Veterinary compliance

Re: Veterinary compliance

Rebecca MacMillan — Mon, 03 Mar 2014 15:55:19 GMT

[quote user="Francisco Gomez"]

(And If you're an employee and disagree, use your monthly meetings to prove your point).

[/quote]

Monthly meetings?? In all three different veterinary practices that I've worked at so far, we only seemed to have one once every 9-12 months...

Re: Veterinary compliance

Utlendigur — Mon, 03 Mar 2014 15:04:43 GMT

[quote user="Anthony Todd"] as they were at the meeting that agreed it...[/quote]

Don't get me started on meetings.... the 60-90 minute vet meetings every 3-4 months where nothing is ever firmly agreed on

Might be worth another look at

www.youtube.com/watch

Re: Veterinary compliance

Anthony Todd — Mon, 03 Mar 2014 14:59:40 GMT

[quote user="Utlendigur"]This is something that drives me mad.[/quote]

+1 and vets were the most non-compliant of all. Poor management skills on my part I'd say but one expects a highly paid and qualified person to mbe able to agree, then follow age of neutering or frequency of worming etc, etc, as they were at the meeting that agreed it...

Re: Veterinary compliance

Utlendigur — Mon, 03 Mar 2014 14:19:59 GMT

This is something that drives me mad. I'm all for clinical freedom but support staff need some guidance in the routine advice they give out. Where I work we have very few protocols, and those that exist have exceptions made at the drop of a hat. Most of the time staff are told that things will be decided on a case-by-case basis, or to ask a vet. There is no formal staff training (that would mean having protocols - you can't train people unless you decide what you want them to do) and the advice clients get depends on which staff member they speak to - if they speak to more that one, they will get different - sometimes poor - advice (eg on age of neutering, overdue vaccines, worming, returns/refunds, repeat prescription checks) or staff hunting for other staff to ask - leaving a confused, sometimes angry, client losing confidence in the practice. Eg vets happy to spay bitches at 6mnths but some reception staff telling clients that bitches have to have a season first and even refusing to book pre-season bitch spays despite the client saying that the vet had advised this (and notes to same effect) We have also had a number of new staff and they struggle to get up to speed because there is no real induction and the rest of the staff are all doing things differently. I've tried to write a reception manual to try to prevent the confusion and endless trivial queries during busy surgeries, but the problem staff don't bother with it, or feel they don't need to because they were told something else 25years ago, and there is no requirement for them to do so - and no consequences even for deliberately and persistently flouting the few policies we have such as those on medicine supply. I feel utterly frustrated that the good staff are left floundering and often stressed through lack of information and support, and there is no mechanism for dealing with the "bad apples".

Re: Veterinary compliance

Mark Holmes — Mon, 03 Mar 2014 12:43:46 GMT

I agree with the benefit if protocols. If they make life easier and make some of the decision making routine it frees up time and brain space for dealing with clients and concentrating on that relationship - something which is compromised by other stuff going on in your head. There is a question of how things are handled if protocols are broken. I read the other day in a thread somebody had been subjected to a bollocking. Nothing is achieved by a bollocking which cannot be achieved by a rational conversation - other than perhaps alienating staff and building resentment.

Re: Veterinary compliance

Braden Collins — Mon, 03 Mar 2014 12:43:17 GMT

The other benefit of this sort of written system is that when we open/purchase another clinic, we can take our systems to the new clinic and have it operating at the same standards and giving the same high quality advice.

Re: Veterinary compliance

Braden Collins — Mon, 03 Mar 2014 12:34:36 GMT

[quote user="Hannah Wynne Richards"]

How on earth do you find time to actually treat the patient?

Wynne

[/quote]

You'd be amazed how much time systems like this save. Even for things that get done once or twice a year you can save a lot of time by writing down how it was done and you can then go back to it the next time and do it the same again. Great if you do focus months such as dental month. You can then tweak as needed until it is just right.

NEw staff get the list of systems and the time to read them. New staff get up to speed so quickly. Staff on reception really notice how fast people pick up on things with the systems. they don't have to keep asking other staff as they know where it is written down if they are unsure of anything.

It also means that when someone is on holidays, other staff can read the systems and cover their jobs well.

