Spring Parker Accelerating Health Care Performance

Featured Guest: Ron Morgan

What he does:  Ron is the President and Chief Executive Officer for DoveLewis in Oregon.  At Dove Lewis Ron is responsible for the vision and strategic initiatives that as a nonprofit serves its customers, donors, and veterinary community.  His career spans 40 years in human and animal health care with roles including insurance, joint ventures, rural health networks, and marketing, public relations, and communications. 

On risk:  "There's risk everywhere. There's nowhere we can't turn both as a veterinary hospital and as a nonprofit where we have a lot of risk to make sure we address … You have to try to anticipate all the scenarios that could affect your business. It's nothing that can happen overnight. You have to plan ahead and you have to look at your scenarios … If you don't foresee and look out for what risk factors could affect your business, it really doesn't take much to affect you from a negative perspective. And next thing you know you might be out of business … With the risks that we face from a recruitment and retention perspective, we've had to change the way that we help train people and bring them into the organization and mentor them … Need to have the right people that can identify those areas of risk. But then you need to have regular work and discussions about those risk factors you need to have, make sure that there's plans in place to check in on the development of those risk factors."


Scott Nelson  0:01  
Welcome to The Risky Health Care Business Podcast, where we help you prepare for the future by sharing stories, insights, and skills from expert voices in and around the United States health care world with a mission to inform, educate, and help health care organizations and individuals, ranging from one doctor practices to large integrated systems and organizations throughout the dental, medical, and veterinary health care industry with risk, while hopefully having some fun along the way. I'm your host, Scott Nelson, a guy that grew up in Ohio and has been working all over the United States during my 20 plus year and counting career in the health care industry, with a commitment to accelerating health care performance through creativity, not just productivity. Let's dive in.

According to the American Veterinary Medical Association, as of 2022, there were 124,069 veterinarians in the US.  That number includes active AVMA members and nonmembers.  The 124,069 counts 78,717 in clinical practice (of which companion animal practice accounts for 67%) plus 14,158 in public/corporate employment (where almost 7% is in academia) plus 31,194 with no available information. 

The AVMA released an August 2023 news article stating roughly 11,000 veterinary practices each year experience a cyberattack, and with just over 800,000 complaints of suspected internet crime in 2022, according to the FBI, odds are the average practice owner is at risk.  If we make as assumption using the 11,000 impacted practices and the 78,717 veterinarians in clinical practice the impact rate is greater than 7%.  All are not solo, 1 doctor practices so the impact rate is likely to be higher than 7%. 

Cyberattacks and technology are only 1 of many risks where veterinary practices can be vulnerable to an adverse event. Workforce gaps where patient demand outpaces the supply of doctors and staff. Payment models reflect cash and credit instead of insurance. Slow supply chains. Expense increases. Macroeconomic forces 

Today I'm speaking with Ron Morgan about risk in veterinary care, including those issues and more.  Ron is the is the President and Chief Executive Officer for DoveLewis in Oregon.  DoveLewis is a $40 million nonprofit company based in Portland, OR that has 24-Hour emergency and ICU animal hospitals as well as advanced veterinary care services.  It has one of America's largest volunteer-based animal blood banks, a nationally recognized pet loss support program, 24-hour stabilizing care for lost, stray, and wild animals, and financial assistance for qualifying low income families and abused animals.  It's an accredited teaching hospital and AVECCS Level 1 Center as well as accredited by the American Animal Hospital Association and ranks in the top 10% of accredited specialty hospitals in the US.  At DoveLewis Ron is responsible for the vision and strategic initiatives that as a nonprofit serves it's customers, donors, and veterinary community.  His career spans 40 years in human and animal health care with roles including insurance, joint ventures, rural health networks, and marketing, public relations, and communications. Let's talk with Ron about risk in veterinary care. 

Ron, welcome to the show.

Ron Morgan  3:19  
Hey, thanks for having me. Appreciate it.

