Growing a Culture of Care

Mary Ann Vande Linde, DVM

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As a practice owner or manager, your goal is to have a practice that focuses on a culture of excellent patient care and safety.

Achieving this requires client compliance—and compliance requires protocols. Is your entire veterinary care team aware of what it takes to keep a pet healthy?

After all, clients cannot be expected to comply with your recommendations if staff members aren’t sure what they are. Involving your team in making consistent, incremental improvements is a powerful fuel for your practice’s culture of care, growth, and financial return.

Teamwork without protocols is like using a road map. Teamwork with protocols is like using a navigation system. With a road map we must stop, pull out the map and hope for a road sign to pop up so we can tell if we are on the right road. However, with a navigation system, the team is continuously instructed and coached along the pathway, corrected if they make a wrong turn, guided to the correct location, and comforted with a consistent endpoint in mind. Protocols keep us all heading in the shared direction of patient care. Protocols control the flow of information, keep the record and medical plan up-to-date, increase patient well-being, and decrease suffering of the patient, team, and client. Furthermore, protocols also increase employee retention, improve time management, and grow a practice’s return on investment (ROI).

Protocols reduce the variation in care within the team and between team shifts by providing communication pathways that allow vital communication to be shared with everyone. The Intestinal Parasite/Zoonotic Detection and Prevention Protocol is an example of a protocol organized by team role and is easy to follow. It explains where and how the steps are performed and who is responsible for the task. In the “Prior to Visit” section, a reminder is automatically computer generated when service is due or overdue. When a team follows a consistent protocol, clients are more likely to comply with your recommendations for their pets’ health. All team members should be empowered to give feedback, train, and develop the core message for each protocol. Often a task force or committee, such as policy and procedure, is helpful in finding a collective voice for the team and expediting the protocol creation, revision, and implementation process.

Develop a Protocol


To create a unified team protocol that makes your practice a “compliance superstar,” a brainstorming meeting can be helpful and fun (see How to Run an Effective Brainstorming Session). Remember to break your steps down into small chunks. Many teams stall in the process and become overwhelmed by attempting to change everything at one time. Getting the small chunks in the open and reviewing all the obstacles as a team creates open communication while bringing the total picture to light.

Start with a question like, “What one thing can we do to increase our rate of parasite management compliance?” Then follow the brainstorming instructions. Keep in mind that no idea is too silly or unimportant to be included. If you are thinking, “We’ve tried that idea before,” remember, negative remarks are brainstorm-killers and lower the open-minded exchange.

The goal of a protocol brainstorming session is to determine the top idea elicited from and voted on by the entire group. The group can now begin to create action plans for accomplishing the goal.

To be achievable, it is recommended that protocol planning goals be SMART (specific, measurable, attainable, realistic, and timely). See the May/June 2011 issue of EVT or download the handout ( for information on the SMART format of goal-setting.

Protocol Planner
By using a protocol planner, the team can plan how the top idea will be implemented. In this scenario, the team has decided to increase client compliance with the hospital’s intestinal parasite/zoonotic detection prevention recommendations. The team can set goals and brainstorm all the potential obstacles, including tools and methods needed to overcome said obstacles. Using our example, the brainstorming meeting yielded a set protocol for reviewing the client’s record the day before an appointment. This step allowed greater staff awareness of how practice consistency helps improve client compliance. An additional benefit of protocol creation involves stimulating future team conversations that address scheduling, time management, and auditing charts to ensure patient reminders are in place.

Teamwork with the support of protocols has been found to be one of the key elements that can transform your hospital culture and in turn increase client compliance and the financial health of your practice. A culture that promotes consistent quality in practice improves the cost efficiency of service delivery and creates an energized, focused—and unstoppable—team. Who would not want that? | EVT 


You cannot create instant team protocols, but there are numerous resources available for your use and review. Any of the following are a great place to start and, with your team’s input, can be adjusted to your needs.


  • Preferred Medical Protocols, ed 2 (Johnny Hoskins, PhD, Diplomate ACVIM; AAHA Press) is a useful tool in formulating diagnostic and therapeutic protocols for common conditions seen in small animal veterinary practices. It also comes with a CD ROM.


  • How We Do Things Here: Developing and Teaching Office-Wide Protocols (Nan Boss, DVM; AAHA Press) includes scripts and quizzes for everyone on the heathcare team.

Consulting Services:

Working with a veterinary management consulting firm can provide you with additional guidance on protocol creation and implementation.


Want to grow your culture of care? Develop a protocol for the Microchipping Process. Get started using this handout

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Veterinary Team Brief delivers practical skills for team-based medicine—with clinical strategies for team training, peer-reviewed credibility, concise content, essential training modules, and easy-to-implement protocols. From the publisher of Clinician's Brief.

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