Practice Smarter columnist Mark Opperman is the president and founder of Veterinary Management Consultation Inc., director of veterinary practice management at Mission Veterinary Partners, and founder of the Veterinary Hospital Managers Association. His column won first place in the Florida Magazine Association’s 2020 Charlie Awards.Read Articles Written by Mark Opperman
A problem facing many veterinary practices as clients come back inside clinics is exam room efficiency. Doctors get backed up with appointments, pet owners wait, and frustration abounds. What can you do to ensure a smooth and orderly flow of clients? First, consider the fact that not all appointments are the same or require identical time commitments. For example, a sick animal visit typically takes longer than a wellness visit, and a wellness visit needs more time than a medical progress exam. Yes, you should teach customer service representatives to ask the right questions and schedule appointments correctly, but that would be a training matter.
Start by implementing flex scheduling if you haven’t done so. Ten-minute flex scheduling is the most popular. To incorporate it, divide your daily calendar into 10-minute increments so that you can block 10-, 20-, 30- and even 40-minute appointments. For example, a medical progress exam might be 10 minutes, a wellness visit 20 minutes and a sick animal appointment 30 or 40 minutes. Some practices use 15-minute increments. Your fee schedule should reflect the appointment lengths, so a sick animal visit should cost more than a wellness or medical progress exam.
Flex scheduling is the first step.
Who Does What?
One of the biggest impediments to exam room efficiency is when hospital team members don’t know their precise roles. Instead, everyone works independently and tries their best to serve patients and clients. In a veterinary practice, every team member needs to know what they’re supposed to do and be fully trained on the duties. I want clinics to run like well-oiled machines.
One analogy involves a baseball team. Imagine if every player on the field chased down a hit ball and no one stayed near a base or in their assigned position. Watching it would be funny, but the team wouldn’t win many games. Unfortunately, some practices function similarly. To perform efficiently, everyone needs to know their job, be trained on it, and learn when and how to support each other.
The best way I know to achieve exam room efficiency is to develop a dance card for the types of office visits usually seen. For example, a daytime practice would have dance cards for wellness visits, sick animal appointments and medical progress exams. A specialty, emergency or exotics practice would have specific dance cards for routine visits.
See “Exam Room Protocol” below for an example of a wellness visit dance card.
As the dance card shows, it starts with the customer service representative:
- Greeting the client and pet. (Make sure to use the names of the client and pet.)
- Reviewing the reason for the visit.
- Obtaining the pet’s weight.
- Offering a bottle of water or another refreshment.
The CSR then informs the exam room assistant (ERA) that the client is ready to be seen. The ERA reviews the pet’s medical record, enters the reception area, introduces themself, and escorts the client and pet into the exam room. The dance card goes on to show the flow of the ERA, veterinarian, CSR and veterinary assistant during the outpatient office visit.
I have worked with hundreds of veterinary practices but have yet to find two that do things the same way. Some have the CSR escort clients into the exam room. Some obtain body temperatures during wellness visits, but others do not. I have been at practices that take patients into a back room for the exam and vaccines, while others do everything they can in the exam room (my preference). In addition, some practices do not use an ERA and instead have the doctors handle everything during a wellness visit.
The Value of Teamwork
I can’t emphasize enough that a wellness visit will have a different dance card than a sick animal appointment or medical progress exam. During wellness visits, the ERA will likely spend more time explaining preventive procedures and heartworm and flea control. However, during a sick animal visit, I’d want the ERA to determine the admitting problem, get a brief description of the symptoms and summon the doctor. The veterinarian will spend more time with the client and pet during a sick animal visit, so flex scheduling comes into play.
A dance card does not pigeonhole team members. An ERA might need to help a CSR at times, or the doctor might ask the CSR to restrain a patient. We all know that things don’t always go as planned in a veterinary hospital, but hopefully, everyone knows what they’re supposed to do most of the time and how the practice should function. At that point, we have a team that works well together, is efficient and provides outstanding customer service and excellent veterinary care. The work environment simultaneously becomes less stressful.
EXAM ROOM PROTOCOL
In this wellness visit scenario, CSR is the customer service representative and ERA is the exam room assistant.
- CSR greets the client using the owner’s and pet’s names.
- CSR reviews with the client the reason for the visit.
- The pet’s weight is obtained.
- The client is offered a refreshment.
- CSR informs ERA that the patient is ready to be seen.
- ERA reviews the pet’s medical record.
- ERA goes to the reception area and greets the client and pet.
- ERA escorts the client and pet to the exam room.
- ERA reviews a pre-exam checklist with the client and notes any suggested services.
- ERA educates the client about preventive procedures.
- ERA records the pet’s temperature, pulse and respiration, if possible.
- ERA prepares vaccines and gets any needed equipment, such as an otoscope, and incidentals, like a puppy or kitten kit.
- ERA informs the doctor that the patient is ready to be seen.
- ERA reviews with the doctor the reason for the visit and the information obtained.
- ERA and the doctor enter the exam room.
- Doctor greets the client and pet.
- Doctor reviews what is planned and any medical recommendations.
- Doctor performs a comprehensive physical exam. ERA assists and restrains the pet.
- Doctor verbalizes the exam while performing it.
- Doctor makes any additional recommendations.
- Vaccines are given, and laboratory samples are obtained in the room when possible. (A veterinary assistant might be present.)
- ERA is told which medications or additional lab procedures are needed.
- ERA leaves.
- Doctor reviews the exam report card with the client.
- Doctor leaves.
- If needed, the doctor reviews the recommendations with ERA, and a medical care plan is established.
- ERA reviews the medical care plan with the client and obtains permission for services.
- ERA reviews with the client any medication needs and laboratory findings.
- Client is escorted to the reception area.
- Charges are recorded by ERA and reviewed by the doctor.
- CSR reviews charges with the client and itemizes the statement.
- Reminders and follow-up appointments are scheduled.
- Client is thanked.
- CSR transports food or the pet to the parking lot if needed.