Slide Flashcards
Name the differing types of interview questions?
Initiative
Motivational
Attutude
Persona (job related)
Management
IN pre employment testing, reliability refers to?
2) in one on ones- what types of questions?
how dependable or consistently a test measures a characteristic
2 behavioral, competency, situational
What is onboarding
The planned and executed process of welcoming, orientating and training a new employee
Management tasks prior new hire first day
1.send a welcome letter, training dates, where to park, website, early access intranet
2.notify current employees of decision, new schedule and expectations
3. meet with trainers to discuss
4. inform new employee what to bring first day
4 c’s Onboarding
compliance
clarification
culture
connection
facilitate onboarding with EASE
Encouragment
Align
solve
End
What is a reasonable training investment
1-2% of gross revenue
Give examples of core competencies
Teamwork
Customer focus
Accountability
Technical skills
Employee IDP are
between management and staff
can include ann goal setting
effective training tool-built on positivitiy
used to increase scope of tasks and gives employee fulfillment
What are employee improvement plans
plan when employee in line for progressive disciplinment without improvement
What is ten minute flex schedule
fastest growing system. 10 minute increments dependant on appt type
Most common due to flexibility
What is preferred bonding rate
70% tentured doctors
25% new doctors
What is formula for fill rate
booked appt/# apps in day as %
ex. 8 booked- 10 in day=fill rate 80%
How often update clients when have emergency
every 5 minutes
What are acceptable appt reminders
call
text
automated service
email
Name some staff scheduling considerations and timer off requests
limit new employees all at once
staff budget likely guild # staff members
Post schedule consistent deadline in advance
30 days time off requests
keep those request two years like timecards
no verbal agreements
time off policies limit favoritism
Key to successful vet practice.. Two words pm too think about
delegate and empower
smart system for teams
specific
measurable
agreed
realistic
time bound
What does it cost average hosp to be open per minute
$10
Step to determine staff if a leveraged correctly
ask them list every task in one week period. are they working below potential
Various type task classification “to do lists”
opening
departmental
individual
task specific
time list
training meeting considerations
can be as long as needed.
set goals. no matter who speaker it- list notes.. after meeting “you should be able to”
should include tests( ensures quality time -time well spent)
What is PM challenge in employee reviews
make them relevant and useful to practice and employee
Marsha Heinke’s 3 basic approaches to employee performance evaluations
- formal performance reviews
- coaching conversations
- corrective action discussions
What are 4 elements of most successful employee performance review programs
- regular informal feedback by supervisor
-day to day observations- even .
praise– can practice with quarters
2.performance goals set by employee and supervisor- employees need 5to have active role in review process help with goal setting- timeline and quantificable- give them tools- record and review often, modify is needed
3.Actions plans to address performance or disciplinary problems- e mployee should have input.. help them design plan- will get more buy in and greater commitment. ** review often
4. formal reviews that address big picture (follow through)- has the statements goals been met, have action plans been followed, is team member on right path
What is role of 3- corrective action
- annoyed, take notice
- second time, mentally note-pattern
- 3rd-warrants conversation
three occurrences is justified conversation- examples are helpful
ABCDEF formula- for corrective action
Awareness-describe with clarity to employee
Behavioral Expectations-explain improvement employee must make
consequences- what will happen next if behavior repeated
Decision confirmed-ask employee if able to make change=need agreement here
employee involvement-if employee agrees, THEY must write action plan- can use smart goal - help them WHAT NEEDS TO CHANGE TO MEET EXPECTATION
follow up-SCHEDULE a time to follow up employee
steps in managing conflict management with employees
- conflict addressed
- listen all issues
- determine real problem
- exercise control avoid argument
- avoid delay in decision
- maintain records
Conflict management thougths pm
as pm we need to model way and help them succeed-
questions to ask in conflict
- is this individual problem
- who is involved
- does it relate to job satisfaction
- is patient care compromised
- is poor service the issue
confirm what you hear with :what i heard you saY is
General discipline/discharge employees. 3 steps
- verbal warning with correction method-documented with supervisor signatures
- written warning (# decided practice) doc/signed- bjoth parties
- final waring should state next step termination
Pitfalls leading to wrongful termination
- no regular evaluations
- unsatisfactory eval… no raise
- policy manual should stae- employee may be terminated on 2 weeks notice, with or without causse
- education on policy
- not related protected class
- family stessor- give time
Immediate termination grounds- no warning
unethical behavior
criminal activity
falsification of records
insubordination
ppe
will violation policy
timecard violation
sleeping on duty
imappropriate computer use
What is qualification for Cobra .
20 employees on 50% of the typical business day previous calendar year
Session 4
Session 4
Preferred Provider PPO
blend of fee for service and HMO- not required to visit primary- do have network of providers and cost more to go outside network
Point of Service Plan
like HMO except don’t have to see primary first to see specialist unless the specialist is outside of network
Section 125 plans
tax saving both employer and employee. allows employees to pay certain expenses including premium, before taxes deducted
IN FSA account- who owns it? can it roll over
FSA acct , pretax section 125 plan, owned by employer, no high deductible plan required. generally use or lose end of years
ACA
Affordable Care Acct PPACA of 2010
What are stipulations ACA
50+ full time employees or be penalized if not providing health insurance employees, If you are under 50 employees and don’t provide, employee can be penalized. Act also places certain cap/CONDITIONS on HSA and FSA
Who enforces ERisa
Dept of labor
What is name of act for ERISA
Employee Retirement Income Security Act. Title 1 1974
What is SIMPLE IRA
Savings Incentive Match Plan
Specifics of SIMPLE ira
established by employers, employee contribute pre tax $- employer required to match or % contribution- simple to administer
401 K Plan specifics
Established employer
employer not required to contribute
can have profit sharing component
need professional admin and can be costy]
SEP stands for
Simple Employee Pension
What are the specifics SEP pension plan
similar profit sharing
funded employer- NOT EMPLOYEES
employer has tax savings
Types of employee benefits
Health insurance
Retirement Plans- 401 k, simple, sep
PTO
Sick leave
Vacation
Holidays
Pet Health care
Dues/license- need a policy
continuing education- cost 5% practice(team development)
Disability insurance
uniform allowance
life insurance
dental and vision plans
Pay during CE
Practices that require CE are required to pay time incurred for all non-exempt employees. Hours must also be counted in overtime
Considerations disability insurance
elimination period
benefit period
non cancelable guaranteed renewal
residual coverage
automatic benefit indexing
waiver of promiums
future insure options
total recovery clause
Considerations in creating employee file policy
environmetal protection
access and storage protects confidentiality but remains accessable
what records should be stored separately
retention and disposal guidelines
personnel files contents
application-resume-interview notes-background check
job description
offer letter
discipline docs
W4
copy degree, diploma etc
contracts, non competes
action forms- changes
attendance leave of absence-not FMLA
emergency contact-
employment records including date of hire, promos etc
Which entity requires detailed payroll records
IRS and FSLA- access limited- stored separately
Payroll files should include at min
full name, address, ss
birth date
work schedule- pay rate, earnings record
benefits records
timeclock records
What not to keep in the personnel file
docs cannot be legally used to make decisions (protected class)
docs on gender, race, religion , vet status, disabiltiy
Garnishment or credit report
investigation docs for criminal cases
What are the 5 potential employee files
1personnel file-job related
2. Security file- docs related garnishment, background results, credit checks, docs no legal role in firing, promotion
3. Medical file
4. payroll file
5. I-9
Reasonable time frame to request view employee file
2-5 business days
Retention time frame generally employee files from date of termination
3 years- I-9, hiring records, personnel file
4 years-(rolling four years) tax records, pay rate, pension plans
5 years- injury and work comp
30 years- medical exam findings, exposure records, covid
Laws that state employee retention rate
Title VII civil rights, ADA, ADEA- require 1 year from termination
FMLA-3 years
I9 -3 years
Hard verses soft skills
Hard skills are generally technical skills that can be taught
soft skills are generally inherant—- critical thinking
If job descriptions are not legally required.. how are they used legally?
lawsuit, discrimination allegations, some unemployment claims
uses of job description
used training-roadmap new hire
performance reviews and expectations
Task verses responsibility
Engaged employees are typically seeking more than new tasks, they want more responsibility
What three purposes do Manuals serve
- reference tool for standards of care and practice guideline
2.training and instructional tool - define a standard which employees can be help accountable
Considerations creating employee policy (general thoughts not diff. sections) manuals- what should it look like
court may consider contract.. be sure to state.. not a contract
attorney review
large print
positive and not authoritarian, create positive work environment, prevent problems via clarity open dialogue–
think about culture you project
HOw to create organizational efficiency with manuals
same directory/file name
network location and file organization
revision date and initials- bottom of revision page
Procedures Manual contain
correct way to do tasks as well as benchmark to determine whether employees are achieving stated standards
Checklists are valuable and usually evolved from these manuels- update as they evolve
when creating procedure manual, ask yourself 6 things
What is procedure
who is responsible
what resources
optimal outcome
steps to complete
when this created and when reviewed again
Name 3 primary function procedure logs such as lab log
- allow convenient storage of important data
- improve quality of patient care/client care
- facilitate charge capture and auditing processes
Types of Logs
Hybird logs ex. cremation-paw prints
Patient logs- ex laboratory logs
Procedure logs- task completion-autoclave cleaning
Hospital safety manual 3 key points as to why
- required (federal law) written plan to notify staff how hospital complies with OSHA Hazard communication standard
- at core is Right to Know law - every employee has right
- Employer responsibility to be educated about risk, not only to mitigate them but inform employees of risks.
