Practice Life Issue 5 September/October 2014 by The Magazine Production Company

September/October 2014 www.practicelife.biz

Job done! How to recruit the right person plus top tips for job-seekers

Reviewing your fees A model for small animal practice

Nurse Clinics Special

THE MAGAZINE OF SPVS AND VPMA

In the Spotlight: Americaâ&#x20AC;&#x2122;s Pet Advocate Dr Ernie Ward

Insights on best practice and case studies

SPECIAL FEATURE:

Perfectionism

FOCUS ON DIAGNOSTICS DAY

Why good enough is good enough

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EDITORS’ LETTERS

Editors’ Letters

elcome to the first edition of Practice Life in what I hope will be a successful second editorial year. September is the time when new graduates are often looking for, or just starting, their first job. With many of our members being potential bosses for those graduates, SPVS runs an annual course for veterinary students about to embark on their final year of studies, with the aim of helping them to adapt to life in practice; to cope with the stresses that go with it as well as making them more aware of how a veterinary practice works as a business and thus appreciate their responsibilities to their employers. The 4-day Lancaster Seminar takes place in early July and many SPVS Councillors give up their time to attend; in particular, credit must be given to SPVS Officer Cat Curtis for all her work organising it. I went again this year and as last year, enjoyed it immensely; there was a great mix of interesting,

here has our first year gone? It’s incredible to think that our joint association efforts have seen such a variety of practice management issues since we first went to press this time in 2013. Continued thanks must go to our great team of writers, particularly the real vet practice staff who share with us their words and experiences of real practice – I hope you’ll agree that this is what sets Practice Life apart. This edition’s “In the Spotlight” guest is Dr Ernie Ward – American pet advocate and vet who, by his own admission, devotes most of his time nowadays to spreading the word of good business management. True, you may have read articles elsewhere in the wake of his “appearance” at BSAVA in April (and I use the word wisely, since Ernie captivates his audiences just as much as any Hollywood movie star!).

relevant talks and social events and it was a privilege to meet so many young people enthusiastic about and looking forward to embarking on their chosen career. Read Cat’s write up of the event in our SPVS pages. Continuing the theme of new employment, this edition also contains interview tips as well as advice about employing foreign graduates and then – because unfortunately things don’t always go smoothly – help with disciplinary procedures including some personal perspectives and experiences from real practices. Hopefully these articles will be of use to many of our readers at some stage; if you’re not recruiting now or in the near future and someone else walks off with your magazine copy don’t worry – the Practice Life website has been improved to allow SPVS and VPMA members to access archived editions for just such a situation!

Stephanie Writer-Davies, SPVS editor

I hope, however, that when I once again interviewed him, you’ll see he was particularly frank in his opinions and took the chance to convey them, rather than just giving a brief overview. It’s a pity that the feature couldn’t extend to a couple more pages, as those of you who know Dr Ward, will be well aware that he has much to say! On the basis that sometimes it’s easier to listen to such a global authority, I have included an audio piece via a link at the end of the printed article which will fill in the blanks. Hope you enjoy this edition. Do remember that we welcome your stories from practice as a great way of sharing experiences and new ideas. Best wishes as ever

Ian Wolstenholme, VPMA editor

Practice Life is the magazine of SPVS and VPMA. If you are interested in joining either or both associations, visit www.spvs.org.uk and www.vpma.co.uk www.practicelife.biz z September/October 2014 z Practice Life

Contents Editors SPVS

UPDATE: NEWS & VIEWS 5

VPMA NEWS New member benefits

Ian Wolstenholme, Practice Manager ian@practicelife.biz

SPVS NEWS Lancaster 2014 report and EBVM Network

Publisher

NURSE TALK Wound management course and new council members

IN THE SPOTLIGHT America’s Pet Advocate Dr Ernie Ward

COLLEGE CORNER The new complaints and disciplinary process

Stephanie Writer-Davies BVSc MRCVS steph@practicelife.biz VPMA

Mojo Consultancy Ltd 181 Sandpit Lane St Albans AL4 0BT Tel +44 (0) 1727 859259 info@mojoconsultancy.com www.mojoconsultancy.com

Advertising and Sales Enquiries Libby Sheridan MVB MRCVS libby@practicelife.biz Tel:01727 859259 Sales Administrator Eva Lambe eva@practicelife.biz Practice Life is the magazine of the Society of Practising Veterinary Surgeons and the Veterinary Practice Management Association. It is distributed quarterly to the members of both associations as well as a wider mailing list of veterinary practices annually. www.spvs.org.uk www.vpma.co.uk The magazine contains articles on veterinary business and management as well as other topical updates and relevant features. The information contained within these articles is intended for general information only and does not replace the need for advice from qualified professionals in the relevant field. Articles and photographs are welcomed for submission, though publication is not guaranteed and is at the discretion of the editors.

© 2014 Practice Life All rights reserved. Practice Life is edited, designed, and published by Mojo Consultancy Ltd. No part of Practice Life Magazine may be reproduced, transmitted, stored electronically, distributed, or copied, in whole or part without the prior written consent of the publisher. A reprint service is available.

VDS NEWS

A sting in the tail g

WELL-BEING Veterinary Perfection: Why good enough is good enough

MANAGING PEOPLE: Performance and conflict management

CLIENT CARE AND MARKETING Special Feature: Nurse Clinics

FOCUS ON DIAGNOSTICS SPECIAL The business, clinical and ethical case for doing more in-house

BUSINESS HEALTH AND FINANCE Reviewing fees in small animal practice

PRACTICE DEVELOPMENT Job Done! Recruiting the right person and tips for candidates

CPD DIARY 52 Registration opens for 2015 VPMA/SPVS Congress g

WHAT’S COMING UP Events listing and a peek at what’s in the next issue g

54 35 28

Opinions expressed in this journal do not necessarily reflect those of the associations, the editors, Practice Life Magazine or its publisher, Mojo Consultancy Ltd. ISSN 2053-1877

Practice Life z September/October 2014 z www.practicelife.biz

News & Views SPVS-VPMA Congress 2015 Early Bird Discount Don’t neglect to grab your congress registration at the early bird rate before 31st October! For an overview of congress see our write-up in this edition. You can book online now at www.vpma-spvs-events.co.uk

WHAT DID YOU THINK...

of our first year?

We’d love to hear your feedback on Practice Life. Help us by completing our survey at www.practicelife.biz

BRAEMAR FINANCE TO COMPETE IN 2014 VET CHARITY CHALLENGE Nationwide specialist lenders to the veterinary market, Braemar Finance have signed up a team of four for the 2014 Vet Charity Challenge to raise money for animal related charities. The challenge, which takes place on 27th September at St Francis School, Pewsey, Wiltshire will raise vital funds for Hearing Dogs for the Deaf, Cats Protection and the Society for the Protection of Animals Abroad (SPANA). The challenge will last for a full day and involve walking, running, off-road biking, kayaking along with mental and physical team challenges and orienteering along the way. The team will be headed up by local Area Manager, Steve Forsyth as Team Captain with Colin Cornish, Office Supervisor, Andrea Hill and Accountant Marion Guthrie. Steve Forsyth commented: “We are all really excited to be taking part in the Vet Charity Challenge. We see this as a great way to get fitter and we will be training throughout the summer, albeit separately due to our locations, to make sure we are up for the challenge.” Last year the Vet Charity Challenge raised over £50,000 and we hope that with our fundraising efforts, they can raise even more in 2014. If you would like to donate, please visit: http://uk.virginmoneygiving.com/team/Braemar100

COMPETITION:

Win a copy of Management Solutions for Veterinary Practices Royal Canin have kindly given us 50 copies of Management Solutions for Veterinary Practices by Pere Mercader to give away. If you’d like to be in with a chance to win a copy, just email us at editorial@practicelife.biz with your full name, your role in practice, practice address , telephone number and email. The first 50 names drawn after the 30th Sept 2014 will win a book. Simples! Competition terms and conditions 1 No purchase necessary. Only one prize draw entry per person. 2 T he draw will take place on the 1st October 2014 and winners will be notified by email. The books will be posted out by Royal Canin to the winners. 3 T he names of the prize winners will be available on written request to the Practice Life publisher after 8th October 2014. No other correspondence will be entered into concerning this promotion. 4 No cash alternative will be offered. 5 Entry to the draw is free and entrants must send full details as above to qualify for the draw. 5 All information on the entry forms part of the Terms and Conditions. 6 E ntrants consent to being contacted by Royal Canin for selected updates on Royal Canin Practice Support initiatives. Entry into the draw is deemed to be acceptance of the Terms and Conditions.

www.practicelife.biz z September/October 2014 z Practice Life

NEWS IN BRIEF

PRETTY PET PICS WIN PRIZES There’s a reason that cats and dogs always feature in the top ten Google image searches – a fun pet pic can perk up anyone – and with up to £200 in photography vouchers to be won, it’s time to get out your camera and start snapping with the launch of the 2015 PetSavers Photography competition. PetSavers, a leading charity that funds vital research into small animal diseases, has launched its popular annual photography competition and this year’s guest judge will be the well-known TV and radio personality, Gyles Brandreth. There are no limits on what you can submit for this digital photography competition – the judges are looking for a really great image that captures the personality of your pet. So send in your striking and original photographs of your beloved dogs, cats, rabbits, small furries, or exotic pet – whatever you share your home with. For some inspiration you can visit the PetSavers website to see what caught the judges’ attention in recent years. The competition is free to enter, with a closing date for entries on the 30 January 2015 – it has two categories, Adult and Junior (16 and under). Prizes will be awarded to first, second and third in each category. Gyles Brandreth, PetSavers first patron, said: “I am delighted to support because I believe that we humans benefit in so many ways from being pet owners. There is plenty of evidence that pets help us to be happier and healthier and it seems only right that we re-pay them by helping them to lead longer, happier and healthier lives themselves.” To enter the competition, or find out how you can help support PetSavers, go to www.petsavers.org.uk.

OUR BEST EVER SPVS/VPMA CPD PROGRAMME We’ve had record attendance at our CPD courses this year, up 50% over all for our first 9 courses. This is particularly pleasing as we’ve travelled further afield with events in Leeds and Preston and one planned for Scotland in September. We ran two courses aimed at nurses in management roles in association with the BVNA and these have been very popular. The programme was again sponsored by Zoetis who delivered our days on Marketing and Conflict Management. Our Focus on Technology Day in June had a record number of exhibitors and the feedback from delegates on the workshop programme was excellent. This will be followed up by our Focus on Diagnostics Day in October (see the feature in this issue) and a further 5 CPD courses on Google, Facebook, Health and Safety, Training the Veterinary Receptionist, and a repeat of our sell out ‘Moving Up’ – don’t miss out! More details on page 54 and on www.spvs-vpma-events.co.uk

Call for abstracts from all the practice team Would you like to be a speaker at BSAVA Congress in April 2015? In the Clinical Abstract stream you could have 15 minutes to present your work to the veterinary profession at this world class event. BSAVA invites all members of the profession, from nurses to practice managers, vets to support staff, to submit abstracts either as presentations or posters from 15th September – 20th October. Your work can be on clinical or business-related topics. Further information is available at www.bsava.com/congress. Prizes will be available in the following categories: • Practitioner • Intern/new graduate • Intern/resident (surgery) • Intern/resident (medicine) • Nurse/practice manager • Poster

Don’t forget you can send us your press releases on practice successes and initiatives. Suppliers are also welcome to send information on management-related products and services. Email to editorial@practicelife.biz Practice Life z September/October 2014 z www.practicelife.biz

VPMA News VPMA President,

Helen Sanderson

This summer has certainly not let us down this year with lots of long hot summer days, just like the ones we remember in our school holidays (and that’s going back a long time for me!). Even with the nice weather the VPMA council has been busy attending regional and industry meetings. Our Member Services Group has been working alongside other organisations and businesses and I hope to announce a fantastic new member benefit at congress in January. Autumn is always a busy time with invitations to other congresses. This year I am particularly looking forward to attending SEVC in Barcelona which has a very strong management stream and is always very interesting to attend. I am, though, even more delighted to announce that our own joint VPMA / SPVS Congress is open for registration. A major theme this year is “The Client Journey” and I am looking forward to hearing Michael Pagnotta, Head of Learning and Development at the Celtic Manor Resort talk about delivering 5 star service. Having been to Celtic Manor for our congress in January 2014, they certainly walk the talk. Mental health is again a key topic this coming year and we have eminent psychiatrist and public educator Dr Max Pemberton speaking for us. I am also very excited that the Equine Management stream is even bigger and better this year. A highlight for me will be Chris Pearce speaking on how to win back the dental work, which I know is a big issue for many practices. And finally, to kick off congress we are delighted to have Monty Halls, BBC presenter, explorer and speaker on leadership and performance. He has been a personal favourite of mine since his programme Great Hebridean Escape was broadcast from a remote croft in the Applecross peninsula in Scotland where he was living with his dog Reuben. So with all this and more in an overall excellent programme, I’d urge you to book yourself and your team in for congress. Spaces will get booked up quickly so don’t delay. Best wishes,

Helen

www.practicelife.biz z September/October 2014 z Practice Life

VPMA NEWS

A 5 minute chat with… Winner of the Petplan Practice Manager of the Year Award, Sharon Lane-Kieltyka. Sharon, you head up a large team at Shepton Veterinary Group in Somerset. Tell us a little bit about the practice and its people. Shepton Vets is a sixteen vet mixed practice based in the heart of Somerset. We have a fantastic team of vets, nurses and support staff who are dedicated to looking after the animals in our care. Describe a typical day. No two days are the same! I generally find myself dealing with day to day running issues, for example, computers not working properly. Dealing with individuals’ personal issues also keeps me very busy and with 35 staff there are always challenges. I also enjoy the financial side of things and spend a lot of my time crunching numbers. What was your working background prior to Shepton, and how has your career developed since joining them? Before joining Shepton Vets I worked predominantly within the financial sector – I trained as a book-keeper and worked as office administrator for an accountancy firm. I moved into the Shepton Vet role initially as a Practice Administrator and within two years became Practice Manager. Although a lot of my current role revolves around finance, I discovered quite accidentally that one of my greatest strengths is being a people person. So HR became an area I dealt with more and more. The practice is genuinely mixed and places a large emphasis on providing training and services to the wider agri-industry. How has this been beneficial to the practice? It has raised awareness of our brand and the skills of our vets. This has grown our reputation and the amount of work that we do outside of the business both in the UK and overseas. With such a diverse offering of services, it must be tricky keeping on top of staff development. Tell us a little about how you manage this. We have a very good appraisal and CPD structure in place – this helps us plan and discuss the needs of our staff on a regular basis. Your director Martin singled out your ability to form great personal relationships with both staff and clients as a real strength. Why do you think this is important, and does it make it tricky when you need to have difficult conversations? I am a great believer in listening before speaking – I like to prepare well in advance for difficult conversations and listening to all sides of the story. I don’t judge people and like to treat everybody in a fair and consistent manner. Today’s practice managers have to be masterful in many different areas, including HR, finance, marketing and more. Tell us how you manage to juggle so many different things, and a little about your own professional development plans and CPD. I have a good team around me that helps with all of these areas, so although I have responsibilities I can rely on Directors and staff for help. Good time-management always helps!!!

VPMA NEWS

Regional Co-ordinator,

Renay Rickard

MEET YOUR REGIONAL ORGANISERS If you are not in touch with your local regional group and would like to get more involved, please contact the VPMA Secretariat.

I hope that you are all having a good summer and manage to get a well-earned rest at some point. It’s the time of year when living in Cornwall most definitely has its advantages, as a cooling swim in the sea with the dogs on the way home from work has made a wonderful end to a few hot stuffy days in the office. Historically the summer is quiet for regional meetings as people are either on holiday or covering members of their team who are on holiday. But this year we have had meetings in the London & Buckinghamshire regions, with upcoming meetings in the South West and the new Essex region. Full details are given below. We would like to welcome our new regional organiser for Essex – Liz La-Page. We’re looking forward to hopefully meeting up with her at our annual regional organisers (RO) meeting at Congress in January. The ROs use this meeting (and the networking evening afterwards!) to catch up with each other and share ideas as to how successful regional meetings can be run. We also feedback from our regional members so if you have anything you would like us to discuss then please let your RO know either at a meeting or via their email address (found on the VPMA website). How many of you use our Yahoo group? This is another place you can share ideas, or ask questions. The details for joining this e-group are in your membership pack or you can do it through the secretariat. Join us for some interesting discussion and debate! Unbelievably my next column will be the December one! Where has the year gone?

Renay

GILLIAN KIDD Scotland Tel: 01408 622217 ro2@vpma.co.uk

HELEN SANDERSON Oxfordshire/Wiltshire/Berkshire Tel: 07765 338607 ro13@vpma.co.uk

PAULINE GRAHAM Cumbria Tel: 07803 228720 ro3@vpma.co.uk

CLAIRE BAKE Co. Durham Tel: 01388 602707 ro16@vpma.co.uk

DENISE WHITHAM Herts/Beds/Northants Tel: 07837 058155 ro4@vpma.co.uk

SUSAN LUNN Stoke on Trent/South Staffordshire Tel: 01543 424100 ro17@vpma.co.uk

MELVYN WILKINS Gloucestershire/South Wales Tel: 07887 895274 ro5@vpma.co.uk

JULIE BEACHAM Buckinghamshire Tel: 07710 317310 ro18@vpma.co.uk

CATH GRIMSEY & HELEN MANNING East Anglia ro6@vpma.co.uk

SUZANNE HEADINGTON South West Tel: 01242 680000 ro20@vpma.co.uk

MARK HARWOOD London Tel: 01242 680000 ro7@vpma.co.uk

RENAY RICKARD Cornwall/Devon Tel: 01208 872254 ro21@vpma.co.uk

RITA DINGWALL East Sussex Tel: 01435 866058 ro9@vpma.co.uk

LIZ LA-PAGE Essex Tel: 07772 382465 ro22@vpma.co.uk

MEET LIZ LA-PAGE, VPMA’S NEW REGIONAL ORGANISER FOR ESSEX I’m practice manager at Elands in Kent, having moved there from a busy charity practice in London. I live in the Essex area though and was keen to keen to provide an opportunity here for practice managers to get to know and support each another. My own home is bursting with animals; everything from a crazy rescue dog who is almost blind to my son’s more exotic geckos. In my spare time I’m a keen horse rider and mountain biker but I also enjoy more leisurely family walks in the countryside – and meals in country pubs! I’m looking forward to catching up with managers from Essex and beyond in September this year at my first regional meeting and am delighted that Kirstie from Onswitch will be presenting for us. Please feel free to email me at any time with suggestions for future meetings or any questions you might have.

LET US KNOW..

If you’v e got a particula you’d li r topic ke som e CPD o region, n in please le your t us kno also lov w. We’d e to hea r about you’ve speaker liked. s

Practice Life z September/October 2014 z www.practicelife.biz

VPMA NEWS

New VPMA Member Benefits

UPCOMING Regional Meetings ESSEX REGION Tuesday 23rd September 2014 At the Thames Chase Visitor Centre, Upminster 7.30pm – 10.00pm

CPD SOLUTIONS are pleased to announce that they are happy to offer a preferential rate to VPMA members for their Veterinary Expert Pet Health Videos. The professionally produced videos are a series of easy to follow educational films which enhance your own practice website. The videos feature in a personalised player on your page and answer many of the common questions owners ask, giving you a unique opportunity to build a stronger bond with your clients, promote your practice and save valuable time. There are currently 2 playlists; one centres on ‘General Health’ topics, such as vaccination, neutering and microchipping, and the other covers ‘How To’ topics, for example how to apply eye and ear drops, how to give your dog or cat a pill, and how to clean your dog’s teeth. www.pethealthvideos.co.uk ONSWITCH are pleased to be able to offer two packages for VMPA members. ONSWITCH SEASON TICKET which includes – Ongoing Onswitch Index with support for 12 months, 3 private Bertha training days with 5 Step and Consult Skills training (to be used within 12 months), 1 Fixer, a full health check of your business looking at 4 key areas – Customers, Team, Operational Effectiveness and Finance. All of this would normally cost £1088+vat per month but we are offering it to VPMA members for £799+vat ONSWITCH BESPOKE SEASON TICKET which includes – Ongoing Onswitch Index with support for 12 months, 3 bespoke Bertha private days, tailor-made for each practice with one day to include a Footsteps training day, 1 Fixer, a full health check of your business looking at 4 key areas – Customers, Team, Operational Effectiveness and Finance. All of this would normally cost £1213+vat per month but we are offering it to VPMA members for £899+vat We would also like to offer our brand new customer care board game, FOOTSTEPS, at a special Onswitch Family rate of £150+vat and postage – that’s £45 off the usual price. I’m sure you will agree, some great offers there! Please contact one of the Onswitch Team if you would like any more information. www.onswitch.co.uk www.practicelife.biz z September/October 2014 z Practice Life

“Your Customer Journey... How easy do you make it for people to recommend you?“ Speaker: Kirstie Faulkner, Onswitch This evening meeting will look at each touch point on the customer journey and outline what you can do to help your customers find you, choose you, stay with you and ultimately recommend you.

