PVMC: The Practice Audit Process

Our management consulting services are comprehensive and cover most areas related to the operations
of veterinary practices. We provide all levels of management consultation, but the most complete and
thorough is the On-site Operational and Management Audit.

Practice audits are the most effective means of identifying areas for improvement and developing
proactive action plans. They also can be outstanding tools to help bring the practice health
team together as cohesive, functional unit.

The following is a description of that specialty service. This program is very flexible and is
tailored to fit the needs of each practice and the desires of its owners. There are three phases
to the process.

Phase 1 Pre-Visitation Analysis of Practice

It is imperative that we thoroughly understand your practice before we can provide effective consultative assistance. To assist us in this objective, we have a detailed list of practice information which we need to review prior to visiting the practice. The requested information includes an Owner Information Questionnaire, financial statements for the most recent three years, fee schedules, employee data, work schedules, and information on accounts receivable.

Also, to help identify staff concerns, a questionnaire is provided for each member of the practice health care team to complete. Similarly, to gain an understanding of client's perceptions and opinions of the practice, we have client surveys which are provided to clients as they exit the practice.

Phase 2 The On-site Visitation

Mid-week visits seem to work best for most practices, so we usually schedule a Tuesday-Wednesday-Thursday for the on-site visit. The visit normally starts about noon on the first day and ends late morning on the last day. The following is a rough itinerary of what is accomplished, but the order and extent of involvement can be varied depending on the practice situation.

Day #1

a) Facility evaluation
The first step is to complete a thorough and complete tour of the practice facility in order to gain an understanding of the environment in which the practice functions. This allows us to acquire a sense of what, if anything, could or should be done to the physical plant to improve its attractiveness to clients or reduce staffing costs.

b) Meeting with the owners' and/or management team
This introductory meeting allows everyone to get to know each other. Concerns, objectives, special problems can be brought forth and initially discussed.

c) Employee interviews
One-on-one, confidential interviews of approximately twenty-five minutes are completed with 50-100% of the staff to gather information about:

the staff attitudes toward practice leadership and management

what motivates individuals as staff members of the practice

the staff members' impression of team harmony and employee effectiveness

suggestions to improve the quality of services, provide income for the business, and/or improve the working environment of the hospital

customized issues identified through prior discussions with management

d) Operations assessment
Depending on the priorities established by the practice owners, and the time available, the audit may focus on one or more of the following important areas of practice management:

front office management of clients, appointment procedures, client flow, telephone procedures, etc.

record keeping procedures, case management, case follow-up

client information/education procedures and forms in place

laboratory procedures, provisions made to assure accuracy, technician competency

in-hospital patient case management, record keeping, surgery and anesthesia methods

maintenance and housekeeping

Day #2

In most cases, the second day is needed to complete the employee interviews and to evaluate hospital procedures.

In some situations, during the afternoon of this day, we schedule individual group meetings with the front office, technicians and, in multi-doctor practices, the associate veterinarians. These meetings necessitate a scaled back appointment schedule allowing the technician staff to cover for the receptionists during their meeting and vise-versa. Usually an hour is needed for each group, which consumes most of the afternoon.

During the evening of day 2, the office is closed and the entire staff meets together, ideally in a private room at a local restaurant. This meeting is conducted in a number of ways depending on the needs of the practice.

The technique we generally use is a variation of a SWOT analysis. SWOT stands for strengths, weaknesses, opportunities and threats. The SWOT procedure a) identifies significant problems and areas of risk perceived by the staff, b) establishes priorities for the more important issues; and c) initiates a discussion of the prioritized issues. The limited time frame of this evening meeting will not allow for in-depth discussion of all identified issues, but rather should be viewed as the initiation of a staff-involvement process which will continue after our on-site visitation.

Day 3

This morning is spent with the owners and, depending on the size of the practice, other members of the management team. The objective of this final phase is to discuss areas where the practice performs well and to identify those where improvements will need to be made. Finally, we develop an action plan which focuses attention on the tasks with the highest priority. Usually, this meeting is concluded in the late morning.

Phase 3 Follow-up

Following the on-site visitation, we provide an analysis report which summarizes the assessments, recommendation, and initial plan of action. Because we strongly believe that follow-up contact is an important part of the consultation process, we build in four monthly, one-hour telephone consultations during which issues, concerns, and progress on the plan of action can be discussed.

