For a veterinary practice to be successful, it must strive to deliver the best care to its patients, service to its clients and job satisfaction to its team. To do so relies on a process of continuous assessment, measurement and improvement.
RCVS Knowledge is a charitable organisation whose mission is to advance the quality of veterinary care for the benefit of animals, the public and society. It does this through advancements in evidence-based veterinary medicine and by encouraging and supporting quality improvement initiatives within practices.
Quality improvement (QI) is about inspiring practices to embed a culture of continual improvement and constantly consider what they do, how they do it and how they could do it better. There is a dedicated team for QI within RCVS Knowledge, and the BVRA met up with QI Clinical Lead, Pam Mosedale, to find out more about this initiative.
What is quality improvement and how did it evolve?
Quality improvement is about telling us how we can do it – it’s a systematic approach for us to improve. We define QI as the combined efforts of everyone to make changes that can lead to better patient outcomes, better care and better learning for the team
Clinical governance has always been done in veterinary practices but in a very informal way – it provides a framework on which we can look at what we’re doing and ways to make it better. If clinical governance tells us what to do, then quality improvement is about telling us how we can do it – it’s a systematic approach for us to improve. We define QI as the combined efforts of everyone to make changes that can lead to better patient outcomes, better care and better learning for the team. The QI team have produced tools such as guidelines, resources and CPD courses to enable practices to review, identify and measure certain processes and then provide tools to find solutions. Such tools include clinical audits, benchmarking, significant event audits, guidelines and checklists. Our resources come in a variety of formats, for example podcasts, webinars and real-life case examples, which can help to kick-start the process for a practice new to QI.
Why do we need to be concerned with QI in veterinary practices specifically?
Everyone working in veterinary practice wants the outcome of better care and practice culture. It is the only way we can enjoy continued success and growth. Carrying out clinical audits and measures of existing processes, protocols and standards will highlight which areas need to be improved. Practices are then able to discuss these issues as a team to fix them – quality improvement is not just down to the managers! Listening to team members creates a better culture, a more cohesive and committed team and ultimately improved levels of care.
We are all only human and as such, things do go wrong. A QI focus in practice enables a team to reduce errors and be more efficient and productive in dealing with errors or inefficiencies when they occur. It is about lowering risk and problem-solving – not blame.
Whose responsibility is QI and what involvement can veterinary receptionists have in quality improvement within their practice?
Quality improvement should be carried out with a holistic team ethos; this means looking at things from the perspective of the entire team. Focusing on just one role within the team will not result in efficient problem-solving. Vets tend to focus on the clinical or scientific aspects of a situation or occurrence but perhaps the real underlying issues lie within a different aspect of the patient journey within the practice. An example might be the death of a rabbit under anaesthesia. Vets may look at the anaesthesia protocol, nurses may look at the care given pre- and post-op, but it could be the receptionist that can tell you the rabbit was waiting next to a yappy terrier in reception for a long time before being admitted, meaning it could have been under undue stress prior to the anaesthetic. Involving the whole team gives you the bigger picture and enables the problem-solving to be more realistic.
Quality improvement should be carried out with a holistic team ethos; this means looking at things from the perspective of the entire team. Focusing on just one role within the team will not result in efficient problem-solving
Of course, there are areas of quality improvement that are purely clinical: pre-anaesthetic checklists, for example. However, if the receptionists know about these measures, they are then able to reassure clients better with regard to clinical processes. Similarly, if the practice is aware of national benchmarking standards for veterinary practices and shares this information with the whole team, including their receptionists, it can also be used to offer reassurance and confidence to clients.
For us at the BVRA, learning more about the QI initiative and the resources available has highlighted another area of positive growth for the role of veterinary receptionists and the value the role has in the overall success of a practice. This is a really empowering process for all members of the practice team to be involved in, strengthening a shared direction and nurturing team commitment, which will generate worthwhile and positive results for the practice.