December 2015 – EasyDVM Practice Management Blog

When the Veterinary Client is Stressed

by Sam D Meisler DVM

In veterinary practices, we deal with a multitude of situations in which the client is stressed. How we deal with this anxious client up front often determines whether the overall experience for both the client and the pet is a happy one. In the October 2015 Harvard Business Review article, When The Customer Is Stressed, authors Leonard L. Berry, Scott W. Davis, and Jody Wilmet, use the example of the human oncology patient as their subject in looking at this situation. They explain that in dealing with “high-emotion services” — those services related to major life events like birth, death, health care issues, airline travel, etc — intense feelings are elicited for a variety of reasons. In the veterinary practice, those reasons include a lack of familiarity with our services, a lack of control over how those services are delivered, major consequences if the services are performed incorrectly, the complexity of the service, and sometimes in cases of chronic illness, the long duration of the services to be performed.

How we deal with the stressed veterinary client will ultimately govern the outcome of our patient’s care and well-being. According to the authors, the first step is to identify emotional triggers. In veterinary practice, this could be the discussion of finances in the exam room, the point where the pet is taken to the back and left at the practice for work-up procedures, or even when the pet is sent home with vague instructions on what to do next. The important point here is to ask your clients about their worst fears and worst experiences in a veterinary hospital.

The second step is to prepare the client for what will happen before these emotional triggers occur. Before you take the pet out of the exam room for diagnostics, explain to the client what you will be doing. For long term conditions like skin allergies, go over with the client what to expect in the future. Is your treatment a cure or is it maintenance treatment for allergies? Go over long term treatment plans. Prior to the dental or surgery procedure, go over with the client all the steps that will occur. Even better, show them where it will happen. Tell them that you will go over finances before committing them to any services.

And communicate with care. Most of our communication as human beings is through primarily what our body language is showing, followed by our tonality and lastly by our actual word content. Make sure your body language and voice tone are nurturing, compassionate and unhurried. Monitor the client for those unexpected emotional or anxiety triggers by asking them if things are going ok. Don’t assume that all is well, ask.

Step three is to enhance the veterinary client’s control. Involve the client in any and all decision-making about their pet. When the pet is discharged, the client should not feel abandoned by their veterinary team. Discharge instructions must be very clear on what to do if complications arise or if things do not go as expected. Would it really hurt to give out your cell phone number? Call clients with results from diagnostics as soon as possible; and do not ever over-promise and under-deliver. As the gap increases between when you said you were going to call and when you actually call about results, anxiety will rise exponentially.

And finally, hire the right people and teach them well. You need empathetic, non-domineering, nurturing individuals who can communicate well. Teach your veterinary team how to listen, how to make a client feel in control, how to hold a client’s hand through the process of diagnosing and treating their ill pet. The Cleveland Clinic has two videos about empathy: Empathy: The Human Connection to Patient Care and Patients: Afraid and Vulnerable. Model the behavior you expect from your team. Show them what you expect. Meet regularly. Go over client complaints as a group. Complaints are a well of anxiety or emotional triggers gone awry. Ask how could we have done better and not who is responsible for this fiasco.

Online Reviews – Aaaaaagh!

by Sam D Meisler DVM

Online reviews are here to stay and you as a practice owner have to figure out what to do about them. First of all, what are they good for? If you have good reviews, they can serve to bring in new clients (if they are read). Even better, they raise your practice website’s ranking on search engines like Google. The more in-links that you have, the better your website will rank.Bad reviews, on the other hand, can be disastrous. If you are one of those practice owners who have just been quietly going about your daily activities without checking review sites, you may be vulnerable to attack from a bad reviewer. If you have been thinking that everything will work out fine simply by providing great service, watch out. You and I both know that in practice, even when we do our best, we occasionally come across that one client that does not connect with us or one of our associates. In today’s times, this does not result in a simple parting of ways. It often results in a bad online review.

Step One. Open Your Eyes.

“Your customers are talking about you – and the whole world is listening.” writes Kermit Pattison in the NY Times. He recommends monitoring your online reputation at various review sites like yelp and citysearch. You can also set up a Google Alert to alert you everytime your practice name is mentioned on the web.

Step Two. Take Defensive Steps.

Take care of every dissatisfied customer; train your staff to notify you within 2 hours or less when they have an interaction with a customer who is not happy. A quick phone call from you or someone designated by you may head off a bad review. Remember that most online reviews are either made by extremely satisfied customers or extremely dissatisfied customers. So if all you do is call the unhappy client and just listen to them, you may move them into the more complacent although “still dissatisfied” category from the really angry “I’m so dissatisfied that I’m gonna trash you all over the web” category.

Step Three. Be Proactive.

Yes, if you provide really great service, you create clients who want to help you succeed and who would be willing to write great reviews of your hospital based on the experience that they have had with you. You still, however, can not sit back and wait for this to happen. You need to encourage your clients to write reviews. You can do this by including links to various review sites on your website or on a handout that you give to clients as they leave your hospital. Note some review sites may frown on this; check the site’s rules to make sure.