JOINT AVON, SOMERSET, DEVON & CORNWALL REGIONAL MEETING Tuesday 23rd September 2014 At North Park Veterinary Group Ltd, North Tawton 2.00 – 4.30pm “Practice Standards Scheme update” Speaker: Renay Rickard, VPMA PSS Representative The Practice standards are currently under review with a re-launch planned by the end of 2015. Renay will be able to give you some information with regards to this re-launch and also chair a Q&A session on matters relating to the RCVS practice standards.

And at the same meeting “Building your Best Team in Practice” Speaker: Carolyne Crowe Carolyne will introduce a tool to help managers and team leaders recognise and appreciate individual team members’ psychological make-up and how best to manage and work with them. Registration forms for both regional meetings can be obtained at www.vpma.co.uk/education/cpd.html or by phoning the VPMA secretariat on 07000 782324. Everyone is welcome – the meetings are open to non-members. The sessions cost £12+VAT for VPMA members and £18+VAT for non-members.

SPVS News

Evidentially, my dear Watson... RCVS and SPVS Past President, Jacqui Molyneux was recently appointed Chair of the Board of Trustees at RCVS Knowledge, the charity partner of the College, having served on the board for three years. Here she discusses why she is supporting the charity’s focus on evidence-based veterinary medicine (EBVM) as a practitioner and as a practice owner.

he RCVS Trust, as the charity was known as until recently, has always been about veterinary knowledge. Be that the task of preserving veterinary history through its historical collection – which houses material dating back to 1514 – or discovering new knowledge by supporting research projects and further study with its grants programme. Over the past few years, the question we kept asking ourselves was: how can veterinary knowledge make the biggest difference to veterinary outcomes? The answer was obvious: by making the best evidence available to practitioners. This is the concept at the heart of EBVM. So the RCVS Trust held an EBVM symposium in October 2012 which sold out within hours of being announced, giving us a clear mandate, from the profession, to concentrate on supporting evidence-based practice. We rebranded as RCVS Knowledge in July 2013 to reflect our new focus on EBVM. It can be quite shocking how little evidence there is to support much of what we’ve been practising as a profession for years. Many practitioners are aware of this, which is why there was so much support for our initial EBVM symposium. I believe most practitioners want to practise evidence-based medicine, not eminence-based medicine. They want to see advice backed up by research, they want to have access to that research themselves, and they want to be sure that it’s reputable and reliable. There are three main problems standing in the way of practitioners getting this information. Firstly, they simply don’t have the time to read and review thousands of veterinary papers each year to stay on top of the latest research. Secondly, they don’t have the access they need to research papers or to quality literature reviews. And lastly, they might not have confidence in locating, assessing and evaluating the evidence – especially if, like me, they graduated some time ago and haven’t had recent experience with primary papers. RCVS Knowledge is tackling each of these problems with the belief that the gap between academic research and daily practice can be significantly narrowed. This is the idea behind the EBVM Network, which was launched last year and now has over 500 members from across the world. The EBVM

Network is a community of people interested in supporting and furthering evidence-based practice – that’s all – there’s no other requirement for membership. We have practitioners and professors, consultants and technicians, veterinary nurses and charities all on board. The EBVM Network is going to produce short, clinically relevant, critical summaries of the best available evidence in a specific area of veterinary care. These summaries – called Knowledge Summaries – will be available to practitioners at the point of care, so that they can make decisions that are informed by the best available evidence, even in the busiest practices. RCVS Knowledge is making sure the development of these Knowledge Summaries is also evidence-based – that the veterinary caseload is benchmarked, so that the priority is given to summarising evidence for the most common complaints. We might think we know what takes up most of our day, but there needs to be an analysis of a much bigger pool of data than just one or two practices. The first round of our Target Grants did just that, ranking presenting complaints, diagnoses and interventions in order of frequency from 1.35 million clinical records in first opinion practices across the globe. Target Grants II, which will open later this year, will support the development of a teaching programme for short courses on EBVM. These courses will give practitioners the skills they need to formulate an answerable, focussed clinical question, find the primary papers, assess that literature and then summarise it for others to use. This has the potential to make a big difference to evidence-based practice. If even just 200 practitioners contribute a little bit each to the Knowledge Summaries, and have help to do that, it will be a huge amount of extra knowledge available to the profession, in a format that can be used every day. The EBVM Network is hosting the 1st International EBVM Network Conference 23-24 October this year in Windsor, and we have some great support already. We’ve offered bursaries to make sure that veterinary students, veterinary nurses, practitioners from low income settings and information specialists are all represented. Most importantly, we’ve got speakers that have first-hand experience in how evidence-based practice can improve veterinary outcomes. Having all of these people in one room sharing their knowledge about EBVM is a big first for the international veterinary community, and I hope to see all of you there. If you haven’t already, you can book your place at www.ebvm-2014.com. You can also join the EBVM Network at www.rcvsknowledge.org/network. Practice Life z September/October 2014 z www.practicelife.biz

SPVS NEWS

Tour de Yorkshire Colin Thomson

t the time of writing this, it’s July, which means Tour de France. This venerable bike race, some say the toughest endurance test in the world, and the largest annual global sporting event, always takes place in the first 3 weeks of the month. This year, it started in Yorkshire. The news that Yorkshire had won the right to hold the first two stages of the Tour was greeted mostly with delight, but there were some dissenters. “Disgusted of Harrogate” featured in the local press on several occasions over the two years’ build up to the event, complaining about everything from road closures to cost, the influx of the wrong sort of tourists to their potential inability to get to Bettys (a locally famous Harrogate emporium) for coffee on the Saturday morning. In the event, it was a spectacular success. The crowds came out in huge numbers and great good humour. All sorts attended - keen cyclists, occasional cyclists, those who hadn’t cycled for 20 years and those too young to sit on a bike. The atmosphere, the pre tour cavalcade and the good weather turned many of the grumblers into supporters. My son (who at times might be described as “Grumpy of Skipton”) and who was on Facebook the day before complaining about road closures, posted afterwards saying how much he’d enjoyed the day and the spectacle. The sun shone and the Dales looked picture postcard gorgeous on the TV coverage – so much so that in a poll the following week 25 per cent of people from the rest of the UK said they wanted to visit Yorkshire! However, the naysayers did have a point. The tour spent two days in the county and ran through our practice locale both days, splitting it north/south on day one and east/west on day two. These splits caused us and our neighbouring practices considerable logistical distress. The road closures were unprecedented in their nature; the whole route was closed to vehicles from around 6.00am until at least 3.00pm. We had to have vets based on both sides of the route for our large animal work and arrangements with neighbouring practices to see small animal cases as required. It curtailed my attendance at SPVS Lancaster Student Seminar. As well being the only vet who lived on the same side of the route as our surgery, I had to return early as no one else could get in. The whole weekend highlighted community. Yorkshire came together as a community to organise the tour, then came out to en masse to celebrate it; our local veterinary community pulled together to overcome our logistical troubles. I had to leave Lancaster to man the fort at home, but Lancaster is all about introducing the community of student vets into their next community - the community of veterinary practice. SPVS itself is a community of vets helping those in practice. Our CPD, surveys, email discussion list, congress and other events all bring tangible benefits, but I feel SPVS membership also brings an intangible sense of community around veterinary practice. If you’re a vet, particularly a vet in practice, you should join. I’m sure you’ll enhance our community, you’ll enjoy and benefit from it, and you’ll be made very welcome.

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SPVS Dates For Your Diary 2014 September 11th – CPD Course ‘Training the Veterinary Receptionist’, Ingleston September 24th – CPD Course ‘Top 10 Essentials to keep you Legal & Compliant’, Surrey October 8th – CPD Course ‘Google Masterclass’, Surrey October 16th – Focus on Diagnostics Day, Daventry October 22nd – CPD Course ‘Facebook Masterclass’, Solihull November 5th – CPD Course ‘Moving Up’, Leeds December 8th & 9th – Officers and Council Meetings, London. If you have any items you’d like to see added to the agenda please contact the Hon Sec, Tom Flynn via the SPVS office. December 9th – SPVS Christmas Dinner, Institute of Directors, Pall Mall Contact the SPVS Office for more details.

2015 January 23rd & 24th SPVS VPMA Congress at the Celtic Manor Hotel, Newport See the SPVS Website for more details or contact the SPVS office. March 7th to 14th Snowscene at the Col Altro Hotel, Covara, Italy May or June Cyclescene, France Exact details to be confirmed – Watch this space!

SPVS NEWS

SPVS & Citation

launch Small Practice Compliance Service After listening to feedback from both members and existing clients, SPVS and Citation are delighted to announce the launch of the SPVS Small Practice Service. SPVS editor, Stephanie Writer-Davies, caught up with Peter Sherlock, Head of Partnerships at Citation, to find out the finer details… SW-D “Peter, Citation are well known for working with SPVS over a long period of time, why the new service?”

SW-D “It certainly sounds potentially useful for smaller practices.”

PS “Smaller practices face the same day to day Health & Safety and Employment Law issues and penalties for noncompliance as their larger peers but may find it harder to address them due to lack of time, resources or personnel. We have spoken to SPVS a number of times and talked to members at events such as Congress about how we can help out the smaller practices; we think this new service will be very helpful to them.”

PS “Definitely. The sector is highly regulated with Practice Standards and the HSE, etc. so if your practice falls into this size bracket and you are considering reviewing your existing Health & Safety, HR or Employment Laws provisions it is worth contacting us to discuss it. There is no large deposit needed as payments are on a simple monthly direct debit, and agreements start from as little as 12months, allowing you to budget and plan your practice operations accordingly.”

SW-D “Who would benefit from this new service?” PS “Essentially, the new service will be ideal for smaller practices with up to 5 employees. It will enable them to access a whole host of Veterinary specific support systems, documentation and tools to demonstrate good practice and compliance. For only £15+vat per week, the service provides 24/7 support through provision of advice lines, legal updates, document and factsheet libraries, HSE posters and signage, COSHH and Risk Assessment software, Online employee training and much more. The service elements it provides are exactly the same as those enjoyed by our larger clients, but at a more cost effective rate.”

To speak to Citation about how they can help, call 0845 844 1111 or email spvs@citation.co.uk

SPVS Launches Recommend a Vet Campaign

he Society for Practising Veterinary Surgeons (SPVS) is launching a ‘Recommend a Vet’ campaign as part of its plan to increase the organisation’s membership over the next three years. Working along the same lines as a ‘Friend get friend’ initiative, the society’s 1200 members will be asked to recommend another practising vet to the organisation with a £10 John Lewis voucher as a reward for both the existing and new member. Colin Thomson, SPVS President comments: “We are proud to have a very high membership retention rate, proving that once vets join SPVS, they appreciate all of the many benefits and stay loyal, renewing their membership year after year. Now we’d like to harness that loyalty by asking every member to recommend a veterinary colleague who should also be enjoying the benefits of membership.”

“SPVS is the only organisation that exists to support practising vets and help them develop their practices. It provides members with networking opportunities so that they can share their experiences whether it’s face-toface at Congress or as part of our CPD programme or via our very proactive email discussion group. Our fee and salary surveys are being further developed and we will be launching new initiatives later this year. It’s an exciting time to be joining SPVS and we look forward to welcoming new members on board.”

For further information about joining SPVS visit www.spvs.org.uk or call 01926 410454.

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SPVS NEWS

Do you lead your practice in management, marketing and business matters... or do you aspire to? autumn, where we will facilitate you visiting other practices to share experiences. One of the key reasons our members join SPVS is to access our salary and fee surveys. An important aim for us over the next 12 months is to build on these to create an industry leading benchmarking service. Additionally we plan to further develop our email discussion group, using it to identify issues of real concern or interest to vets in practice and then take these to the rest of the membership and potentially the wider profession. It has almost become a cliché to say that the industry is undergoing seismic change. Like all change this offers both challenges and opportunities and SPVS intend to help identify these for our members. Our views are sought by RCVS, BVA and industry and in the last six months alone, we have influenced discussions on 24/7 service, recruitment and Practice Standards. There has never been a more exciting time to be a member of SPVS and in turn we need you to help us shape our future. What are you waiting for? Join today by visiting www.spvs.org.uk or calling the office on 01926 410454.

If so, I hope you are already a member of SPVS. If not, then please read on and I hope you’ll be persuaded that there is no better way to spend £12 a month! If you are between 5 and 15 years qualified and thinking of coming Congress, then it really is an easy decision... you’ll get your first year’s membership for free as well as receiving the membership discount on your registration. SPVS is about supporting vets to develop their practices. Whether you are a Joint Venture Partner, in a traditional partnership, in industry, or not yet decided what you want to do next, if you’re looking to progress and develop your career SPVS will have something to offer. If you want a steer on the issues that really impact on the profession and on practice, then SPVS will keep you up to date. How do we do this? First and foremost we are about networking and sharing experiences. We understand that times are changing and that today’s successful practices work because of a partnership between the vets and their team. That’s why SPVS partners with VPMA offering joint opportunities to learn and network. Together we run a fantastic programme of CPD, two ground breaking Focus Days, the number one business and management Congress and of course, our joint magazine, Practice Life. However we also recognise that there are times when vets may want to share experiences with other vets and so we offer our own, unique (and I use the term advisedly) SPVS email discussion group as well as Snowscene and, brand new in 2015, Cyclescene (friendly, sociable holidays in lovely hotels which combine quality CPD with skiing or cycling). We are also launching our Vet Swap scheme in the

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Nick Stuart SPVS President Elect

All solutions great and small Expert accountancy advice for every practice From accounting and tax through to benchmarking and sage software advice, there is little Hazlewoods doesn’t know about the veterinary industry. Our 20 years of experience working with veterinary practices means that we not only understand the problems you face, but we can also provide tailor-made solutions to help you maximise your potential. To find out more about our services, please contact the Vet Team Tel: 01242 680000 Email: vets@hazlewoods.co.uk Web: www.hazlewoods.co.uk

SPVS NEWS

LANCASTER 2014 SPVS Lancaster Organiser Cat Curtis, reports on a successful summer event for final year vet students

or over 25 years final year students from all the UK veterinary schools and Ireland have descended on Lancaster University for the SPVS final year seminar. The event is held every summer by SPVS, BVA and the RCVS and is also supported by a number of commercial sponsors including the VDS. It never fails to ignite pride and passion in the students for the profession they are about to enter as well as re-igniting the same pride and passion in the speakers, sponsors and other members of the profession who attend. I always leave feeling that we really are part of an incredible profession and having met the newest members I know it is definitely in safe hands. The seminar runs over 4 days in July, the key aim being to prepare the students for real life in practice. Most of the speakers are, or have been practitioners and attend to impart their pearls of wisdom to the students. The seminar traditionally starts by discussing the dark art of CV writing and interview techniques. The focus is not on the template itself but rather is about how to make their CV stand out from the multitude of others that practices receive. This is a recurrent theme throughout the seminar, helping the students think about how they can set themselves apart from all the other new graduates. Over the last few years the number of graduates in the UK has increased markedly while the number of suitable jobs hasnâ&#x20AC;&#x2122;t. The information they pick up at this lecture is invaluable and year after year this is one of the most highlyrated sessions. Much of the content of the 4 days focuses on life as a practising vet in small animal, mixed and equine practice. Topics include the practicalities of the euthanasia consult and how to survive those first few months in the job. In addition there are sessions on business and personal financial management as well as a review of the workings of practice finances. The level of debt that students anticipate graduating with seems to increase all the time; it can be a source of stress for many. The opportunity to speak to experts in this area and to gain realistic expectations of potential salaries can be very beneficial. On the Friday afternoon the students learn about careers outside practice. Options such as academia, emergency medicine, industry, public health, Royal Army Vet Corps and charity work, both in the UK and abroad, are included. Delegates regularly comment that it has opened their eyes to alternatives they would never have considered beforehand. Further on, we look at what could lie beyond being an assistant in a veterinary practice; corporate models are discussed, as well as partnerships or setting up on their own. Lancaster also provides an ideal platform for the students to meet officers from the BVA, RCVS and SPVS both formally during the lectures and informally over dinner or in the bar.

NOT a casualty of Lancaster, we hasten to add!

This interaction is important for all parties; it allows the students to see that the officer and management teams are real people who genuinely do have their best interests at heart and it also allows our organisations to get a glimpse into the lives of the students as they enter their final year. It helps to ensure that we are supporting them and their peers as best as we can. Promotion of initiatives like the BVAâ&#x20AC;&#x2122;s Young Vet Network is crucial as this can be a vital source of support for the new graduates as they start work. The RCVS also clearly presents the workings of the preliminary investigation and disciplinary committees; this is often enjoyed as much by the practising vets present who frequently comment that they learnt as much as the students! Another focus is on preparing the students for some of the potentially more difficult times in practice. It is important that we acknowledge the fact that our profession has a higher than average suicide rate as well as being aware that problems can arise with alcohol and drug addiction; we aim to give the students coping strategies that will help when they feel stressed or depressed and we highlight the various organisations and support networks available to them. Key to this is a presentation by the VBF about the charity, Vet Helpline and Practice Life z September/October 2014 z www.practicelife.biz

SPVS NEWS

Vet Life; it raises awareness amongst the students as well as the importance of fundraising. Funds for VBF are traditionally raised at Lancaster and it is a testament to the students that every year since 2011 the donation total has exceeded £1000 with this year’s final total reaching a staggering £1200. Over the last few years, challenges have been made and taken up to help boost the donations. These have included the BVA president rapping, myself, as organiser, eating an equivalent of 10 persons’ puddings, cross-dressing by eminent members of our profession and the now annual appearance of a gorilla during dinner! The social side of the seminar is almost as important as the formal lectures. It provides great networking time between the

students, speakers and sponsors which is often as useful for the latter two as it is for the students! Thursday and Friday night dinner seating is pre-arranged with students randomly allocated to tables with speakers, sponsors, SPVS Councillors and other supporters. As they sit down on the first night you sense that they are slightly un-settled having been separated from their peers, but by the end of dinner there is always a convivial atmosphere and it can be a struggle to persuade them to move from their new found friends into the bar! On the final night, inter-university games are organised and the friendly rivalries which exist between the universities come into play with speakers and sponsors secretly assisting the team from their old college to try to ensure victory! This year it was a combined Nottingham and Poland team who raised the trophy high. Whether they can retain it next year remains to be seen… There is no doubt that the seminar continues to play an important role in our profession. If you look back, many of the profession’s notable members are ex-Lancaster delegates. It continues to be the place for students to learn how to stand out and start making the transition from being a student to becoming a fully-fledged member of the profession. The ethos of the seminar is that it is the profession helping to prepare the students for the realities of the life they will have after they take their oath and become an MRCVS the following year. And everyone leaves with the feeling that they really are part of something incredibly special.

SNOWSCENE 2015: Insights into the heart of the pet and the heart of your business… all within the heart of the Dolomites! Mark Patteson

Mark Patteson, Specialist in Veterinary Cardiology and Alan Robinson, Veterinary Business Consultant will provide the CPD for Snowscene 2015 to be held in Covara in Northern Italy in the stunning Dolomite mountains. Mark will provide interactive case based illustrations which will enable you to advance your knowledge of cardiology and your diagnostic ability. He will take you through what’s new in both diagnostics and treatment and help you feel more confident about what you can do in house and when you should refer. Alan Robinson will help you get to the heart of your business through a series of case studies and practical examples taken from his wide experience of working with different vets in very different practices. The seminars will lead you to a new way of thinking about issues, giving you tools to help you build a sustainable, profitable and purposeful practice.

