March 23rd is National Puppy Day. The goal says the National Puppy Day website, is “to help save orphaned puppies across the globe and educate the public about the horrors of puppy mills.” Begun in 2006 by author Colleen Paige, it has been adopted by a wide range of agencies and organizations to celebrate the unconditional love that puppies bring to people’s lives.
The ways to observe the day are limitless. This year, we’ve culled the many ideas supplied by readers to the most responsible ones. But there’s no reason not to add in a few puppy parties, new toys, family vacations, and pup portraits.
Adopt a puppy from your local shelter, rescue or pure breed, certified rescue organization.
Donate, donate and donate some more. It doesn’t have to be money—food, gently used bedding, toys, leashes and collars, etc. are always appreciated by shelters and rescue organizations.
Contact your Congressman and request support to ban your state’s puppy mills.
Know a sick or elderly person? Take their pup for a walk that will make you both feel great.
Host a community event to raise money for your local animal shelter.
Volunteer at your local shelter and offer the help they need.
Puppy-proof your home and yard.
Install a car safety harness to keep your puppy safe during travel from
From the first bark, make sure that your garden is puppy safe from toxic plants and materials.
Buy a puppy gate to keep your puppy out of hazardous areas of the home.
Microchip & I.D. Tag your puppy so the shelter can locate you if he gets lost.
Make sure you have all required vaccines and a regular health exam.
Buy a canine first aid kit and put it in your car in case of injury while away from home.
Teach your children and their friends to be kind to your puppy by never pulling on his ears or tail.
Take your puppy to an elderly community and spread some love.
Install a fence around your unfenced yard so your puppy can run and enjoy some freedom at home.
Inspiring quotes about man’s best friend
Happiness is a warm puppy.
-Charles M. Schulz
Dogs never bite me.
The average dog is a nicer person than the average person.
Money can buy you a fine dog, but only love can make him wag his tail.
The more boys I meet, the more I love my dog.
Don’t take a puppy for granted
Having a puppy is like having a baby or child. They need your time, attention and effort.
Socialization is the key to a happy puppy and, ultimately, a balanced dog. They need to ply with other dogs. They need to be comfortable around people other than you.
Spay or neuter your pet. Let’s break the cycle of “throwaway” dogs.
And remember that puppies grow up. Too many animals are given up when they outgrow the puppy stage of life. If you’re ready for a puppy, go for it. What better way to celebrate National Puppy Day with a new four-legged friend.
Vet X-ray by Thomas E. Catanzaro, Dvm, Mha - 3d ago
As Americans, we often rally around symbolism, we believe in the effectiveness of a logo to establish a community identity. Most salute the Stars and Stripes. In California, the “bear” flag flies with pride. What is the “flag” that flies in your veterinary practice? What are the pride factors? Why do many Australians think the USA is “over patriotic?”
The “client-centered” habits that build most practices during those first few years after the doors opened soon shift to a “bottom line” fixation on the Profit & Loss statements. Then the “flag” of caring for clients often changes to caring about the average transaction fee and gross sales (neither of which have a “net income” insight). The staff starts to fret about their “bonus” rather than client satisfaction. The veterinary practice of the new post-GFC era must do more with less (the bull market is soon due for an “adjustment). The margin of profit has dwindled. A business cannot spend the gross, it can only spend net! The reason for the dwindling net varies with the practice from increased community competition, to veterinary price wars, to poor management techniques, to under-utilized veterinary extenders. Regardless of the cause, the best tools available to change trends are the human resources within the practice. Veterinarians work hard to produce the gross, but the paraprofessionals are the ones who can easily increase the practice net.
BUILD A NEW PRACTICE FLAG FOR TOMORROW
Every practice owner can change their “practice flag.” It is more than a slogan like “Sharing the care” or “We care for pet as if it was our own.” It should be based on a systematic approach to quality health care, continuity of care, and use of veterinary extenders. Veterinary extenders are simply those people or things that give the veterinarian more time for patient care, whether they be forms, policies, computer assisted education devices, or veterinary nurse technicians who provide quality patient and client care. Let’s look at a few of the elements that need to be included in a quality practice “F-L-A-G”:
Followers – every team requires players, else you cannot call it a team – they must
be willing to play by the rules established for the game.
Leadership – every team needs someone to make the hard decisions, set the pace,
and provide the feedback on activities.
Attitude – the attitude of concerned excellence must be seen at all levels, from the followers to the leaders, and must be positive to be successful.
Goals – any team needs to know where they are going, the end point where they can be recognized for making a successful score.
Believe it or not, psychologists tell us that 50 percent of the American work force have the personality that prefers predictable, steady, routine work. Another 16.3 percent of the American work force prefer life styles that are very concise and structured, and a work place loaded with policy statements and procedure manuals. This provides the veterinary practice manager a two in three chance to select a process-oriented follower when they hire people to be on their team. By definition, these type followers must have a savvy leader to be effective and comfortable within their work environment.
The follower (USA, Australia, New Zealand, Commonwealth, etc.) needs to know what the expectations are, where the practice is going, or simply, what determines competence; they do not like rapid, unpredictable, operational changes. The basic issue in healthcare delivery must be competency; training, recurring training, and is required for peace of mind. They need to have a clear “flag” to rally behind. The performance range is not excellent, outstanding, good, fair, weak, or poor; competency is excellence in healthcare, and nothing less is adequate. Every text in human healthcare delivery says a single standard of performance is necessary and, within our consulting programs, that is called “competency” [Building the Successful Veterinary Practice: Programs & Procedures (Volume 2), Chapter 6]. If a staff member is below competency, they “need training”. If they are truly incompetent, they need to be dehired (fired for inability to learn)! Above competency, which must already be excellence (considering the forensic nature of healthcare delivery), is a category we call “ready to train others.” This category recognizes the training ability of the best followers to help improve their team members’ performance. There is a monograph in the VIN Bookstore addressing this Performance Planning Process and offers the forms needed for quarterly self-assessments and goals setting.
Members of a veterinary practice staff want to believe they are in a caring profession, they want to be recognized as being the best in healthcare delivery. When staff members know they share the practice philosophy and vision, that they are meeting these needs, they know they follow the practice standards (flag) of the owner or veterinarian. These philosophies are core values of the practice and apply to everyone. When decisions are made by staff members using these core values, only accolades should occur. No one should ever feel the standards or values are inconsistent. These are the “flag” characteristics of a quality practice and are the keys to practice leadership and team building.
