How does your veterinary hospital stand out from the other three down the road? Clients choose among veterinary hospitals based on a variety of factors and perceive quality of care in different ways than you might expect. The reality is that, no matter how outstanding your veterinary medical skills are, clients do not fully perceive quality of services until you convey how much you care about the client and the pet.
Here are ten ways to enhance client satisfaction. If you implement these strategies, it is reasonable to expect to strengthen the hospital-client bond and increase hospital loyalty and business.
Strategy #1: Make an excellent first impression.
How do clients first interact with your hospital? Typically, on the telephone. So, be sure to train the receptionist to extend a warm welcome to new clients and find out the specific reason why a client is calling. In the following example, the receptionist politely answers the call, referring to the client and pet by name, and makes it easy for the client to provide the information the receptionist needs.
Receptionist: “Hello, this is ABC Veterinary Clinic. My name is Susanne. How may I serve you today?”
Client: “Hi, this is Peter Oswald. I’m calling to schedule an appointment for my dog, Harris.”
Receptionist: “Thanks for calling, Peter. May I ask if you or Harris has been to our clinic before?”
Client: “We haven’t.”
Receptionist: “In that case, welcome to ABC Veterinary Clinic! We’d be happy to see you and Harris for an appointment. May I ask some questions about Harris to determine how we may best meet your needs?”
Strategy #2: Offer a welcome kit to new clients.
Nothing says “thank you” to a new client more than a goodie bag with free pet-themed items. A welcome kit serves to exceed client expectations (a value-added benefit), enhance the hospital-client bond, and offer incentives. Example kit contents include:
- A “welcome to our clinic” greeting card
- Healthcare brochures tailored to the age and species of pet
- Pet items with the clinic’s logo (perhaps a dog toothbrush, bandana, leash and/or pet dish placemat)
- Helpful articles, such as “Choosing a Pet Food Diet” or “Common Household Toxins”
- Incentives, such as a free nail trim at the next visit
Strategy #3: At the end of the initial client visit, offer an incentive to return for a second visit.
Instead of (or in addition to) a welcome kit, you can offer a free service to first-time clients. This serves as a small gift as well as an incentive for the client to return on a second visit. Examples include a free nail trim, free ear cleaning, or an item many pet owners are sure to enjoy: a pet “Driver’s License” (e.g., mypetdmv.com), which is a pet ID tag that comes with free registration on a lost dog registry.
Strategy #4: Extend the support clients need during euthanasia.
A 2004 JAVMA study asked clients to rank the most important factors in their experience of pet euthanasia. “Compassionate and caring attitude of hospital staff” ranked #1 among the clients’ list of factors. Interestingly, clients ranked logistical concerns (e.g., short waiting times and availability of grief resources) the lowest. Thus, staff euthanasia training should emphasize providing emotional support to clients. It may be helpful to supplement staff training by allowing new staff to be present during euthanasia conversations and the euthanasia itself. An empathetic and compassionate disposition is a vital component of the euthanasia experience for clients.
Strategy #5: Acknowledge the owner and pet by name.
What is a word that is music to your ears? Your own name! Greet a client as soon as he or she walks in the door with his or her own name and the pet’s name. How can your hospital accomplish this with every client? At a pet’s initial visit, take a picture of the pet and keep it in your records. When a client walks in for a scheduled appointment, the receptionist and greeter should acknowledge the client and pet by name based on skimming through that day’s medical record pictures.
Strategy #6: Send a quarterly newsletter.
A hospital newsletter – even if it’s just quarterly – personalizes the hospital and allows clients to feel as family in-the-know. Grab your audience’s attention by addressing popular owner questions such as how to choose a pet diet, grain-free pet food, dental care, or behavior (“Why does my dog/cat do that?”). In addition, be sure to introduce new staff, promote health awareness and hospital services, and demonstrate hospital strengths such as AAHA accreditation or recent awards. This is also your chance to offer incentives to current clients (e.g., a discount on your hospital’s grooming service).
Strategy #7: Outfit the reception area to suit clients’ needs.
While the waiting room may be a holding area in our eyes, clients need it to be much more. How does your reception area address their needs? Clients are burdened with hands full of pets on leashes, paperwork, coats and purses, and possibly accompanying children. To best serve your clients while they wait, provide a clean and quiet area with entertainment, a separate area for cats or exotics, a dedicated children’s table with coloring, and coat racks near benches.
Strategy #8: Send a pet birthday card.
Surprise your clients with a signed pet birthday card mailed the month of their pet’s birthday. This enhances the hospital-client bond and reminds clients of your services at a random time during the year (i.e., not in association with a vaccine reminder). Pet birthday cards do not have to be specifically ordered from a veterinary greeting card company; an ordinary birthday card with animals on the front will do!
Strategy #9: Provide a personal tour.
At a client’s first visit or at pet drop-off, offer that client a quick tour of the treatment and surgery areas or boarding facility. The dedicated attention his or her pet receives should relieve client fears of leaving the pet in an unknown setting. Furthermore, this level of transparency should strengthen the hospital-client bond. As an added benefit, a tour is a chance to ask the client for feedback and improve your practice based upon suggestions given.
