VNA Level III Module 6: Learning Objectives Learning Objectives After completing this module, your basic understanding should include: Knowing how critical effective teamwork is to patient care and practice productivity. Understanding the need for continuous improvement, even when things are going well. Having a proven process to utilize such as The Improvement Engine. Appreciating how your involvement in VNA can enhance your practice s ability to make teamwork work! Your progress is saved. Slide 1 of 21
Introduction Introduction Throughout VNA, we have utilized the phrase veterinary health care team, (As defined in Level I, Module 8: People with complementary skills, who are committed to a common purpose, performance goals and approach for which they hold themselves mutually responsible), instead of the word staff, (A body of assistants to an executive). While veterinary health care team and staff are commonly used interchangeably in conversation with the semantics not often scrutinized, the relevance of team cannot be overstated. T.E.A.M. = Together Everybody Accomplishes More. A competent and confident veterinary health care team, (VHCT) is an extremely critical element of consistent, continual proper pet care and practice productivity. In VNA we ve looked into such topics as; Basic Nutrition, The Bond, Marketing and Compliance, and provided exciting insights into wellness and therapeutic nutrition with Hill s pet food products, all with the team s overarching concern of being advocates for the pet s best interest. All of this information and education has been intertwined with the importance of communication, (connecting) with clients, (dependents). The remaining Modules of VNA, starting with this one on will focus on the other two elements of team effectiveness; application and appreciation. Effective communication by the entire veterinary health care team can lead to substantial enhancement of proper pet care and practice productivity, (compliance). Your progress is saved. Slide 2 of 21
Introduction Introduction Figure 1. Communication is the connector between information/education, (acquiring knowledge) and the benefits of being involved in veterinary medicine; application/appreciation. In accentuating the importance of overall compliance, communication should result in a higher level of application, (productivity) where the team is allowed to expand its collaborative creativity-the essence of teamwork. With this concept in mind, let s explore some exciting insights into how to actually make teamwork work! = Collaborative creativity. Your progress is saved. Slide 3 of 21
Obligations Obligations For a team to be able to deliver continuous improvements long term, there should ideally be a healthy practice culture, built upon a solid foundation of values, beliefs, purpose, respect, all contributing to a positive atmosphere. This type of environment is often cultivated through nurturing leadership that proactively embraces change, (improvement) enabling the practice s continued success. Likewise, key to this process is each VHCT member s realization of his or her personal obligation to productivity while being an advocate for the pet s best interest. The leadership in the practice should be helping all team members grow and at the same time, team members need to feel comfortable in identifying and addressing their own areas of improvement. Remember the old adage, A chain is only as strong as its weakest link. Each individual on the team must help herself or himself, and each team member needs to be supportive of all other members. Each team member has an obligation to practice productivity while being an advocate for the pet s best interest. Figure 2. As a member of the veterinary health care team, everyone has an obligation to continually enhance skills, talents and abilities, in order to deliver consistently superior pet and pet owner care. If not, breakdowns in the process will occur. Your progress is saved. Slide 4 of 21
Continuous Improvement Continuous Improvement As new research, technologies, breakthroughs and advances continue to enhance our ability to provide better pet care, a team s ability to do teamwork is still at the foundation. This involves continually reviewing our delivery of products and services, and challenging ourselves to improve, that is; as our knowledge grows regarding ways to improve pet and pet owner care, so should our willingness to provide them. Your progress is saved. Slide 5 of 21
Continuous Improvement Continuous Improvement As Figure 3 shows, almost any concept over a period of time can become stagnant, and as a result, lose its relevance for providing the best that the team is capable of. A team needs to be vigilant about what works well and what doesn t, and find ways to enhance effectiveness. In the A phase, the existing team is Accepting of the concept, and trying to make it work. In phase B, (Beneficial phase), the team is leveraging the concept and is providing what it feels to be the best. Phase C, can be considered the Crisis phase, a place you want to try and avoid! In this phase, decisions are usually made too hastily, and even then, it might be too late to make the concept work well. Keep the good, ( B ) and discard the rest, ( C ) while at the same time, the team should challenge itself to be creative in making the good, better, and the better, best, at least for a period of time. Then the continuous improvement cycle advances the concept to the next level, for the benefit of all involved. Figure 3. Concepts used to have much longer lifespans, that is they may not have needed any type of improvement for extended periods of time in order to keep their relevance. In phase A, an idea gets off the ground. In B, it is useful and productive. In phase C the concept loses its relevance as is, but may still remain viable if improved upon while still in phase B. Your progress is saved. Slide 6 of 21
