Staff Satisfaction Linked to Productivity

Shawn Wilkie: Hey you’re listening to the veterinary Innovation podcast my name’s John Welty I’m sitting here with a close friend of mine once you go ahead and introduce yourself and our special guest for today private

Meet our guest – Dr. Frank Marchell

Ivan Zak: Hi I’m Ivan Zak then we’re here to introduce you to Dr. Frank Marchell so I met Frank couple months ago in a hospital too far from Portland Maine and I was quite amazed with the way he was the clinic and quite a few changes that you made so we decided to invite him to this episode we’re going to dive in with just sort of a couple questions to begin with so this week

Shawn Wilkie: I guess to start out of it and Frank what I wanted to say is you know we kind of picked a topic for this which is kind of Staff satisfaction late to productivity and Frank what I know about you is your bit of a wonder you know actually talk about you and the first episode so it’s really exciting that we’re able to get you he described you almost as like a Orchestra conductor sitting behind a computer he said he was very confused and amazed when he saw you actually operates so you know that’s what is really exciting for me to have you here and so Ivan get wanted you wanted to jump in and pepper this guy with some questions

Ivan Zak: Yeah so I guess hey

Frank Marchell: Hey let me let me just say one thing right now just make a quick correction it’s everybody here Ivan it’s not just me I provided the tools for everybody to do this right so I just want to make that clear I don’t want to take any of the credit for what leads to Our Success here because it really is everybody

Ivan Zak: What do they say about the great leaders they share the success and they take the responsibility over there now huh I take more pleasure in seeing my staff succeed I’m very proud of them

Ivan Zak: Well that’s what we’re about here to do is to discover how did you get there so so I think that the topic is sort of you know and I was trying to look at the angle of friction here it isn’t how we run the hospital’s from efficiency and productivity and this is where you know where I kind of researching that area right now and I was thinking that especially with smart cloak I was thinking that by improving efficiency you will do will make the hospital’s better but it seems like people are not really interested in efficiency productivity and money-making they’re more interested in it flow in the hospital and and the balance sort of lifestyle and and the right leadership so I wanted to kind of open it up Frank with you and just explain to us what have you done in your hospital that you think is different

Efficiency and productivity in veterinary hospitals

Frank Marchell: I mean just and it’s hard to explain what happens at our hospital and words because it’s real you actually have to see how people coordinate their work together we’re very small hospital we have computer stations adjacent to each other we are we we have very few walls we can see each other so it’s more like a newsroom where you have maybe five or six reporters sitting at their desk with their phones but we’re not taking new store racing we’re taking animals in and then when they come in you know we immediately know what’s coming in and we know who’s going to do it and we can help each other out and get people right into rooms we had toy we only have two exam rooms but we have to and eivin can explain this a little bit better but we have to sort of Alcove areas in our store now where we see big dogs and fearful does so they don’t even go in the room but they just go in an area and they can see us approach um so they’re not apprehensive but I think one of the key things here is everybody can see what everybody else is doing the only place where people disappear and you can’t see what they’re doing is out back but now we have cameras out so we can just look at our iPhones and see what’s going on out back and if they need help jump in so I really think the key and it’s just what I think is that we’ve removed barriers we produce handoffs and we can actually capture all of the information that we need we’ve got 13 computers and we’ve got six people on it a time plus the veterinarian so it’s not that everybody needs their own computer they really need a computer right where they’re standing at the time that they talk to the person or run a lab tests or take a phone call and if you don’t get that information into the computer system right at that moment and then you go do something else have time you get to do it so I mean that’s what’s nice about idexx equipment you know they put it right back into vechten X Plus and Ivan’s program it actually does a lot of the math for you but I mean it really is like I even said it’s more of a Wizard of Oz and we’ve added a lot of automation tools on top of a problem

Shawn Wilkie: Prentiss the state is in the tech industry in the software industry that I’ve been a part of we have this thing called The Daily stand-up where everybody comes in talks about what they’re working on for the day and it sounds like you’ve kind of taken that that idea of kind of like this connectiveness inter staff and made sure that people don’t even need to really talk about things because they can see what’s happening yes your call yep and so has that little