Strategy #10: Text a picture of the pet to the client.
What a relief it must be for a client to view his or her pet in recovery! Send your client a photo via text of the pet after surgery to share how everything went well and to confirm the pickup time.
The best way to create the future you want is to set goals and then plan appropriately for them. Roadmaps are essential to your career plan! Here are key issues to consider and address during the early years of your practice.
Your days are likely to be busy as you care for clients and manage your team. It’s important, though, to sometimes step away from daily fire drills to focus on long-term strategic planning. A strategic plan provides an overall sense of direction directed towards future prosperity. To be effective, it should deliberately be put into practice, modified when needed, and reviewed regularly (often annually). Components of a strategic plan typically include:
- Mission statement/purpose
- Core values
- Long-term vision (perhaps 3 years, or 5, or 10)
- Strategic agenda (projects undertaken to move towards your vision)
- Project plans (for each item on the strategic agenda)
- Project milestones, and the metrics and measurements used
- Accountability plan (who will be responsible for what)
Fortunately, plenty of free resources exist to help you to create a viable strategic plan, including a 30-minute online training by the Small Business Administration (SBA) found here: https://www.sba.gov/tools/sba-learning-center/training/strategic-planning. This section of the SBA site also offers significant amounts of supplementary resources for strategic planning.
Appropriate Financial Planning
Although “budget” appears as the last bullet point of the strategic planning process, it’s very important, as the funds generated by your practice will serve as the fuel of your success. There are numerous financial planning issues to consider, far too many for an article, but here are several high-level recommendations:
- Get a handle, early on, on your cash flow. Are there times of the year when cash flow increases? Decreases? How predictable are they? Are you paying your bills on a schedule that avoids late fees and takes advantage of any early pay discounts?
- Monitor your own time. If you’re having to work extra-long hours every week to be profitable, this isn’t a sustainable strategy. What changes need to be made to create a more realistic workload, long term?
- Ensure that you truly understand your profit and loss statements, and other financial documents. If you don’t, ask for help! Although there is nothing wrong (and plenty right) with having financial professionals assist with managing your financials, you need to thoroughly understand where your business stands.
- Look to the future:
- Determine the best retirement plan options for you and for your practice team. If you have no more than 100 employees and no other qualified plan, consider a Savings Incentive Match Plan for Employees (SIMPLE).
- Know that it’s never too early to create a succession plan (ownership-wise and management-wise) in case you become incapable of working or die; this helps to ensure a smooth transition at the lowest cost.
- Finally, save for a rainy day! If you never need to use these funds, then you’ve got a nice financial cushion that can come in handy if you decide to expand your practice or otherwise make large expenditures – and you don’t have to panic or go deeply into debt if an emergency does arise.
Creating Your Employment Environment
The people in a practice can make or break its success, so creating a success-friendly environment and company culture is crucial. Core elements of this environment include:
A mentor is simply a more experienced person offering guidance to a lesser experienced person. A workplace mentor serves as a role model, sharing knowledge that will help someone else chart his or her own successful career path. Mentorships can be formal or informal, and the roles can be quite fluid. For example, a more experienced veterinary tech can mentor a newly graduated one in job-specific duties, but the roles could shift if, say, conflict resolution skills are needed and the new tech has significant experience in that from another job or different context.
A healthy workplace has an engaged workforce – and engaged employees are those who are eager to participate in workplace activities and meet the challenges of the day. Engaged employees are motivated employees, and there are two types of motivation: external and internal.
External motivators include wages and benefits, and are needed to get people to work. Internal motivators go beyond that, and exhibit a much stronger pull. They include:
- Autonomy (control and decision making)
- Mastery (learning)
- Purpose (achieving personal goals)
To motivate teams externally, analyze what similar clinics are paying in wages and benefits, and pay the fairest amount you can. You don’t want to invest time and energy into an employee only to have him or her enticed away by a competitor who offered better compensation.
To internally motivate, provide autonomy, perhaps through flexible scheduling, incentivized earning programs and results-oriented managing (in other words, don’t micromanage!). Create a culture wherein practice members can master their favorite specialties through continuing education and teaching clients. Highlight purpose by noting what a difference a staff member is making in people’s lives, participating in charity events and building a culture in which praise and encouragement is given.
Finally, create a culture of transparent workplace accountability by clearly defining roles, and by focusing on teamwork. Clarify the importance of each person’s role in accomplishing team goals, and share and celebrate successes, while brainstorming how to overcome challenges together. Honestly evaluate processes and encourage practice staff to make suggestions. Reward integrity.
From a practical standpoint, organizational charts can help. Having a formal written organizational chart can help the growth of your practice in many ways, including serving as a:
- Roadmap for developing a management team
- Blueprint for hiring employees and developing their skills
- Method to improve flow of information throughout the practice
- Framework to boost efficiency
As you need to hire staff, give raises and otherwise manage a practice, having quality negotiation skills are important. Whenever two people have differing needs and interests – and each has what the other wants and needs – then a series of negotiations are likely to take place. For example, you want to improve the bottom line and so are watching expenses, but need the services and engagement of your veterinary technician, while the veterinary tech needs to earn more money for her family. So you need to discuss (negotiate!) a solution that will work for both of you.
