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Client satisfaction and loyalty can go a long way toward ensuring adherence and optimal patient care—not to mention repeat business. Client satisfaction is about meeting expectations, whereas loyalty, is about relationship building. Both contribute to the likelihood of a client returning to—and even recommending—your practice, or switching practices altogether. 

The news from the American Veterinary Medical Association (AVMA) 2021 Pet Ownership Survey is encouraging in this regard. Despite the challenges to health care delivery posed by COVID-19, 90% of pet owners who responded were somewhat to extremely satisfied with their last veterinary visit, and half were very likely to recommend the practice to friends or family. Even so, 2% were extremely dissatisfied, and 9% said they were extremely likely to switch practices.

Although low in number, dissatisfied clients can disrupt our days, harm the well-being of our teams, and jeopardize the hard-earned reputations of our practices. Indeed, we’ve seen this all too often recently.

So what can we target to improve client satisfaction and loyalty? The answer may surprise you.

AVMA’s survey found that the most influential factor in client satisfaction is perceived value. Forty percent of clients who were dissatisfied with the overall value of services provided by their veterinarian said they would be likely to switch practices. By contrast, only 18% of clients dissatisfied with the practice’s convenience (hours, location, etc) were likely to switch. Convenience, it turns out, is the least influential factor.

Perceived value isn’t just important to maintaining clients, it also affects an owner’s decision whether to visit the veterinarian in the first place. The survey asked specifically about primary reasons owners did not visit the veterinarian, and respondents told us the following:

Seventy-eight percent chose responses suggesting low perceived value.

Convenience ranked much lower, at less than 10%.

The truth is that although many people consider their pets as part of the family, many of these pet owners don’t understand the value of the recommendations their veterinarians make. This is particularly true when it comes to routine examinations and preventive care. Some of the reasons owners gave for their pet not seeing a veterinarian in the past 2 years are as follows:

Veterinary care costs more than it’s worth—6%.

This lack of understanding is not surprising if we consider findings from the Bayer veterinary care usage study,

 which found that communication during veterinary appointments can be unclear. The responses included the following:

Forty-three percent of pet owners didn’t completely agree that their veterinarian communicates with them in language they understand. 

Fifty-six percent didn’t completely agree that their veterinarian clearly explains when they should bring their pet in to be seen.

The disconnect between what clients perceive as valuable and what veterinary professionals know is important for patient health limits our ability to provide the care our patients need. How can we address, and perhaps eliminate, this disconnect? It all comes down to communication.

Language-focused research conducted by the AVMA shows that simply changing how we speak about veterinary care can significantly influence pet owners’ perceptions about the value and importance of regular care. The AVMA’s Language of Veterinary Care findings indicate that pet owners value 3 main things when it comes to their veterinarian:

It also uncovered strategies we can use to meet these expectations, as follows:

Emphasize our experience, not training, to convey expertise.

Leverage the relationship owners have with their pets: Acknowledge them as their pet’s advocate.

Provide individualized care, as personalized recommendations can differentiate the veterinary team from other information sources such as groomers, trainers, or the internet.

, explores the results of this research in further detail, with words and phrases that veterinary teams can use—or should avoid—to help build client relationships and loyalty. We’ve also developed a robust training module that helps veterinary team members connect meaningfully with pet owners to improve adherence, enhance patient care, and drive your business forward. Both resources are available online at avma.org/LanguageOfCare.

Other tips to help clients appreciate the value of the services you provide, building trust and loyalty, are as follows:

Use a relationship-centered approach to communication involving back-and-forth with clients to create a partnership rather than a 1-sided delivery of information.

At the start of the appointment, partner with the client in setting an agenda. Ask about any concerns they have, listen, probe for additional concerns, and confirm the list.

Talk through what you’re looking for while conducting a physical exam. Conclude with a clear, customized recommendation.

Explain, in client-friendly terms, the benefits and efficacy of the treatments, diagnostic tests, or other services you’re recommending.

In situations involving choice, such as recommending one vaccine over another, explain the rationale in terms of the patient’s needs.

Be transparent about costs and explain the value of related services in relation to the pet’s current and long-term health.

Conclude the appointment with a personalized follow-up plan.

Partners for Healthy Pets offers a free preventive health care certificate program that provides more detail on communication styles that promote relationship building and perceived value. It can be found online at avma.org/Axon. An added bonus: veterinarians, veterinary technicians, and practice managers can earn 9 continuing education (CE) credits by participating.

