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Watch and learn

Observing what happens in the exam room, possibly through videotaping, can improve communication, customer service and patient care.

Watch and learn
Having a checklist can help make sure all the information gathered by the team member is communicated to the doctor.
What does an effective exam room visit look like in your veterinary practice? Ideally, the client does not have to wait for the appointment. During her visit, she is educated about all she needs to do to provide optimum care for her pet. Appropriate services are rendered and the pet appears to have had a good experience. The client appreciates the value of the services provided, pays her bill with a smile and offers to write a very positive review on social media. How does all that sound to you? Hopefully all your outpatient office visits are as effective as this one, but do you actually know what is happening behind those exam room doors? I have consulted with many practices over the years, and it seems that what happens behind exam room doors is usually a secret and hardly ever evaluated. I think this is a big mistake. A practice will make it or break it in the exam room, and it is management’s responsibility to observe, evaluate and coach those who work in the exam room. Let’s begin this process by looking at your veterinary nurse or, if you use one, an exam room assistant well-trained in preventive medicine. How effective is she in her communication, customer service and patient care? I have been in exam rooms where the assistant made little or no eye contact, didn’t engage the client or pet, wasn’t knowledgeable, had no presence and, in general, represented the practice poorly. I also have been in practices where the assistant was amazing. She was personable, interacted well with the client and pet in a professional manner, was knowledgeable, and represented the practice in a Ritz-Carlton manner.

Install Video Cameras

The question, of course, is which category do your exam room assistants or veterinary nurses fit into and how do we evaluate them? I suggest that your practice manager be present in the exam room at various times. Most of us have heard the adage “Don’t expect what you don’t inspect,” and I would agree. This is an area where management needs to get involved. In consulting with veterinary practices, I often go into the exam room to observe. You might think the client would ask about my presence, but most of them could not care less. I simply tell the client that I am visiting the practice. The client says hello and then turns her attention to the doctor, nurse or assistant. In the absence of having a manager inside the exam room, I would suggest setting up a video camera. Check your local laws on this, but in most states you can install a video camera in the exam room. Place a sign on the wall stating, “Video surveillance is being used for training and educational purposes,” and have your employees sign a release form acknowledging that they are aware the rooms are under video surveillance. I would never suggest this be done covertly; everyone needs to know that video cameras are present.

Use Checklists

We have used video training in our consulting practices for several years now, and I have found it is by far the best tool to help veterinarians and other team members improve their effectiveness. Once again, how do we know if the exam room assistant or nurse has reviewed all preventive procedures with the client and done so in an effective manner? I like to use pre-exam checklists during annual wellness visits. (Canine and feline forms can be found here and here.) Pre-exam checklists list all the preventive procedures necessary for a pet’s optimum wellness. Exam room assistants use checklists to review with clients the services that are needed for their dog or cat. As this is done, the assistant will note any services that are due in the future, recommended or declined. The checklists include a brief description of each service so the completed form can be given to the client at the end of the visit as a further source of education. Anytime the practice recommends a service, we note it on the pre-exam checklist. As an example, suppose the doctor recommended a dental cleaning but the client wanted to think about it. We would note the dental cleaning as a recommended service and a service code would be entered into the computer. This would cause a line to be added to the invoice stating that a dental cleaning was recommended, and it would prompt a follow-up call to the client in seven to 10 days. A declined service is a little different. Suppose a doctor, nurse or exam room assistant recommends a service, such as a feline leukemia test or vaccination, and the client declines. We will note that the service was declined on the pre-exam checklist, and a service code would then be entered so that the invoice contains the line, “Declined Feline Leukemia Vaccination.” No follow-up will be done by the practice, but don’t be surprised if the client returns a day or two later and asks for the service to be rendered. Perhaps another family member saw the notation on the invoice and, knowing someone whose cat had the disease, approved the vaccination after all. Once the nurse or assistant is done in the exam room, the next step is to evaluate the effectiveness of the hand-off information to the doctor. Once again, having a template in the computer or a checklist can help to make sure all the information gathered by the team member is communicated to the doctor. Clients don’t appreciate having to tell an assistant something and then having the doctor come along and ask the same question. It is one thing to say, “Susan said Casey has been vomiting” versus someone asking, “So, why is Casey here today?” Effective communication between the nurse, exam room assistant and doctor is necessary.

Difference Makers

If a client sees one doctor during one visit and a different doctor during another visit to your practice, will the experience be the same or very different? What is it that makes one doctor more effective than another in the exam room? I would love to think it is their medical knowledge, but I have found that it is normally their communication skills and the relationship they form with the client that makes the difference. Some veterinarians can tell a client to do almost anything and she will, while other doctors have a hard time getting compliance. I coach doctors in the exam room almost every day, and I will tell you that most of them are able to drastically improve their communication and bedside manner, and thus, the bonding with their clients. Many times, it is the little things: how one enters the room, greets and interacts with the client and pet, conducts and verbalizes the physical exam, and makes recommendations. One doctor will say, “You might want to consider having Fluffy’s teeth cleaned,” while another doctor might say, “Mrs. Jones, take a look at all this tartar on Fluffy’s teeth. We really need to get these teeth cleaned. Let’s get that set up before you leave today.” As you can imagine, the results are night and day different. Sometimes it is not what you say, but how you say it. The results will impact patients, who will hopefully receive excellent preventive care, but it also can affect the financial aspects of the practice. If a veterinarian can increase each professional transaction by $20, that can equate to over $60,000 in increased income by year’s end.

Video Evidence

Once again, I will plead my case for video evaluation in the exam room. I have looked at hundreds of videos and can tell you that every one of them allowed me to help the veterinarian improve the exam room experience. I am lucky enough to teach at many veterinary schools every year. Many, if not most, of these schools are videotaping students in clinics during their senior year. Boy, how I wish veterinary practices would continue to do this once the students graduate. If you could give me a tool that is guaranteed to help make me better at what I do, I would jump at it. Well, that is exactly what videotaping is: a tool that will help you and your associate doctors to become more effective in the exam room, enhance your verbal and non-verbal communication skills, and, more than likely, improve your professional transaction and client bonding rate. The question of the day is: What is your exam room experience from the client’s perspective and what can we do to improve it? We cannot treat the exam room as an inner sanctum where no one is allowed to see what happens. This is where we make it or break it in our hospitals, so let’s evaluate, coach, train and improve upon this most important aspect of your practice. Practice Smarter columnist Mark Opperman is president and founder of Veterinary Management Consultation Inc. and co-author of “The Art of Veterinary Practice Management, Second Edition.”