Tag Archive for: Practice Manager

Mastering change with Kotter’s 8-Step approach in veterinary practice

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You discover a smart solution to a meaningful problem, only to face the toughest challenge yet: getting people to change. In this how-to article, we’ll go through a simple and popular method which you can use to win the hearts and minds of your colleagues in practice – helping you successfully implement your next improvement project.

What is it?

Developed by Harvard Business School professor John Kotter and introduced in his 1995 book, “Leading Change,” this method comprises an 8-step plan designed for any change leader to follow. These steps are to be used at the very end of your project when implementing a solution.

Why use it?

After spending lots of time and effort getting to the point of implementation, the Kotter 8-step approach helps maximise the chance of adoption so that you can start seeing results.

How’s it used?

Step 1: Create urgency

Spend time crafting a message around the need for change. Consider both the ‘push’ (reasons to move away from what you’re doing) and ‘pull’ (benefits you’ll gain from the change) factors. Use data where possible to highlight any key points.

Step 2: Form a powerful coalition

Assemble a team to lead the change, focusing on team building and defining roles. Ensure the core team is proficient in explaining the change with consistent language.

Step 3: Create a vision for the change

Craft a high-level narrative linking the change to company values, vision, mission, or strategy. Keep it simple and easy to understand, providing a rationale for the change.

Step 4: Communicate the vision

Communicate the message dropping it into conversations and incorporating it into daily behaviours. Make it a topic that people feel comfortable asking you about and be transparent when answering questions on how it might impact them.

Step 5: Remove obstacles

Shift from creating messages to implementing structures that facilitate change. This may involve hiring new staff or buying new equipment. Acknowledge and praise those embracing the change, while identifying and addressing obstacles, including outdated processes or behaviours. Be on hand to provide ‘hypercare’ for those adopting the new system. 

Step 6: Create short-term wins

Build momentum by achieving small wins, which serve as building blocks for significant change. These wins offer tangible evidence of progress, establish a pattern of success, attract allies, and deter opposition. Use these wins as learning opportunities to spot barriers and facilitators.

Step 7: Build on the change

Embed the change by incrementally building on these small wins. Do this by gathering peoples feedback into a ‘backlog’ of ideas and decide what to prioritise based on effort and impact.

Step 8: Institutionalise the change

Enhance the visibility of the change and its results. Measure and communicate results. Share success stories illustrating how the change has improved lives and work efficiency. Recognise and celebrate teams or staff members who played a crucial role in the change.

Example

Nikita is a lead nurse. Her practice recently had its RCVS Practice Standards assessment. The assessor gave the practice a deficit for wearing outdoor shoes in theatre. Nikita is tasked with addressing this deficit. She uses Kotter’s 8-step method to help manage the change:

Step 1: Create urgencyNikita starts by crafting a message and posts it on the staff notice board. The message explains the team have 3 months to address the deficit or risk loosing their accreditation
Step 2: Form a powerful coalitionNext, she identifies a core team to help her. She meets with the theatre nurse and clinical director to agree the plan and rehearse the key messaging together
Step 3: Create a visionDuring the meeting, they also decide to tie the change in with an existing practice goal to increase its surgical caseload. They set the change as a milestone in their practice action log
Step 4: Communicate the visionOver the following weeks, they talk about the change during daily huddles. Nikita reminds her colleagues on the number of weeks remaining to implement and evidence the behaviour change to the RCVS
Step 5: Remove obstaclesNikita coordinates with the practice manager to buy indoor shoes for the team and install a shoe rack. She also adds signage to the entrance of the theatre to remind the team not to enter with outdoor shoes on
Step 6: Create quick winsNikita decides to communicate the purchase of shoes and fitting of the rack as  ‘phase 1’ and celebrates the accomplishment with the team during the daily huddle
Step 7: Build on the changeDuring the huddle Nikita realises that some staff members don’t like sharing shoes and are being vocal about it. She decides to update the plan and asks her colleagues to select a pair of shoes and label them
Step 8: Institutionalise the changeThe change becomes the norm and Nikita uses a practice meeting to update the team on its success. She thanks everyone for their hard work, especially those who were impacted the most. SOPs and policies are updated to reflect the new way of work

