Faking it

First published 5 Mar 2018 in the Veterinary Times

You don’t fake your

appointments… do you?

Whether due to being inundated with clients, understaffed or trying to

catch up on workload, resident RVN blogger Jane Davidson discusses

the prevalence of staff members booking out false practice

consultations, as well as the reasons they choose to keep up this

pretence...

Controversial statement alert: I believe every practice I’ve worked in that

has an appointments system has had someone working in it who books

fake appointments for the final appointment of the day/session/week.

Before you all start piling on to agree, disagree or otherwise, let me explain

what this is about.

I am aware booking false appointments to ease workloads is “a thing”. I’ve not

done it personally, but have been aware of “fake appointments” being booked

in many places I – and friends – have worked in.

From my experience, either clinical or reception staff have taken a view on how

busy the day is and tried to alleviate this by ensuring the final appointment is

booked by someone they know is not going to turn up.

They may use real clients or fake accounts, but, essentially, this client is never going to appear – buying the team an extra 15 minutes of time, at a cost of one £0 turnover consult.

How does this work for a business with consults as its first point of contact for

creating turnover? What does it say about the team in that business?

The overrunning consult/procedure/consult domino effect is trying for

everyone – the vet, VN, reception team and client/patient. Is the “fake

appointment” used to cushion this effect? Let’s explore – what issues can

booking a fake appointment alleviate or create?

Issues for business

I am aware of places where the practice owner will micromanage the diary,

even when away from the practice – viewing the diary remotely and

contacting the team to check why the final appointment on a given day hasn’t

been booked.

This creates a lack of trust between the team and management. Many places

try to keep the final appointment free for emergencies, but if the diary is being

watched then staff may start to fake book it to avoid the accusatory telephone

call and work without the feeling of being watched, assessed or judged.

Missed opportunity

But I’m sure practice owners or managers are just considering the impact on

the business. Surely this one missed appointment is a missed revenue

opportunity?

I’m not so sure. Is it better to have all possible appointments booked so you

get a better average spend per consult? Or, is it better you fake book an

appointment and spend quality time with those already booked, increasing

your spend per consult that way?

I have worked in places always at capacity, where staff and clients suffer;

diaries overrun, clients are always waiting for a vet to be free, consults are

rushed to try to make up time.

Emotional blackmail

The team may think “phew, it’s a first vaccination; that’s quick, they can come

back for a follow-up for flea and worming info to save time today”. But what if

you are saving time every day and that full consult for puppy or kitten health

doesn’t happen? You’re then using clients’ time to save your own.

Asking clients to make repeat trips to the vet, to meet your diary needs, will

see some look elsewhere for their veterinary health. Is that rushed consult

really worth it?

I’m sure some teams have even had the emotional blackmail of turning away

emergencies to protect that fake appointment.

Well, I hold #teamvet as having more integrity than that – and this system exists called triage. No one I have worked with would ever refuse an emergency appointment to protect the fake appointment – in fact, sensible places have appointments booked out for emergencies; a legitimate fake appointment system.

In my experience, fake appointments are not booked to give people an easy

life, nor a sign of laziness. It’s a sign of a team under stress that wants time to

do its jobs properly.

Perhaps this is a sign of team burnout, or staff protecting those in the team

they feel suffer most under pressure. Those who book fake appointments are

rarely doing it for personal gain, but are viewing the team as a whole and trying

to protect everyone. We know we may need to stay late to complete patient care or deal with a genuine emergency, but an emotional impact – as well as a financial one – occurs over time.

Emotional impact of overtime

The emotional impact of overtime can include:

Staying late being accepted as, sometimes, our patients need us.

Staying late often because your diary is regularly overbooked, because of

staff numbers or skill, is demoralising.

Financial impact of overtime

I know not all overtime is paid. I worked in a practice where you had to work

five hours of overtime in a week before you started getting paid for it. So, up to

an extra half day a week would be worked for free.

Yes, veterinary work contracts are often abominably written, but that’s another

blog. What is often at the crux of the problem is the hours we are paid to work

don’t reflect the opening hours of the practice. We face an issue almost daily

of time paid versus time actually spent:

Many practices have a final appointment at 6:45pm and staff paid to 7pm

or, possibly, to a crazy 7:15pm.

How can you ever leave on time if your contracted hours don’t match the

needs of the practice?

Last to leave

I once worked in a practice that closed at 5pm on Saturdays, and I would

usually be the only person there. I would need to restock the consult room and

cash up after 5pm. I was lucky this place had a cleaner, otherwise I would have

been cleaning and mopping floors, too!

In this practice, final appointments were not 5pm. But the planning of my work

hours, and the opening hours of the practice, were not thought through. I was

always there for 15 to 20 minutes after closing doing my job role, regardless of

whether I had to do something over and above my job role – getting the

working day done was over and above my working hours.

While I’m always happy to stay on for the patient’s benefit when true

emergencies hit, an expectation of staying every day for routine work makes it

a slow grind until you burn out and cannot take it any longer.

Controlling elements you can control

Hospitals and vet practices work best at about 80% capacity – it is better for

patients, staff and clients. Just increasing the number of people through the

door without considering how you deal with them is not enough to increase

revenue; in fact, it can increase complaints and poor service.

We cannot control client or patient needs, nor do we want to. But we do want

to work somewhere we can have some say in the work levels we undertake. If

booking a fake appointment is the only thing you can control to save the team,

you’re going to do it.

You need a happy and healthy team to serve people and pets. If you find fake

appointments being booked, don’t shoot the messenger – instead, listen to

the message they are trying to tell you.