Following my February 14 blog on Accounts Receivable and Cash Flow in Equine Practice I received some responses on Facebook that were thought provoking.

The first Facebook response was from an equine practitioner who was frustrated that although she printed an invoice in the vehicle and handed it to the client. The client didn’t pay, but rather put the invoice in a pocket, thanked the veterinarian and left. The veterinarian assumed that printing an invoice and handing it to the client was asking for money. It should be, but it’s not.

The second Facebook response was from a Technician. Her point was that a technician should be collecting money not the veterinarian because ‘technicians aren’t afraid to ask for money.’

It is my observation and opinion that somehow for decades if not a century, veterinary admissions committees have consistently selected people who are uncomfortable discussing money. I am sure this was not their intent but it has had a profound effect on our profession.

I think the technician who responded to the blog was correct. I would like to share a personal experience supporting that thought. Because I knew a guy who was an IT wizard, in 1995 I had a 100% ambulatory practice with a laptop and printer in the truck. I had all electronic medical records, generated invoices and collected money at time of service from clients. There were a lot of I’s in that paragraph but I didn’t ask for the money.

At that time, I worked with a remarkable RVT, Trish MacDonald. Trish was an amazing multi-tasker and we had a great process. As I worked up a case, I explained in detail to the client what was happening and what would happen next. Basically, while talking to the client, I was dictating medical history to Trish. At the end of the call, I reviewed the case with the owner and answered questions. Meanwhile, Trish finished up the records, printed the medical history and the invoice, and handed both to the client then ASKED FOR THE MONEY. Then she collected the money.

BT, before Trish, I did my own collecting. In that scenario, the client’s last interaction with me was to watch me write up the bill and then have me ask them for money. Meanwhile there were probably some unasked questions and unanswered questions left hanging.
WT, with Trish, the client’s last interaction with me was discussing their horse, reviewing the case, maybe talking about their kids, dogs or whatever. If you are in a service industry, which we are, that’s a much more productive end to an appointment.

As we drove out the driveway, we had the money that Trish asked for and the client had an interaction with me that allowed me to demonstrate caring, compassion and interest. All in all, a pretty good outcome.

In many areas of the country, Accounts Receivable are the bain of Equine Practitioners existence.  We earn our money the first time as veterinarians then we earn the same money the second time as bill collectors.  Keep in mind that more businesses fail over cash flow than profitability.

It is interesting that there are a few regions in the US and Canada in which veterinarians collect their money at time of service. There is usually a history of ‘old doctor thus and such’ who, decades ago, asked for his money.  Over the years, lots of vets started out with that person and learned that ‘normal’ was to get paid at time of service.  When they left to start their own practice, they took ‘normal’ with them and they asked for their money.  Gradually a regional culture developed in which veterinarians expected to be paid at time of service and clients expected to pay at time of service, similar to virtually every business in the known universe.

I like to think of it as the veterinary version of Amazon.com.  No one gets a book without a credit card and no one gets mad about it.  There are regions in which, for the forseeable future, this will never work.  However, I believe there are many more regions and diciplines where equine veterinarians could collect at time of service…if they just ask.

Last Saturday, I spoke to the University of Tennessee chapter of VBMA (Veterinary Business Management Association), a student organization focused on business education.  They have created a six module curriculum to be completed during veterinary school,  leading to a Business Certificate.  This is not part of the veterinary curriculum, this is a nights and Saturdays program.  U of T was the third VBMA meeting where I have spoken.  VBMAers are always an engaged audience and without fail ask great questions.

In parting, I want to paraphrase a statement from a participant in last Saturday’s VBMA meeting.  One of the students made the comment “I have worked for vets since I was a kid and I have never heard anyone talk about accounts receivable and collections.  We have never had accounts receivable.”    That could be your practice talking.  Give it a try, ask for your money.  Collecting at time of service is the ultimate solution to cash flow challenges.

