technology: tools and tips for today and...
TRANSCRIPT
Sydney, Australia 2007
32nd WSAVA Congress 2007
Australian Veterinary Practice Management Association
Conference Proceedings
Technology: Tools and Tips for
Today and Tomorrow
INSERT: HILLS
PROCEEDINGS ADVERT HERE
The Australian Veterinary
Practice Management Association is proud to present:
Technology: Tools and Tips for
Today and Tomorrow
Proceedings sponsored by
Hill’s Pet Nutrition
A Satellite Meeting Of 32nd WSAVA Congress 2007
Published by the Australian Veterinary Practice Management Association A Special Interest Group of the Australian Veterinary Association 3/2404 Logan Rd EIGHT MILE PLAINS QLD 4113 This volume should be cited as: Proceedings of the Australian Veterinary Practice Management Association, WSAVA, 2007, Pre-Congress Day, Technology: Tools and Tips for Today and Tomorrow, Sydney, August 2007. The papers in these proceedings are as they were received from the authors, and have not been reviewed or edited, except to provide consistent presentation. ISSN 1445-3711 Requests for copies of this publication should be sent to: Australian Veterinary Practice Management Association 3/2404 Logan Rd EIGHT MILE PLAINS QLD 4113 Phone: 07 3423 2599 Fax: 07 3423 2027 Email: [email protected] Web: www.avpma.com.au
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Table of Contents
Hi-Tech Toys for Today’s Vets 5
Dr Shane Simpson BVSc (Hons) GCM (VP), CMAVA Running a Successful Website 17
Dr Mark Allison BVSc, Cert SAC, Dip Vet Clin Studies Key Performance Indicators – Key Steps To Profitability Or A Shortcut To Missing Opportunity? 31
Dr Carole J Clarke MA, VetMB, CVPM, MRCVS Using Computers For Communication And Training In Your Practice 43
Dr Lindsay Hay BVSc, MVS, MACVSc, AIMM How To Set Up Fair Fees? 51
Dr Yannick Poubanne DVM, MSc, PhD Mobilising Veterinary Practice Processes 59
Dr Alastair Stott, BVSc, MBA (Melb) It’s All Too Much - I Just Need To Market!! 71
Doug Fletcher
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HI-TECH TOYS FOR TODAY’S VETS
Dr Shane Simpson BVSc (Hons), GCM(VP), CMAVA
Karingal Veterinary Hospital Aspendale Gardens Veterinary Hospital
Nepean Veterinary Clinic 328 Cranbourne Road
Frankston, Victoria, 3199 Australia
Phone: +613 9789 3444
e-mail: [email protected] Skype ID: shanesimpson Web: www.kvh.com.au
There is no doubt that there is an ever increasing demand on us a veterinary practitioners to offer our clients the most up-to-date diagnostic and treatment options available. It seems that every time we open a new journal, peruse a new veterinary magazine or attend a conference, there is some new “must have” piece of equipment available. The list of toys, gadgets and gizmos that we could buy is almost endless. While many of these will simply remain on our “wish lists” it is always fun to dream. So if you had an infinite cash flow and the room to store it all … what would you buy? Wouldn’t it be great if we all could put a CT Scanner in our practices? Or digital radiology? The reality is that we cannot (yet!) and so the “hi-tech” toys that I am going to talk about today have all been chosen so they meet the following criteria
1. They cost less than $10,0000; 2. They help veterinarians deliver a more complete service to their
clients; 3. They improve the level of patient care and; 4. They make practice more exciting
PC-VetGard+™ The PC-VetGard+™ is a compact, lightweight hand-held, rechargeable battery operated, Bluetooth® wireless patient monitor that displays dynamic multiple monitoring modalities on a Windows based computer. Cables and bulky equipment are a thing of the past in the modern veterinary surgical suite with the PC-VetGard+™ monitors. The system is scalable in that you purchase only the monitoring modalities you want now with the flexibility of adding additional capability later without having to purchase a new monitor.
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The following monitoring modalities are available: 1. ECG/Temperature/Respiration/Sp02 2. Animal validated NIBP with systolic, diastolic and MAP 3. Inspired/Expired C02 and apnea detection 4. Inspired/Expired C02 and 02
5. Inspired/Expired C02, 02 and Anaesthesia Agents (including halothane, isoflurane, sevoflurane)
The other benefit is that by connecting a monitor to multiple patients all their data (up to 8 patients) can be displayed on the one screen at the one time. A digital copy of the anaesthetic monitored is recorded and saved to a designated computer and then attached to the patient file in your practice management software. Instant print outs of the data can be made or alternatively saved files can be launched in real time at a later date. PC-VetGard+™ can be used in the exam room too. By using the included chest sensor and low force leg clips quick ECG exams and pre-surgical screens can be performed. ECG interpretation software is available to screen for heart abnormalities that may cause problems before, during or after surgery. There is also bonus reviewer software that allows automatic file storage, dynamic playback of traces, electronic ECG calipers help in identifying and measuring ECG complexes and a table of normal ECG values for cats and dogs. Cost: $US6695 for base unit. $US2300 - $5300 for additional modalities More Information: www.vmedtech.com or www.dvmsolutions.com Sales Contact:
Paige Martin DVM Solutions 16201 San Pedro Ave Ste.200 San Antonio, Texas, 78232 Mobile: (210) 373-9627 Ph: (866) 373-9627 Fax: (210) 499-4665 Email: [email protected]
Vet Call Voice Messaging This innovative technology is a telephone-based voice-messaging machine that can call up to 1,500 clients per day with specific reminders or information you wish to disseminate. Vet Call is smaller than a fax machine, compatible with DOS or Windows systems and comes with a microphone and digital card reader. The system works with any veterinary software and allows you to record personalised greetings with the client’s name and pet’s names and specific
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instructions or an all-purpose message. Importantly the message is in your voice and not a computer generated one and clients see your hospital number on their caller ID display. The reminders are generated on your practice management software and downloaded onto a digital card in a reader connected to your computer’s USB port. The card is then inserted into the Vet Call unit. You record the appropriate message and begin the dialling session. For personalised messages the client and pet’s names are said and recorded once. They are then captured for future calls. When dialling clients Vet Call recognises an answering machine or live conversation so you can choose a “message only” option or let your clients press “0” to be connected to a receptionist. It also redials busy signals and no answers. It can also be set to only call between certain times. Disconnected or changed phone numbers print on a call report so you can enter updated information into your database. The system can be used for things such as vaccination reminders, appointment confirmation calls, surgery confirmation calls, diagnostic testing for medication monitoring, renew relationships with inactive clients, promotion of new products or technology and messages to introduce a new doctor. Cost: $US3,500 More Information: www.vetcalling.com Sales Contact: Tim Hooper Hooper Communications 4904 Oak Circle Drive North Mobile, Alabama Ph: 800-9333-4383 Email: [email protected] Swift Optics Nine Series Digital Binocular Microscope The Swift Nine Digital Series microscope integrates a high quality 3 mega pixel digital camera and a 2.5” 360° rotatable LCD screen into an advanced binocular microscope. The digital camera allows capturing of stills and “real time” video clips, including time-lapse video. There is an internal media card reader / writer so saved images can be reviewed if needed. The microscope has multiple signal output – USB for direct connection to your computer, RCA and S-Video connection for TV monitors and video projectors. In addition the light source is a variable LED that provides cool, energy efficient light for up to 100,000 hours so no more blown globes!
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Cost: $AU3930 (inc. GST) More Information: www.swift-optics.com/products/featured/nine Sales Contact: Con Sapounas SciTech Pty Ltd PO Box 1625 Preston South VIC, 3072 Ph: 03 9480 4999 Fax: 03 9416 9959 Email: [email protected] Radiograph Digital Converter Many veterinary practices cannot afford the high cost of digital x-ray systems or expensive radiograph scanners. The Radiograph Digital Converter (RDC) is an exciting innovation that allows you to have all the benefits of digitised radiographs while continuing to use your existing films. The system allows radiographs to be converted to high resolution DICOM or JPG images by simply placing a film in the unit and using the software package. The images can be imported directly into practice management software programmes including RxWorks and Cornerstone. There are enhancement tools such as bright/contrast, labels, ink, text, symbols, measurement tools, dual view and more. Video and still images can be captured from ultrasound units and dental radiographs films can be digitised using the new dental film converter. Images can also be burnt to CD for clients to take home. Cost: $US3295 though do have specials and do release units onto the international market at a reduced cost. More Information: www.radiographconverter.com Sales Contact: Mathew Russell LogicRad Suite 100, 10725 Plano Rd Dallas, Texas 75238 Ph: 1-888-484-XRAY Fax: 214-432-9068 Email: [email protected]
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TonoVet Tonometer The use of tonometry to measure intraocular pressure (IOP) is the only real tool for the screening of glaucoma in veterinary patients. IOPs are measured using instruments called tonometers, which measure IOP from the outside surface of the cornea. Traditional tonometers like the Tonopen Vet measure by the “applanation” method. The instrument is repeatedly pushed against the cornea manually. The amount of force necessary to flatten the cornea is calibrated and an electronic read is made in mmHg. The newer TonoVet utilises a newer technology called “rebound” tonometry. The portable handheld unit is held about 7mm away from the cornea. At the push of a button, a tiny probe painlessly and rapidly reaches out and touches the cornea. Six rapid measurements are automatically taken within seconds. Most of the time the animal will not even react and certainly no local anaesthesia is required. An audible beep tells of a successful result which is displayed digitally. Cost: $AU3995+GST. A box of 100 replacement probes cost $AU158+GST More Information: www.tiolat.fi/overview_tonovet Sales Contact:
Designs For Vision Cameron Loveless Product Specialist – Southern Division Ph: 1800 225 307 Mobile: 0439 897 967 Email: [email protected] www.dfv.com.au
Wireless Otoscope The Tele-View TV-16 high-resolution wireless otoscope allows users to wirelessly project images of the patient's ear to any television or computer. The Tele-View otoscope displays crisp and clear images of the ear allowing users to show all clients all ear canals and eardrums. By revealing ear pathology to your clients, the clinic will experience an increase in billable procedures and revenue. The Tele-View otoscope affords excellent illumination and clarity because of its 1.3 mega pixel camera and bright LED lights. The Tele-View otoscope will connect to any television by interfacing through a wireless receiver that connects to the television with an RCA plug. It can also
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connect to any computer by interfacing with a wireless receiver that connects to the computer via an RCA plug, a composite video input or a USB 2.0 plug. Cost: $US2495 More Information: www.admon.com Sales Contact: Rick Ferlito Advanced Monitors Corporation 6215 Ferris Square
Suite 125 San Diego California 92121 Ph: 858-677-3880 Fax: 858-677-3881 Email: [email protected]
Kacey P.A.W.S. Stainer One of the most common laboratory procedures performed in veterinary clinics is the staining of cytology samples for viewing with the microscope. While this process is simplified by the use of prepared stains such as Diff Quik it can still be messy to perform, particularly for Gram stains. In addition, the quality of the staining depends greatly on the time the cytology slide is left in the various stains. The Kacey® P.A.W.S. Stainer is the first walk-away automated “animal” slide stainer. In four simple steps slides are stained for haematology, cytology or Gram stain consistently, cleanly and conveniently. The sample is collected and prepared on a plastic, shatterproof microscope slide. The stain protocol is selected on the unit’s display window. The slide is placed into the stain chamber. The start button is pushed and the process in begun. The chamber is filled with the appropriate stains in the correct order and drained after the correct slide contact time with each stain. The slide is washed, dried and ready for viewing in 1 to 5 minutes depending on the stain protocol selected. Cost: $US2195. Stain packs cost $US80 and will prepare 200 slides. Sales Contact: Richard Carsillo President Kacey 50 McCormick Place Asheville North Carolina 28801 Ph: 828-258-1482 Fax: 828-258-0140 Email: [email protected]
