Transcript The veterinarian–client–patient relationship

DOKTER
DOKTER HEWAN
 Veterinarian–Client–Patient relationship.
 satisfying the client, caring for the animal and
promoting professional fulfilment.
 The dynamics of the veterinarian–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 viewed their pets as family
members (Brown & Silverman 1999).
 acknowledges the 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 of their clients,
as well as those of their clients’ pets (Blackwell 2001).
 Veterinarians’ responsibilities for addressing questions
and providing client education are increased.
 Consumers are not forgiving of unprofessional services
(Blackwell 2001).
 Most complaints related to poor communication and
deficient interpersonal skills (Russell 1994), with
breakdowns in communication being a major cause of
client dissatisfaction.
 Given (1) growing client expectations, (2) the strong
attachment between people and their pets and (3)
increasing consumer knowledge demands a shift in
communication style from the traditional paternalistic
approach to a collaborative partnership.
 Many clients want to take an active role in decision
making on their pet’s behalf.
Paternalism
 the veterinary team does most of the talking and the
client plays a passive role.
 enhances efficiency and promotes time management
 the agenda and subsequent diagnostic or treatment
plan may not be shared between the veterinarian and
client
Consumerism
 the client sets the agenda 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 services on the
basis of the client’s demands.
 The challenge in this situation is to engage with the
client as a working partner and to build trust with the
veterinary team to reach an agreement between the
client and the veterinarian agendas.
 Partnership
 Between these two extremes is relationship-centred care, which represents a
balance of power between veterinarians and clients and is based on mutuality
 In the relationship-centred model, the relationship between veterinarians and
clients is characterized by negotiation between partners, resulting in the
creation 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 actively involved 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
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relationship-centred care.
There is two-way exchange between the veterinarian and
the client, identifying preferences and working towards
consensus
An interactive approach (e.g. Frisbee) is promoted in giving
information, in contrast to direct transmission approach
Silverman et al. (2005) recommend using a ‘chunk and
check’ method
The aim of this technique is to increase recall,
understanding and commitment to plans
 Provides an opportunity for the client to participate in the
conversation, provide feedback or ask for clarification.
 Taking the client’s perspective into account and
establishing mutual understanding and agreement
encourage the client to fully participate in the discussion
and commit to the diagnostic or 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 hesitant about
surgery’), asking for the client’s suggestions (‘What options
have you and your husband discussed?’) and checking for
the client’s understanding (‘What will be the most difficult
for you?’).
 Use open-ended inquiry to explore the client’s perspective
(‘How do you feel Max is doing since the surgery?’);
ascertain the client’s thoughts (‘What do you attribute to
his good progress?’); and assess the client’s starting point
(‘What do you know about the risks of arthritis?’).
 Extrapolating from medical communication outcomesbased studies, obtaining the client’s expectations,
thoughts, feelings and fears about the pet’s health or illness
enhances client participation in the appointment, with the
potential to increase client satisfaction and adherence to
veterinary recommendations (Stewart et al. 1995).
Communicating with colleagues
 Even the smallest practice will comprise more than
one individual, and once there is more than one,
communication, or lack of it, becomes an issue.
 The word ‘communication’ comes from the Latin
communicare meaning to impart, to share or to make
common.
 Words may be important, but how we treat colleagues
in terms of our attitude and our body language is just
as important.
THE TEAM AND ITS LEADER
 Every team deserves a good leader who has the vision to
see where they want to take their business, the confidence
to know that the destination they are heading towards is
the correct one, and the wisdom to know when, along that
journey, adjustments need to be made to alter course.
 Leaders must have the ability to communicate that vision
to the team as a whole and must know its constituent
members well enough to understand what motivates each
and every one of them
 destination is reached with as many of the team on board
as possible
 When team members are asked what is important to them in their job,
the following responses will usually appear high on the list of
responses:
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Confidence in the leader
A sense of belonging
Excitement in the job
 why that confidence exists:
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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 reach for a different tool,
when to apply it, and will know just the correct
amount of strength and/or leverage to apply to get the
job done.
 The leader should lead by example
 adhering to standard operating procedures (SOPs) in a
practice
 If the boss flouts the rules, then it must be okay for the
rest of the team to do likewise.
Types of People
 Anggota tim memiliki karakter dan perilaku yang
beragam
 practices are teams, however small that team may be,
and the success or otherwise of each team will depend
on, not only the individual skills within the team, but
how the team functions as a cohesive unit.
 A good team will produce results, which are
consistently better than 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 skills into the team or to
strengthen existing ones
 Communication with new employees starts at the
advertising stage.
 The interview is an important opportunity for both
sides to communicate just what is on offer from the
practice and what the potential new recruit wants.
 The interviewee should leave with a copy of the job
description and the terms of employment.
DELEGATION
 One of the key objectives of any practice owner, leader
or manager is to achieve their goals through the efforts
of others
 all too often it is a case of abdication rather than
delegation with team members being left to get on
with it with little or no instructions or backup
 The other major fault is too much interference having
delegated the task
 To achieve our objectives we have to motivate and
delegate to others
 The basic components of successful delegation are as
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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 1954 management
book, The Practice of Management:
 SMARAT are
 Specific
 Measurable
 Achievable
 Realistic
 Time-bound
 The acronym SMARTER introduces the new words,
‘extending’ and ‘rewarding’, which highlight the
importance of engaging individuals.
 SMARTER objectives can also be employed in agreeing
and setting the personal development 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:
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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 and teams but need to
be used with care
 If one wants to use money as a motivator, it should be
done with caution
 Rewarding one individual financially may incentivize
that person but may well demotivate all the others
 The criteria need to be simple, transparent and under
the direct control of the individual
STANDARD OPERATING PROCEDURES
 SOP should provide detailed written instructions to
achieve uniformity of the performance of a specific
function
 SOPs can cover such diverse topics as registering new
clients, credit policy, admitting and discharging
patients
 an SOP should have a title; the person writing it
should write down what they do and those who are
involved in that process should do what is written
down.
 it is advisable to ask those most involved in the process to have
the first stab at producing a draft.
 The draft document should be circulated throughout the team
and comments are sought before the final SOP is adopted
 The aim is to have a written procedure that is agreed and utilized
 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 displayed in 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 within the practice at
all levels
 but only if they are structured to be efficient and
effective.
 Amongst the questions that need to be answered are
the 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 reporting structure,
which is accepted and understood by the team
 The schematic or organogram should provide details
of which topics should be communicated to whom
within the practice.
 to facilitate the transmission of information, top down
as well as from the bottom up
 The schematic or organogram should facilitate any
member to request or convey information to another
individual, a group of people or to the entire team.