Despite our best efforts, we’re bound to encounter disgruntled or angry clients. When this happens, how can we build a bridge to reestablish friendly and trusting relationships?

Let the client vent and listen to understand. Appreciating the concern can help you decide whether and how to address it.

Acknowledge the problem and apologize. Let the client know you hear them.

Be willing to solve the problem. Compassion is an effective antidote to anger.

Remain calm. Consider your body language and aim for a relaxed posture with good eye contact.

Consider difficult feedback a gift. You can’t fix what you don’t know about, and talking things out in person may prevent complaints on social media.

If you’re attending AVMA Convention 2022, you’ll find specific CE sessions that can help deal with these situations, including “Difficult Clients: Turning Snappy Into Happy,” led by Amy Newfield, MS, CVT, VTS.

Pet owners appreciate convenience, but understanding the value of veterinary services will keep them coming back. Simply changing how we talk can help owners better understand this value, ultimately leading to healthier pets and stronger, more rewarding relationships.

Von Simson C. Bayer veterinary care usage study: the decline of veterinary visits and how to reverse the trend. AVMA. July 18, 2011. Accessed March 15, 2022. https://brakkeconsulting.com/wp-content/uploads/2018/01/ BAYERBCI_VET_CARE_USAGE_STUDY_PART2.pdf

Burns K. Communicating with clients key to preventive care. J Am Vet Med Assoc. 2013;242(10):1325-1326.

CVM Courses. Client communication: physical exam. Accessed March 15, 2022. www.cvmcourses.com/courses/mod/page/view.php?id=175

Coe JB, Adams CL, Bonnett BN. A focus group study of veterinarians’ and pet owners’ perceptions of the monetary aspects of veterinary care. J Am Vet Med Assoc. 2007;231(10):1510-1518. doi:10.2460/javma.231.10.1510

Volk JO, Felsted KE, Thomas JG, Siren CW. Executive summary of the Bayer veteri- nary care usage study. J Am Vet Med Assoc. 2011;238(10):1275-1282. doi:10.2460/ javma.238.10.1275

Burns K. When clients bite: dealing with difficult clients ... in a pandemic. J Am Vet Med Assoc. 2020;257(8):783.

Articles

AVMA’s survey found that the most influential factor in client satisfaction is perceived value

The secret to happy clients

Good morning dvm360® readers! We hope you plan to spend the weekend relaxing and (hopefully) enjoying nice weather. As you prepare, catch up on this reading material and maybe learn a thing or 2 this weekend! 

Here is what was hot this week on dvm360.com:

, Darci Palmer, BS, LVT, VTS, breaks down a common anesthesia mistake veterinary professionals make and how to avoid it, plus more. 

Do you currently struggle with work-life balance? If so, check out these 

 that can offer you more of a balance between your personal and professional life.

 of The Vet Blast Podcast features Seth Wallack, DVM, DACVR, and takes a closer look at how artificial intelligence can enhance veterinary radiology.

, Jessica Nord, VMD, shares tips on relieving the stress of emergency and critical care situations when the veterinary clinic is understaffed.

 conducted by the American College of Veterinary Dermatology shed light on why pets with dermatologic conditions should be a higher priority for referrals.

Have you registered for our Directions In Veterinary Medicine conference from June 24-25 in Indianapolis? There is still time to sign up! Register 

News wrap-up: This week’s veterinary headlines, plus avoiding this common anesthesia mistake 

Mungil exploring her new habitat in the wild (Photo courtesy of The Orangutan Project). 

The Bornean Orangutan Rescue Alliance (BORA)—a joint initiative of the Indonesian Nature Conservation Agency (BKSDA), Centre for Orangutan Protection, and The Orangutan Project—has released 2 critically endangered Bornean orangutans into the Busang Ecosystem. This ecosystem is among the last standing viable rainforest habitats for orangutans on the island of Borneo.

 18-year-old Ucokwati and her 8-year-old daughter Mungil were considered eligible for release after successfully finishing rehabilitation at the BORA Rescue & Rehabilitation Centre in East Kalimantan. Prior, they were cared for at the Wildlife Rescue Centre in Yogyakarta on the Indonesian island of Java. Ucokwati was introduced to the Centre after being rescued from an amusement park in October 2011.

When the Wildlife Rescue Centre closed due to financial difficulties associated with the COVID-19 pandemic, the duo was translocated to the BORA Centre in April 2021.

