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Practice Management

Hire the Best, and Lose the Rest

by Stith Keiser
    3D people

    You could have heard a pin drop after the door closed. In the air, there was an aura of apprehension and excitement. The client service representatives at the front desk knew why the new owner and I were there. We flipped the “Closed” sign on the door so that it faced the parking lot, and then the meetings began.

    This was my first day as manager at a two-doctor, small animal practice that we’ll call “The Animal Clinic.” Ownership had just changed hands, and the elderly former owner was all too happy to get out of his practice. From the outside, it didn’t look too bad. The clinic was in a good location, at least in terms of visibility; the building was in decent shape; the equipment was operational; and the support staff and doctors had all been with the practice for years. And that was part of the problem. A few key members of the staff had grown complacent and interpreted their tenure at the practice to mean it was theirs to run. So run it they did…right into the ground. The practice’s expenses were too high, patient visits were down, and production was dismal. Now it was time for us to live up to our promise to turn the place around.

    It would be easy to blame this situation on the economy, but I’ve been in enough practices to know that while the economy can be a factor, it is rarely solely to blame for a practice’s performance. The motto for a successful practice is “hire the best, and lose the rest.”

    What Do You Need to Improve?

    As practice managers and owners, our top priority is to provide the best medicine possible. It is tough to do that without also running a great business. If we can’t make money, we can’t buy the equipment we want, we can’t hire the best staff, and we can’t afford to offer the exceptional client service that separates successful practices from ones that struggle.

    So how do you build a great business? In a recent article, “What’s Your Hiring Strategy?,” the first thing I suggest is to figure out what your practice’s mission and vision are. At The Animal Clinic, I quickly learned, neither a mission nor a vision existed. As a result, the bottom line was suffering: the doctors had an average client transaction (ACT) of $109, which is well below the national average of $145 to $162. Targeting ACTs isn’t just about making more money; rather, a low ACT means there are inefficiencies in the clinic. When we broached this issue with the staff at The Animal Clinic, their number-one rationale for their low ACT was the fact that the clinic was located in a semirural area where clients didn’t have the disposable income to afford thorough medicine. Since the staff assumed this, they always recommended the bare minimum of care. For example, they didn’t recommend presurgical blood work or regular fecal examinations, and they didn’t spend time on client education about dental disease, obesity, or heartworm prevention. The staff assumed that clients wouldn’t want to pay for nonimmediate medical care, partially because they themselves didn’t understand the value of it.

    Our first priority, then, was to create a culture, through staff education, leadership, and the implementation of a practice philosophy and mission, that emphasized practicing high-end, thorough medicine. It didn’t mean that every client would opt for every recommendation, but it did mean that if the staff educated themselves about the value of conducting blood work and fecal exams, performing dental cleanings, and talking to clients about diets, they would recommend these things, when appropriate, because they believed in them.

    Who Is Going to Help You?

    Once you have identified your goals, the next step of building a great business involves, to steal a strategy from Jim Collins in his book Good to Great, getting the right people on the bus and then getting them into the right seats. It doesn’t matter if you are taking over an existing practice, are starting a new practice, or have just finally realized that your clinic isn’t performing to its potential: you have to get your whole team on the same page.

    To do this, I recommend sitting down one-on-one with each existing staff member to better understand his or her work goals, professional interests, and career goals. The objective is to figure out why your people are with you, whether they fit with the practice’s mission/vision, and, if so, how you can best use their interests and abilities. During my interviews with the staff at The Animal Clinic, it became apparent that a few might not be the right fit for the team.  Specifically, several staff members seemed to lack enthusiasm regarding the changes and to have difficulty in recognizing the “big picture.” A few, I realized, viewed their role in the practice simply as a means to achieving a paycheck rather than as a key piece of the puzzle that would  allow the practice to perform at its best. As we began training, we quickly noticed pushback from some of these staff members, who felt that the recommendations featured in the new practice philosophy were just ancillary services that veterinarians pushed to make money. This attitude conflicted with the clinic’s new identity. 

    When faced with resistance from a staff member, an owner has two options: to give the staff member a chance to “rise and shine” or to move forward without him or her. Almost everyone struggles with change, and most of the time, resistance is due to a lack of understanding rather than outright objection to the new process. Therefore, before making a rash decision to let someone go, consider giving them a chance to digest the changes. Before taking over The Animal Clinic, the owner and I agreed to refrain from making any staffing decisions for a period of 90 days. Ninety days isn’t necessarily a magic number, but we felt it would give us enough time to determine how well the staff was adapting.

