December - Mid-Month - Care and Feeding of a Transition Plan
IS GLASS HALF FULL OR HALF EMPTY?
I just left dinner with some dear friends who were clients over 20 years ago, and they are still using the transition plan procedures we taught them over two decades ago in their annual planning retreat for practice improvement (last year they has a 10% growth and an INCREASE in Net Income). But the secret does not lie in the TRANSITION PLAN as much as it lies in the mind set. For instance, is the above picture showing a glass that is half full or half empty, and for the traditional veterinary practice owners out there, I included a measuring device for the most accurate answer. What do you think? Make a decision before reading further please.
Got your answer? You sure? Okay, read on . . .
Back to mind set - there are nine critical verbs which form the foundation for all actions: see, hear, feel, know, think, believe, focus-on, internalize, and need. Now if you have been raised to "prepare for the worse", your verb use effects the solutions selected. For instance: does 'see' related to a challenge, or does "see" related to an opportunity"? Is it a half empty situation, or a half full situation? Only YOU can effect this answer . . . maybe . . .
My answer to this question is to NOT include my own bias in the reply, and instead, attempt a clear description of the situation, ergo - the glass you see above is actually FULL, half with air and half with liquid. Now, what are we going to do with this opportunity?
The ones that's elect the opportunity side of the verb, and the plural "we" when building the transition plan extension, will usually get super results. Inversely, when the leader puts a negative assessment into the initial observation, and then dictates process, they will most often repeat the downward spiral of the past. But then that is why I do consulting, to help break the old paradigms of pessimistic behavior of the practice leadership. E.G., P.S. after the Merry Christmas logo following my title block.
So enjoy the attached article about TRANSITION PLANNING.
December 2013 - Consultant Selection
Howdy Folks: I sent the mid-month VCI FORTNIGHTLY NEWSNOTES early because Karen and I was heading to New Zealand for a series of workshop seminars; participant feedback was that they were the most interactive seminars they had ever attended. Karen's 'lessons learned' and practice stories were the star elements for sure! Now I need to send the EOM VCI FORTNIGHTLY NEWSNOTES a bit early due to Thanksgiving and my travels to Colorado & Canada.
This past quarter found me speaking at AVMA in Chicago, AVAPM in Sydney, AVBA in Melbourne, and most recently, New Zealand. One common thread is the desire of participants to get the "answer" to their practice challenges without investing in a diagnostic consult within their own walls. We all know we have to see the animal to have decent diagnostics to develop a treatment plan, although some old timers will rely on empirical treatments, and some staff will provide home remedies over the phone. But then, these are the same veterinarians who use trained nurses only as animal holders, open their own mail, snake their own toilets, change their own light bulbs, and spend their weekends doing their own practice maintenance (rather than earn $400 an hour on outpatient or $600 an hour on inpatient), so I should not be surprised, should I?
You think these "one question" conference participants would jump at the chance to spend seven days with seven Internationally recognized consultants on an Alaskan cruise (more if they went on the Denali pre-trip or Canadian Rockies Post-trip), which allows them to tailor the subject matter discussions to their own practices during the social and professional venure offered by the August 2014 VCI Seminars at Sea, /site/view/214832_.pml. The room (cabin) and board (13 meals a day included) seven-day costs of our ship, Radiance of The Seas, is less than the cost of lodging and dining at the average 3-day meeting, and the 24-hour continuing education registration fee (less than $500 for primary attendee, with 2nd person less than $200) is about half of the usual fee charged in Australia for a three-day conference. A cabin of YOUR CHOICE is reserved with just a $250 per person deposit paid to our cruise coordinator, Randy Norris (firstname.lastname@example.org), with 9 months to pay the balance. Also, the airfare is usually covered by drug purchase points, so that should not be a barrier either. So color me puzzled!
