Motivating changes?

Re: Motivating changes?

Judith Joyce — Mon, 21 Nov 2011 14:57:30 GMT

[quote user="Anthony Todd"] doubt if a tribunal would find in the employers favour if the employee had continued to use brand B instead of Brand A particularly if this protocol could be shown to be dictated by profit.[/quote]

I disagree. An employee, whether a Vet Surg or not is still required to follow the reasonable instruction of an employer. Furthermore, ours is one of the only types of business where profit is not the dominant, if not sole, dictator of best practice.

Re: Motivating changes?

Anthony Todd — Mon, 21 Nov 2011 13:13:18 GMT

[quote user="Gerry Henry"]You've gone off on a money tangent[/quote]

Well. not me. The thrust of the thread seems to be aimed at profit increase to a large part , and while this is connected to protocols and best practice,I think it's better to measure these directly not via turnover.

I doubt if a tribunal would find in the employers favour if the employee had continued to use brand B instead of Brand A particularly if this protocol could be shown to be dictated by profit.

Re: Motivating changes?

Gerry Henry — Mon, 21 Nov 2011 12:08:36 GMT

[quote user="Anthony Todd"]

[quote user="Gerry Henry"]Comes under misconduct; one verbal, 2 written, the second constituting dismissal.[/quote]

I'll bet London to a jar of jam you'd lose every time in a tribunal just 'cos it is palpably not fair and reasonable, and compensation is unlimited now AFAIK....

You'd be seen, embarrassingly as being solely profit motivated and the response by the Daily Mail and others would be not favourable......

We measure best care, not money ie microchip, worming, dentals, Xrays, lab tests etc. against contacts, nothing about money, except as a ratio of performance, and nor it should be.

[/quote]

You've gone off on a money tangent; failure to adhere to procedure/and or changes in procedure could be failing to obtain informed consent, failure to discharge animals properly, failure to close the (new opening!) back window when opening cat cages, etc etc; compensation is only unlimited in cases of sexual/racial descrimination.

Re: Motivating changes?

An On MRCVS — Mon, 21 Nov 2011 11:43:09 GMT

[quote user="Braden Collins"]

I think it needs to be approached from several fronts.

I think you need to involve the staff in the decisions and explain the reasons for it. People won't change without a reason. DONE, sort of in that opinions sought but buck stops with the partners.

Keep the staff up to date with regular performance reviews, They need to know how their turnover and performance compares to others in the clinic if it is to be shown that they're underperforming. DONE on a broad-brush basis

Link payrises to performance - there's no point in them complaining they're not paid enough if they are undercharging the clients and not providing a good quality service. DONE, following on from the previous matter

Encourage CPD and make it compulsory - I am happeir charging more when I feel more confident in an area. DONE, budget per vet per year

Be open to staff about the running cost of the clinic - explain how much it costs to open the doors each day, what the break-even point is and what hourly turnover is needed to keep the clinic profitable - many employees would be shocked how expensive it is to run a clinic. DONE, again in broad-brush terms

Make sure they understand the true costs of undercharging - if a procedure costs the clinic $100 to perform, it gets charged out at $150 for example and the vet undercharges by $25, they need to realise they are not reducing the clinics profit by 1/6, they are halving it. DONE

[/quote]

Whoever it was who described it as herding cats came closest to the reality. How long do you go on before you make people redundant due to rising costs yet static turnover?

Re: Motivating changes?

Anthony Todd — Mon, 21 Nov 2011 10:47:14 GMT

[quote user="Gerry Henry"]Comes under misconduct; one verbal, 2 written, the second constituting dismissal.[/quote]

I'll bet London to a jar of jam you'd lose every time in a tribunal just 'cos it is palpably not fair and reasonable, and compensation is unlimited now AFAIK....

You'd be seen, embarrassingly as being solely profit motivated and the response by the Daily Mail and others would be not favourable......

