An abusive client - fractious or fragile?

By Olivia Oginska
DVM MRCVS PgCert SAS MAPP Cert Workplace Conflict Mediator

One of the most common and, at the same time, disheartening scenes that take place in the clinic’s waiting room is an angry client, openly complaining or even offending the members of the team. Internet forums burst with stories about abusive customers that disrupt the work of veterinary workplaces and cause emotional injuries to the team.

A study performed in human medicine suggest that up to 90% of healthcare staff encounter incivility at work with it being considered “part of the job” (Credland & Whitfield, 2021). Another group of researchers surveyed 3544 healthcare workers from 19 countries between January and February 2022 and the results showed that 54.8% of respondents reported acts of aggression, whereas about 13% experienced some form of aggression daily, 26.4% suffered from the abuse weekly, and 38.8% reported violence a few times per month. Importantly, the administrative staff were 3.5 times more likely to experience abuse than other healthcare workers (Garcia-Zamora et al., 2022).

During the COVID-19 pandemic, nearly every single industry was challenged and forced to develop new coping mechanisms to protect their employees and satisfy their clients. In the world of veterinary science, the pressure related to the new, life-threatening environmental conditions was amplified by the fact that the public not only worried about their own health, but also about their pets’ welfare. Many of our clients turned their newly acquired free time and attention to their pets and sought mental comfort in their company. Unfortunately, that led to the increase in demand for the veterinary services, and severely overstretched clinics’ capacity. As a result, the prolonged waiting time, limited interaction with veterinary staff, financial threats, as well as many more challenges related to using veterinary services became emotional and intellectual triggers to the owners. The aftermath of such explosive combination we could observe in a plethora of uncivil behaviours exhibited in the practices. The survey performed by BVA in 2021 on 572 veterinary practitioners found that 57% of them had felt intimidated by clients' language or behaviour, an increase of 10 percentage points since the same question was asked in 2019. The problem was particularly pronounced in small animal practice, where 66% of respondents complained of harassment from pet owners.

Interactions with abusive clients can be extremely harmful to healthcare workers, including veterinary professionals. In the above mentioned large study looking at the human hospitals, nearly half of the study participants exposed to abuse experienced psychosomatic symptoms after the event, and 12% sought psychological care (Garcia- Zamora et al., 2022). Research performed in the veterinary setting shows the following adverse consequences associated with rude behaviours from clients: increased stress, mental health impacts and withdrawal from clients (Irwin et al., 2021). Literature clearly shows that both customer incivility and verbal aggression may impair employees’ wellbeing and job outcomes (Sommovigo et al., 2019). What is more, studies suggest that in order to deal with incivility, healthcare workers often reported taking the path of least resistance in the interactions with clients, which impacts the ways of working and shapes subsequent clinical decision-making, potentially threatening patient safety (Credland & Whitfield, 2022).

Managing such clients can seem stressful and daunting, but it is necessary to protect veterinary professionals. It is within the team’s hands – especially leaders – to appropriately communicate with challenging clients and provide safety and mental support to the employees who fall victim to uncivil behaviour.

When someone in the veterinary community reports their terrifying story of an abusive client and asks their audience: “What should I do?”, the most common answer offered by the fellow veterinary professionals is “fire that client”. At first, such reaction seems obvious – we should not tolerate uncivil behaviours in our workplaces. The best solution seems to be to get rid of the problematic customer. However, this might be just a quick and dangerous fix.

Psychology, as well as the research in other industries teach us that the vast majority of uncivil behaviours originate from the place of pain. As much as this might sound ‘cheesy’, studies have shown that only 4% of rudeness occurs just because the felon believes that such behaviour is fun and it will slip by unpunished (Porath & Pearson, 2013). This means that, most probably, the greater part of our difficult clients resorts to incivility due to emotional or intellectual struggles. While resolving anyone’s personal problems is outside of our responsibility as veterinary professionals, serving our clients and patients in a fully aware, compassionate way definitely is. Seeing the vulnerable human being behind the furious mask of an angry client is a great challenge, but also a powerful tool. Once we master the art of ‘looking under the surface’ and de-coding the true process that occurs in our clients’ minds, we can provide the appropriate care to our patients, while protecting our own mental health. The art of becoming ‘human-savvy’ is built on the foundation of our emotional intelligence (EQ). It allows us not to only understand and communicate with other people who might be suffering and, because of that, entering the state of tantrum, but also to remain ‘abuse-proof’ ourselves.