Alan Robinson

Snowscene 2015 will be in the beautiful Dolomite Mountains in Northern Italy for the very first time. 1,200km of beautifully maintained runs linked by 450 lifts on a single ski pass, circling the spectacular Sella Ronda within this World Heritage Site national park. The impressive and rugged mountains are like nowhere you will have skied before. The food in the mountain restaurants is both delicious and, by European ski resort standards, extremely good value. Après-ski is influenced by Austria, just a hop over the border. What’s not to like?! What’s more, our deal with one of the best hotels in Corvara has NO single supplement! For more information, or to book your place, visit www.spvs.org.uk

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Nurse Talk 16

NURSE TALK

In association with

Meet our new BVNA council members for 2014/2015 BVNA elections have seen the appointment of four new council members. Here is just a snippet about each one before they start on council after ratification at the AGM which is held at BVNA congress in October. Bizzy Allen-McClure RVN Bizzy proudly qualified as a VN from Sparsholt College in 2010. Prior to this she completed a Degree in Business Information Technology but decided that a 9-5 office job just wasn’t for her! Bizzy has worked in a variety of roles including first opinion, emergency nursing and a few years in industry as a Practice Support Advisor. She is currently Head Nurse at a small animal practice in Portsmouth. Her areas of interest are nursing care of exotic animals and critical care and emergency nursing. She trained as a Clinical Coach in 2011, attained a certificate in Exotic Veterinary Nursing in 2013 and qualified as an SQP in 2014. Bizzy is currently the regional coordinator for Surrey and has previously held the position for the Hampshire and Berkshire areas as well. We welcome Bizzy’s enthusiasm onto council.

BVNA and Taylor & Francis launch new publishing partnership

Whilmari Worrow RVN Whilmari qualified as a Veterinary Nurse in Onderstepoort, South Africa in 1998. Whilmari’s nursing experience includes bovine only and mixed practice for the first 3 years in South Africa. During her 13 years in the UK she has mainly been in small animal practice (3 years) and ECC nursing for the last 8. Her other skills include business management, coaching, and project management. In her new role as Head of Clinical Nursing for Vets Now she will oversee clinical audits, clinical governance and nursing standards for the company. We are very excited about the experience that Whilmari will bring to council.

Kirstie Shield, President of the British Veterinary Nursing Association said, “BVNA Council are delighted to announce our publishing

Megan Whitehead RVN

collaboration with Taylor

Megan studied in Nova Scotia Agricultural College in Canada and qualified as a Registered Veterinary Technician in 2008. Prior to nursing Megan had obtained her Masters in Science and worked in human clinical trials and other biological research, but always had an interest in animals and medicine. Megan keeps up her Canadian registration and is still a member of the Eastern Veterinary Technicians Association in good standing. She currently works full-time at a small animal first-opinion and referral practice in Scotland. Megan’s main clinical interests at work are pain management and anaesthesia, however she enjoys having extra projects on the go and is currently organising an infection control study group based on the Bella Moss Foundation guidelines for her nurses. Megan’s experience and passion will be an excellent addition to council.

and Francis. The BVNA’s highly valued membership journal the Veterinary Nursing Journal will enjoy continued success and ongoing commitment to future development with the support and experience of our new publishers and colleagues,

Sarah Wyatt DipAVN (small animal) RVN

Taylor and Francis.”

Sarah started her veterinary nursing training in 2003 and qualified in 2005 with a merit. Since qualifying she has worked in several first opinion practices within Wiltshire and Somerset and most recently has taken the challenge of a Head Nurse position at a busy mixed practice. Sarah attained the A1 Assessor qualification in 2008, the Clinical Coach training in 2012, the RCVS Diploma in Advanced Veterinary Nursing in 2013 and currently completing a BSc (Hons) in Clinical Veterinary Nursing. Her professional interests include anaesthesia and analgesia, life limited conditions and critical care. Sarah spent five years as BVNA Regional Co-ordinator for Wiltshire and Dorset. BVNA will be very lucky to have a council member with the drive and passion of Sarah.

Through the publishing partnership, VNJ will benefit from the Taylor & Francis Online platform, with functionality such as forward citation linking and advanced online publication of articles ahead of the print edition.

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NURSE TALK

BVNA Congress hosts RCVS Declaration of Registered Veterinary Nurses Ceremony

Kathy Kissick

BVNA is delighted to have been invited by the RCVS to host this important ceremony for the first time at BVNA Congress. As RVNs we value our qualification and role within the profession and this prestigious event provides us with an opportunity to show we are responsible and devoted to what we do. Kirstie Shield, BVNA president urges all delegates to attend this session whether you are taking part or merely observing and adds “this ceremony is important to our profession and shows we are united and dedicated in our work”. Following the ceremony both Kirstie and Fiona Andrew, BVNA Vice President, will attend the RCVS VNs Question Time, alongside Kathy Kissick, Chair of VN Council and Julie Dugmore, RCVS Head of Veterinary Nursing. After a short presentation delegates will be invited to put forward questions on any issues.

BVNA Announces ‘Delving Deeper into Wounds’ Course Approval by Lantra Awards Photo courtesy of The Veterinary Wound Library

BVNA Education Development Co-ordinator, Debbie Gray announces “The BVNA are delighted to have become an approved Provider for Lantra Awards. This recognition as Provider ensures that the course is delivered to a good standard, providing reassurance to delegates and employers alike that a high standard of education is being delivered. The newly accredited and certified course ‘Delving Deeper into Wounds’ accepted its first students in June this year. With more students already signed up for the second intake in September, it is already proving a very popular course. Designed by the BVNA in conjunction with The Veterinary Wound Library, the course aims to offer bespoke training in wound management specifically aimed at veterinary nurses. To find out more about the course or to register for a place on the course in 2015, please contact Debbie Gray on 01279 408644 or email debbie@bvna.co.uk. To find out more about The Veterinary Wound Library please visit www.vetwoundlibrary.com

There’s still time to register for BVNA Congress at the Telford International Centre from 10th – 12th October! The UK’s best known sole veterinary nursing congress offers delegates unlimited high quality CPD and provides great value for money. Congress offers dedicated lectures for both practice staff and veterinary nurses of all levels, with a tiered lecture stream each day, interactive workshops and an excellent social programme. Delegates can also enjoy a large exhibition which is open throughout the event and hosts a vast range of companies offering information and advice on their products and services, along with new product launches, a chance to enter a competition or two and great networking opportunities. Don’t miss out. You can register online at www.bvna.org.uk. If you’re not a BVNA member you can join at the same time as registering to avail of the substantial member discount. What are you waiting for?! Hope to see you there.

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IN THE SPOTLIGHT

in the This month we hear from ‘America’s Pet Advocate’ and recent BSAVA Congress speaker Dr Ernie Ward. VPMA Editor Ian Wolstenholme caught up with him between lectures. IW: Practice Life likes to feature health and wellbeing matters and when we were discussing who should be in the spotlight, my first thought was Dr Ernie Ward. It’s a bit of a sad indictment of our UK vet practice scene that my mind should turn to an American vet, athlete and pet advocate. But seriously Ernie, research shows that our profession is still overshadowed by anxiety, stress and depression here. Why do you think that is? EW: I would add to that list substance abuse and this is prevalent in our profession worldwide. We’ve seen studies out of Germany and the US that corroborate all you say about experiences here in the UK. We all work in an emotionally charged environment, with client and financial issues plus staff problems which as veterinarians we are

not trained to deal with. We’re not grief counselors or psychologists or human resource managers and yet we are all suddenly thrust into a world where we do have to be all those things and more and I think that’s what adds up to stress that leads to depression and ultimately can lead to personal destructive behaviour. IW: Facebook and Wikipedia are great tools and with a few clicks it’s relatively easy to discover that you didn’t always have a health and wellbeing outlook. For instance back in the late 80s and early 90s you were in a rock band called The Violets and I guess maybe in some way enjoyed the lifestyle and trappings of fame and success. What was that period like and did any of it contribute to your decision

to change from a rock and roller to a sensible veterinarian? EW: With The Violets we reached our peak of popularity whilst I was at vet school so I’m very proud of that. But there is a story here. Whilst I was in this college band my father had open heart surgery at a very early age and seeing that, it kind of accelerated my emphasis on having a better diet and exercise and so forth and even though I was in the rock band, I was a vegetarian and leading a pretty clean lifestyle which wasn’t quite as decadent as you might think! My perspective on lifestyle changed because I had watched both of my grandfathers die at an early age, I’d watched my father had his chest cracked open in his forties and I wasn’t willing to go down that path. Most of my relatives were from the deep south of America where everything is deep fried

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IN THE SPOTLIGHT

and high calorie, were alcoholics and heavy smokers and this of course lead to their early demise and all this showed me that I needed to get my act together. IW: I’ve read on your website that 1996 was a turning point for you after four years of veterinary practice. You say that you took a long, hard look at your life and decided you wanted to seek a higher quality of life for yourself, your family and the pets you served. I love the phrase, and it’s become your philosophy hasn’t it, that no longer would you accept wellness as the absence of illness. In what ways have you achieved this ideology? EW: Too often do we think that we are not sick as long as we are not ailing or in the hospital or taking medication, so we must be well! There’s another level to wellness that we don’t like to talk about and that is what I would call “optimal being” when you are at the peak performance, mentally, physically and emotionally. Certainly the majority of Americans go through their life sort of in this middle state of health and they think it’s something lost with youth. I’m just not willing to accept that. OK so as I near fifty my body is different than it was when I was twenty five but I still have the same vitality and energy; I still have the same emotion, passion and drive and I really believe that if you can keep your body as well and as strong as possible, your mental faculties come along. IW: You said in a recent interview that vets had allowed nonveterinarian pet service providers to encroach on territory that should be our domain: the health and wellness of our pets. What can vets do to take back this business without appearing ‘greedy’ for money (which I think is one of the reasons vets shy away from selling wellness.) EW: When I say that we’ve given it away, I truly mean that. These were topics that originated in the veterinary hospital – nutrition, behaviour, preventative parasite care – and vets lost focus, we got too busy, something happened in the US for sure and we stopped talking about the basic veterinary elements and stopped

doing a good job with things such as communication and examining our patients. People still hungered for this information so they sought it from somewhere else and suddenly there were retailers who were all too happy to talk about nutrients, there were self-proclaimed dog whisperers that were un-credentialed behaviourists! We created this: when there’s a vacancy or void in any market, someone will fill it. I fear that the safety and wellbeing of our pets are at risk because now we have people who really are not educated, knowledgeable or credentialed, giving some lousy and potentially dangerous advice. One of the things we have seen in the US is the confusion with flea products and flea and worm products. They go to a pet retailer and then purchase the wrong product and apply it to their cat and then many veterinarians, myself included, have seen the toxicosis and the ravages that can occur. That’s just one of those areas that we need to be talking about because I want to avoid that harm. As vets we shouldn’t feel as though we’re being greedy if we’re selling something that is in the best interest of the pet. If we do, then I think we’ve lost the real essence of medicine. For me, I’m extremely comfortable talking about those topics in my exam room, because if I don’t talk about it Ian, someone else is going to! IW: Obesity in pets is on the increase in the same way that it is in people. Do you have any tips for vets in terms of addressing this, particularly in cases where the animal’s owners are also heavier than they ought to be? EW: In the States we know that over 68% of adults are overweight and we’re still at around 52/53% of all dogs and cats. This is a huge number of pets and people that are affected. You have to understand the science and pathology behind obesity – this is not just a lump of lard, it’s a biologically-dynamic tissue that’s secreting dozens of harmful chemicals, compounds and hormones. So you have to acknowledge that this is a medical condition like type 2 diabetes or a contributing factor to osteoarthritis and cancer in dogs. So what I would like to see (is for) vet staff to say (a) this is a medically-relevant issue, (b) have a “conversation” with every pet; do a

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body-condition score, weigh them, trend it with the last year (uppers and downers) and then finally (c) you have to talk about nutrition and show that we are the experts. I normally get a couple of excuses about this from vet staff. Firstly that I’m not knowledgeable about food. Well, you need to hone up your skills or else your clients are going to their information from a sixteen year old sales clerk who really knows nothing! Secondly, there are so many pet foods out there, raw food, all-natural organic garbage….I don’t know what to say to them etc. Well again, start by identifying your own personal philosophy and ideology about nutrition. It’s incumbent on vets to do that and to explain clearly to clients why you are making such recommendations. Remember it’s not about the person, it’s about the pet. I wrote a book in 2010 called “Chow Hounds” and there’s an entire chapter in there on how to teach veterinarians how to discuss this. I’ve found that in 22 years of private practice, if you make it about the pet, the owner is rarely offended. I have had only five people leave my practice in that time for that reason, so I’m willing to take that gamble. What people want is good care, good advice… gotta have that conversation. IW: Here in the UK, there’s some debate on the risks of over-supply of vets due to more vet schools opening. What’s your opinion on this? Are you seeing the consequences of this in the US on vet salaries /competition/ fees? EW: I think you’ve got to spin this question a little differently. One aspect is the supply side of the equation – if there’s excess supply of vets, we have problems. What I’m really focusing on now is the demand side. We’re seeing slippage in the number of dogs in the UK and seeing decreased number of vet visits in the US and so when the demand side of an economy or a market starts to slip, that is an opportunity. With the supply side, we have to do that through regulation and so forth but do I have some concerns about the number of graduate vets coming in from other countries and worry about a balance. In the short term, I feel that veterinarians should worry about how to get more people back into our revenue stream.

IN THE SPOTLIGHT

Here’s a simple fact. Last year in the US, pet owners spent more money than ever before on their pets; they just aren’t spending as much as they should at the vets! If I saw the overall pet spend go down I would say “Oh Ian we have a real problem, the ship is sinking”. This ship is sailing along at fast speed and we are not keeping up. One of the things in the UK that I think is a real problem is that you have too short a consult time and there’s often not enough time to discuss these things. You have a client in front of you once or twice a year for fifteen minutes and we wonder why they’re seeking advice elsewhere? We all need to focus on what’s the product we’re delivering, how do we deliver that, concentrate on the demand side and say, come back to the vets – we can be your behaviour expert, we can talk to you about nutrition, we’ve got you covered for flea and worm prevention – all these areas that we’ve let gradually creep away. IW: What do you think the vet industry is going to look like in 10 years’ time? And what are the top 3 things in your opinion practices should be doing/changing right now to prepare for it? EW: Hey, the next time we talk we should discuss the twenty year plan! I think that you are going to see more and more corporate practices – that is clearly the trend in the US over the past decade plus. There will probably be more encroachment of OTC service providers as we’ve mentioned earlier. Vet-governing agencies are going to have to come together more and have conversations. Top three tips? Focus on what’s important for your practice with an eye to what is important for your clients and their pets. Number two, we have to continue to focus on our staff – they are an important leverage point that we’re not maximizing. As a veterinarian, I can only be in front of one person at any given time but my staff simultaneously can be in front of three, four or more clients. So what is the message that’s being transmitted? If I concentrate on staff training and communication skills, then I am leveraging additional opportunities that I may never see. I always point out to vets, hey, you think of appointments,

surgeries and exams you perform, but guess what, a lot of those clients who walk in never see a veterinarian. They walk up to the front desk to buy a bag of food or flea treatment – how valuable is that transaction? Are we adding real value to that exchange? Finally, vets need to understand economic principles because some see this as the dark side or that business is the dirty word! If we’re going to survive the next ten years, those practices that embrace real sound business principles are going to do very well. 2010, 2011, 2012, 2013 these were stellar years for me! Maybe partner with people outside the profession if you’re not comfortable with the business side. Remember what I said about people spending money now. We can change that to our advantage by simply changing the message. IW: A new departure for Ernie Ward is running for the US Senate. How did that come about and what impact will it have on your role as a veterinarian? EW: I have always been a very politically active person and enjoy helping people who want to help themselves. In college I was president of student governors and was elected all four years in vet school so this is something that is not so alien to me. I finally got fed up with our government and said I’m tired of whining and want to do something about things that are a big problem in my state – clean air, health and even animal welfare are real issues. How will it make a difference to me as a vet? Well I’m already seeing clients on just a part time basis because I spend most of my time managing, innovating and creating and many of these skills I’ve developed over the years as a practising vet are directly transferable into politics and that’s given me a real advantage over many politicians. I’ve worked in the real world and collaborated with many diverse groups and associations so to immerse myself in these arenas is actually an opportunity to learn more as a person, to help my profession but also to help the pets that I serve. I’ve always said that there are two types of successful people in this world; those who say “I got mine, now you go get yours” and those who say “I got mine,

let me help you get yours” and falling into the second category, I feel really fortunate that I’ve had the success that I’ve had for the past twenty two years solely in the veterinary profession – every article, every lecture, every interview is trying to help my profession get better and now I’m on targeting, hey I’m tired of my community, my state, my country... I want to help it do better! Big time politics in the US, it ain’t beanballs, it’s hard ball and the punches are real, the gloves are off and that’s the one thing that I think is disappointing but expected in this day and age. You’d like to be able to think that as a candidate you could run on the merits of your ideas and your history and accomplishments but US politics gets pretty dirty! If you would like to listen to Dr Ernie Ward simply type this link into your web browser http://1drv.ms/1na9mEf

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COLLEGE CORNER

College Corner

Maintaining high standards within the profession Eleanor Ferguson is the Head of Professional Conduct at the Royal College of Veterinary Surgeons (RCVS) with responsibility for managing the College’s largest department as well as the Practice Standards Scheme. Here, she talks to Practice Life about the College’s complaints and disciplinary process, which has recently undergone an overhaul to make it simpler and more efficient.

First, could you describe what kind of complaints you receive and how many? It’s fair to say that the concerns we receive from members of the public are a mixed bag and run the gamut from concerns about the service received to serious concerns about the professional conduct of a veterinary surgeon or registered veterinary nurse (RVN). We also receive some complaints from other vets or VNs. I would like to reassure the profesison that we receive relatively few complaints – between 700 and 800 every year – and that the vast majority, around 80%, are closed during our initial Assessment and Investigation stage. The remaining 20% are referred to our Preliminary Investigation Committee (PIC), and of those, only a small amount – around 10-12 a year – are then referred to a full Disciplinary Committee (DC) hearing. However, it is important to note that we are required to investigate all concerns that are brought to us, to determine whether there is any substance to them.

and which individuals may feel if a concern is raised against them. I would also like to draw attention to cases dealt with under the Health or the Performance Protocols. These are cases that, in years gone by, could only have been dealt with by referral to Disciplinary Committee hearings. However, these protocols provide an alternative route that still offers protection for the public as well as for veterinary surgeons or RVNs whose fitness to practise may be impaired because of adverse health. For example, those with alcohol or drug addiction, may be subject to undertakings and will also be monitored under the Health Protocol. Similarly, for some competence issues, remedial action can be taken via undertakings and ongoing monitoring through the Performance Protocol.

Are there any concerns that you don’t deal with? We will not generally deal with complaints about fees – unless they are so excessive that they bring the profession into disrepute – or allegations of negligence, unless the errors are serious enough or amount to disgraceful conduct.

Of the concerns you receive what is the threshold between those you close and those that you refer to PIC?

Now that you have outlined the complaint process could you tell us how it has changed?

We can only deal with serious concerns reflecting behaviour that falls far short of the conduct expected of a veterinary surgeon or RVN. These would include serious breaches of the standards we outline in our Code of Professional Conduct, as well as fraud or dishonesty and some criminal convictions. So it is these types of cases that – after the initial Assessment and Investigation stage – will be referred to PIC for further scrutiny and examination. As I’ve said, most of those that do go to PIC are also closed – although advice on professional conduct can, and often is, given to the person in question. Cases may also be held open for up to two years, for example, to check that changes have been made and remedial action taken. So, few cases actually end up in front of DC and these represent only the most serious breaches of professional responsibilities. I hope this fact dispels some of the – perfectly understandable – trepidation that the profession as a whole feels about our disciplinary process

As of August 2014 we’ve decided to institute something of a cultural shift in the way that we deal with complaints – the system has been made simpler and more efficient, allowing us to better target our resources so that we can expedite more serious cases to PIC and deal with less serious cases more quickly. One immediate change that we have made is that we will now be dealing with ‘concerns’ raised by members of the public rather than complaints. If referred to PIC, and DC, these then become ‘cases’. The changes have come out of last year’s First Rate Regulator initiative, which involved wide-scale consultation and sought feedback from both the profession and the public. This involved contacting those who had been involved in the complaints process in the previous three years about the complaints and disciplinary process. Responses we received from those members of the profession who had been subject to concerns suggested that while,

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COLLEGE CORNER

overall, they were pleased with the service they received and the outcome of our investigations, they were worried with the amount of time it took to reach a decision about a complaint and a lack of communication around the progress of the concern against them. Being subject to a concern can clearly lead to a great deal of worry and, equally, as we saw from the feedback, can be a frustrating and distressing time for the person who raised the concern. With this in mind we looked at how we could make the process more satisfactory overall for all of those involved. One of the key areas we’ve improved is communication. For example, if a concern has been raised about you then you will now be assigned a case manager from the Professional Conduct Department as a single point of contact, with follow-up phone calls to discuss the case. Crucially, we have also given case managers greater freedom to manage expectations so that, where appropriate, they can give an indication of the likely outcome of an investigation to both parties – therefore reducing the ‘fear factor’ that members of the profession may feel. In terms of speed, the initial Assessment and Investigation stage will be handled by a small team of three – comprising a case manager and veterinary and lay case examiners – which should allow for greater flexibility in how we handle concerns, in order to resolve some concerns quickly and fast-track serious concerns to PIC. Ultimately our aim is that the whole disciplinary process – from a concern being raised to a potential DC hearing – should last no longer than a year; with the Assessment/Investigation stage taking place within three months and PIC consideration taking place within nine months of the concern. 1 04/03/2014 15:19 354 SFG Half Pageoriginal Advert ART_OL.ai

In practical terms, if you are a veterinary surgeon or registered veterinary nurse who is subject to a concern, what happens next? Wherever possible you will be contacted by a case manager within two weeks of the concern being raised and, if you have one, your employer will also be notified. Our Case Examiner Groups will then investigate what has happened, gathering information about the concern from those involved. We will usually then ask you to provide further information. This could be provided in written form but may also come from a face-to-face or telephone interview – and you may also be asked for relevant clinical records. Throughout the investigation your case manager will make sure to keep you well informed of any developments. You will also be able to contact your case manager at any time during office hours if you need any information. For detailed legal advice, however, you would need to obtain your own legal advice or to consult your professional indemnity insurance provider.

