Good evening, everybody, and welcome to the latest webinar from the webinar in the practise management series. My name is Andy Mee from Veterinary Management Consulting. And tonight, it's my pleasure to introduce you to Libby Kim Karen Thompson.
Before moving into management consultancy and growing and developing a business, Libby worked in the city as a recruitment consultant and built her own business there. After retraining to be a vet at Cambridge, where she also did a degree in behaviour, Libby worked in Essex and Cambridgeshire as a first opinion small animal vet for 5 years. Following a car crash which left her unable to perform surgery, Libby opened up to new businesses and also moved back into the field of business consultancy, this time specifically helping vets.
Now, Libby works passionately for the UK's largest veterinary consultancy company, Vet Dynamics, where she offers a portfolio of coaching and bespoke development options for independent practises and their teams to improve their performance and their quality of life in practise. Libby's run sessions for Bayer, MSD head nurse congress at the College of Animal Welfare, and was a keynote speaker for this year's Sears Snow scene, presenting for the week topics on human behavioural psychology and why people do what they do. Our sponsors this evening are Simply Health, the Saint Francis Group, and 8 Legal, and Libby's going to tell us why clients don't buy and vets don't sell.
Over to you, Libby. Hello, everybody. Thank you for that introduction.
So this is a really interesting piece about communications and culture, and it's, it's about the mindset piece behind our job as vets. Why do clients have this resistance when we start talking about the pricing behind what we do and why do vets hate that word selling? Why do we always struggle as a team to actually deal with this financial part of our job?
As you so kindly summarised, obviously, my, my background is business. And what I saw when I was, I was specialised in growing businesses and increasing profits and team engagement, what I found when I came over to the vet world was So much that's commonplace in the city markets hasn't yet made it over as a technology into the vet world in terms of business principles and real models of, of development. Why is it so slow?
Some of it is down to this mindset that I'm going to talk about tonight. By the end of this webinar, what you'll have is hopefully a piece of this, this toolkit, toolkit that I go around the country delivering to practises, large and small, lots of different demographics, lots of different locations. And it's a, it's a full team piece.
So this is relevant whether you're either at the practise management or the practise owner end of the scale or whether you're working within a team of vets. So, without further ado, let's begin. What makes a good vet?
It's not clinical that I'm talking about. I'm talking about vets as in the practise, and this is a little worldle that came out of research that was done recently about what does make a good vet. This was a Melanie study tell in, I believe it was.
2011 this was done. And why is that word communication shouting out at us from there. The answer, we get sued if we get it wrong.
You know, there's huge consequences if we're not aligned with what the client believes we're doing, not least of which, the consequences can be a worse outcome for the pet. So we need to sort of dig into this, this piece of communication. What we have to do first is dig into what do we really need to do in our standard interaction with a client, which takes the form of a consult.
So, We start with this as our model whenever we do any consultancy with Any client, big or small, no matter how many full-time equivalent vets they're running, we, we look at these four key outcomes. So what do we want? Poly puppy comes in.
First thing we need to do, we want that clinical resolution. We want to really zoom into this piece of the puzzle. We want to fix it, don't we?
We want to make it better. But what do we desperately want that client to do as a result of our actions? What do we want them to feel?
The answer really is satisfied because virtual hands up, how many of you here have had that rubbish experience where you've done everything right, you've been clinically amazing and the client still walks out really upset with you. And you can also have the opposite. You fail utterly to save their dog.
The case gets away from you, you know, you can die. And then the next day you get a bunch of flowers and chocolates. You know, it's just there there sometimes isn't a direct correlation.
The two are not intrinsically linked, and both of them take a piece of work to, to make them sort of come together. Then the next one, and this is where we're going to focus our attention on today, we want the client to walk to that front desk and we want them to pay. And again, sometimes we have to put some work around that.
And then the final one, and everyone gets a gold star if they come up with this one. I'm running this as a workshop, and We also want the team to feel like the right thing has happened. We want the team to feel it's worked.
We need this team harmony. So these are our 4 outcomes that we work towards. But here's the thing.
There is a massive challenge specific to this country as we're operating as vets with our clients on their pets. And I use this as a really tangible example of what the problem is here. If I asked you how much does this cost, and by the way, guys, I travelled the country doing this, so I've got quite a large sample size to judge a response on.
I tend to get a response that invariably comes back of, oh, it's free, or they'll give me the cost of prescription. No, it's not, is the answer. My daughter's on this.
She's severely asthmatic, a month's supply for her costs out at about 52 quid every month, probably for the next couple of years of her life. And yet, as a country, we have no clue. About what this medicine costs and why is that?
Because we've got this wonder of a system called the NHS. We have no clue what good medicine really costs. Classic example being our bitch bay, we even call it a routine or.
And we charge what, 250 quid again from the sample size I've got around the country, I get answers between 250 pounds, possibly at the top end in London between sort of 350, 400 pounds for that. And yet the hysterectomy is costed out on the NHS at around 5000 pounds. Now, why have we devalued the work that we're doing?
Why does our surgery get priced so low in comparison, obviously the answer is because we want our clients to do it, don't we? So we've affected our behaviours and changed our pricing models. To get the behaviours that we want from our clients, which is please spare your animals.
And so this, this has a problem because obviously if that same client maybe comes in with another animal that has a pio, what's our charge going to be for that surgery? It's not going to be the 250 quid. It's going to be more likely around the 700 mark.
