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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Developing Communication Skills for Veterinary Practice Developing Communication Skills for Veterinary Practice provides a thorough grounding in practical communication principles for client and team interactions, and helps veterinarians and staff take their communication skills to the next level through self-development and coaching colleagues. The book describes specific evidence-based techniques, gives examples of their use, and demonstrates how to use each skill in the clinical setting, with learning activities to put into practice. It covers every mode of communication, including face-to-face, virtual, telephone, and written communication. Organized by the tasks of the clinical appointment, each chapter showcases specific communication skills. The book introduces a communication toolbox of 20 key communication skills, which can be applied to any area of veterinary practice or veterinary career path. The book: * Defines each communication skill, demonstrates techniques, and provides examples * Emphasizes the importance of communicating effectively with clients and colleagues * Provides a process and structure for coaching communication with colleagues * Discusses client and team interactions using many methods, including in-person meetings, telephone conversations, and emails * Outlines best practices for effectively communicating using technology Developing Communication Skills for Veterinary Practice is an invaluable resource for veterinary professionals at any level seeking to develop their communication skills and improve clinical outcomes.
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Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Dedication Page
About the Authors
How to Use This Book
Acknowledgments
1 Introduction
Communication Matters
Equip Your Communication Toolbox
Practice, Practice, Practice
Appreciate Communication is An Art and a Science
Build, Maintain, and Sustain Relationships
Enhance Clinical Outcomes
Foster Veterinary Team Culture
Make Time to Communicate
Answer Key
References
2 Communication Styles
Introduction
Set the Scene
Adapt Communication Styles to Clients
Adapt Communication Styles to the Team
Put the Communication Styles into Practice
Take It Away
Answer Key
References
3 Opening‐the‐Interaction
Introduction
Set the Scene
Opening Client Interactions
Opening Team Interactions
Put the Opening Skills into Practice
Take It Away
Answer Key
References
4 Information‐Gathering
Introduction
Set the Scene
Gather Patient, Client, and Environment Information
Gather Situation, Colleague, and Environment Information
Put the Information‐Gathering Skills into Practice
Take It Away
Answer Key
References
5 Attending to Relationships
Introduction
Set the Scene
Attend to Client Relationships
Attend to Team Relationships
Put the Relationship Skills into Practice
Take It Away
Answer Key
References
6 Attending to Tasks
Introduction
Set the Scene
Attend to Client Tasks
Attend to Team Tasks
Put the Task Skills into Practice
Take It Away
Answer Key
References
7 Diagnostic and Treatment Planning
Introduction
Set the Scene
Plan with Clients
Plan with the Team
Put the Planning Skills into Practice
Take It Away
Answer Key
References
8 Closing‐the‐Interaction
Introduction
Set the Scene
Closing Client Interactions
Closing Team Interactions
Put the Closing Skills into Practice
Take It Away
Answer Key
References
9 Communication Coaching
Introduction
Set the Scene
Attend to the Process of Communication Coaching
Attend to the Content of Communication Coaching
Commonly Asked Questions Related to Communication Coaching
Colleague Scenario
Team Scenario
Talk Through Technology – Video Recording
Put the Coaching Skills into Practice
Take It Away
Answer Key
References
10 Transferring the Skills to Various Contexts
Introduction
Scenarios
Client Conversations
Team Conversations
Take It Away
References
11 Now What?
Twelve Recommendations
Put the Communication Skills into Practice
Take It Away
References
Appendices – Tools to Support Coaching and Communication Skills Learning Sessions
Appendix A: 20 Communication Skills
Appendix B: Coaching Process Card
Open‐the‐Session
Prep‐the‐Interaction/Appointment
Observe‐the‐Interaction/Appointment
Take‐a‐Break in the Interaction/Appointment
Debrief‐the‐Interaction/Appointment
Close‐the‐Session
Appendix C: Communication Skills Checklist
Index
End User License Agreement
List of Tables
Chapter 2
Table 2.1 Factors that may influence the use of communication styles.
List of Illustrations
Chapter 1
Figure 1.1 Learning ladder. Adapted from Wackman, Miller, and Nunnally, (197...
Figure 1.2 Relational coordination.
Chapter 2
Figure 2.1 Communication styles.
Chapter 4
Figure 4.1 The inquiry funnel.
Figure 4.2 Three components of a complete history: patient, client and envir...
Chapter 6
Figure 6.1 Structure of the clinical interview.
Figure 6.2 Structure of the team meeting.
Chapter 7
Figure 7.1 An Example Feline Hyperthyroidism Value Matrix.
Figure 7.2 Percentage distribution of US adults aged 16–65 at selected level...
Figure 7.3 Health literacy model.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Dedication Page
About the Authors
How to Use This Book
Acknowledgments
Begin Reading
Appendices – Tools to Support Coaching and Communication Skills Learning Sessions
Appendix A: 20 Communication Skills
Appendix B: Coaching Process Card
Appendix C: Communication Skills Checklist
Index
WILEY END USER LICENSE AGREEMENT
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Developing Communication Skills for Veterinary Practice
Jane R. Shaw, DVM, PhD
Professor
Department of Clinical Sciences
College of Veterinary Medicine and Biomedical Sciences
Colorado State University
Fort Collins, Colorado, USA
Jason B. Coe, DVM, PhD
Professor
Department of Population Medicine
Ontario Veterinary College
University of Guelph
Guelph, Ontario, Canada
Copyright © 2024 by John Wiley & Sons, Inc. All rights reserved.