Where can I go to find out more information? The full details of our complaints procedure – including how we investigate concerns, forms and details of our previous Disciplinary Committee hearings – can be found at www.rcvs.org.uk/concerns For more information on the Health and Performance Protocols visit www.rcvs.org.uk/health; www.rcvs.org.uk/performance

CMY

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VDS News

A Sting in the Tail Ted had landed in his ideal job attending the farming community throughout Snowdonia and happily climbing the varied peaks in any free time available. The only fly in the ointment was his requirement to cover Saturday morning clinics in a seaside resort, where the local population was swelled by an influx of city dwellers escaping to enjoy the delights of the Welsh coast. Whereas the indigenous population took a pragmatic approach to pet animals, the temporary in-comers tended to be rather more demanding. One Saturday, Ted found himself facing a middle-aged couple with their cat, Sweetie. It came as a great surprise to him that anybody should consider holidaying with their cat, especially in a caravan, never mind interrupting their vacation to seek attention for the small injury Sweetie had suffered to his tail, presumably at the claws of a ‘proper Celtic’ cat. Although the owners showed considerable enthusiasm for Ted’s decision to prescribe antibiotics, they were quick to point out that Sweetie was allergic to penicillin. Being the first to admit feline medicine was not his strong point, having missed certain sections of the small animal pharmacology course as he only ever intended to work with ‘proper stock’ , Ted was stumped. Surveying the pharmacy shelves, his eyes alighted upon an enrofloxacin product he vaguely recognised. As the carton depicted a picture of a cat suggesting it was ‘fit for purpose’ without delay, he hit the keyboard to generate a label automatically for a tablet course. The faithful veterinary nurse, Megan, dispensed the product albeit somewhat distracted by the clients cooing over the patient in baby language that ‘the nice man would take the sting away’. Several weeks later, Ted received a letter from the owners handwritten in large, bold capitals. Fearing the worst, he grabbed a cup of coffee and sat down to read it carefully. Upon their return to Manchester, Sweetie had apparently developed neurological problems and her usual vet had declared her permanently blind. Wishing to do everything for Sweetie, the owners had taken her to an eye specialist where retinal damage associated with a reaction to enrofloxacin was confirmed. Ted now learnt that this was a rare, but recognised side-effect of the drug in cats and kicked himself for his decision to use antibiotics in the first place, simply to appease the owners. After all, he believed the wound would probably have healed with benign neglect and a hefty dose of Snowdonia’s mountain air, but surely he could not be held responsible for an acknowledged side-effect of a licensed medication? It was the last paragraph of the letter that caused him to shiver, as it became clear he had prescribed an overdose of the medication by the simple expedient of inserting the incorrect computer code. Being distracted by the owner’s ‘it’s our little baby’ antics at reception, Megan had not noticed the error and simply dispensed the canine product. The owners claimed they had spent a staggering £30,000 converting their home into accommodation safe for a blind cat and now employed a full-time feline nanny during the day. In addition, they hoped to take Sweetie to America, for an experimental stem cell procedure which could possibly restore her sight, evidently expecting poor Ted to cover all their expenses. As these amounted to over £50,000, they were clearly not intending to fly EasyJet! Ted dialled the Society’s number and relaxed slightly when the consultant explained that such dispensing errors had already been www.practicelife.biz z September/October 2014 z Practice Life

the subject matter of several claims, although he had to admit the sum sought in this case was disturbing, especially as liability would have to be conceded. The Society took the strain leaving Ted to return to his sheep and having pointed out the claim was conspicuously disproportionate to the cat’s value they eventually negotiated a settlement of just over £5,000 with Sweetie’s owners, not including the proposed trip over the Atlantic… Ted was delighted to learn the claim was closed, but just 48 hours later, a bombshell. Megan received a formal looking missive from the RCVS seeking her response to an allegation regarding her ‘reckless approach’ to dispensing veterinary medicines and suggesting anything she put in writing might be ‘put before a Disciplinary Committee’ in the future. Ted was devastated by the effect the letter had on his colleague who had made a quite understandable human error after his ‘silly’ mistake. He recalled reading something in the veterinary red tops about nurse regulation, but had failed to realise a Registered Veterinary Nurse faced the risk of receiving the same dreaded letters as the veterinary surgeons. He knew Megan would not have insurance cover, but feeling guilty he determined to phone the VDS for advice as to how to respond. He was surprised to learn the Society was a step ahead of him and realising RVNs were now under the same regulatory scrutiny as the veterinary surgeons in the profession, they had created a policy specifically to cover RCVS complaints. Better still; this unique cover came as part and parcel of Ted’s practice policy as Megan was named on the schedule of employees. Alternatively, the consultant explained, Registered Veterinary Nurses working outside the protection of a practice policy, such as locums, could still obtain their cover on an individual basis. The consultant was therefore immediately able to reassure, a rather anxious, Megan that the nature of the complaint was not likely to mean she would ever have to attend a Disciplinary Hearing, although her policy cover extended to providing expert, specialist legal representation in the unlikely event it should prove necessary. The Society also helped Megan to compose a considered response which included a ‘protocols changed’ message to prevent a similar situation occurring in the future, in view of the fact she had to contend with the pharmacologically and computer challenged Ted. As predicted, the complaint was closed without fuss. Megan admitted she had not realised quite how much stress such a simple dispensing error could bring to her door, now she was working in a regulated profession. She felt the only good thing to come out of the whole affair was she now understood the value of the Society’s inimitable support package (practical, financial and psychological), for all RCVS complaints and would endeavour to spread the message far and wide to her colleagues to call the VDS, if they were unfortunate enough to find themselves in the same position.

WELL-BEING

VETERINARY

Perfection Why good enough should be good enough Author and Liverpool 2005 graduate Rosie Allister is Chair of Vet Helpline and a director of the Veterinary Benevolent Fund. She is currently based at the University of Edinburgh where she is investigating the transition from veterinary student to practising veterinary surgeon as a prospective cohort study for her PhD. She has a particular interest in mental health and wellbeing at the time of transition from student to graduate.

hat is your greatest weakness?” It’s that standard question near the end of a job interview. Of course isn’t wise at this point to discuss the weaknesses that actually impact on your working life. Detailing the extent of your Facebook habit, your dodgy timekeeping, or how irritable you become when tired, may not be the best way to sell yourself to a prospective employer you are trying to impress. So what do we say instead? Very often candidates suggest that they are a perfectionist. A lover of detail who will check and recheck, stay late, try too hard. Interview coaching websites even have perfectionism as a model answer to this question, a negative question turned into a positive by a trait that employers will be attracted to. But what is being a perfectionist at work actually like? Does perfectionism help or hinder a vet’s working life?

What is perfectionism? Perfectionism is the tendency to employ high standards and overly critical self-evaluation (Frost and Marten, 1990). It has been linked to a range of psychological and physical disorders as well as being closely linked with normal functioning. Some manifestations of perfectionism can be adaptive, and associated with benefits; however the majority of the effects of perfectionism are maladaptive, and cause difficulties for the individual. Perfectionism has been associated with psychological disorders including depression, OCD, anorexia nervosa and bulimia nervosa, social phobia, performance anxiety in groups as diverse as professional athletes and college students, as well as suicidal thoughts. Over the last 20 years our understanding of perfectionism has increased, and a number of different scales developed to assess and study it. Perfectionism is now understood as a multidimensional personality characteristic, with more than one type.

One of the most popular models of perfectionism, developed by Hewitt and Flett (1991b) identifies two main forms of perfectionism: self-oriented perfectionism, and socially prescribed perfectionism. Self-oriented perfectionism is when an individual believes that being perfect is important and is characterised by setting excessively high standards for oneself. Socially prescribed perfectionism is when an individual believes others have set high standards for them and is characterised by the thought that to be accepted by others, they need to fulfil those standards. In a recent paper, Stoeber (2014) reviews evidence on these two dimensions of perfectionism and highlights that most studies agree that socially prescribed perfectionism is a negative form of perfectionism showing strong and consistent positive correlations with psychological difficulties. Self-oriented perfectionism is not entirely negative and as well as being linked to psychological difficulties also has links to indicators of good psychological adjustment such as positive affect, goal progress, and academic achievement. It’s a complicated picture, and just as the consequences can be complex, so too can the causes. The link between perfectionism and personality has been extensively explored, and associations have been made between perfectionism and two of the Big Five personality traits, neuroticism and conscientiousness, with conscientiousness being associated with self-orientated perfectionism and neuroticism with socially prescribed perfectionism. However, although traits such as the Big Five play a role in the development of lower level personality characteristics like perfectionism, they don’t explain the whole story. Perfectionism in individuals can have its origin in the family, in personality traits and in cultural influences, including group level culture such as work or learning environments. Practice Life z September/October 2014 z www.practicelife.biz

WELL-BEING

In Association with the Veterinary Benevolent Fund

Vets and perfectionism Most people who’ve been in a vet school environment around exam time will have experience of how cultural pressures can impact on working behaviour. When you see everyone else working and achieving very high standards, it can be hard to resist feeling some of the pressures being experienced by others. There is evidence that we may be selecting for perfectionism in the veterinary profession too. This question often arises when considering the high suicide rate in the profession. We know that vets are three to four times more likely than the general population to die by suicide (Platt et al., 2010). This raises questions around whether there is something about veterinary working life or training that causes mental ill health, or whether the veterinary profession is selecting a ‘risky phenotype’ – selecting people who, because of genetic, or prior experiential factors, are already at elevated risk of going on to develop mental health problems, and/or be at risk of suicide. These factors are clearly not exclusive. The suicide rate and mental ill health in the veterinary profession is likely to be a mixture of both causal and selection factors, combined with an amplification of personality factors in a highly pressured environment. However, as Platt (Platt et al., 2012b) observes, the psychological characteristics of those attracted to the veterinary profession are relatively under-researched, so selection factors are poorly understood. Perfectionism is a personality trait which may be selected for by the very competitive veterinary training application process. Veterinary courses in the UK are persistently oversubscribed and selectors can afford to choose only candidates with top level grades and who have shown strong vocational motivation in gaining relevant work experience prior to veterinary school, often whilst still at school and from early teenage years. It has been suggested that vets may be especially vulnerable to suicide because of the high academic requirements for entry to veterinary training (Halliwell et al., 2005) which may select for individuals with perfectionistic traits and high achievement (Haas, 1994). However, as Bartram and Baldwin (2008) highlight, the association between intelligence and mental ill health and suicide is unclear. Perfectionistic personality traits are associated with suicidal behaviour (O Connor, 2007) and are known to be prominent in the medical profession (Platt et al., 2012b, Blachly et al., 1963) and personality traits among doctors and medical students are known to differ from the general population (Clack et al., 2004, Meit et al., 2005, Meit et al., 2007) but their prevalence in the veterinary profession is not known. People who are perfectionistic are at increased risk of depression (Hewitt and Dyck, 1986, Hewitt and Flett, 1991a), judge their work harshly, and experience negative affects before during and after evaluative tasks (Frost et al., 1990). Experience of failure may also be very difficult for those with high levels of perfectionism (Blatt, 1995, Frost et al., 1990, Hamilton and Schweitzer, 2000). As failure is an inevitable part of clinical work, people with perfectionistic traits may struggle to adapt to the clinical environment. Hamilton and Schweitzer (2000) assessed the relationship between perfectionism and suicidal thoughts in (non-veterinary) university students in Australia and found a significant and www.practicelife.biz z September/October 2014 z Practice Life

positive relationship between increased levels of perfectionism and suicidal thoughts. Veterinary students who may be accustomed to being the highest achievers among their pre-veterinary cohort may find themselves at veterinary school surrounded by others of very similar ability, and may struggle to adjust to this. Veterinary students report veterinary school to be an extremely competitive environment, a theme which emerged strongly in interviews with veterinary students with a history of suicidal thoughts (Allister, 2011). This may contribute to some students feeling inadequate or suffering feelings of being an imposter or academic fraud (Zenner et al., 2005, Kogan et al., 2005). Imposter syndrome and difficulties with the transition to professional training are described in students in other healthcare professions (Henning et al., 1998) and are currently being studied in the veterinary profession too. In Platt’s study of 21 UK veterinary surgeons with a history of suicidal thoughts or behaviour, when asked for their own explanations of the high suicide rate in the veterinary profession, unprompted, 11/21 participants described veterinary surgeons as having personality traits that were likely to expose them to difficulties (Platt et al., 2012a). Difficulties allied to those experienced by the participants included perfectionism, difficulty adjusting when veterinary working life was different to their expectations, a sense of pressure to succeed because others around them appeared to cope, pressure while studying and a sense of failure (Platt et al., 2012a). So perfectionism is a lot more problematic than just the conscientious hard-working portrayal we show to interviewers and it can have drastic consequences. The statistics paint a troubling picture. But like many of the issues associated with mental ill health in the profession, there are things that can be done to help. Continued overleaf... References available on request from Practice Life.

WELL-BEING

Veterinary Perfectionism: What can you do about it? So what can you do if you recognise that you have perfectionistic beliefs in yourself and realise that these are holding you back from living in a way that makes you fulfilled and happy?

• Perhaps reflect upon who it is you feel you have to prove yourself to. If the only answer you have is yourself, is the effort and disruption the perfectionism is causing your life worth the short lived feelings of achievement?

How many of these statements apply to you?

• Another technique, which makes use of perfectionist’s love of detail and measurement – but tries to create balance rather than destroy it – is to take a weekly personal inventory. Take a moment to look at your week, identifying things that are good for you and reviewing whether and how often you did them that week. This might be taking time to eat lunch, to exercise, to read to your kids. Try not to make this an exercise in self-punishment. It’s about making sure the basics of self-care and wellbeing are included in your weekly goals too, and don’t get lost in your quest for achievement at work. Use this technique to gain more control over the targets that are important in life, not just those at work.

• Nothing ever gives you a feeling of lasting worth • Achieving perfection at work will earn you love and respect • You achieve goals but are left feeling unfulfilled • You often think your work is not good enough and compare yourself to others • You measure your self-worth by your achievements • You can’t give yourself permission to do a ‘good enough’ job, you feel pressure to be extraordinary and faultless • Even when you do achieve you feel you don’t deserve it This isn’t any kind of diagnostic test, but if you find those statements resonating, it might be time to review the role perfectionism has in your life, and the impact it’s having on your working life. Ask people what they want in life and you will get a variety of responses, but for most people it comes down to love and respect. People struggling with perfectionism can get caught up in the belief that the only route to love and respect is through high achievement, through faultless, extraordinary work. This is almost always a trap, and doesn’t lead to the sort of lasting happiness people are looking for. It leads to years on a work-treadmill and never really feeling fulfilled.

• Find something in your life where you can learn or develop but where that sense of joy at learning is not lost through endless assessment and competition, where improvement is possible but not a requirement. Experiment with recapturing the joy of learning a skill without the burden of assessment or exams.

So what can you do?

Finally, if you feel that your perfectionism is coexisting with other problems, or you don’t know if you can tackle it alone, seek help. Perfectionistic thinking may label seeking help as a sign of weakness, but actually asking for help takes strength. Call Vet Helpline, speak to someone you trust at work, or your GP or counsellor. We know that asking for help is really difficult for vets but there are people out there who want to help.

• In his book on Performance Addiction, Arthur Ciarmicoli (2004) advises that a first step to tackling perfectionism can be to return to the scene of the crime. This isn’t hours of Freudian introspection, but just reflecting on which situations you first felt that perfection in your work would achieve you love and respect. By identifying when your perfectionism started you may be able to better understand those early influences when you first started to believe worth was determined by achievement.

• Spend time with people who respect you for who you are, not what you do. Find people in your life who seem to have a good work life balance and use them as role models, as well as those you aspire to be like in academic or work fields.

Vet Helpline can be reached on 07659 811 118

For more about wellbeing see www.vetlife.org.uk/wellbeing. VBF, the registered charity that supports the veterinary profession, offers free, confidential and professional support through the Veterinary Surgeons’ Health Support Programme to anyone in the profession who is struggling with depression. The National Co-ordinator of the programme can be contacted at VSHSP@vetlife.org.uk or 07946 634220.

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WELL-BEING

CASE STUDY – Sick cats and silent people: A case of missed symptoms Caroline Jevring-Bäck, Leadership and Practice Management Coach, shares a tale from her time in practice...

ayne’s 30th birthday party was a blast. One month later she went on fulltime sick leave for stress and emotional exhaustion. It was to be more than two years before she was able to work as a vet again. We worked alongside Jayne every day in the practice: how could we have missed the signs that she was so ill? One of the questions I’m often asked as a veterinarian is, how do you know when an animal is sick, as animals can’t talk? We learn that animals are often masters at hiding signs of illness and weakness until they are pretty advanced as a way of surviving. I think some people are masters at hiding their illnesses too, even if they can talk. I think they are so driven by internal forces that they refuse to recognize the seriousness of the signs of their failing health. They become adept at hiding them for themselves and the people around them. I believe Jayne was such an example. Of course, looking back I can see the behavioral warning signals that might predispose to stress: working excessively long hours, setting punishingly high levels of performance, and always being available to clients. Jayne loved a medical challenge and as she was very meticulous she would spend a long time interviewing the owners of each new patient to extract every possible detail. Consequently, she was constantly behind with her case load and would work through lunch breaks and stay on after work to write up her cases. She was determined to put a diagnosis on every case she saw which meant long hours of reading and internet research in her own time. We certainly appreciated her knowledge and, initially, admired her dedication, but didn’t realize what it was costing her in terms of mental distress. Jayne set no limits on client contact. She felt strongly that she needed to ‘be there’ for her patients so she got to know all her chronic cases personally, and encouraged their owners to phone her whenever it suited them to discuss case progress. Usually this was evenings or weekends which meant that, in effect, she was always on call. She set high standards of care, and started up an ambitious program to update all the nurses about disease and disease management. The concept was lauded by the practice principals and much appreciated by the nurses, but, again, involved long hours after work and over weekends for preparation of training materials. On the private side, there was a boyfriend on the scene but he had an important job in a global IT company and seemed to spend more time away than at home. In the last six months before she went on sick leave, I think we all noticed some changes in Jayne. She decided to go an all fruit diet for a while and lost significant

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weight which she never regained. As she was already slim to start with she became very thin. She looked exhausted some mornings, with dark rings under her eyes, and she complained increasingly of headaches. She appeared to be very busy but actually her case load started to drop and a few clients complained to the principals that she seemed very unsure of what she was doing. Her manner of talking changed: at times she would almost gabble as though her thoughts were running away with her. She became shorttempered and irritable and would snap at the nurses who worked with her. She also seemed very prone to heavy colds that she had trouble shaking off, but rarely took a sick day, choosing not to let her clients down. Her birthday party was a big event. She had looked forward for some time to turning thirty and was determined to have a party to celebrate. The whole event was nearly called off when the boyfriend suddenly left three weeks before, having apparently met someone new on his travels. But she seemed to take his departure in her stride, and carried on with the planning. She refused all offers of help and fixed the food and drinks herself. On the night, she seemed to be thoroughly enjoying herself, although I remember thinking again how very thin she had become. And then a month later came the collapse. A nurse found her in the changing, shaking and crying uncontrollably. A client had called to say she wasn’t satisfied with Jayne’s management of the case and wanted a second opinion. For Jayne, this blow to her self-esteem became the final straw and her carefully built up world of perfection fell to pieces. Fundamentally, I think Jayne had very low self-esteem. Despite being an attractive, empathetic and clearly highly intelligent person, she was terrified of doing something wrong. On the very few occasions when she did make a mistake, she was almost in despair, and would blame herself harshly for her ‘stupidity’. Being unable to set boundaries for herself both with the excessive hours put into extra study, or in being available to clients, meant she could seldom relax and recover from strenuous days at work. She had no pets, hobbies or outside interests to take her mind off work. And she had the near obsessional drive to make the correct diagnosis for each and every patient. Could we have spotted trouble earlier and take action? The answer is undoubtably, yes. Perhaps we could have persuaded her to cut down her hours studying, convinced her that clients should call only during working hours, and even advised counseling to help her find a better balance in her life. But, like those pet owners who come in with a cat with advanced kidney failure and swear that the cat only lost weight in the last few days, it is difficult to do any of this when you don’t see and understand the symptoms. www.windofchangeconsulting.com

MANAGING PEOPLE

SPECIAL FEATURE

Performance Management & Disciplinary Matters James Cronin BSc PGDL LLM, Director, Eight Legal Ltd www.eightlegal.co.uk

am often asked to talk about performance management and always begin by splitting the topic up according to the reason for the poor performance. In this article we only have space to discuss two – aptitude and attitude. I have to say that that most employees are great and hard working and most employers are fair and reasonable and respect their employees.

