Good evening, everybody, and welcome to the, latest webinar vets practise management webinar. My name is Andy Mee from Veterinary Management Consulting, and tonight's talk is sponsored by MWI Animal Health. And our speaker, Gillian was one of the first RVNs in the UK to own a veterinary practise and was co-founder of Ayrton Veterinary Hospital.
The business opened in 1999, progressing to a purpose-built veterinary hospital in 2006, and Gillian was part of the design team and co-project managed to build. She led the sale of E to independent vet care in 2017, but continues in the role of business director. As centre manager for the College of Animal Welfare, she was involved as deputy programme leader in the setting up of Scotland's first BSC Honours degree in veterinary nursing.
Her interest is in leadership, practise, culture, and clinical workflow. She holds the European School of Veterinary Postgraduate Studies certificates in Business and Professional skills. And she's the senior vice president of the veterinary Management Group of which she was president, from 2019 to 2020.
So Gillian, over to you. Hi everyone, good evening. A question.
Would we all benefit from having a few more smiles around us just now, to go some way to helping reduce increased tensions, or a reduced tolerance that we may be experiencing in ourselves or others due to our current circumstances. Personally, I think the answer is yes. And so with that in mind, I thought I'd start this evening with an image that might just raise a smile.
And there it is. I cannot imagine that there are many people who wouldn't smile when they see those faces, or if not exactly smile, than to have a feeling of lightness and positivity. Is that just me?
I don't believe so. Apart from lightness and positivity, there was another reason that I chose dolphin images for this talk, and that is when I sat down to write it, and I was thinking about clinical workflow and flow in general. So a smoothness and efficiency, dolphins and their natural ability to achieve that flow came to mind.
They move swiftly, effortlessly, and when in groups harmoniously from one location to another. Dolphins have a natural flow, but to top it off, they appear to be curious and inquisitive creatures, and they stop along the way to have some fun. Maybe we could learn something from that.
Now with all the doom and gloom that surrounds us during this COVID-19 global pandemic, and a very real concern about the state of our profession in terms of little or no profit in practise and a seemingly ongoing shortage of vets and nurses, I also wanted to bring some hope to this session. No one has all of the answers for the challenges that we are facing. But in terms of helping to increase profit and practise and aid staff retention, I wanted to offer something that might just help, and that is the introduction of a well managed clinical workflow into general practise.
Well, you know, often when this term is used, there seems to be some real confusion as to what exactly it means. But if we break it down, it really is quite simple. Flow is the action of moving along steadily and continuously.
Workflow, the process involving a series of tasks, events or interactions, how the tasks are accomplished. What time in what order, and by whom? So clinical workflow is really the successful delivery of our clinical services.
So that's what it is. And I'd like to look at the reasons why we might just want to introduce it. In 2015, RCBS BVA VET Futures VN Futures, launched an action plan with the aim of having a profession fit to face the future.
I love that phrase. Amongst the ambitions of that action plan was for the profession to have thriving innovative, user focused businesses. Structured and rewarding career paths for veterinary nurses.
And maximising nurses' potential. Now, the necessity to consider clinical workflow, I actually just gonna go back to that slide and leave it up a little bit there. So the necessity to consider clinical work flow in a veterinary school or a large referral hospital would seem to be largely accepted.
But often the importance and benefits to a general practise are still questioned. The truth is that most fit teams in general practise do well, even when structures, protocols and processes are designed poorly. Vets tend to understand the clinical needs of their patients.
And nursing and support staff often go to heroic lengths to make sure that things are done well. When problems do arise, most practise staff will do what's necessary to ensure that the client gets a good service and that the patient gets good care. But at what cost?
And when I say cost, I mean cost in terms of the vet meeting. What about our people? Certainly, we have enough evidence to show that significant team stressors are.
A disorganised working environment. A lack of control in the job that we do. Unable to have input in the practise that we work in, the job that we do.
Something Particularly relevant, I think in our, in our veterinary profession is the uncertainty in our jobs and then what's coming in during the day. The ever present time pressure that we're under. Whether it's real or not, there's a perceived lack of being valued and limited professional growth.
We'll look at patient flow. Now you could argue that the bitch has been spayed, so why would we want to introduce a clinical workflow? Well, perhaps the questions to ask would be.
How were the team feeling at the end of spaying those bitches? How was the atmosphere and the practise and their their environment? Could another bitch spare procedure be accommodate accommodated that day?
And often the answers can be overstretched, tense, and no. By revising clinical workflow. It can result in the answers to those questions being valued, relaxed, and yes.
