Case Studies

387 Vets epitomise the importance of wellbeing at the core of everything they do: it’s key to their culture and has been from the day the practice first opened. This comes from the top with evidence of strong leadership from husband and wife team, Hamish and Rachel Duncan.

As their practice grew and the team expanded, Hamish and Rachel looked to Investors in People (IiP) accreditation to guide positive change and felt that has been invaluable as a ‘good business’ benchmark.

One of 387 Vets’ recent initiatives for encouraging mutual appreciation was their gratitude board. Team members write up thanks for something another staff member has done under one of the 12 headings on the board. Under ‘Aiming High,’ one team member thanked a vet, “for chivvying us along to start new audits.” Two of the nurses were thanked for being ‘Team Focused,’ by “…taking the time to makeover the crowded kitchen.” The board makes people feel special, boosts morale, flags up good deeds to all staff including managers, encourages a culture of thanks and gets staff to think about the practice’s fundamental values.

Monthly and bimonthly meetings enable sharing of clinical and in-practice information where everyone’s contribution is equally important and actively encouraged. On any given day, a white board by reception charts how in-patients are progressing so the reception team can inform owners easily; here, important incidents or euthanasias are also noted so staff off site can get up to speed later: this avoids potentially uncomfortable situations and any feelings of being out of the loop.

Rachel and Hamish run 6 monthly appraisals to review how staff feel as well as to talk through their professional development. Mental wellbeing is important to the couple who funded access for the whole team to a veterinary specific 8-week online Mindfulness course. Participation is of course optional, but at one particular member of staff’s annual appraisal, she and Rachel agreed completion of the 8-week course should be one of her objectives to help her with stress surrounding her chronic illness and managing day to day responsibilities.

The whole team took part in bereavement and end of life training with external provider Compassion Understood. All team members have been involved in changing the practice’s end of life protocols, introducing longer appointments, using sedation as standard and introducing end of life experience meetings (where the team discuss difficult cases openly). Not only has this made the experience better for clients, it has also helped staff manage such an emotionally challenging part of the job.

Martina and her team have spent a lot of time developing protocols for all aspects of their service including both clinical and non-clinical procedures which are written up in a ‘Standard Operating Procedures (SOP) Bible. Everything is covered from A (Appointment booking procedure) to Z (Zoonotic diseases) and this ensures consistency in the treatments and tests they offer. They also make use of check lists, which are regularly audited, for a wide range of procedures from surgery to general anaesthetics to daily cleaning routines. Martina believes this helps the team feel more confident in what is expected of them, and allows new team members to be integrated quickly which is both good for them and the practice. It also helps people feel empowered and confident with a positive impact on their wellbeing.

The practices core values are clearly defined as: We work as a team/ We put pets first/ We take pride in what we do /We get better every day/ We do what we say we will do.

This practice takes pride in the fact that those working there say work is an extension of their family life… in a good way. Their central London location means that they are able to open early but close at 5:30pm, Monday to Thursday and at 4:00pm on a Friday.

Work-life balance is important at Hyde Park and the practice is set up to extend this to everyone in the team. Communication is key with monthly meetings for the whole team at 7am on a Friday mornings and there is normally 100% attendance. These meetings allow everyone to become involved in practice decisions and be kept informed. The early start on Friday is rewarded with an early break for the weekend. This has allowed the practice to recruit and maintain a stable team.

The team at North Tyneside demonstrated in an extraordinary way, how working together for a charitable purpose can bond the team, improve morale and increase overall wellbeing.

In April 2016, North Tyneside Vets4Pets set up their own charity, Newcastle Street Paws, to provide health checks, vaccines, microchips, flea and wormer products and medication for ear and eye infections for the pets of homeless people on the streets of Newcastle. The team give up five to six hours a week to Street Paws and fundraise to finance the treatments. It has had fantastic effect in bonding the team together, as well as the positive media coverage it has attracted to the practice. The project has been so successful that now they are getting enquires from veterinary practices in other towns and cities wanting to set up their own Street Paws.

Like many other practices, the team at Stanley House Vets found themselves working harder and harder in order to provide the level of service they believed their clients deserve. Employing more staff would help, but as everyone knows, finding the right people at the right price is increasingly difficult. Their solution? To act like a family, making their practice somewhere people want to work and stay and then extending their reach to new graduates.