"We don't know how long Ucokwati had been held in captivity at the park," said Hardi Baktiantoro, field manager for The Orangutan Project and founder of the Centre for Orangutan Protection, in the release. "As with most orangutans that end up in such places like these, it is highly probable that she was taken from her mother as an infant and sold into the illegal pet trade."

"Both had demonstrated advanced foraging and nest-making skills, as well as a healthy dislike for humans," Baktiantoro said. "Ucokwati is particularly aggressive towards humans, no doubt due to her ill-treatment while in captivity, and this made her a prime candidate to successfully transition back into the wild."

Ucokwati and Mungil were released onto Dalwood-Wylie Island, located in the Busang Ecosystem. The journey consisted of a 10-hour expedition by road from the BORA Centre and then a 3-hour expedition by boat along the Busang River.

Their release onto the island offers the mother and daughter to experience the freedom of life in the wild while also remaining closely monitored by staff from BORA. According to the release, the Centre predicts they will make a full transition back to the wild within a few months as they become more independent and explore the Busang Ecosystem.

"We are currently living in the most important decade in the history of our planet for species survival," said Leif Cocks, founder of The Orangutan Project.

"We are facing an extinction crisis, unlike anything we have ever seen before due to the ongoing impact of habitat loss and the illegal trade of wildlife that has devastated populations of many animal species and led to an unprecedented loss of biodiversity.”

Two additional male orangutans under the care at BORA will also be released into the Busang Ecosystem later this month. The alliance aims to secure and protect viable ecosystems such as the Busang Ecosystem to perpetuate the survival of critically endangered orangutans.

"The release of orangutans like Ucokwati and Mungil back to the wild gives hope that we can revert the impending extinction crisis," Cocks said. "But we cannot do it alone. We need more individuals to join us to secure and protect viable rainforest habitat before it is too late."

Orangutan mother and daughter released back to the wild. News release. The Orangutan Project. May 19, 2022. Accessed May 20, 2022. https://www.prnewswire.com/news-releases/orangutan-mother-and-daughter-released-back-to-the-wild-301550870.html

This marks the first of a series of orangutan releases back to the wild in 2022

Orangutan mother and daughter duo released back to wild

At the Fetch dvm360® conference in Charlotte, Dawn Boothe, DVM, MS, PhD, DACVIM, DACVCP, shared key information veterinary professionals should share with their clients about nutraceuticals. 

View the video below for the entire discussion. The following is a partial transcript.

Dawn Boothe, DVM, MS, PhD, DACVIM, DACVCP

Many of our clients just don't understand that they're not drugs. They're not regulated. They don't go through a pre market assessment. They don't go through a good, "is it safe [and] does it work" [test]. You know, you can go get some grass and some dirt and mix it up in your bathtub and put it in a bottle, put a pretty label on it, and you can sell it, and there's really nobody to hold you accountable.

Videos

Clients may have misconceptions about the safety and efficacy of nutraceuticals.

What clients don't know about nutraceuticals 

Jaguar Health, Inc. will host an in-person, outdoor special media event and performance in New York City at Madison Square Park on Monday, May 23rd, 2022, from 12:30 to 2:30 pm EST. This event honors the debut of the Jaguar Health Canine Cancer: 

 (Canine Health And ReGistry Exchange) initiative.

 this marks the first-ever US Canine Cancer Registry and Cancer Care index as safeguarding dogs from cancer starts with understanding its effect on breed, type, age, gender, and location. The index is for dog owners, veterinarians, veterinary oncology specialists, and others interested in addressing and helping to manage canine cancer.

"This first-ever U.S. Canine Cancer Registry and Cancer Care Index is being created to assess the prevalence and incidence of cancer in dogs. We will be revealing data at the event from the first nationwide Gallup survey of pet owners addressing their experience with canine cancer, as well as the registry itself that is based on the analysis of thousands of anonymized canine medical records,” expressed Lisa Conte, Jaguar Health's founder, president, and CEO.

“The data may also provide insights to help better understand cancer in humans as well,” she added.

What’s more, attendees will receive swag for themselves and dogs on a first-come, first-serve basis. The event will highlight presentations by renowned veterinary cancer specialists and performances by Broadway icons.