They do take a long time to write, but are really worth it.

Re: Veterinary compliance

Hannah Wynne Richards — Mon, 03 Mar 2014 12:27:11 GMT

How on earth do you find time to actually treat the patient?

Wynne

Re: Veterinary compliance

Braden Collins — Mon, 03 Mar 2014 11:54:29 GMT

This is an example of how we write our "Systems". We find this format is very easy to follow. Staff are given a copy of the system at a one-on-one meeting, read it and sign it. Once signed they are expected to follow the system. The all have a chance to give input before the system is implemented but once it is implemented it is followed. If they don't follow it there will be a please explain.

(sorry, whole thing hasn't copied but you get the idea, and "Map" hasn't reproduced properly but there is a flow diagram that should be there to show the flow of steps)

Name of System Include identification number if you use a numbering system.

PD2-14 Estimates System

Accountability Name the job position, not the individual person, who is accountable for supervising the system.

Vet Manager

Results Statement Briefly but completely describe the result (output) the system must produce.

All clients leaving their pets with us for treatment will be aware of the likely costs that are likely to be incurred in the treatment of their pets and will be aware that payment will be due at the time of discharge.

System-Wide Standards and Tracking Requirements

System Standards For the overall system, not the individual work steps, what are the output, process, and input standards that must be met?

· Every pet that is admitted to the clinic for treatment will be given an estimate which will be written on the consent form and for non-routine procedures, a copy printed and attached to the consent form

· The consent form must be filled in completely and signed by the owner or their agent who must be over 18 years of age

· Estimates will be worked out properly and include all costs likely to be incurred

· For all staff in their initial 3 month trial period, estimates will be checked with one of the partners or Head of Nursing before being presented to the client

· The client will be made aware that the price is an estimate, not a quote and therefore may change

· Where possible we will contact the client and gain their consent when the bill is going to exceed the estimate

· When the estimate exceeds the clients ability/willingness to pay, they will be made aware of the possible complications or problems associated with excluding various options from the procedure

System Tracking How will management monitor the system? What information, how often, and who gets it?

The system will be monitored daily by the surgery/inpatient vet and nurses, with any discrepancies reported to the Vet Manager

System Map

Diagnose problem/Develop Differential List

Discuss Diagnostic/Treatment Options

Present estimate to client

Ensure Consent Form is completed and write estimate on form, then have the client read through the form and sign it and/or record on clinical record for when do presents for procedure.

Modify Estimate as needed

Check Estimate with Partner or Nurse

Manager

Produce an estimate using the Estimate Function on Vetlink and the Estimate Check List Sheet and in accordance with our Best Practice Policy

During 3 month trial period

If Client Agrees to Estimated Fees

If Client Indicates that Estimate is too high for them

#	Work Step Name & Description	Work Step Results Statement	Accountability	Timing
1	Diagnose Problem/Develop Differential Diagnosis List
2	Discuss Treatment Options	Owners are informed of the range of diagnostic and treatment options available	Veterinary Surgeon Responsible. Supervised by Vet Manager	Before the consent form is signed or the animal is admitted to hospital
3	Produce Estimate	An accurate estimate of costs is produced so the client can make an informed decision taking into account costs and animal welfare considerations	Veterinary Surgeon Responsible. Supervised by Vet Manager	Before the consent form is signed or the animal is admitted to hospital
4	Check Estimate with Partner/Nurse Manager	The estimate given to the client will be consistent between staff within the clinic	Veterinary Surgeon Responsible. Supervised by Vet Manager	Before the estimate is presented to the client
5	Present Estimate to Client	The client receives the estimate and the costs are explained to them as needed		Before the consent form is signed
6	Modify Estimate as needed	An estimate is produced within a price range that the owners are willing/able to pay while the owners are made aware of the problems which may arise with the variations made	Veterinary Surgeon Responsible. Supervised by Vet Manager
7	Complete Consent form and Admit to Hospital and/or Record Estimate on Clinical Record	We will have a signed form showing the client has agreed to pay for the treatment and has consented to the procedure	Veterinary Surgeon Responsible. Supervised by Vet Manager	On admission to hospital

