Fixing A Broken System

2. FixingA Broken System Craig J Mohnacky DVM VMG-Sponsored Management Track AAHA Nashville March 2014 craigmohnacky@mohnackyvet.com

3. Presentation Outline • 1. Objectives • 2. AVMA Veterinary Workforce Report • 3. Practice Models (Segmentation) • 4. Mohnacky Learning Systems • 5. Guiding Behavior • Appreciative Inquiry • Epistemology • Customer Service Meetings • 6. “MLS” Summary

4. 1. Objectives • Maximize Return on Veterinary Education • Eliminate “Burn-Out” • Increase Productivity • Resolve staff, doctor, and business financial issues • Build Something to Last • Maximize Practice Value • Prevent Premature Practice Sales • Retention of Ownership with Residual Income.

5. 2. 2013 AVMA Veterinary Workforce Report • IHS Healthcare & Pharma • Center for Health Workforce Studies • In 2012 90,200 DVM’s • Supply exceeded demand by 11,250 FTE’s • 11,250 Unemployed DVM’s ???? --No • 12.5% of Veterinary capacity is being underutilized • 53% of DVM’s feel they are working under capacity • Are 47% of the DVM’s who feel they are at full capacity truly at full capacity?? • Excess capacity through 2025 of 11-14% • Decrease Demand for Veterinary Services?

6. 2. AVMA Veterinary Workforce Report • Likely Greater Potential for Excess Capacity • Stagnating Incomes • High Cost of Education • Postponement of Retirement

7. “Inviting the Elephant into the Room” • Nine-Page paper authored by • James F. Wilson, DVM, JD • U of P School of Veterinary Medicine • Incited dialogue at: • North American Veterinary Conference • AVMA • AAHA convention • Per James F. Wilson, DVM, JD • “The Current Veterinary-School Model is Broken”

8. College Debt • Graduates shackled with large monthly payments and low starting salaries. • Debt represents 184% of starting salaries • Most DVM’s are not recommending the profession to students. • The word is out that you have assigned yourself to utter poverty by entering veterinary college.

9. DVM Newsmagazine • Richard Vedder – Economist • The good news is they’re going to be veterinarians. • The bad news is they’ll be miserable.

10. Reality of a Veterinary Education • Pure Economic Standpoint • Is it a good return investment?

11. Why not Face Reality? • Too disheartening • It’s Political • No one has offered up any easy or clear solutions.

12. AVMA’s New Proprietary Software • Workforce Simulation Model • Utilized by the Newly Established Veterinary Economics Division of the AVMA • Goal - Disseminate this information to “Industry Participants” so best practices can be applied

13. 3. Practice Models • Agrarian Model • Veterinary Centered Model • Ego Centered Practice Model • Client Centered Practice Model • Team Centered Practice Model

14. 3. Practice Models • Agrarian Model • Focus = the “Work” to be Done • Reactive vs Proactive Medicine • Standard Way of Treating Most Presentations (Shot-Gun) • Hope to hit the therapeutic target • DVM Thinks he Should Know What is Wrong “Void of Diagnostics” • Wellness Programs and Products not a Part of the Practice

15. 3. Practice Models • Veterinary Centered Model • Is the Result of the Vision set in Veterinary School • DVM has a “Pent-Up” Demand to practice Veterinary Medicine • DVM Has No Interest in Management – Just Wants to be the Vet

16. 3. Practice Models • Veterinary Centered Model • DVM Makes All the Decisions • Single File • Staff are underutilized • They are Overly Focused on “High Quality” but in Essence They are Unable to Achieve. • Results in a Multitude of Philosophies Existing in the Same Building – Confusion to Clients. • Typically Highly Chaotic Practice.

17. 3. Practice Models • Ego Centered Practice Model • The Practice is an Extension of the DVM • Very Charismatic and Paternalistic • Focused on Higher End Medicine and Surgery • Standards in Place Reflect that of the Owner • Owner of the Practice is Usually the Highest Producer

18. 3. Practice Models • Ego Centered Practice Model • Controlling Owner • Staff has Little to do with Developing Relationships or Knowledge Sharing • Practice Struggles in Owner’s Absence.

19. 3. Practice Models • Client Centered Practice Model • The DVM and Team is Focused on the Client • High Standards with Uniforms, Staff Training and Meetings • Stress High Quality Medicine with Lots of Referrals to Specialists • Goal is to Educate the Pet Owner and be an Advocate for the Pet

20. 3. Practice Models • Client Centered Practice Model • This Practice has Wellness Plans, Geriatric Plans, and Celebrate Pet Dental Month • DVM can Oversee more than one Exam Room • Exam Rooms are used by Techs • Computer System is Usually Current and Updated with Good Medical Record Keeping with all Team Members Updating Records.

