University
life
as a
veterinary
student
-
leisurely
surgery,
lots
of
manpower
-
possibly
no
lectures
on
the
management
of a
practice
including
KPI,
productivity
and
efficiency
for
a
new
vet
in
practice.
Video
of
University
campus
&
graduation
in
Australia,
UK,
USA,
France,
Canada
----
Campus
life,
spring,
summer,
autumn,
winter.
Flowers
in
Spring,
Summer
holidays,
Studying
hard
for
examinations
at
the
last
minute.
Lots
of
caffeine
to
keep
awake
during
lectures.
Youthfulness.
Idealism.
Change
the
world.
Realities
of
the
private
practice
-
competition
is
common
in
any
business.
Over
50
veterinary
practices
in
Singapore
in
2013
and
more
being
opened.
The
discerning
pet
owner
now
picks
and
choose.
Proximity
is
important
for
most
if
there
are
no
nearby
practices.
What
is
the
practice's
USP
(Unique
Selling
Proposition)
and
the
owner's
perception
of
the
competency
of
the
vets
in
the
practice?
-
high
rental,
labour
&
drug
costs
increasing
every
year.
Landlords
and
the
bureaucrats
want
more
income
every
year.
-
Need
to
earn
sufficient
to
sustain
the
practice
and
invest
in
upgrading
equipment
and
maintenance
-
Performance
of
the
new
vet
is
assessed
by
the
seniors.
Getting
fired
for
poor
performance
is a
fact
of
life
for
all
employees
of
any
business.
1.
What
is
KPI?
2.
Why
is
KPI
important
in
veterinary
surgery?
The
pet owner's primary concern is anaesthetic death. What has that to do
with KPI in veterinary surgery? The duration of surgery
1. Old and very young dogs are high anaesthetic risk. Taking
too long to operate may result in anaesthetic deaths from heart failure.
The owner will be unhappy and avoid the practice. Bad-mouthing the
practice and advising friends or internet forums not to patronise that
practice (video of forums).
2. Waste of resources. More time spent by supporting staff
when they need to do other work. More drugs, sutures and anaesthetic
wasted as the vet does surgeries inefficiently and without planning.
3. Less surgeries can be done/day. Turning away clients to
competitors.
4. Less consultations can be done by vet as he or she takes an
unreasonably long time to complete the surgery.
5. Less referrals from owners as they are not satisfied with
the services and surgical outcomes.
3.
How
are
KPI
measured
at
Toa
Payoh
Vets?
3
case
studies:
Case
1.
KPI
-
How
long
it
takes
to
remove
one
bladder
stone
from
a
10-year-old
female
poodle?
Case
2.
KPI
-
How
long
it
takes
to
remove
one
bladder
stone
from
a
9-year-old
male
Jack
Russell?
Case
3.
KPI
-
How
long
it
takes
to
remove
one
big
fast-growing
skin
tumour
from
a
10-month-old
poodle?
.
CASE
1.
www.sinpets.com/F5/20130615stones_urinary_poodle.htm
Removing one bladder stone in a female poodle
A: Injection of Induction Drugs 2.50 pm
B: Isoflurane gas first given: 2.55 pm
C: Isoflurane gas stopped: 3.39 pm
D: First skin incision: 3.11 pm
E: Completion of skin stitching 3.41 pm
E-D = 30 minutes of surgical time for a vet with 40 years of experience.
E-A = 51 minutes for the whole process excluding pre-op
preparations
C-B = 44 minutes of isoflurane gas + oxygen used.
CASE
2.
Video
Recent
case
operated.
Refer
to
medical
records.
Removing four bladder stone in a male Westie
A: Injection of Induction Drugs
B: Isoflurane gas first given:
C: Isoflurane gas stopped:
D: First skin incision:
E: Completion of skin stitching
E-D = minutes of surgical time for a vet with 40 years of experience.
E-A = minutes for the whole process excluding pre-op
preparations
C-B = minutes of isoflurane gas + oxygen used.
CASE
3.
Video
Recent
case
operated.
Refer
to
medical
records.
Removing one large skin tumour from a 9-month-old male Poodle
A: Injection of Induction Drugs
B: Isoflurane gas first given:
C: Isoflurane gas stopped:
D: First skin incision:
E: Completion of skin stitching
E-D = minutes of surgical time for a vet with 40 years of experience.
E-A = minutes for the whole process excluding pre-op
preparations
C-B = minutes of isoflurane gas + oxygen used
CONCLUSION
SAC (Speed, Accuracy and Completeness). These 3 factors are
important in surgery. The KPI measures speed mainly. However, Accuracy
and Completeness depend much on the vet's knowledge, skill and
expertise.
A good surgical and clinical outcome from Accuracy and
Completeness will satisfy the pet owner. This results in more referrals
for the veterinary surgeon and sustain the practice in the long term.
Over the past 3 decades, no KPI were formally practised
during veterinary surgeries in Toa Payoh Vets.. Since 2010, I have
introduced the KPI in the anaesthesia and surgery of all patients
operated at Toa Payoh Vets to achieve the my mission of making Toa Payoh
Vets one of the top 3 veterinary surgeries in Singapore.
KPI measurements takes time to be accepted by the associate
vets as most people do not like change and it is likely that the
veterinary professors do not lecture on this topic to the impressionable
students.
The reputation and stature of the practice depends on
good vets and affordable value for money fees, as perceived by the
heartlander pet owner in Singapore. KPI are a very important direction
to ensure a consistent and high standard of veterinary surgery at Toa
Payoh Vets to sustain the survival of the practice over the years.
TOA
PAYOH VETS
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