Compliance Conversations and the Power of Curiosity

This adds layers to making veterinary diagnostic and treatment recommendations, and it likely makes conversations about compliance more challenging. Sometimes, too much information found online without enough case-specific context results in freaked-out clients. They may appear resistant when they’re likely confused or overwhelmed, not combative. Consider, therefore, channeling any compliance frustrations into curiosity.

By being curious in conversations, practitioners and practice team members can build stronger partnerships with clients. It requires, however, a new paradigm.

In the old paradigm, professionals in all fields — from physicians and architects to lawyers and accountants — got paid for their expertise and services, with the assumption people would automatically do as instructed. Now, it’s more about sharing your veterinary expertise and recommendations and then asking clients how much of what needs to be done they can do. When there is a mismatch between the recommendation and getting the required action done, then the curiosity conversational strategy kicks in.

Kathy Taberner says, “Instead of being directive, we’re moving to a place of ‘I’m sharing my expertise. Let me be your thinking partner to help you figure out how best you can do this.’”

Taberner is the co-author of The Power of Curiosity: How to Have Real Conversations That Create Collaboration, Innovation and Understanding. In addition, she is a former physio and occupational therapist, based in Canada. She earned a master’s degree in leadership and she is a certified physician coach. She often does one-day trainings with small groups of doctors followed up with coaching sessions as they implement curiosity-based strategies in their conversations with patients.

Asking What’s Doable

Taberner once worked with a pediatric transitional unit that helped families prepare for children going home after lengthy, serious hospital stays. The unit served an entire province. In many cases, home might be a couple of hours from local medical facilities and even farther from the hospital itself.

The old process provided parents with written at-home care instructions, followed up a few hours later with a face-to-face meeting to go over what was needed, including coaching on any clinical tasks.

“What we found was parents at home where overwhelmed,” she says. “They couldn’t remember anything, and they didn’t do anything. So, the hospital team would call to follow up two weeks later and nothing had been done, or very little.”
The transitional unit stopped assuming families could automatically do everything needed and began asking, “Now that you’ve had the chance to review this list, what’s doable for you?”

These conversations became more realistic and less overwhelming for parents. Rather than a directive conversation, the discharge process asked families how they saw themselves doing these critical clinical tasks at home. Let’s say the list included 10 items. The hospital staff may note a few things as non-negotiable and absolutely needed to be done. Other items fell into more of a “would be nice” category.

In some cases, the process required creative solutions. For example, if a family felt they could not do a non-negotiable item at home, then the hospital team would offer an alternative such as appointments a few times a week at a public health facility nearer the family’s home. Now, to the medical team, giving up a half-day, several days each week may sound more troublesome than handling the procedure at home, but maybe that works better for the family. You won’t know if you don’t ask.

Taberner says, “The initial compliance conversation might have taken longer, but then everything went smoother thereafter.” Overall time spent throughout the course of the case did not increase because staff spent a lot less time in emergency mode trying to line up local help once they realized tasks were not getting done at home.

Framing Better Questions

Closed questions—those that typically be answered with a yes/no or short reply— are not as effective because they don’t spur people to think on a deeper level, like open-ended questions. Those include:

• Who
• What
• When
  Where
• How

“Why can be judgy, so we don’t include why,” Taberner says.

She finds that keeping the words what and how top of mind prevents her from slipping into critical-sounding questions.

“It’s incredibly hard for professionals because they’ve been groomed and trained for many years to tell,” she says. “So, for them to shift to this place is particularly challenging. They want to share their knowledge, and they feel like this is what they went to school for. They want to help people, and they think of helping as telling.”

Compliance Glitches

Taberner says that conversations based in curiosity work when clients seem to resist recommendations at the time they’re made, as well as for cases where the pet doesn’t improve or comes back markedly worse.

If clients resist recommendations such as using a medication, administering an injection or vaccine or doing a procedure that requires anesthesia, Taberner suggests asking questions like:

• What makes you uncomfortable about that?
• What makes this overwhelming for you?
• What would make you feel more comfortable?
• How can we make this more doable for you?

“It’s exploring and digging a little deeper about what’s behind this, for the veterinarian to understand what’s driving them, what’s making them concerned about this and not just leaving it at ‘I’m resistant to this. I’m not going to do that.’ And throwing your hands up,” Taberner says.

