Lifelong Care, Issue 3

Published by the American Animal Hospital Association with a generous educational grant from

™.

LifelongCare . . .

Tools Techniques Conversations

Caring Conversations

Build the bonds that get results.

Published by the American Animal Hospital Association with a generous educational grant from

™.

LifelongCare . . .

Tools Techniques Conversations

Lifelong Care from Zoetis™ is an initiative providing veterinary practices with educational tools and resources to help move veterinary care toward a healthier, proactive model. For more information, go to zoetis.com/lifelongcare.

Health Risk Assessments

Taking preventive care to the next level

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Published by the American Animal Hospital Association with a generous educational grant from

™.

LifelongCare . . .

Tools Techniques Conversations

Pet Wellness Report® Implementation Toolkit

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Published by the American Animal Hospital Association with a generous educational grant from

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LifelongCare . . .

Tools Techniques Conversations

Bridging the Gap

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6 Tips for Bringing Clients on Board

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Empathy First

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How to Talk about HRAs: the Pet Wellness Report® (PWR) Example

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What Would You Say to This Client

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PWR Action Plan

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Caring Conversations

Build the bonds that get results.

LifelongCare_PetStage.indd 5 Published by the American Animal Hospital Association with a generous educational grant from

4/30/14 9:18 AM ™.

LifelongCare . . .

Tools Techniques Conversations

Don’t miss Dr. Carol Barton’s web conference, Lifelong Care: Essential Skills to Communicate Value and Drive Compliance, airing September 1–14. Her presentation can be viewed at aaha.org/webconf.

Sustaining Success

Your next step in lifelong care.

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2 Lifelong Care

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©2014 American Animal Hospital Association (aaha.org). All rights reserved.

In Brief

The February and May issues of Lifelong Care emphasized the following points: • Thriving veterinary practices strive to nurture long-term client relationships that lead to consistent, lifelong proactive care.

• Lifelong Care is a health care platform, conceived by Zoetis, which encompasses prevention, detection, and treatment personalized for each pet.

• A proactive care approach emphasizes prevention, early detection of disease, and timely treatment intervention.

Lifelong Care is the extension of this proactive approach throughout the pet’s lifetime.

• A health risk assessment (HRA) helps clients identify their pets’ health risks; it also serves to underscore and help prioritize your recommendations.

• Among veterinary HRAs, only the Pet Wellness Report® (PWR) from Zoetis incorporates all three keys to success: • A standardized, pet owner– completed, online questionnaire to discover modifiable lifestyle risks • Comprehensive laboratory screening to identify subclinical risks • Communication and follow-up to help clients understand findings and act on your recommendations

• Success with an HRA depends on every member of the practice team working together.

• Goal: To have owners of all dogs and cats in the practice receive an HRA annually for each of their pets.

• Creating a standard protocol and workflow, assigning responsibilities to staff, providing training, communicating with pet owners effectively, and following up are the building blocks of success for any new medical service, including an HRA. • Zoetis offers many tools to help practices implement the PWR. You can find them here: aahanet.org/Library/Lifelong_ Care_Resources.aspx.

If you are asking what else your practice can do to improve pets’ health, further engage clients, and secure the future of your practice, the answer is simple:

Prevent. Detect. Treat.

It’s the foundation of Lifelong Care.

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Enhancing Preventive Care 3

There is a real gap between the care pets are

getting and the care they need—and communication with pet owners is one reason for the gap.

To solve similar problems in human health care, health risk assessments (HRAs) are used as an assessment and communication tool to develop a personalized health care plan focused on the most critical health issues a patient faces.1 Most veterinary practices collect some data about a pet’s lifestyle and health risk factors, but few have implemented an HRA process complete with a standardized risk assessment questionnaire, comprehensive laboratory screening, and follow-up. These practices are missing the opportunity to identify modifiable health risks and uncover a host of conditions that require immediate attention or long-term monitoring. That’s why more and more practices are turning to comprehensive HRA processes, like the Pet Wellness Report® (PWR), to maximize a pet’s lifelong care.