Now, at the beginning of my own career, nearly 130 years ago or near enough. Little thought had to be given to the numbers of applications that we received for jobs, or the retention of staff or the well-being of those staff and certainly bad debt was was seldom addressed. It was something we just never even thought of.
But the challenges of modern day practise are very different. It's a common challenge to plan and sustain the future vet and RVN workforce. The vet new market is more competitive than ever.
And with the BDE expressing concern, with a survey that demonstrated more than half of responding vet practises to that survey had below average profitability. While 15% generated a negative value for profit. Scary stuff.
It gives further confirmation that some practises are struggling to be financially viable, and in some cases, sadly, unable to financially reward vets who have worked a lifetime and are about to retire. Now there is no single answer to solving all of the many and varied challenges in our current climate. But in terms of the practise team becoming depleted and practise profit being little or none, then a well managed clinical workflow in a general practise can be of enormous benefit.
So, let's look at some of those benefits. If we do implement work flow in practise, it can help ease individual stress. Definitely increase staff wellbeing because it removes the chaos that is often in our working day.
A staff retention because people are happier at work and if they're happier at work, they tend to stay longer in the jobs. We have what our goal is about. It's why we do the job in the first place, improve clinical outcome.
If we have improved clinical outcome and a team that hang around, then our clients have more confidence in us. And if they have confidence in us, we have confidence in their own profession, and it increases footfall, which ultimately increases practise profitability. Now I would have to say here.
That the introduction of an improved working flow can be, you know, as uncomfortable at the start. But it is good to bear in mind that often those things that prove worthwhile and for a greater good, can feel uncomfortable, or certainly until it becomes like a second nature. I was until 2 or 3 years ago, the co-owner of Ayrton Veterinary Hospital, a small animal hospital between Glasgow and Edinburgh.
We started this practise from a cold start in a porta cabin, but all of us with the dream of eventually designing and building. A veterinary hospital. In the early days in the port cabin, there was only 4 or 5 of us.
So we were often asked why we needed to put in a clinical workflow when we were in such a small tiny space, and you can see it there. It really was quite tiny. Well, we actually felt it more important to get the work flow right because the environment was so small and because there were so few of us.
The quick growth of the practise meant that in order for us to be efficient, effective and smooth, and also to keep a really good feeling between us, we had to be organised. So that much dreamed of veterinary hospital opened in 2006 and incidentally was named after my beloved cat Ayton, who was in turn named after the beloved Formula One racing driver Ayrton Senna. But when the dream of Ayton was realised, and it's almost 14 years ago now, that came with it the shock of making it financially viable in the short term.
So we had substantially increased costs, but we didn't yet have the footfall to support those costs. If I just give you an example of that was when we were in the port cabin, our electricity bill was around 100 pounds a month, and the day. For the month that we moved into Ayrton, it went up to 1200.
So anyone who's listening, who has or had a young practise with all of the costs involved will know that our thinking was that we needed to review our strategy, and we needed to do it quickly. So that led us to. Deciding to look at work flow based on our joint experience of training in a university, but then working in a general practise.
And we were absolutely sure that by implementing a good clinical workflow would actually be the key to Ayton a successful venture for us. We took the principles that we built into the small port cabin, and we took them into the hospital, just as stringent, even though we now had all of that space. When we moved into Ayrton, it was extremely important to us to achieve this bold statement.
We need, and we still do make all these years later, our business model to have clinical workflow as a primary consideration. And There's nothing complicated in it really. It's fairly .
Common sense, just governed by a methodical and logical approach. So I'd like to look at that approach in a simple form. So we decided to start at the very beginning.
And that was with the patient journey. So we would. Begin at the front door, and we would go all the way through the building, to every area that that patient would be worked on, and we would go back out through that front door.
And the kinds of thoughts we would have. So who needs to be communicated with on that journey? And who does what and how will they do that?
And when will that happen? And where will that happen? And what would be the protocols to consider, and what would be the records to complete.
Now, perhaps everyone or anyone listening this evening works in a super organised and ordered practise. But for most of us, it can sometimes be that during our working day, and we've got this time pressure. That we miss things.
So we miss things when we're setting up for a procedure. And the result is that, and you will recognise this, someone is running from room to room or drawer to drawer, looking for that drill or extra swabs or suction, you absolutely know the thing. And if I just gave a few common examples.
Of things that can be missed and cause frustration. So perhaps postoperative sheets not filled out, everyone thinking that someone else had actually done that. Catheters still in place when the patient is about to go home.