In veterinary practices I try to teach doctors and staff to  focus on two outcomes; the patient outcome and the client outcome.  Not all the patients have a good outcome no matter who’s the vet.  However, I truly believe that in nearly all cases it is possible, although not easy, to have a good client outcome.  I am absolutely certain that clients value good client outcome and will be loyal to the veterinarian who provides it.  Good customer service, client outcome, is low hanging fruit in our profession.

Last Friday I had two totally unrelated great experiences with businesses that both left me with a definite WOW .  Friday morning I needed to have a horse somewhere at 11.  It takes an hour to get there.  At 9 AM I discovered that through some unexplainable event, my gooseneck trailer hitch pin was bent and the hitch could only be partially secured to the ball. I was definitely not putting a horse in that trailer.  Winners Circle Trailers is 20 minutes away.  When I arrived there was a lot going on and it actually looked like a busy equine clinic. Without realizing it, I behaved exactly like a pushy horse owner.  I walked into Cory’s office and said, I really need your help Cory, I have a hitch emergency.   Yes,
you get the picture; I defined a routine problem as an emergency on a Friday and expected a fix.   It would have been perfectly reasonable to tell me, “Sorry, the shop is full.  Leave the trailer and we’ll get it back to you Monday.”  That’s not what he did.  He stopped everything, replaced the hitch and had me on the road in 20 minutes.  I drove home picked up the horse and made it to the 11 O’clock on time.  Wow number one for the day!

I buy almost everything except groceries on line.  When I lived in the San Francisco Bay Area, I could order groceries on line too.  At any rate, I buy shirts on line from a company called Paul Fredrick.  Recently, I needed a pink shirt to wear to a cancer fund raiser and in an effort to be uber efficient, I ordered the shirt on my iPhone while in an airport security line.  When the shirt arrived it was GIANT, imagine a small pink tent.  I had ordered the neck 2 inches too large.  I checked my ‘out box’ to learn that I had, in fact, ordered the wrong size.  Ok fine, the shirt is hanging in the closet as a reminder to be careful multi-tasking while ordering stuff on the iPhone.  Friday afternoon, someone from Paul Fredrick contacted me as a follow up to the purchase.  I admitted my mistake and said I can’t wear the shirt but I know it’s my own fault.  It would have been perfectly reasonable to tell me “sorry for the mistake but we are very clear that custom orders can’t be returned”   Now for the WOW; what I was told was this “I appreciate your honesty but we want you to have that shirt in the right size, we’ll send one Monday.  WOW!!

Both businesses could have been perfectly reasonable and I would not have thought less of them because I value the service they provide.  However, both provided a WOW moment, a great client outcome.  Winners Circle Trailers fouled up their Friday service schedule and Paul Fredrick is out the cost of a shirt.  Now, not only do I value their service but I’m LOYAL!

In your business, look every day for opportunities to provide a WOW moment for your clients.  We all need LOYAL clients.

Following my December 1 blog, “Change is Our Companion but NOT Our Friend in Business Management…Ollie the horse is teaching me why”, I received lots of emails, some phone calls and a few people actually walked up to me at meetings asking for more ‘implementing change’ insight from Ollie the horse. In the Ollie Blog I discussed implementing change in business and how trust is often the rate limiting factor in managing change. In the blog, since I love a metaphor, I wrote about Ollie the horse as if he were a consultant helping me implement change. Hang in there; I understand that it is a little out of the main stream business management thought process. The best thing to do is to back up and read the Ollie Blog and then come back to this one. In case that just seems to be too complicated here is a summary from the Ollie Blog that will sort of bring you up to speed.

 “My current hobby objective is to learn to jump. I hired (actually bought) a well-credentialed Irish jumping consultant with a great track record who really knows his business, Ollie the horse. Kathleen, my wife and riding coach, has told me that the business of jumping the fences is divided into Andy’s business and Ollie’s Business. Andy’s business is to point Ollie at the middle of the jump and have him going at the proper pace. Ollie’s business is everything else. At critical points in the process of implementing change necessary to reach my objective, I stopped letting the expert, Ollie, do his job and I tried to do his job myself. The results were 100% poor, yet I continued to do it occasionally and even blamed poor Ollie..