Scott Nelson  3:22  
Before we begin talking about risk in veterinary care, let's go back to the beginning. You have experience in both human and animal health care. How did you get into health care and where you are today in animal health care?

Ron Morgan  3:32  
Yeah, so it's been a it's been a long time. You know, it's interesting, I've I have a kind of different background, I actually graduated in advertising and public relations and went to work in human health care actually, in the insurance world for Blue Cross and Blue Shield way back in the in the 1980s doing marketing work, really and doing advertising and marketing and PR work. And through that work, I actually got exposed early on to strategic kind of work that was going on in the business. Had really early access to the CEOs and vice presidents and people that were working on the planning side of, of the of the work that we were doing, and it just kind of kicked in a whole new career path for me because I became fascinated with the business world and strategic planning and work and had moved on to different health care organizations subsequently after that, and really kind of was lucky to find a mentor who needed somebody to grow into strategic planning and overseeing a lot of our external affairs and at a very young age, I was able to kind of move into that direction in my career, and spent about 17 years working in in various aspects of human health care, both on the kind of payer side, and then my last few years working in kind of the health care company that kind of allowed me to kind of transition my career I spent a couple of years working on joint venture development with hospital executives, hospital CEOs, physician group leaders, building kind of rural health care networks. And that was just a really great experience that allowed me to kind of understand that the the inner kind of workings of hospitals and physician leadership and physician groups and human health care. At the end of the day, though, after a while, I kind of just felt like I needed to transition my career and I actually got recruited by somebody who was CFO in one of the companies where I was in human health care. And the one where I kind of started working in my strategic planning career, she reached out to me about a job opportunity with Banfield Pet Hospitals. I had never thought about working in veterinary medicine. I mean, it just had never crossed my mind, to be honest. I mean, I love animals I have my whole life. But someone reached out to me about a great opportunity and Banfield was is headquartered in Portland, where I live, and one thing led to another and I joined them. And that kind of started my career path in veterinary medicine. I was the Vice President of Sales and Marketing for them for a couple of years and before I moved on to DoveLewis.

Scott Nelson  6:12  
You mentioned having a love of animals. I don't think we can have any type of conversation about veterinary care without at least one question about Bella and Sadie.  Would you mind sharing a bit about who Bella is and who Sadie is?

Ron Morgan  6:23  
Sure, those are my two my two dogs. I've got one little one, one big one. Bella is a fawn colored pug, and she is quite a clown. She's had medical issues her whole life, we found out actually after we got Bella more than 10 years ago that she had collapsed trachea and some sinus cavity issues and needed surgery at a really young age, and has had to deal with a collapsed trachea her whole life. So it was really actually pretty fortunate that we ended up having her because I'm not sure, I'm not sure anybody else could go through the medical issues we have with the had with her and we really honestly didn't think she probably live as long as she has, but thanks to the great medicine and care at DoveLewis you know, we've we've had her in our family for more than a decade and she's just just an amazing pet. So like I said, she's quite a clown, quite a character. I'm not sure people are familiar with pugs, but they have quite the personality. Sadie's our yellow lab. She's just a little bit younger than than Bella. And Sadie actually is a career change guide dog. She was raised by Guide Dogs for the Blind, which is an amazing organization. And she was actually going to be one of their breeder dogs, but went through her full guide dog training and then prior to her breeding career, though with them, they found out she had a medical issue and had to move out of the breeder pool and out of Guide Dogs because of a medical issue, and so we were fortunate enough to be able to adopt her. And we at the time had a really great partnership with Guide Dogs at DoveLewis. We do animal assisted therapy work, and all of our animals for the most part, are career change or retired guide dogs. And so anyway, Sadie joined our family and she's been with us ever since and just a joy having in our lives.

Scott Nelson  8:12  
What do they have as their favorite activities? What do they do to keep you guys busy?

