ANICURA

| QUALITY & & QUALITY |

SUSTAINABILITY Quality& SUSTAINABILITY REPORT 2020 REPORT 2020 REPORT COVID-19 affects us all

Focus on people

CREATING AND SHARING BEST PRACTICES TOWARDS SUSTAINABLE VETERINARY CARE

ANICURA QUALITY & 2 SUSTAINABILITY REPORT CONTENT 15 REALISTIC DIAGNOSTIC MEDICINE

PROFESSIONAL DEVELOPMENT An online AniCura Laboratory AND SPECIALISATION toolbox helps clinics to improve A robust infrastructure the quality of laboratory work. across continuous competence development is key for future success. 26

4 MESSAGE FROM THE CEO

6 HIGHLIGHTS 2020

ANICURA’S ANTIBIOTIC GUIDELINES 7 ANICURA IN BRIEF Guidelines for the most common 8 COVID-19 AND VETERINARY CARE indications of systemic antibiotic use 10 FOCUS ON PEOPLE will reduce unnecessary usage. 12 MEDICAL QUALITY AT ANICURA

13 QualiCura 30 15 Encouraging professional development and specialisation

18 Creating and sharing medical best practices

22 Improving professional communication skills

26 Providing reliable diagnostic medicine

28 Monitoring surgical site infections 34 30 Ensuring wiser antimicrobial use 28 32 Securing infection prevention and control

MONITORING SURGICAL 34 Enabling good incident handling SITE INFECTIONS 37 Ways of Working Surgical site infection can be prevented to a large extent ENABLING GOOD 42 High quality data for better pet care INCIDENT HANDLING if the right protective A system for reporting incidents 44 FIVE YEARS WORKING WITH QUALICURA mea­sures are in place. enables improvements, learnings 48 FOCUS ON PEOPLE and preventive actions. 50 ANICURA RESEARCH FUND

ANICURA QUALITY & 3 SUSTAINABILITY REPORT “AniCura’s impact on our industry is significant, as is our responsibility. We make a better world for pets, by shaping the future of veterinary care, together”

AZITA SHARIATI, GROUP CEO, ANICURA

ANICURA QUALITY & 4 SUSTAINABILITY REPORT Staying strong in the crisis

AniCura continues to stand strong and grow rapidly as a We started to take vital first steps to leading provider of modern, high-quality veterinary care for improve and harmonise our diversified infrastructure and systems, securing pets. COVID-19 had an unprecedented effect on society and improved operational efficiency and businesses, but we rose to the challenge in all of AniCura’s services to pets and our partners. markets. Above all, we never deviated from AniCura’s natural Our new graduate programme provides mentorship, improved medical knowledge DNA - sustainable operations, high quality and wellbeing for pets. and safety for new veterinarians. We also launched Engage – AniCura’s new leadership & business development program, an important step in main- As of December 2020, AniCura is Our industry impacts animals, people taining a values-based company with present at 350 European locations in and the environment. We must therefore great leaders. 13 countries and we attend to three strive for a more sustainable way of Our key priorities have become million companion animal patients working, inspired by the guiding the cornerstones in our new business per year. Our impact on the veterinary principles of the United Nations strategy for the coming three years. care industry is significant, as is our Global Compact*. AniCura’s co-operation with Mars responsibility in shaping the future. In a five-year period, the use of Veterinary Health has started to antibiotics at AniCura’s veterinary evolve, and we are developing new HIGH MEDICAL QUALITY hospitals and clinics in Europe has opportunities within the ecosystem. Health and wellbeing for our associates declined with almost 50%. By intensi- The ambition is to be a driving force in have been a high priority for us. fying our actions, AniCura is confident developing veterinary care on a global During 2020, all AniCura’s hospitals to reach its goal of 5% antibiotic use scale. and clinics have been open. We have in 2030. This is also well aligned with We will continue to make a better continued to operate with the highest the strategy set by AniCura’s parent world for pets, by shaping the future safety standards during the pandemic. company, Mars Veterinary Health. of veterinary care, together.

“Operating with OUR PEOPLEPETER DAHLBERG, CEO the highest safety Throughout the year, AniCura has continued to invest in more advanced standards during medical equipment, facilities and in AZITA SHARIATI the pandemic” our associate’s future development. Group CEO, AniCura

* https://www.unglobalcompact.org/what-is-gc/mission/principles

ANICURA QUALITY & 5 SUSTAINABILITY REPORT Highlights 2020

Four years with reduced use of antibiotics

14% 13% 12%

8% 8% 40% MORE PETS 2016 2017 2018 2019 2020 ON ANIPLAN

DESPITE COVID-19, 500 ANICURIANS ATTENDED ACE COURSES AND 1st DEVELOPMENT PROGRAMMES QUALICURA SURVEY ON PROFESSIONAL AniCura Medical Interest Group discussions on Yammer COMMUNICATION SKILLS 8,000Attract VIEWSMore than CHEMICAL 93% APSIS FREE of 460 surveyed CLEANING AniCurians 150 clinics are actively reporting incidents in APSIS 8/13 countries use APSIS 92% of incidents are preventable INITIATED IN 40% result in patient , harm &

AniCura veterinarians state that communication ANICURA’S CONSULTATION skills have strong APP AVAILABLE IN ALL or very strong impact on quality of care SCANDINAVIAN COUNTRIES

ANICURA QUALITY & 6 SUSTAINABILITY REPORT AniCura in brief

AniCura is a leading European provider of high-quality AniCura veterinary care for companion animals. AniCura is a family of well-known animal European locations and creates peace values hospitals and clinics specialised in of mind for pet owners through excel- veterinary care for companion animals. lent access and patient safety. Every Born out of the idea that sharing year, AniCura’s 7,500 passionate TOGETHER resources creates opportunities for veterinary professionals attend to better veterinary care, the company three million companion animal RESPONSIBILITY & INITIATIVE was established in 2011 as the first patients. AniCura is a trusted training merger of companion animal hospitals and referral body. CARE & COMPASSION in the Nordic region. Today, AniCura is a role model HOW WE WORK EXPERTISE & DEVELOPMENT with­­­­­­­­­in specialised veterinary care and At AniCura, most decisions are taken a valued partner for pet owners and locally, close to the patients and HONEST & OPEN referring veterinarians across Europe. customers. On country and group Since 2018, AniCura is part of Mars level, functions within for example Veterinary Health, a family-owned HR, IT, marketing, veterinary quality company focused on veterinary care and administration provide support and pet nutrition. Mars Petcare’s to clinics. Our vision, values and purpose is to create A BETTER WORLD medical quality, program ensures a FOR PETS. joint direction and structured quality development. WHAT WE DO AniCura offers a wide range of high-­ THE VALUE WE CREATE IN SOCIETY quality medical services covering Investments in improving medical preventive and basic health care as quality and patient safety through well as advanced diagnostics, internal education, research, equipment and medicine, intensive care, and premises are significant. orthopaedics. AniCura also provides The company stands for a large rehabilitation, physiotherapy and part of the round-the-clock emergency dietary advice and offers selected pet care availability in Europe. Direct and food and care products. indirect job creation in the veterinary AniCura provides modern, high- industry and adjacent sectors form an quality veterinary care for pets at 350 important part of AniCura’s value creation.