In addition, an HRA helps you cross the divide that so often separates doctors from clients. An HRA helps you to find common ground with clients and create memorable experiences based on a unique quality: your compassion.

Here’s an example: In the exam room, veterinary communication operates out of the biomedical perspective (i.e., how the medical staff approaches the patient): Jack, border collie, male, neutered, 10 years old, is lethargic and inappetant after 2 days of vomiting.

In the same exam room, the client’s perspective is quite different: Jack is her best friend. She has years of ball and stick chasing, hiking, swimming, napping, hugging, and ice-cream-bowl-licking memories. Now he’s weak, scared, and vulnerable. She doesn’t know if she will be able to afford the care Jack may need or if the condition is even treatable.

It’s easy to understand how communication gaps can arise with such diverse perspectives. To cross the divide: • Rather than “take a history,” seek to really understand the pet owner’s perspective and empathize with her and Jack. What is the client feeling?

What is Jack feeling?

• Take a moment to demonstrate authentic compassion.

• Let your client share in the decision-making process.

• Give personalized (owner- and pet-specific) recommendations.

The HRA process provides a communication platform for veterinary professionals who are dedicated to proactive health care and a lifelong relationship with clients and pets. For these professionals, acute care has given way to a lifelong continuum of care.

This continuum has three familiar phases: prevent, detect, and treat. The HRA process is especially useful in the first two phases, though there are clear benefits for all parts.

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4 Lifelong Care

An HRA helps you to find common ground with clients and create memorable experiences based on a unique quality: your compassion.

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Enhancing Preventive Care 5

6 Tips for Bringing Clients on Board

1

Prepare to speak with clients about the health risk assessment (HRA).

2

Turn your team into enthusiastic experts.

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Pet owners want to know more than what the veterinarian is doing during an appointment. They want to know what to do to keep their pet healthy.2 While technical and office staff support the effort, there’s no getting around the fact that if doctors want patients to benefit from an HRA like the Pet Wellness Report® (PWR), then doctors need to be front and center in the client communication and marketing effort.

Besides regular veterinary visits, keeping a pet healthy involves caring conversations on topics like nutrition, exercise, environmental enrichment, and keeping the pet out of harm’s way. An HRA provides openings to discuss all of these issues.

The effectiveness of the veterinary team starts with quality and frequency of training. And it’s not just about information; it’s about commitment. Get staff excited about Lifelong Care and all the ways the team works toward this goal, including an HRA. Treat your staff as if they were your clients.

Share the client education materials with them, and demonstrate the value of Lifelong Care and an HRA to them. Ask them to complete an HRA, like the PWR, for example, for each of their pets. Find out what they learned about their own pets and what value this would present to pet owners. Gauge their responses; acknowledge and discuss their questions and concerns; and, as a team, find your voice to best deliver the value of the PWR or another HRA to your clients. If you can’t convince your own staff, you certainly won’t be convincing to clients.

Assign staff roles/responsibilities and agree on practice protocols. Involve the team for ongoing improvements.

6 Lifelong Care

3

Take advantage of clients’ undivided attention in the exam room.

Make sure clients understand your personal commitment to Lifelong Care. Help them realize that you want to work together to keep their pet as healthy as possible for as long as possible.

Talk about the three pillars of Lifelong Care: prevent, detect, and treat. Explain that an HRA is a tool to improve Lifelong Care through better prevention, earlier detection and monitoring, and timely treatment.

See page 12 for a sample script. Pick up more key concepts and phrases from the first issue of Lifelong Care (aahanet.org/Library/Lifelong_Care_ Resources.aspx).

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Use your words… and our tools.

With clients in the exam room, draw on the words and messages you used in staff training.