Ron Morgan  8:16  
Well sleeping is a big one these days as they as they get a little bit older. But you know, Sadie loves just going out on walks, running, anything she can do to be outside. She actually when she was raised, loved to swim, although we don't have a pool, so I haven't had to have been able to do that with her much. But really just typical activities. She loves to be outside and just get exercise and loves being around kids and people. She's quite you know, through her guide dog training, was really acclimated to being with people and we've seen that with her. She's really a gentle soul. And Bella is a little bit more exercise restricted because of her collapsed trachea. But same thing she loves playing with their toys and going on walks when she can. We have to be a little bit more careful with her. But if we were to take Bella, for instance, to doggy daycare, she would rather sit in someone's lap watching the other dogs play than then being out with them. I think she's got a little she got a little bit of an attitude I think that but it's just wonderful. They bring a lot of joy to our lives.

Scott Nelson  9:16  
Well with Bella and her you mentioned her medical issues, and this might be the big question, is do Bella and Sadie like going to the vet?

Ron Morgan  9:25  
You know what they've got quite used to it. Sadie, Sadie hasn't had very many medical issues actually. The issue that kind of bounced her out of Guide Dogs really never manifested itself into a serious medical issue and she's fine. She'll go anywhere and be around people. She loves it. She she goes kind of crazy. She's got a lot of a lot of energy. Bella has to be sedated quite a bit to go on car rides and go to the vet. But once she gets there, she loves being in people's laps and and being treated. So they've gotten used to it. I wouldn't say it's their favorite thing. But yeah, I think they've gotten used to it.

Scott Nelson  10:00  
Well let's use Bella and Sadie as a way to introduce DoveLewis. For a background overview DoveLewis is a 501c3 nonprofit organization and the only referral center in Portland, Oregon, the Portland Oregon area, accredited by the American Animal Hospital Association, and the only VECCS Level One facility in Oregon. It has 11 advanced care departments in addition to its 24/7 emergency room. DoveLewis expects to treat more than 26,000 animals this year, making it one of the highest volume veterinary hospitals in the country. And it provides a variety of services as well as education. So that's a quick overview. Ron, I'd love for you to share more about DoveLewis.

Ron Morgan  10:36  
Yeah, it's quite a special organization there really is there are not DoveLewis's all over the country in other cities. There's really only, you know, I can think of Boston and New York City where there are other comparable, large, nonprofit veterinary, you know, multi-specialty ER hospitals that are also providing community programs. We've been around for more than 50 years, we had our 50 year anniversary last year. We were actually one of the first, if not the first, veterinary emergency hospitals in the country, in 1973, founded by the Portland Veterinary Medical Association. And what makes us really special, you know, is to equate it to, I think the listener is it's, it's like a human trauma center, that you might go to, you know, an ER, ICU, all the specialties that we offer that you wouldn't find in you know, a lot of typical veterinary clinics. We offer 24/7 emergency surgeries. And so as a surgery center, it's really important to be able to take care of animals in need. And we really kind of pride ourselves on focusing on what you know, both ends of the leash, you know, it's not just the pet, but also the family, the person attached to that. Our mission very much is the human-animal bond focus. And we're a teaching hospital. And so we not only teach veterinary students and veterinary technician students, and also veterinarians coming in to learn the ER world but we have a product that we produce called atdove.org, which is a distance learning website, which is one of the best, really in the world in terms of production and video produced teaching that we offer to veterinary clinics throughout the United States and throughout other parts of the world.

Scott Nelson  12:21  
You joined DoveLewis in 2003 and under your leadership it's grown in size, reputation, and more. What are your areas of responsibility and day-to-day activities?

