Evidence-based veterinary medicine (EBVM) has the power to enhance and transform the quality of animal care¹.

EBVM practitioners have reported a positive ripple effect on client relationships and practice teams, leading to business and financial rewards, and competitive advantage².

Effect on client relationships

Satisfaction and perception of value

In a survey of veterinary professionals, 74% reported that clients appreciated when they put in extra work researching their specific case³.

Veterinary practices that have adopted EBVM can enjoy greater client satisfaction, stemming from the value clients perceive in the thoroughness of the science-based approach².

When Quality Improvement (QI) activity – often practised as part of EBVM – leads to successful process changes, it consistently brings improvements in customer satisfaction, as well as profitability and market share, according to research in human health⁴.

Clients can also benefit from the financial value that EBVM can provide, when practitioners avoid unnecessary or outdated procedures, and only employ interventions that are supported by evidence of success².

Considering quality and cost together to create value allows practices to optimise the outcomes delivered and patient experience per pound spent⁵.

This enables veterinary professionals to make appropriate efficiencies and offer a scientifically supported set of treatment options to suit different budgets.

Steve Howard, PDSA’s head of clinical services, said: “At PDSA we have a duty to all our stakeholders to demonstrate that charitable funds are used as effectively as possible, and that we are delivering an appropriate standard of clinical and customer service that provides the pet welfare outcomes and client care required.

“Good-quality, reliable and practically relevant evidence is a cornerstone of our ability to decide what care we should be providing, how we are going to provide that care effectively and how we reassure ourselves that we are providing the outcomes and welfare that we desire.”

Trust

Professionals who take care and time to involve animal owners in decision-making and research tend to build trust and closer relationships with clients². This can be particularly valuable in discussions with owners who have researched conditions and treatment options themselves^2,6.

When the vet becomes a trusted partner rather than simply an expert for hire, a strong, loyal client base is built². A business case for EBVM exists because trust is intrinsically linked with quality, cost, value and speed⁴.

Veterinary surgeon and researcher Carol Gray said: “EBVM provides a cornerstone for shared decision-making between veterinary professionals and clients.

“The vet professional needs to have a good grasp of the latest evidence to present options, risks and benefits associated with proposed treatments.”

Anji Kingman, pet owner and NHS clinical outcomes manager, said: “Like most owners, I love my pets and want the very best for them by a vet who is knowledgeable as well as caring.

“It is important to me that the practice offers treatments that are based on evidence gained by research and outcomes monitoring.

“I know that my local veterinary practice is a member of the voluntary RCVS Practice Standards Scheme, which, as a layperson, I find reassuring. I feel I can trust my vet to keep up with the latest evidence so that my pets are in good hands when needed, no matter what the situation may be.”

Confidence and reputation

The systematic and rigorous approach that is fundamental to EBVM has the power to inspire confidence in clients of consistent high-quality care². It can also enhance a practice’s reputation, helping to attract new business^2,4.

Allisdhair McNaull, veterinary surgeon and former clinical director, said: “EBVM provides the best route to improve the quality and consistency of care provided by the profession. It is also the best way to improve the public perception of the profession, which in turn will improve the well-being of the profession with reduced complaints and increased public confidence in what we do.”

Promotional benefits

Practices that employ QI techniques as part of their application of EBVM seek out and apply data to enhance performance.

The statistical results of audits and benchmarking – and the commitment to excellence they demonstrate – can act as powerful promotional tools when shared in the waiting room or by word of mouth, potentially setting the practice apart from competitors and boosting reputation among clients^2,7.

Maximising efficiencies

EBVM and QI enable practice teams to identify and address inefficient or ineffective care or supporting activity⁴.

The sustained application of EBVM can systematically remove waste from processes and product usage, which in turn liberates both financial and human resources for the benefit of practices and clients.

Cost efficiencies

Considerable cost savings have been made in human health as a result of QI^8,9. Potential savings can often be identified through simple processes – a straightforward medicines audit, for example, allows practices to avoid duplication, waste and the high prices associated with last-minute purchases⁷.

As noted previously, audits can furthermore provide confidence that existing treatment approaches are effective in producing strong outcomes. The data gathered can, therefore, demonstrate efficient use of funds and that more costly procedures are unnecessary.