21. 3. Practice Models • Team Centered Practice Model • DVM Leveraging • New Interface to Increase DVM Capacity • Knowledge Sharing • Focus on Systems Problems • Sharing of Metrics and Financial Results • Rewards and Compensation are Based on Quality of Outcomes • A Culture of Accountability Pursuing Key Focus Results

22. 3. Practice Models • Pluralism • Many world views in the same space • Pluralistic Society • Agrarian World View • Industrial World View • Information Age World View

23. What’s The Answer To Our Challenges

24. A New Business Model for Veterinarians Multifaceted Approach to the Problems We Have Described Changes in Workflow and Knowledge Sharing Dedication to Change + Appreciative Inquiry+ MLS = Preferred Future Shared Meaning Cultural Transformation Epistemological Growth 4. Mohnacky Learning Systems “MLS”

25. Old Model

26. New Model (Team Centered)

27. 4. Mohnacky Learning Systems • Characteristics • Team Centered Practice Model • Staff Educational Opportunities • Career Paths • Proactive Medicine • Health Maps • Multi-tasking – DVM Leveraging • Knowledge Sharing • Enhanced Organizational Capacity for Positive Change • Customer Service Meetings • Appreciative Inquiry.

28. 4. Mohnacky Learning Systems • Course Work • Pre-Employment screening • Orientation • Mentorship • Progress Plans • Technical Training • Reception Training • “Exam Room Advocate” Training* • In depth study of medicine and surgery for the acquisition of conversational capacity of the common maladies encountered in Veterinary Medicine

29. 4. Mohnacky Learning Systems • Staff Development and Course Work • Safety Training* • Culture of Safety • Leadership Training • Accountability Training • Career Paths.

30. 4. Mohnacky Learning Systems • Use of Mind Maps • Purpose • Facilitates Staff Development and Knowledge Sharing • Clients Appreciate “Wholeness” of Health Care Challenge.

31. The Mind Map Book • Tony Buzan • How to Use RadiantThinking to MaximizeYour Brain’s UntappedPotential

32. Mind Maps

34. 4. Mohnacky Learning Systems • “Exam Room Advocate” • TrainingTools • SWANS • Smart • Work Hard • Ambitious • Nice

35. 4. Mohnacky Learning Systems • “Exam Room Advocate” Course Outline • Standards of Care • Internal Parasites • Dermatology • Ectoparasites • Nutrition • Client Communication • Physiology • Vaccinations • Dentistry • Otology • Heartworm • Socialization • Anatomy • Leadership

36. Course Completion Staff are promoted to “Exam Room Advocate” Receive a certificate Business cards White scrub top for differentiation Increased compensation. 4. Mohnacky Learning Systems

37. 4. Mohnacky Learning Systems • “Exam Room Advocate” Role is to Oversee: • The Plan • Medical Record • Hospital Patient Flow

38. 4. Mohnacky Learning Systems Bicycle vs Sports Car

39. 4. Mohnacky Learning Systems • Tools of “MLS” • Customer Service Meetings • Appreciative Inquiry • Affirmative Topic Choice • Metrics • Create Motivated People • Staff Training and Development • Desirable Careers • Cultural Transformations • Epistemology • Guiding Behavior.

40. 5. Guiding Behavior • All Business Needs To: • Direct • Guide • Influence Behavior • Why Guide Behavior: • Reasoning or Problem Solving Ability • Alignment • Maturity • Ability to make Meaning in Life.

41. 5. Guiding Behavior • Tools For Guiding Behavior at MAH • Appreciative Inquiry* • Epistemological Growth* • Customer Service Meetings* • Language and Communication • Acclimation of New Employees • Cognitive and Moral Development

42. 5. Guiding Behavior Appreciative Inquiry A Practical Guide to Positive Change By Diana Whitney and Amanda Trosten-Bloom

43. 5. Guiding Behavior • Beliefs of Appreciative Inquiry • The images we hold of the future are socially created and, once articulated, serve to guide individual and collective actions. • Words create worlds. • We see the world that we describe.

44. 5. Guiding Behavior • Appreciate & Inquiry • Appreciate • To recognize the best in people and the world around us • To increase in value • Inquiry • To ask questions • To study • To search, explore, delve into or investigate.

45. 5. Guiding Behavior • Combine Appreciate and Inquiry • Has a powerful effect on leadership and organizational change • Creates self organizing enterprises • We become what we study.

46. 5. Guiding Behavior • Epistemology • A philosophic theory of the method or basis of acquiring human knowledge. • The process by which we make reality or meaning.

47. 5. Guiding Behavior • Four Epistemological Orders • Subjective, Magical Mind • Infant to ten years of age • Concrete Mind • Ten - Twenty years of age • Socialized Mind • 20 to 25 years of age • Most people live their lives here • Bound by cultural and dictated norms • “Self Authoring” Mind • 25-50 years of age • Writer of reality that we become faithful to

48. 5. Guiding Behavior • Concrete Mind • No attachment to cultural values or norms • Choice is limited to what they have seen or experienced directly or concretely • Don’t see their actions as having any lasting effects on people • Huge Problem for Parents and Employers • Young DVM’s • Need to advance from “Concrete” to “Social” Mind.

49. 5. Guiding Behavior • Customer Service Meetings • Practical Use of Appreciative Inquiry • Supports moving from the concrete level to the socialized level • Transformational Epistemological Event “TEE” • Creation of knowledge in a group setting • Turns Independence Into Interdependence • What is best for the group?

50. 5. Guiding Behavior • The “Customer Service Meeting” • Sole purpose is the client and not the staff • Mandatory attendance • Staff sits in a circle • Mandatory that everyone speaks • Initiation of the culture to new staff members • Positive language in a group setting • Accelerates the “TEE”