Clinical freedom vs Clinical autonomy

Re: Clinical freedom vs Clinical autonomy

J G Wray — Fri, 08 May 2015 12:58:08 GMT

[quote user="Jo Dyer"]

My thoughts on the OP:

1. Everyone likes to work in a well-organised practice, well, everyone worth their salt anyway. They feel more secure when the commonly-occurring decisions have ready-made answers e.g. parasite control, which vaccs to recommend etc. There are enough tricky decisions to be made without having to reinvent the wheel regarding the straightforward stuff every time.....

[/quote]

Thank you for your reply. We are organised with these basics sorted and in cycles or reiteration. It was the vets asking for a sort of straitjacket which engaged me and the comprehension of how best practice takes care of value and thus...

[quote user="Jo Dyer"]The next stage is to measure Net Promoter Score but I'm pretty sure it would improve that as well.[/quote]

I'm a little bit wary of customer satisfaction scoring systems, even sophisticated variants, as metrics for this because we have , as previously mentioned at least four or five outcomes to be met from a consult for instance and this only measures one.

As an aside how would you interpret the election turnout as a metric for RCVS? - couldn't resist.

Re: Clinical freedom vs Clinical autonomy

Simo — Fri, 08 May 2015 12:18:29 GMT

If the practice have the time and patience, a few meetings to put down a set of guidelines is good CPD too.

Re: Clinical freedom vs Clinical autonomy

Jo Dyer — Fri, 08 May 2015 10:51:05 GMT

My thoughts on the OP:

2. Protocols are about 'how XYZ practice does things' and include all sorts of stuff including 'how we diagnose, treat and monitor various medical and surgical conditions' and 'what we tell clients phoning in for advice about when to spay their bitch'. I presume all practices have a few at least.

3. They need to be decided by discussion with the relevant staff, mainly vets. This can be a time-consuming process! Then they need to be written down in a staff manual because otherwise everyone forgets what was agreed.

4. Of course, every animal and owner is different, so individual variations occur, but it's good to have a default for the straightforward case.

5. Most practices rely on a team. If every member of the team is doing something different it causes problems for staff, client, animal and practice. For instance, a webinar on Weds showed evidence that consistent recommendation for preventive health products improved both client compliance (and hence animal health and welfare) and practice profits.

6. Protocols are not set in stone, they are an ongoing process. They need reviewing regularly and updating with new information regarding latest evidence, products or techniques.

6. If members of your staff don't want to abide by the protocols in the main, then either you didn't get complete 'buy-in' at the discussion stage or you have a determined non-team player or players and that will need to be sorted. Some people are just better working on their own, and they have to accept that that is the only way they will get total clinical freedom.

I think that was what you were asking JGW? And yes, I have had this discussion with several teams. It has contributed to improved staff satisfaction and improved practice profits. The next stage is to measure Net Promoter Score but I'm pretty sure it would improve that as well.

Re: Clinical freedom vs Clinical autonomy

Simo — Fri, 08 May 2015 08:58:36 GMT

I guess it depends on the object of the protocols. From a locum point of view I always welcome clear protocols on the preventative care side of a practice, and probably a practice protocol about what kind of antibiotics to use as trial therapy in the most common cases is a good idea, as is a good idea a protocol for regular monitoring of chronic diseases. I feel that anything else should be left at the personal choices of the vet in charge of the case though, at most there can be an open discussion about what the best practice is felt to be by everyone but with always the knowledge that every case is different and that after all we work mostly on subjective perception.

Re: Clinical freedom vs Clinical autonomy

J G Wray — Fri, 08 May 2015 07:18:49 GMT

[quote user="Anthony Todd"]

We had a practice meeting re flea control. Decided unanimously [9 vets including me] that Advantage worked better than Frontline.

I did a massive deal with Bayer.

Sales of Frontline soared, sales of Advantage dipped.

I was accused of favouring Advantage 'cos I got a better deal......

I, myself, then had to persuade clients that failed Frontline prevention could be reversed with Advantage.

I wish I knew the secret of practice protocol compliance!