Let clients see your passion for animals as you explain your commitment to Lifelong Care and an HRA as a tool to support it.

Let your words convey the strength of your belief. Don’t say, “You might want to think about this HRA thing.” Instead say, “We now use an online questionnaire to gather critical information to help us (pet owner and doctor) keep Trevi healthy. Answering these extra questions will really help us personalize Trevi’s health care recommendations. Your involvement in this way can really make a difference.”

5

Market proactive care every day in every way.

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Use stories and pictures.

Lifelong Care doesn’t start or end in the exam room, or even in the veterinary practice. It is reinforced every time you reach out to clients with persuasive messages about preserving their pets’ health.

When you recommend a dental cleaning to Rocky’s pet parent, for example, you’ll find it easier to win the client’s acceptance if you have already consistently communicated the “dental care” message on your Facebook page or website, in your newsletter, posters in the exam room, brochures in the reception area, messages on invoices, and the like. The very act of completing the HRA questionnaire further reinforces the educational messaging but now in a very personalized (pet-specific) way, for Rocky and his pet parent.

By the time you do the “show and tell” dental exam on Rocky, the client has already heard the dental message through a variety of communication modes and is more likely to listen to and accept your recommendation. To bring it full circle, reinforce your recommendation by handing the client educational material and directing them to your website.

Encourage staff to talk about success stories; perhaps a team member or client has identified an unknown problem by using the PWR, for example. Stories are more fun and easier to understand than dry medical discussions. Ask staff or clients to write or share their stories (with pictures!) on your Facebook page or website.

Tools for Talk Scripts, tips, FAQs, client handouts, videos, and the PWR itself help make the case for Lifelong Care and an HRA. Check out the resources on page 12 to get started.

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Enhancing Preventive Care 7

Empathy First Listen for feelings; appeal to pet owners’ love for their pets Lifelong Care helps veterinary teams encourage pet owners to put their love into action by adopting healthier behaviors and investing in products and services that improve or safeguard their pets’ health.

Through effective conversations, veterinary staff build collaborative relationships with clients, speak candidly about a pet’s health even when it’s not easy, and foster a shared approach to decision-making.

Facilitating these kinds of conversations requires new skills. You can master them in the same way you do any skill: by learning the key concepts and practicing them.

Nonverbal cues

Open-ended questions

Facial expressions, gestures, tone of voice: All of these speak louder than words.

Verbal communication is voluntary and reflects a person’s thinking. Nonverbal communication is largely involuntary and provides clues to how we feel.

Needless to say, when there is a mixed message, or the “audio doesn’t match the video,” communication suffers.3 If you are a person who smiles or laughs when you’re nervous, you’ve probably heard, “That’s not funny!”

Likewise, what does it mean when a person shakes his or her head “no” but still says “yes”? Finally, a person’s natural tone of voice can cause confusion, such as when someone says “OK!” too forcefully.

To create the effect you want, choose your body language as carefully as you choose your words.

Looking people in the eye, shaking their hand, speaking at the same speed and volume they do: These actions show you truly mean it when you say, “Welcome, I’m glad you’re here.”

Notice the difference between “Did Maisy vomit?” and “Let’s start from the beginning. What exactly happened?”

The first question calls for a yes or no answer. The second invites the client to tell his story.

Using open-ended questions, especially at the beginning of the conversation, introduces the topic of interest and encourages the client to share important information that otherwise might be missed if you only ask a series of yes or no questions.4 Open-ended questions let the client tell the whole story. This can improve diagnostic accuracy and promote client satisfaction and compliance. Here are a few tips for using open-ended questions: • Ask one thing at a time. Avoid double-barreled questions like, “When did you notice Minnie Pearl’s vomiting and diarrhea?”

• Encourage client participation: “Please start from the beginning and tell me about Minnie Pearl’s symptoms.”

• Pet owners often draw from what they know when describing their pet’s behavior. Get their perspectives: “You said Jacquie was coughing. How would you describe the sound? Do you have any thoughts on what might be going on with her?”