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Guardian Real Time Continuous Glucose Monitor Continual interstitial fluid glucose monitoring has been used in human diabetic patients for a number of years to identify trends and patterns in glucose control and allow better therapeutic control. Interstitial fluid glucose levels have been shown to very closely correlate with blood glucose levels. In veterinary practice diabetic patients are often monitored by having a number of blood glucose values taken over a 12-hour period. These results are often greatly influenced by the stress involved in being hospitalised, handled and having the blood samples drawn. In addition an animal’s true pattern of glucose control may not be adequately described by only taking a number of measurements through the day. The continuous glucose monitor rectifies many of these problems. A small area of skin on the lateral thorax is shaved and cleaned with alcohol. A small stylet with an attached sensor, not much bigger than a drawing pin, is inserted through the skin and secured using a bandage. After some initial calibrations and set-up the sensor is attached to a transmitter that sends an interstitial fluid glucose level measurement to a monitor every 5 minutes. A real time glucose level can be checked at the touch of a button. Levels can be entered to set off an alarm should the glucose level fall to low or reach a maximum level. Events such as when insulin was administered, when the animal was fed or when the animal was exercised can be recorded into the monitor. The sensor can be left inserted for up to 72 hours and so a 3-day glucose curve with 864 glucose measurements can be taken. When finished the data collected by the monitor can be downloaded to a computer and a trend graph created. Cost: $US2588. A pack of 10 sensors costs $US350 Sales Contact:
Dan Scott & Associates 235 Luke Ct. Westerville, OH 43081 Ph: 614-890-0370 Fax: 614-818-9330 Email: [email protected] www.danscottandassociates.com
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Wireless Digital Cameras The old adage of “a picture tells a 1000 words” has never been truer in the modern veterinary practice. Whether it is documenting lesions to monitor progression, showing clients images of their pet’s surgery or emailing images off for specialist opinions, digital imaging is becoming an invaluable resource. When selecting a digital camera there are many things to consider including image quality, ease of use, optical zoom, digital zoom and speed of image capture. An area that is often not really considered is getting the images from the camera to the computer. In general this is either done by connecting a USB cable to the camera or alternatively removing the media card from the camera and inserting it into a card reader attached to a computer. The problem with this is that USB cables, card readers, and media cards are delicate things and veterinary practice staff are often not the gentlest people! The small doors on cameras that hold the media cards in are prone to breakage as are the USB connections. There is, however, an alternative and these are wireless digital cameras. These cameras are WiFi™ enabled so they connect into a wireless network. No cables, no media card and no breakages! For around $200 a simple wireless network can be set up from a computer in the practice and with a minimum of computer knowledge these cameras can be set to send photos. There are currently only a few wireless cameras on the market. These are:
1. Canon Powershot SD430 2. Kodak Easy Share 1 3. Nikon Coolpix P2 4. Nikon Coolpix P3 5. Nikon Coolpix S6
Our practices use the Nikon Coolpix P2 cameras. They are a 5.1 mega pixel camera that takes excellent images and are extremely easy to use. They can be set to automatically send images straight to a computer as the photos are taken or alternatively you can select which photos you send across. Cost: $200 to $500 More information: www.photographyreview.com/wirelesscameracrx.aspx Breath Safe III Anaesthetic Apnoea
Monitor This compact little monitor is only 1.25 inches in diameter, 1 inch high and weighs only 1.4 ounces. It simply connects between the endotracheal tube and
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the anaesthetic machine using a convenient elbow adaptor. The unit automatically turns itself on when the attached patient takes its first breath and makes an audible beep with each breath. Should the patient not breathe for 30 seconds the Breathe Safe will sound a distinctive apnoea alert for 15 seconds. The monitor is sensitive enough to detect the breath of a 500 gram kitten. It has an auto shut-off such that when the patient is disconnected the monitor will wait 30 seconds then beep for 15 seconds before turning off. The Breath Safe III Anaesthetic Apnoea Monitor is packaged in a strong, flexible polypropylene housing with a soft vinyl cover. It can be dropped or submersed in water. The battery is a high-density lithium battery that provides up to 10 years of service and never needs changing or recharging. There are no cables to be broken or get in the way. Cost: $US159.95 More information: www.markkenny.com Sales Contact: Kenneth Lerman
Mark Kenny Products Company, LLC 55 Main Street Newtown Connecticut 06470 Ph: 888-476-7386 Fax: 203-426-9138 Email: [email protected]
WrapArt® for Pets WrapArt® is not a product for bandaging but rather designs made out of cohesive bandage material like Vetrap™ and/or CoFlex® that is intended to be applied to bandages (soft padded, splint or cast) for decoration. WrapArt® provides veterinarians with a very fast, inexpensive and fun way to express how much they care about their patients and pet owners by adding that little something extra to bandages, splints and casts. It is a simple way to express good will and strengthen the doctor-pet owner relationship. You can even get your practice logo placed on bandages as a means of branding and advertising. Cost: $0.30 to $1.80 More information: www.wrapart.net
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RUNNING A SUCCESSFUL WEBSITE
Dr Mark Allison BVSc, Cert SAC, Dip Vet Clin Studies
Balgownie Veterinary Hospital 156 Balgownie Rd
Balgownie NSW 2519 Australia
Phone: +612 4285 5210
e-mail: [email protected] Web: www.balgownievet.com.au
Background The BVH website was started in 1998 using MS FrontPage and a “Websites for Dummies” book. At present, the website receives over 2 million hits (40,000 visits) a month.
Figure 1. BVH home page With knowledge of shortcuts and potential pitfalls, you too can have your own economical and easily managed website. Why have a website? A website is an excellent marketing tool for existing and new clients. People who have moved into the region like to see behind the scenes and get a feel for a veterinary practice; hence they use the internet rather than the Yellow Pages. A short online video clip set to music gives them a real feel for the practice. A photo gallery and description of the facilities helps make the decision for them.
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We often see new puppy or kitten owners because they typed “puppy care” or “kitten care” in Google. After reading a few pages and seeing the special offers (e.g. puppy pack contents) they make their decision. Some pet owners with particular problems with their pet seek free advice from our FAQ section which is free to regular clients and those residing in the region (they submit their postcode). Although we try and direct them back to their own vet to have” this and that done”, they often ask to see us. Run your own site or buy a package? There are a couple of veterinary website packages on the market with all the bangs and whistles. You may need to pay an upfront fee to get one up and running followed by ongoing maintenance charges e.g. hosting fees, downloaded traffic, percentage of sales, changing of articles, uploading photos etc. D.I.Y. websites can be set-up and run for a fraction of the cost of a package site. With full control over its content, you and your staff can enjoy changing, adding or removing articles, pet photos and promotions at your own leisure. Website Hosting- beware of charges! The first time the BVH website went over the 1 GB download limit, we received a monthly hosting bill for AUD$350.00. After searching the internet, we came across several hosts offering more reasonable charges e.g. Ix WebHosting offered 5 GB of downloads and 500MB Website size for just US$4.95 a month. Required Software You don’t need to go past MS FrontPage and Websites for Dummies.
Figure 2. Websites for Dummies and Microsoft FrontPage If you can create a word document, it won’t take long to get the hang of generating a webpage with links to other pages or photos. You will need a
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graphics programme for touching up pet photos and creating titles and graphics for your website. If you have the money, look at Adobe Photoshop.
Figure 3. Examples of graphics Finding the Time and Getting Started Step 1) Have a great looking logo If you don’t have a good logo, get one! It’s very important, as everything seems to stem from its appearance.
Figure 4. BVH Logo Step 2) Obtain a design template We asked out local computer company, Rodin Computers www.rodin.com.au to design a website shell. Neil Domagala came up with a superb layout, navigation system and templates. Well worth every cent. Step 3) Find a Webmaster to do the work By doing a search in Google for “webmaster, position vacant, (local technical college/university name)” you will find a few sites in which to place a free advertisement e.g. http://wollongong.sydneyexchange.com.au Expect several replies within 24 hours and be spoilt for choice from very qualified computer “geeks” who are happy to work for $20.00 per hour. Leave the website updating, importation of original articles and pet photos etc. to them and within a few weeks you will have a creative pro-active website which you control. Most of the regular website maintenance can be automated by a webmaster, which makes life easier for you and their weekly hours low. Specify that you want the site built using MS FrontPage and be shown how to maintain it should they move on.
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Ask the webmaster to look at your fileserver and network to see if they can keep it up to date and suggest improvements e.g. anti-viral and anti-spam software, setting up an intranet site, firewalls, designing an online video tour. Disadvantages of having a website 1) Time It’s easy to become hooked on having a great website, so make sure you have plenty of time and a good webmaster to make your job easier. 2) Annoying e-mail traffic If you set-up an FAQ or Pet Advice page, make sure it is password protected e.g. only your clients can ask you questions. Otherwise, you will quickly become inundated with queries from pet owners all around the world trying to avoid a visit to the vet and having no intention of ever visiting your hospital. You can design it so your clients have to type in a password to submit the query. 3) Spam from your e-mail address “Web page crawlers/robots” scan websites looking for e-mail addresses to add to a database for spamming. Preventing Spam from the Website 1) Using Trend Anti-Virus/Spam software in your e-mail software programme 2) Do not have your normal business e-mail address displayed on your website. Use a different address to the one for everyday business. 3) Use an alternative to a text e-mail address: i) Have a piece of text/graphic saying “Contact Us” linked to a FAQ submission form page. Design the form so they need a password to submit their enquiry. If you are not interested in replying to any pet related enquiries, have a note on this page saying e.g. ”Sorry, due to work commitments, I am currently unable to reply to pet health issues- please contact your own vet.” NB Some web page crawlers/robots search online submission forms for e-mail addresses by looking for the @ symbol hidden in the background design. Ensure the online form has a different e-mail address to your normal work e-mail address.
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ii) If you must have an e-mail address displayed, design one using a graphics programme and paste it wherever you want your e-mail address to appear.
