Quality& SUSTAINABILITY REPORT 2019
Wiser use of antibiotics CREATING AND SHARING BEST PRACTICES Focus on people
ANICURA QUALITY & SUSTAINABILITY REPORT ”A Better World for Pets”
ANICURA QUALITY & 2 SUSTAINABILITY REPORT CONTENT
SECURING INFECTION PREVENTION AND CONTROL In 2019, the majority of our clinics increased use of alcohol-based hand sanitiser. ENVIRONMENTAL IMPACT New cleaning methods improve infection control and reduces our 30 46 environmental impact.
4 MESSAGE FROM THE CEO
5 HIGHLIGHTS 2019
PREVENTIVE CARE 6 ANICURA IN BRIEF In November, we launched 8 MEDICAL QUALITY AT ANICURA a new mobile app with online consultations. 10 Encouraging professional development and specialisation
14 Creating and sharing medical best practices
44 20 Improving professional communication skills
22 Providing reliable diagnostic medicine
24 Monitoring surgical site infections
26 Ensuring wiser antimicrobial use
30 Securing infection prevention and control
32 Enabling good incident handling 26 32 34 Promoting patient medical record quality
40 OUR PEOPLE ENSURING WISER ANTIMICROBIAL USE 44 PREVENTIVE CARE For the third year in a row, we reduced unnecessary ENABLING GOOD 46 ENVIRONMENTAL IMPACT INCIDENT HANDLING use of antibiotics. 48 COMMUNITY ENGAGEMENT More than 1,000 learnings were gathered in the AniCura Patient 50 ANICURA RESEARCH FUND Safety Information System.
ANICURA QUALITY & 3 SUSTAINABILITY REPORT The intention with this report is to share our learnings, provide insights into AniCura and inspire the industry to develop. Join us on our journey to shape the future of veterinary care, together!
AZITA SHARIATI Group CEO, AniCura A new era In 2019, I decided to join AniCura as new Group CEO. I joined because I found a company that shared my personal values and is committed to shape the future of an industry that plays OUR PEOPLE an invaluable role for the wellbeing of pets and humans. To create sustainable working condi- tions is a challenge facing the entire sector in several countries. During 2019, important steps have been taken The past eight years, AniCura has ahead of us. The world we want in several AniCura markets to har- grown into a leading provider of veter- tomorrow, starts with how we do monise and modernise employment inary care in Europe with 300 clinics. business today. conditions. Investments in shaping a The size of the company emphasizes values-based organisation with strong our responsibility to take decisions HIGH MEDICAL QUALITY and appreciated leaders will continue with consideration to the impact we To ensure good patient safety and to be an important component of this have on animals, people and on the high medical quality is at the core of work as I start to formulate my agenda. environment. Since late 2018, AniCura is our operations and one of our most During the year, the first steps have part of the family owned group Mars. important contributions to society. also been taken around our environ- This marks a new era for AniCura and Since 2015, AniCura’s quality program mental impact with more sustainable allows us to not only think about the has played an important role in sharing cleaning methods, renewable energy next couple of years, but also to plan best practices and guiding our clinics and the implementation of a new sup- for the wellbeing of the generations on how to improve quality. plier code of conduct. Three years in a row, we have The more I learn about AniCura, the “Three years in reduced unnecessary use of antibiotics more convinced I am that AniCura has are proud at our clinics to counteract the spread played an important role as a force for a row, we have PETER DAHLBERG, CEO reduced unnecessary of resistant bacteria which is a major good in veterinary care. At the same of working global threat against public health. time, I also realize we have a long way use of antibiotics Our 2030 goal is that no more than 5% to go to achieve real change in many at our clinics” of our patients should receive antibiotics. important areas. at AniCura
ANICURA QUALITY & 4 SUSTAINABILITY REPORT Highlights 2019
Three years with reduced use of antibiotics
14% 13% 12%
8% 75% OF KEY SUPPLIERS COMMITTED TO THE NEW ANICURA SUPPLIER 2016 2017 2018 2019 CODE OF CONDUCT
Group CEO, AniCura Mars Petcare DOUBLED INVESTMENTS 58% in veterinary research at AniCura OF CLINICS HAVE IMPROVED AniCura Patient Safety More employees HAND HYGIENE Improvement System recommend AniCura as an employer Employee Net Promotor Score
17 87% 14 of employees 2/3 12
2/3 OF CLINICS NOW 2017 2018 2019 USE ANICURA PATIENT SAFETY IMPROVEMENT SYSTEM Benchmark companies = 9 CLINICS IN are proud of working SCANDINAVIA at AniCura ARE POWERED BY RENEWABLE ENERGY
ANICURA QUALITY & 5 SUSTAINABILITY REPORT AniCura in brief
AniCura AniCura is a leading European provider of high-quality veterinary care for companion animals. values
AniCura was born out of the idea that HOW WE WORK TOGETHER sharing resources creates opportu- At AniCura, most decisions are taken nities for better veterinary care. The locally, close to the patients and RESPONSIBILITY & INITIATIVE company was established in 2011 by customers. On country and group a non-profit foundation as the first level, functions within for example CARE & COMPASSION merger of companion animal hospitals HR, IT, marketing, veterinary quality in the Nordics. and administration provide support EXPERTISE & DEVELOPMENT Since November 2018, AniCura is to clinics. Our vision, values and part of Mars Petcare, a family owned medical quality program ensures a HONEST & OPEN company focused on veterinary care joint direction and structured quality and pet nutrition. Mars Petcare’s development. purpose is to create A BETTER WORLD FOR PETS. THE VALUE WE CREATE IN SOCIETY Every year, AniCura helps 3 million WHAT WE DO companion animals to a better quality AniCura is a full-service provider of of life and improved health. Invest- veterinary care from preventive care ments in improving medical quality to advanced diagnostics, surgery, and patient safety through education, rehabilitation and intensive care with research, equipment and premises has 24/7 service. The company also offers totalled SEK 1,3 billion since AniCura’s selected pet nutrition and care inception. The company stands for products. a large part of the round-the-clock Meeting the increasing demand emergency care availability in Europe. across Europe for more advanced Direct and indirect job creation in care and better quality is at the core the veterinary industry and adjacent of what we do. The clinics that form sectors form an important part of AniCura’s part of AniCura are carefully selected value creation. In 2019, AniCura contri- based on specialist competence and buted with social charges, VAT and quality. corporate income taxes of more than SEK 1 billion.
3 MILLION PATIENT VISITS
6,000 EMPLOYEES
We shape 11 COUNTRIES the future of veterinary care, 300 ANIMAL HOSPITALS together AND CLINICS
ANICURA QUALITY & 6 SUSTAINABILITY REPORT Sustainability AT ANICURA
In 2018, more than 1,000 This report includes a description of our “We all have a responsibility customers and employees ambitions and achievements as well as for a sustainable future. The environment needs it, pet across five countries were our challenges within these four areas. We put special focus on our medical owners demand it and invited to give their input on quality program including the work to employees want to contribute” AniCura’s impact in society. ensure a wiser use of antibiotics. ANICURA EMPLOYEE IN 2018 SURVEY
Sustainability at AniCura
They were asked which areas that are most important for AniCura to focus on. Based on their input and an analy- Meet expectations Focus Working Antibiotics conditions sis of AniCura’s value chain, four areas High medical Perceived emerged as key to ensure sustainable quality quality vs. operations: price Environment Preventive care Anti-corruption
Quality and antibiotics Community engagement People Equality and Supplier control Preventive care diversity
Environment STAKEHOLDERS TO IMPORTANCE Retail assortment Maintain Develop
OUR IMPACT ON SOCIETY
ANICURA QUALITY & 7 SUSTAINABILITY REPORT QualiCura
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ANICURA QUALITY & 8 SUSTAINABILITY REPORT MEDICAL quality at
89% of AniCura’s AniCura employees believe that patients visiting AniCura established its medical quality development program – their clinics receive high or very high QualiCura – in 2015. The purpose of the program is to increase quality of care patient safety and to improve medical outcome.