    If a staff member is “fighting” changes, the first step I recommend taking—and the step that we first took—is to sit down with him or her and try to understand where the resistance is coming from. Does the employee not understand the “why” behind the changes? Does he or she feel left out of the decision-making process and a lack of “ownership”?  Through learning how to best communicate with each staff member and then tailoring your explanation to that style, many problems can be overcome. However, if, after walking through these steps, a staff member is still not fitting into the clinic’s culture, it may be time to allow him or her to pursue a better fit elsewhere. As it turned out, this was our ultimate decision with two of the staff members at The Animal Clinic. Although cutting staff is never easy, the refusal of even one person to adopt your practice’s philosophy and mission, no matter how long that person’s tenure at the clinic or how well liked he or she is, is as unacceptable as it is unfair to other staff members, clients, and patients.

    The Best Employees Prefer the Best Clinics

    One of the worst things you can do is start interviewing potential new staff members before assessing your practice’s culture and values. I once spoke with an experienced credentialed technician who had recently been offered a job at a practice along the front range of Colorado. The practice had been chasing her because of her experience and special interests, but when she came in for a working interview, she heard a doctor cussing and screaming at the support staff over an innocent mistake. To top it off, she also watched as a dog that was brought in with a gaping wound at 5:30 p.m. was allowed to lie in the bottom of a cage for more than an hour because the day staff didn’t want to deal with it and decided to wait for the evening shift staff to arrive. Based on those observations of the practice’s culture, she declined to work there.

    How Do You Find the People You Need?

    Assembling a great team starts with honestly assessing your current staff members, including yourself.  One method of assessment that can provide great insight is a “360 evaluation.” In this type of evaluation, all the staff members review each other, including the managers. This is a good tool for staff who have been working together. If you are a new owner, it doesn’t make sense foryou to participate in such an evaluation right off the bat, but it is something that could be done after you have had a chance to acclimate to the new environment (e.g., after 90 days).  You could also ask the existing staff to review the former owner to get a better understanding of what was—and wasn’t—working with regard to his or her management style. Such evaluations can be completed anonymously. Technical skills are an important component of staff knowledge, but they can be taught. Values, interpersonal skills, and leadership are much harder to teach.

    After you’ve assessed your current staff, how do you “hire the best” to fill any positions you still need? It starts internally, by asking yourself some tough questions to help define your culture:

    1. What is my management style?
    2. How do I handle conflict?
    3. What is my learning/teaching style?
    4. What type of personality does best in my practice?
    5. What are my expectations—technical, medical, customer service, management, etc.—for a new hire?
    6. What are my goals for my new hires?

    Asking, and answering, these questions is just the first step. Knowing what to do with the information you discover is equally important. Many veterinary consultants work with 360 evaluations (a list of consultants can be found on the VetPartners Web site). More information on 360 evaluations can be found here and here.

    After you’ve performed an honest assessment of your strengths and weaknesses, use what you’ve learned. As hard as it is, don’t ignore the “ugly” discoveries of your assessment. If you do, you’ll pay for it with staff turnover. It is not uncommon for a practice owner to realize, after completing a self-assessment, that he or she is not the best leader/manager to fulfill his or her own vision. If this is true for you, don’t be ashamed! Seek out a practice manager. However, if you hire a practice manager, it is crucial that you share your vision and goals with him or her so that you can work in tandem.

    Once you have determined your practice’s identity, I recommend using the following process for each new hire:

    1. Build a job description and advertisement.
    2. Thoroughly screen applicants.
    3. Cull resumes.
    4. Conduct phone interviews.
    5. Conduct working, or face-to-face, interviews.
    6. Check references.
    7. Run a background check.
    8. Use a personality assessment.

    In today’s market, most practices don’t have trouble gathering resumes, but don’t be lulled into thinking that having a large pool of candidates means it’ll be easy to pick the right one. Move away from traditional interview questions such as “what are your strengths and weaknesses,” and focus more on situational interview questions. For example, most candidates will tell you they’re good at client communication, especially new graduates who have been coached for interviews. Instead of settling for that answer, ask them about how they’ve handled various situations in the examination room. Or maybe you’re thinking about growing dentistry within your practice, so you advertise that you’re looking for people with an interest in it. Assuming that all your candidates will express an interest in dentistry, ask them what their practical approach to implementing it would be. I’ve lost count of how many candidates have told me in an interview that they’re interested in whatever I say I want, but when I ask them how they plan to grow that particular service, build a client base, or exemplify leadership, I get a blank stare, not a well-thought-out strategy.

    In addition to conducting thorough interviews, a compatibility assessment can be a great tool. I don’t recommend making a hiring decision based solely on these assessments, but they can be used to tell you more about how a potential employee will handle stressful situations, interact as part of a team, work independently, think on his or her feet, or learn a new system. Many available assessments also offer coaching strategies based on potential areas of concern and suggest strategies for playing to an employee’s strengths.


    A year after taking over The Animal Clinic, we have reversed the trend of decreasing patient visits, improved our medical protocols, increased gross revenue threefold, and grown a few niche services based on the interests and talents of our staff.  We haven’t lost a staff member since the first two. Like everyone, we’re not perfect, and we still have work to do, but we’re off to the right start because we have the right people.

    Stith Keiser is CEO of My Veterinary Career.


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