Among those scheduled to present include:

Jaguar Health founder, president, and CEO Lisa Conte

 scientific advisory board co-chair Theresa (Terry) W. Fossum, DVM, MS, PhD, Diplomate ACVS

 scientific advisory board member Susan Ettinger, "Dr. Sue Cancer Vet," DVM, DACVIM (Oncology)

TogoRun president, CEO & owner Glo Janata, JD

Ivee (Intelligent Veterinary Enhanced Experience) CEO and founder Chelsea Rhoads

Gallup director for eastern region Bill Reid

Among those scheduled to perform include (with artists subject to change):

Actor, director, and producer Richard H. Blake

. To those who can’t attend, the event will also be live-streamed 

Media advisory: Jaguar Health canine cancer: Take C.H.A.R.G.E. launch event in NYC on Monday, May 23rd! News release. Jaguar Health, Inc. May 17, 2022. Accessed May 20, 2022. https://jaguarhealth.gcs-web.com/news-releases/news-release-details/media-advisory-jaguar-health-canine-cancer-take-charge-launch

In light of the first National Canine Cancer Awareness Day, this initiative will launch in NYC and feature well-known veterinary cancer specialist speakers, plus Broadway performers


Jaguar Health to debut Take C.H.A.R.G.E. with canine cancer awareness event 

Bo Brock’s name has been “famous” in the wild plains of Lamesa, Texas, for almost 40 years. He has seen his share of affectionate critters that have walked in and out of the clinic. I am personally fond of Bo because he consistently picks up the phone when I call, often displaying keen interest in my cases and career as an equine practitioner in West Texas.

This time, I was informing Bo about Play-A, a horse I had seen on and off for 2 years. When you own a riding stable, it is vital to have lesson horses like this one, and his owner, Jennifer Moore, was willing to do what she could to take care of him. Unfortunately, in the beginning of 2021, the horse was diagnosed with equine protozoal myeloencephalitis, and toward the end of his treatment, he had fractured his kneecap. The fracture was small and located on the front side of the left patella, outside the joint and underneath the quadriceps tendon. Play-A was sore in the left hind leg, especially if you flexed his left stifle.

When I initially diagnosed the fracture, Bo and I visited treatment options. We decided conservative management, consisting of stall rest for 30 days plus 7 days of nonsteroidal anti-inflammatories, would offer the best course of action. At the 30-day recheck, Play-A’s condition had worsened. The tissue surrounding the patella was firm, swollen, and painful. He seemed OK walking, but he was significantly worse at a trot. He was 3-legged lame after flexing the left stifle. I was discouraged to say the least. I took a follow-up x-ray, and it was worse as well. The chip fracture had shifted toward the ground and it appeared larger than it had initially.

“Just get in there and take it out,” Bo recommended on the phone. “You tried to treat it conservatively and it just isn’t working. I’d lay him down if I was you. No sense in trying to do it standing. I tried something similar on a horse’s scapula one time, and the horse jumped, and I cut his supraspinatus tendon clear in half. Get in there. You can do it...or if you don’t want to, then I’ll do it.”

Bo advising me to just “get in there and take it out” is why I appreciate his insight. Not because that wasn’t what was best for the horse, or because I wasn’t qualified to do it, but mainly because it instilled confidence in a young veterinarian eager to help a horse in need.

Once off the phone with Bo, I discussed different scenarios with the client. “What if we do nothing?” Jennifer asked.

“Unfortunately, his lameness is so bad that we may have to put him down,” I responded. “I suspect it will continue to get worse. Bo thinks we need to surgically remove the fragment from the patella. He thinks I can do it, but he said he would do it if you wanted to take a trip down to Lamesa.”

I appreciated the confidence she had in me, but I wasn’t so sure about this one. So many things could go wrong. I may not be able to get the chip fracture out. I may cut too much soft tissue, and the horse may not be able to use that leg anymore. I could inadvertently enter the stifle joint and cause it to become septic. The poor outcomes were running through my brain. “OK, well, let’s give it a go,” I said.

When the day of surgery arrived, I was feeling confident. I had a good plan: Cut it open and take it out. Easy. I sedated the horse with xylazine and while he was sedated, I started clipping the hair over the surgery site. All my instruments were in order and we were ready to get started. I placed an intravenous (IV) catheter in the left jugular vein, and when it was sutured in place, I administered ketamine to induce anesthesia. My goal in that moment was to get Play-A to lie down on his right side. You can flip a horse over to the other side if you have enough people, but it was not going to be a good omen if he lay down on the incorrect side. He started wobbling and tried his hardest to lie down on the left, but I gave him a last-minute nudge that pushed him over to the right. I moved the IV pole next to his neck and hooked up the triple-drip anesthesia that would keep him down while we operated. We finished our final surgical scrub, I donned my sterile gloves, opened my pack, and clamped the drape— we were ready for business.

