Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate American College of Healthcare Executives
The man who will use his skill and constructive imagination to see how
much he can give for a dollar, instead of how little he can give for a
dollar, is bound to succeed. Henry Ford
PetsMart, Wal-Mart, and even the grocery store down the street have decided to offer alternatives to the clients of your practice. They are competing for the pet healthcare dollar. Some even hire transient professional corporations which provide low-cost veterinarians. What the competition does not have is a nurse technician-veterinarian healthcare delivery team to listen to the clients; listening is a method to become "special" in the client's mind. The veterinarian may produce the gross income, but the nurse technician can produce the net income required for survival and prosperity. In a progressive veterinary practice, together you offer a caring and trusted alternative to concerned pet owners - if they choose to talk to you.
Getting and Giving Information
The worse the news, the more effort should go into communicating it. A.S. Grove
Communication is simply the getting and giving of information. When a consumer enters an average retail store, it is "buyers beware." When they enter a "discount store" it is different. They expect less quality and better prices, and look forward to finding a bargain from some standard they have pre-established in their mind. The communication which occurs is usually price-centered. When a healthcare consumer enters a healthcare facility, that person is stressed, but there is still an expectation of a quality service and at a fair price, usually covered with insurance paid for by their employer. There is also an unspoken social contract which exists in veterinary healthcare settings:
1. First, the veterinary healthcare facility team will do no harm.
2. Secondly, the providers will only do what is needed.
3. Thirdly, there will be a fair fee assessed for the services rendered.
4. Fourth, all parties want to restore wellness in the patient.
In the consultation room, most veterinarians speak in "professional" terms, which is appropriate if explained; the latter seldom occurs. Most clients don't know about the most common terms, like BUN, CBC, FVRCP, DHLAPP, FeLV, FIV, etc., and understand less about the -itis, -osis, -ectomy, and even "benign" findings. (A recent survey by the American College of Healthcare Executives showed 46 percent of the population did not understand the term "benign" when used with the word "cancer".)
Clients deserve to be told what is needed and why. They deserve the opportunity to ask questions. They deserve the respect of the healthcare provider. When these steps have been taken, the client needs to be asked for his/her position. The phrase may be, "What seems fair for your pet today?" or "Do you want us to start today, or would you like to make an appointment for a return visit?" or some other positive request for a positive reply. I do not advocate levels of care, just alternative "yes" replies. When a "maybe," a "stall" or a question is the reply, then we react in accordance with the situation (this is the "deferral", as with "DG1+[D]3w" medical record entry ("DG1+CR-D3w" in electronic records); meaning, "This early dental cleaning is needed to get the pain out and bacteria removed that causes bad breath, we are deferring the decision for 3 weeks of home care before re-evaluation by Nurse Mary". Regardless of the reply, client bonding requires that we take the 30 to 60 seconds needed to validate the client's decision. This short effort gets the client back through the door. This is positive communication.
Pet Health Counselor
Speech is a mirror of the soul; as a man speaks, so he is. Publilius Syrus
The first thought to the communication emphasis discussed in the paragraph above is, "There isn't enough time in the day!" Does that mean you don't want clients to come back, or does it mean you don't want clients to be supportive of the treatment plan offered? There are alternatives to the doctor doing all the consultation room "communication." In most veterinary practices in America, there exists at least one underutilized staff member waiting to be developed. Doctors try to do too much themselves and, in turn, don't do enough for each client and pet. Ask yourself these questions:
Who does the nutritional counseling?
Are serial weights, with body scores, in every medical record?
Who does the monthly client recall, patient appearance recheck and weigh-ins?
Who monitors the client's reorder point for prescription diets?
Who discusses the home supplementation concerns when the client stops the prescription diet feeding?
Who does the parasite prevention and control counseling?
Who does the heartworm concern discussions, and ensure clients have the ability to medicate their pet?
Who does the Lyme disease discussions, and ensure clients have the understanding of the zoonotic concerns for their family with tick control?
Does the practice understand the difference between foggers and a premises eradication guarantee (such as Fleabusters)?
