In a brainstorming session with other consultants, we looked at the average veterinary practice client cycle and counted the moments of truth that any practice could possibly influence. While all the ideas listed here will not fit every practice, the majority should. The challenge is to get the staff members to accept the responsibility to improve the image in each area they touch. They need to have pride in what they do, moment by moment, to affect these moments of truth. To establish that pride in performance is the challenge of leadership, but that is a different topic! Most of the concepts discussed below are expanded in the three-volume text series Building The Successful Veterinary Practice and the sequel Veterinary Healthcare Services: Options in Delivery. Look at these opportunities, and discuss them with your team:

Finding the practice (you need to ask this question to compile these answers):

 Yellow Pages ad. (Why did they select you from the Yellow Pages?)

 Referral by friend/client.! Newspaper ad.

 Community literature source.

 Referral by out-of-state veterinarian.

 Outdoor signage.

 Ancillary pet supply referral.

 Staff community service.

 Community activities/Rotary/Scouting/women's clubs/government.

The initial contact

 Phone for a price quote.

 Phone for a service quote.

 Phone for an appointment.

 New client newsletter (mailed post-phone contact).

 Directions to the practice.

 Stopping in for a tour.

 Meeting a staff member out in the community.

 Meeting the veterinarian at a community function.

 Actual appointment hours offered.

Arriving with the pet

 Practice identification.

 Direction signage for parking and entrance.

 Parking lot appearance/tidiness/potholes/debris/droppings.

 Access to the front door.

 Entry ease and protection of pet from other patients.

 Lighting/security.! Initial waiting room impression (smell, sight, sound).

 Access to the front desk.! Staff appearance.

 Decor/odor/noise/cleanliness.

Client relations specialist (reception) staff

 Courtesy/attentiveness.

 Friendly/smiles.

 Responsiveness/caring.

 Pace/professional approach.

 Phone techniques.

 Gossip level.

 Talk about pets/clients by name rather than condition.

 Bond-centered practice approach.

 Waiting time (a maximum of seven minutes).

 Amenities available.

 Other clients entering and exiting (and their satisfaction).

Initial client/patient movement methods

 Appearance/uniforms/shoes/personal composure.

 Personal hygiene/makeup/hair/breath/face hair.

 Escort to examination room.

 Initial interview techniques.

 Hands on pet within seventeen seconds.

 Nurse (technician) appearance.

 Body language/voice tone.

 Staff competency.

 Paraprofessional rapport.

 Bond-centered practice approach.

 Wellness examination.

 Diplomas on wall (staff and doctors).

 Odor/cleanliness/noise.

Veterinarian initial impact

 Appearance/personal composure.

 Treatment of staff.

 Self-introduction.

 Touching the animal.

 Listening technique

 Body language/voice tone/rate of speech.

 Terminology.

 Explanation of consultation/examination/findings.

 Patient advocacy/speaks of pet's needs/ensures client decides.

 Bond-centered practice approach.

 Empathy/concern for client's position (feelings and fiscal).

Consultation (examination) room exit

 Summary of findings.

 Training to administer treatments.

 Bond-centered practice approach.

 Explanation of charges.

 Pre-qualify each departure with the three Rs (recheck, recall, reminders).

 Escort to discharge.

 Protection of animal during transit through hall/reception area.

Discharge actions

 Attentiveness at discharge/waiting time.

 Discharge desk clutter/appearance.

 Cleanliness/odor/noise.

 Presentation of invoice/bill (consistency with estimate).

 Collection of fees. Some practices have the nurse do this in the consultation room.

 Dispensing medication.

 Concern for client understanding

 Bond-centered practice approach.

 Establishing the three Rs compliance expectations (recall, recheck, remind).

 Privacy/courtesy/caring.

 Literature offered to ensure family understanding.

Post-discharge

 Follow-up telephone call by nursing staff.

 Quarterly informational newsletters.

 Sympathy cards/memorials for deceased pets.

 Thank you correspondence.

 Health Alerts (see Building The Successful Veterinary Practice: Innovation & Creativity).

 Satisfaction surveys.

 Reminders.

Over one hundred moments of truth were listed above, and the ability of the veterinarian to directly alter them accounted for only about ten percent of the total.

The balance is done by the veterinary healthcare delivery team. The staff effectiveness is directly proportional to their level of training competence. Many practices have not yet discovered the value of team-based training, facilitated by veterinary-specific team-based trainers. Training programs are available at http://www.drtomcat.com. The amount of concern, including training and rehearsal, exhibited by most veterinary practices does not equal the importance of these client impression opportunities.

Consider the moments of truth from the client's perspective. How many times can your staff, facility or practice methods offend their impressions of your practice before they are no longer a client? Conversely, when staff members feel proud of the practice and the healthcare delivery philosophy, every moment of truth is an opportunity to cement the doctor-client-patient bond.

Remember this fact: the pet parents were never "your clients", you were "their veterinarian". When nurtured and made to feel important, they will seldom change practices.

In fact, as proven in most every service industry, how the operational managers and supervisors treat the staff will determine how the staff members treat the clients. When Carlzon asked the SAS headquarters staff what their "mission" was, it took three weeks for the team to decide it was "the movement of people". They closed the headquarters for about six months and took the client-centered service to the field and impressed every one of the forty thousand employees with their importance in the moments of truth. In two years, SAS went from a failing airline to one of the top three income producers in Europe. But then they rested on their 1988-89 performance laurels and forgot to reinforce the client-centered programs. They forgot to look into the future and make the SAS employees responsible for changes in the future. There was no continuous quality improvement. SAS lost money.

American examples of image and professionalism do exist, like Marriott, Nordstrom, Worthington Steel, Federal Express, and American Airlines, but they are the exception, rather than the rule. In industry and corporate America it has been called Total Quality Management (TQM). Authors like Juran, Deming, and Crosby have made their consulting fame by basing their approaches on reintroducing employee-based quality and pride factors to American corporations. They believe that when the employees put pride into their daily effort, when they are empowered to make changes for the betterment of the team, without first climbing the supervisory ladder for permission, the output will be perceived as quality.

The successful veterinary practice empowers its staff to react and change to meet the client's needs. The staff member needs to have the freedom to commit resources, without additional line item permission, and to make the client perceive a caring staff and a quality healthcare facility. In human healthcare this concept is called continuous quality improvement (CQI).

Assigning accountability or empowerment to an employee must be accompanied by the needed authority, and these must be supported by job/task ownership. The staff member must think of the practice as "our practice/our hospital" at every decision point in the process. In the consulting business, we find that practice "luck" is usually directly related to the preparation of the staff to grab opportunity as it comes knocking. Where does your practice approach sit in the scheme of things, when it comes to preparing your staff to grab the moment of truth and turn it to the practice's advantage?

During the 1970s and 1980s, the veterinary client-centered trend in the United States inched away from client service in the quest for high-tech and personal specialization. However, the 1990s rediscovered the importance of service to the client, and client-centered service was rediscovered. The AVMA even published an outstanding series of workbooks to help their members relearn this critical business facet, but very few used the AVMA texts as team-based training workbooks to establish an enhanced practice culture or solidify the practice philosophy. The new millennium already demands this facet for success!

The practice that best controls its respective moments of truth will become different from other practices in the mind of its community. These astute veterinary practices will succeed where others have floundered, because practice quality and client impressions are communicated during the moments of truth and have very little bearing on the professional facts. They will become the leaders in the veterinary marketplace during this new millennium.