Dale A. Moore 2014-01-30 23:08:52
The bovine veterinarian plays an important role. Although we don’t know who said it first, “Assumption is the lowest form of communication” seems to ring true more often than not. As bovine veterinarians, one of the biggest assumptions we make when communicating with dairy clients, such as those tasked with treating calves, is that the clients are following our protocols. Unfortunately, that assumption might not be accurate. In a previous article (Bovine Veterinarian, October 2013), John Wenz, DVM, MS, indicated that “Protocol drift has become almost accepted as an inevitability on the dairy.” But does it have to be that way? In this article, we’ll try to convince you of five things about your role in communication by using evidence from medical communication research and “pearls” that our WSU and Cornell research group picked up from interviewing owners, veterinarians, herd and calf managers, and calf feeders and treaters on 54 dairy farms of varying herd size located in the West and the East. • The bovine veterinarian has a significant role to play in helping to create a better dairy business communication climate. • Communication is an essential clinical and business skill. • Effective communication is not an innate talent but a set of learned and honed skills. • Experience alone is not the best teacher of clinical communication. • Effective communication does not take any more time than ineffective communication. The bovine veterinarian has a role to play Regardless of the size of the herd and the number of people employed on a farm, the cows need to be cared for and the chores need to be done. When it comes to health care — whether feeding protocols or treatment, preventive medicine or reproductive procedures — all programs require effective communication with those implementing them to ensure good outcomes. We’ve all been on farms where the dairy business is like a well-oiled machine — no fuss, no muss, and we and our clients are happy with herd performance. Throw a monkey-wrench into the business, like an employee who is not well-instructed in the organization’s culture or does not communicate well with others, and our progress can come to a grinding halt. Examples of different types of organizational cultures include: • Collaborative or “clan-oriented,” family-like structure • Hierarchical or “control-type” culture that focuses on rules and procedures • Creative culture that encourages innovation • Results-oriented or market culture. What type of culture is on our client’s farm? Where do we fit in? We make recommendations and set up protocols for all aspects of animal care, and one check on the system, just like looking at data for herd performance, is ferreting out the lines of communication and where they might have broken down. Do we have a role in dairy business communication? In our research we interviewed five people on one large dairy farm and asked the question: “Do you have written protocols for calf health?” On this farm, everyone said “yes” except for the calf treater. Is this a problem, considering that a veterinarian most likely carefully developed the treatment protocols for the calf treaters to use? Communication is an essential clinical skill In human medicine, a large body of research shows that improving clinical communication can improve the effectiveness of consultations with patients, result in better coordination of care and improve the outcomes of care including patient satisfaction, better understanding, compliance and follow-through, better medical outcomes and fewer medical errors. Transferring those outcomes to the farm, are we interested in improving client satisfaction with our services? Compliance with our protocols? Fewer mistakes in treatments? One set of questions in the interviews we did for our research was about the last calf health problem the farm experienced. Half of the 224 persons interviewed indicated that the veterinarian was the person who decided what changes to make to resolve the problem. However, only one-third of all those interviewed thought that the veterinarian was notified that the problem was resolved. We know that providing feedback to employees is important to reinforce protocols, but feedback to management and to veterinarians from employees is just as important. Communication skills we can learn are based on overcoming the critical barriers. Although language differences are important, other, critical barriers to effective communication exist and include: clients’ issues are not being “heard” (we’re not listening); communication is only one-way; there is no twoway communication on how to implement a recommendation; uncertainty exists about the why of the recommendation; there is no repetition of the procedures; and there is no feedback on how a recommendation is implemented. Effective communication can be learned Most medical colleges and many veterinary colleges have organized, specific training in patient/ client clinical communication. In veterinary medicine, these courses are relatively new and many of us out in practice for a while have not had the opportunity to participate in them. But just like doing a good physical exam on a cow is an essential skill for practice, clinical communication is a similar set of procedures. Do you know how to better prepare for an important client conversation? Did you know that there is only a nine second “trust” window for someone’s first impression of you and whether they are going to believe what you say? Do you really know how to listen actively or gauge the emotional state of the person you are talking to? Do you clarify what you hear? Get an understanding of what their beliefs about a situation are? Demonstrate empathy? Use signposting? Check for understanding? Negotiate a plan for implementation? If you said “no,” or “I don’t know what that is” to any of these questions, there is a communication learning opportunity. A goal of our research was to find the best places to target information for calf care. One thing that we learned from our interviews is that there are a lot of different dairy organizational communication structures out there. Some of the structure depends on the size of the farm, and some of the communication structures have evolved over time and are a result of management style. Have you learned what the structure of communication is on your clients’ farms? We used a simple organizational chart to help those that we interviewed describe who they think talks to whom when health goals are being developed or when communicating daily tasks. This is another learning opportunity for the herd veterinarian: find the right receiver for our messages and how (or if) messages are transmitted from whomever we talk with to others who need to understand those messages. In our sets of interviews, when asked, “Who do you talk to when you have a concern about the health of the calves?” 83 percent of the herd owners talked to the veterinarian, but only 30 percent of the calf managers and 6 percent of the calf treaters did. Do we wait until the health concern finds its way to management? Or can we have a different scheme for a two-way communication of health care concerns? Experience alone is not the best teacher Experience is really great for reinforcing habits — be they good habits or bad ones. We know what we meant to say or what we intended to say, but was it perceived that way? Often our perceptions of our communication skills are inaccurate and we may be unknowingly reinforcing them. In one study, doctors overestimated the time they spent providing information to patients by a factor of nine. It is like Albert Einstein’s definition of insanity: doing the same thing over and over again and expecting different results. If you feel like you have been beating your head against a wall in getting a program implemented on a farm, is it time for a different approach? Effective communication does not take any more time Once communication skills are mastered, effective communication usually results in greater efficiency along with better outcomes — messages are clearer, understanding is more accurate, misunderstandings are picked up earlier and mistakes and errors are reduced. Effective communication is essential in any organization and the dairy business is no exception. Dairy management structures are more complex, more critical decisions are made by middle management and employees, and communication between owners and employees is more complex and often indirect. To effect change in the business, we need to understand the structure of communication, the flow of information, the best place to target our information as dairy health advisors, and ways for ensuring that our messages and plans get accurately from the people we speak with directly to the people who are involved in implementing those messages and plans.
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