Figure 5. BVH email address graphic A web surfer looking for advice can however still read your e-mail address and contact you directly rather than going through your password-protected FAQ page. But genuine enquires can still get through. Preventing Fax Spam We also see Fax Spam courtesy of web page crawlers/robots. The same rule applies for fax numbers on your website i.e. use a graphic rather than text.
Figure 6. BVH fax number graphic Marketing Power of the Website Our marketing strategy concentrates on existing clients rather than trying to attract new ones with large yellow pages advertisements or blanket mail outs. We find the most popular pages are: 1) Pet Photo pages A real favourite for our clients who: · Use them as screen savers · Post them as e-mail attachments · Show them off to their friends Figure 7. Pet photo page
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2) New Product Information New products can be displayed on your website in a few hours.
Figure 8. Product promotion page- Advantix 3) Special Deals Special product deals can be in our client’s hands within a few hours. An e-mail pointing them to the new webpage advertisement and a “while stocks last” generates quick sales. 4) Pet Information Pages The majority of the 800 online pages relate to some type of pet information. It may be a photo from the Hills Colour Atlas showing a particular disease or a short video e.g. how to search for ticks. Other times it’s a simplified description of a complex disease e.g. Addison’s or diabetes. It’s easy to either print the page from the consult room computer or direct them to the website for more information.
Figure 9. Pet information page- Addison’s disease
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5) Joke section This has grown and grown and clients send them in regularly. It helps break up the website and is a great source of humour for after dinner occasions.
Figure 10. Joke page Web Page Ideas 1) Testimonials and Xmas Cards Old and new clients love to read thank you letters. They are a great testimonial. Ask your webmaster to scan and import the cards to the website. It’s a good idea to modify the cards to remove the client’s name/signature.
Figure 11. Cards from our clients 2) Pet Memorial Pages Clients can leave a photo and message here to remind them of their lost ones
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Figure 12. Pet memorial page with Figure 13. Pet memorial page link to David Foote (Pet loss support) 3) Online Video Tour Ask your webmaster to capture footage of the hospital, staff and patients. Once edited and set to music and/or a commentary, it is best imported into Macromedia Flash for conversion into a “flash movie”. This reduces its size and it may appear a little grainy, but it will load and run smoothly on the website.
Figure 14. Online BVH Video tour (Flash movie) A spin off of designing a video is to burn a larger none-grainy version to DVD to pop in your pup/kitten packs and/or new client welcome letters. You can even have practice information handouts saved as PDF files) on the DVD (if viewing on a computer) - potential for drug company sponsorship. Speak to Alex Sturman at Xander Productions for all you need. www.xanderproductions.com.au Phone: 02 4228 8455
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4) Medical and Surgical Cases Online We use a digital camera to time-stamp operations and place interesting anonymous cases online.
Figure 15. Medical cases page 5) Google map location This is a free service and is much more impressive than a snapshot from the local street directory. The viewer can also go hunting for aerial views of their home.
Figure 16. Google map (diagram) (above) Figure 17. Google map (satellite photo) (right) 6) Importing Pet Photo Thumbnail images into RxWorks By following a set convention when naming the pet photos prior to publishing them to the web, you can with just a few clicks of the mouse have the thumbnail (small) website image attach itself to the patient’s image box.
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Figure 18. Pet photo page Figure 19. RxWorks Patient screen You can then incorporate the photos into your mail merge documents e.g. vaccine reminders, vaccine certificates.
Figure 20. RxWorks reminder letter Figure 21. Vaccine certificate
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Improving your Google Ranking The higher your ranking, the better chance you have of someone looking at your website and hopefully deciding to visit you. Traditionally, it has involved placing hidden words in the design (HTML) of each page. The words would include pet products, diseases, suburb, city etc. Nowadays, Google looks at the freshness of the website i.e. new pages, changing information. It also takes into account the number of hits and number of links from other websites to yours. Methods to increase the number of visits include: 1) Online Newsletter We have a pop-up box which captures people’s email addresses for inclusion in an automated e-mail newsletter system. There are 20 pre-made newsletters set to go off at set intervals (e.g. days 0, 7, 14 then once every 30 days) to the submitted e-mail address. The stories are linked back to the main website to increase traffic. There are currently over 3,000 subscribers who receive a regular newsletter into their Inbox. This is handled by an online company called Get Response www.getresponse.com
Figure 22. Pop-up box for collecting (above) e-mails Figure 23. BVH Online Newsletter (right)
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2) Place client database online By placing your client database online so they can view information about their pets e.g. next vaccines due, you will quickly create a large number of hits. It will need regular updating so your webmaster needs to set-up a quick and easy way to export the data out of e.g. RxWorks and update it online. It needs to be password protected.
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KEY PERFORMANCE INDICATORS – KEY STEPS TO PROFITABILITY OR
A SHORTCUT TO MISSING OPPORTUNITY?
Dr Carole J Clarke MA, VetMB, CVPM, MRCVS
Mill House Veterinary Surgery and Hospital 20 Tennyson Avenue
King’s Lynn, Norfolk, PE30 2QG United Kingdom
Phone: +44 1553 771457
e-mail: [email protected] Web: www.millhousevets.co.uk
In this session, I want to look at the numbers and results we produce in practice, see how we can use certain of them to do more than look back at our performance, and give some examples to illustrate how Key Performance Indicators can be used day to day in practice to empower your staff to improve their performance and build your practice. Veterinary practices produce a lot of numbers. We all keep accounts, so can state with accuracy our gross and net profit, our turnover, our salary bill, overheads and direct costs such as the drug and external lab bills. Most of us can drill down further and split income into various categories, and overheads into departments or classifications such as training, rent and rates, stationery etc. Some can develop this record keeping into management accounts, which can be produced quickly on a monthly basis and allow much more detailed examination of the financial performance of the business. A few practices may use this information to reward staff on the basis of increases in turnover, profit, or personal fee-earning ability. Our practice management systems can also give us a wealth of information about how many of each procedure we carry out each day or month or year, our stock holding in days, the turnover of different drugs and over the counter items such as food, healthcare items and toys. Some practice managers can see how many clients are visiting each day, and how many revisit; how many are new clients and how many pets each client owns and brings in for treatment. Average spending rates per client and patient type can be calculated, and uptake of services examined by client and patient category, and vet or nurse. New client numbers can be tracked and ‘bonded’ clients identified, so that marketing activity can be targeted to certain higher spending and loyal groups.
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This information can be extremely useful in looking at where practice growth is occurring, how marketing initiatives are making a difference and where more profit can be made. It can also be overwhelming, extremely confusing and very time consuming to extract, sort and present, and the validity of the data may be suspect particularly if input is erratic or altered easily. You may decide that some of these numbers are key indicators of how well the practice is performing against your set criteria. Different managers and different practices will select different measures of success, and these may change with time as the practice develops new services and moves into different markets. By agreeing a standard set of indicators, however, it is possible to set up inter-practice or even inter-sector benchmarking so that individual managers can see how their practice performance in each area compares with others and if there is variance, why this may be. Targets can be set to improve performance and profitability, budgets can be agreed and management accounts can be monitored to fine tune performance throughout the year. As described so far, our key indicators are more accurately called Key Result Indicators – they are historical measures, showing how you have done up to now, and a lot of them relate to financial performance – return on investment, net profit, turnover, stock holding, bad debts etc. Their value diminishes with time, in that the longer the time taken to produce the figures, the less use they are in helping you form future strategy and make changes which will improve your practice’s performance and ultimately its profit. In business, much time and money is spent on devising effective Key Performance or Result Indicators (KPIs or KRIs), displaying them for the board and stakeholders and proving that they are the way forward, as long as enough money is spent on appropriate consultancy! Reports can be presented as numbers, line or bar graphs, pies, dashboards of speedometers with little dials going in either direction (for Grand Prix fans), and interactive computer screens offering detailed drilling down to raw data and the fascinating prospect of seeing exactly where each KPI is at a snapshot in time. Sometimes so much time can be spent on this that the biggest asset in your practice – its people - can get lost along the way. Choose the wrong KRIs, or KPIs and you can be convinced you are doing well, whilst your competitors are gathering up your market share. Choose too many and you will remain unfocussed. Choose too few and it can be easy to miss trends you weren’t expecting and find that in performing well in some areas, you are missing out on new opportunities which your competitors have spotted and are developing. Neglect the performance factors that lead to KRIs and you will driving with a set time for arrival, but no way of measuring time, or changing speed along the way. The chances are, you will miss the deadline. In his recent book, David Parmenter defines three types of performance measures:
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Key Result Indicators KRIs tell you how you have done. They are often the result of many actions, and give a clear picture of whether you are travelling in the right direction. As well as most of the examples already given, they include measures of customer and employee satisfaction. These KRIs are the indicators most often used in veterinary practice and available from our practice management systems. Performance Indicators PIs lie beneath the Key Result Indicators and are measures that are monitored on a daily, weekly or even hourly basis. They focus on those aspects of practice performance that are the most critical for the current and future success of the practice. PIs are understood and acted upon by all staff, and indicate what action needs to take place. The most current ones are the Key Performance Indicators KPIs can also be ‘future measures’, for example the amount and type of work you have booked in for the day and for next week. How many free appointments do you have, and can you open up some slots by changing your staff scheduling to improve practice performance? Good KPIs have a follow-on effect – improvements in a KPI should follow through to improvements in other measures and ultimately the bottom line. I see these as the key to maximising practice performance and putting success in the hands of your dedicated and motivated staff. Never forget that by measuring something, and telling your people you are measuring it, you are automatically drawing attention to and rewarding the behaviour that produces the desired movement in the indicator. This may not always be a good thing for the practice as a whole. For example, certain performance pay schemes which reward individual financial turnover may encourage staff to concentrate on high earning activity at the expense of lower priced work, staff development activity and innovation which may not bring in an immediate reward, but which may be essential for the long term health of the business. Your system of charging work will determine what your people will do, and customer service issues may take a back seat in this environment if your charging system does not reflect this or your professional values. In our veterinary practice environment, active listening and meeting client expectations may be more difficult to quantify and measure than achieving set targets based on more rigid protocols. In the future, the successful practice will have a workforce that can adjust its activity according to the needs of the client, not slavishly follow set procedures. In this model, the manager’s job is to support the team from behind, not lead blindly.