3 MILLION PATIENT VISITS

We shape 350 ANIMAL HOSPITALS the future of AND CLINICS veterinary care, 7,500 EMPLOYEES together 2,800 VETERINARIANS

ANICURA QUALITY & 7 SUSTAINABILITY REPORT COVID-19 and Veterinary Care

AniCura is committed to develop medical quality, customer service and work environment

ANICURA QUALITY & 8 SUSTAINABILITY REPORT COVID-19 and Veterinary Care

Emergency and critical care support during the COVID-19 pandemic

During the first initial phase of the veterinary business units within COVID-19 pandemic, many hospital Mars Veterinary Health developed ”Thank you for putting and clinics at AniCura had to re- clinical webinars and checklists. together such incredible focus and prioritise emergency These were made available to all resources” cases. To support and provide up- AniCura employees through the Veterinarian working to-date, easily accessible facts and intranet and digital learning night shifts guidelines, a team from across the management platforms.

Securing continuity and safety during COVID-19

In March, Mars Veterinary The purpose was to deliver the best The Business Continuity Health formed a Business possible care to the patients during Team’s deliverables: these difficult times, but also to • Risk assessment

Continuity Team, to keep support our clinics in the best • Support in procurement track on the changing possible way. of PPE COVID-19 situation amongst It became clear early in the • Recommendations, and guidelines in the ways of countries and continents. pandemic that recommendations and guidelines had to be adapted working under COVID-19 according to specific situations. restrictions

ANICURA QUALITY & 9 SUSTAINABILITY REPORT Focus on people

STRONGER together

Year 2020 has showed that important this year and has certainly An extended period of care leave for strong company values are played a role in forming AniCura’s caregivers was also implemented. corporate culture. To manage any anxiety due to the fundamental in a crisis. Early in the pandemic, employees situation, a phone services with psycho- were encouraged to work together and logical support was made available for collaborate among clinics with hygiene employees. AniCura’s values course for employees issues as well as with colleagues when These early actions helped relieve was transformed to a digital format clinics suffered with significant sick the initial stress for our employees in and also adapted to all relevant lan- leave. the beginning of the pandemic. guages. Each one of AniCura’s values To support the employees that The collaborative spirit at AniCura TOGETHER, RESPONSIBILITY & needed to stay at home due to COVID-19 was high throughout 2020. Standing INITIATIVE, CARE & COMPASSION, or suspected symptoms, a 100% illness stronger together resulted in innovative EXPERTISE & DEVELOPMENT and compensation during the first two solutions and initiatives at AniCura’s HONEST & OPEN proved especially weeks of sick leave, was implemented. hospital and clinics across Europe.

ANICURA QUALITY & 10 SUSTAINABILITY REPORT Focus on people

Employer of Choice Since 2015, AniCura has Based on the result for each team, each the previous year, had a 50% higher conducted an annual manager at AniCura works with his or engagement this year. 86% of the em- her team and creates an action plan for ployees feel proud of working at AniCura. engagement survey. the coming year. The employee survey for Our strong culture forms a core part of 2020 shows high employee engagement AniCura’s identity as an employer. across AniCura, high customer focus AniCura’s aim is to be the employer and strong willingness to help each of choice in the veterinary care industry. other and cooperate. The survey AniCura will continue to build a strong also showed that teams that actively sense of togetherness and invest in STRONGER worked with their action plans from the company culture. together COVID-19 Initiatives

WEBINARS ON OUTSIDE WAITING DONATING DIGITAL WEBINARS THANK YOU VIDEOS FACEBOOK ROOMS VENTILATORS IN AniCura DACH created AniCura Djursjukhuset Several clinics created AniCura donated AniCura Italy created a special “Thank you” Albano arranged two outside waiting rooms to four ventilators to webinars where senior video to all employees. live webinars on their enable social distancing. be used for human veterinarians shared The videos were also Facebook page about healthchare. knowledge around shared externally on dental care for dogs and emergency care to social media. The video cats. Over 300 pet owners colleagues. 500 people received lots of likes and attended during the attended in 17 lessons love. livestream. The webinars performed live. The have generated thousands sessions were recorded of views afterwards. and can be viewed by all employees.

ANICURA QUALITY & 11 SUSTAINABILITY REPORT QualiCura

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ANICURA QUALITY & 12 SUSTAINABILITY REPORT QualiCura MEDICAL

quality at QualiCura celebrates 5-years AniCura anniversary

AniCura established its medical quality development program – QualiCura – in 2015. The purpose of the program is to increase patient safety and to improve medical outcome.

Nine focus areas were identified as FOCUS ON IMPLEMENTATION DEDICATED RESOURCES important 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 the to develop veterinary medicine and Encouraging professional develop­ 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 communi­ visits to all new clinics joining AniCura. improvement processes and communi- cations skills The purpose is to establish a relationship cation. This person can also be the and understand clinic specific quality • Providing reliable diagnostic medicine coordinator of infections prevention improvement plans and challenges. and control activities in the clinic. • Ensuring wiser antimicrobial use The team also re-visits clinics in need • Monitoring surgical site infections of additional support. AniCura’s Scientific Council: The council consists of merited veterinary • Securing proper infection prevention QualiCura studies: Data-driven, researchers from AniCura and universities and control quarterly surveys enabling unique and allocates funds from AniCura’s comparison and knowledge transfer • Enabling good incident handling Research Fund. across clinics and countries. • Promoting patient medical Role models: After each QualiCura record quality study, “role model” clinics are identified to share clinically proven examples of The work within each of these nine improvements. Their work is presented focus areas during 2020 is covered in under each focus area. this report.

ANICURA QUALITY & 13 SUSTAINABILITY REPORT “Trainings in professional communcations skills are valuable assets every day, in every single consultation”

STINA TØRVIK-PEDERSEN, A SMALL ANIMAL SPECIALIST IN BERGEN,

ANICURA QUALITY & 14 SUSTAINABILITY REPORT Encouraging professional development and specialisation

Percentage of employees having regular discussions about long-term SECURING PROFESSIONAL competence development COMPETENCE for all medical situations

Encouraging professional development In 2020, 52% of AniCura’s employees and specialisation is a focus area to assessed their competence development, strengthening the quality of care at a slight decrease from 54% in 2019. These 50 % 45 % 45 54 %

AniCura. Continuing education is results are not satisfactory, as AniCura’s 52 % equally important for all medical staff am­bition is that every employee should and the main driver of employee satis- have regular discussions regarding faction. Building a robust infrastructure professional development with his or for competence development is the her manager and a clear individual foundation for AniCura’s long term success. development plan. 2017 2018 2019 2020

Source: AniCura employee survey 2017 (1,800 participants), 2018 (2,511 participants), 2019 (3,375 participants) and 2020 (4,312 participants)

ANICURA QUALITY & 15 SUSTAINABILITY REPORT Encouraging professional development and specialisation

ENCOURAGING

highest medical AniCura Continuing Education (ACE), AniCura’s concept for education and professional standard of care development includes courses and programmes and is open Professional development and speciali- up to date and high quality veterinary for all AniCura employees. ACE sation among veterinarians and nurses care. At AniCura general practice is also often open for external is important at AniCura. specialisation is equally important as medical professionals. AniCura’s clinics are encouraged to be- specialisation within focus areas like During 2020, with infection come accredited teaching institutions anaesthesia or . prevention in mind, on-site courses for various national and international Over 300 national and international in conference venues were not specialisation programmes. Currently veterinary specialists including 120 arranged. Instead, many other one third of AniCura’s clinics are European and American board- different formats were used, accredited. certified specialists (Diplomates) including online, hybrid and Specialists are important to secure are employed by AniCura. in-clinic education.

ANICURA QUALITY & 16 SUSTAINABILITY REPORT Encouraging professional development and specialisation

ANICURA GRADUATE PROGRAMME for veterinarians The AniCura Graduate Programme, an immersive two year development programme, is offering a practical and compre- hensive transition from university to rewarding work in practice.

