Part 2: Great expectations: client care

COVID client care

One of the biggest challenges the veterinary profession had to face when coronavirus struck in March 2020 was how to protect animal health and keep clients happy.

For a sector where customer service has always been such a big priority, the impositions placed on clients – especially during the first frantic months of the pandemic – put enormous strain on many businesses.

The removal of restrictions has seen most practices return to a pre-COVID way of working, but there can be little doubt that two years of pandemic vetting has left a lasting legacy.

As discussed in the previous article in this series, transformational technology, many practices adapted their approach by providing more digital access and by restructuring their teams to maintain levels of patient care and client engagement.

But did these approaches work? We asked members of our panel what they thought of the profession’s response to the pandemic.

Managing director of Onswitch Alison Lambert said: “There isn’t an SOP for how do we deal with a pandemic, and I think everybody who dealt with it did what they could and did it brilliantly in those initial months – patient care, team protection, public safety; the whole thing.

“I think that was done brilliantly by everybody and everybody was on the same page about it. I think wave two was different; other industries had modified, flexed and done stuff, but the anxiety started picking up in the veterinary sector – I think that’s what our client mediation service data showed as well. It was fine in the beginning, but then when we went into lockdown two, it started to get a bit fractious.

“We could have modified sooner; there were still people not embracing things such as asynchronous communication, outbound calling, looking at how we can do digital engagement, how we can do proactive sending of meds – all of that stuff; we did it in phase one because we had no choice, but we didn’t embrace it as a profession and take it into phase two in the way that perhaps we could have done.

“And now we are in phase three, there are still people who haven’t done what most people did in phase two, so there are a few practices that are still not doing online booking, asynchronous communication work and outbound calling.

“Some practices are flying because they embraced the learnings from wave two and one – they are doing really well – but there are still lots of others still pondering on all of this.”

Lessons

For business consultant and founder of Vet Dynamics Alan Robinson, there are clear lessons to be learned from the profession’s approach to client care during the pandemic.

He said: “I think practices did the best they could on what they knew on the day, but with any major change there are three rules at play. The retrospect scope always works; so looking backwards we could always say we could have done better and done differently.

“The second thing is, no matter how much you do communicate, you will always need to do more – no matter how much information you give people you will always be asked for more. And the third rule of communication is that whatever you say is not what people hear, so that just adds to that confusion. I think the important part of this question is that communication was what it was on the day.

“Going forward, I think the terminology is digital first; what we tend to do in the veterinary profession is bolt it on – bolt on another app; bolt on this; bolt on some remote things. There’s no integration of any of that. With any of these things – client care; vet performance; anything – it’s the amount of friction we produce in the process that stops this stuff happening.

“Digital technology increased client care and increased client interaction. We need to meet the client where they are and technology is just the perfect way to do that; embracing that is the difficulty for a lot of other reasons.

One of those reasons is that the needs of clients are often very different and those needs are constantly evolving; a point made by VMG president and clinical director at Blue Cross, Rich Casey.

“Not all clients were coming from an equal playing field; it’s a lot easier to implement an application or a new way of working once all the risks and the ways of working are clearly understood, and not all practices had that understanding,” he said.

“Talking from a charity sector background, I can say that client needs are often different. For example, it’s a common misconception that clients within the charity sector have less means or ability to interact digitally, whereas we have seen that the download rate and utilisation of it is in the upper quarter of any private practice.

“With my VMG hat on, we’ve seen the whole range, but a lot of practices have worked hard to ensure that things are communicated consistently among their team and among their client base, and those practices have absolutely thrived.

“When the pandemic started, everybody was in the same place because bang – it was a big shock to everybody. Now we need to accept that people are going to remain being anxious. People – staff and clients – will remain being a bit brittle for the foreseeable future, and it’s about how then we manage and accept that our clients and our team will remain anxious and brittle, and how that’s not going to go away, so how we do manage that.”

On the same page

For practice owner Jenny Reason, keeping her practice team up to date and fully informed was key to delivering successful client care during the pandemic.

She said: “You have to make sure that you are on the same page as your team, because otherwise, you’re giving mixed messages out to your clients anyway.

“For us, any of the little hurdles were because things were being communicated to the team at a different speed to how they were being communicated to clients and the people weren’t quite all on the same page for a while.

“But we also had to learn a lot of other stuff and fast; we brought in a teleconsulting platform quite quickly – it wasn’t without its bugs, but you know we’ll forgive people in that sort of situation because that’s what happens, so we were able to utilise that.

“We have also started doing a lot more outbound calling just to stop the phone ringing because the phones were jammed, and that has helped a lot – our staff are spending less time on the phone and our clients are not spending ages sitting on the phone waiting to get through to us. That helped a lot.”

‘Still things we can learn’

Closing this section of the debate, vet and innovation consultant Greg Dickens suggested that the veterinary profession should look at how other sectors had evolved their services offering to clients during COVID.

He said: “We spent the last session talking about technology and I’m going to move it away from that. I’m going to say that outside the veterinary profession in the medical field, they had the whole telemedicine debate. But they also started looking at ways to offer completely new services. They looked at what it was about pandemics and lockdown that changed people’s health and well-being, and how they could target that specifically. There was a huge boom in psychological and relationship medicine, and a lot of very lockdown-specific services.

“I didn’t see that at all from the veterinary profession here. I didn’t see ‘so, you have to live with your dog 24 hours a day – we can help you with that’. I didn’t see ‘you’ve now realised that your dog is in the house all day whether you’re there or not – you didn’t know that before, did you?’.

“I just wonder if there are still things we can learn from this pandemic before we leave it for good, hopefully.”

