Safari Knowledge Systems
Veterinary practice is evolving from a single file reactive system of addressing illness and injury driven by the energy of the individual veterinarian to a multi-tasking pro-active system of wellness and disease prevention focused on empowerment of the entire health care team in an information-bonded socio-cultural system of knowledge sharing. The purpose of this collaborative site is to first outline the principles of Veterinary Practice Transformation from the agrarian model to the socio-cultural model of organization as an educational effort. Then to encourage collaboration from practitioners and others who have an interest in advancing this knowledge, with the goal of providing a guiding path for the profession to follow. This initial framework is the original work of Steven Dale Garner, DVM, DABVP. His efforts to transform the veterinary profession using a systems approach are outlined herein.
- 1 Historical Veterinary Image
- 2 Ethical Basis for the Safari Knowledge Systems Business Process
- 3 Standards - The foundations of empowerment
- 3.1 Code of Ethics
- 3.2 Moral Heirarchy
- 3.3 Cognitive and Moral Development
- 3.4 Care Standards
- 3.5 Service Standards
- 3.6 Communication Standards
- 3.7 Conduct Standards
- 3.8 Appearance Standards
- 4 Work-Flow
- 5 VetPlan
- 6 Training
- 7 Regional Issues
Historical Veterinary Image
Veterinary medicine has a proud and rich heritage of serving and caring for animals.
The science of veterinary medicine grew from and continues to parallel the human medical field enabling veterinarians to practice “human level” care on animals. Historically for veterinarians, the agrarian need for healthy horses for transportation and livestock for food created the demand that has allowed the profession of veterinary medicine to prosper and to become one of the best professions on the planet. Today, the science and technology of veterinary medicine continues to advance and to incorporate many life-saving cures and preventions for disease into the care of animals.
As our science advances, so does the care of animals and recently the care of animals has been re-defined as the care of pets. The agrarian lifestyle of the past has been replaced today by a new “bond-centered” lifestyle where pets are a part of the family. Pets have made a historic migration from the backyard to the bedroom, from the kennel to the couch and from guarding the farm and flock to providing companionship, devotion and affection to the family. Never before has the demand for the “human-level” care of pets been so high and never before has the science and technology of the profession been so capable of providing this level of care.
Historically, the veterinarian’s knowledge was shared with the farmer who may have cared for many animals enabling the veterinarian’s knowledge to be magnified across the whole herd or flock. Today, the veterinarian’s knowledge is shared with one or many family members who may be working together to care for a single pet. Because the veterinary technology and the veterinary client have changed, the system for veterinary knowledge delivery must also change. The supply of knowledge is high and demand for knowledge is high yet the veterinarian’s capacity for sharing this knowledge is no longer magnified as it was in the agrarian business model. Magnification of veterinary knowledge is required to satisfy the needs of today’s veterinary client and to provide optimal care for the pet. This magnification can occur through empowerment of the veterinary health care team.
Utilization of the health care team requires a structural change in the veterinary delivery system that must first be preceeded by a change in the image of the veterinary purpose. Today, this mental image is closely tied with elements of the traditional (Agrarian) veterinary cultural norms which are set against the current world view or paradigm. Transformational change requires redefining this image and penetrating the cultural norms as the essence of the veterinary value to the community is reevaluated.
The shifting technological developments complicate the application of veterinary practice to such a degree that the option of simple obedience to the existing cultural norms or codes for example as taught is traditional veterinary school may no longer be valid. The recent advances in understanding genetics and the new diagnostic tests in combination with the perceived value of the pet to the family create a situation where proactive veterinary care must be a justified initiative for the future. Therefore, rationale for advancing practice into the predictive, proactive realm exists today but may not be supported by the mainstream of the profession. Therefore, professionals cannot rely on the traditional codes in all cases, because the codes may not be up to date or may be written from a different worldview than the client or vet is experiencing.
The world has experienced four major shifts in the mental paradigms that we use to determine what is "right" or the way things "should be or should work". These mental images are called world views and are shared by most of the people living within a particular age or era of time. These include the
- Hunter-Gatherer Age
- A Nomadic way of life where people lived in small family units or tribes and followed the seasons gathering nuts, berries and fruit and hunting for a living. This way of life may have lasted over 100,000 years.
- The Agrarian Age
- A farming way of life where grains were grown and cultivated. This allowed enough to be stored over the winter so that people could stay in one location or settlement for long periods of time. Larger groups of people could be fed so social cultures and religions developed to celebrate the seasons. This era lasted over the past 10,000 years.
- The Mechanistic Age
- A Machine Age world view or mind set which brought many farm workers off the farm to work in factories. This age created a different social structure than the farm that for the first time separated people from the land. This age was brought into sharp relief by the writings and inventions of Rene' Descartes and Issac Newton.
- The Information Age
- The Information Age is in the process of eclipsing the Machine Age by changing the social and economical modles from the scarcity mentality to the laws of plentitude. In the Agrarian Age and the Mechanistic Age, anything of value that was also scarce was of more value. In the information age any information, made plentiful has more value. Sharing knowledge does not remove its value from its owner or creator it magnifys it.
Does the structure in the practice encourage participation of all people (clients and other staff) in ways that show universal respect for different voices or is the voice of the veterinarian the only one that is heard? Does our profession use and develop the kind of professional jargon that makes the esoteric knowledge of the profession hopelessly obscure to those who are not members of the profession including lay staff members? Professional jargon forces clients to adopt a position of dependency and mystifies the power over nature of such a relationship. This hinders clients’ ability to express their version of their needs and supports the stance of paternalism taken by some veterinarians. Only when we demystify the jargon and make the communications client friendly and staff friendly do we encourage productive communication on more even footing.
The veterinary knowledge must first be shared with the team of Knowledge Workers who then assists the veterinarian in communicating this knowledge with the client who in turn cares for the pet. VetPlan is a knowledge management system that enables the health care team to participate in the sharing and communication of veterinary knowledge with the client during all steps of the client interaction. The more knowledgeable client makes better choices for and takes better care of their loved ones. The value of a veterinary practice is determined by the knowledge within that practice and how well the knowledge is managed. In the traditional veterinary practice, the veterinarian is the repository of knowledge and is therefore the creator of wealth in the practice. The veterinarian is also the bottleneck in delivery of knowledge. There are only so many hours in a day for the veterinarian to see clients and attend to their pets. Veterinary practice is therefore constrained by the capacity of the veterinarian to communicate his/her knowledge in the service of a client or pet.
