Reframing veterinary communication
Jess Gillon, Claims Adviser at the VDS, talks to VDS Training Consultant and PhD researcher at the University of Lincoln, Elly Russell, about her recent research on the ‘messy details’ of veterinary communication, and they discuss how veterinary professionals communicate with each other and their clients and how shifting mindset and approach to communication problems can help to reduce the risk of mistakes and improve patient safety. During their conversation, Elly and Jess explore the following:
What is the impact of poor communication?
It might seem like a simple question – something goes wrong, a mistake is made, a complaint is lodged or potentially a claim is filed. But the impact of poor communication can have a wider impacts, both short and long term, on the following: The VDS have known the important role that communication plays in cases of litigation and complaints for many years and this forms a key part of the way we develop support and resources for our members, including delivering communication training to veterinary professionals for over 20 years. This new research provides a solid evidence base of the amount and types of communication problems that we see and allows us to continue to explore improvements in communication in practice and develop new ways to support and develop veterinary teams.
To watch the full recording go to thevds.info/Veterinarycommunication
What did the study explore?
The research looked at 100 closed VDS cases of alleged professional negligence. Elly explains that, within the research, they wanted to look at not just how often communication played a problem but also the different types of communication problems. The study found that in 80% of cases, communication had some sort of contributory role to play in the complaint. Jess echoes these findings anecdotally from his day-to-day work with the VDS Claims team, noting that in many cases there isn’t often an identifiable clinical error and that patient care has in fact been adequate, but that a communication problem such as a lack of dialogue, differing expectations or an error in the communication causes misunderstanding, confusion and upset with the client. Both Elly and Jess recognise that, whilst the study, which focused on cases of alleged professional negligence, found that communication was a problem in 80% of cases, there are many more interactions that VDS members speak to the Society about on a daily basis that do not turn into formal claims, but rather are complaints that are dealt with at the practice level with support from the VDS.
“Many of [the situations we hear about on a daily basis] have communication as part or all of the issue and many of them are going to need really good communication to help deal with them and put that complaint to rest [avoiding escalation] into something more significant . . . Communication’s important in the genesis of the complaint or claim, but it’s also very important in managing the complaint and reaching a mutually agreeable conclusion with the client.” Jess
One of the keys ways our Claims team support members contacting us about a client complaint is to work through and discuss how they might respond to the complaint in the first instance, either verbally or in written form. Understandably, receiving a complaint from a client can be a stressful and worrying time, and our Claims team are on hand to help you structure your reply and plan your next steps.
What types of communication problems were seen?
In the study, communication was categorised as: Of the cases where communication was identified as a contributory factor, around half were the first type, based purely on the failure of information transfer such as a message not being passed on that the client had phoned to say that since its castration, the dog hadn’t urinated. The other half were the second type where dialogue and conversations had taken place between veterinary team members or with clients but a shared understanding had not been established. Additionally, the study considered who was involved in the communication, split into three categories: Interestingly, about half of the communication problems identified involved the client, whilst the other half didn’t. Of those that didn’t, the majority of issues were confined to a practice team.
Mistakes and Complaints
“Our reaction to hearing that somebody is either justifiably or potentially unjustifiably unhappy with the way that we’ve taken care of their animal can be really challenging for us . . . We want to do a great job and, not wanting to make massive generalisations, we tend to set pretty high expectations for ourselves!” Elly
Elly explains that a key distinction to make is whether communication problems were contributing towards a complaint or tending to play a role in a mistake actually happening in the first place. For example, a miscommunication error resulting in a mistake with bad consequences for the patient (e.g. a double dose of medication), versus a communication failure where everything goes fine clinically with the animal, but a client feels that things weren’t explained to them properly and they leave lacking understanding and feeling dissatisfied.
“I think listening and asking are complimentary parts of how to try to get a much more complete picture of everything that’s going on within that patient’s care . . . Listening and seeking out other people’s perspectives and points of view on what’s going on are really important and might be bits that we focus on a little bit less.” Elly
Elly goes on to say that it seems that those communication errors and failure of information transfer occurring between team members are more likely to lead to a mistake, but those incidents where a client does not feel they have been listened to, whether or not that involves a mistake, are more likely to lead to a complaint. Jess reflects that it is not always the case and it’s certainly not black and white and Elly agrees that it can be messy and difficult to unpick - in almost all of the cases she looked at, there was more than one communication problem, so there are usually layers of interwoven factors that lead to the final outcome.
Reframing communication
So how does the profession continue to learn, adapt and change its ways of working to support larger teams and more ‘messy’ communication? Jess and Elly reflect on their time studying veterinary medicine at university, noting that there was little to no communication training and that it now forms a key part of the curricula, with organisations like VDS Training filling that non-clinical training gap for many once they are in practice, and it’s advancing and developing all the time. Whilst there may be some truth in the fact that some of us are innately better at communication than others, Elly believes that communication skills can be learned, practised and developed and as Jess points out, improving your non-clinical skills is a lifelong process. Previous research into veterinary communication and the focus of vet training on communication skills at university and beyond has been the consultation process between the vet and client, measured by client satisfaction, business metrics and KPIs, and whilst there is value in focusing on that as a crucial part of the client journey and a key point of information transfer and shared understanding, Elly’s research aims to expand the focus and consider how communication is affected by the physical, temporal, organisational and social context in which it occurs1.
“Yes, we’ve got these individual communication skills, but it doesn’t matter how good you are with those skills if you’re dropped into an environment or the way that work processes are set up that doesn’t allow you to use those very effectively and that a lot of the problems are going to require looking at team communication structures.” Elly
Consider not just the verbal and nonverbal communication in veterinary practice, but all the other ways that your team shares information on a daily basis - ops boards, theatre sheets, clinical notes, post-it notes passed to reception. These also form part of the definition of veterinary communication and small changes to these asynchronous components can be part of the improvement to a team’s communication. Some of the issues that we might think about less often when discussing communication are:
What can I do?
“A really key message from this piece of research is that individuals having effective communication skills is a really good idea. But it's not everything that you need to have communication work effectively across the whole practice because it requires everybody in the team to be communicating well because that all has an impact.” Elly
Some starting points to think about for your team:
Notes VDS Training Services Limited (trading as VDS Training) is a wholly owned subsidiary of The Veterinary Defence Society Limited. 1Russell, E, Mossop, L, Forbes, E, Oxtoby, C. Uncovering the ‘messy details’ of veterinary communication: An analysis of communication problems in cases of alleged professional negligence. Vet Rec. 2022; 00e1068. https://doi.org/10.1002/vetr.1068