• Pause for up to 5 seconds after asking an open-ended question to give the client a chance to think and respond.

• After the client tells the story, you can follow up with closed-ended questions to learn additional details.

Closed-ended questions prompt yes/no or other one-word answers.

• Let the answers to your open-ended questions lead you to the more directed questions.

To listen for another person’s feelings, know what to listen for and what to pay attention to. The first takes knowledge and the second willpower.

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8 Lifelong Care

Reflective listening Reflective listening means reflecting back, in your own words, the thoughts and/or feelings expressed by a client.5–7 When you use reflective listening, clients know they have been heard. It enables them to correct you if you heard incorrectly or made unwarranted assumptions.

In addition, reflective listening allows clients to clarify their story and offer additional information. In these ways, reflective listening ensures you and the client are on the same page.

Here are some tips for reflective listening: • Focus on the speaker’s eyes.

• Occasionally, use encouragers like “Uh-huh” or “Go on” to show you are listening.

• Observe clues in a client’s body language, facial expression, and how he speaks (tone, speed, and volume).

• Be aware when your mind wanders. Take deep breaths to strengthen your focus.

• Ask permission to take notes if you fear losing a key idea or response.

Reflective listening is a two-step process: 1. Pay respectful attention to the facts and feelings clients express through words and body language.

2. Respond by reflecting, in your own words, the feelings and thoughts you heard in the client’s words, voice, facial expression, posture, and gestures.

Try this!

Nonverbal cues

Take these fun quizzes alone or as a group in a staff meeting: • Face Reading (photos): greatergood.berkeley. edu/ei_quiz/ • Face Reading (video): dnalc.org/view/867Reading-Faces.html Could you read some faces easily? Which were difficult for you? Which class of emotions is most difficult to read—negative, positive, uncertain?

Compare your answers with teammates.

Open-ended questions

List 10 words or phrases to use for open-ended questions (examples: how, how much, tell me about).

Convert the following yes/no questions to openended questions using the 10 words you listed: • Would you like to do a health risk assessment (HRA) for Lucky?

• Laboratory tests will help tell us whether Cassie is really as healthy as she appears. Does that make sense?

• Does Charlie eat his food when you put it down?

• Is Rocky vomiting?

• Does Buster seem to be in pain?

• Can I make that appointment now?

Reflective listening

Ask a friend or family member, “How was your day?”

Practice reflective listening. What did you learn?

Now tell them about your day. Did he practice reflective listening?

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Enhancing Preventive Care 9

Try this!

Responding with empathy

Watch these videos without the sound on and guess the key message. Now turn up the sound. Did you guess correctly?

If this person were your friend, how would you respond? If this person were your client, how would you respond?

• youtube.com/watch?v=aaSC7qVRL0w • youtube.com/watch?v=QEdXhH97Z7E

Reflective listening in action

Read “Reflective Listening” (bit.ly/1i6KEEd) and create a presentation and games to share with your teammates.

Chunk-and-check Think about what you want to say to clients about Lifelong Care and the HRA. (Start with the sample scripts at aahanet.org/Library/Lifelong_Care_ Resources.aspx.)

Write a script using the chunk-and-check format.

Find a practice partner, and take turns role-playing with the script. Look for hiccups, and revise the script to improve it.

Shotput vs. Frisbee • Choose two friends or family members for a role-play: One is the client and the other video records the role-play.

• In conversation, using all of the skills on this page, lead the client to recognize the value of Lifelong Care and agree to participate in an HRA. • Get a copy of the video, and watch it three times. Make notes about what you did well and which skills need more work. Note: Where did you shotput? Where did you Frisbee?

• Create goals: “In 1 year, I will become better at including the client in the decision making.

I will do this by taking quizzes and reading articles online. I will practice at work and at the grocery store.”