Practice Business Models
Serve the Client First
The transformative focus for veterinary practice of the future involves understanding that a primary driver of veterinary success is knowledge dissemination. Focusing on knowledge dissemination as an added purpose of the successful veterinary practice is transformative because the result is a relationship with a client, not just a focus on animal that must be restored to health. Once the veterinary knowledge asset has been used to create a client relationship, maintenance of the client relationship becomes essential to the long-term health of the veterinary business. This causes an evolution of the definition of a successful veterinary practice from a “veterinary centered practice” to a “client centered practice.” The eventual culmination will be what is called a "team centered practice". To see a discussion on Types of Practice showing the different archetypes of veterinary practice and their outcomes.
When the client becomes the center of the practice, customer service rises in importance and the need for health care team members to serve in this function rises. Client relationships can be maintained and increased as the veterinary knowledge asset passes through the health care team to the client. Client education becomes more of a function of the team than just the veterinarian. The educated client uses more of the veterinary services than the non-educated client thereby increasing the size of the "veterinary pie". The guiding principle should be “he who has the smartest client – wins”.
Vision of the Future
Setting the vision of the successful veterinarian from one who does “real things” focused on medicine and surgery to one who shares his knowledge with the health care team and clients to build long-term relationships will be transformational. This transformation will result in increased efficiency orders of magnitude above the norm enabling the veterinary industry to overcome the issues addressed earlier and thrive in the future. Undertaking a transformational strategy for a whole industry is challenging but doable if the effort is substantially focused and has the support of those who wield the power within the industry.
Ethical Basis for the Safari Knowledge Systems Business Process
Veterinary practice today exists in a pluralistic society. The tradition model of a paternalistic approach to the client-pet-vet relationship is no longer sufficient to serve the needs of all the stakeholders in the practice. As society becomes more complex our thinking patterns need to evolve to match that complexity and our business systems need to support that staff development and learning. Only by understanding the different stages in society, its matching cognitive functions and the basis for ethical decision making can select the appropriate business tools and processes that will support and bring into alignment the needs of the individual, the team, the business and society as a whole.
This conceptualization examines how society has evolved different codes of conduct to cope with the complexity of society as it moved from the Agricultural or Agrarian society through the Industrial Age to the Information Age. We can see how this compares to the development of the mind and cognitive processes from the child-like mystical mind, to the concrete thinking of the self-serving pragmatic mind, to the ethical mind anchored firmly in its cultural norms to the self-authoring, self-sacrificing moral mind.
The underlying principles of Appreciative Inquiry, Language, the Safari Customer Service Meeting (CSM) and acclimatization are introduced in order to demonstrate how to develop a culture that allows all employees to interact in meaningful discourse. These processes support cognitive and moral development, which enables individuals to make the ‘right’ decisions and choose what is best not just for themselves but for the client and pet and the business as a whole. This development allows them to serve as better members of society. A strong ethical basis is not a nice added extra for the business it is the fabric from which the business success is built.
Every human endeavor from day-to-day life to working life requires a person to make decisions: how should I proceed, what should I do? Arguably, the success or failure of any business system depends on its ability to pre-determine what the meaning of this “should” is for employees engaged in managing assigned duties, and human to human interactions at work.
The answer lies in the way people make meaning. The way people make meaning determines the way they behave. Meaning making is a process resulting from the combination of consciousness and thoughts which are in turn structured by language. Language requires more than one person and is therefore the social act that enables the person engaged in lingual communication to understand their individual identity. In other words; the people you interact with and the language involved in that interaction helps you determine who you are and or who you would like to be. Who you are is measured in reference to the group of people you most interact with.
Standards - The foundations of empowerment
Code of Ethics
As we strive to work together as a team to “do what ever is best for the pet” we find ourselves making judgments about what is “right”, what is “best” or what we “ought” to do. These judgments are sometimes difficult to make in the face of competing commitments or conflicting values. Making the correct decision about what is best for the pet or the client or the business or your job at Safari in certain situations, may create dilemmas where what is best for the pet may not be best for the client and what is best for Safari may appear to conflict with what is best for you. The purpose of this document is to help you better understand the issues that are at play which will better equip you to make good value decisions for the benefit of you as a staff member, for the pet, for the client and for Safari.
First, we will discuss some of the factors that are at work that influence how we make decisions and how these decisions are judged as “best” or what we “ought” to do. Next, I hope to share an understanding of how Safari operates as a veterinary professional organization. Then, I will show some of the situations where people who are working in a professional environment fail to do what they ought to do. This is to immunize you, or make you aware of possible pitfalls of allowing certain circumstances to negatively influence your ability to make moral judgments. Finally, we will develop the Safari Code of Ethics to be used as a starting point for how to address issues as they arise in your day to day work.
The Background affects the Foreground
This statement means that your personal background (your upbringing) affects how you “see” the world or foreground. If your background is markedly different from another person’s background then you may not at all agree on what you are seeing. This is a common cause of conflict with staff at Safari because we employ people who may have had very different home environments, very different previous work environments, very different educational environments, and very different cultural backgrounds. If the background is different the chances are the foreground is also different. Unless we are aware of this difference we make the assumption that everyone sees the world the same way we do. So what works in the world for what one “ought” to do may be totally different for what another person in the same situation “ought” to do. If this is true, how do we know what is “right”, what is “wrong” what is “true” and what is “false”? If everyone has different backgrounds which makes them all have different interpretations of what is “right” or what we “ought” to do how do we ever know what to do?
The answer to this question comes from the fact that while we may have great differences in our individual upbringing, our socialization, our education and our understanding of what is “right”. Each of our own life stories are different, we have made different choices and received different results from our actions. Unless we can find a common understanding, it is difficult to make sure we are all seeing the same version of the foreground. What do we all have in common? The answer is we were all babies at one time. No matter where on the Earth the babies were raised they all experience the same feelings and have to learn the same things. They have to learn to walk and respond to the feel of gravity. All babies therefore, know the difference between up and down, back and forth, day (light) and night (dark), dry and wet. Every baby experiences nurture and hunger, support and falling, protection and exposure, social acceptance and rejection. They know or learn social boundaries and the limits of the space they live in. All language around the World evolved to communicate these common bodily experiences of all babies. All people, regardless of their background, have an understanding of the basic feelings experienced as a child. For example, when we talk about gentleness or trust or care we are discussing feelings that go back to the core of our existence. These feelings are understood by all and it is these feelings – those of a baby, that are so important for the creation of a shared understanding among people with different backgrounds.
