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Reference: Practice Operations, VPC Signature Series Monograph

The above diagram was provided at the beginning of this appendix because the Standards of Care (SOC) are foundation elements of the practice leadership. The SOC has often been explained in a "flow" that has been leadership neutral - now for the key fact which might have been missed in your practice:

Doctors must be Leaders!

Sure, all the coordinators and managers must be leaders, but to create a "safe haven" for staff, doctors have a critical role in leadership and practice harmony. Core values are inviolate, that means, never an exception, regardless of who you think you are or what your power may be in the greater scheme of life forces. Concurrently, the Standards of Care must be stated in a very consistent manner by every member of the team, recorded in the medical record as a "need", and clients are allowed to overtly waive (W), defer (D), make an appointment (A), or decide to do it (X), which are also entered into the medical record after the need. In acute curative case management, the doctor may decide to waive or defer some wellness items, which will again be overtly recorded in the medical record, so any member of the team can pick up the case and not embarrass the previous provider, themselves, the practice, or the client.

Hint: case management is a doctor's requirement for full brain engagement, while protocols belong to the team, and cannot be covertly altered by any doctor.

Practices need to keep initial Standards of Care to wellness surveillance, preventative medicine and practice protocols, not case management, diagnostics or doctor prioritization of treatment modalities. Respect for schedules, coordinators and zone operations, as well as clear identification of the expected outcome(s) (including staff training and empowerment for responsibilities and/or accountabilities, rather than just process), is a function of leadership, and every doctor is expected to embrace these principles at all times.

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The Synergy Model shows that the tangibles rest on the intangibles; the intangibles support the tangible gains. Without the synergy bridge (organization spirit), the four intangibles and three tangibles become just seven observed factors of a successful organization. Again, the neophytes center on the tangibles: they are easy to measure, while most people who 'know the words' but do not understand the dynamics, only address the intangibles at the time of crisis. The tangibles are very important, they are the fruit of dedicated people working hard to be the very best. It is the savvy leader who understands that quality fruit can only grow from healthy seeds, which represent the intangibles.

 Train to a level of being Trusted - this must come first, and in most cases with adults, needs to be self-directed training...... competency is the outcome.

 Respect includes recognitions (non-contingent) and rewards (contingent), and mutual respect must be built upon training competency, embracing skills, knowledge, aptitude and attitude.

 Pride in outcome means assigning accountability for a program outcome, providing the resources needed, and supporting the effort - celebrating the improvements, even though they may not be at the end point desired.

 Harmony and team fit includes an intra-team synergy, no gossip, and supporting each other - a self-healing team.

 The final element is the synergy that emerges to ensure continuity of care to the Standards of Care becomes a primary commitment and personal concern for all team members.

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There are two spread sheets attached to this appendix, one for birth to 18 months, and one for 2 to 12 years. They are written for central United States, south of Chicago actually, in a rural suburbia community, by a practitioner who has diagnostic intensity in her blood. After 12 years, age makes it 'case management' and not Standards of Care. Concurrently, the SOC applies to only risk level 1 animals, anything else is case management, belonging to the attending provider.

Every practice needs to establish a written wellness Standards of Care (SOC) to address preventative and protective care.......case management (other than Risk level 1) belongs to the attending doctor. Risk level 1 animals, in for preventative and protective care (Life Cycle Consults) must have similar care stated as needed for similar conditions, at similar fees....... any thing else will confuse clients and frustrate staff ........confused clients show their feelings by not coming back........and frustrated staff show their feelings by not coming in on time, looking for new jobs, or ceasing their client outreach efforts.

A program-based budget is based on the commitment of doctors to the SOC, since all wellness programs are primary care issues, based on predictable costs, known income rates, and projected client acceptance rates. The Medical Director must ensure training is provided for contemporary issues in the SOC, and convert doctor commitment to program acceptance rates.