AniCura is comitted to give new the participants will develop both veterinarians the best possible start medical and non-medical skills in their professional careers - secur- with practice based mentoring and ing the transition from studies to support. The programme is offered work life. While working at AniCura in all 13 European countries that and participating in the programme, AniCura is present.

First experiences from the Graduate Programme

KIM DE ROOIJ, PARTICIPANT IN ANICURA GRADUATE PROGRAMME 2020

The programme also offers the opportunity Are you happy to be in the First experiences? to expand your communication skills, Graduate Programme? The structure and format of the programme thereby reducing miscommunications with customers and colleagues to a minimum. My initial reaction was “what a great works very well for me. The interaction opportunity” I can’t wish for a better between European colleagues, sharing our start at the beginning of my career. experiences, concerns and cases, together Should as many people as possible with specialists is very supportive. participate in the programme? Any worries at first? What about mentors? Can you recommend the programme Will it work to participate in an international to your colleagues? Yes, especially a starting veterinarian that group? Will I be able to combine the lack experience. My advice to clinics it to programme with my work in the clinic? Yes, I would recommend the Graduate find a motivated mentor. The agreement with my mentor was Programme. It contributes to your personal Mentors also receive coahing and specific clear and I was well informed by the development and helps you to build more mentor training, partly scheduled together Graduate Programme team on self-confidence, which will enable you to with graduates. You are not alone as a expectations which helped a lot. work more independently going forward. mentor.

ANICURA QUALITY & 17 SUSTAINABILITY REPORT Creating and sharing medical best practices

CREATING AND SHARING MEDICAL BEST PRACTICES

– improving patient safety ANICURA MEDICAL INTEREST GROUPS • Antibiotics and resistance

• Cardiology The ability to collaborate and share best practices between • clinics was a key reason for AniCura’s inception. The struc- • Dermatology • Diagnostic imaging ture of AniCura Medical Interest Groups (MIGs) • Emergency and critical care supports veterinary professionals, in different subjects, • Feline medicine to exchange information and expand their network. • Gastroenterology

• Infection prevention and control

•

• Laboratory medicine There are over twenty active MIGs as well as new research are discussed • MIG Anaesthesia and analgesia open to all professionals in AniCura. and analysed. Digital meetings and Within the groups, clinical cases, best journal clubs are other popular MIG • practices in diagnostics and treatment, activities. • Oncology Each month approximately 200 • employees are actively engaged • Physiotherapy and rehab ”The medical interest group in AniCura’s MIGs. During the • Reproductive health supported me with very useful pandemic, a digital AniCura MIG • Small mammals and exotics

advice” Congress was arranged as a • Surgery and orthopaedics MIG Dentistry member substitute for the planned live • Urology

on-site Congress. • Wound treatment

ANICURA QUALITY & 18 SUSTAINABILITY REPORT Creating and sharing medical best practices

AniCura Cardiology Knowledge Sharing programme in

Traditionally, continuing education in veterinary cardiology has been provided through courses, congresses, and in-clinic education. A combination of these modalities with a specialist providing immediate feedback and guidance in the clinical setting is ideal.

In 2019, AniCura Sweden and Mark Dirven, The programme comprises three initiated the very first steps of a Cardiology types of knowledge sharing: Knowledge Sharing programme to further • Onsite support of a specialist with increase the quality of care for cardiology patients: possibility of working with patients. the specialist locally and with local Based in the original inititative, AniCura patient cases. MARK DIRVEN IS A Sweden launched a pilot programme, • Long distance interactions with online EUROPEAN SPECIALIST IN COMPANION ANIMAL running over 2020. educational materials, updates on CARDIOLOGY (DIPLOMATE The programme is intended for veteri- cardiology news and groupd discussions. ECVIM-CA CARDIOLOGY) BASED AT ANICURA narians eager to advance their knowledge, • Group knowledge sharing: Collaborative DJURSJUKHUSET ALBANO, competence and confidence in managing group activities providing a “cardiology SWEDEN. cardiology cases. network” with easy access for support.

ANICURA QUALITY & 19 SUSTAINABILITY REPORT Creating and sharing medical best practices

“I really enjoyed the knowledge exchange with other colleagues, during lectures”

“The best thing was to meet with colleagues in “my” medical interest group”

AniCura Medical Interest Group Congress 2020

Fourteen speakers shared • Ten different medical interest • The second most popular was their expertise in recorded groups were engaged in the “To pee or not to pee - that’s webinar productions the question” webinars available to all AniCura empolyees. • Most popular webinar was • More than 600 AniCura employees “Treatment of preclinical have logged in and taken part of heart diseases” the MIG Congress webinars

ANICURA QUALITY & 20 SUSTAINABILITY REPORT Creating and sharing medical best practices

AniCura was founded to enable closer collaboration and knowledge sharing among different veterinary professionals

ANICURA QUALITY & 21 SUSTAINABILITY REPORT Improving professional communication skills

Communication training in Norway

PROFESSIONAL communication skills

Improving professional MANAGING EXPECTATIONS THE SURVEY SHOWED THAT: By investigating additional issues or • From 2,385 customers, there were communication skills enable concerns, veterinarian can develop a 2,914 issues listed. employees to communicate prioritized plan, clarify expectations, • After probing for additional issues, with a higher level of accuracy, provide structure, and time control. 1,671 more were identified. 46% of efficiency, and supportiveness, The customer interaction is also more these added additional work at the possitive as a result of improved com- time of consultation and only 31% and thereby improve the med- munication. rendered in a new appointment. ical outcome of the patients.

The impact of RESULTS IN BRIEF: communication • 51% of the veterinarians “Clinical communication” means answered “yes” to the question skills about having attended a communication in the context of NO IMPACT communication course in the treating patients. The medical result 2 past, and 30% had attended a course for 1-2 days or more often relies on the owner’s adherence 3 to treatment at home, which depends 4 347 • >82% of the veterinarians on the customers trust in the care VERY STRONG IMPACT stated that communication skills have “very strong” or provider, and the relationship forged “strong” impact on all four 159 during the consultation. parameters:

225 •

213 Quality of Care FIRST QUALICURA SURVEY ON 188 • Medical outcome PROFESSIONAL COMMUNICATION 25 The aim of this survey was to find out 154 • Client satisfaction how our employees value communication • Job satisfaction 93 skills in a clinical context. 123 practice • 70% of the veterinarians 65 have never been given a managers, 460 veterinarians and 505 49 proper training (> 1 d course) receptionists submitted their views. 5 15 12

6 in communication as a 1 2 1 1 1 0 clinical skill QUALITY MEDICAL CLIENT JOB OF CARE OUTCOME SATISFACTION SATISFACTION

ANICURA QUALITY & 22 SUSTAINABILITY REPORT Improving professional communication skills

Clinic example

STINA TØRVIK-PEDERSEN, A SMALL ANIMAL SPECIALIST IN BERGEN, NORWAY

Our work with clinical communication skills should lead to long-lasting changes in the way we work. Veterinarian Stina Tørvik-Pedersen, a small animal specialist in Bergen, Norway, participated in one of our first courses.

Stina, what did you think about clinical communication skills prior to your course? – At first I thought it was a bit unnecessary. I already considered myself really good at talking with clients.

And in hindsight? – It was the best and most useful course I have ever attended, especially in regards of how often I use these skills: every day, in every single consultation.