We measure best care, not money ie microchip, worming, dentals, Xrays, lab tests etc. against contacts, nothing about money, except as a ratio of performance, and nor it should be.

Re: Motivating changes?

Braden Collins — Mon, 21 Nov 2011 07:00:15 GMT

I think it needs to be approached from several fronts.

I think you need to involve the staff in the decisions and explain the reasons for it. People won't change without a reason.

Keep the staff up to date with regular performance reviews, They need to know how their turnover and performance compares to others in the clinic if it is to be shown that they're underperforming.

Link payrises to performance - there's no point in them complaining they're not paid enough if they are undercharging the clients and not providing a good quality service.

Encourage CPD and make it compulsory - I am happeir charging more when I feel more confident in an area.

Disclaimer: I don't own a clinic currently, but am in the process of buying one. These things abouve are what has helped me increase my turnover and compliance with clinic protocols over time.

Re: Motivating changes?

Gerry Henry — Sat, 19 Nov 2011 17:39:32 GMT

Hmmmm. Your employee contracts contain a sacking clause which details non-compliance with practice protocols. I don't think even the Corporates have this. I can think of a couple of budget vets who have something similar

Comes under misconduct; one verbal, 2 written, the second constituting dismissal.

Re: Motivating changes?

J G Wray — Sat, 19 Nov 2011 12:12:31 GMT

[quote user="Gerry Henry"]Only implement change if it represents a demonstrable improvement on the status quo; if that fails then there's always plan P45.[/quote]

As for motivating change, then there has to be a good case, a good argument for change and consistent and persistent leadership on the issue. Demonstrating enhanced profit after a trial period is always good, because demonstrating improvement in clinical practice is cumbersome and difficult. Challenging the back-sliders, particularly with their below-par performance is pretty potent.

JGW

Re: Motivating changes?

Hannah Wynne Richards — Thu, 17 Nov 2011 15:32:45 GMT

I don't re- check everything I recheck everything that needs rechecking or at least suggest it The problem arises when some assistants or locums dont recheck anything -because they have a serious psychiatric problem about charging-even when owners are willing topay-same goes for lab tests discussion about worming checking teeth when presented for vaccinations etc If An On has one of this type,then I honestly thinka P45 is the only answer

Re: Motivating changes?

Julian Earl — Thu, 17 Nov 2011 15:30:12 GMT

[quote user="Martin Atkinson"]

... The impression given was that their is a policy of everything must come back regardless which is just one step short of the (alleged) 'no-one leaves the consult room without they've spent at least £N' policy a certain corporate had.

[/quote]

Absolutely not; it was simply a case of getting a general ratio to see what people do.

Re: Motivating changes?

Martin Atkinson — Thu, 17 Nov 2011 15:05:12 GMT

[quote user="Julian Earl"]

There many cases, every single day, where it is possible to say to the client, "treat Fido for x days, and bring him back if the problem is not better" or some variation thereof.

[/quote]

This is very true and I will say you must bring Fido back in a week to re-check his condition if it required treatment that necessitates an objective opinion as to the success or otherwise, I would not leave it up to the owner, you are leaving yourself open to discipline by putting the onus on someone who is not qualified to make a clinical decision, at least that way if they don't come back and it goes belly-up it is their fault not mine, but I have to confess even as a one man band I forget sometimes. The impression given was that there is a policy of 'everything must come back regardless' which is just one step short of the (alleged) 'no-one leaves the consult room without they've spent at least £N' policy a certain corporate had.

Re: Motivating changes?

Julian Earl — Thu, 17 Nov 2011 13:05:34 GMT

[quote user="Martin Atkinson"]

[quote user="Michael Woodhouse"]

[quote user="Julian Earl"]I've looked at our recheck rates recently and the individual differences can be quite striking. I manage to achieve a 1:1 ratio, but others have a ratio of 5:4 or even 5:1. I have simply indicated to the others that 1:1 is possible.[/quote]

I did give the figure of 75% a bit of thought. There is a proportion of cases that don't need seeing again; remove a tick, squeeze anal glands etc so I don't think it is realistic to ever have a 1:1 ratio. Depends how you work it out and account for things I suppose. What if you see a dog a total of three times because it requires more treatment? Is that 1 recheck or do you count it twice?

