Establishing Preventive Care Practice Standards
Brenda Tassava, CVPM, CVJ, VLCE, VetSupport, New Orleans, Louisiana
Between 2001 and 2014 in the United States, visits to veterinarians slipped by 21% in dogs and 30% in cats, while visits to emergency practices increased.1 This suggests owners are skipping preventive care and seeking veterinary care only when their pet is ill. The perception is that veterinary care is expensive and visiting the practice less frequently will save money. However, regular physical examinations are key to catching diseases early, which likely costs much less than treatment of a sick patient and possible hospitalization. Catching problems early also improves the quality of life for all patients.
So, how can the message be effectively communicated to pet owners that preventive care is fundamental to their pets’ health and well-being?
Send a Consistent Message
First, the message must be consistent. This begins with examining and establishing preventive care standards for the practice. Many veterinarians may consider themselves consistent in their own recommendations, but that is seldom the case even with preventive care basics. Also, the more veterinarians in the practice, the more confusing the standards may be because each one has his or her ideas and recommendations. Unless every team member in the practice is on the same page and speaking the same message in a confident, caring manner, clients will not hear the message clearly.
After shadowing hundreds of preventive care visits at dozens of practices over the past year, the author can attest to the importance of preventive care practice standards and consistent training of veterinarians and team members.
Conduct a Tune-Up
Getting the entire practice team on the same page begins with a preventive care practice standards tune-up —4 phases that will ultimately result in consistent, confident communication from every practice team member and effective client education. Before the first phase (ie, the consensus meeting), ask every team member to prepare by reading preventive care resources (see Preventive Care Resource List).
Preventive Care Resource List
Every team member taking part in the Core Standards Consensus Meeting, the first phase of the tune-up, should read and be familiar with these resources:
AAHA Dental Healthcare Guidelines for Dogs and Cats5
AAHA Nutritional Assessment Guidelines for Dogs and Cats6
AAHA/AVMA Canine Preventive Healthcare Guidelines7
AAHA/AVMA Feline Preventive Healthcare Guidelines8
Companion Animal Parasite Council General Guidelines9
Heartworm Guidelines Summaries for Cats and Dogs10,11
Phase 1. Core Standards Consensus Meeting (1-3 hours)
Keep the number attending the consensus meeting small, but include every veterinarian, the practice manager, and at least 1 member of the veterinary nurse and client care teams. Plan to spend 1 to 3 hours reviewing the practice’s current preventive care standards and discussing changes necessary to update them. The practice manager can act as the facilitator, helping assure all opinions are heard before coming to a consensus, and keeping the meeting on track. At least the following should be put in writing:
The frequency of preventive care physical examinations for puppies and kittens under a year old
The age the practice considers dogs and cats to be senior pets; a breed-specific list is especially useful
The frequency of preventive care physical examinations for cats and dogs more than a year old
The frequency of preventive care physical examinations for senior cats and dogs
Core vaccine recommendations for cats and dogs at each age range (ie, juvenile, adult, senior)
Specifics about diagnostic screenings for cats and dogs (eg, tests recommended as part of the practice’s preventive healthcare standards, age at which tests will begin, frequency of testing)
The frequency of fecal testing for cats and dogs at each age range
Parasite prevention standards, including products to be prescribed and dispensed.
Phase 2. Preventive Dentistry & Nutrition Consensus Meeting (1-2 hours)
Two weeks after the first consensus meeting, convene again to discuss preventive dentistry and nutrition in cats and dogs. Approach the conversation in the same manner, making decisions based on the team’s consistent recommendations. Put in writing the preventive care guidelines for dogs and cats for each age group and include dental reports and body condition scorecards that will help team members educate clients.
Depending on practice size, assign a care champion for each area of preventive care standards:
Physical examinations
Diagnostics
Vaccinations
Parasite prevention
Dentistry
Nutrition.
Each champion will be responsible for training the team in his or her area and providing continued coaching so team members can confidently educate clients.
Phase 3. Team Tune-Up & Training Sessions (2 or 3 1-hour sessions)
When a consensus has been reached and put in writing, conduct team training, distributing copies of the new standards and asking team members to review them. Care champions should use this opportunity to be creative and build enthusiasm for each component of the new standards.
Follow-up meetings should include communication training to sharpen team members’ skills in educating clients about the new standards. Several helpful resources are available: Partners for Healthy Pets has created Words That Work, a series of team training videos2; the American Heartworm Society provides many veterinary resources and client education materials on its website3; and the CAPC’s website includes interactive parasite prevalence maps that are useful team training tools.4
Coaching & Feedback
All the training in the world will be in vain if the team does not receive feedback and coaching (see Cycle of Service Coaching Method).
Cycle of Service Coaching Method
The author recommends the following coaching method to ensure team success.
The practice manager or team member shadowing the client and patient during the visit should get in the habit of checking the schedule and selecting an upcoming preventive care appointment for team member coaching.
A few minutes before the appointment, the manager should be in the lobby ready to greet the client and ask permission to shadow the visit. The manager should explain to the client that accompanying him or her during the visit is to provide team coaching.
While shadowing a preventive care visit, the manager should put him- or herself in the client’s shoes and listen to team members make their recommendations. It is important to observe the flow in the treatment area (eg, when samples are collected) and to take detailed notes of what is seen and heard.
The shadower should avoid interjecting or participating as a team member and interrupt only if patient care is about to be compromised (eg, wrong medication dispensed, inaccurate information).
After the visit, the shadower should conduct a 5-minute debrief with the veterinarian and the team members. Commend them for all the good things they did and coach them through any problems by offering alternative phrases or more efficient steps that would have emphasized the practice’s preventive care standards.
The practice manager should shadow 3 to 4 preventive care visits each week for at least 4 weeks after completing the tune-up meetings and training sessions. Once team members seem confident and consistent, shadowing 1 to 2 appointments each week should be sufficient. Continued shadowing provides a consistent coaching methodology and team support. Also, making it part of the weekly routine helps identify problems before they become bigger issues.
Conclusion
Giving the practice’s preventive care standards such a tune-up will not only bring preventive care visits to the forefront but will also bring team members together and increase job satisfaction when they see improved compliance with preventive patient care.