• Save the video and noted goals. Practice daily.

Every month, check your progress against your goals.

• On your calendar, make an appointment on the first of every month to review your goals.

• Practice your skills at every opportunity. It may feel awkward at first, but in time, it will come naturally. Eventually, you will find your voice.

• Repeat the exercise in 1 month, in 6 months, and 1 year and watch yourself grow! Where did you improve? Share your success!

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10 Lifelong Care

Responding with empathy Empathetic responses are essential to building strong relationships with clients.8,9 When you respond to feelings before you respond to facts, clients know that you see them as people, not as “presenting cases.”

Combining verbal empathy with nonverbal communication can say more than a thousand words. Facial expressions, a gentle touch, and your tone of voice tell the client that you care.

In building relationships with clients, your medical competence isn’t enough; often, it is less important than this personal touch.

Your initial empathetic response earns the client’s full attention. Once you have that, you can explain and educate. But education must come second. The first response is to let the client know you appreciate her or his feelings or predicament (“seek to understand”).

Let’s say the HRA indicates the client uses flea/tick preventives only sporadically on Ruby. “Why?” is a perfectly logical response—but perfect logic doesn’t play well in relationship building. It comes across as scolding.

Instead ask, “What is it like to apply the flea/tick preventive to Ruby? What would make it easier to apply?

What would make it easier to remember to apply?”

There’s no way to know where that open-ended question might lead. You may discover a behavior issue or find out the client is afraid of getting the flea/tick preventive on her skin. Imagine the number of closed-ended questions likely needed to discover this client’s fear!

A good empathetic response might be, “I appreciate that you have some fears and concerns around topical flea products.”

In the end, the information you give may be the same—but your empathetic response is the added value that clients treasure.

It’s one thing to feel empathetic, but the key is to communicate that understanding to the client in a supportive way.

The frank™ Communication Series provides training tools to develop effective communication skills like empathy and reflective listening. To learn more about the frank™ initiative, go to: 1. Overview: bit.ly/1gpvtqw 2. Online learning: bit.ly/1ibvObN 3. Workshop: bit.ly/1p0Ex8e

Putting these skills into action Empathizing with clients doesn’t mean you agree; it means you understand.

After you tell a client that diagnostic tests indicate a serious condition, he may cry. The natural first instinct is to offer a solution. Don’t do it! Before he can even hear the solution, he needs some comforting.

Let your first response reflect the feelings you perceive: “I can see that you are very concerned about Chase.” Give your client a minute or two to talk about his feelings. Then he will be able to turn his attention to the facts and your advice.

Likewise, when a client sees an invoice and exclaims, “This is outrageous!” let your first response reflect the client’s feelings: “I see that the bill for Napoleon surprised you; can you help me understand why?” There is plenty of time to point out that the client signed the estimate earlier. What the client wants first is a sign of respect, that is, to be heard. Once a client feels respected and heard, he can settle down and be open to your explanation.

Chunk-and-check No client will remember everything you tell them. That’s one reason we send them home with written instructions and handouts.

Using chunk-and-check, you can help clients understand the key points:10,11 • Break information down into two or three concepts.

• Focus on one important concept at a time.

• Keep your language plain. No medical jargon!

• Keep your sentences simple. Complexity creates confusion.

• After each important concept, take a moment to check for the client’s understanding. Use open-ended questions (examples below).

Here are some scripts for checking your chunks: • I want to be sure I explained everything clearly. Will you please explain it back to me so I can be sure I did?

• What will you tell your pet sitter about the changes we made to Cassie’s pain medication today?

• We’ve gone over a lot of information, a lot of things you can do to help Opal get more exercise. In your own words, please review what we talked about. How will you make this work at home for you and Opal?

Remember! Chunk-and-check doesn’t test the client; it shows how well you explained a concept.