In order to activate our emotional intelligence and compassionate client care, the whole veterinary practice needs to prepare the ground for managing a variety of possible human behaviours. Such groundwork involves establishing a solid and uniform mindset in which everyone on the team agrees that patient care comes first. Given that distressed and distracted staff cannot provide patient safety, the employee wellbeing comes hand-in-hand with the principle of prioritising patient care. Satisfying our clients’ needs is possible only if workplace priorities are set in the right way and such healthy hierarchy naturally results in an excellent customer service. Research shows that leaders’ humility and integrity – how well and humbly they act on their promises (and prioritising patients and employees over the clients is such promise) – is positively related with high performance, employee engagement and wellbeing (Owens et al., 2013).

Once this approach is set in stone and everyone – especially leaders – put it into practice on a daily basis, that is when the space for empathy and compassion towards uncivil clients opens up. To enable difficult conversations, we must create a safe environment. We often need to wait out the outburst of negativity before we can invite the client into a peaceful space where the true dialogue can start. It is useful to have at least one person on each shift who will be trained in difficult conversations. The team member who is well equipped in managing such situations can provide the sense of safety and reassurance to the client, which then allows asking questions and communicating in a non-violent way. It is crucial to give our client the space for expressing their discontent and understanding the underlying pain. Such suffering most commonly derives from the unfulfilled need to be noticed, listened to and respected. Given the intensity of veterinary work and the high caseload, it is way too easy to accidentally miss out on the needs of our customers. It takes time to develop the client-employee trust and very often we never reach the state of true rapport, which results in unexpressed concerns and miscommunication. If the situation escalated to the outburst of client’s anger, it can be soothed through an open and safe dialogue, which then allows mutual understanding. During such conversation, it is imperative to emphasise the impact of uncivil behaviour on the wellbeing of the team and, eventually, on the level of patient care. Finally, the consequences of continuing abusive behaviour must be stated in a clear and explicit way – if they repeat their actions, they will need to find another veterinary clinic.

Opening the dialogue is an indispensable part of managing difficult clients. Unless the underlying issues are understood and addressed, the negative behaviour will not change. Simply firing the abusive clients carries the risk of perpetuating the harmful behaviour, because the client will most probably move to another practice and treat another team in the exact same way. Communicating with abusive clients is certainly not easy, but it can be learnt and expanded through EQ training, and it can positively transform many lives in the same time.

This article originally appeared the The Vet Times and we thank them for their permission to share it with AVA members. Please note that in cases of client aggression, the AVA supports veterinary clinics having zero tolerance policies in order to protect the mental health and wellbeing of staff. Zero tolerance posters are available for download, including posters for general animals, companion animal clinics and equine clinics.

Dr Olivia Oginska is a qualified veterinarian, positive psychology practitioner, a Certified Workplace Conflict Mediator and an Emotional Intelligence and Dignity Coach. She has a Master's degree in Applied Positive Psychology from Anglia Ruskin University and founded her business, VetGoneReal, promoting mental health and wellbeing for veterinary professionals, in 2020. She also presented the AVA's R U OK? Day webinar: Words, gestures and psychological safety - the hidden power of communication. A replay of the webinar can be found here.

References:

• Credland, N. J., & Whitfield, C. (2021). Incidence and impact of incivility in paramedicine: a qualitative study. Emergency Medicine Journal, 39(1), 52–56. https://doi.org/10.1136/ emermed-2020-209961
• Garcia-Zamora, S., Pulido, L., Miranda-Arboleda, A. F., García, D., Pérez, G., Priotti, M., Chango, D. X., Antoniolli, M., Zaidel, E. J., Lopez Santi, R., Vazquez, G., Nuñez-Mendez, R., Cabral, L., Sosa-Liprandi, L., Liblik, K., & Baranchuk, A. (2022). Aggression, Micro- Aggression, and Abuse Against Health Care Providers During the COVID-19 Pandemic. A Latin American Survey. SSRN Electronic Journal. https://doi.org/10.2139/ssrn.4104369
• Irwin, A., Hall, D., & Ellis, H. (2021). Ruminating on rudeness: Exploring veterinarians!& experiences of client incivility. Veterinary Record, 190(4). https://doi.org/10.1002/vetr.1078
• Owens, B. P., Johnson, M. D., & Mitchell, T. R. (2013). Expressed Humility in Organizations: Implications for Performance, Teams, and Leadership. Organization Science, 24(5), 1517–1538. https://doi.org/10.1287/orsc.1120.0795
• Porath, C., & Pearson, C. (2013). The price of incivility. Harvard business review, 91(1-2), 114–146.
• Sommovigo, V., Setti, I., Argentero, P., & O!Shea, D. (2019). The impact of customer incivility and verbal aggression on service providers: A systematic review. Work, 62(1), 59– 86. https://doi.org/10.3233/wor-182842