Who actually defines where in the house (floor plan assessments) foggers need to go for most effect versus a total premises plan?
Who does the follow-up to ensure there was effective elimination of the parasites identified and treated by the practice?
Who ensures the external parasite and internal parasite relationships (e.g., tapeworms, anemia, etc.) are understood by the client?
Who monitors and administers strategic deworming program?
Who does the dental hygiene counseling?
Are serial dental grades (0, 1+ to 4+), in every medical record?
Are clients wanting to defer care allowed to go home for 3 weeks of home care, and are they asked to rub the pet's teeth nightly with tuna water (cats) or garlic water (dogs) before coming back to discuss dental options? Who does this return visit counseling?
Who takes the time to discuss the diet and bad breath effects of poor teeth?
Who cares enough to tell clients that "red gums mean pain" and explain the healthcare options?
Who does the follow-up ERD screen (Heska) to show that the bacteria of the brown teeth are harming the kidney, and explain it to clients?
Who does the behavior management counseling?
Does it automatically start with the puppy/kitten series?
Is house training assistance given during the first puppy/kitten visit as a value-added service (shows on the invoice, as a fee, with the cost reversed, as a "courtesy first visit")?
Who spends time listening to the client's needs (85 percent report that they do have a pet behavior problem)?
Who schedules short familiarization times in the clinic on a weekly basis to help change the unwanted behavior?
Who does the call-backs to ensure the behavior management ideas are working in the home with all the family members?
Who does the sequential laboratory sample collection?
How does the referral to the nursing staff occur, and how is it tracked?
Who calls back negative findings and celebrates with then client? This is a nursing function in practices using team-based healthcare delivery.
Who calls back positive findings and establishes a new plan with then client? This is an attending veterinarian function in practices using team-based healthcare delivery.
Who calls back clients who did not come back as expected? This is a client relations specialist function (Recovered Client Program) in practices using team-based healthcare delivery.
Who screens the "other pets in the household" with every client's visit to the practice? This is a client relations specialist identification function (Recovered Pet Program), as well as an Outpatient Nurse role to add a sense of urgency for the need, in practices using team-based healthcare delivery.
Who does the client call-backs?
New clients are called and told, "Welcome to our practice!"
Post-medication dispensing call (half-way through treatment) to ensure client does not have questions (and hasn't stopped the treatment program or forgotten the recheck appointment). This is an attending nurse's role to add a sense of importance for the need, in practices using team-based healthcare delivery.
Post-surgical call, at recovery and again four days after discharge, to ensure the client has no worries. This is the discharge nurse's role (about 70% of discharges should be done by the nurse, so they follow their own cases) to add a sense of caring concern, in practices using team-based healthcare delivery.
To promote the human-animal bond, and to "walk the talk", any deferred or symptomatic care must receive increased surveillance until the condition is resolved. Nursing staff must ensure the client does not have questions and knows to return when things are not going as planned; nurses can even do the interim recheck appointment.
The above examples are just a few situations where the client relations (receptionist) - nursing staff (technicians) team members can extend the effectiveness of the veterinarian. Veterinary extenders may also be reminder postcards, established staff protocols, laboratory result telephone calls to the client, or a host of other client service oriented activities. Many new software programs automatically link reminders to text messaging and e-mail communication systems, and this linkage monitoring must be a staff function. For example:
Night before surgery - text message -Please remember, no food after midnight, water is okay, and we will see Spike for surgery admission at 8:15 tomorrow morning.
After surgery - text message -Spike is awake and alert, anesthesia was uneventful, surgery was successful. Your discharge appointment is at $:15 with Mary, our surgical nurse.
Six Months After last visit - e-mail - It is time for Spike's Life Cycle consultation, and this time we need to assess what is happening with his elimination process, so please bring a fresh urine sample (collect it in a pie pan, transfer it to a margarine tub, just before you come in). Please call today for an appointment time that works for you.
Once a month for cats - text message -Today is the monthly Revolution administration time for Fluffy - don't forget to spread the hair coat and get it directly onto the skin between the shoulder blades.