Ron Morgan  12:31  
Like, you know, any CEO, I'm really responsible for the vision and the moving forward of the business in terms of our strategic initiatives, making sure overall the umbrella of the organization is is serving our customer base. As a nonprofit that includes our donors. As a veterinary hospital that includes our referring veterinarians. So for me, it's really I've got my hands in, from a management perspective and a leadership perspective, in the key areas of the organization, not just for the hospital, but for the community programs, as well as just general operations. You know, I don't dig my hands in day-to-day in operations at all, we have a great management team, we've got a great leadership team. So my work is really focused on making sure that we are staying focused on our strategic initiatives, staying focused on emerging issues that could be affecting our ability to meet our mission or to meet our strategic plan. And also, then, you know, making sure that I'm keeping a close tie on new initiatives. We're currently involved in a hospital expansion project, for instance. So being a part of that planning, and then as a nonprofit, also making sure that I'm staying connected with you know, our major donors and people important to the organization. But I like to say I probably spend as much time looking in the future and making sure that we're prepared for the strategic initiatives and the issues that we're involved in to keep our business growing and thriving. We're in a very competitive environment in the Portland market and as a nonprofit we also need to make sure that we're, we're moving forward, you know, and meeting our goals related to fundraising needs to keep our programs viable. So it's as much you know, it's a big mix of day-to-day in terms of today's world, but also making sure that we're prepared for what we need to deliver tomorrow.

Scott Nelson  14:22  
Transitioning to risk, I'm interested to know how you view and approach risk in veterinary care, in your work, and at DoveLewis.

Ron Morgan  14:32  
Well, you know, I've thought a lot, you know, I think about the the focus of the podcast and the questions, and it's, there's risk everywhere. I mean, there's nowhere we can't turn both as a veterinary hospital and as a nonprofit where we have a lot of risk to make sure we address and so there's risk in our hospital operations, there's risk in our medical care, there's risk in our financial performance, there's risk in our competitive environment and making sure that we're prepared to meet those challenges. There's risk in, you know, huge growing risk in cybersecurity issues and being prepared for that. And those are really things that, that as an organization we as a leadership team and myself have to pay a lot of attention to because there isn't really one area you could turn away from and say that there is, there isn't great risk to our organization, especially as you know, we're a standalone, large hospital and nonprofit. So I don't have you know, anybody from a corporate perspective behind us to back us up related to financing or strategic initiatives or marketing, whatever it might be staffing the hospital. So all of those risks are really on our shoulders to make sure that we don't make mistakes and erase, you know, 50 years of goodwill in the community.

Scott Nelson  15:54  
Why do you believe it's important to plan and be prepared to risk?

Ron Morgan  15:57  
Well I think if you if you aren't prepared, then you know, you can, you can really erase your business viability in a heartbeat. And so we as a nonprofit organization, so to speak, don't we don't run on huge margins, you know, so from our operating income, and our net gains from our, what we have available for, you know, rainy days, we have to be prepared to support ourselves, because it doesn't take much for that to affect your business. You know, there's, as corporate medicine has grown in veterinary care, it's still probably less than 50% of the veterinary hospitals are owned by corporate entities or private equity funds, venture capital, so you're really looking at a lot of small business owners who run veterinary clinics. DoveLewis is a large one, but a lot of them that are smaller, and, you know, have a few million dollars in revenue a year or whatever. They're small business owners, and there are people that need to keep their business viable. And if you don't foresee and look out for what risk factors could affect your business, it really doesn't take much to affect you from a negative perspective. And next thing you know what you might be out of business.

Scott Nelson  17:14  
During the American Veterinary Medical Association Veterinary Business and Economic Forum last fall there was a session that identified headwinds for veterinary practices such as macroeconomic uncertainty, labor costs, population migration and demographic shift, and technology including Artificial Intelligence.  The AVMA also broadly includes government and education issues.  How do you approach and focus your attention when it comes to risk that is everywhere?

