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CONCORDANCE AND COMPLIANCE

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01 February 2013, at 12:00am

GEOFF LITTLE calls for a greater focus on compliance and the need to ensure there is effective communication before, during and after treatment has been agreed upon

A GREAT deal of resource is invested in the area of concordance and compliance within human medical spheres, as non-adherence to a doctor’s recommendations has a major negative impact on individual and public health.

However, it’s rare that, within the animal health profession, we focus on these areas, the success of which wholly depends upon our communication skills. This article argues for a greater focus and looks at what needs to be done to begin closing the “compliancy gap”.

So what does “concordance and compliance” actually mean? Concordance is defined as an agreement between a veterinary team and their client in relation to treatment. Essentially, it can be summed up as shared decision making.

Compliance is defined as a client’s adherence to a recommended treatment plan (although, of course, it’s also important that practice staff buy into and adhere to any such treatment plan too). Unilaterally altering what a client sees as an agreed way forward, without further consultation, can result in anything from a slightly miffed individual to somebody who makes a claim against the practice.

Optimum levels of both concordance and compliance lead to a number of benefits: firstly, happier clients with fewer complaints; secondly, and most importantly, healthier patients. This is because clients are consciously agreeing with our approach before wholeheartedly committing to following through on a recommended treatment regime. There are greater levels of pet supervision as a result. 

The good news is that the practice also benefits. Improved concordance and compliance result in a greater level of job satisfaction amongst staff, which usually means happier, motivated colleagues and a more cohesive team. By virtue of the fact that clients are happier too, recommendations increase and the practice can secure new clients whilst reaping the financial rewards of increased client visits and follow through.

Total compliance can turn a good practice into a very successful business but in order to strive towards this goal, practices need to go far further than simply printing legible prescription labels!

Practices need to ensure there is effective and efficient communication before, during and after treatment has been agreed upon.

Measuring

In human medical fields, compliance is frequently measured. On average, compliance with human medicine is between 15% and 50%. However, adherence to recommendations in lifestyle changes – such as dieting – can be lower. It’s fair to say that compliance tends to be higher with more severe conditions, and lower in perceived less important situations.

Unfortunately, very few veterinary practices measure concordance and compliance and, if they do, it is only with very few services and products. But if we don’t measure it, how can we possibly manage it effectively?

Interestingly, where veterinary data do exist, figures tend to mirror the above at between 15% and 60% which suggests there is a real opportunity for practices to benefit from a focus on compliance.

If, for example, a practice turnover per vet was £240,000 (with each vet having 1,436 active patients) and if the average pet was (bear with me!) a cross between a 30kg dog and a 4kg cat, what would the turnover per vet be if all patients were vaccinated, received regular worm and flea treatment and were fed on a premium dry food purchased from the practice?

The answer is a staggering £750,000, with a gross profit of approximately £356,500. This is merely attending to the pets’ basic needs; it doesn’t take into account the treatment of any ill patients or any out-of-hours or emergency work. Of course it is not possible to achieve what has been suggested, but it does demonstrate that there is so much more we can be doing for our patients than we currently are, if we alter our approach in the practice.

Setting SMARTER objectives can be a useful first step in achieving the business success described above. For example, if your practice wants to fill more appointment slots during the day, the objective could be: to research the reasons behind low conversion of enquiries into “appointments made” and then agree proposals for action to be taken that will lead to an 80% uptake by an agreed date.

If you have an 86% response to vaccine reminder letters, your compliance rate, more or less, is 86%. Great! However, how would you interpret data from your practice management system reporting that in the last 12 months 16% of canine patients received dental treatment? Is this a good result and/or a healthy measure of compliance? 

In terms of success, it could either be an excellent result if, for example, no dog owners received any recommendations to have their pets’ mouths attended to; or it could be a terrible result if all dog owners who came through the consulting room door received advice regarding the state of their pet’s mouth. In any case, it is not a measure of compliance. 

Could you be SMARTER in managing and measuring your dentals? For example, perhaps you could agree categories of tooth and gum disease and create codes for each category. From this, you could then agree a course of action for each category and examine every patient’s mouth over a given period (such as Pet Smile Month) and better manage the results.

Closing the compliancy gap

So what are the main factors which can help your practice to reduce its compliancy gap? Firstly, strong practice management. A practice needs a business plan in place with efficient processes to measure and track compliance – ideally benchmarking against previous years/quarters. 

Processes also need to be rigorous – with clear standard operating procedures that all team members buy into. These processes will ensure individuals are well versed in encouraging repeat visits and implementing efficient reminder systems.

A vet’s behaviour also impacts on compliance. Careful consideration needs to be given to the choices presented to clients during a consult and appropriate levels of information should always be provided to ensure understanding.

Summarising what is said during the consultation can also be helpful in boosting client understanding, whilst providing clients with a “safety net” will encourage all clients to repeat visit, irrespective of their initial level of co-operation.

Trust is everything. Clients need to believe that your aim is to get their pet as well as possible, as quickly as possible, as easily as possible and as cheaply as possible.

It is a common misconception that financial concerns are the main factor for poor uptake of veterinary services and products.

Indeed, in a recent study, only 7% declined dental treatment on cost factors, only 4% stopped diet treatment due to cost and only 5% abandoned senior pet screening due to financial constraints. 

Clients frequently have a very strong pet bond and owners essentially want the best possible care for their animals but they need to be involved in that initial decision making process and communicated with regularly to be sure of compliance.