So we also then have to deal with another version of this sort of barometer setting that goes on because of the NHS. We have a media view of us. We have a perception that's quite sort of nationalised as a barometer.
Love this headline, that's threatened on a regular basis by pet owners angry at the cost of treatment. What other profession do you get threatened by the work that you're doing? You know, we've got, we've got a problem.
Equally, at the same time, We know that most practises in the UK are operating on a 2 to 8%. Profit margin That's really low, guys. That's not, that's not a healthy business model.
That's a business model that really is going to struggle to deal with those bumps in the road that come up, these random things that happen like Brexit. We've got, we've got to look at where that profit margin should be. Then we have things like this.
Thanks, telegraph, pet costs. Why do vets charge so much? Brilliant.
So we've got this presupposition deep in that headline, that is the fact that we're already charging too much. Actually, incidentally, this is quite an interesting article. It's quite well written.
Have a look at it if you want to sort of see how we're being portrayed. There's this one as well though, vets charge 5 times more the same procedure and the pet postcode lottery. Yeah, because, you know, rents are different in different areas.
Facilities cost more. They There are other reasons behind these headlines, aren't there? We all know that.
I don't know if any of you were at BSAVA last year, but this little washing line affair was strung up, and there were so many of them that had this theme around it, and this is just one picture we took and trying to convince clients that vets are not just trying to steal your money and that their pet does need veterinary attention. Grammar Nazi and me wants to pick on the there, but I'm not going to. So we've got to look at what's happening in our industry when we talk about this mindset piece, we've got to think about.
What are the actions that we are taking? What are the behaviours? Because I look at everything from a behavioural point of view, that's what I do.
Why the vets struggle to charge? And the answer is this. A lot of vets don't start with the fundamental understanding that to do all this great vetty stuff that we want to do to cover all these things that we're capable of, we must exchange it for this token called money.
We must do a swap. We've got to swap our vetty time for this token, which we then reinvest back into that business. And, you know, the, the reinvestment is in the form of delivering those other outcomes when we look at the, that for outcome grid to deliver that team harmony, to deliver that client satisfaction, all of those do take a certain amount of money.
. And it's like oxygen. When there's enough of it in the room, you don't know it's there. You don't notice it.
As soon as it starts running a bit low, you get a bit gaspy. And this is where money becomes so important is at the point where you're about to run out, or at the point when you're struggling or the point when the banks are getting really shirty with you about how much you're borrowing to tide you over those flat times when you're only on a 2% profit. So staff need to know this link.
All staff need to know this link about this swapping all of this great stuff up here. For this token called money and income growth being that way of delivering on those goals. But here's the problem.
There are 3 really big issues around this. Number 1, We don't like selling. #2, we're not motivated by money.
We're not carrot and stick type people. And number 3, commercialism is very low on our list of traits. It's the least important trait, perhaps of anything we do with so much more driven by other things like the altruism, like wanting to save the world one puppy at a time.
The research that we've done suggests that in the vet student. World and as a, as a company, we're involved with the thrive initiative with the Royal Vet College, which is all about, you know, looking at what students need to really not just get through, but to really thrive in, in their journey. In terms of desirable character traits, commercialism isn't even questioned.
It's very low importance all the way through the process of turning a student into that, that new grad. So suddenly when they drop out, when they get to that first year, you know, a lot of the reasons for dropping out comes back to the, they didn't understand perhaps what they're going into. They don't understand the business side, and that's what we're desperately trying to address now.
And here's the problem. Who I am dictates very purely what do I do. And at the moment, veterinary professionals equate being commercial with being unethical.
That is a massive roadblock because we do have to manage this pet versus profit paradox. We do have to work with this client mindset of being completely ignorant as to what good medicine costs. So we do have to find a way to be commercially successful that is ethically acceptable.
To the profession. So I hope that sort of makes sense. This is the, the setup to what we're going to talk about, because at the moment, we, we are trying to instil a sense of commerciality in our vets, in our full-time equivalent vets that are working at the coalface, but it doesn't replace that feeling of altruism and social justice that most of them have come into the profession for.
But we can, if we reframe that commercialism, make it this pathway back to that purpose. And then once the practise is commercially viable, You can go back to just purely being on purpose, but we need to redefine it because we've got to be aware that what we have to offer must come at a price, because we're not, we're not running a charity model. There aren't any collecting tins around your hometown with your name on it.
You know, we have to swap what we do with the client's token of money, and it's got to be the right amount. So we can therefore really define this for outcome balancing trick. As commercialism in itself is making sure that we don't just zoom into one quarter, we don't just do the clinical resolution and dam all the rest, you know, we have to focus on all four of these.
The trouble is, it is a conflict. Sometimes it is. A problem and every 15 minutes, every 10 minutes, you might be faced with yet another conflict, and that's incredibly stressful.
Any conflict needs strategy. You can't rely on your emotional response to conflict because you get hijacked. Your amygdala kicks in, your old lizard brain takes over.
You go into that fight or flight, all the others which are freeze, friend or flop. You know, there are, there are very precise coping strategies that we have as humans that don't serve the business. They don't serve.
You as a vet either, it's not nice to feel amygdala all, all the time. So what can we see? What can we hope to see if we get a good strategy in place around this?