When I teach complex topics I use simple metaphors to extend or expand the understanding of something we are familiar with to something new or unfamiliar that may work the same way. For example, when I describe how the white blood cells called neutrophils work in the body, I say they are like the policemen of the body. Then, I give examples of the actions of policemen and how they correspond to the actions of the white cells in the body. In this example, the policemen are metaphors that extend our knowledge as to the function of white blood cells.
The common experiences of a baby are developed into what we call shared values which are shared across all people on the Planet. These values are created by using metaphors that extend the experiences of a baby to more complex thought or concepts. For example all babies experience verticality (up and down). This common experience leads to the metaphor to the understanding of more and less. More = Up and Less = Down. More and less are difficult to explain as ideas of quantity unless you can tie them metaphorically to the baby experience of up and down. Examples of language using this metaphor are, “Prices keep going up”, “Turn down the heat”. It is this way that more complex ways of being are linked to the basic experiences shared by all. These metaphorical extensions are the common thread that can be used to create a common understanding of moral and ethical values that can be a universal foundation for discussions about what we “ought” to do regardless of our prior background.
Be Conscious of your Background
While we share these values it only means we have a common understanding of what they are, not necessarily that we agree with others about how we should apply them to arrive at what we “ought” to do.
For you to be effective you must evaluate your history, your background so that you understand yourself before you can decide what you “ought” to do. For example, all children need love and affection but not all children require the same source of this need. All children “ought” to be taught to read and have an education but there can be many ways to arrive at this goal. You have opinions about how children “ought” to be cared for but is this opinion the best way for the situation today? Similarly, with regard to pet care at Safari; is the solution you would pick the best for the pet with regard to this client and so on. You must apply the “best” way to accomplish the shared value for the situation, not just the way it may have happened in your background or from your experience.
You come from a culture where you learned what is “right” and what is “wrong”. This culture taught you everything from what was the “right” thing to eat for breakfast to what was the wrong type of girl to date or right husband to marry. This culture has taught you how important a family is to your “people”. It teaches you everything from what you are loyal to to what skills you are expected to have, usually in the form of stories. These stories may use others in your family to represent examples of how to or how not to act when it comes to religion, family, love sex, food, tastes, and general lifestyle preferences. The culture may represent symbols of religion or loyalty or may involve a work or honesty perspective. All of these become a part of you and affect how you answer the “ought” question but more importantly, they are likely different than those from our Safari clients or other co-workers or the veterinarians. When you are conscious of your background and the way it affects your value judgments, you are better able to communicate with others to find common solutions to issues that may develop during your day at work. For example, are there taboos in your background? Things you do not violate or question? Does this affect how you make decisions?
We are witnesses to one of the most significant societal shifts in human history. Human civilization has undergone four ages. First, came the Hunter and Gatherer Age. This was followed by the Agricultural Age, then the Industrial Age and fourth and finally the Information/Knowledge Worker Age. This is the age in which we now exist. Each of these ages represents a different way of life, a different method for creating wealth and a different social structure. During any one day at Safari we can have people who may come in with different world views representing each of these ages. We may have hunters who treat their dog as a tool as necessary as their gun for capturing game. We may have people who farm and the pet is used to gather up the cows. We may have a factory worker who has a pet which is part of the family and a knowledge worker who wants human level medicine and surgery for their pet. During the same day we may have people from the US, from India, from Mexico, from Europe and from Asia all of which have different cultural backgrounds and different world views with different versions of what is “right” for them. This combination of different cultures and different world views creates a very complex environment.
The roles of the healthcare team are changing from serving the doctor to serving the client. Ethical and moral decisions are therefore now in the domain of the entire team who are working together serving clients who represent the agrarian, industrial and information age belief systems and coming from many different cultural backgrounds. The environment is complex because the social norms for agrarian society are different with regard to pet care than the norms for an information age pet owner. The agrarian pet owner may feel social pressure to put a pet to sleep when it is ill and the information age pet owner may have already researched the need for an MRI for their pet on the Internet.
Value diversity does exist within the different ethical norms of the different worldviews mentioned earlier and shifting technological developments have complicated the application of veterinary practice to such a degree that the option of simple obedience to ethical codes is no longer sufficient. For example, the recent advances in genetics and diagnostic tests in combination with the perceived value of the pet to the family create a situation where proactive veterinary care must be a justified initiative for the future. The rationale for advancing practice into the predictive, proactive realm exists today but may not be supported by the mainstream of the profession. Therefore, professionals cannot always rely on the traditional codes in all cases, because the codes may not be up to date or may be written from a different worldview than the client or vet is experiencing.
Safari has a highly developed ethical code that has been forged through professional discourse focused on the needs from the veterinary profession of the bond centered client. This discourse has involved over 4000 hours if discussions held in 4 hour weekly meetings spanning 20 years of practice. The Safari Code of Ethics for team based proactive veterinary practice is the result of these efforts.
Client communications should be in both oral and written form using client friendly vernacular for the wellness recommendations, physical examination findings, and veterinary recommendations following an examination, for every prescription and for every recheck given. We at Safari believe it is unethical to make recommendations for diagnosis or therapy or to communicate what we feel is required to ensure health, treat illness or promote wellness without written materials supporting such communications.
At Safari in all client communications there should be a clear distinction made between what is “recommended” by the veterinarian as being an optional test or procedure to promote wellness or predict illness and what may be “required” to diagnose disease or illness or “required” to ensure health or treat disease or injury.
At Safari it is considered unethical to communicate the medical, diagnostic or therapeutic, or other non-professional services without communicating the costs to the client of such services.
At Safari it is considered unethical to develop a client veterinary pet relationship without communicating the risk factors of disease that may affect that pet. This includes the possible genetic and hereditary diseases, environmental disease, parasitic disease, neoplastic disease, nutritional disease, metabolic disease, social disease, degenerative disease, toxic disease, traumatic disease, behavioral disease and any other aliments that risk not only the health the pet enjoys but the health of the human animal bond that the pet enjoys.
At Safari it is considered unethical to not inform the client of their option to perform pre-emptive, proactive, predictive tests or procedures that may make early identification, prevention or treatment of any of the above mentioned conditions possible.