Ron Morgan  17:39  
No, it takes a significant amount of planning, and you have to try to anticipate all the scenarios that could affect your business. So it's nothing that can happen overnight. I think that I think we're fortunate because we've got some great business leaders who have good experience, both inside DoveLewis and outside of DoveLewis and prior, you know, positions, but you have to plan ahead, and you have to look at your scenarios. But you know, from a, let's take, like the technology side of things, we have an IT director who had significant experience within the veterinary space at another organization for years, and, you know, I, that person has done amazing work, opening our eyes up to the exposure that we could be facing with, you know, either a poor network structure or cybersecurity, you know, and, and moving us in the last few years to a much more comfortable, cognizant, you know, position related to understanding the risks that we're facing from just technology. So, my my work is, I'm not a, you know, technology expert, so I have to rely on the people that I hire to make sure that they are meeting our needs related to those functions. And for instance, staying on the technology front, our Board of Directors formed cybersecurity and technology, you know, subcommittee just in the last year or so, because that's become such an important topic for our organization. So it's really elevated to that level. And so it's not just something that I'm doing, but it's something that we're trying to raise organizational awareness about. I would say all of the issues that we face from a risk perspective, we step back and evaluate for the future. We're, we're knee deep right now in our strategic planning for the next several years. And so we will go through and assess from, you know, SWOT Analysis, threats to the organization, growth opportunities, expansion opportunities, and weigh in, what those risk factors will be throughout everything that we're trying to do. Because again, we're, we want to make sure we don't make false moves that that cost us greatly as an organization.

Scott Nelson  19:51  
Now looking and thinking about legal and operating structures with DoveLewis structured and operating as a 501c3 nonprofit. Does that add or remove risk compared to other legal and operating structures?

Ron Morgan  20:03  
I think it adds risk. You know, there are obviously very strict regulations operating as a nonprofit, not only just how you operate as a business, but how you fundraise ethically how you deal with people, and how you treat their donations, restricted, unrestricted and things like that, obviously, on the for-profit side of things, there are obviously, additional different kinds of risks and pressures from investors, and other people like that. So you know, it kind of you kind of find it on both sides, I just feel like as a nonprofit, you have the extra responsibility to the community as terms of community benefit as a social service organization, ethically, how you run your business, how you charge for things, how you set your bottom line expectations, I feel like there's an additional responsibility that we have, being a nonprofit that's got 50 years of experience in the market that we have. And we take that really seriously. You know, our, our mission is something that we pay attention to, and helps us guide ourselves, for instance, through the pandemic, and how we made decisions about our operations and decisions that we made to help us survive the pandemic operationally. So I think it where, to me, it bears a greater responsibility, because I feel like the public has a high expectation of of what nonprofits do, and how they should be operated. And the people that operate them in terms of holding them, I think, to a higher standard.

Scott Nelson  21:36  
Looking at an example, back in 2022, DoveLewis, temporarily adjusted overnight walk in ER hours in response to a staffing shortage, which has since been restored and similar to other experiences across the country. That can be an example of a proactive way to address potential risk scenarios. Take me back to that time and talk about the thinking before, during, and after to identify and address the staffing issue and implement that decision, as well as restore service once on the other side. How did DoveLewis go about that?

