VMDiva

Recent news out of Australia slammed physicians for instituting late fees for patients who show up more than 10 minutes late to their appointments. Many argue these physicians are implementing a double standard given how far doctors log behind during their appointments. Perhaps this is a double standard but I guarantee one argument you’ll hear from these physicians is the patient’s tardiness contributes to the physician’s tardiness.

I have toyed with the idea of implementing late fees for chronically tardy clients (and we all have them, usually know them by name, and plan accordingly). My practice runs on a busy 15-minute appointment schedule. A client’s 10-minute tardiness can throw off the entire block of appointments. I know a late fee would go over like a lead balloon and so it remains an idea droning in my temples every time a client shows up late on a busy night. It’s my fantasy revenge.

The facts against a late fee remain: Most clients are on-time or early for their appointments. Legitimate excuses happen. You can’t teach common courtesy.

I have found some of the best ways of dealing with tardiness are as follows:

• If owner’s are more than 10 minutes late, have front desk staff politely inform them they will need to wait because the veterinarian is seeing her next appointment. It’s unfair to clients who show up on time to have to wait even longer for their appointment.
• Squash clients who decide to “sneak” that extra pet into their 15-minute appointment. If you simply cannot fit her in without making clients with appointments wait longer, do not do it. If you do have time to look at Little Lucy’s skin condition, use the line “Fortunately I have time to see her tonight without an appointment, but just make sure to have one down the road for when we are booked solid so we make sure to address your needs.” Spin the situation toward looking out for the owner’s best interest and you’ll avoid an awkward moment. You know the saying “If you give a mouse a cookie….” Set the tone for future appointments.
• Veterinarians must practice excellent time management given the frequently unpredictable and sometimes emergency laden appointment schedule. If a two-minute recheck and a sick exam arrive at the same time, see the recheck while the technicians triage the sick patient.
• Apologize and offer a reschedule. Veterinarians run behind, mostly, due to surprise illnesses mentioned at annual examinations, emergencies, and sick patients who require admission. Once we are behind it’s very difficult to catch up and we find ourselves rushing through appointments. Sometimes it’s better to reschedule than make a client sit an hour in the waiting room with a labrador who has chewed through the leash, peed on the wall, and jumped on the counter during the wait.

I’m a follower of the adage ‘do unto clients as…‘ and believe the best business practices start with that idea in mind. However, sometimes in business, the “Golden Rule” mentality doesn’t quite cut it. My wants and needs as a pet owner don’t match the wants and needs of all pet owners. When I read this article by Gladys Edmunds of USA Today, it begged for reposting! It highlights the importance of open communication and proper training with staff.

The focus on client/patient care should comprise the majority of focus for the staff at a veterinary hospital. The same is true for the practice owner, but with one caveat. If a practice owner desires the best care for her clients, she must provide the best care for her employees. In an effort to focus solely on client care, employee relations can get tossed by the wayside.

Many employees go through motions day to day without an understanding of why and how their tasks improve patient care. What type of message does it send to employees? If you repeatedly send the message of dispensibility, you cannot cultivate loyal employees. Loyal employees are the key to practice success. Attitudes toward their boss and work, for right or wrong, affect the very behavior the employees bring to the table. If a boss has not earned employees’ trust and respect (that’s right bosses, you’ve got the earn it),  they are more likely to under perform.

Practice owners struggling with income need not worry. Not every “perk” requires significant monetary investment. I am no subscriber to kumbaya-type community builders. I seek realistic solutions. Some simple (and not so simple) steps can cultivate a culture of practice loyalty and pride that will transfer down to where it matters most – the client.

Be Kind and Approachable

All staff members deserve respect no matter what level of education or proficiency. Kindness and interest in staff members personal lives speaks volumes. Get to know a little bit about them and do something to remind them you listened.  Acts of kindness are as simple as assessing personal comfort. I often ask technicians if the table height is appropriate for them during an exam because too many times I see the short staffer on her tiptoes restraining a struggling dog.

Never forget to compliment a job well done.

Pay ‘em what they’re worth

This is usually more pay than what many technicians and receptionists currently receive. One of the surefire ways to make staff feel under-appreciated is to pay less than the average salary for the geographic area. Performance review based pay raises help ensure incentive to maximal performance.

