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Compendium February 2010 (Vol 32, No 2)

In Practice: Tools for Practice Success: Caring, Compassion, Confidence, and Communication

by Kathleen A. Bonvicini, MPH, EdD

    Effective communication is the cornerstone of quality animal care and leads to positive experiences and outcomes for patients and clients.

    Providing quality veterinary care involves more than just technical competency. Regardless of the health care needs of the patient, clear and compassionate communication on the part of the veterinary team is critical to enhancing the overall experience for the animal and the client before, during, and after the visit. Fortunately, recognition of the importance and value of communication skills in veterinary medicine has gained momentum in the past decade, supported by data and standards from sources such as the following:

    • National reports on veterinary business practices and compliance (e.g., Brakke1 and KPMG2 studies, AVMA Pfizer Business Practice Study3, American Animal Hospital Association Compliance Study4)
    • AVMA Council of Education veterinary curriculum standards5
    • The North American Veterinary Licensing Examination, which assesses knowledge of client communication skills6
    • Veterinary alumni surveys that consistently demonstrate that practice success depends on effective communication skills7–10
    • Consumer surveys indicating that animal owners look for good communication and customer service when choosing or staying with a veterinarian11–12
    • A professional association and international conference dedicated to communication in veterinary medicinea

    However, surveys indicate that although clinicians recognize the importance of communication, they have not received formal training or reinforcement in this area. The good news from 30 years of research in human and veterinary health care is that communication skills are teachable.

    The Institute for Healthcare Communication (IHC), a nonprofit, New Haven– based organization, has provided communication training and continuing education to more than 150,000 clinicians in human medicine for the past 2 decades. Since 2002, a series of educational grants has allowed IHC to expand the scope of its communication training to veterinary medicine. The Bayer Communication Project was initially developed to address gaps in veterinarian–client communication training at schools of veterinary medicine in North America.b It has since produced 12 educational modules that include teaching tools and resources focusing on veterinarian–client and health care team communication. These modules provide skill-based training on a variety of topics: building trust and rapport with clients, decision-making and eliciting owner consent, end-of-life discussions and euthanasia, increasing client adherence, the power of nonverbal communication and client relationships, difficult interactions and conflict, talking about money, sharing bad news, discussing medical errors and adverse outcomes with clients, ethical decisions and high-stakes discussions, and veterinary team building and communication.

    As part of the Bayer Communication Project, two faculty members from each veterinary school are selected to participate in a weeklong faculty training program. This program uses IHC’s train-the-trainer model and provides participants with knowledge, confidence, tools, practice opportunities, and resources for teaching communication skills within all domains of veterinary medicine. Trained actors portray clients in simulations that allow participants to practice newly acquired communication skills in settings involving a range of health care issues. To date, 209 faculty members have been trained, representing every veterinary school in the United States and Canada, as well as schools in the Caribbean, Australia, and Europe. Each school has integrated the communication modules into its existing veterinary curriculum. An April 2009 survey of trained faculty members reported that the program modules have been used to teach an estimated 9,000 veterinary students and 350 veterinary residents and interns.

    A growing number of veterinary schools have also invested in the training of additional faculty, thereby creating a critical mass of communication-proficient faculty. Leading this effort is Michigan State University, where more than 50 faculty and staff members have been trained and have hosted training programs on their East Lansing campus. The University of Calgary conducted onsite training of 18 faculty members in 2009.

    In addition to faculty and students in veterinary schools, the reach of the communication program has extended to practicing veterinary teams through invited presentations, workshops, and seminars at state, national, and international veterinary conferences. More than 7000 practicing veterinarians and members of veterinary teams in practice, research, industry, and academia have participated in these events, many of which have been sponsored by the AVMA Professional Liability Insurance Trust (PLIT). Sponsorship and endorsement by AVMA PLIT are predicated on reports that most veterinary liability claims and formal complaints are driven by poor communication between veterinarians and clients.

    Effective communication is the cornerstone of quality animal care and leads to positive experiences and outcomes for patients and clients. Conversely, failure to communicate effectively is more likely to lead to poor outcomes, such as client dissatisfaction, poor compliance, veterinary team dissatisfaction, and threats to patient safety. Skill-based communication training provides clinicians and teams with practice tools to improve client and staff relationships. It is no surprise that most thank-you letters sent to veterinarians and their teams are related to compassion and empathy shown during emergency and end-of-life discussions with clients. Caring, compassion, and confidence are what clients remember and value most.

    1. Cron WL, Slocum JV, Goodnight DB, et al. Executive summary of the Brakke management and behavior study. JAVMA 2000;217:332-338.

    2. Brown JP, Silverman JD. The current and future market for veterinarians and veterinary medical services in the United States: executive summary. JAVMA 1999;215(2):161-183.

    3. Volk JO, Felsted KE, Cummings RF, et al. Executive summary of the AVMA–Pfizer business practices study. JAVMA 2005;226(2):212-218.

    4. Rees AM, ed. The Path to High Quality Care: Practical Tips for Improving Compliance. Lakewood, CO: American Animal Hospital Association; 2003:4-25.

    5. American Veterinary Medical Association Council on Education. Accreditation Policies and Procedures of the AVMA Council on Education. Accessed November 2009 at avma.org/education/cvea/coe_pp.pdf.

    6. National Board of North American Veterinary Examiners. North American Veterinary Licensing Examination (NAVLE®). Accessed November 2009 at nbvme.org/.

    7. Butler C, Williams S, Koll S. Perceptions of fourth-year veterinary students regarding emotional support of clients in veterinary practice in the veterinary college curriculum. JAVMA 2002;221(3):360-363.

    8. Routly JE, Taylor IR, Turner R, et al. Support needs of veterinary surgeons during the first few years of practice: perceptions of recent graduates and senior partners. Vet Rec 2002;150:167-171.

    9. Tinga CE, Adams CL, Bonnett BN, Ribble CS. Survey of veterinary technical and professional skills in students and recent graduates of a veterinary college. JAVMA 2001;219(7):924-931.

    10. Williams S, Butler C, Sontag MA. Perceptions of fourth-year veterinary students about the human-animal bond in veterinary practice and in veterinary college curricula. JAVMA 1999;215(10):1428-1432.

    11. Coe JC, Adams CL, Bonnett B. A focus group study of veterinarians' and pet owners' perceptions of veterinarian-client communication in companion animal practice. JAVMA 2008;233(7):1072-1080.

    12. Case DB. Survey of expectations among clients of three small animal clinics. JAVMA 1988;192(4):498-502.

    aInternational Veterinary Communication Institute; iccvm.com.
    bFor further information about this project, visit healthcarecomm.org and click on Veterinary Communication.

    References »

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