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Seeking to improve ‘sustainability’

by
01 October 2010, at 1:00am

reports from the recent Dairy Sustainability veterinary symposium held in Barcelona

PROFESSOR Ynte Schukken from Cornell University College of Veterinary Medicine defines sustainability as “survive in the long-term without interruption”, a concept that can apply equally to veterinary practices or clients.

At the recent international “Dairy Sustainability” veterinary symposium staged in Barcelona by Pfizer Animal Health and attended by 250 vets from 20 countries, speakers and delegates returned a number of times to factors that would improve the sustainability of veterinary practices.

Professor Volker Kromker from the University of Hannover said that in his mastitis consultancy work, the goal was to reach his farmers’ goals. “We need to understand human behaviour and motivation, and think more like our farmer clients,” he said.

On a similar note, Professor Pamela Ruegg from the University of Wisconsin proposed “a new paradigm for vets as educators and persuaders rather than scientists or technicians”. However, she also reported “disappointing uptake” by US vets of training courses in communication and consulting skills that she had staged for the profession.

Salutary findings

Prof. Ruegg also outlined some salutary findings from a seven-year 600-vet programme in Wisconsin involving farmer-led teams of appropriate experts to help them tackle specific problems. At the outset, she said, the expectation was that vets would take an initiator or group leadership role, but the reality was mostly the opposite.

“We found that most vets wanted to be the technical adviser to a group rather than a leader,” she said. “It’s also the case that rural vets in the USA are already busy with the hands-on work that many or most of them prefer.”

A similar observation emerged during the symposium at a sustainability seminar involving UK vets. “Most practices have plenty of work,” said one participant who asked not to be named.

“Finding new clients or generating more work from existing ones can easily pose its own sustainability problems in balancing workload with the practice’s capacity.”

Among the UK discussion group, Pfizer Animal Health facilitator Niall Jaggan noted the view that some non- veterinary advice providers to farmers, such as Kite Consulting or Kingshay, were better at demonstrating their value to clients than the average veterinary practice.

“However, while some practices or vets still take a predominantly task- orientated approach, an increasing number are now looking at the big picture with their clients and pursuing the kind of holistic goal-orientated approach advocated by Professor Kromker,” he said. A consensus he did identify was that practices needed to get better at positioning veterinary services as an investment in improvement rather than an unavoidable expense. From the Westpoint Veterinary Group, Jon Mouncey said, “We have to show worth.”

Some, but not all, of the UK group supported a hypothesis that farm work would follow the lead of small animal vets in the use of para- professionals as part of small multi- disciplinary teams. From Synergy Farm Health, Ed Powell-Jackson said his practice now employed five cattle foot trimmers, for example. Others maintained that they and their clients alike preferred a multi-skilled vet who could handle most procedures themselves.

Whichever model practices follow, symposium speaker Dr Theo Lam from the Dutch Udder Health Centre identified a commonplace area for improvement. “We have lots of knowledge on the shelf,” he said, “but it’s no good there and we must get it into routine use in the milking parlour.”

He described a research project in which 17 consultations between “top flight” Dutch vets and their clients were recorded and analysed. Only three contained a formal “statement of purpose” opening to the consultation, and in only three others did the vet ask the client about his or her needs.

Just one encounter involved any follow-up to the previous consultation and only two included summaries of the encounter at its closure. None of the 17 consultations contained a “listen-summarise-clarify” component.

“To survive and thrive as a veterinary practitioner, it will be essential to become proficient in advisory and consulting skills,” said Dr Lam. With this in mind, he said that a symposium on communication, persuasion and behavioural change was being staged in The Netherlands next year.

Mastitis remains...

“Despite years and years of applying science-based management, mastitis remains,” said Professor Ruegg, who opened the udder health session at the symposium.

Challenging delegates to find new ways to help clients defeat an old problem, she suggested that, in view of abundant scientific knowledge, “failure to control mastitis is down to poor communication, poor on-farm management and weak or absent commitment to change – all normal human behavioural things. 

“Whether it’s farm failure or vet failure, they have the same causes,” she said.

One of the main challenges she identified was for vets to become re- involved in the battle against mastitis, because in many respects the tactics deployed were in the hands of the herd owner and farm staff, with little day-to-day involvement of the vet.

In addition to this, Pfizer vet Matt Williams said that some or indeed many dairy farmers have become conditioned over time that a certain frequency of clinical mastitis cases is inevitable.

“Once a norm gets established like this in someone’s mind, it can create an expectation that it cannot be changed and an acceptance that ‘it happens’, which both act as significant barriers to change,” he said.

To break out of this rut of acceptance, Mr Williams believes vets need a game-changing gambit with which to establish a new mastitis dimension in client relationships. One such gambit is the ultra-comprehensive Dairyco Mastitis Control Plan that is currently in use by 168 vets on 375 farms. A somewhat simpler one suggested by Bruce Haggerty from Miller and Partners in Lockerbie was a review by the practice of each client’s lactating cow tube use. While working in

New Zealand, he witnessed “annual script consultations” with clients, in which the practice would review with each owner or manager their herd’s medicine use and identify any concerns arising, such as above average use of lactating cow intra- mammary antibiotic tubes. 

He said the consultation gave vets an opportunity to agree with clients a programme of action together with a maximum number of tubes that could be issued to the farm in a defined time period, which if reached would trigger a further consultation.

“The dispensing staff at the practice were very good at keeping track of this,” he said. “At the very least, this process gave you an excuse to point out where tube use was well above the norm. If we can’t flag this up to clients, we shouldn’t expect them to be able to identify it for themselves, because they don’t have the benefit of seeing the norm across a number of herds.”

Another aspect of the problem for vets to overcome is that only about 2% of farmers have a goal for mastitis control, according Dr Lam. He regarded it as very simple for vets to tackle this.

“Just ask them about it,” he said. “Do a review with them, ask what they want to achieve, help them identify and understand a few key performance indicators that can be used to track progress and measure success.” 

An approach adapted for the UK, according to Matt Williams, is to analyse practice dispensing records and identify clients whose lactating cow tube use suggests high incidence of clinical mastitis. He suggests that these clients can then be approached by their regular vet with a simple proposition that, “We’ve noticed your tube use is a bit on the high side and we’d like to help you reduce it. Are you OK if we have a chat about this?”

For many vets, he said, the opening gambit can be the most difficult part of getting re-involved in tackling mastitis. But if nothing changes, he said that Prof Ruegg may be able to begin her presentation to the 2020 symposium by saying: “Despite everything we considered at this event 10 years ago, and everything we know about this disease, mastitis remains.”

Parasites

“Parasites and their control is an area of opportunity for vets, which currently many don’t give enough attention to.” That was the view of vet and parasitologist Professor Mike Taylor from the Food and Environment Research Agency (FERA).

He told the symposium that it was the matter of sustainability of control, in particular slowing or halting the development of anthelmintic-resistant parasites, that required veterinary intervention. “We need to help and encourage farmers to understand the different wormer groups and how to employ them effectively,” he said.

“World-wide, it is true that we haven’t seen much evidence yet of wormer-resistance in cattle compared with sheep, but we cannot be complacent. The veterinary profession has a responsibility both to promote responsible use in general and to prescribe the use of new POM-V wormer groups only where their use is justified as a component of sustainable parasite control.”

The symposium was chosen as the launch pad for the new Control Of Worms Sustainably (COWS) initiative, developed by Prof. Taylor with sponsorship from Eblex, Dairyco and RUMA, whose websites offer the COWS technical manual for vets and advisers as a downloadable file.