Emphasizing traditional clinical skills at the expense of the so-called “soft skills”—maintaining an ethical practice, improving interpersonal communication, managing social media, risk management— can be a mistake, however, because maintaining the business health of a veterinary practice is a necessary factor in providing the exemplary care clients expect.
“Business of Practice” sessions at the 59th Annual Convention of the American Association of Equine Practitioners on Dec. 7-11, 2013, ran the gamut of topics, from ethics to the environment, case studies to news updates, legal issues to social media, communication skills to the “best kept secret in vet school.” If a single theme emerged from these diverse sessions, it was this: Effective communication between veterinarians and their clients, whether face-to-face, via text messages or email, or through social media, is more important than ever.
Communication Skills and the Veterinarian-Client-Patient Relationship
Expectations about the fundamental nature of the veterinarian-client-patient relationship are rapidly changing, and it is incumbent upon veterinarians to adapt. Once satisfied with being lectured to by a veterinarian about the care and treatment of their animals, today’s clients often mine the Internet for information and expect to take an active role in decision-making regarding treatment options.
Jane R. Shaw, DVM, PhD, from the College of Veterinary Medicine and Biomechanical Sciences at Colorado State University, is a proponent of a “relationship-centered care model” for interactions between veterinarians and their clients. A middle ground between two extremes, one in which the veterinarian directs the animal’s care with little input from the client and the other in which the client is in charge and the veterinarian acts as an advisor, the relationship-centered model is based on an interactive exchange between veterinarian and client. Rather than simply dispensing information and advice about an animal’s medical condition and treatment options, a veterinarian seeking to build a meaningful relationship with the client should seek feedback, both positive and negative, to enhance the client’s involvement in the decision-making process.
This process, Shaw explained, can include actively encouraging the client to participate in discussions about care and treatment of the animal, being receptive to often-subtle clues about the client’s attitude, asking for suggestions, and being certain that the client fully understands what is being discussed. Benefits of a relationship-centered care model include more accurate data about the animal and its condition, better compliance with the veterinarian’s instructions, increased satisfaction for both the veterinarian and the client, and ultimately, an improved outcome for the patient.
As with most skills, effective communication requires practice and often is best learned in a hands-on, participatory setting. Two half-day sessions emphasizing communication skills were offered at AAEP: “Building Client Relationships: One Conversation at a Time” (presented by Shaw) and “How to Work More Effectively with People” (addressing effective communication skills in the workplace, presented by Kathryn Jeffers).
The benefits of encouraging meaningful communication between veterinarians and their clients are not mere speculation. Colleen Best, BScH, DVM, who works in the Department of Population Medicine at the University of Guelph’s Ontario Veterinary College, presented research identifying what equine clients want and expect from their veterinarians and suggested ways for practitioners to meet those needs.
Her session, “Exploring and Meeting Client Expectations of the Veterinarian-Client Relationship Through the Use of Clinical Communication Skills,” was an encore presentation from the AAEP’s Aug. 4-6, 2013, Business Education Meeting. Like all good information, it deserved a second hearing before a larger audience. Complete coverage of Best’s presentation, along with articles about inventory management and developing equine dentistry into a profit center for veterinarians, can be found in the Winter 2013 issue of EquiManagement. Those articles and additional coverage of the fall AAEP Focus Business sessions also can be found in the Resources>Downloads section of EquiManagement.com, brought to you by Zoetis.
Human medicine and small animal veterinary practice have generated most of the current literature addressing what clients expect from a relationship with a medical professional, Best said. Those expectations include complete information about choices and options for treatment, two-way communication with the veterinarian and discussions about the costs of various treatments. An earlier AAEP survey and Best’s own focus group research identified similar categories for what equine clients expect:
- Good customer service
- Veterinary competence
- Understanding of the financial aspects of care
- Meaningful veterinarian-caretaker relationship
- Meaningful veterinarian-patient relationship
- Effective communication
Clients want—and expect—to be understood and respected by their veterinarians. They want ongoing relationships in which the veterinarians understand their goals as riders and as horse owners, in which the veterinarians ask questions and listen to the answers, and in which the veterinarians understand and respect the undeniable bond between horses and their owners.
