Hello everybody, and welcome to this session. Sadly, not actually in Auckland, but, you'll be listening to this from the comfort of your own home in, in some sort of COVID-19, lockdown situation. So this, this session was originally planned to be delivered as part of the World Veterinary Association Congress in Auckland.

So thank you to the guys that. NZVA for inviting me along and to the WVA for, getting me involved because it was a, it is a great stream that would have been put together. So you're gonna probably see these sessions out of sync, but we'll make, the, the best of it.

So, by way of introduction, this session is all is all about how we need to listen. It's called Listen Up, and it's about how we as a profession need to look at how we reposition. Our approach to how we use language and how we embrace and engage with our client base and colleagues.

So by way of introduction, my name is Alison Lambert, and I'm from a business called On Switch, and we've been, around now for nearly 20 years, and our, our purpose has been to inspire change, great customer centred practise, so that pets, horses and livestock receive best care. And this may be now more than ever, very pertinent to the current environment. Is that we've, we've learned very quickly that without the, the, the, the client, the customer, the farmer, the yard owner, the horse owner, we can't actually deliver patient outcomes.

We need their input in a way we've never needed it before because we've been practising physical distancing, . So the idea here is that, you know, we exist to create customer centred thinking so that, you know, that our patients receive good outcomes. And that's because our patients on their own cannot present for care, cannot give themselves medication, can't, you know, sign consent forms.

So The role of the human, is critical and and maybe the one positive to come out of COVID-19 is that we've recognised the impact of not being able to connect with our patients as much, and we actually have needed our client base to really give us a richer picture. So our value sets are around being passionate about this subject, and we hope to inspire, collaborative. So, you know, working with the NZBA to bring this to you in the WBA and innovative.

We've done a few crazy things over the years, but most importantly of all, we're just gonna tell it as it is. So, I'm from Yorkshire and honesty is a thing that kind of runs through our veins. So this is me, probably sitting in my front room, sitting on that chair.

These are my declarations of interest. I own this business 100%. I'm the associate professor in business at the vet school in Nottingham, and I'm a member of the CAT Consulting Group for brewing, and the Cat Expert Group, which is a global group of people who love cats, and we get together and talk about cats.

Not quite sure what brewinger do with any of this information, but we all have a jolly nice time. So that's my declarations of interest. So, at the end of this session, I'm gonna give you 5 things to do.

There will be an action list, a to do list at the end of this session, and all of the sessions I'm doing, in this programme. And they're very much crystallizations out of what we've talked about. So you'll need a pen and paper to write down your to do list at the end.

You may obviously come up with other ones as well, that are relevant to you or interesting to you. So where do we start? Where do we start?

We start at the beginning, and we start with the relationship between humans and, and, and animals in their lives. And we, we have to start there because we have to start with that emotional depth and that understanding that there is a powerful relationship between people and animals, whether that's for companionship or for production or performance. And I'm a huge fan of Twitter.

I, I like to kind of see what's going on, and I, I stumbled across this image, from this lady, Christina Wiederbach, who's an archaeologist, and this is a Roman tomb, with, an engraved epitaph. Across it. And this is going back to Roman times.

And what it says on the tomb, it says, My eyes were wet with tears, our little dog, when I bore thee to the grave. So Patricius, never again, shalt thou give me 1000 kisses. Never can't thou be contentedly in my lap.

Now, that's Roman times. That's a long time ago. And there is a deep-seated, deep-rooted emotional connection between a human being and an animal in this instance, Patricia the dog.

And that's why we have to start with veterinary medicine. We have to start with, what do these animals mean in the lives of these people? And if we start with that relationship and work back, we will find that our communications, our conversations, our outcomes will change.

It's when we start with the clinical disease first and then think about the people that we kind of mismatch sometimes. So I wanted to start this session with a really deep-rooted start point around, you know, People have animals in their lives for lots of different reasons, and the vast majority of them have a deeply connected emotional connection to them, whether they're for companionship, production, or performance. And if we value that and take a moment to look at that, we go, right, OK, we need to reframe how we approach these people.

And there's, you know, the world is full of, you know, quotes and memes and all sorts of different stuff. But I, I quite like this one. And this one's from George Kuros, and this is just a phrase that just reminds us, to inspire any meaningful change, you must make a connection to the heart before you make a connection to the mind.

And this is incredibly relevant to our profession, because we are a science-driven, evidence-based profession, and we speak around. Facts and figures and signs and deep meaning that we all understand. Yet to the typical person who is caring for our animal patients, they start their relationship with an emotional connection.

They don't start with that fact base. You've got to connect to their heart and their emotions before we can help them and guide them with facts, so that we engage their thinking capacity. And this is something that's really important is we must connect to the heart before we make a connection to the mind.

And if we start thinking about that emotional start point, it will change our conversations and it will change our outcomes. And ultimately, it will change the outcomes for our patients. And the literature is, is very strong in this area around patient centred practise, client centred practise that helps us find better outcomes both in the human field and in the veterinary medical field, is that when we take that time to connect.

Then we find higher adherence rates to treatment plans, recommendations and satisfaction for all, all parties. So it's a good one, just to frame this session around, we really do need to take that time out. And that timeout is all about taking the moment to think about the art of veterinary medicine.

And this is a picture for those of you not familiar with David Hockney. This is a David Hockney, really beautiful picture of Garribee Hill, in East Yorkshire, which is where, until very recently, my parents lived at the top of this hill. .