Safari is a pioneer within the veterinary profession that is addressing these very difficult issues. Safari’s answer to these issues involves a team based approach to veterinary practice where the entire team must deal with the pluralistic society and the entire team must operate on a professional level. The follow section identifies what it means to be a part of a professional organization.
Four Characteristics of the Veterinary Profession
First, to become a member of the veterinary profession a person must master the esoteric knowledge of the profession. This information is so theoretical that the general public cannot easily acquire it. This is not something a person can do on the Internet in their spare time. Since the first clinical examination on a pet focuses on diagnosing the nature of the pet’s problem, a professional has to have a theoretical understanding of all the possible causes of the problem and how the various problems can be resolved. Theoretical understanding provides a broad background that makes it possible to diagnose the nature of the problem even when the pet has an unusual or rare disease. People come to veterinarians not only because they want the disease and treatment identified but because they want to understand what they should do next. Should they treat, should they confirm the diagnosis, should they consult a specialist, should they start treatment now, should they start it later, should this vet do the surgery and so on are possible questions. Veterinarians must develop the cognitive skill and moral sensitivity needed to function as a consultant in this pluralistic milieu.
Second, the veterinary profession has explicitly dedicated itself to serving the social values that are tied to the essential human needs hence the veterinary oath:
“Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of livestock resources, the promotion of public health and the advancement of medical knowledge.
I will practice my profession conscientiously, with dignity and in keeping with the principles of veterinary medical ethics.
I accept as a lifelong obligation the continual improvement of my professional knowledge and competence.”
These values are so important to the members of society that society does not want to risk allowing incompetent people to offer services and society is willing to spend tax dollars to protect these values. Tax dollars are used to build and fund veterinary schools, pay for tuition, fund research, police malpractice, and prosecute those who practice without a license.
Third, to exercise moral control over veterinary professionals the profession needs a way to standardize practice, communicate new techniques to each other, and to ensure that only people of integrity and competence become members of the profession. The AVMA along with state chapters set standards for education and entry into the profession, create a code of ethics, investigate malpractice charges, and encourage research to enhance the profession’s ability to serve pets, sponsor educational programs and in general police the profession. Self-policing is essential, since it is difficult for members of the public to judge incompetence when they lack the esoteric knowledge.
Fourth, veterinarians, like other professionals, have an extra strong moral commitment to serve the values to which the profession is dedicated. There is certainly something embarrassing and almost repugnant about a veterinarian who does not care when the delivery of care is compromised. One reason people feel it is an honor to be called a professional is the implication that the person has an uncommonly strong commitment to the quality of his or her work. In fact, veterinarians are so committed to the values the profession serves it seems inappropriate for them to think they joined a profession for anything resembling financial reasons. Veterinarians are not as concerned with their own financial well-being as with the delivery of their services. Veterinarian’s have an extra strong moral commitment to professional values which takes priority over personal financial interests because of a broader obligation to the public good. The following is a list of attributes expected of the veterinary profession. a. Impartiality; objectivity b. Openness; full disclosure c. Confidentiality d. Due diligence / duty of care e. Fidelity to professional responsibilities f. Avoiding potential or apparent conflict of interest
Safari staff members represent the veterinary profession every day as they do their job and strive to make the correct value judgments. That is they are striving to make decisions about “right”, “wrong” and what we “ought” or “should” do. These decisions are made from different points of view depending on the mental maturity of the individual, the complexity of the situation the cultural background of the individual and the virtues they honor. These decisions are also guided by the Duties of Station” or job descriptions, the Safari Code of Ethics, and universal Moral Principles that apply to all groups. This creates a Moral Heirarchy culminating a an overarching Moral Theory called Discourse Ethics which is what we use every week in our Safari Customer Service Meetings.
To understand how Safari has set up its Code of Ethics we must understand certain definitions and the justification for these codes of behavior.
Actions and Judgments – Individual decisions about the “ought” question based on the situation and the background of the individual guided by the Duties of Station and the Codes of Ethics. These actions and judgments are influenced by the three personal characteristics; the background of the individual, the virtues of the individual and the stage of mental and moral development of the individual. Duties of Station – All the special duties and rights that apply to people who have a specific responsibility or role at Safari. These are most closely related to your job description but also may include other known “right” and “wrong” actions that are a predictable and prescriptive role played at Safari. These are guided by the Safari Animal Care Centers Standards. There are five categories of these standards: Standards of Care, Standards of Communication, Standards of Appearance, Standards of Conduct and Standards of Service. Codes of Ethics – Published rules and principles that regulate the behavior of all Safari staff and are the guiding principles used to accomplish the Duties of Station. Ethics define how the individual should act when trying to solve a value conflict.
Moral Principles – Are the justification for the Code of Ethics which answers the question “why” we have the need to create these rules. The moral principles are most closely connected to the shared values mentioned above. They are applied across groups of people and are shared norms that define how a group of people such as our staff at Safari ought to treat one another and our clients, our suppliers and other members of our profession. These moral principles span all world views and all groups of people; they are worldwide, cross-cultural and have been here prior to most civilizations.
Moral Theory – The overarching moral theory of Safari has been that of Discourse Ethics as practiced in the Safari Customer Service Meeting. Virtue Ethics are also considered a part of the Safari Moral Theory. Traditional virtues such as patience, awareness or focus, caring, consciousness, dependability, flexibility, honesty, trustworthiness and unselfishness are considered necessary to guide the development of appropriate moral actions by Safari staff.
Moral Agency – Ought Implies Can
Moral Agents are people who are held responsible because they know the difference between right and wrong and have the capacity to intentionally act on this knowledge. Actions are called immoral only when moral agents who could have chosen to do their duty intentionally violate a known moral rule or refuse to accept responsibility for their actions. By contrast people who lack knowledge and or the capacity to choose their behavior are called amoral (e.g., babies, the retarded, the insane, the comatose, etc.).
Barriers to Morality
These are common mental states that can create an inability to respond appropriately to difficult situations. The best offence is a good defense and knowledge that these types of things that can happen to cloud your reasoning and moral judgment is the best way to immunize you from these things happening to you.
- 1. Situational Control refers to occasions when features of the environment seem to shape and control individual adult behavior to such an extent that the individual seems to have lost the ability to act in the usual voluntary or free manner we would expect from good moral agents.
- a. Zimbardo Prison Experiment
- i. Demonstrated how people could develop immoral and sadistic behavior if given that as a role to play.
