Veterinary practice effectiveness begins with the appointment log.

The geography:

 A perpetual appointment log (sample by Profiles is easily tailored), with the entire day visible and room to write, and is very receptionist friendly. Ask the front staff for their preference!

 The ten-minute slots are for flexibility, not for a single appointment. Most appointments are two blocks (twenty minutes), with new clients or exotic pets getting an extra ten minutes (thirty minutes). The ten-minute blocks allow the last ten minutes in one room to overlap with the first ten minutes in the other room, which gives us time leverage and high-density scheduling, without dual booking appointments.

 Most quality computers can be configured with the same system, but the computer must make the first appointment column the doctor's name, then have the two exam room columns following, leaving space between doctor columns.

 A "Surgery" column allows the client and patient to be scheduled for an early morning arrival, usually before 7:55 a.m.

 A "Drop Offs" column provides spaces for the before 7:55 a.m. arrivals, whether they are early appointments, drop-offs, or day care. Insert your own times as desired.

 Most practices have core appointment hours within the 8:00 a.m. to 6:00 p.m. period, with some form of staggered lunch break.

 There are nine appointments over the lunch break, usually single-staffed with a doctor, so use the full width if "lunch time" appointments are desired.

 The "five-minute" schedule endings (10:25, 10:35, 14:45, 14:55, etc.) cause far greater client compliance in arriving on time, since it sounds so exact. Please don't disappoint them

 The after-7:00 p.m. special appointment needs could be scheduled into a "Call Back" column, with times inserted as desired.

 With a two-point-four doctor clinic, with an adequate inpatient load, the third "doctor" column could be for emergencies or walk-ins, both handled by an inpatient team, or technician outpatient time for nutritional, parasite, dental, behavior, etc.

The schedule:

 We prefer to book two consultation rooms (examination rooms) rather than one doctor. One doctor handles two consultation rooms with an assigned OPNT who controls the zone. Even a new doctor should be able to work one-and-a-half exam rooms at a time, and a seasoned veterinarian with a good OPNT can work two, or sometimes three, at a time.

 No doctor is allowed to ever touch the appointment log or "cherry pick" cases that are coming into the practice. Clients and patients are placed into the zone by the client relations team, and the nursing staff ensures the case is moved to a room, even before the doctor is involved. This system allows productivity systems to be more equitable and flow more smoothly.

 These concepts are discussed in detail in Building The Successful Veterinary Practice: Programs & Procedures. After guidance, maintaining the log and appointment durations should be the front staff's duty, not the doctor's.

 A standard "sick call," with a full doctor's consultation, for an established client is seen as twenty minutes (two spaces).

 A practice can add ten minutes to the "standard appointment" for exotic pets, a second or third animal, each new client, an ophthalmology problem, etc.

 A single ten-minute space can be used for recheck, suture removal, vaccine clinic, heart worm screening clinic, etc.

 Add ten or twenty minutes to each appointment for a new veterinarian graduate, only ten extra after sixty days, and no extra "orientation" time after four months.

 The two rooms are always scheduled "out of sync". That is, the last ten minutes in one consultation room overlaps with the first ten minutes in the other consultation room.

 The inpatient team is the "relief valve", when the outpatient team is fully scheduled. They can do a "catch-up room" if the outpatient team is behind. This is coordinated by IPNT and OPNT through the client relations team. They can come forward and admit an emergency or late drop-off, and they can do the unusual morning discharges.

 Non-availability of doctors is monitored by the client relations team, and the log is annotated (long lunch, surgery, late arrival, early departures, etc.).

Alternatives/exceptions:

 In some practices, the OPNT does the client invoicing and discharge, which may require thirty-minute appointments if you are understaffed.

 Other practices start high-density scheduling with thirty-minute appointments to allow the nursing staff more breathing time, and allow the doctors a little flexibility to learn how to reduce their babbling time with clients.

 Some practices use a discharge client relations staff member to invoice and discharge from the consultation room, which then requires the OPNT and doctor to be working at least three rooms concurrently.

 When an appointment log, meaning room fill rate, exceeds eighty percent, the practice needs to look for ways to increase client access, whether it's more appointments during lunch hour, appointments during inpatient surgery time, longer evenings, more drop-off, or even extended weekend hours.

 Some skilled clinicians can work four to six consultation rooms concurrently, which requires more OPNT staffing and more OPNT assistants.

 Some highly skilled outpatient clinicians also keep a pair of IPNTs busy in a "day admit" support role, since they admit thirty to forty percent of their outpatient cases, as in ears, radiology, lab, etc.

 A few one-doctor practices have pushed their transaction rate in excess of seven hundred transactions a month by leveraging their time with their staff. The usual transaction rate for a companion animal doctor is four hundred to four hundred fifty per month, before the doctor starts to destroy his/her quality of life.

 When consulting, we usually mix and match many of the options to better tailor the transition plan and development to the practice staff needs. The better the flexibility when learning, the better the accountability, when you reach the desired outcome.

Additional resources are available to you from Veterinary Consulting International®, as they relate to the topics in this chapter:

 Web site: www.drtomcat.com.

 Free on-line Health and Safety Newsletter.

 Free on-line Management Newsletter.

 VCI® Signature Series® Monographs, each with a unique CD of tools.

 Staff-based training meetings (VCI® Shirt Sleeve Seminars®).

 VCI® Seminars At Sea® for the leadership of practices.

 Summaries of topical emerging issues

Tables 8 and 9 will also be of use to you.

High-Density Appointment Scheduling Sample

Table 8: Sample Schedule

(See Appendix E in this text for more examples)
(two exam rooms, one doctor with one OPNT)

Table 9: Zone Staff Training Sequences

Manager: Responsible for the staff within an operational area and their behavior, as established by practice standards and expectations:

Quality Assurance: Spot check expected outcomes based on established standards.

Quality Control: Surveillance of process to ensure proper procedures are followed.

Coordinator: Responsible for the operations of a zone, and the resources available, including developing competency via recurring training programs:

Continuous Quality Improvement (CQI): Accountability of each person to affect continued improvement in their own areas of operation. Details in Building the Successful Veterinary Practice: Leadership Tools.