Key takeaways • Be very aware of your nonverbal cues • Listen and observe for nonverbal cues • Seek to understand (open-ended questions) • Respond first with empathy • Explain in small chunks • Check for understanding Shotput vs. Frisbee In shotput, athletes compete to see who can throw a heavy ball the farthest. The ball lands with a thud, and that’s that. Compare that to a casual game of Frisbee, where everyone passes the disc back and forth. If players simply heaved the Frisbee, there wouldn’t be much of a game.

The shotput veterinarian believes it’s her job to impart her knowledge to the client. Heave-ho… thud.

The Frisbee-playing veterinary team collaborates with each client to build a shared understanding of the pet’s health needs. Everyone pulls together to arrive at a shared decision and an agreed-upon plan of action based on input from both sides. Everyone plays, everyone wins.11 Frisbee is fun, and it’s not too hard. You can start playing right away—and the more you play, the better you get. The tools on these pages will get you started.

Ready to play? Pick any tool and go for it!

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Enhancing Preventive Care 11

How to Talk about HRAs: the Pet Wellness Report® (PWR) Example These scripts include key messages that lead clients to say yes to Lifelong Care and an HRA, like the Pet Wellness Report® (PWR). Using your own words and the skills described on pages 8–11, turn them into conversations to use every day.

Open the Conversation

Explain the Results

Answer Client Concerns

“To enhance Kira’s annual wellness visit, I’d like to get more in-depth information from you about Kira’s lifestyle and conduct some routine screening tests. This will help me identify health risks or diseases early, in many cases before any physical signs of illness appear.

The PWR is a tool that compiles this information about Kira into a personalized, easy-to-read report.

Here is a sample copy of the PWR (hand a sample PWR from a pet at your clinic to the client and guide them through it). You can see from this example how valuable all of this information on Kira would be.”

“The PWR explains the results of these blood and urine tests and incorporates your responses to the online questionnaire to help me understand Kira’s specific lifestyle risks. We will review all of this together and discuss how to prioritize Kira’s care. You can keep this report and access it online whenever you want to review it.”

Kira is young/looks healthy. I don’t think she needs the PWR. “Our hope is that Kira is as healthy as she appears. The PWR will give us both peace of mind that we are doing everything we can to keep her healthy, happy, and out of harm’s way. Even a completely normal PWR laboratory screening has tremendous value. Besides peace of mind, it also provides a good baseline, so that if Kira’s laboratory values change in the future, we will know right away. This helps make health concerns more manageable and easier to treat.”

Like this? Get more!

Go to aahanet.org/Library/Lifelong_Care_Resources.aspx for scripts and videos to use in staff training and client communications. You’ll find: • Addressing Client Concerns: 10 responses • Staff Training Video Series: Discover How the PWR Works

Importance of Prevention

Would You Recommend the PWR?

What Do Pet Owners Think?

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12 Lifelong Care

Keep practicing and fine-tuning until the conversation feels natural—and clients routinely say yes!

you say

What would

1.

I don’t know if I should do the PWR on Roscoe.

to this client?

2.

Yazminie looks healthy; I do everything you tell me to, so I just don’t think she needs the PWR.

What is your first response?

What is your first response?

A. If Roscoe were my pet…

A. You’d be glad to know about any hidden health risks, wouldn’t you?

B. It can be hard to know what to do.

C. Well, I think it’s pretty clear that…

D. What is troubling you?

B. I agree, she does look great! You do a good job of caring for her.

C. The PWR is a good way to tell if she’s as healthy as she looks.

D. It’s always surprising when we find hidden health risks—but we do find them in about 30% of dogs who look just as good as Yazminie.

3.

If you find anything on Phoenix, what then?

4.

What do you mean Athena has elevated creatinine levels?

What is your first response?

What is your first response?