Like any good family, Stanley House give support to their team members, while at the same time fostering independence. Partly through necessity, like many other practices, they have started to recruit new graduates and that has meant putting in place a mentoring system. The whole practice has gained from this as teaching and training new graduates in both clinical and social skills has meant the more experienced vets have also had to reassess their competencies. Fast tracking social and communication skills allows vets to be more relaxed with clients and gain their confidence. This is such an important component to overall job satisfaction and wellbeing. In 2016, the practice were recognised as ‘Pendle Employer of the Year’.

Clare Dudley and Tanya Crawley are joint JVPs; Claire’s background is the Navy, and she leads on people development, Tanya, a vet, leads on clinical development. They believe that the profession is full of passionate, dedicated individuals but that this can sometimes be taken for granted, leading to staff burnout. Claire and Tanya demonstrate strong leadership and well developed staff development programmes.

At Swindon Vets4Pets, there is an acknowledgement that everyone is different with one-on-one mentoring, regular appraisals where realistic targets are agreed and opportunities for more junior members of the team to shadow those who are more senior including the JVPs. Vets have individual performance reports each month to help guide and develop their progression. There are clinical workshops and visits to other centres, allowing the team to share knowledge and gain experience. CPD is mandatory and uncapped and includes a subscription to online CPD which is used independently and in groups. They are a Nurse Training Practice and encourage and fund not only clinical, but customer service, marketing and management courses for all, including the Reception Team. Swindon Vets4Pets offer a genuine 40-hour week including paid breaks, made up of three weekdays and equally shared weekends. A non-rolling rota ensures people can plan their leisure time and get the days off they want.

Bell Equine is an equine first opinion and referral clinic with hospital facilities. As the only equine practice to be Highly Commended in the awards, it highlighted some of the specific wellbeing issues around ambulatory vets and the subsequent isolation and lonliness they can face. Bell Equine demonstrated how they tackle this.

An Ambulatory Equine Vet will spend much of their time away from the main clinic. As a result they can have very little contact with their colleagues, and this results in less supervision, guidance and mentoring, things that can be so useful, particularly for younger vets. Bell Equine hold regular meetings and social outings and encourage good communication. All ambulatory vets aim to start and/or finish the day from the clinic so that the team do spend time together and vets are encouraged to attend hospital rounds when they can.

There is a new graduate programme whereby they start as interns within the hospital for 12 months, gradually integrating ambulatory calls on one day a fortnight after the first three to four months. Check lists are used throughout the 12 month internships to ensure each new graduate has the opportunities to master the necessary clinical skills.

Nurses are encouraged to train to VN standard, and with this increasing knowledge and skills, they are given opportunities to match, for instance primary responsibility for the acquisition of diagnostic images within the hospital, including radiography, scintigraphy, MRI and CT. They have proved to be extremely competent in this role.

Husband and wife team, Verity and Ian Johnson believe from their experience, that veterinary practice can attract caring, over achieving, perfectionists and that the demands of the job can make these people particularly vulnerable. That, combined with increasing focus within the profession on mental health led them to set up an initiative to put wellbeing at the heart of their culture.

Sandhole set up a practice ‘Wellbeing Week’ with competitions for such things as the most colourful healthy lunch, daily emails with tips and techniques to help boost happiness levels, lunchtime walks, encouraging the team to get some fresh air and exercise, and a yoga and laughter workshop. The most successful activities might then continue all year. Inevitably some activities might be forgotten, but the following year’s Wellbeing week refocuses everyone. This is not about putting wellbeing into a once a year box and ticking it off as ‘done’. It is about a focus for wellbeing that then allows it to be ingrained in the culture and underpin everything they do, bringing it ot the top of the agenda, ensuring it is talked about and creating a supportive working environment where the team all work together.

Westmoor is an example of how a strong belief in wellbeing and leadership from the top (in this case the Clinical Director and Practice Manager/Head Nurse) sets the tone and a supportive open culture throughout the whole practice.

When recruiting new staff, great emphasis is placed on how well the new person will fit in with the team – new technical skills can be taught, but team coherence is harder to come by. They have supported team members through bereavement, hospitalisation, miscarriage, pregnancy, depression, and other mental health issues. Working hours and tasks are adjusted to give people the time and space they need, whilst enabling them to feel valued in completing the work that they CAN manage.

As a result, this year, one colleague dealing with depression for the first time decided she was better on reduced hours at work than off sick because of the contact and support she received from the team. The assumption is always that everyone is kind, skilled and hard-working, and any mistakes or short tempers result in the question of ‘Are you Okay?’, rather than just rapping of knuckles.