Frank Marchell: We don’t have to call for help if the staff is coordinated they see you need help and they’re right there I mean we have one office manager who is sort of you know I call or the Sarah Connor our practice she’s the one if people are kind of want to give up and they’re sluggish she comes over and says come on we can get this done so you need a person like that and she really keeps everybody going in a good way in a good way but everybody understands that they work for each other and they understand that they’re working for each other to work for the patient in the client

Ivan Zak: Speaking of working for each other you told me about the pirate code in the past and decking

Frank Marchell: The whole pirate culture didn’t last very long culturally it’s a lot of movies have been made about it but was kind of short lived in this area but essentially the Pirates got all their employees from multiple places a lot of times it was people escaping servitude or they had no job but yeah you’re all on a boat you’re all have to work together you’re stuck close to each other and to get paid it’s kind of very upfront you know whatever it is that you earned in your capture lay that out on the deck and then everybody everybody divides it up and then everybody gets to pick pick his chair but in what I was telling Ivan that what we do here is the staff gets paid a percent of the gross 20% and I don’t care if it’s do it they still get that and they understand that so they work hard so they do not have to hire a new employee most clinics I think as busy as we are would probably have close to twice as much staff but my staff understands now we can get this done we don’t need more people we just need more efficiency and many more teamwork so then I mean they’re all making probably closer to 15% more than the typical person in their role in this area but I can get those numbers for you I have no idea what anybody makes Jen does it all I haven’t seen payroll in 10 years

Shawn Wilkie: Yes it’s amazing and you know it there’s a couple of things that I want to zoom in on quickly Frank one is this idea of bad apples spoiling the bunch it sounds like you don’t need bad apples but I wonder if you could take us through if you’ve had a bad apple and it sounds like you’ve got such a in my personal experience when when you know a bad apple comes into a really cohesive team that gets spit out really quickly have you got any experience with that in the past

Building a cohesive team

Frank Marchell: Yeah we really haven’t hired many people in years I mean Jen’s been here 23 years March 20 years it’s just we’re not good at hiring because we have good hires but we’ve only hired was like five people in the past 20 years so as we about hiring but I can tell you a good story about bad apples and we had a person that we hired Miss was like 15 years ago and she came to work 15 minutes late every day for the first week and on day five Jen said hey come with me we got to go outside and talk to Kelly it’s okay and so she pulled in 15 minutes late and Jen knocked on her window and said hey Kelly I just wanted to let you know it’s you know I appreciate you coming but it’s not working out we really needed you here on time and I’m going to send you a check like no I’m sure you’ll fit in someplace out and suddenly said amen what Jen what just happened there do we just fire Kelly and she said yep it wasn’t working out and we knew it wasn’t going to work out I didn’t even know we were firing I thought I was going out to help her carry something in from outside but and that’s only happened a couple times but they’re just very good at sizing people up they make people better you know that the core of the team here sort of sucks in the culture and I know what you mean about the bad apples but I don’t really know how to deal with that because you know everybody oh I have a bad moment or get upset or something but that’s that’s not a bad apple and you know we have our moments during the day and if there’s an elephant in the room we talk about it now I we don’t dance around issues you know if there’s a problem that we I can see something’s going on here what’s you know what do we have to solve right now the longer you let somebody’s do about something that’s bugging them it gets worse it doesn’t go away Ivan hasn’t been at our practice long enough to see the dirty part

Ivan Zak: What I’m hearing is that they said this pirate code is is an action actually I think it’s a combination in your hospital where you share they rewards and they yes people are Commissioned I know it’s a controversial area in that individual strand not everybody wants to share the commission but you really share the success and then people take responsibility and accountability for their actions and then when someone is not performing and it’s a shared success then then if someone is not helping then everybody will point out that first pretty quickly so it’s still itself but I think that’s right quite quite interesting to me

Frank Marchell: That’s not perfect though I then you know I don’t want you to I don’t want anybody thinking oh you’ll just do this it’s Senator it’s going to be Shangri-La everybody else get along

Ivan Zak: No I think you just combination what you are and those a couple sort of you know that other two secret words that I wanted to ask you about so you showed me your your diagram of sort of the one snapshot of how to run the the leadership and I wanted to ask you to expand on the toilet paper concept and the egg carton concept

