Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate American College of Healthcare Executives
In this day of a veterinarian on virtually every corner, the average client has two or more veterinary practices within 15 minutes of their home. It is likely that our better clients even drive past one or two practices just to get to "their veterinarian." While the proliferation of "store front" one-doctor practices has increased this millennium, so has the "walk-away" failure rate; we see about a 10 percent failure rate this millennium, where previously "quitting" was rare to absent. It is client-animal-doctor type of bond that must be developed as anyone builds a veterinary practice, and it starts by the entire staff becoming aware that the human/companion animal bond is the basis of a caring practice philosophy.
Acquiring a dog may be the only opportunity
a human ever has to choose a relative.
As companion animal veterinary practices develop new ways of talking to their Pet Parents (clients) (e.g., NCVEI now says it is more effective communication, not just dollars, that is needed to be successful), remember to stress the verbal culture change within your practice staff that is needed to change their traditional mind set:
Nurse technicians, or Veterinary Nurses if permitted (nurse is a bonding term)
Resort managers, not kennel masters
Animal caretakers/pet partners, not kennel kids
Consult rooms, not empty exam rooms
Comfort Room, not euthanasia room
Whelping center suites, not large runs
Hospice care suites; a nursing/hospitalization alternative to large run boarding
VIP Suites (very-important-pet), not just large runs with TVs
Exploration zone; not exercise yard
Pet family reunions
Free "yappie hour" with purchase of Kong toy (fill with food before feeding)
Memorial services/In Memoriam web page on Practice Web Site
Over-40 programs for mature pets, not "geriatric exams"
Holy-mutt-ra-mony breeding programs
People time with play time
Doggy day care; explore like a dog as fun time
Kitten Kindy (kitten socialization evenings)
Canine eat-sleep-play routine, NOT just exercise time for boarders
Stop-drop-roll training for boarders
Pet showers, pre-departure cleansing baths
"Every Pet Deserves A Pet" awareness program
Restoring puppy kisses, not "doing dentals"
"Dogs, Cats, & Kids" video by Wayne Hunthausen for canine socialization
Kong Toys became 'Behavior Management Systems' after our counsel
PetCareTV came on the scene, and offers a "Welcome Home" CD for new pets
Behavior CDs, like Linda White's "Puppy Smarts", are becoming mainstream for practice staff development
Anthropomorphic characteristics can be capitalized upon to create an awareness to get clients to listen to the needs of their pets. This concept, and these phrases, are not a gimmick; they are a communication necessity! Dr. James Harris, the person who taught me "Every Pet Deserves A Pet", was promoting pet hospice on the speaking circuit before he went to Tasmania for a working retirement......at the turn of the century, Dr. Kathy Mitchener and Dr. Greg Ogilvie were sponsored by Hill's to do an international speaking tour on compassion fatigue, which is now being copied by many others.......in the first edition, we introduced puppy and kitten socialization programs, which was discredited by many academics as not appropriate for a general practice, but now, most companion animal practices provide or refer clients to this type socialization program......this is all neat stuff, and it matches what we have been promoting for years as a nursing/hospitalization alternative to boarding when the economy of scale is not in the facility.
Opinion: The Dogs, Cats, & Kids video by Wayne Hunthausen is a critical element in staff training for canine socialization awareness.
We Must Care
The need to convey the reason most of us entered veterinary medicine is critical to building that client-practice bond. No one entered practice for the short hours, or for the great hourly wage, or for the job security. Most practitioners and staff members have an innate love of animals, a compassion to alleviate suffering, and a caring for the humanity we serve when delivering concerned health care. But to be successful, we must convey these human/companion animal bonding traits to our clients, and they must be conveyed sincerely and consistently.
The process of thanking a client must be specific and timely to an effective bonding technique. The most common is the attending nurse technician giving the client a business card and saying something like, "Ms. Jones, thank you for selecting our practice to help you care for Spike. This is my card; please call me whenever there is any concern or question." The other first appreciation is the "thank you for the referral" letter that a client gets; a tailored letter that reinforces the quality of the practice, the appreciation of the referral, and a hope that you will continue to provide the type of service that they want to refer friends to in the future. The second "thank you" is when client relations shows appreciation for a client calling with a concern, stating something like, "Thank you for calling Ms. Jones, this s just the kind of condition the doctor needs to see. Would you like to drop Spike off for assessment, or do you want an appointment later today or early tomorrow?" The next mailed "thank you" usually talks about "thank you for sending another client" and adds a premium as a gesture of appreciation. I have found that practice discounts are perceived as self-promoting rather than appreciation (it also has no tax deductibility). A pair of tickets to a local movie, zoo, or animal park reflect a "no strings attached" appreciation (as well as a clear tax deduction as a business gift). Some practices even send tickets to sporting events or concerts if they know it is a special interest of that client (again, a clear tax deduction as a business gift). But that means you must spend the extra moments to record these factors on the client data sheet of the medical record, and that is another issue.
Business Cards for Staff = Mini Bill Boards
Above I recommended the outpatient nurse give a client her card as part of the discharge process. To put that in perspective, after the 90 day Orientation (e.g., successful completion of Phases D, C, B and A, Staff Orientation & Training, Signature Series Monograph, VIN Press), they get their name on a generic practice business card. At the first year anniversary, they get a new stock of business cards with a title of their choosing (e.g., Outpatient Nurse, Nutritional Counselor, Behavior Manager, Medical Record Audit Specialist, Dental Hygienist, etc.). In most cases, staff members will use these cards in the community with pride.
Hint: With fancy embossed or multi color cards, most printers will print 10,000 and keep them in stock, then the practice can order single color printing for name and/or name and title, in 250 card lots, at more economical rates.