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Library of Congress Cataloging‐in‐Publication Data
Names: Shaw, Jane R., author. | Coe, Jason B. (Jason Bradley), author.Title: Developing communication skills for veterinary practice / Jane R. Shaw, Jason B. Coe.Description: Hoboken, NJ : Wiley‐Blackwell 2023. | Includes bibliographical references and index.Identifiers: LCCN 2022059959 (print) | LCCN 2022059960 (ebook) | ISBN 9781119382713 (paperback) | ISBN 9781119382720 (adobe pdf) | ISBN 9781119382751 (epub)Subjects: MESH: Veterinary Medicine–methods | Communication | Professional‐Patient RelationsClassification: LCC SF610.5 (print) | LCC SF610.5 (ebook) | NLM SF 610.5 | DDC 636.089–dc23/eng/20230323LC record available at https://lccn.loc.gov/2022059959LC ebook record available at https://lccn.loc.gov/2022059960
Cover Design: WileyCover Images: © kali9/Getty Images; Pressmaster/Shutterstock; Juice Flair/Shutterstock; Seventyfour/Adobe Stock Photos
We dedicate this book to our parents.
Evelyn and Donald Shaw provided me with every opportunity and endless love and support to follow my dreams of becoming a veterinarian. ∼ JRS
Bruce and Frances Coe, to whose absolute support I owe everything. ∼ JBC
About the Authors
Neither of us knew when we first met in 1999 that two‐and‐a‐half decades later, we would be writing a book together on veterinary communication. At the time of our first meeting, Jane Shaw was a graduate student enrolled in the Department of Population Medicine at the University of Guelph with a veterinary degree from Michigan State University, and Jason Coe was a third‐year student veterinarian at the Ontario Veterinary College (OVC), University of Guelph. We met fortuitously one Saturday morning in OVC's Veterinary Teaching Hospital Wellness Clinic, a student‐centered primary care service, where Jane was practicing, teaching, and supervising students, and Jason was volunteering to gain more clinical experience prior to graduation.
With a focus on clinical communication, we both completed doctorates in veterinary epidemiology under Cindy Adams, MSW, PhD, who implemented the first veterinary communication curriculum in North America at OVC. In addition, we spent time in clinical practice, which informs our teaching and research in veterinary communication. Jane spent 10 years in academic and private practice in companion animal medicine, whereas Jason's 9 years of clinical experience were rooted in mixed animal followed by food animal practice.
We also have decades of experience as dedicated educators, teaching students in two of the leading veterinary communication programs in North America. In these roles, we continue to develop skills‐based, learner‐centered clinical communication curricula, which received commendations from the American Veterinary Medical Association Council on Education for innovation. We are committed to student veterinarians' and, more broadly, veterinary professionals' success in practice by equipping them with a toolbox of communication skills to manage both routine and challenging client and team conversations. The result is reflected in positive alumni ratings of our programs and the career performance and testimonials of our graduates.
As leaders in the field, we often venture out of the classroom to speak nationally and internationally to veterinary professionals at conferences and continuing‐education events. We participate in and offer intensive interactive communication workshops with strong reputations for transforming the practice of veterinary medicine. We coach veterinary professionals in their examination rooms as they communicate with their clients and care for their patients. Through these experiences, we are privileged to witness individuals and entire practice teams taking their communication skills to the next level. Veterinary professionals reap benefits in the form of increased practice performance, client satisfaction, client adherence, patient health, and career fulfillment.
In addition to teaching and coaching, a significant component of our professional identities is developing and conducting evidence‐based research in veterinary communication. As trained epidemiologists, we implement research in the field, often video‐recording client interactions in veterinary practices and interviewing key informants, including veterinary professionals and their clients. In writing this book, we translate our research findings into hands‐on recommendations to enhance interactions in veterinary practice. In all these endeavors, we maintain a pragmatic view where we strive to be practical, skills‐focused, and outcome‐based. In doing so, we hope to enhance uptake of new approaches, change habits, and maximize results.
In veterinary practice, much meaning stems from day‐to‐day conversations with veterinary team members and clients. Veterinary professionals empowered with communication tools enjoy more satisfying interactions and relationships and affirmation of their day‐to‐day work in veterinary medicine. And when discussions do go awry, as they will, veterinary professionals with the skills and capabilities to manage difficult conversations experience less stress and derive more fulfillment.
For 25 years, we took note of what we learned individually and together and packaged it up for you. This book offers proven methods that withstood the test of time in academic and clinical settings among diverse veterinary professionals. Now it's your turn. Are you curious to see where the rubber meets the road in your interactions? If so, throughout this book, we help you develop your communication toolbox to enhance your daily exchanges with clients, colleagues, and beyond.
How to Use This Book
We would like to begin by sharing our underlying intentions for developing this communication resource and by highlighting a number of unique aspects of the book. We strove for this book to be user‐friendly, accessible, practical, and applicable to all members of the veterinary team. We hope the book is used as a communication skills operating manual; we expect the cover to become coffee‐stained, sections to be highlighted and underlined throughout, and pages to be marked and dog‐eared.
The book is organized into tasks of the clinical appointment, with chapters flowing from opening‐the‐interaction, information‐gathering, and attending to relationships and tasks to diagnostic and treatment planning, and closing‐the‐interaction. In each chapter, we showcase key communication skills integral to achieving these tasks. We define the communication skill, demonstrate techniques, and provide examples. Over the course of the book, we introduce a communication toolbox including 20 communication skills.
We emphasize the importance of effective communication with clients and colleagues. In each chapter, we present routine and challenging scenarios in day‐to‐day practice, and we model how to use the communication skills in both caregiver and collegial interactions. How you communicate with your clients is the bread and butter of your business and establishes long‐term client relationships and a strong client base. How you communicate with your colleagues defines the veterinary practice culture, which is integral to creating a healthy, functional workplace environment in which employees thrive.
