Zone Staff Training Sequence

Phase Client Relations, Outpatient Nurse Technician, Inpatient Nurse Technician, Doctors, Animal Caretakers

1 Review Chapter 2, Building the Successful Veterinary Practice, Volume 2, and all appendices of Promoting HAB in Veterinary Practice.
Discuss practice applications with nursing/technician staff. Learn the asymmetry exam in treatment room. Get it down to three to five minutes. Be able to share more good news than bad about pet with owner. Time to build confidence in "client narratives" vs doctor talk. Develop inpatient white board, with columns and rows for cage site, client/patient, treatment, priority, RTG, etc. Anyone can write on board, only IPNT can erase. Review Chapter 3, Building the Successful Veterinary Practice, Volume 2. Doctor core value meetings, standards of care, value added OPNT asymmetry exam. Animal holding techniques reviewed along with standards of cleanliness in areas where animals are caged in facility.

2 Narratives-value added
Coordinator tasks outcome and ensures accountability is shared. Read VCI® Signature Series Monograph Recovered Pet/Recovered Client Program. Move to consultation/exam room, shadow doctor, learn narratives, shift initial asymmetry and closing client CE to OPNT, while doctor in room. Still linear scheduling. Shift most all q.d., b.i.d., t.i.d., q.i.d., and other treatments to IPNT staff, train to a level of being trusted. Brief doctor on atypical cases on arrival. Continuity of care by doctor, schedules for Phase 4, mentor OPNT in consultation room, patient data sheet, and day admits. Begin to schedule any down time for shadowing as technician assistant.

3 Practice fill pattern in linear foci scheduling, beginning mid-morning or mid-afternoon, then schedule up and down from there. Planning time needed for high-density scheduling with doctors for Phase 4 appointment length. Linear scheduling, OPNT loads room, does asymmetry, puts record on back of door, doctor reviews before entering, transfers case back to OPNT in ten to twelve minutes for client CE. Doctor listens outside door, but not to be inside room with OPNT. Medical record and travel sheet accuracy. Only senior IPNT can ever erase white board and-done only after medical record is annotated. Technicians initial their actions, doctors sign the episodes. Standardize appointment length for new pet, exotic, wellness, etc. Start looking at day admit rates from outpatient cases. Application continues and training expands to drawing up fecals, a second person in X-ray, and treatment room restraint.

4 Now schedule two consultation rooms with doctor and OPNT, plus or minus pharmacy float. High-density scheduling begins to showcase OPNT training in client education areas. Two rooms scheduled for doctor and OPNT, with pharmacy float for another set of hands, working "out of sync," ensuring first ten minutes overlap with last ten minutes of other room. -Evaluated after every four-hour test of doctor-OPNT combination. Tech rounds at early AM and mid-day, set priorities. AM are toughest cases first. Mid-day assessments based on RTG times promised clients. Doctors verify and/or adjust priorities, when entering inpatient shift Outpatient doctor and inpatient doctor separation begins. Doctors to respect zone coordinators. Tech assistant in outpatient as pharmacy float, in inpatient as restraint specialist, and wellness monitor.

5 Mid-day shift changes. Full high-density scheduling. Review new OPNT narratives and OPNT/IPNT services. AM outpatient doctor becomes PM inpatient doctor to complete all the day admits and workload left from AM shift. Expect thirty percent-plus day admits from OP doctor. AM inpatient doctor becomes OP doctor to see clients of inpatients, as needed, on discharge. Expect thirty percent doctor discharges. Balance techs. Inpatient doctor does walk-ins and emergencies. Animal caretaker develops zone duty standards.

Aid for Implementing the Zone Staff Training Sequence

Phase Client Relations, Outpatient Nurse Technician, Inpatient Nurse Technician, Doctors, Animal Caretakers

1 Divide the reading assignments into small bites and share discussion leader role with zone members. Leader can provide pre-read study question and/or a question review to measure understanding..Role-play and exchange roles, so you grasp a better understanding of how the client may feel during this initial exam. Don't assume the client knows what you are doing. Keep client informed. Any pet in hospital needs to be noted on white board.
Do a spot check together to make sure all the pets are entered and that everyone understands the notes. Standards of care need to be communicated with pride to team.
NEED [ ] replaces "recommend".
Must say "I trust you" before next phase. Training includes information on reading pet's body language.
"Clean" needs to be clearly defined.

2 "Value added" means "caring added" by word choice and voice tone. NEED [ ] replaces "recommend". Schedule this for a doctor block with OP doctor. Take notes on specific narratives you need to hear again. Ask mentor questions you have about his/her narratives. Continue to start day at white board. Change of shifts is responsible for making sure board is correct before shift ends. Weekly doctors' meeting to discuss continuity of care with review of one OP and one IP medical record from last week for each doctor. Responsibility and accountability necessary for animal care takers.

3 Narratives needed to enable the foci scheduling. Every client gets two "yes" questions: "Morning or Afternoon?" "9am or 10:20?"
Gain control of client flow into hospital. Have a stand-up meeting after we do this exercise, to note what went right and how could we have done this better?
OPNT needs doctor support for many more times than just once.
Doctor feedback is confidence builder. Who covers when the senior IPNT is not on schedule?
Plan ahead.
Clear behavior expectations for the "other person" are necessary, as is additional mentoring by senior IPNT. Remember, eighty-five percent of clients want to be out in twenty minutes. Keep your focus on the pet and the client. High-density scheduling does not allow for socializing extensively. Practical experience is necessary. Be resourceful in finding samples to use for this lab procedure.

4 Start out high-density scheduling with one morning scheduled in two exam rooms. Meet at noon with team to discuss what went right? And hope can we do it better next time?
OPNT is responsible for making sure doctor flow in/out of rooms enables us to stay on schedule.
OPNT is now linked to follow pets under surveillance care. Schedule feedback sessions at this level. Good communication with IP team is mandatory.
NEED [ ] replaces "recommend". Doctor arriving to work before scheduled time is imperative. Now scheduled time means on-the-floor, ready-to-go time. Mentors at this level will be able to give additional attention to team member.

5 Provide session with zone members to identify areas of additional training. Are we fully utilizing the AviMark? Appointment scheduler? AM OPNT can now be scheduled as IPNT after middle of day. NEED [ ] replaces "recommend".
Surgery nurse zone may need to be added at this level. Time to have session for doctors to share challenges and successes with high-density scheduling.
Learn from each other. Standards necessary for training of new zone members.