What does specific areas do VET hospital have in OSHA Hazardous comm plan
- anesthesia and wag
- accident prevention and response
- animal handling, bite prevention, noise risk
- blood borne path and first aid
- infection control/zoonotic disease prot
- Hazardous chemical
- chemotherapy
- driving/machinery
9 dentistry
What building/staff concerns are also in written plan safety plan
electricity concerns
ergonomics
fire and emergency evacuation
lasers
meals. snacks
nature disasters/weather
radiation
safety training
securuty and violence prevention
Right to know
every employee must have access to handbook and told they have right and responsibility to view it
CE- if required.. what direction should practice suggest
set CE goals that help support the Mission and Vision of practice
Benefits of CE
inspires team to improve quality care
contributes to prevention burn out
important in staff retention
Reasons declining interest CE
staff felt CE skills learned were not used
management doesnt place value on ce
management doesnt embrace new ce information
personal family challenges
License fees
for rvt,dvm, cvpm practice usualy covers cost of renewal and can amount to 1200 yearly
Section 5- law and ethics part 1
Section 5
What Act is enforced by the DEA-established 1973
Controlled Substance Act
Vets working at two+ locations- what can they legally do
can RX ANYWHERE if registered at some principal place of business.
to administer or dispense, must be classified as employee or registered at the facility
Can non vet admin controlled drugs?
yes if agents/employees of registered dvm
yes if performing in reg course of business
yes if acting under direction of Dvm (present)
yes if under the direction of dvm (on premises)
Can IC dispense or admin drugs at relief site?
The law is less clear.. they certainly can RX but should maintain their own DEA license to support IC factor-
How to get DEA 222 forms
they are sent out by DEA no charge when registration granted.. and appropriate box requesting copies checked
Who can sign DEA form
only registered DVM or person with valid power of attorney may legally sign
What to do once receive controlled 2 drug
when shipment arrives, date of receipt and the number of containers of each drug docuemtned on copy 3 or original order form used when order placed.. file separately all Schedule II drugs and copies
Can a DVM employee rx, dispense and admin-controlled drug
yes if is employee of location registered dvm
how many locations can dvm employees rx drugs?
4 different locations owned by the same business owner
Can schedule 2 drug records be mixed with other records
no- C2 drugs must be recorded and stored separately from medical record
Can C3-5 drugs be stored in medical records?
yes if they can be readily retrievable- common belief is they are not retrievable in quick manner in case of audit
To lend C2-C5 drugs
must obtain a receipt signed by registerd vet who received drug and stored with other records of these drugs. These drugs can be returned to same dvm using same receipt records
Can lend C2 drugs
yes but use same format as if purchasing drug using DEA 222 form
When purchasing vet hosp
accounting must be done- old vet prepares invoice all drugs (dated and signed with time), exact count of Schedule 2 drugs- C3-C5 can be estimated counts unless bottle holds 1000+ tabs- then exact count.
these records must be keep in controlled record keeping book or log
How often required to count all controlled drugs
biennially or every 2 years
examples controlled drugs
I- las heroin
II- oxymorpphone, morphine, pentobarbital fentanyl
III- hycodan, codeine, buprenorphine, hydrocodone, ketamine, teleazol
IV- tramadol, valium, phenobarbital, butophanol
V-lomitil. robitussinAC
What DEA form for loss-theft-breakage
106
DEA inspectors must present
ID selves, state purpose, give credentials, written notice to inspect or warrant
Questions to ask applicants
Within past 5 years have you been convicted of a crime or within the past 2 years a misdemeanor, or ARE Presently chargge
IN Past 3 years have you knowinngly taken narcotic, amphetamine or barbituarrates not prescribed
What title under Controlled Substance Act. What intent and what kind system
is Title II of the Comprehensive Drug Abuse Prevention and Control Act 1970
REgulaates by registration, persons involved in the manufacture, distribution, and dispensing of controlled substances
CSA designed “closed system” for handlers of these drugs to reduce them coming into the illicit drug market.
Schedule 1 drugs
Highest abust
lowest potential medical use
heroin LSD
Schedule II drugs
High potential abuse-severe dependence
accepted medical use
morphine oxymorphine
Schedule III drugs
less potential abuse-dependence
accepted medical use
codeine, hydrocodone, ketamine,telazol
Schedule IV drugs
low potential abuse- limited depend
accepted medical use
tramadol, phenobarb, valium
Schedule V
lowest potential aboust
accepted medical
Robotissuin Lomitil
who can reclassify controlled drugs
DEA and attorney general
What is FDA/CVM
Food and Drug Administration Center for VEterinary medicine
What is FDACVM responsible for
regulating animal foods/feeds and animal care products
What are adulterated drugs
unsanitary, lack of control in manuf, differ in strenght from compendum, mixed
What are misbranded drugs
False misleading labels that not have adequante information for manf/packer/distrubute/quantity- NO adequate directions for use
What are 3 classifications that qualify a legend drugs
- For use only under veterinarian
- in possission person engaged in manuf/storageg sale of vet drugs
- in possession of a Veterinarian
Are medical devices (including syringes, needles. etc) required to get approval by the FDA
no except radiation emitting devices
Define Generic Drugs
FDA approved which requires a demonstration of bioequivalence with the safety and efficacy with the orginal pioneer drug
Who registers Radiation emitting device with
Center for Devices Radiological Health
What is the act that regulates EPA
FIFRA- Federal insecticide, fungicide and rodenticide act
Define Pharmacoviligence
the science and activities relating to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problem
What catagories are required to report ADE
1.drugs/ medical devices,food and dietary-FDA
2.pesticides-EPA or reporting page provided- Nat’l Pesticide Info Center NPIC
3.vaccines- not required to report- required to record- report to USDS CVB- APHIS
The FDA is within what US Department
US Department of Health and Human Services
Compounding regulations- what are 4 conditions
- vet believes need to alter approved drug for non food animal with Dx
- there is VCPR
- Pet has medical condition
- Vet determines compounded drug is needed
Adverse Drug reporting- call 888-fda-vets or find form 1932a and include
- person familiar with event
- Clinical signs right after exposure
- Product name and lot
- Patient or owner
According to OSHA and right to know- what items are required for Vet Practices to be compliant in their safety program
- safety manager
- ann hazard inspection
- Safety plan
- Chemical list- plan for safety
- SDS
- Secondary labeling
- Protocol emergency evat
- Training program all PPE, monitoring devices and hazards
OSHA many standards list include
First Aid Kits
Hazard Assessment
Personal Protective Equipment
Safety and hazard training
sanitation and housekeeping
waste disposal
egress and emergency exits
Fire extinguishers and sprinklers
electricity
stairs
vehicles
ergonomics
indoor air quality
SDS library
container labeling
noise hazards
radiology
chemotherapy
Hazardous Chemical Plan
The Hazardous Chemical Plan must have, what are the 5 basic components
- must be in writing
- Complete list of all hazardous chemical
- SDS
- Secondary labels
- staff training
Admin Requirements of OSHA
- It is the law poster- state poster if avail
- Notice of pending inspection
- Inspection citation 3 days or until fixed- longer
- warning signs, exits and radiation
- written plans for
OSHA rights for Employer
Set and enforce safety
Be present during the inspection
can require warrant
can request postponement
Trade secrets cant be divulged
consult before, during after inspection before responding inquiry
see complaint
insist staff members interview during off times
right to appeal
OSHA Employer Responsibilities
provide workplace-free unnec hazards
set and enforce safety rules
Provide PPE and proper use
provide training hazards
Staff member rights- regarding osha
- workplace free hazards
- informed rights
- informed hazards and trained to do job safelyu
- provided and instructed on PPE
- view and receive copies OSHA standards
- access medical exposure records
- be presnet when safety testing performed
- present complaints to emplyer or OSHA
- speak compliance officer privately
Staff member responsibilities under OSHA
to comply with all safety rules, regualtion and orders by workplace or OSHA
know that can be discipline up to including termination for violation of safety rule provided given proper instruction or training
Addl staff responsibilities OSHAS
- READ OSHA POSTER
- comply standards
- follow safety rules and regs
- wear PPE
- report hazardous conditions supervisor
- report job related injury and seel treatment
- coorpeate with compliance officer
OSHA form 300
11 or more employees!
Log of work related injuries- record every work related injury beyond first aid. also work related illness diagnosed by dr
OSHA Form 301
- every business-
Illness and Injury Indicent Report- within 7 days that you know of recordable work related injury- this form or equivalent
OSHA 300a
11 or more employees
Summary Work Related illnesses/injury-
must posted Feb 1 to April 30- displayed even with zero reports
How long keep OSHA forms
5 years
Section 6 Laws and Ethics part II
Section 6
What are three ethical areas affect teams
- social ethics
- personal ethics
- professional ethics
social ethics
principles accepted by society codified into law
personal ethics
right or wrong on individual basis
professional ethics
developed by professionals that create codes of conduct for members of profession
What is the purpose of a professional code of ethics
To help members achieve high standards of behavior through moreal consciousness, decision making.
What are 4 branches of Veterinary Ethics
- descriptive-study of ethical views
- official- professional ethical standards- they develop and enforce
- administrative- actions by administrative govt bodies- license revoke
- normative- search for good/bad right/wrong
difference in law and ethics
the govt enforces laws, the professional asso develop the ethics and enforce the ethics
What 4 types of moral problems does Rollin believe in vet med
- peers
- clients
- animals
- society
What are detailed sections of AVMA Code of Ethics
Professional behavior
VCPR
Attending, consulting, referring
influence on judgment
therapies
genetic defects
medical records
fees and remuneration
advertising
euthanasia
VHMA code of ethics include talk of
promote profession
CE refinement skills
equitabel cooperative with fellow members
excellence to clients-pets
Honest, integrity, industriousness above all elese
confidential bus affairs
protect hosp funds
keep hosp records in house- owner of practice soley
What are two examples of situation with both legal and ethical considerations in vet med
INformed Consent
Emergency care
What constitutes informed consent
- consent freely given
- treatment/diagnosis in understandable terms.
- risk/benefits/prognosis stated
- prog if no treatment stated
- alternative treatmetns with risk, benefits cost
- ability to ask questions
what aspect of emergency care has both ethical and legal considerations
emergency care of the pet ,not in owner’s possession.- ethically vet has responsibility to save life or relieve suffering. Without owner, getting paid can be issue. Lact of payment due to lack of consent.
The law of Unjust Enrichment was created to avoid unjust enrichment of one party at expense of another
What does legal system look for before considering unjust enrichment
- more valuable animal, the greater chance recovery
- More emergent animal’s need, more urgency to provide medical care
- Vet attempted to reach owner
- The emergency care was reasonable
Ethical consideration in vet med- wilson cautions a dilemna in what is ethical and not
Wilson states, It is the situation, not the act that should be analyzed for ethical considerations because what may be unethical in one scenario, may be acceptable in a different scenario.