Clinical records not written up or priced up correctly thoroughly. Medication not ready when the owner arrives for the discharge appointment. Does all of this is it starting to sound familiar.
The thing is that small but important examples like these put the team under constant pressure. And that gives rise to uncertainty, which we've just covered as a big stressor for most people. And that can make our working environment unnecessarily pressurised.
So Using clinical workflow for every task that there is a single process, there is a specific person to do that task, and the collective aim being that the parts of that process and procedure are completed. And nothing falls between two stools. And things flow.
So I'll use an example now, everyday example of bits coming in to be spayed, and then I'd like to walk through the detail process. And also I would like to say here that to have a well-being outcome or an outcome will of wellbeing can only be achieved if we are this detailed. So, the client arrives with a bitch and is asked to take a seat in the waiting room.
The consent forms for all patients being admitted that day, they've been typed up and I know it seems unbelievable, but they will have estimates already on them, made up the evening before by reception. The surgical vet one or RVN would admit the bitch and walk that bitch to the kennel room. In the kennel room, there would be a surgical vet too, for that day, and they would be working alongside a veterinary nursing assistant.
So the veterinary nursing assistant would be weighing the bitch, and the surgical vet too would be drawing up all of the pre-medication needed for that bitch. The admitting veterinary surgeon, one, or RVN, having passed the batch over to those colleagues in the kennel room, would just turn back to the consulting room to admit the next patient. They wouldn't actually be the people to be weighing, to be putting into the kennel, to be organising if bloods needed taken or to be giving pre-meds or fluids or anything else.
So they would walk back into the consulting room to admit the next patient. I think I've already said the surgical vet too and the veterinary nursing assistant would we and together pre-med each patient on arrival. Now, I see immediately that that's down there twice.
One, it's there twice because it just looks better and it flows and secondly, I wanted to see if at this time of night, you were actually still awake. Let's look at the surgical overview and flow. So the surgical overview would always take place in front of the ops board, not in the corridor, not in the consulting rooms, not in the wards, but in front of the ops board for that day.
And the veterinary surgeon on ops and their team. The lead RVN. Would be beside the board and as a team, they would decide in which order the procedure was going to be carried out and when and by who.
The prep RVN rota that morning would be that if you're on prep rota one, you would be, your tasks for that morning would be the preparation of patients, taking any blood samples, setting up fluid therapies, dressings, radiography. You can tell they're entering patient's progress reports onto computer for client updates. The theatre RVM rota that morning would be the placement of IV catheters, dent and scale and polish, minor procedures, monitoring of anaesthesia, and at the end of all the tasks being done that morning would be writing up and pricing of procedures so that at 2 o'clock, everybody was good to go and everything was thorough and complete.
And The theatre RVN each day would be the person to discharge the patients through a consultation. Already booked by reception. So if we look at discharging our patients.
So the theatre staff would be those responsible to write up clinical notes, to price the procedure, to complete post-operative care sheets and make up any medications that were necessary to go home with that patient. The catheters would be removed one hour prior to discharge by RVN and VNA. So that gives you an idea of the admit, surgical and discharge process that would make things go smoothly for the team and hopefully make everybody at the end of that morning feel that they've contributed to their environment, that they feel valued and they're feeling, hopefully a little bit relaxed too.
We've looked at the patient flow going through the building, so we would have to now turn our attention and consider the humans involved in this. Now, there's enough research and examples out there to suggest that in order for us, for people to feel valued, we don't need very much actually. We need the opportunity to contribute.
We need to be encouraged to grow as professionals, as individuals, personally as well as professionally. And we know that professional confidence increases our happiness at work. And if we're happy at work, or we're at least, that's a funny word, isn't it, happy, happy, happiness.
But if we are at least Contend to our work, then we might just stay longer in our jobs, which helps with. Retention. Now, we may be suffering as a profession from depleted numbers of vets and nurses, and whilst that is a little concerning, did you, did you notice my understatement there?
It's a little bit concerning. We should also remember though that a large part of the workings of a veterinary practise are actually carried out by support staff. So I'd like to go in and look at the rules in a veterinary practise a little bit more closely.
In terms of Ayrton, When we, when we moved into the building, we thought about the rules involved in a veterinary practise. We thought about the team in our practise at that time and we considered three things. What were the tasks that could only be performed by a veterinary surgeon?
And what would be those that could only be or actually considered best to be undertaken by an RVN? So anaesthesia consultations, radiography, dentistry. I'll come back to that later.
