{"id":23861,"date":"2023-06-01T00:00:58","date_gmt":"2023-06-01T00:00:58","guid":{"rendered":"https:\/\/todaysveterinarybusiness.com\/?p=23861"},"modified":"2023-05-24T20:58:01","modified_gmt":"2023-05-24T20:58:01","slug":"veterinarians-qa-ernie-ward-0623","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarybusiness.com\/veterinarians-qa-ernie-ward-0623\/","title":{"rendered":"Q&A: Clinical Guardrails, Time Management and Stress"},"content":{"rendered":"

Q: I\u2019ve always believed in allowing veterinarians to exercise their judgment. Lately, however, I\u2019ve discovered that two of our younger doctors are not practicing to the standard I expect. I\u2019ve heard you refer to using written treatment protocols in your practices. Any advice about adding standardized protocols to help with efficiency and consistency?<\/strong><\/p>\n

A: You discovered one of my favorite topics: clinical guardrails. I\u2019ve found them to reduce errors of omission, remind me of tests or treatments I might have forgotten, and serve as a gentle teaching tool for young associates. I began creating checklists and general treatment outlines early in my career as a solo practitioner.<\/p>\n

But let me explain a critical concept: I use checklists and protocols as suggestions and reminders, not directives and mandates. In other words, I allow my veterinarians to drive their cars however they choose, and I build railings so they don\u2019t go off a cliff.<\/p>\n

Over the years, I\u2019ve heard grumblings that such guides don\u2019t allow for autonomy. I suppose that depends on enforcement and culture. My associates always seemed to appreciate the ability to reference a standard to see whether their medical rationale was sound. Likewise, my support staff and clients praised the consistency and reliability of our advice and services.<\/p>\n

Even better, associate veterinarians can double-check themselves privately without risking embarrassment or discomfort by asking a senior clinician for help. If they disagree or question a step or suggestion, they could confidently ask for clarification, particularly after having a chance to research and process. In addition, written protocols make uncomfortable conversations less personal when you can reference a written standard. The focus shifts from \u201cDon\u2019t tread on me!\u201d to \u201cExplain why you deviated from our protocol, and should we change it?\u201d<\/p>\n

Every clinic should provide clinical guidelines and checklists. Start with presurgical lists outlining all necessary steps before the induction of anesthetics. Next, create actions and standards for simple tasks such as surgical pack preparation, lab machine calibration and immunization appointments. Be as general or specific as you want, although the more details you provide, the more consistent your service is. The guidelines serve as a foundation for staff training and enable you to quickly and efficiently onboard new team members.<\/p>\n

For veterinarians, begin with guidelines for the 10 most common diagnoses your clinic sees. Pull the data in your practice management software to ensure it reflects the reality of your daily schedules, not your favorite conditions. Make sure the lists mirror how your team practices, and accommodate personal preferences as much as the scientific evidence allows. Start with outlines, checklists or a format you feel comfortable with. Just start.<\/p>\n

The effort is worth the investment. As you learn how your team uses the protocols, adjust, adapt and add to them. Over time, referring to guidelines becomes second nature. And that\u2019s my final point: They\u2019re available when needed. While your veterinarians are busy whizzing along the highway of patients, the protocols stand ready to nudge your doctors back onto the road.<\/p>\n

Q: A few months ago, I hired a veterinarian who had excellent references and 18 years of experience. The problem is she takes too long during appointments, goes into too much detail with clients \u2014 many ask not to see her again \u2014 and our support staff is frustrated. We\u2019ve discussed the issues numerous times and put them in writing. She admits a problem and promises to change, but nothing happens. She\u2019s a good veterinarian, and we need her, but she\u2019s hurting clinic morale. Can she be fixed?<\/strong><\/p>\n

A: Allow me to adapt one of my favorite quotes to your question: You can\u2019t fix people unless they want to be fixed. I\u2019d further elaborate that you can\u2019t fix people unless they know they\u2019re broken, have a correction plan and want to change. And then comes the hard part: doing the work required to change. That\u2019s a lot of elements that must align to help your veterinarian. Yet I remain hopeful.<\/p>\n

If you\u2019ve followed me over the past three decades, you\u2019ve heard me extol the benefits of structured team training (including for veterinarians) and videotaping the staff in action. As a result, I\u2019ve engaged in more than my fair share of debates on:<\/p>\n