I'm from Yorkshire, and this is, this is kind of what Yorkshire looks like. It's, you've got flatlands, and rolling lands and it's got moors and dales and coastline and phenomenal history. So if you've not been to Yorkshire, then I would strongly recommend you, you know, when you're, when you're in Britain, take that time out.

. But this is art, and for scientists, we look at art and then we're going, well, what's that got to do with veterinary medicine? And the what and the point I want to make is that it's not all about science. It's about seeing that bigger picture, seeing the impression of that patient in that context of that home or that farm or on that yard.

You know, what, what is going on outside of the haematology and biochemistry? What's going on outside of the, the scan results? What's going on?

You know, you've got some crazy cell counts coming through. What's the bigger picture? So take that time to look at the art of veterinary medicine.

And Hockney will make a few appearances as we go through. And I, the mantra, I suppose if it's a mantra, it's mantra the right word, . The kind of guiding principles of where we get to from again, looking to the literature, looking to all the work done by the Calgary Cambridge Group, looking at more recent studies, looking at human healthcare communications, looking at real talk analysis, the start point for any change for any patient outcome is listening.

And that listening has to be active and considered and done with intent. It's got to be done with the intent to hear what's been going on in a way that you can then utilise that to make a good treatment plan. So, when we talk about listening and reconnecting with our client base, what we mean is we've got to start with listening.

We have to take that opportunity to listen, and then to empathise and to understand what that situation means to that, that human being. And then personalise, personalise that, that set of circumstances for that individual family or flock herd or farm. Then we need to sort a plan out.

And this is really one of the big important things that we can't sort a plan if they haven't heard what was going on. And then we need to recommend the next step. So we take some decisive action and recommend a treatment plan for that individual patient or for the flock on herd situation.

And I'm going to keep coming back to this because listening is at the heart of all medicine. Whether that's human or veterinary, if we don't hear what's going on, and we don't make time to hear what's going on. Then we will miss crucial pieces, and COVID-19 has certainly taught us a lot, where we can't physically examine many of our patients and have been doing, remote consultations, whether that's by phone or by video, is we've had to maybe refocus our listening and history taking elements.

Whereas previously with the patient in front of us, we can get very hands on very quickly, and maybe not hear the full story with the richness and depth of understanding coming through from the owner's explanation. So listen, empathise personalises critical first steps, then sorting your plan and recommending what's gonna happen next. We'll come back to this.

And again, you're going, why is she now showing me a bunch of people, stark naked, painted blue? Well, you know, I'm from Yorkshire, and the Hall was, City of Culture a couple of years ago. And as part of the City of Culture, Kingston Pon Hall, and very historic town, again, for those of you interested in looking outside of science and looking at, you know, the formation of some of our parliamentary systems today in the UK, Kingston Pon Hall is a really interesting one.

This is an art installation, so it's part of the City of Culture, an artist, Spencer Cunick, decided to put an ad out to say he wanted a couple 100 volunteers to join him on a Sunday morning, take all the clothes off, get painted various shades of blue, and then walk around the city of Hull. Now, On a, on a rational scientific level, you go, yeah, that's not a bright move. However, people did it.

They wanted to be part of something. He was persuasive. You know, he created a compelling vision of, you know, an art, a living art installation, and he's done some really good stuff.

So, again, I just want to challenge you to, maybe that's not a rational thing to do, you know, to take all your clothes off and walk around naked with total strangers, painted bright blue in a hull, which is on the east coast of, the UK, which is quite a chilly wind coming in from the North Sea. But people did it, because it was a compelling vision, there was a reason, there was a purpose, and he communicated that these people wanted to be part of something in spite of the fact that they were going to be standing like this. And if we could get to the point where our clients go, I get you.

I get what you're trying to do here. I hear you. I see you're trying to do the best thing for me.

I will follow you. In the same way these people listen to a total stranger and did this, we can, by listening and embracing with our client base, get them to move forward to our patients get the treatment plans that we, we, we believe that they need. And this all kind of builds up into this whole experience piece that our customer base are going through and the customer experience is multisensory and that's one thing that You know, again, we're realising in in COVID-19 is that the, the loss of some of the sensory input between you as a clinician or you as a practise team member and the client, is that, you know, you, you're not seeing them, you're hearing them, you know, but there's no physical connection there and there's no physical contact in many of the consultations.

And then when they do arrive at the clinic, it's a drop off. It's a curbside. It's a, here's my dog, here's my cat, or there's a horse down there.

It's what we're losing some of that multisensory input into the experience. So the experience is diminished. And the reason this matters is, you know, in the whole scheme of things, the vast majority of clients are not judging this profession on their clinical competence.

It is assumed. We're a credible profession. We're a profession that is, you know, well regulated, you know, people are out there who are competent, .

So that's never the judgement point. There'll always be one or two. You're gonna say, oh, well, there was Mrs.

So and so, she judged me because I couldn't do this. You remember the exceptions. Remember you hear the dissenting voice, you hear the negative feedback.

The vast majority of people are not judging you or making decisions about you based on what you did clinically. They're judging you completely on how you made them feel. So what did they see?

What did they hear? What did they smile? What did they touch?

What did they taste? This whole multisensory aspect. And this matters because it means that their, their whole experience of, of the practise is built around multi-layered input.

And we know as scientists that, you know, how we remember situations and how different aspects of, an experience go into our memories. We know this. Now, what we have to do then is make sure that they feel that they were listened to.

And this is a bit where all the feedback is saying we can listen more. So the customer experience is just some of all the interactions with the practise shaped by the culture of the organisation that influence those perceptions in the owners across the continuum of care. And this is a really well studied area in patient experience in human field, and more and more so now in the veterinary field.