As I said before, the clients who write reviews are not a genuinely representative sample of your client base’s opinion of you; they usually represent the extremes. This may change in the future but at the moment, that is the way it is.

Andrew Gruel, owner of the SlapFish restaurant chain, (see the New York Times Article, A Bad Review is Forever: How to Counter Online Complaints, by Constance Gustke) responds to all reviews good and bad. And he begs customers who gave poor reviews to give the restaurant a second chance.

What not to do.

Do not “astroturf” review sites. This means do not have your employees write false reviews of your hospital to make you look good.

Do not get on the review sites and make “defensive” or “offensive” replies or posts to negative reviews. Be respectful if you are allowed to reply to a comment, identify who you are and give out facts only.

Do not keep your head in the sand and hope you won’t be a victim of a bad review.

What kind of people are you looking for when you hire a veterinary assistant?

by Sam D Meisler DVM

Warren Buffet – CEO of Berkshire-Hathaway and investor who avoided the internet bubble bursting – stated in a lecture to MBA students that the three characteristics that he looked for in people were energy, intellect and integrity. When you look at your top team members, you will probably find that they possess these attributes and it is these attributes that set them off from the others. Energetic people have initiative and find things to do; they are motivated about their job and energize others. Obviously, one has to have the appropriate intellect for the job or success just will not happen. Integrity, however, is the toughest to determine. And what is integrity anyway?

Stephen Covey of The 7 Habits of Highly Effective People fame defines integrity as having that unique combination of character and competency. He illustrates this point by asking would you rather have a competent but greedy surgeon perform a knee surgery on you that you did not need or an honest but incompetent surgeon perform a knee surgery that you did need – or neither.

Integrity implies competency; it implies that one gets the job done and finish tasks, and that one does it well. Someone can ask a person of integrity to do something and not worry about checking up on that person later. But that’s just half the picture. Possessing good character is essential as well. Persons with good character do the “right thing” and are honest, trustworthy and make good choices.

So how does one screen for people with energy, intellect and integrity? Generally, people with energy show it during the interview process. They are interested in what you have to say, excited about the chance to work for you, and have questions. People who are slightly introverted, however, may not show their enthusiasm until they have been on the job for a few weeks. So be careful you don’t exclude a person from your roster just because they were a little shy.

Intellect is easy to screen for. If you are not testing applicants for basic skills like reading, writing and arithmetic, then you should be. You can devise your own screening tests or use an IQ testing company like the Wonderlic Corporation . For reading and writing skills, have them read a passage from literature and then ask them to answer a few short answer essay questions on the passage.

Integrity, on the other hand, is the hardest to screen for. Here you can also “outsource” integrity screening to third parties or try to develop some questions of your own to ask an applicant during an interview. Here are some relevant questions:

Tell me about your last boss?

I would strongly urge you to consider another candidate if the person disparages a former employer. This has more to do with how they will act in your hospital and whether they will disrupt the work place by complaining about you without your knowledge. See Stephen Covey’s article on Be Loyal to those Absent. Warning: don’t expect your prospective applicants to behave better than you.

If a client comes in with a very ill pet and can not afford the medication to treat it, do you think that you should give it to them anyway if it means saving the pets life?

There isn’t necessarily a correct answer on this one. You are the owner or manager of the hospital. How do you want them to act? Should they act on their own and give the medications away or should they ask you about it? Consider how many of your employees fit in the same profile where they can’t always afford the medications either. It’s about trade-offs and about moral trade-offs in particular. How the candidate presents the trade-off to you says a lot about how they would behave in the future.

If you saw a fellow employee smoking marijuana outside of work and it was a long enough time from their next shift as to not interfere with work, what would you do?

This gets at the heart of attitudes towards illegal drugs period. Again, the answer depends on you and how you feel. Be careful, if you don’t mind your employees having relaxed attitudes against drugs for recreational use then expect them to have some relaxed attitudes against stealing if they have a good reason to do so (ie like “I couldn’t afford the Heartgard”).

Describe a product you were able to sell in a previous job position that you didn’t believe in yourself. What techniques did you use to overcome this?

This is sort of a trick question. I would be looking for the “deer in the headlights” look. If they can’t come up with anything then that’s good. If they do come up with something, then examine it carefully. Obviously, in order to sell something that they didn’t believe in, they had to make some sort of trade-off (ie dishonesty vs a paycheck, or dishonesty vs feeding my family). This question is from personal experience. I had a receptionist who was my best “seller” of pre-anesthetic bloodwork and pain medications (before we made them both mandatory). When I asked whether she believed in them, she replied, “Heck no. But I can sell anything.” She later became a very disruptive force in the clinic as soon as she no longer believed in me.

These are just some thoughts on the hiring process. Indeed, it can be very tough. Also, please be mindful of staying well within the law with your interview questions.

