The global Covid-19 pandemic has resulted in monumental changes to our daily lives in an effort to reduce the spread of the disease; in the UK, the veterinary industry has been very actively involved in these events. This article focuses on some key areas of change that veterinary practices have had to accommodate, with tips on how to implement them effectively.
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Pete Orpin qualified from the University of Bristol in 1983 and worked as a farm vet within the Park Vet Group in Leicestershire for 35 years before retiring. He is a board member of the Society of Practising Veterinary Surgeons (SPVS) and the Covid-19 lead for the association. He also works as a consultant for Anval, providing business consultancy for veterinary practices.
Anna Judson qualified from the University of Liverpool in 1987. She was a partner in a mixed practice for 23 years before running a small animal practice until late 2019. She is currently SPVS president.
Ryan Davis qualified from the University of Glasgow in 2002. He worked in the small animal arm of a mixed practice for 17 years before taking on a leadership role. He has been a SPVS board member for six years.
Key learning outcomes
After reading this article, you should understand:
The key areas that have been impacted the most during the Covid-19 pandemic;
How to effectively communicate with team members and clients;
How to maintain staff health and wellbeing;
How to create a safe workplace environment;
How to secure and optimise the economic performance of a practice, including methods for reducing overheads.
Robust and prompt responses from the BVA and the RCVS have allowed for a centralised and coordinated response to the Covid-19 outbreak. From the outset of the pandemic, veterinary practices moved to a ‘closed-door’ policy, with the prioritisation of work established on a case-by-case basis, taking into account the urgency of the admission and the welfare of each animal.
This article provides an overview of how Covid-19 has impacted veterinary practices, alongside some insights into how practices can prepare for the ‘new normal’ that lies ahead. Future articles will explore these areas in greater depth.
Challenges and concerns
The Covid-19 outbreak has impacted the veterinary profession in four key areas:
Day-to-day operations; and
Animal health, although to a much lesser extent.
An initial survey by the Society of Practising Veterinary Surgeons (SPVS) and the Veterinary Management Group (VMG), from the period 24 March 2020 to 4 April 2020, revealed that 75 per cent of practice owners had serious concerns about the future economic sustainability of their practices, whereas for the employees, the health of the practice team itself was their highest concern (Fig 1).
Furthermore, nearly 40 per cent of owners said they had concerns about their own welfare, which subsequently triggered SPVS, the RCVS’s Mind Matters Initiative and Vetlife to reach out to those in the profession to provide wellbeing advice to practice teams.
Creating an effective Covid-19 response plan
Ethos, values and purpose
For an effective response to the Covid-19 crisis, a defined ethos, clear objectives and a sensible delivery plan must be determined. A successful business must have consistent values that the whole team supports, and a sense of purpose and direction must be maintained. This vision and focus is achieved by creating a safe workplace and an economically sustainable business model.
Strategy, planning and communication
Effective contingency planning is central to change management. The SPVS board has developed a three-stage overview of the Covid-19 crisis to help rationalise our response through the three stages – acute, transitional and long-term.
The initial acute phase, during the height of the pandemic, revolved around creating a completely new method of operating for practices. The most successful practices were able to create new operating systems following a process of staff engagement and the implementation of new biosecurity and biocontainment arrangements.
Responsibility fell on every person working within the practice to understand the ‘why’, ‘how’ and ‘who was doing what’, to minimise the entry and spread of Covid-19.
To help create credible contingency plans and ensure teams were fully engaged in these changes, SPVS and others provided various resources, such as meeting templates, webinars and podcasts (see useful resources).
Additionally, two-way communication is essential to the success of any change and decision-making, as any objections to the proposed changes must be considered and managed carefully. Tips for effective communication are as follows:
Have open and transparent conversations based on the most up-to-date knowledge;
Consistently give the same message to the whole team;
Listen to and welcome all contributions and sympathetically manage any objections or contrary opinions;
Openly discuss plans to try and come to an agreement;
Have face-to-face meetings in car parks or socially distanced spaces;
Use video conferencing in preference to overusing email services.
Managing client needs and expectations is the key to any progressive business, but effective communication and engaging with clients has never been more important; managing expectations regarding reduced services, and communicating these changes to clients quickly and efficiently is key.
Once practice policies have been agreed, simple and consistent messages need to be sent to all of the practice team and the client base; practices must ensure all of the three C’s of client interaction are met – competence, consistency and compassion (Box 1).
