Chapter 13: Tales from the COVID-19 front lines
“I have never seen so many angry, rude, unreasonable, demanding and disrespectful clients. It’s very sad. Practices are supporting the team and firing those clients who misbehave.”
This week: Sandy Walsh on protocols and angry clients, Dr. Peter Weinstein on leadership fatigue, Dr. Wendy Hauser on telemedicine, and more.
Read the first 12 installments in this series:
Getting Technical columnist, practice management consultant and Patterson Veterinary University instructor Sandy Walsh, RVT, CVPM
Well, it’s three steps forward and two steps back. Just as businesses started to reopen and hospitals were preparing to allow clients back inside the practice, we are seeing COVID spikes and hot spots. Now, many communities are taking a step backward. With good protocols in place, however, we are moving forward cautiously.
Curbside is still encouraged for most visits, but some clients are now given the choice to come inside. We’ve stepped up and enhanced cleaning efforts in preparation and have determined how clients will move through the practice with the least amount of direct staff or other client interaction and contact.
Here’s what I’m seeing:
- Separate entrance and exit doors.
- Face coverings required for all clients and staff.
- Only one family member permitted to enter the hospital except during a pet euthanasia.
- History and registration forms sent to clients in advance of their visit.
- Payments taken over the phone or with a portable credit card terminal.
- Strong demand for prepaid wellness plans.
It’s summertime and practices are busy. Many are short-staffed, however. Clients are a continued challenge.
With so many practices at capacity, it’s difficult to accommodate patients that haven’t been seen in years, clients who have been turned away by their regular veterinarian and pet owners who don’t have a regular veterinarian. These clients are taking out their frustration on the team. I have never seen so many angry, rude, unreasonable, demanding and disrespectful clients. It’s very sad. Practices are supporting the team and firing those clients who misbehave.
The good clients before COVID-19 remain supportive and show their appreciation through patience, kind words and food. This helps the team stay positive about showing up for work day after day to do the same thing over and over. It’s a difficult time.
Paycheck Protection Plan loan-forgiveness information is changing constantly. Some practices are getting ready to submit forgiveness applications to beat the rush. Check out www.gattomcferson.com for the latest information from the Small Business Administration.
Meanwhile, continuing education has a new look. All the traditional summer veterinary conferences have gone virtual. We won’t see each other in person, but we will be able to take advantage of some great learning and networking opportunities. We need to stay connected in any way possible.
Veterinary industry consultant and Southern California Veterinary Medical Association executive director Peter Weinstein, DVM, MBA
Are you feeling any of the following? Tired. Lack of energy. Feeling as if you’re in survival mode. No long-term vision and just happy to get through the day. Pretending that things are under control. Overreacting to what would be a small issue. Not bothering to handle work issues because they are too exhausting.
These are symptoms of leadership fatigue, which has become far more prevalent since COVID-19 turned our world upside down, forcing business leaders to work harder than ever at keeping their companies alive and their staffs employed, safe and motivated.
I am noticing both leadership and staff fatigue. And personally, I know that leadership fatigue has impacted me.
Leadership is draining under the best of circumstances. Mounting adversity can lead directly to leadership fatigue. Quite often, the overwhelming stress created by setbacks leads rapidly to a further decline in performance.
Most of you could be suffering from leadership fatigue without even knowing it. There is little doubt that the past few months led to a few sleepless nights as you tried to keep all the balls in the air. If you are regularly experiencing any of the signs outlined above, are struggling to stay motivated or are feeling uncharacteristically low, now might be the time to seek help. You’re not weak for reaching out and asking for help. It takes self-awareness, strength and courage, but the effort might just save your life.
A few things to note:
- You are not alone. A lot of your friends and colleagues are suffering as well. Doing the right thing all the time is hard.
- Get your emotions in order. Are you angry at something or someone? Maybe it’s time to take the pebble out of your shoe and acknowledge the irritant.
- Take a day off. Completely. Don’t work from home. Go off the grid.
- Stop doing everything you don’t necessarily have to do. Make a list of things you can stop doing, not a to-do list but a don’t-do list. Learn to delegate.
- Take a walk, run, bike, meditate. Get your physical health in order. Your mental health will follow.
When the crisis started, you were given an added weight to carry. As the pandemic progressed and everybody started to get more stressed, the weight got heavier and heavier. It was imperceptible at first, but over time it began to sneak up on you and, if you’re not careful, it can lead to the first signs of leadership fatigue.
Take the time to take care of yourself using the same focus and energy you have spent taking care of your team.
Crum & Forster Pet Insurance Group assistant vice president of veterinary relations Wendy Hauser, DVM
Where does veterinary telemedicine fit into a transformed veterinary profession, now and post-crisis? According to the Veterinary Hospital Managers Association’s “Insider’s Insights” report for May, 35% of surveyed hospitals that began offering telemedicine services during COVID-19 plan to continue it when full-service operations resume. Another 38% stated that they would discontinue the offering and 28% were unsure.