Is Veterinary Staff Turnover Really a Bad Thing?

by Sam D Meisler DVM

“How much employee turnover do you have at your veterinary hospital?” I squirmed down into my seat as I reflected on the high turnover that we had last year. It was late January and I had just finished printing out W2 forms the week before. For those of you outside the United States, W2s are a tax form that you have to send to each employee – current or former – that worked for you that year at the end of the year . The number of forms that were to be sent to former employees was quite significant. And now the veterinary associate candidate posing the question was expecting an answer.

I dug in my heels and vowing not to sound too defensive, I replied to her question with the following analysis. First of all, I divide turnover into two categories: “good” turnover and “bad” turnover – sort of like “good” cholesterol and “bad” cholesterol. Good turnover counts those employees who did not fit in with the hospital and have now left – either voluntarily or involuntarily. Bad turnover, of course, counts those employees who you really wished would have stayed.

Every year after printing my W2s, I sort through them and divide them into the following piles: current employees, fired employees, those who left and we were happy about it, and those who left and we were sad about it. I then take the number in the first pile (current employees) and divide it by the total number of employees minus the number in the two middle piles. That is my true “retention rate”. In other words, I am most interested in what percentage of employees who succeeded at the hospital did I actually keep.

This brings one to an important statistic; how many employees were actually encouraged to leave or were terminated? A competent practice manager will not be afraid to make tough decisions where necessary. There are many practices where no one is ever terminated; either the hiring process is so fine-tuned that only great employees are hired or someone at the top cannot terminate anyone. Usually, the latter is true. And in these practices, great employees tend to stagnate as they see co-workers get away with subpar performance.

When I do lose a great staff member, I usually have to hire up to 7 employees before I find a suitable replacement. You can imagine what that does to your turnover rate if you only looked at it in the traditional sense.

So the next time someone asks you about your employee turnover, be proud if you have made tough decisions that year in order to cultivate a great staff.

Unfortunately no matter how you classify it, turnover has costs. With each new hire, you incur the cost of time and money spent looking for him or her, the cost of training, and the cost of incompetency. Your time is valuable and time spent placing advertisements, going through applications and interviewing must be factored in. The cost of training includes the hours paid for training the new hire before they are even exposed to their work environment, the cost of slowing down your other employees as they mentor the new hire, and the cost of the new hire as you double them up with one of your current employees shifts until they are ready to handle the shift on their own. The cost of incompetency includes the charges a new hire will potentially miss, the services the new hire will potentially not sell, and the potential clients the new hire will turn away. As you may note, these costs can convert to quite a significant monetary amount. As such, preventing “bad” turnover – losing valued employees – and limiting the cost of “good” turnover – replacing incompetent employees – becomes imperative.

To avoid losing valued employees, many factors come into play. Employees leave for a variety of reasons which include but are not limited to the following: poor work atmosphere and inadequate compensation. These reasons are not mutually exclusive. For example, employees will work at a hospital with a poor work environment if the compensation is high enough and vice versa.

Enhancing the work environment is a whole topic onto itself. One should start with an assessment of your hospital’s work environment by surveying your employees. At SurveyMonkey.com, a free basic membership allows you to conduct an online survey with up to 10 questions for up to 100 employees. The survey should be done anonymously. To make sure that an employee does not submit more than one survey, have everyone pick fictitious names or numbers out of a hat which they can use to identify themselves on their surveys. Include questions about their feelings on their current compensation, the amount of recognition they receive, whether or not they are currently seeking employment elsewhere, how they feel about their co-workers in a general way, whether or not they enjoy coming to work every day, etc. Include a suggestion area at the end. Be prepared for some interesting answers. Revealing these answers to your employees may be helpful (make sure that you edit out anything that might reveal an individual’s identity). You now have a good foundation to start from to enhance your employee’s work environment.

Enhancing compensation may not be that simple. Generally, twenty percent of hospital revenues are budgeted for overall non-veterinarian employee compensation. The only way to increase this budgeted amount relative to the amount of employees is to increase prices. The immediate effect of increasing prices is either to increase revenues allowing you to pay your employees more or to decrease the relative amount of services performed freeing up your employees time or a little of both. As an aside, the best way to immediately improve the quality of care in any hospital is to raise prices to the point that clients begin to opt for fewer services per patient; your employees now have more time available to deliver these chosen services. Many veterinarians would then argue that you are compromising your patient’s care by doing this. On the contrary, you have made an ethical decision that you will not undervalue your services to the extent that your employees can not spend the needed amount of time on them. Curiously, as your employees are paid more and have more time to communicate the value of needed services to your clients, revenues now increase due to more services being sold.

Obviously once prices are set, the budget limits overall compensation. Individual compensation, however, is only limited by an individual’s productivity. Three very talented employees may produce as much as four or more not so talented employees and as a group deserve the same overall compensation. Being willing to terminate incompetent employees – “good” turnover – allows one the opportunity to find these very talented employees. Cultivating these talented employees depends on having both an excellent training program and an encouraging work environment.

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