Define Moral Distress
you know ethically appropriate action to take but you are unable to act on it. You act in manner contrary to personal and professional values, it undermines your integrity and authenticity and causes moral distress
What are 4 A’s to rise above moral distress- an ongoing process
Ask-is moral distress present
Affirm- commitment to address moral distress
Assess-Contemplate readiness to act- risk and benefits (4 R’s)
Act-develop a plan-identify resourcess inside and out
When assessing Moral distress- what 4 r’s can help
RElevance- impact
risk- what about not acting
reward- when acting
roadblocks- identify struggles
Define Ethics exhaustion
fatigue, emotional distress, and lack of will to act in a way consistent with the belief of what is right. It isn’t a lack of compassion, but prevented from acting in a way you feel is morally right. Prevention is key- minimizing moral distress ahead of time
What are the most common complaints to the board
Unsatisfied Experience
lack of communication
Unexpected Death
Conduct, record keeping, premises, and Pharmacy issues
What is the most common premise complaint?
the surgery room is not separate room
Common pharaceutical complaint
vet not honoring request to prvide written rx
What SOP should be created in area of ethics/law for many aspects hospital
*Hospital policy for shredding
*Develop liability release volunteers, interns
*follow AVMA updates Fairness to Pet Owners Act and Compounding
*Develop medical records standards (SOAP format, abbrev. data entry, password protect
*SOP for client communication, conflict, and complaints
*Ensure practice meets state requirements
Law is broken into two sub-categories, what are they
civil law and criminal law
What two sub categories fall under civil law
tort and contract
Four elements of a contract
Offer
Acceptance
Consideration
Intent to contract
(Today, more emphasis is placed on what a reasonable person would conclude from the conduct of the other)
3 situations where capacity to contract exists
Minority
Mental Disability
Intoxication/substance abuse
In law of agency- what are two most common situations
Agency and consent for care- best practice - contract owner for confirmation
Agency and Consents for Euthanasia- when someone other than presents a pet for euthanasia- request owner come in to sign form
Statute of Fraud
requirement for written memorandum before courts will enforce certain contracts
What contracts require written memorandum as per statute of fraud
- contracts for sale of real estate.
- leases longer than a year
- contracts not performed within year
- contracts to answer debt of another
- contracts over a certain price
define parol evidence
any agreement not contained in written contract– under parol evidence rule, these agreements are inadmissible
What is Guardian Ad Litem
person appointed to protect interests of minor or legaly incompetent person. In vet med- if pets become guardians, what is potential issue- who determines best interest pet
wrongful death civil lawsuits?
no pain meds- neglect lawsuit?
Session 7- Laws and Ethics part 3
e
What does EEOC protect when it comes to unfair Tx
unfair tx cuz of race, color, religion, sex (including preg/gender identity/sex orientation) national origin, age, disability or genetic info.
What does EEOC protect when it comes to Harrassment
Harrassment because of race, color, religion, sex (including preg), national origin, age, disability or genetic info
What does EEOC protect when it comes to work accomodations
Denial work accom needs becauseof religious beliefs or disability
What does EEOC protect when it comes to retaliation
protects employee who complained about job discrimination or assisted in job discrimination case
Immigration Reform and Control Act- who does it apply to
EMployers although specific count is unclear
Law seeks to preserve jobs for American citizen and immigrants who are authorized to work
Immigration Reform and Control Act- what does it do- EEOC enforces
Amended Immigration and Nationality ACt- make unlawful to hire alien knowing person is unauthorized to work without verifying- or continuing to allow to work knowing unauthorized
Established I9 system (EEOC)- required to attest on form made by Attorney General that docs have been verified- the worker also attested he is authorized- keep records for 3 years
Fair labor Standards apply to ?
all business- Fundamental Employee Act
What are minor regulations in FSLA
14-15- permitted with work permit- 3 hours school days- 8 hours non school- hours must be between 7a ma -7 pm- except 9 pm summer break
Exemptions ovetime
salary 455 week
cannot be reduced quality or quantity work
job duties under these:
executive- 2+ direct reports
administrative
professional- dvm
Who enforces FLSA- ( FaIR LABOR sTANDARDS aCT)
WAge and Hour Division of US Dept Labor- inspections can be random after complaint
Civil Rights Act 1964- Broad umbrella cover in addition to discriminaton- what are different classes outsude of act
SExual Harassment
Preg Discrimination
Amer with disabilities
Age discrimination
What is Civil Rights Act 1964 Title 7
Unlawful for employer to refuse to hire any individual or discriminate with respect to race, color, religion, sex or national origin
EEOC
EEOC was created to enforce the anitdiscrimination law
Sexual harassment- what are three area of discrimination focus
gender based discrimination
sex discrimination based on pregnancy
sexual harrassment
What are two types sexual harassment
Quid Pro Quo
Hostile environment
What is sexual harrassment-hostile environment
unwelcome conduct sex or not directed because of gender and interferes with work
Pregancy Discrimination ACt - amended title 7 Civil rights- who does it protect
based on pregnancy, childbirth, related medical conditions
Pregnancy Discrimination ACt What does it say
Preg women must be treated same as other empoyees on ability or inability to do work
Preg worker must be allow to work at all time as long as she can perform duties
Americans with Disabilities Act 1990- what employer does it apply too
emplyers 15+ who are on payroll at least 20 weeks
expanded to include persons with mental disabilities
** be sure jjob description includes essential task including physical, time, stress requirements
Age Discrimination ACt 1967- 20 emplyees
Can’t discriminate based on age- special rules pertainning to pension and other benefit plans
ERISA - Employee Retirement Income Security Act- who
employees in qualified benefit programs (retirement, stock, group medifcal insurance, prepaid legal services
ERISA provides safeguards for employee interested in these plans
ERISA -what are in 3 Titles
Title 1- reporting and disclosure- fuduciary standards- enforced DOL
Title 2- IRC enforced IRS
Title IV- Administered by Pension Benefit Guaranty corp
all reports must be filed, DOL,IRS. PBGC annually and to participants and beneficialy]
Equal Employment Opportunity Commission
enforces feral laws, prohibiting discrimination- protect employees and job applicants against discrimination- 15 or more employees- wrk at least 20 calendar weeks last 2 years
COBRa- what is it
Consolidated Omnibus Budget Reconciliation Act
Who does Cobra apply to
employers 20+ employees .. for employees who leave under certain circumstances
What does COBRA provide
Qualified individuals are allowed to enstend th3eier coverage on a self pay basis for 18 months to 36 months after end of employment- lentgth of time determined by type of event
COBRa has numerous notice requirements on employers, plan administrators, and covered employees
HIPPA
Health insurance portability and Accountability Act
Who does HIPPA apply to
all eligible employees
What does HIPPA do
protects employees health inusrance coverage when they change jobs, limits exclusions for preexisting conditions, and prohibits discrimination against employees and dependents based on their health status.
Also deals with privacy concerns regarding health care and some tax implecations
Mental Health Parity Act
all eligible employees
Mental Health Parity Act
Provides for fairness and consistency between medical and surgical benefits .
Same annual $ benefits medical.mental
Employee Polygraph Protection Act 1988-
prohibits most private sector employers from directly/indirectly requiring lie detector test
employers cannot discharge, discipline or discriminate against any employee who refuses lie detector test
EPPA does permit on some job applicants9 stringent requirements)
Name the 7 required posters employment
- Fair labor standards and min wage
- equal opportunity provisions
- Family and Medical leave act
- OSHA Job safety and Health Protection requirements (right to know)
- Employee Polygraph Protection ACT
- Uniformed services employment and reemployment rights act
- Right to join/form unions and asso
define confidentiality
duty of keeping private information pertaining to patient health obtained dur8ng formation of diagnosis (more than medical records)
Do all states require confidentiality?
Not all states specifically recognize veterinary-client-patient confidentiality but ethical considerations remain the same regardless
What entity specifically requires confidentiality
the Principles of Veterinary Medical Ethics of the AVMA require vets to protect the personal privacy of clients and patients and clients. All records are considered privileged and confidential and should not be released except by court order or consent of patient’s owner.
Does PVME has force of law?
In most states it does not
what is the concern regarding confidentiality in abuse cases?
Some states require vets to report animal abuse or neglect to child protection/welfare authorities due to some studies suggesting a correlation between animal abuse and child abuse
If reporting the abuse… is there protection
States that have abuse reporting requirements will protect reporting vet from civil lawsuit providing report done in good faith
Who owns the confidentiality, the client or vet?