[/quote]

The policy of enforcing a 're-check' rate is anathema to me. I don't have a clue what re-check rate I have - if something needs seeing again it is seen, if it doesn't, it doesn't, simple really, the day I put commercial practice above best practice is the day I quit. I certainly wouldn't work anywhere that tried to force me to do it.[/quote]

There many cases, every single day, where it is possible to say to the client, "treat Fido for x days, and bring him back if the problem is not better" or some variation thereof. Those cases are not rechecked, by and large. The point of showing the numbers to staff is to encourage the situation whereby they, the vet, decide that Fido's ear/joint/ swelling/chest/cough/etc/etc is better, not the owner. That is not to say that ALL cases need a recheck, they clearly do not. But when I, on average, check first presentations once, and when we all see similar cases, there must be a reason why someone else only checks first presentations on one in five occasions. It is good practice and, funnily enough, good business as well.

Re: Motivating changes?

Martin Atkinson — Thu, 17 Nov 2011 11:27:06 GMT

[quote user="Michael Woodhouse"]

[/quote]

Re: Motivating changes?

Julian Earl — Wed, 16 Nov 2011 20:15:10 GMT

[quote user="Michael Woodhouse"]

[/quote]

I looked at total first consultations versus total rechecks so the one to one ratio included those that are rechecked twice or as often as necessary. It was not a case of every single case gets a recheck. However, it doesn't include post-operative checks - those are listed separately here.

Re: Motivating changes?

Hannah Wynne Richards — Wed, 16 Nov 2011 09:34:55 GMT

I'm not offering any advice-merely sympathy to An On I'm hopeless at getting other veterinary surgeons to do things myway so lack of employee compliance is one of the reasons (greater profitability is the other ) I decided I was much better off without assistants-but it is a massive problem toemployers, and assistants who won't toe the line need (especially in today's job climate ) to realise that if pushed too far,the boss may decide on the P45 solution

Wynne

Re: Motivating changes?

Gerry Henry — Wed, 16 Nov 2011 09:04:53 GMT

[quote user="katja wagner"]

[quote user="Gerry Henry"]

I wasn't joking about plan P45; two written warnings then ta ta.

[/quote]

Hm,with that attitude you might aswell employ a slave or a well trained monkey just dont expect employees who go the extra mile for your practice !

katja

[/quote]

Actually all my staff go the extra mile; no reasonable (staff) request is ever refused, time off when needed at short notice etc etc and we pay well; also all changes are discussed and agreed before implementation; I won't say its a democracy but I probably back down in the face of good counter argument more than they do ... however once policy is decided that's it. I've only had to sack two people in 15 years, not bad really.

Re: Motivating changes?

Michael Woodhouse — Tue, 15 Nov 2011 23:31:55 GMT

Re: Motivating changes?

Utlendigur — Tue, 15 Nov 2011 23:13:00 GMT

I don't think there's a "one size fits all" for motivating staff - it depends very much on the staff member, their personality and what factors motivate them, or hold them back, generally. We have some staff who get very anxious and automatically dig their heels in at any change - new ways of doing things have to be introduced gradually and with a "just try this way, we can always go back to the old way if it doesn't work" presentation. Trying to force the issue just results in more anxiety and more inclination to refuse, grumble, complain, even sabotage. What causes the anxiety? - who knows - maybe feeling that people don't think they're doing the job well enough currently, fear that they won't cope, laziness, perceived extra workload etc etc. Others are motivated by a desire to do the job well and are generally much more open to new ideas, especially if someone takes the time to explain the benefits - often then they will run with idea and expand on it or tweek it to be even better - wish we could clone them. For someone who is money motivated a financial incentive may work - but that might actually have a detrimental effect on someone who values doing the job well above all else, because they'd feel like they were compromising their principles. Herding cats I think is the phrase

Re: Motivating changes?