In some cases, the application of EBVM can lead practices to propose new routine procedures to clients, with the twin benefits of increased clinical rigour and income generation¹⁰.

Time efficiencies

When practice teams adopt evidence-based checklists and guidelines for handling common, routine conditions, practitioner time can be saved and directed to more complex cases¹¹. Regular use of checklists and guidelines also ensures that the whole team is confident about the processes to be followed in a range of scenarios. This frees up time that can be spent on other parts of the business (and that can be critical in emergencies)⁷.

Most importantly, the systematic working that EBVM and QI foster reduces errors. Potentially crucial in terms of patient outcomes, this also translates into time saved in rectifying care deficiencies and mitigations^4,7.

Reliability

Reliably delivering the basics of care has been shown to improve outcomes and drive considerable savings in human health^4,11.

Applying EBVM assures practitioners of the reliability of their selected care option. A standardised, reliable evidence-based approach acts as a foundation for efficiency and rapid innovation when variations in treatment are deemed beneficial¹¹.

Effect on team

Practising EBVM can have a major positive impact on practice employees, both as individuals and as members of a team².

Potential to reduce burnout

A QI culture with a focus on patient safety acts as a powerful antidote to burnout¹². Six months on from the first coronavirus national lockdown, 74% of vets were concerned about stress and burnout in the profession¹³.

Highly unpleasant for the individual, burnout is characterised by reductions in professional efficacy, patient safety and satisfaction; and increased turnover of team members^14,15. There is, therefore, a strong business case to invest in efforts to reduce burnout¹⁵.

Organisational factors are the primary drivers of burnout, and research suggests a synergistic relationship between patient safety culture and reduced burnout. Many elements of a patient safety culture mirror the workplace characteristics that protect against burnout, including open communication, participation in decision-making, a degree of autonomy and non-punitive managerial practices¹².

Veterinary surgeon Mark Turner said: “With a knowledge of patient safety and QI, I believe that I have different conversations with colleagues now – I’m able to think about my mistakes and the mistakes of other people from a different place.

Using an understanding of complexity, systems and human factors just means you are naturally disinclined to blame yourself or others right off the bat. This doesn’t mean that I never have a bad day, but it does mean I can get over them more quickly and pick myself up.”

Improved engagement and productivity

Practising EBVM and QI has a very strong positive effect on employee engagement⁴, given the inherent critical thinking about how work is carried out. This, in turn, can give rise to greater professional investment, a sense of ownership and heightened passion for the job².

Alison Thomas, head of veterinary services at Blue Cross, said: “The development of a set of evidence-based, QOL-driven clinical guidelines at Blue Cross has helped to create a consistent approach and a pragmatic level of service, reducing the costs to the charity.

“Involvement of the whole team in their creation has been an excellent source of free CPD, but has also ensured a sense of ownership and encouraged more critical thinking in the way we approach all our work.”

The enhanced employee engagement and teamwork that result from EBVM can induce greater productivity and reduce shortcomings in care, providing a return on investment due to productivity gains and a fall in adverse significant events⁴.

Strengthened communication and culture

Effective EBVM and QI necessitate good communication to secure sustained support from the whole team¹⁶. This can break down barriers and create an environment of infectious enthusiasm and camaraderie².

The emphasis on shared responsibility and improving systems of work – whether things go well or not – strengthens relationships and morale.

This kind of patient safety and learning culture can be a factor in retaining and recruiting team members^2,7,12. It can also deter against “organisational silence”, which can ensue when disengaged team members become disinclined to share information that would be strategically useful¹⁷.

Increased confidence

The confidence that EBVM builds among vets and the satisfaction gained from practising good medicine was by far the most discussed theme in a study investigating the non-clinical benefits of EBVM².

Consulting and applying the best available evidence gives veterinary professionals the confidence and reassurance that they have done their best for an animal in their care. It also gives vets confidence that they can offer reasoned and transparent support for their decisions when faced with searching questions from clients^2,6.

Principal nurse manager Lesley Moore said: “The QI process has been hugely beneficial to our nursing team. It has increased the confidence of team members, ensured a high level of consistency for every general anaesthetic and, most importantly, has improved patient outcomes.”