What does it look like? When we start talking about anything to do with this conflict, I've got to ask you firstly, very bluntly, how do you feel as you're sitting there listening to me talk about this, how do you actually feel about charging clients? Are you personally still stuck in this altruism trap of I desperately want to help, but they can't afford it.
So what I'm going to do instead is I'm going to invest my energy into discounting behaviour. Is that the story of your day? Do you do as I did as a very altruistic young grad who's, you know, I changed my life around to qualify as a vet.
Desperately wanted to help this parade of poor animals that I was seeing coming at me, but with the clients that I just hadn't considered, wouldn't perhaps necessarily always want to pay for things. I remember once even taking this cat who had this mass in the abdomen. I desperately wanted to know as well, because you're very nosy as a new grad.
I smuggled this cat under my lab coat out the back for a quick ultrasound because I knew the client wouldn't afford it. I didn't want my boss to see. I thought the equipment's there.
I might as well just have a quick look. You know, we, we start investing energy and we, we do behaviours that perhaps aren't helpful to the practise, aren't going to be the best use of our resources. And we have to start with us.
We have to always, when we look at any behavioural, tricks, we have to think, what do I do? What's my story? And ask yourself as well as you're asking, OK, how do I feel about charging.
What happens when someone challenges your pricing if you're the one that sets the pricing or your practises pricing if you work for someone else, the pricing, do you feel anger? Do you feel annoyance? Do you feel frustration?
You might feel a mix out of all of those, or you might just feel really jaded. You might be exhausted with this because it might be at the point where you've dealt with this for so many years, you're sick of it. Now here's the clue.
How you feel dictates your behaviours. If it's too painful, you will choose what we call away from behaviours as a coping strategy. You move away from that feeling because it's not a comfortable one.
So the behaviours you then demonstrate, try to solve this problem. Again, it's lizard brain behaviour. It takes you in a direction that chooses a different outcome, and this will affect your team, who you work with.
Is affected by your behaviour, whether you're the boss or whether you're a team member, what they see you do does percolate and it does affect others. So do they feel confident? About the pricing or your pricing of it.
Do they know this link of cash in to the reinvestment out and that reinvestment, let's be really explicit about this, that reinvestment of where that money goes, it's not building a practise owner in another swimming pool usually. It's more about reinvesting in equipment, you know, updating your X-ray is a big thing people have had to do in the last 5 years as we switched over to Digital X-ray, getting in dental X-ray, getting in a new ultrasound machine, even just investing in CPD that's an investment. And let's be really blunt, pay rises, because you don't get a pay rise out of thin air, it comes from this Income growth that sustains the practise.
Do the team know this? Do they feel confident about the pricing? Because if not, they will not be billing correctly and they won't be invoicing confidently and discounts and cat smuggling on the case will happen because the behaviours are designed to solve a problem, not be a problem.
No one behaves in a certain way to be a problem, and this is a great phrase to remember when stressed with your partner or your kids as well, because behaviour solves problems, that's all. So we need to start with the reframe. We need to look at changing this word selling.
We need to take this out of the equation, just get it off the table altogether, never ask a it to sell. We just don't do it very well. But think about how often, how much time do you spend either persuading or convincing or influencing.
People, because we have to do that anyway, don't you guys? We have to sometimes persuade a client that perhaps coconut oil doesn't cure everything, and, you know, let's just try these nice steroids over here, or let's, let's have a go at some antibiotics, you know, instead of wrapping bread around that foot wound like you've been doing for the last two weeks. So there's, there's a reframe that needs to happen in our brain to do this bit, which is moving people to part with resources in exchange for the value we create.
And this is a really key phrase. The key word here is value. We have to create this perception of value for our clients for them to be happy with the money that we ask from them.
They won't buy, effectively using that word buy in a very literal sense. They won't buy our services if they don't perceive the value. And it is perception.
Things are worth what you think they are. Literally, we've all got a value in our heads. And the figure that we have as a sort of go to the vet's price in this country is approximately 75 pounds.
If the figure below that comes in as a result of console injectables, tablets to take home, you probably don't need to discuss money as much with the client. If it's a penny above 75, yeah, you've really got to make sure you've Checked it with them before they get to that front desk and problems created there. So we need to look at this as a, a reframe in our own heads first before we then start talking about client behaviour.
Client behaviour is never gonna change. Until our behaviour is sorted to move people to part with those resources in exchange for this value we create. So I hope this is making sense so far none of this is rocket science.
It's all just Giving you the rationale behind the emotional reasons behind why it's such a problem in our market. So Let's just talk about Who's on my team, because this is really important. Now, I left school with GCSEs.
I had nothing beyond that, no big qualifications. I went into the city, into the world of recruitment and then management consultancy in a very short space of time, I was a director level at the age of about 26. And the reason that happened is not because I'm brilliant.
I'm not telling you that to impress you, just to impress upon you. Success leaves clues. I figured out very early on how to model someone that was successful, to look at what they do and mimic it, and you get to be a level of success much faster than if you have to reinvent the wheel yourself over and over again.
Why does this work? Because that person that is successful has already figured out a belief system and a set of behaviours that translate into an operating plan. So when you look at modelling someone, what you're effectively doing is this act of just jumping ahead to what they've already figured out works.
You're just short circuiting the system and just copying things that have already been proven to work in some way. You might have to adapt them slightly, but you can very quickly elevate your behaviours. To a level that is incredibly successful.