Skills and aptitude This area takes up about 15% of my time usually. If you have an issue in this area, the first question to consider is whether the problem could be addressed by training or additional support or mentoring. If so, this needs to be discussed with the employee and a suitable plan made. There should be clear objectives and an agreed timescale, and a date set for a review of progress. If there is a genuine illness or injury which affects an employee’s ability to work effectively, then you will need to seek a medical report, and consider what changes could be made to the working environment or schedule. You need to consider the possibility of the issue being classified as a Disability under the Equality Act 2010.

Depression and Equality Act 2010 Unfortunately, as you will be aware, the profession has high rates of depression and suicide and it is heartbreaking when an employee is affected. There is a huge difference between an employee who ‘won’t do’ and one who ‘can’t do’. It is beyond the limits of this article to discuss the detail of managing depression as a protected characteristic under the Equality Act 2010, but it is vital that you do not put a foot wrong in this area both for moral and legal reasons. The largest payouts for Disability Discrimination where the protected characteristic was depression have been in the hundreds of thousands of pounds. Remember there is no upper limit on the amount of damages that can be claimed for discrimination and there is no qualifying time period that must be served before a claim can be made. Indeed you can be successfully sued before employment starts (i.e. not only employees can sue!) The employer is often caught between the Equality Act (rightly) wanting the employee to be helped back to work as soon as possible, often backed by an eager GP, and the Health and Safety at Work Act 1974 (rightly) demanding a (reasonably) safe working environment for employees. Of course we then have to add working with lethal drugs into the equation.

Attitude By far the most common problem that I see in the profession is practices dealing with employees who have an awful attitude. In my experience, it is best to not even try to manage this situation, save for one heart to heart, or informal chat. If this does not work, and the change is not significant and instant then you need to separate from the employee. Many books are written about complex performance management schemes and associated psychology. HR advisers will often suggest putting the employee on a performance management scheme of some sort, taking up to a year with several built in review stages. ACAS (the Advisory Conciliation and Arbitration Service) would support this approach in most cases. ACAS is is a Crown non-departmental public body of the Government and every Employment Tribunal or potential Employment Tribunal action initiated is referred to them. For their advice on managing poor performance see www.acas.co.uk. The best advice I can give, albeit contentious, is don’t bother. My experience is that if the one heart to heart chat has not changed the person’s attitude then nothing will. It’s best to face facts and let them go. Otherwise you could spend many, many hours of management time (which adds up to thousands of pounds in a year - it is not free) and you will still have work on your hands. You are, however, likely to lose your good employees who cannot stand to work with the person. Most vets will admit to doing anything to avoid confrontation and it can take (in the worst case I have seen) up to fifteen years before the problem is finally solved! I must reiterate that you should do the maths on what it costs to keep the person. For example, an employee receiving £25,000 a year will cost you £125,000 over a five year period in salary alone. If you then factor in management time – say, two hours a week – this would equate to 500 hours over five years, and we haven’t got onto the cost of losing your good staff yet. Until an employee has worked for you for two years, there is no protection for them against unfair dismissal (take advice though, as there are exceptions to this rule). There is no qualifying time period for Discrimination claims. So, if there are problems with attitude, pick them up early and act on them promptly.

Common themes I commonly see two types of poor attitude in the profession. One is the young, fairly new graduate who isn’t used to negative feedback and see their employer as the problem rather than themselves. Practice Life z September/October 2014 z www.practicelife.biz

MANAGING PEOPLE

The other is the much more mature employee who has been doing the job for decades and believes that his/her job is protected by a ring of steel, no matter how badly they behave to the directors, other employees or even clients. This behaviour can be irrespective of job title and seen within all types of staff, Receptionists, Practice Managers, Vet Nurses or Vets. My advice is to give them one chance to change and one conversation only. If this does not bring about change (and it usually will not cure decades of toxic behaviour), they must go. No procrastination please! It’s not risk-free, but neither is keeping this employee. I have to confess that I am staggered by the attitudes I have seen in the profession (although I do usually only get called in when things have gone wrong) and wonder how long these employees would be tolerated in any other private sector employment. Ask yourself what you would do with this employee if there were no such thing as employment law. Would you keep them? If not, you have your answer.

Conclusion It is very important with any problem employee to decide what the cause of poor performance is. One of the worst, most frustrating and recalcitrant is poor attitude. This will NOT get better if left alone. Most employers add up the costs of removing a poor employee on just one side of the page and then stop. They usually fail to add up the column on the other side of the page, looking at the cost of keeping the employee. They are thus left with half of the equation, which makes a fully informed decision impossible. If nothing else, add up both columns and do the maths, please! www.eightlegal.co.uk Eight Legal Ltd, a veterinary specific Employment Law retainer service is owned and run by James Cronin LLM and Kay Hamblin BVSc MRCVS This article contains general information only and is not a substitute for specific legal advice.

Let’s Talk!

Avoiding disciplinary action through early conflict management

Teresa Mulvena is a psychotherapist and accredited workplace mediator, primarily working with staff in the NHS

n an earlier issue (Practice Life March/April 2014) I wrote about how to improve communication at work in order to improve morale and performance, and prevent conflict destroying working relationships. But if conflict does develop it is useful to know when to intervene, and what action is appropriate. Grievance and disciplinary procedures are costly and often have an unsatisfactory outcome. Mediation is a good alternative. As a mediator I find that if you can get people to talk to each other directly, with someone helping them to be constructive, it can improve their working relationship enormously, even in the most intractable conflicts. Skills for dealing with staff conflict are useful for everyone, and particularly for managers to resolve situations before they escalate into disciplinary matters. If you are not a manager the ideas here can be used in improving any relationship. This article focuses on two situations: • How to respond when a staff member complains to you about a colleague • And how to facilitate a meeting with two colleagues who are in conflict with each other. www.practicelife.biz z September/October 2014 z Practice Life

Handling conflict sensitively Conflict is unavoidable. How to handle it sensitively and skilfully is the question. Why is it difficult to deal with conflict? 1. We are afraid of causing offence or upset, including fear of making the situation worse. 2. We lack the skills to know how to approach it effectively. Conflict may be openly expressed through arguing or shouting. At other times it is not always obvious, but just as corrosive to morale. It can go underground and be expressed “passiveaggressively”, for instance by not co-operating, undermining others, and gossiping. Unaddressed conflict results in a lack of co-operation within teams, diminished motivation, and can sometimes cause people to leave their jobs, or express a wish to do so. An unhappy workforce that doesn’t communicate effectively, can affect the quality of service to clients.

What to do if a staff member complains to you about another staff member/an issue at work that they are unhappy about and asks you to do something about it. Firstly, whose problem is it? It is important to ascertain whether it is your responsibility, and if it is an issue that you should get involved with. For instance, what should you do if a staff member complains that another staff member always interrupts

MANAGING PEOPLE

her? Is this a management problem? It may be useful to empower the complainer to address such issues directly themselves. You may wish to assist them in talking through such problems, but it is less helpful to do it for them. Is it a Performance Issue or a Relationship problem? If the complaint is along the lines of someone taking longer for their lunch-break or that they don’t clean up properly, this may be a management issue. However, it isn’t always clear if such a presenting issue is a symptom of some underlying conflict between the staff. Often people will tolerate the same behaviour in someone they have a better relationship with. For example, if a staff member complains about another colleague’s manner, and says she doesn’t want to work with her because that colleague is always abrupt, what should you do? Alter their work schedules? Tell them to get over it? Mediate the situation? I suggest it may be better to help the complainer to deal with the interpersonal situation themselves, rather than intervening separately on their behalf. People find it extremely difficult to talk to others directly because conflict is so uncomfortable. However, beware of using disciplinary procedures for interpersonal conflicts as they rarely work. You need to help them to deal with the conflict itself. Clearly if it is a performance issue, you can have a word with the person concerned about their behaviour, but if it is an issue about the relationship with each other, then the following strategy is useful: 1. Listening: It sounds basic, but it may be all the complainer needs. In a private space listen to the complaint and the underlying feelings and needs. This in itself can be very helpful to the complainer – just for someone else to know what they are struggling with. They may not need you to do anything else at this point but just sympathise. Don’t respond with ‘but’ or ‘at least’ because that can sound like you are giving excuses or being defensive. For example “That sounds frustrating. What do you need?” is so different from “but you are both adults, find a way of being more professional”, or “at least he is good at the job”. With the latter you risk the complainer feeling that their concerns are being dismissed. At this stage they just need to be heard. People can’t listen or take anything on board until they feel that you have really understood them. Don’t move too quickly to the next step of finding a solution until you have helped them identify what they need. 2. Dealing with the problem: help them deal with it constructively. They are much more likely to take a course of action if the idea comes from them. While it can be helpful to make suggestions, telling them what they need to do is unlikely to be as effective. You are aiming for a collaborative approach. Offer yourself as a support. For example, you could role play the situation and help them formulate what they want to say in a way that is constructive – focusing on what they feel and what they need. These are sometimes referred to as “I statements” and they are very effective because they are non-blaming. The other person in the conversation doesn’t need to defend themselves and can hear what the other person needs.

I STATEMENTS Describe the behaviour (When…) Explain the impact (I feel…) And it’s also helpful to add one of the following if appropriate: State the desired outcome (therefore I want/need…) Consequence (So that…) This format can seem rather formulaic but it can be really useful when people don’t know how to go about structuring something and don’t wish to hurt or alienate a colleague.

For example: When you criticise me in public I feel embarrassed Next time can you express your concerns in a private space So that I can listen to your concerns properly When you talk about my colleague when she is not here I feel uncomfortable Is it possible to bring these concerns up with her directly So they get dealt with? When you make a change without asking my opinion I feel unimportant and resentful Could we find a way of discussing proposed changes first? When I hear rumours about me I feel misunderstood and hurt Can you talk to me directly? Try to get the person to talk about themselves and their feelings and needs, rather than merely complaining about the other person. Helping them to construct the problem in terms of what they need, means they are much more likely to articulate it in an uncritical, non-blaming way to the person they have the problem with and are therefore much more likely to get listened to. Help them to be specific about what they need e.g. rather than saying “I need respect” saying something like “I would feel part of the team more if you check with me about decisions that affect me”.

ow to facilitate a meeting between H two staff in conflict with each other he aim of a facilitated meeting is to find a constructive T way forward for dealing with the conflict, by talking about it directly together. The hope is that they will understand each other better, especially in terms of what they both need. Focusing on what they need is the most important aspect of facilitating the meeting. 1. The Start Start by thanking them for coming and acknowledging that it isn’t easy, but that you hope it will be constructive. This may seem obvious, but usually people will be feeling anxious Practice Life z September/October 2014 z www.practicelife.biz

MANAGING PEOPLE

about talking directly about the issue to the person they have a problem with. It doesn’t hurt to show some appreciation that they have the courage to deal with it. Check how they are feeling about being here, and acknowledge any hesitation or reservations. Explain the purpose of the meeting and establish the ground rules: The Purpose You can explain that your role is to be neutral, and to assist them in talking about what they both need in order to be able to work together. Avoid showing any favouritism. Ground Rules These include establishing confidentiality, and the importance of one person speaking at a time. You can ask them if there is anything else they would like to have included. Be clear at this stage how long the meeting will be. 2. The Discussion You can begin the discussion by asking them to tell each other what it has been like for them, and what they would like to get out of this meeting. Throughout the meeting encourage them to talk directly to each other – rather than complain about the other person to you. To facilitate this you can use phrases like “tell (the other person) what you need” Encourage them to start sentences with “I think...” “I feel...” “I need...” rather than “You always...” “The problem with you is...” “You never...” Try and turn the conversation away from blame and arguing about who did what, when and what was actually said, because people will have different versions of past events and these are usually irreconcilable. Instead try to look for common ground and what they both need e.g. “you are both saying you want respect.” Ask them what it is they would like i.e. keep steering them away from blame back to what they need. Encourage listening: Regularly throughout the meeting ask them directly what they heard the other one saying. This way of checking ensures they are actually listening and not forming a defence or counter-argument in their head instead. Also it helps to clarify any misunderstandings as you go along. Reframe any unhelpful accusatory comments: “She’s a liar” could be “So you didn’t agree with what was said” ”They never listen to me” could be “”You don’t feel heard by them” or “You sound as though you would like more time to talk”. “They’ll never change the way they do things” could be “You don’t think they will try out new things” Try to give them equal air time. This can be difficult especially if one of them is angry or generally more vocal. You need to be firm and kind at the same time. You can try phrases such as: “You’ve made a number of points there. There will be time for you to say more but let’s give your colleague a chance to respond before the points get lost.” If they engage in unfair www.practicelife.biz z September/October 2014 z Practice Life

“Try and turn the conversation away from blame and arguing about who did what, when and what was actually said, because people have different versions of past events and these are usually irreconcilable. Instead try to look for common ground.” tactics such as saying “everyone finds you difficult” or “no one likes you” you need to intervene and say something like “that might be quite hard to hear” and then ask that they speak for themselves and what they feel instead. Be prepared to stop the meeting if you don’t feel they are being constructive or if they are getting too emotional (either tearful or too angry to listen to the other person). In this situation you have to differentiate between whether you feel uncomfortable with the emotion being expressed or if they do. You can simply ask. “You have got quite upset. Are you OK to continue or would you like a 5 minute break?” If one person is being quite angry you can check if the other person is OK to continue or it they are finding it difficult. Agreeing on the way forward: They may or may not want to have something in writing about what they are both going to try and do differently. Do thank them for coming, no matter how much or little you achieve in the meeting. Remind them that the meeting is confidential to all of you.

Professional Mediation or DIY? Facilitating a meeting can be a good option for a team leader to address relationship problems between staff before they become more serious or entrenched patterns of relating. Remember there are trained professional mediators and you may need to call on one to conduct a more formal full mediation in the following circumstances: • The issues are long-standing or more intractable. • You don’t feel confident enough to deal with this particular conflict • You find yourself feeling biased about the issue, in regard to who is in the wrong. • You have a strong relationship with one of the participants – or any other complication in your relationship with them that might make you the wrong person, such as a past conflict with them personally. Remember you may need support yourself. Conducting this kind of meeting can be stressful. Ideally facilitate it with a colleague; otherwise have a trusted person you can debrief with later. Clearly the content is confidential, but you can still talk with someone about how you feel, and what it has left you with, and any doubts you have about how it went. teresamulvena@hotmail.com

MANAGING PEOPLE

CASE STUDY Jerry Crick, Business Director at Boness Veterinary Hospital in Bedfordshire, shares his experience of a disciplinary case with us...

everal years ago a member of staff, Francis (name changed), had been systematically bullying other members of staff and appeared to have taken a grudge against one or two senior people. At the same time, unknown to us, Francis had been keeping a notebook of things said by staff and management. Eventually disciplinary action was started and immediately Francis went sick on the grounds of stress. It took months to get back to the meeting table largely because every time we made invitations there was another doctors report claiming stress and depression. By the time we sat down for discussions the relationship had completely broken down and was unlikely to be repaired. After long consultations with solicitors we were advised to issue a letter giving Francis the sack. We considered this and subsequently issued the letter. The legal advice was unsound. With hindsight we should have used our common sense and arranged for a second opinion. The case ended in tribunal and Francis won,16:43 largely Medivet_PracticeLife_230814.pdf 1 26/08/2014

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because the case had not been managed correctly and relevant procedures had been missed by legal counsel. During the lead up to the hearing the legal team, which had changed slightly, recognised the problems and made it clear there was an issue. Despite then securing a barrister, we lost. The tribunal chairman made some unsavoury points about our process and management – which were largely due to the errors introduced by the legal advice. Having said that, the organisation had not kept sufficiently accurate records of events, meetings and conversations that had happened prior to the commencement of disciplinary proceedings. Although Francis won, there was a significant compensation claim against the legal team and, whilst this saved the bulk of the costs, did nothing to allay the stress and personal pain of those involved. In my present company, relations with staff are much better; however, you can never be certain about the future. My advice, with hindsight, is to: get great staff; maintain good staff relations; arrange appropriate contracts and keep them updated; nip issues in the bud as soon as they occur; and in every case, write everything down.

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Practice Life z September/October 2014 z www.practicelife.biz

CLIENT CARE & MARKETING

SPECIAL FEATURE

NURSE CLINICS SPECIAL FEATURE Joy Howell is a Registered Veterinary Nurse who works for Bayer Animal Health as Senior Practice Support Advisor.

am immensely proud of my profession and since qualifying in 1985 I have seen increasing opportunities for Veterinary Nurses who wish to be acknowledged as key members of the practice team. During my time in practice, with a keen interest in preventative veterinary healthcare, I particularly enjoyed the role of Clinic Nurse/Pet Health Councillor. Since joining Bayer Animal Health, this interest has continued and part of my job is motivating other nurses to also become actively involved in nurse consultations and clinics. Many practices have nurses with keen interests in consulting and Nurse Clinics are the ideal opportunity for them to pursue the specialism that interests them e.g. senior pets, behaviour, while still performing their other duties. It will give them career satisfaction as well as providing an excellent service to clients and their companions. If you or a member of your family have recently attended your doctor’s surgery or have had an outpatient consult at the hospital you may well have met nurses with a variety of roles, including: • Nurse Practitioners – These nurses carry out care at an advanced practice level. They often perform roles similar

to those of doctors. They commonly work in primary care (e.g., GP surgeries) or A&E departments, although they are increasingly being seen in other areas of practice. • Clinical Nurse Specialists – Nurses undertaking these roles commonly provide clinical leadership and education for the Staff Nurses working in their department, and will also have special skills and knowledge which ward nurses can draw upon. • Nurse Consultants – These nurses are similar in many ways to the clinical nurse specialist, but at a higher level. These practitioners are responsible for clinical education and training of those in their department, and many also have active research and publication activities. I hope that one day we will see the Veterinary Nursing profession following a similar career path and we will have our very own Veterinary Nurse Practitioners. In the meantime I would like to introduce you to a shining example of my profession, Bizzy Allen-McClure. Bizzy has been involved with running nurse clinics for many years. As well as enjoying the successes of her nurse clinics, she is also keen to help others interested in setting up clinics overcome some of the barriers they may encounter...

