The Winston Canadian Dictionary defines anarchy as "the absence or lack of government". I have seen it in Veterinary practices. It is all too commonplace. Lack of or abdication of leadership is prevalent in the corporate world. Recognition of this fact has prompted leading institutions like the university of Guelph to offer a Master Degree in Leadership Studies, one of the first in North America.
Lack of leadership, or anarchy has many ramifications including confused or dissatisfied employees. Some employees just "wing it", others will under perform, while others yet give poor customer service. Employee turnover is high, a very costly scenario. Customer satisfaction is low as is employee morale. The negative effect on employees and customers can be potentially disastrous.
"Medical Anarchy" on the other hand is more insidious but every bit as costly to your bottom line. Failure of hospital owners to provide clear medical protocols and programs leads to a myriad of consequences. Different doctors will offer different treatments for the same condition. There is a risk that a client with several pets or frequently seen pets will have different treatments offered at different times for the same condition leading to a lack of confidence in the hospital personnel. This will also confuse the staff. They do not know what to expect nor can they educate clients about what the client might expect to happen when their pet arrives at the hospital.
Medical Anarchy rears its ugly head most insidiously when it comes to wellness programs. Lack of consistency in recommendations for parasite prevention, blood testing, dentistry and nutrition will cause compliance to plummet. Once again staff will be confused because they cannot be confident which treatment or product will be recommended. They cannot educate clients in the exam rooms during preliminary examinations prior to the doctor's complete physical exam nor can they speak with confidence at the desk when asked by the client their opinion.
Practices that have a nutritional protocol, that is, a specific first recommendation for a given brand of food, will be more successful in their program than the hospital that makes multiple suggestions. The clients are looking for a strong recommendation from their doctor and are more than willing to embrace that recommendation when it is given with confidence. It is much easier to train staff well when they are primarily responsible for one product line. Of course there should be a secondary line to backup the first recommendation for reasons of palatability or patient tolerance. When there is a clear nutritional protocol in a practice, with a well-trained staff, the hospital will sell more food. This results in more patient visits per year, more opportunities to interact with and educate clients, higher compliance and healthier pets.
Likewise practices should have a parasite control protocol. All the doctors should be giving all the clients consistent recommendation. The same logic applies to wellness-testing. When there are clear guidelines in place that are regularly trained upon, the practice will be a more organized, harmonious workplace. But WHO determines the protocols?
Veterinarians are well-educated, passionate and sometimes highly-opinionated individuals. When it comes to the health of the practice and the well-being of the patients there must be a setting aside of egos. I recommend all practices have an organizational chart clearly stating who plays the various roles within the organization. Someone must take the role of Chief Medical/Veterinary Officer. This person will be entrusted to develop protocols. They will study the best scientific information available. Solicitation of input from workplace colleagues who can help with research, may be helpful.
In an organization with a Mission and Core Values this will be easier. Common Core Values are... Respect, Trust, Medical Excellence, Exemplary Customer Service and so on. In these organizations once the Chief has developed protocols based on the excellent science, common sense and with an eye to the provision of excellent customer service, adoption of the protocols should be easy. The Chief will trust his/her colleagues to adopt the protocols as will the colleagues trust the protocols were developed with the patient's best interest in mind. The colleagues will respect the protocol and the effort to develop it while the Chief would have respected the opinions of his colleagues when developing them. Everyone will recognize the benefit of a consistent protocol to both the pets because they will receive consistent care and to the practice as compliance improves. It will be easy to train the staff on a clearly stated protocol and this will also improve the delivery of service to the client.
Is Medical Anarchy eating away at your practice's bottom line? Clear written protocols developed by a Chief Medical Officer, embraced by all staff and regularly trained on in an atmosphere of trust and respect is a sure way to "slay the dragon".
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