Sharing the dream and vision is one method to build a common team effort. Being fair is impossible, since fairness is in the eyes of the beholder. The good leader ensures that staff is treated in an equitable manner. Stars will be treated differently from the rookies just joining the team, client relations specialists are limited to duties different from nurse technicians, and owners have privileges not available to associates. Equitability is most often defined in the work place as predictability, being able to depend on the veterinarian for support of the practice standards, even if it upset a client. If the doctor learns to say, “I’m sorry, it was my fault, we initiated that program to help the majority of our clients; I’m sorry we hadn’t planned for your situation…”, then the staff will feel supported by the leader. As the boss treats the staff, so will the staff treat the clients. The leader’s vision and dream will be supported when the team is led by example (Building the Successful Veterinary Practice: Leadership Tools (Volume 1), Appendix B, 14 leadership tools are outlined; they should all be understood and in use on a daily basis by every practice manager and leader).
The simple rule in leading a team is, “Whether you think you can, or whether you think you can’t, you will make it come true.” The positive attitude builds on the strengths for which each individual was originally hired. We don’t hire people for their weaknesses. The positive attitude says team members were hired to solve the problem, not wait to see what the rest of the people are going to do. The positive attitude is patient advocacy, a quality of care issue, speaking for the needs of the pet and letting the clients get involved in the economic decisions whether or not to access that level of care for their pet.
A great practice attitude is remembering that the only team members who stumble and make mistakes are those who are moving and trying something new. This is a characteristic of learning. Those who never make mistakes and never stumble are standing still and playing it safe. This is not a practice growth posture. The “uncommon leader” will see a mistake and identify it as a training shortfall of the practice; traditional managers just try to assign blame for the mistake. When building a team “flag”, catching people doing things right is more important than catching them doing things wrong.
Everyone wants practice growth but there are many who do not realize that direction is needed for an orderly team advancement. While many practices say they have not had the time to define clear, concise, and embraceable objectives, they have concurrently made the time available to train new staff members on a recurring basis. High staff turnover is often symptomatic of a staff who does not identify with the practice standards. With each training cycle required for new employees, the time taken to build the standards (flag) usually gets shorter because of subject familiarity, degradation because of word-of-mouth concept transfers, and staff shortages.
The foundation of “standards” and “goals” during delegation will be the core values; beliefs and attitudes that are inviolate, by anyone, even the boss. Clear core values allow others to make decisions based on those inviolate standards, and they know their protection from “blame” is always basing the decision on the core values of the practice.
Every team must have a goal, whether it be goal posts, a basketball hoop, scoring the points, or making a touchdown. All team sports have expectations that are clearly defined, from what they wear to the size of the playing field, to how they are to treat others while they try to score. The team captain and the coach tell the team what is expected and how they are to work together to make the score. Some teams need more direction than others. Great goals and team building can start at these sport analogies, but they also go beyond these boundaries. A practice team must be in for the long haul, not a four-hour game of youthful endurance. A good leader keeps the goals and objectives clearly defined and in front of the team. The purpose of the goal is well explained to add the power to the motivation. A great leader also puts himself into the team’s shoes and tries to see the challenges from their perspective. The alternatives are selected from reality and the strengths of the team, not dreams and wishful thinking.
PRODUCTIVITY AND QUALITY
The US and Australian economy is volatile and recovering, and only clear leadership can affect the trend. In the early days, small groups worked together to produce a product or deliver a service. They rallied around a tribal banner. Look to the caveman heritage of hunter/gatherer that led to the development of small community groups seen only a few hundred years ago to see the genetic imprint we carry (University of Minnesota research says 50 percent of personality is genetic):
The fleetest of the group became the scout/chaser.
The keen eye became the tracker/spotter.
The most skilled archer or spear-chucker was the hunter.
The hunters discussed the method to track and attack the prey, our species survival strength was in the coordinated effort of the team.
Each person was used for their strength and was not elevated to another position on the team just because they had been on the hunt before.
Those who did not hunt, gathered the resources needed to support the hunters.
Gatherers developed skills (baker, shoemaker, blacksmith) that could be bartered for other food stuffs.
Then the industrial revolution came and we moved to a system where hundreds were doing the same mechanical thing. Corporate logos replaced tribal banners. We lost the ability to speak within the total group. Each worker became a number on a massive assembly line, each person was protected from individual responsibility for the quality of the finished product. Labor unions were developed around the concept of the workers’ take-home pay and benefits rather than the quality of the finished product. In the same method, education became an assembly line basis. The three Rs taught at home or in the village school for proficiency gave way to the public/private school system, with grades awarded to increase the evaluation capabilities. Why should there be losers and winners in education?
It would be unrealistic to expect a national reversion, but things can be changed to increase personal responsibility at the practice level again. Take the competition out of the life of students and workers by eliminating grades as well as merit pay would devastate the average American. Teach team cooperation and goal achievement can be implemented concurrently with existing programs, and eventually, people will shift their paradigms based on the management 3Rs (Respect, Responsibility, Recognition) being equitably applied on a daily basis. Giving workers the opportunity to do their job right means giving them the charter to make it better each day (CQI). Put solid values and standards into the framework of your practice image (flag) and promote systems that will bring achievement and recognition back into the practice.
The methods and philosophies to use have been tested and promoted by W. Edwards Deming, the driving force behind Japan’s economic growth. In fact, the highest award that the Japanese developed to recognize outstanding quality is called the “Deming Prize for Quality Control.” James Barksdale, Chief Operating Officer of Federal Express, states the only permanent piece of paper on his desk is the Deming management principles. We know from Tom Peters that Federal Express has developed a cutting competitive edge by empowering their people to act for the good of the company WITHOUT prior permission. This is the human resources commitment that underlies the American industrial success stories of all the leading companies of the 1990s; these commitments to human resource excellence will become the mandate in the new millennium for every business.
While the western industry standards declined, W. Edwards Deming was the moving force to establish quality as an industry standard in Japan. I have taken the liberty to slightly modify the original fourteen management principles developed by Deming and come up with key elements for veterinary practices.
DEMING’S STEPS TO QUALITY MODIFIED FOR VETERINARY PRACTICES
Create a constancy of purpose (innovation, research, education, and continuous improvement and maintenance) for the improvement of healthcare delivery and client-centered service to become competitive, stay in business, and provide jobs.