The program includes nine focus areas FOCUS ON IMPLEMENTATION DEDICATED RESOURCES that are key to fulfil the program’s dual QualiCura is focused on implementation To support clinics and drive positive purpose: and achieving actual change at AniCura’s change, AniCura has dedicated resources clinics. Several processes support to develop veterinary medicine and Encouraging professional develop- the local implementation of quality quality. ment and specialisation improvements: Creating and sharing medical best Quality coordinators: Each AniCura QualiCura visits: The veterinary medical practices clinic appoints a “QualiCura coordinator” quality team perform quality-oriented responsible for the clinic’s quality • Improving professional communica- visits to all new clinics joining AniCura. improvement processes and commu- tions skills The purpose is to establish a relation- nication. • Providing reliable diagnostic medicine ship and understand clinic specific quality improvement plans and challenges. Quality Development Team: • Ensuring wiser antimicrobial use The team also re-visits clinics in need of Dedicated central team to support • Monitoring surgical site infections additional support. in-clinic development, run QualiCura and provide expertise. • Securing proper infection prevention QualiCura studies: Data-driven, and control quarterly surveys enabling unique AniCura’s Scientific Council: The comparison and knowledge transfer council consists of merited veterinary • Enabling good incident handling across clinics and countries. researchers from AniCura and universi- • Promoting patient medical record ties and allocates funds from AniCura’s Role models: After each QualiCura quality Research Fund. study, “role model” clinics are identi- fied to share clinically proven exam- The work within each of these nine ples of improvements. focus areas during 2019 is covered in 86% of this report. Quality conference: In 2019, AniCura employees believe held its second conference dedicated their clinic works to medical quality. All clinics were systematically to invited to share knowledge with focus improve quality on implementation barriers and of care pragmatic solutions in daily operations.
ANICURA QUALITY & 9 SUSTAINABILITY REPORT Encouraging professional development and specialisation
FOCUS ON continuing education
Veterinary medicine is deve- ANICURA CONTINUING EDUCATION loping rapidly and continuing AniCura Continuing Education (ACE) Percentage of includes courses, programs and webi- employees having education for veterinarians nars in different medical fields, based regular discussions and nurses is key to secure on the needs expressed by clinics and about long-term competence patient safety. individuals. These trainings are open development for all AniCura employees. In 2019, more than 1,000 veterinarians and nurses participated in ACE courses and Structured professional development webinars. 60 plans for all veterinary professionals is Throughout the year, several offsite 54% important, as this is one of the main conferences for veterinary profession- 50 drivers of employee satisfaction within als are arranged to develop and share 50%
AniCura and key to strengthen patient knowledge around medical quality, 45% safety. The plans can consist of on-the customer communication and different 40 job trainings as well as external veterinary fields. Read more on page 16 trainings. and 19. In 2019, 54% of employees had reg- 30 ular competence development discus- SPECIALISATION AT ANICURA sions with their managers, compared AniCura encourages its employees to to 50% in 2018 and 45% in 2017. These specialise as it is important to advance 20 results are not satisfactory, as AniCura’s veterinary medicine and patient safety. ambition is that all employees should It can include achieving a certificate 10 have regular discussions around their in a focus area or become a national or professional development. international certified specialist. 2017 2018 2019 % About one third of AniCura’s clinics are accredited as teaching institutions Source: AniCura employee survey 2017 (1,800 participants), 2018 (2,511 participants) and for various European or country-specific 2019 (3,375 participants) specialisation tracks.
ANICURA QUALITY & 10 SUSTAINABILITY REPORT Encouraging professional development and specialisation
AniCura Surgery Centre of Excellence
In 2019, the educational The purpose is to provide an Each module of five days attractive training and career comprises theoretical lectures program AniCura Surgery development opportunity for in surgery in the mornings, Centre of Excellence was veterinarians who are eager to followed by hands-on training launched to support new become high-quality surgeons. in the afternoons. All is led and surgeons at AniCura. The one-year program consists supervised by surgery specialists. of 10 modules arranged at the Each participant has a local mentor, training centre AniCura Istituto who will ensure continuous Veterinario di Novara in Italy. support and a long-term follow-up.
Certified Anaesthesia Nurses
JANNICKE KROGDAHL, approved by Harpers University in England. protocols, but we need to improve NURSE AT ANICURA Jannicke Krogdahl, nurse at AniCura everyone’s understanding of “what, DYRESYKEHUS OSLO, Dyresykehus Oslo, participated. why and how”. NORWAY Have you implemented your new Will the course impact patient knowledge in the clinic? safety? I think we are improving our communi- Yes, definitely! Personally, I have cation regarding anaesthesia, and thus become more experienced in searching Nurses with experience and knowledge in addressing possible complications BEFORE for articles and new research. We have anaesthesia and analgesia are very valuable they occur. This is vital to us, as we have to submit a clinical audit to pass the for safe and efficient surgeries and after- many complicated surgeries. certificate. The clinical audit is new to care. To encourage nurses also to take an I find that we already have good me as a Norwegian veterinary nurse, exam and get a certificate in anaesthesia, although I know it is widely used in AniCura arranged a course with eight modules “I was longing for a human medicine. I think the clinical spread over one year. Twenty-three nurses formal accreditation audit is a great tool for improving our from several countries attended the program daily work on many levels, not exclu- of my knowledge” the first year. Following a final exam, sively anaesthesia. nurses can achieve a European certificate JANNICKE KROGDAHL
ANICURA QUALITY & 11 SUSTAINABILITY REPORT ANICURA QUALITY & 12 SUSTAINABILITY REPORT “The purpose of our quality program is to increase patient safety and improve medical outcome”
ANICURA QUALITY & 13 SUSTAINABILITY REPORT Creating and sharing medical best practices
Medical Interest Groups in AniCura
· Antibiotics and resistance · Cardiology MEDICAL · Dentistry · Dermatology best practices improve · Diagnostic Imaging · Emergency and critical care patient safety · Feline Medicine · Gastroenterology · Infection prevention and control The ability to share best There are twenty active MIGs open · Laboratory medicine to all veterinary professionals within practices between clinics is · Nutrition a key reason to why AniCura AniCura. Within the groups, best practices in diagnostics and treat- · Neurology was founded. ment, new research and findings · Oncology are discussed and analysed using · Ophthalmology a digital platform for networking. · Physiotherapy and rehab AniCura believes in sharing of Each month up to 200 employees are · Reproductive health knowledge and best practice guide- active in each of the twenty medical · Small mammals and exotics lines between clinics and countries interest groups. The groups also · Surgery and orthopaedics to strengthen medical quality. arrange physical meetings, journal · Wound treatment A structure of Medical Interest clubs, courses and congresses and · Urology Groups (MIGs) has existed in AniCura issue best practice guidelines and since the company was founded. protocols.
MIG Ophthalmology
HEGE JØNTVEDT, IS THE We received help with how to treat a How do you create and share medical LEADER OF THE MEDICAL specific tumour, and I found the perfect size best practices in your MIG? INTEREST GROUP IN of my new ophthalmology surgery theatre OPHTHALMOLOGY AND with the help from AniCura colleagues. I We have made nine best practice guidelines VETERINARIAN AT ANICURA think what has changed our daily routines in ophthalmology that we shared on AniCura’s DYRESYKEHUS STJØRDAL IN NORWAY. the most after joining AniCura is the work to intranet. I learned a lot myself about the use reduce the use of antibiotics. of antibiotics when creating these guidelines with my MIG group. What does knowledge sharing mean Why are you engaged as a MIG leader to you? at AniCura? Knowledge sharing is the best of being part I think it is important to take active part in of AniCura. When you need help – you get it. building the platform of knowledge sharing There are always colleagues out there with that we all want, and I love to work with my knowledge in fields you are not comfortable colleagues in different countries. with yourself.
ANICURA QUALITY & 14 SUSTAINABILITY REPORT Creating and sharing medical best practices
What results have you seen from communication trainings? The most important effect is the sense of improved control, over both time and infor- mation flow, which in turn increases the feel- ing of competence among employees. Less complaints from customers as complaints often are results of poor communication. For example, we could see how the customer satisfaction score (NPS) showed a direct increase in clinics where a majority of their staff had attended a communication course. Best practice Key findings: What part of the trainings are most appreciated? study: Canine The role plays are very appreciated! Talking The study showed that all clinics Antibiotics were used to treat 23% about prices and costs is difficult for many patients with used appropriate criteria for hospi- of the dogs and NSAIDs and/or vets and nurses, and the tools to facilitate talization or referral of patients steroids were used in 10% of the this communication are highly valued. acute diarrhoea with acute diarrhea. (The criteria cases. These results are not satis- Conveying bad news to our clients can also be tough, and this is something our included; but were not limited factory as antibiotics, NSAIDs and In 2019, a study was performed to course participants are happy to learn more to, hypovolaemia, dehydration, steroids are not recommended as a about, as well as handling complaints in the understand the compliance to medical signs of sepsis, abdominal pain, first line approach for these best possible way. best practices in diagnostics and anorexia, tachycardia, bradycardia, patients. The microbioma in the gut treatment of canine patients with arrhythmias, melaena or significant can be disturbed for months after Can communication trainings acute diarrhoea. 1,080 dogs with acute haematochezia.) such treatments. improve medical quality? diarrhoea treated at 108 primary YES! Using the course skills in daily opera- care clinics in eight countries were Dietary modification is the most Follow up of patient outcome was tions enable us to build trust in a better way included in the study. appropriate management strategy low, even though this is important which increases the chances that the owner for patients with acute diarrhoea. to discover complications at an early will follow our advice regarding treatment All clinics in the study followed this stage. Only 44% of the patients and follow-up. recommendation. were followed up.