Frank Marchell: Yeah well so all of us and that have businesses we in start out running businesses so you read books about business so you get everybody’s experience and ideas about what they think businesses are and after a while I know you guys have read those books and they all start just repeating themselves and then you realize it’s somebody’s guys actually never ran a business they just wrote a book about running a business then I start getting a little bit skeptical women this guy never was really in the trenches with play what it was were doing and they’re giving us advice that is really more theoretical like if you become more efficient and more cohesive so what are those two things I work mostly with women I’ve got a partner is a man and you sport metaphors and they just zoom over their heads none of them really are into sports but they’ve all worked in restaurants so use restaurant metaphors but what about is I always can tell when when we have a problem is when I hear the staff saying hey does somebody know where this is or do you know who did that and it’s like wait a minute that’s not good because for one thing that person may not even be here now so I said we got a in our system we have to have a place for everything and so we actually have areas in the hospital mapped out and I call that the egg carton rule they have it drawn on the table a sample comes in to be run it starts in one little box it goes to the next one and I’m sure other hospitals have this but when you see something sitting there you know what needs to be done with it and you also know if something’s missing from an exam room morale back because everything has a circle around where it’s supposed to be so if there’s a bottle of supposed to be there and it’s gone you didn’t have that Circle there you wouldn’t remember there’s there’s a bottle that’s supposed to be there but the people stock in there there I can say oh yeah I’m missing an egg they’re supposed to be 12 eggs in this carton there’s only 11 but if you just had eleven eggs in a bowl you wouldn’t know you’re missing the 12th egg unless you counted them all that make sense

Ivan Zak: Yeah didn’t you tell me that they use that rule in jail so they you tell them

Frank Marchell: Yeah well the idea I got per map and everything out in the kitchens in prison say have all of the way tolls in the knives or whatever it is are using actually is outlined exactly for the size of the utensil because somebody might break off two inches of a ladle to make a knife at least this is the article I read

Shawn Wilkie: So Frank one of the things that I’ve done in the past is run a computer repair business and after buying the Thousand screwdriver I did the same thing in our service departments we had an outline of exactly the type of screwdriver the pliers and it worked quite well like you know it was like well you know it was physically missing thumb

Frank Marchell: This isn’t even my idea we did this in shop class in high school you know

Shawn Wilkie: Same as the computer store

Frank Marchell: Yeah same thing I mean once a being tools that you need and information that you need you need to know where to find it where to put it otherwise it’s an Easter egg hunt

The importance of customized technology

Shawn Wilkie: Yes really interesting so the two things out to other things I want to dig into it you’re Frank specifically around technology so I’ve already picked up on the fact that you get double the amount of computers and you do people and I’ve heard that you’ve done that to reduce the time required to get to technology you want to make available to people wherever they’re at in the hospital and all those count I remember working with Radiology teams and and the team at idexx actually and they said you know our big challenges we want to reduce the number of seconds that these Radiologists are reading these reports so whatever we can do in them a third screen or can you specifically dig into like the efficiencies that you found and maybe even talk about technology the technology that you use on a day-to-day basis

Frank Marchell: Oh yeah and in fact I think I mean I’m just kind of throw this out right now what’s really need to do is come down and watch the show and in fact you don’t have to come down and watch the show I can give you the password to the cameras Ivan has the passwords to them but in only because again it’s like me telling somebody how to hit a baseball and now you really have to put the bat in your hands and swing it and get a feel for it I’ll just outline basically what it is that we have found in if you have to stand and wait to get to a computer you’re wasting time you’re not getting that time back Ivan said time motion guy just like I am so I’ve actually timed with the cameras I’ve timed everybody and and I know how long they sit at a place I know how long it takes to review a record and what used to take maybe two to three minutes when I come out of an exam to write up a record and write up the prescriptions and then to put follow-ups a lot of experience I know buttons to push and eivin can tell you that what we’ve done is just we’ve sort of automated the keyboard so there’s a lot of programs out there to do that there is auto hockey’s but any of them will work it’s just they’re a little bit tedious to learn but once you learn learn them then it’s exponential and everybody has their own station everybody has their own macros for getting their work done and it’s just to be more efficient more accurate and then you have more time to do other things like talk to the people