Top Tips

  1. During the initial stages, capture your key message on a presentation slide to help condense it down. Rehearse the key message with the core team so you can deliver it quickly and confidently.
  2. Prioritise quick wins by adopting an ‘Agile’ approach. Focus on delivering the ‘minimum viable product’—a basic solution with the most significant impact. Plan for refinement in subsequent ‘phases’.
  3. Ensure long-term success by keeping documentation up to date. Update any standard operating procedures (SOPs) and archive older versions. Don’t underestimate the work involved in this step!

Kotter’s 8-step method offers a proven and reliable approach for implementing change in any practice. For additional support in change management or assistance with specific challenges, reach out to VetQI

Where to begin on your quality improvement journey in practice

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Are you eager to do some quality improvements but find the sheer number of potential improvement opportunities overwhelming?

In this blog article, we’ll identify six key areas to begin your improvement project, complete with practical examples. By the end, you’ll feel confident and ready to embark on your journey.

Aligning with Strategy 

When diving into your improvement project, remember that quality goes beyond the shop floor. Companies that value quality also have big-picture strategies that dictate where staff should be prioritising their time. If you want to get noticed by ‘higher-up’, align your project with your practice or company’s plan.

For instance, let’s take the practice’s goal to increase high-value procedure sales. Karen, a new nursing team leader, noticed her new employer isn’t doing as many dental X-rays as her previous practice, despite having all the equipment and a similar caseload. Karen teamed up with the practice manager to test a new pricing model that bundles together dental procedures and X-rays. She closely watched how this impacted sales.

Profit and Loss

Most organisations, including charities, are concerned with understanding their costs and how well they cover them with sales. So, any improvement project that targets these areas is a smart choice and is easy to demonstrate results. Don’t let financial metrics intimidate you; it’s all about finding ways to cut costs or sell more in the same time.

Consider Sally, the surgery nurse. She noticed that the practice was using costly 1ml syringes when the larger cheaper variety would do. She added clear signage to the drawers, encouraging her team to ‘think twice’ when grabbing a syringe. She monitors the number of syringes ordered and compares it to previous months.

Reducing Defects 

In the veterinary world, “defects” can be seen as things that didn’t go as planned. A common example includes significant events, animal mortality, avoidable morbidity, and resulting client complaints. When these occur, the impact can be significant. A quality-driven team seizes this opportunity to investigate what went wrong in a blame-free environment and works on improvements to prevent such incidents from happening again.

For instance, consider Martin, the in-patient nurse. He takes over a shift and notices that a cat with an indwelling urinary catheter is in pain and the bladder isn’t draining properly. After the team resolve the situation, Martin conducts a root cause analysis with the team. Together, they develop a new standard operating procedure (SOP) for managing blocked cats, which involves doing an additional check on the bladder every 4hours.

Listening to the Voice of the Customer (VoC)

Maintaining a strong relationship with our customers is crucial in making sure our patients get the treatment we reccomend at home and also supporting the practice financially. Customers interpret quality in different ways so its important to research and understand what your customer value.

In the example above, Karen introduced a new pricing model, bundling all dental X-rays into dental procedures as a value-added package. After conducting a client survey, she found that some customers didn’t fully appreciate this change. In response, she piloted a new way of work in which the team sends the dental X-rays to the customer after the procedures in order for them to see what was done. She repeated the survey 6 months later. 

Listening to the Voice of the Employee (VoE)

The practice team are close to the action and can provide valuable “bottom-up” perspectives on opportunities for improvement. But listening to all their suggestions and effectively managing their ideas is a skill in itself. It’s important to develop this skill to develop a culture of ‘continuous improvement’ amongst the team.

Consider Chloe, the practice manager. She regularly receives improvement requests from her staff but finds it challenging to handle them all. In a quality improvement effort, she created a closed suggestion box and provided template cards for her team to submit suggestions. On a monthly basis, she shortlisted the ideas that aligned with the practice’s strategy and presented them to the team for voting on the “quickest win.”