At the end of each chapter, we offer learning activities to work through, individually or collaboratively, in a small group or with the entire practice team. Through these exercises, we outline a developmental curriculum to build a strong communication toolbox. The book provides ample opportunities to practice the communication skills through either a self‐led or guided experiential learning process. The tasks progress from easier, structured, low‐risk approaches (e.g. skill spotting exercises, guided reflections, and individual role‐play) to more challenging, small‐group, high‐stakes methods (e.g. in‐the‐moment coaching or communication and video‐review rounds). Over time, the focus shifts from personal communication skill development to coaching and mentoring colleagues.
One key takeaway is that the communication toolbox is transferable to all areas of veterinary practice, to any career path, and to one's own personal life. Although this book is situated in companion animal primary care, the communication tools are critical to success and fulfillment in both general and specialty practices, and in equine, livestock, avian, exotic, zoo, and wildlife medicine. They are equally important for working in laboratory medicine, governmental and non‐governmental agencies, public health, regulatory medicine, and industry – not to mention supporting the inter‐ and intra‐professional communication that is instrumental in the referral DVM‐specialist relationship, as well as in developing partnerships with vendors, behaviorists, groomers, doggie daycare providers, breeders, and crematorium directors. Finally, these are life skills, and they work well with spouses, partners, children, other family members, and neighbors and at book clubs, on ballfields, or in volunteer organizations.
We take into consideration the myriad of ways in which we communicate with our clients and colleagues. Face‐to‐face interactions still predominate, followed by telephone and then electronic communication (e.g. email or text) or virtual care. Each method has its own purpose and special considerations and can be highly effective in getting a message across. Unfortunately, if used inappropriately, each modality can result in miscommunication and challenges.
Furthermore, we weave in aspects of technology that can enhance or detract from communication. As with any tool, technology has its time and place. It is critical to know when and how to use each type, from the telephone, whiteboards, and printed care instructions to treatment plans sent via email, or interactive video consultations. In the “Talk through Technology” section of each chapter, we outline best practices for complementary use of technology.
As leading researchers in veterinary communication, we also share Research Spotlights that highlight relevant findings from our veterinary communication studies. Two strong evidence‐based books, one on medical communication (Silverman et al. 2013) and the other on veterinary communication (Adams and Kurtz 2017), provide a more thorough and extensive review of the broader clinical‐communication literature. Our emphasis is on translating our research into practice – how to apply the findings to real‐life scenarios that will inform and enhance client and colleague interactions, develop the veterinary practice, and further veterinary careers.
Here are our 12 recommendations for how to get the most out of this book:
Capitalize on strengths.
Be aware of your communication assets on the table. Know what they are and how they work. Then use this book to fine‐tune, dust off, or sharpen communication skills that may be currently underutilized.
Stretch outside your comfort zone.
Try on the communication skills, even if they do not “fit” at first. Start with learning the stem phrases, then implement the scripted examples, and, finally, improvise and own the skills. It may feel fake or artificial at first; however, with continued application and adaption of the skills to fit individual styles, over time the skills will feel natural, authentic, and genuine.
Be forgiving, and let go of perfection.
Practice makes better, not perfect. Communication competency has a high ceiling, like many other clinical skills – clinical reasoning, surgery, or interpreting test results. Strive to be a good communicator, know that mistakes will be made, and make a recovery when it does not go as liked. The resulting relationship is often stronger after repairing a mishap.
Self‐reflect, and be courageous.
Be fearless, vulnerable, and open to taking a good hard look at the current communication skills in your toolbox. Regrettably, our perceptions of our communication competence are far from accurate. So, self‐reflect on client and colleague interactions, and be bold and request feedback from mentors and peers to identify blind spots.
Engage with this book.
Each chapter includes a traditional knowledge component to foster awareness and understanding of communication concepts. And an interactive section with learning exercises that provide opportunities to practice the skills, identify strengths and challenges, and set learning goals for continued development.
Keep a journal, and document progress.
Before embarking, start a communication journal to capture insights, lessons learned, and communication goals and to mark growth, progress, and milestones. Look back in the pages to see the headway made and be accountable for achieving objectives.
Apply the skills with clients and colleagues
. Use these communication skills to transform day‐to‐day client interactions, address challenging conversations, and lend a compassionate ear to clients. Do the very same thing with colleagues to create a veterinary team culture characterized by strong communication, morale, teamwork, and retention. Enhance self‐esteem and confidence. Enjoy going to work. And make a difference in the lives of colleagues, clients, and patients.
Read this book multiple times with different intents
. For example, on the first read, work on building your communication skills toolbox. Then, the second time, lead your team or veterinary practice through the exercises, developing their skills and coaching techniques. On the third read, mentor others on the practice team while they coach their colleagues. The goal is to create a critical mass of individuals to build, lead, and sustain a communicative and collaborative team culture.
Teach the team the communication skills.
It takes a village in a veterinary practice to serve clients and care for patients. Set colleagues up for success by equipping them with the communication skills they need to excel in their positions. Set the practice up for success by expanding the team of effective communicators and delegating appropriate conversations (e.g. agenda‐setting, preventive care education, follow‐up progress calls, or sharing diagnostic test results).
Be creative in involving the team
. Depending on the personality, character, and culture of the team, make it fun by designing communication role‐plays,
Jeopardy
, or “choose your own adventure.” Or, as the team implements skills, set goals, assess metrics, and monitor trends, such as changes in appointment efficiency, veterinarian average client transaction, or client reviews. Ask teammates who model exemplary communication skills to mentor and coach colleagues.
Get a leg up or a new lease on practice.
For new employees or early‐career veterinary graduates, the communication skills ease the professional transition. Entering with a well‐equipped communication toolbox promotes victories and reduces failures associated with trial and error. For late‐career veterinary professionals, these communication skills reignite and reinvigorate “the why” – to enjoy meaningful interactions with colleagues and clients and to care for patients.
Take the communication skills home.
Use these communication skills when interacting with clients, colleagues, family members, neighbors, and friends, and see how they change life in and outside the veterinary practice. Reap the rewards in client and collegial interactions, as well as in family and social life, leading to more fulfilling conversations and deeper connections.
