Three Aspects of Human Healthcare That Can Help Shape the Future of Veterinary Medicine

As the year winds down, I find myself thinking more than usual about the future of the veterinary profession.?

What can we do in 2022 and beyond to increase quality of care for our patients? How can we meet the evolving needs of our clients? How can we address the challenges affecting our veterinary teams the most? Three areas of opportunity that come to mind for me are:

• Exploring value-based veterinary care
• Continuously improving patient safety
• Evolving the role of veterinary technicians and nurses in our clinics

These also happen to be areas in which human medicine has made—and continues to make—strides. It makes sense, then, that we’d look for opportunities to borrow from their successes. Here are a few ways we can do just that.

Value-Based Care

In a value-based care model, clinical teams are focused on effectively and efficiently delivering the outcomes that matter most to the patient. Despite being a model that's frequently reported on and largely seen as the future of human healthcare, it has struggled to gain traction. This is likely due, at least in part, to the complexities stemming from the payer/provider model.?

Luckily, in the veterinary industry, we have the opportunity to pick what's working in value-based care in human medicine, and make it our own, unencumbered (or at least less encumbered) by some of the logistical challenges. At Mars Veterinary Health, we have started down that path.

There is a lot of variability in outcomes in human and veterinary healthcare. One of the goals of value-based care is to identify treatment pathways that provide value with little variability. In 2019, I attended the annual International Consortium on Health Outcomes Measurement (ICHOM) conference. In partnership with physician leaders and patient representatives, ICHOM develops minimum outcomes standards. At the time, they had created standard sets for 28 disease conditions, which account for more than 50% of disease burden.?

Critical to creating these standard sets is the incorporation of the voice of the patient (or, in veterinary medicine's case, the voice of the client). Let's look at ICHOM's standard set on breast cancer as an example.?

Survival and disease control and disutility of care are the outcomes that often come to mind for medical professionals. But by using survey tools to collect patient-reported outcomes, ICHOM captured a host of other outcomes that matter much more to patients—but are unlikely to be understood when just reviewing a medical record. Looking at this approach, I could clearly see the need to bring the voice of the client into any value-based veterinary care (VBVC) efforts we undertake at MVH.

With ICHOM as our guide, MVH chose two disease conditions that represent a large disease burden in our practices—cranial cruciate ligament in dogs and hyperthyroidism in cats—to pilot our vision for VBVC. Though we're early on in our effort, I truly believe VBVC will increase accessibility, improve client engagement, and enable our clinical teams to work more effectively together to improve meaningful patient outcomes. I look forward to sharing more as we analyze data from our current pilots and expand to other disease conditions.

Patient Safety

Have you ever made a mistake??That was the title of a presentation given by Dr. Albert Wu, a practicing internist and Professor of Health Policy & Management and Medicine at Johns Hopkins University, during our?MVH patient safety summit?earlier this year. Dr. Wu has done extensive research on quality care and medical outcomes. In his presentation, he referenced a landmark report published in 1999 by the Institute of Medicine titled?To Err is Human. The key takeaways from that report were that, by and large, risks to patient safety are caused by flaws in the system, and individual healthcare workers are rarely solely to blame. Another reality, described in a paper written by Dr. Wu himself, is that healthcare workers involved in medical errors can suffer emotional trauma, making them "second victims" who need support themselves following adverse events.

Recognizing the need to gather information about patient safety events to prevent future errors, Johns Hopkins developed a medical error disclosure policy 20 years ago that includes two key elements. First, a patient has the right to receive information about medical errors. Second, no punitive action will be taken when errors are reported promptly and in good faith. Ten years after developing this policy, as the toll on "second victims" became clearer, Johns Hopkins launched a program to support those impacted called “RISE: Resilience In Stressful Events.”

How does this apply to the veterinary profession? Pet healthcare is susceptible to the same systemic weaknesses that exist in human healthcare, and veterinary care providers are equally at risk for becoming "second victims" when adverse events occur. And in both human and pet healthcare, the core of patient safety is a safe, supportive and transparent culture. Since human medicine has a head start in tackling patient-safety challenges, it offers veterinary medicine a solid foundation to build on when creating patient safety and quality programs. This is one wheel that does not need to be recreated.?

