ANICURA

| QUALITY REPORT 2017 REPORT QUALITY | Quality report 2017

”Quality is always top of mind when meeting our patients”

KARIN KRISTRÖM, VETERINARIAN ANICURA DJURSJUKHUSET ALBANO, CONTENT ”Through AniCura, we gained knowledge and support to improve patient safety at our clinic” 30 improving professional communication skills The quality of interpersonal communi- FLOOR STEMBERT, PRACTICE MANAGER AT DIER MEDISCH cation has an impact on both patient CENTRUM KENNEMERLAND, PART OF ANICURA, THE ensuring wiser antimicrobial use outcomes and customer satisfaction. AniCura’s use of antibiotics was lower in 2017 than 2016, but there is still a large spread between clinics and countries. 20

customer satisfaction 39 Customer satisfaction is highly dependent upon the perception of quality. More than 20 000 customers took part in AniCura’s customer satisfaction survey.

5 Message from the CEO 6 The year in brief 8 Shared resources for quality development in AniCura 10 QualiCura 12 Encouraging professional development and specialisation 16 AniCura 2017 18 Creating and sharing medical 14 best practices 20 Improving professional communication skills

encouraging professional 22 Providing reliable diagnostic medicine development and specialisation 26 Monitoring surgical site infections In 2017, AniCura launched a new 30 Ensuring wiser antimicrobial use companywide education and training 32 Securing infection prevention surgical site program called AniCura Continuing and control Infections and the use of antibiotics Education (ACE). 34 Enabling good incident handling

in were analysed among 36 Promoting medical record quality 1 000 dogs that underwent surgery 39 Customer satisfaction at clinics across Europe. 41 QualiCura visits 26 42 Deep-dive Sterkliniek 44 Clinical research in AniCura

ANICURA QUALITY 2 REPORT YEAR 2017 ANICURA QUALITY 3 REPORT YEAR 2017 QUALITY as our first priority AniCura was founded in 2011 with a clear vision of shaping systematic, long-term quality develop- the future of veterinary care, together. This vision is about ment across the company.

providing the highest quality of care available and create a TRANSPARENCY AND INSPIRATION sustainable improvement in the quality of life for companion In this report, we describe our develop- animals throughout Europe. ments and how we work to improve medical quality. We present data and results from our efforts within infection control, the use of antibiotics, customer communication, incident AniCura is a values-driven organisation program for systematic quality handling and more. For 2017, we have where motivation and engagement development, covering the most also included data around how our among employees is high, and the critical aspects of medical quality most important stakeholders, our quality agenda is widely spread across and patient safety. customers and employees, perceive the company. The 200 animal hospitals AniCura and our work around quality. 2017 IS THE THIRD YEAR that form part of AniCura have been The purpose of this report is to WITH QUALICURA, AND WE carefully selected based on their level ensure transparency around our CAN NOW SEE HOW IT LEADS of expertise and ambition to further TO TANGIBLE IMPROVEMENTS operations, highlight the benefits of develop medical quality. The quality AT OUR CLINICS close collaboration between clinics, “As a leading provider of specialised initiatives that are currently ongoing and to inspire the entire veterinary at our clinics, and the engagement The program is a support to AniCura’s industry to develop medical quality veterinary care in Europe, we have great for these topics among our 4 000 clinics, and is together with our initi- and patient safety. employees, is truly amazing. atives unique within the veterinary My hope is that this report provides opportunities but also a responsibility to industry. inspiration to all readers. A GREAT RESPONSIBILITY 2017 is the third year with QualiCura, develop the quality of veterinary medicine” Being a leading provider of specialised and we can now see how it leads to veterinary care in Europe, we have a tangible improvements at AniCura’s PETER DAHLBERG, CEO great responsibility to further accelerate clinics. Through our studies and surveys,

the development of veterinary medicine. we are gaining the necessary data and PETER DAHLBERG In 2015, we launched QualiCura, a knowledge that is a prerequisite for Chief Executive Officer, CEO

ANICURA QUALITY 4 REPORT YEAR 2017 ANICURA QUALITY 5 REPORT YEAR 2017 The quality year in brief AniCura in brief

One of Europe’s leading provi- highest medical quality available. ders of high-quality veterinary Clinics that form part of AniCura have all been carefully selected based on care for companion animals. their level of expertise and ambition to develop medical quality. In 2015, a 1 116 AniCura is a family of well-known companywide program for medical MEMBERS IN 20 MEDICAL animal hospitals and clinics quality development, QualiCura, was INTEREST GROUPS specialised in veterinary care for launched to support clinics in their companion animals. Born out of the development efforts. The same year, idea that sharing resources creates AniCura Research Fund was founded opportunities for better veterinary to financially support clinical research. care, AniCura was established in 2011 RESEARCH13 PROJECTS RECEIVED FUNDING as the first merger of companion FROM THE ANICURA RESEARCH FUND animal hospitals in the Nordic region. • 2 MILLION PATIENT VISITS Today, AniCura is a role model within • 4 000 EMPLOYEES HIGH AND STABLE We asked AniCura specialised veterinary care and a CUSTOMER SATIFACTION valued partner for pet owners and • 1 200 VETERINARIANS

employees: referring veterinarians across Europe. ”Do you think the • 7 COUNTRIES patients visiting INDEX FOCUS ON MEDICAL QUALITY • 200 ANIMAL HOSPITALS 24 000 your clinic recieve AniCura’s ambition is to provide the AND CLINICS patient records reviewed to veterinary enhance quality care of high quality?” 92% 4 industry unique quality studies 88% VISION:

SOURCE: ANICURA CUSTOMER SURVEY 2017 SWEDEN 83 QualiCura 85% We shape the • 6% INFECTION RATE AT future of veterinary • 13% OF PATIENTS RECEIVED NETHERLANDS ANTIBIOTICS care, together • 7,6 ML HAND SANITISER USED PER DAY AND PATIENT

• 50% OF CLINICS DO REGULAR CONTROL CHECKS ON LABORATORY AND IMAGING EQUIPMENT , AND SWIZERLAND AND AUSTRIA GERMANY,

600 employees in professional communications trainings SOURCE: ANICURA EMPLOYEE SURVEY 2017 SURVEY EMPLOYEE ANICURA SOURCE:

ANICURA QUALITY 6 REPORT YEAR 2017 ANICURA QUALITY 7 REPORT YEAR 2017 “Our ambition is to provide veterinary care of highest possible quality” ULRIKA GRÖNLUND, SHARED GROUP MEDICAL QUALITY MANAGER During 2017, AniCura’s central Veteri- nary Medical Quality Development resources team comprised: JO AMUNDSTAD, DVM, MVM, Managing Director, VetScan

ANNELI BJÖERSDORFF, for quality DVM, PhD, AniCura Group Education Manager ULRIKA GRÖNLUND, DVM, PhD, Associate Professor, Group Medical Quality Manager development PETER FELEDY, Group Care Services Director KIM MIDDELDORF, DVM, Operations and Quality Manager