There's a huge list. And then, if not those two. Could all of the other tasks, duties, rules be undertaken by complimentary other team members?
So that decided, we looked at the tasks that we could recruit for. And so we focused on administration, reception, animal husbandry, laundry, maintenance of surgical kits, cleaning of environment. And The aim of that, well, in recent times anyway, was to enable the practise to function well with depleted numbers of vets of vets and nurses.
And although that is true, it is true, but on a more personal level, and more importantly, I think, we also wanted to have in place a working culture. And processes and beliefs that were in line with our own values as people. So that was to help others grow, contribute and to feel valued.
So I'm just going to put that up again. Having decided on those areas that could be undertaken by support staff, we Decided to recruit for several positions. So recruitment of other team members.
So we, advertised for administration to, we wanted to do direct claims, so we were looking for an insurance advisor, cos, and clerical person. We wanted receptionists who had a background in customer care, so they could represent Ayton in the best way possible. We employed veterinary nursing assistants or animal care assistants.
And they undertook animal husbandry, laundry, cleaning of veterinary environment, equipment, and the support of vets and nurses. We also decided the size of the building and the length of time it took to clean the thing that we would employ an individual cleaning company to undertake all cleaning throughout the building. So the team were not being asked to do that.
And here they are. I do believe that professionally competent and confident RVNs that are utilised to their full potential can often negate the need for an additional vet. Many tasks can be performed and are performed by our RVNs so examples to include admit and discharge of cases, consultations, client liaison, blood sampling, radiography, dental skin and polish, filling of prescriptions, IV castor placements, fluid therapy, application of dressings.
Are you tired yet? Under direction, administering pre-medications, monitoring anaesthesia, direct support team on patient care and under direct vet instruction, carry out minor procedures. What an amazing skill set for a group of people to be able to contribute.
A group of people, a group of professionals to be able to contribute. Absolutely amazing. And not to do so is seems a real shame under underutilizing that skill that you have available.
So veterinary nursing assistants or animal care assistants assisting flow. It can be extremely difficult. You'll be aware already, for people who want to work with animals, but they're perhaps unable or unwilling to train as RVNs to find a position in a veterinary practise.
So the role of veterinary nursing assistants gives people the opportunity, and particularly thinking about those people with certificates, HNC HND and animal care. Can confidently carry out many important and time consuming tasks. So animal husbandry, maintenance of kits and surgical areas, laundry, patient care under instruction, as well as being an extremely confident pair of hands to help assist vets and nurses with patients.
Employing veterinary nursing assistants has a long term benefit also to our profession of encouraging more young people and not so young people to work with animals. And really, that can only be a good thing. Perhaps it's not as interesting for most of us.
But considering the impact the IT flow has, it also delivers a huge positive in terms of improving flow. It's a, it's a significant thing in general practise, can it be? So it's usually not intentional, but costs do get missed.
And over a week, that can be a lot. And so when we moved into the hospital, within a short period of time, we decided to use our practise management system to set up bundles for procedures. So that all items that were going to be involved in each procedure were already included in each bundle.
So as a team, we weren't having to think about individual items and perhaps missing them. Now, was that popular at the start? Absolutely not.
That I almost get rotten eggs thrown at my door? Absolutely, yes. But, in time, everyone gets used to it.
They can see the benefit of it, and it helps the practise considerably. So items can seldom be missed that way, and we even introduced prompts to help us to. We looked at client difficulty with paying.
So any client that was expressing difficulty with payment when they were coming in for a procedure with a pet was noted on the practise management system temporary account notes and highlighted in all notes to do with the procedure, so that the whole team were aware and we could Reduce our emotional difficulty with it and be proactive instead of reactive. It puts such an emotional strain on us sometimes talking to clients about paying for things, ought not to really. And this one Almost a wee bit of a mutiny and that we change the user login authorization levels so that the clinical team were unable to alter pricing or to get discounts at that time without discussion with the management team.
And again, although not popular at the beginning, absolutely was in the end, so. Good call. We already had ward rounds, but we decided to make them a minimum of twice daily.
The ward rounds, the ward RVN sorry, and the veterinary nursing assistant would update clinical notes following that ward round with the veterinary surgeon, and they would then put costs onto the patient record, onto the practise management system. So that the whole practise was aware of the, not only of the progress of that patient in terms of medically, surgically, and procedures to be undertaken that day, but also it would alert everybody that if costs were rising, we could be communicating them during client telephone calls. Now, I'm not going to pretend that we got that, that we did this perfectly or even today that we do it perfectly.