Adopt a new philosophy of total quality management that matches this economic age; reliable quality service reduces costs. Awaken to the professional competitive challenge, learn the practice management responsibilities, and address the internal leadership that can be used to make changes occur.
Cease dependence on mass inspection (inspect bad quality out); eliminate inspection for mistakes. Start to build new quality in; effectively train with caring and help them to learn to do it right the first time.
End the practice of awarding business on price tag alone, the mind set contaminates internal operations.
Putting out fires is not that important in the grand scheme of CQI (continuous quality improvement). Collectively and individually, improve constantly and forever the system of production and services.
Institute training and retraining by skilled and knowledgeable trainers; it is very difficult to erase improper training.
Institute leadership; discover the barriers that prevent workers from taking pride in what they do and eliminate the causes. The aim of leadership should be to help the paraprofessional staff to do a better job.
Drive out fear! Preserving the status quo is safe, secure, and an economic disaster; admit mistakes, allow people to take risks, build on discoveries rather than habits.
Break down all barriers between front and back staff; management creates the teamwork responsibility system rather than dividing the blame.
Eliminate slogans, exhortations, and numerical targets for the work force; center on quality of healthcare delivery. If they can’t reach production targets, they will come to ignore them.
Eliminate the numerical quotas and quantity goals based on other people’s performance within the practice or veterinary industry; they impede quality more than any other single factor. Define the expected quality and promote personal pride, not numbers.
Remove barriers that rob staff of their right to take pride in their workmanship and performance; people are hired because they are motivated, build on this trait.
Institute a vigorous program of paraprofessional continuing education (on-site and at central meetings), self-improvement and retraining; the education must fit people into new jobs and responsibilities.
Take action to accomplish the transformation; put everybody to work to accomplish the practice transition. Use the PDCA cycle: Plan, Do a test/trial, Check results, Act).
Deming states that the above concepts, used together, will result in a continuous quality improvement (CQI), but it takes management courage.
RALLY AROUND THE FLAG
George M. Cohan brought a flutter to the heart as he sang, “It’s a grand old flag . . .” and you can do it for your practice. You must build the emotions of support, which requires sharing personal beliefs and a personal commitment to the staff and their goals. It requires stretching beyond personal comfort zones, and taking off your shoes BEFORE you try walking in their shoes. As a backpacker, I can tell you, it is not the height of the mountain, but rather, the grain of sand in your shoe, that prevents the successful assent. Since the practice leader is the key to success, here are less than half a dozen factors that you need to do. “Taking off your shoes” is not always the easiest thing to do. To make success happen, establish the core values as inviolate standards, and then:
You must understand that the needs of staff members (not their wants) must
be met before they will be dedicated to meeting the demands you have for the practice.
You must find what excites each person (their “hot buttons”), what they want to achieve, how they want to contribute to the practice.
You need to tailor your staff utilization plan to the strengths of the team members, allow them to build on their own strengths.
You must be willing to build on small easy successes before you attempt those big challenges (baby steps for those who like the comfort of the status quo).
You must be willing to commit resources to build their individual self-image before they will buy into saluting the practice standards and philosophical “flag.”
SETTING THE VISION
The vision for the team is the reason for the rally. We go beyond client-centered when we empower our staff to operate independently. Authors like Deming, Juran, or Crosby have used the phrase TOTAL QUALITY MANAGEMENT (TQM), but in healthcare delivery that becomes a misnomer. It isn’t a management system, it is a provider-driven process. A process of each member on the healthcare delivery team striving for continuous quality improvement (CQI) in the areas they touch.
The concept of Continuous Quality Improvement (CQI) is not unique to veterinary medicine. It has been taking hold in the human healthcare arena for the past decade-plus. It is based on core values, pride in performance and clear expectations by management. When pride is the input desired, then quality becomes the output. If the practice builds the team and promotes the personal accountability (pride) as key elements of performance, then the quality outcome is free.
There are many reasons to build a team “flag” and to pursue continuous quality improvement, but the bottom line is that it rewards our staff. It is a factor to increase net, and the net can be shared with the team, but the recognition and pride in personal performance becomes a stabilizing factor in the work force. With the low wages veterinarians usually pay, and the dedication of the staff who join the team, the ability to reward and recognize makes the difference between turnover and tenure. Look to your practice image, internally and externally, and see if it is something others can rally around.
Both clients and staff want to believe in the quality of care, and want to feel safe about the expectations they carry concerning the practice. Build to that level of consistency and continuous quality improvement and the staff will be proud to represent the practice. When the staff is proud, the clients become proud. When the clients become proud, the market niche will develop within your community.
A new federal standard designed to protect the safety of health-care personnel who handle hazardous drugs has sparked confusion and concern among veterinarians who fear that the change will complicate their jobs.
Proof-of-concept study reveals feasibility of eliminating rabies in Africa By: Institut Pasteur
Scientists have carried out a mass dog vaccination in Chad and determined its effect on human rabies exposure.
A helping paw: comfort within crisis
By: Hannah Wagle, Assistant Content Specialist
In the aftermath of a tragic event or natural disaster, Lutheran Church Charities’ K-9 Comfort Dog Ministry helps bring light back into the victims’ dark world.
Why using ‘baby-talk’ improves our bond with dogs By: BBC News
Using “dog-speak” is important in building a bond between a dog and their owner, scientists from the University of York have found.
Otitis Externa: Inflammation of the Ear Canal By: Sandra Grable, AAS, CVT
The many factors that can contribute to otitis need to be addressed so that initial infections do not progress to chronic changes, such as irreversible structural damage to the ear canal and cartilage.
The feline facets of Cushing’s disease
By: Sarah J. Wooten, DVM
Unregulated diabetic? Fragile skin? Recurrent UTIs? Your feline veterinary patient might have Cushing’s! Dr. David Bruyette shares everything you need to know about diagnosis and management of cushingoid cats.
Surgery STAT: Don’t forget nutrition! Placing esophagostomy tubes in cats By: Marc Hirshenson, DVM, DACVS, American College of Veterinary Surgeons
This simple procedure ensures adequate nutrition for postsurgical feline veterinary patients-which can speed recovery time and minimize hospitalization.