Suggested Timeline
To set realistic expectations and maintain momentum, we suggest the following timeline as guidance for how long it will take to complete each chapter and the associated learning exercises individually or as a practice team:
Chapter 1 – Introduction – 1 week
Chapter 2 – Communication Styles – 3 weeks
Chapter 3 – Opening‐the‐Interaction – 2 weeks
Chapter 4 – Information‐Gathering – 6 weeks
Chapter 5 – Attending to Relationships – 3 weeks
Chapter 6 – Attending to Tasks – 3 weeks
Chapter 7 – Diagnostic and Treatment Planning – 8 weeks
Chapter 8 – Closing‐the‐interaction – 2 weeks
Chapter 9 – Communication Coaching – 6 weeks
Chapter 10 – Transferring the Skills to Various Contexts – 2 weeks
Chapter 11 – Now What? – 2 weeks
Total: 38 Weeks – Approximately 9 months
References
Adams, C.L. and Kurtz, S. (2017).
Skills for Communicating in Veterinary Medicine
. Parsippany, NJ. Dewpoint Publishing.
Silverman, J., Kurtz, S., and Draper, J. (2013).
Skills for Communicating with Patients
. London, England. CRC Press.
Acknowledgments
This book is the culmination of decades of trials and tribulations and collaborations and contributions. First, we thank our mentors in veterinary medicine, Dr. Cindy Adams and Dr. Brenda Bonnett, and colleagues in human medicine Dr. Suzanne Kurtz and Dr. Debra Roter; they are pioneers in their fields and laid a rigorous foundation. Second, we are grateful to all the student veterinarians, graduate students, simulated clients, communication coaches, coordinators, and co‐instructors we worked with through the years. They taught us more than we taught them and left lasting fingerprints on our knowledge and programs. Third, we recognize the support and advocacy provided by our colleges, deans, associate deans, and department heads, who envisioned the future, invested, and committed to equipping veterinarians with communication skills for success. Finally, many veterinary clinics opened their doors, hearts, and minds to participate in live learning laboratories to put our teachings into practice.
Specifically, we appreciate individual contributions to this book. We are indebted to Dr. Susan Ring deRosset, who served as our editor. Her combined veterinary and literary background provided instrumental suggestions that shaped this book. Courtney Hensel contributed to formatting and layout; Maddi Funk created the figures; Catherine Groves assisted with final edits; Dr. Naomi Nishi who provided counsel on justice, equity, diversity, and inclusion; and Dr. Tracey Jensen, Dr. Elizabeth Alvarez, and Lorna Wyllsun reviewed early versions of chapters and provided feedback.
And far from last, our families who nurtured us in becoming and supported us as veterinarians and academicians; it would not have been possible without their unconditional love and care. The support of friends and social outings and adventures provided respite and fueled creativity. Our own companion animals provided unconditional love, poignant life lessons, and lived meaning of the human‐animal bond.
1Introduction
Abstract
In this chapter, we lay the groundwork for why it is worth investing in developing a strong communication toolbox consisting of 20 communication skills with proven success. We begin with recognizing that communication skill‐building takes practice and time. Then we argue that communication is both a science and an art. The science of communication entails using the skills with purpose and intention. The art of communication requires using the skills adeptly not only in straightforward interactions but also in nuanced, complex, challenging, and high‐stakes situations with diverse individuals. We acknowledge the stressful context of a busy veterinary practice and the daily challenge of attending to tasks (i.e. getting work done) and relationships (i.e. building trust with clients and colleagues). Being successful and striving for the right balance requires establishing long‐term relationships with clients and colleagues. And we emphasize that team communication makes the difference between a healthy practice environment and a dysfunctional one. We conclude that embracing both roles – as animal healthcare experts as well as partners to our clients and colleagues – promotes positive outcomes for the veterinary practice and our colleagues, clients, patients, and, importantly, ourselves.
SELF‐ASSESSMENT QUESTIONS (True or False) See the end of the chapter for the answer key.
Effective communication can be learned through practice, feedback, and coaching.
Effective communication is critical to achieving significant outcomes for the veterinary practice; with colleagues, clients, and patients; and self.
Effective communication is integral to maintaining and sustaining a healthy practice culture and interprofessional relationships.
Effective communication takes more time.
Communication Matters
Communication is the most common clinical procedure performed daily in veterinary practice and prevails in every client and colleague interaction. For client service coordinators specifically, their entire day is spent communicating with others. A veterinary professional involved in 20 appointments per day will engage in more than 200,000 client interactions over a 40‐year career (Shaw et al. 2012). This does not account for the too‐numerous‐to‐count colleague‐to‐colleague conversations. The final sum is an astounding number of exchanges.
Everyone on the veterinary team plays a vital communication role. It takes a village to run a veterinary practice, care for people and their animals, and establish a functional practice team culture. Every conversation with clients and between colleagues impacts outcomes for the veterinary practice, and the resulting social dynamic affects veterinary practice team members, the clients served, and the patients cared for. Communication makes or breaks practice financial metrics, teamwork and morale, client satisfaction and adherence, and patient health. The return on developing veterinary team communication competence is multifold and an investment in patient care, client service, and team coordination. It literally pays dividends to invest in communication skills.
Equip Your Communication Toolbox
This book highlights 20 communication skills with proven success in navigating diverse clinical scenarios (Sidebar 1.1) (Appendix A). Taking a skills‐based approach means we do not need a specific strategy for each routine or difficult conversation. Instead, we carry our toolbox to each scenario and pick the appropriate tools to accomplish the task. As a result, we are ready, agile, and adaptable to meet all day to day communication circumstances that present in veterinary practice.