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Key Performance Indicators can be difficult to measure at first, but once systems are set up, most computer systems can help you with taking control and driving practice performance at the ground level. To work, KPIs must have buy-in from your staff. In fact, your staff will tell you what their KPIs are. They will tell you where they could give better or more timely service if only they knew x, y and z. If they can measure how things are going, they can put things right themselves when targets start to slip. In fact, you as manager or owner often need do nothing once the system is set up. We already know from surveys that what employees value most from their jobs is job control, responsibility and recognition. Financial reward usually follows. We don’t need to dangle a financial bonus in front of people to get them to perform better (assuming we are paying them adequately in the first place), we just need to put them in control of their own work. Looking at it another way, stress at work is often exacerbated by lack of control over the job and processes, poor recognition and conflicting demands from clients and colleagues. By using indicators effectively, solving problems can be put into the hands of those doing the job, and they can see at first hand the benefits to the client and the practice. Putting Key Performance Indicators together with regular practice research makes them invaluable as a prospective tool – to plan the year or years ahead, show you where opportunities are arising, where trends are being bucked, where your clients are behaving unexpectedly, and – as a real time measure of performance they can help you improve your service and profitability at the time of delivery, not a few weeks or months later. So start thinking about what it is that makes your practice successful, brings you in new clients and encourages your current clients to return and to refer friends and relatives to you? What makes you efficient and effective day to day so that you can deliver clinical excellence and encourage people to take up your services? How can you use your computers and other support systems to measure the ‘intangibles’ and start to manage these factors to deliver that excellence in customer service that makes you stand out from the competition? What numbers do our clients value? If we are not measuring these, we may be letting the most important people in our practice, our customers, down. To find out what our customers think we should be measuring, we need to ask them. Client surveys are helpful, and freehand comments from clients are vital for information gathering on attitudes. Just giving clients boxes to tick in answer to your questions will not give you the information you need, because it’s the answers you are not expecting that matter. Record complaints, niggles and offhand comments made to staff – these are the clues to help you understand what your clients are expecting. What do your clients value? Short waiting times, plenty of time with the vet, less time with the vet, clear pricing, explanations, accessibility, friendliness of staff, clean reception etc? Fail to monitor these as KPIs, and by the time you see the result of poor performance in your KRIs, it may be too late.
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To look at a few examples: Telephone Answering In our practice, almost every client will contact us by phone first.
• Do we make this easy for them? • Do we have sufficient incoming lines? • Are they answered promptly ? • Do we deal with the enquiry in the best possible way?
KPIs can include telephone call logging reports, such as the one illustrated here (Figure 1). These should be available from your line provider, or from your own telephone system. The cost is almost always worthwhile. From this report we can see numbers of engaged and lost calls, time to answer, what time of day performance drops and who was responsible at the time. We can ask the staff to set targets for call answering and can discuss with them reasons for falls in performance. By measuring these indicators, we can correct shortcomings in service as they happen, the staff involved can modify the way they work to improve performance and we can also make strategic decisions about staffing levels, scheduling and phone infrastructure.
Figure 1
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Fail to measure telephone access for your clients and you could be convinced that your performance is good, because all those engaged calls just phone the practice down the road instead of keep trying to contact you. Your Key Result Indiactors may not show you where the problem is occurring, and the chances are your clients won’t tell you if they’ve voted with their feet. Monitoring call handling performance can be more difficult. Sampling recorded calls, and listening in can be time consuming but very effective, particularly if standard forms are used and information on performance fed back to those involved, with suggestions for improvement. Identifying exceptional performers is useful and they can be used as trainers and quality control workers. Response to phone shoppers must be monitored and conversion rates recorded and reported. Again your exceptional phone shopper converters should coach and support their colleagues. Appointment scheduling and waiting times Occupancy can be measured by many practice computer systems, allowing decisions to be made about staff rescheduling, recruitment for peak times and expansion of consulting hours into more popular time slots for your client base. The result of customer surveys can help these deliberations. Day to day, however, are you looking at occupancy, opening up extra slots when they are needed, and reducing down time when surgeries are not fully booked? Does your system make it easy to see a snapshot of the day on the appointments diary and to even out appointments? Some systems can measure average waiting times per surgery, and per veterinary surgeon. Again, this information can be used to discuss with those involved how best to change systems or behaviour to maximise efficiency. Of course, keeping to time should not be valued in isolation, but compared with turnover per consultation session, return rate and client satisfaction level. It is possible to survey clients after consultations to assess whether they have had all their queries answered satisfactorily, and whether they were happy with the consultation. Your response to consistently high waiting times for scheduled appointments could be to retrain your staff to work more quickly, or to increase appointment times to maximise income per session. Our own client surveys show that clients value short waiting times, being seen the same day without fuss and not spending more than 20 minutes or so in the surgery (they are busy people). They also value being able to wait in a separate room if necessary, not feeling they are being sold unnecessary items or services, and being able to stay with their pet. Most importantly they want themselves and their pet treated with respect – and they really appreciate that we like their pet and treat it as a member of the family. Fail to measure your waiting time statistics, and your only input will be the few complaints you get from loyal clients and those who have had particularly long waits. The ones who just wait a bit too long each time, with no explanation will most likely silently walk elsewhere. Your KRIs will not indicate why they have gone.
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MILL HOUSE VETERINARY SURGERY Waiting room summary (Surgery 1) (CJC)
Recently seen: Veterinary:Pooc:1 seen by MW in p4pc owing 124.82 Staff, Mr:Ca:51762 seen by SZ in CR2 owing 149.32 Requires Action: CURL, Mrs S : 9889 See Nurse at 14:45 1 mins Prosser, Mrs : 8798 See Nurse at 14:46 0 mins Being seen: Byrne, Mrs JA : 47926 with SZ in CR2 In waiting room: Whitby, Mr : 4567 to see DDC for Booster Vacc at 14:43 3 mins Stevens, Mr J : 27316 to see SZ for Vomiting at 14:43 3 mins Sharpin, Mrs : 9876 to see SZ for Cut Pad at 14:44 2 mins Press any key to return to menu .
Figure 2 Hour to hour, a real-time screen snapshot of who is waiting, for how long, and who is being seen is a tool we use almost continually to ensure that waiting times are minimised and that urgent cases are seen quickly (fig 2). Vets tied up with difficult cases or distressed clients can then be assisted so that they do not build up a waiting log of clients, and if a wait is inevitable, we can explain what is happening to those involved. The screen is basic but accessible from anywhere in the practice, as is the reception area network camera. Any client waiting for more than 10 minutes appears in red type to alert staff that action is required. Client Satisfaction and Complaints In this area, concentrating on collecting the data is important as it often relies on active recording by your staff. We must beg for complaints – not the long letter that arrives on Monday morning after a great weekend away, but the little things that make clients go elsewhere just because they didn’t get the exceptional client service they have come to expect from your practice. Unless you ask, clients will often not tell you when your service has fallen short of expectation. So ask. We are extremely fortunate as a profession in that all our clients talk to us face to face every day. We mustn’t waste the opportunity of this contact with them to find out what makes them choose our practice, and what drives them to try a different one, or just not bother to seek our advice at all. Make it easy to record comments by having a simple to access area of the computer to write them in. Let the people involved know
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when someone makes even an offhand comment about your service – putting it right straight away is a very powerful practice builder. Longer term, categorise the comments into broad groups and review them at staff meetings regularly. Act on the comments, put systems and training right, and monitor progress. This is not a counting exercise; it is performance management on the hoof. We have run client surveys for over 10 years now, and the most value comes from freehand comments that we ask for. Of course the results are biased to the positive, but they make great reading after a bad day! Record all comments on a spreadsheet and circulate them regularly – they are very motivational, and often mention staff members by name. Celebrate this. You can score satisfaction rate, but it means little as a figure. Clinical Services In all the examples above, it is clear that whilst numbers are important, they are really the domain of the KRI, and the day-to-day service improvements and quality control functions will use a whole host of other more qualitative tools. Our IT systems are crucial to the success of this approach. Devising KPIs for your clinical care can be difficult – what matters to us as clinicians is not what matters to our clients and sometimes our patients. Clients will be interested in clear, simple explanations, and guidance with decision-making. Access to their pets whilst undergoing treatment – visiting the wards, seeing where their pet will be staying even just for the day is mentioned frequently in our surveys. Calling clients post-operatively to let them know how things are and also the following day for a progress report are very much valued by clients and performance can be easily monitored here. Delays and late collection can be a source of dissatisfaction and can be monitored. Post operative wound problems, other reactions and poor responses to treatment can be recorded automatically, producing reports showing percentage complication rates, and these can contribute to clinical audit. Client compliance can be monitored by recording actual versus expected medicine use, and by gathering data at recheck time. No-shows for appointments should be monitored, tracked and followed up. In all cases, it is vital to gather a mass of data first, before you can decide on targets to audit against. Benchmarking in this area is not widely available, but computer software companies should be addressing this issue, and making this data easy to record and retrieve. For veterinary surgeons and nurses, it would be helpful to be able to monitor clinical progress and performance rather than just concentrate on financial success, particularly if the behaviour encouraged by financial bonuses is not producing excellent client service nor building the practice in the long term. Chasing higher fee turnover at the expense of spending time training and mentoring junior staff, and helping with problem solving can be very damaging to a team. I have also spoken to several managers who have had issues with
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vets on personal performance related pay who alter records, and ‘claim’ others’ work as their own to maximise rewards. It is tempting to monitor and value the indictors we can measure easily, those that are already in place on our practice management computer systems, those that other vets measure, or that are frequently quoted in the veterinary press, used in benchmarking systems, or bandied about by commercial companies. We may be missing the point. The Key Performance Indicators we really should be measuring and valuing are those that are crucial to ongoing business success, and that we can use to improve our performance and results on a daily basis. They are the indicators that make a real difference to our clients and customers, but they are the essential building blocks for our KRIs and our bottom line. We can maintain or grow the bottom line by ensuring that we measure the things that matter, and have structured our charging policy to follow desired behaviours, not lead them. If we don’t listen to our customers when developing KPIs, we miss the opportunities to improve our service and profit. By developing our IT systems to help front line staff deliver the best possible care within our agreed parameters, we also free up management time for innovation, market research and strategic development. References: Parmenter, David, Key Performance Indicators, Developing, Implementing and Using Winning KPIs, John Wiley and Sons Inc, 2007 Clarke, DD and CJ, Practice Survey Results–Practice Reports to 2006, unpublished
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USING COMPUTERS FOR COMMUNICATION AND TRAINING IN YOUR PRACTICE
Dr Lindsay Hay BVSc, MVS, MACVSc, AIMM
Baulkham Hills Veterinary Hospital 332 Windsor Road
Baulkham Hills, NSW, 2153 Australia
Phone: +612 9639 6399
e-mail: [email protected] Web: www.baulkhamhillsvet.com.au
Computer based communications are an important part of modern veterinary practice management. Most practices have made a significant investment in computers for the operation of practice management software and it makes sense to gain as much value as possible from that investment. There are many ways of using a computer network to achieve better practice communication and this talk by no means presents all the options – hopefully it presents some examples and ideas to take back to your practice to help build a better training programme. I am sure there are some more computer savvy practices that are already doing all this in a very sophisticated way.
