The veterinarian–client–patient relationship

1. Theveterinarian–client–patient relationship

2. DOKTER DOKTER HEWAN

3. Veterinarian–Client–Patientrelationship. • satisfyingthe client, caring for the animal and promoting professional fulfilment. • The dynamics of theveterinarian–client–patient relationship are complex with multiple dimensions to take into account

4. A PARADIGM SHIFT • Recent societal changes have caused a paradigm shift in the veterinarian–client–patient relationship. • 85% of pet owners viewedtheir pets as family members (Brown & Silverman 1999). • acknowledgesthe human–animal bond will lead to better outcomes for veterinary practices and their patients(Brown & Silverman 1999).

5. Veterinary professionals’responsibilities have expanded to include the mental health and well-being oftheir clients, as well as those of their clients’ pets (Blackwell 2001). • Veterinarians’ responsibilities foraddressing questions and providing client education are increased. • Consumersare not forgiving of unprofessionalservices (Blackwell 2001). • Mostcomplaints related to poor communication and deficient interpersonalskills (Russell 1994), with breakdowns in communication being a major cause of clientdissatisfaction.

6. Given (1) growing client expectations, (2)the strong attachment between people and theirpets and (3) increasing consumer knowledge demands a shift in communication style from thetraditional paternalistic approach to a collaborative partnership. • Many clients want to take an activerole in decision making on their pet’s behalf.

7. Paternalism • the veterinary team does most of the talking and the clientplays a passive role. • enhances efficiency andpromotes time management • the agenda and subsequent diagnostic ortreatment plan may not be shared between the veterinarian and client

8. Consumerism • the client sets theagenda 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 serviceson the basis of the client’s demands. • The challenge in this situation is toengage with the client as a working partner and to build trust with the veterinary team toreach an agreement between the client and the veterinarian agendas.

9. Partnership • Between these two extremes is relationship-centred care, which represents a balance ofpower between veterinarians and clients and is based on mutuality • In the relationship-centred model, the relationship betweenveterinarians and clients is characterized by negotiation between partners, resulting in thecreation 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 activelyinvolved 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).

10. SHARED DECISION MAKING • Shared decision making is a key component of relationship-centred care. • There is two-wayexchange between the veterinarian and the client, identifying preferences and working towardsconsensus • An interactive approach (e.g. Frisbee) is promoted in giving information,in contrast to direct transmissionapproach • Silverman et al. (2005) recommend using a ‘chunk and check’ method • The aim of this technique is to increase recall, understandingand commitment to plans

11. Providesan opportunity for the client to participate in the conversation, provide feedback or ask forclarification. • Taking the client’s perspective into account and establishing mutual understanding andagreement encourage the client to fully participatein the discussion and commit to the diagnosticor 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 hesitantabout surgery’), asking for the client’s suggestions (‘What options have you and yourhusband discussed?’) and checking for the client’s understanding (‘What will be the mostdifficult for you?’).

12. Use open-ended inquiry to explore the client’s perspective (‘How do youfeel Max is doing since the surgery?’); ascertain the client’s thoughts (‘What do you attributeto his good progress?’); and assess the client’s starting point (‘What do you know aboutthe 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 illnessenhances client participation in the appointment, with the potential to increase clientsatisfaction and adherence to veterinary recommendations (Stewart et al. 1995).

13. Communicating withcolleagues • Even the smallestpractice will comprise more than one individual, and once there is more than one, communication,or lack of it, becomes an issue. • Theword ‘communication’ comes from the Latin communicare meaning to impart, to shareor to make common. • Wordsmaybe important, but how we treat colleagues in terms of our attitude and our body language isjust as important.

14. THE TEAM AND ITS LEADER • Every team deserves a good leader who has the vision to see where they wantto take their business, the confidence to know that the destination they are heading towardsis the correct one, and the wisdom to know when, along that journey, adjustments need tobe made to alter course. • Leaders must have the ability to communicate that vision to theteam as a whole and must know its constituent members well enough to understand whatmotivates each and every one of them • destination is reached with as many of theteam on board as possible

15. When team members are asked what is important to them in their job, the followingresponses 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

16. ‘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 reachfor a different tool, when to apply it, and will know just the correct amount of strengthand/or leverage to apply to get the job done.

17. The leadershould lead by example • adhering to standard operatingprocedures (SOPs) in a practice • If the boss flouts the rules, then it must be okay forthe rest of the team to do likewise.