Feds Address Horse Industry Concerns About CDL Requirements By: Edited Press Release
The American Horse Council requested clarification from the FMCSA regarding commercial driver license regulations. Read More
EIPH in Barrel-Racing Horses
By: Kentucky Equine Research Staff
Though EIPH is most closely associated with racehorses, researchers recently set out to determine the prevalence of the disease, also known as bleeding, in barrel-racing horses.
What’s old is new: A new horse genus emerges through DNA analysis of North American fossils By: Jennifer Gaumnitz, Senior Content Specialist
The equid family tree was shaken up in a recent study by an international research team.
Arizona Horse Diagnosed With EHM
By: Michelle Anderson
The Quarter Horse gelding attended cutting events in Las Vegas and Arizona in the month prior to developing clinical signs. Read More
Veterinary coalition looks to study access to care By: Veterinary Practice News
Group hopes to identify barriers that families face as well as best practices in delivering veterinary care to underserved pets
Two tricks to create less waste
By: Heather E. Lewis, AIA
Cutting down on waste is possible for anyone, including veterinary professionals. Here are some quick changes you can make to reduce the impact at your practice.
By: Thomas E. Catanzaro, DVM, MHA
The team-based healthcare delivery system allows doctors to be far more productive, while establishing pride and productivity at the staff level; this is a true win-win format for veterinary practices
Topical, pill or chewable? Pet owners weigh in on preventives By: Sarah Mouton Dowdy, Associate Content Specialist
At Fetch dvm360 in San Diego, we wanted to know the real reasons veterinary clients choose one route of administration over the other.
Come to our booth for demos and special pricing
According to the American Animal Hospital Association, oral tumors are the fourth most common type of tumor in dogs. These growths come up from both soft tissue and bony structures within the mouth and, less frequently, the tongue and tonsils. They can be benign and cured surgically, or malignant and require more aggressive therapy including chemotherapy and/or radiation surgery. General categories of tumors include the epulides (fibromatous, ossifying, and acanthomatous), locally invasive malignant tumors (fibrosarcoma, soft tissue sarcoma, and squamous cell carcinoma), and malignant tumors that have a higher rate of spreading (metastasis) to other parts of the body (melanoma, osteosarcoma).
Depending on size of the mass and its location, a fine needle aspirate or wedge (incisional) biopsy may be performed under general anesthesia. Sometimes these biopsy tests are inconclusive or less-than accurate; only after the entire tumor is removed and studied by a pathologist can a final diagnosis be made. Chest X-rays are used to identify any visible spread of the cancer; unfortunately, microscopic spread of the tumor to other organs cannot be detected with this examination. X-rays of the tumor site may help determine if the tumor has invaded into the bone. A CT scan of the jaw may be recommended to additionally evaluate the extent of the tumor. Enlarged lymph nodes will be checked for spread of cancer via biopsy. A complete blood count, biochemical profile and urinalysis are performed before surgery to check internal organ health.
The goal of surgery is to remove the entire tumor with the likelihood of treatment achieving a cure and the fitness of the patient (curative intent). Removal of any part of the upper jawbone is termed a maxillectomy. Removal of any part of the lower jawbone is termed a mandibulectomy. The amount of the jaw that is removed is dependent on the size and location of the tumor. There can be instances where massive amounts of the upper jawbone need to be removed or when one side of the lower jaw is completely removed. Despite removing such a large portion of the jaw, the cosmetic outcome is very good in the majority of cases.
If your buddy has a tumor that tends to spread (metastasize), chemotherapy will be recommended and administered every third week for a total of five treatments (ncbi.gov). Unlike humans, most dogs do not lose their hair and generally suffer only mild side effects, which may include transient loss of appetite and vomiting. Certain types of tumors cannot be cured with surgery alone; therefore radiation therapy is needed to help delay the redevelopment of remaining cancer cells in the mouth. As a rule radiation is administered daily for 5 days per week (2 rest days) until 18 to 21 treatments have been completed.
The prognosis for your companion is dependent on size, location and biopsy results of the tumor. In general, tumors located on the front part of the jaw have a better prognosis. The oncologist will discuss your dog’s prognosis and the need, if any, for additional treatments after the final biopsy results are available.
Surgery—will result in soreness and may result in difficulty chewing as compensation for the loss of teeth and bone. Soft food is recommended at the start, and the owner may need to hand feed small amounts.
Chemotherapy– injected into the tumor can also cause the mouth to be sore and possibly bleed. Soft food and/or a special diet may be recommended. NOTE: Chemotherapy often does not have a curative effect, but it may slow the growth of the tumor and help to make your dog more comfortable (National Canine Cancer Association).
The content is not medical advise, nor is it intended to be a substitute for veterinary treatment or care. First, consult with your veterinarian before use.
Vet X-ray by Thomas E. Catanzaro, Dvm, Mha - 1w ago
Receptionist, secretary, or a client relations specialist, the person(s) at the front desk of a veterinary practice controls the most important business asset: client access. They have been trained to be the “caring heart” for patients not recently presented by the client; they can talk the walk at a minimum! Training and nurturing are required!
Client Relations deals with the Pet Parent and front door swing rate, while the Outpatient Nurse Technician deals with the client-patient pair as a veterinary extender, following the prescribed healthcare plan, ensuring client awareness with patient advocacy and promoting quality healthcare to extend and enhance the quality and duration of the animal’s life. These are the practice gate keepers – they can talk the walk at a minimum!
Inpatient nurses can actually walk the talk! The team-based healthcare delivery system allows doctors to be far more productive, while establishing pride and productivity at the staff level; this is a true win-win format for veterinary practices
LEVERAGING THE CLIENT RELATIONS SPECIALIST
The development of hospital zones (initially client relations, inpatient, and outpatient, and maybe later, resort and surgery) requires the reception team AND nursing staff to accept accountability for operations, and see the doctors as visiting consultants (doctors work a specific zone for only a half day, then shift zones). Shift changes occur when all restocking and cleaning is completed, or the shortfalls are transferred in an overt and apologetic manner. The problems associated with doctor-centered healthcare delivery (this is how we start all practices) can now be addressed by staff at shift change, from updated medical records and charge sheets (travel sheet), to restocking and cleaning; in short, the goal is to leave the hospital zone in better shape than you found it.