ANICURA QUALITY & 15 SUSTAINABILITY REPORT Creating and sharing medical best practices
“I really enjoyed the knowledge exchange with other colleagues, during lectures as well as during breaks and dinner”
“The best thing was to meet with colleagues in “my” medical interest group and to be inspired by the lectures”
AniCura Medical Interest Group Congress 2019
In March 2019, more than 400 em- sessions with AniCura specialists ployees from all AniCura countries lecturing about different medical ”Sharing were gathered for a two-day Medical subjects. The medical interest is caring” Interest Group (MIG) Congress. groups also met in their groups Veterinarians, nurses and biomedical for networking, to discuss future scientists participated. activities and how to strengthen On the agenda was twenty scientific knowledge sharing.
ANICURA QUALITY & 16 SUSTAINABILITY REPORT Creating and sharing medical best practices
“AniCura was founded to enable closer collaboration and knowledge sharing between different veterinary professionals”
ANICURA QUALITY & 17 SUSTAINABILITY REPORT Creating and sharing medical best practices
”The purpose of the quality conference was implementation; how to go from thought to action”
ANICURA QUALITY & 18 SUSTAINABILITY REPORT Creating and sharing medical best practices
The AniCura Quality Conference 2019 Almost 200 quality coordinators and practice managers AniCura’s medical quality program. Presentations and group discus- were gathered to share knowledge on how to improve sions where held within for example within the nine focus areas of AniCura’s medical professional communication, quality program. infection prevention and control, antibiotic use, surgery improve- ments and more. The participants also got in-depth training in patient- “How to put quality into practice” quality coordinators and practice safety event handling, how to do was the theme of AniCura’s second managers were gathered to share root-cause analysis and how to quality conference. In early December knowledge on how to improve introduce a culture of continuous in Munich, Germany, almost 200 within the nine focus areas of improvement in the clinic.
“I learnt about AniCura’s surgical safety checklist and will start using it at my clinic”
“We got new ideas and valuable input on how to prevent medication errors”
ANICURA QUALITY & 19 SUSTAINABILITY REPORT Improving professional communication skills
INVESTING IN customer communication
Communication skills impact diagnosis phase, as the patients cannot sionals, as customer communication patient safety, but are not speak for themselves. Good communi- is rarely covered by the educations at cation can also increase compliance universities. The trainings are set-up in focus at the veterinary to aftercare at home. in local language per country and held universities. by communication specialists. The COMMUNICATION TRAININGS trainings typically cover areas such as Since several years, AniCura offers conversations with different person- Good communication skills are impor- all employees with direct customer ality types, how to convey sad news, tant to convey messages to pet owners contact, communication trainings. complaints management and how around treatment, expected outcome These trainings play an important role, to inform about prices and costs for and pricing. It is also important in the not least for newly graduated profes- different treatments.
ANICURA QUALITY & 20 SUSTAINABILITY REPORT Improving professional communication skills
Perspectives from a communications trainer
UTE GRUNDT IS A CONSULTANT HELPING ANICURA CLINICS IN GERMANY, AUSTRIA & SWITZERLAND IMPROVE THEIR CUSTOMER COMMUNICATION SKILLS. UTE HAS BEEN WORKING WITH VETERINARY PROFESSIONALS FOR OVER 22 YEARS.
What challenges have you seen in the veterinary world? I can see four key areas; 1. Communicating prices and costs for treatments, diagnostics and medication 2. Dealing with pet owners’ emotions 3. Meeting unspoken expectations from customers 4. Handling complaints regarding long waiting times
I think it is positive that AniCura invests in improving customer communication skills as it is usually not well covered in the educations of veterinarians and nurses. The trainings we offer cover everything from basic communication skills and how to deal with different personalities over to more complicated tasks such as complaints management. Beside the communication trainings, AniCura also asked me to support in individual clinics. For example, at AniCura Bielefeld we worked with the reception team to strengthen the “first impression”. At AniCura Kleintierspezialisten Ravensburg we are developing a series of modules on how to communicate around costs.
“After every course, we made a number of changes to improve the communications with our customers and also between ourselves”
DR. DIRK RÖMER, KLEINTIERSPEZIALISTEN KEMPTEN, GERMANY
ANICURA QUALITY & 21 SUSTAINABILITY REPORT Providing reliable diagnostic medicine
X-RAY IMAGING can improve
A successful treatment is dependent upon high-quality diagnostic medicine.
well as radiation safety violations were assessed. X-ray imaging is one of the most “This is the first time we could The study revealed that correct common diagnostic procedures and is perform such a large and conclusions were only drawn from 65% performed in about one of ten patient international study on diagnostic of the x-ray examinations. The results visits in veterinary care. In 2019, quality in veterinary care. It were similar across all participating AniCura studied the quality of x-ray provides key findings that countries. All clinics received feedback examinations. 600 x-ray images from can help advance veterinary on how to improve x-ray diagnostics. 111 veterinary clinics across Europe medicine” More training and guidelines on were included in the study. DR. ANTHONY PEASE, RADIOLOGIST how to use x-ray imaging will be im- (DVM, MS, DACVR) portant. Using specialist competence 65% OF X-RAY EXAMINATIONS WERE via digital services can also strengthen CORRECT interpretations. Images and the clinics’ patient safety. Since 2018, AniCura Clinics that were part of the study interpretations were reviewed by an offers digital imaging services via submitted five x-ray images together external imaging specialist. The image AniCura Telemedicine. with their clinical findings and quality, interpretations, conclusions as
ANICURA QUALITY & 22 SUSTAINABILITY REPORT Providing reliable diagnostic medicine
Learnings from laboratory workshops
MORTEN JOHANNESEN, VETERINARIAN AND PRACTICE MANAGER AT ANICURA DYREHOSPITALET CITY SYD AND HEAD OF ANICURA’S VETERINARY ADVISORY BOARD IN DENMARK.
AniCura Dyrehospitalet City Syd participated in one of the laboratory workshops and realised that they did less pre-anesthetic blood testing (PAB) than expected. We spent hours discussing pre-anesthetic blood testing and how to present this service to the pet owners. In the end, we decided to send out a brochure to our customers describing the benefits of PAB. It was a simple action, but made a real difference. Now the pet owners ask for PAB themselves when their pet is booked for surgery.
“We spent hours discussing pre-anesthetic blood testing and how to present this service to the pet owners”
MORTEN JOHANNESEN, VETERINARIAN AND PRACTICE MANAGER
Laboratory quality Exploring artificial at AniCura intelligence
Good laboratory quality is important to make accurate diagnoses. In a cooperation between AniCura, A series of laboratory University of Aarhus in Denmark, workshops have been held Antech and Mars New Technologies, with clinics to identify ways to the possibilities to improve quality improve laboratory processes using machine learning are explored. including sampling, handling and In the project, called Canine Thoracic Artifi- interpretation. The format and cial Intelligence, a clinical decision support structure of these workshops algorithm is created, using AniCura x-ray will be available online so more images as well as images from the larger Mars family. The purpose is to evaluate and detect clinics can improve laboratory pulmonary disease, pleural space disease and quality. cardiomegaly.