Now, here's the good news. A lot of people have already done a lot of research into What are good behaviours in this area. But here's the thing, are your team modelling you?
Are you successful at this, or are you the worst discounter in the practise? Here's why it matters. The reason I have to ask, do you discount is because it's so blooming common.
And on my travels around the country delivering this is a workshop to, teams of all different shapes and sizes. What I find again and again is that as an industry, we just are pretty Shocking at this. This is a study done by the Canadian Federation of Small Businesses and it looked at the percentage of clients that discount their percentage of professions, excuse me, who discount for their clients every single day.
So no surprise, lawyer less than 5%, Accountant, 0%, love that. What do you think that's coming at? You look at that list, you know, there's a variance there of between nothing at all with your pharmacist or accountant, up to sort of 14% at the chiropractor and the scale.
Are we going to be near them, we can be near orthodontists? No. The answer is vets every single day are discounting approximately 41%.
Of the time, which is shockingly high. Look at the difference in those, in those range of professions there. What?
How come what we do, you know, are we worth less than a car mechanic? Yeah, they have to train. Yeah, they have to know how things work under the bonnet.
Yeah, they have to, you know, look at their data sheets, know the metrics, know the numbers, but do they do that any more than we do? Why do we feel embarrassed about our pricing enough to put our energy into this discounting behaviour? And this is what we see time and time again.
So We have to start thinking about our beliefs. What is the belief driving this behaviour? Because all our behaviours come from an expression of an internal, hard-held belief.
We then form our habits around that. What we do most commonly is the truest reflection of our internal belief terrain. So I want to introduce you to something which delves a bit more into these behaviours that take you towards or away from.
So we call them closer to or further from behaviours. And, you know, what, depending on what your goal is and your outcome, we want to do behaviours consistently that move us closer to. Sadly, what happens in a veterinary practise most often is we do behaviours that move us further from the financially successful, healthy income growth.
So, here's what happens. I mentioned the word triads. I'm going to introduce you to this concept of triad, and this is one of those key pieces that when I learned this, it's back in 2001.
As soon as I learned this one bit of information, my business went up 300% overnight because suddenly I understood where my barometer was getting dialled down, and I also understood where my behaviours were getting affected at a really core level that I wasn't even aware was there. So this is the triad. What we do is we use a combination of these three things to enact our daily behaviours.
We use our physiology and our posture. We use our language and our mental focus. Those two things are both stemmed from your belief system.
So your physiology, your focus, and your beliefs and language are wrapped up together in this thing called the triad, and you might look at that and think physiology, does that really matter? Does that count? I want you to just think very quickly.
Imagine that I've got a depressed person behind the curtain too. You know, what, what is their body shape? Are they energy up, with the shoulder squared, or are they likely to be a bit more slumped and their energy a bit lower, their eyes meeting your gaze directly or they possibly looking away.
We know these things intrinsically, we don't think about them that often. But when we look at communication, body language is so pivotal to the extent where it makes up a larger part of the transaction than we're ever aware of. Our words are accounting for 7% of the message that we give out.
Our body language, 55% of the message that we're giving comes from that presentation of yourself. And then the rest of it, 38% left is the pitch, pace, and tone of your voice. It's as simple as that.
And that's why there's so many fights on the internet because we don't have eyebrows on a, on a text message or on a Facebook post. So we read an awful lot from people's behaviour, from their physiology, read the rest from the language, and we read and focus. This is one of those key pieces.
If you think about your beliefs, You create your state every day. You wake up, you get out of bed, your body and mind work together with your language and your mental focus and your beliefs to create the state that you're in every single day. And this triad is so pivotal to that.
Now, working with that. In our brain, we've got the reticular activating system layering behind that our window onto the world. And the RA works going back to our second year of neurology here, the Raz works as a very, very strong philtre.
Have you ever bought a new car and then suddenly you're seeing it everywhere on the road? That's your mental focus. That's purely your mental focus.
What's happening is that the reticular activating system is literally screening your environment and because you've just bought that new car, guess what? Oh look, there's one over there, and oh, there's another one that I'm parked next to in the car park. They were there all along, just that you now suddenly see it.
So What do our beliefs make us do? Perhaps a slightly better question to ask is how do they affect our communications because that's what we're talking about. That's, that's the big word at the beginning of this webinar and in that world that really screams out at us about what makes a good vet.
And let me give you a very strong example of this. I'll use people as an example. If you've got a problem nurse, and you're a new vet, you've just walked into the practise and you've had a little run-in with her and you go to the reception, you say, is, is Diane all right?
And the receptionist does this dramatic iron and go, Oh, Diane, don't worry about her. We all know about her. Instantly you've been communicated a very strong message.
You have got to remember that affects your behaviour because you've just been given a very strong social proof about Diane. I'm deliberately trying to pick a name of a nurse that I haven't ever worked with. Diane has now been communicated to you as a problem.
You've seen behaviours that fit with that. What you've just done is use two pieces of information. As soon as you've got 3/4, we call them table legs.
These are your supporting evidence with data gatherers. We like data. We like to know from our research into the world around us what to do.
So we use that data when we prop up our tabletop on that data. So our beliefs will then be set, and we have to remember to circling back around again to our clients, we have to remember it affects our clients too. Just going back to that NHS that I started off with, the whole point of those clients walking into us, effectively ignorant of what they're going to have to pay is that it affects their behaviour from that moment on.