Techniques that Enhance
The environment of the reception room is a mood setter (atmospherics, as discussed earlier). Does the practice keep Better Homes and Gardens, People, or Time magazines in the reception area so they can be bought as tax deductions, or are there client bond builders like the Delta Society Journal, Healthy Pet, Pet Health News and Latham Letter? Does the practice keep a scrapbook in the waiting area, with appreciation/recognition letters, staff action photos, and pictures that have been sent by clients of Your patients (some practice even have scrap books in the consult room, next to the client's seat)? Has someone taken the effort to label the scrapbook pictures with a little extra information about the pet, client, and the location/situation where the picture was taken? Is there a pictorial available concerning the activities that occur in "the back room"? Our clients wonder about that mysterious place that they never go, and a collage or scrapbook, or even individually framed pictures help take the mystery out and bond the client to your concern about their pet. Do the receptionist, technician, and staff address the client and patient by name at every opportunity?
Compliments of Jessica and Meleaguer Catanzaro.
When we discuss the needs of the companion animal, does the staff address them as an advocate of the animal's well-being, or is the practice philosophy one where we try to keep a superior or professional position? Does the outpatient nurse do a 3-5 minute asymmetry exam when loading the consult room, and state, "This does not seem right, I have made a note for the doctor to talk to you about it." Does veterinarian tell the client what the pet "needs" for proper health maintenance, then fall silent and listens? Do providers clearly state what the practice "needs" to do for comprehensive health care, then record the clients response with a W (Waiver), D (Defer - until when), A (Appointment) or X (Do it!)? When the practice staff hears a deferral, do they acknowledge the client decision to the services, and state the follow-up need clearly (and record it in the medical record (e.g., Dent2+[D}3w, on paper records, or Dent2+CR-D 3w, on electronic records)? This "communication" process centers of more patient support and client cooperation in the healthcare process, not to mention the resulting increase(s) per patient transaction fee. Does the veterinarian take time to explain the "philosophy of quality healthcare practices" or does the practice cop-out with cold "clinic policies"?
Does the practice "reach out and touch someone" by text message, e-mail, snail email or in person? The Gen-X and Gen-Y clients usually prefer e-mail or text messaging, and many baby boomers will opt for electronic communications when given the option. In the "modern practice", clients are asked specifically of they prefer e-mail or text messaging, and snail mail is not mentioned unless the client asks for it specifically. How many follow-ups, recalls, or reminders are done by mail versus using the telephone or electronic means? We have practices that text messaging is automatically sent from the computer's appointment book, for example:
Do not forget, no food after midnight, water is okay, and we will see you and Spike at 8:15 Tuesday morning.
Spike has recovered from anesthesia in great shape, your discharge appointment is at 4:15 with Nurse Wendy.
Spike's Life Cycle consult is tomorrow, do not forget to catch a fresh urine sample in a pie pan tomorrow and bring it in with him (use a margarine tub).
When following up a surgery case or an extended medication treatment plan (e.g., 21-day cystitis therapy), it isn't hard to teach the client relation specialist (receptionist) or Nurse Technician "high impact" telephone techniques:
"Mrs. ____, this is Judi from the ____Veterinary Hospital, we know you are due back in about a week, but the doctor and I just wanted to ensure you haven't had any questions arise now that you've been home for a couple of days."
When calling a new client, something like, "we know you're coming back for the next puppy shots in about two weeks but wanted to say we enjoyed your first visit and just wanted to be sure there aren't any new questions" can close the "doctor and I" telephone introduction.
After a sequential laboratory test, ".....we have great news, the tests were negative, and we will put a note in the records to review this again at the Life Cycle consult in March (about 5 months away)"
When an appointment is missed, wouldn't it be a nice touch to show concern for the pet and client rather than the appointment log? Teach the client relations team (receptionists) to pick up the phone and say something like, "Mrs. Jones, this is Suzie at XYZ Veterinary Hospital, we missed you and Spike this week and the doctor and I just wanted to ensure everything was okay at your house?" Please do not continue talking after this opening statement; the first person to talk now will have to "explain." Just let the client talk and listen carefully; if they want to reschedule, they will say so. If they are ducking the appointment, a caring, "That's fine, we just wanted to make sure your family and Fluffy were healthy and didn't need any assistance....." will get a better bond established than trying to force the making of another appointment. These "scripts" must be practiced before they are used. The words must seem real. If you are not willing to take the time and sit together as a team to rehearse the practice narratives, then do not expect someone on staff to take the time and listen to clients.
Great Reference: The text How to Get Your Point Across in 30 seconds or Less by Milo Frank comes in paper back hard cover and/or audio tape. This easy reading reference provides the basics for enhancing the effective communication techniques needed in a healthcare setting. Once the principles are understood client centered narratives need to be rehearsed until the flow naturally.
There are many communication techniques that convey the caring and concern of a practice; the preprinted postcard is not usually one of them. The first reminder by postcard is great but let the practice concern show through on follow-ups. A letter or a phone call will usually result in greater bonding results than that second postcard. Point: First reminder goes out 5 weeks before the "needed care" preventative/protection and second card goes out 2 weeks before the "needed care" preventative.......then within 72 hours of the client/patient missing the suspense, the caring phone call is made (as described above). Trying to "recover a client" when screening records annually is a futile process that is very similar to trying to teach a pig to sing, it is frustrating to the trainer, and it sure annoys the pig!
A possible exception to the telephone call follow-up is in communities that are saturated with telemarketing programs that keep the family phone ringing off the hook from 6 p.m. to 8:30 p.m. In this case, an e-mail or snail mail letter that appears personally written will be the best follow-up to make that client feel like a member of your "practice family."