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PROFESSIONAL PRACTICE APPRAISALS

REPORT ON: YOUR VET PRACTICE

BY: ROB TULLOCH, BVM&S, MRCVS

DATE: AUGUST 2019

You Practice Here

Sample Report

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‘PROFESSIONAL PRACTICE PRACTICE SUMMARY:

Your Vet Practice is situated in the somewhere close-by. Here I give a break down of the practice, the area, the demographics and the staffing levels. I will add anything that gives the reader more information about the practice.

The following report is an amalgamation of several practices I have worked in and is used to show how I highlight the issues (if there are any) and how I go about demonstrating what I see happening on the ground and what can be done, in my opinion, to rectify these issues.

SUMMARY OF FINDINGS:

Below I will list the areas of importance that may will need addressing. I will list these as positive attributes of the practice (usually self explanatory) and the negative attributes which I will go into in more detail in the report. Given that this report is produced to highlight areas where changes can possibly be made they will be listed as 1) Issue 2) Solutions and 3) Outcomes. Where some of the issues have a financial implication I will highlight these and offer to show a positive financial gain offered by the solution offered.

Positive:

• Very Friendly / Family Feel.

• Excellent Consulting Facilities.

• Good Kennels

• V. Good Prep / Op Facilities.

• Well Equipped.

• Excellent reception set up.

Negative:

1. Pricing Structure - Pricing & Estimating

2. Drug Ordering & Stock Control.

3. Poor PMS.

4. Consulting : Operating Ratio Poor.

5. Vet Mentoring requirements.

6. Confused Management structure.

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COMPANY NAME1) Pricing Structure - Pricing & Estimating:

Issue: Pricing within the practice is at best considered erratic. Some things are cheap and others expensive. Fundamentally the high prices of routine procedures prevents them being used routinely. The low prices of others mean that you in essence ‘give away’ certain products and services. The lack of effective estimating (due to poor PMS) coupled with the high pricing structure means that there is no transparency for the client. Commonly leading to much higher than expected invoices and poor client experience as a result. (see Appendix 1 for further explanation)

Solution: A ‘root and branch’ pricing rethink is required. In my opinion you need to redress the imbalance by taking a look at the majority of your routine procedural costs as well as your drug mark ups. The consultation costs are fair as are the majority of drug prices. This is evident as your consulting lists are busy and people are happy to pay these costs. However, in my opinion the majority of the veterinary work is done in the consulting room and there is not enough through put to your hospital & operating set up. This is wholly to do with the costs involved.

Outcome: Effective pricing for routine procedures and work ups is essential for these modalities to be used effectively. Allowing for these procedures to be estimated and priced accordingly will effectively enable the vets too feel happy to promote and use them. At present this is not the case. For Example:

Dentals (Grd 1 to Grd 3) = £385.00 - £582.00

(And these costs don’t include bloods, fluids or treatments)

Cons + IVFT + b/s + Hosp = £305.00

Both of the above should be considered routine prices and charged accordingly. When priced effectively these procedures sell well and generate effective turnover and subsequent profit.

Dental S & P = £195 x 1 a day x 52 weeks = £50,700 turnover. At present you probably do less than half of this in dental work. I good vet can sell dentals at this price all day every day.

Admit for Fluids, b/s and hosp = £175.00 x 5 a week x 52 weeks = £45,500 turnover.

These figures are supportive of the idea that a Paradigm Shift in pricing policy and attitude towards it will have a far greater effect on turnover and subsequent profitability than just increasing the prices year on year. As this only goes to exacerbate the issue.

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2) Drug Ordering & Stock Control:

Issues: Drug ordering & stock control outside of clinical control. Constant failure of enough stock being present or running out of key product at key times. This is likely due to product being used in the hospital but not being charged for? If you are going to rely entirely on automatic reordering then this needs to readily and frequently brought to the attention of the staff. The ‘my way or the highway’ attitude is fine in principle but is clearly not working on the ground. Resultant inability to keep shelves effectively stocked has negative effect on staff morale.

Solutions: Better and more frequent communications as to how the system works and why some drugs run out. I would give the control of stock ordering levels to the head nurse after discussion with the PM via the directors. I would set min & max levels after discussion with all parties. I would also allow an override system to make sure the head nurse could order at her discretion (in emergencies)

Outcomes: All drugs stocked in appropriate volumes and be sold accordingly. Staff happier as have the drugs needed to do their jobs effectively.