Higher levels of happiness and perception of competence

Treatment decisions when clients have limited budgets is a perennial ethical challenge, and more than two-thirds of veterinary practitioners have experienced this challenge at least several times per week since the advent of the COVID-19 pandemic¹⁸.

The reassurance of offering high-value treatment options supported by science that are in line with clients’ budgets can, therefore, contribute to veterinary professionals’ happiness.

Effective QI calls for colleagues to treat one another with civility. Respectful behaviour has been shown to increase team happiness, as well as the perception of individual and team competence and autonomy – all of which are strongly linked into job satisfaction.

Conversely, incivility has a detrimental impact on team performance, patient outcomes and client relationships. It results in decreased cognitive function, attention and helpfulness, and increased errors, mental ill health, stress and team turnover. Incivility also negatively affects clients’ enthusiasm for, and trust in, a practice, as well as concordance with advised follow-up care¹⁹.

Laura Playforth, professional standards director, said: “If we treat each other more politely and compassionately, it makes everybody’s job more satisfying, and it results in much more highly functioning teams.”

Job satisfaction

EBVM can boost job satisfaction, deriving from the knowledge of a job well done².

Veterinary surgeon, practice director and clinical director Martin Whitehead said: “In my hospital, I think the clearest example of a non-clinical benefit of practising EBVM is the job satisfaction of doing so, and vets’ increased confidence in their diagnosis and treatment decisions when they can be underpinned by best evidence.”

Satisfaction also results from the opportunity to share learning, contribute to the knowledge base and ultimately play a part in the evolution of practice².

Vet Danny Chambers said: “If you are involved in submitting a clinical question or publishing an answer to that, the information you provide will go globally, and it will affect how vets make decisions regarding that situation worldwide. And the feeling you get knowing that you are impacting animal welfare on a global scale is absolutely phenomenal.”

QI empowers team members, given that all members of a practice can lead improvement initiatives, regardless of role⁷. This empowerment can increase job satisfaction²⁰, commitment to the job and practice loyalty.

In the course of applying EBVM and QI, team members frequently acquire new knowledge and skills, advancing their professional development¹⁶. Further, they may become published authors or be recognised formally for these activities, leading to a sense of pride and accomplishment².

Veterinary surgeon and clinical director of referrals Ross Allan said: “EBVM presents opportunities to involve all members of the veterinary team in collecting, reviewing and assessing information. It also allows opportunity for newer members of the team to take the lead on reviewing particular areas that are of their interest – a useful step when team members are developing their particular clinical interests.”

RVN Kay Lockwood, practice director at Riversbrook Veterinary Group, said: “I think getting the whole team on board to challenge ideas and work towards best medicine is how a practice develops itself, and becomes a better-bonded team.”

RCVS Knowledge: your trusted partner in EBVM

In summary, the business benefits of EBVM are many, varied and enduring. As with most strategic practice developments, resources need to be committed to reap these rewards.

Practising EBVM often calls for an investment in skills, to enable the team to undertake or update learning. Research shows that high-performing care settings tend to have leaders who are more skilled in quality and safety, and who spend more time discussing these at a senior level²¹.

Teams also need to have regular, dedicated time to apply EBVM, and to share findings and improvement ideas with colleagues. Practices can, however, start to enjoy some of these gains from day one.

RCVS Knowledge is a charity that’s here to help practices access the business and clinical benefits of using EBVM, through our wide range of free resources. We understand that time and know-how can be in short supply, so we work with veterinary professionals to create our fast-growing suite of free services and tools that make EBVM approachable and manageable for busy practice teams.

Your team can get started with EBVM by taking our free and comprehensive EBVM Learning course at their own pace. Take a look at our QI tools – guidance on using checklists, protocols, audits, and more to help your whole practice strengthen performance and team culture.

Explore our highly regarded library and membership service, which provides economical access to a wealth of veterinary literature, including friendly support from our in-house experts. Many practices fund their team’s library membership, so you may already have access to this. Whatever kind of practice you manage, you’ll find resources to help you and your team start reaping the business benefits of EBVM today. Visit rcvsknowledge.org

• An abridged version of this article first appeared in VBJ.