Sidebar 1.1 Skills in the Communication Toolbox
Preparation
Introduction
Agenda‐setting
Open‐ended inquiry
Closed‐ended inquiry
Pause
Minimal encouragers
Reflective listening
Nonverbal behaviors
Empathy
Partnership
Asking permission
Logical sequence
Signpost
Internal summary
Easily understood language
Chunk‐and‐check
End summary
Contracts for next steps
Final check
We rely on our communication toolbox to guide most routine client interactions, from preventive care topics, such as vaccinations, weight management, and dental hygiene, to complex end‐of‐life conversations, medical errors, and financial discussions. Equally important, bring our tools to collegial conversations; use them when interviewing potential employees, hosting team meetings, and conducting performance reviews. These skills are indispensable and an important part of every veterinary professional's development. Although all communication skills are highly pertinent and critical for success (Adams and Kurtz 2017; Silverman et al. 2013), effective communication requires a lifetime of mastery. So, as a starting point, we chose 20 foundational communication skills to stock the toolbox: once acquired, expand upon them.
Practice, Practice, Practice
Just like learning any clinical skill, such as navigating new practice management software, performing a surgical procedure, or interpreting radiographs, communication skill‐building takes practice and time. We obtain the baseline knowledge through reading, attending a lecture, or completing an online module. Where the rubber meets the road is testing our competency in everyday practice. Once we get the underlying principles and concepts under our belt, the best way to learn communication skills is to “just do it.” This allows us to apply our understanding of effective communication and form good habits through practice and experience.
The learning ladder (Figure 1.1) depicts four stages of learning new communication skills, from raising awareness to reaching mastery (DePhillips et al. 1960, Wackman et al. 1976). We do not know what we do not know. The first step is obtaining knowledge to raise awareness, answering for ourselves such questions as “What is the communication skill?”, “What does it sound like?”, and “When, why, and how might I use it?”
Figure 1.1 Learning ladder. Adapted from Wackman, Miller, and Nunnally, (1976) Student Workbook: Increasing Awareness and Communication Skills‐with permission from Interpersonal Communication Programs, LLC, Evergreen, CO. USA.
Awareness (we know what we do not know) is followed by a period of awkwardness as we put the new skill into practice. This stage is messy, feels inept, and demands courage, patience, perseverance, and a big, heaping dose of self‐acceptance until we are consciously skilled. Like learning anything new, communicating differently feels strange and sounds unnatural; the words do not always come out right at first. This necessitates a shift in mindset away from expecting perfection to embracing the awkward.
With more feedback, practice, and reflection, communication skills fall into place. Initially, using a communication skill requires a great deal of mental effort, concentration, and purposeful intent, like when we learn to ride a horse, pedal a bike, drive a car, or ski. Eventually, proficiency is achieved, competence becomes unconsciously integrated, and the skills are automatic and habitual.
This learning process demands being forgiving of ourselves, letting go, and being all right with not getting it right the first time around. Dr. Tracy Jensen, a primary‐care veterinarian, consultant, and communication coach at Colorado State University College of Veterinary Medicine and Biomedical Sciences, says, “If you are not falling, you are not skiing hard enough.” If we are not stretching ourselves outside our comfort zone, we are not learning. So, lean into the challenge of learning these communication skills and welcome the initial clumsiness that is often on the path to competence.
Appreciate Communication is An Art and a Science
Communication is about establishing trust and achieving outcomes. The field of medical communication was founded in 1968 (Korsch et al. 1968) and veterinary communication in 1988 (Antelyes 1988), and research touting the benefits of effective communication in healthcare is robust and persuasive. Thousands of studies in medical communication, including randomized clinical trials (Silverman et al. 2013), and hundreds of studies in veterinary communication (Adams and Kurtz 2017) inform best practices. The communication toolbox provided in this book is fortified by a database of literature and evidence‐based recommendations.
You might recall a role model sharing, “It's not what you say, it's how you say it”; truthfully, it is both. Communication content is what we say (i.e. the science), and it comprises the biomedical background and experience required for effective information‐gathering and client education. The communication process is how we say it (i.e. the art), or how we come across when we ask questions, provide explanations, or support decisions. For the message (the content) to be received, it comes down to our delivery (the process), which requires paying close attention to the communication skills used.
The science of communication entails using the skills with purpose and intention. Many of us did not receive formal training in communication skills and were schooled painfully by trial and error. With knowledge of communication skills and their impact on clinical outcomes – like choosing instruments from a surgical pack – we select the best communication tool or tools at the appropriate time to target and achieve our sought‐after outcomes.
The art of communication reflects our ability to apply the skills adeptly not only in straightforward interactions but also in nuanced, complex, challenging, and high‐stakes situations with diverse individuals. One size does not fit all. An indication of communication mastery is the ability to be fully present in the moment, quickly assess the scenario, and implement our communication skills accordingly. A high level of proficiency is also demonstrated in keen self‐awareness, noticing when an interaction goes off the rails, and the ability to make a prompt repair and recovery.
Build, Maintain, and Sustain Relationships
A common retort we receive during communication workshops is “I'm not a counselor.” So, let's get this straight up front: we are not asking, expecting, or training you to be or become a therapist, as you, a veterinary professional, are not equipped or licensed to provide psychological counseling. However, we are strong proponents of building relationships and supporting clients and colleagues for success in veterinary practice. Dr. Matthew Johnston, an avian, exotic, and zoo veterinarian and communication coach at Colorado State University College of Veterinary Medicine and Biomedical Sciences, says, “If you use effective communication, you won't need to be a counselor.”
Veterinary medicine was established in the eighteenth century with a focus on animal healthcare. With the cultural shift in our views and uses of animals and the transformation of the human‐animal bond, it is now a “people profession.” Veterinary medicine serves animals and the people who care for them. The daily challenge in a busy practice is balancing attending to tasks and relationships. It entails embracing both roles – as animal healthcare expert as well as partners to our clients and colleagues.
