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Profitable Patient Advocacy (H/CAB) in Healthcare

Thomas E. Catanzaro, DVM, MHA, FACHEDiplomate, American College of Healthcare Executives

"No client can be worse than no client."

Today's healthcare market allows the elective patient to choose their hospital and the density of quality healthcare facilities in our urban areas allows virtually all patients to choose their hospitals for second encounters. The effective healthcare manager is constantly alert to actions or programs that give the perception of more or improved services as well as those activities that may cause dissatisfaction among their patients or the patients' families. While the proposed national healthcare programs appear to want to curtail these advantages, the rules are still valid today. These statements of fact apply to human healthcare and veterinary healthcare equally in this time of increasing new graduates.

The traditional goal of business has always been to maximize its profit or market share, and secondarily, satisfying customer wants. The veterinary hospital has always been seeking to provide quality care for patients in need. While these two are not opposed, in healthcare, quality comes first, proper compensation to the provider and facility come second, and developing a community market niche is the third business priority. There has been an unwritten social contract between society (community) and the veterinary medical establishment to minister to individual and herd health needs; we now call this the Human/Companion Animal Bond (H/CAB). In return for the benefits we provide, society accords the veterinary health professionals substantial independence, prestige and pecuniary rewards, although these monies seem to be harder to find lately.

This social contract is an expression of interdependence between the veterinarian and the community served. The phenomenon is unique to healthcare but it is in jeopardy in today's competitive market. We must recognize the transformation trend and develop mechanisms to preserve the covenant and social purpose of veterinary medicine.


The term "client" may be becoming overshadowed by "customer" or "consumer," at least in the literature. The sublime difference between a veterinary client and a customer is that the social and moral responsibility to a client should be sacrosanct. A customer is defined by the ability to bargain for commodities. A business exists to provide commodities and is successful if it remains competitive in a dynamic free enterprise system. A veterinary practice exists to provide services to meet the social contract between society and the healthcare system, which is based on caring, treating, curing, preventing pain, and saving animal life. There may be a conceptual and factual danger in trying to provide services dependent upon profit motives in a competitive marketplace rather than delivering the quality care expected based on the veterinarian's oath.

Traditionally customers have alternatives based on elasticity of demand. This elasticity is based mostly on price. If the price is too high, customers will shop for a bargain, delay purchase, select a cheaper alternative, or not purchase at all. Customers are assumed to be informed and able to substitute, delay or go without; the buyer beware syndrome. However, in acute animal illness, severe pain, or trauma, price may not dominate in the decision process. People who have accepted stewardship of animals that are in anguish are without the power to bargain, delay or go without; the demand is inelastic when it comes to preservation of life, limb, or relief from undue suffering.




The customer can say no and go elsewhere for a quote.

The client feels at the mercy of the healthcare provider.

Most people are there voluntarily.

Wellness concerns force access efforts by the client

Most people are in a good mood.

Most clients are anxious, scared, or feel exposed.

Many people feel they can bargain for a deal.

Most people are panicked about required costs.

Customers expect to be pampered and served, often by staff members that are inexperienced but trying to please.

Clients are confused with high technology, but expect know-how and compassion from the professionals.

Employees must try to be courteous and responsive to the customer's desires, regardless of the demand.

The client must be responsive to the professional's case assessment, while the staff must be safe, accurate, kind, skilled, alert, and much more.


There appears to be a paradox when calling veterinary clients our "customers." Some practices endorse the "customer" approach with coupons and bait-and-switch tactics, such as a "low-cost surgery" offer that then has vaccinations, anesthesia, parasite testing, dental offerings and similar services hard-sold to the client when they arrive. At the other end of the scale, some practices do not even participate in phone price quotes; they require a patient examination before determining the anesthetic risk.

In light of the veterinarian's oath and these "client" concepts, it would be unethical to consider animal owners with pets in pain/need as "customers." From a veterinary professional view, our patients have needs, not wants, so the owners have needs, not wants. Some practices unilaterally determine hospitalization needs and scope of professional services, many times failing to offer needed care because of economic reasoning. They advise their clients as to the "minimally adequate" healthcare requirements for their pets, then turn around and scheme to market services to them as customers. It seems less than professional.

The trends as we entered this new decade, in the so-called veterinary healthcare industry, have been to market services and merchandise product lines to our clients. This is easily verified by reviewing many of our professional journals. The business customer's orientation in the veterinary marketplace environment has stressed practice survival techniques and strategies rather than providing community service. Consumer beware has been the rule in some communities. The reason for the customer approach is that most veterinarians are looking for the quick fix to competition pressure.


The strength of the human/animal bond has been well documented by publications of the Delta Society and its related conferences and meetings. The role of animals in reducing stress and anxiety has been well accepted by healthcare providers, although the mechanisms are still debatable. The publications of CENSHARE at the University of Minnesota, THE PET CONNECTION, and subsequent periodicals, laid to rest the early concerns of disease and damage that had been forewarned by those fearful of animals in healthcare facilities. For instance, in twelve months, in 284 facilities in Minnesota, no disease was transmitted and only 19 minor mechanical injuries had occurred (scratches, chicken peck, tripped over leash, etc.). Even the injuries due to leash errors were in violation of the protocols that precluded patients from walking pets.

These same studies have alluded to better patient harmony and an improved staff attitude when animals are involved if the involvement was voluntary. As in any healthcare delivery situation that holds apprehensive situations, such as pediatric oncology, hospice, or geriatric nursing, forced involvement by healthcare providers causes negative responses. When the clinical expertise and animal interest is present in the healthcare providers, the patient care time often decreases due to the pets fulfilling the patients need for caring interaction. Programs have been tailored to fit the facility's needs and restrictions from pet visitation programs to a central facility location, to bedside visitation programs to the in-room bonding program. While in-room boarding of patient pets increase, private room marketing success, human/companion animal bond programs have a far greater impact.