For states that do have regulations, the client owns the confidentiality
When do state statues’ regarding confidentiality, not apply
- Client or agent consents to release
- law requires disclosure
- animals health at stake
- legal dispute has arisen in court conflict
- board investigation exists against vet or owner
- suspected or actual abuse
- vet served with subpoena
Who reviews social media postings
they all should be reviewed by the social media manager
What type of social media postings need to be supervised
all potential confidentiality breaches both on the practice and staff need to be addressed. Employees can create legal problems for vet posting unauthorized photos or confidential text
Can employers dictate what staff can post
Practice cannot dictate what staff post on personal site but can establish professional guidlines with disciplinary consequences when violated
What are some social media confidentiality rules the hospital might want to create
- all post on practice websites taken with hospital camera-never personal cell
- cell phone policy prohibits any and all recordings while on duty
- only authorized staff can post
- all photos/detailed text must have client authorization
- statement any negetvity caused may result in disciplinary action up to and including termination
- inappropriate posting include- remarks, harassment, threats, unprofessional comments
Why to have a identity theft program
federal/state laws obligate us to protect sensitive info
written policy/training
Name some identity theft considerations to apply to employees when thinking about theft
Perform reg background checks all
limit keyed access
computers password protected
shred all personal/financial paper
red flag rule
What should identity theft training include
how to gather and store personal info
what can and cannot be discussed over phone./internet/fax, 3rd party
leaving records unattended
keep staff phone lists/computer codes out of public view
Identitiy theft and verfiication- red flags regarding controlled drugs
inabiliity to provide govt ID
handwritten credit card numbers
photo doesnt represent previous records
presents altered or forged medical records-drug seeking
What are risks of breaching confidentiality and may be in policy documents
Sharing w/o consent may result in disciplinary actions. this even includes kennels, trainders
**Unauthorized disclosure of information may lead to client claiming invasion of provacy or breach of duty to maintain confidentiality
Session 8 Financial Part 1
Chart of accounts
systematic listing of all account names and numbers by company. Recommended use only chart of accounts needed
Profit and Loss statement
income statement, PL, covers specific period of time. reports revenue less expenses to show net income during that period of time
Balance sheet
shows financial condition of practice listing assets, liabilities and owners equity. - does not forecast- no historial data. can use to create accounting equation
Basic accounting equation
Asset=liabilities + equity
Cash flow statement
shows were cash in practice comes from and how used
Net Income
expenses subtracted from income-
What is AVMA net average profit goal is
10-12%
INtangible property
nonphysical property that has value- goodwill, non-compete, copyrights
Assets
everything of value owned by practice (intangible and tangible)
What two subcategories are included in assets
Current assets and fixed or long term assets
current asset
items consumed within a short periof of time often a year. ex inventory
fixed or long term asset
assets that extend longer than a year ex building, land equipment, software
liabilites
debts. can be short term like accts payable or long term like mortgage
equity- another name and formula
asset-liabilities. it shows the net worth of practice. sometimes referred to as net book value
cost of goods sold
products used to produce a service for client or products sold to client- variable expense
What are four main theoritical areas when understanding financial statements- the 4 ideas behind them
The theories
the purpose
the practicality
the effect
what are the two theories of accounting methodologies
Cash based accounting
accrual based accounting
what is cash based accounting
recognized revenue when cash received and expenses paid. Allow more clear vision of day to day operations. important bills paid on time.
majority of practices use this
shows many peaks and valleys
What is accrual based accounting
required in corporations with gross > $10 mil
recognizes revenue when it is earned and expenses when they incur. Goods received and services are performed. As general rule, considered more accurate.
more complex
poor job tracting cash
better at matching
what is differnet in straight line depreciation and MACRS (modified accelerated)
straight line - cost asset evenly distributed over useful life
MACRS- cost distribulted accelerated, more cost at first couple years then reduced
Purpose fo Financial Reports
enable ownership and management to properly review what has happened in period
Who should be part of the monthly financial review
key employees and department heads
Practicality of Financial statements
Identifies trends and recognized problems that need attention. beneficial and necessary.
The effect of Financial statements
Helps to make sound and thoughtful business decisions. Enables performance of practice to be measured in historical and prospective terms so that decisions can be made
Income Statement- basic thoughts behind this statement
Most important of financial statements
important detailed as possible to help with inconsistencies
correct categories
stating expenses as % valuable tool to compare historial data. % give more accurate picture than numbers
What is an expense and name 2 types of expenses
any outflow of money owed to another company. fixed and variable
what are fixed expenses
set cost that don’t fluctuate with busyness of hospital. ex dr on salary=fixed expense
what are variable expenses
will change with amount of business. ex vaccine, dvm on production, staff payroll
What to do when expenses dont look right on pL
compare percentages
ask questions of percentages
implement change
Possible issues when PL shows inconsistencies
invoice paid late
income drop signficantly
expense misclassified
Do we need to manage profit centers
***If center is not managed, it cannot be improved
What are steps or things you will look at to evaluate profitability of service when it comes to sq footage
- gross revenue per month for service
- square footage used by service
- fixed cost practice
- fixed cost per square foot for service
How to determine if profit center can be improved- what is formula
got to look at numbers ex;
Revenue from profit center- fixed cost of sq footage(including dvm/eqt)/facility) -variable cost staff= net income for that center
What is balance sheet
also called- Statement of Financial Condition of Practice
summarizes assets, liabilities, and equitites at time-no historial
although real estate could be increasing in value, this increase not represented on balance sheet
What is cash flow sheet
illustrates cash generated minus cash flowed out rendering cash total end of year
Snapshot of checking- but not necessarily correct because could have inventory not sold that was purchased, account receivable,
b
What are some financial reporting process considerations for the PM in delivering to owners
- timeliness- 5-10 business days end of month
- accurate- often times cpa audit not feasible. manager does self audit
- Simplicity
- sufficiently detailed - so non acct can understand
- analytical- information worthy of analysis- benchmarks/budgets
What are some practices to consider when analyzing finances and looking to grow- how do grow your financial condition
- safeguarding assets
- pricing/fee structure- is it adequate
- cost evaluation- consider cost of services
- procurement of capital- assuring owners ROI
- incremental performance- CASH FLOW, PROFIT, CHANGE IN COST, INVESTMENT
- accountability via departmentalization- what are profit centers doing
- profitability analysis- two different number- profit for owners and profit for tax purposes
- return on capital analysis-
What are key ingredients of incremental performance to make it happen- four short words
change in cost, cash flow, profit, and or investment
what should you take into consideration when measuring true profitability- true value of practice
depreciation of assets, owner compensation, rent to owner, other owner discretionary expenses
What is formula for return on capital percentage?
EBITDA
income divided by average total assets= return on capital %
usually measured before interest, taxes, depreciation, and amortization
What are KPI’s
basic statistics used to measure preformance, compare benchmarks and identify changes. Usually entered in spreadsheet compares over previous year
Common KPIs
*Total revenue and total trans per month
*average trans per month
*new clients and lost clients by month
*revenue transactions, and average transactions per DVM by month
*revenue by category
*accts receivable by aging classification
Net profit margin
practice profit/practice revenue- measures simple profit. A higher value indicates more revenue falls to the bottom line instead of being consumed by expenses
Why should you use % statement analysis
% make it clear how practice is doing
What is variance analysis
Identifies the variance of financial metric and may help explain why
Gross Profit Margin
Gross profit/revenue- measures how much profit is in service
Average Transaction charge
practice revenue/practice transactions.
Ideally number should increase
Revenue Per full time DVM
practice revenue/full time DVM
What is a full time DVM
DVN who spends 100% of their time with clients
Accounts receivable turn-over
credit sales/average accounts receivable- higher number better, indicates acct receiveable converted to cash more often
What are the 3 types of payroll methods
Manual- employers liable for error- highest risk errors
Automated in house- quickbooks- more efficient manual, can schedule regular reoccuring deductions
3rd party- convenient, expertise, savings
What are different types of payroll periods
Weekly- 52
biweekly- 26- problem: difficult to make specific historical comparisons since quarters inconsistent year to year 2 quarters 6 and 2 qts 7 pay periods
semi monthly- 24
Shift differential- wage premium used in 24 hr facilities- less desireable shifts more rewarding
What if FICA
Federal Insurance Contribution Act
What is FUTA
Federal Unemployment Tax Act
State payroll tax
vary often include state income tax and unemployment tax- THERE MAY BE OTHER TAXES DEPENDANT ON STATE
What should written employee payroll policy include- long form
definition of part time - full time
how and when PTO is accrued and if rolls over year end or is paid out at termination
segregate duties for up0dating personnel data from duties of payroll accumulation, recording, and reporting
require manage approval changes payroll records or personnel info
restrict access as need to know basis
mandatory direct deposit
process new hires timely
personal records
when using 3rd party- compare records
monitor timeclock- cant clock in for other employee
track advances- signed auth from employee and payback asap via payroll deductions
what should personal records include regarding payroll
date orf hire
PTO jpaid vs used
tardiness
What if you dont issue 1099
Can be liable for back taxes, interest, penalties
Accounts Payable considerations
watch that not spending more than making
must develop a plan if getting out of control
How to mitigate large accts payable or not enough $ bottom line)- WHAT YOU CAN DO TO DECREASE
decrease spending-increase revenue
hold employee accountable waste’
consider reevaluation fee structure
review charges be sure charged correctly and not missed
if line of credit needed- have plan to pay back asap
What is account receivable
monies owed practice for services rendered that not paid at time of service
What is acceptable AR Balance
no higher than 1.5% gross rev
What is AR problem %
AR over 3% should get focus entire team
What can you do to reduce Ar while still helping clientele that is hurting
If it is high, should look at AR policy and
Institute Flex or Indigent acct financially sustained by client contributions or fund raisers. Team develops guidllines for eligible cases
What are choices when check NSF
take loss, try to capture by self, turn over 3rd party
How to avoid NSF
check verification machine- either verifies or immediately captures funds . Real time transfer is most cost effective- make sure always get DL
Why ask for DL when accepting check
Part of best practice plan to prevent fraud
How many basic ways of accepting payment on AR accts
Manually or Computerized AR system
what are some precautions in manually accepting AR check
want to prevent internal embezzlement. Usually finance fees are added. When payment rec’d, a receipts provided and the copy of receipt forwarded to AR manager who will update ledger. Aged acct can be flagged different colors and appropriate notices sent
what are some computerized AR systems perks over manuel systems
All calculations of interest and fees are automatically added. Eliminates errors and decreases embezzlement
How to: creating and enforcing AR policy- basics
OPost sign at practice,
estimates to all clients
signature required from the client
50% required all services- all employees must be okay with this
Hold Checks
accepting check with current date but depositing later- not recommended.
Problem with tracking and depositing on right date.
No guarantee of funds
If mistake, usually hospital has to pay service fee
Are post dated checks legal
Illegical in some if not most states
Collection Procedures- when should AR be due
Should be paid within 30 days
What is benefit of aged acccounting AR
It offers the PM a more accurate review of AR
When are AR statements sent
Immediately after service
What to do if no payment in over 60 days
handwritten note on stateemetn
overdue sticker placed on statement.
Fair Debt Collection Practices Act says stickers cannot be placed on outside envelope. Also, return address is okay but cannot put Debt Collector name on outside envelope
What about collections over 90 days- strategies?