CASE STUDY Bizzy Allen-McClure RVN, BSc (Hons) Business IT, City & Guilds Certificate in Veterinary Nursing of Exotic Species, Clinical Coach

am the Head Nurse at Harbour Vets, a first opinion small animal Tier 2 Practice in Waterlooville. My role involves the general running and management of the practice including organising the veterinary nurse team, allocating duties, regular team meetings, staff appraisals and training. I’ve been involved in running nurses clinics for many years. Here, I’ve broken down what I perceive as common barriers into topics and tried to offer some suggestions to help overcome them. Clinics are commonly run in topics such as senior pet care, weight management, development and growth. However, the clinic can also be expanded to involve the nurse in the management of clinical cases such as the one below. ‘Lucy’ was a 10 year old cavalier King Charles Spaniel and had suffered from repeated anal gland infections. Her

www.practicelife.biz z September/October 2014 z Practice Life

owners were struggling to cope with her care, both in terms of compliance with treatment plans and with financial issues. They were seriously considering having Lucy euthanised. The Veterinary Surgeon referred Lucy to me to attend weekly nurse clinics. During the weekly appointments I ensured Lucy’s anal glands were emptied and that the owners were coping with administering the antibiotics. The clinic also gave me the opportunity to address other issues such as weight loss, parasite control and grooming to improve Lucy’s quality of life. This was a highly rewarding case as it allowed me to have a real involvement in Lucy’s care. Her owners trusted me and felt able to talk to me about any issues that they had. The appointments allowed me the opportunity to support them and care for Lucy that wouldn’t have been possible during the limited time available during a vet consultation. Suggested further Reading The Consulting Veterinary Nurse – Nicola Ackerman Wiley-Blackwell ISBN 978-0-470-65514-6

CLIENT CARE & MARKETING

Common barriers to running nurse clinics

Suggestions to overcome barriers

Having enough team members to run the clinics Time

• Look at nurse rotas – which days can you spare a nurse for consult appointments or look what times of the day are the quietest.

without leaving the rest of the team short staffed.

• Put together a case for recruitment of another team member. Nurse clinics can generate considerable income as well as freeing up the vet’s time for more complex cases and bonding clients to the practice.

Space Lack of a dedicated nurse consulting room.

• Look at times between consultations or whilst the vet is operating when the consulting room will be free to use.

Support Lack of support and referrals from the rest of the team.

• Communicate the benefits of nurse clinics and what services you can offer with the rest of the team during practice meetings or via memos.

• Arrange for the receptionists to shadow a nurse during some clinics so that they are aware of what they involve and will be able to promote them effectively.

Uptake Lack of uptake from clients.

• Nurse clinics need to be marketed effectively – Advertise in the practice newsletter, send information with booster reminders, posters in the waiting room and on the practice website or Facebook page.

• Send a mail shot using your practice management software. E.g. send an invitation to all dogs over 7 to attend a ‘Senior Pet’ clinic.

• Ask the whole practice team to refer clients to you at every opportunity.

Joy’s Top Tips on Setting Up Clinics • • • • •

Set up a practice meeting with all staff involved Discuss length, times, costs Ensure all staff know what is involved Clinics can be run at times when the practice is quiet Consider pricing carefully

Marketing of Nurse Clinics and Puppy Classes

The Nurse Consult Room • Consider rearranging consult room to create a relaxed feel • Turn table sideways – no barrier between you • Angle keyboard and monitor towards clients so you don’t have to turn away to type or read notes

• Website/newsletter • Posters in reception • What motivates owners to come? • Best slogan • Best advertising copy for poster (max 3 sentences)

Consulting is a skill!

Fun, informative, professional

Use Open Questions

• Practice leaflets (printed or PDFs on website) • Targeted letters / phone calls • Mail shot from database (but remember you can only target animals which are registered, often elderly pets may not have attended the surgery in years!) • Advert in newspaper • Register for vets to refer clients – nurses call/write to clients to book appointments • Invitation from reception staff and vet at first vaccination appointment to puppy parties • Facebook / social media

• • • •

Smile / Eye contact Use names of owner and pet Avoid jargon clinical terminology Observe the client carefully and listen to answers

• Start your question with: Who, What, Where, When, Why (or How) • “When was “Charlie” last wormed?’ • ‘What are you doing about flea prevention?’ • ‘Have you considered how old “Charlie” is now, in human years?’ For more information on nurse clinics and protocols for puppy, adolescent and senior pet clinics you can contact Joy at joy.howell@bayer.com

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CLIENT CARE & MARKETING

CASE STUDY Louise Victoria Dawson RVN A1 and Clinical Coach at Manor Vets Halesowen regularly undertakes nurse consultations and finds it expands her skills set and confidence

he role of a Registered Veterinary Nurse involves a variable list of tasks, both clinical and administrative. The duties of the average RVN are often be changed each day, with many practices using a rota to try to place specific nurses in different areas of the clinic each day. This ensures that everyone is utilised to their best abilities, and that those undergoing training spend time alongside qualified and more experienced staff. RVNs are now also actively encouraged to participate in other areas of clinical work, leading to the development of such titles as, ‘the consulting nurse’, or ‘nurse practitioner’. Though nurses are still legally unable to diagnose, they are able to provide a number of other services to clients and patients, which enables them to deal with issues that would otherwise take up a veterinary surgeon’s time. Procedures undertaken by VN’s in nurse clinics involve the following; • Grooming – including dealing with anal glands and nail clipping • Microchipping • Worming • Administration of medication already prescribed by a vet, such as flea treatments, repeat injections etc. • Weight management and nutrition advice • Diagnostic testing such as urine, blood and blood pressure checks • Pet travel scheme • Puppy and kitten checks • Post op checks on routine surgical patients, i.e. neutering, lump removals, some dental work etc. • Rabbit health advice • Puppy socialisation • Behaviour Nurses often have more time to spend talking to clients about their pet’s health, whereas vets are usually busy and rushed for time. Clients often also feel more able to relate to a nurse talking to them, and appear to ‘take in more information’. However, in my experience, there are some problems which can arise: • Nurses are not legally able to diagnose, as mentioned above. This can often be a surprise to clients, who will sometimes will book a nurse appointment thinking it will be a free examination, and ask the nurse questions about other health issues. In these cases, it is necessary for the nurse to explain to the client that they can take notes about the patient’s history, examine the patient as best

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they can, i.e. check weight, temperature, and dentition, examine feet and feel the abdomen, and then report such findings to a vet. Clients can become disgruntled when a nurse is unable to tell them what is wrong, and they are then asked to go and make a vet appointment. • Clients often ask nurses to advise on medication during their nurse clinic e.g. can they alter a dose, collect another prescription? They do sometimes get upset when you explain that legally only a vet can prescribe and dose medication. • Some animals are booked in for a nurse clinics, and c learly have a problem that the VN cannot deal with alone. This is often time consuming for the nurse and client – as the nurse will then have to check if a vet is available to see the patient either at the time, or at another appointment. After qualifying as an RVN in 2004, I was involved in setting up the now very busy and successful nurse clinic system in the large practice in which I still work. I enjoy nurse consulting very much. My most memorable and successful nurse appointment involved a rabbit being presented for what was booked in as a weight loss appointment. The owners were concerned that the rabbit was gaining weight, and wanted to discuss ways in which to reduce its weight whilst maintaining a healthy diet. When examining the patient, it became apparent that the rabbit was not overweight at all, but had a very swollen abdomen, which was hard to the touch. This was obviously an issue unrelated to weight, which was beyond my capabilities as a VN. After arranging for the rabbit to be examined by a vet, an abdominal tumour was diagnosed, and was later surgically removed by one of the practice specialist exotic surgeons. Luckily this condition was identified before the tumour became fatal. As nurse consulting is now integrated into the practical Veterinary Nurse training scheme, future nurses will hopefully be more aware of the services that can be provided. RVN’s that qualified prior to 2010 will not have benefitted from such training, as it was not included in the syllabus prior to this time. For this reason many RVNs will be less confident in the consulting role. As the profession develops, I look forward to seeing more of an emphasis on the role of the RVN in the consulting room, and the introduction of specific nurse practitioner CPD sessions, which would enhance the skills and confidence of RVNs when undertaking this very important part of the job.

CLIENT CARE & MARKETING

Nurse Clinics... For Vets! Many nurses commonly cite difficulties with internal communication and lack of buy-in from other practice staff as a barrier to running successful nurse clinics. So we asked 2011 vet graduate Katherine Costaras to give us her views…..

ate is a vet at Your Vets in Dagenham, one of 7 clinics in the group, based in the Midlands and Essex. She works as part of a 4 vet, 5 nurse team. The nursing team actively run clinics which run throughout the day. The involvement of the nursing team in running clinics was already established when I joined Your Vets, with this activity being a core part of the business model. The Consulting Nurse runs a variety of clinics, from the usual weight management clinics through to diabetic and rabbit clinics. The system was set-up to follow a defined protocol which sees dedicated nurse consults running from 10am to 6pm, shadowing the timings of the vet consults. The majority of the appointments are pre-booked, some with adjacent time slots for the vet and nurse to work co-operatively on a case, for example, a cat with kidney failure who will be having bloods taken and BP checked in an appointment preceding the one with the vet. They’ll also do things like second vaccs, diabetes checks etc. Where there are gaps in the nurses’ appointment list, they are free to help the vets in their consults, triage cases and walk ins or help out back in prep if needed as an extra. The nurses are rotated through consulting nurse duties, so they get variety in their job, and learn new skills. They have a dedicated nurse consult room with all the equipment and client information they need. We make full use of the nurses in our clinic – they are a tremendous help and time-saver for us vets – and since they are so highly-trained, we have complete faith in their abilities. The vets do what they do best – diagnosis and treatment planning/ surgery, and leave the nurses to do everything else that is within their permitted schedule. It makes no sense to me that vets should want to be spending time doing bloods, setting up ops and hooking up drips when they complain that their biggest job pressure is time! I think that getting buy-in from the full team is really important in any system where you are running nurse consults or clinics. This is how we do it in our clinic and it works: Finding ideas for nurse clinics are the responsibility of the nurses. They need to investigate their idea and come up with a plan of how it would work. This plan is then given to the vets who assess it and give their input into the protocol. The nurse who has ownership of it then has the responsibility of training the rest of the nursing team in the protocol, assessing what skills gap there might be, and putting in additional training if necessary. It is important that the culture is there to support the nurses in coming up with and developing their ideas. As a business, our ethos is to support the individual in finding special interests and developing their skills. But they have a remit to share their knowledge with the rest of the team, whilst still having overall responsibility for their idea. An example of a clinic that has worked particularly well for us is the Diabetic Clinic. The incentive for this came from the fact that

these cases are so time-consuming, particularly in the first 3 months while the patient is being stabilised. The programme of care is to improve client compliance by repeated messaging of the importance of good management. S tep 1 involves the vet making the diagnosis and discussing the initial results with the client (over the phone or in the clinic if they’re still present). At this point they are usually pretty overwhelmed by the news. If they are in the clinic, the vet gives the first insulin injection with them present and they are asked to come in 12 hours later for a second consult with the diabetic nurse. If the owner has been informed by the diagnosis over the phone, then they are booked in for a nurse diabetes consult the next day. From there forward we try to dedicate the responsibility for that case to those two individuals, so that the owner has the reassurance of always dealing with the same vet, and has their own special diabetes nurse they can talk to. S tep 2. At the first nurse diabetes consult, the nurse will re-explain everything in detail as it’s likely that little information has been retained by the owner. We developed a diabetes questionnaire that the nurse will work through with the owner, to ensure that we have a full picture of the patient. Working to this protocol means that the vet can have confidence in knowing that everything has been covered, and it will highlight any gaps in knowledge/ management/understanding. At this first nurse consult, they will reinforce the vet’s diagnosis and management instructions, as well as advising the owners of the long term implications and need for regular checks. The nurse will also price up the cost of on-going management for the patient and give them an information booklet. The nurse will demonstrate the injection technique to the owner and get them to practice on a soft toy and then administer an injection of insulin to the patient to ensure they have adequately learnt the injection technique. S tep 3. The day after the initial nurse consult, the nurse will follow up with a phone call checking that everything is okay and books the client and patient in for their next appointment which is with a vet for a glucose curve. This is usually 1 week after their initial vet appointment and patient diagnosis. So within this first week, they will have spoken with or seen a vet twice and a nurse twice. A lot of the questions the owners will have can be fielded by the nursing team and any questions they cannot answer can then be referred to the case vet. S tep 4. After two weeks they will have another nurse appointment where the patient will be weighed, drinking and appetite assessed, and their owner management charts checked. Thereafter the check-ups will alternate between vet and nurse. Practice Life z September/October 2014 z www.practicelife.biz

CLIENT CARE & MARKETING

CASE STUDY Gemma Cooke Registered Veterinary Nurse at Ian McConnell’s Veterinary Practice in Oldham, believes that nurse clinics benefit the whole practice and not just the nurse involved.

urse clinics have become more popular as vets and clients have gained more knowledge and confidence with the nurse’s role in practice. Allowing nurses to run certain clinics can help raise awareness of a veterinary nurse’s abilities in practice. They help to free up the vet’s time, making more appointments freely available for other animals and clients, and allow pet owners to become accustomed to other veterinary team members. Nurses also have the opportunity to examine and treat patients, whilst at the same time building rapport with clients and boosting their confidence in the practice. As people, nurses are very versatile and adaptable to both patient and client needs. We can offer advice to pet owners and apply our knowledge on subjects ranging from parasite control, neutering advice and grooming techniques to postoperative and pre-operative care, physiotherapy, bandaging, nutrition, blood sampling, weight clinics, diabetes clinics, Using the nurse as an integral part of that diabetic patient’s management team allows us to deliver a high standard of care where the patient is checked very frequently, while not putting undue pressure on vets’ time. It also means that we can deliver the same messages regarding management 4-5 times in the first month which really drives compliance and as a result we can stabilise them much more quickly. So really, the full use of our nurses helps us to drive an even higher standard of patient care than we would be able to do using our vets alone. Currently we do not charge for our first diabetic nurse consult, however this is something we are thinking of reviewing due to the www.practicelife.biz z September/October 2014 z Practice Life

senior clinics, puppy parties, microchipping, behaviour and training. Assisting the veterinary surgeons in theatre on a day to day basis helps to boost confidence in surgical skills which means that the nurse can then discuss procedures in depth with clients, explaining the reasons for the surgery and the techniques used. This again can help build confidence in the veterinary practice as pet owners begin to understand veterinary care in more detail. In order for nursing clinics to become successful, you must have full support from the entire veterinary team. Receptionists and administration staff should know what clinics are available, the times of these clinics and what they involve. This then means they can offer advice to clients on the necessary appointments whilst demonstrating knowledge and confidence in the nursing team. Vets should also be aware of the types of clinics the nurses are happy to run and what is involved in them from topics discussed to how pet owners can be introduced to them. I find it is always a good idea to promote nurse clinics by other means too, including posters in and around the waiting room, leaflets, local radio and newspaper adverts, social media advertisements and general word of mouth. That way when a client attends the practice they can see clearly what is available and how useful the nursing team is. Before setting up any clinics, you need to ensure you have everything available to make the clinics a success. A consultation area should be available, where nurses and their clients will not be disturbed, allowing for animal examination and a private area where pet owners can discuss things in confidence. In this consultation area there should be an examination table, some weighing scales, access to patient records, a microchip scanner, flea combs and grooming equipment, nail clippers of different sizes, muzzles and restraint equipment, literature (leaflets, posters etc) and body condition score charts. Preparation is key. A well run clinic can not only boost client confidence and bonding, but have benefits which run right through the practice. skill, expertise and time the nursing team bring to these cases. Overall though, we don’t lose money as we are still getting income from the medications and from the vet consults and we see the nurse clinics as allowing us to drive good compliance and bond the client. Using the nurse properly allows us to free up more fee-earning consults for the vets. It also leads to job satisfaction for everyone, as we are empowering the nurses to use the skills that they have been trained in. Our nurses love their consulting roles. To me, it’s a win-win for both the vet and the nursing teams. Bit of a no-brainer really.

CLIENT CARE & MARKETING

The Changing Face of Practice Support Lee Danks, Veterinary Scientific Support Manager at Royal Canin looks at the evolution in support from industry and other providers

“There is nothing more certain in this world than change” I ask you to read this article with this truism in mind.

hether attributable to the human condition or the current information revolution, the (veterinary) world is changing. I feel that how we let the progress around us affect the workplaces we spend so much time in is dictated very much by our attitude. Seeing varied business models and speaking to a wide variety of stakeholders at many levels in practice, it becomes obvious who is willing to accept change, to embrace it and to build a business which is prepared not only for the challenges of the day, but for those we’ll face tomorrow. Many, both within and outside our sector, attest that ‘vets are change-averse’ but I’m not comfortable with us all being painted with this brush. I’ve seen evidence of many practices thinking outside of the box. Some don’t even see the box at all. That’s what this article is about – demonstrating that our practices are only as limited as our (albeit pragmatic businessminded) imaginations… and to highlight that the support available to us all is evolving just the same as the industry in which we work.

Communications Firstly, people are communicating in a host of different ways, with pet owners previously responding to phone calls or letters now having more ‘digital’ expectations; acting on SMS, emails and social media as a preferential mode of receiving messages. There’s an excess of information in the world and we’ll never have enough time to digest it, let alone make judgement on its long-term value. Time-poor owners want information about their pets presented in increasingly visual and convenient ways and yet still demand the personal touch from their vet practice if they are to reward them with customer loyalty. Seeking to respect the relationship you’ve developed with your clients, interactive communications tools such as Catom™ (an anatomical cat model) provide just that: reliable reference materials for the inquisitive pet owner who responds to visual messages from digital sources (think ‘Dr Google’!).

journey, respecting the animal-human relationship and sparking an interest via digital technology.

Bespoke training I’m a big believer that ‘a leaflet never sold a bag of food’. That leaflet needs to be in the hands of a knowledgeable person; someone who can add value to that piece of paper. A strong culture of training and staff development is very important. Over the past two years at Royal Canin we’ve worked hard to develop a series of bespoke training courses for veterinary staff, including one of a series of Management Modules on The Client Journey which encourages owners and managers to truly critique their business when faced with personalised feedback from their own customers.

Not just a leaflet

Interactive tools

In this brave new world, veterinary manufacturers are asked (and often expected) to provide their partners in practice with more than an array marketing materials. There’s only so far a leaflet or poster might go in encouraging owners to worm their dogs, purchase a new product or change the habits of a lifetime (when was a client last convinced to brush their cat’s teeth on reading a hand-out!?). What we all need are collaborative tools which engage clients; conversation points to educate and inspire action and (more often) entertain in the process. This means vets involving pet owners in every step of their pet’s health-care

Added value training, coupled with interactive tools can really engender a sense of partnership between pet owners and the practice. Compliance tools such as ‘Vet Follow Up’ is one example and there are others available from various manufacturers and software companies. Vet Follow Up is an online weight management tool which automates precise target weight and ration calculations and allows practice staff to track a patient’s progress. It also allows pet owners to input their pet’s weight from home and this information is relayed to the practice, completing the feedback loop and enlisting the Practice Life z September/October 2014 z www.practicelife.biz

CLIENT CARE & MARKETING

owner as an integral part of the monitoring process – ultimately leading to greater engagement, more frequent and valued interactions, client compliance and healthier pets.

£10

The second book of tips from VBF

“This book should be a ‘must’ for all new graduates and all ‘old’ graduates too.” Pete Wedderburn BVM&S CertVR MRCVS Journalist, The Daily Telegraph Kindly sponsored by Bayer Animal Health

Where do I start? When asking who to turn to for assistance, it makes sense that we need to have a vision of our end-point. An appreciation for your business, its identity and direction is of course essential. Speak to as many people as possible, attend CPD events which incorporate networking opportunities, make posts on VPMA and SPVS forums or Vetpol, VetGrad or VetBoss while www.practicelife.biz z September/October 2014 z Practice Life

VBF

With the advent of on-line training platforms (e-learning and webinars), manufacturers and suppliers are now offering new CPD formats to veterinary staff. It’s brilliant that much of the knowledge normally reserved for an internal audience can easily be distributed to veterinary staff. Delegates and presenters no longer need to organise travel, accommodation and adapt their busy agendas; for many, webinars have become the format of choice for their convenience, brevity and accessibility to so many practice staff. This said, popularity for the face-to-face training and support given to practices to run various clinics for their clients has not waned in recent years. There is clear acknowledgement that – be they puppy clinics, dental clinics, senior pet clubs or a specialist service offering – clinics provide practices with an enormous opportunity to position themselves as experts on all a pet’s needs, as well as prompting customer loyalty through a real sense of belonging. Clinics also reinforce the essential role of VNs and support staff.

