Behavior wellness programs can create safe, compasionate environment

Compassionate care in the veterinary hospital setting would seem to be a given fact of everyday operations.

Nonetheless, a few recent high-profile media exposès seem to portraythe opposite.

For example, some of these stories disclose the potential rough handlingsome difficult to handle animals might receive, whether real or perceived.These news stories probably do not consider all of the facts and circumstances.But, anyone who has been an employee in a veterinary practice setting knowsthe potential. Outsiders don't necessarily understand the stresses and challengesany veterinary staff can face from time to time.

Contributing factors

What contributes to staff anger and short-tempered responses during patientinteraction? Time constraints for multiple case management and the pressureof handling many tasks at once are contributing factors.

Pressures come from other sources: the need to complete work and alsohave a presence with your family; the requirements to meet a never-endingassortment of rules and regulations guiding business operations; the demandsof coworkers and employees.

Workspaces that are too small or not well designed, resulting in insufficientpersonal space for both staff and patients are another source of stress.

Keep it personal

Perhaps the patient becomes an outlet for anger building up about otheraspects of personal and practice activities. Veterinarians and other staffmembers experiencing burnout are at risk for de-personalizing their patients,potentially leading to bad situations. One warning sign may be when patientrestraint techniques veer more to strong-arm control tactics compared towhat should be a cooperative approach with the patient.

Not only do such staff attitudes and potential misbehaviors present asignificant risk to the patient, but danger also exists for the communityreputation of the hospital, and the overall workplace safety of employees.When short tempers fray, the probability of mistakes for human as well asanimal injury are greatly increased.

Credibility at risk

Veterinary staff that has not learned compassionate behavior-based handlingtechniques may put their own credibility at risk. For example, when a dogis manhandled in order to vaccinate it or complete a phlebotomy, the clientmay perceive that veterinary hospital employers are at best inept. Whenpatient interaction is poorly conducted, clients may perceive staff as uncaring,and will discount an employee's ability to discuss any aspect of animalcare and welfare.

Behavior-based handling

A solution to combat the potentially devastating results of anger andoverzealous patient restraint in the veterinary hospital as well as to increaseemployee and patient safety is behavior-based handling. What does this mean? Behavior-based handling refers to a compassionate approach to patient carethat incorporates knowledge of normal, species-typical animal behavior intoevery patient interaction; so that restraint and management techniques arechosen to decrease patient stress and arousal, and thus the likelihood ofinjury. This results in more efficient completion of tasks, lowered stressfor staff and more enjoyable interactions with patients and clients.

Behavior-based handling is a foundation stone of incorporating behaviorwellness into veterinary practice. Behavior wellness is an actively soughtgoal of acceptable pet conduct that enhances the human/animal bond. Hospitalsembracing behavior wellness concepts give planned attention to pet conduct,and actively integrate concern for and knowledge of behavior into the deliveryof pet-related services, including routine veterinary medical supervision.

Behavior services

Veterinarians tend to be skeptical of introducing behavior services intogeneral practice. Some mistakenly believe that behavior services are solelybased in problem resolution.

In fact, with behavior wellness, the opposite is true. Formalizing staffand client training about animal behavior results in a practice structurethat supports communication and enhancement of appropriate animal behaviorwith every medical appointment, beginning early in the pet's life. The goalis to thwart the probability of difficult behaviors from developing thatmust be corrected at a later date.

Behavior wellness cornerstone

Before effective behavior wellness counseling can begin, the entire practicehierarchy must embrace a mission of compassionate care supported by behavior-basedhandling techniques.

The benefits of such an approach are immense. When all employees arewell-trained to use their behavior knowledge to minimize confrontational,stress-inducing interactions, and instead promote calm cooperation fromthe patient, worker safety increases substantially.

Incidents of bite wounds, back injuries and other psychologically andphysically debilitating accidents can be reduced. Workers, who use behavior-basedhandling techniques, are non-verbally communicating to clients their understandingof behavior and 'positive' training techniques.

The actual body language used by trained staff results in client perceptionof a more gracious and kind handling of the pet. Competent performance improvesclient perceptions of worker sensitivity toward their beloved pets.

Client, staff turnover

In many practices, animal restraint and handling techniques may be appropriate,but the client may perceive them differently. When staff has apathy aboutclient observations and concerns, increased likelihood for the client'ssilent withdrawal from the practice in search of an alternative providerincreases.