ANICURA QUALITY & 23 SUSTAINABILITY REPORT Monitoring surgical site infections
INFECTION CONTROL in surgeries
Many infections after surgery were detected in 5% of the surgeries. GUIDELINES FOR INSTRUMENTS can be prevented through Infections were detected in all types Aseptic surgery routines involve ade- better hygiene routines. of surgical procedures except eye and quate preparation of the environment dental surgeries. in the surgical area, surgical site, surgical equipment and anaesthesia team. INFECTIONS CAN BE PREVENTED These are basic and easy procedures, Healthcare associated infections are As several factors contribute to the but the compliance to these routines infections which patients get while development of surgical site infec- is sometimes low. In 2019, AniCura they are receiving health care for tions, a bundle of preventive measures developed new guidelines for instrument another condition. Surgical site in- must be put in place to reduce the risk. handling in all our eight local languages fections are one of the most common Aseptic surgical routines, appropriate to help clinics achieve a proper clean- healthcare associated infections in antimicrobial prophylaxis, careful liness of surgical instruments. Courses human health care. selection of surgical patients, surgi- on instrument handling are also Prevalence of surgical site infec- cal experience and technique have offered on a regular basis. tions are rarely measured in veterinary a preventive impact. Good hygiene care, but there are scientific articles routines prevent wounds from being reporting rates ranging from 1–18% of contaminated by microorganisms that surgeries in dogs and cats. In AniCura’s originate from the patient, the surgery study from 2018, surgical site infections staff and the environment.
*Surgical site infections defined according to guidelines from the Centres of Disease Control and Prevention, USA
ANICURA QUALITY & 24 SUSTAINABILITY REPORT Monitoring surgical site infections
Creating a culture of infection control
Inspired by the AniCura Quality several orthopedic procedures. Conference and the QualiCura Despite the decrease in antibiotic survey about surgical site infections, use, post-surgical infection rates Thorsten began changing many have not increased. routines for the surgery theatre. Thorsten points out that the He reviewed the entire process of clinic’s infection control culture preoperative care for the orthopedic needed to change and that it is THORSTEN THUDE, VETERINARIAN AND patients including hair removal, necessary to shape a workplace PRACTICE MANAGER washing and disinfection of the where people have the courage to AT ANICURA VARDE surgical site and how to move the talk with colleagues who breach DYREHOSPITAL, DENMARK patient from the preoperative room into the surgery theatre. “We use less antibiotics, Creating a culture During surgery, the number of and surgical infection rates of infection control staff in the room has been reduced have not increased” to a minimum. The surgical staff Thorsten Thude, veterinarian also had to train how to correctly put the hygiene guidelines and remind and practice manager at sterile gown and gloves on. each other why it is important to AniCura Varde Dyrehospital, For a long time, there was a routine follow them. to give all orthopedic patients antibi- Screen savers with reminders Denmark created a culture otics during surgery. Now, the clinic to disinfect hands were also put on of good infection control. has stopped using antibiotics for all computers.
ANICURA QUALITY & 25 SUSTAINABILITY REPORT Ensuring wiser antimicrobial use
”In 2019, 2/3 of our clinics have reduced antibiotic use”
ANICURA QUALITY & 26 SUSTAINABILITY REPORT Ensuring wiser antimicrobial use
LESS ANTIBIOTICS at AniCura
Three years in a row, AniCura’s from 3.4 to 13.7%. The significant more than 5% of AniCura’s patients country and clinic differences were should receive antibiotics in 2030. clinics have reduced unnec- addressed in the feedback to clinics. In 2019, a strategic working group essary use of antibiotics. The results from this study are with representatives from several unique as authorities in Europe do not countries was formed to accelerate measure use of antibiotics for compan- the work around antibiotic use. The ion animals. work includes not only the prescribing Unnecessary use of antibiotics accel- veterinarians, but targets all team erates the spread of resistant bacteria ANICURA’S 2030 GOAL members, as well as pet owners and which is one of the biggest global AniCura’s groupwide goal is that no referring veterinarians. threats against human and animal health. With three million patient visits every year, AniCura can have significant impact on the use of Percentage of dogs THE STUDY IN BRIEF: antibiotics in companion animal care. • 8% of dogs received antibiotics, receiving systemic compared to 12% in 2018, 13% in 2017 and 14% in 2016. THE FOURTH ANTIBIOTIC STUDY antibiotics during For the fourth year in a row, AniCura one week per • More than 65% of clinics reduced antibiotics use. 18% of clinics reduced measured the use of systemic an- country (%). use with more than 10%. tibiotics among 24,150 dogs at 154 • Surgical prophylaxis was the most clinics across Europe. This year, clinics common indication for dogs receiving recorded over a week what antimicro- antibiotics (21%) followed by wound bial substance they used in dogs for ITALY infection including abscesses (19%), gastro-intestinal disorders (12%), skin systemic treatment or prophylaxis, 13.7
FRANCE infections (dermatitis, furunculosis etc) DACH DENMARK together with indication for this use. NETHERLANDS THE (11%) and urinary tract infections (7%). SPAIN
In total, 2,048 dogs received AVERAGE ANICURA 10.8 10.7 10.7 • The most commonly used antimicrobial antibiotics during the measured 10.1
8.9 class was beta-lactam antibiotics (74%). 8.5 week, which equals 8% of the canine • Most dogs were treated empirically, SWEDEN
patients, compared to 12% in 2018. NORWAY i.e. without any diagnostic aid like
The incidence of antibiotic use varied 4.8 bacteriology and/or cytology results. 3.9 among hospitals from 0 dogs treated to • Duration of treatment varied from 55% of the canine patients. In addition, 1 to 60 days with a median of 7 days. the mean incidence per country differed Source: QualiCura Q4 study 2019
ANICURA QUALITY & 27 SUSTAINABILITY REPORT SWEDEN
14 24 Ensuring wiser antimicrobial use
Dagmar Zeppelfeld, Elisabeth Kasper and Isabelle Wandling from Aspern, Austria A WISER USE OF ANTIBIOTICS
THE CLINIC’S INSTRUCTIONS ON ANTIBIOTIC USE: in practice 1. We try to work as we did not have any antibiotic drugs available to use at all. The clinic AniCura Tierklinik & Tierheilzentrum Aspern redu- 2. To directly give antibiotics to a patient is only allowed in cases of emergency ced their use of antibiotics. Markus Kasper, veterinarian and when the patient really needs this former practice manager together with Elisabeth Kasper, treatment. veterinarian and practice manger tell their story. 3. “4-eyes-rule”; treatment with antibiotics of other patients than emergency cases must be authorized by the head of department (surgery, dentistry, intensive care unit etc) or an internal specialist. We discussed the topic of antibiotic 4. The veterinarian who initiates an use with our team over a long time “Clear antibiotic treatment must write an period and in several meetings. We explanation in the patient’s medical record and fill in the following vairables also discussed the negative impact instructions in an Excel file; patient data, diagnosis, that antibiotic drugs have on the gut why antibiotics were given, substance, flora and how to improve hygiene. But for antibiotic dosage, duration. it did not really impact our prescribing use help vets 5. Remember to sample for bacterial behaviour. culture and susceptibility testing and honor the results. After a lecture by AniCura’s Group change their Medical Quality Manager Ulrika 6. The clinical status of the patient overrules behaviour” the laboratory results; if the patient is in Grönlund on antimicrobial resistance a healthy condition, no antibiotics are and treatments, we decided to create needed. new instructions on antibiotic use.
ANICURA QUALITY & 28 SUSTAINABILITY REPORT Ensuring wiser antimicrobial use
”What changed our daily routines the most after joining AniCura, is the work to reduce use of antibiotics”
HEGE JØNTVEDT, VETERINARIAN AT ANICURA DYRESYKEHUS STJØRDAL, NORWAY
ANICURA QUALITY & 29 SUSTAINABILITY REPORT Securing infection prevention and control
HAND HYGIENE in focus
Proper infection control is average consumtion of hand sanitiser HANDLING OF ENDOSCOPES important to protect patients was 6.5 ml per patient and day ranging AniCura also studied how clinics handle from 0.4 to 38 ml per patient and day. cleaning and disinfection of rigid and and employees from antimi- Looking at comparable clinics that flexible endoscopes. Endoscopes are crobial resistant bacteria. participated in the study both in 2018 used for invasive and non invasive and in 2019, the results show that the procedures and thorough cleaning majority of the clinics have increased and disinfection are crucial to prevent Clean hands through using alcohol- the use of hand disinfection. transmission of microorganisms based hand sanitser is the single between patients. most important measure to minimise “The majority of our This survey revealed that 91% of spread of infectious agents in a clinic. clinics have increased the participating clinics cleaned the AniCura works actively to secure the use of hand sanitiser” endoscope channels directly after the proper hand hygiene routines among procedure was finished, which is reas- all employees through educational Especially clinics in Germany, suring. However, only 40% of clinics initiatives, guidelines and measure- Austria, Switzerland and the Netherlands brushed the channels with a cleaning ments of compliance to routines. have improved their hand hygiene. agent 3 times or more, which is recom- While many individual clinics show mended. Encouragingly, 84% of the STUDY ON HAND HYGIENE great improvements, we have not clinics used a proper disinfectant for For the fourth year in a row, a study reached the companywide goal of disinfection of endoscope channels. about hand hygiene was performed at doubling the used volume of hand 120 AniCura clinics. The unweighted disinfection per patient day.