Medical quality development through knowledge sharing LISEN SCHORTZ, Biomedical Scientist, Group and shared resources makes AniCura unique. Through the Medical Development Coordinator STEIN ISTRE THORESEN, support from central functions and by sharing best practices DVM, PhD, Professor, Dipl ECVIM, Dipl ECVCP, across clinics and countries, the development of medical Group Medical Development Director quality can be accelerated. reviews research applications and al- ANICURA’S VETERINARY MEDICAL PETER DAHLBERG, Chief Executive Officer QUALITY COORDINATORS locates funds from AniCura’s Research DEVELOPMENT COUNCIL NANNA DENNEBERG, DVM, with Swedish In 2017, each clinic within AniCura Fund. AniCura’s Veterinary Medical Devel- specialist qualification in canine and feline oncology appointed a quality coordinator to opment Council ensures that trends PETER FELEDY, facilitate and organise the clinics’ AniCura’s Scientific Council enjoyed and developments in the veterinary (chair), Group Care Services Director One of the benefits of AniCura as an the central quality team, the scientific implementation of QualiCura. The the following members in 2017: industry are appropriately reflected in BIRGITTE GRANN GREVE, DVM, veterinary specialist employer, institution and company council and the veterinary medical quality coordinators are veterinarians, ANNELI BJÖERSDORFF, AniCura’s strategies. The council also is the possibility for closer collabora- development council. nurses or managers. However, it DVM, PhD, Group Education Manager addresses ethical dilemmas arising MARIE GUSTAVSSON, Veterinary nurse tion to facilitate best practice sharing is always the Practice Manager at STEEN ENGERMANN, DVM, Danish specialist from the rapid advancement of special- FRANK HÖHNER, DVM and thereby accelerate development QUALITY DEVELOPMENT TEAM each clinic who has the ultimate veterinarian (specialdyrlæge) in oncology ised veterinary care. MAAIKE MARIJNE, Veterinary nurse of medical quality in a way that was This team supports the continuous responsibility for systematic quality BARBARA KASER-HOTZ, MARCEL REIJERS, DVM Prof. Dr. med vet., Dipl ACVR, Dipl ECVDI previously not possible. in-clinic development work by provid- development. AniCura’s Veterinary Medical Develop- HENRIK STRANGE, DVM, Danish specialist MONIKA LINEK, DVM, Dipl ECVD Quality improvements across AniCura ing specific expertise and infrastruc- ment Council enjoyed the following veterinarian (Fagdyrlæge) are implemented locally at each clinic. tures for knowledge sharing. The team ANICURA’S SCIENTIFIC COUNCIL CHRISTINA STRAND THOMSEN, DVM, Dipl ECVS members in 2017: To support this, and to ensure that sets the companywide agenda for AniCura’s Scientific Council was insti- ANNA TIDHOLM, (chair), DVM, PhD, Associate Professor, Dipl ECVIM-CA quality improvements are shared, AniCura medical quality development and runs tuted in 2013 and supports AniCura’s provides central structures and AniCura’s medical quality development clinics with regards to evidence-based STEIN ISTRE THORESEN, DVM, PhD, Professor, Dipl ECVCP, Dipl ECVIM-CA resources. Three of these structures are program, QualiCura. care and research strategy. The council

ANICURA QUALITY 8 REPORT YEAR 2017 ANICURA QUALITY 9 REPORT YEAR 2017 In 2015, AniCura established QualiCura, a companywide QualiCura program to systematically support quality development at AniCura’s clinics.

The program’s purpose is to increase patient safety and improve medical outcome for patients in veterinary care. QualiCura focuses on nine areas that have significant impact on patient safety and medical outcome.

THESE AREAS ARE: • Encouraging professional development and • Monitoring surgical site infections specialisation • Securing proper infection prevention and • Creating and sharing medical best practices control • Improving professional communications skills • Enabling good incident handling • Providing reliable diagnostic medicine • Promoting patient medical record quality • Ensuring wiser antimicrobial use

Following the QualiCura wheel (pictured to the left), studies were performed on surgical site infections in the first quarter, infection prevention and control in the second quarter, diagnostic medicine in the third quarter and antimicrobial use in the final quarter of 2017. Employees positive to quality development

91% In AniCura’s annual employee survey, more 84% 84% 84%

than 80% of the company’s employees 73%

stated that their clinic works systematically NORWAY SWEDEN SWEDEN

with medical quality development. DENMARK

Does your clinic work systematically with NETHERLANDS THE improvements of the quality of care that you provide? GERNAMY, AUSTRIA, AUSTRIA, GERNAMY,

ANICURA QUALITY 10 REPORT YEAR 2017 ANICURA QUALITY 11 REPORT YEAR 2017 ENCOURAGING PROFESSIONAL DEVELOPMENT AND SPECIALISATION ENCOURAGING PROFESSIONAL DEVELOPMENT AND SPECIALISATION

GOALS and development plans for every individual

A structured professional development for all employees is the latest medical standards. AniCura important to secure the quality of veterinary medicine. encourages its employees to specialise and about one third of AniCura’s clinics are accredited as teaching institutions for various European or country-specific specialisation tracks. As a consequence of AniCura’s emphasis Throughout the year, AniCura further plan is also a main driver of employee on advanced and specialised care, the How did your clinic accelerated its investments in educa- satisfaction (AniCura employee survey company has a comparatively high share tion and trainings. To capture more 2017). of specialised veterinarians employed. support professional benefits stemming from collaboration At the end of 2017, more than 200 in a highly-specialised environment, ENCOURAGING SPECIALISATION national and international specialists development? a new educational program, AniCura Veterinary specialists are important to were employed at AniCura, including Continuing Education (ACE), was secure a high-quality care based upon 54 European specialists (Diplomates). launched (read more on page 14). 54% Within AniCura, all clinics are 50 expected to discuss, set goals and 47% MARK DIRVEN, Percentage of VETERINARIAN AT ANICURA development plans for every individu- NORWAY 42% DIERENZIEKENHUIS 39% could take four months off to study Mark Dirven started a residency program at al at each clinic. Plans contain in-clinic 40 employees having DRECHTSTREEK,

SWEDEN Utrecht University to become a European 34% THE NETHERLANDS prior to my exam. When I passed the training as well as theoretical and regular discussions about specialist (Diplomate) in cardiology. During

DENMARK exam, my AniCura colleagues and the practical courses, internal as well as ex- 30 long-term competence the five-year program, Mark started to work “My immediate managers were very AniCura Group Management team for AniCura Dierenziekenhuis Drechtstreek. ternal. In 2017, about half of AniCura’s development supportive of my training. They were were among the first people to con­ The managers at AniCura helped arrange employees regularly discussed long- 20 scheduling and work hours so Mark could flexible around my work hours and I gratulate me.” term competence development with complete his specialisation. THE NETHERLANDS THE their managers. It is AniCura’s ambition 10 to greatly improve this proportion as active use of a personal development % AUSTRIA+SWITZERLAND GERMANY+ Source: AniCura employee survey 2017 (1 800 participants).