Increased staff turnover may also result from what is perceived as inappropriatehandling techniques. Technicians and veterinarians may not have the desireto stay in a practice that does not formally support tenets of anger managementand proper animal control techniques through formal training.

As for clients or any inexperienced observer of practice activity, perceptionis everything.

Stepping stone to behavior care

Behavior-based handling techniques become the training and foundationfor a variety of positive practice outcomes. The first of these is improvedemployee communications with clients. When clients can directly see whata difference this approach can make in their pet's behavior in the practicesetting, this serves as an opening for staff to discuss other behavioraltopics.

Information about normal social behavior, animal communication signalsand body language, what constitutes threatening or non-threatening humanbody postures, what motivates various behaviors, warning signs of behaviorproblems and other aspects of providing behavior care can be relayed effectivelyto clients. Through formal training, practice administration has reducedthe probability of incorrect information transfer.

Much of what staff learn through formal training to be able to implementbehavior-based handling, can be applied to other aspects of behavior care,including promoting behavioral health and preventing problem behaviors.Veterinarians and technicians become more comfortable conducting behavior-relateddiscussions with clients.

Warning signs

The following examples illustrate the probability that behavior-basedhandling technique training may be helpful in your veterinary practice:

• · Do you dread the arrival of certain patients recorded in the appointment book?

• · Do you sense a trend of increasing numbers of patients that are difficult to handle?

• · Does your staff tend to dispense medications over the phone, rather than establish an appointment when a client reports a problem?

• · Are some standard patient treatments deferred for a lesser treatment protocol, related to the difficulty in patient handling?

• · Does your staff have the attitude that wrestling with a nail trim procedure must be par for the course?

• · Does the hospital's treatment atmosphere change from hour- to-hour or day-to-day, in that sometimes a tough approach to animal restraint is taken and at other times, a slow and easy attitude occurs?

• · Does your staff feel conflicted about which approach to take with any particular patient at any particular time?

Where to begin

A first logical step is for veterinary hospitals to develop formal ethicsand procedures for the handling and restraint of patients. In JAVMA (Vol.218, No. 4, February 14, 2001), Drs. Gary Patronek and Charlotte Lacroixrecite ideas for veterinary standards. Incorporation of such standards withinhospital policy and procedure manuals would be a logical first step. TheDelta Society's "Professional Standards for Dog Trainers: EffectiveHumane Principles," while focused more on dog training, also has standardsapplicable to handling and restraint.

Secondly, communication of such standards must occur. Employee trainingcan be furthered through other resources such as ACT video education programsfor teaching staff to accurately observe and interpret animal body posturesand introducing them to behavior wellness concepts.

Back to the basics

Many times, those who are experienced in providing veterinary care forgetthat new employees may not have a common knowledge base of normal animalbehavior. Without this basic information, employees are at risk for causinginjury to themselves or to the animal.

Employees need to know the correct responses to client questions aboutanimal behavior, and also to set their own expectations of normal. Variousbooks and literature are available but a ready access can be found throughInternet access via VetSuite (www.vetsuite.com). This new resource for veterinaryhospitals allows employee access to peer reviewed articles regarding behaviorissues.

Consider staff membership in the Society of Veterinary Behavior Technicianswhose mission is based in the enrichment of human/animal interactions bypromoting scientifically based techniques of training, management and behaviormodification.

resources

• Animal Behavior Associates, Inc., 4994 South Independence Way, Littleton, CO 80123; (303) 932-9095, www.animalbehaviorassociates.com

• Animal Care Training, Inc., 918 N. Elm, Denton, TX 1-800-357-3182

• Delta Society, 289 Perimeter Road East, Renton, WA 98055-1329; 425-226-7357, www.deltasociety.org; info@deltasociety.org

• Society of Veterinary Behavior Technicians, 406 Branchway Road, Richmond, VA 23236; (804) 379-4702, www.svbt.orgHospitals that embrace the concept of more compassionate behavior-based handling will win advantage in multiple areas of operations.

Clients will perceive a gentler handling of patients. Staff will experienceless anger and distress. Burnout may be reduced and professional fulfillmentincreased with reduced staff stress. Client referral of new clients is enhanced.

Improved workplace safety leads to decreased absenteeism due to injury,and reduced premium cost for Workers' Compensation insurance.

Practice value is protected through decreased likelihood of situationsleading to potential permanent damage of the practice's reputation.

A proactive approach to workplace safety through behavior-based compassionatehandling presents huge opportunities for improved operations and patientcare.