Ivan Zak: Without give it away too much secret but I want to describe just verbally in what I’ve seen you do with the programs that you had so so Frank stitch together his three screens which I thought was amazing the more screens the better and he really was operating with his eyes I believe you have a mark as a central system and then each did to it Thunderbird mail is not supported anymore so we’re not talking sophisticated stuff here is just how you and then also Google Voice I think wife yeah if you use for text messages emails yeah and then everything that he does what I was amazed with the client communication tools seems to be the most important topic in the technology right now in veterinary medicine and we’re all looking for these new and the greatest you know applications and then you literally took a sewing machine and put a Porsche engine on it this is how easy it you basically connected three outdated and not supported Technologies and now you’re pulling the revenue which is time and a half more than anybody else I’ve seen in the industry and including your new vets I mean I don’t know if it’s a secret or not to share how much revenue one vet started bringing on the date to when she came in but you told me the number I mean that’s just crazy person

Frank Marchell: That goes back to the very first thing I said it’s the system it’s a staff and we should be able to put most people in and get them up to speed quickly and we’re just fixing the problems everyday Ivan yesterday at the end of the day Leslie left a message for me I contacted an owner with some results we use the primary email well this guy wanted us not to contact them are you wanted us to text him and that was buried in some node in the record some place and I didn’t find I don’t have time to go read every note looking for something I don’t even know that it’s there so this morning I got to work and I wrote a macro such that as soon as they open up a follow-up window it pops up a choice of six things text the owner call the owner emailed me on it text the spouse child or spouse email with spouse and you just click on that and that automatically puts it in a subject that’s right on top of our to-do list so it doesn’t get anyplace again place it’s a very simple solution

Shawn Wilkie: Frank if you ever get bored as a veterinarian you know me and I have been are both thinking about starting new technology companies we don’t know what for but if you wouldn’t

Ivan Zak: Yeah I did say that we need to digitalize Frank that’s really what a but I think one thing that’s interesting and they kind of Link’s back to burn out and sophistication when I’ve seen in the especially the consolidator industry in order to increase the efficiency or productivity what a lot of consolidators do they consolidate and then change the technology and Technology you know being a smart phone for the last six years I realized that you can come up with the best tool on Earth but how do you make people to change yeah when you hire you just hired a new vet and plugged in right into the system she enjoyed it you have any sort of Secret change management reason be

Frank Marchell: I don’t like don’t get worried I’m going to stand behind you I got to see how you use it because the way I use the system is different than they use it their needs are different than my needs and I tell them I’m doing that so I can make your job easier and that’s why this morning I got here and I wrote that little section of code just before you called and I put it on the front receptionist computer and as long as you’re working to make their life easier they don’t mind change if you think your ideas are gonna make their life easier you got a problem because you got to be there next to them you got to see what they’re doing you’ve got to identify their prom because sometimes people say Frank I got a problem with this my first answer is all right let me see what you’re trying to do I don’t listen to what they tell me and think I’m going to come up with a solution and I think that’s a big problem with computer computer programmers trying to make a program for veterinarians when they don’t know what it is we actually do minute by minute and I went up to idexx once a nest has invited me up their pocket some programs I thought I was going to talk to two or three programmers I got in a room they had 60 people and I said and that’s just what are what are we in am I gonna listen to a lecture here with what’s going on so now these are the programmers that I want you to talk to you are the elected well when I said well I said you got 60 programmers he said yep and Cornerstone still runs away it runs and he said yeah I said all right let me ask a couple questions I said all right raise your hand if you’ve been in a hospital all 60 hands go up I said leave your hand up if you’ve been in a hospital for a whole day half of them come down your hand up if you’ve been in a hospital for a week and there was one hand up at the end of that and I’m gone all right here’s your problem you guys you don’t even know the – with a database and fill in some boxes and it works but you don’t realize that’s 25 klicks to just record the temperature or to open this up or to go look it’s like we don’t have that kind of time we want the information just to pop up in front of us or at least find the field where we have to enter it and that’s what we’ve done we’ve integrated a number of different tools I mean we use Evernote I love I’d expect neck because we can just click on the animals chart and it goes right to their back neck results Ivan can explain that to you yeah

