How to Use the Building Sustainable Nonprofit Veterinary Clinics Toolkit

If your clinic wants to cover more of its costs, keep good staff and reach more of your community, these five free tools give you a place to start. We built them for the clinics in our Accelerator program, PetSmart Charities' multi-year grant and coaching program for nonprofit and low-cost veterinary clinics. Now we're sharing them with any clinic that wants to use them.

You don't need to be an Accelerator grantee, or even a nonprofit, to get something out of them. This guide walks you through how to use them in order, and what we've learned from the clinics that use them every year.

Tool	What it does	Format
Clinic Metrics list	Defines the monthly numbers to track: staffing hours, visits, revenue, expenses, clients and staff turnover	PDF, 5 pages
Employee Engagement Survey	An anonymous survey of how your staff feel about workload, communication, growth and the mission	Fillable PDF, 6 pages
Accessibility 360 Survey	A 40-question self-check of how easy it is for your community to use your clinic	Fillable PDF, 13 pages
Strategic Plan template	Sets three-year goals under three pillars (Operations, People, Community) with quarterly steps	PowerPoint
Clinic Budget template	Turns last year's actual numbers into a three-year monthly budget	Excel

Step 1: Know where you stand

Before you plan anything, get a clear picture of your money, your team and your community. This step takes about one to two months.

Pull your numbers. Use the Clinic Metrics list to gather the last 12 months of data. If you only calculate one number, make it cost recovery: the revenue from client fees divided by your total clinic expenses, times 100.

• For nonprofit clinics, we aim for cost recovery between 70% and 100%. That covers most of your costs from fees while keeping prices within reach.
• Well below 70% usually points to pricing or efficiency problems.
• Well above 100% can mean prices are drifting out of reach for the people you want to serve.

Survey your staff. Give the Employee Engagement Survey to everyone on your team.

• Keep it anonymous, and only share results as group averages.
• Read the written comments closely. They tell you why the scores are what they are.

Check your accessibility. Ask every staff member to fill out the Accessibility 360 Survey, not just leadership.

• Encourage people to use the comment boxes. That's where the most useful ideas come from.
• A lot of "I don't know" answers is a finding in itself. It usually means staff don't know what the clinic offers.
• To score it, give each answer 2 points for Yes, 1 for Don't know and 0 for No. Add up each person's points (out of 80), then use the scoring bands in the survey to see where your clinic stands.

Run both surveys at the same time each year so you can compare results year over year.

Step 2: Write your strategic plan

Use what you learned in Step 1 to choose a small number of goals for the next three years. The Strategic Plan template organizes them under three pillars:

• Operations: pricing, services, workflow and systems
• People: hiring, pay, training and keeping your team
• Community: who you serve, outreach and partnerships

How to fill it in:

1. Write a one-page executive summary: what your clinic wants to be in three years, and why.
2. On the overview slide, name your goals under each pillar for each of the three years.
3. For each goal, break the work into quarterly steps. Name who owns each step and how much of a priority it is.
4. Fill in "Assumption and Risk Mitigation" for each goal. What has to be true for this to work, and what will you do if it isn't?

The template includes a filled-in example (marked EXAMPLE) to show what a finished plan looks like.

Tip: Fewer goals are better. Tie each one to something your numbers or surveys actually showed you.

Step 3: Build your budget to match the plan

Always write the plan first and the budget second. When clinics budget first, they end up paying for last year's priorities instead of next year's.

The Clinic Budget template does most of the math for you. Type only in the cells with blue text on a yellow background. Everything else is calculated.

1. Clinic Setup: Enter your clinic name and choose a scenario: Base, Conservative or Stretch.
2. Prior Year Actuals: Enter 12 months of real revenue, cost of goods and expenses from your last full year.
3. Assumptions: Set how much you expect each revenue and expense line to grow. This is where your plan becomes numbers. For example, if your plan raises wages, raise the wage growth rate here.
4. Year 1, Year 2, Year 3: Review the monthly projections. Don't type in these tabs.
5. 3-Year Summary and Dashboard: Check the big picture and pull charts for your board.

Tips:

• Start with the Conservative scenario. You can always raise it later.
• Wages are typically 40% to 55% of a clinic's total expenses, so pay close attention to that line.
• If you don't have monthly data, enter annual totals spread evenly across the months.

Step 4: Track your numbers every month

A plan only works if you check it. Each month, use the Clinic Metrics list to record your numbers and compare them to your budget.

The numbers worth watching most closely:

• Cost recovery (fee revenue ÷ total expenses × 100): are you moving toward your target?
• Visits by type: which services are growing and which are flat?
• Clients paying less than the posted price: a sign of how many families are stretching to afford care.
• Staff turnover: divide the number of employees who left during the month by the number on payroll at the start of the month.
• No-show rate and new clients: early signs of how well your scheduling and outreach are working.

Share a short monthly summary with your leadership team or board. If a number moves the wrong way two or three months in a row, revisit that part of the plan.

Step 5: Repeat every year

Sustainability isn't a one-time project. Once a year, at the same time:

1. Run both surveys again and compare the results to last year's.
2. Refresh your strategic plan. Keep the goals that are working, drop one that isn't, and add what the new data shows.
3. Roll your budget forward. Enter this year's actuals as the new baseline and update your assumptions to match the refreshed plan.

What we've learned from our grantees

These are patterns we see across the clinics in our Accelerator program.

• Plan first, then budget. Clinics that budget before they plan end up redoing the budget.
• Communication is usually the weakest spot. Across our grantee clinics, internal communication and how leadership shares changes score lowest on the staff survey. Starting there tends to pay off.
• Engaged teams stay longer. Clinics with higher engagement scores tend to have lower staff turnover.
• "I don't know" is useful data. On the accessibility survey, many "I don't know" answers usually mean staff don't know what the clinic already offers. A one-page staff guide can fix that quickly.
• Don't try to fix everything at once. Pick a few goals, assign an owner to each, and check progress every quarter.