”The new source of power is not money in the hands of the few but information in the hands of many”
WW Rostow Why Should We Train? The benefits of staff training accrue at several levels. At an organisational level the benefits include:
Improved staff retention – staff loss has a very significant financial impact on any business and well trained staff tend to stay with a practice where they can feel appreciated and valued
Improved customer satisfaction outcomes Standardisation of service and treatment protocols as staff will be
taught to perform tasks in the same way Improved teamwork, better staff relationships and a happier workplace Higher productivity and profitability
At a personal level for individuals there are benefits as well:
Improved career paths Better financial rewards Higher self esteem Happier and more satisfying lifestyle
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Our animal patients also benefit by:
Increased client compliance Ability to effectively leverage support staff – this leaves veterinarians to
do what they do best – high quality veterinary science Client benefits – the entire team can make health care
recommendations We should therefore develop staff training programmes not only because it is good practice management but also because it is good for business, our patients, their carers and it is especially good for the people we work with every day. It should be seen as an investment in the future of the business as well as the individuals that work in the business.
“In the next decade and beyond, the ability to attract, develop, retain and deploy staff will be the single biggest determinant of a professional service firm’s competitive success.”
David Maister Generation Y Understanding what stimulates and motivates your staff, in particular those who are members of Generation Y (Gen Y) is an important place to start when planning your computer based communication and training processes. Gen Y is made up of those born from 1979 to 1996 and within the next decade they will make up 40% of the workforce and are already the majority of workers in many veterinary practices. They have been exposed to computers as part of their learning since their primary education and for them computer based communication and learning is as natural as breathing - just think about their daily communication styles based on SMS text and messenger systems. Increasingly our recruitment, retention and training processes will be directed towards this group and technology based training will be integral to these processes. Gen Y is the best-educated generation of all and obviously the most affected by technology. They don’t use books very much and have been taught with electronic teaching aids and computers since primary school. They are hungry to learn and expect to be trained and mentored. They are used to things happening now and to be immediately rewarded. Their parents and teachers have worked constantly to reinforce self-esteem and they have received enormous amounts of praise and encouragement. They were taught to make choices rather than be told what to do. Whilst it is easy to see all this as hard work for an employer, the reality is that if we do address these challenges in a positive way then we can increase staff satisfaction and efficiency as well as reduce staff turnover. This in turn leads to increasing practice profitability and a greater return on the investment in computers. We also have to realise that dealing with the needs of this generation is inevitable as older employees move to retirement.
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There is also a need to understand the different learning styles of your staff and adjust to their needs when planning training programmes and materials. The Computer Network Computer based practice management is very reliant on getting the appropriate technology in place at the beginning. Veterinarians are typically reluctant to make a large investment in a computer network but it is well worth getting it right from the beginning – the efficiencies that flow will repay the costs of the investment and maintenance. It is necessary to regard the expenditure as an investment and budget for maintenance and regular upgrades – it is simply a cost of doing business that we have to live with and leverage for our benefit. Some guidelines for the development of a practice computer network include:
Terminal server based networks seem much better than ones built on peer-to-peer platforms.
In most situations a network built on cable is more stable and reliable than a wireless one (although technological advances may change that in the future).
Internet access should be available from all stations. Ensure that there are sufficient stations to allow staff access at all
desks, treatment and phone stations. Choose a company to install and maintain the network that has a
history of success in network installation and maintenance – reference checks from other customers is essential. Stay away from family members as computer consultants in most situations even when it seems like a good idea!
Include a communication platform such as Microsoft Outlook to allow email communication with clients as well as with staff via a practice intranet.
Include a printer network that is capable of printing out documents when needed by staff or for distribution to clients.
Give all staff individual addresses on the network as well as having general contact addresses for the practice. Use the Internet for outside communication with laboratory results and specialist reports being loaded into medical records without transcription and its attendant risks of errors.
Some clients like to be able to communicate via email – give them the opportunity and answer in a timely fashion.
Train staff on basic computer knowledge so that they can use the system efficiently and maximise computer productivity.
Build a system of folders and establish guidelines to ensure accessibility and consistency and limit the ability of staff to alter documents.
Document protocols and procedures as they are developed and file them in the appropriate folders. All documents (within reason) must be filed in the system and not discarded.
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There are programmes available to improve searching of documents within the system.
Back up the ENTIRE SYSTEM every day internally and externally and take a copy off site – there are many ways of doing that via disc, tape or online web based services. Backup should be automatic rather than relying on human compliance.
To enhance communication with clients beyond email consider new technologies such as automated SMS from practice software (that will reduce phone time and missed appointments) and VOIP phones to reduce costs of calls.
“I think there is a world market for maybe five computers”
Thomas Watson Chairman IBM 1943
The Internet There are many who are concerned about giving staff access to the internet in an open and uncontrolled way. The value and power of having easy access to the internet far outweighs the possibility of misuse as long as proper guidelines are established. The rules should be clear, documented and specific to control unnecessary personal use during work hours and to prevent the problems associated with the downloading and/or distribution of unwelcome or unpleasant material. Controlling the programmes on the desktop is important and in particular try to avoid the personal messaging systems that are widely used by many for personal communication and “chatting”. An automatically upgraded (at least daily) anti virus programme is absolutely essential to protect the server and all workstations. It is good for all staff to have a personal practice email address to communicate internally and with the outside world. This means that all staff can be reached individually or as a group by using the practice intranet. It also means that staff has their own desktop that is private and available for them to work and study on with no risk of losing their notes and assignments. One value of internet access is to identify valuable and properly refereed sites to provide information internally and to clients. These sites can be easily collected on a Favourites list or as shortcuts directly from the desktop. Young veterinarians in particular are adept at identifying useful web based information sources as they have used them during their studies such as VIN, VEIN, Google Scholar and many others. The Desktop The desktop should have some files and icons common to all addresses and some personal and therefore individual ones. Apart from desktop links to useful information based sites there should also be links to commonly used service sites such as microchip databases, wholesale suppliers and also legal compliance ones such as Veterinary Boards, Awards and OHS (WorkCover) sites. It is best to have control of what appears on the desktop. There are a
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number of commercial desktop (or “Dashboard”) solutions to address many of the needs in this area of practice management. The “Company Folder” is a way of storing all the policy and procedure documents generated within a practice in a useful and accessible form. It can be done in one of several ways:
As an independent, customised series of folders and subfolders with documents added appropriately by the practice.
As a series of documents within the practice management software programme.
As part of a commercial document handling system purchased “off the shelf” with procedures and templates already in place.
We use our company folder like an electronic employee handbook. The information is stored in multiple folders in a hopefully logical way including:
General staff information – uniforms, appearance leave and the like. Reception policies and procedures such as phone answering scripts,
FAQs. Nursing procedures. Veterinary treatments and procedures. Staff rosters. Contact lists for staff, specialists and suppliers and who to contact for
repairs and maintenance of both veterinary and general areas. Client handouts. Chemotherapy protocols. Minutes of staff meetings - document and publish meeting minutes and
send to all staff as well as on the general folder. OHS policies. Forms for leave applications, credit applications and other activities. Polices for dealing with customer service matters such as training
schools and useful products and services. Training information and interns folders.
An Electronic Library There are enormous resources available in an electronic form. Many national and international conferences distribute their proceedings as a CD ROM and there are a number of information sources also distributed as electronic texts. Drug companies also provide a great deal of electronic information both CD and web based – use it rather than sit it on a shelf. It needs to be remembered that our younger staff may be more comfortable with electronic and web based information even if we have a book on the shelf that provides what is needed. The important thing is to create a culture that welcomes and exploits the strength of technology rather than neglects or rejects it. If a practice leader is not keen to develop computer literacy then they should identify an IT champion within the practice and delegate the responsibility.
“The information highway will transform our culture as dramatically as the Gutenberg Press did in the Middle Ages”
Bill Gates
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HOW TO SET UP FAIR FEES?
Dr Yannick Poubanne DVM, MSc, PhD
Chemin de Bellegarde 31380 Azas
France
Phone: +33 608 818 893 e-mail: [email protected]
Pricing is vital to your practice. A small change in pricing can lead to a big change in practice. Different methodologies exist to set up fees which are fair not only for the clients but also for the practice. The aim of this article is to present all of them after having reviewed the possible objectives of a pricing strategy. 1. Possible objectives in price setting Price setting is a very delicate exercise that can have at least six different objectives. The first objective is usually to increase client traffic. By cutting prices, a practitioner hopes to increase or to maintain a certain level of client visits and by increasing prices he expects a decrease in the number of transactions. The following curve illustrates this concept.
price
n° of
buyers
The second objective can be sales increase. Actually, sales can be expected to increase according to the prices increase. But they sometimes don’t, because when price increase the number of transactions drops and if the drop is too heavy, it can more than compensate a price increase so that the sales also drop! In the following graph, the surface of rectangle 1 represents the
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sales (number of buyers times selling price) at price P1 and rectangle 2 is sales at price P2. The driver is obviously the design of the curve.
price
n° of
buyers
1
2
P1 P2 The third objective can be to increase the margin. In that case, the variable costs of the goods must be included in the equation. If the percentage of margin is constant whatever the selling price is, the margin will be maximised at the price that also maximises the sales. But if the percentage of margin depends on the volume of sales, the margin maximising selling price is different from the sales optimising price. The fourth objective can be to increase the profit of the business centre. In that case the fixed costs of the goods must be included in addition to the variable ones. The profit maximising selling price will then be different from the three previous ones. Surprisingly, it is rarely the cheapest price that maximises the bottom line profit. A fifth objective can also be to influence consumers’ perceptions in order to maintain or to build a product image. For instance, a super premium consultation fee will communicate to the clients that the practice might be of high quality and a cheaper level of fee will communicate the opposite. In all cases, it is important to also consider this aspect of pricing in order to control the positioning of a practice consistently with its philosophy. Last but certainly not least; a sixth objective can be to acquire market shares by maintaining the lowest level of price in a giving market. This is a classical strategy when of new company want to penetrate a market or when an existing one wants to acquire a leadership position. 2. Pricing methodologies 2.1. Pricing through “Cost + profit” This is the method spontaneously quoted by a scientific person when asked to calculate a selling price. It takes the costing of the product and adds a “reasonable” profit to define the selling price.
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Doing so, one feels that they will set an objective and fair price. But it is true? To answer this question, let’s consider the three following points. First, a “reasonable” profit cannot be objective. It is fully subjective. Second, anybody who has one day worked on costing knows that any method relies on a set of conventions. So costing is also subjective. Third, this “cost plus profit” method calculates a price that is higher where you are bad than when you are good. Actually, the price of a surgery will be higher when you need two hours to perform it than when you need just one hour. Is it fair? Certainly not! So, let’s have a look at another technique: the “competition” approach. 2.2. Pricing through “Through competition” This method consists in surveying competitive prices in order to make your decision. Depending on your practice philosophy, you can then position your pricing as premium, similar or cheaper than competition. This method is applicable for product and service pricing, provided they are easily comparable with those of your competitor. This is the case for drugs, pet-food and basic services. But this method is still less appropriated for services you can hardly compare to competitors ones. Another method will fill the gap: the “client value” approach. 2.3. Pricing through “Client’s perceived value” This method is also called the “psychological pricing” method. It assumes that a product or a service has got a perceived value in a client’s mind. This value has nothing to do with the costing of the product/service. It has to do with the benefits delivered to the client according to his needs, expectations and means. This “client value” price is actually based on the utility for the client of the product/service. The pricing through “client’s value” needs you to use a client questionnaire describing the service and asking clients the two key questions:
- “What is the maximum price over which you won’t buy the service considering it is too expensive for you?”
