THE Saturday morning session at the 2015 BEVA congress on “The hospitalised horse: horses and their owners” was sponsored by Rainbow Equine Hospital and chaired by Debra Archer, professor of equine surgery at the Liverpool veterinary school.
Gemma Pearson of the Royal (Dick) described “Dealing with the difficult and dangerous horse: a behaviour-based approach”. The value of this work is emphasised by the fact that veterinary surgeons have the highest prevalence of occupational accidents in the civilian population. On a daily basis, dealing with an uncooperative patient is time-consuming, frustrating and potentially or actually dangerous for horse and handlers.
Gemma explained that what we need to do is to use the horse’s learning skill. What behaviourists call “classical conditioning” is just what horses (and people) are doing all the time. It is startlingly simple and essential to survival.
The horse associates Event A with Event B and learns from the experience how to behave the next time it meets the same set of circumstances. For example, it walks into the examination stocks and has cold alcohol poured all over its abdomen. This unpleasant experience is linked with being in the stocks so the horse may never again want to walk into them. Its future behaviour pattern has been set.
“Counter conditioning” is what we do to repair the bad behaviour pattern that we have created. Giving the horse a food reward when it walks into the stocks creates a positive association. The horse is happy; we have it where we want it. Do happy horses heal faster? Whether they do or not, they are easier to handle.
Conditioning can be as simple as rewarding a horse for being caught by scratching it on the withers for a few seconds. You may notice it twitching its lip in response and its heart rate can drop by 10 beats per minute. This process is an example of positive reinforcement in an operant conditioning situation.
The horse is in control. He has made a choice (I will be caught), the action results in wither-scratching (pleasant) which is a positive experience for him and for the human as the horse will be caught more easily next time, expecting a reward.
Negative conditioning is removing what is annoying the horse. A frightened horse moves very fast. A needle-shy horse tosses his head so the vet moves her hand away from his neck. The horse is training the vet: his reaction has achieved what he wants.
Each time the attempt is repeated the horse will toss his head faster and further. This can be reversed by rewarding tolerance of the nasty stimulus. When the vet puts her hand in the saddle region, the horse stands. This needs an immediate response: the hand (the potentially aversive stimulus) is removed and the horse is rewarded. The hand moves up the neck, pressure being released every time the horse tolerates it.
This conditioning can be reinforced by using a clicker, creating a sequence of tolerance (desired behaviour), immediate click and then reward (usually food).
Behaviour modification is effective. It needs to be built up in small increments, each tiny desired reaction being rewarded. It works! It should be part of the core curriculum because it is inherent in all our interactions with our patients: they are conditioning us as much as we are conditioning them.
Coping with complaints
David Green, who practises with Aireworth Vets in Yorkshire and is a claims consultant with the Veterinary Defence Society, gave excellent guidance on “Coping with client complaints”.
While most clients are reasonable, complaints are an inevitable part of practice: 80% of them are based on poor communication, 54% on breakdown in practice procedures.
The three mainstays of client feedback are compliments, comments and complaints. They all need to be listened to, recorded and responded to.
Compliments deserve to be celebrated. Comments need attention, they are a valuable early warning and if they are ignored they can grow into a complaint.
The real complaint is a clear expression of dissatisfaction whether it is given verbally, in writing from the client or even the client’s friend, or from a solicitor or the RCVS.
A complaint feels very personal to the recipient. The initial handling is critical as the person who is the first point of contact in the practice sets the scene for the final outcome. He or she needs to convey genuine concern and commitment to resolving the issue.
Horse owners are deeply attached to their animals; money will buy a new car but the individual horse cannot be replaced. An owner will not see what goes on in a hospital, and may need reassurance, facts and the details of what went wrong.
From the practice’s point of view, it is wise to ascertain whether the client is right. Has he got a point in his complaint, or does he just want to avoid the bill? There are three “As” in handling the complaint, all to do with empathy and active listening. The first “A” is acknowledgement. In talking to the client be aware of body language. Take time and allow periods of silence in between your responses. Record the conversation. Try to decide what is driving the complaint. Ask openended questions and pick up on the key words. If necessary, involve a third party to deal with the resolution of the complaint.
The second “A” is apology. It is pertinent to express sympathy for the client’s unhappiness. This is not accepting liability: leave this decision to the Veterinary Defence Society or other indemnity insurer. An offer of a cash payment to diffuse the situation can be inappropriate and lead to much more trouble.
Listen to the story again and, finally, in the third “A” assure the client that “something will be done”: you can outline the steps of the thorough investigation you are about to undertake. Your aim is to restore the client’s trust in the practice.
If it is necessary to interview staff, be careful and considerate and record all the information. Ideally, all staff should be aware of how to pick up on a complaint, or the rumblings of a potential complaint, and there should be a plan in place so that these bad things are seen as a challenge with the potential for improving weak spots in the practice.