ANICURA QUALITY 12 REPORT YEAR 2017 ANICURA QUALITY 13 REPORT YEAR 2017 ENCOURAGING PROFESSIONAL DEVELOPMENT AND SPECIALISATION ENCOURAGING PROFESSIONAL DEVELOPMENT AND SPECIALISATION

AniCura Continuing Education (ACE) To support a a high quality continuing education for our nars as well as a revolving curriculum intended for veterinarians and nurses employees, AniCura has in 2017 established AniCura with 0-10 years of experience. Continuing Education (ACE), a companywide education In line with AniCura’s ambition to To view and training program. develop the veterinary care industry, almost all courses are open for partici- our courses visit: Continuing education within vete- veterinary associations. ACE is a pants outside AniCura. The individual anicuragroup.com rinary medicine is offered by many complement to the existing national courses and course programs also suppliers, but there is still need for and international educations in the serve as a mean to establish relation- additional educational initiatives as the veterinary industry. ships and enable knowledge sharing international market is fragmented and between different veterinary professi- difficult to embrace. With ACE, AniCura INTERNATIONAL, NATIONAL AND onals in the industry. aims to take a holistic view on contin­ REGIONAL COURSES ACE was launched in May 2017. uing education and ensure that the Based upon the educational needs of During 2017, more than 20 courses clinics, courses are created by AniCura and seminars were organised and CONTINUING EDUCATION or together with selected course part- marketed by ACE, covering a wide IS KEY TO IMPROVE ners. ACE consists of both individual range of veterinary fields for both MEDICAL QUALITY medical courses, seminars and webi- nurses and veterinarians. educational needs of a new generation of veterinarians and nurses are met. Tied to ACE is a reference group with “I am very pleased with the continuing education representatives from AniCura’s clinics possibilities that are now available through AniCura. across Europe, to review the curricu- Last month, I participated in a special AniCura lum and ensure the right focus of the surgery course in Munich. Not only was the course program. in itself excellent, but as an extra bonus I got in AniCura is a firm believer in the bene- touch with colleagues from all over Europe. When fits of taking part in different trainings SIRI SEDBERG, VETERINARIAN you get to know people, it becomes easier to ask and meeting veterinary professionals AND PRACTICE MANAGER AT ANICURA DYRESYKEHUS for support and learn from each other.” from different parts of the industry and STAVANGER, NORWAY institutions at conferences, courses and seminars arranged by various

ANICURA QUALITY 14 REPORT YEAR 2017 ANICURA QUALITY 15 REPORT YEAR 2017 2017 was the third year with AniCura’s quality development program QualiCura, and a wide range of measures to improve medical quality and patient safety were implemented. More than 1 000 employees started to use AniCura’s digital tool for knowledge sharing ANICURA2017 and a record number of veterinarians applied for funding from AniCura’s Research Fund. SEP APR QualiCura quality AniCura publishes coordinators quality report appointed in for 2016 JUNE each clinic

FEB AniCura New findings Quality Report about 2016 antibiotics use New findings OCT about surgical AniCura’s Medical site infections Interest Group in 20 000 Feline Medicine customers in annual organises a congress satisfaction survey in Amsterdam

AniCura’s Medical Interest Group in surgery publishes this year’s first AniCura Continuing case discussion covering 1 000 active Education (ACE) thoracic radiography and users on AniCura’s organises one course surgery knowledge sharing AniCura Research AUG in infection control and New findings platform Yammer Fund supports 13 one in anaesthesiology. around hand new projects During 2017, more than hygiene 20 ACE courses were JAN organised in 6 countries 179 active users on AniCura’s know- ledge sharing MAY platform Yammer DEC Ulrika Grönlund is awarded the Swedish Hygiene Prize OCT New findings about diagnostic MARCH medicine

ANICURA QUALITY 16 REPORT YEAR 2017 ANICURA QUALITY 17 REPORT YEAR 2017 CREATING AND SHARING MEDICAL BEST PRACTICES CREATING AND SHARING MEDICAL BEST PRACTICES

REBECKA FREY, DVM, SWEDISH SPECIALIST QUALIFICATION IN , CHAIR OF DERMATOLOGY GROUP

Tell us about yourself! My name is Rebecka Frey and I work as head veterinarian at AniCura Norsholms Djursjuk- hus. I am a Swedish stage II specialist in dermatology. When did the dermatology group start? The group has been active since 2013 and now has more than 60 members from seven countries. STRUCTURED What have you done in the interest group during 2017? We have posted articles and golden grains from lectures on our intranet and on Yam- knowledge sharing DERMATOLOGY mer, as well as tips about good webinars to attend. On Yammer, we also had numerous case discussions with participants from several countries. We organised a full-day develops veterinary otitis lecture in Stockholm with AniCura Medical Interest Group deep-dives dermatologist Monika Linek, Dipl ECVD, as medicine appreciated speaker. CARDIOLOGY Working together, sharing knowledge and best practice across clinics and countries is important for developing quality in AniCura’s Medical ANNA TIDHOLM, veterinary medicine, and at the core of what AniCura does. Interest Groups DVM, PHD, ASSOCIATE PROFESSOR, DIPL ECVIM-CA, CHAIR OF CARDIOLOGY GROUP

• Anaesthesiology AniCura has put considerable efforts MEDICAL INTEREST GROUPS • Anitibiotics and resistance Tell us about yourself. into providing several different struc- AniCura medical interest groups are • Cardiology My name is Anna Tidholm and I am a Diplomate of ECVIM (Cardiology) working at tures and digital platforms to enable focused on different veterinary fields • AniCura Djursjukhuset Albano. I am also an knowledge sharing between clinics and open to all veterinary profession- • Dermatology active researcher collaborating with national and professionals in the company. This als at AniCura. Each group typically • Diagnostic Imaging and international cardiologists and I am includes a database knowledge bank consists of 30 – 150 veterinary profes- • Emergency and Critical Care currently chairperson for AniCura’s Scientific council. with best practice cases across all vet- sionals from different countries. Within • Feline medicine erinary fields, an intranet with access the groups, best practices in diagnos- • Gastroenterology The cardiology group is the first medical to medical databases and journals, as tics and treatment, new research and • Infection prevention and control interest group and actually started long (Hygiene) well as several different international findings are discussed and analysed. before AniCura! How did it all start? • Laboratory medicine and national forums and councils. The medical interest groups arrange Albano’s cardiology group started in 2001 • with the intention to train future cardio- In 2016, AniCura also implemented meetings, publish case studies and • Oncology logists both clinically and scientifically at “Yammer”, a collaboration platform help each other with patient cases. • Ophthalmology Albano and elsewhere. The group initially for enterprise social networking. During 2017, two new medical interest • Physiotherapy and rehab consisted of 7 people from Albano and other Swedish animal hospitals. We met Towards the end of 2017, more than groups were formed, making it a total • Reproductive health monthly to discuss cases and current 1 000 AniCura employees were actively of 20 active medical interest groups in • Small mammals and exotics (new) literature. Today we are almost 70 members using Yammer to discuss patient cases, AniCura. • Surgery and orthopaedics all across Europe. recent research and for general knowl- • Wound treatment edge sharing. • Urology (new)

ANICURA QUALITY 18 REPORT YEAR 2017 ANICURA QUALITY 19 REPORT YEAR 2017 IMPROVING PROFESSIONAL COMMUNICATION SKILLS IMPROVING PROFESSIONAL COMMUNICATION SKILLS

GOOD CUSTOMER communication What did you do to improve your requires training communication skills?