To successfully negotiate:
- Understand the other person’s interests
- Be well prepared with factual information
- Determine where and how you can compromise
- Treat the other person the way you’d want to be treated; the goal is a successful long-term relationship, not a quick short-term win
A unique type of negotiation occurs with practice residents. Finding the right resident for your practice takes time, and you need to protect the investment you’ll make in your resident by including proper retention provisions in your residency agreements. At the core of a residency agreement: you are agreeing to pay for your resident’s training and living expenses in exchange for a certain amount of work after he or she is board certified.
Consider a carrot and stick approach to your agreement. At a minimum, require your resident to pay back the expenses you fronted if the residency is not passed in a timely manner or if your resident leaves your practice before the retention period expires. The carrot is optional, but serves as external motivation: if your resident successfully works through the retention period, he or she receives a bonus that is well-defined. And, it also makes sense to cultivate internal motivators with your resident. What autonomy can you provide? What mastery can you help to create, and what sense of purpose can you encourage?
Remember to take care of yourself! It’s crucial to create a healthy balance between work and the rest of your life – crucial for your health and well-being, as well as for the rest of the practice and your clients. Tips to help make this happen include:
- Mark important milestones on your calendar, perhaps your anniversary or child’s birthday, and arrange ahead of time to have time off to celebrate.
- Learn to prioritize and say no when you simply don’t have time to take on an additional task – or even something extra that would be enjoyable.
- When you get home, leave the workplace behind as much as possible. Try not to dwell on problems that happened or answer your email. Make your personal time truly yours.
- Track your time at work for a week. What tasks could you delegate to free up time? Or what isn’t necessarily a priority and can be put on a back burner?
- Consider starting a workplace wellness program. Participate!
- Lower your expectations at home. Incorporate more rest and enjoyable activities in your day whenever possible.
As a final piece of advice, during the early years of your practice (and, later on, for that matter), when you face challenges, reach out for help. Other professionals have been through similar scenarios and can provide guidance. You don’t have to go it alone.
Stories involving ethical decisions can frequently be found in the news, usually because someone’s ethics have been found wanting. And, although some people either intentionally make unethical choices and/or don’t spend enough time determining the appropriate behaviors, even the most ethical people can sometimes struggle with deciding what actions are most appropriate to take.
To add to the mix: in the professional arena, few industries have as many ethical and legal obligations to as many parties as those in the veterinary field. Veterinary professionals must consider:
- Wishes of their clients
- Obligations to:
- the animals
- the general public
- professional colleagues
In situations where all of the interests mesh, then ethical practices are fairly easy to uphold. But, when interests and obligations conflict, then ethical dilemmas arise. For instance, perhaps a client doesn’t authorize treatment that you know is in the best interests of the pet. What do you do?
When a moral dilemma arises, it’s important that you ensure you are thoroughly familiar with the AVMA Principles of Veterinary Medical Ethics, and then apply those ethics to the situation at hand. Note that collective ethical rules have, at times, been given the force of law when adopted by veterinary medical boards.
Also, what state laws apply? All fifty states have some statutory framework focusing on veterinary practices, creating licensing procedures and establishing basic governance of veterinary medicine. State boards of examiners enforce and administer the laws under the state’s practice act, and include these codes of professional conduct. Also, non-veterinary-specific state laws also need considered; malpractice laws are just one example. And, what local laws also need to be considered?
Although laws and professional codes are crucial to consider when making ethical decisions, these decisions often go beyond codification. They also include a person’s moral convictions, ones that aren’t – assuming that laws and codes are met – enforceable from an outside body.
Although no one ethical dilemma is exactly the same as another, we recommend the following eight-step approach to solving the ethical problem you’re facing.
- First, clearly define the core ethical question, typically framed using what “should” or “ought” to be done.
- Next, determine who is affected by this issue. Who are the major stakeholders? Minor ones?
- Take a look at each of the major stakeholders. What are each of their primary interests and/or concerns?
- Examine the facts you have. What else do you need to know? How can you get this information?
- Brainstorm! What are your goals? What potential solutions are available to you? Alternative courses of action?
- Now it’s time for moral discernment. Which moral values, principles and/or rules are relevant? How would you prioritize them?
- Go back to the list you created in response to number five and eliminate any alternatives that aren’t feasible. With your remaining list, how would you assess each of the solutions when evaluated using the values you prioritized in number six? Which solution is most acceptable when viewed through the lens of your priorities? Which one satisfies the greatest number of stakeholder interests? The solution that is doable, respects the broadest array of priority values and satisfies the greatest number of major stakeholder interests is the most ethical choice.
- Finally, it’s time for moral closure. Review your process. Have goals from step five been accomplished by your proposed solution? Are they compromised in any way? Have all parties’ views been represented, whether they were actively participating in the decision making or not? Can this alternative truly be implemented as proposed?