The desire to help our patients using the scientific mind leads us naturally down a path of “find it, fix it.” There's a downside, however, to this apparent efficiency. We miss things. Make assumptions. Make a mess of an interaction, even misdiagnose. When drilling clients, like a detective interrogating their suspect, we drive our agenda forward and neglect to invite client contributions. With insufficient information‐gathering and understanding, we prescribe treatments that a client cannot administer, afford, or get on board with. In our rush to finish the appointment on time, we unintentionally run over the animal's advocate. The result is a time‐consuming snarl to untangle, and efficiency goes out the door.
Retired emergency veterinarian and Colorado State University College of Veterinary Medicine and Biomedical Sciences communication instructor, Dr. Sam Romano says, “Go slow to go fast.” This means listening more, being curious, and acknowledging client perspectives, backgrounds, and experiences. Doing so pays off with efficiencies later in the interaction. We are often fearful of opening a can of worms and not knowing what to do with them, or how to respond to, what is shared. And we are always afraid of running behind. It seems paradoxical, but slowing down now with a client and showing patience and the courage to listen reaps rewards and time savings in the end. Take the time to be present. Empathize and collaborate to build trust, buy‐in, and commitment – these are the critical ingredients for client adherence, satisfaction, and long‐term client retention.
Enhance Clinical Outcomes
Communication impacts clinical outcomes at every level – for the veterinary practice; our colleagues, clients, and patients; and, importantly, ourselves (Sidebar 1.2). From generating a sustainable client base to retaining talented team members to ensuring that our patients receive the care they need, it all comes down to communication. Be purposeful and intentional, focusing on communicating, to achieve desired outcomes with colleagues, clients, and patients.
Sidebar 1.2 Clinical Outcomes of Effective Communication
Veterinary Practice
Enhance efficiency
Reduce malpractice claims
Improve practice performance
Veterinary Team
Foster satisfaction
Clients
Increase recall and understanding
Promote adherence
Cultivate satisfaction
Patients
Boost health
For the Veterinary Practice
Enhance Efficiency
Time management is one of the greatest day to day challenges in veterinary practice. A common misperception is that partner‐oriented appointments take longer. Building relationships is the ticket to getting down to business. Invite clients to share their thoughts, feelings, and ideas; and listen closely, as clients who feel heard are ready to problem‐solve, tackle decision‐making, and accept a plan.
To better manage appointment time, elicit the client's agenda up front to meet their expectations and mindfully structure the appointment (Dysart et al. 2011). If unable to address all the client's concerns, prioritize – and seek alternative approaches, such as a drop‐off or a recheck visit. Pace with the client during diagnostic and treatment planning to identify concerns and address obstacles, detours, or roadblocks in the moment. Ask “What else?” throughout the appointment to avoid an “Oh, by the way” moment at the end (Dysart et al. 2011).
Reduce Malpractice Claims
A strong foundation of trust and a resilient client relationship provide a cushion when things go wrong. Set a tone of collaboration upfront, make authentic connections with clients, and ask them about themselves. Listen to their stories and how they share observations on the animals with whom they live and believe in the client's expertise. Build rapport to enhance information‐gathering and subsequent diagnostic accuracy to minimize medical errors (Dinsmore and McConnell 1992). A trusting relationship carries the partnership through good times and bad. Clients know that we as veterinary professionals are imperfect human beings. When we let clients see our goodwill, compassion, and underlying intention to keep their best interests in mind, regardless of outcome, they will be more understanding and forgiving.
Improve Practice Performance
Communication that builds client and collegial relationships is the bread and butter of a successful veterinary practice. Connect with clients to enhance efficiency (Dysart et al. 2011), promote client adherence (Kanji et al. 2012) and satisfaction, and improve patient health – all of which directly affect the bottom line. Revenue is generated when patients receive the healthcare they need and clients the quality service they expect. The result is meeting the metrics of practice success, including average client transactions, return client visits, client referrals, a healthy client base, and positive client reviews, while attending to patient care. A base of loyal clients is critical to practice financial performance, and so is a core team of content and dedicated employees. Equally important is the recruitment and retention of talented team members, resulting from appreciation and recognition, opportunities for professional development, and a healthy workplace culture (Moore et al. 2014; Pizzolon et al. 2019).
For the Veterinary Team
Foster Satisfaction
Professional wellness is a major factor in the health, well‐being, and longevity of veterinary professionals (Nett et al. 2015). The ability to successfully navigate difficult discussions is related to veterinarian and client well‐being. When unsuccessful, veterinarians experience a reduced sense of well‐being and job satisfaction, increased emotional strain, and detrimental client impact. For example, facilitating the euthanasia decision‐making conversation was found to be more challenging than performing the euthanasia procedure (Matte et al. 2019).
One of the protective factors against compassion fatigue is the fulfillment derived from interactions with teammates and clients (Cake et al. 2015). Client and team interactions are a source of professional fulfillment (Moore et al. 2014; Pizzolon et al. 2019; Shaw et al. 2012) and reduce stress and burnout (Moore et al. 2014, 2015). Improving teamwork reduces medical errors, a major stressor for veterinary professionals (Cummings et al. 2022). Enjoying work with our clients and colleagues boosts team morale and makes the veterinary practice a fun, engaging, and empowering place to work.
For Clients
Increase Recall and Understanding
It is often challenging for clients to comprehend all the details, jargon, and descriptions related to their animal's disease, diagnostic tests, or treatment plan. Before launching into one of our well‐honed spiels, in the name of client education, stop and assess what the client knows already, to tailor information directly to them. Gauge the depth of their knowledge, and identify their communication preferences to provide the level of detail they desire and present information in a way that makes sense to them. To enhance client understanding, translate foreign medical terminology and speak in layman's terms. Take complex medical concepts and break them into bite‐sized pieces. Invite clients to ask questions throughout the appointment, check in frequently, and ask them to repeat back what they are hearing to increase their recall and understanding (Stoewen et al. 2014a).