The Goal for the Client Relations Specialist (CRS) — to ensure all client contacts are timely and meaningful, by phone, written media, and electronic means. Maintains “client friendly” first impressions, be an advocate for what the patient ‘needs’, and supports the practice’s Mission Focus. Schedules client/patient access to all healthcare delivery systems based on practice facility capabilities, increasing the doctor’s productivity by scheduling staff appointments within the scope of the practice’s written Standards of Care (SOC) (verbal SOCs are never preferred). Concurrently, be operationally proficient with veterinary software, and work in harmony with the nursing staff, doctors, and community in general.
The Client Relations Team controls all access into the hospital, from parameters provided by the inpatient and outpatient nursing coordinators, based on the doctor staffing forecasted for that period. In short, the hospital operations are now OWNED by staff and the doctors do NOT mess with operational issues; doctors now only diagnose, prescribe, and surgicate! The core duties within the Client Relations Zone include, but are not limited to:
booking and receiving clients – scheduling the facility resources, not specific individuals, to maximize client/patient access and service.
hospitality functions for clients and community members
total practice telephone service
discharge (if not done by the outpatient team from the consult room)
veterinary software operations, including electronic client contacts
editing/sending newsletter and health alerts
timely reminders (pet parent alerts)
client access area maintenance and cleanliness
medical record audits (organization as well as standards of care)
recovered pet & recovered client programs (VCI monograph)
The Outpatient Nurse (OPN) controls two consultation room (what used to be called exam rooms), one Outpatient Doctor, and shares one Pharmacy technical assistant float. The location of the laboratory determines who has operational control of that zone, and the potential staffing. Morning outpatient appointments are scheduled from 7:30 a.m. to 12:30 p.m., so the outpatient team (explained in Zoned Systems & Schedules VCI Signature Series Monograph) can leave the zone by 1300 hrs. The afternoon outpatient shift is from Noon to 17:00 p.m., and the evening outpatient shift (on practices with “late days”) is 1600 to close (e.g., 2000 hrs) (the evening doctor usually starts the shift with OHE and neuters from noon to 1500 and then has 15:00 to 1600 hrs for food and phone calls). The schedule is controlled and orchestrated by the Client Relations Team, with input from the nursing staff (and maybe the doctors or owners).
The Inpatient Nurse (IPN) controls the treatment room, with surgery, imaging, dentistry area, wards and runs; a inpatient doctor, who may also be the surgeon in smaller hospitals, and one inpatient technical assistant float, as well as the animal caretaker staff. Morning inpatient rounds are at 7:00 a.m.. The morning outpatient system stops at 1230, and the afternoon inpatient rounds are over the lunch hour, about 1300 hrs, that means there are 30 minutes to overtly transfer the shift to the next team. Morning outpatient staff becomes afternoon inpatient team, so they can ensure their “day admits” are closed out as promised; the morning inpatient team becomes the afternoon outpatient team, so they can ensure they are available if there are questions at inpatient discharge. The p.m. doctor shift (noon to 8-9 p.m.) allows a larger practice the high density scheduling overlap for end-of-day rush times (common in bedroom communities and high dual income populations).
The evening transfer of zones is assumed to be similar to the mid-day exchange, and assessed by the morning shift, and may require greater calibration coordination, but the habits built on the mid-day shift change between zones will eventually carry over to EOD changes.
The key elements to accept in this transition of thought include:, 1) no one leaves their zone except for the technical assistants, 2) the client relations team establishes the schedule and balances the caseload based of facility resources available, 3) nursing staff has the schedule and keeps the doctors on schedule, 4) the doctors respect the schedules and the nurses, and 5) the hospital is scheduled (not the doctors) with a client-centered commitment for the social contract of meeting the clients expectations in a timely manner.
THE 24-HOUR CLOCK
The 24-hour clock is needed for fail-safe communications in medical records.
6 p.m. is not as clear as 1800 hours. T.I.D. is often 0600, 1400 and 2200 hrs.
The 24-hour clock is accepted as the STANDARD in human healthcare due to need for continuity between shifts. Get with the program!
THE CLIENT RELATIONS TRIAD
The client relations zone ideally includes the greeter, telephone staff (usually off line), and a medical record audit floater; they should rotate positions within the zone every 4 to 5 hours, so no one gets “cold” in telephone service or greeting clients. Everyone is on wireless head sets, so communication is ergo-metrically enhanced. The scheduling must be done by computer, and most of the newer computer programs (like, EZVet, RxWorks, Cornerstone, Avimark, Impromed, IntraVet, etc.) have good clinical appointment capabilities, with variable boarding capabilities. The client relations zone team must also be the software gurus, able to resolve challenges with a simple phone call to their software vendor POC with their pointed and targeted question/issue. The doctors request appointments via the outpatient or inpatient nurse to the client relations reception team; doctors do not touch/adjust the appointing system in any manner. The doctor’s inpatient time, besides for telephone voice mail review, can also be a flexible healthcare delivery time, if no surgeries are scheduled (handle walk-ins (NEVER a ‘work-in’ since the term sets up a failure mind-set scenario), emergencies, and drop-offs through an “odd” consultation room).
In the slow season, only one of the two consultation rooms assigned to an outpatient doctor needs to scheduled, and walk-ins, drop-offs, and emergencies can then be used to fill the second room. If the two rooms are totally booked for a doctor/OPN team, the IPN team will see the walk-ins, drop-offs, and emergencies through the “odd” room, as well as be used to “catch-up” an outpatient doctor who has gotten off pace (coordinated by OPN and IPN through reception). The client relations triad of duties, reception, telephone, and discharge, must also have a mid-day shift change, so no one MUST work telephone for more than 5 hours at a time.
The Recovered Pet and Recovered Client programs, as described in the VCI Signature Series® Monograph, Client Relations Zone Operations will fund many more programs as well as the additional staff needed for zones and transitions.