If a practice manager genuinely follows this pledge, then ethical decisions will naturally follow.
I pledge myself to:
- Comply with the principles and declarations of the Veterinary Hospital Managers Association, Inc.’s code of professional ethics.
- Maintain and promote the profession of veterinary practice management.
- Assure my continued growth and development as a professional by utilizing, to the highest extent possible, the facilities offered to me for continuing the professional education and refinement of my management skills.
- Seek and maintain an equitable, honorable and co-operative association with fellow members of the Veterinary Hospital Managers Association, Inc. and with all others who may become a part of my business and professional life.
- Play a fundamental role in maintaining excellence and quality of care to our clients and their animals.
- Place honesty, integrity and industriousness above all else, and gainfully pursue my profession with diligent study and dedication so that service to my employer shall always be maintained at the highest possible level.
- Keep all information concerning the business or personal affairs of my employer confidential, except as may otherwise be required or compelled by applicable law or regulation.
- Protect the employer’s funds and property under my control. Information gathered, maintained or produced within the veterinary practice is the property of the practice owner and will not be reproduced, shared or distributed outside the practice without consent of the owner.
This session will discuss multiple ethical scenarios such as: custody disputes, clients who do not pay, unauthorized use veterinary equipment, misuse of controlled substances, and more. Read two of scenarios below.
Ethical Scenario #1: Custody Disputes
When a couple is divorcing, plenty of complicated issues can arise. This can affect your veterinary practice, especially if one member of a couple is requesting irreversible procedures on a pet and the other may disagree. These procedures include euthanasia, spay/neuter, cosmetic (ear cropping, tail docking, and declaw), and relinquishing the pet for adoption. Furthermore, courts are increasingly considering animals to be subject to custody laws, rather than as personal property, which makes this an even more pressing issue.
Here’s a worst-case scenario: a longtime client, Mrs. Jones, is the documented owner of Olli, a ten-year-old male toy poodle. There is no mention of a Mr. Jones. One day, though, Mr. Jones bring in Olli for euthanasia because the dog is urinating on the carpet and barking too much. To make matters more complicated, a relief veterinarian was on duty; this veterinarian presented alternative options, but Mr. Jones could not be swayed and he signed the consent form.
People in the practice knew that this couple was in the middle of a heated divorce, but the relief veterinarian did not, and he euthanized Olli. Mrs. Jones subsequently filed a lawsuit against the practice, saying that Mr. Jones took this action to spite his wife.
Using the decision-making model described above, what alternate solutions would you have presented? What actions would have been reasonable, ethics-wise? What safeguard procedures would you implement?
Ethical Scenario #2: Human Medicine
It isn’t unusual for a frightened cat to lash out and, even when safe-handling procedures are followed, someone gets bit. So, how much treatment can a veterinary practice employee offer, given that veterinarians are not permitted to practice human medicine? Clearly, someone can assist the person with washing the wounds thoroughly with soap and water, and applying bandages, since procedures that any “reasonably competent” individual can undertake are not considered practicing medicine. And, as many veterinary practices have staff members certified in standard first aid, this is clearly within scope.
But, what about applying an antibiotic, such as cephalexin? It’s easy enough to apply and readily available, and saves time for the person who was bitten. To balance clinic inventory, a prescription could be written for that person’s animal. If all heals well and no one says anything, this is unlikely to cause problems for anyone. This, though, however well intended, violates multiple professional ethical tenants. These include practicing medicine on a human and writing a false prescription.
Run this scenario through the decision-making analysis. What conclusions do you have? Then, throw in this added twist: what if this happens during a raging blizzard and the wound looks fairly serious? Does this change anything?
- Tannenbaum, Jerrold. Veterinary Ethics. Baltimore: Williams & Wilkins, 1989.
- Rollin, Bernard E. An Introduction to Veterinary Medical Ethics: Theory and Cases. Ames: Iowa State UP, 1999.
It’s hard to dispute that strong leadership is important, so how can this readiness gap be filled in? Here are eight strategies from Monday Morning Leadership by David Cottrell.
Drivers and Passengers
Are you a driver – or are you a passenger? Drivers must keep their focus on the road, whereas passengers have more freedom to goof off. And, to be a good leader, you must become like the driver with more responsibilities and fewer freedoms. As a manager, for example, you must oversee people, and you should not complain about company management. Plus, as a strong leader, you should never look for someone else to blame. That causes you to focus on the past, whereas fully accepting responsibility permits you to focus on today, on now, to move forward and to plan for positive change in the future.
Here’s the bottom line. You can’t always control a situation, but you can control how you respond. Yes, there are struggles in management, but there is no point in feeling sorry for yourself, because that’s a total waste of time.
Keeping the Main Thing . . . the Main Thing
What’s the most important thing – the MAIN thing – for your department or team? Ask ten different people and you’ll most likely get that many answers. So, as a leader, it’s crucial that you communicate what the main thing is, both to the people you manage as well as to your superiors. When everyone has the same understanding of purpose and goals, it’s much easier to remain focused and productive.
