The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
A2 = G2
If you Always do what you have Always done,
You are going to Get what you have always Got.
This chapter is not for the light-hearted. It is for the top forty percent of the practices in veterinary medicine. The rest will continue to ask, "What is the national average?" and continue to strive for average. Mediocrity does not become the best of the best.
The veterinary profession has been a static endeavor for so long, we have come to believe that hard work alone makes a practice successful. This is no longer true in the rapidly changing American environment. When Tom Catanzaro wrote the first chapter of Building The Successful Veterinary Practice: Programs & Procedures, and titled it, "The New American Veterinary Practice", core values and Key Result Areas (KRAs) were the cornerstones of that chapter.
Times have changed, and while the profession has embraced those initial concepts and brought them into common usage, a new level was required. Five years later, Veterinary Medicine & Practice - 25 Years in the Future - and the Economic Steps to Get There was published. This text shared insights and perspectives about this changing professional environment, and introduced "Strategic Assessment" and "Strategic Response" as the strategies required for rapid responses to the fluid dynamics of veterinary healthcare delivery.
Now is the time to look at the next level. The primary model for this chapter is built on three emerging strategies for healthcare delivery performance improvement. They include:
A foundation of known quality standards, such as ISO 9000 - IWA 1, not unlike the recent AAHA Standards for Accreditation, which have increased from the traditional three hundred facility-based standards to over eight hundred fifty quality healthcare delivery and facility standards.
The dynamic process of defect reduction, and performance improvement. It is based on Six Sigma, a statistical assessment of standard deviations from the target result desired. Definitions are provided in Appendix S of this text. In simplest terms, it is a "fine old wine in a new bottle". Proven statistical analysis tools, plus proven project management, plus cultural calibration, equals "Getting Better Faster", better financial performance, better teamwork, and a better place to work!
Malcolm Baldrige National Quality Award in Performance Excellence is a combined public-private system used to align effective leadership with increased value to the clients (customers), improved organizational effectiveness/capabilities, and to develop the descriptors of monitoring the measured results of performance excellence.
Granted, any one of these three performance enhancement models could move any veterinary practice forward, just as any consultant can help any practice move beyond where they are. But this chapter integrates the three programs to provide an integrated working model that provides breakthrough performance, when adopted and implemented.
If you have not read the VCI ® Signature Series Monograph Strategic Assessment & Strategic Response and the discussion of new metrics being required for new programs, please read that system before progressing into this set of models. You can obtain a copy at the web site: www.drtomcat.com.
The Change Model
We introduced and have used the "change model" in many of our seminars and in our published literature. This new performance model combines all the facets:
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C = D x P x M < costs |
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Where: |
C equals change, which equals breakthrough performance.
D equals dissatisfaction/desire, which equals comparison to known quality standards.
P equals participative process, which equals reducing the standard deviations from the goal.
M equals modern model, which equals monitored and measured performance excellence.
Less than costs, which means you cannot go broke while trying to do better |
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C: |
When considering change just for the sake of change, don't consider changing. When looking at what you have been doing and comparing yourself to what you were doing, has the technology or knowledge increased faster than your changes? In veterinary medicine, it is said that our knowledge is doubling every twenty-four months. What is the rate of change being exhibited by your practice? Change occurs because of the three elements of the formula, and since the three factors are each multiplied by each other, if any one factor is zero, change will not occur! |
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D: |
When we enter into a consulting engagement, the average practitioner always wants to know how the practice compares to other practices we have seen. What we try to do is cause dissatisfaction with where that practice is performing, and builds a desire to change. When using the 2003 AAHA Standards for Accreditation or ISO 9000 - IWA 1, which are the new healthcare criteria as the comparison, discomfort with the level of nonconformance usually causes the desire to improve. |
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P: |
The need to measure progress is essential, and Six Sigma provides a statistically valid assessment model. If you are weak in statistics, please review Statistics for Veterinary and Animal Science, by Petrie and Watson (ISBN: 0-632-05025-X). Six Sigma empowers the team, and uses terminology like:
"Black Belts", full-time project workers.
"Green Belts", the staff using the programs in their daily routines.
"Master Black Belts", the developers of tools and teaching materials, and mentors of the Black Belts.
"Champions" and "Sponsors", the leadership that selects the Black Belt candidates and help identify projects, while removing the barriers to change.
"Change Agents", those who drive Six Sigma into the culture of the organization. |
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M: |
The modern model was created in 1987 by Public Law 100-107, and is a private-public partnership to improve the performance of U.S. Organizations. It is called the Baldrige National Quality Program (BNQP), named after the 26th U.S. Secretary of Commerce, Malcolm Baldrige. It is internationally accepted as providing global guidance in promoting performance excellence and in learning and sharing successful performance practices, principles, and strategies. The BNQP Criteria for Performance Excellence are self-assessments, and are used for giving feedback to award applicants. |
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<$: |
Less than costs" seems a "no-brainer" to many, but in fact, we have seen practices losing money on a procedure or drug, and the owners say they "will make it up volume. "There is no such thing as a "loss leader" in healthcare delivery, and there is no such thing as losing money on each procedure and making it up in volume .There is only one hundred percent in each dollar, and if it costs more to provide than what is collected, it is called NO NET, and dumb business. Also, "costs" can be time, as well as money, and it may even be morale in some practices. Change has to be seen as beneficial to the client, the patient, the staff, or even the practice, for the team to buy into it. |