Harder to collect beyond 90 days
Client should be notified will be turned over if not made
Team member calls cleient to discuss status and attempt to collect or make arrangements
Once all attempts exhausted, turn over to collections
- waht happens at collection agenfcy
turn over to agency, if they cant collect, amt reported to credit bureau and credit affected 7 years
Is small claims court possible
Yes but need to weigh options, costly to go small claims with fees and time lost, maybe only for larger amounts
What to do with delinquent accounts
flag them in PMS to avoid further services
What does the Fair Debt Collection Practices Act regulate
regulates collection procedures of past due accounts to protect public from unethical collection procedures against all collectors
What is stated in Fair Debt Collection Practices Act
cannot subject client to harassment, oppressive tactics or abuse
cant make false statements, claiming to be lawyer
cant call client work if client objects,
cleints cant be called before 8 am or after 9 pm
Acct details only discussed with client
What are guidelines when calling client with overdue acct
use caller ID
Counsel team not to take personal
keep conversation focused on acct collection
team member introduces themselves
Team member confirms who speaking with to avoid disclosing personal info. never leave voice message with details, just leave name and practice name and phone number
Conversations should be documented in PMS
-Collection letters- when given and how should they be worded
at 30, 60, 90 days
letter short and polite, simple words
make sure date, amt and client info correct
provide specific date client must respond
provide a date when action will be taken
include a thank youi
Employee AR considerations
Written policy
Best practices says employees should not be allowed to charge
May not be able to collect employee leaves
practices can loose money with discount
balance should not be greater than 100
mandatory monthly payments
if deducting payments from check- check state law
must have signed document employee authorizes payroll deduction
federal law prohibits money being withheld that would take wages lower than min wage
Collection agencies- info needed
client full name, address phone
balance due
client occupation
cleint employer address
driver license
copy of client info sheet and signature guaranteeing payment
they charge 40-60%
formula average AR
beginning AR+ending AR/2
AR turnover
credit sales/average AR
days in AR- what is it and what is formula
indicates how many days clients acct sits in AR before being collected
# of days in period/AR turnover
How to analyze AR or how practice is doing
AR turnover and # days in AR important to see how practice is performing
Two most common ways of analyzing AR
used to help determine liquidity, solvency, and profitability. Two most common formulas is AR turnover and days in AR ratios
What does days in AR tell us
how many days of working capital to maintain the practices cash flow needs.
Alternatives to extending credit
Pet insurance- studies show pet insurance means more visits, HIGHER cap on treatment, spend TWICE AS MUCH OVER PET LIFETIME- 3 types are major medical, accident, wellness
cARE CREDIT
HELD CREDIT CARD PAYMENTS- consider adding fee to cover costs - be sure read credit care agreement- surcharges may not be allowed
WELLNESS AND PREVENTATIVE PACKAGES-to encourage to accept highest level of care- allow clients to spread out payments ADDing admin fee is reasonable
What are the two causes of action- risk of liabiltiy in necropsys
Tort of outrageous conduct
right not to have one’s sensibilities shocked
Financials part 2
Define Budgeting
process of planning expense and revenue and measuring values against actual financial results which provides knowledge of how operational plans are being executed
Reports necessary to start budget process
- last 3 yrs PL
- all lease/loan docs
- fee schedule
- list op changes expected next few years
- list major capital expenses expected next few years
- employee rooster and recent W2
what is economic cycle (aka business cycle)
Predictable long term pattern changes in national income. Has an impact on consumer confidence, labor market, inflation and therefore impact on practice revenues
name traditional business cycles 4 stages- short fancy answer
expansion, prosperity, contraction, recession
Name 2 things outside issues that can influence vet service demand
technology- ex telehealth
interest rates and access to credit
Name 6 steps of budgeting
- determine financial results- where do want to be- $ dollar amt profit
- analysis financial statements- how have you been doing
- normalizing the revenue and expenses
- budgeting revenue
- budgeting expenses
- combining budgeted revenue and expense - making adjustments
How do you determine financial results
specify goals of practice, usually profit and/or earning to gross- amount of profit on every dollar
Step 2 What to look at when doing analysis of financial statement
Revenue- historical trends by profit centers- which centers have the greatest potential
RR says Breaking down revenue by profit centers and taking the time to understand the main sources of practice draws income and which areas possess the greatest potential.
Expenses- can be reorganized in 4 categories
What are categories of Expenses
personnel expenses
variable expenses/cost of goods- related revenue
occupancy/facility expenses
fixed/administrative expenses-leases dues interest
how to normalize revenue and expenses
remove any one time item from financials or use average last 3 yrs to normalize
Step 3. How to budget for revenue
can look at patient volume (key driver)
look at schedule and # procedures poss day
look at fee schedule
what are some considerations estimating revenue when estamating patient patient volume in future
adding or subtracting services
adding or losing vet
economic conditions
advertising
fee increase
demographics in area
what are some constraints
How to estimate revenue looking at schedule, tp project income
average time dvm appt
average time dvm procedure
average number appt/procedures in day
look at 5 day work week and 48 weeks to project practice potential
ex. 48 weeks year X 24 appts day X 5 days week= 5760
what are some consideration in increase your fees
can increase client loss
best to project revenue on per profit center basis for more accurate projection.
When introducing new service be conservative and conduct market research
*** RR like profit centers
How to budget expense- easier because not having to consider the overall economical factors as in revenue
normalize figures by add last three years growth rate to base expense figure
* doesnt work unless practice established, expenses stable last 3 years, and expect to continue
How to calculate budgeted anticipated expense categories, explain each category
personnel wages- estimate raises and potential staffing adjustments. add benefits package expense
occupancy/facility-look at mortgage/lease docs and increase utilities by consumer price index
variable expense/cost of goods-use historical %
fixed/admin expense-typically grows consistently with last three years data
When do you need to make adjustments after completed budget
once subtracted expense from revenue and got profit, determine if addequate- if not adjust with
increase reveneue
decrease expense
adjust profit
What to do with completed budget
use as guideline for daily operational and financial activities. If large variance, thorough analysis is in order- create action plan
Client Credit policies-not recommended but at times we have reasons. when would you create client credit policy
long term dependable clients and goodwill- it can also increase compliance for high dollar tx.
What are two sub-policies to extend credit
cleint credit policy
charge account policy
What is client credit policy
establishes pre qualification necessary to open charge account
what is client charge account policy
establishes credit limits, payment due dates, payment methods, invoice procedures
Charge acct policy should include
all pre-qual procedures, process of flagging, invoice amount, % bill must be paid at discharge, procedure for managing aging account and collection overdue AR
What would your charge acct information form include on the form
client info
amt unpaid
credit service fee
total financed
terms-day mon payment due and penality if not paid
interest rate and timing
client signature in agreement
What other steps should be taken if creating credit policy- when it comes to your staff and the policy when it comes to clients
train employees (no exceptions or will lose team trust)
post written guidelines about providing estimates so everyone informed and know to request if concerned about payment.
talk to clients about payment options when scheduling new appt
give 2 simple pre-qualifications procedures
call phone number, is disconnected-no or very little credit
call employer to verify employment and length
Annual fee schedule review- what is min you should do
markup remains consistent when practice costs increase
be aware of Consumer Price Index and increase prices annually to reflect the cost of living at minimun.
What is formula for deterimining cost of service fee
((Fixed cost/min + staff cost/min X length of procedure) + (DVM cost/min X length procedure) + (direct cost X 2) + profit)
fixed cost per minute- how do you get formula
=fixed cost for month/ # minutes practice open month
staff cost per minute formula
= staff cost per month/# minutes practice open mon
Fee setting considerations for new and current pricing- some things to think about for your customers
avoid sticker shock with single large increase
be aware shopped/non shopped
fee setting determined by type practice
dont be too far off competitors unless value component
What are some value components that add value to your hospitall
location and appearance
practice history in community
staff training. client relationships
competition
What are some clues to persons embezzlement possbility
sudden wealth
talk of money problems
call at work creditors
complaints bookeeping errors
declines vacation
gambling
lift stress divorces, family illness
what are some actions to take when you suspect theft
proceed caution
notify owner/leaders
secure important records. backup offsite
second copy attorney
inform insurance- what are insurance policy theft
contact accountant/attorney advice
reassign duties concerning money
on attorney advice, contact police but no accusattions
do not talk about dollar amount
Session 10
What is quote by stowe regarding Marketing
Marketing is how we tell people what we promise to give them each and every time they visit our practice
Stowe believes Marketing needs to be redefined from the 4 P’s product, price, place and promotion. What are they
Emotion-comfort
Value
Virtualtechnology always changing
Excel-every experience
Expeerience- - treat people well
When looking at marketing and situations, we often look at demographics, what kind of demographic questions should you consider
breaking down demographics into segments helps you define the needs within each segment
what is economic environment
what is the demand for vet services
what is competition for animal care dollars
what is the median age of the population
know your market segments
what is client segmentation in BW?
A marketing term refers to the aggregating of prospective buyers into groups (segments) that have common needs and will respond similarly to a marketing action. Market segmentation enables businessess to target different categories of consumers who perceive the full value of certain products and services differently from one another.
using the client profile data to categorize existing clients into groups with smaller characteristics- (that is the goal)
what are some broader environment marketing demographic characteristics?
Rate of movement of the population
rate of growth or decline?-
Municipal government influences
Industrial influences
Income levels
Single families vs multi-family housing
marketing considerations within competition- assess them by asking what is differnet
distance from practice
# of Doctors
Impression of facility
# of clients
Gross revenue
strengths
differences in fees- what sets us apart
What marketing objective or goal in terms of smart goal is defined
specific
measurable
achievable
realistic
time-dependent
Looking at marketing, what are some goals you might look at, visits, cleints, #?