With the density of practices in the USA and Canada, I never had a problem staying busy with the top 40% (I left the lower 60% for the new consultants who were using material I had published in my 15 texts over the past 20 years, but probably did not know where their material had come from - I have seen the same with the neophyte consultants speaking here in Australia - I published to share the "secrets", so I am not upset at all with their approach to seminars), yet when I came down under in 2008, the consulting business dropped off. First, I was the crazy annoying yank who spoke up too often. Second, practice density is less than 10% of the USA. Third, I expected people to speak-up and be counted when they were successful, but that is NOT the Aussie way, so word of mouth referral is minimized. So the attached article (SELECTING A CONSULTANT FOR PROFIT AND PRODUCTIVITY) for this month is semi-self-serving, since it involves my thoughts on employing a consultant (which most all practices actually need to do at least once every 5 to 7 years, just to keep the innovation engine greased and operating).
So now I am about to travel to Canada (-22 degrees yesterday, compared to the 33 degrees here in Brisbane) for a quarterly follow-up on a consult. Therefore I am sending this edition of the VCI FORTNIGHTLY NEWSNOTES a tad-bit early also.
I hope you have a great Thanksgiving with family and friends . . . and think about giving your significant other, and maybe the whole family, an Alaskan Cruise (August 2014 - continuing education is tax deductible in most jursdictions) for Christmas. :>)
Tom Cat >*-*<
November 2013 - Innovation or Stagnation
We are heading into the holiday season - USA has Thanksgiving (the time to eat to excess) which is a wonderful family weekend - Australia has Schoolies, where high school graduates head to the Gold Coast to let off steam, and for many, to get drunk and party 24/7 for a week-plus straight - it is actually a one month period of excess for these youngsters . . .
Karen and I are heading to New Zealand to conduct a three-day seminar workshop series with Pet Doctors this coming weekend, so I will be sending this FORTNIGHTLY a bit early, my apologies.
From my consulting trench - recently I have had a few crocodile tears about staff behavior and the subsequent replacement stresses [usual practice syndrome - "hire warm bodies" when in a panic and then keep them too long when we see they are not fitting into the team].
FIRST - hiring sequence is a time to upgrade the practice team- hooray
SECOND - always hire for attitude - skills and knowledge can be trained (if they have the aptitude)
THIRD - do not hire clones - diversity the team - I had one clients who hired all dog breeders, and then wondered why they would talk to pet owners, solving their problems, and never bring them into the practice - that is what breeders do - do NOT hire people who do not want to follow the written practice SOC (WHAT and WHY)
FOURTH - build a profile of what the new hire should look like in skills, knowledge, attitude and aptitude (KSA-A), and train your hiring team with what questions they should be asking to define this profile - the same questions MUST be asked of each candidate.
FIFTH - in the text Building The Successful Veterinary Practice: Innovation & Creativity (Volume 3), Wiley & Sons, I provide interview questions and checklists for the various duty zones, and give hints on what to listen for to determine attitude . . . as well a show to score using "+" and "-" scoring for final tabulations.
SIXTH - there is a 90-day Staff Orientation & Training plan in the monographs in the VIN Bookstore, and it is time-lined for each zone area - if the new hire cannot self-develop per the checklists and guidelines provided, dehire them early (dehire means they are NOT a bad person, they just do not fit the team).
SEVENTH - when you have a new program, use a mind map (also explained in Volume 3), and watch who is contributing and who is hiding from participation accountability. Check your DIG TEAM lists (also explained in Volume 3), and see if here are more or less than last quarter . . . if the number is down, there is a leadership shortfall occurring, not a staff problem.
EIGHTH - there is the 7-day high adventure continuing education seminar coming August 2014, VCI Seminars at Sea (/site/view/214832_.pml), on an Alaska cruise, with a Denali pre-trip and Canadian Rocky post-trip for those that want a two week break from practice, which includes an amazing international faculty, respected veterinary professionals who has been there, done that, and have the autographed and ripped T-shirts to prove it. And you get all of them for the full 7-days of social and professional discussions. It is like no other venue.