Ron Morgan  22:04  
Yeah, that's a great question. That was probably the hardest decision that I made in my time at DoveLewis. So during the pandemic, first of all, let me back up a little bit, before the pandemic, the veterinary world had a staffing shortage. There were, there was one survey that came out that said, there were 2,000 more job openings for veterinarians than there were veterinarians looking for jobs in the US. And that was before the pandemic. So there's been a shortage of veterinarians, veterinary technicians, or nurses for quite a while. And when the pandemic hit it just exacerbated the whole problem. We had to go through 60 to 70 operating changes just to keep our doors open and meet the requirements as an essential business for how we would operate. And you mentioned that veterinary hospitals and clinics across the country, you know, changed their hours, it was very rare for an ER to be able to stay open 24/7 and meet the demand that was coming in their doors, and our patient volume just grew tremendously. To kind of go back to your question, we, we made a decision, while other ERs around us were closing overnight hours and changing their operations during the pandemic we felt like part of our mission says that we'll be there for the community always. And so we we felt like if not us, then who would be open for the people 24/7 that needed veterinary emergency care. So it was a really difficult time, not just the decision about eventually, you know, shutting down the overnight receiving but to stay open before that. We always felt like our time would come like we were soldiering through this we were working with and coordinating with other ERs in the area about who was open and who was not. So because we knew that the overflow was always going to come to us. And it was from a risk perspective, I can tell you that I am still amazed at the staff at DoveLewis and how much they persevered through that and hung in with us and stayed there because it was really stressful and really difficult. As what happened in that period of time, though, as the pandemic started to kind of everybody was kind of coming out of it our negative impact was about to hit and like I said, we always knew at some point we were going to pay the price probably for for staying open for the community for so long. And what happened was we had a very, we had a very sudden rash loss of our technician staff. So our nursing staff over a period of about six weeks or so we just had a lot of people just say burned out, like I can't do this anymore and or I'm going I decided to leave the industry and I'm gonna go do something different. And we took several weeks to evaluate what our options were and at the end of the day we knew that at some point this may happen. And we said, it was we played the long game, I guess is what I would say is that we made a decision that in order to not risk the entire future of the organization and try to stay open, and with a staff that just couldn't provide the level of medicine that we needed to, that we needed to do what to us was at the unthinkable, which was to shut down those overnight ER receiving hours. The ICU stayed open 24/7 so our critical care unit, our intensive care unit, was still open. But for you know, several hours late at night to the early morning, we just couldn't receive, we didn't have the staff. So we made that decision. And we really paid a price for it financially, I think, you know, we probably lost some support of the community. But we did it because we had to minimize the long term risks of the organization. And so we got to work really quickly, we revamped our hiring processes, our recruiting processes, and were really able to reopen at the beginning of June last year to 24/7 operations. And, you know, so it was a, it was a rough time for the organization, both financially and I think, you know, image wise, but it was, it was we played the long game we took we measured the risk of staying open versus doing that, and knew that for the long haul for the organization, it was the right decision.

Scott Nelson  26:32  
DoveLewis provides a lot of services. Considering a long game approach and looking at risk in the future, is there a risk in providing a service versus not providing a service?

Ron Morgan  26:43  
Yeah, yes, I mean, because the things that we do, you know, we provide $25,000 a month in financial assistance, we are the organization where injured, stray, and wildlife go are taken, among many other things that we do in our nonprofit, with our nonprofit programs, we have a lot of discussions all the time about if we were to close or if something happened to DoveLewis, who's going to pick up those programs and who's going to provide those for the community? And there's not really an answer for that, you know, I guess some other organizations would step up, but the breadth of what we do for the community is, is pretty hard to replace. And so as we make decisions about the viability of the organization, and decisions that we need to make, that definitely comes into play. I want to also say, you know, one of the things that we do from from kind of evaluating our planning and our risk, is, I think it was probably pretty rare is we did early on in the pandemic, we did market research, related to the effects of all the changes that we were going through. And, and then last year, we went back and did that same research and we ask questions and evaluate our performance in our operations, pre-pandemic, post-pan or in the pandemic and post-pandemic to measure the risks that were affecting the organization in our operations and how we can evaluate those and change those. And part of that is our hospital operations. And a lot of it is our community programs, and the things that we need to do to make sure the organization is viable in the eyes of our clients and our referring veterinarians.

Scott Nelson  28:20  
From the results of that research, what have been some of the either the changes, the takeaways, or the lessons-learned that DoveLewis has implemented?

Ron Morgan  28:29  
Well part of it was we learned that the most important factor for both clients and referring veterinarians, that was that we were open 24/7. So that time when we had to close from mid-October of 2022 through June of 23 meant that we were we had, you know, for a short period of time taken away what was most important for people, and so getting back open was obviously a great need for us to do and focus on it. So that result, you know, took place. And then we've learned a lot of other communication factors, in terms of just you know, on whole, you know, how long people are waiting to see a doctor, how long they're on hold on a phone, and a number of operational things that we're, we're working on right now, as part of our strategic planning. We also evaluated our own employee engagement, you know, because right now, recruitment and retention of employees in veterinary medicine is about as important as it's ever been. So all of those factors are going into our current strategic planning work for 2024 and beyond to really mitigate our risk in all of those areas. And so, we're focusing on what our employees need, what our clients need, obviously, our patients from a medical, you know, performance perspective and then our referring veterinary community.