We dropped the ball. I think . But the important thing is if you have the intention of doing it and the majority of the time, you're striving to do it, but at times to realise that for whatever reasons, time pressure.
People focusing on other areas, we can drop it, but we do try our best. So we look at the summary of the benefits and outcomes of a well managed clinical workflow. For the patient.
Definitely enhanced healthcare quality, safety, reduced errors. Improved coordination of care and clinical outcome for the client, it's a better clinical outcome for the pet. They have reduced waiting times, improved patient welfare leads to increased clients satisfaction.
And if they're satisfied, they're going to have confidence in the profession. And it's something I personally feel quite strongly about, that clients not only have confidence in the practise that they choose for their pet, but they have confidence in our whole profession. For the veterinary team, well, undoubtedly it allows growth of individuals through the tasks.
Given and those tasks increasing as the individuals in the team become more competent and confident. And it does reduce stress by taking away practise chaos, which many of us have worked in on a number of occasions. So it's just It's just nicer environment not to have that.
If you have a happier and more content vetting, veterinary team, then for sure, it improves our mental well-being, which leads to the retention of staff, professional confidence, . And I guess that relates back to a better outcome for our patients as well. In terms of financial, as some people might turn off at this because we're not really driven by profit, but it is important, just the same.
On the financial side of things, we maximise the efficiencies. And efficient practise can take a higher caseload, no doubt about it. It also helps us if we're retaining our team, our staff, to have reduced costs in terms of advertising and interviews, the time involved in that.
If we utilise very capable. RVNs then often we can have not a need for an initial vet salary. If our clients are satisfied that they're coming to practise that's well organised, efficient, smooth, and they can tell clients pick up on it.
It encourages them to come back to see us. And if they keep coming back, and more often each year, then we're going to have increased profit margins. Often when I'm talking to the vet team about this very thing, and the questions will come up about, but, but we do it like this and it's fine, but we do it like this and it's fine, and we're not that driven by profit and profit margins.
Well, I guess maybe when I was purely on the clinical side myself, I would have those sorts of thoughts. But when you're trying to introduce it to your team, is to make everybody aware of what's in it for them. And I don't mean that in a selfish way.
There are so many selfless ways that's in it in it for each individual. So if we have increased profit margins, we can invest in the business and if we can invest in the business and a better facility, the latest equipment, we can also invest in each person in terms of teaching, training, salaries, all sorts of all sorts of positives for the team. I like this.
So, the BBA said, it is vital that veterinary practises have a sustainable, profitable future, so that they can care for and protect the health and welfare of animals. Now, that is such a simple and yet a strong statement. And I don't know about you, but I have quite a strong emotional response when I read it.
So, in summary. Clinical workflow in practise is a proven useful tool in helping to ensure that practises can meet the increasing complexity of today's ever changing veterinary environment, and perhaps it would allow us to take more time to be curious and have that necessary fun along the way. So, I would like to leave you tonight, where we started, hopefully, and that is with a smile.
Thank you. Thank you very much for that, Julian. We do have a few questions for you.
If you're happy to take them. And if anybody's got any more, do please type in, in the Q&A box. So the first one, I think it's referring to quite early on, what is a poor profit?
A lot will depend on staff wages. Staff wages for vets have rocketed, nurses are lagging behind, and the boss, if a vet per hour is possibly earning less than a locum. So often staff will not charge clients, but will build the business.
Yes, I, I, yes, I understand that. What, could you repeat what the question would be what's a poor profit, I think, was, was the actual question. So what, what would you define, I, I, I guess it's going off the spiffs, .
Was it less than 5% they said it was a poor profit. I can't remember, but yeah, you know, Andy, I would I probably wouldn't be bold enough at the moment to to actually answer that one. I think I would need to give that further consideration actually.
Yeah, I mean, I think going off the spiffs thing, quite a few were actually losing money as well, weren't and that was a really serious concern. Yeah, no, no, absolutely. They they are they are losing money, low profit, but it's also, I would say, It's the reason is I find that a difficult question, difficult just to come down on one figure, is that it definitely depends on my own experience of the setup of that practise and the costs involved in that practise.
And, so the figures that each of us would be looking for and not just looking for but needing would vary, . But yeah, have gone with 5%, obviously, they'll have a good survey to to prove that. But for me, I wouldn't be bold enough to to give that, sorry.
