The veterinarian–client–patient relationship

DOKTER

DOKTER HEWAN

Veterinarian–Client–Patient relationship. satisfying the client, caring for the animal

and promoting professional fulfilment. The dynamics of the veterinarian–client–

patient relationship are complex with multiple dimensions to take into account

A PARADIGM SHIFTRecent societal changes have caused a

paradigm shift in the veterinarian–client–patient relationship.

85% of pet owners viewed their pets as family members (Brown & Silverman 1999).

acknowledges the human–animal bond will lead to better outcomes for veterinary practices and their patients (Brown & Silverman 1999).

Veterinary professionals’ responsibilities have expanded to include the mental health and well-being of their clients, as well as those of their clients’ pets (Blackwell 2001).

Veterinarians’ responsibilities for addressing questions and providing client education are increased.

Consumers are not forgiving of unprofessional services (Blackwell 2001).

Most complaints related to poor communication and deficient interpersonal skills (Russell 1994), with breakdowns in communication being a major cause of client dissatisfaction.

Given (1) growing client expectations, (2) the strong attachment between people and their pets and (3) increasing consumer knowledge demands a shift in communication style from the traditional paternalistic approach to a collaborative partnership.

Many clients want to take an active role in decision making on their pet’s behalf.

Paternalismthe veterinary team does most of the talking

and the client plays a passive role.enhances efficiency and promotes time

managementthe agenda and subsequent diagnostic or

treatment plan may not be shared between the veterinarian and client

Consumerismthe client sets the agenda for the appointment; the veterinary team does not explore the client’s

values; the veterinary team plays the role of a technical

consultant, providing information and services on the basis of the client’s demands.

The challenge in this situation is to engage with the client as a working partner and to build trust with the veterinary team to reach an agreement between the client and the veterinarian agendas.

Partnership Between these two extremes is relationship-centred care, which represents

a balance of power between veterinarians and clients and is based on mutuality

In the relationship-centred model, the relationship between veterinarians and clients is characterized by negotiation between partners, resulting in the creation of a joint venture, with the veterinarian taking on the role of advisor or counsellor.

Key to this relationship-centred model is that clients must sense that their ideas, feelings, expectations and fears are understood (Epstein et al. 1993) and that they are being actively involved in the decision-making process.

The conversation content of relationship-centred visits is broad including biomedical topics, lifestyle discussion of the pet’s daily living activities (e.g. exercise regimen, environment, travel, diet and sleeping habits) and social interactions (e.g. personality or temperament, behaviour, human–animal interaction and animal–animal interactions) (Shaw et al. 2006).

SHARED DECISION MAKINGShared decision making is a key component of

relationship-centred care.There is two-way exchange between the

veterinarian and the client, identifying preferences and working towards consensus

An interactive approach (e.g. Frisbee) is promoted in giving information, in contrast to direct transmission approach

Silverman et al. (2005) recommend using a ‘chunk and check’ method

The aim of this technique is to increase recall, understanding and commitment to plans

Provides an opportunity for the client to participate in the conversation, provide feedback or ask for clarification.

Taking the client’s perspective into account and establishing mutual understanding and agreement encourage the client to fully participate in the discussion and commit to the diagnostic or treatment plan.

This entails encouraging the client to contribute to the conversation (e.g. check) (‘What questions do you have?’), picking up on client cues (‘You seem a little hesitant about surgery’), asking for the client’s suggestions (‘What options have you and your husband discussed?’) and checking for the client’s understanding (‘What will be the most difficult for you?’).

Use open-ended inquiry to explore the client’s perspective (‘How do you feel Max is doing since the surgery?’); ascertain the client’s thoughts (‘What do you attribute to his good progress?’); and assess the client’s starting point (‘What do you know about the risks of arthritis?’).

Extrapolating from medical communication outcomes-based studies, obtaining the client’s expectations, thoughts, feelings and fears about the pet’s health or illness enhances client participation in the appointment, with the potential to increase client satisfaction and adherence to veterinary recommendations (Stewart et al. 1995).

Communicating with colleaguesEven the smallest practice will comprise

more than one individual, and once there is more than one, communication, or lack of it, becomes an issue.

The word ‘communication’ comes from the Latin communicare meaning to impart, to share or to make common.

Words may be important, but how we treat colleagues in terms of our attitude and our body language is just as important.

THE TEAM AND ITS LEADEREvery team deserves a good leader who has the

vision to see where they want to take their business, the confidence to know that the destination they are heading towards is the correct one, and the wisdom to know when, along that journey, adjustments need to be made to alter course.