To that end, Mars Veterinary Health looked to best practices in human health when creating our Quality Foundations Guide, which is available to our Associates as a resource for designing quality programs that result in better outcomes for pets. Developed by veterinary leaders who oversee medical quality programs within MVH and our family of practices, it offers background information and tools that can be used to look at systems when errors occur, build in defenses to prevent future errors, and support the veterinary teams impacted by adverse events. Examples from the guide are shared in one of the MVH Patient Safety Summit speaker sessions, a collection of which are available on our website:?marsveterinaryhealth.com. I'd encourage anyone interested in learning more, earning free continuing education (CE) credits, or looking to expand patient safety programs in their hospitals to check out the presentations.

Elevated Roles for Technicians & Nurses

The recent pandemic-inspired surge in pet adoptions led to unprecedented caseloads for veterinary teams. While I'm personally thrilled that more pets are finding homes and more people are experiencing the joys of pet ownership, the increased demand for veterinary care is creating challenges for our profession. A Banfield Pet Hospital?study?estimates 75 million pets in the U.S. could be without the veterinary care they need by 2030, in part due to a shortage of veterinary professionals to handle the demand. Yes, we need to increase the pipeline of veterinarians, but arguably just as important is expanding the roles of other veterinary team members.?

Here again, we can look to human health as a model. The nurse practitioner (NP) role emerged in the U.S. in the 1960s, in response to America's changing healthcare needs. Nurses saw an expansion of their role as the best way to deliver care to underserved and vulnerable populations. As a result, educational programs were created, and advanced degrees were offered. Over the last 50 years, the NP role has continued to evolve, with?research?showing they deliver both quality care and high levels of patient satisfaction. And most recently—faced with a doctor shortage made worse by the COVID-19 pandemic—some states?temporarily lifted restrictions?on NPs, allowing them to perform the full scope of services for which they are trained. There's no reason to think veterinary nurse roles could not—or should not—follow a similar trajectory—and the work has already begun.

I sit on the Veterinary Innovation Council (VIC) Board of Directors. VIC's current priorities include working with key stakeholders to tackle broad curriculum changes and distinctions for veterinary technician degree programs that will ultimately expand the career path and scope of responsibilities for individuals who pursue careers as veterinary nurses. This past summer, the American Association of Veterinary Medical Colleges (AAVMC) and the Colorado State University College of Veterinary Medicine and Biomedical Sciences presented on this topic in a?symposium?titled "Leading Change: Emphasizing Team-based Veterinary Care" during which speakers shared information on emerging innovations in technician/nurse education aimed at broadening access to clinical care. And a couple of months ago, Lincoln Memorial University College of Veterinary Medicine announced plans for a Master of Veterinary Clinical Care degree program, with a tentative start date of August 2022. So, the wheels are very much in motion.

Within Mars Veterinary Health, we've taken several steps to support and elevate veterinary nurses and technicians in MVH hospitals and across the profession. Recently, we formed the Global MVH Veterinary Technicians and Nurses Council. This group of primarily women from across our family of practices helps set the vision for veterinary nursing across our more than 2,500 veterinary hospitals worldwide. Their contributions include setting, upholding and enhancing clinical nursing standards and education across MVH, advocating for veterinary nurses and empowering them to practice at the top of their licenses. Realizing the importance of continuing education, MVH sponsored NAVC's virtual Level-Up Summit, a free CE event for veterinary technicians and veterinary assistants. The Summit took place this past October but is available on-demand on?Vetfolio.com. Individual MVH practices have also implemented programs of their own. These include a CVT Pet Nutrition Advisor Program and the ability to schedule veterinary technician appointments. Both programs expand the role of CVTs in the hospital and enable them to build more meaningful relationships with clients.

Just as nurse practitioners have added value in human healthcare, I believe if doctors embrace giving more responsibility and autonomy to mid-level practitioners, the result will be much-needed relief in terms of individual workloads, more rewarding careers for the entire veterinary team as everyone practices at the top of their licenses, and ultimately better care for pets.?

Looking Ahead

I've called out three areas of human health that can be a source of inspiration to all of us looking to advance the veterinary profession, but I know there are others. To my veterinary colleagues: what elements of human medicine do you think are the most relevant and useful to evolving high-quality pet care?