Practice protocols


practice protocols

Practice protocols aren’t always clear or necessarily followed. They’re also often set without input from all staff members. But does it have to be this way? John Burfitt investigates

Try this as a quick exercise: go onto the Australian Veterinary Association (AVA) website and click through to the Policies page where you’ll find a Statement of principles.

To be sure, what’s presented is a superb resource: a wealth of information to advise on various in-clinic procedures to assist practitioners adopt best practise principles. But it’s also an enormous mass of professional guidelines to consume and interpret—and that’s before even the day-to-day protocols within each clinic are considered.

It’s little wonder, then, why some practitioners become overwhelmed by practice protocols and, most tellingly, are unclear who is responsible for ensuring adherence.

When discussing workplace protocols, several practitioners told of their frustrations that while some rules seem crystal clear, others were vague or even blatantly ignored.

Among the cited examples was the tale of the clinic receptionist who chewed gum loudly while dealing with clients, both in person and on the telephone. Then there was the practitioner who often pulled out his smartphone to take personal calls while in the middle of patient consultations. And yet, other staff members claimed they didn’t know what the practice rules were regarding such matters, or who was even ultimately responsible.

There was also the case of the new vet at a practice who, while being trained in clinical protocols, was told repeatedly, ‘this is what it says to do in our guidelines, but just ignore it as everyone here does things their own way’.

A lackadaisical approach to aspects of protocols is simply not good enough, says Dr Peter Higgins, Honorary Associate of the University of Sydney’s School of Veterinary Science.

“What some people in the profession need to be reminded of is this is 2017, and not 1997—things are very different in regards to following all the rules than they were 20 years ago. The fact is, we now have more legal constraints, more insurance constraints and more government rulings from both state and federal bodies to work with.”

“Any veterinarian who doesn’t stick to the clear protocols—either in the way they treat a patient or even how they behave within a clinic—could be endangering their livelihood,” Dr Higgins adds.

“What some people in the profession need to be reminded of is this is 2017, and not 1997—things are very different in regards to following all the rules than they were 20 years ago.”—Dr Peter Higgins, University of Sydney

Protocols adherence can have significant impact on performance within a practice, reveals veterinary coach and professional mentor, Dr Diederik Gelderman.

“Most vet practices I know are small businesses with one or two people running them, and as long as those people are in charge, it’s good,” he explains. “But when they grow larger and there’s not enough of the core people in control, that’s when I’ve seen the whole thing fall into a hole.

“I believe most vet practices aren’t well systemised when it comes to protocols. There are too many practices in which each vet operates very differently. When the bosses want protocols in place, they often ask me who should police it. This is when I reply, ‘Get real—this is a business.’ So few people want to be that person in charge, and yet what’s needed with implementing good protocols is leadership.”

Effective implementation and adherence to protocols often comes down to the team understanding why the protocols are there in the first place, and what the desired outcome is of following such a routine. To achieve this, consistent training, checks on understanding and reviews need to be undertaken by designated team members.

“It’s important that clinic staff have a consistent shared understanding of the clinic’s protocols,” Dr Paula Parker, president of the AVA, says. “In a crisis, staff don’t have time to think about protocols—they need to know them well enough that they can follow protocols without having to refer to them.”

Dr Parker adds that reviewing the way protocols apply should become a regular process where the entire team is involved.

“Everyone should be encouraged to challenge protocols through discussion if they don’t feel it adheres to best practice, isn’t consistent with the values of the clinic or doesn’t support the practice,” she says.

“Regular discussion with staff on current protocols is important. This can be through a conversation regarding a challenging clinical case to facilitate a discussion around how the protocols support the practice.”

Involving all members of the team in the process of creating and evaluating protocols, can become one of the most effective strategies of adherence.

“Too many vet practice owners do too much telling, when they’ve got a great team of people working for them on the frontline,” Dr Gelderman adds. “Let them come up with what protocols they think need to be implemented, and that way you’ve got 10 times the brain power working on that problem and coming up with ideas that will probably work well.”

“Everyone should be encouraged to challenge protocols through discussion if they don’t feel it adheres to best practice, isn’t consistent with the values of the clinic or doesn’t support the practice.”—Dr Paula Parker, president, AVA

It’s a point Janet Murray, board member of the Veterinary Nurses Council of Australia, agrees with wholeheartedly.

“Let the staff be part of the development phase, and don’t make it a ‘rulebook’, because as the saying goes, ‘sometimes rules are meant to be broken’,” Murray says.

“Protocols are there to keep staff safe, guide them through specific procedures and if staff are really involved in the production of them, it allows for ownership and therefore compliance.”

Allowing the team to take an active role might be an essential step in initiating protocols that are not only best practice, but most importantly achievable, says Dr Matthew Muir of All Natural Vet Care in Sydney.

“Before deciding on a range of well-intentioned ideas, check with the team that these protocols are necessary and achievable,” Dr Muir says.

“The practice protocols need to become an evolving working document that changes with time, and when a new staff member is coming on board, that’s a great opportunity to take a hard look at your existing protocols and see if they need updating.

“But if you do, just be sure to have a meeting or a training session where everyone is informed of any changes. It’s no good having updated great protocols that no one but the practice manager knows about.”

Once good protocols are in place, conducting a regular audit of how they are working out for the team as well as clients must become part of the process, advises Dr Peter Higgins.

“This is not one big audit done every year, it’s a regular audit throughout the year by a person in authority to check they’re being followed, and how they’re working,” he says.

“It might be a case of checking that case notes are being regularly completed and on time, the drug registry book is in order, and the various licences of the team are up to date. From time to time, check in on the details so it doesn’t become one major task, but a necessary one that is being taken care of throughout the year.”


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