If the fear of failure keeps you from trying, you will never need to decide what to do with the fruits of success. - Anonymous

In Chapter One, we looked at the new understandings in human relations and staff motivation, as well as the evolution of veterinary leadership beyond the trite management paradigms of the previous millennium. We provided new models, which diagrammatically showed the flow and application of aptitude, knowledge, attitude, and skills.

In Chapter Two, we looked at where we have come from, and the "ambulatory farm Doc" habits that crept into our small animal practices. It was these practices that became paradigms of operation. They seamlessly evolved into the current companion animal practices. They reduced the effectiveness and profitability by entrenching doctor-centered linear thinking at multiple operational levels.

In Chapter Three you encountered many scenarios that arise already in practice configuration and networking, to new technologies never before discussed in mixed company. We already have injectable sterilization of dogs, via Neutrosol^®, and vaccination protection from cancer (Marek's Disease). We can determine genetic defects in babies, during neonatal periods. The worldwide genome and recombinant DNA/RNA research is producing results faster than the bias and prejudice of politicians can control them by developing and passing new restrictive laws. Yesterday's excellence is today's mediocrity and tomorrow's sub-standard healthcare delivery. For example, some veterinarians still use non-reversible injectable anesthetics, without any form of pre-anesthetic laboratory evaluation of the patient.

Today is a very special time. It is the beginning of the future. The here and now allows us to have learned from our past, but does not mandate that we repeat the bad encounters of the worst kind. Habits and paradigms, on the other hand, often result in bad encounters of the worst kind, such as:

 Lack of clear standards of care in multi-doctor hospitals.

 Minimal pain management.

 Poor fluid therapy, during surgery.

 Empirical symptomatic treatments, instead of accurate diagnostics.

 Poor subsequent nursing surveillance of deferred or symptomatic care patients.

 And, the worst sin of a team-based veterinary healthcare delivery system, inadequate medical record documentation, so that neither the staff nor subsequent doctors can use it to ensure efficacious continuity of care.

Where Do You Start?

Every practice needs at least one risk taker. This is the staff member whose vocabulary contains statements of "Why are we still doing it this way?", "Pushing the edge of the envelope", or "Asking forgiveness instead of permission." They are described by others as "Type A" personalities, "tenacious", "persevering", and sometimes "pushy". In some behavior styles, they are usually Dominant (D). This is the person often given tasks others shun. There is no fear of trying the unusual. To be allowed to be creative or innovative is a "benefit" of that type person's job.

Peers and supervisors react differently to risk takers. Some fear the unknown, for themselves and the practice, while others hope the risk takers will fail, so they don't have to change. But generally, risk takers enjoy what they do, and the other people on a team with them can have fun, between the hard pushes to accomplish the unusual, the chaos of creativity, and the imagination of innovation. The team can, in fact, push the edge of the envelope within the veterinary practice -- honest. All it takes is the veterinarian to create the appropriate environment in the workplace.

Example of Human Resource Leveraging: The "Two Yes" Option Syndrome

In the early days of "small animal practice", we used to ask clients when they wanted to come into the practice. Leveraging our time was not that critical. As we increased staff and overhead expenses started to climb, we needed to approach healthcare delivery in a different manner in "companion animal practices", while keeping clients in the forefront of our systems. The "Two Yes" option system evolved as an essential technique for increased efficacy.

The client relations specialist:

 "I am glad you called this morning. That sounds just like the type of case the doctor needs to see today. Do you want to drop Spike off at lunch, or would you prefer the 1:25 appointment?"

 "Yes ma'am, the life cycle consultation is done twice a year, and Spike is due. Would you prefer Wednesday or Thursday?...Thursday, okay. Morning or afternoon?. Afternoon, that's good. Which would work better for you, the 3:35 appointment or a 4:15 appointment?"

 Hint: Client relations have two foci for scheduling. One in the morning and one in the afternoon. For example, 9:15 a.m. and 4:05 p.m. They offer an appointment either side of that foci for the Two Yes Option. This allows appointments to be consolidated, and frees up the mid-day time, as well as early morning and late afternoon.

Doctor

 "The brown on the teeth is plaque, which is where bacteria live that cause the bad breath, and cascade to damage the kidney. The slight redness in the gums mean pain and will only get worse. We need to get a dental scheduled. Would you prefer the end of this week or the beginning of next?"

 Mary, we need to increase our staff support of husbandry issues, as we implement the Think Two Visits for Life program [www.npwm.com]. Would you like to learn the skills of a nutritional advisor or behavior counselor this quarter?"

Some believe this sounds pushy, while others use modified excuses to not change. The fact is that we must schedule the facility, not the provider. We must control the client access to increase practice efficacy. By providing "two yes" options people feel consulted, and will most often respond as scheduled.