Communication is really important and each day starts with tea and the ward round, attended by all the day’s vets and ward nurses. There is an open-door policy, where staff are encouraged to raise issues at the time and address them as soon as possible. In addition to formal meetings, there is an ongoing and informal process of discussing and updating on different issues, such as morbidity and mortality discussions. Recently, nurses noticed a possible increase in wound complications at post-op checks, and brought this to the attention of the vets. This led to discussions between the vets about suture materials, spay techniques and antibiotic usage, but as a reflective learning exercise, rather than seeking to apportion blame.

Highcroft is a large, multi-branch first opinion and referral practice which demonstrates that excellent communication is possible regardless of the size of the practice and that good communication is good for staff wellbeing as well as being a key contributor to effective team work.

There is a practice meeting for all staff every three months. In addition, there are various committees that regularly meet, such as the Clinical Care Committee, Wellbeing Focus Group and the Events Committee. There are daily rounds at the hospital, and morbidity and mortality rounds monthly – all clinical staff are invited to attend these. Every member of staff has a line manager, with whom they have monthly 1 to 1s. This is somebody that acts as their mentor, helps with their training and development and supports and aids them to resolve any issues they may have, personal or work related.

Many of the team members regularly spend time together outside of work and there is a busy social calendar co-ordinated by an Events Committee, including a Christmas party, Summer BBQ/Booze Cruise, dog walks. In the past few years Highcroft teams have taken part in ‘The Coniston Challenge’, Petsavers ‘It’s a Knockout Challenge’, and many, many 10K’s and half marathons. In September 2016 they held a ‘Tour De Highcroft’ – a cycle team composed of a regional director, vets, ambulance drivers and other support staff, who cycled 80 miles around all the Highcroft branches raising money for Hounds for Heroes. People are encouraged to look after themselves and be aware of stress in the workplace. Line managers have attended stress awareness training to look out for early signs that their team members may be struggling and the practice have created a ‘Stress and Mental Health Flow Diagram’ to help people work through their options when they feel they are not coping.

Rutland house is a busy first opinion and referral hospital in St Helens, with 9 branch surgeries. Like many other practices, they have found it increasingly difficult to recruit experienced vets and so have introduced a New Graduate Programme, looking after the development and wellbeing of young vets during the first stage of their careers.

The Practice Manager, Jane Clare and Head First Opinion Vet, Gerard Tennyson masterminded the New Graduate Scheme. The plan was to take on a new or recent graduate and support and mentor them for 12 months before they are fully integrated onto the rota. The first 6 months is off rota with maximum support and a steep learning curve which supports them to increase their surgical and consulting repertoire. At 6 months they are integrated into the rota, often working alongside experienced surgeons at the hospital or branches. They also have a third of their time off the rota again allowing the pressures of time and deadlines to be removed and instead continue further learning, performing more complex surgeries with assistance, case discussion and ongoing tutorials to improve their knowledge base. By 12 months the aim is that they are fully integrated into the team and capable of working alone on the rota with support as required.

They continue to have close contact with their mentor/coach who is available to chat about cases or even difficult clients! They have a plan of topics they try to focus on each week, from vaccinations and parasite prevention, to interpreting laboratory results and covering endocrine diseases. The practice also attempts monthly 1 on 1 with all their vets to provide an opportunity for any ideas or concerns to be raised.

As providers of a dedicated out-of-hours service, individuals working for Vets Now are particularly vulnerable to isolation from friends and families. The company have robust policies in place to counter this and support the wellbeing of their teams. Infact, there are so many initiatives across the group that a head office Wellbeing Team has now been established to co-ordinate them.

Two senior managers, Michelle and Laura, were specifically tasked with setting out a programme and rolling it out to the districts. Area managers were trained in mental health first aid and in recognising the signs of people under stress or depression. An intranet was set up to allow vets, nurses and receptionists to share ideas and problems across all sites. This took some time to become accepted and well used, but is now a fantastic resource where both clinical and non-clinical questions are asked and responded to. It is reassuring for clinicians to know that in the middle of the night they can contact other colleagues, who might be hundreds of miles away, and ask for advice. Or it might be used to ask for advice on how to manage sleep and exercise when doing shift work, or even where to turn if your car breaks down on the way to work. In every district there is a Wellbeing Committee who organise more local events such as breakfast clubs, events and socials.