EEDS GO T OC

Staff development

The pocket book of small animal tips for vets

ALL PR

online and never be afraid to listen to others’ ideas. You never know when someone is going to present you with a solution you never thought possible. On the flip-side, the bad ideas (knowing what won’t fit in your business) helps define you too. It differentiates you from others. I recommend vets seek out those who have a vested interest in the industry, who have time to ‘take the pulse’ of the profession and heed new directions and possibilities, as these are the exciting organisations to work with. Often vet suppliers and manufacturers are willing and dynamic enough to change with you, making them excellent partners for the journey. Choosing these partners can involve a leap of faith or an investment of time in sitting down with local business managers but they’ll give you an idea of their often vast and untapped resources. A company’s employees should be able to give you an idea of their identity and underpinning values, which should mirror your own wherever possible. The resources of a switched-on supplier should also be evolving to meet new industry trends. Ultimately, the suppliers you decide to partner with should reflect your established, tried-and-true practice ethos. If a brand is to permeate your entire business, you’ll have to be confident that (for both your staff’s and particularly your client’s sake) everyone is proud of the association. For me, this delineates a manufacturer from simply being a supplier of products to becoming a true ‘partner’ in practice – and defines truly useful Practice Support. Don’t forget to enter our Royal Canin sponsored book competition on Page 5! – Ed.

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FOCUS ON DIAGNOSTICS

SPECIAL FEATURE

FOCUS ON DIAGNOSTICS: The business, clinical and ethical case for doing more in-house Don’t miss out on our second ‘Focus on Diagnostics Day’ to be held at Staverton Park, Daventry on 16th October. The feedback for last year’s event was summed up by one delegate who described it as ‘the best day’s CPD I’ve been to in 10 years’.

Brian Faulkner, who will chair one of this year’s workshop streams, uses a very apt Tour to France analogy to explain why you should be there: ‘Just because you’re making progress doesn’t mean that you are keeping up with the peloton!* Twenty years ago everyone was adopting a practice management system, ten years ago it was ultrasound and today it’s a digital x-ray machine. What we aim to do in this very intensive one day event is help you decide not only what equipment the peloton are using today (and I don’t mean EPO!), but what they are likely to be using tomorrow, to ensure that you are keeping up with or even ahead of the competition’. The day combines an exhibition of relevant suppliers with seminars from a stellar cast of speakers including Dr Mark Patteson, Veterinary Specialist in Cardiology, Paddy Mannion, Veterinary Specialist in Imaging and Peter Southerden, European Specialist in Veterinary Dentistry. Mark will try to persuade vets they can do more than they think with their ECG, by helping them focus on what really matters, while Peter Southerden will make the case for shifting your practice mindset around dentistry. For many vets, dentistry is something you do at the end of the day after you finish surgery rather than an opportunity that not only improves your bottom line, but is also a genuine benefit to pets and their owners. However, there is world of difference between one vet having a particular interest in dentistry, and the whole practice, from vets to nurses to receptionists, buying into oral healthcare, education and marketing. Paddy Mannion will consider the balance between imagery interpretation in-house, via telemedicine or by referral, while Marwan Tarazi will explain why he feels every practice should be able to offer laparoscopic spays. Keyhole surgery means minimal scarring, quicker recovery and less pain for the animal. This creates a feel good factor for your vets

and a strong marketing message for owners. Marwan will also argue that laparoscopy will very rapidly repay the investment in equipment and training and marketed well, increase your footfall. Stem cells and Platelet Rich Plasma has opened a new field of medical science for treating patients in both human and

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MIUS - ‘When Quality Counts’ Mount International United Services Ltd Edison Close, Waterwells Business Park, Gloucester, GL2 2FN www.mius.org.uk info@mius.org.uk Tel: 01452 729 380 Practice Life z September/October 2014 z www.practicelife.biz

FOCUS ON DIAGNOSTICS

veterinary medicine. Stephen Barabas will give an overview for veterinary practice, including a review of clinical studies on regenerative medicine, the practical aspects of using these technologies, the financial cost to owners, and the rewards for your business. The day is also an excellent opportunity to talk to suppliers of equipment with over 20 relevant and focused exhibitors. Braemar Finance, our headline sponsor will help you work out the most tax efficient and cost effective way to finance your investment in new equipment. *For you non-cyclists out there like me, the pelaton is the name given to the main body of riders in a cycle race! – Ed

TALK SYNOPSES Regenerative Medicine Stephen Barabas BSc., BVMS., MRCVS, VBS Direct Stem cells and Platelet Rich Plasma has opened a new field of medical science for treating patients in the 21st Century by medical and veterinary practitioners. This lecture aims at giving an overview for the veterinary practice of existing human and veterinary clinical studies surrounding regenerative medicine, the practical aspects of using these technologies for vets, and the financial cost to the pet owning client and rewards for the veterinary practice. Making the Most of your Microscope Mike Wickham Woodley Equipment Microscopes are only as useful as the people who use them and care for them. This workshop takes you through the basics of microscope care and maintenance that will help you improve your in-house results. Mike will also demonstrate how to fix a simple wifi camera to your microscope. This is an excellent way to enhance the value-perception in your clients, thus improving compliance, as well as sharing findings with your veterinary colleagues, not least external referrals. One of Woodley’s medical scientists will share some of the most common calls to their helpline with tips on how to get better accuracy from haematology and smears. 5 things you can’t do without a digital X-ray! David Chambers DCR(R) DMU, Burtons Medical Equipment Ltd.

Practice & IT finance solutions Maximise your tax relief Current tax legislation may allow you to offset the cost of equipment and IT packages against taxable profit in the year of purchase. This can provide a significant cash flow benefit, allowing you to obtain new equipment or IT solutions whilst spreading the cost into affordable monthly payments. To find out how we can help you, contact us on 0845 154 7638 or visit www.braemarfinance.co.uk

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Close Brothers Group

Finance approval is subject to status

Braemar Finance is a trading style of Close Brothers Limited. Close Brothers Limited registered in England and Wales (Company Number 00195626) and its registered office is 10 Crown Place, London, EC2A 4FT. Braemar Finance, Braemar House, Olympic Business Park, Dundonald, KA2 9BE.

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The aim of this session is to explore a specific list of the practical benefits of having a digital x-ray system including the diagnostic, operational efficiency and profitability implications of creating, enhancing, storing, retrieving and sharing radiographic images. You will leave with new insights into what your machine can do – and if you don’t yet have one, at least 5 compelling reasons why you should! Dentistry in-house; moving your mindset Peter Southerden MBA DipEVDC European Specialist, Vet Dentistry, Eastcott Vets Are you charging less than half the price for a dental procedure compared to the same length of soft-tissue or orthopaedic procedure because it’s ‘just a dental’? Whilst technical advances in veterinary dentistry have progressed significantly in the last ten to twenty years, it could be argued that the typical first opinion veterinary surgeon’s ‘mindset’ towards dentistry hasn’t evolved at the same pace as other areas; take for example the shift in attitude towards the in-house management of cruciate disease over the same period. This workshop, delivered by one of Europe best veterinary dentists, will explore the ethical, clinical, client and economic arguments that could transform your entire approach to what you think, feel and do with everyday veterinary dentistry.

FOCUS ON DIAGNOSTICS

TALK SYNOPSES continued... The in-house laboratory. What should its clinical role be and is it really the best financial option for a practice ? Dr. Andrew Torrance Veterinary Pathology Group A leading referral laboratory will outline the clinical and financial arguments for using results and advice from expert pathologists in your daily practice. Improvements in diagnostic technology particularly molecular technology are providing rapid advances in veterinary diagnosis. Guidance on the applications of these developments is likely to become essential to vets in practice and will influence their choice of external laboratory and their thinking on in-house laboratory work. ECGs: You really can do more than you think! Dr. Mark Patteson MA VetMD PhD DVC CertVR, HeartVets/Vale Referrals Many vets duck out of recording ECGs because they lack the confidence to use them. What equipment (printed ECG, monitor, Holter, event recorders) to use and how to use it, when to record an ECG and, most of all, what they mean. Important information often gets missed because ECGs don’t get recorded as often as they should, or are done in the wrong way. A methodical approach means that most cases can be managed in house, with online help where needed, in both small animal and equine patients. Developing confidence breeds better practice and increased turnover. This workshop, delivered by the leader of the UKs leading independent veterinary cardiology consultancy, will review recent development in ECG equipment and how best to use it to the benefit of both your small animal and equine patients and your business. Abdominal Imaging: case studies based around X-ray, ultrasound and CT scans Paddy Mannion BVMS DVR MRCVS DIPECVDI, Cambridge Radiology Referrals Accurate interpretation of images may require skills in diagnostic imaging that you don’t have in-house. On the other hand, using in-house equipment can give instant insights and a much quicker diagnosis. This workshop, from one of the country’s leading veterinary radiologists, helps you decide if investing in imaging is for you and considers where the balance lies between in-house interpretation, telemedicine/ teleradiology and referral.

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FOCUS ON DIAGNOSTICS

Financing the investment Simon Norman & David Foster Braemar Finance

Why Eclipse webPACS?

This workshop will compare and contrast case studies in order to demonstrate the return on investment benefits of different finance options. Tax and business relief implications will also be explored. According to one delegate to last year’s event, one tip alone in this workshop paid for his delegate registration many times over and made this a very worthwhile day out of the practice. Dashboards and Income Analysis Brian Faulkner CertGP(SAM), CertGP(BPS), MBA, MSc(Psych), Vetpsych If we are investing in diagnostic equipment and training, we need to ensure we have a simple means of tracking their use, productivity and our return on investment. Brian Faulkner will share his experience of creating and using the Teleos Dashboard as a means of monitoring a practice or practitioner’s attitude towards promoting and performing diagnostics in first opinion practice. Can you afford NOT to offer Laparoscopic Spays? Marwan Tarazi DAM, MSc, MRCVS, Nu Vets Keyhole surgery means minimal scarring, quicker recovery and less pain for the animal. This creates a feel good factor for your vets and a strong marketing message for owners. Marwan shares his experience of making a return on the investment and increasing his footfall. James Towler offers the pros and cons of new versus second hand laparascopic equipment.

The venue is Staverton Park, Daventry, from 9:30am to 5:00pm. CPD certificates, lunch and refreshments are included. The cost is from just £100 for SPVS/VPMA members. For further details, or to register for the event, visit www.spvs-vpma-events.co.uk or call 01453 872 731.

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Would you like just one place to store all your diagnostic scans and be able to view them easily on any PC/Mac, even from outside the practice (e.g. from home?) via a standard web browser… • The storage capacity can easily be upgraded at any time. No expensive hardware lock-in. • X-rays, MRI, CT, Ultrasound can all be stored. Use an iPad (or laptop) to explain procedures to owners worried about their animal’s treatment. • Local server (not cloud) so not dependent on the ‘speed’ of your internet link. Access always quick. • Installed by experienced, friendly support people, knowledgeable about Dicom and PACS. • Integrates with practice management systems. Please do get in touch with us if you would like a demonstration? Call 01799 532988 or email: enquiries@eclipsesoftware.info

BUSINESS HEALTH & FINANCE

Reviewing Fees in Small Animal Practice Peter Gripper BVetMed MRCVS, Managing Director, Anval Ltd

ow often you review your fees is up to you, but in an ever-changing and increasingly competitive marketplace, fine tuning your fees will help you to remain a profitable business. “Inherited” fee structures that have changed only by incremental “annual inflationary rises” are not a realistic approach to determining your fees. If you have a well-balanced fee structure then a quarterly review may be all that is needed. If you are unsure which areas of your work are profitable and which areas of work you are subsidising then a full review is the answer. There is an element of cross-subsidising in any business but it is important to know what work you are subsidising and what work is profit-generating. This is particularly relevant if you take over a business. If you are offering a new service, or are a new start-up business you can begin from first principles. Determining appropriate fees is an essential part of the business plan for a start-up practice. Fee structures will reflect each business and the cost base of providing the service. It is self-evident that a lock up consulting facility has a very different cost base compared to a fully-staffed new build veterinary hospital offering intensive care 24 - 7 with overnight staff. New entrants to the marketplace with different business models can cherry pick work to fit their model and are able to provide services at a much lower cost. This changing marketplace means that “profitable” work may be lost, and your practice is left with a greater proportion of the marginally profitable or unprofitable work. Your current fees may need to be reviewed to ensure you remain a viable model. In addition to regular quarterly reviews other triggers may prompt a review including:• Change in the services you offer • You are a start-up business, or take over a business • Changes in working practices • The market place has changed - New competition - Special offers advertised locally - You are considering ‘price-matching’ a competitor • Profitability study or business review identified action required New services require you to determine the correct fee to charge. This could be new equipment, e.g. an ultrasound scanner, an upgrade e.g. digital x-ray, or new techniques, e.g. laparoscopic surgery. Changes in working practice and working arrangements can alter the cost base for example, changing from 10 minute appointments to 15 minute or to 5 minute appointments. Veterinary practices are trading in an ever more competitive market place with greater competition from the number of practices, types of practices and other supply routes. Higher

profile marketing, special offers and discounts all contribute to the mix. Your fees need to reflect not just the marketplace, but also the level of services that you provide including equipment, facilities and skilled staffing. The fee scales and structure you devise have to be sense checked against the current marketplace. They have to be justifiable to your practice team and to the customer who will judge them. Cost centre analysis is the start point to understand the true underlying cost of any procedure and helps direct a practice to set fees at the correct level for the services it is providing. Cost centre analysis considers the fixed and variable costs and the principles of the calculations are illustrated in the case study opposite. Variable costs arise each time you carry out a procedure. The variable costs for any procedure need to be identified to help set the fee for that procedure and includes staff and consumables. In additional to variable costs, the fee needs to contribute to the fixed costs for the procedure. Fixed costs do not change, irrespective of how often you carry out a task or procedure, and include premises, rent, rates, insurances and similar. Equipment has a fixed cost to purchase and likewise, an operating theatre will have a fixed annual cost. In any review you must consider the marketplace, fixed price fees, headline prices, packaged or bundled fees, longer term illnesses, volume and value, and I have included some pointers below. Value and Volume – How often do you use the fee? Adding £120 to the cost of a cat caesarean will make little difference to practice economics because you carry out very few of these procedures each year, whereas adding £1 to a consultation fee will make a big difference with many consultations booked daily. Focus on the main income streams. Fixed Prices and Fixed Price Plus Extras – What is included or excluded from a fixed price procedure such as neutering a cat or first vaccination course for a puppy? A fixed price operation may have ‘extras’ charged for – medications required on the day or for the next 5 days, or lab tests arising as a result of the procedure. Are these all included in the fixed price or are they extras? Procedures must be priced properly to reflect the costs involved and very importantly must be explained properly to your clients and to anyone phoning round and comparing fees. Hidden Costs and Consumables eg dressings, bandages, catheters must be costed. Removal of front dew claws may be seen as a relatively simple and defined surgical procedure by the client. Does the price include dressings and bandages? Are cases Practice Life z September/October 2014 z www.practicelife.biz

BUSINESS HEALTH & FINANCE

CASE STUDY Cost Centre Analysis Calculation Illustration

or example, if an ultrasound scanner costs £15,000 to buy and is costed over 3 years then £5,000 has to be funded annually (plus any interest payments). If this equipment is used twice a week (104 times pa) the fixed cost is £48 each time it is used (£5,000 pa divided by 104) and this has to be built into the fee charged. Training, a scanner table and reference books may be a further £900 fixed costs which equates to £3 per scan. Staff time is a large element of the variable cost – if a procedure takes 30 minutes for one vet and one nurse their employment costs have to be included. Hourly costs for 1 vet + 1 nurse may be £36 per hour (based on £60k pa + NIC for combined vet + nurse salaries), so 30 minutes costs £18. There may be consumables to include too. The premises cost can be calculated and allocated per room based on floor area, and central management and business admin costs need to be included and allocated across the range of work. I have included a notional £3 for

this example but these need to be calculated accurately. An operating theatre used 3 - 4 hours of the day will have a higher “hourly” cost to include in the calculations than a consulting room that is used for 8 hours a day. The fixed costs of equipment in the operating theatre will also be much higher than in a consulting room. On this very quick calculation example, a 30 minute procedure with a vet and nurse, using equipment that cost £15k to buy, has a minimum cost to the business in the order of £72. This only covers the cost and, as yet, no profit has been generated. If the practice sets a 20% margin for profit contribution, the fee should be £90 + VAT. (£18 margin on £90 fee). A similar approach can be used to review and determine other fees, for example, a hospitalised patient. Different costs will arise dependent upon the level of care and time required, which may range from “recovery post op”, through “observations”, to “intensive care”. These have hugely different costs and your fees need to reflect this.

that require re-dressing for 3 or 4 weeks charged the same as cases that need re-dressing for one week? Packaged Fees and Pet Health Schemes have operated successfully for many years with bundled packages, for example, a first year fixed price package for a puppy or kitten that includes primary vaccination course, neutering, flea and worm treatment for a year. You can run your own schemes or external providers offer pet health plans and run the administration for you.

Veterinary Practice Management Systems

Longer Term and Lifetime Illness – more wide-ranging treatment plans are possible for ongoing, longer-term illnesses such as joint disease or cardiac disease. Devising health plans for specific diseases that cover the examinations, projected diagnostic investigations and treatment plans that will be required over time can offer better options for the client, the patient and the practice. Headline Pricing – Price comparisons are familiar territory in other market places as are several difference prices for the same ‘product’. Services might be perceived by clients to be similar but are very different, and it is important to provide information to clients so that they can make a judgement as to the difference between fees quoted for “the same” procedure. Finally, Fee Application is not part of this article remit but it has to be mentioned because this can be a major area of lost profit in practices if people are not selecting the correct fee or not booking all the work.

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28/08/2014 10:46

PRACTICE DEVELOPMENT

JOB DONE:

RECRUITING THE RIGHT PERSON Dave Nicol is co-founder of Recruit Right for Vets, a HR agency that helps vets attract good applicants and filter out the poor ones so practices only hire the right people to help achieve their business objectives. (And stay sane!) He also owns two veterinary hospitals in Sydney Australia.

Recruitment – the most epic fail in business yet

Recruitment mistake 1: No preparation

When I’m speaking at conferences I challenge the audience to tell me their problems and see if they are not all in some way linked back to poor human performance. So far it’s approximately Dave 100 - Audience nil. The implication of this is profound and, I’d wager, seriously underestimated. Why else would we put up with such very ordinary practice performance or high stress levels other than we can’t figure out the source of the issue? Estimates on just how much a poor hire can cost your business each year vary. The CIPD (Chartered Institute of Personnel and Development), for example quotes 2.5 x salary. However my own research done in conjunction with accountancy firm APL Accountants (Australia) and HR consultants Vinehouse (UK) has placed the figure for vet clinics at a minimum of 4 x salary. Let’s say for a single poor performing vet that means you could be missing out on £200,000 per year!

Many practices just go into panic mode when a staff member leaves. The pressure to fill a hole in the rota is huge and a ‘recruitment-reflex’ kicks in that leads to a pattern of repeat failure. As they say, if you do what you always did, then you are going to get what you always got. When someone leaves it’s time to stop and work out what you really need. This means reviewing your business objectives, putting together a job description and making sure you are clear about the type of person who could fill the role. When I recruit I build out a person specification that has about 25 attributes that I know are crucial for success in the job and organisation. These include technical skills, values and behavioural traits. The time taken on this level of planning detail is absolutely crucial.

Is 80:20 working against you? The 80:20 theory states that 80% of outputs are due to 20% of inputs. Put another way 80% of production or revenue is being delivered by 20% of your staff. The horrible side of the equation shows that 20% of your production comes from 80% of your staff! Now take a wild guess at which side of the team are giving you the most trivial, soul destroying and unproductive management work? If you were a smart manager then you’d be focussed on the 20% delivering the 80%. These are your champions. If you were a smart manager then you’d find it immensely profitable to work out what these stars do and replicate it elsewhere. But no, that’s not what happens. Most of us are caught up on our little hamster wheels scurrying around putting out fires caused by our problem people; those who don’t follow procedures; those who upset clients and colleagues; those who choose their own pricelist or work conditions; those who drain the team of their energy; those who don’t show up at all. Those problem people who you keep hiring! Is this your life? Then it’s time to get on the right side of the 80:20 equation. To get there quickly, you must bring more superstars into your business. So the £200,000/vet/year question is how do you find and choose good talent? Well let’s focus on the common five mistakes that most recruiters make and give you some tips to do things better.

Recruitment mistake 2: Running a job advert that looks like everyone else’s Have you seen adverts that start with “A vacancy has arisen at Shady Pines Veterinary Hospital…” or simply entitled “Veterinary Nurse Needed”? Not only that, have you noticed how many adverts have content that is almost identical to others on the same page? They give boring, dry lists of responsibilities and desirable candidate attributes: “The ideal candidate will…” They are advertisements with little personality that give no idea of what it would be like working for the company. Nothing to really tempt your ideal candidates. This means you can get swamped with unsuitable candidates, but not get applications from the people you really want. The job advert has two functions. Firstly, to speak with authenticity about what life is like in your clinic and attract people that connect with your values and culture. Secondly, to deter those who are not suited and will cause problems. My advice is to be honest and write with passion. Don’t be afraid to tell it like it is. The truth will out and it’s far better it comes out sooner than later. (Please note, if your practice has major problems, just being honest in a job advert will not improve performance - but cultural reform is perhaps beyond the scope of this article).