Best explained that building these relationships is a process that often depends on a veterinarian’s communication skills. Among her suggestions for enhancing those skills included asking open-ended questions, reflective listening, empathy, “checking in” with the client and being cognizant of non-verbal communication.
Open-ended questions are those inquiries that cannot be answered with a simple “yes” or “no.” Instead, open-ended questions start with “how,” “what,” “why,” or “tell me,” “describe” or “explain.” They demonstrate the veterinarian’s interest in the client and in the patient, and they give the client an opportunity to provide additional information. “Yes” and “no” questions allow the veterinarian to direct the conversation; open-ended questions allow veterinarians to express themselves while showing respect for what the clients have to say.
Reflective listening, a communication technique in which the veterinarian paraphrases the client’s answer, is another way to show attention and interest in the response. Best’s suggestions for keeping the conversation going in a productive fashion include phrases such as: “What I’m hearing you say is...”, “So, it sounds like...”, or “If I’m hearing you correctly...”.
Showing empathy for the client’s situation is similar to reflective listening. By recognizing and appreciating the client’s point of view, then commenting in a way that demonstrates that recognition and understanding, the veterinarian shows genuine interest, validates the client’s position and builds trust.
“I can imagine that this would be difficult,” or “I can see that this hasn’t been easy for you to deal with” are examples of statements that demonstrate empathy.
Best added that emphatic statements do not have to be reserved for uncomfortable situations. “It sounds like you’re really excited about...” shows that the veterinarian also recognizes and appreciates the good times a client might be experiencing.
Both Shaw and Best endorsed the idea of “checking in” during a conversation with questions or statements that actively seek feedback from a client. The purpose is four-fold: to keep the client actively involved in the communication process, to facilitate information gathering, to assure client understanding of treatment options and to increase compliance with the veterinarian’s instructions.
Finally, Best addressed a topic that hardly any veterinarian enjoys: talking with a client about the cost of care.
Her advice was straightforward: “Don’t be afraid to talk about money. You don’t want the bill to be the first time that the client learns how much the service really cost.”
Clients want to know all the treatment options for their animals, Best added, not just those options that the veterinarian thinks the client can actually afford. Knowing the options, the prognosis associated with each option and the costs all are necessary for the client to make an informed decision about treatment.
Horse owners today are more knowledgeable and proactive regarding their animals’ care than ever before, and fostering meaningful communications is one way for veterinarians to understand and meet their clients’ expectations. Meaningful communications between veterinarians and their clients do not “just happen,” however. It is a process that takes work. The good news is that communication skills can be learned.
Making Sense of Social Media
While there is no “one-size-fits-all” social media strategy, here are some tips on how to have a successful campaign.
Mike Pownall, DVM, from McKee-Pownall Equine Services in Campbellville, Ontario, addressed communication of a different sort in his presentation, Social Media: What We Have Learned. The social media mindscape has changed dramatically in the last four years, he said, and those changes have created “great opportunities” for veterinarians to communicate with their clients.
There is no one-size-fits-all social media strategy, however, and Pownall offered some suggestions about things that should be done before embarking on a social media campaign.
The biggest challenge that most practices face when it comes to utilizing social media is deciding who is going to do it, Pownall said. That decision, whether it turns out to be the veterinarians, staff or some combination of the two, ultimately will determine the nature of the practice’s presence on social media.
A team effort is essential, he added, and it’s important to sort out the roles practice members will have in the social media effort.
It also is important to align the goals of the social media campaign with the business goals of the practice, so that the success or failure of the effort can be evaluated. Adopting a comprehensive social media program will divert a significant amount of time away from other practice responsibilities, and a successful social media campaign will advance the goals of the business. If that does not happen, spending time on social media is a waste of valuable resources.