Why, you ask, would a person with three college degrees refuse to let the expert do his job? Ollie the horse is teaching me about trust. Managing change is about trust. I have been an independent and resourceful person all of my life. With the help of trusted mentors and friends I have met life’s challenges by implementing change. In this situation, learning to ride in and English saddle and jump with potentially severe consequences, I am having trouble trusting Ollie to do his job. I’m stuck where I am until I can learn to trust that Ollie will do his job. Only then will I will be able reach my objective. I have assembled the resources I need, but until I trust, I can’t make the change necessary to be successful. Maybe that’s why we resist change. We aren’t used to trusting. Perhaps we should work on trusting instead of changing…change might take care of itself. “

Ok, here is the next chapter in the Ollie the horse change management story. When I completed the first Ollie Blog, I was having trouble trusting Ollie, the jumping consultant, to do his job helping me implement change in my hobby. Since then, Ollie and I spent ten days in Ocala, Florida, working on jumping cross country jumps. First of all I would like to make an observation.  It is remarkable how much bigger a log looks if you plan to jump over it than if you plan to ride around it. While we were in Florida, I made some great progress trusting Ollie to do his job. He’s a star and I looked like a good pupil once I learned to do my business, address the middle of the jump at the proper pace, and trust Ollie to do his business, everything else. Ollie trusted me and I trusted Ollie. Things were going great!

The big day came when Ollie and I were going to jump over a 3 foot 3 inch tall obstacle called a ‘roll top’. We had a great warm up and were ready to jump over the brute (not classic jump terminology but that’s what it looked like that day).

Here is the scenario; I did part of my business, I addressed the jump in a straight line toward the middle. However, as we approached the jump I wasn’t sure how much pace was appropriate. I was apprehensive, so I slowed down (less pace), exactly the wrong thing to do. Ollie the horse recognized that I was not doing my part of the business, establish the propper pace, so he tried to step up a little. I resisted. Kathleen called out “MORE PACE.” I couldn’t believe she was seeing the same thing I was seeing so I resisted her advice as well as Ollie’s advice. I didn’t trust the two experts.

Let’s stop here and look at the situation at that moment. I am approaching the biggest thing I have ever jumped; I have a great horse who is trying to make up for the fact that I am failing to perform on my part of the business of jumping, establish proper pace. I have a great coach who is telling me what to do to get my part of the business of jumping back on track, proper pace. I resist both. About this time we arrive at the point of takeoff. Since I haven’t given Ollie the pace he trusted me for, he tries to do his job in spite of me. Ollie jumps the fence with massive effort.

Now let’s see the results of my inability to trust my team and the problem lack of trust caused. I had always heard about being ‘jumped out of the tack’ but it never seemed that dramatic when it happened to someone else. WRONG! Visualize a human being launched from a Roman catapult. Due to the massive jumping effort necessary because I failed to establish the pace, Ollie was the catapult and I was the human. As I was falling upward for what seemed like a long time, I realized that it was going to be a very long drop to get to the ground. I’m just fine so there was a good ending. I landed lying on my back with my feet pointing in the direction we had been jumping. Ollie was standing motionless with my head between his front feet. I clearly remember my head hitting the ground and being really impressed with how well the helmet worked! Ollie just stood there staring down his nose at me. The image was similar to those head on photographs of a horse that are taken from way too close. Ollie looked embarrassed if that is possible.

In a moment of exhilaration at not being dead, I had the epiphany that the entire fiasco was due to my unwillingness or inability to trust the ‘consultants’ I had engaged to help me implement change. Since I didn’t do my part, Ollie the horse/consultant, had to try to do my business and his business in spite of me. Splat was the result. While I was still lying on the ground, I remember thinking “Wow, this is going to make a great blog!”

When I was a kid, ‘getting back on the horse’ was an expectation. Now, I think that’s movie stuff. I did get back on Ollie but I rode back to the barn instead of jumping again. The next day we had another lesson. I trusted Ollie and Kathleen. I not only approached the middle of the obstacle but I also made sure the pace was right. The brute just looked like any other jump and Ollie and I declared victory over the brute at the end of our lesson.