For hospitals that are considering ending telemedicine service or are unsure, some insight can be gained from Geisinger Health System. As reported in a Harvard Business Review article in June, the human health care provider averaged roughly 40 daily telehealth visits across all locations before COVID-19. With the early restrictions of COVID-19 and recently relaxed boundaries, Geisinger staff members now provide 4,000 to 5,000 telehealth visits a day, 40% of which are video appointments.
The most fascinating part of the article — read it at bit.ly/3g7MzcG — isn’t the tremendous uptake in telehealth services in Geisinger’s health care system but the reported change in patients’ perception of virtual care.
Before COVID-19, patients perceived telehealth services as dismissive: “This provider must not think my problem is important since they are seeing me via telehealth.” Now, the feeling is “This provider cares about me and therefore is seeing me via telehealth.”
Other reported benefits include better management of chronic conditions and the ability to “be present” in the home environment — or gaining a better understanding of how it impacts the patient.
These human patients might be pet owners. How will their telehealth experiences drive the expectations for their pets’ care? Will their new attitudes accelerate the demand for telemedicine services for pets?
Numerous studies outline client preferences for veterinary care. Whether veterinary telemedicine services will become a valued means of servicing clients has yet to be determined. It would behoove veterinary hospitals to explore their clients’ experiences with telemedicine, both human and veterinary, when they make decisions regarding telemedicine services.
PetDesk director of strategic partnerships Branon Hanono
Over the past three months, veterinary practices scrambled to find technology solutions to address the abrupt shifts in operations, client expectations and economic outlook. The unease of change in everyone’s day-to-day life, coupled with the rushed implementation of oftentimes unproven solutions, pushed practices close to the breaking point.
Now, practices are starting to find their feet. Practice owners and managers can take a long-term view. Some are personalizing the experience to solve the problem of curbside appointments that feel transactional instead of service-oriented. Others aim to solve unsustainable front desk situations by working to reduce phone volume and remove friction from appointment protocols.
Either way, practices stopped hoping for changing circumstances to solve their problems. Now, they are taking inventory of their problems and addressing them by proactively integrating solutions into their practice’s protocols. For instance, data compiled by Petdesk shows that veterinary-client conversations are happening over various channels to meet client expectations and reduce phone volume. During the week of June 14, the average number of weekly text messages exchanged per practice was up 148% from pre-pandemic levels. Hope is not a strategy, and savvy practices are adapting to the new communication reality to keep care flowing.
Numbered parking spots, “Text when you arrive” signs and streaming exams live to the client’s car are examples of practices enhancing service through the use of technology within the new normal. In this way, practices are solving now-familiar problems before they arise and are reaping the benefits of happier clients, shorter hold times and more productive customer service representatives. These positive impacts are causing practices to consider keeping certain adaptations as permanent upgrades.
Some obvious candidates for permanent changes are digital client forms and the delivery of videos, photos and PDFs to clients via text messaging. The problems these changes solve will exist without COVID-19. Curbside service also has a place after the pandemic. Consider stellar experiences using a differentiated and branded “valet” service for elderly clients and for clients with pets in carriers.
Much is still in flux, and the outlook for the broader economy is uncertain. But one thing is clear: Practices are making changes proactively, and less reactively, within the new normal. Moreover, these changes can improve the client experience moving forward.
Creative Disruption columnist and WellHaven Pet Health chief medical officer Bob Lester, DVM
Our profession has demonstrated a remarkable ability to change over the last several months. Remarkable for a profession that’s known for its aversion to change. Historically, we’ve been the poster child for a belts-and-suspenders industry. In the face of crisis, we’ve adapted, innovated and grown. There’s more we can change to benefit ourselves, society and the pets and families we serve. Windmill tilting? Perhaps, but a worthy challenge. What else might we change?
- It’s time to move from a doctor-centered sick care model to a team-based well-care model led by veterinary nurses. Our profession is mired in a doctor-centric paradigm prioritizing sick care when a team-based model promoting well care is better for pets, families and veterinary professionals.
- A minimum of twice-a-year examinations, physical and/or virtual. Annual exams are inadequate, particularly in juveniles and geriatrics. How can we effectively educate pet owners in one 20-minute conversation one time a year?
- Portable licensure and reciprocity. Why do we need a license for every state we practice in? Didn’t we take a national exam?
- Enhanced licensure (aka limited licensure). Why do we insist on an outdated James Herriot-driven curriculum and licensure? Imagine how much better prepared new graduates could be without diluting valuable educational time on acquiring skills never used.
- Hybrid-distributed clinical education models. A partnership between academia and real-world clinical collaborators to provide an immersive, cost-effective, high-caseload, hands-on experience to best educate our future colleagues. All with the goal of teaching and learning commonly seen conditions uncommonly well.