Tom Cat >*-*<
October 2013 - Poker Hand
You know what is really scary? People are still blaming the economy for reduced client visits, and consultants have started telling practices how to go out and find new clients, how to use social media to solicit new clients, and a bunch of other wasted efforts. Here are a few facts to consider:
1) Unemployment + those not looking for jobs = about 16% population without discretionary income (this is the same number of decreased client visits - gee whiz - magic coincidence).
1a) Most pet owners use discretionary income for pet care.
2) Practices have increased in number in most all communities, diluting the catchment area.
2a) There are not many people roaming the streets looking for a new veterinary practice
3) Social media can be designed to maintain improved client relations
3a) Social media can be used to differentiate your practice to new potential clients in the area
3b) Word of mouth from satisfied clients is what should get you over 50% of your new clients
3c) You need to ask new clients WHY they selected your practice, and reward referring clients with some recognition.
I can go on, but the attached article sums it up well - you cannot win at poker unless you play the hand as dealt. Here are a few player hints:
1) 'Need' is an action word - 'recommend' is not. The last AAHA survey showed the word "need" doubled the booking rate. Our data shows the word "need" with two "yes options" (time related, as in 'do you want to schedule that for later this week or next?') triples the booking rate.
2) 'Compliance' describes the provider performance within the walls of your practice, using the SOC document as a yardstick. 'Adherence' describes what the client does with the information they are provided. These definitions are in use in human healthcare, since they know there is a significant difference between providers and know they must track it.
3) SOC procedures per number of patients seen is a good indicator of SIOC compliance, whereas $$ spent does not reflect "net" or provider compliance to the SOC.
4) National average = best of the worst or worst of the best = mediocrity . . . a real "dumb"thing to strive for when establishing pride in performance.
5) Average client transaction and Gross Income are NOT indicators of net income; a practice's success measure is based on the business formula of Income - Expense = Net Profit, and there is not any veterinary software currently integrated to give you this management factor.
6) Want extended discussions and tailoring to your own practice needs? There is a great adventure continuing education opportunity, with seven consultants for seven days, at super reasonable rates (/site/view/214832_.pml), so book your cabin today for only $250 per person, with 9 months to pay the balance.
If all this does not scare you, have a great Halloween! If it does, I still do consulting. :>)
Tom Cat >*-*<
October 2013 - Ethics - Leadership
The spring has sprung in Queensland - meaning temperatures like summer. Loverly!
I have been watching Linkedin and Facebook, as well as the VHMA Boards. It is amazing things are people putting up in pubic domain. If you have a legal question, please refer to a transactional attorney, unless it is litigation, then find a trail lawyer. If it is about how to give money away to staff (discounts in excess of legal limits), ensure you ask a tax attorney who understands veterinary medical operations. If you want information on handling credit limits, go to your banker. If you want to know what your practice is worth, go ask a professional practice appraiser who has subscribed to the Veterinary Partners systems for capitalization rates and appraisal standards. If you need a human resource help or organizational behavior insights, please, get a dedicated veterinary practice consultant who matches your psychology profile and understands the "calling" associated with people in our profession. Lastly, if you want to benchmark your practice operations, you need to find similar practices in similar demographics, and use the top 15% as the benchmark for your comparisons (also ensure the "n" is adequate); I suggest you center on procedure counts rather than dollars for a truer picture of compliance.
On Linkedin, there are some great minds offering concepts; most of them do not understand veterinary practice nor the culture of progressive veterinary practices. If you extrapolate from their contributions on Linkedin, it often becomes intriguing information. Then in other venues, I watch people offering opinions who have not researched the theory nor do they have a sufficient "n" in their personal knowledge . . . "This is what I did", or "I saw it once", is NOT a valid benchmark . . . and to offer advice seems to me to border on the unethical.
Do I believe I have all the answers? After over 2000 practices visited (in USA, Canada, Northern Europe, UK, Japan, Australia, and New Zealand), the one thing I have learned as FACT is that I will never know all the answers. In fact, every practice I walk into teaches me something new (many of the best things come from staff who are being ignored) and some things come from the owners (many who teach me what NEVER to do again). Some managers have accepted the practice as their patient, and ensure ethical and bioethical treatment of that entity by all players, including the owner (e.g., full compliance to written SOC and inviolate Core Values, as well as high respect for protocols, which actually belong to the staff), while others are stuck in the GOPHER MODE (go for this and go for that style of delegation). Some Medical Directors share accountability by defining outcome expectations, yet many more actually define the processes, which keeps them in the eye of the hurricane.