A. We’ll cross that bridge when we come to it.

A. Don’t worry; the number is very low. It’s just something we need to monitor for now.

B. Don’t worry; we’ll be right here, and we’ll all face it together.

C. I doubt we’ll find anything; the large majority of pets don’t have laboratory results that are concerning.

B. Elevated creatinine levels are an early indicator of kidney disease.

C. We’re so lucky to have caught this early!

D. It sounds scary, doesn’t it?

D. It’s worrisome, isn’t it?

5.

$375! That’s outrageous!

6.

So, P.J. is normal? You’re sure?

We’re good to go?

What is your first response?

What is your first response?

A. Yes, it’s substantial. But it will save you money in the long run.

A. You bet!

B. What did you expect?

C. Just be glad you don’t have a big dog.

D. You are surprised with Ringo’s treatment costs?

B. That’s good news. You do a great job taking care of her.

C. Almost. To keep her in tip-top shape, we need to schedule her next dental.

D. She’s normal for her age, yes.

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Enhancing Preventive Care 13

Competence is assumed and courtesy is expected.

Compassion sets you apart.

2.

B

This client is proud of Yazminie’s health, and rightfully so. The first thing she wants is for you to recognize that. Start there, and she will be more open to hearing how the PWR will help her keep up the good work.

answers: 1.

B

Offering advice or probing for additional information are logical responses. But logic doesn’t build relationships—empathy does. So, your best first response invites clients to acknowledge their uncertainty.

Note: People tend to equate “I don’t know” with “no.” But if you empathize with your client’s uncertainty, you can move the conversation from “I don’t know” to “now I know” to “yes.”

4.

D

3.

D

Is this client upset or confused? Only the nonverbal cues will tell. Whatever the case, telling the client what to feel is just plain rude. First, respond to the client’s underlying emotion, then you can move on to reassurance and explanation.

Action without empathy is hollow. Don’t rush to reassure anxious clients. To earn their gratitude and trust, first show that you recognize how they feel.

6.

5.

B

With these statement-questions, the client wants more than simple confirmation. To build rapport, start by giving her the reassurance she seeks.

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14 Lifelong Care

D

What’s the number one thing a complaining client wants? To know you are listening. It’s a sign of respect. You’ll have plenty of time to explain the charges or remind the client that she agreed to the estimate. Your first response is to assure the client you are listening.

Pet Wellness Report® Action Plan Start now

When you are ready, contact your Zoetis representative to get started with the Pet Wellness Report® (PWR). Together, you can create a plan to implement the PWR in your practice. Use this outline to help plan as you get ready to implement.

Step 1

Step 2

Read the case study “Engaging Mrs. Miller” (aahanet.org/ Library/Lifelong_Care_ Resources.aspx), and discuss it during a staff meeting. What insights will you put to work?

Be specific about what you will do and say.

Review the workflow for the PWR. Write a script for each step that requires conversation. In each script, include at least one sentence promoting the value of the PWR, even if it seems a little off topic. To the client, value is always on topic!

Complete the activities on pages 8–11. Share what you learn in a staff meeting. What insights will you put to work? Be specific.

Talk about your experiences conversing with clients: your challenges and successes along with unexpected or funny situations.

Encourage team members to use their conversational skills outside the practice and tell the group about their experiences.

As you are using the caring conversations you scripted (page 13), and noticing what leads clients to accept Lifelong Care and the PWR, what works?

What doesn’t? Share your insights, and keep fine-tuning your conversations.

As a group, determine two to three ways to track the team’s growth in conversational skills. Track improvements in teamwork as well as in compliance.

Expand your conversational skill set with insights and tips from Exam Room Communication for Veterinarians by Jon Klingborg, DVM (AAHA Press, 2011) bit.ly/1hh8heV.

Step 3 By now, staff should be relying less on scripts and more on conversational skills. Encourage staff to talk about their growth in a staff meeting.

Never stop growing! Look online for activities or create your own games. Aim for 10 minutes/week.

Encourage staff to notice each other doing things right.