The mental anguish of a pet owner separated from their animals is significant. Most research has shown that 3 out of 4 pet owners believe that their pets are members of their families. Seventy-five percent is a significant proportion when we understand that over half of our patients are pet owners. The stewardship felt by pet owners extends to the care and feeding of their "wards," especially during the acute care episode when preplanning had not occurred. Concern for the out-of-facility pet care for inpatients, with or without visitation programs, gives the perception of increased concerned care. This may be no more than a couple of simple questions on all admission forms to query on pet ownership and interim pet care provisions.

When a pet and owner are reunited after a protracted hospital stay, the tears of joy tell the significance of the bond. As we encounter the oncology ward that has walled contact out, whether due to death or sensory overload, we see the introduction of animals as a method for opening the doors and windows to life. The nonjudgmental love by a ward mascot is often the difference between satisfied or dissatisfied working environments for staff members as well as the patients.

In today's healthcare delivery spectrum, with the increase of competition comes the need to increase a facility's market share of patients is constant. The competitive edge goes to the facility which meets the community's needs while minimizing additional costs in material or manpower resources. The contemporary pet programs, like an active pet selection assistance program, pets by prescription, and behavior management, do just that while supporting the healthcare reverence for life and quality of care programs.


The American Veterinary Medical Association developed and has available all the documents and aides needed for active pet selection assistance by veterinary practices, including very well done color brochures. The Delta Society has developed the protocols for pets by prescription within the community and school environment. Either of these programs develop new pet owners, clients who are already bonded to the practice since they selected their pet with the expert assistance of the veterinary professionals of that facility.

Behavior management is another potential practice area, and the head collar by Ameri-Pet, Inc., is allowing behavior changes to be facilitated in minutes at the practice level rather than weeks, as previously encountered in "obedience training" sessions. Behavior management is also emerging in Japan, with Ms. Terry Ryan conducting multiple programs every year. Regardless of the country, the state, or the city, most animals lose their home, and often their lives, because of behavior problems. The practice which helps prevent this "disposable pet" syndrome not only keeps clients, but gains recognition in the community. Recognition for helping animals is a marketing benefit to the practice, without having to advertise or market routine services or products.


Resources are available at almost no cost to the veterinary healthcare facility. There are multiple human/companion animal bond (H/CAB) programs available from nonprofit organizations. The international clearing house for interdisciplinary H/CAB groups and programs is the Delta Society (206/226-7357); the American Veterinary Medical Association (708/925-8070) has the pet placement information. The use of these groups has to be controlled and monitored to insure they meet proper healthcare. Any good program will include at least these six basic techniques with documented implementation planning:

1.  Screening of staff and patients for bias or acceptance toward H/CAB programs.

2.  Screening and quarantine procedures for any animal used in the program.

3.  Volunteer training and indoctrination program before their participation.

4.  Health records and preventive medicine parameters for participating animals.

5.  Continuing education and in-service training at recurring intervals for facility staff due to employment turnover.

6.  Evaluation of program benefits and problems for patients and staff.

As an evaluation process, the astute healthcare administrator challenges the animal facilitated therapy programs with an open mind, but a jaundice eye toward longevity. The people facilitating the program must be ready to participate for the long term and should have nonprofit backing to allow the development of the program. Once the H/CAB program has proven to be effective, it should become a budget line item of the facility to insure continuity and control.


It is the responsibility of each and every veterinarian, technician, business manager, and receptionist to put the practice of veterinary medicine back into perspective. Patient welfare and compassion come first, patient advocacy and continuity of care must be the motivating forces and ethical quality care can be the watchwords of the future. We cannot let the patient become secondary to our quest for clients.

Quality care can and should differentiate a caring practice within the community. Even in the toughest competitive veterinary marketplaces, low-cost vaccination clinics that have offered a doctor's consultation (at a premium price) have about 75 percent of their clients accessing the veterinarian. In other communities, 75 percent of the discounted spay coupon clients have declined to waive pre-surgical laboratory tests (at an additional cost greater than the coupon price). The early human/animal bond research (The Pet Connection, CENSHARE, University of Minnesota) showed that 75 percent of the families considered their pets family members. When the pet is a member of the family, as perceived by clients, needing a higher quality level of concerned care becomes a decision factor.

The perspective of a balanced healthcare approach will assure our professional position as the guardians of animal health and welfare. The quality-based role of the veterinarian of tomorrow will provide the economic future needed to continue this healthcare profession. The personal pride and client concern that accompanies this approach will provide what we sought when we decided to enter this profession.


The progressive veterinary practice understands that client bonding is the secret of success in an overcrowded veterinary community, and marketing of their patient advocacy philosophy feeds this image. The active participation in human/companion animal bond programs is usually good for free press, often to include television and radio.

A secondary benefit that results is the sensitivity of the practice staff to the emotions involved in the human/companion animal bond, which in turn softens the harshness seen in some client relations. It is also a great ego boost for support staff members when they get accolades and the 'warm fuzzies' associated with an outreach program involving animals; it is the best recognition program available for many veterinary practice staff members.

The windfall benefits take many forms, sometimes including a great increase in the white collar clients (doctors, teachers, healthcare professionals) that have come into contact with the human/companion animal programs that your staff is supporting. The client that has a full realization of the human/companion animal importance will be more likely to do what is needed for proper healthcare maintenance of the family animal(s); they take their stewardship seriously.

The only thing between being a special practice and an average practice is the desire to do the little extra needed to be perceived as unique in your community. The choice is yours. Capitalize on the original covenant as the provider of animal welfare and wellness; care enough to become committed. Dare to become more than average?

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