Scott Nelson  29:54  
I’d like to get your thoughts on risk and resources.  You talked about technology and cybersecurity, staff and employee engagement and recruitment and retention.  Should plans and processes be included as risk resources?  Dove Lewis has a veterinarian mentorship program that includes Entrustable Professional Activities or EPAs which are essential tasks or responsibilities that a competent professional should be able to perform unsupervised once training is complete and can enhance competency and lead to better patient care and outcomes.  What resources have you found helpful or critical to manage risk?

Ron Morgan  30:27  
Well I think just making sure that we have experienced people on staff so that we are doing the things that we can to retain people that can't provide those that mentorship that you mentioned. So the one thing in that area is that in order to help us meet the growing demand for emergency veterinarians, and the shortage that we've been dealing with, we needed to create our own mentorship program. So it's important for us to make sure that we are doing the things internally to keep our staffing numbers high with people who've been with our organization a long time. So they can help us identify the areas for mentorship and growth for people that can come through the organization. And we can kind of create our, our own pipeline, so to speak, of staff coming into the organization. Because for us that's one of the biggest risk factors is that you know, you, if you're going to run a 24/7 hospital with three shifts a day, 365 days a year, it takes a lot of people to do that. And so with the risks that we face from a recruitment and retention perspective, we've had to change the way that we help train people and bring them into the organization and mentor them. And so I think from a hospital perspective, that's probably been one of the biggest changes we've made in the last year is creating our own mentorship program. And so identifying the right people in the organization that can provide those services is critical because that their performance in those areas will be the deciding factor on whether it's successful or not.

Scott Nelson  32:03  
Should risk be a group mentality or and responsibility like we're all in this together and have a role or is it an individual overseer with responsibility and accountability to make sure risk is managed?

Ron Morgan  32:15  
Oh, that's a great question. I'd say it's both. We were just having this conversation a couple of weeks ago at Dove related to the are we all in this together kind of mentality. Because in today's veterinary world, you have, you have a lot of people and especially in a 24/7 environment where you have a lot of people that don't, they don't ever see some of the people that work in the organization in different days or, or parts of the week or shifts, you know, if you work during the days, you may not ever see people that work at night, or you know, people that work in the administrative side of things may not know a lot of people in the hospital. And you know, when you've got 250 employees, again, it's not huge from some corporations perspective, but for a single hospital location of veterinary mMedicine it is and when you've got that many people creating that culture of we're all in this together and we all need to care about the growth of the organization, the risk factors that we face, I think that's critical. And we would like to be in probably a better place than we are today related to creating that environment where everybody feels like we're all rowing the boat in the same direction. And I have something that I can contribute to make sure that we are being successful. And then I do though, think that it does take individual accountability to create that but also oversee the areas that you are at risk. I mean, you have to have people that are identifying and have the expertise to identify the risk areas, both from a financial perspective, from a technology perspective, and other parts of the business to make sure that we are covering our risk factors. I mean, for instance, if you, you can say we're you know, we're all in this together, and we're all focused on it but if you don't have somebody that has the knowledge, that hey, by the way, we better make sure that we have, you know, cybersecurity insurance or, you know, from a technology perspective, we're making sure that we're training all those people to recognize when a phishing expedition might be taking place in their email, you know, those kinds of things, you've got to have the expertise to oversee it. So I think it's both.

Scott Nelson  34:21  
We talked about having an individual or person with the experience to be able to cover risk factors. How can those vulnerabilities or risk vulnerabilities be checked? And what might be some potential obstacles? Maybe it is the person that's involved in overseeing that or checking that? How can vulnerabilities be checked? And what might some of those potential obstacles be that that can be overcome?