- “What is the minimum price under which you won’t buy the service considering it cannot be of sufficient quality?”
For each given price you then get a number of purchasers.
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If we put: P = price; N = n° of buyers; B = profit; V = unit variable costs; F = fixed costs
At first, we can say that:
N = a.P + c (a<0)
and
B = N.(P-V) – F Consequently:
B = a.P2 + (c - a.V).P – V.c – F
The profit B is maximised when:
dB/dP = 0
that is to say when:
P = (a.V – c)/2.a It says that there exists a price based on client perception that maximises the profit. This is the psychological price of the “client’s value” pricing. The beauty of this method is that it takes into account the needs not only of the practice (like in the “cost plus profit” method) but also the value of the service to the clients. 3. Price reviews When should a vet consider reviewing his prices? To answer this question, two constraints must be taken into account. The first one is annual inflation rate and the second one is the Weber’s law. Annual inflation rate depends on each country but must always impose a higher rate of price increase. Otherwise the practice would year after year loses its power of buying and consequently its capacities to finance resources to maintain and develop the necessary level of service quality to satisfy clients. At a result of that, the annual pricing change should be at least the level of the local inflation rate. Weber’s law tells marketers that consumers are more sensitive to relative price changes than to absolute price changes. For instance a consumer will perceive a 10€ price increase as important if the initial price was 50€, but as not important if the initial price was 500€. Relative changes more influence consumer behaviour than absolutes changes. As a result of that, frequent small price changes are better perceived than irregular large price changes.
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Consequently, the following price review strategy can be recommended to veterinarians in their practice:
• For services, a minimum price increase of the level of the inflation rate must be implemented each year at the same anniversary date. It is also interesting to split this annual price increase in two part: one in January on one category of services and one in July on another category of services;
• For products, the practice selling price changes could simply reflect the buying price changes and so, the manufacturers recommended selling prices. This will work on preventing a price war between the different practices or outlets of the surroundings.
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Notes
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Notes
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MOBILISING VETERINARY PRACTICE PROCESSES
Dr Alastair Stott, BVSc, MBA (Melb)
Schmik Solutions Pty Ltd 757 Bourke Street
Docklands, Victoria, 3008 Australia
Phone: 1800 724 645 (1800 SCHMIK)
e-mail: [email protected] Web: www.schmik.com.au
1. Introduction – Why Handheld Technology Now? There are a number of technology and social trends that are creating opportunities for veterinary practices to utilise mobile and handheld technologies to improve practice performance. The opportunities are greater for large animal practices but small animal practices should look at the potential benefits from mobile and handheld technologies. House calls, after-hours work, branch practices and personal productivity can benefit from improved use of handheld technology. Technology and Social Trends: Increasing handheld device functionality and convergence. Over the past
two years, we have seen a flood of new devices that offer the functionality that used to be only available in a number of separate devices. This functionality includes organiser (diary, contacts, tasks, notes), phone, GPS, Dictaphone, camera, MP3 player, email and internet access. Manufacturers are “slicing and dicing” functionality for different user groups.
Increasingly easy access to applications – handheld devices offer instant
access and in-the-pocket portability. Increasing connectivity speed for handheld devices for accessing the
internet and emails. The latest high speed 3G and 3.5G mobile networks (such as the new Next GTM Telstra network and office WiFi networks and “hot spots”) offer download speeds that are up to 10 times faster than older networks with the promise of significant further increases in speed. They also enable web-based applications to be accessed from handheld devices rather than having to operate on the device (with limited processing power and memory). The geographical coverage of these networks is also rapidly improving.
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The improving reliability and security of handheld technology. It is becoming easier to install and maintain the latest handheld technology (although there are still problems when you try to mix & match technologies from different suppliers). Device management applications now enable remote management of handheld devices including the wiping of lost/stolen devices. A rugged handheld device for Veterinary Surgeons may a better alternative to expensive, fragile laptops that take time to access.
The falling costs of handheld devices (such as SmartPhones and PDAs)
and mobile voice and data plans for handheld devices. Some new technologies and services are significantly cheaper than existing technologies. For example:
A laptop with a mobile broadband card may be less expensive
than having multiple PCs and fixed-line broadband connections if you need to access your emails and the internet from home and “on-the-road” as well as at the office.
Lower voice and data plans are available (see below). Mobile
phone Cap Plans are significantly cheaper than heavily promoted and bundled Business Plans – practices can decrease mobile plan costs by up to 70%. Newer Data packs are significantly cheaper than default casual data plans.
Improved design and reduced costs of developing handheld applications
(see below). These can automate current paper-based processes. Issues with multiple operating systems and expensive handheld license fees can be avoided by buying or developing web-based handheld applications that can also be accessed from any laptop, PC or MAC. Handheld application designers are recognising the limitations of the small screens and the importance of understanding the users work flow. Examples of handheld applications now being used include Medical Specialist billing and adverse event reporting (see below), CRM, Asset tracking, Order taking and tracking, Customer billing, Expenses and Onsite audits.
Increasing expectation that individuals can always access information from
anywhere at anytime Greater mobility of professionals and patients/customers What can handheld technology do for your Veterinary Practice?
Handheld technology has the potential to improve veterinary practice performance and personal productivity. If it is well implemented, it can: Provide remote access to client details and patient histories. Improve access to important knowledge banks such as drug
databases.
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Improve personal productivity by providing from anywhere access to contact lists, diaries, task lists, emails and the internet.
Streamline current manual processes – eliminating manual forms and reducing back office processing costs.
Improve cash flow – getting invoices completed more accurately and paid more quickly.
Improve customer service – from improved responsiveness.
Tips to ensure you maximise the gain and
minimise the pain from handheld technology:
1. Initially identify where there is a clear business benefit from having staff using handheld technology. Avoid technology for technology sake!
2. Select the best technologies and vendors to achieve these requirements and deliver the identified benefits.
3. Avoid vendors who sell products not solutions. 4. Do not assume that handheld applications you download will work well for
you. Trial first if possible. 5. If you are using 3G connectivity for your Smart phone or laptop, check
your Telco’s geographical coverage for the areas you want to use it in before your sign up.
6. Ensure that the components you select work well together – there are still many interoperability issues with handheld technologies.
7. Avoid being on the “bleeding edge” of technology unless you are prepared to spend considerable time problem solving.
2. Identifying small animal practice processes that can be “enabled” by mobile technology Examples of Veterinary practice processes that can be mobile technology enabled: Processes Handheld technology enabling solution
1. After-hours answering
phones Remote access to registration, patient history and appointment/ theatre schedules
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2. House calls GPS navigation, remote access client registration and recording treatment plans and billing information (via 3G enabled smart phones with web-based applications that interface with your practice applications)
3. Prescribing drugs Remote access to Drug databases and handheld script writing
4. Managing kennels/ catteries
Recording patient observations and updating treatment plans on handheld devices
5. Remotely Creating Client Invoices
From anywhere using applications developed specifically for handheld devices that interface with your practice based invoicing applications (via 3G or WiFi)
3. Recognising what handheld applications can benefit veterinary practices Applications for handheld devices include:
a. Productivity-improving business applications Mobile email, diary, contacts and Dictaphone applications that enable recordings to be emailed from the device can improve personal productivity. The diary and contact synchronisation applications have reached a maturity that ensures reliability. Remote synchronisation is now available.
b. Handheld versions of enterprise applications (such as Patient Information Management Systems) Rapid application development tools enable businesses to easily create mobile versions of existing network and web-based applications. Applications for handheld devices can run on the handheld device or can be web-based if the device has internet connection. Web-based applications are easier and cheaper to develop and upgrade. They are also operating system “agnostic” and allow access from desktops and laptops with internet access. Schmik has developed web-based billing and adverse event reporting applications for Medical Specialists. These enable Medical Specialists to quickly and securely record billing, adverse event and case log data from any handheld, laptop or
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desktop with internet access. These applications can interface with practice or hospital based applications.
c. Specialist reference applications
There are a limited number of reference applications available to Veterinary Surgeons compared to those available to our medical colleagues. Merck Handbook of Veterinary Drugs Dosage Calculators
d. Billing and expense applications that can eliminate the need for forms and manual back-office processing.
4. Selecting the right handheld devices Handheld devices include smart phones, personal digital assistants (PDAs), ultra-mobile PCs (UMPCs) and laptops/tablets.
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a) Smart phones and personal digital assistants (PDAs) Smart phones are increasingly popular because they provide mobile phone, email and organiser functions in one pocket-sized device. They also have the potential to provide real-time, from-anywhere access to practice information systems and specialist reference databases. Smart phones and PDAs are easier to carry than laptops, and quicker to access. The latest 3G mobile networks provide high-speed broadband access to the internet and emails. Major disadvantages are limited screen size and processing power. The 3G Smartphones can be used as high-speed broadband modems for your laptop although the data costs are higher than ADSL or cable broadband.
Leading examples of Smart phones available in Australia include Palm Treo 750, Imate Jasjam, Samsung Blackjack, Blackberry, Sony Ericsson w950i and Atom Flame. The much hyped Apple iPhone (right) will be available in Australia in 2008.
The popularity of PDAs is declining as the sales of the “converged” smart phones take off. These relatively inexpensive devices are organisers with the ability to run applications. Some users prefer to have separate and dedicated organisers (that synchronise with their desktop/PC Outlook) and mobile phones. This does require emails to be accessed on the PDA using the phone as a modem, and results in contacts being held
in held in two locations.
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Tips on Smart phones:
Select your handheld device by prioritising your functionality needs and
budget. Make sure you evaluate the handset offers available from retailers
including Telcos but do not get sucked into costly business plans just to receive subsidised devices (see below)
The best all-round Smartphone at present is the Palm Treo 750. It has
high-speed internet access, a touch screen and fixed keyboard but no WiFi.
The coolest device will undoubtedly be the iPhone but it does not have 3G
connectivity which will be a major negative for a lot of users The best “push email” devices are the Blackberries but they lack touch
screens and have fewer applications available for their operating system. b) Ultra-mobile PCs (UMPCs)
These little tablet-like devices weigh less than a kilogram and have a 7” touch screen that can be difficult to see outside or at an angle. Battery life is a reported 2.5 hours and they lack the “grunt” of laptops or PCs but can do far more than a PDA or smart phone. At around $1400 they will be an attractive option for some mobile workers.
c) Laptops Mobile broadband (see below) and falling prices are increasing the potential attractiveness of laptops for mobile workers who want full-screen access to documents, network applications and the internet when they are out of the office.