Escape from Management Land
How can you do that? Here are three steps:
- Hire the right people.
- Coach all of your people to succeed.
- De-hire the people who don’t pull their share of the load.
And, here’s a common trap to avoid. There are three categories of workers: superstars, middle stars and falling stars. Managers far too often give superstars increasing amounts of work to do while taking away the work from the falling stars. This rewards the falling stars by giving them less work to do for the same pay while your superstars are being overworked. Flip this model upside down! Instead of lowering the bar to accommodate falling stars, raise the bar and reward your superstars.
The Do Right Rule
Do the right thing, even if no one is watching – and even when doing so is hard. It’s your job to establish a code of behavior and to protect your integrity, which will help to build trust between you and your team. Also, do not make decisions when you’re in a crisis. Instead, implement previously-prepared plans as your response. Think of yourself as a pilot who sees a flashing warning light. He or she doesn’t ignore the light in the plane. Instead, the pilot troubleshoots, refers to a manual of potential fixes and then implements the correct one to fix the problem before it becomes an emergency.
When you hire tough, managing becomes easier – a much better scenario than hiring easy and managing tough. The right people can be your greatest asset, while the wrong people are your biggest liability. Here are hiring tips:
- Always plan your interviews ahead of time.
- Develop your questions and then practice the order in which you ask them.
- Hire using the rule of three: interview at least three people for each position, see each person three times, and have three people evaluate them.
- When you interview someone multiple times, schedule them for different times of the day. You will be working with someone all day so seeing them at different times for an interview is useful.
- Never lower your standards to fill a spot. Finding the right person is more important than filling a hole.
- Ultimately, make it an honor to work for your team.
Do Less or Work Faster
You can’t add time to your day so, to be more efficient, you either have to do less or work faster. To accomplish the latter, you’ll need to implement strategies to make better use of your time. Here are examples:
- First, spend uninterrupted planning time every day. This allows you to be organized in how you spend your time.
- Next, clean your desk. A cluttered desk doesn’t make you look busy or important. Instead, it makes you look unorganized and can lead to shuffling and reshuffling files or papers, which wastes time.
- Only check email at scheduled times.
- Organize similar activities into batches to reduce transition times.
- Change your lunch time to 11 a.m. or 1 p.m. to avoid lines.
- Keep meetings short and productive.
Here’s a big one: limit interruptions because time is wasted every time you are interrupted. If you can’t avoid an interruption, limit it. Sound impossible? Here’s one tip: if you stand up when someone comes in your office, that helps to keep the interruption shorter.
Buckets and Dippers
Picture each person as having a bucket of motivation. For some people, the bucket can be overflowing; for others, it is virtually empty and needs refilled. Also imagine each person with a dipper that represents negativity – or anything else that can drain someone else’s motivation.
An outstanding leader keeps everyone’s bucket full. But, how? Here are four ways to fill a bucket:
- Identify what’s important for people in order to do a good job and avoid creating confusion or being inconsistent.
- Provide feedback on how each employee is doing.
- Let employees know you care about them and the job they do.
- Also let them know how well they are doing as a team.
The best news is, the more you as a leader fill other buckets, the more your own bucket will be filled. And, interestingly enough, leaders actually need their employees more than their employees need their leaders. If you remove the leader, employees will typically still get 95% of their work done. If, though, you removed all the employees, the leader would probably only be able to get 10% of the work done. So employers should focus on helping employees be the very best they can be.
Enter the Learning Zone
Leaders need to focus on their own growth; otherwise, they will get stuck in their comfort zones where nothing changes. As a leader, you can picture yourself in the learning zone that has three rooms.
The first room is the reading room. Most leadership problems are not unique and wisdom can be found in leadership books. If leaders spent just ten minutes a day reading, they would have read 12 books over the course of a year, which could significantly increase knowledge on a subject.
The second room is the listening room. The main reasons executives fail are arrogance, ego and insensitivity. When leaders forget to take the time to listen to their teams, they become insensitive to their needs and desires. Also, use your listening time wisely. When you are in the car, for example, you could spend time listening to motivational or inspirational tapes instead of talk radio or music.
The third room is the giving room. Teach others what you have learned. The more leaders teach, the more they become accountable to what they are teaching. Set goals for yourself as a leader because goals are the strongest force for self-motivation – because they push you out of your comfort zone.
Finally, stay positive! Bad things happen to everyone, but the successful don’t get discouraged.
The Components of a Disaster Plan
A Small Business Administration study determined that almost 60% of small businesses impacted by a disaster would close, the majority of which would simply never re-open after the initial event10. Such numbers speak volumes to the need for a plan in the face of a disaster. The plan ought to cover four basic principles: mitigation, preparation, response, and recovery.11
Mitigation is essentially the practice’s insurance and legal coverage. This can be as different as any two practices in terms of what it covers, but includes any act to reduce the severity of the hazard, which may include not having trees too close to the practice, evacuation plans, and communicating those plans to clients. A large animal practice dealing in multi-million dollar racehorses and a specialty practice dealing predominantly in pocket pets will not have the same degree of risk. However, there are some common denominators even among practices of varying types.