Work Listing

Work Step Specifications

SYSTEM NAME and NUMBER
PD2-14 Estimates System
WORK STEP NAME and NUMBER
2	Discuss Treatment Options

ACCOUNTABLE JOB POSITION

Veterinary Surgeon

WORK STEP OUTPUT REQUIREMENTS (The “results statement” for the work step)

Owners are informed of the range of diagnostic and treatment options available

WORK DESCRIPTION

· Discuss the various diagnostic and treatment options available for the presenting problem and any other issues detected on examination

· Explain the risks and benefits of the various options

· Where indicated explain the cost difference between the different options

SCHEDULE and TIMING

Before the consent form is signed or the animal admitted for treatment

RESOURCES NEEDED

None

WORK STEP STANDARDS

The clients will be able to give informed consent for any treatments or diagnostic steps undertaken

WORK STEP TRACKING

Vet Manager will discuss cases at weekly meeting

SYSTEM NAME and NUMBER
PD2-14 Estimates System
WORK STEP NAME and NUMBER
3	Produce Estimate

ACCOUNTABLE JOB POSITION

Veterinary Surgeon

WORK STEP OUTPUT REQUIREMENTS (The “results statement” for the work step)

An accurate estimate of costs is produced so the client can make an informed decision taking into account costs and animal welfare considerations

WORK DESCRIPTION

· Use Vetlink computer software estimates function, billing templates and Estimate Check List Sheet

SCHEDULE and TIMING
Before any animal is admitted for treatment
RESOURCES NEEDED
· Vetlink Software · Estimate Check List Sheet
WORK STEP STANDARDS
· All estimates are worked out using the estimate function on Vetlink, not just by giving a number from memory or a “rough guess” · The client is made aware that it is an estimate, not a quote and hence may be subject to change. We will endeavor to keep within 10% of the estimate. When we will exceed the estimate by more than 10% the clients will be contacted before further work is undertaken. · All estimates are to be recorded on the consent form prior to it being signed · The client will be made aware that payment is to be made at discharge, except where parvovirus or other severe gastroenteritis is suspected as a $500 deposit at the time of admission is needed, with payments made daily to keep the bill up to date · Animals admitted to the hospital are to have an estimate created and recorded on clinical notes and a copy stapled to the consent form. Owners will also be offered a copy of the estimate to take with them · Initial estimates are to be produced in accordance with our Best Practice Policy · If cost are likely to exceed the estimate provided, the client will be notified before additional costs are incurred where possible · If the client expresses they are unable/unwilling to pay any more than the estimate provided, they will be made aware that this may compromise treatment if the procedure becomes more difficult or complicated than anticipated · Estimates will include all costs likely to be incurred during the treatment of a condition. For example, is an animal is likely to be hospitalized overnight, the estimate should include the cost of initial treatment, a cost for the first 24 hours, and a daily cost for ongoing treatment
WORK STEP TRACKING
All vets will ensure estimates are correct before commencing work and inform Vet Manager of any problems

SYSTEM NAME and NUMBER
PD2-14 Estimates System
WORK STEP NAME and NUMBER
4	Check Estimate with Partner/Nurse Manager

ACCOUNTABLE JOB POSITION

Veterinary Surgeon in their 3month trial period

WORK STEP OUTPUT REQUIREMENTS (The “results statement” for the work step)

The estimate given to the client will be consistent between staff within the clinic

WORK DESCRIPTION

Excuse yourself from the consultation and check your estimate with the Nurse Manager or a Practice Partner before it is given to the client

SCHEDULE and TIMING

Before giving the estimate to the owner

RESOURCES NEEDED

None

WORK STEP STANDARDS

· Will be done by all staff for the duration of their 3 month trial period

WORK STEP TRACKING

To be monitored by nursing staff and Vet Manager to be informed of any discrepancies

SYSTEM NAME and NUMBER
PD2-14 Estimates System
WORK STEP NAME and NUMBER
6	Modify Estimate as needed

ACCOUNTABLE JOB POSITION

Veterinary Surgeon

WORK STEP OUTPUT REQUIREMENTS (The “results statement” for the work step)

An estimate is produced within a price range that the owners are willing/able to pay while the owners are made aware of the problems which may arise with the variations made

WORK DESCRIPTION

If the client indicates that the estimate is above what they are willing or able to pay, the estimate is to be revised to fit their budget.

