Knowledge Award Audio Overview: Recording ownership and consent by Medivet

Hi there, my name is Rhian Littlehales, and I am the Clinical Governance Director at Medivet. I’m so excited to be speaking about our ownership and consent quality improvement project. And that’s been recognised as a third place champion in the RCVS Knowledge Awards. So this project came about because we received a number of complex complaints that related to animal ownership and consent for treatment.

I know as a vet in practice myself that these cases they can often be really challenging because they kind of sit at that intersection between clinical care and ethics and legal considerations, and also can be quite difficult when we’re managing client relationships. And I know that I’ve always found these, and my team have always found these incredibly stressful concerns when they’re trying to make the decisions that’s just in the best interests of their patients whilst navigating these really complex ownership arrangements.

We initially thought these complaints were isolated incidents, but using the RCVS Knowledge significant event audit methodology, we were really able to take a step back and look at the wider system. It became really apparent to us that lots of the cases shared a common underlying issue which was that our internal practice management system (PMS), which was across all of our clinics, didn’t allow colleagues to clearly record multiple owners or to differentiate between owners, agents, secondary contacts, or document different levels of consent and authority from owners.

So what we decided to do is rather than view the complaints as individual failures, we recognised they were often a symptom of a system that wasn’t adequately supporting our teams. So we reviewed all of those complaints across our organisation and carried out detailed significant event audits. We identified about 20 cases where there were limitations within the system that had contributed to these confusions or delays or disputes. And then once we understood the root cause, we worked collaboratively with colleagues from our clinical team, our legal team, our IT teams and obviously most importantly our practice teams across the estate to redesign the registration options within our PMS.

And that meant animals could be linked to multiple owners, agents, you could list someone as a secondary contact, each with a really clearly defined ownership and consent permission. And then we also introduced guidance around that to help colleagues use the new functionality really consistently and really confidently.

I think one of the things that made me so excited about this project was the degree of collaboration involved. I think we often think of quality improvement programs of just sort of being involving clinical teams. This was not led or developed by one single department. Our clinical team shared their experiences. Our legal colleagues helped us ensure that all of our terminology and our definitions were appropriate. Our IT teams translated the requirements into a workable system change, and our communication team supported us in making sure that we landed this well.

By bringing together all those different perspectives, we were able to develop a solution that really reflected the realities of what was happening in our practices, and the results were so encouraging. Since we’ve implemented this, we’ve seen a marked reduction in ownership and consent-related complaints.

Those that do arise are resolved much more quickly, and teams are much more confident when dealing with these ownership situations. So we’ve really reduced time and resources that we spend managing this. I was just so surprised to see how much impact this simple system change could have. They often, these complaints, stemmed from individual actions or conversations. And so we just were able to address that real underlying issue.

If you’re thinking about doing any kind of quality improvement project in your practice, my biggest advice would be from this case, look beyond the individual event and try and think of the system that was around it. The significant event audit, which can be all found on the RCVS Knowledge website, is a really powerful tool for helping us identify root causes that maybe weren’t immediately obvious.

We are so proud of this project. We are grateful to RCVS Knowledge for recognising it, and I thank all of the colleagues and teams involved. And yeah, thank you very much for listening.