Compliance: Concern With Conviction

The role of the health care profession in responsible pet ownership is one of being an advocate for the pet's best interest! A way to significantly enhance this role is to truly understand "compliance," and constantly seek and try ways to elevate the importance of the "compliance continuum."

Simply stated, "compliance" can be thought of as: The pet actually received the care, products and services, which the veterinarian believes is best for the pet. Traditionally, "compliance," if thought about at all in veterinary medicine was usually linked to the client, as in the phrase, "client compliance." That is: did the pet owner do what the veterinarian and health care team told the owner to do? If so, we said there was "client compliance." If the pet owner didn't do something that was recommended, we said there was "non-compliance" on the pet owner's part. For many, that may be the end of the thought process on compliance, never really reflecting on how, or even why, to make the pet owner visit more beneficial and productive.

Compliance Complacency

Some people within the veterinary profession may not believe that there are any compliance problems, and at the same time believe that they are delivering the highest quality care possible to all pets. Others may think there are some compliance problems, but only from the client perhaps hearing: "I told them a million times," "They don't listen," "Isn't it up to the pet owner?" "We're busy. After all, it is THEIR pet!" "If they don't care enough, why should we?" "They said ‘no' to that several times, though I'm not sure why. Still, I'm not going to bring it up again."

Others in veterinary practice may not have ever given the concept of compliance a second thought. As a result, some may be "compliant complacent," feeling that it is not really worth spending time on. While "compliance" may not be worth "spending" time on, it is definitely worth "investing" time in!

The Compliance Continuum

A "pet-centered" team, the "internal" team, (health care practice personnel) needs to work in concert with "external" team members, (clients, product and service representatives, etc.). When the pet owner, (part of the external pet health care team, including the entire family) brings a pet into the practice, the internal practice team needs to maximize everyone's time by communicating effectively. "Compliance" is not an endpoint when the client did or did not do something, but rather a continuum. This Compliance Continuum presents us with incredible opportunities to influence pet care in positive ways. The benefit for all involved is better medicine, which is also part of being more productive.

However, this box below depicts the potential flow of a simplified pet owner wellness visit.

Many would look at the flow above and think the compliance part rests with the client: The client either "did or didn't." This paradigm needs to be changed. From Table 1, do you see opportunities to enhance the veterinary "experience" for all involved, especially the pet and pet owner? Are there areas where you and other members of your health care team can be more compliant for the pet's best interest? As Table 1 depicts, the concept of "compliance" in veterinary medicine is a multi-faceted continuum that deserves focused attention.

Continuity of Care

In general, the fact that a pet owner brings her pet into your practice, implicitly says, "At this moment, my pet is a priority to me." In order to make the client feel that she received value, (real or perceived "benefits" greater than just what it "costs") the health care team should direct a unified effort in, "Making that pet, at that moment the team's priority too." How can that best be accomplished, especially in a busy practice?

In reviewing the steps in Table 2, and thinking through the "compliance continuum" in Table 1, review for examples of positive influence points, to see where the health care team can be more compliant, because "something is important"- the pet! In doing so, there are a variety of ways to add substantial value to the client's experience, which in turn should add value to the health and well being of the pet.

The following exercise can be conducted during health care team meetings on a variety of protocols. The result will be more synergy, more efficiency and effectiveness, and more productivity.

Pet owner receives some sort of reminder, or remembers it is time for their pet's check up.

How can the health care team positively influence?

• Send or call far enough in advance of the time for the actual exam, so the pet owner can plan accordingly.
• Let the client know you will be doing this, so they can rely on you. Emphasize the importance of such a visit.
• Be sure the reminder is impactful, (by mail, email or phone).
• Be specific about the pet's individual needs, as defined by the practice, mention key areas the team wants to reinforce, (proper pet nutrition…).

Pet owner calls the practice to set up an appointment.
Receptionist reviews appointment book, schedules a physical exam.

How can the health care team positively influence?

• Be courteous on the phone.
• Look at the pet's medical record, seeing what might need to be done in addition to the exam. Make appropriate suggestions (based on veterinarian's approval).
• Find a date and time that works well for the pet owner.
• Check about other pets the client has.
• Let the client know you'll be phoning her the day before, as a courtesy reminder.
• Suggest that the pet owner (including family) prepare questions in advance, to ask during the exam of the veterinarian and health care team.
• Mention, with enthusiasm, key areas the team wants to reinforce, (proper pet nutrition…).
• Ask/verify and pertinent information.
• Be sure client knows where practice is, and any other potential traffic problems/road construction information.
• Phone the day before to confirm appointment time, remind client of questions to ask…

Client brings pet in. Receptionist checks pet and pet owner in. Pet weighed.

How can the health care team positively influence?

• Phone the client prior to their appointment time if necessary, to inform her of any delays/emergencies.
• Have reception area in order and pleasant.
• Greet the client and pet by name. Welcome them into the practice.
• Verify any pertinent information.
• Review medical record and note any points to discuss.
• Weight pet, if appropriate. Compare to the pet's weight chronology.
• Verify what pet is being fed. RECORD in the pet's record.
• Mention, with enthusiasm, key areas the team wants to reinforce, (proper pet nutrition…).
• Make sure the reception area is conducive to learning
• Make the pet owner and pet comfortable in the practice.
• Minimize waiting time.

Client and pet placed in an exam room.

How can the health care team positively influence?