What this is actually saying is, if you notice, it's the sum of all the interactions. So at every step of the way, every client touch point that you have from the point where they maybe engage with you, find you online, maybe see something on your website, or engage with a social message, maybe they call you, maybe they pop in, maybe they sit and wait. Maybe you, they're hanging around on yard for you.

Maybe you send them an invoice or a late payment statement or doesn't really matter. There's lots of different bits and bobs that build to say, this was a good experience, this wasn't a good experience. It's not just on the head of the clinician in that clinical moment.

And therefore, we have to not just listen in the clinical moment, we have to listen in the pre-clinical and the post-clinical moment. So those places where, where building experience of the practise service across all the team members, the whole of the one vet team from customer care, through nurse and tech support, through vets, through management, through yard managers, whatever it happens to be. Is that their experience is formed by what each of us do at each step along the way.

And at each of those steps we need to demonstrate that we are listening and that we are empathising and that we get what this means to that person. And this is, this is tough because it requires a little bit of investment in time and energy and thought to say, every role matters, every job role matters. Every person in that job role matters, because how they interact with our clients is building the experience of this practise, which means that they're gonna recommend us or not recommend us or come back or give you a hard time.

. The sum of all the interactions and that's the key to the customer experience is everybody's little steps matter. Little steps don't brilliantly make a difference. And you may say, oh, well, that's just, you know, that's just liberal tree hugging nonsense.

So no, it isn't it's evidence. There's a lot of work out there, recent, recent, collaborative study between, the UK and Australia looking at what UK and Australian clients want, in terms of the, you know, the capabilities within the veterinary professions that the veinary professionals that they're dealing with. And, and this showed quite clearly that, you know, they wanted us to care about their animals, know our stuff, and take them seriously.

So, you know, the headline here on this particular paper was, care about my animal. Know your stuff and take me seriously. Well, I would hope that we do care about the animals.

I think that's, that's probably a bit of a given, and we know our stuff. I think that's a given. Take me seriously.

Is the piece here that's the lesson. The lesson is, I live with these animals. I live with this dog or cat or this, this horse or this flock or herd.

I live with them, and I know something isn't right. Something's changed, something's not right. Something's not going the way it should be.

My view matters. Take me seriously, and that's about listening. And this whole frameworking around what do people want so we can do the right thing for the patient, is absolutely critical that it starts with listening.

And when, you know, studies across two continents and two hemispheres can say, take me seriously is actually a key finding, it's telling us something that we need to put a bit more effort into listening. Recent PhDs have also found this, there's two here, Louise Cora's work on defining the good consultation, what it is and how we, how we could measure it. This was, co-funded by On Switch in collaboration with the University of Nottingham.

Louise, submitted this in and, and got her PhD in September 2019, so last year. Really important piece of work, and again, primary findings are, listen, listen, listen, listen. You know, we really need to work collaboratively in a co-production way with our client base to get patient outcomes.

Alison Pike's PhD on service quality in the veterinary and Allied Health covered, species. Farm, equine and small animal, Louise's PhD was small animal focused. Both of these PhDs both came out with the same finding is that what the users of veterinary professional services want is somebody to listen to them.

You know, I want you to hear my story. And that's the bit that this whole session is around, is that we need to actively and with good intent to start listening. It's fascinating stuff.

Elizabeth Armitage Chan, from the RBC published some stuff again. This was October 2019 last year, looking at what vets are feeling around, you know, their professional lives and some of the factors that are contributing to some clinicians feeling, you know, not so good about it. And what she says in here is a really interesting one, if we look at the two purple arrows on the left there, you know, that there were graduates who, who really valued the client oriented skills, you know, the tailoring, understanding, being individual.

But they felt that they needed to be more academic or clinical or specialist. Yet those who had positive, you know, client relationships, were finding that they're difficult situations, that they were more resilient and have greater mental well-being. So there's something about not getting sucked into the client as the enemy, and, you know, what Doctor Amy Chan saying here is, you know, when you dig down into this sentiment that is clear, her words, you know, however, further analysis found a clear sentiment of the client is the enemy in colleagues discussions and social media.

This groupthink around the client as the enemy isn't helping us, and it's creating a, a position where it's harder to listen to those folks when there's a, a herd mentality that says they are part of the problem. And I think this is a really important piece of work. And again, her findings here, you know, being able to work with a client who was highly troubled by either financial limitations or, you know, loss of a pet.

When, you know, there's lots of anxieties, the social media message of the client is the enemy obstructs this skill. It is often easier to rant about the difficult client. However, when this becomes embedded, it prevents career satisfaction that comes from working with clients.

We have a body of evidence building that we as a profession, need to be very careful about how we communicate within our own professional groups, whether they're close Facebook groups or private groups. Firstly, none of them are ever private. But we're building a culture of the client as enemy or client as difficult, and that's where we need to stop because we, we're compounding and creating identity for a group of clients who are just having a bad day, you know, and then they need the vet.

So we need to reframe that, and that's what listening is all about. So we deliver great pet outcomes, good patient outcomes, and we work with people that live with them. And this is a really critical point that If we work with people that live with our patients, there is a greater likelihood that we will get patient outcomes, adherence to treatment plans, and some feeling of, of value and satisfaction with our work and our daily lives.

And the evidence is building that that's a profound behaviour change that we need to do, that we need to really stop and really consciously decide to embrace with and engage with our client base. The challenge though is where we start our journey and this is some findings from a recent, beaver BSAVA survey recruitment and retention survey, and it's fascinating. And they, it's available if you go to either the beaver or BSAVA web feeds of the whole of the, the research is available to view.

