Three of them sat solemnly across the consultation table in the consultation room with from the left, two associate vets and my assistant. A vision from the founder is empty talk if it cannot be properly executed and so I have regular "trust and audit" checks on the veterinary performances and frank talk with them. No beating around the bush. No cakes and tea all around as we would be interrupted by in-coming clients and mobile phone ringing.   

"One vet cannot make Toa Payoh Vets a top 3 veterinary, no matter how clever he or she is," I said. "It is the work of the team to produce the good results in treatment and surgery well done.

"As for you," I said to a lady vet. "When you set up your own practice later, it will be to your benefit if you have had worked in a top 3 veterinary surgery, rather than from the bottom 5," I would zero on her as she does most of the cases in 2012.

I had done a "trust and audit" of one of two cases and discussed the results with everyone present. I have practised since I graduated in 1974 and know the work performance of younger vets in the trade, unlike a non-vet founder who may be fooled with lame excuses when performances are not up to expectations.

For example, if a vet tells me he or she can do a cystotomy to remove bladder stones and a neuter in a Miniature Schnauzer in less than 30 minutes and needs to use 3 packets of sutures, I will have serious doubts. Even if it is a cystotomy in a Chihuahua whose bladder is smaller in size than a Miniature Schnauzer. I will use 2 packets at the most.

As for my assistant, I advised further on the recording of the hospitalisation record and he would talk about any problems encountered. As regards the amount of food and water consumed, I gave instructions on how they should be monitored consistently. Dr Daniel proposed water to be "ad lib" in the hospitalisation recording as some dogs upturn the water bowls and so no accurate measurement could be done. As for urine output, it would not be possible to measure the exact volume of pee passed out. As for stools, I told my assistant to record the consistency of whether they are solid or not. 

"Do you know what is HR and RR?" I asked my assistant as he ticked the columns with the HR and RR heading. He is a veterinarian technician.  As his English expression is not so good, I asked him again and he mumbled: "The dog is breathing or not."

For some reasons, the older vet burst out laughing. The younger vet was serious and that should be the way. It was a contagious laugh and I got infected.

"HR and RR" are beats/minute for the heart and the lungs," I said to my assistant. As the clinic manager, I have to persevere to set the high standards of veterinary care at Toa Payoh Vets. There will be processes, procedures and protocols set up by me to be adhered to and "audit and trust" checks will be done. There is no other way to be top 3 without any effort and many meetings as each staff has his or her mindset in working. 

During this meeting, I instructed that the "inpatient records" with serial numbers be used immediately. Later, I would introduce the "hospitalisation records" with serial numbers. "If cases of negligence litigation," I said. "These records are our defences of the duty and standard of care and each vet will be responsible for his or her records. I will get them scanned and retained for the number of years required."

Presently there are around 50 veterinary practices in Singapore and competition is expected to be intense. It takes a lot of my time to train staff and to supervise their work performance but this is needed if I want to build a high quality of care and thus to become a top 3 veterinary practice in the next 2 years.