Continuous Improvement Continuous Improvement Figure 4 shows this process of improvement as a series of stairsteps, where the team looks for ways to improve (in B, even though things are going well!) before the concept becomes dated and loses its value. It may seem strange to try and improve on something when it is currently working well, but waiting too long and falling into the C phase can been very disheartening and disruptive to the team s ability to deliver the best care, (products and services) possible. Figure 4. In today s fast paced environment, concepts need to be continually refined, refreshed and reinvigorated in order to maximize their productivity potential. It is important not to wait until phase C before considering improvements, but rather, begin looking at renewal while things are still going well in the B phase. This is the proactive process of continuous improvement. Your progress is saved. Slide 7 of 21
Continuous Improvement Continuous Improvement Figure 5 shows the area between the end of B and the beginning of C and where the ideas of refinement can come into play. This is where Old meets New and it can be a source of turmoil and frustration if team members don t appreciate why it is necessary to address. This area can be thought of as the tumultuous area of change, but the exciting part is that the team is actually creating this change, crafting enhancements in a process called The Improvement Engine. Figure 5. This Improvement Engine is where old meets new and the concept is refined, renewed and revitalized to deliver even better pet and pet owner care. Your progress is saved. Slide 8 of 21
The Improvement Engine The Improvement Engine Engines make things work. Extrapolating this concept further, a great way to help make a team work is by taking care of the engine itself, providing the appropriate fuel and lubrication so the parts can function at their potential. Figure 6 is a template of The Improvement Engine, where the ovals can be thought of as fuel/lubrication, (ideas) put into the engine, and the rectangles can be thought of as the engine parts, (the VHCT s utilization of the ideas). Let s see how this seemingly abstract concept can help deliver continuous improvement. Figure 6. The Improvement Engine. Ovals can be thought of as fuel/lubrication, (ideas) and the rectangles viewed as the engine parts, (the veterinary health care team acting on the ideas). Your progress is saved. Slide 9 of 21
The Improvement Engine The Improvement Engine Figure 7 provides the key elements of an Improvement Engine. We ll discuss each, then looks at some examples. Improving, Assessing, Planning and Maximizing are the ideas related to the fuel and lubrication of The Engine. Awareness, Opportunity, Commitment and Productivity are the parts of The Engine that the veterinary health care team acts upon to make The Engine run smoothly; efficiently and effectively. Figure 7. Components of the Improvement Engine. Your progress is saved. Slide 10 of 21
The Improvement Engine The Improvement Engine Improving In order for The Improvement Engine to be of any benefit in the first place, there needs to be the realization that Improving should be a constant goal. This means, all VHCT members should be looking for ways to improve. Looking at other businesses we frequent, how they provide customer service, (or not!) the ability to grow personally and within the practice, things we pick up from reading or other mediums can all influence thoughts on what can be improved upon. Thoughts on Improving feed into Awareness. Awareness Thinking and talking about improving allows for all team members to constantly be aware that change (improvement), to enhance the team s ability to provide exceptional products and services is a very important and positive part of being in a service business. Assessing Assessing how things are done at your practice and why, will help the team look at how procedures might be improved. As discussed previously, it is appropriate to look at these things while they are currently working well. In fact, that IS the best time to be assessing things! Having an Awareness that Improvement is important and Assessing things within the practice leads to Opportunities. Your progress is saved. Slide 11 of 21
