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Veterinary Forum November 2007 (Vol 24, No 11)

Business Skills: Doing the right thing — or doing things right

by Thomas E. Catanzaro, DVM, MHA, FACHE

    Editor's Note: A key to building a successful veterinary practice is deciding on the standards-of-care policy and adhering to guidelines accordingly. But realizing success not only means following standards of care for patients — it also means adopting and implementing these standards for practice team members as well, a point raised by Dr. Catanzaro in his discussion of the importance of ethics in setting standards of care. — Stephen Fisher, DVM, Column Editor

    USA Today ran a cover article last year about doing things wrong. After I had read it with great interest, I realized that the challenge was not "doing things wrong," but rather "not doing the right things." A survey of 1,300 American workers was done to discover their thoughts on workplace ethics. The results were revealing.

    Recent findings against insurance companies indicate that they "falsified" claims on some products designed for senior citizens and must make amends accordingly. The companies blame the problem on the sales people, but every insurance policy issued was reviewed by underwriters. Likewise, I have seen practice owners blame technicians or receptionists for a problem when they were just following the "policy" of the practice as well as practice managers blame failing business flow on competition from other practices in town or the super pet store that recently opened. In each instance, the individual failed to accept the simple fact that if you are meeting clients' needs, they will not go elsewhere.

    Ethics start at the top of an organization, and the ethics the staff perceives generally reflect the tone set by the owners or bosses: The practice owner who skims cash never trusts the staff. The doctor who deceives the clients always believes staff members are deceitful too. The doctor who guesses at a treatment protocol rather than running diagnostic tests suspects other practitioners in the area also are treating symptomatically. The causes of unethical behavior revealed in the USA Today survey (see the box " Top 10 Factors Causing Unethical Behavior ") may create a clearer picture of which factors can trigger unethical behavior.

    In a USA Today survey of 1,324 workers, 57% said they felt more pressure to be unethical than they did 5 years ago and 40% said the pressure has become worse during the past 12 months. For example, retail stores now "plan to lose" more from employee theft than customer theft. Surveys show that entry-level restaurant and fast-food workers admit to stealing an average of $239 per year in cash and merchandise.

    The "expected" unethical behavior is what disturbs me. In this same survey, 74% of men and 78% of women believe their families have been neglected to some extent because of workplace pressures. To curb unethical behavior, 73% believe that more open dialogue would help, and 71% say they need to see a more serious commitment by management. It is the uncommon leader who dedicates adequate time to open feedback, meaningful ethics discussions and commitment to staff by supporting daily veterinary practice activities. The pursuit of excellence must start with building the team. Setting the example and creating a safe environment are critical support elements of this equation.

    Are we corrupt and don't know it?

    Take a look at the veterinary profession's "special of the month" mentality: dental month, senior month, spay month, diabetes month, wellness month. How can needed health care be determined by the calendar rather than by comprehensive recurring consultations? In reality, many practices are causing their clients to wait for the "special" before receiving the well-care expertise of the veterinary health care team. Practices need to integrate a standards-of-care program that is effective 24/7/365 and is constantly upgraded to reflect new health care releases and recommendations, such as new vaccination protocols.

    What does all of this mean to a veterinary practice? In the simplest terms, in trying to keep the lions from the door, some practitioners are "making exceptions" as to what they really believe while trying to get the books to balance. Leadership has been replaced by gamesmanship, and in the process, practice owners are grasping at straws and confusing their staff. The people who enter veterinary medicine, from the doctor to the technician to the receptionist to the animal caretaker, have all joined because of a "calling" of sorts. They are not paid enough to stay because of financial greed, so there must have been an underlying value or trait that initially encouraged them to persevere. Most veterinary consultants have found that these traits, beliefs and values can serve as the building blocks for rebuilding a practice.

    A leadership solution

    For the past 2 years, my consulting firm has been involved in presenting a "Partners in Progress" short course based on the AVMA/Fort Dodge Animal Health initiative of two visits a year for life. By establishing affordable fees — often decreasing client costs — for well care visits, practices have experienced increases in gross income of 15% to 68%. The "special of the month" has been replaced with comprehensive, age-dependent "life cycle consultations" tailored to providing husbandry and wellness programs. In addition, staff development programs have focused on competency and the delivery of patient-specific programs.

    The leadership of a practice must awaken the lions within instead of fearing those at the door (see the box " Behaviors That Inspire Leadership "). Owners must lead by example, must regain the ethics that drew them to this profession and must nurture team harmony. In other words, we must awaken in others the same attitude of mind we hold toward them.

    Industry research has shown that doctor- or owner-driven programs have a 30% success rate, while staff-driven programs have an 80% success rate. According to AVMA trend data, the intangibles — human resource factors — in health care delivery account for 65% of any program's success, while the tangibles account for only 35% of successes. In short, leadership can be a new way of life — think about it!

    For more information:

    Catanzaro TE: Building the Successful Veterinary Practice. Volume 1: Leadership Tools. St. Louis, Blackwell Publishing Professional, 1997.

    Catanzaro TE: Building the Successful Veterinary Practice. Volume 2: Programs and Procedures. St. Louis, Blackwell Publishing Pro­fes­sional, 2004.

    Catanzaro TE: Building the Successful Veterinary Practice. Volume 3: Inno­va­tions and Creativity. St. Louis, Blackwell Publishing Profes­sional, 2004.

    Catanzaro TE: Professionalism and bioethics. J Vet Emerg Crit Care 2004;4(1):52-54.

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