Average Transaction Fee- set targets
number of transactions- begin with 5000/dr
# of visits per client- set goal 10
# of active clients- aim 1000/dr
Marketing is about communicating the passion and value behind products- what to think about when chatting with clients
non verbal communication
listening
sequencing- logical chain of thought
scripts- not prepared - define points to follow as looks guidelines
Indirect marketing
client education
consistent message
clean office
professional clean employees
professional warm relationships
Direct marketing
centers on bringing new clients into practice expanding services to current clients and is delivered in many ways
What is key to increasing compliance and retention
client communication
Internal marketing
focus on retaining current clients
includes
recalls, reminders, newsletters, postcards,
telephone etiquette, always running on time, staff enthusiasm, pets by name, anything that makes client experience better
External marketing
aimed at potential clients- key to determine prospective cleints and determine best method to attract them ex social media, website, signage, open house, community classes, office tours
what does a website do in relation to marketing
allow for direct, indirect, internal and external marketing, Hire a co. to develop but make sure it is unique
What is target marketing?
reaching a specific group determined from your demographic and segment research- where to concentrate efforts.
what does the reading tell you in regards to target marketing- who should we be directing our efforts towards
to target our marketing to the majority of pet owners in the community.
What does Stowe say is the 16 but 3 main considerations when considering a retail space- VIS
Your vision- retail fit with your vision
Image-
Space
What are the many considerations in retail space. what are the 16 sections
ASSIGN a designated driver
staff training- manager should spend 30min week reviewing selling with team
needs of facility- traffic flow
veterinary recommendation- vet needs to know and agree with what on shelf-
Assumptive sale- One number way to sell
advertising/promotion
unique retailing- blend medical vs product- feliway
active marketing - dont just place on shelf
accomodate children
show products
return policy
know price advantage
display strategy
What does stowe say is budget target for advertising retail products
1-3%
What is the number one way to advertising
word of mouth- testimonials is a great tool
what are other ways to promote retail space
increase traffice flow
name mascot
gues # biscuit
open hourse
* stowe notes- DONT TAKE time away from more important vet servcies
What are 4 basic strategies for pricing advantage under retail marketing?
Unique
value-added- extra size
value - based- rawhire dental chew enzyme
volume
Name some ideas in display strategies
products not above 5’ and lower 1 ft
group products for convenience comparision
displays open
keep in view of receipt for theft
keep stocked
display near checkout-impulse
put prices on products
create product reviews
consider seasonal
What is the Resistance Principle
Says for am y price, there will be resistance
What does Resistance Princple say
if one person complains, you too low
If every client, you’re too high
Price products to have 15-20% resistance, and accept the fact always some resistance.This % appropriate for business to push the envelope for profitability.
If no complaint, consider raising prices Aim for 1.5-2 people out of 10 to complain
What is SEO
Search engine Optimization- the process of affecting the visibility of a website . Client searches with key word,The goal is to have practice at tiop of listed results
Keywords
keywords chosen potential clients should be woven into webiste and more often they appear, the higher the SEO
Internal Hyperlinks
linking other pages within your website
External Hyperlinks
linking other successful businesses on your website
what is goal of website
to promote, to bring people in and keep them coming back with portal, educaiton, forms, blogs social media links
what should be on practice brochure
mission, doctors, services
doctors with photo and bio
hours
contact info
website address
map QR code
What are the 5 specific objectives of practice brochures **
- provide essential information to new clients
- compel new clients to consider loyalty
- establish relationships new clients
- Establish a sense of trust
- establish a sense of partnership- the hospital works with me rather than something else
Name some marketing strategies or options to market your practice
social media
client education materials
business cards
magnets
on hold messaging
donations- develop a budget
gift certificates
what does prendergast say aobut marketing marketing programs
marketing techniques will not overcome effects of poor client relations within practice
How to train staff for marketing to clients- where it happens
1.exam rooms- where cleint relationshops are built- marketing in exam rooms important
2. recommendations- train staff use assertice marketing techniques that give clients the information they need to accept services
3.Client perception- tour the practice, what looks good or bad- secret shop
When managing negative reviews, what to do
1.take time investigate, create planned response that will be positive
2. response should be empathetic and apologetic, invite to discuss. try to reach clinent and if cannot, reply to post that trying to reach
3. promote good reviews
4. be proactive and create positive culture in practice to avoid client experience that creates negative review.
Name the four basic steps to a succesful marketing plan
- gather data- perform a SWOT-what are target groups
- define your goal
- Implement strategy-what when where why and how will plan work
- create a WRITTENwritten plan- time line and budget what is predicted ROI- execute and measure
What is the most critical step to consider when measuring results of marketing plan
a critical step- creating a plan without measuring and adjusting strategy is likely a waste of time- always measure the results
What are some kpi or formula to consider when measuring results of marketing plan
- cost per client
2.revenue per FTE vet - net income
- income per client
- shopper call conversations
- net new clients
- service and inventory sales
what is cost per client formula
gross revenue/ # of clients X % of cost
what are the two formulas for measuring revenue per FTE
average transaction fee X invoices per year (DVM specific)
average expenditure per client per year X # of active clients
What is net income profit for the owner according to stowe
stowe defines profit as what the owner gets to take home end of day
what does stowe believe the number to reach for achievealbe net income
It is challenging but achievable to aim for a profit of 39-40%-ACHIEVEALBE IF- gross rev high, expenses controlled, efficient
What are the stats on shopper call conversations
13% directly concerned about price
87% looking best vet- train team turn calls into appt
what ideal metrics does stowe offer to measure growth in new clients
6:1 ratio indicates significant growth in new to lost clients per monthly
5:1 or 4:1 needs investigation
3:1 or 1:1 indicates poor growth nad agressive research
Define Advertising
creates and places paid media message- best strategies if need immediate results- beign boastful can backfire. at best can persuade your target to try you once.
Define Marketing
matches products/services to c onsumer needs. Attempts to forecast products should be agressively promoted, has 5 basic components
What are the 5 basic component of marketing **
- product/service attributes
- marketing communications
- market research
- customer service
- sales management
Define Public relations
art of developing reciprocal underrstnading and goodwill between a business and the public
paves way to sale but more imp increases moral, productivitiy, job satisfaction
provides early warning system because you built a relationship with community, avoid disruptions should jsingle surprise issue arise
protects long develped reputations when org is under attack- no shame in promoting
WHEN PLANN9NG YOUR PUBLIC RELATIONS STRATEGY, TAKE A LONG TERM APPROACH AND USE THE TOOLS TO ESTABLISH CREDIBILITY, INCREASE AWARENESS, AND BUILD COMPETITIVE DISTINCTIONS.
How does fear free relate to marketing
tells clients that we are concerned with not only physical but also well being of pet and their emotional well being
What are key concepts of Fear Free
Communication
considerate approach
gentle control
touch gradient
Define customer experience
sum total of all following ingredients that clients experience as they interact with practice
How are some ways you can improve customer experience
client loyalty-know your top 20%-overwhelm
reputation- positive practices are more profitable
make client active partner
improve communication
demonstarte love of animals
develop pet loss strategies- help with grief
create bonds clients
personalize experience
great last impression]
evaluate image
Have a plan to create memorable experience with framework each step of way- what happens if dont wow client
if you dont consider each step, can loss to another practice
What steps does stowe suggest we focus on to create best experience at the phone call / reception counter level
Create memorable with:
phone call–answer 3rd ring-give name- not on hold, recept is credible, confident, competent,
Reception counter-eye contact, warm smile, greets by name, likeability in 90 secondds, pre-prepare forms, refreshments, uncluttered desk
facility-
Have a motto- if cleint calls… fill that need
What are the 7 categories where, according to stowe can create memorable experience
phone call
reception counter
faciltiy
service provided
patient care
meeting needs
follow up
What is number of female to males that visit practice
majority is female with 1.5 children- they welcome distractions for children
Give some examples of other services that you can provide
pickup drop off services
large print materials
house call- transporation
pet school
extended hours
multiple ways to contact hospital
pet adoption
self service bath area
How to increase patient care visit
personal possession in boarding
treats
comfort hospitalized pets with blankets, close circuit video
boarding as a Band B
cats not cages, have condo and sunshine
doggy day trips
Give some ways to meet needs of clients
large holding cages reception room
compl cat carriers
comp leashes
water bowls
pet sitting, dog walking
new client kits
through discharge instructions
What are some follow up marketing tools
email photo of pet and discharge\
immediate response to questions
medical surgical call 48 hours assess progress
What is customer experience management
proactive process of creating experience positive and memorable
What is customer relations management
proactive marketing tool like salesforce, process of gathering data on client prefeerences and activities to better target to meet client needs
CRM can be used to enhance CEM
what are some examples to consider in improving your customer service standards - do these things over and again- train staff- think about
consider virtual tours including patients
mood, odors, smile, noise, uniforms, client library
Six c’sto client relationship management
consistency-
customer service-cost 5x more to get new client than retain existing
competence
cost-value driven
compassion
convenience
Name a couple of unique practices
high touch
high tech
what is high touch practice
refers to high quality service and ambiance leaves lasting impression- retains more clients, offer client options, comforatlbe space, respectful
How to increase key performance indicator, cleint retention
must exceed client expectations every time
in general small animal hosp will lose
10-15% clients every year
goal is retain 70-75% over 3 year period
What are 3 R’s client retention?
recall, reappointment, reminder for each client, each visit
Name some aspects of client education- what they remember
clients retain only 20% hear and 30% read- average client needs to hear 5 times
Aspects of client education material
handouts should be professional and have practice ontact info on it.. all clients should be sent home with at least 1 piece, document when handing out documents
Why is cleint education inportant
person in exam may not be person who cares for pet
reflects professional competent team
ensures the same infor sent every client
pateint care and compliance is increased
giving information in writing and documenting in records helps protect practice liability
Name some client education tools
info sheets specific diseases
on hold
practice brochures or newletters
brochures by vendors
business cards
exam room power point
models body systems
videos
Session 11
define Procurement
act of obtaining and buying goods
Supply and Demand
Relationship between the product availability and the need of the consumer to purchase it
Inventory
all goods owned and held for sale or use in the regular course of business
shrinkage
decrease in on-hand inventory that is caused by use that is not recorded or invoiced
Replacement cost
The price that will have to be paid to replace an existing inventory asset with the same or similar product
Medical supply inventory
Sometimes called Professional inventory- items used in the course of providing vet medical and surgical services
Inventory Control
process whereby the need to maintain sufficient inventory to meet operating demands is weighed against the monetary cost of carrying the inventory. Optimal inventory control ensures that frequently used items are always available and that the return on investment for carrying and managing inventory is at the highest possible level.