One of the questions, what's the most sing, what is the one single thing that you enjoy the most about being in the vetting profession? This was asked to a, a group of veterinary nurses and a group of veterinary surgeons and that there was a significant number of respondents in both groups. And when they were asked, what is the one single thing that you enjoy the most, for the veterinary nursing professions, the animals came out strongly, animals, patients, you know, the bigger the word here on this word, all the more responses are worth saying those things.

And for the veterinary profession, again, animals kicked in. There is some thing about variety, some little bits about, you know, clients in there. But the big number one single thing is, you know, we're doing this because we're like animals.

Which is great, we get that. The challenge is when we ask the next question, you know, what is the one single thing you dislike the most about being in the profession? Both the vets and the nurses had clients in there as a fairly large response.

And if you look at the veterinary surgeon response word, which is in the top left there, clients, hours, and then you've got a host of other things coming through. So there's something about clients, there's something about work-life balance and, and working practises. And for the veterinary nurses, clients again, and then pay salary, lack of money.

So if you look at those and go, what's the biggest, you know, single thing, number 1 and number 2, about the vets that aren't, you know, not enjoying, particularly in the vetting profession would be clients and hours, work-life balance for the vets and for the nurses, clients and pay. Again, it shouldn't be a surprise to anybody the pay piece for for nurses, certainly, and the work-life balance hours thing for the veterinary surgeons that other people have come up with this. But the client thing is one where we go, hang on a minute.

If that's a bit of our daily lives that we've got a challenge with, then our world has them in it, and COVID-19 has taken a lot of them out of the discussion. So for some people at the moment, doing non-client present consulting is actually their ideal job. And they're actually quite enjoying that.

But it's bringing its own difficulties because they haven't got, you know, elements that they would have had if the client was involved. But it doesn't take away the fact that for most people, there is a challenge between or a mismatch between what they like the most and what they like the least. And therefore, this potential for us to create an enclave of that the client is part of our problem is an easy one to fall into.

And we need to be consciously. And with intent, going, No, let's just watch our language and create a collaborative co-production approach. We need the people that live with our patients to help us get the patient outcome.

If our primary motivation is to do the right thing by our patients, then the people that can help us do that are the people who live with them, the people that, you know, they feed them, they care for them, they medicate them. They look after them, they bring them to you. They ask you to come and look upon them.

So we, we have to find a way of working with, and that first start point from the client research and from all of the work is that the, the people need to be, you know, listened to and hear my story, hear my view of what's going on, and we have to do that to get us to a clinical outcome. And this all builds into trust. And trust is a really interesting construct, and various people have put together various equations, and like all good models, that models are only models, so there'll be variability and wobble wobbly in all of your models.

There's always bits that don't fall for you. But just if you were to Google the trust equation, you'll see variants, and it looks a bit like this. So trustworthiness is a sum of how credible you are, how reliable you are, and how intimate you are with that situation.

And in this context, credibility will be high within our profession. Reliability, we have our moments where we don't call back or do what we said we would do. So we can be a little bit, you know, flaky there sometimes.

And intimacy is, you know, the personalization of care, making it that I know you, I know your, you know, your cat, your dog, your horse, you flock your herd. That intimacy piece can be where we can do better. It falls away more so in, the, the small animal world.

We see, you know, thousands of different animals, maybe only see them once every couple of years, and it tends to be higher with our farm and production, where we're on farm every week, and we know that people will live in the community. So trust is is constructed from credibility, reliability and intimacy, and it's it's broken down by self orientation. And as a profession, we need to be mindful of some of our behaviours and actions that would demonstrate self orientation.

So are we doing this because it's easier for us, or are we doing it because it makes it easier for our patients to get care? So that's where we need to just be thinking, you know, how does this all fit in? But notice yet again, the intimacy, knowing, knowing this patient, knowing where it lives, knowing the family that live with it, knowing what this, you know, flock or herd means to this farmer and his family, and for generations, that intimacy piece is all about listening.

It's about connection and listening and, and hearing their story. So listening is that skill. That for Most of us, we could put a bit more effort in because we tend to jump straight into clinical manifestation and maybe don't hear the full story.

So making time to do that. At the London Vet Show last year, a really interesting session from Prue Hobson West, who is associate professor of, sociology and social policy at the University of Nottingham, and also, is involved with the vet school in Nottingham. And she's been working for years with, .

The medical profession's looking at the debates around vaccination in humans and and some of the things that happened with people not wishing to uptake vaccination regimes in the way that the medical profession would like them to. So she's been involved with, in the, on the human medical side, looking at where and how the medical profession maybe missed some opportunities to communicate, particularly childhood vaccination. Challenges, and you know, this phrase, the anti-vaxxer, became, you know, kind of common parlance, and proves's insights and Prue's advice to us as a profession very clearly is we mustn't create.

The noun, the noun being, you know, that person is an anti-vaxxer, you know, the, the descriptor of a group of people who don't follow our treatment plans. Because they're not, they're just a group of people who've got questions and want to do different things, but we've created, as the medical profession learned, they created a coalescing of people who were a bit uncomfortable with vaccination but needed a bit of help into an entire community with a name, e.g., they are the anti-vaxxers.

Well, actually they weren't, but they coalesced around a cause and then created an entity. And once it's got an entity, it's got a name, and then it becomes adversarial. So Prue's work is really interesting and, and her guidance to us would be be really, really careful about creating identities, you know, like creating subgroups of people like, you know, anti-vaxxers.

