The veterinary brain, interrupted

We've all been there: highly focused, deep in concentration, and then you hear it—a quiet knock and a rushed, "Do you have a second?" from a coworker. It's not her fault, of course, but nonetheless, you've been interrupted.

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A recent Wall Street Journal article (September 10, 2013), says that it can take "over 25 minutes, on average, to resume a task after an interruption," which means it's possible or even likely that interruptions in your veterinary clinic could compromise productivity and ultimately, your profits.

Making matters worse, a study performed by the Journal of Experimental Psychology: General confirms that error rates increase dramatically after a person has been interrupted. The journal's study showed that even the briefest of interruptions, which amounted to less than 3 seconds, could disrupt the mind's flow for minutes afterward—again, a feeling many of us might recognize. These lapses in concentration could then lead to mistakes in dosing, medications, instructions and completing other tasks.

In veterinary practice, we see mistakes with written prescriptions to the local pharmacy every day. Even with an audit, a practice's prescriptions still go out the door with errors. And our suppliers aren't immune, either. While unpacking a delivery, one might find the wrong products, the wrong counts or invoicing errors. After all, even packers get interrupted. Worse yet, how many distraction-induced mistakes affect animals every day? How many cats might receive 1.0 ml versus 0.1 ml of meloxicam because someone was interrupted?

Better results with focus

Most of us will admit that a quiet Sunday in the office affords us the ability to get more done in just two hours than a full eight hours during a regular, interruption-filled workday. Two hours of focused, uninterrupted work increases our productivity four-fold. Even my one of my employees, Susan, once joked on a snowy day, "My, it's amazing what we can get done without any customers." Ah yes, if only.

Realistically, the key here is focus. Amit Sood, MD, MSc and author of "The Mayo Clinic Guide to Stress-Free Living," says that a normal mind processes 150 random thoughts and undone tasks at any given time. To avoid becoming stressed out by all these thoughts, or worse, wandering around in a barely-aware state, professionals need to develop sustained attention on their tasks at hand.

But how? We know that minimizing interruptions in the veterinary clinic would make for better patient care, better customer service, an improved staff attitude, not to mention increased productivity and profits. But how do we go about gettting there? Get started with these 12 steps.

1 Track interruptions and then kill them. For two weeks, keep a log of each and every time you are interrupted. At the end of this period, assess the patterns that emerged. Then, rework your clinic's schedule to work around your clients' needs, eliminate superfluous interruptions and find new ways to direct needed tasks into focused time slots.

2 Recognize the role of records. Streamline the medical record to have prompts, cues and templates to assure that when an interruption does take place, it is easier to resume the concentration on the task at hand.

3 Wear "no-interruption" sashes. Just like police tape, bright-colored sashes can signal "Stop" to would-be interrupters. Obtain sashes for staff to wear during critical times like medication preparation and anesthesia. My clinic staff wears pink sashes when they perform clinic-critical duties.

4 Eliminate verbal instructions. Focus on written in-hospital directives that staff collect directly from the patient record.

5 Signal for success. Institute a raised hand signal, which forewarns an employee of an impending interruption: consider it the "May I interrupt" signal.

6 Use the double-tap rule. In the workplace, adopt the mentality that each medication and prescription is to be double-checked before administering or dispensing. The "double-tap" protocol means two individuals must check the data. One cannot effectively edit one's own work.

7 Live within appointments. Stay on time. A scattered and uncontrolled patient appointment flow is one that is ripe for interruptions.

8 Control the phone. A major source of interruptions is the phone. Controlling incoming and outgoing phone calls should be a major priority in the veterinary workplace. All practice inquiries made over the phone should have a note within the record where the written response can be noted and a client advised. Similarly, call for a cell phone hiatus. Turn off your cell, text and email prompts during morning and afternoon rounds. Keep them off. Secretly place "necessary" numbers on special cues or on vibration. (I like the duck quack.)

9 Call-in appointments. To improve the flow of necessary telephone duties, a practice might try scheduling "Call-in" appointments for client inquiries. I have six ten-minute appointment slots scheduled each day for inquiring clients to call me to chat about their pet.

10 Schedule holes. Every two hours, create a 15-minute "hole" in the schedule. This is to allow staff members to take a deep breath, a short walk or address a necessary interruption from earlier in the day.

11 Control training. Training offers two opportunities: a chance to learn and a chance to be interrupted or distracted. You must control these divergent activities. As internships increase, senior clinicians can expect the day to be two hours longer. Plan for it.

12 Close the (surgery room) door. Make sure to follow the AAHA standard—keep the door closed to minimize interruptions to the surgeon and team.

Dr. Michael Riegger, DABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him by telephone or fax (505) 898-0407, Riegger@aol.com, or www.northwestanimalclinic.com. Find him on AVMA's NOAH as the practice management moderator. Order his books "Management for Results" and "More Management for Results" by calling (505) 898-1491.