So I am attaching an article on "Ethics, Bioethics, and Leadership" . . . it comes with checklist, which if used, I ask you to be honest and candid (that is more bioethical than ethical).
Tom Cat >*-*<
September 27, 2013 - Common Mistakes ; The Wellcare Dilemma
Michael Archinal has authored a landmark winning book . . . ANIMAL WISDOM, published by PanMacmillan Australia - ISBN 978-1-74261-199-0 (only $19.99 RRP in Australia)
First, the chapter titles are right on . . . they are the values that we have talked about for so long.
Second, the literature notes round out each chapter and add the academic/technical depth to the stories that add the heart & soul.
Third, as a story teller, Marty Becker watch out! By adding his personal memories and stories to each of the values, it brings out the warm fuzzy feelings that we have always associated with the HAB.
In the Mid-month FORTNIGHTLY, I sent out Organization Behavior & the Uncommon Leader . . . and this month is a double follow-up to expand upon that concept.
FIRST - THE WELLCARE DILEMMA . . . which is in PDF so the diagrams transmit cleanly to I-Pads
SECOND - REPAIR KIT FOR COMMUNICATION MISTAKES . . . since owners talking at people often overshadows the communication systems of talking with people.
September 2013 - Organization Behavior and the Uncommon Leader
Howdy friends and colleagues.
Amazing as it sounds, I got some wild feedback on the '10th bag free' foot note of last edition. As a review, I prefaced it with Greencross or LFR retailer competition with 10th bag free (Greencross gives 10% off each bag). I also said most all practices tell me they know the net is low (below 30% in OZ), but they want the traffic . . . but then 1) they do not assign a nutritional advisor to track the animal, 2) they do not use a nurse consult to counsel the clients, and 3) they do not even track return rates of nutritional patients . . . Hills tells us about 40-45% get started on prescription diets, but less than 7% stay on the diet program.
I still got people who wanted to argue the loss of net income for food sales if they gave away the 10th bag in a year as a client loyalty reward . . . I will not argue that point - anything given away is a NET INCOME loss . . . just like a 10% discount for "special clients" . . . in a 9% true net practice, a 10% discount will take how many months, or how large a number of sales, to become profitable?
- - yep, like it is IMPOSSIBLE for a 10% discount to move into net income in a 9% net practice.
One of my seminars at AVBA this week is Maintaining Practice Value, using the 13 Risk Factors for Capitalization developed by the Valuation Task Force of VetPartners . . . again, I expect some participants will want the valuation formula rather than how to use most of the factors to improve their net income . . . so many just do not listen! I had one participant argue for full cost accounting for adding the DG1+ procedure as a nurse function . . . yet he would not discuss why he was selling nutrition products without doing full cost accounting . . . he wanted to argue a 5x mark-up for nurse prophy was inferior to his 30% nutrition net position . . . old paradigms are so interesting!
On that same note is the attached article . . . I know from the text we have posted in the VIN LIBRARY, The Practice Success Prescription: Team-based Veterinary Healthcare Delivery, which is offered as a free download, too many readers are cherry pickers, and do not do what it takes to integrate and implement a new idea into their practice values and philosophy. That is where doing an on-site consult makes money for a practice - not only have I read all my publications, I have integrated them into many a practice philosophy and core values. I have seen the problems, understand the variances, and can adjust to make the systems come together . . . which is why the best consults are the YEAR-LONG consults, which have multiple return visits to check and balance the practice's growth and adaptation.
Please enjoy the attached article - Organizational Behavior & the Uncommon Leader.