They're not, they're people who have got some concerns. So her guidance to us was to very clearly is to make sure we don't create entities that weren't there. And that's the lesson is we need to be really, really careful that we don't buy our use of language, create entities that make it adversarial for us.

So there's some really interesting stuff going on around this whole importance of making some form of connection, making some form of emotional engagement before we start to move forward. So the listening, the, you know, the empathising and the personalising before we sort a plan. And in our busy lives, and I get that, that, you know, sometimes we have crazy days, and it's busy, so we get straight into the clinical manifestations, and we may miss that listen, empathise and personalise piece because we're going to sort a plan out.

All of the work in all of the social science fields, going back to, this is Amy Cuddy's work from 2013 that was published in the Harvard Business Review. And You know, this whole thing about connecting, we can't move people forward onto an appropriate treatment plan if we haven't made a connection. Remember George Kuros's words, you know, first, connect with the heart before you connect with the mind.

It's this, this feels non-scientific. It's highly scientific, but it's just a different piece of science. It's social science.

And Maybe we don't value that as much as we should, and maybe we can positively take time to listen, empathise and personalise so that we can connect and therefore lead our patients to their next stage. And HBR, Harvard Business Review have a habit of producing some really kind of nice infographics around, . You know, the, the, the papers, and if you don't already subscribe to the half a business review, it's what I would do.

There's some interesting stuff in there, always thought provoking, always controversial, always interesting. And this one is a nice way of saying that, you know, until we have made a connection, we can't lead. And then what do we mean by lead in this context in the veterinary professionals life?

What we need is, we can't make it, you know, recommendations of treatment plans for good patient outcomes if we haven't connected with the owner. So we have to do that, listen, empathise and personalise before we recommend a treatment plan. It's, it's absolutely critical.

Connect, then lead. If we go straight in with, you know, this is what's wrong with your dog, your cat, your horse, you flock your herd, and we need to do this. And we haven't done the bit before that, there's a potential for that to be like, well, hang on a minute, I haven't told you what I think.

So, the whole point about listening is it's part of this connection phase. And it's so important that we take that time. So, the key thing here is before people decide what they think of your message, they're gonna decide what they think of you.

And this is really important that We, we really consider that if we want to do the right thing for our patients and get really good patient outcomes, we need our client base to say yes to treatment plans that are appropriate for that patient. Then what we need to do is they need to get you first. They need to, you know, think that, OK, I, this person seems believable, you know, I'm connected, I get what they're doing.

I can say yes to their message. Before people decide what they think of your message, they decide what they think of you, and that's the key to this. Because the way to influence is to start that bit with it.

Positive intent is to listen, empathise and personalise, start with warmth, build some, you know, foundation of trust before we get to the clinical piece, which is where we tend to start at the moment. We see the case, we see the sorting of the plan piece. We know what to do.

You know, it's, it's diagnostics, it's tests, it's meds, it's, it's something. But we need to do the bit before that, so that the owners who are the carers of that patient can say yes to that treatment plan. So we, we have to start with.

Making that connection to the heart before we make the connection to the mind. And this, this brings us around to some really controversial stuff. And, and in this book, the Intelligence trap, David Robson talks about, where really, really clever people have made some really quite daft decisions.

And the book is one of those books where if you read it, you'll just go, really? No, surely we didn't do that. And it, it looks at situations where what we mean by intelligence, and you would put the medical professions into intelligent bunch of people.

And he argues that, you know, smart people do do stupid things, and, and how we can make wider, wiser decisions. And there is an intelligence trap where we, we kind of fall into, because we know stuff, we think we know other stuff. And it's a really provocative read, and it's one for you to maybe to think about.

Because the findings from, you know, looking at what smart people do is, we do make mistakes. You know, we're not only just as prone to make mistakes as everyone else. We might actually be more susceptible to them.

Not. He describes as the intelligence trap. It's, it could be that we're wrong on a few things.

We might be misunderstanding the importance of this listening empathy piece for the outcome of our science brain. Our science brain may be saying, yes, but I know the answer, I know the meds for this. I know the surgery for this.

I know the, you know, the herd health for this. I know all of this, but no one's saying yes to it. Yeah, no one's saying yes to it because you've missed a bit before that.

And maybe we need to revisit the decision making, because we're so bright on this clinical piece that we need to look at the other bit. And it's provocative, and you might not like it, but it's one to consider is, you know, it could be we've missed something, and that bit we've missed is the sole importance of hearing the story of the people that live with these animals, so that they feel that we have heard it, that they, we know, so that intimacy piece from the trust equation comes through, the listing piece comes through. Not an easy read.

As part of this, it was just interesting to just think about how we listen to emotions and how we connect and how those memories and emotional memories stay with you. And this is a collection of letters and cards I still have, you know, I qualified as a vet in 1989, and I stopped practising in the 1990s, and where are we now? We're in the 2020s.

And I still have a shoebox with cards and letters from people who At the end of their pet's life, I was there, you know, I euthanized their pet. And this little cat here on the ironing board is Kizzy, and I remember going to the home and, you know, you, you know, put to sleep, euthanizing this cat. And I can't throw this set of box of letters and cards away.

It's just something I can't do. It doesn't feel right. It's an emotional embeddedness, and the emotional depth of that end of life is where we absolutely get it right.

We are so empathic at this moment, on this occasion, that people get it, write cards, send letters, send gifts, and we get it because we don't throw them away. So if you think about how we listen and empathise and personalise at the end of life in that one moment, in that one end of life moment. We get the perfect customer engagement.