What has been most useful? – I realized that insufficient cost communi- cation made me want to reduce expenses for the client. Another topic was the client’s perspective. I have found it highly rewarding and it often gives me valuable information. I still have things to improve, like giving clients bad news.

Do you have an example of a situation where the skills have improved your outcome? – Due to lack of communication I did not give a dog the proper rabies revaccination before the clients went on a trip to Denmark. I had clearly made a mistake. I rehearsed the method from our course and the outcome was much better than I could expect. The clients stayed with me and it also helped me not to dwell too much on my mistake.

ANICURA QUALITY & 23 SUSTAINABILITY REPORT ANICURA QUALITY & 24 SUSTAINABILITY REPORT Our ambition is to be the most attractive employer and drive positive change for veterinary care across Europe

ANICURA QUALITY & 25 SUSTAINABILITY REPORT Providing reliable diagnostic medicine

DEVELOPING an online AniCura Laboratory toolbox

The laboratory is essential The toolbox will be centered around To support the outcome of the a workshop called “Boost your lab”. workshops, AniCura is currently in veterinary diagnostics. developing and testing materials The aim of the workshop is to guide and courses. Therefore AniCura is currently the clinic through the entire process developing an online labo- and help identify the most important FOR EXAMPLE: areas of improvement in the laboratory. ratory toolbox. The aim of • Guidelines for monitoring chronic diseases The outcome of the workshops the toolbox is to help clinics • How to interpret specific results will typically be two-three specific like e.g. electrolytes harness their local potential actions. To further support the clinic, • How to perform quality control and improve the quality of AniCura’s continuous improvement their laboratory work. team, WoW, will help and create a • How to reduce errors in the lab realistic implementationplan. • Customer communication materials

ANICURA QUALITY & 26 SUSTAINABILITY REPORT Providing reliable diagnostic medicine

Telemedicine

Telemedicine is a modern evolution in human healthcare and it will likely Why Telemedicine? have a similar impact in veterinary medicine. Telemedicine is a part of the Long distances may preclude practitioners veterinarians toolbox which can improve the quality and accessibility of from referring clinical cases. Telemedicine veterinary care throughout countries. allows veterinarians to receive assistance wherever they need it and when they need it. Also, strong collaborations are formed be- tween specialists and veterinarians through telemedicine. What is Telemedicine? Do I learn from Telemedicine? Telemedicine is a consultation service of­­­­­­­­­ ered to veterinarians taking care of com- In video-consultations, continuing education is panion animals living far away from referral offered to gain the most updated scientific centers. Telemedicine offers the possibility information regarding pet diseases. The mix to receive a useful diagnostic aid and in help of case-solving and teaching expertise of treating pets. each specialist allows the veterinarians to ERIC ZINI PROF. DR., DIPL. ECVIM-CA learn, in a friendly atmosphere. (INTERNAL MEDICINE) IS A PRACTICE MANAGER AND RESPONSIBLE FOR Which Specialties? TELEMEDICINE AT ANICURA. Conclusion Specialists of European or American Colleges in Cardiology, Dentistry, Dermatology, Diagnostic Telemedicine is a fairly new concept in veter- Imaging, Internal Medicine, Neurology, Nutrition, inary medicine but it is expected to develop Oncology, Reproduction and Surgery are ready fast. Telemedicine provides high-quality pet to suggest the most appropriate diagnostic health care from a distance and makes the and therapeutic approach, for each single case. world smaller.

ANICURA QUALITY & 27 SUSTAINABILITY REPORT Monitoring surgical site infections

MONITORING surgical site infections

Surgical site infection (SSI) is a patient safety event that cause unnecessary harm and suffering for the animal, increased treatment ”Without knowing costs and emotional strain on the pet owner. Additionally, SSI is a your SSI rate, you will healthcare associated infection that is to a large extent preventable not know if you are improving or not” if the right protective measures are undertaken.

The first step to be able to reduce the SSI developed an SSI within 30 days after the countries SSI rates do not vary rate in the clinic is to start monitoring surgery. Country specific data and use much, but the use of surgical antibiotic them and finding out how many SSIs of surgical antibiotic prophylaxis (SAP) prophylaxis (SAP) differs greatly. (%) you have. Without knowing the SSI is shown in Figure 1. In conclusion, rate, the clinic will not know if they are improving or not. Scientific research shows that this must be done actively. If Average results per country THE STUDY IN BRIEF: you only rely on that the owner comes as percentage of surgical site • Surgical site infections at AniCura clinics infections (SSI) and use surgical back if there are issues, there are studies decreased from 5.5% in 2018 to 4.4% in antibiotic prophylaxis (SAP) 2020. from human medicine showing that • Too many patients undergoing clean you miss more than 30% of your SSIs. SHARE SHARE OF OF PATIENTS surgery received antibiotic prophylaxis Active surveillance is also directly PATIENTS RECEIVING WITH SSI SAP (44%). associated with monitoring your in- (%) (%) • 58% of patients received antibiotics at the house bacterial flora and controlling SWEDEN 3.4 16 correct time (60 minutes before incision) the risk of outbreaks of antimicrobial and with correct length that is only first 24 hours after surgery. resistant pathogens. For these reasons, DENMARK 4.4 40 and for targeting our surgical antibiotic • 70% of the patients had a body tempe­ prophylaxis, it is important to sample ANICURA GROUP 4.4 44 rature above 37°C, which is similar to the 2018 survey results. Too low body all SSIs for bacteriology analyses and temperature during surgery increases to register the results. Of course, this THE 4.7 40 risk for complications afterwards. does not imply that the patient needs • 41% of clinics use surgery safety checklist, GERMANY, AUSTRIA 4.8 60 antibiotic treatment. & which is a higher proportion compared to This is the reasons why AniCura the 2018 results (33%). It is scientifically NORWAY shown that the use of such a list reduces for the fourth time performed a study 5.6 26 the risk of surgical complications. on SSI. In total 115 AniCura clinics and • 95% of clinics use an anaesthetic protocol, hospitals from nine different countries Source: QualiCura Q1 survey 2020. , Spain, and Italy are excluded which is a higher proportion compared to participated and 2,197 dogs were examined due to few participating clinics. the 2018 results (83%). for SSIs after surgery. 4% of the dogs

ANICURA QUALITY & 28 SUSTAINABILITY REPORT Monitoring surgical site infections

Improvement report from AniCura Kleintierspezialisten Ravensburg

JUDITH WAGNER, VETERINARIAN AT ANICURA CHANGE OF USE OF PERIOPERATIVE TO KEEP THE PATIENT WARM KLEINTIERSPEZIALISTEN ANTIBIOTICS We have improved managing the body RAVENSBURG Today, we must report why antibiotics temperature of our surgery patients. are desirable and why we justify the By discussing the survey result in the Once a year, data on surgical use. Previously we had to report why team and explaining why and how to site infections are collected perioperative antibiotics were NOT keep a patient warm during the surgical in the QualiCura survey. As used. preparation phase and during surgery, a result of the outcome, the we have improved our procedures. A SMALL CHANGE WITH A BIG IMPACT For me, a decisive factor for daily practice in our clinic Thereby, we have gradually omitted continuous improvement is the has changed. the peri- and postoperative antibiotics annual repetition of the study. in various types of . Additionally This encourages people to assess The QualiQura surveys have played we have adjusted the intervals of check­- perioperative management once a a big role in bringing management of ups of surgical sites after surgery. We year and prevents them from falling body temperature and perioperative have learned that in many procedures back into old behavior. It also allows use of antibiotics to the attention of an antibiotic has no effect on the us to change a small part every year the whole team. development of surgical site infection. for the benefit of our patients.