Well, that's fine. That's OK. And again, I, you know, there are other things you can look at aren't there like the percentage of, revenue spent on staff and that kind of thing, can't you to determine, you know, the rule of thumb don't go over it about 45% on Well, I, I think if you're, I think if you're staffing levels if they were coming to about.
Say 42, 43%, you would know you were on the right track for staff salaries. We as a guide, I would say sort of yeah, 41 to 43% would be you being in the right ballpark. Yeah, great.
Thank you. Just, just something else that I was thinking about quite a significant thing. Certainly we found is in terms of consumables, you know, again, you'd be looking around the 28%, maximum 30 but around about 28% of your expenditure would be on consumables.
So that, yeah, there's all sorts of figures individually you can use. Yeah, OK, great. Thanks.
Another question then you talked about the ward rounds. So the question is when in the day do you do the ward round? And how many vets to other staff ratio do you have?
OK, so ward rounds are twice a day, and we do them at, we have a vet meeting at sort of around 8:15 20 in the morning to have a general discussion on each inpatient. And then the ward round would be at 8:30, and then the ward round in the afternoon would be at 2. But as I say, we can be short, long on these, we can drop the ball, but it's something that we're continually striving for.
In terms of ratio, we would have, what we're told, we're actually told we have a luxury of staff until recent recent times with people being off for various reasons on maternity leave or holiday leave. But we would have to support staff per vet. And that's split across RVNs and veterinary assistance, is it?
Yeah, it is. Yeah. OK.
Last question I have at the moment leading on from that in fact Andy just just wanted to come in on that there. Yeah. We've been told so often that we have a luxury of staff because it, it's, it has been on occasion we've been up at 2.5 support staff per vet, and that's, that's, as you quite rightly see RVNs but nursing assistants.
But the thing is, if you're utilising your team properly, and those RVNs are being freed up by having vein nursing assistants, so they're able to take on a such a, such an enormous amount of tasks to free vets up to be concentrating on surgery. And diagnosis, then ultimately, that's gonna affect profit for the better. Absolutely, yeah.
And it kind of linked, another question, last one, as I said, I've got at the minute, if anybody does have any more, please post now. The examples you gave of flow were very good, but were staff rich. How does flow work with, much less staff, for example, just one RVN, a veterinary nurse assistant and receptionist.
So I think you mentioned about having, you know, surgery vet 1 and 2 and that type of thing. So yes, I can appreciate that it would come across as that, that you might need plentiful staff to be able to do flow, but you don't, you absolutely don't. To make it look more glamorous, you know, everybody going about in their scrubs up and down corridors.
Bringing dogs back and forwards, it might look more impressive, but in actual fact, when we introduced flow into the practise, from that we started, from a cold start, and if you remember back to the beginning, we actually begun in a portacabin. So there was only 4 of us, perhaps 5, but 4 of us, one of, the team members was a reception. So we had 2 vets and 2 nurses, and we still managed to achieve flow.
Flow is, is really just an order of things. So it's an order in the way that something's done and when it's done, who it's done by, and, and at what time. For how long and what part of the day.
And really, that could be done with 3 people. You know, I don't think it's about numbers of people. It looks that way in a bigger practise or a hospital or university because it does come across as, you know, plentiful, a team in a in a in a lovely big environment.
But in actual fact, you can do it in a tiny little port cabin. OK, great. Thank you.
And you think that answered that I'm just aware there that perhaps I made that sound too simple, but I wanted to really get across the fact that numbers of people are not the important thing. It's, it's the people that are within that team. Taking part of the task and and making it theirs.
So if you had a procedure, for example, and within it, there were 4 or 5 components to that that procedure, each person could take on one or two of those things consistently. Yeah, I guess so it's it's each person having clearly defined roles and organising. Yeah.
Yeah. OK, follow up question to your staff. Does the staff ratio answer.
You said 2 for that. Does that include management and admin? No.
OK, right. So that's clinical. It's clinical, just clinical, in actual fact, very essential to have management and admin as well.
But no, on the clinical side, we're thinking about when we talk about 2 or 2.5, we're talking about clinical, Throughput, so case load, throughput of case load. Brilliant.
Thanks. And another question has come in. Do you find staff become distracted with their home lives sometimes and how do you keep people focused?
Yes, and you know why? Because we're human. We are, I think as human beings, we will have days at work where all of us can become easily distracted.
How do we keep people focused? It's a really good question. I think if if a practise has a good structure.
And good working systems. And competent colleagues. And colleagues that on the whole you like, people tend to be happier in their environment.