Recovered Pet – this involves the client standing at the front desk, and the client relations specialist screening the household database for a pet that is past due for being seen. It involves alerting the client that, “We have not seen Spike this year for . . .”, and waiting for a client response. This “one a day” is considered “easy” by most every front team surveyed. At an average transaction value $100, and one a day, 6 days a week, drive is $600 new income each week for 50 weeks, or $30,000 income; with 3 to 6 visits a year per pet, 3 x $30,000 is $90,000 income (for just one pet a day, it not require much overhead, so it is mostly pure net),
Recovered Client – this involves the client NOT at the front desk, the one who did not come back as expected, and the client relations specialist screening the 3R (recall, recheck, revisit) database for a client that is past due for being seen. It involves picking up the 2000 pound phone (must weigh that much, or we would have been doing this before), calling the client, and saying, “The doctor and I missed you and Spike this week, is everything okay?”. It is not a missed appointment call, it is true concern. Over 50 percent of the called clients will respond with an apology for missing the appointment and request to schedule another, but the savvy staff will respond again, “That is okay, we just wanted to ensure you and Spike were okay?”. Just “one a day” is considered “easy” by most every front team surveyed. At an average 1.5 to 1.6 pets per household, the $90,000 income from a recovered pet becomes $135,000 (for just one pet a day, it not require much overhead, so it is mostly pure net).
To look at $90,000, plus $135,000, or just under a quarter million dollars a year, being missed is staggering, until you remember the AAHA Compliance study that says the average companion animal practice loses in excess of $630,000 a year per doctor due to the lack of making the patient ‘needs’ significant and known to the client.
At a 50 percent success rate, this is still over $110,000 a year for OVERTLY caring about your clients and patients, without any significant additional costs. One caution, do not try to ‘recover’ clients outside the one-week window, they perceive you have already forgotten them.
CLIENT RELATIONS CONTINUING EDUCATION
Training of client relations staff is the most neglected CE position in most veterinary facilities, yet they have the highest amount of client contact. Team development can be used to refine the narratives (e.g., use the Milo Frank text, “How to Get Your Point Across is 30 Seconds or Less”). These must be rehearsed with the nursing staff to ensure a common position is being shared with clients, and must be based on a consistent Standards of Care and Inviolate Core Values. To handle walk-ins and emergencies in a professional manner, there must be a great trust with nursing staff’s support; also, reminders and follow-ups are shared with the nursing staff. Setting the “need standard”, body language when doctor is behind schedule, post-consult discussions on care and follow-up, fee collection and the departure “last impression” need development.
The texts, tapes, and workbooks from AVMA and AAHA are excellent tools, and when tailored to the veterinary-specific needs of the specific practice, are great training aides for the initial 90-day orientation and training phases. This person has the MOST local continuing education training opportunities of anyone on staff: banks and hospitals are always running CE for their front line people, and in most metroplex communities, there are short day courses, and even Dale Carnegie courses on people-to-people skills.
In team training, most VMAs neglect this critical team member, so team-based CE experiences, like the VCI Shirt Sleeve Seminars, hosted by VCI twice a year (1995 to 2007) become a great reward and recognition for these unsung heroes and heroines of veterinary client relations; these CE experiences also allow staff bonding and better planning ownership. Never allow a “them and us” environment to emerge; utilize the CRS team to help OPNs with narratives, and the IPN team to help the CRS and OPN understand the needs and procedures. The ‘training day’ concept discussed with the SYNERGY MODEL, two issues ago, is an excellent starting point (also discussed in the Practice Operations VCI Signature Series monograph and the new Team-based Healthcare Delivery text in the VIN library available for a free down-load).
OUTPATIENT NURSE (OPN)
The first challenge is nomenclature; a bias in the American culture. In the UK, Australia, New Zealand, South Africa and other English speaking Commonwealth nations, what we call technicians and technologists are termed Veterinary Nurses. Client response to the term “nurse” is acutely significant, and their trust is immediately elevated. Some States have caved into medical nurses and prohibited the term ‘veterinary nurse’, starting the slippery slope for eliminating the term ‘doctor’ for veterinarians. The terms such as nurse sharks, nurse bees, nurse ants, and nursing care have not been addressed in those States, yet in the State of Colorado and others, ONLY licensed, certified or registered technicians may be called “technician”, and other staff members have to be assigned other titles (e.g., veterinary nurse, veterinary assistant, etc.). For the purposes of this discussion, I will define Outpatient Nurse Technician as a skilled communicator accountable for consultation room activities (see the Blackwell Text, Building The Successful Veterinary Practice: Programs & Procedures (Volume 2), for a greater in depth discussion).
The development of hospital zones (initially client relations, inpatient, and outpatient, and maybe later, resort and surgery) requires the client relations (reception) team AND nursing (technician) staff to accept accountability for zone operations, and see the doctors as visiting consultants (doctors work a specific zone for only a half day, then shift zones). Shift changes for staff members occur ONLY after/when all restocking and cleaning is completed, or the shortfalls are transferred in an overt and apologetic manner.
The Goal for the Outpatient Nurse Technician (OPNT) — to allow the consult room encounters to go smoothly, to increase the doctor’s productivity, and to give the client another healthcare provider to talk to, in the consult room and on the telephone.
The Outpatient Nurse Technician (OPNT) is responsible for escorting the patient and client into the consult room, completing the interviews required for baseline client and patient information, doing the history review of the client’s concern, conducting the TPR-BP and wellness exam, and providing the delivery of healthcare information as directed by the veterinarian. The skilled OPN also provides whatever else the client may need. They act as a friend to the client and have genuine concern for the companion animal. Nurses always act, dress, and look like a member of a superior healthcare team. They must always remember that they are “on stage” and that their actions, appearance and words are not missed by owners. They are impressive simply because they are friendly and they know “their stuff.”
Duties usually allocated to the Outpatient Zone include, but are NOT limited to:
Pharmacy-Lab forward to reception
Client/patient outpatient movement
Three-to-five minute asymmetry exam before the doctor enters
Life Cycle Consultations (asymmetry exam) w/parasite checks
Transcribing the doctor’s healthcare plan directives
Puppy/kitten programs (e.g., vaccine, fecal, preventatives, etc.; over 40% do not stay on prescribed frequency required for full protection)
Outpatient client education, include medication administration
Nutritional Advisor, including body condition scoring (BCS – 5 point or 9 point), monitoring feeding trials and assisting pet parents in re-feeding programs.
Parasite Prevention & Control advocate
Dental screening, including recording the four levels of dental needs
Behavior management assistance to clients
Monitoring genetic predispositions (upei.ca/cidd/intro.htm), over-40 surveillance, Golden years and other age-related programs (cardiovascular, dry eye, arthritis, diabetes, thyroid surveillance, etc.)