ANICURA QUALITY & 29 SUSTAINABILITY REPORT Ensuring wiser antimicrobial use

AniCura’s use of antibiotics has declined by almost 50 percent

ANICURA QUALITY & 30 SUSTAINABILITY REPORT Ensuring wiser antimicrobial use

WISER antimicrobial use

AniCura’s clinics have reduced The significant country and clinic variations ANICURA’S ANTIBIOTIC GUIDELINES unnecessary use of antibiotics were addressed in the feedback to clinics. ARE RELEASED AniCura’s goal for antibiotic use is for In 2020, AniCura’s strategic group for for four consecutive years. no more than 5% of AniCura’s patients antibiotic use produced guidelines for to receive antibiotics in 2030. our eight most common indications The results from this study are for systemic antibiotic use; surgical Unnecessary use of antibiotics accel- unique as authorities in Europe do not antibiotic prophylaxis, wound infections erates the spread of resistant bacteria measure use of antibiotics for companion and abscesses, gastro-intestinal disorders, which is one of the biggest global animals. This year’s feedback to clinics skin infections, urinary tract infections, threats against human and animal was categorized according to the dental procedures, and lower and upper health. With three million patient European Medicines Agency proposal respiratory diseases. This group was visits every year, AniCura can have (https://www.ema.europa.eu/en/news/ formed in 2019 and has representatives significant impact on the use of categorisation-antibiotics-used-ani- from several countries and work to antibiotics in companion animal care. mals-promotes-responsible-use-pro- accelerate AniCura’s achievements tect-public-animal-health). to ensure wiser antimicrobial use. THE FIFTH ANTIBIOTIC STUDY For the fifth year in a row, AniCura measured the use of systemic antibiotics Percentage of dogs THE STUDY IN BRIEF: among 23,308 dogs at 165 clinics. receiving systemic • More than 65% of clinics reduced Throughout a one week sampling antibiotics use. 18% clinics reduced use with more than 10%. period, clinics recorded what antimi- antibiotics during crobial substances were used in dogs one week per • Surgical prophylaxis was the most common indication for dogs receiving Y

country (%). AL antibiotics (23%) followed by wound

With more than three million IT infections including abscesses (22%), patients patient visits every year, skin infections (dermatitis, furunculosis AniCura can have significant FRANCE 14.3 etc) (12%), gastro-intestinal disorders impact on the use of antibiotics NETHERLANDS THE (10%), and urinary tract infections (7%). 12.4 GERMANY, AUSTRIA AUSTRIA GERMANY, & SWITZERLAND & • The most commonly used antimicro­ for systemic treatment or prophylaxis, 11.3 ANICURA AVERAGE ANICURA bial class was beta-lactam antibiotics

and for which indication. 9.3 (72%). SPAIN DENMARK

In total, 1,914 dogs received antibiotics 8.2

SWEDEN • Most dogs were treated empirically NORWAY

during the measured week, which 6.7 (78%), i.e. without any diagnostic 6.3 aid like bacteriology and/or cytology 5.3

corresponds to 8%. The incidence of 5.1 results. antibiotic use varied among clinics from treated, to 55% of the canine patients. • Duration of treatment varied from one to 90 days with a median of seven days In addition, the mean incidence per which was similar to last year’s result. country differed from 3.4 to 14%. Source: QualiCura Q4 survey 2020

ANICURA QUALITY & 31 SUSTAINABILITY REPORT SWEDEN Securing infection prevention and control

INFECTION

PERCENTAGE OF PARTICIPATING CLINICS PER COUNTRY WHO PREVENTION WASH WORK WEAR AT HOME (%) DENMARK 64.3

GERMANY, AUSTRIA & SWITZERLAND 55

THE NETHERLANDS 41.3 and control NORWAY 4.2

SWEDEN 0

To ensure patient and employee safety, compliance with Spain, , Italy and France are not included, due to the low number of participating clinics. Their results indicates that washing at home also occurs in these countries. dress code and proper laundry handling are very important 2020 Q2 survey QualiCura Source: measures to prevent the spread of micro-organisms. GENERAL RESULTS IN BRIEF: • 74% of the clinics have an infection control practitioner in the clinic, who coordinates the local infection control work. 130 clinics from nine countries DOES THE PERSON: • 83% of the clinics have documented participated in the QualiCura survey 1. Wear short-sleeved upper-part? infection control routines in place. and completed 1,293 real-time 2. Wear covered shoes that are • 68% have written routines for how to dress code observations. This was only used inside the clinic? handle and wash work wear. 3. Have long hair and/or the first time real-time observa- • Almost 30%, have replied that they beard put in a tail? tions were conducted throughout wash whole or part of the work wear at AniCura. 4. Have no nail polish/fake nails? home, which is not recommended.To protect employees and avoid the spread Ten employees per clinic in 5. Have hands and wrists free from watches and jewelry? of infection, no work wear should be patient-related work were observed washed at home. Washing at home occurs according to the following five The results showed that AniCura in all AniCura countries who participated has >85% compliance to each parameters: in the survey, except for Sweden, and is of the five observed parameters. most common in Denmark. Full compliance to all parameters, were only observed in 22% of • 84% of clinics, employees change work the observations. wear daily or more often if soiled.

ANICURA QUALITY & 32 SUSTAINABILITY REPORT Securing infection prevention and control

”AniCura guidelines for the infection prevention and control and instrument handling have helped me a lot”

ANTONIA BAUER, THE QUALITY MANAGEMENT REPRESENTATIVE IN ANICURA AUSTRIA

Securing infection prevention and control in AniCura’s clinics in Austria

or the results of the QualiCura surveys. In addition, in collaboration with the largest ANTONIA BAUER, These sessions also provide opportunities supplier of disinfectants in Austrian AniCura THE QUALITY MANAGEMENT to exchange ideas, share experiences and clinics, we held a training course for the REPRESENTATIVE IN discuss problems. ANICURA AUSTRIA WORKING hygiene officers and we made hygiene plans ON SECURING INFECTION for the clinics. PREVENTION AND CONTROL What are your best tips for succeeding The QualiCura results, the infection in implementing new hygiene routines prevention and control and the instrument Please, tell us how you work to secure handling guidelines have helped me a lot in in the clinics? infection prevention and control in the supporting the clinics and provided them with reference material. Austrian clinics. The team in Austria is highly motivated and interested in learning more about the I realized that infection prevention and control importance of hygiene. We have started What are the biggest challenges with could be improved. I therefore initiated a to strengthen our knowledge and create implementing the hygiene guidelines? project to optimize our hygiene work. Each awareness. It is helpful to record the actual clinic appointed a veterinarian and a veterinary situation in the clinic, to discuss the results In a stressful working environment, it is a nurse as hygiene officers. I regularly hold in the team, but also to decide together challenge to implement new guidelines for online training sessions with them and we what improvements we would like to the whole team. Changes in daily routines talk about topics as instrument handling achieve. require time and effort.

ANICURA QUALITY & 33 SUSTAINABILITY REPORT Enabling good incident handling

INCIDENT HANDLING analyse and learn from medical incidents. TAKES TIME, Malin Åberg, nurse and manager of the ward department at AniCura Regiondjursjukhuset Bagarmossen in Sweden says that “we see continous but it is worth it! improvements to patient safety as Even with the best intentions in mind, a patient’s outcome we are able to capture and reflect on does not always turn out as desired or anticipated. things that happen in our work every day. It takes time but, it is worth it”.