I made an incision through the skin directly over the patella. I dissected to the hypothetical region of the chip fracture. I could palpate a piece of bone that was embedded within soft tissue that felt like the golden ticket. I grasped it with forceps, dug it out, and we were ready to take a follow-up x-ray to ensure full removal. We snapped the picture, and there was still a large piece in there. I went back to work. I felt around with my fingers, but I couldn’t feel anything broken. Everything felt firmly attached and smooth. What was I going to do? I extended the skin incision and opened the soft tissue to provide me a wider window, and I felt around again—still nothing. We lined up the x-ray generator and I pointed an instrument in the hypothetical location. We snapped the picture again, and I looked. The instrument was just above where I needed to be. I dissected and opened more tissue below where I was looking.

“Ledford!” my technician, Kiersten, yelled. As she pronounced the final syllable of my name, Play-A woke up and his neck started rising from the ground. I leaped on top of his chest, and I was lying belly down on his shoulder. He started trying to sit up, and I was flopping on top of him like a flounder. For whatever reason, I was still holding my hands in the air, trying to stay sterile. Sterility was long gone, but it was an instinct.

“Get the xylazine and ketamine,” I yelled while Play-A flopped into the water bucket and splashed mud all over me. Kiersten drew up the ketamine and ran over to give him a bolus. He started settling down and I looked over at the situation behind me. In the hubbub, I hadn’t paid attention to the surgery site. The drape clamps were still attached, and the drape was lying in the mud. The horse had flopped onto the x-ray plate, but my instruments were still where I left them. I pulled off my gloves, helped raise him up, pulled out the x-ray plate, and assessed the surgery site. Kiersten pulled up some saline flush and we started to lavage the incision with it. I donned a new set of gloves, pulled the instruments over to where our new surgery location was, and got back after it. I felt a sense of urgency after the rodeo we had just experienced. Kiersten was ready with ketamine, just in case.

It’s an easy surgery, I told myself. Find the fracture, take it out, and sew it up. I probed around with my forceps hoping to find a divot or crack in the bone’s surface—nothing. I kept searching, but I was losing confidence at this point. What was I going to tell the owner? “Sorry, I suck. I couldn’t find it. I filleted his leg open for no reason.” Or, “Sorry, we are going to have to put him down.”

No. I reminded myself: It’s an easy surgery. Just get it out and sew it up. We took another x-ray. I was looking in the right place. My feet were falling asleep kneeling next to the horse. I was hunched over, arms up, knees on the ground, head half-cocked to the side, and my pants were stained with blood and mud. My brow was dripping with sweat. My hemostat dragged across a lip. I went back over it. It was progress. I stuck the hemostat in a crevice and leveraged up. An oval piece of bone creaked and lifted underneath the periosteum, sucking it down to the bone. It was what I had been looking for. I leveraged with my left hand and cut the periosteum with my right. I worked it up, leveraging the bone fragment away with the hemostat like it was a crowbar. It snapped up, and I clipped the last remaining piece of connective tissue loose and held the piece of bone in my hand. My golden ticket. We snapped the x-ray and the screen hovered in limbo as the software processed the image. The image popped up in view. It was out. We got it.

Kiersten opened the bone rasp and I smoothed out the rough edges. We had to lavage it with saline again and squirt some antibiotic in there for safe measure. I closed it as quickly as I could. I threw the last stitch and breathed a sigh of relief. We had done our part. Now we just had to hope Play-A healed.

I was covered in blood, mud, and sweat. My feet were asleep. My head was pounding from my acute hypertension, and my belly felt like I was Mike Tyson’s punching bag from flopping around on a horse’s chest while he tried to wake up with his leg cut open. But hey—I was in the wilderness, operating on horses, trying to make them better. A smile flashed across my face. No wonder Bo encouraged me to take a stab at this one. I couldn’t wait to call him.

s a mobile equine practitioner in Lubbock, Texas, where he is a partner at Hub City Veterinary Clinic.

Jeff Ledford, DVM shares his story about an equine surgery he performed that was supposed to be easy, but ended up causing Ledford to question himself

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