So, I want to briefly introduce you to Pam in Sainsbury's. Good love Pam. I want you to imagine Pam's face if confronted with some of the rubbish we get thrown at us when we sit at the front desk and some of the things that we get said, just imagine, just imagine for a second saying them in Sainsbury's.
You know, we, we see these things all the time. Oh, I've only got a tenner with me. Can I pay you the rest?
What would Pam do? Would that wash at all? No, it wouldn't.
You'd be summarily marched back to go and put your basket full of stuff back on the shelf. And yet at a vet's practise, we see all of these things and we get the emotional blackmail, but you're supposed to care. These affect our behaviours really strongly.
We get sometimes, unfortunately, a very consistent message that what we're doing is wrong. And this is where we get a problem in Aldi, it's only 3%, then go to Aldi. But all of these things come at us from our clients' behaviours and from their words, and we have to remember this when talking about anything to do with our pricing.
So, I need to ask you to again just have a little internal think. What does communication look like? What does good communication look like?
A better way of sort of saying that is What is your question that you ask yourself every day? Your brain is human Google. You ask a stupid question, it will find you a stupid answer, and you'll meet these people in the world, won't you?
Why does it always happen to me? And the brain will pop up with an equally stupid answer if that's the thing that's running through your head as a litany every day. Everyone has got a primary question.
Mine, if you're interested, happens to be, how can I make this better? And that's what's taken me into the field of business consultancy. How can I make this business better?
How can I make this client better? And then it's led me into medicine. How can I make this animal better?
And now full circle back to helping businesses just in the petty world. But the quality of your question determines the quality of your daily experience. And I'm going to say that again because it's a really important point.
The quality of your primary question. Determines the quality of your daily experience. Our beliefs set that question.
That then sets our behaviours. Our behaviours set our communications. So all of our team harmony gets affected all the way back through our communications back to our behaviours and beliefs.
They all stem. From this primary question. So if your communication looks like to the clients, what you're trying to do is how can I make this as cheap as possible for my clients, then this will be expressed as a set of very different behaviours than if your primary question is, how can I deliver the best standards, the very best standard of veterinary care for this animal.
If that's your primary question, that client is going to perceive a different value base from what you're doing. They will stop measuring you on how cheap you are. And guess what, guys, you can never be cheap enough.
You can never be cheap enough. They will always want you to be free because of the NHS. You are not the NHS.
You can never be cheap enough. There will always be clients that want you to be actually dishing out what you do for free. So if we change our primary question, And make it.
How can I deliver the best standard of care for this pet? We will start to see different behaviours, but here's the problem. We all come loaded.
We all come very preloaded with our beliefs. We also then form new beliefs based on the data in front of us. We are data gatherers.
We are pattern recognition experts. We look for information, we film myself a ticks. Have a look at this picture.
Tell me what you see. What do you see in front of you there? And I get some brilliant answers to this when I run this as a whole team workshop.
Some people just shout out Eropion. I've had someone else shout out, Muppet. My favourite is genetic disaster, but What does the client see?
Do they see any of that? No. They have a completely different perception of what's on that consult table and Guess what happens?
Is this a great way to start their experience with us when we've got such a perhaps different perception of what's in front of us, because guess what guys? It will be leaking out of you. It's called lexical leakage.
Your brain thinks it has to come out somewhere. It's been proven when they do little monitor. Electrodes, you even do subglottal vocalisations, which means it doesn't make it out through your voice voice box, but your throat actually moves and forms the shape it would need to form to say those words out loud.
This is a, a brilliant bit of research that was done, based on your hidden belief systems and those subglo vocalisations are, are gonna, they're gonna come out of you in other ways, it's going to be expressed in your pitch-ba tone or your body language somewhere. So we need to think about this because how, how do we set those beliefs? Well, obviously, with the Shar Pei, we've probably seen enough slash being bitten by enough to have a set of beliefs that are based on data.
We also go with that social proof like the eye roll for Diane, which gives you a belief that you may not have even experienced fully for yourself, but you've got enough of a marker. Anytime your partner says anything to you that starts with you always, or you never. Guess what?
As a global belief system that they've set up, they will now be filtering your behaviour with the reticular activating system, looking for more ways to prove what they believe because that's what our brain does. It goes, Oh, you want that? I'll give you that.
It hopefully looks like that new car that you've just bought. It hopefully looks around the car park and picks out those ones that match. So how do we change this?
How do we go about setting a healthier belief system? What is the The point of this, well, there's 3 things that we need to remember. Anytime you want to change behaviour, there's the 3 E's to lasting change.
First, we need to educate, then we need to engineer, and then we need to enforce or encourage those behaviours so that we're positively rewarded. And this works for children, it works for dogs, it works for spouses as well. So we need to do the education first, then we engineer, then we enforce and encourage.
So here's the model that we use when we're running this, and we display this to the whole team and we get them to understand. This model starts with a leaky bucket. So we get a flow in of cash.
This is our cash flow coming in, which is driven by your team engagements, your leadership, and drip drip drip into the bucket, your identity, your branding, your niche, your client compliance, your rabbit awareness campaign, whatever you're doing forces the flow out of your tap into this bucket. Here's the bad news. There are some holes out the side.
We've got leaks coming out on both sides. One of those sides is your systems. So that's the behaviour of practise, if you think of it in those terms.
