1 Mar 2017
The traditional dynamics of the referral process have often left clients feeling a little out of the loop, but times have changed. Here, Ray Girotti explains why it is now essential to see the client as central to the choice of whether or where their animal is referred.
Ray Girotti
Job Title
So, Mrs Boffin’s love of her life – her pug, Noddy – isn’t doing well and you are considering a referral. Do you keep it in house and tackle it yourself? How about getting a colleague who has more experience or maybe a special interest in this type of disease to take it on (and Mrs Boffin)? Or, do you refer to a referral centre? A university? Another first-opinion centre with a referral practice attached? A dedicated referral centre? Choices, choices.
How many of these choices are yours and how many of them are Mrs Boffin’s? You have her trust, but she has Dr Google. She knows what she wants and what is available. How much choice should you offer Mrs Boffin? After all, you have a relationship with the referral centre and the vet you’re referring to. You have the knowledge to make a judgement about the competence of who you’re referring to. You’ve likely dealt with many referrals, so you know what kind of service and communication to expect. You’re who Mrs Boffin trusted to look after Noddy.
Only Mrs Boffin can make the decision on how much she can afford to spend on Noddy’s care, but do you have a duty of care to manage those expectations and prevent her embarrassment, and guilt, if she’s confronted with an estimate for treatment larger than she can afford? Likewise, she may have a different concept of value than you might understand and may have been expecting even more from the self-same estimate. A good referral centre will help you manage those expectations with good communication and options as they look after our mutual client.
Mrs Boffin’s choices – and your choices – may not seem as clear nowadays as they once were. Insurance companies are setting up preferred referral networks and many dedicated referral centres are now coming under corporate ownership. Have your and Mrs Boffin’s choices been compromised?
Corporatisation of veterinary practice has undoubtedly had an effect on the profession as a whole – some good, some not so good. Much will depend on who you speak with and his or her own attitude. But there will still be many practices that acted and behaved with a corporate mind-set prior to the mid/late 90s when corporatisation generally kicked in.
Practice groups and managers brought a professional understanding of business and this had been going on for many years. Medium-sized and large groups with a central practice or hospital had outlying branches – many independently run – and this was the true start of preferred referral networks.
Lately, many of the stand-alone, dedicated referral centres have come under corporate ownership, with groups such as CVS, Vets4Pets, IVC, Linnaeus, VetPartners and others bringing referral centres into their business model.
The purchasing of referral hospitals by larger corporate groups goes back more than 15 years, so this is nothing new.
Moves by RSA to set up a referral vet network, likewise, aren’t new. For more than 10 years various insurance companies have experimented with trying to encourage, or even dictate, where pet owners, such as Mrs Boffin, could take his or her pet for a second opinion. Early experiments saw M&S trying to dictate which out-of-hours centres could be used, but this was abandoned. Vetsure set up a network of partnered consultants more than seven years ago.
All of these moves have met with various degrees of success and failure; none have come as a surprise. Practice goes on and the profession moves along with it, and you still have to determine the best way to treat – or refer – Mrs Boffin’s Noddy.
Mrs Boffin wants only the best for Noddy (naturally) and thanks to tens of thousands of comments left in various online forums (which, of course, have all been left by experts in the field), she knows what is available.
Clients don’t always have the expertise to judge the appropriateness of a referral, or the competence of who will be carrying out the work – that is what you are there for. Clients do, however, know good service and what to expect. As Harry Beckwith points out in his book on service marketing, Selling the Invisible – a Field Guide to Modern Marketing: “Clients are experts in knowing if they feel valued.”
How much should a member of a preferred referral network dictate your decision? It shouldn’t, but it may influence Mrs Boffin’s decision and part of that choice is up to her. This is part of the discussion that needs to be had with Mrs Boffin and is part of the important three-way (first opinion vet [you]/referral vet/pet owner [client]) communication that needs to be had to ensure a productive referral.
More than half the dogs, and almost a third of cats, in the UK are insured. But insurance doesn’t mean the job is done. Many insurance policies do not have enough cover to meet even modest treatments – there may be exclusions and how much of the policy was used at the first opinion practice may have a bearing on referral options. This is before considering preferred referral networks, and let’s not forget the overall majority of pets are still uninsured.
A discussion on costs, value and affordability is essential so Mrs Boffin doesn’t get a surprise. While it is good if you know the rough costs of a referral and what some common procedures may cost, you may not know all the costs that go into various procedures are or what options may exist if there are affordability problems. That is the job for the referral practice. Good communication at an early stage will help ensure things run as smoothly as they should.
Value is one of the core demands clients make of any service provider. We should not be surprised Mrs Boffin is demanding. Michael Porter noted 15 years ago in his groundbreaking book examining consumer behaviour there were five key areas where customers’ demands were increasing:
Not too demanding, then. Surprised? I didn’t think so.
It is important you, as the first opinion vet, and we, as a referral practice, develop a relationship so you trust not only are we going to look after our mutual client, but we aren’t going to disparage you, either directly or inadvertently.
The client journey when visiting a referral centre is daunting. He or she knows you, your practice, your receptionists and your nurses; however, when coming to a referral centre, it is new and strange. Often, referral centres are larger and more modern-looking than first opinion practices. Clients often have to travel long distances to be referred – and frequently dwell on the worst case scenario. So, a client often visits a referral centre going to a strange place, far away, to spend a lot of money and to get bad news. Not a good combination.
They need you to help give them reassurance they are doing best for their pet. You also need to trust us (as all referral centres) that we are going to treat Mrs Boffin as you would have treated her, and treat Noddy as you couldn’t have treated him.
You should have confidence in knowing what and when to refer (your referral centre should help with this through, for example, CPD and advice), where to refer (the importance of a positive relationship) and who to refer to (the competence that gives you reassurance).
Mrs Boffin needs you to help guide her. Sure, she knows when she is being looked after and her expectations are high. She needs choices, but also direction. She knows how much she can afford and what value that is to her, but you know about the competence of who will be carrying out the work on Noddy. And because three parties are involved in Noddy’s care, she will demand we have a relationship and that communication among all three parties is strong enough so both she and Noddy get what they deserve.
Our mutual client, that is, the pet owner who has put years of faith in you and trusts, vicariously, your judgement of when to refer, where to refer and who to refer to, is reliant on the relationship we have and the communication we prize to make sure Noddy has the most productive referral possible.
