Seeing double: managing the referral process

So, who is the client when it comes to referral practice?

Is it the referring vet or the client? After all, they are the ones who make the decision to use – or not use – a service.

Or is it the pet owner? After all, he or she is the one who pays for the services – either directly or indirectly. The referring vet is a repeat user (hopefully), and the one with whom the practice develops the relationship and will try to market to. The pet owner is (usually) just a single, one-off user of a practice’s services.

So, who is the client for a referral practice? And does it matter?

The answer is, of course it matters – especially when a referral practice is trying to effectively and efficiently manage the referral process.

So, who is their client? Well, they both are – as well as a few others, but more on that in a moment. And there is nothing wrong with having multiple clients. When you stop to think about it, most practices – of whatever hue – as with most businesses, have multiple customers; it is just a bit more explicit with referral practice.

From a referral point of view, we will concentrate on two forms of client – who each have different needs. While the referring vet wants the pet he or she is referring to receive effective treatment and for the client to be satisfied, he or she also wants to have an enduring and trusting relationship. He or she wants the referral hospital to reflect well in the eyes of the client, so that his or her decision is validated and reflects well on him or her.

He or she wants to be able to discuss a case with welcoming, available and knowledgeable staff who won’t patronise him or her, and who can help his or her learning and understanding of the case so he or she may avoid referring that type of case again in the future. He or she wants – and needs – access to ongoing CPD offered by the hospital.

He or she (and his or her team) need a simple referral procedure with minimal waiting or delays, and treatment options that are affordable for his or her client. The quality of the hospital and the clinicians involved will almost be assumed, but this must be reflected in the referral choice.

If the referral hospital can offer all this – and sometimes a bit more – then a long and mutually beneficial relationship is likely to be maintained.

The client, on the other hand, just wants his or her pet cured/sorted/fixed – or is that the real reason?

This, of course, assumes the reason why a referring vet is making the referral is because additional experience and expertise is required for the patient’s treatment. This isn’t, of course, always the case.

Reasons for referral include:

• access to instruments and tools not available in the primary care practice
• client demands for a referral – either as a second opinion or the client’s own perspective on the level of treatment required
• a severely demanding client
• a case or procedure outside the referring vet’s comfort zone
• the necessity for aftercare at a level the referring vet can’t offer

While the referral clinician is an expert in what he or she does – and frequently a specialist in his or her discipline, with many years devoted to the study of an individual aspect of medicine or surgery – the referring vet is an expert in the general needs of his or her clients and patients.

One of the sad developments in how veterinary medicine has evolved is in the devaluing of the role of a good, experienced general practitioner. This calls to mind Isaiah Berlin’s analogy of the hedgehog and the fox: the fox knows many things, while the hedgehog knows one thing very well. One isn’t better than the other, it’s just that both are different and each does what it does as well as it can.

Customers, customers, everywhere

Ultimately, we are all responsive to customer demand. Everyone has a choice – as consumers, we all have choices; so do your clients.

Key drivers exist that help clients make decisions – and they are looking for:

• spending less money
• spending less time
• more quality
• someone offering more value-added services
• someone who is easier to do business with

A compromise will always be required, and clients aren’t stupid; they know this. Different drivers will take precedence over others at various times, but they are generally looking for as much as they can from each driver.

Referral hospitals must be cognisant of this and not rest on their laurels of assuming their “quality” of service is all they have to offer.

And while clients often lack the technical skill to make a choice – and that’s where they rely on a knowledgeable and trustworthy GP – you can expect them to research your recommendations. Ultimately, however, they will know whether they are being looked after; they are experts in that.

While referring practices and pet owners are the most obvious clients, or customers, like every other organisation a host of internal customers exist – such as the clinical team, the nursing team, the support team and the admin team. Each group – and each individual within these groups – have individual needs, wishes and desires. Satisfying these, as satisfying the needs of referring vets and pet owners, is essential for the referral process to be as effective as it possibly can.

Taken together with the external customers, such as the referring vets and the pet owners, these represent just some of the stakeholders within the organisation. All have needs – and all need to be dealt with differently.

Choices, choices, everywhere

It is essential, from a referral hospital point of view, to keep the needs of the client front and centre when managing the referral process.

Which client? Well, all of them really. But like the hedgehog, let various people within the organisation look at individual processes. They are the experts at what they do, and need the freedom and support to get on with what they do best.

The important thing to remember is to keep the process as informed and as transparent as possible.

It is important to recognise the general dynamic you are dealing with. You have a client who is being referred to you who is going to a practice he or she has never been to before, to see a vet who he or she has never met before. He or she is generally rearranging his or her personal arrangements because his or her beloved family member is unwell and needs care. For all this, he or she is frequently travelling a long distance and having to take time off work. Oh, and for this privilege he or she is going to have to spend a considerable amount of money. These are generally not the makings of the start of a great relationship.

So, as a practice, you are not dealing with an anxious client, but someone else’s anxious client. Because, no matter how much you treat him or her, you are just looking after that client on behalf of his or her referring practice.

Clients have heightened demands and an expectation of choice that they get from their own health care, and, naturally, feel the same about the health care for their pet. Their family member. And it is useful to regard the patient you’re treating as a family member.

The most useful external analogy is that of a consultant paediatrician. As is the same with paediatrics, you are treating a patient that can’t tell you anything directly about their symptoms. Instead, you must rely on a surrogate – the owner – to both help explain the timing and severity of the symptoms, and to make the treatment decision once a treatment plan is devised.

As with paediatrics, a heightened sense of emotion exists. Not only is the owner concerned about the welfare of his or her beloved, but he or she is going through additional anxiety by making decisions that have a bearing not on his or her health, but on someone else’s. This additional layer of concern for the client creates uncertainty, takes him or her out of his or her comfort zone and, therefore, increases anxiety.

Does this happen with every client? Well, no, not really. Some process all this additional information in a matter of nanoseconds and are completely unfazed by it. But you should start – and assume – that like any parent, heightened anxiety and concern will exist as part of the treatment.

Shared goals

A healthy pet and a happy client – isn’t that what we all want in life? The only way to achieve this, though, is by acknowledging that many people are involved in a referral process and have different needs. Everyone is working towards the same objective, but what he or she needs at various stages can be quite different.

Knowing what each customer requires and desires throughout the process will help you ensure a referral process that works for you and will meet, if not exceed, what each customer – internal or external – is seeking.

In a world of choice, where expectations and demands run high, it is essential to running an effective referral service that you keep your clients’ – your customers’ – needs front and centre.