Training and Follow-Through

New employees, especially those less familiar with the ins and outs of a veterinary practice, are typically overwhelmed. Climbing through mountains of medical jargon, procedures, and policies make them cringe. Training is essential. Follow-up meetings are also essential. New employees need regular reviews of their progress and mile markers. This is their chance to talk about what they want to improve upon and also brings any gap in training to the forefront. The time and effort put into training and following up with new employees speaks volumes for commitment to employee happiness.

Continue the Education

Veterinarians are not the only ones who need CE. Licensed vet techs are required to complete CE, but many unlicensed technicians and assistants fly under the radar of licensing boards. This staff still requires continuing education for a practice to continue to provide optimal care. Fruitful staff, committed to learning and developing new skills, are invaluable assets to any practice. Fruitful employees who see how their jobs make a difference are more committed to their position and the practice. Many drug representatives offer lunch-and-learn sessions about new medications, common disease processes, and technology updates. Who wouldn’t enjoy a free lunch, some swag, and an education all in one hour? Make the time to educate the staff.

Additionally, the onus is on the veterinarians of the practice to teach technicians skills and medical knowledge. Take every opportunity to instruct. Better education equals better medicine. Period.

Regular Staff Meetings

Including all staff in regular meetings builds a sense of community and togetherness. Staff meetings allow the practice to work through logistical issues between front and back office staff along with clarifying performance expectations. The feeling of inclusiveness goes a long way in creating employee loyalty.

Lighten’ Up

Practices that are all business all of the time are oppressive. Fun, laughter, and a little bit of chatting can go far in keeping employees happy (of course, all things in moderation). An occasional potluck, party, or birthday cake brings the crew together and builds camaraderie and trust, and therefore, increased job contentment.

Above and Beyond

Exceptional practices provide bigger perks like:

• Gym memberships or on-site exercise equipment
• Periodic massage days
• CE stipends for all technicians
• 401k and profit sharing plans for all employees
• Uniform allowance
• Performance-based bonuses
• Practice-wide community service days
• More low-cost perks
• Recession friendly perks

I like to think I can separate my personal life from my professional life, but let’s admit it, we’re all guilty of letting emotions roll over from home to work and vice versa. When personal life drama spills into work everyone is affected. From patient care to interpersonal relationships, the entire practice feels the impact.  Everyone has a personal struggle that affects work occasionally, but what do we do when that person’s problem becomes the practice’s problem?

Gossip Solutions: Veterinary hospital staff is predominantly made up of women. My various experiences with large groups of women leads me to believe that, no matter where you are or what the mix of personalities, conflict will arise. A wise businessman I know adopted a no gossip policy at work: first offense received a warning, second offense resulted in termination. The policy worked very well at stopping the behind-the-back sniping (at least in the office).  Additionally, veterinarians and higher-ups must lead by example. It’s pretty difficult to correct a toxic environment if those in control are polluting it.

Relationship/Family Drama Solutions: Break-ups and divorce have no place at work. A person can talk with coworkers, however, personal relationship problems should be kept under wraps. In addition, parents with small children should be prepared for a child’s illness. They should have open communication with the employer regarding missed work days. Employers can and should allow use of sick days, vacation time, and/or unpaid time off for parents to care for sick children. However, at-will employees who repeatedly fail to show up at work are at risk for termination. Businesses require reliable help to operate properly.

Illness: Employees dealing with extended illness require us to explore our options. Nobody asks for cancer. Most reasonable small business owners will bend over backwards to accommodate ill employees as they seek treatment. There can come a time when an employer considers termination. Terminating an employee simply due to a diagnosis of cancer or disability is unethical but may not be illegal depending on employment agreements. At-will contracts allow employers to dismiss employees for any reason, extended illness and inability to perform duties included. Many employer contracts allow for legal termination if the employee cannot work for a period longer than two months.

The biggest problems arise when the illness prevents the employee from performing his/her normal duties. These employees can be reassigned different tasks in most cases. A bigger issue comes when the use of medications, fatigue, or lack of mental clarity directly affect performance. Small mistakes are forgivable. Bigger mistakes affecting client and patient care directly affect the quality of care and economics of the practice. These situations warrant medical leave and need delicate handling. Employers, though simply looking out for the best interest of the practice, can appear calloused and uncaring if they don’t make it apparent this is a professional issue and not a personal one.

Termination is a final option. Unfair? Probably. Legal? Most likely. Necessary? Maybe. Difficult? Absolutely.