Shawn Wilkie: Also need they wanted to dig into a little bit was this idea of change management so funny because one of the things that I’ve done in my past is we integrated email systems for the biggest companies in the world and I remember we were doing this email migration from Microsoft Outlook to Google Apps it was for a company that had over 8,000 employees and the CIO of that company went out and did the training with us and I learned something so impactful that day he’s like all you have to do is tell them what’s in it for them start with a personalized approach for them show them the benefits that they’re going to get asked them about their struggles and try to relate the things that you’ll be solving and that stayed with me forever right you know the ability to kind of talk to the person as if you have something to gain you know that you’re going to help him reduce the number of spam emails I get or whatever it is with the specific technology that you’re using I think it’s really really important

Frank Marchell: Yeah I think what really is key here at our little facility are and of one little tiny group is that we’re all willing to solve each other’s problems and when we have a when we have a frustration I always identified that as a positive thing you guys are frustrated with all right well we can fix that that’s an opportunity but before I fix it I really need to understand better what it is you guys are having a problem with then I mean I got more things to fix and I’ve got a list of project that I could stop practicing and just keep fixing these problems and making the system better and better Ivan For What Little he’s been here and how much we do in a short time I’m not trying to brag I’m just saying there’s an opportunity to be even 25 or 30 percent more efficient than we are now without raising our cortisol levels without being stressed out without burning out I mean it’s the end of the day everybody’s worked hard they got a lot of work done they’re going home but they actually made a decent salary and if I could design the world differently I wouldn’t have capitalism and I wouldn’t have socialism of everything that’s not the way it works I’ve got two employees whose kids are going to college they need money they want more money and it’s not a bad thing to work efficiently as long as you’re charging what the market is charging you just have to be twice as efficient to make twice as much and it’s there therefore any practice

Ivan Zak: I think that all we’re talking about here I would just bring it was I wish you know maybe next year you’ll be interested to go I just went to a health care Summit on implementation of lean thinking in healthcare and I was trying to find out what it what are they doing in healthcare for sort of improvement of efficiency what they found out is that it’s more about allowing people to make the changes and I think that that’s what you’re doing in your hospital a lot of things I done they’re actually scribe I remember I sent you a sort of a pre publishing version of the lean vets it’s a it’s written a yeah here for time for these a DVM and an author of lean vets quote which I think is coming since publishing and always talking about here at a lot of the lean methodology it’s sort of finding out the outcome and then mapping your processes to outcome it’s the pool concept we’re not pushing next task to next person but everybody knows what’s going on and then communication it’s those are the sort of main tools and they had a really great success and health care I think that they lack of centralization right now it’s a bit of a challenge because even if you are sort of a unicorn of a practice where you do this this it doesn’t have any impact on the industry overall and I think that’s a very serious issue with the raising concerns about burnout and suicide every classmate I talked to from the vet school probably 80% of my classmates they don’t want to do it anymore because it’s just not fun it’s frustrating we are running in circles and circles don’t progress you’re not progressing forward your just keep doing the same thing over and over and making more of it it just doesn’t help so I think that you’re doing there is is exceptional I think that the combination of that with technology knowledge of it you put together you just proving the concept that it’s not about the tools it’s about creating the environment that is willing to change and that the learning curve then becomes just easier and on top of that you’re rewarding people so there’s incentives and incentives are aligned on both ends you don’t even know what you’re paying people but they’re happy so everybody is is rewarded so I think it’s just fascinating when you look at all the sort of things that you implemented they were to combination of quite a few Frameworks with technology so criticism right

Frank Marchell: And you know I then it’s everybody nobody deserves more credit than anybody else for what’s happened here I’m just really proud of everybody here and I tell them that