The Improvement Engine The Improvement Engine Opportunity There are always opportunities to improve but oftentimes teams get bogged down in the day-to-day, hustle-bustle activities of a veterinary practice. Having an Awareness and then conducting an Assessment of what can be improved lends itself nicely to realizing the Opportunities for the team to act upon. This takes discipline, otherwise the hectic pace of practice consumes the team s creativity. The need to anticipate the future is a key element of continuous improvement. Planning Having Assessed the Opportunities, the team needs to decide what makes the most sense to improve, and at the same time how to accomplish it. This is where planning comes in, and will be covered in detail in VNA Level III, Module 9: Goal Planning. An improvement process should not be carried out in a rushed, haphazard fashion. Once the Assessment of Opportunities and Planning the improvements have taken place, there needs to be buy in - a Commitment from all team members to try and achieve the improvements. Commitment In order for the Plan to work as efficiently and effectively as possible, every team member should be allowed to voice and clarify concerns, seek resolution and/or revisions, gain agreement, and then Commit to the Plan. Proclaiming your commitment to an endeavor helps signal to all the other team members as well as to yourself that this truly is a team approach. This is an extremely critical element in making teamwork WORK! Your progress is saved. Slide 12 of 21
The Improvement Engine The Improvement Engine Maximizing The Plan is in place and all the team members have Committed their skills, talents and abilities to make the Plan work. There should be a clear understanding that everyone should not just hope the Plan works to a degree, but that the team will work together to Maximize the Plan, that is, to at least reach the established objectives. Committing to a Plan and collectively collaborating on Maximizing the Plan s effectiveness leads to the very essence of : PRODUCTIVITY. Productivity Recall from Figure 1, all of our information and education on a concept needs to be communicated appropriately in order to arrive at application; being allowed to do the things we are confident and competent in. Application = Productivity! In focusing on the pet s best interest, Productivity is a very important part of making a practice a vibrant, vital part of the community. Productivity, combined with thoughts on Improvement, feed into Awareness, and the Improvement Engine enhancement process cycles through once again. Your progress is saved. Slide 13 of 21
Cranking up the Improvement Engine Cranking up the Improvement Engine Now let s utilize the Improvement Engine in a few examples: Figure 8 shows the flow for addressing proper pet nutrition for puppies and kittens. Figure 8. Example of The Improvement Engine focusing on proper pet nutrition for puppies and kittens Your progress is saved. Slide 14 of 21
Cranking up the Improvement Engine Cranking up the Improvement Engine Improving: There is a realization at this practice that there should be a higher standard of care, based on observations of other service businesses in the neighborhood from various team members. Awareness: Overall care, for the pets, pet owners and the veterinary health care team can always be improved. Assessing: Wellness care of pets was the area explored. Opportunity: Pediatric Care, (puppies and kittens) was identified as the area the team felt needed improving at that time, based on the number of new pets they were seeing and the importance of starting these pets off right. Planning: Of all the things to consider in pediatric care, promoting proper pet nutrition became the team s area of focus. The American Animal Hospital Association s Standards of Accreditation states: Nutritional assessment and counseling are part of routine wellness care. (For more information, contact AAHA at 800-252-2242 or practice.accreditation@aahanet.org). The team s goal planner contained a SMART Objective, (something that can be quantified). SMART stands for: Specific, Measurable, Actionable, Realistic and Time-bound. For this situation, the SMART Objective is: For the next 8 weeks, start at least three puppies and three kittens per doctor per week on the appropriate Hill s Science Diet pet food product. Commitment: The team realizes that they have not been good stewards of puppy and kitten nutrition. This attainable goal that they ve committed to achieving will get them into a fluid process of being more cognizant about their role as advocates for the pet s best interest. Your progress is saved. Slide 15 of 21
Cranking up the Improvement Engine Cranking up the Improvement Engine Maximizing: This process will be monitored daily with a graph placed in the health care team lounge. Everyday, everyone on the team can see how they are performing against their committed-to objective, discuss successes, ways to improve Productivity: There is no doubt in the team s mind that promoting proper pet nutrition, (in this case the appropriate Hill s Science Diet pet food products for puppies and kittens) is part of Good Medicine. Through repeat visits for Hill s products as the pets mature, the practice will also benefit from the Good Business Hill s products convey on the financial productivity of the practice. Improving: As the team sees how their efforts during this process on pediatric nutrition elevates their ability to deliver better pet and pet owner care, this approach should become part of the practice s protocol. But, the process should be viewed as dynamic, meaning it can always be improved. Through collaborative teamwork for continuous improvement, The Engine can be fired up all over again! Your progress is saved. Slide 16 of 21