[/quote]

This is a non-issue here because we have a healthy pet club. When it comes to protocols we are starting from the other end which is getting the vets to work out why they want them. This is accountable and they will be desigining them and coming back to management with their requirements. The aim is for them to have the autonomy and control and for us to keep provifing a clear purpose, rather than it being product led or autocrat led exercise, after all we are an independent practice.....

The staff designed our HPC and our role is to keep it fresh and reiterate its purpose

The thing that surprised me was the force of vote for consistency through protocol. It was felt that best care and best practice has these hallmarks, rather than fad or personal experience or personal way of working. Mind you, we have a bunch of mature vets here and the issues of different levels of knowledge and skills aren't part of our consideration.

Re: Clinical freedom vs Clinical autonomy

Mark Hedberg — Thu, 07 May 2015 20:40:32 GMT

I googled it and have learned something magnificent today. :)

Re: Clinical freedom vs Clinical autonomy

james herriot lied — Thu, 07 May 2015 20:24:04 GMT

[quote user="Bob Russell"]

For those too lazy to look, in essence this is a polite way to suggest someone goes forth and multiplies!!

Made my day!

[/quote]

+1: mine too.

Re: Clinical freedom vs Clinical autonomy

J G Wray — Thu, 07 May 2015 19:18:50 GMT

[quote user="Bob Russell"] It is firmly logged under favorites on my computer for future use in correspondence with the tiny number of oxygen wasting complainers.[/quote]

Another useful reference for complainers is this

http://www.lettersofnote.com/2011/02/regarding-your-stupid-complaint.html

Use sparingly.

Re: Clinical freedom vs Clinical autonomy

Bob Russell — Thu, 07 May 2015 17:13:25 GMT

[quote user="J G Wray"]

[quote user="james herriot lied"]I bet the days just fly by in your place[/quote]

I refer you to the reply in Pressdram vs Arkell 1971

in the nicest possible way

[/quote]

Must 5* this response!

As an avid reader of Private Eye throughout my student days, I cannot see how I missed this response in issues. It is firmly logged under favorites on my computer for future use in correspondence with the tiny number of oxygen wasting complainers.

For those too lazy to look, in essence this is a polite way to suggest someone goes forth and multiplies!!

Made my day!

Re: Clinical freedom vs Clinical autonomy

J G Wray — Thu, 07 May 2015 12:47:37 GMT

[quote user="james herriot lied"]I bet the days just fly by in your place[/quote]

I refer you to the reply in Pressdram vs Arkell 1971

in the nicest possible way

Re: Clinical freedom vs Clinical autonomy

Luca Poddighe — Thu, 07 May 2015 12:40:03 GMT

[quote user="Martin Atkinson"]

[quote user="Hannah Wynne Richards"] I decided I was much much better off single-handed.[/quote]I did that before any discussions. I often however discuss things with myself and always find myself agreeing because I'm always right!

[/quote]

Martin you should record a webinar on how to build self-esteem... for the ones like me that need a bit of help

Re: Clinical freedom vs Clinical autonomy

Martin Atkinson — Thu, 07 May 2015 12:34:09 GMT

Re: Clinical freedom vs Clinical autonomy

Hannah Wynne Richards — Thu, 07 May 2015 11:29:55 GMT

Another who's totally failed - and the stress involved was one of the reasons I decided I was much much better off single-handed. No simple answer to that one.

Wynne

Re: Clinical freedom vs Clinical autonomy

Anthony Todd — Thu, 07 May 2015 11:21:37 GMT

[quote user="J G Wray"]Has anyone else had this discussion with their staff?[/quote]

Yup, tried it and totally failed!

We had a practice meeting re flea control. Decided unanimously [9 vets including me] that Advantage worked better than Frontline.

I did a massive deal with Bayer.

Sales of Frontline soared, sales of Advantage dipped.

I was accused of favouring Advantage 'cos I got a better deal......

I, myself, then had to persuade clients that failed Frontline prevention could be reversed with Advantage.

I wish I knew the secret of practice protocol compliance!

Re: Clinical freedom vs Clinical autonomy

james herriot lied — Thu, 07 May 2015 07:32:53 GMT

I bet the days just fly by in your place.