There are many tools that you can use to connect with your clients, from printed instructions on paper to text messages on smartphones. But your communication skills—your good old-fashioned barnside manner, if you will—are every bit as important to compliance, if not more so. In this article we’ll explore the effect good communication skills have on compliance and patient outcomes.
The Backbone of Compliance
Building a collaborative relationship between you and your clients motivates them to trust your recommendations and follow through with their horses’ treatment. Dr. Ann Dwyer, DVM, and American Association of Equine Practitioners (AAEP) president-elect, says it does the horse no good to have a problem diagnosed and then not get proper treatment due to poor communication. “Few things are more frustrating than noncompliance,” she says.
“Sometimes it results in permanent health problems or even the animal’s death. Clients need to ‘buy in’ to comply, be it a follow-up appointment, a management change or treatment protocol, to carry it through. They must believe it is important. This sometimes takes convincing. This takes seeing eye-to-eye, and that requires good communication.”
Dwyer adds that good communication makes a client feel good about carrying through on the plan. It affirms the client’s absolutely pivotal role in patient health.
Dr. Jane Shaw, associate professor of Veterinary Communication and director of the Argus Institute at Colorado State University, says good communication also fosters a strong partnership between the veterinarian and client, and that partnership plays an influential role in compliance. “Customized communication promotes client satisfaction and builds a collaborative relationship, which is the backbone of good compliance. The client trusts the veterinarian’s recommendations and is empowered and motivated to put the treatment plan into place.”
You can set the stage for good client communication by reflecting on your communications style and the preference of your clients. Frequently, challenges result from a mismatch in communications styles. In the “Handbook of Veterinary Communication Skills,” Shaw advises veterinarians to tailor their communication to the client’s knowledge, experience and perspectives in order to enhance mutual understanding and agreement. “It seems appropriate to incorporate both paternalism and partnership in your toolbox and to interchange your pattern to meet that of your client,” she explains. “Matching the relationship enhances the potential of achieving significant clinical outcomes, including enhanced client satisfaction, improved patient health and, as a result, professional fulfillment.”
‘We,’ Not ‘I’
One of the most significant findings from the 2003 American Animal Hospital Association (AAHA) Compliance Study (Path to High-Quality Care) was that practices confused telling clients what to do with having clients accept the recommendation and follow through on it. Similarly, the study revealed that communication failures were responsible for a large part of noncompliance. The study concluded that for successful client compliance, practices must understand the difference between telling and gaining agreement. By contrast, in the 2009 follow-up study, one practice was found to have doubled compliance by changing how it communicated the need for and benefit of treatment—from “I recommend a dental cleaning” to “We need to get these teeth cleaned.”
Another study appearing in the Journal of the American Veterinary Medical Association (JAVMA) earlier this year concluded that a veterinarian’s use of a relationship-centered care approach, characterized as a collaborative partnership between a veterinarian and a client with clear recommendations and the rationale for the recommendations, has positive implications for client adherence. The odds for adherence were seven times as great for clients who received a clear recommendation, compared with clients who received an ambiguous recommendation from their veterinarians. Moreover, adhering clients were significantly more satisfied. Although the study sample included companion animal veterinarians and clients, the results can easily be extrapolated and applied to equine practices.
Get Your Client’s Attention
Thanks to the Internet, clients are more educated, want to be more empowered, and want to play an active role in their animals’ healthcare. This opens the door for you to be a clear communicator, but that still means you have to gauge the situation to hit just the right wavelength. Dwyer explains, “You may visit a busy trainer who wants you to ‘cut to the chase’ and be efficient. You may see a horse-crazy 12-year-old girl who wants to spend A LOT of time with you. A middle-aged woman may be paying more attention to her cell phone than to her horse or you.”
Dwyer recommends tailoring your communication toolbox to accommodate the wide spectrum of clientele. She says you can congratulate the trainer on a win she had with another horse last week. Tell the child you like the horse cartoon on the shirt she’s wearing. Suggest a handy horse related iPhone app to the woman glued to her phone. “Little niceties show them you take your relationship with them seriously. Then, when you ask them to give time, energy and attention to their horse’s treatment plan, they are more apt to take YOU seriously.”