Julian Earl — Tue, 15 Nov 2011 22:34:09 GMT

[quote user="Michael Woodhouse"]

Is the solution here the carrot rather than the stick? Could you give them a 'recheck' target and once 75% of their 1st consults are booked a second they get a bonus? Each Frontline sale they get 20p, but nothing for the others?

The spot on argument is flawed as each do a different job. There will always be times when the practice policy choice for treating condition X isn't suitable in this case and you need to use something else. Its fine having a policy but what do you do when the Metacam makes the dog sick and your policy dictates that what arthritic dogs have to have?

Simple thing is to have the boss 'sign off' each order. We don't do that, but know a few practices that do.

[/quote]

I've looked at our recheck rates recently and the individual differences can be quite striking. I manage to achieve a 1:1 ratio, but others have a ratio of 5:4 or even 5:1. I have simply indicated to the others that 1:1 is possible.

As for the spot-ons, I can see that rationalisation would be beneficial. They may all do different jobs in some senses but it is helpful if the standard spot-on to someone coming in to purchase an over the counter (Ok, we're talking about POMs but let's assume they are a client) flea treatment is the same every time and not dependent on which vet happens to be available.

Re: Motivating changes?

Vet2Vet — Tue, 15 Nov 2011 21:29:18 GMT

By the way , I think Michael's point is very valid about carrot versus stick . Most people need a little more motivation than NOT being shouted at !

Re: Motivating changes?

Vet2Vet — Tue, 15 Nov 2011 21:28:04 GMT

It is an interesting discussion . I think the kernel lies in the fact that private practice traditionally allows choices available for clients and staff alike in terms of what is on offer . If you "brand" it so that choice is limited for clients and staff you will be able to make economies in this way . We are seeing elements of this emerging with large groups and also low cost clinics . The trouble is , some vets and nurses do not want to work under these conditions and also many clients prefer options and choices and a traditional service . I think if you want to severely limit choices then you probably will be aiming at the lower cost end of the market .

Re: Motivating changes?

Michael Woodhouse — Tue, 15 Nov 2011 20:57:53 GMT

Simple thing is to have the boss 'sign off' each order. We don't do that, but know a few practices that do.

Re: Motivating changes?

katja wagner — Tue, 15 Nov 2011 19:41:54 GMT

[quote user="Gerry Henry"]

I wasn't joking about plan P45; two written warnings then ta ta.

[/quote]

Hm,with that attitude you might aswell employ a slave or a well trained monkey just dont expect employees who go the extra mile for your practice !

katja

Re: Motivating changes?

Martin Atkinson — Tue, 15 Nov 2011 19:33:41 GMT

To a lesser extent I have this problem with my nursing/reception staff, they just re-order what we've always used even though we've had a discussion on change of protocol - they forget. One answer was to put a sticker on the shelf next to the product to remind them, and myself really because I'm almost as bad. Because I run a tight ship I can review the order and send stuff back if I don't want it so all is not lost, or I can disable it from the ordering system. This is of course easier for me as I don't have to deal with recalcitrant vets as well. I know you are just giving examples but the example you gave is a good one: there is room on the shelf for Stronghold, Frontline and Program (and Advocate as well) they all have their plus points, that applies to any number of products like NSAIDs and again I think you do your staff a disservice if you deprive them of making that choice. In the end you can wield the big stick but having been in both scenarios I can empathise with both sides, just be careful you're not treating them like fools who can't make their own decisions, I know if I was dictated to what I had to use or do, if I didn't like it and thought it was unreasonable, I would have walked and did several times

Re: Motivating changes?

Gerry Henry — Tue, 15 Nov 2011 19:32:11 GMT

I wasn't joking about plan P45; two written warnings then ta ta.