So whether you've got decent cost control set up, whether you've got credit control in the first place to stop debt from building up and then decent management of your debtor days to get it down so that the money is in your account, not your clients when you've already done the work.to control, making sure you haven't got loads of stock going off and bottles of alfaxan and conveniia turning origin in the fridge. But then the other side, or forgive me, let me just go back.
The other side to that is this side here that we really have to talk about . What does this mean? Correct pricing.
What does that mean? We have to make sure that our prices are set for the correct amount of money, not just the finger in the air diagnosis of, I think we should charge that, but actually to cover your costs and leave a bit extra because look, we have to rise above the amount to cover a fixed costs. So that is the fabric of the building, the electricity, the lights, the heating.
Then we've got to pay for the drugs that we want to dispense. Only when we've got above this level. Is whatever's left floating on top called profit and obviously it's draining out at the same time.
So we've got to meet these costs, to be able to be left with that. So your pricing must reflect what the amount of money is that you need to charge to get into that zone. We've then got to make sure that we're accurately invoicing.
That means not smuggling a cap under your lab coat out to the back for an ultrasound and actually remembering to invoice. You might think you've just missed a shot of me can, but that's 6 quid if your profit margin at the practise is only, you know, 8%. And the whole op was 100 quid.
8 quid is actually quite a large hit out of your profit. So we need to talk about this bit down here, missed opportunities, and I'm coming to the last piece of this now, because I know I've got a time limit. I've got to make sure I don't run over.
So I'm going to go through this. I'm always happy to answer questions at the end or talk to people afterwards on the email if they want more detail on this. What does this mean?
Well, we've got to think about adding value to the client. They've got to perceive the value in the consultation. To be able to feel OK about the price we then charge for it.
When we start discounting our professional time, the very first thing that happens is the client starts to not value your work for what you do. As soon as you start saying things like, Yeah, we'll come and have a free consult. Oh yeah, it's free for a recheck.
As soon as we start selling ourselves at too low rate and not charging for everything we do, that is a missed opportunity to actually In a way, educate the client that medicine costs money, just like a lawyer, just like a mechanic, just like a plumber, for goodness sake, don't have to spend the 5 or 6 years at that school that we do. And we also have to really be sure that we're listening to that client concern. And what does that mean?
There's this lovely statistic in a 10 minute consult. The number of open questions used, that's a question that requires more than a yes or no answer, is 2. What's really funny is when we increase that consult time to 15 minutes and even to 20 minutes or 30 minutes, guess how many open questions are then used?
2, still. And one of those is, how are you? So there we go through these heuristic shortcuts, we, our behaviours are designed to get us to that diagnosis as quickly as possible.
Sometimes though, the client doesn't want just the diagnosis, they want the prognosis. They want to know what's going to happen next to my pet. We must be aware that we need to listen to those client concerns to be able to effectively serve them.
For them to feel this value that we're trying to help them to perceive. Then there's this one, the failure to recommend treatment. I'm going to come on to that as my last piece in this presentation, not doing the work presented.
Why is that? Why is that such a problem in this industry? And then there's failure to follow up, which perhaps isn't as big a problem because I think we're all intrinsically nosy, aren't we?
But this failure to recommend treatment, I'm just going to zoom in on that briefly. So here's a study done by Hills. It's a very interesting one.
They took 100 pets that had a need of treatment. Of those diagnosis was made of 90% of them, 90 out of 100 diagnosed correctly. That's fairly good.
The biggest drop off in terms of those that then go on to actually receive the correct treatment for that condition is a 35% 1, and it happens here between this diagnosis being made and the recommendation made. Why is that? Only 45% end up getting dosed correctly.
It's ridiculous. When vets were asked this. They came up with a number of reasons.
The biggest one being I didn't think the client could afford it. The other one, the other biggest win was, oh, the client was stupid or they didn't hear me. I gave them all the options.
They just weren't educated enough. And those were the two biggest reasons for this huge lack in compliance here. However, the clients, when asked, said things like, well, yeah, I didn't know that was what the vet wanted.
When they were then qualified with, if the cost was X, would you have gone ahead with it? Yes, I would have done. So it's really interesting and, and they, there were a couple, to be fair, that did say, oh, the vet mentioned something, but I didn't understand it.
That did happen for a number within the study. But also very interesting was, well, the vet gave 6 or 7 different, different options and I couldn't decide. How interesting is that?
We're not correctly perhaps offering what we think should happen. So this is just the graph of the veterinary perception and the keyword is this perceived again, the perceived reasons for client noncompliance. Look at that, 60% the cost.
And I think it's 57 were the client communication, client education part. But that's a huge whacking great amount to lose, to be missed opportunities, and the key word is that perceived thing. Don't X-ray your client's wallets.
As a better question. If we can get to the point where we're asking good questions, we will start to, find these break points in our systems and our processes that mean we can better serve those animals and we want to do that. That's what we're all here for.
Coming to the end, so I'm just gonna summarise everything we said today. We want to add value to the consultation, so we've got to start by being willing to charge a fair price for your professional time. This must be an amount that covers those costs.
Remember that leaky bucket. We've got to rise above that level that we must generate, to get to that point where we're then making some profit on the top. And again, it's got to be done in an ethical way.
It's not about charging. Extortionately for what we're doing, but it's charging a fair price. Those are the key words.
We've also got to aim to be respected first and light second. We do a lot of appeasement behaviours, a lot of spanieling, rolling over and showing our tummy. We go for the friend option quite a lot as vets.
