Most of us are happy to use trial data and statistical analysis to assist us in evaluating pharmaceuticals or procedures. But how often do we apply numerical analysis to monitor and evaluate the behaviours shown by our clients? All too often we rely on gut feel or the belief that we “just know” what clients want in terms of services and products.
In other fields, marketers look at trends in behaviour to predict future demand. Can we, or should we, look at clients in a more analytical way? Does doing so imply that we value profit over people, or is there some way to marry such an approach with a focus on improving animal welfare?
What do we know about the market?
Recent figures indicate that 43% of the British population own at least one pet, with dogs being the most popular(1). PFMA (Pet Food Manufacturers Association) figures for 2008 suggest that the cat and dog populations are currently neck and neck at 7.2 million and 7.3 million respectively. An estimated 75% of dogs in the UK are pedigree breeds.
The dog food market takes by far the largest share of the pet food market, which you would expect purely as a result of the size differences between the species but value sales of cat food increased by 3% in 2007. The growth in the cat food market has partly been driven by the purchase of more premium products such as single serve pouches and treats.
What do we really know about our clients?
The AVMA’s (American Veterinary Medical Association) 2007 US Pet Ownership and Demographics Source Book highlights some rather interesting trends(2). Drawing on a 2006 survey of 50,000 pet owners it was identified that while just under 50% of owners saw their pets as members of the family, a further 48.2% saw them as companions and 2.1% considered their pets to be property.
The pet owner’s perspective on the human companion animal bond proved to be rather telling when it came to predicting their attitudes to veterinary care. Those households that saw their pet as “family” averaged three visits per year to their veterinary practices, compared to 2.2 visits per year for those that considered their pets to be companions and just 1.1 visits were made by those who thought their pets were property.
Not surprisingly, those who made the most visits tended to spend the most but what is surprising is that spending on cats has hardly changed in a decade and only 63.7% of cat-owning households had at least one veterinary visit in 2006. This may be because of changes in vaccination protocols, with many practices adopting a three year re-vaccination programme, but it does suggest that practices have not been successful in replacing the booster vaccination appointment with an annual health check.
The cat issue aside, the number of visits to the vets each year made by both cat and dog owners declined in 2006, although analysts felt that spending on veterinary care had increased significantly overall because some dog owners were choosing to pay for more major services and procedures.
Where does this leave the profession?
What does all this mean for the average UK practice? Should we run out and up the ante with diplomas and gadgets? You might be relieved to hear that this might not be necessary. One clear finding was that the AVMA research did not find a correlation between household income and price sensitivity to veterinary fees. The bond between pet and owner was the best predictor of spending at the practice.
That sounds blindingly obvious. People who love their pets want the best for them and they don’t mind paying to keep them in tip-top health. Take that thought to the next level and that means that the next time we presume that the client will not want to pay for a particular preventive health procedure, we are making assumptions about the depth of feeling they have for their pet.
The alternative argument is that we are somehow protecting clients from making a decision about something that they cannot afford and shielding them from guilt. This paternalistic approach is out of step with modern society and, as the research shows, based on an inaccurate premise anyway. Every client has the right to be offered the best care the practice can offer his or her pet. For most pets, that care is more likely to come from diligently carrying out routine procedures at optimal intervals, than specialist services.
But like all large surveys, publication of the findings often lags behind what is happening in the here and now. As we all know the current economic environment is challenging, to say the least. Some of us may remember practising in the early 90s against a background of much higher interest rates and high unemployment.
What is so different today is that the current credit crunch emerged relatively quickly and people did not have the time or opportunity to make big adaptations – buying a smaller car, a smaller house, reducing borrowing – to the way they live their lives. This puts day to day spending under more pressure.
Recent consumer and shopper behaviour data suggests that in the last six months consumer spending habits in the UK and the US have changed faster and deeper than they ever have before. Animal charities in the UK are also reporting record levels of people relinquishing their pets.
Does this mean we should consider the AVMA findings irrelevant at this moment in time? What we perhaps should remember is the core message: most people want the best for their pet and will go without luxuries to get it. Those relinquishing their pet could well come from the “pet as property” demographic, who view their pet as an expensive status symbol, easily disposed of when times are lean. While our spending habits might be changing, it is important to remember that our core beliefs and attitudes change very slowly, so the AVMA research still offers important insights.
So, if we believe that most people care about their pets and will pay for necessary treatment, what’s the issue? We are pretty much informing and educating clients and they are pretty much following our recommendations.
Correct? The American Animal Hospitals Association carried out a survey, which was funded by Hill’s, looking at compliance(3). In nearly every case the vets rated compliance – in terms of both the giving of a recommendation and the client acceptance of the recommendation – highly. The study showed a very different picture. Of those dogs and cats with six diet-responsive conditions – kidney disease, bladder stones or crystals, food allergy, chronic GI disease and acute GI disease and obesity – just 19% of dog owners and 18% of cat owners fed the diets long term.
With dental disease the picture was no better: those cats and dogs with dental disease rated grade 1 had treatment in just 15% of cases and just 35% that had grade 2 disease received treatment. These were all animals that had visited a practice and therefore received a diagnosis. With a significant number of pet owners failing to visit their vets at all within that year, there is obviously a huge gap in what treatment animals are having and what they actually need.
There are many factors at work here. The survey found that sometimes the vet failed to make a recommendation – perhaps for worries or assumptions about affordability but in many cases because they feared rejection or a negative response from the client.
The medical profession has faced similar issues and found that developing a set of clear guidelines increased the doctor’s confidence in making recommendations. An effective protocol that has been developed in consultation with the whole practice team not only has better buy-in but also resolves that conflict between doing something because it is good for the animal or purely perceived to be good for the practice.
In response to all of the findings of the AAHA survey, a formula was developed to help vets improve compliance: C = R + A + FT (compliance = recommendation + acceptance + follow through)
The approach of choice
The key to improving compliance is embracing the need for active intervention – to accept that measuring compliance is not a bad thing, that it is acceptable to set practice targets for client compliance and that doing so is in our patients’ best interests.
One of the problems many practices feel they face is increasing complexity and choice, making it difficult to develop protocols that everyone agrees with or making them unwieldy because of the numerous provisos that get built in. But choice is never all bad: without choice our jobs could be performed by machines and it is important that there is scope for the individual to exercise choice in order to minimise stress.
One of the ways that manufacturers can reduce complexity and simplify choice is by producing multifunctional products. Hill’s Prescription Diet Feline c/d Multicare is one good example as the same product can be used to treat all common feline lower urinary tract diseases (with the exception of dissolution of struvite calculi; or when ammonium urate, cystine, xanthine or silica, or the rare brushite form of calcium phosphate are identified in an analysed stone), including interstitial/idiopathic cystitis, struvite and oxalate prevention and urethral plugs.
Embracing these types of products can make it easier for the healthcare team to play an active role in compliance through making a clear recommendation.
Of course, compliance is just one strand of the equation. There is obviously still a need to educate and raise awareness in the pet-owning population that pets need regular health checks and to reduce the barriers to coming forward for treatment. What is clear, even in these credit crunching times, is that cost may not be as big a barrier as we think it is.
1. Pet Food Manufacturer’s Association figures
2. American Veterinary Medical Association 2007 US Pet Ownership and Demographics Source Book
3. The Path to High Quality Care – Practical Tips for Improving Compliance, American Animal Hospital Association, 2003.