lectures on the Four Habits Model. There is strong scientific evidence that the quality of inter- SABINE LEHMANN & JOHANNA GALL, THORSTEN RAVNBORG SANDRA GÖRANSSON, personal communication has an impact on both patient RECEPTIONISTS THUDE, VETERINARIAN PHONE TRAININGS VETERINARIAN AT ANICURA AT ANICURA AND PRACTICE MANAGER REGIONDJURSJUKHUSET outcomes and customer satisfaction, so for AniCura it is There is only one opportunity to make KLEINTIERMEDIZINISCHES AT ANICURA VARDE BAGARMOSSEN, SWEDEN a first impression, and at a veterinary ZENTRUM HÜTTIG, DYREHOSPITAL, DENMARK natural to continuously invest in this field. REUTLINGEN, GERMANY clinic it is usually the initial phone call that sets the first impression. The initial phone contact effectively works as a first “For me, the seminar gave me tools “We, the reception team, changed “I learned a lot from our audits. Medical professional communication and exchanging information is funda- triage, demanding emphatic listening on how to convey sad news to the our greeting on the phone, so that The main learning was to have is a multi-faceted topic ranging from mental. One of the methodologies that and communication skills from the staff pet owner. It also helped me impro- the calling person knows who he patience with the pet owner and call-around price quotes to breaking sad AniCura has introduced to improve in sometimes very critical situations. ved how I respond to the owner’s or she is talking to. We also use not hurry things. In the end, it gave news. AniCura addresses professional customer communication is the “Four AniCura is working with a range of feelings and emotions.” the pets name a lot more during the me more information about the communications skills from several Habits Model”. phone communication specialists across Sandra Göransson went to a two-day com- phone call. The feedback from our patient without being more time perspectives: best practice phone our geographies to train our staff and munication seminar with Bård Fossli Jensen, clients was quite amazing, they noti- consuming.” “EXCELLENT COURSE WITH communications, training of front desk continuously develop. who is medical doctor and paediatrician ced those little changes immediately.” GREAT CONTENT! A LOT TO with a PhD in medical communication. The AniCura Varde Dyrehospital has practiced and reception staff, excellence in the ABSORB, BUT IT WILL HAVE A seminar gave Sandra a better understand- Sabine and Johanna participated in a one- peer-to-peer audits to improve their day-communication seminar for nurses professional communication skills. In these veterinary consultations, and handling BIG POSITIVE IMPACT IN THE GATHERING FEEDBACK ing for the pet owner’s questions. She also learnt how to better end a consultation and and receptionists with Ute Grundt, our audits, two veterinarians participated in the tough and sad situations such as grief CLINIC. I WISH EVERYONE Every year, AniCura performs a how to summarise the meeting, which has German communication coach who has consultation room, one veterinarian was or strong emotions. COULD TAKE THIS COURSE!” companywide customer survey. Most been very helpful in her everyday work. been working with veterinarians and clinic responsible for the patient and talked to the staff for 10 years. The focus of the seminar pet owner, while the other listened to the – PARTICIPANT IN FOUR HABITS SEMINAR clinics within AniCura also track ESTABLISHED MODEL FOR feedback from customers on a weekly was the communication on the phone as communication. After the consultation, the well as handling difficult situations at the observing veterinarian gave feedback to the COMMUNICATION TRAINING AniCura regularly conducts seminars basis, including how easy it is to get in reception desk. examining veterinarian on how to improve. The veterinary consultation, and espe- and role plays with support of some of contact with the clinic, treatment, and cially the interaction between veterina- the most renowned authorities in the perception of care. Read more about rian and pet owner, is at the very core field. In 2017, about 600 employees AniCura’s overall customer satisfaction of what AniCura does. Communicating have attended one of the courses or on page 39 in this report.

ANICURA QUALITY 20 REPORT YEAR 2017 ANICURA QUALITY 21 REPORT YEAR 2017 PROVIDING RELIABLE DIAGNOSTIC MEDICINE PROVIDING RELIABLE DIAGNOSTIC MEDICINE

SKILLED STAFF and documented routines are keys to improve quality

Medical clinical decisions are often based on results of that established routines with confident imaging and laboratory analyses, and the quality and employees create an efficient work flow. reliability of these analyses have a significant impact on In this QualiCura study, the clinics medical outcome and patient safety. were asked if they have, and actively use, documented and established routines ”Diagnostic quality (sampling, handling and analyses) for different kinds of laboratory samples. is highly dependent on Almost every clinic within AniCura assigned responsible veterinarian. For Answers showed that for the more has x-ray imaging and instruments for imaging, the study displayed that there common samples like blood and urine, established processes, in-house laboratory analyses. Also, is a wide difference between clinics around 60% of the clinics had docu- more than 40 clinics have computed in the competence of the person who mented routines and processes and quality controls and tomography (CT) equipment and 16 performs, approves and reads images used these actively (see figure, page 24). clinics have magnetic resonance and scans. AniCura’s aim is to have an The need for improvement in this area above all trained imaging (MRI) equipment. In 2017, a assigned responsible veterinarian or is particularly clear concerning routines QualiCura study among 78 AniCura medical specialist for every instrument for bacteriology sampling. personnel” clinics was performed to monitor the or machine. That person should set THE QUALITY OF IMAGING quality of diagnostic medicine. the routines, supervise the quality and ANNELI BJÖERSDORFF, AND LABORATORY ANALYSES GROUP LABORATORY MANAGER evaluate the results as it all requires in HAVE A GREAT IMPACT COMPETENCE IS IMPORTANT depth knowledge. ON MEDICAL OUTCOME Knowledgeable veterinarians and medical personnel are essential when BEST PRACTICE PROCEDURES The clinics that in 2017 had standard using diagnostic equipment and eval- Laboratory analyses and imaging operating procedures or documented uating the images and test results. The procedures should be performed in the routines were asked to share their 2017 QualiCura study about diagnostic same way every time to ensure correct routines and documents with other medicine showed that in 50% of AniCura’s results and possibility for comparisons. clinics in the company, to improve in-house clinical laboratories, the labo- This requires documented routines the quality of laboratory diagnostics ratory processes were supervised by an and processes. It is also well known across AniCura.

ANICURA QUALITY 22 REPORT YEAR 2017 ANICURA QUALITY 23 REPORT YEAR 2017 PROVIDING RELIABLE DIAGNOSTIC MEDICINE PROVIDING RELIABLE DIAGNOSTIC MEDICINE

What actions did you take to improve diagnostic medicine?

RESULTS AND CONCLUSIONS

ANNA GEHLIN, BIOMEDICAL SCIENTIST AT ANICURA INCREASED USE OF QUALITY CONTROLS IS ESSENTIAL Percentage of clinics using REGIONDJURSJUKHUSET • 47% of clinics do regular performance controls of their x-ray documented routines for BAGARMOSSEN, SWEDEN machine and imaging system. laboratory samples • 48% of clinics run quality controls of the laboratory instruments monthly or more often. “I was worried about the quality of 64% our bacteriological analyses. But Clinics are encouraged to regularly perform an oversight of their 59% quality controls, as diagnostic medicine plays an increasingly now, after having our work audited 48% 48% important role in modern veterinary medicine. 44% by a specialist and our results

BLOOD

URINE controlled by the quality assurance TOO FEW IMAGES ARE READ

BACT programs, I feel much more secure

AND EVALUATED BY A SPECIALIST FAECES Only 17% of clinics have their x-ray images read and evaluated by that our results are reliable” a radiologist (board certified specialist, diplomate ACVR, ECVDI) PATH HIST At the clinical microbiology laboratory at always or sometimes. In another study, random x-ray images from a AniCura Regiondjursjukhuset Bagarmossen a handful of clinics were sent to a radiologist for second opinion and in quality improvement program was initiated 10-15% of the cases, new and/or different conclusions were drawn, 2017. Together with external microbiology which highlights the benefits of using specialists for image reading. experts, the biomedical scientists evaluated SOPs and routines for bacteriological DENTAL PROCEDURES REQUIRE A DENTAL X-RAY analyses and antibiotic susceptibility testing. 46% of the clinics had defined routine protocols to do dental Implementation of updated procedures has radiography before dental treatments, but with some regional now started. The laboratory is also part of differences. two different quality assurance programs, In Scandinavia, 56% of the clinics had protocols and in continental sending out bacteriological samples for Europe 35%. It is best practice to always perform an imaging before them to identify and test for susceptibility. dental procedures to correctly assess the clinical situation.

SOURCE: QualiCura Q3 study 2017.