When a case returns without improvement or has worsened, it’s tempting to make the conversation stern. That can backfire.

“Keeping on that strict or firm track causes blame and shame and fear,” Taberner warns. “When people are in that state, they’re not going to learn. If they haven’t been in compliance coming in, for the last however long, they’re not going to leave and become compliant if they are feeling shame and blame.”

Rely on curiosity to determine what’s truly happening with the case:

• How much of our treatment plan have you been able to do?
• What challenges have you faced following the treatment plan?
• What other things may be affecting our success?

For example, maybe the family added vinegar rinses they read about online to an intractable skin-allergy case. Maybe that’s irritating the skin more than the prescribed treatment can combat.

Do your best to stay in a place of curiosity to avoid making accusations. If you get to the point where the client says they are doing everything you’ve recommended and have not added anything that could be hindering treatment, Taberner suggests the following type of statement:

“Here’s the thing. I’m trying to figure out if we’re going down the wrong road in terms of diagnosis and prescribed solution or if there are gaps in the real-world application of our treatment hindering our success. I just need to know everything you can share about how things are going, what you’re doing (or not doing), and what else may be happening because we need to know moving forward what steps are doable and best for your pet.”

That may encourage clients to admit to challenges they’re having at home or mistakes they’ve made. Maybe work has been crazy. Maybe their kids have been sick. Maybe they misplaced the medication and missed several doses. Maybe they completely misunderstood how to apply a topical medication.

Especially if the pet is in pain or experiencing worsening symptoms, you may need to redirect the conversation toward the next non-negotiable steps:

“So, this is getting serious now. What can you commit to over the next three weeks?”

Then move into problem-solving mode to find ways for the pet to receive the recommended care.

Values and Emotional Triggers

Typically, when we feel emotionally triggered by a conversation, it’s because it irritates something we value. Try to remember when people struggle to accept veterinary recommendations it’s often from discomfort or lack of understanding and likely has nothing to do with you, your expertise, or even the recommendation itself.

Even when the conversations feel like a dent to your confidence, focus on being secure in your expertise and comfortable with your recommendations. Turn your attention to asking clients what they need to commit to the recommendation.

“The vet is still there to create the treatment plans,” Taberner says. “Instead of just creating it and making the assumption that because people paid their money they’re going to go home and they’re going to do it, it’s digging down and understanding what they need.”

The key is providing information that builds clients’ comfort and confidence, and that’s likely different for different people. So, don’t expect cookie-cutter strategies will always work. For example, some clients benefit from clear expectations such as:

• In three days, I expect we’ll see [description of improvement].
• In a week, my hope is that we’ll see [description of improvement].
• And, if everything goes perfectly, I suspect [pet’s name] will be back to normal by [anticipated timeline].

Others, though, might find that long-tail description of what’s ahead overwhelming, so ask questions to probe for what that specific client needs right now.

Do You Have Any Questions?

This question, often asked in the process of wrapping up an exam or consult, is a good starting point. Overwhelmed people often will say they don’t have questions, only to think of a bunch of questions once they get home and decompress. Let people know how they can ask questions later and which team member will reply with answers.

In addition, it can help to circle back to questions of do-ability, such as “Now that we’ve worked through the treatment plan and talked through your concerns, how doable does this feel for you?”

The goal is to have clients head home feeling less overwhelmed and more okay with what they’ve committed to do for their pet. 

Curiosity and Calm

The process of asking curious questions can be calming. From a neuroscience perspective, true, judgement-free curiosity triggers the release of dopamine and oxytocin, which support feelings of connection. Curiosity also helps offset physiological stress responses.

Taberner says asking questions or saying “Tell me more” changes the energy in the conversation, even during conflict. “Although there hasn’t been research,” she adds, “my thought is that there is a thing called ‘contagion theory’ that the emotion of one person goes to the other, and I think that probably happens in this case.”

Essentially, curiosity builds a sense of partnership, increases comprehension and confidence and helps diffuse times of tension, misunderstanding or disagreement. So, whether it’s merely providing the information clients need in a format they can grasp or handling potential conflict with professionalism, curiosity adds an important tool for effective leadership in veterinary medicine.