3) Poor PMS:

Issues; Ageing practice management system (PMS) which is is grossly outdated. Difficult to navigate through and has multiple issues.

Solutions: Invest in new, modern, updated PMS.

Outcomes: Positive staff moral, better ability to charge effectively, estimate properly and provide client information.

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4) Wrong Consulting : Operating Ratio:

Issues: The majority of the clinical work is done in the consulting room with a smaller percentage done in the operating theatre & hospital. This is a result of a 2 main issues: 1) pricing policy mentioned above and 2) experience split between directors and assistants. The more experienced vets can do the majority of their work up based on experience and pattern recognition and hence do not follow the EBVM process. Less experienced vets who are more likely to work up cases following a diagnostic trail are NOT doing so due to a) cost and b) poor mentoring.

Solutions: Address pricing structure mentioned above (Paradigm shift in thinking required). Also need to alter interaction and rota time with less experienced veterinary staff. (see below)

Outcomes: Longterm your profitability will rise due to a better spread of chargeable work between cons and operating theatre. Your less experienced vets will be provided with the help and guidance needed for them to move forward in their career. The knock on effect of this is better staff morale and retention. (see below)

5) Vet Mentoring Requirments:

Issues: As mentioned above one of the more subtle issues that you as directors have is regarding mentoring of your less experienced vets. You have a really good team in place but their combined level of experience is quite low. Whilst I have witnessed one to one teaching inside and outside the operating theatre by Chris, which is to be commended, I am also aware that there is an underlying lack of guidance for the new graduates and less experienced members of the team. Having discussed this with CS before I left she informed me of the ongoing conversations and meetings that went on with the junior staff that I wasn’t aware of. This all sounds very proactive but I get the feeling that this approach is a little formulaic and the system needs to be relaxed more.

Solutions: I would enable the rota to place the directors / more experienced vets to be working alongside the assistants in a more relaxed and proactive way. Being shut off for several hours at a time consulting does not lend yourselves to being available for discussion and practical help. Also the occasional trip into the hospital to support the vets when on call will pay dividends for their confidence level, allowing for less reliance on you in the future.

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6) Confused Management Style:

Issues: Obvious clash between ‘A’ and ‘B' from my point of view with respect to delegation of duties. Whilst I’m sure that ‘B’ many fine qualities that make him a good fit for the job, the fact that he is married to one of the directors makes him far more of an ‘unofficial’ director and less able to be treated as a practice manager. ‘A' is superbly qualified and a well respected member of the team. He is an ideal candidate for this role and it is a shame that his abilities are being hindered by the lack of ability to see this situation as untenable.

Solutions: Employ ‘A’ (solely) in role of Practice Manager and allow him to go forward implementing the changes required my the directors of the company. I have never worked in a practice where this job role has effectively been shared.

Outcomes Better and more effective managership of the business. PM can go forward and effectively implement changes required by the directors with no conflict of interests.

Outcomes: Happy, motivated and content staff. Less likely to move job and more likely to become the next generation of experienced vets in your business. You have a great team and are really nice, caring people to work with as I have found out myself. Altering your working times and availability can really make a difference.

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Conclusions:

I believe you have a fantastic practice with lots of great things going on. Some of the issues I have raised are easy to fix. Rota changes, drug ordering and stock control are easily accomplished as is your change over to a new PMS. All these will have a positive effect of the general day to day running of the business and the general morale of the staff.

Changes to your pricing structure for routine procedures is easy to accomplish but will likely take a ‘mind set’ change to allow you to actually follow through and achieve the end goal of increased throughput into the hospital and associated financial gain as a result. I believe that, as a result of your poor pricing structure and poor price transparency for clients, you already have a reputation for being too expensive. Your prices for routine spays and castrates are neither too high or too low yet the practice does so few of these that there can be no other explanation. There is no point in lowering these prices as you will only go forward and make less money for each one you do.

I believe that some simple changes to your time allocation for X and Y will allow better and more effective mentoring of the younger and less experienced vets. Again this will have tremendous effect on their wellbeing, work life balance and general morale. This has positive effect across all the groups of staff as well as having a positive effect on staff retention.

Appendix 1:

Poor ability to discuss cases with regard to escalating cost, coupled with higher than expected costs for services and goods allows for invoices to get to excessive levels very quickly. Clients then faced with a bill way in excess of what was initially discussed. This leads to bad feeling and poor service experience for the client. The new system, if used properly will allow for these issues to be rectified. Of course you still need to address the excess fees charged for certain procedures.