Investigation of the effects of a practice-level communication training program on veterinary health-care team members' communication confidence, client satisfaction, and practice financial metrics

A Need for Targeted Teaching of Shared Decision-Making as Identified from an Assessment of Client-Centered Communication Skills Training with Companion Animal Veterinarians

Shared decision-making has been increasingly discussed as a communication practice within veterinary medicine, and it is gaining more traction for diagnostic and treatment planning conversations and specifically offering a spectrum of care. This teaching tip describes the data from an investigation of veterinarians' shared decision-making in a pre-test/post-test communication skills training intervention that used a client-centered, skills-based communication approach. Practice teams from a purposive sample of four companion animal veterinary clinics in Texas participated in a 15-month communication skills intervention, including interactive group workshops and one-on-one communication coaching. To assess the outcome of the intervention, for nine participating veterinarians, appointments recorded pre- (n = 85) and post-intervention (n =  85) were analyzed using the Observer OPTION 5 instrument to assess shared decision-making. The intervention effect was evaluated using mixed logistic regression, adjusting for appointment type. The communication intervention did not significantly impact participating veterinarians' demonstration of shared decision-making (pre = 25.42, n = 55; post = 28.03, n = 56; p = 0.36). Appointment type was significantly associated with veterinarians' OPTION 5 scores (p = .0004) and health problem appointments (OPTION 5 = 30.07) demonstrated greater shared decision-making than preventive care appointments (OPTION 5 = 22.81). Findings suggest that client-centered, skills-based training traditionally used in veterinary curricula and continuing education may not foster the use of shared decision-making, which is a higher-order communication approach that may require a dedicated process-oriented training. This teaching tip highlights the need for a targeted stepwise approach to teach shared decision-making.

Discussion of cost continues to be uncommon in companion animal veterinary practice

OBJECTIVE

To determine the prevalence and nature of cost conversations occurring during veterinarian-client-patient interactions within companion animal practice.

SAMPLES

60 randomly selected, practicing veterinarians working in 55 practices across southern Ontario, Canada, and 909 of their clients, sampled by convenience.

PROCEDURES

A cross-sectional descriptive study including 917 video-recorded appointments. Associations between veterinarian, client, or appointment-level factors and occurrence of a cost conversation were evaluated using multi-level logistic regression.

RESULTS

215 of 917 (23.4%) videos included a discussion of cost between the veterinarian and client. Cost conversations involving veterinarians primarily focused on conveying the price in relation to the time or service being offered (74.0% [159/215]), whereas the benefit to the future health and wellness of the patient was conveyed in 14.4% (31/215) of veterinarians' cost conversations. Costs were most frequently discussed by veterinarians in relation to diagnostic testing (44.2% [96/215]). The odds of a cost discussion occurring were greater during problem appointments versus wellness (P = .011) or recheck (P = .029) appointments, for feline versus canine patients (P = .037), as appointment duration increased (P < .001), and as a client's number of visits in the past year decreased (P = .049).

CLINICAL RELEVANCE

Discussing cost of care in veterinary practice continues to be relatively uncommon. Opportunities exist for veterinary professionals to frame their communication of the cost of veterinary care in relation to the benefits offered to the future health and wellbeing of the veterinary patient.

On-site communication skills education increases appointment-specific client satisfaction in four companion animal practices in Texas

Objective

To assess the impact of a 15-month, in-practice communication skills intervention on client visit satisfaction.

Sample

4 purposely selected veterinary clinics, 9 veterinarians, and 930 appointment-specific client satisfaction surveys.

Procedures

The study was designed as a multipractice, preintervention-postintervention study. Practice teams participated in a 15-month communication skills intervention that included interactive group workshops and one-on-one communication coaching with the entire practice. Client Satisfaction Questionnaires were completed 3 months before (mean, 55 questionnaires/veterinarian) and after (mean, 48 questionnaires/veterinarian) the intervention. The impact of the intervention and factors associated with client visit satisfaction were evaluated with mixed logistic regression.

Results

Client satisfaction scores were dichotomized owing to extreme negative skewness. In total, 57% (284/496) of clients were completely satisfied on pretest questionnaires, and 67% (290/434) were completely satisfied on postintervention questionnaires. The odds of clients being completely satisfied were significantly higher after the communication skills intervention (OR = 1.56; P = .002). When controlling for the intervention, predictors of client visit satisfaction included appointment type (odds of being completely satisfied were significantly higher for recheck appointments than for preventative care appointments [OR = 1.71; P = .02] and health problem appointments [OR = 1.99; P = .003]) and duration of the veterinarian-client relationship (probability increased by 0.52 with each 1-year increase in relationship duration; P = .008).

Clinical Relevance

Results suggested that the client-centered, skills-based communication intervention resulted in increased client visit satisfaction. Findings contribute to current evidence that client-centered communication and duration of the veterinarian-client relationship promote client satisfaction during veterinary visits.

Evaluation of a novel communication and consultation skills model (WISE COACH) on dog owner perceptions of veterinarians and projected spending on veterinary care

OBJECTIVE

To assess the impact of a novel communication and consultation skills model (WISE COACH [WC]) on dog owner perceptions of veterinarians and projected spending on veterinary care.

SAMPLE

1,200 US dog owners who had visited a veterinarian within the prior 18 months.

PROCEDURES

Video recordings of 2 staged client consultations were made, with the veterinarian following the WC recommendations in one video and not following them in the other (control). Participants were randomly assigned to view one of the videos and completed an online survey to assess their perceptions and projected spending. Qualitative responses were coded to identify themes.