- Any business should undergo periodic insurance reviews to make sure they carry sufficient protection. Practice owners may be surprised at how much their business has grown and/or changed in the past two years, and how a plan that initially covered every contingency is now deficient. Most veterinarians have professional liability insurance to protect against allegations of malpractice or state board investigations; however this is grossly insufficient to protect against other damages, including damage to the property, loss of revenue, or injury to pets and/or clients. Accordingly, owners should invest in business insurance, which not only protects against losses due to fire and/or theft, but against business disruption and loss of revenue due to any number of reasons.12 Flood insurance is usually a separate policy, and practices in known flood plains should consider the added expense. One other major insurance issue is the patients themselves. Bailee insurance, or its equivalent, is recommended to protect against losses that result from the injury and/or death of a patient that is NOT a result of malpractice. And one of the major pluses to “animal bailee insurance” is that the pet is covered regardless of the circumstance. Malpractice insurance only covers the patient’s injury or death if these occur while being actively treated as a patient. If a client’s dog is tragically killed in a fire, or if the vet risks himself and frees it only to have it killed by a speeding car, or to disappear into the woods, the vet is only covered for that loss if he has bailee insurance.13
- Copies of patient records should be made and kept securely off-site. Electronic back-up systems are an excellent investment, even if the practice never has a true “disaster.” However, make sure that the system is working properly and back-up files are actually being produced. Too often, records are thought to have been backed up only to have the owner find out that the back-up was not doing its job for the past 3 years. It would be helpful for owners to attempt a periodic restore effort to prove it is working. Also, copies should be made of inventory and practice equipment documentation, and these should also be kept off-site.
- The practice’s building should be inspected by the local fire marshal for safety and structural soundness, and to make sure that local fire codes are met. Smoke alarms and basic firefighting equipment (e.g., extinguishers and fire blankets) are valuable investments. Fire codes may differ from state to state; for instance, Oklahoma does not require a written evacuation plan for animal hospitals employing fewer than 500 people.14 It does require on premise fire extinguishers, though, and the presence of a sprinkler system or smoke detectors based on building size and number of occupants. The AVMA PLIT insurance plan may potentially lower its premiums if a policy holder can verify they have a written and demonstrable evacuation plan, though by what amount is subjective and owners should speak with their individual agents.15
Preparation is probably the most overlooked part of any disaster management plan. Plans should also include how the staff is involved. For example, if the practice wants to stay open and be a community resource after a hurricane, but the staff live in outlying locations in mobile homes and have to evacuate themselves and their pets, the ability of the staff to assist would be compromised. It is not enough to type up a plan and post it on a bulletin board, although this is an important part of the process. The plan should be available in multiple copies where they are easily accessible, discussed frequently by the staff, and practiced regularly16. These basic principles ensure the plan will help save lives and protect property; otherwise it may literally go up in smoke no matter how outstanding or well written. The plan should:
- Designate important responsibilities to trustworthy people (e.g., calling 911 and making sure all staff/clients have evacuated the building). The immediate concern in preparing a plan is the safety of the owner’s staff and clients. Although the patients are important and may need assistance, the first step in any plan is the axiom “people come first.” This is not only logical but reasonable, as there will be no one to care for the animals if the people are themselves trapped in the fire.
- Consider the fate of the animals only AFTER people have been safely evacuated. Whenever possible, animals should be rescued from dangerous situations. However, people cannot be allowed to re-enter a potentially deadly situation to rescue animals. This need must be filled by trained emergency personnel.
- Name a common meeting place away from the immediate area if evacuation is needed, even if only across the street. The meeting place may be a vacant lot, or a private business or municipal area. Ideally, the place should be able to accommodate animals at least temporarily. The meeting place should also be within easy walking distance of the practice.
- Develop a mutual-assist agreement with another local veterinarian or animal welfare group, or the nearest specialty hospital or university for emergencies. If patients are evacuated, they may require further veterinary attention or at least temporary boarding. In a larger, more far-reaching tragedy, local vets are encouraged to be able to be self-sufficient for up to 72 hours. In this instance, a generator would make a sound investment and is suggested for vets in tornado-warning areas and along hurricane coasts. Generators need to be tested, fuel needs to be fresh or stabilized, as well as properly sized. Some generators may require an electrician to install appropriate switch panel. Also be sure to take into account the amount of fuel that will be needed.
- Designate someone trustworthy to call the clients/owners and inform them of the situation. This important step highlights the need for current and complete information about clients. Contact information on clients should be verified regularly, ideally during each appointment. It would be helpful to periodically remind your clients what the policy for the practice is.
- Practice, practice, practice . When a plan has been implemented, discuss it with all staff and associates. And then practice the plan, even if it’s only a fire drill. It’s important that you not only practice evacuating the building, but also that the back-up files are checked, client contact information verified, and your meeting place tested for its size and suitability to your needs.