A recent innovation has been the Palm Treo Foleo (left) which looks like a laptop but replicates the functionality of the smart phone. It lacks the memory and processing power of a laptop but is significantly cheaper.
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5. Reducing your practice mobile voice and data costs With the increasing complexity of mobile phone plans offered by carriers in Australia, many small businesses are paying significantly more than they need to for essential mobile communication. Mobile Voice There are more than 250 voice plans (as well as fleet plans) for mobiles and smart phones from the carriers in Australia that use a range of network technologies. Each plan has differing rates, credits, discounts and bonuses for voice calls. There are capped plans, cheap intra-fleet calls, cheap intra-network calls, differing rates for different times of the day and bundled deals. Each carrier also has different data rates for accessing emails and the internet. You also need to consider national and international (roaming) rates and geographical coverage and costs when selecting voice and data plans. This makes it extremely difficult for veterinary practice owners to do anything but accept the advice of the phone plan vendor. Unfortunately, it has also made it difficult for the phone plan vendor to understand how to minimise costs for veterinary practice clients. In addition, the mobile phone plan industry has not yet taken on the accountability and transparency that financial advisors and mortgage loan lenders have belatedly embraced. Upfront and trailing commissions (that provide financial incentives for the resellers and dealers if you spend more) are not declared. Net rates, with all the confusing bonuses, discounts and credits stripped out that would enable meaningful comparisons between different offers, are not included in promotional materials or in bills. Mobile Data Data connectivity is required to access the internet, emails and corporate network applications, and on mobile devices such as smart phones and laptops. Data plans are attached to your voice plan. Some providers have limited and very expensive casual-use-only data plans, so be careful when selecting voice providers. For handheld data, there is now a choice between the slower second-generation (2.5G) and the faster third-generation (3G) networks. Telstra claims that there Next G network has a geographical coverage 100 times the coverage of any other 3G network.
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Pricing varies significantly between plans and carriers, so determine your usage and shop around. Mobile Broadband There are increasing lower-cost mobile broadband options for laptops that provide broadband speed for internet access.
Alternatively, you can use your 3G mobile phone as a modem but watch the data costs. Mobile broadband can provide significant business benefits for mobile Veterinary Surgeons either alongside handheld devices or on handheld devices. Many applications are better accessed via a full screen laptop, such as PowerPoint, and applications with significant graphics. All four telcos and two specialist service providers (IBurst and Unwired) provide mobile broadband services that vary in geographical coverage, service, features and underlying technology. Mobile broadband costs start at about $29/month.
Tips on Picking the Right Voice and Data Plans for Your Practice:
1. Analyse and understand your usage – all offers will be usage based so
you will need usage to determine likely cost. 2. When analysing your usage and negotiating with the telcos, focus on the
rates of the services that contribute mostly to your bill. 3. Avoid Member and business type plans – even with intra-fleet calls and
credits, you will pay more compared to well selected cap plans. 4. Avoid bundles – the benefits rarely outweigh the high rates you pay for
individual components. 5. Review bills regularly for billing errors and for individual usage (abuse). 6. Consider geographical coverage of the different networks. Coverage
does vary between so test the coverage where you want to be able to use the phone with a borrowed SIM card before you sign any contracts.
7. If you are not confident on determining the best plan, engage an
independent advisor, such as Schmik, to assist in determining the best plan for your usage.
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Glossary - Demystifying the jargon
Handheld applications – software that either run on the handheld device or are accessible on the handheld device via the internet. SmartPhone – a mobile phone that has a diary, address book, task list and email that can be synchronised with your PC or MAC. It can also run applications and access the internet. PDAs = Personal Digital Assistants – personal organisers with diary, address book, task list and email that can be synchronised with your PC or MAC. It can also run applications. 3G mobile network = 3rd generation mobile phone network – enables users to download content more quickly (music, web pages, emails) Mobile (wireless) broadband card – enables laptops and PCs to access the Internet and emails from anywhere within the mobile phone or WiFi network Blackberry – an email service that “pushes” your emails out to your handheld device. WiFi networks and “hotspots” – local wireless networks in offices, cafes, airports, hotels and offices that enable users to access their network and the internet (if connected).
Schmik (www.schmik.com.au) is a boutique Australian consultancy providing advice to small business, corporations and individuals on handheld technology.
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Notes
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IT’S ALL TOO MUCH - I JUST NEED TO MARKET!!
Doug Fletcher
General Manager RxWorks 17 Bowen Bridge Road
Bowen Hills, Queensland, 4006 Australia
Phone: +617 3635 8640
e-mail: [email protected] Web: www.rxworks.com
This is a day centred on technology, and the use of technology within a veterinary practice. So, why a session on marketing? And does marketing tie in with technology usage within the modern veterinary practice? As you will see there are very good reason to have a session on marketing. You will also find that technology plays a very real and useful role in effective practice marketing, and because of this, references to technology will be made several times throughout this session. In my very humble experience, when people discuss marketing, what they tend to be discussing is the sending of reminders and/or the use of a website, or SMS or similar. This is all part of marketing but only a very small part of it. Lets break marketing down into three ‘P’s” – which may be different ‘P’s’ to what others may talk about. Let’s discuss these in some depth, look at how technology helps with these, and try and give guidance and useful ways for you to make use of the information back at your own practice, regardless of where that might be.
The three ‘P’s’ are: Positioning Price Perception
Positioning Some understanding: Marketing is a very different discipline to surgery, but yet the two tie together through communication. Therefore, whether the doctor likes it or not, even surgery has a role in marketing. And of course, technology has a definite role in surgery, and by default this technology also has a role in marketing.
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So, assuming the practice has some methodology in sharing what is happening with the surgery, then obviously this has to be communicated, and that communication is part of the practice marketing. More on how to do it later. For now, simply understand that most, if not all, of what you do within a veterinary practice everyday has some tie to marketing. And everything you do everyday has everything to do with positioning your business – hopefully where you want it! The other key point that needs mentioning is marketing is a different discipline to selling, but these two disciplines cannot be separated. So, for those people who own or work in veterinary practices and state they do not get involved in selling, this is not possible. The reason is every time you communicate to your clients, through email, mail, SMS, phone or face-to-face, you are selling in one form or another – just probably don’t realise it. So marketing, designed to bring a client into a practice or keep them within the practice (bonding), can only go so far and from that point on selling must take over. Selling does not need technology. It needs good communication skills. Sometimes selling uses technology to help drive a sales process, which in many cases can dovetail with a marketing process, whereas marketing needs technology to help position your practice where you want it Communication is the common point between the four disciplines mentioned above. It is communication that helps people understand information about surgery: it is communication that brings people into the business and/or helps keep them there: it is communication that is at the forefront of selling. And communication is very important to your practice positioning, which starts with marketing. So, what are some of the things covered in marketing and where does technology come to the fore? And how does this Position the practice and what does Positioning mean? Let’s start at what the customer sees:
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In this hotel example, based on what can be seen from the outside of the building, a customer – or prospect if they have not purchased from you even – will make a decision on the level of service available simply by what they see – a visual assessment. This is a very basic approach to marketing. Try and decide based on these four photos (first one on previous page) what service is given and which one suits you.
Here is the first level in Positioning – what you as the customer – thinks the market position these four motels fit into. Write down your answer beside the photo so you can easily recall your thoughts. At the end of the notes are the Star classes for these hotels – try and guess them right first!!
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Now, let’s take this basic approach and relate it to veterinary practices What do these say to you?
These are all veterinary practices and by their very appearance will create a starting position in the marketplace No technology yet – but you will see how this ties together soon. While we are in the basics – what about how the staff are dressed? Look at these two options within a practice – what do you assume based on dress?
By now you should understand some of the basics of marketing and how it helps with positioning. So, lets delve a bit deeper and see how technology can assist you to position your practice where you want it to be positioned. Here is a question – where do you want to be positioned?
Do you want to be seen as a high level, high priced practice? Or a high level middle priced practice? Or a middle level high priced practice? Or a middle level middle priced practice? Or a low level low priced practice?
Note – you cannot be a middle or high level low priced practice simply because the economics won’t work!! The answer to this is important because it is the answer to these questions that you will use to develop your marketing.
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It is all to do with congruency. If, for example, you have a very interactive and customer friendly website which gets the prospect all excited about coming to you, and when they walk in the door the delivery team is bickering, the building does not match the promise of the website – you have blown it. Even without the bickering of the team you have blown it – simply because the promise made by technology has not been kept with the physical infrastructure. Therefore it is important to keep congruency – everything needs to interlink like a jigsaw to give a final picture that reads right. Even the phone strategy fits in here. A telephone is an old piece of technology – yes there are some new ones out now - but essentially the phone allows you to communicate with your prospect and customer. So, have a fantastic website, and a lousy phone manner – and you don’t have congruency. Here are some tools that you can use to help position your practice where you need it – from a technology viewpoint Telephone
Buy the best you can afford and use it to its fullest value. Be prepared to upgrade when you need something better. And as with all technology – the success rest with how it is used. Poorly answered telephones will ensure the best of systems fail to give a decent return on investment!! Computer technology
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This is one where you should not simply purchase the cheapest. Technology is one of the three key legs (good medicine, good delivery team, good technology) a veterinary practice stands on and shortcutting here will cost you over time. Also remember, some practice management programmes are designed to operate within set environments so your vendor may insist on specific technology here. Therefore check with your vendor BEFORE purchasing computers. Website
Websites are becoming more important as the days go by. Think through what it is you want a website to do for your business, and is the website you are finally intending to use developing your business or some other companies positioning. This is what we at RxWorks want a website to do:
Provide knowledge on our products and services to both customers and prospects
Allow users to easily choose what information they need and provide searching capabilities for that
Be a learning tool for customers and their staff Assist users to understand the flow of the products and help them in
the use of screens Give a central place for new product and service information Allow the raising of web based support cases direct from the practice
management programme
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Give customers visibility of the progress of their support cases at any time 24/7
Supply a user wide, if not an industry wide, community site where all sorts of good things happen – users help develop a practice management handbook, place job ads, look up resumes, even list practices for sale!
Be a good resource for the veterinary and business press Friendly and easy to access and use information that assists in
creating a stronger business based on improved healthcare and practice profits
Think through what you need before committing to a website and make sure it is yours and not another companies business you are growing from the website Invoices
Why use it just for communicating pricing? Why not for marketing communication as well that will help further bond the customer and bring repeat business back to you? Make sure you logo and details are on it. Remember the comments on communication earlier in the session???
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Reminders
And don’t stop at one! Remember your client is time poor and will often forget – and not deliberately. So have more than one. Make sure your article, whatever it is, remains congruent with the practice – don’t be like the example earlier of a great web site and a poor building. Here is one specifically for fleas – don’t be afraid to develop as many as you need!!