We want them to like us, don't we? But we also want to practise good medicine. So go for respect, even if that is respect of your fee structure.
The liking can come later, but that's not what the clients are there for. They're there for our veterinary medicine. We've got to learn to live with 10% price queries.
So a price query is the how much the sucking of your teeth, which you do like I do every time I go to the garage to collect my car after an MOT, and it's like, what? What's it need now? You know, I have to pay it.
Why? They've got my keys hanging up in that little box behind their desk. I'm not getting those keys back until I pay my bill.
I will still always say, how did I, did I really need a new car? I'll always do that. But usually the answer is yes, madam, you did get in your car.
So 10% price query is what is acceptable. That's normal. 2% price rejection, where they actually say, I am not paying that.
But you know, it is 2% and maybe those clients do need to Be a client of another practise because you need to be able to feel that you can charge for what you do. And we need to ask open questions. Remember that statistic of the average consult only having two questions that are open in it, no matter what the length is.
And then the last point is that clients and team must look at resetting their beliefs in order to deliver income growth that allows this reinvestment back into the practise in the form of either equipment, CPD, pay rises. That's where it comes from, guys, and it's as simple and as beautiful as that. We've got to have this wheel turning.
Where we are able to add this value to the client so that they perceive the value we're giving them, just like we do with the plumber, just like we do with the lawyer, just like we do with the mechanic. And then we're able to financially sustain ourselves and ride out those bumps in the road that we know are going to come up anyway. So I just want to leave you with one last thought, and that is just this little reminder of that trial, that physiology, focus and beliefs.
Your beliefs set your behaviours. Your behaviours come directly from whatever belief system you hold. That's just down to your reticular activating system.
It's neurology. And how you behave is usually driven more by the chimp part of your brain if you follow the chimp paradox, and that very old part, the amygdala, your emotional hijack, drives your behaviours, which then as a net result, drives your communication. So when we talk about communication, just circling right back around to where we started, what we're really talking about is our beliefs, our habits, our behaviours.
They all stem from those key held. Deep in the part of your brain that we never even think about. So, thank you very much for your attention.
Happy to answer any questions you've got. Thank you very much, Libby. That was fascinating.
Anybody, if you do have any questions, you can either post them to the Q&A, section or the chat box, and I'll pick them up. As yet, we don't have any, so you must have answered everybody's questions already. That's a good sign.
I'm, it is indeed. Just whilst I remember, I'm delighted to hear you talk about the chimp Paradox because I love it. If you're interested, Steve's got a new book coming out on the 15th of November.
So, if anybody likes Schimp Paradox. There's actually two books coming out, one aimed at adults, one aimed at children. So, I've got a couple of questions for you, whilst I wait hopefully for some others to come in.
I totally agree with you on the NHS and having worked in the NHS, I think it's ironic that nobody in the NHS knows how much it costs either. No, they don't, but, . Is it, you know, how much of this is the mindset of the vet and how much is it of the client expectation?
It's both. Yeah, it's, it's both. You, you need to start with you though.
We can't ever affect behaviour of those around us until we've set our own barometer. And what I find most commonly that's really sad is Aspects tend to agree with the client. We think, we think it is too much.
We get embarrassed. I remember doing a discount for a lovely client of mine who I, you know, when you get into the consult room and you're just chatting and it's going really well, I did a discount because she brought in two animals for a dental for me, slid the bill across the test at the end and went, so I, so I've taken some money off because you did two at once, and she's like, Why'd you do that? And then as she walks out, And the receptionist turns to me and just says, you do know she owns a yachting company, don't you?
And I was just like, Oh God, no, I didn't. But my perception was that the charge was extortionate because I'd not seen two dentals for one client before. And so the bill came to, I think it was like around 800 quid or something like that.
And for me, as a new grad, I was horrified. So when we start to look at client behaviours, we do have to start with, where does my own Needle sit and a lot of the time when I deliver this workshop, people have never thought about this cycle of money in money out and it has to, it has to work that way. Yeah, I mean, it still amazes me to this day, the number of vets that don't know their break even point.
Gobsmacks. You touched on that, you talked about being a new grad. Do you, as you're going round, notice any difference between new grads, assistants, partners, owners?
There's two ends of the scale. Yeah, there's two ends of the scale. What I see is a lot of partners are firmly in the friend zone, you know, some of their clients have been with them for 2030, 40 years, and so they discount as a way of honouring that relationship.
They haven't worked out link perhaps about a value proposition. And the difference between being a friend and being valued for your service is huge. And you hope that your friend won't sue you, you know, you hope that your friend won't complain about your work, but offering value and, and that perception of value is so important.
So partners are often the worst culprits in my experience. Equally, you get a lot of people that are sort of 2 or 3 years qualified who have got into the rhythm, they've found their flow, they know what they're doing, and They, if they haven't had this chat about where the break even point is or what the costs are, they genuinely don't understand what price is for. They just turn up every day and do their job.
They do it really well. They've got a level of competence that they're happy offering that. So they see it as, oh, well, if I'm happy doing my time for free, does it matter?
And obviously, yes, it does to the practise, not to that individual vet. So I have a larger education piece with sort of 2 to 5 years qualified as well. New grads in answer to where your question started.
It's really interesting. It's beginning to be more accepted to talk about business than when I was even graduating about 8 years ago, something like that. So, you know, now it is beginning to work its way into curriculum.