ANICURA QUALITY & 30 SUSTAINABILITY REPORT Securing infection prevention and control
Results and development How did you improve Use of alcohol-based hand hand hygiene? sanitiser per country, ml per patient and day*
ITALY (1 CLINIC) 26.4
SWEDEN (29 CLINICS) 10.4
NORWAY (21 CLINICS) 7.7
PETER SVANSTRÖM NADIA LEONI DACH (23 CLINICS) 7.2 “Positive feedback to the team has “Abundant number of dispensers is been key to improve hand hygiene” crucial; it must be easy to do right!” ANICURA AVERAGE 6.5
The clinic AniCura Strängnäs Djurklinik, Clinica Veterinaria San Siro, Italy, partici- 2019 Q2 survey QualiCura Source: Sweden, with practice manager and veteri- pated for the first time in the survey on NETHERLANDS 4.7 narian Peter Svanström doubled the use of use of alcohol-based hand sanitizer and (36 CLINICS) hand sanitizer between 2018 and 2019. achieved the top result of 26.4 ml per DENMARK patient and day. Veterinarian and practice (10 CLINICS) 2.4 Achieving good hand hygiene and to main- manager Nadia Leoni describes their work. tain good results is challenging. My belief is *Measured as volume used during a month, divided by the number of that availability of alcohol-based sanitizers, First of all, we have installed two dispensers patients and the length of their stay in the clinic; ml per patient and day repeated reminders and positive feedback in each consultation room, and we also from managers are key features for progress have dispensers in place in corridors, in the and success. Our results are good this year, intensive care unit, waiting rooms, etc. In • 81% of the clinics in the study had a but we cannot lean back and expect it will total, we have 28 dispensers spread out on designated person to coordinate the stay like this without more work. 500 sq.meters. local infection control work which is a slight increase compared to from last Along with the high number of dispensers, year’s result of 75%. we have also shared the AniCura’s guidelines • On average, the clinics had 1.0 dispen- for infection control with the whole team. sers per room with patients, similar Furthermore, we have decided to print number as last year. some copies of a summarized protocol for a good hand hygiene and share with the staff. • 58% of clinics (clinics that also participated in 2018’s survey) have Parts of the team might have caught wind of increased their use of alcohol-based the ongoing supervision, this may have led hand sanitiser. This is an important to an overall increasing use. sign of improved hygiene routines.
ANICURA QUALITY & 31 SUSTAINABILITY REPORT Enabling good incident handling
LEARNING from mistakes
By learning from our mistakes, we can improve patient 2019, more than 1,000 learnings have safety and avoid individual blame. been gathered. Data indicate that medication and treatment related inci- dents are most common (see figure).
Medical incidents take many forms, SYSTEM FOR REPORTING INCIDENTS EDUCATION AND KNOWLEDGE from patient accidents, to mistakes in In 2018, the AniCura Patient Safety SHARING administering medications, to mis- Improvement System was launched During the year, educations have communication among team mem- to enable clinics to systematically been held around how to perform a bers. There are many reasons and document, analyse and learn from root cause analysis to help identify factors contributing to why incidents medical incidents with the help of a the actual root cause, find the right occur. In general, these incidents are digital system. corrective actions and avoid individual caused by failures in the healthcare Two thirds of AniCura’s clinics are blame. Each quarter, a newsletter is system and organisation and not indi- now using the system for analysing issued including statistics and learnings vidual misconduct or mistakes. medical incidents in the clinic. During from different incidents.
AniCura Patient Safety Improvement System
An error did occur and Medication related did reach the patient but 33% incident (excl. Anaesthesia) 39% without causing any harm Treatment related 33% The incident caused incident (incl. surgery) 35% temporary injury to the patient Diagnostics- Types of 13% related incident Degree An error did occur events of patient 16% but never reached Anaesthesia the patient (near-miss) reported 12% related incident harm The incident resulted Healthcare 7% in the death of the patient 105%% Associated Infection The incident caused 4% Patient accident 3% permanent injury to the patient N=990 N=1,169
Note: These numbers are based on data collected in the APSIS system by self-driven reporting.
ANICURA QUALITY & 32 SUSTAINABILITY REPORT Enabling good incident handling
back with swollen tongues and Case: MISTAKE WITH inflamed ear tips. The clinic team realised that the cats had been in DISINFECTION MADE contact with the same surfaces. ACTIONS AND LEARNINGS Using root cause analysis, the CATS SEVERELY ILL clinic was able to identify the root cause to be an incomplete check THE INCIDENT the ready-to-use solution. of incoming goods. A new check- A clinic ordered 10 new canisters The concentrated disinfectant list and an improved routine for of ready-to-use disinfectant was used without dilution as the incoming goods was implemented solution. Upon arrival, the staff thought it was the ready-to- to mitigate risks. delivery note was checked, and use solution. As a result, several The checklist was translated the canisters placed in the storage. cats in the clinic came in contact and shared with all AniCura Nobody noticed that one canister with the concentrated disinfectant. clinics to avoid similar incidents contained concentrate, and not After a few days, these cats came in the future.
Culture of continuous improvements
What is the goal with your work? What impact can this have on medical incidents? There is a major global change on how to manage and develop people and compa- These methods will help our clinics to nies. Adopting these new ideas has proven address medical incidents and find sustainable to be very impactful. We want every ways to improve. The first step is to define employee to be capable, empowered, and agree on desired conditions i.e. what MÅRTEN JEGENSTAM, GROUP CONTINUOUS and expected to be in control of his/her does a “good day” look like (important IMPROVEMENT MANAGER AT ANICURA, HAS daily work and make improvements. Key routines and KPI’s). Next, we start measuring 20 YEARS OF EXPERIENCE OF DEVELOPING components are; flow orientation from to identify deviations (i.e. problems) and ORGANISATIONS AND PEOPLE. HE IS NOW both patient and customer perspective, take immediate actions. For problems or LEADING THE WORK TO CREATE PROCESSES empowered employees that are supported medical incidents that arise, we let the AND A CULTURE OF CONTINUOUS IMPROVEMENTS by daily meetings at the clinic to learn from employees ask around “why” to get to AT ANICURA’S CLINICS. the previous day and plan for a “good” root causes and then we develop and test upcoming day, and a coaching leadership. actions. This “improvement engine” will become embedded in AniCura’s DNA and part of our daily routine. Intention is to create a learning cycle that will enable us to reduce number of incidents over time.
ANICURA QUALITY & 33 SUSTAINABILITY REPORT Promoting patient medical record quality
Reviewing medical records
Floor Stembert, veterinarian and practice manager at AniCura Kennemerland, the Netherlands
In the Netherlands, more than NEW AND 1,200 medical records from 14 clinics were asssed in 2019. 84% of these medical records were judged to be of adequate quality.
MODERN Floor Stembert, veterinarian and practice manager at AniCura Kennemerland in the Netherlands, has implemented new routines to ensure medical records of high quality.
