Customer Experience (Part 2) - Client Adherence PDF

Customer Experience: Part 2 Promoting client adherence / client compliance VETS6308: Veterinary Practice Management Dr Ingrid van Gelderen...

Customer Experience: Part 2 Promoting client adherence / client compliance VETS6308: Veterinary Practice Management Dr Ingrid van Gelderen The University of Sydney Learning outcomes Understand the difference between client compliance and client adherence Understand the benefits of client compliance / adherence Recognise protocols to achieve and improve client compliance / adherence Recognise ways to monitor client compliance / adherence Image (previous slide): https://files.brief.vet/migration/article/38191/client-compliance_header-38191-article.png The University of Sydney Adherence vs compliance Adherence Compliance The extent to which a The consistency and person’s behaviour accuracy with which a corresponds with agreed patient follows a recommendations from a prescribed regimen (Shaw health provider (WHO & Boynton 2006) 2003) Authoritarian Relationship focus Emphasis on client obeying Client active in decision the vet making Inviting client to interact Giving orders The University of Sydney Page 3 Adherence vs compliance What approach would work for these two situations? Advice to a client to following a C3 puppy vaccination protocol at 6-8wks, 10-12wks and 14-16wks Advice to a client about establishing a plan for heartworm prophylaxis in a dog What statements by the vet reflect the approach that works best for the situations above? The University of Sydney Page 4 Why the difference? – Adherence focuses on relationship between vet and client – Clients who are active participants in decision making are more committed to recommendations for longer than those who are not (Abood 2007) – Many previous studies in veterinary literature have framed the vet/client relationship in terms of compliance…. But important to distinguish the difference in approaches. When would compliance be the preferred approach? The University of Sydney Page 5 Abood, S. (2007); Jevring-Back & Back (2007) What are the benefits of adherence Abood (2007) Improves client confidence – they cannot endorse what they do not understand Improved patient outcomes – quality and length of life Increases confidence that vet has in client – enhances trust and builds strong relationships Improves revenue and enhances team interactions Adherence success means everyone wins Image: https://todaysveterinarypractic e.com/wp-c ontent/uploads/sites/4/2012/01/iStock_000015645044Medium.jpg The University of Sydney Page 6 How well do clients follow veterinary recommendations? (see MacKay 2005) – Not as high as many vets think – Study looked at seven key areas (dogs and cats): seen by a vet at least once in the previous twelve months – Framed the study in terms of client ‘compliance’ Heartworm testing and prevention Dental prophylaxis Therapeutic diets Senior screenings Canine and feline core vaccinations Preanaesthetic testing – Ideal is 90-100% compliance The University of Sydney Page 7  AAHA study for companion animals Health care item Estimated Actual compliance compliance Heartworm testing 73% 81% Core vaccines 77% 87% Preanesthesia screens 66% 69% Senior screenings 43% 34% Heartworm preventive 70% 48% Dental prophylaxis 54% 35% Therapeutic foods 59% 21% 2005 American Animal Hospital Association The University of Sydney Where are vets underestimating client compliance? Why don’t clients comply / adhere? Shilcock and Stutchfield (2008) They don’t understand They didn’t listen They didn’t agree with treatment They stopped the treatment Too difficult to administer Busy lifestyle Didn’t like giving drugs Didn’t think the pet was really ill They didn’t trust the vet/practice Poor continuity of treatment/advice. The University of Sydney Page 9  The old man and cat Jevring-Back & Back (2007) The University of Sydney Page 10  The ‘natural’ horse owner Page 11 The University of Sydney Image: https://media.istockphoto.c om/photos/bonding-with-horse-pictur e- Jevring-Back & Back (2007) id1065388382?k=20&m=1065388382&s= 612x612&w=0&h=yMmzuL7yu0JjZQK0nZI8bZtZI-AAzNjui KjW6k2ToI8= Does the veterinarian or practice contribute to poor compliance / adherence? YES! Benefits of treatment not explained by the practitioner Too much / too little / no information provided Client rushed Client pressured Assumptions made about the client and their ability Conflicting messages and lack of vet continuity Little support from practice after treatment initiated Clients cannot adhere if the vets do not give them the opportunity to do so The University of Sydney Page 12 Strategies to improve compliance / adherence Clarke and Chapman (2012) – Recommendation and Reinforcement – Acceptance – Follow through Adapted from the CRAFT equation where compliance is still identified as the goal The University of Sydney Page 