Ollie the horse is working hard to teach me about the importance of trust in implementing change. If this educational effort keeps up, Ollie the horse may be a presenter at the managing change seminar we are planning to present in 2013. Let’s work on trust. I think change will be easier.

I am working with a group putting together a business program that may be presented in 2013.   One of the discussion points has focused on the conflict in organizations that accompanies most if not all efforts to implement and manage change.  It remains fascinating to me that to a person, our colleagues in the veterinary profession speak effusively about the changes we are experiencing and the remarkable rate at which change is happening.  Very few believe that their practice does not NEED to change, BUT…change efforts are often met with fierce resistance within the organization.

Since we all appear to be in alignment on the presence and necessity of change, it is odd that so many resist change so strongly.  I have been spending a lot of time lately trying to contribute to the program with some bit of understanding as to why this resistance to change is so predictable.

Veterinarians, especially equine practitioners can be a remarkably independent lot.  We routinely work alone without immediate access to colleagues or mentors.  Our clients expect and even demand that we come up with a plan on the spot, regardless of how serious or bizarre the situation we face.  We have learned to trust ourselves and we don’t have a strong fundamental tradition of trusting others.

We assemble management groups, informal groups of peers and hire advisors, all in the effort to change our practices with the objective of becoming more financially successful.  We explain and understand our objectives.  So far that’s all good.  Then train comes off the tracks; we resist the change necessary to achieve the objective.

I was raised around cattle ranching and spent all of my life until a year ago riding quarter horses in western saddles.  My hobby changed radically about a year ago when my quarter horse was killed in a strange accident.  My unlikely hobby decision was to take up riding in an English saddle and learn to jump.  My wife Kathleen found a great horse for me.  His name is Ollie.  He is an 8 year old Irish Sport Horse and he is an expert at his job.  When I tell people about my plan I get a lot of “you’re nuts” looks.  Everybody has to have a goal and mine is to learn to jump.

As Kathleen has been giving me jumping lessons she has made it perfectly clear that the business of jumping the fences is divided into Andy’s business and Ollie’s Business.  Andy’s business is to point Ollie at the proper jump and to have him going more or less the right speed.  Ollie’s business is everything else.  I have decided to implement change in my life.  I understand the objective and how to  achieve it. I need to take care of my business and  let Ollie take care of his business.

We started over poles on the ground.  I was totally comfortable sticking to my business and then letting Ollie stick to his business.  The plan worked wonderfully.  Ollie and I each did our part and we made the first successful steps in implementing change, learning to jump.

As the jumps got a little bigger (still small), I began to hear coaching input from Kathleen, “you are in Ollie’s business”.  When I am able to stay out of his business we jump the jump!  However when I insist on being in Ollie’s business…we don’t jump the jump successfully.

The point of this blog is to explore our resistance to implementing change even when we acknowledge its necessity. My hobby objective is to learn to jump.  I hired (actually bought) a well-credentialed jumping consultant with a great track record who really knows his business, Ollie the horse.  At critical points in the process of implementing change to reach my objective, I stop letting the expert, Ollie, do his job and I try to do it myself.  The results are 100% poor, yet I continue to do it occasionally and even may blame poor Ollie for the results.  Why, you ask, would a person with three college degrees refuse to let the expert do his job???

Ollie the horse is teaching me about trust.  It’s all about trust.  I have been an independent and resourceful person all of my life.  With the help of trusted mentors and friends I have solved my problems. In this situation, learning to ride in and English saddle and jump, with potentially severe consequences, I am having trouble trusting Ollie to do his job.  I’m stuck here until I can learn to trust that Ollie will do his job.  Only then will I will be able reach my objective.  I have assembled the resources I need, but until I trust, I can’t make the change necessary to be successful.

Maybe that’s why we resist change.  We aren’t used to trusting.  Perhaps we should work on trusting instead of changing…change might take care ofitself.