And if the message put across from the leadership team in that practise is that this job is important, this patient's important. We care about standardisation. We care about our reputation, we care about the business.
If, if that's a consistent message from the leadership team in the practise, I think it helps people feel secure and focused and more motivated. Now again, you'd have to say, can everyone Have we achieved that all the time? No, we haven't.
Is it something we're conscious of and try to do and try to work towards? Yeah, absolutely. So I think it's about creating a positive culture in the practise.
And the culture cannot be affected by just one person. It's got to be a group of people. And I would leave that the leadership team within that business.
OK, great. Thank you. Another question coming in.
Do you think it's necessary to have a designated manager and what size practise would that work for? Absolutely. That's it.
So any size practise is what you're saying. Absolutely. That's, I cannot imagine the successful running of a business without a manager.
Whether that's a business director, a business manager, a practise manager, whatever the term for that person would be, that they are given support to run that practise, that they are given, autonomy in the role as well in certain aspects that they're encouraged to make. Consistent sound management decisions on behalf of that business is absolutely essential. Otherwise, and I've, I've always thought this from my early years.
Otherwise, you've got people who are so good at what they do, if say if we mentioned veterinary surgeons, for example, so good, so skilled, but perhaps not best placed to be working in a management. It's a different set of skills. Now, I'm not saying that some individuals can't do all because I'm sure they can.
But best not, they are much better focusing on, turnover, profit, skills, clinical. OK, it was interesting that you actually started answering the question. I, I was thinking, you know, what is your opinion on, you know, vets being practise managers?
I've always felt that like you, you, you hinting out there, the vets aren't trained as to be managers and the way they make money is to do clinical work. So I wonder if you want to expand on that a bit, or do you think you've covered it with that Andy. I think that.
There, there, although I think the veterinary courses now actually do bring in business, so there is more knowledge than there were years ago. But it comes down to the fact that you didn't, that's not presumably why you became a veterinary surgeon or you would have become a businessman, you would have focused on business. But I think it's about focusing on the area where you're best.
To generate income from that from that business. So I do think it's a whole different set of skills and others actually, my mind's flooding now. There's so many things that come to mind, because otherwise, if a vet, if a vet surgeon is doing it all, you're not actually growing the team around you.
So the team around you're not growing and developing and if they're not growing and developing, neither is the business. And also, the next thing that comes to mind is if you've got one individual in that lead role who's doing, who's doing surgery, they're doing business, they're doing financials, the strain of that is phenomenal. And that cannot be sustainable, and that cannot be healthy long term.
So I think anyone that's undertaking that should probably really decide. What, which, which area do you want to focus on? But don't split yourself in two and try to cover everything.
And are you a fan of, of having, say, a, a non-clinical practise manager and a clinical director, or? Oh, yeah, fine. Give me a minute to think.
Yeah. Why, why a fan of that. I think certainly, there are many advantages to bringing in people from outside the profession.
Into practise management because I do believe that if you're managing a practise, or you were managing, gonna get mail for this one, but I think it's not necessary. It's an advantage, but it's not necessary to have been brought up in the veterinary industry to manage a practise well. I think you could have managed many other types and sizes of industry and companies and then moved into practise.
Manage and do a great job, because the principles of practise management are the sorry, the principles of management are the same. But do I think it's an advantage having that understanding in terms of being able to communicate to the team around you why you made those decisions and that you do understand their day, and you do understand their struggles, and you're very aware of what they're going through on a daily basis. And these are your reasons for making the decisions you have.
But I don't think it's essential. So am I for people coming out from out with the profession? Yes, I am.
Was was an expert A I for clinical directors? Well, it was kind of that d you know, so as I say, I was saying, you know, vets get the manager's role and they get bogged down in HR and finance and stuff. So maybe let them focus on the clinical aspects of the management and that would include your clinical workflow, obviously.
And then you. Sorry. No, no, that was saying then you have the non-clinical person doing the, the HR, the finance, the, the marketing, that type of stuff.
Yeah, but you know, Andy, I, I am a believer. It's all about personal choice. So nobody can say to you that's absolutely wrong.
It's your personal choice. But I suppose what you would say to somebody who's, and they probably are struggling to do that, you know, if it's your business, I can see why you're choosing to do all and take on that all and take on all of it. But at what cost?
To yourself. Sure. To your family, to the people around you, to the business as a whole.
I do think it's better to give your whole self to one aspect, and that aspect is the one that you've you've trained for. You've spent years training for, and you're highly skilled at as well, and leave the other side of it to somebody who's passionate about management, you know, give other people a chance to contribute to success. OK, great.