13 How to improve customer compliance / adherence Determine who your client is Measure current level of adherence Set protocols Staff training Reminder systems Communication Boone (2017) The University of Sydney Page 14 Improving compliance / adherence – Know your client The University of Sydney Page 15 Improving compliance / adherence – Measure current levels of adherence The University of Sydney Page 16 Improving compliance / adherence – Protocols and policies Case of the routine spay – what could be improved? Boone 2017 The University of Sydney Page 17 Improving compliance / adherence – Team training The University of Sydney Page 18 Improving compliance / adherence – Reminder systems Image: https://www.pomelohealth.ca/appointment-reminders The University of Sydney Page 19 Improving compliance / adherence – Communication Image: https://www.thesprucepets.com/things-your-vet-wants-you-to-know-1118670 Frankel & Stein (1996) The University of Sydney Page 20 Useful communication tools Signposting Be aware of verbal and non verbal cues Communication styles Treatment options Explain and demonstrate medication Summary notes for client Always provide estimates Follow calls and rechecks Clarke & Chapman (2012) The University of Sydney Page 21 Communication checklist Check client understanding Does the client have the ability to understand Can the client hear and see what is being communicated to them Can the client can administer the treatment Can the client read/understand instructions Is the information presented appropriate for this client Has trust been established Jevring-Back & Back (2007); Shilcock and Stutchfield (2008) The University of Sydney Page 22 To Summarise – Adherence is more relationship centered than compliance – There are benefits to enhancing client compliance / adherence – Client compliance / adherence improves animal welfare, enhances trust – Client compliance / adherence can be underestimated by vets – Clients cannot comply / adhere if vets do not give them opportunity to do so – Set protocols to enhance compliance / adherence – Provide training to the team – consistent messaging – Use reminder and reporting systems – Communication is key The University of Sydney Page 23  References – Abood, S. (2007). Increasing Adherence in Practice: Making Your Clients Partners in Care. The Veterinary Clinics of North America. Small Animal Practice, 37(1), 151–164. – American Animal Hospital Association. The path to high-quality care. Practice tips for improving compliance. Denver (CO): American Animal Hospital Association; 2003. – Blache, E. (2009). ‘Customer service in Equine Veterinary Medicine’, Veterinary clinics of North America, vol.25, no. 3. pp. 421- 432. – Boone, D. (2017). 2ManageVets Consulting. Compliance: A Team Effort. Todays Veterinary nurse. July- August 2017. Practice Management – Clarke, C. & Chapman, M. (2012). BSAVA manual of small animal practice management and development. Quedgeley, Gloucester: British Small Animal Veterinary Association. – Frankel RM, Stein TS. The four habits of highly effective clinicians: a practical guide. Kaiser Permanente Northern Californi a Region. Oakland (CA): Physician Education and Development; 1996. – Howard, B. (2012). Bridge the veterinary client communication gap. Veterinary Economics, 53(9), 22-24. – Jevring – Back, C. & Back E. (2007). Managing a Veterinary practice. Second edition. pp. 252- 287 – Lambert, A. (2009). ‘Increasing client footfall’. In Practice, 31(8), 406 - 408. – Lambert, A. (2013). ‘Customer-centred practice - is yours?’, Veterinary Nursing Journal, vol. 28, no. 1, pp. 24-25. – MacKay, C. Client Compliance - The Key to Successful Veterinary Practice. World Small Animal Veterinary Association World Congress Proceedings, 2005 – Morrisey, J.K. & Voiland, B. (2007). ‘Difficult Interactions with Veterinary Clients: Working in the Challenge Zone’, Veterinary Clinics of North America - Small Animal Practice, vol. 37, no. 1, pp. 65-77. – Radford, Stockley, P., Silverman, J., Taylor, I., Turner, R., & Gray, C. (2006). Development, teaching, and evaluation of a consultation structure model for use in veterinary education. Journal of Veterinary Medical Education, 33(1), 38–44. https://doi.org/10.3138/jvme.33.1.38 – Shaw J, Boynton B. Communicating with clients: enhancing compliance. Presented at the Hill’s Symposium on Dermatology. Palm Springs, California, April 2–4, 2006. Available at: www.HillsVet.com/conferenceproccedings. Accessed June 1, 2021 – Shilcock, M., & Stutchfield, G. (2008). Veterinary practice management: a practical guide. Elsevier Health Sciences. – Tiffin, R. (2005). ‘Keeping contented clients’, In Practice, 27(9), pp. 493-495 – World Health Organization. Adherence to long-term therapies: evidence for action. Geneva (Switzerland): WHO Library Cataloguing; 2003 The University of Sydney Page 24  Questions? The University of Sydney Page 25