The best statement about the “response” portion of disaster preparedness is “Respond as you train, and train as you intend to respond.”17 In a single sentence this summarizes and hammers home the point of all disaster response training. Train your personnel in the manner you would have them respond to a given disaster, and expect them to respond to a true disaster in exactly the same way in which they trained.
Recovery from a disaster can take months, even years. The length of time depends on many elements and what remains after the immediate danger of the disaster is past. Even after the damage has been assessed, it is up to the practice owner to decide if there is a possibility to re-build. In many cases, the feasibility of coming back from a disaster will hinge on mitigation and preparation of the individual vet. For instance, Dr. Smith and his predicament:
The Dr. Smith Individual Disaster Management Plan
- Evacuate the building of all human personnel. Have all or most of the files on that day’s patients on hand so they can be brought out too.
- Call 911.
- Meet at a designated place, ensuring that all people are safely out of the building.
- If the situation is stable and the risk very low, evacuate the animal patients or as many of them as can be safely brought outside.
- If there are patients in need of immediate veterinary assistance, designate a driver to take them to the nearest veterinary hospital, shelter, or similar location where help can be acquired. NAME Phone Number:
- Using the files from the day’s patient case load, begin calling owners to collect their animals. If owners cannot come immediately, take them to the nearest veterinary hospital, shelter, or similar location that will allow them to be boarded and inform the owner of the name, address, and phone number.
NAME Phone Number
- When the local 911 responders have the situation under control, check on the status of any controlled drugs that may have been spared by the fire. Do NOT leave on-site even if the safe or locked cabinet where they are normally stored is intact. Fill out a DEA Form 106 (Theft and Losses) and report the incident to your state DEA office.18 Controlled substances must be kept in a secure location, such as another vet hospital or even the local police station.
- Contact the vet hospital, shelter or other locations where your patients were taken for the day and make sure they arrived safely and/or were picked up by their owners. If there are no doctors at this site (e.g., humane shelter volunteers), send an associate to check on them. If there is no associate, check on them yourself at the end of the day.
- Contact the insurance company and file a claim. (This step may fall wherever the owner has time.)
The AVMA website www.avma.org contains numerous disaster preparedness resources, including state-specific emergency plans. It is highly recommended that veterinarians review these resources and download the state emergency plan that applies to them. Unfortunately, the vast majority of these plans deals with state-wide issues solely and do not address individual emergencies such as a hospital fire.
Practices along hurricane coasts and in areas where major natural disasters such as floods, tornadoes and/or earthquakes are likely to occur may consider educating their clients about pet evacuation. The website http://www.chelandem.org/flyers offers information on pet evacuation kits and general information for pet owners about caring for their animals during a disaster. Veterinarians could suggest the site to their clients, or create a link to it or a similar site on their own homepage.
ASPCA also provides animal welfare disaster funding including for organizations that take in animals from a disaster area. This funding can cover qualified veterinary expenses and medical care for animals. More information can be found at http://www.aspcapro.org/emergency-and-disaster-response-grants.php.
Although Hurricane Katrina was a true disaster, resulting in significant numbers of human and animal death and injury, good came from the tragedy, thanks to the attention given to the pet component of disaster management planning. The strides that were made helped agencies, many formed post-Katrina, to prepare for evacuations and to help alleviate pet and pet owner suffering during the Category 3 hurricane named Sandy in October 2012. This is not to suggest that Hurricane Sandy was not the cause of numerous pet-related crises, only that the groundwork laid post-Katrina appears to have somewhat of a positive impact on large scale disasters.
Veterinarians need to adopt individual disaster management strategies not only to protect the safety of their staff and patients, but to reduce their risk of being driven out of business by a sudden crisis. In the end, explaining all of the possible caveats and provisos of Dr. Smith’s situation is a gesture in rhetoric. The point is not in the fine print, but rather in the headline. Disasters are often categorized as such because they are unexpected, but preparations can be made even without a specific danger in mind. Dr. Smith could just have easily arrived at work to find a flood, or a tornado ripping through town.
Dr. Kevin Dennison19 formerly of the Colorado State Animal Response Team classified disaster management not as a myriad of plans covering the minutia of every possible problem, but rather as a contingency to face “the elephant in the road.” Where did the elephant come from? What is it doing here? Who cares, for as long as there is a plan for unexpected emergencies, an elephant in the road is nothing more than an unusual spin on a common theme. Ultimately it is within the power of the private practitioner to decide how disruptive it will be.
- 17. Business Contingency Planning for Veterinary Practices. Pg 5
By Kevin Dennison, DVM,
Director Animal Emergency Management Programs.
Colorado Veterinary Medical Foundation
191 Yuma St
Denver, CO 80223
- 18. Drug Enforcement Agency
Code of Federal Regulations
21 CFR 1300-end
1301.72 Storage of Controlled Substances
1301.76 (B) Other Security Controls for Practitioners
- 19. Surviving Emergencies. Your Family, Your Practice, and Your Community. Pg 5
By Kevin Dennison, DVM,
Director Animal Emergency Management Programs.
