have the computer print an alphabetical client list on a monthly basis - this "index" can be done during off-times and takes absolutely no human work to accomplish. If a client is new (e.g., since the last report was printed, then their file can be relatively easy to find in the last 50 or so records at the end of the file system.

Reusing client numbers. This is a time waster. There are an infinite number of client numbers available and if you don't reuse numbers, then you not only save time, but you have a pretty good idea of which clients have been with the practice the longest (and maybe the most loyal?)

Keeping the "tools" or supplies in one place, but performing the procedure or process in another. For example - keeping the cash box in a drawer that is 20 feet from the computer terminal where clients are checked out is a very big time waster; it also adds to the inefficiency of the front desk where receptionists must "cross paths" too often. Who says you can't have two cash drawers?

As the practice grows, the staff duties stay the same. When the practice was small, one receptionist in the reception area could handle all the administration for the practice and one "assistant" could handle all the nursing duties. As it grows, we add receptionists and assistants or technicians, but we don't "divide up" the tasks. The old moniker of "Everyone is responsible for everything." really becomes "No one is accountable for anything." People can't be in more than one place at the same time.

Reusing disposable supplies. "I can't find good staff." is often a moniker in today's practice, but in many practices, the existing staff has no chance of "upward mobility" and spends most of their time doing the same things that their predecessors did ten or twenty years ago. When labor was $3.00 per hour and syringes were $15 a box, it made a economic sense to recycle and reuse. But that's not the way it is today. Labor is the biggest factor in the cost of delivering a service and we must make the most of that expense and resource.

Summary

Many veterinary practices continue to be "held back" or are placed at a strategic disadvantage in the competitive environment because they fail to do one thing: embrace change. Change for the sake of change benefits no one but the manufacturer of the change, but a change to embrace a new opportunity or an easier method benefits everyone. The practice must not be afraid to let go of the old ways because only by letting go is your hand now free to grasp the new!