Just in time inventory
receiving a product just as needed vs storing the product- pros and cons
pro- low holding cost, no expired product
cons-high ordering cost, stock outs and back orders
define inventory purchaser
identifies product needs and places orders using the suppliers chosen by the inventory ressearcher. Also know as PROCUREMENT
inventory receiver
trained to unpack, account for, and stock the shipments
Inventory documenter and tracker
documents the receipt of inventory, transfers of inventory, hospital use, shrinkage, etc. in order to maintain accurate and up-to-date data in the practice management software.
When it comes to inventory, there should be a division of labor- what should be divided
**the inventory purchaser should be separate from the inventory receiver and inventory documenter tracker to avoid theft.
Patterson says: the inventory counter and the bookkeeper roles should be handled by someone other than the purchaser
What are some areas to consider when
setting up inventory goals
*inventory roles are filled
*products are available to treat and clients can get refills
*quantities are controlled to min expenses
*accurate inventory reports
*regular evaluation of preferred pharmaceuticals and supplies to avoid redundancy
*Employees can efficiently order and dispense items (there are diff types of ordering-call in- online- through pms) should not pull staff away from patient care
* controlled drugs properly mant
* security and safeguards exist to ensure proper use
*employees well versed communicating value of products
*fees adjusted regularly and profit margins are set and accomplished
Losses due to poor inventory management
- too much product
- not enough product shelf
- too freq ordering
*shrinkage
*theft
*back orders
*expired products (print list and use first)
*incorrect products ordered or received
*high cost of overnight - shipping costs with smaller orders
unit cost/product
total amount paid to vendor divided by number of units
replacement cost
price that will be paid to replace the inventory with the same or similar item
ordering cost
labor related expenses such as employee compensaton, including benefits, and taxes paid to perform the various duties ass. with ordering-receiving- managing records
holding cost
cost invested in keeping the inventory on premises while waiting to use or sell. These costs incldue personal property tax, insurance, pharmacy licensing/DEA fees, utilities, loss due to expiration/waste/spoilage. OSHA relautions regarding safe handling of inventory and routine product maint
holding cost range from
8-15%
combined ordering and holding costs account for
25-35%
DVM costs to inventory
If DVMs are paid on production and inventory is included, then allocation of a portion of their pay is considered an actual cost to inventory
What are the 5 steps for getting your computer inventory under control
- print your code and product list- delete or inactivate, look for duplicates, are consumables being counted?- make adjustments
- reprint- have you cleaned up list
- Create a list of unconsolidated products - its important not to carry more than top 2 brands of same type item. (prepare a report that shows profit/loss of each and make some decisions) FINISH THIS STEP BEFORE PROCEEDING
- count inventory
- begin to enter/receive inventory accurately as it is delivered to the practice
Name some control function items and describe
control functions -prepare and distribute written policies and procedures create and maintain security and safety protocols, and regularly monitor the system via counts and accountability. Need to be flexible to change- if incorrect- investigate- what happened- breakage?
written policy on procedures
written safety procedure
counts
perpetual inventory
one that can provide an accurate idea of inventory quantities at any time.
periodic inventory system
uses data from manual product counts at the end of every financial period
internal controls
all measures, systems, and protocols used to prevent errors, waste, and fraud
What is the difference when counting inventory and the numbers do not match
a variance
what amount of variance indicates a weakness
a 1-4% variance on high turns items can be acceptable
the more signficant the variance, the more signficant loss
controlled items- issue!!
expense items- issue!!
Give a simple formula for finding the re-order point
average daily use X lead time
What is the forecasting function
the ability of inventory system to signal when an item needs to be reordered to avoid an outage. It should account for the estimated delay between ordering and receiving
items with longer delay should be given a high re-order level or amt
things to consider when looking at lead time
if you order weekly, consider the shipping.. if it is one day shipping, you lead time is 8 days (with weekly ordering)
WHEN factoring in lead time, start with the longest potential lead time
Round up rather than dow based on expected growth or items that can have a run (ex fluids all sudden used up)
calculating re-order quantity (how much to order)
The amount to order once the re-order point has been reached.
Formula for re-order quantity
average daily use X turnover goal in days
** turn over goals shouild try to match the vendor’s billing cycle to sell before the practice has to pay
What are some of the inventory selling (profits) responsibility or functions
Price setting
tracking profit margin
compare inventory and supply expense to revenue generated
gross profit is the difference between $ product to client and cost of product to practice
Give an back up example for inventory ordering to prevent stock out
red tag system
What is red tag system (system for manuel inventory or even back up system)
tag inventory with red tag that contains all necessary ordering informaton on it. The tag represents the point at which a reorder should occur. When that product is opened or sold, the team member is responsible for placing red tag in box.
some cautions- tags fall of, packages get out of order, team mmeber loses or forgets to place in box
Name 2 important inventory organization techniques
zoning and central supply
What is the zoning system
Like creating A MAP where you store products
* begin with inventory team leads creating list of supplies they are responsible for
*helps ensure inventory will not float which makes difficult to track
* create a stocking list with min re-order amounts of each item
* team leads can spot check by referring to stocking list
*great for mobile trucks
Give another name for central supply system and define
also known as Ration Based Inventory
supplies and inventory are stored in main highly secured area and systematically rationed out to other areas of practice. used main in large practices
describe steps of central supply
*used to control internal theft or waste as aid in tracking
*location for primary9majority) and secondary storage
*access limited 1-2 people
* keyed lock or electronic key pad- dont hid keys
* physical removal requires sign out reports iwth quantities
No person should have control over the asses and the record of the assets movement
inventory optimization is obtained through what in two words
Efficient turnover
what are the 3 important factors that help drive optimal turnover and therefore inventory efficiency
re-order point
re-order quantity
effect of billing cycles
What is selective inventory control
profit based management system that prioritizes inventory based on value and importance. uses the pareto 80/20 rule
When can central supply and zoning together be used
in large hospital where they carry all the basics like cotton balls but check out inventory as needed by using their pin to gain access- then another person records the numbers logging in the product to the zone. two peolple in mix
What is Pareto 80/20 rule
sya 20% of items account for 80% of sales, that 80% of costs exist in 20% of items, and that 80% profit can be predicted to come from 20% from the products sold
**also 20% client base accounts for 80% income
what does selective inventory system suggest
suggest investing the most time in in manage those products in the 20%.
Minimize # times orders are placed per week. Ideeally order top 20% monthly
formula average inventory on hand
value BI + value EI (DMSP)/2
formula for calculating inventory turns
DMSP/Average inventory= DMSP/AI
what is average turnover in companion practices
6 times a year- in general the higher the turnoever ratio, the tighter the controls
how to calculate average shelf life (ASLD) and what is it good for
365=
/ annual turnover rate (ITR)
- useful calculation in determine efficiency of inventory management
what is the goal for turns per year
8-12
There are generally two types of formulas to determine cost to client for a product sold, what are they
Mark-up
Margin
what is mark-up pricing
common in vet medicine historically
multiply acquisition cost by a factor
100%=doubles = product $ X 2
200%= triple= product $ X 3
What is Margin pricing
predetermines the amount of profit desired and adds that to the acquision cost. Can be useful when there are large dfifferences in resulting pprice based on the size of patient. Margin priceing decreased the rate at which the price increases for the client when compared to mark up pricing
What is basic difference between margin and markup
margin is = sales minus the cost of goods sold
Markup=amt by which the cost of the product is increased in order to derive that sales price
what is break even point
amount of revenue that covers all fixed and variable cost without generating either profit or loss
what is breat even sales price equation + profit formula
SP= FC + VC + P
what are the definition of SP
sales price
what is FC
fixed cost (unit cost, estimated ordering and holding cost
what is VC
variable cost (DVM production % and asso payroll benefits/taxes)
can include almost any liability
what is P
profit- aim for 12%
What does equipment budget include
maintenance of existing equipment and purchase cost of new equipment.
What should you consider when purchasing new equipment
is it new to practice or replacement- if replacement, what benefits does it have over existing equipment
* how will equipment be paid
* what will cleint be charged, and where is break even point?
* cash is smartest, most economical
* perform breakeven analysis prior to purchase
define break even analysis
analysis that is used to determine when your business will be able to recover all of its expenses and begin to make a profit
When performing a break even analysis, how do you determine # of times service must be performed to break even- what is formula
price of equipment/
client invoiced cost - cost to actually produce the service
What is the % to invest back into your equipment yearly
1 % gross back into new equipment or maintenance
How can you make equipment investment equitible regarding taxes
Use tax act of 2003
What does section 179 say
you can write off in the first year 139,000 (2012)
What does section 168K says
after used section 179, this section gives you an additional deduction of 50% of remaining balance of equipment that is purchased above the 139,000 amount already written off
what additional deductions can you use
after taken 179 and 168K, you can depreciate the remainder on a straight line depreciation schedule- doesnt allow you to write off the whole thing but reduces the cost even further
what is MACRS
Modified accelerated cost recovery system - established by IRS as formulaic table to calculate depreciation
What are common examples of license board violations
COMMON PROBLEMS WITH RECORDS
*lack of complete patient and client identification
* lace of complete system by system description with annotated exam notes
*lack of tentative diagnosis
*lack of treatment specified and especially lack of clients informed consent or waiver or denial of recommnedation
*illegible entries and alterations or deletions of record after a reasonable contemporaneous period
1) NOT COMPLETED REASONALBE TIME
2. LACK OF SUFFICIENT DETAIL
3. LACK OF READABILITY
give some medical record consideratons
if treatment or diagnosis is not documented it is presumed to not have happened
medical record violations are part of the majority of investigations by state licensing boards
although a client complaint is rarely about records, it is the records that the board will investigate to rule on complaint
even if vet are acquitted, they could still be cited for medical record violations if they do not meet the min standards
Being illegible is same as no medical record
What is the POMR (problem oriented medical record)
most common medical record format.