The purpose with these new routines is to systems ensure that the medical records are filled in the best possible way. If another veterinarian reads the record, it should be 100% clear to her or him what has happened to the patient High quality medical records MODERNISED SYSTEMS and what the next steps will be. are important for the safety Today, AniCura’s clinics use many Medical records are double checked by of each patient. different practice management colleagues. The following measures are taken: systems (systems where medical • Assessment of whether the case history records are created and stored) and has been properly recorded, whether many of these systems do not have the entire clinical examination has been Well-structured and clear medical up-to-date capabilities to register completed and whether the additional examinations have been recorded. records are important to ensure medical records in a structured patients are safe and no information and reliable way. • A differential diagnosis and treatment plan for each patient. It is also always is lost between different veterinary Work is ongoing across the com- recorded when the next appointment professionals. Proper and reliable pany to harmonise and modernise or other contact moment are scheduled. medical records can also be impor- practice management systems per • If a method deviates from the stand- tant sources of data for research. country. New, preferred suppliers ardised protocol, then a question is have been selected in six coun- asked to the relevant veterinarian or a discussion is started on AniCura’s SYSTEMATIC IMPROVEMENTS tries and remaining countries are internal networking platform Yammer. If Since 2017, many AniCura countries underway. Modern systems will necessary, a new protocol is described, run countrywide projects to improve improve medical record quality or the existing protocol is adjusted. medical record quality by stand- across AniCura with for example ardizing routines and establishing common default settings, no double In total, 250 patient medical records are read every month by both nurses and vets at our best-practice. In these initiatives, data entries and provide better clinic. It has also proven to be positive for pro- medical records are typically search possibilites. Important patient fessional development of new veterinarians reviewed by several colleagues in data will also become comparable and nurses. A key success factor has been to create a culture where the team shares between clinics, and key conclu- the clinic to assess anamneses, knowledge with each other in a respectful medical treatment and structure sions can be drawn for research way without blaming anyone. of the medical record. purposes.
ANICURA QUALITY & 34 SUSTAINABILITY REPORT Promoting patient medical record quality
”The healthy medical record project started two years ago. Now it is implemented as a standard practice in our clinic”
ANICURA QUALITY & 35 SUSTAINABILITY REPORT
”Together, we have a responsibility to run our operations with regards to their impact on society; on people, animals and the environment”
ANICURA2019 FEB MAY AniCura Qaulity & 16 research projects Sustainability Report receive funding from for 2018 is published AniCura’s Research Fund
Representatives from Mars Petcare decides to European Parliament visit double investments in AniCura to learn about veterinary research at antibiotic use AniCura
New QualiCura results about hand hygiene
Severine Tasker, Chief Medical Officer of Linnaeus, joins AniCura’s Scientific Council
First international AniCura MIG Wound Management Congress +400 participants with 58 participants JUNE JAN and 20 lectures at the international AniCura AniCura instrument 4th AniCura employee Medical Interest Group handling guidelines survey measuring Congress in Copenhagen are published employee satisfaction APRIL 24 managers graduate Ulrich Göggerle from global leadership appointed new Chief program Accelerator Medical Officer of AniCura
+1,000 learnings are gathered in AniCura Patient Safety MARCH Improvement System
ANICURA QUALITY & 38 SUSTAINABILITY REPORT
In 2019, we passed several milestones to develop quality of care and improve as an employer. For the third year in a row, we reduced unnecessary use of antibiotics at AniCura’s clinics.
AUG New QualiCura NOV results on quality New QualiCura results of x-rays on best practice in treating acute diarrhoea
New QualiCura results on antibiotic use
New app with online consultations launched in Sweden
OCT AniCura Denmark organises a day of free veterinary care for homeless pet DEC owners across the 200 AniCura country quality coordinators participate at the +140 participants AniCura Quality the annual AniCura Conference in Munich Feline Medicine Congress
AniCura Surgery Centre for Excellence is launched
ANICURA QUALITY & 39 SUSTAINABILITY REPORT ANICURA QUALITY & 40 SUSTAINABILITY REPORT Our people
AniCura’s ambition is to be forms a core part of AniCura’s identity as On international level, a two-day conference the most attractive employer an employer. Since 2013, the AniCura was held for all AniCura practice values have played an important role managers, a Medical Interest Group and drive positive change in uniting the group and ensuring a Congress for for veterinary profession- for veterinary professionals common platform for our everyday als and nurses as well as the AniCura across Europe. operations and decision-making. Quality Conference were organised A two-day values training for managers (read more on page 19). is organised three or four times per year. Around 250 managers have been STRENGTHENING LEADERSHIP AniCura is a large employer in veterinary trained since 2014. Following these To strengthen leadership in veterinary care and has significant impact on trainings, managers are equipped with care is a key priority for AniCura across working conditions and satisfaction. tools and materials to work with the all markets. Since 2018, AniCura is part of Mars values in each clinic. Results from the Since 2015, AniCura has an inter- Petcare that has a global ambition to employee survey in 2019 showed that national leadership program with transform the veterinary profession. 87 % of employees can identify with the around 25 participants every year. The During 2019, AniCura’s work has been AniCura values. international program is complemented focused on four areas: During 2019, continued investments with national leadership programs were made in meetings between differ- as well as separate courses covering ent employee groups to build culture coaching and feedback, stress and Shaping a values-based organisation and share knowledge. In each country, conflict management, self-leadership Strengthening leadership several forums and off-site learning and performance management in Creating sustainable working conditions events for nurses, veterinarians and most countries. Following the em- practice managers were arranged. ployee survey in January every year, Structuring competence development individual support is given to clinics with low leadership index. ”Since 2013, the AniCura SHAPING A VALUES-BASED values have served as a ORGANISATION common platform for SUSTAINABLE WORKING CONDITIONS Building a sense of togetherness and everyday decision-making” In some countries, the veterinary sector investing in the company culture faces challenges in securing sustainable
ANICURA QUALITY & 41 SUSTAINABILITY REPORT 87 % are proud of working at AniCura 87% identify with AniCura values 87% are motivated at work
working conditions with adequate implement process improvements in a work-life balance and reduced stress structured way. This initiative is expected COMPETENCE DEVELOPMENT AND levels. Overall, AniCura’s objective is to improve in-clinic workflows to reduce TRAININGS to harmonise, improve and modernise stress, improve working conditions and AniCura is committed to offer high- employment conditions in veterinary daily operations. Ten clinics were part quality professional development to care. Most initiatives are country specific of the first pilots in 2019 and for 2020 our employees. Several countries are as the situation differs from country to the initiative will be scaled up to include in the process of implementing new country. around 60 AniCura clinics. competence development programs During 2019, major initiatives included Looking ahead, AniCura will take part and clearer career paths. Professional development of new pension frame- in global health and well-being programs communication trainings are held on a works in the Netherlands and harmoni- developed for all veterinary companies regular basis in each country. Read more sation of work contracts, implementation within Mars Petcare. about competence development on page 10. of time reporting systems and more flexible scheduling in Germany, Austria EMPLOYEE SURVEY RESULTS & Switzerland. Through AniCura’s new Since 2015, employee engagement to develop action plans to address the pension plan in the Netherlands, veteri- at AniCura is measured in an annual feedback from the employee survey. nary nurses and other employee groups employee survey. The employee sur- Results for the past three years show who did not have occupational pensions vey is important to develop AniCura as a steady increase in the willingness to will now be included in the new pension an employer. All teams are encouraged recommend AniCura as an employer. plan from January 1st 2020. In Sweden, 2017 2018 2019 an analysis of AniCura as an employer was performed. Work was initiated to eNPS* 12 14 17 pinpoint the key areas to become em- Engagement index 78 77 79 ployer of choice, as for example stability Leadership index 69 69 70 in teams and improved workflows. Team efficency index 69 68 69 On group level, a continuous improve- *eNPS = Employee Net Promoter Score, an international KPI based on the question: ”Would you recommend this company ment team was established to help clinics as an employer.” General benchmark is 9.
ANICURA QUALITY & 42 SUSTAINABILITY REPORT
*Sick-leave measured as % of total hours worked ReadinessCamp
AniCura
ANNA WELIN, Readiness Camp LEARNING & DEVELOPMENT MANAGER FOR ANICURA IN A two-day training called AniCura Anna Welin, Learning & Devel- SWEDEN Readiness Camp help newly opment Manager for AniCura in recruited veterinarians and nurses Sweden, explains: get a good platform for their daily The purpose is to give our newly employed work at AniCura. AniCura Readiness veterinarians and nurses an introduction to Camp is organised once or twice AniCura and our values, but also to create a good platform for them to manage customer per year in Sweden, Norway and communication, stress, and other areas that Germany, Austria & Switzerland. are not typically covered by the universities. A similar onboarding training is It provides our new recruits with a network available in the Netherlands. across AniCura and colleagues at different clinics to share knowledge with. AniCura Readiness Camp is an off-site two- In Sweden, we have run it since 2017 with day training that includes AniCura values and around 100 participants at each two-day ways of working, self-leadership, customer training. The feedback from participants has communication and stress management. been very positive, and all clinics are now It also includes medical blocks around for sending as many new recruits as possible to example infection control, incident handling these trainings. and medical record writing at AniCura.