Cranking up the Improvement Engine Cranking up the Improvement Engine Let s look at another example, this one involving a disease entity. The Improvement Engine process can be applied to any product or service your practice offers! Figure 9. addresses the Improvement Engine in enhancing care for dogs with kidney problems. Your progress is saved. Slide 17 of 21
Cranking up the Improvement Engine Cranking up the Improvement Engine Improving: Members of the team seek ways to enhance care for dogs with kidney problems. Awareness: In VNA Level II, Module 5, therapeutic nutrition for kidney disease was discussed. Also, a clinical study, (published in JAVMA 2002; 220: 1163-1170) found that feeding Hill s Prescription Diet Canine k/d dry was beneficial in reducing clinical signs and improving survival time in dogs with mild to moderate spontaneous renal (kidney) failure, compared to feeding a typical adult dog food. Assessing: After reviewing their current treatment protocol at this practice, the team realized it was not doing a good job of addressing nutrition for dogs with kidney problems, and their utilization of Prescription Diet Canine k/d was no where near its potential. Opportunity: Based on the AAHA Compliance information, the above-mentioned article and their better understanding of communicating with clients about proper pet nutrition through VNA, the team saw great opportunity to improve their care for dogs with kidney problems. Your progress is saved. Slide 18 of 21
Cranking up the Improvement Engine Cranking up the Improvement Engine Planning: The team will conduct a computer search in their practice of all the dogs that have been diagnosed with and/or are being treated for some form of kidney disease within the past year. Their follow-up will include a review of the pet s nutrition, including if the dog was placed on Prescription Diet Canine k/d dry, AND as important, if the pet owner has continually been purchasing the product from the practice. Further discussions with pet owners will then take place regarding follow-ups, rechecks Note: This type of retrospective study fits in extremely well with any veterinary health care team s approach to enhancing compliance. Compliance must start with the team itself, that is, did they do their job to begin with, (the recommendation from the veterinarian regarding proper pet nutrition, and the reinforcement of the importance of the veterinarian s recommendation for the pet owner to make an informed decision)? Your progress is saved. Slide 19 of 21
Cranking up the Improvement Engine Cranking up the Improvement Engine As far as a proactive plan, the team has decided on promoting the importance of senior screenings: Complete physical exam, serum chemistry panel, complete blood count, blood pressure measurement and urinalysis, (including the E.R.D. - HealthScreen for microalbuminuria, www.heska.com/erdscreen). The team s SMART objective: For the next 8 weeks, at least three out of every four dogs the team determines could benefit from Prescription Diet Canine k/d will be started on the product. This will obviously involve great communication skills by team members, to help clients realize the benefits of appropriate nutrition for dogs with kidney problems. This is where being an advocate for the pet s best interest can be extremely rewarding! Commitment: Realizing their role in helping dog s with kidney problems, the entire team enthusiastically commits to at least achieving, and ideally exceeding their goal. Maximizing: In order to see their progress, a chart will compare the number of dogs diagnosed with kidney problems that are candidates for Prescription Diet Canine k/d and the number of dogs actually started on the product. Productivity: Starting any pet on an appropriate Hill s pet food product is very satisfying, but the true essence of being an advocate for the pet, ( compliance ) is the team s ability to keep pet owners enthusiastic and involved in the importance of proper pet nutrition. Once again, this approach is definitely Good Medicine AND Good Business! Your progress is saved. Slide 20 of 21
Summary / Are you ready? Summary Team: People with complementary skills, who are committed to a common purpose, performance goal and approach for which they hold themselves mutually responsible. In order for a group of people to actually be a team, there needs to be a process whereby all members can contribute. The example used in this VNA Module was The Improvement Engine. This is certainly not the only approach, and you are encouraged to explore others. Whatever process your team is most comfortable with though, always be sure to have the pet s best interests in mind. Identify areas to improve upon, plan, set goals, monitor progress and enjoy the team s collaborative creativity and productivity. In doing so you ll see teamwork work, AND have fun doing it! Are you ready? To continue, you will need to complete the quiz for this module. When you are ready, click on the forward arrow below to take you to the quiz. Your progress is saved. Slide 21 of 21
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