ANICURA QUALITY 24 REPORT YEAR 2017 ANICURA QUALITY 25 REPORT YEAR 2017 MONITORING SURGICAL SITE INFECTIONS MONITORING SURGICAL SITE INFECTIONS

PETER SKOV, PRACTICE MANAGER AND ONCOLOGIST AT ANICURA ODENSE DYRESHOSPITAL, DENMARK

“We decided to wrap especially our ANTIBIOTICS smaller animals in blankets from the very beginning of their hospi- talisation and added heating pads are not always during the anaesthesia.” AniCura Odense Dyrehospital realised after this survey a need to increase the body temperature of their patients. The clinic necessary will also stop prescribing antibiotics after surgery to contribute to the work against resistant bacteria. Infections in the surgical site can cause severe complications RESULTS after surgery. However, infections can be prevented through • 23% of clinics use surgery safety KLAUS FLAIG, PRACTICE checklists, a proven tool to decrease better monitoring, improved infection control and surgical skills. MANAGER AND SURGEON complications AT ANICURA BIELEFELD GMBH TIERÄRZTLICHE • 83% of clinics use anaesthetic protocols KLINIK FÜR KLEINTIERE, GERMANY At AniCura, the ambition is to have site infections in the survey was 6.3%, “We discussed the need to reduce a process for active surveillance of defined according to guidelines from 8,8% Percentage of surgical the AMP in clean surgeries. surgical site infections in all clinics, the Centres of Disease Control and site infections per Our aseptic work is good enough to diminish the risk for complications Prevention, USA. This level is similar to country (%) and it is more likely that the use after surgery. what is described in scientific veterinary 7,5% Active surveillance means that after literature. Each clinic in this study of antibiotics is about habits.” NETHERLANDS 6,2% discharge from the clinic, the outcome received their clinic specific results AniCura Bielefeld Tierärztliche Klinik für of the surgery is checked one week together with recommendations on NORWAY Kleintiere already meticulously use an 5,0% anaesthesia protocol with success and now as well as one month after surgery how to improve surgical procedures SWEDEN they will also start to use a surgical safety through reappointment or other contact and infection control, to diminish the 3,6% checklist, particularly in emergency services. with the pet owner. After systematically risk for infections. reviewing each clinic’s results from IF THE RIGHT TECHNIQUES several patients, routines can be im- DENMARK

AND HYGIENE PROCEDURES AUSTRIA+GERMANY proved to ensure better patient safety. MAJA ÖHMAN NYBERG, QualiCura Q1 study 2017 Q1 study QualiCura ARE APPLIED, ANTIBIOTICS HEAD VETERINARIAN SHOULD NOT BE NECESSARY AT ANICURA FALU DJURSJUKHUS, SWEDEN UNIQUE STUDY AMONG 1 035 DOGS IN SURGERIES IN NON- SOURCE: In the 2017 QualiCura study, the INFECTED TISSUE %SSI occurrence of surgical site infections “We will after this survey improve was measured for the second year in ANTIBIOTICS NO GUARANTEE our active surveillance of surgical a row. This time, a total of 1 035 dogs AniCura’s study showed country-specific DEVELOPMENTS SINCE 2016 STUDY: site infections by better recording that underwent surgery at 50 AniCura differences in both infection rates (see • 60% of clinics participating both years has these infections, reviewing the data clinics across Europe were included in figure) as well as in the use of anti- decreased their occurrence of surgical site infections How do you work and give regular feedback on the the study. 73% underwent a so-called microbial prophylaxis. In total, surgical • 58% of clinics have increased the number results to our employees.” clean surgery where the surgical site antimicrobial prophylaxis was used of patients kept warm during surgery to prevent surgical AniCura Falu Djursjukhus will also implement is not contaminated. The dogs were in 48% of the surveyed patients. One (above 37°C). Too low body temperature a surgical safety checklist. Another learning, during surgery increases risk for checked seven days and thirty days of the major findings was that clinics site infections? when administering antimicrobial prophylaxis, complications after surgery after surgery to allow reliable detection often using AMP, did not have fewer it the importance of giving it at the right time of any infections resulting from the surgical site infections than others. • 51% of clinics has decreased their use of to achieve the best preventive effect. surgeries. Thus, antibiotics are not a guarantee antimicrobial prophylaxis The average occurrence of surgical to fewer infections.

ANICURA QUALITY 26 REPORT YEAR 2017 ANICURA QUALITY 27 REPORT YEAR 2017 “There are no short-cuts to sustainable quality development. It requires a long- term commitment, hard work and structured processes. Ever since AniCura was founded in 2011, quality development has been a central part of our DNA. Today, I am proud to have a unique program for quality development across AniCura, employees committed to improve patient safety and a track-record of making substantial investments in equipment and research. But I am also humbled about the task ahead. We have so much more to achieve by working closer together and learning from each other.”

PETER DAHLBERG, CEO

ANICURA QUALITY 28 REPORT YEAR 2017 ANICURA QUALITY 29 REPORT YEAR 2017 ENSURING WISER ANTIMICROBIAL USE ENSURING WISER ANTIMICROBIAL USE

DORTHE HANSEN, HEAD VETERINARIAN AND SURGEON AT ANICURA DYRESYKEHUSET BERGEN NORD, NORWAY.

”QualiCura makes us better surgeons making us realise that we do not need that much antibiotics.” At AniCura Dyresykehuset Bergen Nord, the team has initiated discussions around each patient to carefully determine whether anti- microbial prophylaxis is necessary. The clinic also continuously improves preventive measures for the patient and in the surgical ward. DECREASING TREND

ULRICH GÖGGERLE, PRACTICE MANAGER AND in use of antibiotics SUREGON AT ANICURA KLEINTIER SPEZIALISTEN RAVENSBURG, GERMANY. Antibiotics are essential in both veterinary and human their use of antibiotics between medicine for treating bacterial infections, and prudent use 2016 and 2017. Still the incidence of antibiotics use varied among clinics “Previously, antibiotics were admi- of antibiotics is important to counteract resistant bacteria. from 0 dogs treated to 83% of the nistered as a routine to all surgical canine patients. In addition, the mean patients, without further reflection.” incidence per country differed from AniCura Kleintierspezialisten Ravensburg 5 to 18%. The significant country and changed its anaesthesia protocol. They What did your added a field with the heading “no There are no new antibiotics in the antibiotics during the measured day, clinic differences were addressed in antibiotics” which made it possible to pipeline and both human and veterinary which equals 13% and is somewhat the feedback to clinics, and guidelines tick in ”no antibiotics”, highlighting that care must use the available antimicro- lower than in 2016. More than half of on how to use antibiotics consciously clinic do to ensure antibiotics are not always necessary. bial drugs wisely, giving the correct the clinics in the study have decreased were distributed for implementation. substance for the right indication with a wiser use of accurate dose and dosing interval. In addition, unnecessary use must be antibiotics? RESULTS Percentage of minimised. Surgical prophylaxis was the most dogs given systemic HEGE JØNTVEDT, HEAD common indication for dogs to receive VETERINARIAN AND ANICURA HAS A GREAT antibiotics (21%) followed by wound antibiotics during one OPHTHALMOLOGIST RESPONSIBILITY FOR BOTH infection including abscesses (15%), day per country (%) AT ANICURA STJØRDAL PATIENTS AND SOCIETY TO skin infections (dermatitis, furunculosis DYREKLINIKK, NORWAY. WORK AGAINST THE SPREAD etc) (12%), gastro-intestinal disorders 18% (11%), and urinary tract infections (6%). OF RESISTANT BACTERIA 16% ”The most difficult people to change The most commonly used antimicrobial are the oldest veterinarians with a LOWER USE OF ANTIBIOTICS AT class was beta-lactam antibiotics (72%). lot of experience – like myself. You Most dogs were treated empirically, 14% MANY CLINICS i.e. without any diagnostic aid like DENMARK have to be confident with the idea In 2017, AniCura measured the use of bacteriology and/or cytology results. 13% of less antibiotics and implement antibiotics at 111 clinics across Europe. the changes step by step.“ Duration of treatment varied from 1 to 10% For the second year in a row, clinics 60 days with a median of 7 days. NETHERLANDS In AniCura Stjørdal Dyreklinikk, the team recorded for one day what antimicrobial started reducing the days of antibiotics used substance they used in dogs for syste- DEVELOPMENTS SINCE 2016 STUDY: after surgery to become confident with the ANICURA ANICURA MEAN 5% SWITZERLAND AND AUSTIA GERMANY, 52% of clinics participating both years SWEDEN results. At the same time, hygiene before mic treatment or prophylaxis, together have decreased their use of systemic and during surgery was improved. with indication for this use. antibiotics to dogs.

