A GREAT deal of resource is
invested in the area of
concordance and compliance
within human medical spheres, as
non-adherence to a doctor’s
recommendations has a major
negative impact on individual and
public health.
However, it’s rare that, within the
animal health profession, we focus on
these areas, the success of which
wholly depends upon our
communication skills. This article
argues for a
greater focus
and looks at
what needs to
be done to
begin closing
the
“compliancy
gap”.
So what does “concordance and
compliance” actually mean?
Concordance is defined as an
agreement between a veterinary team
and their client in relation to
treatment. Essentially, it can be
summed up as shared decision
making.
Compliance is defined as a client’s
adherence to a recommended
treatment plan (although, of course,
it’s also important that practice staff
buy into and adhere to any such
treatment plan too). Unilaterally
altering what a client sees as an
agreed way forward, without further
consultation, can result in anything
from a slightly miffed individual to
somebody who makes a claim against
the practice.
Optimum levels of both
concordance and compliance lead to a
number of benefits: firstly, happier
clients with fewer complaints;
secondly, and most importantly,
healthier patients. This is because
clients are consciously agreeing with
our approach before wholeheartedly
committing to following through on a
recommended treatment regime.
There are greater levels of pet
supervision as a result.
The good news is that the practice
also benefits. Improved concordance
and compliance result in a greater
level of job satisfaction amongst staff,
which usually means happier,
motivated colleagues and a more
cohesive team. By virtue of the fact
that clients are happier too,
recommendations increase and the
practice can secure new clients whilst
reaping the financial rewards of
increased client visits and follow
through.
Total compliance can turn a good
practice into a very successful
business but in order to strive towards
this goal, practices need to go far
further than simply printing legible
prescription labels!
Practices need to ensure there is
effective and efficient communication
before, during and after treatment has
been agreed upon.
Measuring
In human medical fields, compliance
is frequently measured. On average,
compliance with human medicine is
between 15% and 50%. However,
adherence to recommendations in
lifestyle changes – such as dieting –
can be lower. It’s fair to say that
compliance tends to be higher with
more severe conditions, and lower in
perceived less important situations.
Unfortunately, very few veterinary
practices measure concordance and
compliance and, if they do, it is only
with very few services and products.
But if we don’t measure it, how can
we possibly manage it effectively?
Interestingly, where veterinary data
do exist, figures tend to mirror the
above at between 15% and 60%
which suggests there is a real
opportunity for practices to benefit
from a focus on compliance.
If, for example, a practice
turnover per vet was £240,000 (with
each vet having 1,436 active patients)
and if the average pet was (bear with
me!) a cross between a 30kg dog and
a 4kg cat, what would the turnover
per vet be if all patients were
vaccinated, received regular worm and
flea treatment and were fed on a
premium dry food purchased from
the practice?
The answer is a staggering
£750,000, with a gross profit of
approximately £356,500. This is merely attending to the pets’ basic
needs; it doesn’t take into account the
treatment of any ill patients or any
out-of-hours or emergency work. Of
course it is not possible to achieve
what has been suggested, but it does
demonstrate that there is so much
more we can be doing for our
patients than we currently are, if we
alter our approach in the practice.
Setting SMARTER objectives can
be a useful first step in achieving the
business success described above. For
example, if your practice wants to fill
more appointment slots during the
day, the objective could be: to
research the reasons behind low
conversion of enquiries into
“appointments made” and then agree
proposals for action to be taken that
will lead to an 80% uptake by an
agreed date.
If you have an 86% response to
vaccine reminder letters, your
compliance rate, more or less, is 86%.
Great! However, how would you
interpret data from your practice
management system reporting that in
the last 12 months 16% of canine
patients received dental treatment? Is
this a good result and/or a healthy
measure of
compliance?
In terms of
success, it could either
be an excellent result
if, for example, no dog
owners received any
recommendations to
have their pets’ mouths
attended to; or it could
be a terrible result if
all dog owners who
came through the
consulting room door
received advice regarding the state of
their pet’s mouth. In any case, it is not
a measure of compliance.
Could you be SMARTER in
managing and measuring your
dentals? For example, perhaps you
could agree categories of tooth and
gum disease and create codes for each
category. From this, you could then
agree a course of action for each
category and examine every patient’s
mouth over a given period (such as
Pet Smile Month) and better manage
the results.
Closing the compliancy gap
So what are the main factors which
can help your practice to reduce its
compliancy gap? Firstly, strong
practice management. A practice
needs a business plan in place with
efficient processes to measure and
track compliance – ideally
benchmarking against previous years/quarters.
Processes also need to be rigorous – with clear standard operating
procedures that all team members buy
into. These processes will ensure
individuals are well versed in
encouraging repeat visits and
implementing efficient reminder
systems.
A vet’s behaviour also impacts on
compliance. Careful consideration
needs to be given to the choices
presented to clients during a consult
and appropriate levels of information
should always be provided to ensure
understanding.
Summarising what is said during
the consultation can also be helpful in
boosting client understanding, whilst
providing clients with a “safety net”
will encourage all clients to repeat
visit, irrespective of their initial level
of co-operation.
Trust is everything. Clients need
to believe that your aim is to get their
pet as well as possible, as quickly as
possible, as easily as possible and as
cheaply as possible.
It is a common misconception
that financial concerns are the main factor for poor uptake
of veterinary services
and products.
Indeed, in a recent
study, only 7%
declined dental
treatment on cost
factors, only 4%
stopped diet treatment
due to cost and only
5% abandoned senior
pet screening due to
financial constraints.
Clients frequently
have a very strong pet
bond and owners essentially want the best possible care
for their animals but they need to be
involved in that initial decision
making process and communicated
with regularly to be sure of
compliance.