Three C’s of client interaction
Competence – practice staff should take practical, clear and sensible steps when communicating with clients;
Consistency – use repeated messages across all communication platforms to ensure points are made clearly and effectively;
Compassion – deliver communications in an empathetic way, considering any concerns or worries that clients may have.
The most effective communication routes will depend on the client group. A combination of email, text messages and social media have been shown to be the most popular so far, according to feedback from SPVS discussion groups. Communicating that you are open for business and still able to provide a service is essential.
Health of staff and personal wellbeing
The impact of the changes to veterinary practice has been felt at all levels of the industry, with many experiencing waves of different emotions including shock, denial, frustration and depression, through to anticipation, acceptance and commitment. The Kübler-Ross ‘change curve’ is a useful model to help demonstrate this and guide people through periods of transition (see useful resources).
The combination of economic, logistical and staff challenges has been extremely difficult for practices and must not be underestimated when leading people through such drastic change.
As previously mentioned, there are genuine concerns about both personal and team welfare during the pandemic.
The starting point for improving wellbeing is maximising your personal health and resilience. Only then will you be able to effectively maintain the wellbeing of the entire team as well.
Some steps for improving wellbeing include:
Practice mindfulness, meditation and breathing exercises;
Set boundaries to help maintain a work-life balance;
Ensure optimal sleep, diet and exercise routines are maintained;
Turn to others for support – talking and socialising with those around you, even virtually, can hugely improve your mental health.
In addition to providing wellbeing support, there is a clear need to support the most vulnerable members of the team; they may have a comorbidity or might be living with someone who has.
Leaders should ensure that everyone has an opportunity to discuss their own circumstances, and subsequently prioritise low-risk workloads and home-working circumstances for the most vulnerable.
Tips for maximising team wellbeing include:
Openly discuss the need to identify any person at risk;
Prioritise time for one-to-one discussions;
Develop logical action plans to protect the most vulnerable;
Explore the best way to provide financial support – for example for those working reduced hours while trying to accommodate home schooling;
Create buddy systems to help provide emotional support;
Provide clear structure and purpose to help team members unite;
Encourage everyone to look after themselves as well as each other.
Moving into the transitional phase
As the risk of Covid-19 begins to decline over time, practices will inevitably be faced with an increased volume of work that will somehow have to be accommodated in the future.
The most recent SPVS/VMG survey (from the 27 April 2020 to 11 May 2020, Fig 2), highlighted that both physical and remote consultations were taking 10 to 30 minutes longer than a normal consultation; this suggests that not having enough time in the day to complete all necessary work is the predominant restriction preventing an increase in caseload capacity. The additional time spent triaging, remote consulting and operating with restricted labour, have reduced the potential capacity of practices to a throughput of 50 to 60 per cent of what would normally be expected, lowering the efficiency and economic sustainability of these businesses.
With a continued need to maintain biosecurity arrangements, a renewed focus will have to be directed at either increasing opening hours or improving the efficiency of consultations, if we are to increase the capacity of the caseload again. Both of these solutions come with risks, but as the direct impact of Covid-19 reduces, there will be a time when clients physically re-enter practice buildings and teams must be prepared for this eventuality; supplementary personal protective equipment and physical barriers can be used to reduce risks.
Creating a safe workplace environment and remote consulting
A key part of the practical delivery of the Covid-19 response plan centres on creating a safe workplace environment; guidance for this is provided by the BVA and the RCVS.
The core principles of creating this environment are:
Ensure only low-risk people are working in the practice;
Reduce the risk of disease entry – biosecurity;
Reduce the spread of disease – biocontainment (Figs 3, 4);
Minimise the impact of the disease if it does break out.
These principles can be achieved through various procedures (Table 1) that help protect not only clients who may start to return to practices, but all members of staff too.
It is important to circulate your Covid-19 protocols to clients so that they know what to expect during visitations. Some practices have taken an extra step of embedding videos on PDF files; these can show clients how to present their animal for video consultation, how to submit clinical histories and how to submit photographs of their pet. These simple methods can greatly improve the efficiency of day-to-day operations.
Remote consulting has been widely adopted through a mixture of platforms. Anecdotal reports suggest that telephone calls to discuss photographs submitted by clients can deliver an expedient result that is less complex than attempting a video consultation with an often inexperienced video consulter.
Personal preference will certainly play a part in a vet’s choice of how to perform remote consultations. It would be worthwhile to try several different methods to determine the skill sets required to conduct each one with a successful outcome for all those involved.
Proprietary software tools, such as Vet Help Direct and PetsApp, are being rapidly developed to aid video consultations, and over time we hope that these may be incorporated into our ‘new normal’ modes of operation.
