Using Your Clinic’s Data to Improve Compliance to Veterinary Recommendations
What is Compliance?
The AAHA Compliance report in 2003 defined compliance as: The pets in your practice receiving the care you believe is best for them.
Areas where we know compliance rates are poor include preventative healthcare, repeat medications, elective procedures, and dietary recommendations.
Improving compliance requires the three R’s: recommending; reinforcement; reminding.
The steps to full compliance:
1. A clear recommendation
2. Reinforcement from the team
3. Follow up if not acted upon (reminder)
4. Reinforcement from the team
5. Follow up if not acted upon…
A Few Tips on Improving Compliance
- A verbal recommendation is not enough; a written recommendation always adds more weight.
- Recording the recommendation enables reinforcement from the team.
- Setting a reminder stimulates follow up.
Understanding Your System
Most practice management software includes a system of “Reminders” or “Recalls”, understand how to get these to work for you in your clinic. It will depend on your system, however, most allow reminders and these can often be linked to “Sales items” or can be set “manually”.
“Selling” a recommendation often creates additional visibility because it then appears on the client’s invoice which is visible to front of house staff and can stimulate discussion and reinforcement when the client pays their bill.
Case Study 1—Recommending and Recording
A UK-based clinic where a review of practice data showed that only 35% of vaccinated patients had a record of having received dental advice at the time of vaccination, although all would have had their teeth checked as part of the annual health exam.
To ensure that all patients had their dental health status both determined and recorded at the annual health exam, and that when appropriate follow up reminders were set.
A review of current situation with the clinical team identified 3 groupings for patient’s dental health that could be recorded:
1. Dental health good, no action required
2. Dental problems identified, remedial treatment advised
3. Significant dental problems identified, immediate remedial action recommended
We created 3 new sales items and 2 associated reminder types to allow all 3 groups to be recorded and counted. Using a sales item ensured that the recommendation would be included on client invoice, and visible to front of house staff.
A series of meeting was held to communicate the modified recording process to all staff and a process of monthly monitoring commenced.
Each month progress was reviewed with the vet team and experiences were shared which helped identify the exceptions and omissions, and these lessons were shared with all staff with the result that recording levels quickly improved, and the reminder follow up resulted in a higher proportion of patients receiving the dental care that they required.
Reminders and Recalls
The most important “tool” in the box. We most typically use reminders for events such as the annual health check, routine vaccinations, internal and external parasite control.
We find that despite the fact that we would expect to see every pet at some future date, on average in UK clinics only 50–80% of patients have an active recall or reminder set for any preventative health treatment.
In many regards we should not be surprised at this figure, because reminders are easily missed, for example when a 6-month-old puppy, who was already vaccinated elsewhere visits for the first time for neutering or when a new client visits with a sick animal visits for the first time and the vaccination is not due.
Because we expect to see every patient again, before they leave, we should always check:
1. When do we expect to see them again?
2. What for?
3. Is the reminder correctly set?
4. Does the client know to expect it?
Case Study 2—Routine Reminders and Recalls
UK-based clinic with 4 branches. In the UK typically only 64% of dogs are vaccinated (UK has no rabies or high fatality risks) yet a review of practice data showed that only 59% of active canine patients were vaccinated.
To ensure that all canine patients had their vaccination status determined, and the appropriate reminder set.
A review of current situation with the clinical team identified 5 groupings for patients:
1. Vaccinated by the practice, reminder set
2. Vaccinated elsewhere, reminder set
3. Vaccination not required (medical reason)
4. Vaccination not required (domestic reason)
5. Vaccination declined by owner
Three new sales items and associated reminder types were created to allow all 5 groups to be recorded and counted and the revised process was communicated to all staff.
Monthly monitoring using a “review and learn” process identified exceptions and omissions and these lessons were shared together with improvement ideas across all branches.
The result was that over time the proportion of patients whose vaccination status was recorded now exceeds 95%, with the result that overall vaccination rates now exceed 75%, meaning that more patients are protected.
Get the “Recall” Habit
There are lots of other areas where we can adapt our recall and review habit to improve compliance, such as following up on the first or sample bag of a new diet, following up on lapsed prescriptions for long-term medications, overdue weight checks, and geriatric screening.
Checklist for Change
At every consultation:
- Always identify the next meeting.
- Talk about it before they go.
- Ensure the appropriate recall is set.
- Warn the client what to expect.
- Measure your practice’s performance.
- Review progress, acclaim, learn, instruct.
- Plan how to celebrate your success!