Case Study: Natick Animal Clinic
Bird’s Eye View of Natick Animal Clinic
• Operating for more than 50 years in the Boston suburb of Natick, Massachusetts
• Accredited by the American Animal Hospital Association
• Open 7 days a week, with a veterinarian on call until 10 pm Monday–Saturday
• Includes boarding kennel and grooming facility
• Current staff:
– 6 general practice veterinarians
– 1 visiting board-certified surgeon
– 1 visiting cardiologist/ultrasonographer
– 7.5 veterinary technicians
– 1 practice manager
– 5.5 client services staff
– 4.3 kennel staff
– 2 grooming staff
What They Did
Natick Animal Clinic instituted their first-contact primary care practice model emphasizing care commitment in 6 areas:
• Preventive medicine
• Client education
• Dental health
• Senior wellness
• Specialty surgery
• Weight management
How They Did It
Client and In-House Communication
Today, Natick Animal Clinic assigns each client a primary care veterinarian and schedules wellness and illness visits with this doctor as frequently as possible. Clients maintain direct contact with their veterinarians through telephone calls, voicemail, or email. Veterinarians return nonurgent messages on their next available shift, while the covering veterinarians handle urgent calls for primary veterinarians on their off-days. Email communication is maintained individually at the doctor’s discretion; this is the preferred mode of communication for several of Natick’s doctors. Every staff member has an email account; team members regularly email clients and one another.
Receptionists handle call-backs regarding the schedule, appointment confirmation, and billing issues. Natick’s receptionists are also provided with Client Service Scripts that provide strategies for dealing with everything from appointment reminders to improving compliance. They are taught to “lead” clients to appointments with their primary care doctor in order to reinforce the practice’s model. “We don’t say, ‘When would you like to come in?’,” explains Harding. “We say, ‘Dr. Mani sees appointments on Tuesdays, Wednesdays, and Saturdays. Which one of these days is most convenient to your schedule?’”
All-hands staff meetings are held at least quarterly, and the hospital is an active member of the community it serves, offering military, senior, and shelter service discounts. Natick Animal Clinic also hosts the “Santa Sunday” fundraiser and bake sale; proceeds are donated each year to an animal-based charity.
Preventive Health Appointments
The clinic emphasizes preventive health measures to optimize pet health and minimize emergency room visits. The reception staff sends email reminders 6 weeks in advance of annual wellness appointment due dates. If the owner does not schedule an appointment, repeat emails are sent once a month for 3 months. Clients are called twice—once during the month that the annual visit is due and the month after it is due.
Wellness appointments are scheduled up to a year in advance, and incentives ($25 discount coupons) are offered to encourage clients who miss annual vaccination appointments to come to the clinic. This enhances client retention and encourages preventive medicine.
Communication Among Veterinarians
To help ensure that a good relationship is developed among patients, clients, and primary care veterinarians, the doctors are paired off for coverage and generally work opposite shifts to cover one another’s cases. Client concerns are conveyed to either the primary or the covering doctor. Master problem lists are established for each patient, and all computerized medical records can be accessed off-site.
Standards & Protocols
Receptionists, technicians, and doctors work together to ensure patients are in exam rooms within 10 minutes of arrival. Once the preliminary patient questionnaire is completed, the receptionist brings the travel sheet to the back area and also notifies the outpatient technicians. By using a designated slot for the travel sheets outside the back of each exam room, technicians and doctors can always see if a patient has arrived. In addition, on arrival every client is entered in Natick’s computerized schedule (AVImark) as a “check in” so staff know when patients arrive. “If a client has been waiting 15 minutes or more, the receptionist checks with the technicians assigned to outpatient or tells me and I investigate why this is happening,” says Harding. “When we renovated Natick in 2007, we designed the practice so that my office is up front—this allows me to hear much of the client interaction.”
Natick Animal Clinic has established recommendations for prophylactic deworming, ectoparasite control, and heartworm prevention, as well as standard protocols for vaccinations, senior blood analysis, and drug/therapeutic monitoring blood analysis. Recommend and refuse codes assigned for specific diagnostic tests and treatments are included on the invoice so the client will have a reminder of what took place and what was recommended during each visit.
The hospital creates monthly “report cards” for doctors that are used to assess adherence to various protocols. When the receptionist checks out a patient, all items are coded and included on the travel sheet. Harding then runs reports using the codes and places generated data into an Excel Doctor Report Card that calculates totals automatically. The best grades are given to doctors with the highest compliance rates. The chief of staff reviews the report cards quarterly, and results and goals for improvement are discussed at the yearly budget meeting.
Where They Are Now
Harding reports that since the primary care model was implemented, the new-client base has grown each year and complaints have decreased to fewer than 12 annually and rarely concern quality of care. Clients are satisfied and maintain a strong bond with the Natick Animal Clinic community team. For practices looking to shift to the primary care model, Harding emphasizes that, “getting buy-in from the staff is a must.” She also encourages talking about the model’s challenges at staff meetings during the transition period so the team can work together to find solutions. “Be patient,” she offers. “There are bound to be mistakes along the way, but the model provides the framework for improved client satisfaction and more referrals over time.”