Equine centre of excellence

Transcription

1 Vet Times The website for the veterinary profession Equine centre of excellence Author : anonymous Categories : Business Date : March 1, 2013 It s one thing for a specialist veterinary practice to offer some kind of out-of-hours service, but quite another to have a full team of experts on emergency call, 24 hours a day. At Liphook Equine Hospital, providing that vital day and night facility is at the very core of its remit. LIPHOOK EQUINE HOSPITAL has transformed its fortunes with an intelligent mix of clinical innovation, business strategy and renovation. situated within the boundaries of the south Downs National Park at Forest Mere, it is busily engaged in re-engineering its services for the future. Partner Jeremy Mantell tells VBJ that Liphook has weathered the economic storm with its core ethos intact and a renewed sense of purpose. His days at the practice are numbered as he retires in april, but as one stable door closes, another opens Jeremy is to continue working for the British Horseracing authority at race courses around the UK. During his more recent times at Liphook he presided over an extensive new building project and negotiation on a lease that will keep the hospital at the site for the next 40 years. A two-storey central office building is now the focus of the hospital, along with neighbouring stables, diagnostic facilities and redesigned grounds. the new build went remarkably well, Jeremy says. We had a simple aim to be able to operate or do whatever was required at any phase and never to turn a horse away, and we achieved that. As partners, we felt the buildings were tired, crowded and having an adverse effect on our lives, but, most importantly, on our clients. We wrote to clients to explain what was going on, telling them 1 / 32

2 we were investing to improve the facilities for horses, for them and for our staff. It is clear, almost immediately, how much Liphook s central office building stands out from the rest of the site, with its semi-circular, almost nauticalshaped front, stained cedar panelling and fully glazed reception area. the partners were not sure about its visual impact to begin with, but it has now become a strong part of the practice s identity. A new space age Additional space has banished memories of meetings in cramped offices forever and improved staff comfort and morale. Reordering the facility s clinical space with a new MRI suite, the addition of an american barn or stables, a rebuilt intensive care unit, examination rooms and diagnostic suites have improved workflow and boosted efficiency. We have 10 separate areas where we can examine or treat a horse now, says Jeremy. Before we built all that we frequently had a queue of people waiting outside to get into x-ray or ultrasound. Clients got used to waiting up to an hour before the x-ray machine was free. Our feeling was that times were changing and they did not want to wait that long. The real benefit is that we can see a client and get his or her horse back on the lorry in half the time we used to. They don t have to hang around at any phase. If they come for an ultrasound they can be out of here in an hour. Client feedback has been incredibly positive, better than we could have dreamed. Liphook has rationalised too. It sold its practice on the Isle of Wight, and thoughts of expansion were put on hold enabling the partners to concentrate on the three core businesses the ambulatory practice, the referral hospital and the laboratory. We are able to offer clients more hope and success with their horse s injuries or illnesses because of the investment in time, money, people and equipment, says Jeremy, but especially people. Any client arriving with a sick horse during the night will find a team of eight people ready to assist. It is having that team ready that has transformed our success rates, he says. The cost is having two nurses working, plus others on call every night. We believe we are the only hospital in England with true 24-hour nursing. You could save money by not doing it, but we would lose the whole ethos of the practice. The partners believe in the equine VN qualification and currently have five staff in training and seven already qualified. Six of the veterinary surgeons are diploma holders (RCVS and European specialists). Investment in staff training means the hospital has critically positioned itself as a centre of clinical excellence. Patience and patients sorely tested Things were not always so polished. During its 2m redevelopment the open all hours policy was 2 / 32

3 tested to its limits. Builders digging a trench cut through the mains supply at the same time as a digger operator wrecked the back-up generator. It was almost malicious, says Jeremy, wincing at the memory. Sometimes it was a logistical nightmare. We coped and we did not turn away one patient, because it was a matter of pride, but we did not realise how much referring vets and travelling clients were put off by the idea of coming to a building site. As soon as the builders went our turnover increased significantly almost within a week. That was a salutary lesson really. We thought we had planned well, but we had not coped because we had not told our customers not to worry. What the build team has k created should constitute the best conditions for business success in the coming years. Light floods into reception on sunlit days. Comfortable seating and a free coffee machine create the right impression. In the office to the rear of the reception desk, dedicated teams take calls for either ambulatory or referral services. Ground floor offices all have the same light, spacious feel. An accounts office and client meeting room branch from the central corridor and to the rear is an open-plan vets office. Out back is the entrance to a storeroom for the ambulatory vets kit. All vet offices have an intercom link built in to improve communications essential in such a large complex. On the second floor are the partner offices, administration team office and a combined board and training room. It is a far cry from the original cramped vet quarters now the duty house vet s flat where 20 vets used to hot desk and try to avoid stepping on each other s toes. In the clinical buildings there has been an equal investment of time and thought. First up is the hospital s standing MRI, a 0.25 tesla Hallmarq system, leased direct. It handles roughly 15 to 25 cases per month and has three fully trained nurses for acquisition and two vets to read the scans. Next door is the renovated scintigraphy room, especially useful in complicated lameness and poor performance cases. Afternoons are the busiest period because it takes four hours for the radioactive dye to infuse, says Jeremy. Two well-equipped theatres are ready for use in the surgical block. Today, one is occupied by a patient undergoing gastrointestinal surgery while a watchful owner sits peering through the glass and chatting to a member of the house vet team. It is quite different to small animal practice in that we encourage the owner to be with the horse throughout, Jeremy explains. Stroll out into the yard and you walk around the extensive stables, around 50 in total. The intensive care unit is next, housing postoperative care and colic cases mostly. This is the practice s nursing hub and there are two foal stalls with adjoining stabling for the mares. Walking back through the stables you enter Liphook s laboratory, a large unit with desk space for 3 / 32

