Bad Signs for Your Practice

As veterinarians, we know the difference between signs and symptoms in healthcare delivery. Our patients never tell us their symptoms. We must observe the signs. In practice management, we often wait for someone to tell us the symptoms, rather than watch for the signs that indicate a problem is emerging. There are signs that can be used as indicators to reflect that your practice is moving in the wrong direction. When the patient has the "ADGs" (ain't doin' good), something must be done. When a practice suffers from the ADGs, we have to be able to diagnose the situation. Here are some danger signals:

 People start referring to telephone calls as impositions on their time, rather than opportunities to promote the services of the veterinary practice.

 Staff develop an orientation toward the rules of the practice and the national literature, rather than a value orientation that considers spirit, excellence, and contributions of the individual.

 Paraprofessionals begin to have different understandings of words, such as "responsibility" and "service".

 Problem makers outnumber problem solvers. Problems are given to the veterinarian, rather than being solved by the staff.

 Leaders start to rely on structures instead of people. They write memos and policies, rather than discuss the challenge with the staff members.

 Employees lose respect for the proper use of the English language, or the common courtesy of group sensitivities.

 Veterinarians state that they do not offer full services, because they know what their clients want, and are not going to share what the patient needs, because of cost factors.

 A tendency toward superficiality is exhibited. Doing enough to get by today is preferred to excellence for tomorrow.

 Core values become just "words", rather than beliefs. They change from being inviolate to being violated by "special people" for "special reasons" at "special times". This is BOGUS and makes the practice team lose their mission focus!

 Pressures of the day-to-day operations push aside concern for vision, risk, and healthcare quality.

 Staff members quantify both history and their thoughts about the future, for the practice and personally.

These are indicators of problems looking for a place to happen. They are not unlike the vomiting dog. The signs could be a passing event that will be solved by the "tincture of time". Also like a vomiting patient, they can be an indicator of something deeper, a reason to initiate action quickly and in a positive manner. Work on your practice management diagnostic skills. It will provide for a healthier practice (and patient).

Catanzaro versus Murphy

Murphy's Law: Whatever can go wrong, will
Tom Cat's Adage: Don't cry over spilt milk, just find another cow to milk.

Some say that Murphy's Law was started by an Air Force captain, when a series of problems kept appearing in a California Air Force base missile site. Others say it was created to describe one's life, or in some cases, someone's veterinary practice. Tom Cat says Murphy was invented so people could abdicate the accountability for resolution. If we look at the subsequent laws, which have been developed from the original Murphy's Law, then we can also see the alternatives available to a "leader of people".

"Left to themselves, things tend to go from bad to worse."

This most often applies to team members who were given a job description, rather than an orientation and training phase when employed. They have inadequate training and are provided very little reinforcement, when they do the "right things" within their work environment.

"Whenever you set out to do something, something else must be done first."

This frequently applies to those veterinarians who are reactionary, rather than visionary. Planning allows the proper thing to be done at the proper time by the proper person. Knee-jerk reactions are minimized. Team planning allows the leader to identify human resources to handle the routine problems so he or she can plan for the future needs of the practice.

"Everything takes longer than it looks."

This situation arises when we haven't really assessed how long the activities of a day really require. At least annually, team members should do time studies of their respective workdays, stopping every hour and recording what was done during the previous sixty minutes by ten-minute increments. Good leaders provide a categorized "row and column" form, so the documentation is simply a time inserted into a space exercise. They also use the survey to determine staffing reallocation and procedure adjustments.

"Every solution breeds new problems."

This is the nature of a changing environment and a veterinary practice that responds to the community demands. Solutions are only stepping stones to a new tomorrow. Continuous improvement is the expectation. Each person was hired to solve problems, not just "do a job". There is no such thing as a perfect "Ten", in people or practices. Our profession adds too much information every week to remain as constant, or to be measured by yesterday's yardstick of excellence.

"Nature always sides with the hidden flaw."

Most practices encounter this when they have not told a client that a pre-anesthesia laboratory screen is needed for every patient before general anesthesia. Then when a problem occurs, we call it an anesthetic misadventure. Diagnostic aides are needed for quality medicine, if we don't want to be surprised by Mother Nature or Father Time.

"It always costs more than first estimated."

When a practice has only guessed at its estimate (healthcare plan), or their fee schedule, or they always include "some things" for free (no charge), this situation arises. Many doctors are "penny wise" and "dollar foolish". Would you want the "low bid" doctor to do your heart transplant? When a true healthcare plan is built, all possible occurrences should be included, and then when they don't occur, don't charge for them. Over-deliver for client satisfaction.

"If you try to please everybody, somebody will be disappointed."

A veterinary practice attracts the staff and clients it deserves, and the leadership has a set of values that has attracted both. Know what you stand for in medicine, surgery, and healthcare delivery. Let your staff and clients depend on the practice consistency. Let those who agree with you stay with you. Those who don't have other options in the community.

"If there is a fifty percent chance of success, that means there is a seventy-five percent chance of failure."

There is no sure thing in life, and even the greatest ideas may come before their time. Many practices want a guarantee of error-free ideas and waste time and stagnate trying to get the rest of the facts. Only about twenty percent of the facts ever really cause great changes on the outcome, so go for effectiveness and leave efficiency for the fine-tuning phase of the follow-up. But as you follow up and fine-tune, remember the next application of Murphy's Law:

The practice maintenance program first comes to mind, with all those "quick-fix" repairs done instead of recurring maintenance, but it usually goes deeper. In the 1980s, protocols and procedure manuals replaced free thought, and many practice staffs became stifled as the management "fine-tuned" the staff protocols. Now they do what they are told, "Because it's safe!" This is called a broken system. People need the freedom to make changes unilaterally in their own work areas to make things better for the client and practice, and mistakes do happen! This abundance of documentation led to a reciprocal application of Murphy's Law:

"By making things absolutely clear, people will become confused."

This also applies to clients, especially when we break into "doctor talk". In some people's minds, absolutely clear means, "Will you fix my pet?", while in others it may mean, "Tell me more about the dangers associated with this." To ensure absolute clarity, feedback and listening are required. The good Lord gave you two eyes, two ears, and one mouth. The ratio must have something to do with utilization rate.

It is hoped that this review of the applications of Murphy's Laws has made it absolutely clear for the leaders in your veterinary practice. When the cow kicks over the bucket, don't cry over spilt milk, just go find another cow to milk!