Recruitment mistake 3: Just carrying out a single cursory interview Do you rely on just one interview? Many vets do, and those Practice Life z September/October 2014 z www.practicelife.biz

PRACTICE DEVELOPMENT

interviews are full of poor questions that get you hardly any useful information. Questions like: “What would you bring to the team?”, “What would your last manager say about you?” and “Why are you the right person for this job?” are very common. But these questions are such a waste of time. They don’t tell you if the candidate you are interviewing has the correct profile for the job. Far better to ask scenario-based questions about real situations your candidate has experienced. “Tell me about a recent surgical case you dealt with?” – is a good question to ask a vet you’re going to hire to be a surgeon. When you get stuck into the nitty gritty of a real life case it very quickly becomes clear who has the required experience.

Recruitment mistake 4: Eliminating the good candidates So many people rely on completely the wrong information when they are making their selection. CVs and interviews are charades where everyone is on their best behaviour. They are not reliable ways of hiring the right people as evidenced by the myriad of HR issues that crop up in businesses each day. If you rely on these alone you will hire people who are good at interviews and writing CVs, but not necessarily good at the job you are paying them to do. Conversely, you may be passing by the people who are perfect for you practice but not so good at interviews. Let me give you an example. My own head nurse is a shy person who initially comes across as shy or awkward. Once

upon a time I would not have taken her application forward because she wouldn’t have interviewed well. But boy, what a mistake that would have been. A harder working, more efficient and loyal team member I have never seen. I strongly recommend putting candidates through some tests that replicate the work that you will expect them to perform as part of your interview process. For example, my nurse interviews involve about an hour of practical tasks including animal handling, cleaning and (supervised) anaesthetic monitoring. Only if a candidate successfully completes this part of the interview will I sit down in a face-to-face interview.

Recruitment mistake 5: Thinking it’s all over once you have hired the candidate Once the candidate is in the post, you may think it’s time to put your feet up and relax. Even with the best recruitment processes in the world, there is always a chance that you have made a mistake. And even if you hire the perfect candidate, you still need to make sure that your new hire is successful and earning their keep as soon as possible. This means you have to put some effort into helping your recruit to learn the ropes and make sure they have everything they need in order to perform. And finally, if you find that, in spite of all your efforts (it can happen), that you have made a mistake, you need to make sure you pick it up quickly and deal with it before it costs you a fortune. By avoiding these common recruitment landmines you will be well on the way to helping your business hire in more of the top performers who make your life happy and easy, not miserable and hard.

How to land the job, tips for job seekers It takes two to tango as they say, and though much is written about how to hire, there is less time dedicated to the other side of the equation – how to get hired. I’ve walked on both sides of the line, firstly as a vet who worked for others and, in the last five years, as an employer who has taken a practice from the brink of bankruptcy and seven staff to top performance and almost twenty staff. So, in a world where competition for jobs is increasing as the market gets more crowded, how do you go about landing the successful role in which you will be happy? Here are my top tips: 1. Laser target what matters to you before starting to apply

Answer the question “What matters to me in my job?”. Write down a list. This is essential to your happiness in a job and any role you take must be able to meet these fundamental needs. If a practice cannot meet these needs then you will not be happy. I guarantee it. If you want to do surgery, then choosing a clinic which is known for high surgical standards may seem like a good choice, but if they have three other surgeons ahead of you

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in the pecking order then you are going to live on surgical scraps. The smaller practice where you will be top of the list may be a better choice. 2. Don’t fall at the first fence

Make sure you write a CV and covering letter that is free from typos, gets your key strengths up front and centre and doesn’t make life hard for the poor soul doing the hiring. I once had someone send in a CV that was set up like a newspaper front page. Had I been hiring for a newspaper typesetter this would have been a marvellous way of standing out from the crowd. Alas, I was looking for a vet nurse. 10/10 for creativity (and office comedy value). 0/10 for job-landing potential. 3. Practice for your interview

It’s ok to be nervous. But stammering over your words and forgetting examples of those awesome cases you’ve brought back from the brink does hinder your chances of landing the job. Most employers have some ‘go to’ questions that you can prepare for. Why are you the right person for this team?

PRACTICE DEVELOPMENT

Why should I hire you? What interesting cases have you worked up recently? These are all common questions you should anticipate and have answers for. 4. Be yourself, be honest and establish the ground rules early

Bluntly put, if you dress in a suit and smarten things up for the interview, but intend to come to work each day in jeans, with twenty facial piercings, then don’t expect to have a happy job for long. Don’t land your new employer with unwelcome surprises. It pays handsomely in the long run to have honest conversations with your employer about both your and their expectations before you both enter into a formal

working relationship. Asking questions and establishing ground rules now shows maturity and emotional intelligence. Throwing toys out the pram when things aren’t what you assumed they might be later will get you shown the door. 5. Follow up quickly

After your interview, if you liked the role, send the interviewer a personal email telling them what you liked about the practice and why you will be a great match. It’s a personal touch that will help you to stand out. Plus it shows that you are organised and it gives an employer an idea that you might just pay this level of attention to the clients as well.

CASE STUDY – (from my own practice!): Hiring a new reception team leader The practice: Dr Dave’s Vets & Pets, Sydney Australia. 4 vet, 18 employee business spanning two sites. The recruitment problem and objective: When the business was taken over it was staffed with nurses with reception and clinical responsibility. It was hard however to keep nurses out front and they regularly complained about this side of their roles. The business at the point of purchase was financially bankrupt. The objective: Introduce dedicated reception staff to undertake sales and customer service work with a minimum improvement in sales of 10%. The process: A job description and personal specification was created. The requirements of the process were to hire someone who was friendly, happy to follow procedures, loved paperwork, was borderline OCD, was emotionally intelligent and had experience working in sales/customer services. It was also important that this person would be happy to stay in the role for 5-7 years. A job advert was created that spoke honestly about the problems we had within the practice and also about the potential impact this role would have on animal and organisational health. The job advert can be viewed online here: http://www.vetsandpets.com.au/about/jobs/admin.php

Respondents to the job advert were sent to an online testing webpage where they had a variety of tasks related to the role they had to complete. 80% of applicants did not complete the tasks accurately indicating they did not have the technical competencies to do the job, or did not complete them at all. Only those applicants who completed these tasks successfully were then put forward for psychometric profiling and emotional intelligence testing. Only those applicants who met the criteria defined in the original person specification were invited in for a practical onsite interview. (The most expensive part of the process). Two candidates from fifty made the final short list. Both were capable of doing the job. But one was a standout personality that matched the new culture and “vibe” of the practice. She completed the interview tasks accurately and demonstrated that she had the required previous experience to do the job well. She was hired the following day. The outcome: Our new reception team member was happy to take the vets recommendations and make sure they happened. Client service improved in terms of calls answered, service and product knowledge and friendliness. The uptake of services and products was remarkable and revenue increased over 20%. She remains with the practice today (almost three years later).

Practice Life z September/October 2014 z www.practicelife.biz

PRACTICE DEVELOPMENT

GETTING THAT JOB... Richard Powell of Brightleaf Recruitment takes a whimsical look at the right and wrong ways for job candidates to present themselves...

YOU’RE HIRED!

YOU’RE FIRED!

Understand The Job

Don’t be late!

• If you understand the job, you understand the business. This will demonstrate that this is THE JOB you want, not just ANY JOB. This is a real show of passion and desire!

• Make sure you know where you are going, where you can park, any pre planned rail works that will affect your journey. Barging through the front door after running the last mile, dripping in sweat and panting is never good look. Go for the James Bond rather than the Frank Spencer entrance. Anyone under the age of forty, please Google.

Make An Entrance

The Joker belongs In Gotham City, not the interview room

• You don’t have to sing and dance like you are auditioning in front of the X-Factor judges, however make sure you engage in conversation with clients, receptionists and anyone else in the practice. Making a beeline for a puppy or kitten will always win points with the clients. Show the world that you will immediately fit in with the team and clients.

• Making a joke around every question rather than answering professionally will almost certainly lose you the job (admittedly this will help wannabe stand up comics). Being stony faced and showing no humour at will probably do the same. Carefully choose when to “drop a funny”. If you are going to joke, make sure it is appropriate to the audience. Note to Jeremy Clarkson…

Private Investigation

My boss is a, ahem, “wally”

• You don’t want to seem like a stalker and give the interviewer cause to get a restraining order, however thirty minutes on Google can give you lots of information about the interviewer and their business. Find articles they may have written, their interests, where they studied. Great ammunition for discussions and you will immediately be seen as being on the right wavelength.

• You may currently work for the model of Gordon Brittas, David Brent or even Darth Vader and you are desperate to tell the world how much you despise working for them. Fight the temptation at all costs. Come up with a reason you are looking based around personal development, work-life balance or an equally safe reason. It would be very embarrassing if you were talking to your boss’s Best Man!

A Fist Full Of Questions

What super hero would you be?

• Everyone is nervous in interviews. Everyone forgets something. The most important question you will be asked is “Have you got any questions for me?” Write them down and take them with you. Referring to a list says you prepared for this interview and you wanted to find out key information to ensure you are a good match.

• Don’t be flummoxed by those silly questions that people ask that seem irrelevant. What interviewers are really asking you, is how quickly can you come up with a reasoned answer to a question outside of your comfort zone? Which superhero would you be? Personally, I would be Danger Mouse – he had a great sports car!

When do I start?

Erm, Yes, No…

• At the end of the interview ask the question “when will I hear back from you?” This avoids endless nights chewing fingers down to their nubs waiting for an answer that sadly, may never come. More importantly It also shows you are keen.

• Never answer questions with any of the above. The answer to “do you want this job” isn’t yes. The answer is “absolutely, I reallysee myself fitting into your team and bringing real value to your business.”

www.brightleaf.co.uk

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VET ABROAD

NURTURING VETS

from different nationalities With foreign vets becoming a significant part of the UK workforce, Luis San Pardo from Vet Abroad gives some pointers on how best to assess and integrate an overseas graduate into your practice...

hile it may be long lamented that vets aren’t paid enough or their working hours are ungodly, there’s no denying that the UK veterinary industry is considered one of the most progressive in Europe, offering excellent working conditions and a high standard of service. This certainly hasn’t gone unnoticed overseas, with UK practice attracting vets from all over the world. In fact, 48 % of all new Royal College of Veterinary Surgeons (RCVS) registrants last year came from outside of the UK, with 26% of all vets working in the UK having trained abroad.1

Benefits vs. barriers So where does this leave potential employers? Increasing the number of candidates for a position clearly offers greater opportunities for matching experience and skills more closely to the role. With the growing feminisation of the profession, this may become increasingly advantageous as full-time employees become harder to find. Peter Hicks, Practice Manager of the Maison Dieu Veterinary Group in Kent, describes why he has found himself predominantly hiring foreign vets, “Due to the number of practices recruiting and the wish of UK vets to find their ‘dream’ job, it’s increasingly hard to find British vets. Small, first opinion practices like ours may not have the facilities which new grads are often looking for and the smalltown life isn’t always appealing.” Foreign vets on the other hand can be skilled, keen to learn and extremely hardworking, often being used to doing the job of both vet and nurse. They are also very loyal, moving jobs less often than UK graduates and are generally happy to work out of hours. However, just as with any new recruit,

to fulfil their obligations of professional conduct, to respond appropriately to UK clients and to fit with the needs of busy UK veterinary practices.

Key considerations

finding someone with the right attitude and giving them the correct support is imperative to ensure a win-win situation for both parties.

Overcoming the obstacles While the EU directive insists upon baseline clinical competencies, cultural differences are not so easy to standardise. Single vet practices are often more common outside of the UK so teamwork skills and a sense of what it means to be part of the veterinary community may be lacking for some foreign vets. Involvement of the client in their pet’s wellbeing is also often a stark contrast to their experience so non-UK vets may not be used to having to explain their actions, educate the client or deal with customer complaints. UK pet owners tend to see their pets as part of the family while this is often not the case in other countries. An appreciation of this can make a huge difference when it comes to the consultation ‘chit-chat’ and building a rapport with a client. Luckily, there are now courses available which specifically address these issues and help foreign graduates understand how

With so many aspects to take into account, how can you make sure you’ve got the right candidate for the job? Veterinary qualifications from many EU academic institutions allow automatic eligibility for registration with the RCVS. For non-EU vets, the RCVS Statutory Examination for Membership must be passed, which includes the academic International English Language Testing System (IELTS) exam. However, IELTS does not apply to those with automatic eligibility, so there is the potential for foreign vets to gain membership to the RCVS and start work in practice without decent English. Peter believes that the ability to be understood in practice is paramount and something he places great importance on when choosing a candidate, “If a client is unsure of what’s happening at any point, then this is a client lost – with such tough competition, we can’t afford to be in that situation.” Learning the lingo, however, is just the beginning of being a successful communicator and with around 23% of complaints from clients to the RCVS citing ‘poor communication’ as the reason, this is clearly key to being a successful vet in the UK.

Expectations are everything So they’ve got the clinical skills and mastered English language basics – your new foreign employee is good to go, right? Sadly, this assumption frequently ends in dissatisfaction for the employer, employee or client – or all three. It’s important to remember that vets coming from abroad are not only

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VET ABROAD

trying to integrate themselves into a new practice and a new team, but also a whole new country. Not only do these vets have differences in language, legislation and everyday life to contend with, they also have to learn to do things the ‘UK way’. Employers need to expect, and be prepared, to provide specific training and support which is likely to differ from that which they would offer a UK graduate. However, even with the greatest will in the world, it’s not always easy for practice managers to know how best to do this. This is where mentoring systems become invaluable, providing support for both parties while taking into account cultural differences, common misconceptions and communication dilemmas. Overall, three main challenges faced by foreign vets are the communication conundrum, not knowing what is considered ‘normal’ in the UK and insufficient appreciation of and

preparedness for cultural differences. As an employer, tackling these issues from the start and providing on-going professional and social support for foreign vets will ensure these dedicated, bright and ambitious individuals thrive in the UK and become an invaluable member of the veterinary team. www.vetabroad.com offers the e-learning course for foreign graduates ‘Working as a foreign vet in the UK” and mentoring services for employees and employers through the VetAbroad® Advisory and Support Service (VASS).

References 1.RCVS Facts 2013. THE ANNUAL REPORT OF THE ROYAL COLLEGE OF VETERINARY SURGEONS: PART 2

CASE STUDY Portuguese graduate Joana Rita Almeida learned to ‘talk the talk’ with UK clients...

uperior salaries, better working conditions and more opportunities for career progression.” These are just a few of the reasons why Joana wanted to leave her home country of Portugal to come and work as a vet in the UK. Having now worked here for a few years, Joana has not been disappointed and plans to stay for the foreseeable future. After graduating, Joana worked as a small animal vet in Portugal until her daughter was old enough to make the

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move. With her husband already working here, Joana was able to settle in before looking for jobs which she says was invaluable, “I already had a high standard of English but being able to ‘talk the talk’ with clients is totally different. You need life experience of living in a country first – for example I never knew how important being able to chat about the weather would be in consults!” However, finding a veterinary position in the UK was not easy for Joana, and she was offered only nursing positions at first. She sought help and interview training which allowed her to develop a specific understanding of what it was that UK employers were looking for; she was then better able to demonstrate her knowledge and skills set, “Having been coached on interviewing techniques, I found I got offered every vet job I applied for after that.” Joana’s current employer found her a very positive asset to the team, “Joana’s enthusiasm, confidence and eagerness to learn really shone through right from the start. As long as you’ve got the right candidate, the time and a supportive team, employers shouldn’t be disappointed with their foreign recruits. Joana is a fantastic employee – her clinical skills are superb and the clients love her.” Joana thinks that foreign vets make good employees because they often have a strong ‘instinct of survival’, recalling how the four hour commute from London to Birmingham for her first UK job didn’t faze her. “When I first started in the UK, I didn’t think you had silver nitrate pens for clipping nails as they looked different to back home, which made building a good relationship with the owners of those first few wriggly patients more of a challenge! My biggest piece of advice for employers is to make sure your foreign vet is fully prepared for the differences of UK practice – including the small details which you might take for granted.”

CPD DIARY

VPMA/SPVS Congress 22nd - 24th January 2015

Don’t Miss Out on the Best Congress Yet! Places are already going fast for Congress 2015 so don’t miss this chance to bring your team together for two days of inspiring presentations and memorable networking.

‘Quality speakers with useful information you can take back to work on Monday morning’ This year a major theme will be The Client Journey with 3 of the 8 streams dedicated to the topic and individual presentations acknowledging the importance of a customer focused approach at the heart of effective business and management training. With over 30 speakers, you will find an abundance of new names from inside and outside the profession together with a few more familiar faces tackling new subjects. So take two days out to invest in yourself, your future and your business. Bring along your core team: owner, practice manager, head vet, head nurse and head receptionist to learn together and drive success. For further details and to be kept up to date, visit www.spvs-vpma-events.co.uk, join us on facebook, follow us on twitter @SPVSVPMA_Events or call 01453 872731.

Practice Life z September/October 2014 z www.practicelife.biz

CPD DIARY

Dr Max Pemberton, broadcaster, author and psychiatrist heads up our stream on Mental Health and Michael Pagnotta, Celtic Manor’s head of Learning and Development will share his experience of training staff to deliver 5 star service. Back by popular demand will be Brian Faulkner, Alan Robinson, Nick Steele and Alison Lambert – all delivering new material and new insights into age-old problems. The seminars will be full of case studies and many will include vets and nurses in practice sharing their experiences. The Equine Management Stream will be repeated with talks tailored specifically to equine business issues, including Chris Pearce on winning back your dental work and Steve Headon from Moore Scarrott on Equine Benchmarking. Our guest speaker from the US, Ian McKelvie, heads up our Leadership Programme. Ian is an internationally recognised leadership expert who advises companies across the globe, including Microsoft and the Gates Foundation, on individual and organisational culture, behaviour and strategy. Also from the US, Veterinary Business Consultant, Bashore Halow will share his thinking on Connecting with your Clients. And to kick it all off in the Opening Ceremony, we have BBC presenter, explorer and acclaimed speaker Monty Halls, an ex-Marine who worked with Nelson Mandela during the peace process in South Africa before setting up his own expedition company, leading trips to some of the world’s most inhospitable areas. Monty is passionate about leadership, team dynamics and the effects of stress and pressure on the human animal. The inimitable Bogus Brothers will return as the band for the banquet which this year, on the day before Burns’ Night, will have ‘a touch of Scottish’ about it. The Thursday night networking dinner promises once again to be a fast, furious and fun way to meet new people. All this in the sumptuous setting of the 5 star Celtic Manor Hotel.

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HEADING

WHAT’S COMING UP... SPONSORED BY TOP 10 ESSENTIALS TO KEEP YOU LEGAL AND COMPLIANT Wednesday 24th September, Hartsfield Manor, Surrey (10:00-16:30) Contributors: Samantha Deakin, Citation; John Ingram, LS Fire Group

GOOGLE MASTERCLASS Wednesday 8th October, Hartsfield Manor, Surrey (10:00-16:30) Contributor: Susie Samuel, vethelpdirect.com

FACEBOOK MASTERCLASS Wednesday 22nd October, Village Hotel Solihull (10:00-16:30) Contributor: Susie Samuel, vethelpdirect.com

SPONSORED BY FOCUS ON DIAGNOSTICS Thursday 16th October, Staverton Park (10:00-17:00) Workshop streams chaired by Brian Faulkner, VetPysch and Peter Southerden, Eastcott Referrals

EXTRA DATE DUE TO POPULAR DEMAND MOVING UP Wednesday 5th November, Village Hotel Leeds South (Capitol Blvd, Tingley, Leeds LS27 0TS) (10:00-16:30) Contributors: Claire Stewart, Zoetis, Fiona Sims, Zoetis Full details and online booking at www.spvs-vpma-events.co.uk

Snuggle in with our December/January issue (out Dec 5th...) Special features: Practice Healthplans Digital Marketing Integrating referral work into your first opinion practice Congress 2015 – your full guide

Practice Life z September/October 2014 z www.practicelife.biz

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