Supervision of pharmacy/lab technical assistant float
Sequential Laboratory sample follow-up and surveillance
Client recalls for outpatient and Problem List follow-up
Outpatient zone maintenance and cleanliness
Title 21, CFR (federal pharmacy rules & surveillance programs)
The Mission of the Outpatient Team
With the above philosophies, it must be obvious that we believe OPNs are critical to effective healthcare delivery. We have said it many times, in many seminars, in many areas of this country and internationally, ” . . . veterinarians are accountable for producing the gross BUT it is the staff that can produce the net!” The effectiveness of the staff is directly proportional to the level of trust for which they have been trained. If they have not been trained to be trusted, or if the doctor corrects them in front of clients or other staff members, the healthcare delivery team system will be non-functional.
What are the three basic Outpatient Nurse Technician concepts which must be addressed during the nurturing process and skill development sessions? They include the following needs, but are not limited to the examples provided:
Meeting client needs.
This is” job one”, as Lee Iacocca might say. Effective technicians are able to pick up on client needs for their pets (arthritis, behavior, fleas, etc.) and tell the doctor, verbally usually, and always in the record with a “need box.” They are knowledgeable about our products, programs, and services and how they may help the pet, for that is” job one” for the clinic. Example:
Owner: “Duke’s getting older. He sure does have a hard time getting around these days.”
Nurse: “I see what you mean. I’ll make a note in the record for the Doctor to discuss our Arthritis Therapy Program with you.”
(OPNs will need to be trained on each of these programs BEFORE they emerge in the practice plan.)
Meeting the doctors needs.
The most useful as well as the most useless technicians are the ones who always seem to be around the doctor. The great OPNs seem to know beforehand when clippers, or an otoscope or a woods lamp (etc, etc.) is needed. They are seemingly always available for the doctor. The poor ones wait to be asked. In other words, the focus of the Outpatient Nurse Technician is the outpatient doctor-client encounter. Make it run smooth and easy. Do not get “lost” in cleaning up the back or assisting in surgery. (Other things can be done but only with one eye on the lookout for the doctor.) By keeping this focus, a good Outpatient Nurse Technician can make the most crowded and complicated day run smoothly.
Meeting client relations needs.
The Outpatient Nurse Technician (OPNT) must also have an antenna up for the client relations and the reception room. This is especially true when completing the New Client Welcome Form or the Patient Data Cover Sheet; these are often consultation room interview requirements to keep things flowing. The skilled OPNT always know how many clients are waiting (none hopefully) and which consult rooms are empty. The great OPNT is always “chomping at the bit” to get the clients into the room! The OPNT escorts the patient client pair to discharge and verbally transfers their care to a willing client relations specialist before leaving them there. They realize how upsetting it is for the client relations specialist to have a client wait either for a discharge or for an appointment.
In short, the OPNT is the “glue” that holds the continuity of the outpatient schedule together. This is no small feat. The OPNT must know what’s going on in the client relations specialist’s mind, the client’s mind, and the doctor’s mind and see to it that all their needs are met. They never become diagnosticians but they are always counselors and “hand holders” for those needing someone who cares.
Needed Scheduling Actions:
Zone the hospital staffing plan
Outpatient schedules have two columns (rooms) per shift doctor
Outpatient doctor and Outpatient Nurse work two consultation rooms
OPN escorts all clients/patients from receiving to consultation room
There is a Pharmacy/Laboratory technical assistant float
The OPN and OP doctor NEVER leave front during shift
The OPN keeps the doctor “on schedule” for the entire shift
There should be a day drop-off bank of cages close to front
Client Relations schedules inpatient care regardless of doctor
Inpatient doctor and Inpatient Nurse (RVT) work treatment/surgery; the IPN
(inpatient nurse and IP doctor NEVER leave back during shift
There is always a treatment/surgery technical assistant float
Shifts are half day, changing the doctor’s role (+/- CVT/RVT/LVT/nurse)
Morning outpatient doctor becomes afternoon inpatient doctor, thereby following an “day admits” that were done to ensure continuity of care
Morning inpatient doctor becomes afternoon outpatient doctor, thereby being able to
discharge the morning drop-offs and surgeries
Noon doctor (on three doctor days, this is the noon to 8 evening shift) starts with spays and neuters (noon-3 p.m.), has an hour for phone/food, then does evening outpatient (4-8 p.m.) – hint: more effective is the 24 hour clock (e.g., 1600 hrs to 2000 hours).
IPN & doctor conducts does rounds at 8 a.m. and 1 p.m., and then the IPN keeps the doctor on schedule
ONLY the technical assistants (floats) move between zones, moving patients and support each other
Details of doctor scheduling are discussed in the VCI Signature Series monograph, Zones Systems & Schedules. The doctor schedules need to be done six weeks in advance so all other staff schedules can done 30 days in advance..
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It’s a day like any other day, except that your once cream-colored cat has taken on a brownish tone. Don’t panic, just yet. Skin and hair color is determined by melanocyte cells in the skin and hair follicles. Those cells produce melanin which in turn produces the color. Remember what you looked like last summer; after a day at the shore? When your skin is exposed to the sun, those cells are stimulated to produce more melanin. But what can cause color changes in your cat?
Cats come in a kaleidoscope of colors; or lack pigment altogether in the case of albinos. In fact, did you know that the coloration patterns in “pointed” breeds of cats (Siamese, Ragdoll, Balinese, etc.) are temperature dependent? The production of the pigment is dependent on the action of a particular enzyme and the action of that enzyme is temperature dependent. That’s why the warmer parts of a Siamese cat’s body are lighter in color while the cooler parts (like the face, feet, tail and ear tips) are more darkly pigmented. The scientific name is Wilson’s Syndrome, according to technology.org.
Given the temperature dependent color of pointed breeds, they are especially prone to color changes associated with temperature variations that stretch out over time. Move to Arizona and you’ll likely see the points turn lighter. And be prepared for coat color changes if your animal is shaved for surgery. The first hair re-growth, on less insulated skin will likely be darker; subsequent hair growth should return your pet to the original color. (Medical, Genetic & Behavioral Risk Factors of Siamese Cats by Ross D. Clark DVM)
Black cats often turn a reddish color when exposed to the sun. If you fear it’s something more, have your vet run tests to determine if their diet is deficient in amino acids or something else. Diet deficiencies are easily reversed with the right food balance.