RESULTS

The veterinarian was rated significantly higher in the WC video than in the control video for the characteristics first impression, skilled and knowledgeable, cares about me, cares about my pet, and communicates clearly, and was rated significantly lower for the characteristic rushed or abrupt. Participants who viewed the WC video were significantly more likely to follow the veterinarian's recommendations, return to see the veterinarian, and recommend the veterinarian. They were also approximately 1.4 times as likely to approve the full recommended treatment plan, and their projected total spending was approximately 15% higher than projected spending for participants who viewed the control video.

CLINICAL RELEVANCE

Results showed improved client perceptions, client retention, quality of patient care, and financial metrics when the veterinarian followed the WC recommendations. Further study is needed to determine whether this model may also improve veterinarian well-being by improving client relationships and decreasing resistance to recommendations.

Analysis of Turkish Veterinary Students' Self-perception of Communication Competencies Based on Gender Differences

Communication skills are teachable and learnable skills, which have a vital position among other clinical skills because a student's ability to communicate can increase empathy. The focus of this article is to determine how senior students evaluate themselves regarding communication competence and whether gender has an impact on their perception. The study included 128 volunteering students, using the Communication Competence Scale, consisting of 30 questions, as a data collection tool and the independent samples t-test for statistical evaluations. The evaluation of all participants showed that male participants had the highest score, and female participants had the lowest. However, there was no statistically significant difference between female and male participants' total scores (p = 0.605). There was a statistically significant difference between female and male students in terms of the social competency, empathy, and adaptability. Female scores for empathy were statistically higher than those of males. Male students scored themselves higher than females in terms of social competency and adaptability. In the context of the students' perceptions of their communication competence, it was determined that females assessed themselves to be more empathetic and males perceived themselves to be more social and adaptable. This research is significant as it is the first study of Turkish veterinary students' self-perception of communication competence. Communication training may become more robust in veterinary curricula in Turkey, and further research will be affected by this issue.

Türk Veteriner Fakültesi Öğrencilerinin İletişim Yeterlikleri Algısının Cinsiyet Farklılıklarına Göre Analizi

İletişim becerileri, bir öğrencinin iletişim kurma yeteneği ile empati becerisini arttırabilmesi nedeniyle diğer klinik beceriler arasında önemli bir yere sahip olan öğretilebilir ve öğrenilebilir becerilerdir. Bu çalışmanın amacı, veteriner fakültesi son sınıf öğrencilerinin iletişim konusunda kendilerini nasıl değerlendirdiklerini ve cinsiyetin bu algı üzerinde bir etkisi olup olmadığını belirlemektir. Çalışma 128 gönüllü öğrenci ile 30 sorudan oluşan İletişim Yeterlilik Ölçeği kullanılarak gerçekleştirilmiş, bağımsız örneklemlerde t-testi ile istatistiksel değerlendirme yapılmıştır. Yapılan değerlendirmeye göre, tüm katılımcılar arasında erkeklerin en yüksek puanı, kadınlar en düşük puanı aldığı görülmüştür. Ancak kadın ve erkeklerin toplam puanları arasında istatistiksel olarak anlamlı fark bulunamamıştır (p=0.605). Kadın ve erkekler arasında sosyal yeterlilik, empati yeterliği ve uyum yeterliği açısından anlamlı fark bulunmuştur. Kadınlar empati yeterliğinde, erkekler ise sosyal yeterlilik ve uyum yeterliğinde daha yüksek puan almıştır. İletişim yeterlikleri algısı bakımından kadınlar kendilerini daha empatik, erkekler ise daha sosyal ve uyumlu bulmuştur. Bu çalışma Türk veteriner fakültesi öğrencilerinin iletişim yeterlikleri konusunda öz algılarını yansıtan ilk çalışma olması bakımından önemlidir. İletişim becerileri eğitimi Türkiye’de veteriner fakülteleri müfredatında daha güçlü hale gelecek ve bu konu ileri araştırmaların yapılmasını teşvik edecektir.

Uncovering the 'messy details' of veterinary communication: An analysis of communication problems in cases of alleged professional negligence

BACKGROUND

Communication failure is reported as a cause of error in veterinary practice and has been associated with complaints and litigation. Evidence describing the types and nature of communication problems is lacking. This limits our ability to mitigate the risk poor communication poses.

METHODS

This study used a mixed methods approach to explore the frequency and types of communication problems present in settled cases of alleged veterinary professional negligence. Thematic analysis was conducted on written documents associated with 100 such cases involving canine patients. Interpretation was informed by human factors thinking and communication theory. Results were triangulated with findings from a focus group with the Veterinary Defence Society claims consultants and with healthcare literature on communication failures.

RESULTS

Communication problems played a contributory role in 80% of the cases examined. The analysis highlighted features of problematic communication in veterinary practice that are underrepresented in the current literature. These include the prominence of communication problems within veterinary teams, the impact of communication on the safety of care and also the interdependence of communication events with the context, system and environment in which they occur.

CONCLUSIONS

These results suggest that communication is a collective competency. Effective communication is something veterinary systems, rather than individuals alone, achieve. There is a need to consider the team and organisational contexts in which communication occurs to ensure individual communication skills can be translated into communication practices that support the delivery of high-quality, safe veterinary care for the benefits of clinicians, owners and patients.