The most powerful weapon on earth is the human soul on fire. - Marshal Foch

He called and said, "I need help. Please come into my practice."

It was a mixed animal practice, in a bedroom community of a metroplex. It had a sleepy little companion animal clinic, and an ambulatory equine practice, mostly pet horses, as well as a few backyard production animals.

This veterinarian was a super-nice guy. Clients bonded to him like ants to a syrup spill at a picnic. One of his first statements was, "I am one of the worst two practitioners in the province, so I know I need help. I must discount to get people to come out to my clinic in this bedroom community, since I am twenty miles north of the edge of the city."

He had a very competent certified technician, also very client-centered, yet when we discussed nutrition and body condition scoring, the lead tech said, "Our people will not buy premium food, it is too expensive." Then when we were discussing grading teeth, she said, "Our people will not spend money cleaning their animal's teeth, it is not done in this part of Canada." She also added, "Our people do not need to be sold fecals or heart worm. It is too dry and too cold for parasites or mosquitos."

We worked with the practice on-site for three days, and got the agreement that we would try everything on a ninety-day test basis. No vetoes, no hesitation, no excuses -- just the word "need" linked with a sincere statement of what the patient deserved or the doctor needed for professional confidence, such as pre-anesthetic lab, intra-operatory fluids, pain management, etc.

We developed a draft transition plan, with each element provided step-by-baby-step, with only five or six items a month, for an entire year. We had the practice implement one major new/refined/targeted healthcare delivery program each month, which meant two months before the implementation month. We had them start with targeted in-service training. Then one month before the program, we had them rehearse their new communications for the program, so the mailer and the client relations team narratives had the same "need" belief, when they, or even the OPNT, talked to clients.

Everyone was on the same "sheet of healthcare music" for ninety days of the "test". This sequential training, communication, and marketing, system was first introduced in Chapter 5 of Building The Successful Veterinary Practice: Programs & Procedures, then was further expanded in the text Veterinary Healthcare Services: Options in Delivery.

We initiated the patient data cover sheet, which had the wellness standards checkerboard square, a master problem list, and the medication refill section, so the doctor never has to make a refill decision on the fly. These three elements were religiously completed on the pink (&) or blue (%) patient data cover sheet, so when he brought on an associate, or "locum" (relief doctor in local parlance), that doctor could provide a continuity of care that would provide him peace of mind, as well as the client.

This "exit summary" memory jog was put atop the most recent progress notes, and we ensured the client's concern always followed the date, the assessment always addressed the client's concern first, then the other needs were listed, using the "need" boxes ([ ]).

When a "need" was stated, we taught the entire healthcare delivery team to immediately become silent and listen to the client, while writing the progress notes, and then, as they made the client's response "okay", they would complete the "need box" with the applicable client's response.

Then they were asked to ensure that no patient ever left the practice without being listed as at least one of the three Rs, and the expectation for the next visit/contact was firmly in the client's mind!

This veterinarian saw the change, and completed seventy percent of the plan in the first year. It had caused him to double his income. So, he doubled the size of his practice, making a "1900s train station" appear, including the loading platform, with the luggage cart, as part of the new outside facade. Inside, a model train ran the perimeter high on the walls above the of the client area, belching smoke and sound on command. Kim now knew he was "one of the two best practitioners in the province". He believed his patients were better off now than ever before, his clients still loved him, and his wife came back into the practice to assist.

Kim and Brenda showed their pride in their staff and their clients, and the practice continued to grow. Kim felt he needed to tell others what he had discovered, and by gaining the presidency of the province VMA over the next few years, and leading his colleagues toward the new horizon, he led by example.