Skills and Tools
In our high-tech, gadget-of-the-month world, you can communicate with your clients using a variety of communication tools. You may be able to improve client compliance by surveying how they’d like you to communicate with them, and by instructing your staff to use as many of these ideas, with as much frequency as possible. In the 2003 AAHA study, 78 percent of clients surveyed wanted to be called about overdue vaccines and medication. Flash forward to 2012, and your clients might want to be reached via a combination of snail mail, email, telephone, smartphone or iPad.
The following case studies present real-life scenarios in which communications skills and a combination of tools worked in concert to improve compliance.
Case Study #1 When diagnostic tests revealed severe suspensory ligament desmitis and a lytic lesion in the sesamoid bone in Susan’s horse, she panicked as the university veterinary hospital relayed various options. Dr. Jones, the chief of surgery, was professional yet reassuring, recognizing the client’s emotional state. Jones told Susan, “If this were my horse, and if he were insured, and if I wanted to give him the best shot at returning to work, I would have the surgery.”
Susan trusted the veterinarian’s expertise and agreed. She referred to the hospital’s written discharge instructions papers to remind herself of what the doctor had tried to explain in person, and also used the paperwork to relay the situation to her personal veterinarian and insurance company. Post-surgery, Jones met with Susan and provided discharge papers with the week-by-week protocol for the horse’s recuperation. Susan’s personal veterinarian called her every week to check on the horse’s progress.
On one occasion, when the horse seemed to be regressing, Susan’s vet visited and took videos of the horse which he emailed to Jones. Both veterinarians conferred and instructed Susan to “stay the course.” The combination of spoken and written instructions, the genuine interest in the horse’s recovery, the frequency of contact, plus the immediacy of smartphone video transmission reinforced the compliance recommendations and trust between veterinarians and client.
Case Study #2 Joe’s horse had a sight-threatening corneal ulcer requiring six-time-per-day medication administered onto the eye, plus oral anti-inflammatory medication for several weeks. Dr. Smith knew this treatment schedule would be exhausting and confusing for the horse’s owner, so to improve compliance, she showed the client how to apply the medicine on the edge of the eyelid and then watched as the client tried it himself. Smith’s stallside verbal instructions included good eye contact to emphasize the importance of treatment to save the eye. It was stressed that “all could be lost” if the treatment wasn’t followed to the letter, especially during the first 48 to 72 hours.
Photos that were taken at the initial visit and at re-check visits were downloaded and shared via email between the client and Smith. Colored tape was placed on each treatment syringe to make it easy to identify each of the four different medications that were used, and the practice developed a color-coded spreadsheet the client could use for each day of treatment. Dr. Smith praised the client during follow-up visits, congratulating him for sticking with the plan. The veterinarian’s direct, initial conversation and demonstrations, setting expectations, backed up by a photographic journal and creative way of simplifying a complex protocol, made it easier for the client to comply with the program.
By focusing on personal communication skills, using the latest apps, and throwing in a little creativity to relate to clients, veterinarians can encourage, monitor and reinforce compliance like never before. Shaw says that in addition to fostering good patient health outcomes, strong compliance results in increasing average daily transaction fees and practice productivity.
So use all your skills and tools to your advantage, and boost your bottom line in the process.
Jane R. Shaw, DVM, PhD, is a recognized expert in veterinarian-client-patient interactions. She is an associate professor of veterinary communication and the director of the Argus Institute at Colorado State University. Shaw is scheduled to speak at the International Veterinary Communication Institute Communication Boot Camp for Veterinary Practice Teams in Ontario, Canada, in November.
Ann E. Dwyer, DVM has practiced at Genesee Valley Equine Clinic in Scottsville, New York, since graduating from Cornell in 1983. Dwyer has been one of the owners of the clinic since 1995. She is a member of the American Association of Equine Practitioners, the American Veterinary Medical Association, the New York State Veterinary Medical Society and the American Society of Veterinary Ophthalmology. Since entering equine practice, Dwyer has pursued ongoing interests in equine ophthalmology and practice management. She often shares the results of her research and expertise on these topics at national professional conferences. Dwyer served as the vice president of the American Association of Equine Practitioners (AAEP) in 2011 and is the 2012 president-elect.