Vitiligo is a hereditary disorder in cats that causes white areas to appear as the cat matures. These spots typically occur around the nose and eyes, but are not cause for alarm. Color changes have been reported in cats post-stressful situations (pregnancy, serious illness). For more information related to diseases in cats, see peteducation.com
As a rule, pigment changes in your cat are most likely due to benign conditions that do not cause serious consequences to your cat’s overall health. However, underlying illness or poor nutrition needs to be addressed. Your veterinarian will ask you questions as part of your cat’s evaluation. Diagnostic tests may be necessary and, should the problem be more than benign, the owner and the doctor should respond appropriately.
If you have any questions or concerns, you should always contact your veterinarian — she or he is your best defense to ensure the health of your pet.
The content is not medical advise, nor is it intended to be a substitute for veterinary treatment or care. First, consult with your veterinarian before use.
NC State establishes first veterinary Clinical Ethics Committee By: Veterinary Practice News
Group aims to help veterinarians navigate complex care, quality of life situations
Merck study: Veterinarians have normal mental health but poor well-being By: Kristi Reimer Fender, News Channel Director
Just 41 percent would recommend the profession to a friend or family member; financial stress is a serious concern.
Pentobarbital discovery prompts J.M. Smucker dog food recall
By: Veterinary Practice News staff
J.M. Smucker Co. is recalling some of its dog food products after traces of pentobarbital, a euthanasia drug, were discovered in samples from a range of the company’s brands.
An inconvenient truth
By: Veterinary Practice News
As we’re now learning, preventing reproductive disease isn’t necessarily a good enough reason to remove organs; not if those organs offer more benefits than they pose risks.
Nearly one in three pugs has an abnormal gait By: BMJ
A growing body of evidence indicates that pugs are prone to various orthopaedic and neurological problems, but it’s not clear how common these conditions might be.
Avoid the dangers of spring-loaded mouth props
By: John Lewis, VMD, FAVD, DAVDC
Many possible causes have been implicated in causing postoperative blindness, including anesthetic agents and hypoxia. In recent years, another possible explanation has been proposed.
Journal Scan: Speak! Or should you? What do your canine veterinary patients prefer? By: Michael Nappier, DVM, DABVP
A new study shows that dogs better attend to gestural commands than verbal ones, but for the best result, try combining word and deed.
Veterinary Emerging Topics Report for 2018 focuses on AMR
By: Veterinary Practice News staff
The research examines antimicrobial resistance in felines
On the fence about embracing the AAFP’s Cat Friendly Practice Program? By: dvm360.com staff
The results of a recent survey show how veterinary practices that have been there, done cat, have reaped benefits.
Click here for statewide alerts on infectious disease outbreaks in horses By: Jennifer Gaumnitz, Senior Content Specialist
This easy-to-use online tool keeps you current on equine infectious disease cases occurring in your state.
Detecting Soft-Tissue Injuries in the Hoof: Ultrasound vs. MRI
By: Erica Larson, News Editor
Ultrasound is a useful screening tool for assessing some deep digital flexor tendon lesions, but it could cause veterinarians to underestimate navicular bursa and collateral sesamoidean ligament lesions.
EHM Confirmed in Chester County, Pennsylvania, Horse By: Erica Larson, News Editor
The affected horse exhibited hind limb ataxia but remained in stable condition.
Cure for Equine Osteoarthritis Eludes Researchers By: Kentucky Equine Research Staff
Despite decades of intense research in various species, most notably horses and humans, a cure for osteoarthritis remains elusive.
How Fear Free training decreases on-the-job veterinary injuries By: Marty Becker, DVM
How reducing fear, anxiety, and stress in animals reduces team member injuries, lowers worker’s comp premiums, and helps prevent the kind of serious, permanent, or disfiguring injuries some veterinary professionals experience.
Pass it on: Flu infections in cats and dogs
By: Diagnostic Imaging Systems
Humans aren’t the only ones at risk; flu infection in cats and dogs may be much more common than thought.
When the pet is obese and the client is oblivious
By: Sarah J. Wooten, DVM
According to veterinary nutritionist Deborah Linder, the battle of the bulge starts with your clients’ hearts and minds.
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Break out the treats. Head to the pet store. Visit the local shelter. Today is National Love Your Pet Day. The purpose of this holiday is to encourage pet owners to spend some time with their pets and show them the love and affection they deserve. Dogs, cats, turtles, lizards, fish; it doesn’t matter. It’s the day to show them just how much they mean to you.
No one knows exactly when it started but according to our research, wide-scale celebration began in the early 2000s.
The stats will surprise you
In 2017, U.S pet owners spent almost $70 billion dollars worth of products for their pets (American Pet Products Association). Compare that to the $41 billion spent in 2007. Want to know more about the pet industry in the United States? Then check out the following pet statistics:
Number of Households That Own a Pet (By Type. In Millions)
Number of Animals Owned in U.S (In Millions)
The benefits will blow you away
Strengthen a child’s immune system ̶ Studies have shown that children who live in homes with pets miss less school due to sickness than children who grow up in pet-free homes.
Lessen the chance of developing allergies— Contrary to outdated myth, children in households with pets are reported to have fewer allergies. Nowadays, several studies have shown that children in pet-friendly households lower the chances of developing related allergies by as much as 33% (National Institute of Health). You’ll want to introduce the kids to the animals as soon as possible. If a person has already developed an allergy, the allergy can’t be reversed.
Heart health—Another benefit to owning a pet may be improved heart health. Studies have shown that owning a pet can lower blood pressure, triglyceride and cholesterol levels; all are contributors to the risk of heart attack
Overall fitness—This one’s so obvious. You walk your dog 3X daily; you walk off excess weight and boost your metabolism. The pooch is happy and you get healthy. Win-Win!
Don’t worry; be happy—Yes, they can be expensive. Certainly they can be a pain in the neck. In spite of it all, pets have been shown to turn a bad day into a beautiful one. That’s why their presence in hospitals, nursing homes and long-term care facilities is ever-rising.
Make new friends, keep the old—Pets are instant icebreakers; people are just more willing to stop and chat when they see a person out with their pet. And you’d be amazed by how often friends stop by for pet play dates. Just one more reason to make a dog, cat, reptile or bird a part of the family.
Celebrating National Love Your Pet Day
Stop by your local pet adoption center. Volunteer, foster or adopt. Animals provide love and companionship each and every day. February 20th is your chance to return the favor.