- ii. Demonstrated how a role allows people to lose their personal identity.
- iii. More information in the Appendix I to this document.
- b. The Third Wave Experiment
- i. Demonstrated how people can form allegiance to very simple controlling rules.
- ii. People want to be in a simple ordered society while the world is not simple. By belonging to these societies, the people become the tools or instruments, become brainwashed and can lose their objectivity and moral decision making criteria.
- iii. The world is not simple it is complex and we must learn to deal with this complexity and not abrogate our moral responsibility.
- iv. More information in the Appendix II to this document.
- c. Situational Control Socialization Steps
- i. These are steps used by others to control you by changing the situation or environment which you work or live. By being aware of these tactics you are less likely to be manipulated.
- ii. The authoritarians ask us to make behavioral adjustments slowly, in a series of small steps over time. Little things we are asked to do often seem unimportant but cause us to change our viewpoint of who we are.
- iii. This type of control works because typically we have a lack of awareness of the causal factors that can influence behavior. When we are not aware that we can be controlled this way we are much more vulnerable to this type of control.
- iv. This type of control can only be effective where the people have no historical perspective – never heard of this type of control before.
- v. The authoritarians benefit from the fact that many people have a narrow perspective. Being able to only see your own perspective and not able to see how things you do affects others is called egocentric. Ethnocentric means you are only able to see the affects it has on your own group.
- vi. You may be given a sense of perceived freedom of choice. “It must be okay because we have been doing it voluntarily.”
- vii. We have the natural tendency to respect authority.
- viii. Religious cults and Al Qaeda use situational control socialization steps to convert and control members.
- a. Zimbardo Prison Experiment
- 2. Bigotry
- a. People simply refuse without good reason to acknowledge that competing value alternatives might have some legitimacy.
- b. Black/White Fallacy – the assumption of a false simplicity, people have a tendency to believe things are black or white, in reality there are many shades of grey.
- c. Example is abortion issue
- i. “Abortion is wrong because it is the murder of little babies”
- ii. “Abortion is okay because a woman has a right to control her own body.
- d. In both of the previous statements a tough moral issue is made simplistic by ignoring the considerations that are important to reasonable number of people on the other side of the opposition.
- e. Bigots are not interested in discussion about the truth; they are interested only in getting others to adopt their values.
- f. We see this often in the veterinary profession. Many veterinarians and many dog breeders scoff or look down on us at Safari for selling puppies from the pet shop thinking we are equivalent to the typical pet shop. They simply will not agree to hear our side of the story. They are bigoted.
- g. Watch that your background does not make you have a tendency to take a black or white approach to issues.
- 3. Mental Numbness
- a. Some people have such difficulty understanding conflicting points of view that their behavior appears a bit neurotic. This occurs when we deal with people who have never experienced change before.
- b. People from strong protective cultures that do not have much contact with the outside world.
- c. Examples are very protective religious groups or perhaps some farm families who only know a simple life and have never been asked to make such complex decisions before.
- d. Alvin Toffler called this “too much change so fast it cannot be incorporated in to one’s life world.”
- 4. Decidophobia
- a. Irrational fear of making decisions. Because pleuralism allows for so many legitimate value differences, people fear that there may be no “right” answer at all or if there is a right answer, the will fail to see it.
- b. These people tend to procrastinate until someone else makes a decision for them or the problem solves itself or becomes unmanageable.
- 5. Cynicism
- a. The news media helps us all see corruption and immoral behavior around the world.
- b. Moral Cynicism believe that even if there are higher ethical values there is no need to figure out what they are since people will never use them and always act in their own best interests.
- 6. Nihilism
- a. A psychological state of mind in which a person has lost the ability to believe in any values at all, whether religious, political, moral or social.
- b. Nihilists argue that ethical terms are worthless, irrational meaningless and absurd.
- 7. Moral Drift
- a. Occurs when people make a series of small decisions without paying attention to the overall goal toward which those small decisions are gradually carrying them.
- b. Yale Authority Experiment.
- i. This experiment showed the effect of authority.
- ii. When people think that they are being ordered to do an immoral act by another person in authority they are more likely to it.
- iii. People were told by an authority figure to shock others when they got a question wrong and over 75% administered fatal shocks.
- iv. For more information see Appendix III
- 8. Banality of Evil
- a. Evil that results from motives that are not in themselves wrong in a proper context but that seem excessively thoughtless, trite, or careless as moral motives in complex contexts that require a careful evaluation of right and wrong.
- b. Eichmann – Architect of the Holocaust
- i. Eichmann himself said he joined the SS not because he agreed or disagreed with its ethos, but because he needed to build a career.
- ii. Analysis came from political theorist Hannah Arendt, a Jew who fled Germany before Hitler's rise to power, and who reported on Eichmann's trial for The New Yorker. In “Eichmann in Jerusalem”, a book formed by this reporting, Arendt concluded that, aside from a desire for improving his career, Eichmann showed no trace of an anti-Semitic personality or of any psychological damage to his character. She called him the embodiment of the "Banality of Evil", as he appeared at his trial to have an ordinary and common personality, displaying neither guilt nor hatred. She suggested that this most strikingly discredits the idea that the Nazi criminals were manifestly psychopathic and different from ordinary people.
- iii. Eichmann was hanged in Israel in 1962
- iv. The message here was that he apparently was so focused on his career that he did not notice he helped kill millions of people. While this is difficult to believe such is the case.
- v. See Appendix IV for more information on this subject.
- c. Greek Soldiers – Tortured people who were on the other side of a political junta.
- i. These soldiers were from isolated farming backgrounds
- ii. Their previous life did not prepare them for the complex moral decisions and actions
- iii. They came from a simple existence with simple rules into a complex political war with nothing to keep them from doing horrible things to other humans.
- iv. See Appendix V for more information on this subject.
- d. Nazi Doctors – Did inhumane experiments on human subjects.
- i. These were done in the name of science.
- ii. The doctors were blinded by the science to the moral questions of murder or torture.
- iii. See Appendix VI for more information on this subject.
- 9. Morality and mental maturity
- a. My Lai tragedy
- i. Where American soldiers rounded up the inhabitants of a Vietnamese village and then massacred the captives – primarily babies, women, and old men.
- ii. Studies of the people involved revealed different actions from preconventional mental state, to conventional thinking to postconventional thinking.