SHARING THE BENEFITS Incidents can happen and cause SYSTEM FOR REPORTING INCIDENTS In 2020, 92% of the incidents were harm to our patients, owners and In 2018, the digital AniCura Patient determined preventable. In APSIS, clinicians. By documenting and Safety Improvement System (APSIS) clinics can plan and track corrective analysing incidents we reduce the was launched as a tool for enabling and preventive actions. Learnings are risk of reoccurrence. clinics to systematically document, continously shared within AniCura.

AniCura Patient Safety Improvement System

Medication related 33% incident (excl. Anaesthesia) 41% An error did occur and did reach the patient but without causing harm Treatment related incident 33% (incl. surgery) The incident caused 34% temporary harm to the patient Anaesthesia related Degree Types 13% incident An error did occur but never of patient 16% reached the patient (near-miss) of report- 10% Diagnostics-related harm ed events 11% incident 106%% The incident resulted in the death of the patient Healthcare Associated 5% Infection The incident caused permanent 3% harm to the patient 5% Patient accident

n=1824 n=1644

Note: These numbers are based on data collected in the APSIS system by self-driven reporting.

ANICURA QUALITY & 34 SUSTAINABILITY REPORT Enabling good incident handling

KEY LEARNINGS • When a drug is sent home with Case: CORRECT a patient it is recommended to include information for which patient it is intended, what drug COMMUNICATION it is, which dose to give, which administration route to use and at what time it should be given. IS KEY • To visualise if a patient has an IV catheter in place use colour coding of the bandage. A pre-determined THE INCIDENT pain killers and sucralfate. The colour is used if the catheter is in A nine-month-old cat was venous catheter was, however, place and once it is removed the admitted to the emergency clinic not removed before discharge. At bandage has another colour. due to vomiting. After initial IV home, the owner gave the sucralfate • When possible, special syringes for fluids treatment the cat was sent intravenously and as a result the oral administration, that does not home on oral medication with cat died. fit to IV catheters, should be used.

ANICURA QUALITY & 35 SUSTAINABILITY REPORT ”Improving the quality of our data, will in the long run, improve the quality of our care”

ÁDIN HJERTBERG, GROUP DIGITAL PROJECT LEADER

ANICURA QUALITY & 36 SUSTAINABILITY REPORT Ways of Working

“No more extra hours and the stress levels are manageable”

“Junior veterinarians are more comfortable to participate in discussions”

“Problems are now viewed as an opportunity to improve and to learn”

AniCura – Ways of Working

AniCura strongly believes that A new concept named AniCura Over 150 improvements were in employees make the difference Ways of Working (WoW) was the emergency de­partment. For and lead the way to operational developed and piloted in 2019. example, enhancement in match- excellence. Employees are empow- To date 48 clinics are in ing capacity and patient inflow ered to take an active part in real transformation, adding many that shortened waiting time for time management and to expose more next year. patients. A more optimized sched- and address problems. The end-to- The ambition is to implement uling allowed for more number end patient journey and customer WoW in all clinics by 2023. of operations with the same level experience is the purpose of all of staff. The clinic also noticed improvements. IMPROVED OPERATIONAL reduced stress levels among EXCELLENCE IN CLINICS employees. AniCura Regiondjursjukhuset One of the most important ”Employees make the Bagarmossen in Sweden, was one outcomes is that employees feel difference and lead of the first clinics to start adopting more engaged - key to attract and the way to operational WoW. The leadership team and retain talents. This has been excellence” ambassadors have trained in real verified in AniCura’s employee time management and problem satisfaction survey. solving and has made more than 550 improvements.

ANICURA QUALITY & 37 SUSTAINABILITY REPORT Together, we have a responsibility to run our operations with regards to their impact on society; on people, animals and the environment

ANICURA2020 JAN MARCH MAY COVID-19 demands AniCura Medical Interest new ways of working to Group Congress 2020 deliver the best care offers 16 online interactive to patients and keep courses our employees safe

AniCura Scientific Ski welcome its first meeting in Italy with focus clinic in Randstad which on “Thoracic diseases in is now a member of the dogs and cats” AniCura family

New QualiCura results on surgical FEB site infections JUNE AniCura Survey on New QualiCura Continuing education and results on dress code, Career pathing with more APRIL personal appearance, than 500 respondents, and laundry routines show that courses and programmes in advanced The doors to a new general practice, AniCura Animal surgery, anaesthesiology Hospital Oslo, and emergency and Norway opens critical care are of most importance

ANICURA QUALITY & 40 SUSTAINABILITY REPORT

During the COVID-19 pandemic, AniCura proved the importance of strong company values and we saw many initiatives by our employees.

AUG DEC AniCura Talk is launched – as an online broadcast from Stockholm including a quarterly business AniCura Continuing update and veterinary Education (ACE) launches AniCura medicine special the first fully online courses using digital tools and Talk platforms

For the first time a survey on Professional communication is SEPT OCT conducted within AniCura’s new animal hospital in For the fifth year QualiCura Jönköping opens. The 3,700 square in a row, systemic meter animal hospital is one of the antibiotic use is First round of largest in the country investigated in Q4 mentors in the AniCura Graduate AniCura Spain Programme, get a launches a social 3-day mentorship fund, helping training people affected by Covid-19, and need specialized veterinary care for JULY their pets Kick-off of the 2-year AniCura Graduate Programme with 23 participants from six countries

ANICURA QUALITY & 41 SUSTAINABILITY REPORT HIGH QUALITY DATA

for better pet care SNOMED Clinical Terms is a systematically organized *computer processable collection The better AniCura can leverage high quality data, the better of medical terms providing codes, pet care will be provided. Every entry in the patient records terms, synonyms and definitions used in clinical documentation generate data, but the potential of the data is limited by the and reporting. quality of the data input.

AniCura recently investigated the breed managers decided on a unified breed list in some of the markets and there list within AniCura and adopted were many ways of writing the breed SNOMED* as the reference for medical “AniCura have started taking Labrador retriever. terminology. actions to improve the quality In 2017 AniCura started taking Quality of data matters. Although of our data, because that will actions to improve the quality of data, not immediately noticeable, high in the long run improve the in order to improve the quality of quality data is instrumental in quality of our care” care. In 2020, the Country Veterinary shaping the future of veterinary care.

ANICURA QUALITY & 42 SUSTAINABILITY REPORT AniPlan is a success

CAMILLA ASCHEHOUG KROGSRUD, A VETERINARIAN AND THE CLINIC MANAGER OF ANICURA SKIEN, THE NORWEGIAN CLINIC WITH THE MOST ANIPLAN MEMBERS FOR ITS SIZE.

Why do your customers love AniPlan? The feedback we receive is that they really appreciate the benefits and discounts including free access to the AniCura app.

How come your clinic has so many AniPlan members? Most importantly is that all our em- ployees truly believe AniPlan is beneficial for clients and clinic. It is great to be able to offer a service and a discount at the same time. New clients now request AniPlan by them- selves, based on recommendation. Preventive care This is a major accomplishment and a great team effort.