Tom Cat >*-*<
August 2013 - Path or Reason
This was month of awareness . . . do you remember when phone booths had doors, so there was a bit of privacy for the caller - and a place for Superman to change into his tights - this has evolved to cells phones and very loud conversations by people next to me at baggage carousels, restaurants, and other public places. Gen-Ys are never alone, they have their thumbs moving at the speed of light to keep their social network informed about most every event of their lives.
Many of the "old timer" veterinarians are disturbed by the GEN-Y habits of cell phones, but have not yet implemented a "leave it in your locker" policy. These practice owners are in the center of a self-made hurricane, since they seem to require all questions and decision making to come to them, so they can pontificate with the solution . . . yet the staff generally would like some freedom for the non-case management issues. On a recent consult, I did the D-I-S-C behavior survey, and compared the natural profile with the adapted profile . . . the client relations specialist was a natural high I-S, a perfect profile for the front desk and phone, yet her adapted behavior profile was a HIGH C (she was afraid to make any decisions without asking the practice owner - her compliance overshadowed the inspiration and steadiness)). The exam room tech (I like to call them outpatient nurses, since clients respond to that term better) was a natural High D-I, a true change agent, yet her adapted profile was HIGH S, a crank turner who wants to keep the team together at a status quo. These are indicators of a "control freak" practice culture, usually not by intent, it is just the way a practice gets built to a multiple staff posture - the practice owner has his/her nose to the grind stone, shoulder to the wheel, and eye on the end point . . . not an easy posture to share.
Have you checked out (/site/view/214832_.pml) as a source for alternatives to bad practice postures? Great International insights will be forthcoming!
I am getting an increasing number of SKYPE requests for consulting assistance and/or consultant interviews pre-engagement, and people are forever asking what the time difference would be . . . try http://www.timeanddate.com/worldclock/converter.html
I hope the attached article, and self-assessment survey, will help you understand why training to trust and sharing the operational issue decisions will enhance the organizational behavior (new Signature Series monograph in the VIN Bookstore). Good luck!
Tom Cat >*-*<
August 2013 - Adrenaline
July 2013 - Morale
Don't have to tell you, but doing the Bustad Memorial Lecture at the AVMA/IAHAIO in Chicago was a great experience. Sydney two weeks ago was a good seminar, and I expect AVBA in Melbourne in September to be equally so (they are letting me do the valuation factors to maintain practice value). I am home for only a long week after Chicago, have to go to Saskatoon for a consult before I get ready for Melbourne.
It is nice doing consults in Saskatoon in August, but as a full year, it means I will be back in late November (start of bad winter) and again in late February (bone chilling winter), but during the heart of Brisbane summer. First week I was in Chicago, it gave me a reminder of Brisbane summer (heat index at 105F), but the second week was balmy (high 80s).
From the feedback of the last FORTNIGHTLY, some had great things to say, and a realization just set in for some of them - you must have 50% that do not understand the need to change to allow the other 50% to excel as the top veterinary practices. This is the same thing I tell people about their physicians as they pursue a scary invasive technique - one out of every two finished in the bottom half of their medical class. Think about that at your next physical.
Our clients do not know where your grades were, they just care that you care - client-centered patient advocacy is alive and well in the top half of the veterinary practices, and in many of the practices in the bottom half. We have some academics trying to quantify the HAB culture, but even if it is just an anecdotal observation, you better nurture that feeling, since that is where your client's heart is at for their four footed, furry, family member. While you are at it, assess the PRIDE being shown by the staff to clients - clients perceive PRIDE as QUALITY, and that provides the PEACE OF MIND needed for them to buy into your healthcare plan. BTW, have you changed the word ESTIMATE to HEALTHCARE PLAN on your software yet? A "Healthcare Plan" leads the discussion to the left hand column, and your discussion of NEEDS, while ESTIMATE drive their attention to the right hand column and cost of care. Think about that please.
Please do not forget to book your cabin for VCI Seminars at Sea 2014 - itinerary, agenda, and speaker bios are at VCI Seminars at Sea 2014, on my web site www.drtomcat.com. Please remember, early bookings have a better chance of getting the portside cabins (better views on trip south from Alaska)