The newer vet schools are really good at building it into part of, that leads us on very nicely then we've just had a question pop up from Peter. Hi, Libby, in your experience, how many practises actually discuss the cost of running their business with their staff? Really good question.
Hi, Peter. Well, I go around the country delivering this. That's almost my full-time job.
So the answer is quite a lot. When, a client joins that dynamics, what we do is we try to, educate the whole team because when the whole team is pulling in the same direction, Suddenly, it's like a team of huskies, you know, if you, if you're pulling in the same direction, the sledge just moves faster. So we go in and we, we get everyone from kennel maids to receptionist to nurses, and they're in this room together as we go through the practise figures, and it's a really great thing to do.
Sadly, in answer to your question, not everyone does that, obviously, but There is a, there is a growing trend towards a bit more transparency about where prices come from. There's also what I'm seeing with the clients that I work with as our platinum clients, so they come away with me for 2 days every other month of just pure business CPD. Those type of clients, you know, they, they are only independent vets as well.
We only work with independents. But they are keen for the team to Stay bonded, to stay loyal. We all know that recruitment is a problem.
It's far cheaper to keep your team than to recruit new ones. So, you know, there's an incentive there as well. But if people know why they're charging, they are more likely to charge it.
And so it this education piece, those three E's, is, is really critical. Yeah, absolutely. I mean, a top tip, I actually went with the practise recently, and it was their idea, not mine, but I, I'm going to steal it.
When they had an open evening, they had the price tags of all the equipment. It was a great way of educating the clients coming around that this is why it cost. Yeah, lovely, isn't it?
Absolutely. We've had a comment from Minka who says in California it's just the opposite. First they give the estimates before even the clinical exam and it ends up higher than the estimate.
Wow, isn't that interesting? So that's a whole just as structural difference in terms of where the mindset starts from. Absolutely, yes.
Yeah, that's because obviously they wouldn't enter into it if presumably they couldn't afford it because it's the same with their healthcare system. So, yeah. Yeah, and certainly when I was in America, that was one of, you know, you, you speak to the client and and particularly if they had an inpatient, it was what, what are we going to go up to before we need to ring you and have another chat about how much it's costing.
Yeah, have you got any top tips for dealing with a vet who consistently discounts despite having been spoken to on several occasions about it? Yeah, this is a tricky one, and I've come across this a couple of times, and where you have to start with any behaviour is what problem are they trying to solve. All behaviour is designed to solve a problem, not be a problem, as I said earlier, they are doing something because of what payoffs they're getting.
They're getting a bigger payoff by being quote unquote, disobedient. And again, it's the same with children. If they are consistently repeating behaviours, you have to look at what Benefits are they gleaning from it.
Now, I would suggest in a veterinary world, it's most likely to be that their fundamental belief system is set at a lower barometer price point. So they are only doing what they feel is morally right. Most vets have a high moral compass, so they will behave in a way that serves their rulebook.
It is the best way to think about it. So you have to, you have to sit and ask them what's going on? What do you believe?
Where are you starting from? You can't just keep talking at them if their behaviour hasn't changed. So you have to engage with them and work out why they believe the prices are too high, because that's what their behaviour is demonstrating.
It's very interesting that you say about the reward system because I was at a practise again where it was one vet consistently doing this and actually they did all the breeder work. All the breeders loved this vet. That's it, isn't it?
Got discounts all the time. So that was the reward. So their reward is an increased societal bond.
They've created a system for them which pays off. There's this lovely piece of work about six human needs. I don't know if you know it, it's really powerful, but that person's highest human need is probably the one of love and connection.
And significance might be up there as well. So they are gaining a huge payoff in terms of significance because suddenly the breeders are going to be booking in with them, right? And they're gonna also be getting a lot of love and connection back from that relationship.
The money is incidental. They don't care about that. They're getting a bigger payoff, a bigger reward.
We've had a, a question from Deborah. I'll, I'll just answer this. Is there a recording.
I need to share this with colleagues, so they've obviously enjoyed it. Typically, the recordings will go up within a couple of days on the website. So obviously if you've, if you paid to get this, then you can access the recording.
So that will be available quite soon, Deborah, so don't worry about that. Obviously, I'm happy to come in and deliver this exact workshop to the whole team if anyone's interested. My email address is on screen.
And that's, literally what I do. And I'm really passionate about doing it, you know, it's not about making money out of your clients. It's about believing that we're worth something.
And I think our industry needs that. I think we need to remind ourselves that we do a blooming valuable job. And, you know, we've, we've trained for a lot of years to get to this point, whether we're a vet or nurse, we've, we've jumped through a lot of hoops to be able to offer this service.
We shouldn't be embarrassed about them charging for it. No, absolutely not. Right, I think, let me just have a quick check.
I think you've answered everything that's been asked. So unless I give anybody like 10 seconds if there's any burning final questions. OK, not seeing anything else coming through.
So just to thank you again, Libby, that was fantastic talk. And again, just to remind everybody, our sponsors for this evening were Simply Health, the Saint Francis Group, and 8 Legal, and I look forward to, joining you on the next, practise management webinar. Thanks again, Libby, really useful and as Libby said, if you're interested in, getting in touch, her contact details are there, and I'm sure she'd be delighted to have a chat with you.
Thanks again. Thank you for having me.