In total, 412 of the 3231 dogs received NORWAY

ANICURA QUALITY 30 REPORT YEAR 2017 ANICURA QUALITY 31 REPORT YEAR 2017 SECURING INFECTION PREVENTION AND CONTROL SECURING INFECTION PREVENTION AND CONTROL

BÄRBEL RÖSCH, PRACTICE MANAGER AND VETERINARIAN AT ANICURA TIERÄRZTLICHE PRAXIS DR. XAVER RÖSCH, GERMANY

What did “We performed regular control of consumption of hand sanitiser separa- your clinic do to tely for each room, as a competition.” AniCura Tierärztliche Praxis Dr. Xaver Rösch improve hand has installed several additional dispensers in the corridors to facilitate access. They hygiene? have also decided to continuously put hand hygiene routine and infection control on the HAND HYGIENE agenda for their team meetings. in veterinary care ULRIKA KJELLMAN, HEAD VETERINARIAN AT ANICURA JÄGARVALLENS can improve DJURSJUKHUS, SWEDEN

Good hand hygiene is the single most important measure to routines can improve and each clinic “We made dispensers for alcohol- based hand sanitisers more easily minimise spread of microorganisms, including antimicrobial received recommendations on how to improve and develop their routines. available, increasing them to more resistant bacteria. than one per room.” INFECTION CONTROL GUIDELINES AniCura Jägarvallens Djursjukhus was the top user of alcohol-based hand sanitiser AniCura has written company- and they had increased their use to 43 ml AniCura works actively to secure alcohol-based hand sanitiser, availa- wide guidelines for infection control per patient and day. The clinic has worked proper hand hygiene routines among bility of dispensers and presence of including instructions on how to hard to raise awareness among employees about the need to use alcohol based hand all employees. Within healthcare, an individual responsible for infec- clean and sanitise hands, as well as sanitiser both before and after all contact alcohol based hand sanitisers offer tion control. In 2017, 61 clinics across recommendations for dress code, use with patients. the best and most effective way Europe had an average consumption of personal protection equipment, of 7,6 ml hand sanitiser per patient and cleaning and disinfection of facilities THE PURPOSE OF OUR STUDY IS day, but with large variation between and surgical instruments. In 2017, these TO HIGHLIGHT THE IMPORTANCE THOMAS RIEKER, countries (see figure) and clinics. These infection control guidelines were made OF GOOD HAND HYGIENE TO ALL PRACTICE MANAGER VETERINARY PROFESSIONALS results indicate that the use of hand available in local languages to simplify AND VETERINARIAN AT sanitiser and compliance to hygiene the implementation. ANICURA KLEINTIER­ SPEZIALISTEN RAVENS- of removing bacteria and viruses. BURG, GERMANY To increase compliance to use of hand sanitiser, dispensers must be Use of hand sanitiser per country (ml per patient and day) “After the self-luminous activity, readily accessible and the use of the most forgotten areas to hand sanitiser should be measured disinfect were drawn on a sheet DENMARK 4,1 ml and hung up visible for everyone and analysed to raise awareness RESULTS among employees. These aspects are • 75% of the clinics had a designated person in the kitchen.” included in AniCura’s quality program, to coordinate the local infection control GERMANY 5,5 ml Following the QualiCura hand hygiene survey, work QualiCura. AniCura Kleintierspezialisten Ravensburg laun- • On average, the clinics had 1,2 dispensers ched an initiative to raise awareness about the per room for patients NORWAY 6,3 ml importance of hand disinfection. Employees HAND HYGIENE ANALYSED were assigned to disinfect their hands with a self-luminous disinfectant test solution. Within the QualiCura program, the DEVELOPMENTS SINCE 2016 STUDY: THE NETHERLANDS 8,4 ml Everyone marked their own critical points on a compliance to hand hygiene has been 57 % of clinics have increased their use of alcohol-based hand sanitiser - an important paper with imprinted hands drawn. measured two years in a row. These sign of improved hygiene routines SWEDEN 8,8 ml studies included the consumption of

ANICURA QUALITY 32 REPORT YEAR 2017 ANICURA QUALITY 33 REPORT YEAR 2017 ENABLING GOOD INCIDENT HANDLING ENABLING GOOD INCIDENT HANDLING

NEW INITIATIVE to ensure cross- clinic learning Systematic handling of medical incidents and their root learnings from medical incidents can be made in a constructive way. The causes, as well as structured cross-clinic knowledge sharing, focus will be on finding systemic are keys to reduce the risk for re-occurrence of incidents and causes of errors. improve patient safety. By gathering data around medical incidents, AniCura will be able to answer questions such as:

Unintended incidents are unfortunately care. The need for effective incident • If medication is administered inevitable in all complex processes, and handling processes can be highlighted incorrectly, what are typical causes? veterinary medicine is no exception. by US studies showing that preventable • What can we together learn from However, by adopting a strong safety medical errors are the number three anaesthesia-related incidents? culture as well as applying tools cause of death after cancer and cardiac • Are there any patterns across medical enabling an honest and blame-free disease. incidents with a fatal outcome? analysis and discussion of these adverse • How do we create a safety culture events, the risk of re-occurrence can SYSTEM FOR INCIDENT HANDLING where we collectively learn from be significantly decreased. This has A project called the AniCura Patient incidents? success­fully been shown for a long Safety Improvement System was Improving patient safety through time in the aviation industry, and initiated during 2017. The goal is to good incident handling is a priority more recently also in human health ensure that systematic and cross-clinic for AniCura for many years to come.

