Good medicine, good business. Need time? Schedule it

Nothing messes up a day like a steady string of interruptions.

As we know, interruptions such as an incessantly ringing telephone, multiple walk-ins, emergencies, unending staff questions all cause the day to be longer, stressful and tiring.

The question is: How do we manage these interruptions?

The answer: appointments.

Most workers are believed to accomplish two hours of uninterrupted work in a normal eight-hour workday. American workers are reportedly hit with 300 incoming and out-going messages each day. The reality is that while it might seem busy internally, interruptions aren't helping you complete more surgeries.

When we track our veterinary work week, important patterns emerge. Those patterns can be relegated to an appointment system. With a structured and complex appointment system, interruptions (mostly) disappear, thereby creating more value each day, which can work to improve profits and your medical delivery.

By scheduling appointments, the value of the day increases. Your work day seems to slowdown, and you suddenly have time to enjoy your casework, read, look up a complex case, or just have a nice chat with a long-time client.

In business, the management buzz continues to be focused on productivity. In veterinary practices, productivity improves by taking a thoughtful, conscientious look at your appointment systems.

Contributors to veterinary productivity include:

• a medical records-based practice,

• excellence in training staff personnel,

• effective delegation of duties,

• outsourcing and living with appointments.

Some clinics can live without appointments by making specific adjustments to staff the clinic during peak times of client activity.

Such practices tend to think that control of the Saturday-morning rush without appointments is the best way to go. Yet when we study these issues, certainly one result is a lower average client charge and all of its negative implications.

By solving interruptions with discipline, we can control the clinic activities most of the time, and that is all it takes to restore peace to a chaotic environment. In addition, efficient processing of patients and clients are essential to good medicine and good business (profits).

In the veterinary workplace, all duties can fit into slots.

In my last column, we discussed scheduling appointments for life. This column will deal with setting appointments to achieve a balanced clinic life.

A concept of peak time management is a central theme within business circles because failure to deliver goods or services during these times can destroy goodwill as well as undermine morale. Remember this tenet: We rise to our own incompetence.

Different practices have different needs for client appointments, and these issues must be incorporated into the appointment template.

Specialty practices and "spay clinics" have very different types of peak-time management issues.

Go to a dentist and be prepared to wait for an appointment. One is going to wait even longer for an in-depth procedure appointment as dentists may only set up a couple of two-hour procedure slots per week. So, in the case of a bone graft, for example, one might wait six weeks to get the appointment. Other than emergencies, the same issues seem prevalent for human specialists.

Some businesses thrive without appointments, while other businesses would likely die. Personnel needs also vary.

Some of us can work 7 a.m. to 7 p.m. without breaks. But most of us work well in 90-minute time slots. An example might be to work on outpatient cases for 90 minutes, then switch off to, say, inpatient procedures.

In real medical practices where oncology is on the table, where cardiology is happening and where pancreatitis patients are in oxygen and on fluid pumps, mental breaks are needed.

High-volume practices roll through patients at a quick clip because the tasks are simple and the mental stress low.

But in typical veterinary practices, at least 19 different appointment types are needed.

Anatomy of an appointment system

• Brief: This appointment should take five minutes, e.g. suture removal.

• Limited: Set these slots for 20 or 30 minutes (annual checkups).

• Extended: Set these for 30 to 45 minutes (oncology cases).

• Release: Another five-minute appointment category.

• Conferences: 10 minutes in a specific conference room.

• White time: Nothing is set or scheduled (my favorite). Schedule two hours of white time for Monday mornings, a couple of hours anytime during the week, and late in the day on Fridays.

• Study hall: Reading is the lifeblood of the practice as well as keeping burnout at bay. Set up seven hours per week, but remember that one might only get five of those hours.

• Meetings: All kinds of meetings are needed, so set up three, 30-minute slots per week (one hour is way too long).

• Surgical point systems: Figure out a point system that works for you. A surgical point system can be created based on the complexity of the surgery. For example, a surgical spay might be 2 points while only 1 is assigned to a routine dental. Cruciate repairs might be worth 6 points.

For each day of the week, allocate a certain number of points, so the practice does not get overrun with complicated non-emergency surgeries.

A workable point schedule for us includes 6 points on Mondays and Fridays, 15 on Tuesdays and Thursdays and 22 points on Wednesdays. Specifically stack up certain days with surgeries.

• Drop off: Set up a point system for drop offs as well. A drop-off appointment typically would be 1 point. So if Wednesday has 17 points booked, 5 drop-off appointments could be offered.

• Telephone appointments: Offer call-in appointments. In most practices, four per day per veterinarian is just fine.

• Dot slots: These are appointment-times preserved for the exclusive use of today's callers that require essential duties.

• Slashes: Used to hold appointments for use within two weeks. When one runs an appointment book, appointments get stretched out, sometimes six weeks in advance until routine time slots are gone. So, set up a slash system that staff can only use within two weeks (four per day work nicely).

• Tech time: A separate appointment schedule can be set up for technician exclusive duties. Items including nail trims, suture removal, blood draws and collection of specimens for diagnostics are the domain of the technician.

• Quiet time: Set up 15-minute slots randomly through the day to permit one to take a deep breath, relax or just go for a brisk five-minute walk.

• Major procedure appointment: Set up about three 6-point procedures per week.

• Behavior appointments take an hour. Set up one to three per week depending on the need.

• Walk-ins are always disruptive, so try to keep those appointment types to a minimum. Consider redirecting walk-ins into a "dot-slot" or "drop-off" categories, or expect that one of the regularly scheduled clients will be a no show.

• Dot time: An appointment slot saved for the exclusive use of calling in casework for today. DOTs cannot be scheduled today for tomorrow. Today's DOTs can be used only once the telephone lines are opened for each particular day.

• House calls: Even if one does not do house calls, keep a slot for house calls every couple of weeks as one might need to make a house call for personal needs: visit the dentist, parent/teacher meetings or a lunch with a friend or one's spouse.

• White time: An open schedule slot for one or two hours per day; it really settles the day.

How to get started

Start by setting up a three-month calendar.

Plan how many of each of the 20 appointments you will need during that interval.

Layering of appointments and blending is important.

Set up your own surgical point system based upon surgeries performed in the last 12 months.

Each night before going home, adjust tomorrow's schedule.

Each Friday, before retiring for the weekend, adjust next week's schedule.

Each month, adjust the appointment template because your practice life will change with appointments.

Lastly, be disciplined to hold the line on appointments.

When living with this system, one can double patients seen, improve the quality of medicine delivered, enjoy practice more, sleep well at night, have time for a home life and see improved profits.

Dr. Riegger, dipl. ABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him at www.northwestanimalclinic.com, Riegger@aol.com, telephone and fax (505) 898-0407. Find him on AVMA's NOAH as the practice management moderator. Order his books "Management for Results" and "More Management for Results" by calling (505) 898-1491.