Promote Adherence
Clients are more likely to accept recommendations from a professional with whom they have a trusting relationship. Trust‐building starts with identifying our clients' concerns, goals, expectations, and priorities up front so we meet their needs (Dysart et al. 2011). To further develop the relationship, provide empathy, care, and compassion and offer partnership throughout the visit. Elicit client’s perspective to identify their caregiving strengths and potential challenges that need to be overcome. Then tailor a plan that fits the client and patient. Involve the client at every step, as an actively engaged client is more likely to adhere to recommendations (Kanji et al. 2012).
Cultivate Satisfaction
In many regions, clients have choices when seeking veterinary care for their animals. Interestingly, their decisions are not based on our grades in veterinary school, diagnostic brilliance, or surgical ability, but rather on their perception of how much the veterinary team cares (Brown and Silverman 1999). As Theodore Roosevelt said, “People don't care how much you know, until they know how much you care.” It is the one‐on‐one relationship that often brings a client back, so invest in clients and their pets to foster long‐term relationships and retention. How much we care comes through in the way we interact with the animal, introduce ourselves, listen to the client's concerns, provide support, and demonstrate interest in, relate to, and connect with the client (Coe et al. 2008; Stoewen et al. 2014b).
For Patients
Boost Health
Clients are our conduit for applying our medical knowledge and delivering the medical care that pets need. As veterinary professionals, we need to build trust and engage clients as partners in their pet's healthcare. We rely on the client to share key data to make an accurate diagnosis, to give permission for diagnostic and treatment options, and to provide at‐home nursing care for the pet.
Foster Veterinary Team Culture
Day to day interactions between veterinary colleagues, ranging from social chit‐chat to critical life‐saving instructions, are the foundation of team communication. Highly functional team conversations build a practice environment of trust and respect. And a trusting practice culture creates positive work processes, promotes colleague recruitment and retention, and fosters team engagement, morale, and satisfaction.
Team communication makes the difference between a healthy practice environment and a dysfunctional one; enjoying work or dreading it; flourishing in an open and trusting atmosphere or wilting from gossip, back‐stabbing, competitive one‐upmanship, and tip‐toeing around each other; and taking initiative or being fearful of making a mistake (Moore et al. 2015). It's not surprising then that a colleague's decision to quit or dedicate their life's work to our clinical practice comes down to the quality of the practice culture. Highly functional teams nurture fulfillment, contentment, and meaning, which preserve a long career in veterinary medicine (Moore et al. 2014; Pizzolon et al. 2019).
Coordinate Relationships
Veterinary teams with high relational coordination possess common goals, share knowledge, and demonstrate mutual respect (Gittell 2003). With shared goals, team members envision common targets and outcomes and value working together to achieve them. With shared knowledge, colleagues not only appreciate each other's roles and empathize with each other's challenges but also are competently cross‐trained to step in for each other when needed. The emphasis on interdependence engenders mutual respect, as individuals recognize, grasp, and appreciate the contributions of others.
Achieving relational coordination within a veterinary team requires frequent, timely, accurate, and problem‐solving communication (Gittell 2003). The team “spider web” (Figure 1.2) depicts the communication pattern of relational coordination. When team members communicate and check in regularly with their colleagues, they manifest their best selves within their roles and responsibilities and those of their colleagues. On the other hand, the spider web portrays how easy it is to unintentionally drop information between hand‐offs, forget to pass a message on, or exclude someone from a conversation.
Establishing relational coordination means balancing team communication that nurtures relationships (i.e. builds a cohesive team) while completing tasks (i.e. gets the work done). This is a difficult juggling act in a hectic environment. Often the day to day demands of a fast‐paced veterinary practice favor task‐oriented communication over relational, placing team engagement at risk.
The challenge is looking at each individual interaction and how it contributes to team building, function, and effectiveness. This focus pays off in dividends, including career satisfaction and fulfillment (Moore et al. 2014; Pizzolon et al. 2019), improved task efficiency (Gittell 2009), healthier patients (Gittell 2009), decreased burnout and cynicism (Moore et al. 2014), and reduced costs of care (Gittell 2009). The bottom line is creating a supportive, engaging, creative, and productive workplace that fosters fun, enjoyment, and fulfillment for all.
Figure 1.2 Relational coordination.
Adapted from Gittell (2009) with permission.
Make Time to Communicate
Over the years, one of the most common rebuttals we hear in teaching communication to veterinary students and professionals is “I don't have time for this.” It is not the quantity of time spent with clients that is ultimately of greatest importance; it is the quality of the time together. For both the client and the veterinary professional, being distracted and hurried detracts from the experience, while being present and engaged nourishes the interaction. Client adherence is reduced when veterinary professionals are perceived as rushed (Kanji et al. 2012).
Reflect upon the “quantity versus quality” proposition, and assess your practice culture – is it defined by high‐volume quantity or high‐touch quality of appointments? The differentiator tends to be appointment length – 10‐ to 15‐minutes in high‐volume clinics compared to 20‐ to 30‐minute appointments in high‐touch clinics. A mixed model is flexible scheduling, such as 15‐minutes for a recheck examination, 30‐minutes for a wellness appointment, 45‐minutes for a sick‐pet appointment, and 1‐hour for a new puppy or geriatric visit.
Especially in fast‐paced, high‐volume practices, prudent implementation of top‐notch communication skills improves client service and patient care when there is not a minute to spare. Effective communication is possible during even the shortest appointments; doing so is challenging and requires a highly skilled and attentive communicator. The key is providing an opportunity for clients to share and feel heard. These relationship‐centered appointments can be more efficient than traditional biomedically oriented appointments (Shaw et al. 2006).