SCHEDULE and TIMING

Before entering the estimate onto the consent form

RESOURCES NEEDED

· Vetlink Software

· Estimate Check List Sheet

WORK STEP STANDARDS

· The client is to be made aware of possible problems or complications associated with removing each item from the estimate

· No item can be removed from the estimate that will lead to unnecessary suffering of the animal or breach any OH&S policies

· Do not reduce estimated surgery time or the cost of procedures to meet the client’s budget. All procedures performed will still be charged in full.

· It will be recorded in the clinical notes what has been declined by the client and notes made about any warnings or discussions about the exclusions

WORK STEP TRACKING

Monitored by vets performing procedures and nursing staff. Problems are to be reported to the Vet Manager

SYSTEM NAME and NUMBER
PD2-14 Estimates System
WORK STEP NAME and NUMBER
7	Complete Consent form and Admit to Hospital and/or Record Estimate on Clinical Record

ACCOUNTABLE JOB POSITION

Veterinary Surgeon

WORK STEP OUTPUT REQUIREMENTS (The “results statement” for the work step)

We will have a signed form showing the client has agreed to pay for the treatment and has consented to the procedure

WORK DESCRIPTION

· Ensure the consent form has been completed with all details entered

· The estimate will be written on the form prior to the client signing the form

· Ensure the person signing the consent form is over 18 years of age

· The estimate will be recorded on the clinical notes

· If the patient is booked in for the procedure on another date the estimate will be written on the diary entry as well as recorded in the clinical notes

SCHEDULE and TIMING

Before the animal is admitted

RESOURCES NEEDED

Consent form from reception

WORK STEP STANDARDS

· Consent form must be filled in completely

· Estimate must be written on the form prior to being signed

· Owner will be made aware that payment is due at the time of discharge

· Consent form will be attached to the animals cage as a means of identifying the animal and showing what has been consented to

· A record of the estimate will be attached to the clinical notes

WORK STEP TRACKING

Monitored by vets performing procedures and nursing staff. Problems are to be reported to the Vet Manager

Re: Veterinary compliance

Francisco Gomez — Mon, 03 Mar 2014 11:51:24 GMT

Preventative care should be dictated by protocols agreed within the practice (And If you're an employee and disagree, use your monthly meetings to prove your point). I find it a bit patronising when it comes from the big guys that we don't know (i.e. corporates).

Decisions regarding current disease should be left for the veterinary surgeon to judge and act on this judgement (with a bit of help from older colleagues when necessary). Every patient is a different world, and treating the owners can have an important influence on clinical outcome. (I.e. If you fail to convince the owner of what they need to do, you won't win. This is difficult enough, imagine when you trying to convince them about something that you yourself don't believe in).

To give you a little example:

I was once in a pub with my girlfriend (pub of course belonging to a corporate brewery). To order a burger you had to choose a) the type of burger, b) the sides and c) the sauces. Each a, b and c will mean a different price at the end of the calculations. However, when the burgers came (each with the selected side and the selected sauce), the waitress brought with them a complementary tray of sauces (including the ones I agreed to pay for previously). This shows the 'disconnect' (OMG, how I hate that word) between the people doing the job in the ground and the people planning to maximise the profit somewhere else.

Re: Veterinary compliance

Braden Collins — Mon, 03 Mar 2014 11:45:52 GMT

It does become a major management task to make sure everyone follows protocols. I think as vets we are very bad at managing people and hence a lot of protocols aren't followed because there are no consequences for not following them. It is easier to sell clients cheaper options for example than what may be considered the best option, so many associates will do just that. If people know they will be checked and problems followed up, they are less likely to "miss things".

Of course, having systems and policies based on "best practice" rather than profit making makes that easier.

Some decisions are based on business reasoning alone, and we are open with staff about it. For example, Bayer sponsored some client information folders for us, so we recommend advocate rather than stronghold (revolution). They do pretty much the same thing, but one company has earned our business. We expect staff to sell Advocate as our preferred product and they do because they are aware of the decision behind it.