We nail it completely. We get it, we empathise, we listen, we empathise and we personalise. We write, you know, sympathy cards, we send, you know, flower seeds, we do stuff.

We really get it, the whole team gets it. Yeah, at other stages in that client's life, we may not have got it. So we can do this, and this is so powerful, and I think it's just a really good memory to say that, you know, we can get almost the, the, the perfect listen, empathise, personalised moment because we do it with our euthanasia, whether that's You know, the first time you've done a euthanasia or, you know, goodness knows the 1000th time you've done it.

You get that it's a bad day for that owner. And you've listened to them, you've empathised, and you are personalising. You're, you're changing your voice, you're making it subtle, you're mindful of your body language, you're respectful, you're doing all of the things, because you kind of get that this isn't a good day.

People are having bad days all the time when they see you as a vet. There just maybe isn't a euthanasia consult. It might be a puppy vaccine and having a bad day.

It might be a fertility visit, and they're still having a bad day. We can do this, and this is a really good memory for us to say, right, yeah, that's my highest empathy moment is euthanasia. Let me try and do that with my other consultations.

So listen, empathise, personalise. The start point with all of this is absolutely critical that for our client base, regardless of species, the evidence is clear. They need us to listen to them.

Listen to them in a way that we have heard their story and get what's going on. Empathise with them so that we know that this matters to them for different reasons. Personalise it.

This is about that patient, that cat, that dog, that horse, that flock, that farmer. It's that. It's not dogs in this situation, or cats in this situation, or horses with this need.

It's that horse, that dog, and they have names, they have status. Once we've done listen, empathise and personalise, we can sort a plan, we can say, right, OK. You know, given what's going on here, the treatment plan that I'm gonna recommend is, is this, and I recommend we do it now or next week, or we do it weekly, or whatever the, the actual action step is at the end.

And if you think about and reflect upon your clinical practise and you say, you know, how do I normally run my consults? Do I get straight into sort of plan? Do I get there quite quickly because I'm mindful of the time and I've got a backlog and a waiting room full of people or I've got to get to my next farm visit.

Do you spend more of your time sorting the plan than listening, empathising and personalising, and my, my wish. From today is that we see that maybe we can spend a bit more time in the listening empathise and personalise. So it matters.

And it matters on so many levels, and it matters now more so than ever, when our client base have got multiple sources of information and multiple sources of, input. And the zero moment of Truth, Zema is a Google study that shows what people do prior to accessing goods and services, is it shows how people resource, how they do their own research, how they think about asking people what they do. And this is incredibly relevant to our profession because the zero moment of truth, .

It is relevant to us, you know, the Google state that about 10.5 resources will be accessed by people before they buy some goods or services online. Well, OK, they're not buying us online, but they're still doing the behaviour.

And I think we have to go, you know, from the perspective of where we are, is that this is something that, you know, matters to our client base because they're, they're just human beings living their lives. And then the whole scheme of things, what they do when they're looking at, you know, buying holidays. Or flights to hotels, or a new fridge or a car or shoes or kids' books, they'll do the same thing when there's something not right with the animals that they live with.

So they will search. They will, and they will have done that before they're stood in front of you. They will have done it because it's entirely normal for them to do that.

It's just what human beings do. We research, we self-resource. We find stuff out because it's there.

And it doesn't make them bad people. So the key we've got is the moment that they get in touch with us and say I Would, my, yeah, my cat, my dog. But, whatever that is, the care, that of truth, which is a bit like the spin cycle on a washing machine.

They've gone round and round and listened to 101 different people's views on their dog's ear. And now they've rung the vet practise. That is our moment to say, right, we can help.

This is our opportunity to care. This is our reframe. Unfortunately, we might go, Why the hell have they been on the internet?

Why did the Google, or talk to Google. What a nightmare. Why didn't they ring us first?

They're not gonna ring you first, because that's not what we do as humans. We just self-resource. That's what we do.

So every inbound contact, whether that's a phone call, a social media direct message, a live chat, whatever it is. That's an opportunity to care and we need to reframe them coming at us saying, well, I've been doing this, I left him 3 days and I looked on the internet and I think he might be hyperthyroidism. Our opportunity to care is immediate there.

The likelihood is we might do a, oh God, I've been on the internet moment. We might not say it, our voice might say it, our facial expression might say it. But at that point we need to change our approach to them self-resourcing.

And again, listening to the fact that they're interested, they try to solve something, they care enough to ring you, that's the bit we start from, so it's an opportunity to care. And certainly again, if you like reading Edward de Bono stuff is always a good, good thing to do some really useful books about, you know, lateral thinking, creative thinking, just thinking how we look at situations and, and this particular one, the I'm right, you're wrong, is we're in danger if we're not careful of making a judgement about people who have self-resourced or access to the sources of information. And putting them into the I'm right, you're wrong, like I'm the vet profession.

I'm therefore right and you are the client and you are therefore wrong. Because you know. It Have we They don't build that narrative in the practise.

Allison, so the tea breaks, you know, start, start creating a culture of Hello. Sorry, it's gone again. Yeah, just can you hear me?

Can you hear me? Yeah, I can hear you. Just at the start of this slide your voice went out and it cut out.

Right, so at the start of this one, yeah, start of this slide. The internet's having a bad day. I will start again.

Thank you, sorry to keep interrupting. No, no, you're right, you know, I'll go back to the previous slide so I can remember what I said. OK, thank you.

So this is our opportunity to care. They've been accessing and resourcing other information and now it's our chance to care. So every primary contact is the opportunity to care.