18. Types of People • Anggota tim memiliki karakter dan perilaku yang beragam • Praktik dokter adalah kerja Tim • Sukses/tidaknya suatu Tim bergantung pada kerja tim sebagai unit yg kohesif BUKAN pada Skill individu • Tim yang baik memberikan hasil yang selalu lebih baik dari jumlah total kemampuan individu dalam tim tsb

19. Replacing and/or recruiting new team members • The introduction of a new practice member is a golden opportunity to introduce new skillsinto the team or to strengthen existing ones • Communication with new employees starts at the advertising stage. • The interview is an importantopportunity for both sides to communicate just what is on offer from the practice and whatthe potential new recruit wants. • The interviewee should leave with a copy of the job descriptionand the terms of employment.

20. DELEGATION • One of the key objectives of any practice owner, leader or manager is to achieve their goalsthrough the efforts of others • all too often it is a case of abdication rather than delegation with teammembers being left to get on with it with little or no instructions or backup • The other majorfault is too much interference having delegated the task • To achieve our objectives we have to motivate and delegate to others

21. The basic componentsof successful delegation • 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.

22. SMARTER Objectives • Peter Drucker; it appeared in his 1954management book, The Practice of Management: • SMART are • Specific • Measurable • Achievable • Realistic • Time-bound

23. The acronym SMARTER introducesthe new words, ‘extending’ and ‘rewarding’, which highlight the importance of engagingindividuals. • SMARTER objectives can also be employed in agreeing and setting the personaldevelopment goals for team members.

24. Motivation • What can you do to motivate others? • the prime motivators are intrinsic rather than • extrinsic 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

25. Extrinsic factors such as financial bonuses can play a role in motivating individuals andteams but need to be used with care • Ifone wants to use money as a motivator, it should be done with caution • Rewarding one individual financiallymay incentivize that person but may well demotivate all the others • Thecriteria need to be simple, transparentand under the direct control of the individual

26. STANDARD OPERATING PROCEDURES • Communication comes in many forms; a written format may be bestsuited to the job • an SOP should provide detailed written instructions to achieve uniformity ofthe performance of a specific function • SOP should provide detailed written instructions to achieve uniformity ofthe performance of a specific function • SOPs can cover such diverse topics as registering new clients, credit policy, admittingand discharging patients • an SOP should have a title; the person writing itshould write down what they doand those who areinvolved in that process should do what iswritten down.

27. 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’.

28. PRACTICE MEETINGS • Studies proved that most complaints from members are lack of communication • members desire to have more practice meetings • Practice meetings are the most effective way of ensuring good communications withinthe practice at all levels • but only if they are structured to be efficient and effective.

29. Amongst the questions that need to be answered arethe 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?

30. REPORTING STRUCTURE • To ensure good communications within a practice, there needs to be a well-defined reportingstructure, which is accepted and understood by the team • The schematic or organogramshould provide details of which topics should be communicated to whom within the practice. • to facilitate the transmission of information, top down aswell as from the bottom up • The schematic or organogram should facilitate any member torequest or convey information to another individual, a group of people orto the entire team.

31. Communicating with a wider audience • Mark Twain once said, ‘There are two types of speakers: those that are nervous and thosethat are liars’ • Nearly 100 years later, public speaking still remains one of people’s greatestfears. • There is, for example, anecdotal evidence to suggest that some individualsare more scared of public speaking than dying. Why is this? • speaker’s fearsincluded ‘trembling, shaking, or showing other signs of anxiety’, ‘one’s mind going blank’,‘doing or saying something embarrassing’, ‘being unable to continue talking’ and ‘sayingfoolish things or not making sense’

33. If you tend to avoid public speaking like the plague, it is possible that this could hinderyour personal development and career • public speaking is an excellent way of sharpening critical thinking skills such asgathering and recalling, organizing, analysing and evaluating information • process of ‘discovering’ your topic, shaping it into a message and delivering it orally arecomparable to writing in that it is a learning process

34. Preparation: what to say • When it comes to public speaking, Tilton (2002) says, ‘Nothing can substitute for qualitypreparation’ • Knowing your audience is the first step of this preparation • you need to decide what message you want to get across – what is the mainpoint of this presentation for you • Assessing the right amount and level of informationrequired is important.

35. Raveenthiran (2005) says it is: • boring to talk about what the audience already knows; • futile to talk about what the audience cannot understand; • arrogant to talk about what you know and ignore the interests of your audience; and • dangerous to talk about things you are not sure about.