“The culture of the practice is critical,” he added. There are some “toxic practices” with serious personnel issues, and intentionally or not, social media will expose those internal problems to the public. “Fix those problems first,” Pownall advised, “before considering social media.”
For practical advice, Pownall ticked off a number of observations:
Facebook is king (except when it isn’t): Facebook is the most popular social media platform today, but it is not the best choice for every practice. Nor should veterinarians rely exclusively on Facebook or on any other single outlet. Utilizing several different platforms makes it far more likely that the practice’s message will reach the desired audience.
Understanding the demographics of people who visit a social media platform is an important consideration for practices seeking to reach certain audiences. It facilitates matching the message with the desired audience and, just as important, posting messages on the social media platforms that the intended readers actually use.
Video is one of the fastest growing areas of social media, Pownall said, and video posts can be an extremely effective way to communicate a practice’s message. YouTube or other video platforms that stream significant amounts of data are not good choices for practices in locales where access to broadband Internet connections is limited, however. No matter how compelling a practice’s videos might be, they will not reach clients who use dial-up or other slow Internet connections.
Pownall also explained that Facebook and Twitter are among the social media sites where the user demographics are changing in some unexpected ways. Young people are no longer embracing Facebook with the enthusiasm they once had, he said, possibly because their parents are showing up there. As a result, other platforms might be better choices for posts aimed at a youthful clientele.
“Racehorse people are on Twitter,” Pownall added. This is a surprise, he said, because racehorse enthusiasts who “tweet” tend to be older than typical Twitter users, and the breakdown between male and female users is about 50%-50%. This refutes conventional wisdom that social media appeals mostly to young females.
Demographics and popularity of social media sites themselves also are important. Relatively few people use Google+, Pownall said, and while LinkedIn is “great for getting business referrals,” the site has “has little value for reaching clients.”
Promote good posts: One of the advantages of most social media platforms is that they are cost-free for their users. There is a downside to “free,” however, for practices that want maximum exposure. For example, Pownall said that only 30%-35% of Facebook followers typically see any particular post. Facebook has several paid options for promoting a practice’s page or individual posts to gain more “likes” for a page or to increase the number of people who see a post.
Facebook also offers a paid advertising option that allows a practice to target a very specific audience, such as Facebook users who have identified themselves as dressage riders within a defined geographic area. Targeted ads, according to Pownall, are the fastest way to build a fan base. (Editor’s Note: Keep in mind that media platforms offered by others, such as Active Interest Media, are another option for paid social media advertising to a broad, yet targeted, audience.)
Know the rules: Each social media platform has rules governing how the site can be used. Facebook, for example, does not allow contests unless they follow Facebook rules, and administrators can banish users who violate the guidelines.
Timing matters: The most effective social media users post material regularly and frequently, sometimes as often as two to three times a day, including on weekends. If this sounds like a significant commitment of veterinarian and staff time, you’re right!
Pownall suggested that practices streamline the process as much a possible by developing a calendar for postings and using the slow season, if there is one, to gather content than can be used later when free time is at a premium. It is easier to make posting a habit, he said, when there is a schedule. Repurposing content from one social media platform to another can make posting more efficient.
The calendar must be flexible, however, and practices should interrupt the schedule to accommodate unexpected situations. Being responsive to events in the community provides an opportunity to educate clients about a disease outbreak, for example, while establishing the practice as a reliable source for timely and important information.
Another way to maximize the investment of time and effort involved in a social media campaign is through the use of websites such as hootsuite.com, which allow simultaneous postings to multiple platforms and advance scheduling for posts.
Finally, and oddly, the time of day and the season are among the factors that determine whether a post will be read. According to Pownall, early morning posts are read most often in the spring and summer, while fall and winter favor end-of-day posts.
Be brief: Attention spans seem to be getting shorter, and important information should be placed at the start of a post to a social media site. The same guideline applies to blogs. Although Pownall said that people generally like blogs, it is unrealistic to expect readers to scroll down beyond the opening screen to get to the meat of the message.
