The three R's of veterinary medicine: Relationship, relationship, relationship (Proceedings)


Communication is the key to working smarter, and not harder.

Leveraging the Veterinary Healthcare Team

Communication is the key to working smarter, and not harder. Working smarter, not harder means improving communication — both inside and outside the practice. We were given two ears and only one mouth for a reason — so that we will listen twice as much as we talk. Working smarter means autonomy, and autonomy means empowerment.

What does it mean to empower? It doesn't mean this:

"I'm all for empowerment, but if you come up with something new, run it by me first..."

Remember that the definition of insanity is doing the same things over and over and expecting a different outcome! It is time to create a different outcome — failing to plan means planning to fail.

Accepting Delegation

Advantages to the Client:

  • More needs are met

  • Increased satisfaction with the practice

  • Increased perceived value

  • Increased/improved caring for pet

Advantages to the Pet:

  • Increased opportunity to recognize areas requiring additional attention

  • Increased level of expertise of people caring for patients (other than the veterinarian)

Advantages to the Veterinary Nurse:

  • Increased job satisfaction and self-esteem

  • Increased opportunity to contribute to practice growth

  • Decreased attrition to the profession

  • Opportunity to make a long-term commitment to the practice (usually with opportunities for additional compensation)

Advantages to the Veterinarian:

  • Better utilization of doctor-specific skills

  • Increased time available to devote to personal development, practice management, and life outside the practice

  • A doctor doing more doctor-only tasks means higher practice revenues

  • Less "mental clutter" for the doctor, thus improved effectiveness

Leverage Your Team & Increase Effectiveness

1. Stop trying to be all things to all people

2. Improve communication internally and externally — from front office staff to veterinary nurses to veterinarian and from all to clients

3. Schedule appointments for inpatients and outpatients to prevent unnecessary client waiting time & to prevent unnecessary chaos in the practice

4. Cluster surgery/dentistry cases together on the same day(s) of the week. It takes the same amount of time to set up for 2 surgeries or 10

5. Create job descriptions for each team position to create expectations & consistency of experience. This does NOT interfere with individualism or creativity

6. Cross-train members of your team. This allows team members to fill in effectively when gaps and lapses occur

7. Create a protocol notebook. Don't reinvent the wheel. DO create consistency of experience — for staff, clients, and patients

8. Consider a telephone specialist away from the reception area. This person can choreograph patient flow

9. Business cards for everyone. Everyone on the team is (and should be recognized as) an ambassador for the practice. Bond the client to the practice

10. Call your veterinary nurses "nurses". Pet owners know what nurses do — nurses care!

11. Use readily available organizational aids:

In/out boards

Dry-erase marker boards

Cage cards

Lockers for team members

12. Use laminated, erasable "travel sheets". This will save time (and trees)

13. Save time with "one-write" patient report cards and other forms (include "body maps"). This provides clients with an immediate and written summary of the exam room experience

14. Print 2 copies of prescription labels — one copy for the amber vial & one for the record

15. Use "special diet" and other stickers on medical record folders. Clients have a hard time remembering what food they use — how can WE remember?

16. Create check lists of topics to cover during examinations. This puts every team member on the same page and helps to create consistency of experience

17. Schedule call-back times. These may be different times each day depending upon the appointment schedule

18. Use IV fluid bags for warming patients (add color!). This is not necessarily a time-saver, but your patients will appreciate it!

19. Train clients to call ahead for supplies — food, medicine, shampoo, etc.

20. Consider Vets' First Choice or VetCentric to increase convenience and compliance

21. Create and leverage a call-back system for contacting clients and maximizing compliance

22. Use a centrally posted Year-At-A-Glance calendar to help everyone keep track of vacations, holidays, etc.

Larry Winget said, "We must make a switch from a 'client satisfaction' mentality to a 'client success' mentality." He also said, "A jerk with a bunch of client service techniques under his belt is still a jerk." Attitude is everything. "Whether you think you can or you think you can't, you're right" (Henry Ford). "Weed out the non-believers — they are neither wrong nor dumb if they don't agree with you. They're just on the wrong boat going in the wrong direction." (Bob Boylan)

The Team's Role in Enhancing Compliance

The veterinarian does NOT function in a vacuum. Enhancing compliance and patient care REQUIRES a consistent and coherent message. Credibility depends upon the client having a CONSISTENT experience with compliance messages.

The Compliance Study came from a unique partnership between Hill's Pet Nutrition, Inc. and the American Animal Hospital Association. It was a multi-year, million-dollar plus project, and the first comprehensive compliance study in veterinary medicine! It yielded statistically valid data, and illuminated that overall compliance in veterinary medicine is abysmal. Millions of dogs and cats are NOT in compliance with veterinary recommendations. The study revealed one important root of the problem — a serious "recommendation gap".

Compliance in the "old days":

Did the client do as he or she was told? A compliance failure = client failure to act. Why is this attitude a problem? In the long run, if problems are not prevented or resolved, there may be more issues to deal with. Less than optimal outcomes for the patient lead to decreased job satisfaction for the veterinary healthcare team. The pet does NOT receive the care we know is best for it — the care it needs and deserves!