Client connection

It has been estimated that more than three million people bought pets during the coronavirus pandemic – many of them from the younger generation.

The Pet Food Manufacturers’ Association’s latest pet population report showed that almost two-thirds of these new owners were Generation Z or millennials, with 59 per cent of those buying a pandemic pet aged between 16 and 34. But did our Big 6 panel think the way the veterinary profession interacts fits with its existing client base, as well as those of this changing demographic?

Alan said: “One of the adaptions we talk about is can we take cash off the table completely, because the biggest friction point between clients and practices is money. It is the biggest, most contentious, repeatable, onerous friction point in the whole thing.

“One of the other big needs of clients is compassion and I think vets are hugely compassionate people for pets in particular, maybe less so the client and absolutely not for themselves.

“Then we have compliance – we want clients to do stuff – and then convenience; they want it now. It’s Sunday night; it doesn’t matter – they will do whatever’s necessary because convenience is really, really important as they have no delay gratification.

“But those three client needs are negated by one thing and that’s ‘over-busyness’ of trying to serve every client who turns up to your door. We can treat anybody, but you can’t treat everybody. And I come back to that point that if we don’t control that client quality and quantity, we are going to burn out our people to the point that we don’t have any of those things left.”

Adaptation

On this point, Greg warned that the profession may also need to adapt to the needs of a less affluent client base and the evolving health needs of its pets.

“We are seeing levels of disposable income go down. Now, you just talked about removing money from the table and I agree,” he said.

“Everything should be a subscription model with risk sharing, but the total amount of disposable income is going down. We’re seeing a lot more people in rented accommodation than bought accommodation. And if that continues, that has impact on which pets people can and can’t have. We’re seeing a lot of allergies; a lot more fur allergies coming through – again, with impacts on what pets people can and can’t have.

“And finally, gig economy is pushing us into really weird hours and that might have impact on when they can and can’t come to a vet. So, yeah, I agree that the needs are broadly similar and those three Cs are the way forward, but the needs will be tilted by the new generation coming through.”

‘Things we can predict’

Rich added: “It’s about what’s new today will become the norm tomorrow. But I would perhaps add that we don’t necessarily know what the needs of the next generation will be, but there are some things we can predict in terms of what next generation needs are.

“Greg listed some great ones like the allergies; gig economy – I also think the subscription model approach is a game changer. It started to come into the UK veterinary practice. It’s a bit more prevalent in America.

“In general I think the profession needs to get a bit more comfortable knowing that there’s going to be something around the corner that we don’t know about it yet. And actually, not be so shocked or surprised when that happens. And when it does happen, not get our backs up and try to push against it.

“At the moment there is a choice for practices when it comes to how they engage with clients, but that’s not going to be the case in years to come. That choice of going digital is going to become less and less. So, if you’re not embracing it now, it’s going to become more and more difficult in the future.”

Fair deal for clients?

One of the few predictable aspects of the pandemic was the sharp increase in the number of reports in both the regional and national press of clients complaining about the rising cost of veterinary care.

These complaints are nothing new and, according to Alan, many have their roots in the way practices have been run for many years.

He said: “We know that veterinary practices, pre-pandemic, have made their profits from selling products and drugs with markups that subsidise the business to such an extent that they massively undercharge for their services and discount time.

“This causes a massive imbalance and leads to the product-driven business model. That is what people complain about, so we need to take away that the financial incentive and replace it with long-term subscriptions and other such things.

“The business model is skewed and that has been exacerbated in the pandemic by compassion fatigue; by lack of self-worth; by all the underlying factors that drive veterinary business that need to be re-adjusted and settled.

“And the press has been picking up on that in the pandemic, with some of these stories about vets ripping clients off, but there is an agenda there for sure.”

Greg added: “Vets in the US suffer from this a lot less because consumers in the US are very used to paying a lot for medical care. If you could, if say, the veterinary industry could be very nice to the NHS just for a second and ask them to give people a bill when they leave hospital that itemises just how much everything costs at the end, people might be a little more lenient with vets.”

Pragmatic approach

Rich believes part of the solution is about adopting a more pragmatic approach: “What I want to talk about here is what we have in our individual control when you talk interacting with the client about price,” he said.

“My clients tell me that their top three things they look from a veterinary service is transparency, non-judgement and the ability to spread the cost. The challenge, though, is that the vast majority of – particularly newly graduated veterinary professionals – are just not comfortable or confident talking or delivering pragmatic approaches to veterinary medicine.

“They’ve been taught that the top-notch level of delivering veterinary care is in a referral level hospital, but it’s in our control to look at how confident and skilled our teams are at delivering a level of service that is more pragmatic, so instead of ‘we could do this or that diagnostic’, it’s ‘I would not do this diagnostic because it’s not going to improve the patient outcome – and it’s actually a waste of your money’.”

Teaching

Expanding on this point, Jenny said: “I do think there does need to be much better teaching about the different options and not being scared of not offering every diagnostic.

“Because you don’t need to do everything with every animal you see. I mean a lot of them will get better regardless of what you do, not because of what you do.

“I think there are a lot of recent graduates who want to do every single diagnostic under the sun and the client goes ‘no’, then the vets go: ‘Well, we can’t treat your pet then’ – and that’s the end of the conversation, whereas, that should never be the end of the conversation.

“If every time someone comes in to the vet they are paying for blood tests or further diagnostics then that is where they start thinking that we’re doing tests unnecessarily and they are being ripped off.

“I think if vets were less scared of being sued or having a complaint and realising that there are lots of things you can do as a GP, and also that everything does not need referring as that can be incredibly expensive for clients and can also add to that negative perception of vets.

“We need to get back to being able to believe in ourselves and not thinking that everything needs a specialist because that is not the case.”