Congress on Demand 2021: Practice management, strategy and leadership

The practice and vet perspective: There is increasing evidence within the veterinary profession that the use of a surgical safety checklist reduces post-operative complications. In this presentation, we will present the science behind why checklists work and how they can help improve our performance by promoting teamwork and communication and increasing situational awareness. We will also give tips on implementing checklists in your practice.

The vet nurse perspective: Everyone knows that horrible sinking feeling when they realise that they have made a mistake, but to err is human – so how can we prevent error and keep our patients safe? In 1999, Atul Gawande suggested that at least 50% of surgical complications in people could be avoided by improving perioperative routines. The launch of the World Health Organisation (WHO) Safe Surgery Saves Lives campaign and the publication of the WHO Surgical Safety Checklist (SSC) in 2008 inspired veterinary hospitals to modify the WHO SSC for use with their surgical patients. Studies on the success of the World Health Organisation Surgical Safety Checklist reported a 47% reduction in deaths, a 36% reduction in post-operative complications and a 48% reduction in infections. Checklists have also been found to improve communication and teamwork in the operating theatre. Checklists are quick to perform, cheap, easily modified to suit the intended clinical environment and straightforward to implement. The checklist is completed in three stages; sign in (before induction), time out (before skin incision) and sign out (before recovery). By performing each of these stages at the correct time errors which may occur due to slips, lapses, cognitive overload, and distraction can be avoided.

The Covid-19 pandemic has brought infection control into sharp focus. Many of the measures taken to halt the spread of Covid-19 (particularly hand hygiene and personal protective equipment/PPE) will have also been effective against hospital acquired pathogens. However, the risk from hospital acquired infections (HAIs) will still be with us once the pandemic recedes. Practices should therefore take the time to establish effective infection control measures that will protect their patients, owners and staff. It is important to understand the most likely organisms in each practice and how these can spread in the environmental and be transmitted between animals and humans. Essential tasks include establishing an infection control team, using effective hand hygiene, cleaning and disinfection, have high quality facilities and equipment, optimising procedures and care, using clinical audit, and practicing antimicrobial stewardship.

Ernie Ward and Alan Robinson discuss the owner and the team perspective, what does it look and feel like – it’s not just about perks. Team perspective: I’ll bet no-one had ‘Global Pandemic’ on your 3-year plan at the beginning of the year. So far over this Covid lockdown we have had major disruption to all the critical business areas – profitability and financial strategies, team harmony and resilience, clinical care and vet performance and client experience and resilience – managed through the leadership lens of your unique COVID experience. Some of the consequences have been surprising and some down-right paradoxical. There are a lot of lessons to be learned from our experience so far and, I suspect, a lot more to come. That still leaves us, and our teams, in the liminal space of uncertainty and ambiguity. Time for planning, priority and perspective. For some of them it is just a job. But it is their safety and security and most of them (and you maybe) are on the edge of meltdown. From a team perspective we discuss the three fundamental Flow and Trust pillars that you can provide at work: (1) safety – physiological and psychological – and how they are linked – how does our veterinary neuroticism and need for meaning affect our sense of safety?; (2) connection and belonging – how does our innate Social Protection System deal with our particularly strong vet need to belong, to be liked, to be accepted as well as the need for intimacy, mutuality, and relatedness; (3) self esteem – how we balance confidence (self-worth) with competence (mastery). Are we just trying to be useful – or do we actually feel valued?Productivity is more than a number – rewarding and recognising team excellence: To recruit and retain the best staff, you must reward them well. You must also measure their contributions in order to determine if they’re positively contributing to your practice. For most practice owners and managers, this means tracking revenue and financial productivity. Revenue is important, but not the only metric to recognise and reward excellence. This session shares several other key performance indicators you should be tracking for your team.

Veterinary receptionists are exposed to more ‘raw emotions’ than any other role in veterinary practice by virtue of the fact that they are usually the first point of contact clients have with the practice. This exposure is coupled with the fact that many clients interact with ‘unqualified’ frontline personnel differently to the veterinary surgeons. Whilst attitudes and interactions vary between practices and clients, feedback from BVRA members in their 2020 membership survey (www.bvra.co.uk) revealed how veterinary receptionists are exposed to disruptive behaviour as well as irate, and even abusive comments, and that these became more common with the social distancing measures instigated during the COVID pandemic. This session looks at what we can do to resolve and prevent the five most common client complaints made to veterinary receptionists.

