It is likely that our better clients drive past one or two practices just to get to "their veterinarian". It is this type of client bond that must be developed, as we build a practice, and it starts by the entire staff becoming aware that the human/companion animal bond is the basis of a caring practice philosophy. In the text Promoting the Human Animal Bond in Veterinary Practice we attempted to address the entire human-animal bond (HAB) spectrum, so we could offer practices many alternatives. The text is only four chapters, with an additional twenty-six separate "plug-and-play" appendices for staff implementation. While this section will include some of those basic HAB concepts, it addresses every aspect as part of the VCI® Pet Parenting Program^©.

This is not the gimmick of the decade, nor is it just one more crazy management idea. This concept is a charter to return to the causes and reasons that brought each of us into veterinary medicine. It is accepting that simple fact that each of us has a series of core value choices in practice, as well as in life, and we may choose to approach veterinary healthcare delivery as:

A calling or a daily chore.
Nurturing or blaming.
A lover or a hate
Staff as an asset or staff as an expense.
A builder or a watcher.
Curative or maintaining wellness.
A giver or a taker.
Doctor-centered or client-centered.
A creator or a critic.
The choice is yours, and it starts today!

The scariest realization at this point may simply be that your practice has exactly the staff it deserves. You selected, trained, and maintained them in your own image. Your practice has the clients you deserve. You attracted them, educated them, and thus maintained them, within your own image. These are the key indicators to your existing practice culture, and to change, you must address every aspect of your vision, core values, standards of care, and leadership styles.

Changing Culture Indicators

There are many small items that indicate significant "culture" changes in traditional veterinary practices, some good and some bad. We will not dwell on the bad, but please look around you and count the "good" indicators from this "baker's dozen": Needless to say, the practice is now a fun place to work, staff members are proud to be associated with the practice, and ten percent of all transactions are new clients, with sixty percent or more from word of mouth referral.

 Client relations staff schedules consultation rooms, not doctors.

 Leaders give respect, responsibility, and recognition twenty-four-seven to team.

 OPNT keeps doctor on schedule in two or more rooms at once.

 Each doctor has half-day rotations between inpatient and outpatient daily.

 Staff demonstrates team fit, competency, and productivity twenty-four-seven to all.

 Outpatient doctor or nurse never leaves zone during shift.

 Practice tracks visits/year/pet (~four visits expected per pet per year).

 Medical insurance, PTO, and CE is routine staff benefit.

 Inpatient nursing rounds done before inpatient doctor arrives.

 Staff in-service training is scheduled weekly, and practice closes to train.

 Deferred or symptomatic care, as well as behavior, dental, and nutritional cases get increased surveillance by nurses at two to four-week intervals.

 Concerns/problems are not "tabled" until resolved on master problem list.

 Four-day work weeks are common for doctors and staff weekly.

Needless to say, the practice is now a fun place to work, staff members are proud to be associated with the practice, and ten percent of all transactions are new clients, with sixty percent or more from word of mouth referral.

The "baker's dozen" are only rough indicators of the new culture that is emerging in the most successful veterinary practices. Success has many definitions, but we consider it the best net with least "work", and the most pride by the team in the healthcare delivery programs. Look at a few of the paradigms that have already died, or been proven to be impotent for performance:

 It was not based on salary. It was based on vision, core values, and mission.

 It was never in the gross. It was in the net.

 It was not up to the doctor. It was the consistency of the standards of care.

 It was never hiring and firing. It was about retention and training.

 It was not in quality control. It was in continuous quality improvement.

 It was never cost control. It was income production.

 It was not comparing it to the national average. It was seeking to be a leader.

 It was never in the advertising. It was in the word of mouth referrals.

 It was not in the act. It was in the visits per year per pet.

 It was never in the "cross-selling". It was in the continuity of care.

 It was not doctor-centered care. It was client-centered service.

 It was not selling products. It was selling peace of mind.

We are well aware that there are many "mission statements" hanging on the walls of veterinary clinics that are not based on inviolate core values. They are usually hanging where the "Practice Philosophy" was hanging ten years ago. A true vision is reached by delivering quality healthcare, with a consistent mission focus, on every program being delivered. Mission focus is based on stating the patient's "need" for similar care in similar cases, without regard to the client's ability to pay. Smart practices have already introduced each client to Veterinary Pet Insurance® and Care Credit®, so the miracles of modern veterinary medicine are considered affordable, which include alternative co-pay systems, rebates, or payment systems, all in lieu of discounts.

Confusion Versus Clarity

In traditional veterinary medicine, the "X" in the box ([ ]) means someone had done it. In the new millennium, and in forensically sufficient medical records, the "X" is the client response, and initials reflect the staff member who did the procedure. The attending doctor always signs the episode, but the staff initial their actions. Example: the case of a limping dog:

Bereavement Counseling

These times of stress require a special giving that is not taught in most veterinary schools. The stress is there, with any major illness or injury, and is often seen with even the most minor problem. The client is not trained to differentiate major from minor concerning a loved pet. Any client-perceived emergency or crisis is just that, and your compassion and concern starts the bereavement counseling process. The real challenge occurs in the consultation room, when the stress of a pet problem makes the client's share their other life stresses with you, since grief and stress are cumulative.

In some communities, like Denver, the local VMA has arranged with the local social worker association to provide a courtesy one-month series of group counseling sessions, and if that does not help the individual steward, who has lost a beloved charge, individual for-fee sessions are then made available.

Current studies in thanatology, the academic, and often scientific, study of death among human beings, have shown the loss of a family member requires a minimum of one year to work through resolution, and usually longer. So, for stewards bonded to the loss of a pet, the need for continued therapy is real and often, and it is beyond the practice's ability to address effectively.

This is the reason most new hospitals are planning a comfort room in their consultation room line-up, with a love seat, doctor's easy chair, indirect lighting, throw rugs, and softer presentation. A comfort room is used for counseling, hospital visitations, longer than usual discharges, and even euthanasia. It is a tender, caring place, out of the hassle and noise of the routine clinical care programs.

In the text Promoting the Human-Animal Bond in Veterinary Practice, Appendices M, N, O, and P all address different facets of euthanasia, grieving, and veterinary practice support during those trying times. This is a major staff issue, especially if your practice has been known for indiscriminate euthanasia policies, such as not breed-type from a breeder, unwanted kittens, etc. Believe it or not, this is a critical leadership issue, and a significant tone-setter in practice pride.

AAHA sells great children books about pet loss. I recommend The Tenth Good Thing About Barney (Viorst), Mister Rogers on Pet Loss, and I'll Always Love You (Wilhelm). Non-members can get them cheaper at any local bookstore or www.Amazon.com. I personally have kept a couple of each available for loan. It is not in lieu of caring, compassion, and concern, it is an addition to those exam room shared feelings.

The individual techniques vary with the practice, but most successful practices utilize quality time in the consultation room or home visit, a follow-up sympathy card, and many utilize donations in memory of the animal, such as to the Morris Animal Foundation, Cornell Feline Center, a local wildlife park, or zoo. When there are young children, I find that using a donation to a local zoo or animal park allows the parent to say, "These animals are kept well by our veterinarian in memory of Fluffy's love."

A few even send a bud vase and card, following a good client's tragic experience. The technique must fit the practice's usual image and approach to caring, or it will seem to be a hollow gesture. The bottom line is simple. It is okay to care. It is fine to feel sad, and if you cry with a client, no one will think less of you.

Cowboy says, "Some folks got no more conscience than a cow in a stampede."
Consultant says, "You get what you pay for. Ensure you know what is being offered."