And when we look at what could potentially happen if we think about people who use Google or have self-resourced, or have waited a few days, who then ring up, the possibility that we can end up with this, this positioning of why have they done that, you know, they've been on Google. Edward de Bono has written some really good books about creative thinking and lateral thinking. It's certainly worth reading.

And this particular book about, you know, which is titled I'm right, You're Wrong, is where we get to the point. Where we can't see that there may be another way of doing things and you know, as a profession, it might be that we can end up judging our clients for not ringing us sooner, not coming in sooner. Having listened to somebody else, having utilised, you know, online resources, and we need to be really careful that as a practise, we don't create a practise culture that is judging of these people, and that our language and the eye roll, and they, oh, they've been on the Internet.

We need to nip that in the bud because we're starting to build a, you know, we're right, they're wrong kind of, you know, adversarial conversation. And I'm sure you've all seen, images like this on social media feeds and on Facebook, and we all join in and we laugh and we giggle and we say, oh, that was like Mrs. So and so the other day, and this was that and this was the other.

And this is not helping. It's not helping because we're creating an identity of them and us. And yes, it may be fun, and yes, it may be lots of these things, but we as professionals have to think, by our language, are we creating an enclave?

And as Prue Hobson West said, we mustn't. Create an identity of this group of people, e.g., the anti-vaxxers, or the anti-esters or the whatever it is, because then that creates identity, and then it becomes into our language pattern.

And we, we, we, we pull back from engaging and being collaborative, and it becomes adversarial. So, however much you may feel you want to engage with this, I would strongly recommend that you don't, because we need to take this little piece out, because we're creating, We're creating an identity and a culture and a language that isn't helping us engage and listen and empathise. Similarly is another one, you know, that there'll be a story behind this, but we all join in, and this isn't helping us create client engagement and understanding on an individual basis.

So listen, empathise and personalise for each client on each individual occasion. And this is, this is a challenge. This is certainly a challenge for our profession, as we end up with a tribal or a group mentality around this group of clients versus that group of clients.

And this is not helping, and the, and the research and the the work coming through is, is saying this isn't helping our mental health and our resilience either. If we can engage with our client and deal with each client on a one by one basis and not put them into a group of people who do certain things, it will make it easy for everybody. And it was interesting to see this piece in the in the paper where the BVA British Association had a statement piece that came through, and it was reported that 98% of vets had been challenged by owners about the need for vaccination.

And I think that's an interesting statement. It's I suspect that 98% of vets have had conversations with clients who weren't that keen on having vaccines because they didn't know enough about them. But the word challenge is a very interesting phrase.

It, the word itself brings an adversarial element to it. And then you look at the National Pet Months post, and you see the same piece and some couple of comments from a couple of owners. You know, this one, you know, my view is that if vets had always had a sensible vaccination regime instead of an insisting annually, it would never have come to this, you know, and then another lady saying, I agree, I've got a dog with epilepsy, you know, it's had a tighter test and it's hard to know what to do.

Again, are these people anti vaccine? No, they're not. But we've given them an identity.

If we went with a one, you know, individual personalization, listen, empathise, personalise for each patient and their vaccination requirements and their health status. This would be less adversarial, and it has become that. And we are part of that.

And I know it's hard, and I know some people don't like this, and I know some people don't agree. But when we step back and go to how important language and behaviour is in creating veterinary culture, we need to find a way of embracing these clients, rather than putting them into groups and clusters, and we need to be very, very careful with our language. So we need to find common ground, and that's why listening.

If we listen, empathise and personalise, we find some common ground. And our common ground is clearly with the patient. You know, we may have nothing in common with the human, but we certainly have something in common, you know, we're veterinary professionals and they have an animal in need, that's our common ground and our start point.

So that's our safe ground, and we should go there. And when we look at what the medical professions have been doing to listen, empathise and personalise their care, Care Opinion is a feedback service for the, National Health Service in the UK, and it's a way of gaining feedback about patient experiences from visitors, patients, relatives, carers, and it's really opened up a collaborative engagement around what's going on. And it's been open and transparent, and this is, a, a.

An infographic from the Royal Cornwall Hospitals, where they chose to engage with feedback and listening. So in the top left hand corner, it says in the beginning, we're in the process of an improvement journey and really embracing learning and from feedback. So feedback, you know, where are they now?

Things are improving. It was tough, you know, we need to listen to what our patients were saying. And this whole journey around the patient and family experience, making sure that voices are heard.

You can see the common thread coming through here. The common thread is we need to hear our patients. These are human patients.

It isn't easy. But it is totally necessary for us to get to the point where our patients are getting better outcomes, because the clients are thinking that we're working with them rather than in an adversarial relationship. And this is happening across all medical professions, where the, the voice of the patient, the voice of the families, the voice of the carers.

Actually makes the patient outcomes better because we actually can tailor personalise the care. So by listening and empathising, personalising, we actually get better outcomes. And maybe this is an example of just changing a little bit of what we do to make a big and profound difference.

And again, another book recommendation, if you've not read Nudge, Richard Thaler's book is actually a very, interesting book about changing little things that have bigger impacts downstream. So improving decisions about health, wealth and happiness. And the example that if you have read it, you, you probably know exactly what picture I'm gonna show you.

If you haven't read it, here's a picture of a toilet. There was a problem with the toilets, and I think it was in Amsterdam, either at the train station or the airport, and the cleaners were forever having to clean a lot around the toilet bowl, and for the gentlemen listening, the propensity to use a urinal and, and not get. In the urinal, but to get around the urinal is, is apparently well known and, and apparently men miss more than they hit.

