Blackwell's Five-Minute Veterinary Practice Management Consult

Lowell Ackerman, DVM, DACVD, MBA, MPA, CVA, MRCVS, is a global consultant, author, and lecturer based in Westborough, Massachusetts, USA.

Editor-in-Chief and Consulting Editors


Contributors


Preface


About the Companion Website


Section 1 - Marketplace


1.1 Models of Veterinary Practice


1.2 Challenges to the Profession


1.3 Trends in Companion Animal Veterinary Practices


1.4 Veterinary Trade Areas


1.5 Today's Pet Owner


1.6 Today's Veterinarian


1.7 Today's Veterinary Students


1.8 Internships and Residencies


1.9 Today's Veterinary Paraprofessionals


1.10 Veterinary Staff


1.11 Functioning as a Healthcare Team


1.12 The Differing Perspectives of Practice Teammates


1.13 Generational Differences


1.14 Gender Issues


1.15 Personality Profiling


1.16 Value Disciplines


1.17 Practice Management Support Professionals


1.18 Stakeholders and Strategic Partners


1.19 Importance of the Human-Animal Bond


1.20 Mergers and Acquisitions


1.21 Corporate Veterinary Practices


1.22 Not-for-Profit Veterinary Hospitals


1.23 Housecall and Mobile Practices


1.24 Hospice and Palliative Care


1.25 Specialty and Emergency Centers


1.26 Equine Practice Management


1.27 Food Animal Practice Management


1.28 Mixed Animal Practice Management


Section 2 - Administrative Management


2.1 Workplace Management


2.2 Organizational Charts


2.3 Managing People


2.4 Working in Teams


2.5 Motivating the Healthcare Team


2.6 Accountability


2.7 Change Management


2.8 Compassion Fatigue and Burnout


2.9 Moral distress and ethics exhaustion


2.10 Compromise fatigue


2.11 Making Meetings work


2.12 Leadership


2.13 Leadership fatigue


2.14 Implementation: Getting it done


2.15 Emotional Intelligence


2.16 Finding the right fit


2.17 Negotiating 101


2.18 When to hire an office manager/administrator


2.19 Staff performance planning (proactive goal setting)


2.20 Staffing Budgets


2.21 Operations Manuals


2.22 Procedure Manuals


2.23 Enhancing Doctor Productivity


2.24 Enhancing Team Productivity


2.25 Appropriate handling of medical errors


2.26 Changing organizational culture


2.27 Practice Insurance Needs


2.28 Employee Benefit Programs


2.29 Not-for-profit foundations


Section 3 - Human Resources


3.1 Compensation


3.2 Benefits


3.3 Wage and Benefit summaries: the whole package


3.4 Employee Bonus Criteria Design


3.5 Employee-related costs


3.6 Continuing education benefits


3.7 Effective Staff Recruitment


3.8 Screening potential hires


3.9 Staff Orientation (Onboarding and Integration)


3.10 Staff Training


3.11 Structured on-the-job training


3.12 It's Not Your Job...It's your responsibility


3.13 Leveraging Staff


3.14 Staff development


3.15 Engaging Staff


3.16 Effective coaching for the exam room


3.17 Mentoring


3.18 Staff scheduling options


3.19 Staff performance evaluations


3.20 Staff Turnover and Retention


3.21 Employee Manuals


3.22 Measuring your HR performance


3.23 Office Politics


3.24 Conflict Resolution


3.25 Dealing with difficult employees


3.26 Effective disciplinary protocols


3.27 Personnel Records


3.28 Terminating Staff


Section 4 - Client Relationship Management


4.1 The Basics of Client Service


4.2 Client Service Strategies


4.3 Exceptional client service


4.4 What clients expect from their veterinarian


4.5 Meeting the needs of pet parents


4.6 Client perception and learning


4.7 The Client's Buying Journey


4.8 Pet-Specific Care (Personalized Medicine)


4.9 Lifelong Excellence in Health Care


4.10 Personalized Pet Profiles


4.11 Compliance and Adherence


4.12 Creating a client-centered hospital


4.13 Creating a feline-friendly focus and facility


4.14 Developing a fear-free hospital


4.15 Client appointment scheduling


4.16 Client Reminder Systems


4.17 Maintaining regular client contact


4.18 Telephone Service Management


4.19 Measuring Client Satisfaction


4.20 Client Rewards Programs


4.21 Client Retention


4.22 High touch and high tech customer service


4.23 The extended hospital team - making referrals work


4.24 Telehealth


Section 5 - Communication


5.1 Effective client communication


5.2 Identifying client communication styles


5.3 Speaking as a professional


5.4 Making clear client recommendations


5.5 Translating medicalese


5.6 Shared decision making


5.7 Posing client questions effectively (Open-ended inquiry)