As an optional service, depending upon needs and desires of the practice, we have found it beneficial to facilitate client focus groups with 12 to 18 hand picked clients and 2-4 key staff and office management personnel. This activity provides valuable information and recommendations from clients which, we feel provides a powerful corroboration, enhancement and extension to our analysis report.

Phase 1 Pre-Visitation Analysis of Practice
	It is imperative that we thoroughly understand your practice before we can provide effective consultative assistance. To assist us in this objective, we have a detailed list of practice information which we need to review prior to visiting the practice. The requested information includes an Owner Information Questionnaire, financial statements for the most recent three years, fee schedules, employee data, work schedules, and information on accounts receivable. Also, to help identify staff concerns, a questionnaire is provided for each member of the practice health care team to complete. Similarly, to gain an understanding of client's perceptions and opinions of the practice, we have client surveys which are provided to clients as they exit the practice.

Phase 2 The On-site Visitation
	Mid-week visits seem to work best for most practices, so we usually schedule a Tuesday-Wednesday-Thursday for the on-site visit. The visit normally starts about noon on the first day and ends late morning on the last day. The following is a rough itinerary of what is accomplished, but the order and extent of involvement can be varied depending on the practice situation.

	Day #1
		a) Facility evaluation The first step is to complete a thorough and complete tour of the practice facility in order to gain an understanding of the environment in which the practice functions. This allows us to acquire a sense of what, if anything, could or should be done to the physical plant to improve its attractiveness to clients or reduce staffing costs.

		b) Meeting with the owners' and/or management team This introductory meeting allows everyone to get to know each other. Concerns, objectives, special problems can be brought forth and initially discussed.

		c) Employee interviews One-on-one, confidential interviews of approximately twenty-five minutes are completed with 50-100% of the staff to gather information about:
			the staff attitudes toward practice leadership and management what motivates individuals as staff members of the practice the staff members' impression of team harmony and employee effectiveness suggestions to improve the quality of services, provide income for the business, and/or improve the working environment of the hospital customized issues identified through prior discussions with management
		d) Operations assessment Depending on the priorities established by the practice owners, and the time available, the audit may focus on one or more of the following important areas of practice management:
			front office management of clients, appointment procedures, client flow, telephone procedures, etc. record keeping procedures, case management, case follow-up client information/education procedures and forms in place laboratory procedures, provisions made to assure accuracy, technician competency in-hospital patient case management, record keeping, surgery and anesthesia methods maintenance and housekeeping

	Day #2
		In most cases, the second day is needed to complete the employee interviews and to evaluate hospital procedures. In some situations, during the afternoon of this day, we schedule individual group meetings with the front office, technicians and, in multi-doctor practices, the associate veterinarians. These meetings necessitate a scaled back appointment schedule allowing the technician staff to cover for the receptionists during their meeting and vise-versa. Usually an hour is needed for each group, which consumes most of the afternoon. During the evening of day 2, the office is closed and the entire staff meets together, ideally in a private room at a local restaurant. This meeting is conducted in a number of ways depending on the needs of the practice. The technique we generally use is a variation of a SWOT analysis. SWOT stands for strengths, weaknesses, opportunities and threats. The SWOT procedure a) identifies significant problems and areas of risk perceived by the staff, b) establishes priorities for the more important issues; and c) initiates a discussion of the prioritized issues. The limited time frame of this evening meeting will not allow for in-depth discussion of all identified issues, but rather should be viewed as the initiation of a staff-involvement process which will continue after our on-site visitation.

	Day 3
		This morning is spent with the owners and, depending on the size of the practice, other members of the management team. The objective of this final phase is to discuss areas where the practice performs well and to identify those where improvements will need to be made. Finally, we develop an action plan which focuses attention on the tasks with the highest priority. Usually, this meeting is concluded in the late morning.

Phase 3 Follow-up
	Following the on-site visitation, we provide an analysis report which summarizes the assessments, recommendation, and initial plan of action. Because we strongly believe that follow-up contact is an important part of the consultation process, we build in four monthly, one-hour telephone consultations during which issues, concerns, and progress on the plan of action can be discussed. As an optional service, depending upon needs and desires of the practice, we have found it beneficial to facilitate client focus groups with 12 to 18 hand picked clients and 2-4 key staff and office management personnel. This activity provides valuable information and recommendations from clients which, we feel provides a powerful corroboration, enhancement and extension to our analysis report.