• Escort the client and pet, assisting where appropriate.
• Let the pet owner know exactly who will be coming into the exam room, (technician, veterinarian, assistant…) and when.
• Be sure the exam room is appropriate size for the pet and pet owner/family.
• Mention, with enthusiasm, key areas the team wants to reinforce, (proper pet nutrition…) providing appropriate material/information.
• If certain information is asked by one health care team member, do not ask for the same information again, unless it is to obtain additional insights or clarification.
• Record any pet information, (from observation, client comments…) to assist the veterinarian's examination/discussions.

Physical exam conducted by the veterinarian. Exam information written in the patient's record.
Recommendations made by the veterinarian.

How can the health care team positively influence?

• Thoroughly review the patient's record, noting what was recommended and completed in the past, what was declined or postponed by the client. What where the reasons?
• Review/discuss weight chronology.
• Fill out "patient report card," noting current observations, concerns, positives, recommendations...
• The information obtained is reviewed by the veterinarian and/or veterinary technician, making sure there is effective "communication," conveyed with confidence, competence, enthusiasm, care, and patience. Use good body language, visuals and other materials to "connect" with the client.
• Reinforce the key areas the health care team has been mentioning in a consistent manner, (proper pet nutrition…).
• Is the exam room the appropriate area to try and communicate? Are there minimal distractions?

Client either purchases some products and/or services at that time, schedules another visit, and/or will think about some of the products and/or services mentioned. Client returns to reception area. Pays for products and/or services bought/performed that day.

How can the health care team positively influence?

• Do not give the pet owner a "menu" of suggestions. Since their pet is their priority at that moment be sure to convey that their pet is your priority at that moment as well.
• Use the skills, talents and abilities of the team, the products and services that the practice provides, the information that the discussions and the exam has discovered and the questions the client has raised
• Be formal and don't hurry as the pet owner is leaving. Effectively communicate responsibilities where the client, ("dependent") is able to make informed decisions, based on trust. Anything else short of this often results in the pet owners NOT taking action, feeling that the importance was not communicated, it was not emphasized, not reinforced in a consistent manner by the team.
• Communicate the value of responsible pet ownership and the benefits for the pet's best interest.
• Take the opportunity. When the client does not take action the problem, (therefore the opportunity) may not be one of client non-compliance, but rather, one of client confusion. This is not to infer that the health care team should be "pushy," trying to get the pet owner to agree to something they really don't feel good about. At the same time, all the "blame" cannot be on the client. In order to achieve good compliance and application, (utilization of the practice's products and services) there FIRST needs to be communication.
• Be clear when communicating to successfully transfer and help pet owner's understand intended meaning. Clinic's have an obligation, to the pet and the pet owner, to help the client comply
• Hone the team's compliance skills to help realize that something as important as the pet is caring enough to take action and then this also can be effectively communicated.
• Follow-up by the veterinary health care team is important. If a pet owner elects to wait on a procedure or the purchase of a product, or needs to discuss things with other family members the value, the practice should have protocol in place. As part of the protocol rechecks, rescheduling and repurchase of products should be approached in the same, consistent manner to help ensure proper pet and pet owner care.

Compliance Gaps

Realizing that "compliance" in veterinary medicine is a continuum, it is much more apparent that the veterinarian and others on the health care team need to take "ownership" of the compliance process. In this process, there are "gaps" that can be identified, that if not addressed and overcome, will result in less-than-optimal care for the pet. Let's see how the continuity of care depends on the health care team's ability in caring enough to take action with effective communication.

With every "gap," there are opportunities to either close the gap in order to move on to the next step in the continuum or widen the gap, and in effect stopping the progress of compliance before reaching the preferred outcome. Client acceptance and continual use, [if appropriate] leads to better patient care.

Compliance is not simply clients accepting or rejecting recommendations. Just like "communication," compliance is a multi-faceted process which relies on a cascade of events to flow in order to achieve a positive situation for the pet's best interest. The entire health care team can play important roles in facilitating this process. The more the pet owners are comfortable with veterinary recommendations and health care team reinforcement, the more likely compliance from the pet owner will increase. Realizing this, being a spokesperson for the pet's best interest takes on even more significance!

Clarifying Concerns

Confirming that the client understands what has been discussed and recommended is critical to proper next steps in patient care. From the client's point of view, what might the following statements mean? "The teeth need attention," "Exercise her more," "Feed less," "Twice a day," "Switch her food," "Let's schedule it," "Ask the receptionist," "No food after eight," "She'll be tired," "Call if things don't improve," "We'll recheck in a week," "One cup," "Frequent," "Minimal," "Several,"

These are types of vague statements that are open to a wide variety of interpretation. Don't assume pet owners know precisely what is meant or how to do something that is asked. Make sure to clarify statements and if necessary, ask clients to put the information in their words. This will help check how well you connected, and it will help the client to be able to articulate what was discussed with other members of the family.

Finally, be sure appropriate body language, tone and sincerity are conveyed along with the directions! Provide visuals and other support material to aid in the communication process. Remember, it will be very difficult for a pet owner to be compliant with recommendations if there is either a lack of information or if there is information overload. Continually convert applicable information resources such as continuing education and VNA into education to help provide effective communication. Clients rely on the communication skills of the veterinary health care team in order to make informed decisions related to their pet's best interest.

Continually developing and refining "compliance competencies" in all members of the veterinary health care team will undoubtedly enhance pet care. While the client is the one that makes the final decision as to what the health care team can or can't do for the pet, the team has an obligation to maximize the likelihood of success by making sure that effective communication contributes to the compliance continuum. Clients are dependent on the appropriate recommendations and reinforcement from competent and confident veterinary health care team members. Don't abdicate this responsibility!

Submitted by: Chareles J. Wayner
DVM, Director, Global Veterinary Practice Health
Hill's Pet Nutrition

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