Keep the practice websites up to date: It has become a “Google world,” Pownall said. Clients increasingly search for products and service providers, including veterinarians, on the Internet, and practices want to be near the top of the first page of search results for maximum exposure. Fresh content, along with an awareness of search engine optimization (SEO) principles, will improve practice visibility on the Internet.
Be mobile: Sales of desktop computers and laptops are decreasing every year, Pownall said, and there is no reason to expect that trend to change. Some estimates predicted that by the end of 2014, half of the people in the United States will be accessing web content only on their mobile devices. Pownall suggested that the best way to spend money is development of a mobile version of a practice web site, a version that will display well and function properly on tablets and smart phones.
Be paranoid: What others are saying about a veterinary practice on the Internet, whether good or bad, can be as important as the information generated by the practice itself. The Internet can give disgruntled clients unfettered access to an audience that might be unable, or unwilling, to discriminate between legitimate complaints and angry rants, and web monitoring is essential to protect a practice’s reputation. Google Alerts is a free service that searches the Internet for specific terms, such as the name of a practice or of an individual veterinarian, and reports the results.
When potentially damaging posts appear, and at some point they will, Pownall’s recommendation is to ignore the obvious crank comments (which may be difficult to identify), but respond to the legitimate complaints. Online arguments should be avoided, and the best approach may be a telephone call to the unhappy client with a polite request to try and resolve the issue in the office, and offline.
Measure and test: A social media campaign is only as good as the results it produces. The bottom line is how well the campaign promotes the business goals of the practice, but that impact is not immediate and can be difficult to evaluate. Google Analytics can monitor traffic to a practice website, while Facebook and many other social media platforms offer a variety of tools that track every imaginable bit of information about the audience visiting a practice’s page or reading posts. Using those analytical tools can help a practice discover what works and what does not, while making it easier to match content to audience.
Vet “stuff” is fascinating: People like to read stories about animals and veterinary topics, Pownall said, and posts and blogs about those subjects always are popular. He cautioned veterinarians and practice staff always to respect client confidentiality, however, and suggested that clients sign disclaimer forms allowing the release of information about their animals for “educational” purposes. Even with a signed release in hand, information that might harm a client’s business—a prominent stallion’s fertility problems, for example, or an injury to a high-priced show horse—never should be made public.
Newsletters rule: When considering the myriad ways to communicate with clients, digital newsletters generate the “most bang for the buck,” according to Pownall. He suggested Constant Contact as a good platform and recommended obtaining email addresses from clients and potential clients whenever possible. Email addresses have become “more important than telephone numbers,” Pownall added.
Build a community: Social media can be about more than just advertising for a veterinary practice. The most successful campaigns inform while allowing people to engage online and build relationships with the clinic and with each other.
Building an effective social media presence that matches content with the interests of the intended audience is a trial-and-error process that requires patience, effort and commitment from both veterinarians and staff. The goals of the campaign should complement the business goals of the veterinary practice, and the ultimate measure of success is whether the social media effort aids the practice in reaching those goals. A strategy that is successful for one practice might not work for another. Posting, blogging or tweeting merely to have a presence on the Internet is not a quick fix for a practice’s problems.
Avoiding Disaster with an Email Policy
Here are five issues that you should address to keep your practice legal and communicating smoothly.
It is tempting to think that the growing emphasis on social media, texting and mobile devices has made email passé, but that is not the situation, according to Mark Roozen, DVM, a solo practitioner from Millersburg, Kentucky. In his presentation, How to Protect Your Practice from Digital Disaster: Create an Email Policy, Roozen said that email remains the primary form of digital business communication.
He warned that while email is a useful tool for the rapid exchange of information, it is a tool that easily can be abused. He urged practice owners to craft a comprehensive policy governing the use of email by clinic veterinarians and staff to protect client and patient confidentiality and to insulate the business from the actions of a disgruntled employee.
Roozen identified five issues that should form the basis of a sound email policy: 1) ownership of the practice computers; 2) ownership of emails sent by vets and staff; 3) email privacy; 4) retention of emails; and 5) proper email content (what Roozen calls “netiquette”).