Thank you. And we do have another question coming into this coming in thick and fast now. I think so, I'm reading between the lines here so I've had a bad experience with the manager, but what exactly does a manager do?
Should the manager organise everyone all the time rather than allowing each group to do their jobs? Wow. I think the simple answer to the second question is no.
I'll let you, I'll let you, you expand on that. Well, I, I do feel this need to say though that this is just a personal opinion, isn't it? It's not to say anything is right or wrong, because Myself, I have locum, I locumed for when I was at university, I locumed for 5 years throughout the UK and what struck me was the diversity in practise.
It was . Yeah, it was absolutely amazing. From, from Devon to Manchester, actually didn't ever look in Scotland, but, the differences in each practise really struck me.
But what I would say is I found that the practises that were set up with a very good structure. And part of that structure is the correct person and the correct role, with a remit to make decisions on behalf of the business for the greater good. So the practises that were set up with a very strong structure and processes and systems, and I know those words turn people off.
It used to turn me off as well, but they're so important in a successful business. They take away chaos, they make people feel supported. So, Yeah, I, I think that if you have a a practise that puts in a structure, and you have people within that business that hold different areas and are responsible for different areas and allow the team to grow.
So yes, put in a structure around people that make people feel supported and enabled. To do a good job and to make good decisions, but do not come in and manage those people put just as we've discussed tonight, put a flow and systems and a workflow in place and let people follow it and develop it and improve it. And then step back and and do your job.
Right, yeah. Absolutely. Another question then, it is possible to farm a lot of things out nowadays.
Is that not all useful? Yeah, yeah. It's something that's something that I've personally not had experience of maybe in terms of .
Accounts, you know, in terms of, maybe in terms of accounts share, but that's something that we haven't, I haven't personally done, we haven't done as a practise, but can I see the benefits for sure. I'm all for putting things in place that are viable economically and supportive to the team and to the business. So however you wanted to achieve that.
Yeah, I guess it's just an expansion. You said you've got a cleaner to come in, didn't you? And that can make a huge difference.
It's the end of the day, everybody's been working really hard. The last thing they want to start doing is, is cleaning up the practise. So even that is a morale boost for the staff isn't that you say, well, OK, you can go home now and we'll get these cleaners in.
So yeah, there's lots of different. Andy, that, that one's again, it's very personal. It's a personal thing to me as well, is that, why on earth would you train for years to do a job and trying to be developing yourself and improving yourself and be, you know, have the self-awareness.
And then at the end of the day, you're asked to, clean windows and clean surfaces and I'm not against cleaning, you know, I, it's not, I'm against that, but why would somebody who's trained be off, cleaning door handles and, and doors, and the other thing is give other people a chance to have a job, and to contribute to a business. You know, I do. I'm a big believer in bringing the skilled and motivated people that Want to have in your business in order that it's successful and then treat them well and grow and help them grow themselves.
And you're not going to grow someone's self-esteem or self-confidence. And I think we, we really struggle with that as a profession. You're not gonna grow that if you're asking people to do tasks that, they ought not to be doing.
Sense of satisfaction. Yeah, 100% agree. I actually want to work for somebody that was a bit more cynical than that and said if you can pay somebody to do the same job and it's less money to do that.
It's yes, I have to. I certainly locums and practises like, like that, not many, but some. And I used to, even in those days before I had any thoughts of, management, I think to myself, it doesn't seem common sense to me actually.
I would think that you appear to spend more because you're perhaps employing someone a greater salary and you're bringing in an outside company to clean a building or to do whatever the task is that you want them to do. But ultimately, that business will be more professional. It will have a better reputation.
It will create confidence in the in the in the local environment that you're in with your clients, . Therefore, it's going to be more successful, and if you're more successful, you've got a better reputation. You're able to more easily charge as we should be charging, and people are going to pay it because they believe in you, they have confidence in you, and they see the clinical outcomes there.
I'm getting a bit carried away now, but I do think, I do think. It's a whole knock-on effect and that by paying less and trying to take on people who are not skilled, you know, you take on school leavers and get them to do an anaesthetic. It's a false economy, and it's not a long term positive move.
Brilliant. Well, that's a good way to, to, good thing to end on. So thank you very much.
It's been a great talk, Gillian, much appreciated. And, I'd just like to thank again, MWI Anal Health for sponsoring tonight's webinar. And hopefully we'll see you on the next one, next month.
Thanks again, Gillian. Take care, everyone. Good night.