ANIPLAN - EMBRACING THE NEW PET HEALTH PLANS ARE THE What is the true value with ROLE FOR VETERINARIANS NATURAL PROGRESSION AniPlan, as you see it, for the During the pandemic, pets are By joining a wellness plan, like pet, the pet owner, and the becoming more popular and pet AniPlan, pet owners have the clinic? owners are becoming more inter- reliable information readily It provides the clinic wit a financial ested in their pets’ health since available and their pets will security as well as a loyal customer they spend more time at home. benefit from more frequent base. AniPlan members visit the clinic more frequently and that helps us to As a result, there is an increased health-checks from their build a closer relationship. demand for information regarding veterinarians. The SMS reminders to the clients the pet’s health and well-being. AniPlan is proven to help ensure that they don’t miss their Traditionally, the veterinarian budget and plan for pets’ needs. “free appointments”, and the pet is someone you contact when your Teaming up with the AniCura gets more frequent check-ups. pet is unwell or need immediate app provides pet owners increased Since we started with AniPlan, care. Information on wellness accessibility. we have increased the number of vaccinations by 20%. and longevity has mainly come These are both important elsewhere. parts in making sure our pets Veterinary practices there­­fore stay healthier and can help need to embrace a new role as a pet owners reduce costs for trustworthy and reliable source of veterinary care. knowledge.

ANICURA QUALITY & 43 SUSTAINABILITY REPORT Five years working with QualiCura

QualiCura helped to reduce our total use of antibiotics

Thomas Rieker, veterinarian The first encounter with QualiCura cushions to manage temperature and practice manager at resulted in a very constructive visit loss, has given us more confidence in and discussion about different reducing perioperative use of antibiotics. AniCura Kleintierpezialisten topics including hygiene and The instrumentation handling Ravensburg, joined in March antibiotics. We were very excited guidelines have supported our decision 2015, as the second clinic to work towards wiser antibiotic to invest in an instrument washing use and have more of a deep dive machine (Thermodesinfector) that joining AniCura outside into hygiene topics to enable us gives us a higher level of comfort in Sweden, Norway and Denmark. to be even more restrictive in our providing aseptic technique during usage of antibiotics. surgery. Another routine that changed We have been able to reduce our was the way we prepared our total use of antibiotics in dogs over The QualiCura patients for surgery. Covering the several years. This was possible by surveys creates preperation table with industrial the ideas and surveys coming through awareness sterile foil and positioning in vacuum QualiCura.

ANICURA QUALITY & 44 SUSTAINABILITY REPORT Five years working with QualiCura

Three voices BIRGITTE GRANN GREVE, from the five PRACTICE MANAGER AT F o ANICURA DYRESYKEHUS to : M OSLO ax Emanuelsson years with I received the first draft of the compre- Encouraging professional hensive Quality report in 2015, sharing our QualiCura development and specialisation views on quality and patient safety under has enabled AniCura to prosper the principal aim “To enable AniCura’s patients to receive safer care, with better I still work as a veterinarian in the hospital medical outcome and by publishing the and have predominantly my experience results of our efforts and challenges”. within Ophthalmology and Surgery. The result was phenomenal, and it has turned I was lucky to be among the first and out to be a fabulous tool in enhancing our became involved in several very interesting excellence as veterinarians. I believe the processes and projects – one being as foundation of encouraging professional member of the QualiCura Reference Group development and specialisation is among and another as a member in AniCura’s the key take-aways which has enabled Veterinary Development Council. AniCura to prosper.

PETER MAASBØL SKOV, SPECIALIST IN ONCOLOGY AT ANICURA ODENSE DYREHOSPITAL Heat is now installed in our cages and we have changed our procedures before, during, and after anesthesia. We wrap them The QualiCura survey created in blankets and foils, give them socks on all awareness paws and we apply heat during the operation using heating pads and bags of heated By monitoring surgical site infections, we water are placed towards the body. became aware that our anesthetized patients became hypothermic. The attention to the Our patients now have a much more optimal individual patient is now increased to ensure body temperature during anesthesia and in their body temperature is maintained. the awakening phase. In all, this lowers the risk of surgical complications.

TITTI SJÖDAHL-ESSÉN, SPECIALIST IN quality program, and especially how they OPHTAMOLOGY AT handled incidents. Based on that knowledge ANICURA DJURSJUKHUSET and our own experience, we created our ALBANO own quality program. It has been a fun and exciting journey to implement it. A structured way to learn from our incidents! When AniCura Patient Safety Improvement System (APSIS) was introduced at Albano, we Titti Sjödahl-Essén, specialist in ophtamology, improved our structure and processes on how has worked at AniCura since it started and to handle incidents. We have implemented at AniCura Djursjukhuset Albano, Stockholm several new routines, big and small changes Sweden, since 1997. Titti was involved in that have improved our daily work. the earlier work setting up QualiCura. Results from the QualiCura surveys have We visited the human hospital Sankt Göran given insights in how other clinics are in Stockholm and Scandinavian Airlines working and it possible for us to benchmark System (SAS) to get information on their ourselves in relation to other hospitals.

ANICURA QUALITY & 45 SUSTAINABILITY REPORT COMMUNITY ENGAGEMENT - Volunteer training on a farm

Volunteers are necessary and valuable for a healthy community, them, food safety, fire safety, infectious because they offer vital help to people and animals in need. In diseases and infection control. After completing the training, I signed Sweden, there are 19 voluntary defence organisations that an agreement with Swedish Blue Star contribute to the country’s civil and military defence. in which I agree to be a resource for society in the event of a crisis or infec- tion outbreak. I became a volunteer because I want These non-profit organisations recruit Swedish Blue Star has a mandate to to contribute and give essential help to and train citizens on a volunteer basis take care of animals during crises and animals and farmers in need and to the for defence duties and contribute to other events that may negatively affect wider community. To make a difference. animals. This could, for example, be “I became a volunteer because a major outbreak of infection, to help “To be a resource for society I want to contribute and give oil-damaged birds or to help farmers in in the event of a crisis or essential help to animals and infection outbreak, to make farmers” need in various ways. During two weeks in September a difference” Sweden’s readiness in various areas in 2020, I attended a commissioned train- MADELENE WIJK society. One of these organisations is ing, and learned about animal welfare, GROUP INFECTION PREVENTION AND Swedish Blue Star. cattle behavior and how to take care of CONTROL MANAGER AT ANICURA

ANICURA QUALITY & 46 SUSTAINABILITY REPORT AniCura Social Fund in Spain - supporting unemployed pet owners

Due to the health and economic crisis caused by COVID-19, the ’AniCura Social Fund’ is one of the first initiatives to be launched in Spain to support unemployed pet owners.

”At AniCura, we want to The fund, which has an initial in- “Pets are one more member of our support those who are going vestment of 45,000 euros, will cover family and we want to help them be services of specialized veterinary adequately cared for, avoiding abandon- through a difficult time because medicine up to a maximum of 500 ment or euthanasia,” adds Guillermo of the economic effects euros per pet such as: surgeries, cancer Ruiz, Country Manager, AniCura caused by COVID-19” treatments or diagnostic tests such as Spain. computed tomography (CT). In total, In addition, AniCura Iberia has GUILLERMO RUIZ 104 pets were helped through the donated 6,000 euros to the Spanish Red COUNTRY MANAGER, ANICURA SPAIN fund during 2020. Cross to help other vulnerable groups.