- Asynchronous learning. A semester, a year, four years. Why have U.S. professional degrees been time-bound and set at four years? If a student can learn at a faster pace, opt out of something they already know, take off a semester to immerse themselves in an industry or private practice experience, or curate exactly what they want to learn, why shouldn’t they?
- Life comes before work. My boomer generation can’t be reminded of this enough.
- If you’re not happy where you’re at, go someplace else. If you’re still unhappy, you might need to look in the mirror.
COVID-19 has forever changed pet consumer behavior and our profession. Our old model fails to meet the needs of too many pet families. Perhaps worse yet, the old model is damaging our colleagues’ well-being. Change is required. There are worthy windmills remaining to be challenged. Let’s keep on changing, innovating, growing and learning. We can change. COVID-19 proved it.
Veterinary nurse and National Association of Veterinary Technicians in America President Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM)
Now that we’re a few months into the COVID-19 pandemic, the focus is being shifted from quickly adapting daily practice so that infectious risk is minimized to looking into how to continue caring for patients through the reopening of businesses and a possible second wave.
The shift in mentality and what it means to veterinary technicians was presented in a webinar hosted by the National Association of Veterinary Technicians in America. Led by Leslie Bodreau and Elaine Myers, each an RVT and seasoned hospital administrator, the webinar was aptly titled “The New Abnormal.” It discussed the juggling of patient care in between new protocols for disinfection, personal protective equipment and social distancing, all of which are here to stay for the foreseeable future. As various services reopen, mandatory daily health checks are being instituted within practices to prevent infections from spreading within the veterinary team.
Members of our profession are going through pain points of being an essential worker where concerns for safety are still prevalent and a focus on checking in with each other, practicing self-care and seeking help is encouraged. Frustrations regarding team members’ not following protocols can add to this feeling. Another new reality is that work and family plans have to be made in case one contracts COVID-19.
Veterinary technicians at practices that have seen workload decreases have found ways to become helpful or have picked up shifts. Veterinary technicians at practices that have seen workload increases have found ways to become more efficient while maintaining protocols, focusing on one patient at a time, and ensuring that appropriate breaks are taken to sustain the activity.
A critical part of our work that has been impacted is the ability to show compassion. The simple acts of a hand on the elbow or shoulder and hugs are no longer recommended. Because of the added workload per patient because of protocols, we feel obligated to move on and might not spend as much time as we used to on making the patient and client comfortable. We need to remind ourselves that the situation is temporary and we will get through it together. We can find different ways to show the same compassion.
Through all of it, we are hearing of many examples of support for veterinary technicians. Shows of appreciation through food deliveries, recognition as frontline heroes and trends such as “Corona Curbside Bingo” are abundant. While veterinary workers don’t get mandated hazard pay, many practices have awarded financial compensation (commonly termed “COVID bonus”) to thank team members for working through a difficult time. I’d like to encourage all practices to perform a self-check on how they can support veterinary technicians today, because we’re not yet over the pandemic.
Today’s Veterinary Nurse editor-in-chief and NAVC director of veterinary nursing Kara Burns, MS, MEd, LVT, VTS (Nutrition)
As we prepare to enter July, the U.S. is seeing a spike in COVID-19 in many states. The reasons are many and multidimensional. Just as some hospitals and businesses were considering relaxing restrictions, many are now pivoting and keeping the new protocols in place.
One thing that I continue to see, and it appears to be worsening in practice and affecting my colleagues, is the increased frustration and lack of kindness from pet owners. Although this is not true of all owners, many clients are taking their frustrations out on the veterinary team. Financial stress from the pandemic and its effects are causing pet owners to demand reduced and even free care, and owners are harassing and deriding veterinary teams that do not comply.
Much of the nationwide data is showing an increase in revenue and pets being seen in hospitals. However, it also shows that the higher the revenue and cases, the higher the number of team members who are exhausted or burned out. Add to that tense and vocally disparaging clients and we have a recipe for disaster. People are fearful and anxious, resulting in a change in or an exacerbation of how people react, respond and treat other people.
Working in an environment of new protocols and new responsibilities and then being treated poorly by clients is a dangerous mix that is taking a toll on already beleaguered veterinary teams. Fear, anxiety and future unknowns are leading to such reactions from clients, but taking it out on those who help family pets is unacceptable.
Thank you to those veterinary teammates and hospital leaders who have stepped in to defend and protect the team member and even have fired clients for treating teams poorly. I implore all of us to stick together. Defending a colleague is the right thing to do and might be the light that individuals need to endure this incredibly stressful time. We are all in this together. Be kind to one another.
We want to hear from you: How has the COVID-19 emergency affected you, your practice or your veterinary business? Email editor Ken Niedziela at [email protected].
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