36. Preparation: how to say it • Rehearsing your presentation is also an important act of preparation • It may seem time-consuming, but doing a ‘dummy run’ will help iron out anydifficulties and build your confidence • Go through your presentation out loud. This will allowyou to proofread your slides for spelling or grammar mistakes, as well as work outwhether you are finishing before or after the time limit on your presentation • Try to rememberkey points, but do notmemorize your speech word for word; it is possible that you couldgo blank

37. Perform in front of a mirror, or record it on a video, will enable to look at your own body language. Watch out fortelltale signs of nerves such as crossed legs and arms orwringing hands • rehearse it in front of a trusted friendor colleague. Get them to play devil’s advocate. • Where practical, performing this dummy run at the actual venue of the presentation is the‘gold standard’ • If this is not possible, make sure you know what facilities will be there • If you are nervous, deep breathing and body stretches can be used to relax.

38. ‘What’s the worst thing thatcould happen? Even if it does, you’ll live. Yes this presentation is important, but it’s not brainsurgery’ (Petrini 1990). • it is important to set realistic goalsfor yourself: not set out to engage 100% audience • not to ‘focus on the 10% or 15% who are not listening’ as this takes yourattention away from the larger group of people who are listening • If you are nervous, remember that the audienceresponse is more likely to be empathic rather than hostile or derisive

39. The presentation as a consultation • An oral presentation issimilar to conducting a consultationwith a client. You deliver a message but also to listen to your audience andgauge how they are reacting • Two key factors in the veterinary consultation model: providing astructure to the proceedings and building a relationship with the client (or audience) • In providing structure to the proceedings, an oral presentation should have a beginning,middle and end that are arranged in a logical sequence • An example of this isthe concept of: ‘Tell them what you’re going to say, tell them and then tell them what youhave just told them’ (Petrini 1990).

40. A strong opening is important. It is the crucial time toconvince your audience that you have something interesting to say. Get your main pointout early and give the audience a good reason for being there • ‘Today I’mgoing to talk about mastitis and the three easiest ways to keep your herd cell count down’ • As in a consult, you need to eliminate uncertainty and inform your audience what to expect: • ‘Today I’m going to talk about BVD. I have a short presentation that should take a half hourand, after a period for questions, we’ll break for lunch’.

41. The end of your speech is also important. • Summarize the mainpoints of the presentation or leave the audience with a question • Public speaking also reflects the veterinary consultation model in that it is important tobuild up a relationship with the audience • As in a consult, body language is very important; you are not just communicatingverbally through your speech and slides, you are also doing so non-verbally, with your bodylanguage

42. Non-verbal communication with your audience • adopt body languagethat appears comfortable and confident, it will help your audience to listen • Aim to achieve as open a body posture as possible this means coming outfrom behind a lectern, standing up, facing the audience at all times and using open bodylanguage – including uncrossed arms and legs. Smile too – audiences appreciate a speakerwho appears friendly and enthusiastic. • Eye contact is also key to involving the audience, and not just eye contact with the frontrow • Start by finding the person in the audiencewho is willing you to succeed (there’s nearlyalways one), then look around at the rest of the audience.

43. Use hand gestures to emphasize interesting or important points and try to move aroundthe stage rather than standing in one place • Your voice is another form of non-verbal communication. When you are nervous, yourvoice naturally speeds up and increases in pitch, so consciously slowing down the rate ofyour speech will give out a message of confidence and control. • Using variation in your pitchand rate of speaking will help prevent you from sounding monotonous. Also, as in a consultation,pauses and short silences can be useful to allow an important piece of information tosink in. • As in a consult, body language is a two-way process. During your presentation, look at your audience’s non-verbal feedback – Do they look bored or confused, forexample?

44. Visual aids • When you give a presentation, visual aids such as charts, tables, graphs, movies and imagescan help support your speech and keep your audience interested • The key tovisuals, however, is simplicity. • Visuals should support rather than distract from your ideas .They should complement your speech rather than replace it – it showslazy presentation skills to stand in front of an audience and simply read slide after slideverbatim.

45. Several recommendations for using an electronicpresentation applicationsuch as Microsoft ppt : • Use no more than one slide for every 2 minutes of your speech. • Use contrasting colours, i.e. a light text on a dark blue or black background or vice versa.Care should be taken with red or green because of the potential for red–green colourblindness in the audience. • Use an appropriate style of text. Universal and Arial are the most popular fonts. Avoidcalligraphy, sans serif or italicized fonts. • Do not underline text and do not use words orsentences made entirely with upper case letters. • Use an appropriate size of text. Text should be visible from the back row; try 36 points fortitles and 28 points for the body of the text.

46. Limit the amount of information on the slide. Sentences should be short and punchy likenewspaper headlines. Fivepoints on each slide, consisting of five words each • Ensure there is consistency between slides (same size, colour, background and the same font) • Minimize animation and flashy gimmicks such as bullet point sounds. (exceptbulleted text) • Simplify diagrams and use clear, bold pictures. Eliminate unnecessary elements to aslide.