Ron Morgan  34:41  
Well I think I think it comes down to leadership in some respects. I mean, I always feel like you've got to hire great people. You've got to hire the right people that you can trust. So first of all, I think you need to have the right people that can identify those areas of risk. But then you need to have regular work and discussions about those risk factors you need to have, make sure that there's plans in place to check in on the development of those risk factors. For instance, from a, an IT perspective, we, you know, if we didn't have someone who was overseeing, you know, the development of our training and education related to cybersecurity, and then also working with our Board of Directors, and establishing that kind of accountability expectation, then you know, the work may not get done. So you have to have the right person, I think, doing the work, but then you have to have the levers in place from a leadership management and stewardship perspective to make sure that you're having the conversations related to the plan that needs to be implemented for whichever that might be. So I just think it takes strong leadership and management, but it also takes the right person in the right position in an organization.

Scott Nelson  35:59  
Looking back through recent history, from a risk standpoint, what was expected versus unexpected in veterinary care to you and what could have been potentially done differently?

Ron Morgan  36:07  
I think, you know, one of the things that's been that I probably didn't know, coming into veterinary medicine, and it's been it's been 20 plus years, but there's huge differences between human health care and veterinary medicine. And in terms of just the payment structure that creates a lot of risk for veterinary medicine. So, you know, in human health care, you've got, you know, it's insurance based, correct, you know, in terms of how things get paid for the most part, and there's very little insurance in veterinary medicine. So you have a, you have a cash credit payment system, for the most part in veterinary medicine, which creates a lot of risk, not just in terms of collection of funds, but also in the the kind of data that you have about people. And then for DoveLewis, you know, on top of that, we're a nonprofit so we have a lot of information about donors, and so forth. So, but I think that's a huge kind of thing that I probably going into the veterinary medicine side of things, I probably didn't appreciate it as much in it. It hasn't changed a lot in 20 years. I mean, the amount of insurance has grown a little bit, but nowhere near in the United States as much as it's, it's available in in Europe, for instance, but I think that's a that's a huge difference and in growth in terms of understanding how we can mitigate that that risk, but I would say that's probably one of the primary areas that that that is applicable in veterinary medicine.

Scott Nelson  37:42  
Now looking forward during this year, what do you see as potential issues and how to be prepared?

Ron Morgan  37:47  
Well, I think I think a huge issue for the veterinary world still is staffing. And you know, the pet population is growing, pet ownership is growing, it exploded during the pandemic. It's certainly slowed down a little bit since then. But I think the industry's ability to evolve and change and quite honestly I'm not sure that the the AVMA the American Veterinary Medical Association is really prepared to support the amount of change that needs to take place in veterinary medicine related to certain things like telemedicine and, and other areas like creating, there's there are people that are really trying to grow the area of like a nurse practitioner or a doctor's assistant in human health care, that isn't really available in veterinary medicine to help solve the staffing problem. So I think that there's some real areas of disagreement on how to solve the staffing problem in veterinary medicine, but it's huge. It's we're nowhere near being able to meet the demand. And so I think that is significant threat to veterinary medicine. I believe the cost of care is another one. I have huge concerns that the amount of private equity money that's coming into veterinary medicine, and in helping address the staffing shortage by throwing a lot of money at people to move to different organizations, which in turn is causing the cost of care to rise is is going to price people out of owning a pet. So I think that those those two issues together are critical. And I don't think that it's even hit home yet how the cost of veterinary medicine is going to affect people in the very near future related to the hiring practices that are going on in some of the organizations to recruit people away and fill their their staffing shortages, quite honestly, it's it's quite disturbing, actually. And I think that I can see a part of the population demographic that we serve as a nonprofit organization that simply may not be able to afford to own pets.

Scott Nelson  39:56  
That's an interesting point and will be our closing point today. But one we need to pick up and continue in another conversation. Ron, thank you very much for your time and sharing your thoughts and experiences today. I really appreciate it.

Ron Morgan  40:07  
Oh, you're welcome. Thanks for having me.

Scott Nelson  40:12  
Thank you for listening to The Risky Health Care Business Podcast. You can listen to all episodes from the resource center page of the SpringParker website, springparker.com, or click the Listen link in the show notes to listen and subscribe for free on your platform of choice. And remember, accelerating health care performance is achieved through creativity, not just productivity.

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