Leaders must have the ability to communicate that vision to the team as a whole and must know its constituent members well enough to understand what motivates each and every one of them

destination is reached with as many of the team on board as possible

When team members are asked what is important to them in their job, the following responses will usually appear high on the list of responses:

Confidence in the leader A sense of belonging Excitement in the job

why that confidence exists: Vision Enthusiasm Adaptability Integrity Toughness Fairness Warmth Humility Confidence

‘When the only tool you have is a hammer, all problems tend to resemble nails’ (Maslow 1966).

The effective leader will have a comprehensive toolbox and will know just when to reach for a different tool, when to apply it, and will know just the correct amount of strength and/or leverage to apply to get the job done.

The leader should lead by exampleadhering to standard operating procedures

(SOPs) in a practiceIf the boss flouts the rules, then it must be

okay for the rest of the team to do likewise.

Types of PeopleAnggota tim memiliki karakter dan perilaku

yang beragampractices are teams, however small that team

may be, and the success or otherwise of each team will depend on, not only the individual skills within the team, but how the team functions as a cohesive unit.

A good team will produce results, which are consistently better than the expected sum of the abilities of the individuals within that team

Replacing and/or recruiting new team membersThe introduction of a new practice member is

a golden opportunity to introduce new skills into the team or to strengthen existing ones

Communication with new employees starts at the advertising stage.

The interview is an important opportunity for both sides to communicate just what is on offer from the practice and what the potential new recruit wants.

The interviewee should leave with a copy of the job description and the terms of employment.

DELEGATIONOne of the key objectives of any practice

owner, leader or manager is to achieve their goals through the efforts of others

all too often it is a case of abdication rather than delegation with team members being left to get on with it with little or no instructions or backup

The other major fault is too much interference having delegated the task

To achieve our objectives we have to motivate and delegate to others

The basic components of successful delegation are as follows:

1. Communicate to the individual(s) what it is you want them to do. If it is a specific task, make it SMART or ideally SMARTER.

2. Provide the necessary support in terms of materials and training and advice.

3. Monitor progress without interfering.4. Encourage feedback and continue to offer

support.

SMARTER ObjectivesPeter Drucker; it appeared in his 1954

management book, The Practice of Management:

SMARAT areSpecificMeasurableAchievableRealisticTime-bound

The acronym SMARTER introduces the new words, ‘extending’ and ‘rewarding’, which highlight the importance of engaging individuals.

SMARTER objectives can also be employed in agreeing and setting the personal development goals for team members.

MotivationWhat can you do to motivate others?the prime motivators are intrinsic rather thanextrinsic and include such things as:

Having an interesting job Working within a fair environment Having goals to strive for Receiving recognition and being regarded as an

important member of the team

Extrinsic factors such as financial bonuses can play a role in motivating individuals and teams but need to be used with care

If one wants to use money as a motivator, it should be done with caution

Rewarding one individual financially may incentivize that person but may well demotivate all the others

The criteria need to be simple, transparent and under the direct control of the individual

STANDARD OPERATING PROCEDURESSOP should provide detailed written

instructions to achieve uniformity of the performance of a specific function

SOPs can cover such diverse topics as registering new clients, credit policy, admitting and discharging patients

an SOP should have a title; the person writing it should write down what they do and those who are involved in that process should do what is written down.

it is advisable to ask those most involved in the process to have the first stab at producing a draft.

The draft document should be circulated throughout the team and comments are sought before the final SOP is adopted

The aim is to have a written procedure that is agreed and utilized

why SOPs fail in the workplace? They are difficult to find. They are written in a ‘foreign language’. Instructions and general information are mixed. The procedure is described in an unfamiliar way. Users know a better method and can do the procedure ‘in

their sleep’.

why SOPs fail in the workplace? They are difficult to find. They are written in a ‘foreign language’. Instructions and general information are mixed. The procedure is described in an unfamiliar way. Users know a better method and can do the

procedure ‘in their sleep’.

SOPs should be either displayed in a prominent area or easily accessed in, for example, a folder or on the practice intranet

PRACTICE MEETINGSStudies proved that most complaints from

members are lack of communication members desire to have more practice

meetingsPractice meetings are the most effective way

of ensuring good communications within the practice at all levelsbut only if they are structured to be efficient

and effective.

Amongst the questions that need to be answered are the following: Which types of meeting need to be held and

what are the functions of each type? Who should attend each type of meeting and

why? Which types of meeting need to be held on a

regular basis, and how often? Is there a call for one-off meetings?

REPORTING STRUCTURETo ensure good communications within a practice,

there needs to be a well-defined reporting structure, which is accepted and understood by the team

The schematic or organogram should provide details of which topics should be communicated to whom within the practice.

to facilitate the transmission of information, top down as well as from the bottom up

The schematic or organogram should facilitate any member to request or convey information to another individual, a group of people or to the entire team.