Donald L. Janssen, DVM, DACZM
Building a cohesive and productive group practice in a zoological institution is a worthy goal. Veterinary professionals have considerable education, training, and practical experience with animal management and, therefore, have significant contributions to make towards developing the best animal care practices for their institutions. With the right character, mutual respect, and cohesiveness, the hospital team (including technical and administrative staff) can become one of the most valued assets to a zoological facility. The purpose of this presentation is to offer examples of specific practices and general principles to consider in developing an effective hospital team in a multi-veterinarian zoo practice. Many of the ideas described in this abstract were born from individuals on our veterinary staff looking to improve the way we do things.
Planning and Team Purpose
- Align the purpose and goals of the department team with those of the organization. Make periodic planning sessions an ongoing priority for the department.
- Identify the critical needs of the organization that the team is uniquely suited to meet. Organize all activities to fulfill those needs.
- “Service” (both clinical and strategic) should be a key element in the purpose of animal health care in a zoo.
- Position the veterinary team such that it can monitor animal care practices and influence the animal welfare standards of the institution.
- Maximize the effectiveness of the existing team in terms of quality, credibility, and service in order to strengthen requests for additional labor.
- A team’s effectiveness is directly related to the time and effort given to communication and daily planning.
- Invest time at the beginning and end of each day for planning procedures, follow-up, and other activities. Include veterinary technicians, hospital keepers, and other animal care staff as partners in planning the day.
- Meet each morning with the hospital and animal care staff to make final plans for the day.
- Together with the hospital staff, observe each hospitalized animal in the morning to briefly update each other on the animals’ condition.
- Develop a group decision-making process that strives for consensus but also supports reasonable independent thinking.
- Develop a common understanding among clinicians for when it is appropriate to make changes to one another’s diagnostic and therapeutic plans.
- Resist the temptation to establish case ownership (beyond one or two days) for the purpose of saving time and reducing the need to communicate. This approach is often counterproductive and divisive.
- Make every effort to communicate with dignity and respect. Insist on professional decorum even in the heat of the battle. Never accept verbally abusive behavior regardless of the justification.
- Hold monthly staff meetings where all team members are encouraged to contribute to the agenda, regardless of how trivial or contentious the issues may seem. Make sure someone is responsible for seeing each issue through to resolution.
Case Management, Tracking, and Follow-up
- Designate a rotating daily “duty veterinarian” who is responsible for general communications, organizing the day, and assigning tasks to the veterinary staff.
- Use a shared calendar to organize all planned hospital and field procedures. Review with animal care staff regularly.
- Plan, prioritize, and then “calendarize” as many of the daily activities as possible. Schedule realistically to avoid frequent cancellations. Develop a reliable system for rescheduling cancelled procedures. Adhering to rigorous calendar planning makes it clear to all parties what can be accomplished in a given day. Further, it discourages spontaneous and trivial requests.
- Produce a master “to do” list each day, listing each procedure and identifying who is primarily responsible for each case that day. This can be the responsibility of the duty veterinarian.
- Track all active cases on a master list; keep it current and share it with animal care staff for their reference and validation. Keeping this list current can be the responsibility of individual clinicians.
- Provide rapid attention to new, urgent, and existing cases. Develop a system of triage and follow-up that provides reasonable attention and response time to the animal care staff’s needs.
- Consider using a transcription service or dictation software to expedite and digitize medical records entries.
- Include medical assessments and plans in the record entries so that other clinicians will understand the reasoning and be better able to implement the strategy.
- Have monthly morbidity and mortality review meetings with the veterinary, pathology, nutrition, and animal care staff. Maintain a list of action items for follow-up.
Protocols and Procedures
- Use written protocols and procedures to take some of the guess-work out of the job and provide consistency among the veterinary staff. Written protocols are particularly important to have in place for compliance with governmental regulations, accreditation, and high-risk situations, or any situation where procedural deviation cannot be accepted. Examples of situations where written procedures are important include primate handling, quarantine, animal escape, shipping requirements, narcotic handling, etc.
- If protocols are not used regularly, eliminate them. If they are used, even if controversial, continually revise them making use of input from the users.
- Write protocols to help others do their job better, rather than to transfer responsibility.
- Even though protocols are written well and distributed properly, do not assume they will be implemented. Often, those responsible for implementation will need training, encouragement, reminders, and the opportunity to participate in revisions. Ultimately, supervisors must hold their employees accountable for implementation.
- Consider developing a generic procedure checklist form for organizing complex medical procedures and communicating needs to technical staff.
Responsibilities and Delegation
- Avoid a “caste” system of responsibilities, where some job positions are regarded as less important than others.
- Enable veterinarians and technicians to use their skills and training to the fullest extent possible. Whenever appropriate, have technicians perform higher-level procedures (as allowed by state law) that free veterinarians to focus on their own higher-level activities. Properly trained veterinary technicians, with a clinician present in the vicinity, can perform unsupervised blood sampling, neonatal examinations, bandage changes, anesthesia induction, procedure scheduling, and many others.
- Strive to schedule an equal or greater number of technicians to veterinarians on a given day for the most effective use of skills and resources. This may take a change in mindset for administrators and veterinarians.
- Rotate routine responsibilities such as daily planning, task assignment, treatments, after-hours call, etc.
- Delegate the responsibility for independent projects to veterinary team members. Assure that each project helps to fulfill the purpose of the team. Highlight to the administration each project and its contributor when significant progress is made.
As the size of veterinary staff grow in zoological institutions, difficult interpersonal issues can become enormous detractors in accomplishing our goals. Such conflicts undermine the credibility and power of the department within the institution. No group can expect to perform flawlessly and without conflict but paying attention to and placing a high value on the individual, team members can avert many problems. Forward thinking and planning must be balanced with good day-to-day communications and the need to accomplish daily tasks. Individuals must feel valued, challenged, and accountable. In the zoo environment, the ultimate reward for successfully building a cohesive, credible, and productive team will be the enthusiastic desire of the institution to seek veterinary advice and influence in strategic decision-making related to animal care and management.