ANICURA QUALITY 34 REPORT YEAR 2017 ANICURA QUALITY 35 REPORT YEAR 2017 PROMOTING PATIENT MEDICAL RECORD QUALITY PROMOTING PATIENT MEDICAL RECORD QUALITY

REVIEWING What did your clinic do to medical records improve medical record writing? improves quality Proper and accurate medical records are important to ensure MARKUS KASPER, TITTI SJÖDAHL-ESSÉN, FRANZ XAVER LUTTER, patient safety, reduce medical errors and enable a good com- PRACTICE MANAGER, HEAD VETERINARIAN, PRACTICE MANAGER, ANICURA TIERKLINIK ANICURA DJURSJUKHUSET ANICURA munication to customers. ASPERN, AUSTRIA ALBANO, SWEDEN KLEINTIERZENTRUM HEILBRONN

“We have reviewed the use of ”I have learned to write a short sum- “By improving documentation in To promote medical record quality, To ensure comparability, the clinics 84% of abbreviations in the patient medical mary of the anamnesis from previous our patient records, we can deve- AniCura initiated a project in 2017 used similar checklists as a tool when reviewed records to make sure that we all visits. This can be easily copied to the lop the after-care of the patient where medical records were reviewed going through the medical records. The patient records understand and use the same ones. next appointment. Very useful and as well as future treatments. I am by different individuals and based main focus was on the completeness We also teach our young vets to use quick help especially if the patient more accurate and critical towards upon a companywide checklist. The of the patient medical records and its were of good open questions and to always end has many re-visits.” my own records to state a good purpose is to ensure good and similar effect on medical quality. medical quality by asking the pet owner if anything AniCura Djursjukhuset Albano has reviewed example at the clinic.” routines for medical record writing 84 % of the medical patient records 3 686 medical records during the year. The has been forgotten to mention.” AniCura Kleintierzentrum Heilbronn uses across the company and to raise reviewed in the project were judged major learning was that patient history from The team at AniCura Tierklinik Aspern start- AniCura’s companywide checklist for med- previous visits was too scarce. This created a awareness among employees about to be of a satisfactory medical quality ed to review their patient medical records ical record writing extensively across the lot of additional work and stress as employ- the importance of a proper medical and giving a clear understanding of five years ago and took the chance to once whole team. Especially the newly employed 16% ees had to search in texts from several earlier again evaluate their routines within the veterinarians benefit from having a tool to record for each patient. examinations, results, diagnosis and appointments. Going forward, employees AniCura 2017 project. The medical history check their patient records. will make a summary of the patient history treatment. is very important to the team and they all from previous visits in each medical record. 24 000 MEDICAL RECORDS REVIEWED In 16% of the medical records, there allocate substantial time to get input from Also, the clinic tries to book re-appointment the pet owner. In 2017, 55 clinics in Sweden, Norway, were deficiencies in patient medical in conjunction with the consultation to save Germany, Austria, Switzerland and history, patient condition and lack of time for the receptionists and improve the Denmark participated in the medical clear documentation and evaluation of customer experience. record project. They together evaluated test results. These areas for improve- 84% more than 24 000 medical records. ment were similar across countries.

ANICURA QUALITY 36 REPORT YEAR 2017 ANICURA QUALITY 37 REPORT YEAR 2017 HIGH CUSTOMER

satisfaction care providers the customers had Measuring and acting upon customer feedback forms an visited during the past twelve-month period, the quality of care provided by important part of the quality development work at AniCura. AniCura’s clinics was ranked relatively higher at index 89. Overall, customers were positive to the developments AniCura’s quality efforts include both treatment and quality of the treatment within veterinary care and 90 % do the actual, as the well as the perceived was by far the most important driver believe that the quality in veterinary quality. The perceived quality is of satisfaction in all markets, followed care has increased over the past five to measured both in relation to each by the perception of the front desk and ten years. Each clinic within AniCura clinic visit at many clinics as well as price information. This underlines the received their clinic specific results and in an annual customer survey. These importance of AniCura’s work around analyses. Local improvement plans and surveys show that AniCura has a stable medical quality. activities were implemented during the and high customer satisfaction over In comparison to other veterinary second half of 2017. time, and a high degree of customers is willing to recommend AniCura to 86 others. 84 82 79 Quality is a key driver QUALITY IS IMPORTANT TO CUSTOMERS

Customer DENMARK NORWAY NORWAY for customer satisfaction In 2017, more than 20 000 customers satisfaction SWEDEN from six countries participated in in AniCura AniCura’s annual customer survey. The index 2017 survey showed a high customer satis- faction index of 83, in line with previous

year’s results. The perception of the SOURCE: AniCura customer survery 2017 SWITZERLAND AUSTRIA, GERNAMY,

ANICURA QUALITY 38 REPORT YEAR 2017 ANICURA QUALITY 39 REPORT YEAR 2017 Every new clinic joining AniCura receives a welcome visit

QualiCura VISITS QualiCura The Veterinary Medical Quality and Development team visits each new clinic joining AniCura.

Every new clinic joining AniCura how these can be adopted into the receives a welcome visit from the everyday work at the clinic. There are Veterinary Medical Quality and also some prerequisites needed for the Development (VMQD) team. At the clinic to develop within medical quality. meeting, a general quality briefing is For example, having regular meetings performed. QualiCura’s nine focus areas with all employees and individual are reviewed and discussed together development plans. When walking with the Practice Manager and/or head through the clinics, special emphasis is veterinarian; how is the clinic working put on infection control routines such with patient safety? What are the key as hand hygiene, protocols for cleaning development areas and how can the and disinfection of the facility, and the VMQD team provide relevant support? process around instrument handling During 2017, the VMQD team visited (cleaning, disinfection and sterilisation). 26 clinics. In general, a visit takes half During 2017, measurements of a day and starts with a discussion and cleanliness of surfaces, equipment presentation of the QualiCura program, and surgical instruments were added followed by a walk-through of the clinic. to the visit protocol. Cleanliness was tested through measuring adenosine INTRODUCTION TO QUALICURA triphosphate (ATP), where ATP is an Discussions at the QualiCura visits indirect measurement of the cell commonly involve practical aspects content on a surface, i.e. how dirty a of the nine focus areas of QualiCura, surface is.

ANICURA QUALITY 40 REPORT YEAR 2017 ANICURA QUALITY 41 REPORT YEAR 2017 Clinics within the Sterkliniek group visit each other on a regular basis to discuss quality improvements

Example of quality accreditations in AniCura: ISO 9001:2015

Several clinics within AniCura are accredited according to different national or internal quality standards. One example is Sterkliniek Dierenartsen, a Dutch group of veterinary clinics that became part of AniCura during spring 2017

Sterkliniek Dierenartsen is a franchise and withhold the certification, annual for example waste disposal, are also veterinarian using a mandatory form. School in Maastricht. Looking at the hotel comprising 84 veterinary clinics in the and independent audits are performed covered by the certification. We evaluate the quality of the records and catering industry is very inspiring Netherlands. Sterkliniek is certified by Lloyds Registered Quality Assurance. on several parameters including when it comes to customer information according to the international quality Sterkliniek Dierenartsen started to CLINICS BENCHMARKED physical examination, diagnostics, and experience! Adjacent to this, we ACROSS THE GROUP standard ISO 9001:2015. work with the quality management communication and treatment. have the complaints handling procedure As part of the quality management ISO 9001:2015 is based upon quality system already in 2007. The analyses and conclusions are which is a set process at every single system, there is a structured peer management principles including a discussed in teams at the clinic, and clinic. THOROUGH QUALITY review program where clinics are ENNE KWANT IS QUALITY MANAGER AT AN INTERNATIONALLY once every year discussed in the peer MANAGEMENT SYSTEM benchmarked against each other. STERKLINIEK DIERENARTSEN AND PRACTICE How does the Sterkliniek quality RENOWNED QUALITY STAN- MANAGER FOR STERKLINIEK DIERENARTSEN review program across all clinics. system work vis-à-vis QualiCura? The quality management system at These benchmarks cover employee DARD WITH INDEPENDENT DEVENTER AND APELDOORN IN THE satisfaction, medical record analysis NETHERLANDS. How are employees trained in One of the reasons Sterkliniek became AUDITS BUILDS CONFIDENCE Sterkliniek Dierenartsen clinics is customer communication? part of AniCura is that we share the AMONG PET OWNERS comprehensive and includes aspects and analysis of medical compli- such as infection control, patient cations. Best practice guidelines Continuing education is mandatory for vision of offering the best quality of care strong customer focus, the importance safety, medical record writing, incident on different medical subjects are clinics within Sterkliniek, and should available. Between the two programs, we of a good management, structured pro- handling, customer communication continuously developed based on How do you work to improve include both veterinarians, nurses can share a lot of insights and learnings cesses and continuous improvements. and complaints handling, as well as the peer review. patient medical record writing? and supportive staff. To improve our about how to best run systematic quality It covers all critical processes perfor- employee management and continuing At each clinic, medical records of each customer communication skills, we development programs and accelerate med within an organisation. To achieve education. Environmental aspects as veterinarian are judged by another work together with the Hotel Management this development.