Office computers and the associated hardware and software typically are the property of the practice that purchased them. The same holds true for cell phones and tablets purchased by the practice and provided to veterinarians and staff for business use, whether in the office or in the field.
Establishing ownership of office computer equipment is important because the practice owner has the right to monitor information and data stored on the electronic devices owned by the business. If the practice allows non-business use of office computers by employees, that policy should be clearly defined and reviewed by all employees.
The second component of an email policy is a clear understanding of who owns the emails generated and sent on office computers. Roozen advised that the default position should be that every email created on the office computer system is a business communication that is the property of the practice. This is true whether the practice email system resides on an in-office server or on a remote server such as Yahoo, Gmail or AOL.
The situation can become more complicated when, with or without permission, an employee creates and sends a personal email during work hours, while using the practice’s computer. Such emails are the property of the business in many, but not all, situations. If clinic policy allows employees to create personal email accounts within the office system, such as Microsoft Outlook, for example, personal emails sent through the account remain the property of the be abused. He urged practice owners to craft a comprehensive policy governing the use of email by clinic veterinarians and staff to protect client and patient confidentiality and to insulate the business from the actions of a disgruntled employee. If the employee is using office computers to access a personal email account based on a remote server, on the other hand, a strong argument can be made that the email is the property of the employee and not the clinic.
Establishing a policy for personal emails created on office computers can eliminate confusion about whether employees have any property rights in their emails.
In many clinics it is standard practice for associate veterinarians to use their personal cell phones and service agreements for business communications. While this policy might be more economical for the practice in the short run, there are potential problems because it is not clear who actually owns, and can monitor, the business emails. One option is for the practice to provide cell phones and tablets for out-of-office use by associates. Another option suggested by Roozen is to establish clinic ownership of business emails created on personal mobile devices through a contract negotiated with the employee.
The third element of a sound email policy involves two related privacy issues: client/patient confidentiality and employee privacy.
The importance of maintaining the confidentiality of medical information should be emphasized to all persons associated with the clinic. Email ownership by the practice does not eliminate the responsibility of every person who has access to client/patient information to keep it confidential. One way to be certain that confidential information is not being released inappropriately is to monitor the clinic email accounts.
Roozen did not suggest that clinic owners monitor those accounts on a daily basis, even if they have the legal right to do so, but he said that employees should understand that they have no expectation of privacy in emails they create on the business computers.
Retention of business emails—which communications to delete and which ones to archive—is the fourth consideration when establishing an email policy for veterinary clinics. One option is to save everything, but the sheer volume of email traffic that most clinics handle makes this choice unwieldy and usually impractical. Instead, Roozen suggested purging emails on a regular basis. He said that a 90-day time frame seems to work for most clinics, although he cautioned that any emails that might be related to either pending or threatened litigation should be retained until the matter is finally resolved. One benefit of establishing a regular schedule for email destruction is that it helps eliminate the implication that potentially harmful information was destroyed in anticipation of a lawsuit.
In addition to establishing a regular schedule for purging emails, a retention policy should include guidelines identifying information that should be extracted and saved before the emails are deleted. Roozen suggested that relevant client/patient information should be moved to the correct patient folder and that information related to clinic business should be stored (either electronically or in hard copy) in the proper activity folder.
Finally, Roozen recommended that an email policy should include guidelines about both appropriate content and acceptable writing style for business emails. While this might sound like nitpicking, he said that every email generated by a veterinary practice reflects the “brand” of that clinic, and that an email laced with spelling and grammatical errors indicates a lack of professionalism that might discourage clients from using the clinic.
Email communication is a necessary part of today’s business environment. A sound policy that governs the use of office computers and establishes email protocols can help protect the practice from employee abuse and liability, while giving the practice an image of professionalism. Whether incorporated in an employee handbook or drafted as a stand-alone document, the email policy should be reviewed with everyone in the practice.