The unfair advantage – a digital strategy to fill your vacancies: Hiring clinical team members is harder today than ever before. A shortage of qualified and applicants has left many practices scratching their heads wondering where all the vets and nurses have gone. The old model of posting an advert on a job board and expecting the applications to roll in doesn’t work like it used to. Nowadays, successful recruiters must also be masters of digital marketing. To fill a vacancy, you are going to have to get a message that stands out, in front of as many vets and nurses as possible. You are going to need a campaign plan that ensures you deliver your message to the relevant places in a way that gets views, lots of views. Your advert is going to start life as a long-form written document that is the foundational piece of content. This one piece of content is then cut up into as many as 15 smaller derivative media types including video, Instagram, Facebook and LinkedIn posts, story arcs for Facebook and Instagram, cross-posting/sharing on to influencer networks, and paid traffic advert campaigns. This session covers how to take a basic advert and turn it into a veritable feast of derivative content offerings that will help you reach your desired candidates. Practices may find this slightly overwhelming, but it is worth the investment because being able to reach the employment market in this way allows you a very big competitive advantage when it comes to fills your vacancies.

Writing a compelling advert: A job advert is also an opportunity to market the practice and impress applicants and other interested parties. An advert will need to be designed that will attract candidates that meet the job description and should include: the job title, practice name, logo and website address; an eye-catching headline; brief description of the practice and what it does; summary of the job such as, responsibilities, duties and hours; the skills and abilities required to make an application considered; the benefits that go with the post and employment; ways to apply such as, either an application form, application letter or CV; contact details for further information if appropriate or required; The closing date for applications. You may also wish to include any additional relevant accreditations or awards that the practice may have.

The environmental impact of anaesthesia has risen to the forefront over the last few years; both via the greenhouse effect of the inhaled anaesthetic agents and the environmental footprint of the consumables used. The anaesthetist has an important role in mitigating these impacts through appropriate monitoring and inclusion of steps to offset any increased requirements. Strategies to reduce the use of inhaled anaesthetic agents via the use of appropriate breathing systems, low flow anaesthesia, airway gas monitoring, and additional forms of analgesia are discussed. Alongside this case examples are used to show how nitrous oxide was removed from one referral hospital, and the impact this had on the practice of anaesthesia and the carbon footprint of the hospital, and how a training and implementation strategy was implemented to drastically reduce the volume of inhalational agents and anaesthetic gases used. Finally, some simple steps that can alter the working environment to promote increased recycling and reduction in waste, that have proven successful in our hospital, are discussed. Although a full team approach is required the anaesthetist is often well placed to implement these changes and push for a reduction in your practice’s environmental footprint.

Why culture matters: Culture – a beguiling term used so casually that it’s actual impact is often overlooked. Culture isn’t something that happens, it is created. Culture is the foundation upon which patient care, client service, financial success, and job satisfaction is built upon. Culture requires considerable thought to construct and constant effort to maintain. In this session, Ernie Ward explains why veterinary practice culture matters to him and why it should matter to all of us.

Intrinsic vs extrinsic motivation: Why culture matters, creating a culture and framework that really works and intrinsic vs extrinsic motivation. The carrot-and-stick approach to motivation worked well for typical tasks of the early 20th century – routine, unchallenging and highly controlled. For these tasks, where the process is straightforward and lateral thinking is not required, rewards can provide a small motivational boost without any harmful side effects. But jobs in the 21st century have changed dramatically. They have become more complex, more interesting and more self-directed, and this is where the carrot-and-stick approach has become unstuck. The traditional approach can result in: diminished intrinsic motivation; lower performance; less creativity; ‘Crowding out’ of good behaviour; unethical behaviour; addictions; short-term thinking. This led to the discovery of a possible ‘third drive’ for human behaviour that argues for intrinsic motivation – the joy of the task itself – that human beings have an “inherent tendency to seek out novelty and challenges, to extend and exercise their capabilities, to explore, and to learn”. This new theory of motivation proposes that human beings have an innate drive to be autonomous, self-determined and connected to one another, and that when that drive is liberated, people achieve more and live richer lives. Practices should focus on these drives when managing their teams by creating settings which focus on our innate need to direct our own lives (autonomy), to learn and create new things (mastery), and to do better by ourselves and our world (purpose).

Overview of psychology of uncertainty: So much change in 2020 and it hasn’t stopped yet in 2021! The ‘ifs’, the ‘buts’, the ‘possibilities’ or lack of them. Uncertainty is challenging, draining and can be very unsettling for many and yet nothing is ever certain! How do you manage yourself through periods of change and uncertainty? Do you spend countless hours and amounts of energy trying to control the uncontrollables? Feel anxious and unsure of what you could, should and will do? Feel drained by the situation and unsure of where to turn? If so you aren’t alone, at the end of the day regardless of your role, you are a human with emotions not a robot – so what can you do? This interactive session discusses the impact of uncertainty on how we work, live and feel. It shares practical tools to use and take back to your team to help you feel more settled, less drained and more in control of what you are focusing on during these ever changing and uncertain times. It addresses the role of the leader and how your role is not to know all the answers but to understand and manage expectations of your team, your clients and yourself to help you lead effectively through change and challenge.

Application of this from COVID lockdown perspective in practice: with Alan Robinson.