5.8 Reflective Listening


5.9 Non-verbal communication


5.10 Empathy


5.11 Harnessing the power of negativity


5.12 Discussing pet-specific care


5.13 Discussing finances


5.14 Discussing behavior


5.15 Discussing diet and nutrition


5.16 Discussing oral health


5.17 Discussing pain management


5.18 Discussing anesthetic risk


5.19 Giving and receiving feedback


5.20 Delivering bad news


5.21 Dealing with an angry client


5.22 Discussing quality of life and end of life issues


5.23 Dealing with a grieving client


5.24 Dealing with a crisis


Section 6 - Marketing Management


6.1 The Big Picture: Marketing, Advertising, Promotion and PR


6.2 Giving Clients what they want most


6.3 Better meeting the needs of existing clients (Internal Marketing)


6.4 Attracting new clients (External marketing)


6.5 Defining marketplace opportunities


6.6 Marketing Plan


6.7 Basic tools of marketing


6.8 Demographic Assessment


6.9 Client and Patient Segmentation


6.10 Target Marketing and Targeted Client Outreach


6.11 Push versus Pull Marketing


6.12 Practice Positioning


6.13 Branding


6.14 Emotional Branding


6.15 Practice Differentiation


6.16 Internal Team Marketing


6.17 Professional Promotion and Publicity


6.18 Client Education Tools


6.19 Paid Advertising


6.20 Personalized marketing


6.21 Client Focus Groups


6.22 Outbound Telephone calls


6.23 Measuring marketing performance


6.24 Dealing with the media


Section 7 - Financial Management


7.1 Time Value of Money


7.2 Financial Statements


7.3 Measures of Liquidity, Solvency, and Profitability


7.4 Getting the most out of your accounting professional


7.5 Analyzing client transactions


7.6 Benchmarking


7.7 Data you should be reviewing regularly


7.8 Key Performance Indicators (KPIs)


7.9 Making valid comparisons between practices and services


7.10 Compensating Owners in Multi-Owner Practices


7.11 Understanding Practice Profitability


7.12 Pricing strategies (Markup versus Margin)


7.13 Breakeven Analysis


7.14 Activity-based costing and cost allocation


7.15 Internal Accounting Controls


7.16 Return on investment from Practice Ownership


7.17 Perquisites (Perks) of Practice Ownership


7.18 Forgotten costs of doing business in a veterinary hospital


7.19 Capitalization and Depreciation


7.20 Accounting closing processes


7.21 Tax planning


7.22 Employee Stock Ownership Plan (ESOP)


7.23 Buying a Practice


7.24 Buying into a practice, as a partner


7.25 Practice sales: Planning, Structure, and methods to minimize taxes


7.26 Planning for the sale of a Practice


7.27 Selling to a corporate entity


Section 8 - Cash Management


8.1 Revenue streams in veterinary practice


8.2 Revenue Budgets and Forecasts


8.3 Increasing the top line in practice


8.4 Expenses in veterinary practice


8.5 Managing General and Administrative Expenses


8.6 Improving the bottom line (profit) in practice


8.7 Payroll Management


8.8 Ordering Inventory Economically


8.9 Accounts Receivable issues


8.10 Getting paid for services rendered


8.11 Pet Health Insurance


8.12 Payment (Wellness) Plans


8.13 Third-party Financing


8.14 Digital Wallets


8.15 Cryptocurrencies


8.16 Credit and Collections


8.17 Discounting


8.18 Practice Reinvestment


8.19 Borrowing Money


8.20 Buying versus Leasing


8.21 Controlling Cash flow - Budgeting


8.22 The EFT Payment Process


8.23 Value-add Tax (VAT) and Goods and Services Tax (GST)


8.24 Cash Control: Preventing Embezzlement


Section 9 - Operations Management


9.1 Medical Records and patient documentation


9.2 Patient and Procedure Logs


9.3 Standards of Care and Care Pathways


9.4 Continuity of Care


9.5 Profit Centers


9.6 Value-added analysis


9.7 Continuous Quality Improvement


9.8 Digial Imaging Systems


9.9 Laboratory considerations


9.10 Medical Equipment and fixtures


9.11 Effective Inventory Management


9.12 Inventory Management - Nutritional Products


9.13 Medication Dispensing, Compounding, and Prescribing Practices


9.14 Medication Dispensing, Compounding, and Prescribing -Legal Considerations


9.15 Pharmacy management (as a profit center)


9.16 Retail Sales - The Art and the Science


9.17 Veterinary feed directives


9.18 Adding Emergency Services


9.19 Integration of hospice care into practice


9.20 Kennel Management(as a profit center)


9.21 Waste Management


Section 10 - Information Technology (IT)