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Patient Report Cards
One of the best ‘on the fridge’ marketing tools you can have! Straight from your practice management software and to your client’s kitchen, where all the visitors will see it and no doubt ask about it! Not free, but not too far from it!! SMS Phone Messages
Now becoming an accepted way to communicate with your customers and an exceptional marketing tool if used correctly. SMS messages need to be able to be sent direct from your practice management software. Beware of the security surrounding some SMS providers – there have been instances where the security of the message and phone number has been breached. (Our company, RxWorks, hardwires SMS messages for exactly this reason)
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Practice Management System
Well, yes – the screen is from the RxWorks programme; what do you expect from the company GM?? This is probably the most important piece of technology you can have in your practice today and one that should drive your marketing communication. Today’s modern veterinary practice needs more than just a place to capture data, which is all some veterinary software does – it needs to be a key communication platform along with ability to bring the delivery team together, and be used to help deliver higher levels of healthcare and drive practice profits. These are the two key things to look for when you are considering a software upgrade Here is a key question – Have we now reached the point of a full holistic marketing approach?
The answer – No we haven’t… Then, if we haven’t reached a holistic point in our marketing – Have we reached the point where our positioning is correct?
The answer – maybe, with the above all working together The key point as mentioned with all this is to have everything working together and allowing the practice to position to the buying public the ‘position’ they want in the marketplace.
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Remember as the practice owner you set the position you want, both by the physical looks of the practice, cleanliness, team, medicine, technology used and so on. If this has happened, then the other two ‘P’s’ will dovetail in well. The key specifics needed to get this all together are:
A clear understanding of what the practice offers and at what level Efficient technology to allow the practice to market at all levels to the
customer Ease of communication both to the customer and for the customer to
use Full congruency across all marketing messages
Which brings us to the second “P” - Price
In my role in the industry a lot of interaction happens with many veterinary practices. Most have no idea that price is a key marketing tool and most are too afraid to charge what they should. Yet if the practice is positioned correctly then your customer will be willing to pay your price. The fear of price is more ‘in the person’s head’ at the practice than it is in the lack of money in the customer’s pocket. This is especially true for a lot of veterinarians and in many cases a number of team members. Generally the best person to make sure pricing is somewhat near correct is the practice manager where they are held responsible for the practice cash flow and profitability. I remember a lesson learnt some years back from a consulting business owned by my wife and I. We did a lot of work for the optometry industry and one of the early improvements made was raise the price in most cases by 15%. Not one complaint from a customer – but plenty from the owners and staff who thought they knew their market better than we did. Interestingly they changed their minds when the saw the results. Sometimes you only need to be game enough to do it!! If you have a practice manager in this role – get out of their way and let them loose!!
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Answer this question – which of these two motels would you expect to pay a higher price for the services on offer?
Knowing what you now know about positioning – how would you feel if the motel you believe should be the cheapest charged considerably higher than both its promise and its service? Would that price be congruent? And would you recommend it to others? Which then begs the question – why do veterinary practices that do a good job of all the points mentioned above still charge too low for what they offer – in fact lose money on some services? (And conversely – why do some practices that do not do well on the points above charge too high for the positioning and lose customers?) And Why Do You Do It? These are points worth thinking about, because price is one of the strongest marketing tools you have. The bottom line is anything good is worth paying for and we should never be afraid to charge good money for good healthcare and service. Here are some vehicle examples….
Simply by looking at this vehicle People willingly pay more you know it will be cheaper than $100,000 for some of than others on the market. this marque. Would you pay $100,000.00 for this?
Sometimes these are better value, dollar for dollar yet the price will never be as high – why?
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Part of the answer is to do with perception, which we will come to shortly, but a whole lot of the answer is to do with what both the seller and the buyer (you and your customer) believe is value. Value is a judgement statement – different people see different value at times. Your value statement is wrapped up in your positioning and your price. High price needs to equal high value. Low price needs to equal low value. So if you believe you offer a high value experience (make sure you do) why then are you offering low prices – sometimes at a loss – for your services? Note services – not products. We all understand you may need to meet a competitive market for a product price, but you never need to meet a competitive market for your services. So, can technology help with the price you charge? Absolutely Your price should be made up of the following:
The total billable professional time The items you have purchased to resell The allocation of all expenses of running the practice to the
professional time and to the cost of any product that is purchased for resale
Consider the true cost of a surgery: The true cost is made of building blocks that would look quite unusual if they were listed as charges. The components of a surgery could be:
Veterinarian time for anesthesia Nurse time for anesthesia Veterinarian time for surgery Nurse time for surgery Billable materials such as medications Consumables Allocation for equipment costs Allocation for overheads Return on investment to practice owners
Now, to do this right, you are going to need technology, and the good news is you can use your practice management technology to assist you, dependent on what the programme is designed to do. .
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These are samples from the RxWorks Performance Pack and are examples of how technology is used for pricing. These examples and a number of other tools used together help you decide a fair price to charge – both for you as the practice owner and for your customer.
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Real Time Healthcare Reminders
Live in every area of the practice to ensure the health plan set by the doctor is complied with. Plus, by ensuring these are dealt with when the patient is getting attention, client compliance is raised, healthcare is increased and profits are improved. This s a good example of technology being used in a very positive way allowing all parties involved to gain:
The patient with better health The client with a healthier animal The doctor who see his/her recommendations being Adhered to The delivery team who want to provide good healthcare
There are a couple of key points to remember:
A price too high when compared with what you offer in the main practice positioning will be seen as incongruent and therefore rejected
A price too low when compared with what you offer in the main practice positioning will be questioned and also seen as incongruent. It may be accepted causing loss of income for the practice
A price too low for both sustainability and profit will be detrimental to the survival and long-term health of the business and will ensure you don’t need congruency – because the business will not be operating
Technology is crucial in setting prices if you intend to get your prices right.
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Price is not just a way for you to be paid for what you offer, but is also the main marketing tool you have; therefore taking the time to get it right is important from all angles If price meets you’re positioning, you then have a holistic marketing package you can use in your marketplace to both differentiate your business against your competitors, and have a strong base to build the third ‘P’ – Perception Perception Perception is important in marketing because it is your FREE marketing tool. Perception is what your customer thinks about you. Perception is very rarely built on reality – more it is an emotional response. Think about the number of times you have not liked a company for no logical reason – probably didn’t like something someone did!
Perception is the basis for your ‘WOM’ – Word of Mouth advertising. WOM advertising is free, but it does come with a sting in its tail if both your pricing and your positioning are not perceived to be together.
Where your positioning and price are congruent in the eyes of the customer, you will have free POSITIVE WOM
Where your positioning and price and NOT congruent in the eyes of
your customer you will free NEGATIVE WOM Makes all this worthwhile somehow doesn’t it? What is in your control:
All the aspects of positioning - that is the combination of the medicine provided, how the team works together, technology usage and price, communication, marketing messages and acceptance by the customer
What is not in your control:
The customer’s final thought pattern – however you do have the option to influence this, positively or negatively, dependent on the choices you make
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Question for you to answer: What perception do you want in your marketplace for your practice and are you doing everything in your power to make it happen? An exercise for the practice A worthwhile exercise to conduct is to ask your practice team what perception they think the clients have of your practice. Work this up in a workshop and write down the answers for everyone to see Then run some community surveys and see what perception your clients and your non-clients have of your practice. You may need to have a third party to do this to ensure the results are not based. Bring the team together and compare notes from the two exercises. This will let you know if you are correct in your belief or if there is some work to do Action Steps: Often at the end of a session like this the question gets asked – How do I do this? It is a good question To remain holistic, you cannot move your positioning upwards if you don’t move your price upwards to suit, not can you move your price upwards if you don’t move your positioning upwards to suit. To be cost effective you must have good practice management software in place along with the other technology. You may also choose to have various machines such as x-rays, haematology, chemistry analysers and so on. Again, keep everything congruent. For example, it would be senseless to create a strong web presence if you do not have the capability to manage the increased response, assuming a strong response from your money and effort invested, nor the ability to provide the level of healthcare promised by the web site itself. Remember these three points are the three legs your business is built on
GOOD MEDICINE GREAT TEAM EXCELLENT TECHNOLOGY
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These should be right before moving to the next number of steps. Along with the very basics of positioning - how the business presents, how the practice smells, how you and your team dress and act, these need to be worked on in depth. Therefore make sure these are in place first. Is there a set pattern to follow? Probably not. The strategy should be to move as many things upwards at the same time as you can. It would be worth using Lean Six Sigma strategies in this; here you work on the areas that give the ‘biggest bang for your buck’ first because these always cross over several areas of the business and by achieving the result from this one area, by default you will achieve other positive results at the same time. And don’t be afraid to talk about it, promote it and ‘walk the talk’ Beyond that move the positioning and price of your practice upwards together to achieve the desired level you want.
Tracking: Once you have systems in place, track your marketing success. Tracking is a session all on its own, so only a couple of basics are mentioned here. Use your practice management technology to track your success. This can be:
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Money in the bank
Regardless of whether you think this is true indicator of your success, money is only the result of the combination of good medicine, team and technology. Therefore is really is a true indicator. Success of reminders
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Track your success for all your mailings so you know what to mail, who accepts them and what information to place in a mailing. This will also help you reduce the cost of unnecessary mailings and will also allow you to know which clients need additional contact Also track your results from email marketing so you know what is working and what is not giving you success. It is worth tracking the success of any phone marketing you conduct as well. Do the same for advertising campaigns, Yellow Pages, community sponsorship – in fact everything you do from a marketing viewpoint Do not take things for granted – in marketing as in any other business discipline what is measured is managed. Therefore the only way to know your results is to measure your success and make remedial steps as needed. Of course, if you expect little and you get little you will be happy, so instead expect a lot and reach out to get it to ensure you have the success you should Track yourself…. And your team
Finally track your happiness level and if that is failing, then fix
it first!! Note – top photo is a 5 Star hotel, second photo is a 4 Star hotel, left photo is a 3 Star Hotel and right photo is a 2 Star Hotel
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Notes
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Notes
Australian Veterinary Practice Management Association
VISION To promote and improve management within the veterinary industry.
MISSION STATEMENT To enhance quality of life in Australian Veterinary Practices by ena-bling AVPMA members to develop personal skills in veterinary prac-tice management and by providing resources and networks that en-hance veterinary practice management through knowledge sharing and knowledge creation and through the fostering of relationships and personal support that comes from belonging to the association.
Member Benefits
Award representation
Copies of all relevant industrial awards via Web-based Award service
Continuing professional education
Interaction with stakeholders from the professional and affiliated associations
Document kit containing draft employment contracts and AWA’s
Liaison for Certificate & Diploma in Practice Management (Veterinary Practice)
General advice on management issues to employers and managers
Regular newsletters
Members only website and resources
Access to practice management tools
Free copy of AVPMA proceedings from AVA Annual Conferences
Weekly e-Mail Practice Tips
Website AVPMA Contact Details 3/2404 Logan Rd EIGHT MILE PLAINS QLD 4113 Phone: (07) 3423 2599 Fax: (07) 3423 2027 e-Mail: [email protected] Web: www.avpma.com.au