The aim of this book is to create highly skilled and attentive communicators. We hope to compel you to invest in developing your communication skills and equip you with a strong communication toolbox to build relationships with clients and colleagues. Then use the communication skills with purpose and intention to achieve clinical outcomes for the practice, your colleagues, clients, patients, and, importantly, yourself. We wish for each of your interactions to foster a long‐lasting, fulfilling, and meaningful career in veterinary medicine.
Answer Key
Effective communication can be learned through practice, feedback, and coaching. [True]
Effective communication is critical to achieving significant outcomes for the veterinary practice; with colleagues, clients, and patients; and self. [True]
Effective communication is integral to maintaining and sustaining a healthy practice culture and interprofessional relationships.[True]
Effective communication takes more time. [False]
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2Communication Styles
Abstract
This chapter acknowledges that a paradigm shift is underway in the veterinary profession's relationship with clients. Today, more than ever, clients expect excellent customer service. Clients share strong bonds with their pets, conduct research on the internet, and speak out in reviews if their needs are not met. Clients are moving away from the previous paternalistic relationship and toward a collaborative partnership with their veterinary care provider. Many clients are no longer content with passivity and prefer to take an active role in the decision‐making process and their animal's healthcare. The same is true in the workplace: veterinary colleagues want to be valued for their unique contribution, be engaged in their roles and responsibilities, and play an integral part on a high‐performing team. In this chapter, we introduce four communication styles, with appropriate times and places to be used when interacting with clients and colleagues.
SELF‐ASSESSMENT QUESTIONS
What is my preferred communication style: being an expert (i.e. taking the lead) or a partner (i.e. sharing the floor)? How does my style differ during client versus colleague interactions?
Think of a client or colleague. How do I determine their preferred communication style (i.e. expert versus partner)? What cues can I observe?
How do I align my communication style with that of my client or colleague, and what is the resulting impact on our interaction?
Introduction
A paradigm shift is underway with respect to the veterinary profession's relationship with clients. Today, more than ever, clients expect excellent customer service. Clients share strong bonds with their pets, conduct research on the internet, and speak out in reviews if their needs are not met. Clients are moving away from the previous paternalistic relationship style and toward a collaborative partnership with veterinary care providers (Coe et al. 2008; Shaw et al. 2006; Nogueira Borden et al. 2010; Janke et al. 2021).
Many clients are no longer content with passivity and prefer to take an active role in the decision‐making process and their animal's healthcare (Coe et al. 2008; Janke et al. 2021). The same is true in the workplace; veterinary colleagues want to be valued for their unique contributions, be engaged in their roles and responsibilities, and play an integral part on a high‐performing team (Moore et al. 2014, 2015; Pizzolon et al. 2019). Therefore, alignment of communication styles is paramount to achieving clinical outcomes for the veterinary practice, team, clients, patients, and ourselves (Sidebar 2.1).
Sidebar 2.1 Improved Clinical Outcomes of Aligning Communication Styles
Increase accuracy
Enhance efficiency
Foster client recall and understanding
Promote client satisfaction
Achieve client adherence
Improve patient health
Enhance veterinary professional satisfaction
Communication styles are the first topic of this book because they influence how to use the individual communication skills that follow in subsequent chapters. These styles reflect personality traits and leadership approaches, which are driven by underlying temperament and character. As a result, we possess a natural communication style that feels most comfortable to us, as well as a default style we lean on when stressed.
Despite possessing a preferred communication style, we flex in the moment beyond our comfort zone to use contrasting approaches as needed. Self‐awareness, quick assessments, a strong communication toolbox, and adaptability are keys to success. In knowing our style and gauging that of others, we are poised to adapt to successfully engaging with clients and colleagues.
In this chapter, we introduce four communication styles, with appropriate times and paces – ideal situations or use – for interacting with clients and colleagues (Sidebar 2.2). We define each communication style, discuss its advantages and disadvantages, and provide scenarios for use. First we illustrate the communication styles in the context of a veterinary professional‐client interaction in the Pearsons' and Titus's recheck visit with Gabe, the veterinary technician; then we apply them to a collegial interaction in a couple of meetings between Marta, the client service supervisor, and Theresa, the practice owner to resolve ongoing concerns about patient congestion at the front desk.
Sidebar 2.2 Communication Styles
Expert‐in‐charge
Expert‐guide
Partner
Facilitator
Set the Scene
Client Scenario: The Pearsons present with Titus, a Staffordshire terrier, to recheck his right eye. Titus presented five days ago with swelling, redness, and third‐eyelid protrusion in his eye. While Gabe, the veterinary technician, focuses on his priorities, the Pearsons' frustration mounts, as they are seeking a collaborative approach to care for Titus.
Team Scenario: Marta, the client service supervisor, is concerned about client and patient congestion at the front desk. Clients are angry about being placed on hold while on the phone and waiting far too long to check in or out. Marta is worried about patient safety with animals so close to each other in the queue at the front desk. The entire client service team is flustered from juggling too many tasks at once. So, Marta, who likes to brainstorm options, requests a meeting with Theresa, the authoritative, no‐nonsense practice owner.
Stepping into Gabe's and Marta's shoes, self‐reflect on the following:
How would I diffuse the Pearsons' frustration and meet them as a partner?
How might I approach “get‐down‐to‐business” Theresa with my concerns?
Adapt Communication Styles to Clients
One Shoe Does Not Fit All
The four communication styles are laid out on the graph in Figure 2.1. Let's walk through the communication styles, from expert‐in‐charge to facilitator. A veterinary professional's placement on the graph is based on who is doing the most talking, the nature of the appointment, and the severity of the medical problem (Lussier and Richard 2008).
Figure 2.1 Communication styles.
Adapted from Lussier and Richard (2008) with permission.
Who Is Doing the Talking?
In Figure 2.1