So some bright spark decided, well, let's give them something to aim at. So they painted a fly on the urinal and you can see the little fly on the on the urinal there. And because there was something to aim at, there was less spillages on the outside, so the cleaners were happier, there was less, you know, spillages, so less cleaning, pleasant to work environment, and, and better hygiene management.

So just by changing one little thing, a behaviour changed. And this is a concept of nudge. So by painting a flyer Target in the urinal, the men had to be a ma.

So everything worked better. But it's brilliant, you know, simple. Everyone's happy.

So, what is that for our profession? What are the little things that we could do that would change profoundly and aspects of our care? And I'm recommending to you guys that one thing we could profoundly do is, is consciously and with positive intent, is to hear the story of the client.

So just by changing one thing, we will get a series of richness and, and care collaboration downstream that will make a difference. We hear many voices and there are many voices and we need to tune in because not everybody speaks vet, not the, you know, the, the terminology we use, it can be distancing for some people. People have different literacy levels, some of the language in our written materials may be.

You know, disengaging. Some people can't hear, some people can't see. So we have to get to a language where regardless of what the owners are doing and the language that they're speaking or or how they are articulating or their understanding levels, we have to philtre that down so that we can find some common ground.

And that's a really critical step. And we need to do that by embracing, engaging and empathising. We need to start with the positive intent that our clients are in front of us because they want to do the right thing for that patient.

They're in front of us because they trust that we're going to do a good job. They're in front of us because they care, and they're in front of us because they value what we're gonna do. And if we can start with that moment of intent, and we can embrace, engage, and empathise with why they're in front of us, even though they may have been on Google for 3 days, or they've left it a week, or all the things that have happened, the fact is they're now in front of you, and it's an opportunity to care.

They've chosen to be there. So let's take the positive intent of, I need you now. I need you to help me with this patient.

I need us to get somewhere. And if we can do that, we change the way that we, we, we take the course of our relationship. And listening is the start of that.

The, this whole session has been about, let's take a positive moment to really, really listen. We know the data shows that we interrupt. We ask a question and we've interrupted within, you know, was it 20 seconds or something.

Let's, let's not do that. Let's really listen. Let's listen in a way that we can empathise, and then we can personalise.

Once we've got to that, we're then into the clinic club, let's sort the plan, and let's recommend the next step. And if we can do one thing to change the outcome of our patients, then certainly listing would be the start point. And as David Hockney said, we've seen a few of his pictures along the way, listening is a positive act.

You have to put yourself out to do it. You actually have to put some positive intent in. You have to intend to do it.

It is not passive, it is active. We have to structure it into our conversations at the beginning before we go clinical. We have to go listen.

And this is a really, a really powerful reminder that it, you actually have to put yourself out to do this, but it makes a difference to our patients, and that's what we're trying to do. So your to do list at this session, I've got 55 things on the to do list for you. Number one.

I want you to audit your customer experience and map your customer journey. So what does it look like? Who's speaking to your clients?

How many times, you know, from the moment they touch your website or social media message through popping in or calling or sitting, waiting, going home, getting a bill, having meds collected, yard visits, whatever it is, is, what are those steps? Because you may well be surprised at how many individual client experiences there are for one vet visit or one fertility visit or one booster. So map it because each of those individual touch points is an opportunity to listen.

It's listening in the pre-clinical, listening in the clinical and listen in the post-clinical. Is, is audit that, map it and audit it, what's actually going on. Number 2 is measure your customer experience.

Ask people, you know, listen to the people, do some, some research. Find ways of engaging is what are they thinking and feeling. You can do social scanning, you can do, client feedback loops, you can do research groups, you can use that promoter score, you can do secret client activity.

You can do loads of different things. But just measure it and, and create a KPI for how you make people feel. 3.

Invest in some customer experience education, you know, you have to get to the point where your team see the practises your clients do, so that they understand the importance of the customer and their journey and their experience, and that each step matters. And this is a non-clinical intervention, and it's a whole team intervention and where practises have done this, it makes a huge difference because it puts the client into the front and centre of we can't do the right thing for patients unless we get the right thing for our client base, and we can understand them. Invest some of your clinical education, CPD time and budget to improving listening and empathy.

. It, it really, really, really matters and it's something that for. Maybe for some of you thinking, you know, there's a clinical education budget there is put some of it into non-clinical, put some of it into communications and make that a mandatory part of your education budget. So, you know, 2/3 is on clinical and 1/3 is on non-clinical.

This matters, this is massive. And we know from all the research that patient outcomes in both human and veterinary field in patient-centered practises are better. There, you know, there is better outcomes, both in terms of satisfaction and in some clinical outcomes, and in, in, in, in the whole mix of medicine done better is if you can get your, your non-clinical skills better.

And 5, you know, develop a customer-centered approach, and really work hard to remove language that creates negative client discussions. And you will know what I mean. There will be negative client discussions in your tea breaks, you know, there'll be eye rolling at front desk to handing baton on to nurse, handing baton on to vet, by the time it gets to the vet, the eye roll discussion will have become something else.

Let's remove that. Let's really make a stand and say, Right, OK. They're here now.

We can care now. This is an opportunity to care. This is our chance to do the right thing for a patient.

What's gone on before has gone on before. Let's not judge that. Let's go with the material that we've got in front of us and, and work with positive intent.

. So thank you for listening. And thank you to the NZVA for inviting me along, even though I'm sat in my front room. And next time, hopefully, that I'm down under, I'll pop in and say hello to the guys in Auckland.

So thank you for listening and I hope you found that useful.