Leading with lists: How systems boost practice efficiency

Business experts give real-life examples to improve operations and attract clients

Mistakes happen.

Systems and processes, which help define the way things are done in a veterinary practice, can mitigate errors by encouraging consistency. Virtually every task can be broken down into a step-by-step manner, from phone calls to cage cleanings to inventory.

The truth is most veterinary practices can be more efficient. That is done by making deliberate choices, said Dr. Peter Weinstein, president of Simple Solutions for Vets. Repeating or taking additional steps can impact profitability and efficacy. He explained that the fundamental role of the leader of the practice is to make sure the patient care and client care are top notch. Even incremental changes can reap huge returns in efficiency.

Dr. Weinstein facilitated the session “Systems and Processes to Address Practice Inefficiencies” on October 25 at the annual AVMA Veterinary Business and Economic Forum, which was held virtually. “When you have processes and systems, you can deliver a consistent client and patient experience. Not only that, the chaos goes away and the efficiency goes up because you make fewer mistakes,” he said.

Drs. Peter Weinstein (top left), Dan Markwalder (top right), and Karen E. Felsted (bottom center) speak at the 2023 AVMA Business and Economic Forum
“I’m not advocating for robotic practices,” said Dr. Peter Weinstein (top left), president of Simple Solutions for Vets and facilitator of the session, “Systems and Processes to Address Practice Inefficiencies,” at the annual AVMA Veterinary Business and Economic Forum. “I’m just suggesting the mistakes that we make that lead to having to repeat things or take extra steps cost us both efficiently and financially.” He was joined by co-panelists Drs. Karen E. Felsted (bottom center), founder and president of PantheraT, and Dan Markwalder (top right), chief veterinary officer of Mission Veterinary Partners.

He was joined by Drs. Karen E. Felsted, founder and president of PantheraT Veterinary Management Consulting, and Dan Markwalder, chief veterinary officer of Mission Veterinary Partners, who shared common roadblocks to improving efficiency and potential solutions.

The panel addressed the “5 P’s,” or areas veterinarians can focus on to improve operations, attract and retain more clients, and cultivate a thriving practice culture.

1. Physical plant

Thinking outside the box when looking at square footage can give practices an edge.

“I think as we have this efficiency discussion, it begins and ends with the exam room,” Dr. Markwalder said. “We know many architects have told us we don’t need the large exam rooms, and you can do an exam room for most of your patients in less than 100 square feet.”

He suggested that when veterinarians look to remodel or optimize a space, they brainstorm how to repurpose the area for more efficient usage. That means considering workflows, such as how far away the X-ray room is from the examination room, or if it’s necessary to have a traditional lobby and reception area if most clients are used to waiting in their vehicles.

“We could sacrifice many of the less profitable portions of our practice for the high-profit areas, which are mostly doctor driven,” Dr. Weinstein added.

2. Pharmacy and products

All three speakers agreed that clinics need to be aware of clients’ desire for convenience when it comes to medications and prescription diets.

“If you are a practice owner and you do not have an online pharmacy, then your in-house pharmacy is going to be under attack,” Dr. Markwalder said. “I think it’s essential to have an online pharmacy for your hospital today.”

He noted that somewhere between 18% to 23% of practice revenue comes from the pharmacy, and of that, about 40% to 50% is spent on heartworm and flea and tick preventives. So, outside of labor costs, a practice’s second biggest expense is maintaining a pharmacy.

“We know that online pharmacies increase compliance, and you can make your staff’s life a whole lot easier by moving a lot of those clients to an online pharmacy in capturing that revenue,” Dr. Markwalder added.

However, Dr. Felsted said if a practice switches to an online pharmacy model and doesn’t update its client education or marketing efforts, it may see a drop in profitability.

“The hospitals that are most successful with this are the ones that actively work with their clients to set up their online accounts and to have automatic refills,” she said. “I think you can see an increase in profitability, but you can see a decrease if you don’t do it right as well.”

With now the largest percentage of pet owners being millennials, Dr. Weinstein explained that it’s important to create a business model that meets the needs of various generations, such as how younger clients may prefer to order products online instead of picking them up at the practice.

3. People

A practice with an engaged and productive team has less turnover and “probably has an easier lift in attracting and recruiting the best of the best as well for the different roles within that hospital,” Dr. Markwalder said.

The key to efficiently leveraging veterinary team members to their full skill sets lies in continual training, active onboarding, and having systems in place where everyone has clearly defined roles, he said.

Doctor productivity—or the amount of revenue that each doctor produces—is a metric that Dr. Felsted said all practices need to be measuring. However, submetrics need to be considered, such as how well the doctor used their support staff. Dr. Markwalder cited a statistic that the average veterinarian spends 12% of their time taking vitals.

“Another one of my favorite metrics is the number of hours per transaction,” she said. This is calculated by taking all of the hours that people in the hospital work—from the receptionist to the kennel assistant to the veterinarians—and divide that number by the number of transactions in the same time period. Dr. Felsted typically sees between 1.5 to 2.5 hours per transaction.

The goal is to reduce the number of hours per transaction but also to move the doctor hours down to the nondoctor hours, so the doctor is only diagnosing, prescribing, treating and performing surgery.

According to Dr. Felsted, another metric to keep an eye on is true operating profitability. She clarified that this is not the same as net income on a profit and loss statement.

“You may be able to take care of clients very efficiently when they come in, but if they’re not coming in, you’re going to have a challenge with profitability,” she said. “So those profitability and efficiency metrics have to be correlated with profits as well.”

4. Processes

While many veterinarians have a system in place for a physical examination or a routine spay or neuter, when it comes to the business aspects, such as workflow and usage of people, “I don’t think we’re nearly as good and consistent as with the medical aspect,” Dr. Felsted said.

Dr. Weinstein emphasized that practices should rely on repetitive systems and processes to ensure a consistent manner of doing things. That way they are done exactly the same way each time, regardless of who on the team is doing them. This makes it easier for people to step in and help out.

“The hospitals that use checklists tend to do a lot better than the ones that don’t,” Dr. Felsted said. She mentioned the book “The Checklist Manifesto: How to Get Things Right." Atul Gawande, MD, author of the book, delivered the keynote speech at the AVMA Virtual Convention 2021.

Systems are absolutely critical and must be processed, documented, and dynamic, said Dr. Markwalder.

5. Practice management software (PIMS) and other technology

Nearly three-quarters of respondents to the AVMA’s 2023 Practice Owners Survey report using a PIMS system. That’s followed by 63% who report using an electronic medical record software (EMRS) and 55.8% who say they have a communications software provider that integrates directly with the PIMS to manage communication.

“Let’s face it, there are practices today that struggle with efficiency when it relates to their practice management software,” Dr. Markwalder said. “We know for a fact on a recruiting aspect, that many of the new graduates today won’t even go into a practice, let alone accept a position unless that practice is on an electronic medical record.”

Something as simple as online booking is not being utilized by every practice, and clients are missing out on the convenience, he said. In comparison, some hospitals embrace technology by maximizing their PIMS with templates, which was covered in the October 24 session, “Veterinary Medicine, Innovation, and Technology.”

While the global use of PIMS and integration with people, products, and processes can save time, “We can never substitute technology for touch-ology because this is a relationship-based profession,” Dr. Weinstein said.

A version of this story appears in the January 2024 print issue of JAVMA