What sections are in the POMR medical record
- defined database
- problem list (AKA master list)
- plan
- progress section
Where is the SOAP format found
the progress section
name the SOAP format
subjective- most CRITICAL information for support staff
objective- info collected via physical exam, diagnostics, interpretation- this section is FACTUAL
assessment- a conclusion reached multiple or tentative diagnoses can be documented here with use of rule ins or rule outs
plan- developed according to assessment and includes any treatment, surgery, medication, intended diagnostics and communication with the owner. Need to be accurate for next vet
What is the Source orientate medical records (SOMR)
Data is entered in the medical record and then grouped by the information source and then organized chronologically by date of patient encounter.
Name some information sources that divide the SOMR
client oral history
physical exam findings
imaging studies
laboratory results
Are SOMR records effective
they can be if well organized but depending on the doctor, the date to date history may be very disjointed.
Use of check lists can increase the probability of doctor capturing necessary data
Combination SOMR and POMR records.. Aspects and divisions
Probably the most effective way to orgainze the record from the private practice perspeitive. It would include
*major problem list
*vaccine history
* exam uses the SOAP format with major problems entered using the POMR source orientated format
What is the goal for manager regarding technology
To develop effective automated information and processing systems that can evolve with practice growth and that will be able to take advantage of new technology as it developed
Name some applications in vet med that use technology
online CE
computer appt system
consultation with specialist
digital photographos
digital radiongraphs
email reminder
electronci medical records
supply purchases
webpage design
Software implementation considerations
think about low tech staff and their anxiety- provide time
new software should come with onsite team training, no less than 1/2 day-
appts should be kept at min so team can concentrate on learning
if multiple applications or modules purchased, consider implementing them in phases
if new software is intended to take you to paperless, gradual training transition is recommended.
give the timeline for software training when going to paperless
purchase and implement new hardware
implement new software for 6-12 months
begin final phase of going paperless
what is the strategy behind having a ongoing liaison relationship with attorney
avoid the urgent and crisis oriented circumstnaces and maintains more of a preventativve relationship for the practice.
what might an attorney help with
min liability exposure
review consent forms, handbooks, letter of intent
conduct practice risk audits and form reviews two to three times a year
buy sell agreements
shareholder agreeements
name three types of services from an CPA
audited- very detailed- lengthy-highest level to present fair documentation of bus financial position
review- less detailed than audit focused on confirming fin statements in conformity with GAAP- CPA will identify modification to confirm
compilation - most basic- cpa should determine if any obvious departures from GAAP
define reservoir
place where an infectious organism survives and replicates
define host
living organism provides environment for the maintenance of the organism but may not be necessary for the organisms survival
define direcdt transmission
requires close contact between the reservoir of the disease and the susceptible host
define indirect transmission
more complex and involves intermediaries that carry the agent of diseeasse from one source to another
define vector
living organism that transports
zoonotic diseases # and cross-species
1400 exist and 60% know to cross species
define vehicle
mode of transmissio of infection from reservoir to host, usually air or dirt, non living
when it comes to risk managegment for zoonotic disease what basic should the staff know
zoonotic disease is disease that may be directly or indirectly transmitteed to humans from wild or domesticate animals
Can the vet be held liable for failure to education on zoonotic diseases
the vet can be held liable for tansmissio of zoonotic disease. Teams should received extensive training on issue and each employee receives training should sign docuemnt
what is vet role in education of zoonotic diseases and name one recommendation
the AVMA code of ethics, many state boards, and regulatory agencies require vet to educatio public regarding zoonotic diseease
One reomminded standard of care is to deworm all puppies and kittens on first visit and educate client on zoonotic potential of parasites and alwasy document conversatoin in medical record
What area are zoonotic treatment programs generally focused
on reservoirs and hosts when implementing control methods for zoonotic disease
What should zoonotic disease prevention program look like- what does preventiobn look like
these programs require a thorough knowledge of the disease and how it is maintained in order to break the cycle of the idsease. Examples of preventio may include vaccination, water filtration or superior hygiene.
what is most common bacteria present in dog or cat
Pasterella
common symptom of pasturella
fever, septicemia, menignitis, endocarditis, septic arthritis
what to do if bitten
wash area well warm soapy water for at least 5 min, apply dilute betadine solution, then rinse with strong stream of water and consider seeking medical attention
what if employee declines to seek medical attention
a form should be singed and placed in their medical file to protect the practice form workers compensation case
Name the two different types of insurance coverage
Liability coverage
Property insurance
what is liability coverage
covers damages that the vet (or any employee )causes to other person, pets, or proptery. A liability policy will contain multiple provisions, with separate limits, for personal injury and property damage caused to others
what is property insurance
covers damage to insured own property
Is there specialized forms of liability
yes, malpractice which is clasified legally as a tore that requires proof of foure essential elements and if any of the elements cannot be provided by a preponseerance of the evidence then the cause of action fails
waht is a tort
a civil wrong or wrongful act, whether intentional or accidental, from which injury occurs to another.
What are the four essential elements required to prove malpractice?
- duty of practice within the standard of care is typically established at hte creation of a VCPR
- breach of duty- failure to act in accordance with the standard of care
- proximate cause- the connection between the negligent act of the practitioner and the harm to the patient or client
4, damages- harm incurred to patient or client as a direct result of the negligent act of the practioner.
Is there a duty of vet to treat
There is no duty to treat until a valid VCPR is established- not even emergencies
Once a VCPR is established treament must continue until:
- animal recovers
- vet has completed all the treatment that was agreed upon
- animal dies
- client terminates the VCPR
- responsibility for treament is transferred to another practitioner iwth the consent of the client.
**termination is difficult wiithout client consent
What is contributory negligence
when defendant in malpractice action may be able to show that the client was also negligent in the care of their animal
what is comparative negligence
similar to contributory negligence, except the cleint’s recovery is determined by the percent of negligence on the part of the client. If the client is found to be 25% negliigent, then they will recover only 75% of the total damage. Tyupically, if the client is found to be over 50% negligent the client cannot recover any damages
How to avoid malpractice suits
continuing education- hard for vet to win if client can show vet unaware fo facts that reasonalbe vet would do
*medical records- details are the most important evidence in malpractice case
*informed consent- client must be given sufficient data to make informed decisions regarding health of their pets
* staff training- staff properly trained in medical knowledge and have proepr communiciaotn skills
* referral- general vet should be careful to make cleints aware of plethiora of speicialist having high level of specialized care than they can provide
What is the business life cycle?
Introductory-vision, innovation and energy- before doors are open- REPEATEDLY THIS COURSE HAS PROMOTED MISSION VISION AND VALUES
Growth- efficiency, discipline, and talent development are critical
Maturity- manage risks, problem solve, search for continuous opportinity for growth- TEAM SHOULD BE RUNNING PRETTY GOOD HERE- KEEP TEAM VIBRANT-
decline- decreased demand for services. Revisiting the strategic plan for revitalizing the practice is vital.
What are 4 stages for Strategic planning
Formulation
Development
Implementation
Evaluation
What are 3 phases of Formulation phase of strategic planning
1development of Mission, vision and values- represents how every decision is made. every member must embrace MVV of practice
2SWOT analysis- strengths. opp etdc (IMPORTANT PROFESSIONAL AND PERSONALLY)
3Gap Analysis- compare current performance with potential or desired performance. This will lead to development phase of plan.
DEEP DIVE WHAT IS GOING ON AND WHERE WE WANT TO GO
what are questions to ask in Gap analysis
What services are delivered today and what services are desired to be offered in future?
What skills, knowledge, and abilities does the team need to get to goal?
What is employee retention rate and are there true career opportunities?
What overall aspect make up the development phase of strategic planning
Uses all those things found out in formation phase to create strategic intent to acheive desired goals. HOw you get form point A to point B
What things to consider in development phase
Deep dive on where we want to go
Team members- skill level, training, retention
clients- who is target market, how to find them
Patients- what equipment or tools are needed to reach patient care goals
Budget- what investments are needed to reach goals and how will practice obtain those funds
What is outcome of development phase
to create a strategy that has a “strategic fit” where the practices activities interact with and support the strategy and each one optimizes the other to reach the goal.
What happens in the Implemetation phase of strategic planning
the strategic intent in translated into specific plans of action. There should be allocation of resources, communication to team members, management of team, education and staffing to achieve goals
How to implement plan of action in learning organization
incorporate “System Thinking” where consideration is given to how each department affects another
list objective and how to measure
how will objections be obtained and what resources
what is time frame.. WHAT METRICS
What is the evaluation phase of strategic planning
Time to think about original objectives created in the Development phase. Evaluate the success of those. There should be check-in points for KPI’s that were discussed.
Might consider a balanced scorecard
What is a balanced scorecard
A tool that illustrates the state of the practice in regards to client satisfaction, financial status, learning and development progress. The scorecard metrics can show the side effects of your strategy and its successful implementation, as well as whether the changes have affected other areas of the business.
OUtside of the business lifecycle, there are organizational systems that can apply to strategic planning. What is Organizational Design
The methodology that identifies aspects of workflow, procedures, roles, and systems and aligns them to fit current business realities and goals.
Organization design clearly defines roles within the practice and should empower team members due to clear responsibilities, clear goals, and effective communication.
Organizational Development is different from Organizational Design in it looks at the process of enhancing effectiveness within practice. What are the four compoinents of organizational development?
1 Define the problem
2 Design a solution
3. Implement phase
4 Follow through
What is Learning Organization
Characterized by the ability to adapt to change and respond quickly to environmental/consumer changes
think covid
what are 3 areas to evaluate and consider where change might be indicated in learning organization
client services
patient care
TEAM DEVELOPMENT
WHAT ARE SOME common reasons for failure of Organizaiotn Development
leadershiop dod not support or commit to change
wrong message or message did not resonate with the team
chages were forceful instead of collaborative
lace of clear communicaiton
change does not align with MVV
What does a Learning Organization Do
Uses System Thinking as it relates to being a learning organization
therefore
every team member must generate ideas and create solutions for all parties involved
MVV critical element to systems thinking
team members need to know that leadership readily embraces charge and accepts recommendations
failures create learning opportunities and empower team members to continue being engaged in the process
What is order of events if your information tells you there is fraud
1) notify owner
2) secure important data- badckup
3) inform insurance agency
4) contact attorney/accountant
5) Reassign duties so they are shared
6) on attorney advice, contact policy
7) Do not talk about numbers $