Leadership perspective: what is needed right now and how to change minds? This non-hysterical look at the big picture provides information regarding the crisis we are facing, and details the leadership skills for you to personally take it forward into practice and your lives to feel like you’re making a difference. The time is past where we can all sit back hoping against hope that someone else will lead us out of this situation. There are things that every individual can do, but more power to effect change comes with better strategy – this lecture focuses on the practical delivery of change into existing structures.

What is happening in the veterinary sector: a high level perspective: Medical journal The Lancet has called climate change “the biggest global health threat of the 21st century”, but also the greatest public health opportunity. The veterinary sector has a moral obligation to mitigate against and adapt to the triple threats of global heating, resource scarcity and biodiversity loss. The transformative change required for this endeavour has been forced by the global pandemic; the question is how we choose to emerge from one crisis, in order to deal with the next? Small animal veterinary practice has a unique set of environmental impacts, not least the greenhouse gas effects caused by release of volatile anaesthetic agents, but also single use plastic consumption, hazardous waste production, and resource use. Some opportunities are clear; others present a wicked problem with interdependent impacts, inadvertent consequences of changes, and embedded behaviours all contributing to the tangled puzzle. We will need to show the best of what we can do; work collaboratively, think laterally, dissect the detail whilst seeing the bigger picture, and showing leadership in the workplace and in our communities. This lecture will highlight the excellent environmental sustainability work that is underway in the small animal sector, and the opportunities for growth and participation.

Post-operative complications commonly seen in veterinary practice range from wound healing difficulties to multiple organ failure and death. Regardless of their severity, whenever post-operative complications arise, they are never welcome; let’s face it, the last thing you want to hear when reaching for your coat, after mopping the floor, hungry and tired after a long day, is that the bitch spay from this morning is not doing well and needs to return to theatre as a bleed is suspected. To reduce the rate of post-op complications, clinical audits are used to support quality improvement in clinical settings. Clinical audits enable patient care to be improved by assessing and evaluating current processes in a systematic way. By selecting the correct type of audit, getting the whole practice team on board, and ensuring a blame-free culture is embraced improvement strategies can be identified and implemented. The surgical safety checklist (SSC) is an example of a tool that has been proven to reduce the rates of post-operative complications. By involving the whole practice team in tackling post-operative complications though adoption of audits and checklists the benefits quickly become obvious and real improvements in patient care can be seen.

What do you mean by the word ‘team’? It’s a word we use every day, but what does it mean to you and to your team? What are the words and phrases that come to mind? Particularly a team that is high performing? What do teams do? How do they think? How do they act under pressure? What is the difference between a team and just a group of people? High performance is a culture and permeates through everything you do at work-are you aware of what high performance looks like and how you are monitoring progress, the areas that need tweaking and those that need amplifying? This session discusses the above questions and shares models and tools to help you identify the building blocks of creating a high performance team that works for you and your practice.

Even highly trained and motivated professionals sometimes make mistakes and veterinary practice doesn’t always go to plan. VetSafe is the Veterinary Defence Society’s web based confidential significant event reporting and risk management system – a members-only veterinary patient safety resource. It has been designed to help protect patients, clients and clinicians from professional errors. The VetSafe system can help clinicians learn from their mistakes, it is not a tool for blame, judgement or discipline. The system has three aims: to gather data on mistakes in practice that cause patient harm and near misses; to help clinicians understand why errors occur; to help clinicians learn from errors and prevent their recurrence. Making a report is quick and easy – there are no paper forms to fill in, you can report on the website or the VetSafe App. Practices have access to their reports, to help them assess and improve their systems and compare their results to the larger data set. These reports can also be used to enable significant event reviews and discussion at mortality and morbidity meetings to inform local risk management and enable organisational reflective learning.

The business case for sustainability: Embarking on a sustainability journey presents many opportunities for veterinary practices; cost savings through reduced resource use, encouraging staff engagement as well as innovation, and marketing opportunities to name but a few. If you aspire to reduce the environmental impact of your workplace, and realise the urgency of positive action, then this session is for you! The session covers how to get started on your sustainability journey, what the key considerations should be and what can be achieved on a range of budgets. It also introduces the support material available from Vet Sustain and demonstrates how to put it to use in practice. We delve into the business incentives of operating sustainably, how to communicate your green vision with the team and how to overcome any barriers you might face. Now is the time for the veterinary profession to take action, to preserve our magnificent planet for the future generations and to ensure that we can continue to provide outstanding veterinary care. As they say, ‘be the change you want to see in the world’!

Practice level practical perspective: Zoe Halfacree provides an insight into the work that Vet Sustain is doing to support practices to make changes for environmental sustainability. Vet Sustain has produced a checklist, which is endorsed by BVA, BVNA and SPVS, as a guide for getting started in going green and this session outlines some of this advice. There are lots of great tips from becoming a little greener to embarking upon environmental management accreditation.