The British Equine Veterinary Association Congress 2021 was a welcome reminder to us all to celebrate what's great about our profession and explore what we can improve.
The congress' opening address, which focused on teamwork, was delivered by Tim Greet and entitled ‘Together We Stand, Divided We Fail’. Tim introduced the topic by framing teamwork as an essential ingredient for a fulfilling life. Building trust, absolute honesty, admitting what and when we don't know, vulnerability and effective communication are the cornerstones of a successful veterinary practice. Tim likened practice to a Formula 1 pitstop team, with everyone having their individual roles, working co-operatively with understanding, empathy and cohesive action under pressure.
Tim also spoke about how listening to your team is a fundamental trait for leadership, and how an open and transparent culture will improve patient outcomes, as an honest analysis of our failures leads to future improvements. Tim referenced the modern ‘blame culture’, which puts pressure on new graduates, leaves them reluctant to try new skills and can lead to complaints with the Royal College of Veterinary Surgeons (RCVS).
The ‘moral maze’ was a panel discussion around work–life balance. Equine veterinary surgeon and personal performance coach Carolyn Crowe introduced the topic. A good balance is for everyone, not just for those with kids, as ‘work is just a job, not who we are’. She encouraged delegates to think about what balance means to them as individuals, think about what you enjoy, what you can do more of, think about how you can design your work – the key being that a degree of autonomy feeds into how we balance our commitments. Flexible working patterns, working part time, sharing and buying on-call were all discussed – the message here being that we own our time and can review how we use it to fulfil our needs.
We need to protect our work–life balance to deliver good client service. The take home messages included trying not to get clients bonded to just one vet, trying to co-ordinate taking time off with the big events schedule, and containing our egos: it may make us feel good to be needed, but it gives the message we do not trust the rest of our team.
The discussion focused on the importance of employers creating an environment where people can choose to be happy, by thinking about how we can make it work for both our team and our clients. Regular breaks, linking rotas to rewards, and a culture of fairness were seen as factors that are important for long term sustainability.
In the session ‘Your best teacher is your last mistake’, Andrew Blackie explained that an understanding of human factors improves care. ‘Human factors’ is the ability to recognise that interactions among humans and other systems are complex and not necessarily safe. Consequently, there needs to be a trade-off between multiple goals to ensure the best results. These factors can be categorised into human (such as memory and perception), physical (physiology and anatomy) and organisational and environmental considerations. Better understanding of the human factors and their role in complex working systems improves outcomes, by decreasing errors and increasing happiness.
Julie Gibson then spoke about creating a ‘just culture’ at work so we can best learn from our mistakes. This relates to organisational culture and safety, using fairness as a cornerstone. Part of the issue is blame, but we also create our own biases so that if we look at what has gone wrong, we will tend to overemphasise the role of the people involved, particularly if those people are less relatable to ourselves. Creating a just culture is based on trust, where people are encouraged and rewarded for providing essential safety-related information. This removes the problem from the ‘blame cycle’ where people are scared to speak up, so the issues remain uncorrected, leading to the possibility of a similar event occurring. In a just culture, our own personal responsibility and learning needs to be shared so the organisation can learn. The analogy is with a pendulum – too little discussion produces a learned helplessness, or an ‘anything goes’ philosophy. Too much can lead to scapegoating and bullying. The key is that people need to treat each other fairly, accept we are all fallible and work to improve organisational conditions that encourage or allow people to make bad choices.
The session was concluded by Veterinary Defence Society Risk Manager Catherine Oxtoby who spoke about how to manage a meeting where it has all gone wrong. Making mistakes is totally normal, but there are many barriers to discussing errors, such as the RCVS, clients, colleagues' perceptions and our own personal standards. However, for every human error there will be a system failure, so we need to understand all the factors to understand why things have happened. The Veterinary Defence Society Vetsafe app is a significant event reporting system and people in the veterinary industry should be encouraged to submit all errors and near misses.
Regular morbidity and mortality meetings are encouraged, which should include the whole team. Top tips for these include having a facilitator separate from the presenter and scribe, preparing the meeting together, thinking in systems, and concluding with one positive achievable action.
‘Building trust, absolute honesty, admitting what and when we don't know, vulnerability and effective communication are the cornerstones of a successful veterinary practice.’
In the ‘Staying safe at work’ session, Director of Equine Medicine on the Move Tim Brazil talked about ‘Safeguarding against client complaints’. Complaints are commonplace, and a part of professional life, but there are lots of steps we can all take to safeguard both people and practice. Clients complain for a number of reasons including disappointment, unrealistic expectations and a perceived lack of care. The bottom line for avoiding and managing complaints is effective communication at every stage in the clients' journey, as well as actively encouraging them to ask questions.
Clinical diligence and competence requires us to act with appropriate skill and care, keep up to date, not claim special skills outside of our remit, be prepared to seek advice, talk about risks and provide written instructions. There is also a need to gain informed consent, and note this on clinical records. Veterinary professionals should obtain consent forms for all procedures, euthanasia, and off-license medications. If our suggestions are refused when offered, this should be noted in the clinical records.
Threats of complaints to the RVCS relating to the codes of professional conduct are very common. It is important to know your professional obligations and to always be honest with clients.
There are also conflicts of interest especially in the pre-purchase examination. The advice from the RCVS is that we should avoid such examinations where the vendor is a client, but if we do them we need to protect ourselves by declaring the interest and the full history, and filling out the certificate to reflect this. This is often a matter of perception – so explain the conflict clearly.
Ultimately, clinical records can be a life saver, so be sure to write everything down, including dose rates, warnings and associated risks. Finally, when a complaint comes in, do not ignore it. Acknowledge it, try to understand the client's concerns, ask them what they want, follow a complaints procedure and seek advice where necessary.
This theme continued in Carolyn Crowe's presentation ‘Dealing with everyday stress in the workplace’. Carolyn talked about going into the red zone of excessive pressure and overwhelming demands and how we need to think about what causes us to enter this zone, as we are more likely to make mistakes, become withdrawn and be less effective communicators.
In summary, we can stop being reactive and start being proactive. We can manage expectations by asking ourselves whether we know what is expected and what we expect of each other. We can manage both positive and negative habits by having conversations about doing more of what we love. We can manage our time by thinking about what we expect ourselves to do and what others expect of us, and we can manage ourselves by thinking about our spheres of control and influence. This starts with awareness of what we can control (what we do and say) and what we can influence (other peoples' behaviour). We should then spend our energy on what we can control and influence, and accept what we cannot control and let it go.
From high performance research, we can look at small habits than can improve performance. These include having a morning routine, taking strategic resets (pressing the pause button during the day), eating to fuel and recover, having regular work outs, looking after our brain health, and having a sleep routine that prioritises at least 7 hours of sleep a night.
