Proper staff training will eliminate barriers to providing medical services

This is a story about Mrs. Dunn, her dog, Tootsie, and their visit to the veterinarian. It is a fictional account, but it could just as easily have happened at any veterinary practice on any day of the week, according to the American Animal Hospital Association's (AAHA) newly published Compliance Study.

Mrs. Dunn and Tootsie, her sweet-natured brown Dachshund, had just finished Tootsie's annual exam, and they were at the front counter to settle their account. Mrs. Dunn wrote her check for the day's examination. Upon concluding the transaction, she smiled and said goodbye to the receptionist. She picked up Tootsie and waved the dog's paw in a good-bye gesture, too, and they left. The visit went well. The client left happy. Tootsie received the medical attention she needed ... or did she?

How patient careis unintentionally compromised

Tootsie is a 9-year-old, spayed Dachshund. In the examination room, the veterinarian had mentioned that it might be a good idea to set Tootsie up for a dental prophylaxis and take blood for a senior laboratory panel. The doctor commented that Tootsie's weight had been creeping up for the last couple of years and that it might be a good idea to put her on a reduction diet. Mrs. Dunn nodded her head in agreement with these suggestions and seemed to pay attention to everything the veterinarian said. The doctor vaccinated Tootsie and as he was leaving, said he would like to start seeing her every six months. Mrs. Dunn again nodded in agreement. After the doctor left, the technician came in and took a blood sample for Tootsie's annual heartworm check. She said she would let Mrs. Dunn know if there was a problem, but that the doctor said they should take Tootsie's heartworm preventive home today.

Upon checkout, the receptionist generated an invoice that listed the health examination, the vaccines, the heartworm test and a six-month supply of heartworm preventive medication.

Did Tootsie get the care she needed? What was missed?

Did you identify:

• Scheduling the dental prophylaxis?

• A weight-reduction diet to take home?

• Scheduling Tootsie's new six-month senior exam?

• Setting up the refill reminder for Tootsie's heartworm preventive?

• Taking blood for the senior panel?

• Client literature and someone to talk to about the new services recommended for Tootsie?

Missed patient care opportunities are more common than veterinarians believe, according to the AAHA Compliance Study. The study reports that patient care opportunities, like those listed previously, are among the most common that occur in companion animal practices in North America. (For more information on the AAHA Compliance Study, visit the AAHA Web site at AAHAnet.org.)

Three barriers to compliance

The AAHA Compliance Study identified three barriers that veterinarians need to overcome to ensure that patients consistently receive the quality care they need.

The barriers are:

1. Convincing themselves and their staffs that compliance is a problem. Veterinarians and their staffs do not believe it is a problem in their hospitals. Most veterinarians "guess-timate" their hospital's compliance levels, but according to the AAHA Compliance Study, compliance levels are almost never as high as they think they are.

2. Many veterinarians and their staffs believe that the clients are the problem and that there is nothing they can do about it. Veterinarians may say:

"Clients won't pay for it."

"Clients will think I'm only recommending things to make more money."

In either case, the recommendations aren't made.

3. Clients' perceptions are that recommendations and follow-through are lacking. This may be a reality, and it could also be a communications problem. Nonetheless, it appears to be a serious barrier to improving hospital compliance scores.

The AAHA Compliance Study directly addresses veterinarians' misperceptions with new data about actual compliance levels for core vaccinations, pre-anesthesia panels and other routine veterinary services. It shows that compliance is a serious, but unrecognized problem in most veterinary hospitals.

The study also provides new insights on what clients want their veterinarians to do for them and their pets, and how important cost considerations are when they make pet care decisions in the exam room.

The study cites clients' perceptions that recommendations and follow-through on items like dental prophylaxes and pre-anesthetic screens did not occur. They were not told about them, nor were they asked to schedule the services for their pets.

Veterinarians' misperceptions about the extent of the compliance problem and the causes behind it may be blinding them to the need to act. In other words, until veterinarians and their staffs believe there is a problem, it is unlikely they will do something about it. The good news is that once the hospital team is ready to tackle compliance, the rewards are there. A systematic, step-by-step compliance training plan can usually produce measurable improvement in compliance outcomes and patient care, as well as practice revenue.

Information and team training are keys to success

• Step 1: Start with the facts

A practice manager, technician or an experienced receptionist can usually audit patient records and gather the data. She should check for the six most common compliance gaps identified in the AAHA Compliance Study:

1. Core vaccinations

2. Heartworm testing and prevention.

3. Therapeutic diets

4. Dental prophylaxis

5. Pre-anesthetic screenings

6. Senior screenings

It is not necessary to check all patient records. Thirty records should provide a representative sample in most cases. (See the AAHA Web site for suggested sampling methods for patient records.)

• Step 2: Determine goals and set protocols to achieve them

Using Tootsie as an example, the whole hospital team needs to tackle questions such as what they can do to communicate better with each other on the recommended care for Tootsie. Is there a place on Tootsie's travel sheet or some other way to let the receptionist know that she needs to send Mrs. Dunn home with a weight-loss diet, schedule Tootsie's dental prophy and six-month senior exam, and enter Tootsie' prescription refill reminder?

The team should also consider what else they could do to improve the probability of Mrs. Dunn's compliance. For instance, is there client information they could share with Mrs. Dunn about the best way to introduce Tootsie to the new diet or talk to her about the benefits of your senior pet exam? Who on the hospital team can be the backup and talk to Mrs. Dunn about these things if the doctor is otherwise engaged and the technician and receptionist are busy?

Deciding what specific responsibilities each team member will have and what new protocols the team will follow to get the job done are vital to achieving a consistent client experience and compliance success. Without protocols and training, team members may be unsure of what they are supposed to do, or they may believe that someone else on the team is already doing it. In either case, compliance suffers and pets do not get the care they need.

• Step 3: Create a safe, productive learning environment

What goals have you set? Have they been shared with the whole hospital team so that everyone knows what to focus on? Have you decided how you will track, measure and report your hospital's compliance progress?

It is also important to decide how you will work through unanticipated problems. For instance, how can the receptionist set up Tootsie's six-month exam reminder if she does not know how to override the system's 12-month reminder default? These are the kinds of things that may not be discovered until people start doing the new work, and it is important to create a safe, supportive learning environment where team members, like the receptionist, can ask for help and make mistakes while they learn.

• Step 4: Celebrate success

While it may seem like a lot of work, tracking and reporting results helps to maintain focus and reinforces the expectation that the areas measured will improve. Psychologists tell us that this type of feedback is its own reward. It lets hospital team members know how they are doing, much in the same way as keeping score does for winning sports teams. It also allows timely feedback and shows incremental progress from week to week and month to month.

Finally, celebrating success is often overlooked because hospital teams are too busy to take the time to look back at what they have accomplished. Yet celebrating successes is one of the best ways to build a quality-conscious culture and obtain the compliance you want to ensure that clients and patients, like Mrs. Dunn and Tootsie, obtain the care they need.

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Ms. Gavzer, MBA, CVPM, is a veterinary business consultant, and internationally known writer and speaker. She says her job is to help practices "go and grow" through education, staff training and marketing. Gavzer has more than 15 years sales and marketing experience in the veterinary industry. She helped create public education campaigns to improve pet health care and encourage owners to take their pets to their veterinarians more often. Gavzer's expertise is in marketing and staff training. She works with veterinary practices, associations and industry.