10.1 Information technology in Veterinary Medicine


10.2 Selecting Computer hardware


10.3 Selecting Computer Software


10.4 Selecting financial/Accounting Software


10.5 Cloud-based solutions


10.6 Keeping technology in perspective


10.7 Information Security: Backing up and archiving your system


10.8 Cybersecurity and Network Security


10.9 Blockchain


10.10 Paperless Practice


10.11 Electronic Communication - email and texting


10.12 Digital Marketing Strategies


10.13 Web Sites


10.14 Search Engine Optimization (SEO)


10.15 Paid online advertising


10.16 Social Media


10.17 Mobile Applications


10.18 Patient Portals


10.19 Protecting and defending your online reputation


10.20 Measuring performance of digital media campaigns


10.21 Technology: Redefining the Client Visit


10.22 Online retail - Making it work


10.23 Virtual team training


10.24 Internet Use Policy


10.25 Digital communication policies for staff


Section 11 - Facility Management, Design and Construction


11.1 Contemplating practice ownership - Getting started


11.2 Building, buying or Leasing?


11.3 Asset Ownership (RE, building, equipment, etc.)


11.4 Financing Basics


11.5 Selecting a site


11.6 How large should a clinic be?


11.7 The construction process and working with architects


11.8 Zoning and Permitting


11.9 Managing Construction Costs


11.10 Practice renovations


11.11 Leasehold improvements


11.12 Designing with the Patient in mind


11.13 Client/Patient Flow


11.14 Integrating technology


11.15 Noise and odor control


11.16 Heating, Ventilation and Air Conditioning (HVAC)


11.17 Flooring


11.18 Sustainable Design for Veterinary Practices


11.19 Referral and Emergency Facilities


11.20 Pet boarding and luxury accommodations


11.21 Large Animal Facilities


Section 12 - Practice Safety


12.1 Basics of Meeting Practice Safety Requirements


12.2 Practice Safety Needs


12.3 Client Safety


12.4 Animal-related injuries at the workplace


12.5 Security issues for hospital and staff


12.6 Developing and Implementing a Safety Plan


12.7 Hospital Safety Manual


12.8 Radiation Safety


12.9 Work-related accidents and Worker's Compensation


12.10 Emergency Preparedness for Veterinary Professionals


12.11 Emergency Plans


12.12 Controlled Substances


12.13 Adverse drug event reporting and pharmacovigilance


12.14 Suicide in the Veterinary Profession


Section 13 - Legal Issues


13.1 Veterinary Practice Legal Needs and Dealing with Attorneys


13.2 Informed Consent


13.3 Malpractice


13.4 Unprofessional Conduct


13.5 Privacy Policy and Confidentiality


13.6 Identity Theft prevention programs (red flag rules)


13.7 Employment contracts


13.8 Partnership agreements


13.9 Buy/Sell Agreements


13.10 Employees versus Independent Contractors


13.11 Non-competition


13.12 Legal duty to refer


13.13 Extralabel drug use


13.14 Disability Law


13.15 Workplace Harassment


13.16 Fair Labor Standards


13.17 Employment legalities - Bias


13.18 Accommodating Employees with Disabilities


13.19 Ownership versus Guardianship


13.20 Pet Trusts and Wills


13.21 Animal Abandonment


13.22 Animal Cruelty


Section 14 - Planning and Decision Making


14.1 Career Planning


14.2 Professional Development Plans


14.3 Resume + Cover letter (+ sample in appendix)


14.4 Curriculum vitae (+sample in appendix)


14.5 Strategic Planning and Implementation


14.6 Identifying and Solving Problems


14.7 Time Management


14.8 Keeping up with the pace of change


14.9 Mission and Vision Statements


14.10 Business Plans


14.11 Business Entity Structures


14.12 Fractional Practice Ownership


14.13 Determining a practice's worth


14.14 The Valuation Process


14.15 Practice Value Rules of Thumb


14.16 From associate to owner


14.17 Managers as practice owners


14.18 Risk Management Issues


14.19 Debt Management


14.20 Business contigency planning


14.21 Succession Planning


14.22 Gifting practice ownership


14.23 Retirement Planning


14.24 Your next career


Section 15 - Appendices


15.1 Finding more information on practice management topics


15.2 Sample resume and cover letter


15.3 Curriculum vitae


15.4 Business Plan


15.5 Marketing Plan


15.6 Abbreviations


15.7 Glossary


Index