- iii. Some tried to stop the action because it was wrong
- iv. Some gave orders to kill despite pleas from other soldiers
- v. Some saw no problem in following orders
- vi. See Appendix VII for more information.
- a. My Lai tragedy
Cognitive and Moral Development
The moral authority is who you appeal to when you justify the rightness of actions or rules. When you make a decision about how you should act or about the right thing to do; this decision is made with a certain moral authority in mind. If your decision is questioned then your excuse or reason that explains why you did what you did or why you thought it was right to do what you did is your moral authority.
There are at least three different sources of moral authority or in other words sources of reasoning some of which are more effective as a guide for how decisions should be made.
The lowest (and least effective) form of moral authority involves a strong consideration for whoever controls rewards and punishments. This level is focused on how the outcome of the action or decision affects you with very little consideration for others. Because the thoughts or reasoning about what is the right or wrong thing to do are measured by the direct effect of the amount of punishment or rewards you will receive this level of moral authority is called egocentric.
Egocentric people are able only to care about their point of view. They are not able to see how their actions affect others nor are they able to judge the intents of others. For example: if you were egocentric and if a person were to accidentally step on your foot while trying to save a pet from falling, your reaction would be only to how much your foot hurt with little regard to the intent of the other person. Egocentric people cannot suspend gratification for themselves and cannot judge the intent of others. They only judge the actual physical effect the actions of others have on themselves. Most people who observe the egocentric person would think of them as having an immature and selfish way of acting. It is not that the egocentric person does not know right from wrong, it is that they cannot make themselves behave in a way that does not give them gratification. They do not have self-control. Egocentric people justify their actions based on the effects of the actions not on the correctness of the action. When reprimanded they may say they do not understand why others are so mad, because there was little harm done.
Conventional people are members of a society and live by the rules of a society. Because egocentric people are unable to follow the rules of society they are said to be preconventional. Preconventional people have not yet developed the mental and emotional skills to be accepted by the society or culture. Preconventional people do understand the cultural curriculum that sets the expectations of their behavior – they know what is “right” and what is “wrong”, they just cannot always do it unless there is an obvious reward or punishment for the behavior. Therefore, egocentric people are considered preconventional and use rewards and punishment as their moral authority. Preconventional people seem to consistently make poor value choices because they are using the wrong set of criteria for making decisions about what is right, what is wrong or what they ought to do. If you find yourself at this level of development you must use the judgment of others to supplement your decision criteria.
Conventional moral development can be understood by considering one of the chief virtues of tribal life, that is, the moral virtue of integrity. Integrity refers to a person’s emotional commitment to legitimate rules of conduct. People with integrity have self-control. This character trait is said to be the most important part of the socialization process in tribal settings. It was assumed average citizens all possessed this kind of commitment and without the virtue of integrity a functional community cannot be maintained. Self-control or self-command as a virtue is acquired by habit and practice without the help of philosophy or reason. Self-command is the capacity adults have to restrain their selfish inclinations in order to do what is right or to allow their benevolent feelings have priority. Benevolence is a virtue which means providing good for others through kindness and love. For you to express benevolence you must command yourself to give more to others than to yourself. Self-command as a capacity and benevolence as a virtue are prerequisites for making correct value judgments at the ethical level of decision making at Safari.
A person who expresses conventional patterns of thought obeys traffic laws not only because she does not want a ticket (as a preconventional motive of fear) but also because she is committed to the rule of law for the sake of the community. Without laws and without integrity or commitment to follow laws there can be no community. In other words for me to obey traffic laws at the conventional level, I must command myself to consider the importance of my interests (to get home from work as soon as possible) in relation to the traffic law (make a complete stop at all stop signs) because integrity to or commitment to the rule of law is more important than “my interests.” This order of mental development enables a person to look at the category of “my interests” as an object. A category is a group of desires or values that may be held by an individual or group. An egocentric preconventional person lives within the category of “my interests” and cannot see or understand other people’s interests or intents. A conventional person can hold the category of “my interests” and observe the relationship of this set of desires and values to another category representing the desires or values of others or “their interests”. This ability requires a more complex mental and emotional order of mind and is called cross-categorical meaning making. The major triumph of this order of mind is that it allows other peoples point of view to matter to us.
At Safari, it is important that we develop the ability to care for the view point of others as this is a prerequisite for full moral understanding. We must develop and demonstrate integrity and commitment for the Safari Code of Ethics and rules of conduct. By showing respect to these guidelines for moral behavior, we enter into a membership of the “Safari tribe” and gain acceptance by the rest of the members of the tribe. Membership in the “Safari tribe” creates a new social identity that can help us transcend our initial egocentric focus on personal desires. Our new social identity with new rules demands integrity and a level of commitment to the “Safari Tribal Way” which becomes more important than our previous focus on ourself and membership in the “tribe” provides more meaning and worth and purpose than operating at the level of egocentric moral authority.
People become full social beings only when their identity is inherently linked to the values of group membership. To move up to the conventional level, then, where one becomes a loyal member of a group, a major mental shift towards a more ethnocentric form of consciousness has to evolve. Ethnocentric means that you are deriving your set of decision criteria from a set of ideals that involve what is good for your ethnic group. In this case I am developing the idea that membership in the “Safari Tribe” requires an ethnocentric point of view where your behavior is guided by what is best for Safari because membership in the “Safari Tribe” gives you the opportunity to act in a more morally responsible manner. Being a member of the “Safari Tribe” requires of you to demonstrate integrity and commitment to the Safari Code of Ethics and this membership endows you with inherent value for its own sake regardless of the immediate consequences to your self interests. It is this commitment that shifts the moral authority to a general respect for the Safari Codes of Ethics. In other words when defending your actions or your decisions about what is “right” and what is “wrong” you refer to the Code of Ethics as to the reasons for your actions.
The complexity of life today is derived from the combined effects of differences created by different “world views” and the differences found in different societal values. These differences will be defined below so we can have an understanding of the need for the development of the postconventional mind. Value conflicts are common which create moral dilemmas requiring a different set of mental tools to choose what we “ought” to do or what is “right” or “wrong”. This stage of mental development goes beyond the rules or codes of ethics and has its loyalty transferred from what is best for our community to what is best or what creates the most value for all the stakeholders. For this we need a theory or philosophy applied within a self-critical, rational, principled moral conscience. This order of mind forms allegiance and commitment to moral principles that have validity and application apart from any social group or world view.
