The veterinarian–client–patient relationship

Theveterinarian–client–patient relationship

DOKTER DOKTER HEWAN

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

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).

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.

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.

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

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.

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).

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

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?’).

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).

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.

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

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

‘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.

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.

Types of People • Anggota tim memiliki karakter dan perilaku yang beragam • practices are teams, however small that teammay be, and the success or otherwise ofeach team will depend on, not only the individual skills within the team, but how the teamfunctions as a cohesive unit. • A good team will produce results, which are consistently betterthan the expected sum of the abilities of the individuals within that team

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.

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

The basic componentsof 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 Objectives • Peter Drucker; it appeared in his 1954management book, The Practice of Management: • SMARAT are • Specific • Measurable • Achievable • Realistic • Time-bound

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.

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

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

STANDARD OPERATING PROCEDURES • 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 do and those who areinvolved in that process should do what iswritten down.

it is advisable toask those most involved in the process to have the first stab at producing a draft. • The draft document should be circulatedthroughout the team and comments are sought before the final SOP is adopted • The aim is to have a written procedure that is agreed andutilized • 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 displayedin a prominent area or easily accessed in, for example, a folder or on the practice intranet

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.

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?

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.

The veterinarian–client–patient relationship