ANICURA QUALITY & 47 SUSTAINABILITY REPORT Focus on people

INVESTING IN LEADERSHIP DEVELOPMENT AniCura is constantly striving to achieve a positive people programme moved into a fully virtual experience. Leaders are critical to our ability to attract, retain design. The programme was received very well by the leaders of the two pilot and develop the people we need for the transformation journey countries Sweden and The Netherlands. of the veterinary industry we have started. In 2021, almost 300 of our AniCura leaders will participate in the programme. The programme is an engaging learning experience, delivered In 2020, AniCura analyzed the require- and the backbone of the programme through live facilitated sessions during ments for a new Leadership & Business design was initially face-to-face workshops a nine-week development journey with development programme for all leaders blended with online and virtual activities. multiple activities. It is delivered in across AniCura. The focus of the pro­ But when the pandemic struck the country specific cohorts and facilitated gramme is to raise leadership and world in the first quarter of 2020, the in local languages. business capabilities, create a sense of

Support leaders to be champions for the Feedback on the programme culture we want belonging and maximize the col- “I have better insight “The interactivity was crucial laborative muscle of AniCura while into how I am as a manager for the great experience. The participants supporting leaders to be champions and what I need to work on” made the programme very close to business for the AniCura culture. which is an important factor for me” The programme is called “Engage”

ANICURA QUALITY & 48 SUSTAINABILITY REPORT Focus on people

Digital veterinary VETERINARIAN ARIANNA SAIDI IN services enable SWEDEN WORKS AS VETERINARIAN FOR flexible working THE ANICURA APP conditions What are the main benefits serving pet owners through digital visits?

I am very proud to have been a part of this important digital initiative for more than a year now.

Working as a veterinarian in AniCuras app makes me feel appreciated by the pet owners.

The main benefits serving pet owners through digital veterinary visits is that it allows me to to focus even more on communication in a stress free and INVESTING IN convenient place. I still feel valued by my veterinary colleagues that work at physical LEADERSHIP clinics throughout Sweden. All in all, the AniCura app is beneficial for me as a professional veterinarian DEVELOPMENT and for our pet owners.

Additional benefits INCREASED in physical clinics: interest in digital

consultations • Increased control over the referral flow; pets are referred AniCura now offers digital veterinary services to pet owners to a suitable clinic, based on need, preference, and in all three Scandinavian countries. geographical location. • On arrival, our clinics receive well prepared and well triaged Throughout the year, over 20,000 in referrals to physical clinics. By patients. digital veterinary consultations were reduced threshold to seek medical • Reduced traffic on the clinics’ carried out via AniCura’s app and its advice, digital consultations play an phones which free up time chat, voice and video calling solu- important role in preventive care, and for in-clinic patient care. tion. During its first year, about half on the quality of life for companion of the digital consultations resulted animals.

ANICURA QUALITY & 49 SUSTAINABILITY REPORT ANICURA Research Fund

With more than 30 research project applications in 2020, board from Mars Veterinary Health. 18 projects were granted funding from the AniCura Research The purpose was to identify areas of Fund, by support of Mars Veterinary Health International. improvement and readjustment on study design, statistics, and ethical review. The AniCura Research Fund was pendently and allocated funds to projects More than 25% of the research established in 2015. In the last five with high scientific standards and potential projects over the years have been years AniCura has invested almost of being published in an international published in peer reviewed journals. 6 million SEK in research grants. peer-reviewed scientific journal. AniCura’s goal is to increase pub­ Historically, the Scientific Council This year’s review process introduced lication rate to a minimum of 50% has evaluated all applications inde­ a second review cycle including a review within the coming years.

”MicroRNAs as prognostic ”Flow cytometry evaluation of and predictive circulating light chains of immunoglobulins biomarkers in canine and vitamin D receptor in canine multicentric lymphoma” lymphomas and leukemias” CHIARA LEO, CARLOS MACIAS, ANICURA ISTITUTO VETERINARIO NOVARA, ITALY ANICURA BAHIA DE MALAGA, SPAIN ”Pre- and post-operative paw pressure distribution in ”May a single fast pre-surgical client owned dogs undergoing MRI sequence acquisition surgical treatment for chronic replace standard radiographs inflammatory interdigital for TPLO surgical planning pododermatitis / -furunculosis in dogs?” (PD/PF)”

CHIARA MATTEI, MAREN DÖLLE, ANICURA I PORTONI ROSSI, BOLOGNA, ITALY ANICURA TIERÄRZTLICHE SPEZIALISTEN HAMBURG, GERMANY

”Developing evidence-based recommendations for the appropriate selection of tissue- specific suture material size and assessing their influence on wound healing and tissue stability in cats”

PAVEL SLUNSKY, ANICURA KLEINTIERSPEZIALISTEN AUGSBURG, GERMANY

”Prospective evaluation of the ”Effect of Salovum on Rapid Luxation System in the acute diarrhea in dogs” treatment of patellar luxation

CAROLINE HARLOS, in the dog” ANICURA DJURSJUKHUSET ALBANO, DAVID ONIS, STOCKHOLM, SWEDEN ANICURA DIERENZIEKENHUIS DRECHTSTREEK, RIJSWIJK, THE NETHERLANDS

ANICURA QUALITY & 51 SUSTAINABILITY REPORT ”Evaluation of the use of a flash glucose monitor in cats with diabetes mellitus”

MARIEKE KNIES, ANICURA DIERGENEESKUNDIG VERWIJSCENTRUM DORDRECHT, THE NETHERLANDS

ANICURA QUALITY & 52 SUSTAINABILITY REPORT ”Investigation of HER2 gene ”Perfusion index (PI) and amplification and protein Plethysmographic Variability expression in canine primary Index (PVI) in dogs undergoing pulmonary carcinoma” interventional cardiology” STEFANIA SCARABELLI, ESTER LADDAGA, ANICURA CLINICA VETERINARIA MALPENSA, ANICURA I PORTONI ROSSI, BOLOGNA, ITALY SAMARATE, ITALY

”Renal reactive AA-amyloidosis in shelter cats: a retrospective study based on clinico-pathological data, histopathology and ultrastructural features”

FEDERICO PORPORATO, ANICURA ISTITUTO VETERINARIO NOVARA, ITALY

”Quantification of mitral valve ”The Mitral INsufficiency regurgitation using the radius Echocardiographic (MINE) of proximal isovelocity surface score: a severity classification area method in Cavalier King of myxomatous mitral valve Charles Spaniel and Chihuahua disease in dogs” dogs”

TOMMASO VEZZOSI, INGE ENGELAND VOGT, ANICURA ISTITUTO VETERINARIO NOVARA, ITALY ANICURA DYREKLINIKKEN TELEMARK GVARV, NORWAY

ANICURA QUALITY & 53 SUSTAINABILITY REPORT ”Natural SARS-CoV-2 infection ”Assessing intestinal transmucosal in animals: a prospective study bacterial translocation in dogs to obtain a basis for a One with protein losing enteropathy Health approach to infection (PLE) by fluorescence in situ prevention and control” hybridization (FISH)”

CARLO PALIZZOTTO, FABIO PROCOLI, ANICURA ISTITUTO VETERINARIO NOVARA, ITALY ANICURA I PORTONI ROSSI, BOLOGNA, ITALY

”The role of sex hormones in idiopathic epilepsy in dogs”

SOFIE VAN MEERVENNE, ANICURA KALMAR DJURKLINIK, KALMAR, SWEDEN

”A placebo-controlled study to evaluate the impact of ”Composition of the intestinal near-infrared (NIR) laser microbiota in dogs with atopic therapy on skin microbiome dermatitis versus non-atopic and peripheral biomarkers healthy dogs” of inflammation, and its NANNA ENEMARK, ANICURA AARHUS DYREHOSPITAL, VIBY, DENMARK therapeutic effects in dogs”

GIORDANA ZANNA, ANICURA ISTITUTO VETERINARIO NOVARA, ITALY

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

ANICURA QUALITY & 55 SUSTAINABILITY REPORT ANICURA | QUALITY & SUSTAINABILITY REPORT 2020 ANICURA AB, VENDEVÄGEN 89, 182 32 DANDERYD, SWEDEN | WWW.ANICURAGROUP.COM | SWEDEN DANDERYD, 32 182 89, VENDEVÄGEN AB, ANICURA