Shawn Wilkie: It’s such a Hallmark of like a passionate and thoughtful leader you know to give credit to the people around you you know I read all the business books to and you hear that over and over again and I share that to you and I know Ivan does as well you know when the team gets something right it makes me feel unbelievable I’ve got a question for you you know you’ve read all these books you’ve done all of this stuff you know our listeners out there they’re listening to figure out how to be maybe more Innovative or more productive do you have some recommendations on books or anything that people should watch or do to help them get a handle on their business

Frank Marchell: I really don’t want to give people advice but I’m happy I went and talked to my sons he graduated from WSU this year is going to be working up in Portland a couple years I went out to see him at the school and I talked to his business class and I kind of did a lecture what you’re asking and I just basically said look I will tell you I’ve read all the books I’ve had I’ve gone to lectures you guys have in the business group it’s very useful it’s good it’s like icing Howard the planning part is good but as soon as the day starts all they have planning goes away because now you got the person who just walked in with the laceration and to get a couple phone calls you can’t plan for that type of experience busy Veterinary practice has every day and I just talked to them about the way you got to be flexible don’t blame people when something goes wrong you use the Toyota method ask why five times find out the root problem understand what the books mean by fundamental attribution error which again is just basically don’t jump and blame a person for a problem it’s It’s usually the system that made the problem occur in the person just happened to be there Deming was the same way the guy in developed the Toyota method I mean we have a bunch of simple rules and have a little diagram that Ivan has and it can fit on the one page and it’s just a circle and there’s four quadrants do it you’re either working efficiently waiting to work those are okay then you have working in efficiently that’s where I think most people are the working really hard but it’s taken them twice as long and you’re looking for a stop and you don’t have the information you need pre-written you don’t have handouts for owners you don’t have follow-ups automated Ad nauseam so it takes two to three times more effort and you’re more stressed out because you’re not sure it’s really accomplished everything that you needed to do so I think that’s where most Veterinary practices are and they’re working hard and that’s why they’re tired of it as it’s not like they’re winning the game if you’re working hard but everything works well and you get everything done and there’s no glitches you know my staff it’s like that was cool we just you know we just saw 13 appointment in an hour and everybody got everything they needed nobody got hurt

Ivan Zak: Frank do you think I could share the diagram that you just referred to I know you shared it with me I don’t know if it’s proprietary information but we could okay the link for the listeners here and then this is the diagram that Frank follows in terms of efficiency and productive work

Frank Marchell: I go back to it all the time I then when I get kind of things to going on rides right I got to go back to the home base and look at that yeah yeah I’ve got to make this simpler I’ve got a eliminate that barrier we don’t we’re hand and things off we shouldn’t handoff and you can always make the system better especially when you get new equipment or new Kansas and she came in and tears and said fine time I hate to leave I said we don’t said we were getting transferred the Kansas has had all right you’re going to be my first remote employee and so we set up a station in the other room we call the Kansas and we had a new phone system so she can actually answer the phone they’re like she’s here and put people on hold and we can pick it up back here and she’s got access to the computers we’re going to have camera setup for most clinics that would have been like tragedy and I’m saying now I’ve wanted a remote employee you’re going to be my first one so that’s awesome

Shawn Wilkie: That’s so cool Frank you know it’s really funny that you brought up the Toyota method I’ve got two children first one’s name is Kai second one’s name is Zen and Kaizen is the Toyota method so it’s kind of continuous improvements a big thing I think it’s been so incredible to listen to you speak the takeaway just take away that I’ve heard over and over again is the team you know you’ve got a well-oiled machine down there you know I think it would be really interesting if we could capture a video the next time you’re there and post it for you as well sir the Gasping all of this thing’s in action but yeah I really wanted to thank you for sharing everything that you have with us we’ll be sure to include notes and links to everything in the show notes it was totally awesome to have you anything else you want to share with us before we kind of wrap up here

Frank Marchell: When I first met Ivan I showed him what I did he showed me what he did I said yeah I think gets it and and I get it but now you got to get everybody else to get it my son wrote a paper with one of those avma competitions and I think you came in second place but I think what he wrote about was exactly what Ivan’s worried about the stress that our profession is under and what I tell myself I feel morally obligated to help you guys I want you to make more money but I feel like it’s almost I mean who’s gonna help you in society make more money well it’s right here and if these vets are making money but they’re stressed out, we gotta fix that.