4 around 11 technicians, offering haematology, biochemistry, hormone assays and microbiology services. Elsewhere are a dedicated AI and fertility unit and new stabling. Last on the tour itinerary is the new examination and diagnostic block with its two x-ray rooms serviced by an Agfa CR 85-X system. Results are relayed to an office where vets and owners can discuss the outcome in private. Redevelopment has brought a new outlook to Liphook, but Jeremy is aware it does not operate in an economic vacuum. The recession is affecting clients and us, he notes. We monitor insurance incomes as opposed to clientpaid income and that is going down all the time, which is actually a healthy sign. It always surprises me how much clients will pay for an uninsured horse. Seeing sea changes in equine In truth, the entire equine market is changing. In the 1980s and 1990s the fashionable ideal was to build large hospitals. Now, with mobile technology, and the fact you can fit diagnostic units in your car, our emphasis is to get out there, says Jeremy. We use the hospital for horses that really need it. We take ultrasound, x-ray or gastroscope kit to the yard. There has been a sea change. Ambulatory vets can do more on site, and with the introduction of a computerised system at the hospital they will have access to extensive case notes on their mobile or tablet device. A Canadian tablet-based system is on the wish list and may go live within 12 months. Aiding that transition, an entire section of the land surrounding the M25 has been opened up by the construction of the Hindhead Tunnel. It used to take 30 minutes to get through Hindhead sometimes and now you can do it in three, says Jeremy. Five years ago we had plans for feeder practices, but we have now decided the administrative costs outweigh the benefit. In February the practice interviewed its 54th applicant for internship to the Liphook house vet programme. Four are in residence now and they are seen as future stars. However, no fresh-faced graduates are accepted simply because they are not considered experienced enough without two or three years in practice. Education and research are at the heart of Liphook s endeavours. Papers are published regularly, and with Andy Durham s team leading the way on laminitis it is likely the hospital could become a leading UK research centre. With all the new work we are doing on things such as insulin resistance, we find we can turn them around and get them back to normal, rather than just managing them, says Jeremy. Another big challenge and opportunity is the coming University of Surrey veterinary school, he adds. We have had several years of close cooperation with the laboratory and Andy Durham is now a professor there. The university s vision is that it wants us to be involved as a supplier of equine expertise. We are keen to discuss and explore the concept. There is certainly no complacency within Liphook about business strategy. Dual promotion to 4 / 32

5 clients and referring vets, via Facebook and free CPD respectively, bolsters the income stream in fairly indirect ways. Keeping its name at the forefront by offering free advice to both is a management prerogative. The life of any practice evolves and changes, and those who survive are the ones who adapt quickest, states Jeremy. We have arguably one of the most qualified surgical teams in the country, but it is really important the practice continues to move forward. We have to look at what will provide the greatest benefit to our clients and our vets. In the next year or two, the partners anticipate installing a CT scanner, further investment in the laminitis clinic and a redevelopment of the theatre complex. Life is in constant motion at Liphook and standing still is not an option. Like all these things, what was state-of-the-art in equine practice in 2000 is no longer seen as acceptable in 2013, Jeremy says. We have to move on. PRACTICE PROFILE Liphook Equine Hospital Premises: total 30,000 sq ft. Includes stabling 9,500 sq ft; admin and reception 5,500 sq ft; laboratory 700 sq ft; examination and diagnostic building 3,000 sq ft; and theatre, MRI and bonescan building 7,100 sq ft. Staff numbers: 83. Appointment time first opinion: minutes. Appointment time referral: 60 minutes, usually more for initial consultation. Consultation referral cost: obviously depends, but usually from 260 for two hours plus subsequent reports and so on. Consultation first opinion cost: from Average transaction fee: first opinion 211, and for surgical referral 2, / 32

6 6 / 32

7 Reception desk. 7 / 32

8 The original practice buildings. 8 / 32

9 Above and below: the main administrative building. 9 / 32

10 The examination and diagnostics building. 10 / 32

11 The intensive care unit. 11 / 32

12 Top: vet and client room for discussing cases. 12 / 32

13 Above: a sedated horse being x-rayed. 13 / 32

14 Clockwise from top left: examination and diagnostics area; MRI room; and two views of the laboratory facility. 14 / 32

15 Clockwise from top left: examination and diagnostics area; MRI room; and two views of the laboratory facility. 15 / 32

16 Clockwise from top left: examination and diagnostics area; MRI room; and two views of the laboratory facility. 16 / 32

17 Clockwise from top left: examination and diagnostics area; MRI room; and two views of the laboratory facility. 17 / 32

18 18 / 32

19 The scintigraphy area. 19 / 32

20 A horse being monitored during anaesthesia. 20 / 32

21 Left: exterior of the stables. 21 / 32

22 Right: less intensive nursing stables. 22 / 32

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24 International event rider Emma Collyer is also head nurse at Liphook. Clockwise from top left: the reception office; a staff meeting in boardroom two; the vets office; and the accounts office. 24 / 32

25 Clockwise from top left: the reception office; a staff meeting in boardroom two; the vets office; and the accounts office. 25 / 32

26 Clockwise from top left: the reception office; a staff meeting in boardroom two; the vets office; and the accounts office. 26 / 32

27 Clockwise from top left: the reception office; a staff meeting in boardroom two; the vets office; and the accounts office. 27 / 32

28 Top: euthanasia lawn. 28 / 32

29 Below: the grounds around Liphook. 29 / 32

30 A treatment bay. 30 / 32

31 The trotting area. 31 / 32

32 Client parking for cars and horse boxes. 32 / 32 Powered by TCPDF (