Consistent, Quality Patient Care

It is crucial that employers, relief veterinarians, and part-time veterinarians hold congruent values and provide a consistent experience for pet owners. Consistency is not just a challenge for practices that use flexvets. Practices with full-time employees also have doctors unavailable at certain times, and thus everyone must be consistent in their approach. Consistency is achieved through many actions.

• Team communication is essential, including a practice manual with procedures and policies, and holding rounds at each shift change. Rounds can be a great communication tool, but can be time-consuming if not managed well.
• Hold regular team meetings. This is how people “know what’s going on.” Create the agenda ahead of time, and have meetings for the whole practice, team leaders, and teams.
• Provide a bulletin board for “housekeeping” announcements, and provide individual mailboxes (or use email) for items each person should receive.
• Assign teams (tech/doctor), which reduces resentment of “who’s getting all the help.” Rotate these pairings if resentment occurs or if there is a “favorite” doctor.
• Cross-train employees so everyone can pitch in.
• Interpersonal communication can improve with a practice “Code of Courtesy & Conduct,” which describes how you will treat one another on a daily basis. It is created by the team. Your Conflict Resolution Policy, also created by the team, describes “What do we do when we disagree?” For example, “We start with an immediate one-to-one conversation.” That may seem obvious, but talk about it!

See the book Team Satisfaction Pays for details on how to create these documents.
 

Using the Practice Manual with Flexvets

There are entire books written about what to include in and how to write practice manuals, so we will not duplicate those efforts here. However, it’s important to consider the content and use of the manual for flexvets.
The practice manual (also known as the employee or hospital manual) is an essential resource and guide for both part-time and relief veterinarians. For part-time employees, the practice manual is a binding agreement. For the relief veterinarian, the manual is not necessarily binding but should be referred to in the initial interview and looked to for any questions about overall practice policies and procedures.
The practice manual includes the processes and procedures to be followed on an everyday basis. With regard to flexvets, one crucial section of the practice manual is that covering communication.

Team communication guidelines

Your agreements about team communication may go into a practice guide or manual, not in the actual contract. However, be sure that you do discuss these items.

• How will the transition of cases be handled? What special arrangements will you make to ensure good communication? Examples: Regular meetings, time set aside for “rounds” when one person leaves and another takes over, etc.
• How will part-timers be accommodated for staff meetings? What are the PT’s obligations? The employer or team members may resent having to “work around the PT schedule” in creating staff meetings. Work together to reduce the hassle. Possible choices include rotating the time or day of staff meetings so that the part-timer is able to attend at least half of them; or, scheduling all staff meetings for times the part-timer is present; or, paying the part-timer to come in for staff meetings on their usual day- or time-off.
   

Practice Standards

Standards include surgical, medical, and service standards that are created, honored and upheld by the entire team, especially the leaders.
A consistent experience is easier to achieve if the practice has written service and medical standards. It is not necessary, nor desirable, to create a long document with lots of verbage. No one will read it! At the same time, if different veterinarians are working in the same practice, they all need to know what is expected.
Standards also reduce everyone’s liability. See the checklist from the AVMA Professional Liability Insurance Trust (PLIT) to gauge your practice, or to gauge the quality of a practice where you might work.
The AVMA and AAHA have created a variety of medical guidelines that can serve as discussion points for doctors to provide consistent medical care. See the book Client Satisfaction Pays for details about service standards.

Relief veterinarians

Ask potential employers if they have written service and medical standards. If not, then develop a list of key items to discuss prior to your work.

Part-time veterinarians

Talk to your employer about creating standards. Volunteer to participate in their creation, both to ease the boss’ work, and to ensure that your values are included.

Employers

Create practice, service, and medical standards. Gather your veterinary team to help you create or refine your practice standards. You may want to begin with a template that you modify for your own needs. The following is a rough outline of items you may want to include.
General practice standards.
Practice (operational) procedures.
Examination protocols.
Inventory management.
Medical records.
Service standards.
Client communication: Consents, releases, take-home information / education; your approach to client interactions.
Co-worker communication: Conflict resolution; code of conduct; rounds.
Professionalism and dress code.
Medical standards.
Diagnostic process or approach to common medical conditions.
Treatment of common problems.
Wellness plans: Vaccination, parasite prevention, dentistry, dietary recommendations, life stage care.
Medical procedures: Diagnostic approach; treatment of common conditions; pain management.
Surgery and anesthesia: Pre-anesthetic testing, anesthesia, surgical procedures.
Positions on convenience euthanasia position and cosmetic surgery.
Criteria for referral of cases.
 

Gauging Practice Quality and Your Liability

Any time two or more veterinarians work out of the same practice (whether as relief, part-time, or full-time), both the practice and each veterinarian take on additional liability that you wouldn’t have when working alone. That means you have to take extra care to “do things right” and to communicate with each other and with your clients. Although you should not be unduly worried about your liability, it is wise to consider particular work arrangements that might take away your ability to control your work environment. (Also see the insurance section.)
Every veterinarian has liability in working every day. The following checklists are not meant to scare you into not working. They are meant to give you guidelines to review and to determine for yourself the specific work environment in which you are willing to participate.

OSHA & AVMA liability insurance check lists

The Occupational Safety and Health Administration works to ensure all workers are provided with a safe workplace. The top OSHA violations include these critical items:

• PPE (Personal Protective Equipment) not provided (e.g., lead aprons for radiography; protective eye gear for dentistry).
• No written hazard communication program (labeling requirements, safety and emergency information).
• No fire / emergency plans.
• Employees not trained in safety and workplace hazards.
• Human food in unsafe areas.
• Improper system for waste anesthetic gases.

AVMA Professional Liability Insurance Trust (PLIT) Self-Inspection Survey

Use the following previously published AVMA “Professional Liability Insurance Trust Self Inspection Survey” to test yourself and the practice. Would a relief or part-time veterinarian feel comfortable working here? Would they be taking on unnecessary risk and liability because of the practice’s or owner’s methods and policies? Use this list to help create or improve practice standards.

• Are complete, individual records maintained for each patient?
• Are signed consent forms used prior to surgery?
• Is a separate log of controlled substances maintained?
• Are ID bands or similar ID techniques used on animals at the time of admission?
• Are owners allowed to hold their animals during examination, radiography, or treatment processes?
• Are all drugs clearly labeled with the contents and cautionary wordings?
• Are drugs dispensed in child-resistant packages?
• Are all controlled drugs stored within locked cabinets?
• Are clients made aware of possible adverse drug reactions/interactions?
• Are your employees trained in proper anesthesia recovery procedures?
• Do you routinely use monitoring equipment during anesthesia?
• Do you have a definite policy for a staff doctor to talk to clients on the phone?
• Do you have a standard or routine procedure for reporting updates and progress in patients hospitalized?
• When the cause of death is in question, is a necropsy performed by a veterinary pathologist?
• Are all floor surfaces and parking areas free of tripping hazards?
• Is proper emergency lighting available where needed?
• Have employees been instructed in proper lifting techniques?
• Are animal restraints available and used by employees?
• Are all cylinders containing compressed gases securely fastened?
• Are disposable needles used exclusively?
• Are disposable syringes used exclusively?
• Is a gas scavenging system in place to remove excess anesthetic gas?
• Is proper personal protective equipment available for employee use and is training available in the proper use?
• Is ethylene oxide used for sterilization? If yes, is proper ventilation maintained?
• Is X-ray equipment regularly inspected and tested for leakage by a qualified outside agency?
• Are lead aprons and dosimeter badges used during radiography?

Reprinted with permission.