Securing and optimising economic performance
The reduced caseload capacity combined with increased costs of operation and longer consulting times have severely challenged practices. To date, the Covid-19 pandemic has resulted in an estimated 40 to 60 per cent reduction in income for small animal practices (SPVS 2020), and there has been an even greater impact on equine practice (BEVA 2020).SPVS also indicated that farm practices typically experienced a reduction of income, at 10 to 20 per cent (SPVS 2020).
In order to improve economic performance, key areas to focus on include:
Management of capacity and throughput;
Increase in fees and/or average transaction value;
Reduction of costs.
Results from the second SPVS/VMG survey (Fig 5) indicated that borrowing money and increasing opening hours were not popular propositions among those working in small animal practices to help improve economic performance.
Based on the results from this survey, practices instead focused on:
Reducing staffing costs to match workload;
Increasing remote consultations; and
Charging clients more to cover additional costs.
More detailed work via webinars, the SPVS email discussion list and the Anval financial scenario planner (see useful resources) revealed that increasing throughput and appropriately adjusting fees was the most effective way of increasing income during these challenging times. A modified version of the Anval financial scenario planner was developed to allow for much more detailed planning; by entering simple turnover values and costs, the tool can demonstrate how increasing efficiency and changes in fees can help reduce losses. Although this work has been a great first step, further open discussions regarding optimistic economic performance will certainly be required.
The most effective way to secure income is to increase average transaction value (ie, fees, application fees and cross-selling through ancillary sales). This is preferable to increasing the frequency of visits or number of new clients, as this would pose a greater risk of Covid-19 infection. Other tips to increase income include:
Maintain engagement with clients, keep them updated, informed and involved;
Simplify fee structures;
Use macros to avoid missed billing – these computer pop-ups are reminders to bill correctly at the point of processing an invoice;
Audit invoices to ensure correct fees have been applied;
Focus on efficient and effective consulting practices that generate work;
Adjust fees to match the time taken to perform the work;
Do not use random discounts;
Secure payment in advance for remote consultations.
Understanding the barriers to practice profitability revealed the weaknesses in many practices regarding fee structures and application of fees (Robinson 2020). The fee structure should match the cost of providing the service; if fee structures remain the same and the procedure takes twice as long, then a 50 per cent discount has been applied to the service. Therefore, either the fee must be increased or the procedure has to be done more efficiently.
Simplifying fee structures, ensuring all time is charged appropriately (including remote consultations) and reducing costs effectively are the core principles of profit generation.
The two largest cost areas relate to medicines and labour. Some procurement savings or arranging supplier payment deferments may help reduce the immediate overheads; however, during the pandemic, the major focus has involved furloughing staff to match the workload. Tips for reducing costs include:
Optimise labour costs by furloughing staff and create efficient teams;
Review all expenditure and direct debits and assess true benefit;
Reduce non-essential activities;
Consolidate medicine purchases;
Negotiate with suppliers;
Historically, cash flow analysis has not been necessary in most mature small practices, as prudent management of the business has been enough. However, with the precipitous drop in income, further contingency borrowing has been required for many businesses.
The key financial support measures so far have included grants, loans and job retention schemes. Nevertheless, all areas must be explored and these will change over time (see the most up-to-date business support schemes at: www.gov.uk/coronavirus/business-support).
Looking to the future
It is obvious from the results of the SPVS/VMG surveys that there are varying opinions about workflow and practice efficiencies, clearly indicating that not all practices are equally affected by the Covid-19 pandemic.
The ‘new normal’ for practices will eventually develop; adaptability and innovation are the routes to future success for practices. The client base will be maintained and work will return to a new level in the future.
It is clear that we all need to plan ahead for a different economic climate. The future may involve more development of health plans, more efficient operating structures for practices and new income streams. Normality will certainly return, but it will be a new and different ‘normal’ – let’s be prepared for it.
We are in the process of commissioning further content related to the Covid-19 pandemic, which will provide practical tips and guidance to businesses to help them cope with the challenges of this crisis. We hope to publish these articles over the coming months.
We would like to thank our colleagues from SPVS for their help in providing some of the practical tips stated in this article. A particular thanks must go to Peter Gripper, director of Anval, who developed the financial scenario planner as a gift to help SPVS members plan during this crisis. Special thanks must also go to Richard Artingstall who provided the pictures, and to the vets who contributed freely to help others on the SPVS webinars, podcasts and SPVS discussion list.
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