The preconventional person has not yet experienced conventional thinking or decision making; he lacks the qualitative understanding of the social rules regulating group membership. He lacks self-command. He lacks the ability to see his desires as compared to other’s desires. His egocentric emotional ignorance amounts to a psychological incapacity that deprives him of the capacity (and thus the freedom) to make the right decisions based on what is best for the “Safari Tribe”. In contrast, postconventional freedom combines a new understanding about universal values that apply to all. The conventional minded person has the capacity to care about and be loyal to the social norms or rules (Safari Code of Ethics). The postconventional mind operates to incorporate the values of the conventional mind giving people a new capacity for impartiality that allows them to make value decisions on the level of moral principles while experiencing a feeling of conventional loyalty to what is being judged.
Another way to say this has to do with the virtue of caring. In a preconventional sense we care about ourselves and only worry about what the consequences of our actions might be (egocentric). In the conventional sense we care about our “tribe” and are willing to sacrifice what is best for ourselves for membership in the tribe (ethnocentric). Tribal identity replaces the self as the level of focus and membership in the tribe requires that we care about personal integrity and the rules of the tribe. The Postconventional mind is decentered in that what is important is that we develop the ability to care and then we develop the ability to care for everyone. To care for everyone we must use universal values or universal moral principles that apply to everyone and we must constantly critically evaluate how these value choices serve all involved. We critically evaluate these value choices by using moral theory called discourse ethics. Discourse ethics is another way of describing what we do in the Safari Customer Service Meeting.
What is it that I ought to do? That is the question that can be answered from three points of view. The egocentric point of view answers this question inappropriately focused on the individual, the ethnocentric point of view answers the question based on what is the best fit within the Safari Code of Ethics and the decentered point of view so that the moral authority answers the question within a set of guiding ideal principles that come from a moral theory that prescribes how we all ought to ideally treat each other.
In all groups of people there are people who possess the necessary practical wisdom. These people have the capacity to judge wisely in a variety of practical situations; that is they are virtuous or have practical wisdom – some call it common sense. These people can judge the proper action for the proper situation. Aristotle called this ability “living by the Golden Mean” or appropriate amount. By following and mimicking those that have practical wisdom, people can learn to develop virtues. A virtue is a human strength or skill that helps us live like we “ought” to live. Virtues such as patience, awareness or focus, caring, consciousness, dependability, flexibility, honesty, loyalty, trustworthiness and unselfishness are essential tools for work at Safari. These virtues are tools to be used to control the self while implementing higher moral principles and are best learned from others who demonstrate practical wisdom.
The standards constitute the foundation for communications resulting in client education. Value (wealth) is created through client education and relationship building. The capacity for delivering this service is predicated on setting high standards of care, service, conduct, appearance, and communication. These standards serve as the foundation for client service that is the rate-limiting step to practice productivity.
Standards of Care are detailed or made explicit forming the structural boundaries for client communications by health care team members. The creation and documentation of these standards effectively create a system residing at the client interface with the health care team member. The knowledge contained within this system enables client education about how most of the common procedures are accomplished in the veterinary practice. This knowledge traditionally resides only in the brain of the veterinarian and therefore usually requires the veterinarian to deliver this knowledge to the client either directly or indirectly. By taking this knowledge out of the veterinarian's brain and placing it in a knowledge system (or system of standards) that all employees of the hospital can use enables client education to be accomplished by a network of informed communicators. There are six general categories forming the standards of care; wellness protocols (vaccinations, worming, lab tests, exams), surgical protocols (pre-anesthesia, sterile procedure, quotations), anesthesia protocols (monitoring, fluid therapy, costs), hospitalization protocols, (callbacks, visitation, costs), therapeutic protocols (drugs used, fluid therapy, release instructions), and diagnostic protocols (lab tests, endoscopy, ultrasound, radiology).
Standards of Service determine the way veterinary clients are treated from the time they call the clinic or walk in the door to the time they leave and pay the bill. Standards of Service detail the steps that ensure every client; a warm welcome, compliance with the wishes of the clients and bidding a fond farewell. They dictate whether the client is a welcome potential source of wealth or a "necessary inconvenience". Employees are empowered to provide service through these standards enabling them to act on their own to ensure that the customer experience is a positive one. Service standards include everything from the words that can and cannot be used to the facial expression and eye contact used when serving a client. These standards should mimic those of a Ritz or Marriott and be appreciative of the fact that our customers have a choice of where they take their pets.
Standards of Communications denote how the client interface is managed from a written and verbal standpoint. Telephone skills, written communications about pet care, and the verbiage used to describe specific conditions are detailed within the standards document to ensure that all health care team members understand how to communicate to a client. Situational communications include how to handle a distraught client or a client contemplating euthanasia or how to gather information over the telephone or how to give a quote and so on. Interpersonal communication skills are developed so that the health care team has protocols to use in communication with each other as well as the clients. Communication of the veterinary knowledge asset is the primary wealth and relationship building function of the hospital. All team members who are supported by an understanding of these standards should have the platform to communicate effectively to veterinary clients. This communication depends on having a service mentality, proper conduct and appearance as well as an understanding of the basic care issues addressed by your hospital. By setting these standards and providing formal training to these standards the practice will create the foundation and supporting structure for a highly productive practice.
Standards of Conduct set the operating tone of the Health Care Team environment. This includes the level of professional conduct the personality characteristics that are desirable to best serve our clients. SWAN is an acronym for Smart, Works hard, Ambitious and Nice. This defines the perfect employee. Professional conduct includes how you address each other within the facility and how you should act in front of a client. These skills are detailed so that an air of professionalism permeates the culture.
Standards of Appearance sets the stage for client communications. Appearance of the hospital, (reception, signs, wall posters, colors) give a first impression to the client. Personal appearance also has a huge effect on the effectiveness of a health care team member to communicate health related issues to a client. In general, anything that detracts from the client communication is doing a disservice to the client. Standards of Appearance also include printed materials that the client may see such as the client registration form, reminder cards or wall signs.
Once trusted communications are established through the establishment and adoption of the Standards of Practice and the increased capacity for service generates more business to the practice, it becomes necessary to change the workflow of the practice to accommodate a more efficient multi-tasking model. This workflow change maximizes the efficiency of the veterinarians as well as the health care team members. The roles change in this process from the veterinarian performing most if not all of the tasks of a client transaction to the point that the veterinarian does the tasks that only a veterinarian can do.
