Jane Rose, a Veterinarian and JCU Master of Conflict Management and Resolution student shares her views on the opportunity to use facilitative mediation as part of a regulatory and complaints processes prescribed in the legislation governing veterinary practice in New South Wales (NSW). Jane’s blog post focuses on the NSW Veterinary Practice Act 2003 and has been co-authored with JCU Conflict Management and Resolution Lecturer, Rikki Mawad.
Conflict and Complaints in Veterinary Practice
It is not uncommon for mistakes to be made, costs to escalate and communications to break down between Veterinarians and Pet Owners. As with complaints in relation to human health care, disputes in relation to veterinary practice are invariably related to client dissatisfaction with a veterinary practitioner or the treatment outcome. Veterinarians practice in busy, emotionally charged small clinical businesses and have to make decisions in quick succession with little time for effective communication between team members and at times, impacted families. Each practice is a small business, standards can vary, and an external body does not audit the daily delivery of veterinary medicine.
A common example of conflict between veterinarians and pet owners is in relation to costs. While care costs are discussed at the beginning of treatment with pet owners, these can change unexpectantly. It is not uncommon that a patient may respond adversely to a procedure or for a new problem to be discovered and for the owner to not be contactable, leaving the care team to make critical decisions in the moment. The result of this is often a larger bill, and at times, unexpected euthanasia. The human impact can result in an angry and or grieving client, a stressed veterinarian and a possible hearing before the Veterinary Practitioner’s Board.
Prescribed Dispute Resolution Processes
The Veterinary Practice Act (VPA) 2003 regulates the provision of veterinary services NSW. The Act requires the establishment of a State Board as the regulatory authority, with one function of the authority being the investigation of complaints against veterinary practitioners. The Board recommends that concerns about veterinary practice are first raised with the veterinarian or clinic superintendent. If complaints are not able to be resolved directly between the veterinarian or the clinic superintendent and relate to animal healthcare, the complainant can raise their matter with the VPA State Board.
When the Board receives a complaint, the matter is investigated, experts may be called to give evidence and then a determination is made as to whether the practitioner has breached the Act and what sanctions may apply.
For matters that do not involve a breach or finding of misconduct, there are is no further recourse other than a separate legal action. Often however, the complaints process has further damaged both parties’. Not only does the complainant still feel aggrieved, the practitioner also still feels attacked and untrusted and there is a lingering fear of litigation.
For those involved in a dispute, the journey to resolution of a complaint is often long and arduous for all parties. For veterinarians, complaints can be mentally and emotionally demanding, and take them out of delivering clinical care and out of their businesses. Like medical practitioners, the fear of litigation has impacted the delivery of animal healthcare, with veterinarians increasingly forced to practice defensive medicine and with pet owners increasingly pursuing legal action beyond the regulatory body. Defensive medicine refers to departing from normal medical practice as a safeguard to litigation. It can involve unnecessary tests being performed, or treatments prescribed to be safe, and on the converse risky procedures, that could benefit patients, are avoided, serving the function to protect the physician.
Through the investigation and determination process, there is little to no scope for either party to present on and discuss their interests or needs, therefore preventing an opportunity for the conflict to be transformed. While serious misconduct must be addressed, the dispute resolution framework used by the Board doesn’t offer any opportunity to restore a complainant’s faith and trust in the veterinary profession or allow for any understanding of a practitioner’s perspective. The lack of communication (directly or facilitated by a third party) between the disputants thwarts any opportunity for understanding, forgiveness, apology and or reconciliation regardless of whether there has been a finding of a breach. When no breach has been found, the process has still further damaged both parties’ relationships and little has been done to address the fact the complainant is still aggrieved and the practitioner still attacked and untrusted.
In the author’s experience, the majority of complaints arise due to miscommunications between client and practitioner, accidental mishaps, communication breakdown with the practice team or sometimes acts of nature where an animal has a grave reaction that could not be foreseen. Given the root causes of these complaints tends to be miscommunication rather than misconduct, the author suggests there is much to be gained by introducing mediation into the VPA dispute resolution process.
Better Resolution, Regulation and Relationships through Mediation
With mediation often used in human medicine to resolve clinical, bioethical and medical malpractice disputes to save time, money, emotional energy and lost opportunities, why not introduce facilitative mediation into animal medicine? Using a facilitative mediation process as a precursor to or part of a formal process under the Act arguably gives the parties the opportunity to better address the substance of a complaint, create shared understanding of the issues and potentially party-generated more effective options for resolution.
Other jurisdictions have already moved to include facilitative mediation as part of their regulatory regimes. The Royal College of Veterinary Surgeons (RCVS) in the UK for example found that facilitative mediation should be employed early in veterinary disputes. It was their recommendation that facilitative mediation form part of the dispute resolution framework as a way to improve client interactions, the delivery of care and to better support veterinarians overall in their work/as a profession.
The majority of complaints raised by pet owners in the United Kingdom, like in Australia, fall outside of the professional misconduct remit of the governing body. In these situations, the RCVS has embraced mediation as a way to resolve complaints and allows concerns, that fall outside of the professional standards remit, to be resolved to both parties’ satisfaction. The scheme has reported success with 78% of cases resolved after being sent to mediation (BVA 2017). While the UK approach is only in the early stages, it is already showing huge promise as a better, less adversarial, confidential environment for constructive communication between disputing parties that can only add value to the profession (and the clients). In cases of gross professional misconduct, litigation is likely to remain the most appropriate remedy, however facilitative mediation can still assist to work through the parties’ emotional needs and interests.
Reducing the Impact of Complaints through Mediation
In 2016, thirty-three complaints were submitted to the Veterinary Practitioners Board of New South Wales (VPBNSW). Eight were upheld and the veterinarians were found guilty of unsatisfactory professional conduct or professional misconduct. The remaining 75% of complaints were dismissed. Moreover, since 2010, new complaints raised against veterinary surgeons has risen from 42 to 57 and since 2007 they have more than doubled ( 25 increased to 57) (VPBNSW Annual Report 2018) Though not all complaints resulted in arbitration, they would still have created anxiety to the veterinarian involved and distress to the pet owner. Whether these complaints were seen as legitimate or not by the board, they were to the complainant and remain real threats to practitioners.
As outlined in the previous section, engaging in facilitative mediation would enable each party to see the dispute from each other’s perspective, potentially reducing anxiety and dis-ease, re-establishment of client-doctor relationship and professional self-confidence and acknowledge the emotional impact of complaints. The development of solutions to address why a complaint arose could also lead to improvement in clinical and customer standards.
With the suicide rate for veterinarians in Australia reported as four times higher than the general population and double that of other healthcare professionals, the industry is facing both a mental health crisis and skill shortages. With increased dissatisfaction with the current complaints processes and such serious stress on the profession, it is critical that the authorities review the dispute resolution and regulatory processes. Introducing facilitative mediation as part of the process is a clear and low risk opportunity to improve complaints handling, client satisfaction, practitioner wellbeing and the delivering of quality veterinary care in NSW and across Australia.