Colorado Veterinary Medical Foundation
191 Yuma St
Denver, CO 80223
- John Haven III
University of Florida
The Office of Medical/Health Administration
Please contact Mr. Haven for information relating to disaster response, the VETS Team, SART or Vet Corps issues.
Veterinary Business Advisors, Inc.
The legal requirements for employer recordkeeping and the retention of employee files are not as straightforward as your average business owner would hope. In fact, sorting through the complex and varied requirements can be a daunting task. Here’s why: recordkeeping obligations stem from a number of federal and state laws that vary based on the industry, location, and number of employees. To confuse things even further, similar records are often required by more than one law with varying retention requirements.
To simplify the recordkeeping process, one must consider the four basic elements of legal requirements: create, maintain, protect, and destroy. Once these elements are understood in the context of recordkeeping, it will be easier to approach the process methodically.
Employers should begin by establishing policies and procedures for recordkeeping in their operations manual, ensuring that they comply with all state and federal employee privacy laws. The manual should define what files are created, how long they should be stored, and who has access to them.
An employee’s personnel file should contain a clear record of his or her employment history. It should provide insight into the individual’s work history, benefits history, prior work performance, training, career development, and other documented employment-related facts. The specific layout of these files is up to the employer as long as it fulfills applicable laws. The following records should be stored in each personnel file:
- Employment application, offer letter, and resume
- Job description, and handbook acknowledgements
- Hiring, plus records of promotion/transfers, rates of pay, and other forms of compensation
- Training/education documentation
- Letters of recognition
- Performance evaluations
- Disciplinary and demotion notices
- College transcripts, and background screening
- Test documents used to make employment decision
- Termination records, and exit interviews
As already mentioned, it is important to determine who has access to employee files. Some people will have access to the entire file, while others may only have limited access; some auditors, for example, may have access to some portions of each file but not to others. It is therefore recommended that you keep sub-files within employee files to distinguish what is permitted for certain people to review and what is not. The following records should be included in the sub-file:
- Medical files; the Americans with Disabilities Act (ADA) and the Health Insurance Portability and Accountability Act (HIPAA) require employers to keep all medical records separate and many states also have privacy laws to protect employees
- Payroll files to maintain time keeping records, garnishments, and wage deductions
- Equal Employment Opportunity information and investigations to minimize claims of discrimination
- Immigration (I-9) forms to reduce the opportunity for an auditor to pursue and investigate information unrelated to the audit at hand
- Safety training records from the Occupational Safety and Health Administration (OSHA) to protect the employer from an auditor pursuing and investigating information unrelated to the audit at hand
Records retention encompasses three components: what, how long, and how. These are dictated by federal and state laws. Nevertheless, there is considerable debate on record retention, so it is recommended that management err on the side of caution and base record retention upon risk tolerance and available resources. In other words, do as much as you can to minimize risk (without proper records, employers may be vulnerable to unfounded claims by former employees) with the resources available. The following list is the recommended retention period for each type of record:
Records Retention Period (Years)
- All HR-related records 6
- Any record to support gender pay difference 3
- Payroll records 3
- IRS tax-related payroll info 4
- FMLA/USERRA 3 (after termination)
- I-9 3 (after hire) OR
1 (after termination)
- Pension & welfare plan documents 6
- OSHA logs & summary of recordable injuries 5
- Employee exposure to toxic substances, including MSDS 30
- Employee workers compensation claims 30+
- Resumes & applications 1-2
- Polygraph test results 3
It is important to take the time to double check that personnel files and records are up to date and stored accurately as practice liability issues can result from improper employment record maintenance procedures. Fortunately, technological advances have greatly facilitated the maintenance of record keeping and personnel files, and records can now be stored on paper or in digital format. No matter which method you choose, the records must be maintained in a reasonable order, in a safe and accessible place. Digital recordkeeping systems must have controls in place to ensure the integrity, accuracy, authenticity, and reliability of the records. They also must be able to be converted into a readable paper copy, if necessary.
Employment records are confidential. Security procedures should therefore be in compliance with all relevant current federal and state laws. Access must be limited to the human resource department and other personnel with a need to know. This will apply to personnel files, payroll, and medical records. Auditors and investigating agencies may also be allowed access to data, but only limited to the scope of the audit; employers should be aware that many states have laws regulating employees’ access to their personnel files.
Any time that records containing personal information need to be destroyed, acceptable methods include the following: shredding, erasing, or otherwise modifying personal information to make it unreadable or indecipherable. Employers should obtain a lawyer’s advice on establishing a destruction schedule to limit liability.
Recordkeeping of employee records may seem like a daunting task at first, but it can be managed by taking a systematic approach. Employers should begin by establishing a set of procedures that indicates the necessary documents and timeframe on storage. If there is a question about whether or not to retain a document, always err on the side of caution. The documents should be periodically audited to make sure they are up to date and stored accurately. Finally, the documents must be destroyed in an appropriate manner to ensure confidentiality.
Society for Human Resource Management (SHRM), 2013 SHRM Learning System, Module 2: Workforce Planning and Employment, Section 2-12, 2:282-292, 2013.