The "Transformed Work-Flow" supports the the health care team members. The receptionist takes the initial history and provides the client with an initial quote for the expected services. This may happen prior to the client entering the exam room or the hospital. The client is escorted into the examination room and settled with their pet, much like a hostess would seat you at an upscale restaurant. The case is transferred to a Nurse who collects the medical history and may, if appropriate, collect the samples of blood, feces or urine prior to the doctor exam. The doctor enters the room and performs the examination while verbalizing the findings to the client as well as the nurse who is recording the findings in the medical record. It is imperative that the doctor shows respect for the nurse in front of the client by the professional manner of communication that denotes the Nurse as a valued member of the hospital's team of health care communicators. The doctor may then leave the room and the nurse prepares a quote for the services recommended by the doctor. This quote is accompanied by an explanation in client-friendly terms of the individual medical recommendations of the doctor. This process takes the doctor away from the financial pressure that can tend to alter the medical recommendations. Medical recommendations should be made with the doctor as the medical advocate for the pet with blinders on as to the financial capabilities of the client. Placing the educated, empowered nurse in this position frees the doctor while also building a relationship with the health care team member. Once the client has agreed on the cost of the services, the doctor may re-enter the exam room to ask if there are any questions. While the nurse was going over the quote or doctor recommendations, the doctor can be seeing another client, making a call-back, or reading the next issue of the journal. This change in workflow greatly increases the capacity for service by building client relationships across multiple members of the health care team, by reducing stress on the doctor with regard to financial concerns, as well as by providing the capacity to see more clients within a prescribed time frame.
By scheduling multiple appointments in multiple exam rooms simultaneously for one veterinarian, you take advantage of your health care team member’s new abilities to serve your client. Optimal efficiency will result from three examination rooms per veterinarian. The support staff requirements for this model are two receptionists, two Nurses and one assistant. Exam rooms - not doctors are scheduled. Using this model, one doctor can see 10 to 20 patients per hour of appointments, which is four times the average. The transition to this model of workflow occurs gradually as the numbers of client visits increase but should be facilitated as early in the transformation as possible by "clustering" appointments. “Clustering” is scheduling appointments close together so the workflow can be practiced. This has the added benefit of freeing up time to work on other aspects of the transformation such as Standards training.
VetPlan enables duplication and management of the veterinary knowledge asset so the entire health care team can participate in knowledge sharing. Once the capacity to share knowledge is increased, the veterinary practice will build wealth at a higher level.
Pillars & Standards Training
The Pillars of Practice embody the services and associated products that substantially affect the business and are the most important in maintaining a particular customer mix. Most practice owners can name between eight and twelve “Pillars” of their practice. This might include surgery, vaccinations, internal parasite control, heartworms and so on. Once these pillars are identified, it is easy to see that most of the day-to-day efforts by the health care team focus on providing clients and their pets these “Pillars”. The first task would be to identify these pillars in a practice. Once this is accomplished, the entire staff is trained on the basics of these pillars. It is important to understand that the knowledge level we are striving to attain is not the same level as the typical veterinarian would have about these subjects. We are compelled only to teach what we call a “conversational knowledge” so the staff member can have a “conversation“ with the client regarding these issues of pet health.
The veterinarian should teach the “Pillars” if possible using real life examples of the practice situations as the training progresses. Handouts are used as detailed supplemental material from which to attain a more deep and thorough understanding of the subject matter. The training classes should last two hours each. On average, three such classes are needed for each “Pillar”. The classes should be taught at a level that makes the material available to all staff members who may or may not have formal education. The purpose is to have an understanding of the concepts and not necessarily an understanding of every detail. Using real life examples gives meaning to why this material is important and breaks up the monotony of learning rote material. The most important goal of this training is to change the behavior of the staff member. It should be the health care team member’s responsibility to deliver information to the veterinary customer. This training will insure the information that is delivered is correct.
Health care team education on the Standards and the Pillars serves two primary functions in the new Transformed model of veterinary practice. The first is the increased capacity for service and the second is trust.
Trusted communications are essential in the medical environment and the primary reason that veterinary health care team members are not empowered is lack of trust by the veterinarian. The typical veterinarian does not trust that the health care team member will communicate the same way, with the same accuracy, or same level of care as he or she would. This trust can only be developed in a culture of knowledge sharing and client service, where the doctors work with the health care team to educate the clients. This teamwork is exemplified by the fact that only the veterinarian holds all the knowledge, but the health care team can take many clients from the stage of being unaware to being aware and from being aware to having understanding. The veterinarian may then need to take the client further in the process to conviction and finally to action. Nevertheless, this team approach is much more efficient than Model #1 in which the veterinarian must do all of the client communications.
The Master Class Training Materials are designed to teach at a more technical perspective to the veterinary health care team member. They are designed to give knowledge that is deeper for the staff member who has already been through the Pillars Training. These topics may not be used as frequently in the clinical setting as the Pillars topics, but they are important just as well. The Master Class training series enable you to constantly add value to your staff - even you more seasoned ones. While this material may go over the head of less experienced individuals, it introduces these topics to them and they will appreciate the competence that they will some day achieve by staying on your staff. Examples of the master class training include Eye disease, "Dystocia", "Intervertebral Disc Disease".
Vision is one of the five senses along with taste, smell, hearing, and touch. The eyes are direct extensions of the brain, receiving visual information and processing it to give a stereoscopic view of the world. For the purposes of an example of this type of training the eye disease master class can be viewed.
The HealthMap contains recommendations in the four quadrants of veterinary preventive healthcare.
- i. Examination and immunization
- These items include the full 12 system physical examination and immunizations such as rabies, distemper and parvovirus vaccination.
- ii. Preventive diagnostics
- This quadrant includes such items as EKG examination of pets whose breed predisposes them to heart disease and blood and urine tests aimed at identifying very early kidney disease.
- iii. Preventive treatments
- This quadrant includes flea, worm and heartworm preventives
- iv. Recommendations affecting the quality and quantity of the pet’s life
- Diet, behavioural advice and grooming advice would come under this quadrant.
The HealthMap contains a description of each item in language easily understood by the client. It is prepared by the receptionist prior to the client arriving at the hospital,
From a business standpoint, this tool takes the receptionist from the role of an “ordertaker” to the role of a salesperson.
USA - VetPlan
UK - Safari
Australia - VetMap
Japan - VetPlan
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