ANICURA QUALITY & 43 SUSTAINABILITY REPORT PREVENTIVE care Preventive care has signifi- AniCura has an important responsi- is now offered in Sweden, Denmark, bility to improve pet health through Norway and the Netherlands. cant impact on the quality of better compliance to preventive health life for companion animals. measures and aftercare instructions. ONLINE CONSULTATIONS By preventing illnesses and infections, In 2019, online consultations were pet owners’ costs for veterinary care launched in Sweden after thorough over a lifetime can also be reduced. testing and assesment of medical quality. Via a mobile app and video, PREVENTIVE HEALTH PLAN veterinarians can see the patient, ”Online In 2016, AniCura launched a preven- discuss symptoms and provide advice consultations tive care plan called AniPlan. The to the pet owner. purpose is to offer pet owners a simple Online consultations at AniCura play an impor- and cost-efficient way to ensure good serve as a complement to physical preventive care and detect diseases at care and the purpose is to support pet tant role in an early stage. AniPlan is offered as a owners in preventive health measures, preventive care” subscription and includes for example improve accessibility to the veterinarian annual health checks, dental checks and help emergency triage. Online con- and vaccinations. sultations can also improve compliance In 2019, the number of pets using to aftercare instructions and facilitate AniPlan grew fourfold and AniPlan monitoring of treatment outcomes.
ANICURA QUALITY & 44 SUSTAINABILITY REPORT Why online care?
Veterinarian Sofia Müller in Sweden works with online consultations.
How can online care impact patient safety? First of all, online care lowers the threshold to seek medical advice. This gives us the op- portunity to discover medical conditions at an earlier stage. Pet owners can also easily ask follow-up questions and get a second opinion after a physical visit to a clinic.
Online consultations also allows us to get a glimpse of the pet in the comfort of their own home, without the stress a trip to the clinic may cause.
How can you help the physical clinic? A lot of time at the clinics is spent on the phone, helping pet owners judge their pets’ conditions and deciding whether they need to visit the clinic. We can relieve the clinics of some of these calls and make a first assessment. When suitable, we can give advice on treatments to be started at home. When needed we will refer the patient to a physical clinic. As usual, we refer to the right veterinarian and clinic, regardless if it is an AniCura clinic or not.
We can also liberate time for the more advanced care that we offer at our clinics.
Why did you start working online? It gives me an amazing opportunity to have a flexible work life. I can combine working from home, with work at the clinic. I love helping pets but also really enjoy communi- cating with our pet owners. “With online What risks do you foresee? There is always a risk of misunderstandings consultations between the pet owner and veterinarian. My view is that standardised online consul- we can discover tations with a high-quality technical solution are more secure and provide more detailed diseases at an information than the usual phone calls. If there is any hesitation around symptoms, earlier stage” we will refer the patient to a physical clinic.
ANICURA QUALITY & 45 SUSTAINABILITY REPORT ENVIRONMENTAL impact AniCura’s ambition is to pro- is important to reduce the environ- WASTE MANAGEMENT vide high-quality veterinary mental footprint in healthcare. During Laws and regulations set basic spring 2018, a new supplier code of standards for waste handling in each care with consideration to our conduct was developed regulating country, but more can be achieved impact on the environment. both human rights, animal welfare through improved waste sorting and and testing, as well as environmental recycling. Several clinics address responsibilities for our suppliers. In waste management as part of the 2019, the code was shared with the commitment to different ISO certifi- The development of veterinary med- 59 most important suppliers and by cations they operate under. In some icine with for example more energy year-end, 44 suppliers had signed and countries, preferred suppliers have consuming equipment and increased committed to the AniCura Code of also been chosen to professionalise use of consumables for infection control Conduct. waste management and decrease purposes, highlights the importance to In 2019, the number of logistic share of unsorted waste. address our environmental impact. providers and transportation partners Four areas have been identified as key were consolidated to a few key sup- RENEWABLE ENERGY for AniCura: pliers. Together with them, work has In 2019, clinics in Sweden, Norway started to optimise order frequency and Denmark switched to new energy Procurement from clinics and reduce number of agreements with renewable energy. Waste transports needed. New technologies “Clinics across Scandinavia are are also being evaluated to further Transport now powered by green energy” streamline transportations to AniCura’s Energy clinics and make them more environ- This means that the energy con- mentally friendly both regionally and sumption in the clinics comes from ENGAGING WITH SUPPLIERS across Europe. renewable sources such as sun, wind, To address environmental impact in water or biomass that reduces carbon collaboration with preferred suppliers dioxide emissions.
ANICURA QUALITY & 46 SUSTAINABILITY REPORT ENVIRONMENT
“This method exceeds our expectations both in terms of handling and hygiene. The surfaces are even cleaner than with our conventional disinfection method”
Eco-friendly cleaning in Bielefeld
Sustainable MICHAELA KLÖCKENER, QUALITY MANAGER AT ANICURA TIERKLINIK CLEANING BIELEFELD IN GERMANY At AniCura Tierklinik Bielefeld in In 2018, AniCura partnered with Duotex Microsystems, Germany, water and the high-quality a supplier of high-quality microfiber cleaning products microfiber is used to clean the clinic. which are clinically proven and eco-friendly with very Michaela Klöckener, quality manager low microplastic emissions. at the clinic, explains: Initially, we were all very skeptical of the idea cleaning with only water, but after several microbiology tests directly after cleaning, we EFFICIENT ABSORPTION OF BACTERIA Microfiber cleaning is more reliable were all surprised. The microfiber efficiently absorbs than the manual dilution of chemicals This method exceeds our expectations particles and bacteria, and only which often results in too much de- both in terms of handling and hygiene. The surfaces are even cleaner than with our water should be added for clean- tergents and sticky surfaces where conventional disinfection method – and only ing. The method is used in human bacteria easily are stuck. with water! healthcare and have been carefully 38 AniCura clinics in Sweden It reduces our exposure to chemicals, and tested in AniCura with repeated and Germany have switched to the the Duotex microfiber is eco-friendly which is important for me. Another positive effect is bacteriological tests, all showing new cleaning method during 2019. that we have also saved money by reducing satisfying results. Roll-out to more countries will the amount of detergent and disinfectants commence in 2020. we need to purchase.
ANICURA QUALITY & 47 SUSTAINABILITY REPORT In Denmark, AniCura organised free veterinary care across the country during one day in October.
In March, 53 patients and their owners came to AniCura in Gothenburg.