Maximizing compliance and patient care means giving each client your best effort every day. Improving communication and compliance today involves two critical concepts:

One — Realizing something is important

Two — Caring enough to take action

Recommendations for How to "Close the Compliance Gap"

Steps to Improved Compliance:

1. Begin at the beginning

2. Make a decision and act on it

3. Train, train, train

4. Train some more

5. Get over your reluctance to ask clients for money

6. Track your compliance efforts

7. Get everyone involved

8. Uncover "compliance enhancers" in your practice

9. Commit to advocacy on behalf of a being who cannot advocate for itself

Step One:

Begin at the beginning. Recent studies consistently report that 75 - 80% of pet owners think of their pets as children. Don't fail to plan.

Step Two:

Make a decision — and act on It. Compliance and better patient care will not happen until you decide compliance is important. You can practice high quality medicine OR low cost medicine — not both.

Step Three:

Train, train, train. Internal communication is as important as communication with clients. Answer the questions: "How Do We Do Things Here?" and "How Do We Talk To Clients About How We Do Things Here?"

Team Training Tools


Fleas From A – Z

Ticks From A – Z

Zoonotic Diseases 101

Zoonotic Diseases 102

Companion Animal Dentistry 101

Companion Animal Dentistry 102

Canine Heartworm Disease

Hills Pet Nutrition:

Veterinary Nutritional Advocate


"Discover the Latest in Feline Urinary Care"

This CD gives access to training on over 400 healthcare CE titles offered by ACT online —

at NO COST to the practice!

Lifelearn, Inc:

CD's, DVD's, client handouts, etc.



Animal Care Training



Separation Anxiety

Multi-modal Management of OA

Adequan's Role in OA



Fundamentals of Heartworm Disease

Pet Dental Care, 1 – 4


Atopy 101

Principles of Topical Therapy


Client Compliance w/ Oral Health

The Importance of Feline Oral Health


Building Your Feline Dentistry Practice

Testing for & Managing Retrovirus- Positive Cats

Heartworm Infection in Cats

Fecal Analysis

Tick-Borne Diseases 101 (10/07)

Canine Pancreatitis (10/07)

Step Four:

Train some more. Protocols create consistency of experience — for the team, for the client, and for the patient.

Step Five:

Get over your reluctance to ask people for money! Remember, "All the money you will ever have is currently in the hands of someone else". (Earl Nightingale) Fewer than 10% of clients object to cost. Don't forget the 80/20 rule. Earl Nightingale also said, "Have fun doing what you do and others will have fun spending their money with you."

Step Six:

Track your compliance and patient care efforts. What gets measured gets done.

Step Seven:

Make compliance and improved patient care fun. Get everyone involved.

Step Eight:

Uncover "compliance enhancers" in your practice —

Reminders — written, phoned, e-mailed (up to 5 is cool)

Compliance review of medical record before client and pet arrive

Specific recommendations (oral & written) made for the best interest of the pet

Products and services that are recommended specifically are readily available to the client in the practice

(e.g. nutritional products)

Scheduled follow-up, recheck, recall, or reminder before the client leaves

Step Nine:

Commit to advocacy on behalf of a being who cannot advocate for itself. Your clients want what's best for their pets. Consider call "scripting" to recapture patients:

"We're doing a comprehensive review of our medical records and we notice that we have not seen 'Butch' for ___ months. I'm sorry that we have allowed this to slip through the cracks. We'd like to get 'Butch' back on track with his healthcare. Could we please schedule an examination for him this week?"

Don't Forget Animals With Special Needs


Diabetes Mellitus

Congestive Heart Failure

Body-changing Tumor Removal

Chronic Renal Failure






Seizure Disorder

Chronic Degenerative Arthritis

Immune-mediated Disease (e.g. discoid lupus)


Strategies for Empowering These Clients and Their Families

1. Do NOT prejudge clients and what they want and need! We are advocates for our patients. Our goal must be to help achieve balance.

2. Be knowledgeable and enthusiastic about alternatives to euthanasia when they exist. WE are the ones with the best understanding about what is possible.

3. Examine the circumstances from the client's perspective. What are the practical implications of our recommendations? Listen carefully to what clients say.

4. Anticipate questions, fears, and inhibitions. Be gentle as you create expectations. Use photo albums, drawings, and other patients when possible.

5. Be SPECIFIC about necessary adaptations of the home environment, activities, feeding, elimination, etc.

6. Include discussions about animal cancer patients and other special needs pets at regular staff meetings. Provide help with vocabulary and language — role-playing may help.

Small Kindness at Euthanasia

Giving choices about where to euthanize

Offering water or food for the pet

Tears from you

Respect and reverence for the pet's body

Petting and audible good-byes

Mentioning the pet at their next visit with a pleasant memory

Not feeling rushed

Clipping fur or creating a "Clay Paw" — or other linking device

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