Pareto Principle (80/20 Rule)

The Pareto Principle, often referred to as the 80/20 rule, suggests that 80% of the effects come from 20% of causes. This principle is a valuable tool in quality management as even small or margin improvements in the 20% will result in substantial results.

Sandy, the receptionist, realises the team leaves the desk on average every 15 minutes. Half of the time they are going to the printer. She does an improvement project which moves the printer within safe reach of the desk. She compares the number of time the team leave the desk before and after. 

Deciding the right opportunities to work on when you have so little time can be tough, but by using the above themes you can rationalise your decisions and get your project off to a confident start. These themes can also be used to help facilitate a meeting where you collect idea’s within the team. 

If you need any support in making quality improvements, Contact VetQI—we’re here to help.

Setting the standard for excellence: crafting effective policies for your veterinary practice

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As a veterinary practice, you are responsible for providing high-quality care to your patients and clients. But with the many complex and challenging situations that can arise in the course of daily operations, it can be tough. That’s where policies come in. By providing clear guidelines and parameters for behaviour and actions, policies help to support decision-making, maintain quality of care, and promote a culture of excellence in your practice.

What is a policy?

A policy is a statement that conveys the values, culture, philosophies, goals, and limits of your organization. It helps in decision-making and serves as a link between your organization’s vision, values, and daily operations. Procedures, also known as standard operating procedures (SOPs), are detailed instructions that provide specific steps to execute a policy. They are a part of policies but are more specific and detailed.

Why are policies useful for vet practices?

Key benefits of having policies in place include:

  • Set guidelines and parameters for employees to successfully reach their goals with confidence
  • Increase compliance with regulatory and professional standards
  • Improve the quality of the care being delivered to patients and clients
  • Support decision-making during difficult or complex situations to avoid a crisis

What policies should a vet practice have?

As a veterinary practice, there are specific policies that you should have in place. These policies include:

  • Health and Safety Policy
  • Code of Conduct Policy
  • Complaints Policy
  • Data Protection Policy
  • Waste Management Policy
  • Biosecurity Policy
  • Staff Training and Development Policy

Who should be involved in making policies?

Responsibility for policy-making can vary depending on the type of policy and the size or structure of the company. In a small company, it might be the business owner, while in a corporation, it could be the head office. For specialist services or offerings, it might be the departments themselves. It’s important to involve subject matter experts and conduct research to reflect the latest regulations and standards. 

How should policies be structured?

A policy document should include the following:

  • Document control: Who created and approved the document, who edited last and what version is it?
  • Purpose: What is the policy about?
  • Statement: This is the core of the document. What is the policy statement of your organization specific to the topic? 
  • Procedures: What procedures might sit within this policy?

In the statement, consider the what, why, when, who, and basic how (this will be elaborated on in each procedure that comes out of it). It may be important to lay out the responsibilities for certain roles in this area in some detail. Further useful reading on writing a specific sustainability policy can be found here by the BVA.

Top tips for creating policies

  • To make it easier to read, use simple, easy to understand language and have a set structure to each policy
  • Think about what you want to achieve with your policy and ask yourself ‘what if’ to see if it covers the most common eventualities 
  • Learn about what needs changing by piloting it as quickly as possible with operational teams 

When should policies be reviewed?

Policies are not changed very often (unlike procedures), and when they are, will involve many stakeholders from across the company. Policies should be reviewed periodically to ensure that they remain current and relevant. Examples of when you might want to review and update policies include:

  • Existing policies are not robust enough.
  • Outdated policies with new technologies, systems or services offered.
  • Changes in regulations and professional standards.

In conclusion, having policies in place is essential for the success of your veterinary practice. They provide clarity around how to run the practice within the context of the organisation (e.g., values, mission), regulatory requirements (e.g., health and safety), and professional standards (e.g., code of conduct). For more help withe reviewing or crafting your own policies, Contact VetQI.