Reward team members who show marked improvement in conversational skills, for example: Take pictures of them using nonverbal cues, and start a scrapbook for the break room. Buy supplies so staff can label and decorate the pages during breaks.

Ask them to give 3-minute presentations on the skills they’ve found most useful.

Change your world. Use empathy every chance you get! *You’ll find a sample workflow and protocol in the May issue of Lifelong Care at aahanet.org/Library/Lifelong_Care_Resources.aspx.

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Enhancing Preventive Care 15

The American Animal Hospital Association is an international organization of nearly 6,000 veterinary care teams comprising more than 48,000 veterinary professionals committed to excellence in companion animal care. Established in 1933, AAHA is recognized for its leadership in the profession, its high standards for pet health care, and, most important, its accreditation of companion animal practices. For more information about AAHA, visit aaha.org.

Zoetis (zō-EH-tis) is the leading animal health company, dedicated to supporting its customers and their businesses. Building on a 60-year history as the animal health business of Pfizer, Zoetis discovers, develops, manufactures, and markets veterinary vaccines and medicines, with a focus on both farm and companion animals.

The company has more than 9,300 employees worldwide and a local presence in approximately 70 countries, including 29 manufacturing facilities in 11 countries. Its products serve veterinarians, livestock producers, and people who raise and care for farm and companion animals in 120 countries.

Next issue: Change happens! Reap the rewards of Lifelong Care when you maintain the momentum you’ve started. Find out how to make it stick in the next issue of Lifelong Care, arriving with your November issue of Trends magazine.

References

1. “A framework for patient-centered health risk assessments: Providing health promotion and disease prevention services to Medicare beneficiaries,” by R. Z. Goetzel, P. Staley, L. Ogden, et al., US Department of Health and Human Services, CDC, Atlanta, GA, 2011, cdc.gov/policy/ohsc/HRA/ FrameworkForHRA.pdf.

2. Bayer Veterinary Care Usage Study, Bayer HealthCare, LLC, Animal Health Division, 2011, bit.ly/187JdfT. 3. “Decoding of inconsistent communications,” by A. Mehrabian and M. Wiener, 1967, Journal of Personality and Social Psychology, Vol. 6, No. 1, 109–114.

4. “The open and closed question,” by Howard Schuman and Stanley Presser, October 1979, American Sociological Review, Vol. 44, No. 5, 692–712, http://bit.ly/1hCBY4C. 5. Counseling and Psychotherapy: Newer Concepts in Practice, by C. R. Rogers (Boston: Houghton Mifflin, 1942), 273.

6. “A theory of therapy, personality, and interpersonal relationships as developed in the client-centered framework,” by C. R. Rogers, 1959, in “Formulations of the person and the social context,” by S. Koch (Ed.), Psychology: A Study of a Science, Vol. 3, (New York: McGraw-Hill).

7. Encountering America: Humanistic Psychology, Sixties Culture and the Shaping of the Modern Self, by Jessica Grogan (New York: Harper Perennial, 2012).

8. “Building on existing models from human medical education to develop a communication curriculum in veterinary medicines,” by C. L. Adams and S. M. Kurtz, 2006, Journal of Veterinary Medical Education, Vol. 33, No. 1, 28–37.

9. “Empathy and its measurement,” by Q. Zhou, C. Valiente, and N. Eisenberg, 2003, in Positive Psychological Assessment: A Handbook of Models and Measures, by S. J. Lopez and C. R. Snyder (Eds.), (Washington, DC, American Psychological Association, 2003), 269–284.

10. “The magical number seven, plus or minus two: Some limits on our capacity for processing information,” by G. A. Miller, 1956, Psychological Review, No. 63, 81–97.

11. The “chunk-and-check” and “shotput vs. Frisbee” concepts were introduced by Jane Shaw, DVM, PhD, and Suzanne Kurtz, DVM, PhD, in the frank workshops for veterinarians, http://bit.ly/1p0Ex8e.

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