ANICURA QUALITY & 48 SUSTAINABILITY REPORT COMMUNITY engagement
Many clinics within AniCura AniCura’s community engagement is at no cost to the pet owner. Pet owners mainly conducted locally and based who are offered free veterinary care are actively engaged in the on the needs of companion animals are either homeless or live in temporary local community to improve in each region. Several clinics provide housings. Treatments include health- pet health. veterinary care to animal shelters at a checks, vaccines and dental care. discount and others collaborate with Certain patients are also invited back foundations to help pet owners living for further treatment or surgery. under tough financial circumstances. “When life is hard on you, “Everybody had an pets play an important role” amazing day, and the pet FREE VETERINARY CARE FOR HOMELESS More than ten years ago, AniCura During 2019, days of free veterinary owners were so grateful. Västra Djursjukhuset in Sweden, was care for homeless and vulnerable pet These pet owners can be one of the very first animal hospitals owners were arranged at several clinics difficult to reach, so we are to organise a day with free veterinary in Sweden and the Netherlands. In really happy that so many care. Since then, many clinics and Denmark in October, veterinarians and came to see our vets and countries have followed their positive nurses from AniCura’s clinics across the example. country spent one day visiting hostels nurses this day” The days are organised together for homeless pet owners to help their with local associations for homeless pets and invited pet owners to the clinics MILLE PETERSEN, WHO HELPED ORGANIZED and the clinics typically treat between for free veterinary care. THE DAY WITH FREE VETERINARY FOR HOMELESS PET OWNERS IN DENMARK. 40 and 130 patients on each occasion
ANICURA QUALITY & 49 SUSTAINABILITY REPORT ANICURA Research Fund
Clinical research is important to develop medical quality and AniCura’s Scientific Council inde- patient safety. pendently evaluates all applications to the research fund and allocates money to the projects that assure AniCura has many veterinary profes- Since 2015, around 60 clinical re- high scientific standards and have sionals that devote part of their time search projects have received funding. the potential of being published in an to research. But clinical research out- In 2019, AniCura’s new owners Mars international peer-reviewed scientific side universities often lack financing. Petcare decided to double the funds pro- journal. Therefore, AniCura established the vided by the AniCura Research Fund. In During 2019, the following 16 AniCura Research Fund in 2015 with total, AniCura funded research projects projects were granted funding from support from its owners. of more than SEK 6 million. the AniCura Research Fund:
”The acute phase reaction ”A prospective study of risk and the haemostatic system factors for surgical site infec- in cats with liver diseases of tions in dogs” different ethiologies”
JENS STETTER, KALMAR, SWEDEN JOSEFINE ÖBERG, STOCKHOLM, SWEDEN
Surgical site infection is a source of increased Acute phase proteins, APP, are proteins patient morbidity, mortality and costs in both increased in the blood in different human and veterinary medicine. inflammatory diseases, valuable for detection and monitoring inflammatory This study investigates hypothermia, surgery diseases. Liver diseases commonly affect time, perioperative antimicrobial therapy, the the haemostatic system, but this has use of surgical implants, type of surgery (soft not been evaluated properly in the cat. tissue versus orthopaedic and neurosurgery) The purpose of this prospective clinical and open versus minimally invasive techni- study is to investigate if APP can be used ques as risk factors for surgical site infections to differentiate cats with infectious liver in dogs. disease from cats with liver disease of other reasons. ”Prevalence of leptospira ”Validation of progesterone antibodies in healthy dogs in analysis on Idexx Catalyst for Sweden” use in dogs”
KAROLINA SCAHILL, STOCKHOLM, SWEDEN SARAH ÖSTERGÅRD JENSEN, STOCKHOLM, SWEDEN
Leptospirosis is a bacterial disease that can Oestrous identification is needed for cause life-threatening renal and liver failure breeding. Behavioural analysis, ultrasound in dogs. Leptospira prevalence is not known examination and vaginal smears are in Sweden. The Swedish National Veterinary inadequate for exact timing of ovulation. As Institute hence does not recommend a non-subjective evaluation, progesterone vaccination of domestic dogs. However, measurement is important. Catalyst is a well during the years 2013-2017 there was an known in-house laboratory machine. increasing number of reported cases in The objective of this study is to validate Sweden. If leptospira prevalence proves analysis of progesterone on Catalyst used in to be significant in Sweden, prophylactic a clinical setting. recommendations, such as vaccination, might need to be revised.
”Wireless video-electroen- cephalography in dogs with cluster seizures”
MARIA WINNERBY, STOCKHOLM, SWEDEN
Nonconvulsive seizures are also a problem in veterinary medicine which has been shown in studies where EEG recordings have been used in both sedated and non-sedated dogs with seizures.
”Prevalence of dermatophytes, endo- and ectoparasites and ”Systemic AA-amyloidosis in associated disease in Dutch shelter cats in the North of show rabbits” Italy and shedding of amyloid fibrils” IAN VAN ALPHEN, TILBURG, THE NETHERLANDS Unlike dogs and cats, which are routinely FILLIPO FERRI, NOVARA, ITALY treated preventively for endo- and ectopa- Systemic AA-amyloidosis is a protein misfol- rasites, rabbits rarely seem to receive ding disease. Studies showed that transmis- preventive treatment for such infestations sion of systemic AA-amyloidosis occurs in despite these being relatively common cheetahs through faecal shedding of amyloid in especially young, recently acquired fibrils. Client-owned domestic shorthair cats animals. are rarely affected by systemic AA-amyloido- Results from this study will help identify sis. The aims of the study are to determine whether and which of the aforementioned the prevalence of systemic AA-amyloidosis infestations warrant further attention in shelter cats and to investigate excretion of during the health screening and/or pre- amyloid fibrils. ventive treatment of (young) rabbits.
ANICURA QUALITY & 51 SUSTAINABILITY REPORT “In 2019, we doubled the size of AniCura’s research fund”
ANICURA QUALITY & 52 SUSTAINABILITY REPORT ”Photodynamic treatment of ”The use of the LigaTie implant transitional cell carcinoma in for splenectomy in dogs” the dog”
JORIS VINK, AMSTERDAM, THE NETHERLANDS PETER PANTKE, BIELEFELD, GERMANY
Maintaining haemostasis during surgery Transitional cell carcinoma (TCC) represents is vital for a successful outcome. Cable the most common malignant tumour of the ties made surgery quicker and easier. But lower urinary tract in dogs. Survival rarely studies have shown their limitations and exceeds one to two years. The aim of the disadvantages. present study is to develop a Photodynamic A resorbable device, a self-locking loop, was Treatment Protocol for TCC in the dog designed for surgical ligation. The aim of in combination with palliative TCC laser this study is to investigate the feasibility, the ablation. This approach potentially allows surgery time and safety of ligating the splenic TCC therapy with longer survival times and vessels with the device. improved quality of life.
”Not all the canine oral melano- mas are the same: creation of a new grading system for canine oral melanoma, assessment of its prognostic significance and impact on therapeutic response”
CHIARA LEO, NOVARA, ITALY
Melanoma is the most common oral malig- nancy in the dog. A grading system for canine oral melanoma does not exist. The project has the goal of proposing a grading scheme for canine oral melanomas and in a second, prospective section of the study, to assess whether the grade has an impact on the treatment response rate.
”LAMP point-of-care testing to guide antimicrobial choice for ”Evaluation of resolution time treatment of canine of lesions in atopic dogs with pyoderma” secondary bacterial pyoderma.” ULRIKA GRÖNLUND, STOCKHOLM, SWEDEN KATINKA ODHELIUS, VÄSTERÅS, SWEDEN Pyoderma is a common bacterial skin Veterinary medicine advocates antibiotic infection in dogs. Systemic therapy oral or parenteral treatment during several with antibiotics is usually indicated for weeks for bacterial pyoderma in atopic widespread skin infections. In this project, dogs, without addressing the inflammation we will use a point-of-care test, develop in the skin. There is a need to reduce use of and validate it for canine pyoderma. The antibiotics. The aim is to compare a combined test is based on a novel technology named treatment protocol with topical antiseptic loop-mediated isothermal amplification shampoo, a spray and oral glucocorticoste- (LAMP), which is rapid, specific and roid against oral placebo. inexpensive.
ANICURA QUALITY & 53 SUSTAINABILITY REPORT ”Dimensional and functional echocardiographic assessment of the heart in dogs with pul- monic stenosis”
VALENTINA PATATA, NOVARA, ITALY
Assessment of pulmonic stenosis (PS) severity, the most common congenital heart disease in dogs, plays an important role in the clinical management of these cases and the decision when to start treatment. The aim of this study is to assess the size and function of the right heart in patients with different degrees of PS and to evaluate the main factors that contribute to right heart disease.
”Evaluation of efficacy of ”Description of the normal pregabalin for treatment of post-surgical CT healing featu- pharmacoresistant idiopathic res following bulla osteotomies epilepsy in dogs: a prospective, in cats” open label, positive controlled ZANDRA LUNDBERG, STOCKHOLM, SWEDEN treatment study”
Middle ear inflammation in cats are relatively SANDRA KRIECHBAUMER, MUNICH, GERMANY common. Approximately 70% of dogs suffering from Treatment decision is often based on the idiopathic epilepsy never achieve seizure appearance of the middle ear on computer freedom and 20–30% of dogs are regarded tomography (CT). This study aims to pharmacoresistant, meaning resistant to describe the normal healing appearance antiepileptic drugs. of the area in cats that have undergone bulla osteotomies by performing a CT scan The purpose of the study is to evaluate the immediately following surgery, after 3 and short-term efficacy and tolerability of pregabalin after 6 months’ time. for treatment of convulsive seizures in dogs with pharmacoresistant idiopathic epilepsy.
”Stand-alone intervertebral cage in the treatment of degenerative lumbosacral stenosis in dogs: A prospective pilot study”
NICOLIEN VAN KLAVEREN, AMSTERDAM, THE NETHERLANDS
Degenerative lumbosacral stenosis is a common disease in dogs. Studies have shown that laminectomy and discectomy can lead to spinal instability and worsen foraminal stenosis. An intervertebral cage allows for distraction and restoration of disc height and restores foraminal apertures. The aim of this pilot study is to assess feasibility and clinical efficacy of using the stand-alone cage in patients after dorsal laminectomy.
ANICURA QUALITY & 54 SUSTAINABILITY REPORT ”We are committed to drive positive change in veterinary care for both people and pets”
AZITA SHARIATI, GROUP CEO ANICURA
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