ANICURA QUALITY 42 REPORT YEAR 2017 ANICURA QUALITY 43 REPORT YEAR 2017 ”Influence of bending direction ”Prevalence of epilepsy in on new polyaxial locking plate British Shorthair cats” in fracture gap model” MARIANNE TENGER, ANICURA DJURSJUKHUSET ALBANO, SWEDEN JAKUB KACZMAREK, ANICURA KLIENTIERSPEZIALISTEN AUGSBURG, Historically, epileptic seizures in cats usually GERMANY were considered the result of an intracranial structural disease, for example a brain Locking plate/screw systems are used tumour or an infection. The last 15 years frequently in modern fracture fixation. Most it has become clear that cats suffer from locking systems use the same angle, but recurrent seizures with no structural disease newer polyaxial systems allow for different in the brain (idiopathic epilepsy), just as angles enabling better positioning of the people and dogs do. The aim of this project screw. The study will discover if and how is to investigate the prevalence and clinical the polyaxial system with the advantage of features of epilepsy in British Shorthair cats better screw orientation will weaken the born in Sweden 2006 – 2016. construct and which combination of screw RESEARCH position will give the most stable result. “Genetic sequencing and in AniCura differentiation of Helicobacter spp. in Norwegian dogs with AniCura strongly believes in the advancement of veterinary research projects to fund lie within gastritis and gastric ulcers” the responsibility of AniCura’s THOMAS ØYO, ANICURA BERGEN SØR, NORWAY medicine through scientific research. Each year, the company Scientific Council. The council Helicobacter spp. are a type of bacteria that provides funding for clinical research. reviews and approves applications cause gastric ulcers in both humans and pets. for financial support. Only projects This project aims to research various genetic of high scientific research standards variants of this bacterial species and thereby understand how antibiotic treatment could with potential of publishing the be made more effective. findings in scientific journals will be AniCura strives for evidence based alongside their other duties. granted funds. ”Influence of sex hormones on medicine and practice, and strongly In 2015, AniCura decided together During 2017, AniCura’s Scientific medial patellar luxation in female encourages all medical staff to advance with three of its largest owners to Council reviewed 19 applications small breed dogs” the research-based knowledge within start the AniCura Research Fund to for support from AniCura’s Research EIRIK KVALE, ANICURA BERGEN NORD, NORWAY veterinary medicine. AniCura has many facilitate clinical research by AniCura Fund. Of these, 13 projects were dedicated employees who devote time employees. The scientific screening approved and received funding from Patellar luxation, or “slipped kneecaps”, is one of the major health problems in small breed dogs. and effort to conduct clinical research and ultimate decision on which AniCura’s Research Fund. This project intends to research whether the heat cycle has any impact on patellar luxation or not.

“L-asparaginase activity and plasma amino acid profile in ”The role of sex hormones in ”Carprofen concentration in treatment-naïve healthy and idiopathic epilepsy in dogs” milk of lactating bitches treated “Transthoracic echocardio­ high-grade lymphoma-bearing SOFIE VAN MEERVENNE, ANICURA LÄCKEBY with a subcutaneous injection graphic reference intervals cats after a single injection of DJURSJUKHUS, SWEDEN of carprofen followed by oral in the English Setter dog” Epilepsy is one of the most common PEG-L-asparaginase” LIVA VATNE, neurological disorders in veterinary carprofen for five days” ANICURA DYRESYKEHUS OSLO, NORWAY ADA KRUPKA, medicine. The effects of sex hormones on ANNA EDNER, ANICURA DIERENZIEKENHUIS ZEEUWSVLAANDEREN, seizures and epilepsy are well documented ANICURA FALU DJURSJUKHUS, SWEDEN English Setters as a breed rarely show THE NETHERLANDS within human medicine, but not in heart disease. This project aims to Sometimes bitches that have puppies are veterinary medicine. This project is aiming establish and compare echocardiographic Veterinary oncology is a rapidly growing not given painkillers due to a fear that the to examine the epidemiology of seizures in reference intervals of healthy English field with new treatments being developed drugs may spread to the puppies through dogs with focus on sex and neuter status, Setters with that of other breeds so that to help the increasing number of cancer the milk. The aim of the study is to provide by analysing sex hormones in salivary (and misdiagnosis of heart disease in individuals patients. This research project intends to test veterinarians with statistical evidence of blood) samples of dogs with epilepsy. with healthy hearts can be diminished. a new type of chemotherapy substance and the safety of administering carprofen to develop a corresponding protocol, reducing lactating bitches, to improve animal welfare. the number of treatments needed as well as treatment time.

ANICURA QUALITY 44 REPORT YEAR 2017 ANICURA QUALITY 45 REPORT YEAR 2017 “Heart disease in the English Bull Terrier” HANNEKE VAN MEEUWEN, ”By working together, ANICURA KLINIEK VOOR GEZELSCHAPSDIEREN EERSEL, THE NETHERLANDS In English Bull Terriers, murmur heart sounds we can have a significant are common and the breed may have higher risk for cardiac disease. In this study, we will determine how common heart disease impact on medical outcome is in the English Bull Terrier population by establishing specific echocardiographic reference ranges and finding out if specific and patient safety” cardiac conditions are genetically inherited.

ULRIKA GRÖNLUND, GROUP MEDICAL QUALITY MANAGER

”A study on the association between extraction of dise- ased teeth in the maxilla and “Optimising antimicrobial resolution of clinical signs in periprophylaxis in canine surgery: dogs with lymphoplasmacytic Analysis of data from 44 small rhinitis” animal practices in Europe” OUTI TURKKI, ANICURA REGIONDJURSJUKHUSET ÅSA BERGHOLTZ, ANICURA DJURSJUKHUSET I BAGARMOSSEN, SWEDEN JÖNKÖPING, SWEDEN Post-surgical infection is a well-known potential Nasal disease in dogs is a common problem. complication to different kinds of surgery. The Regardless of the cause the symptoms aim of this study is to evaluate the effect of associated with nasal disease is usually nasal antibiotics given before and during surgery on discharge. It is well known that dental root surgical site infections. It is a multi-center study infections can cause chronic nasal discharge. involving 763 dogs from 44 different clinics in 6 In this study, I will investigate dental different European countries. problems as a cause to chronic rhinitis and see if extraction of diseased teeth leads to resolution of the nasal discharge.

”Importance of hypo-and aplasia of the caudal articular facets in pugs in the develop- ment of progressing non-pain- ful myelopathy”

CECILIA ROHDIN, ANICURA DJURSJUKHUSET ALBANO, SWEDEN

The pug breed has gained increasing popularity in recent year, and with this follows the importance of responsible breeding strategies. Myelopathies (PMP) are neurological disorders of the spinal cord and this project looks closer at how insufficient or defective development of the joints, which could be breeding-related, influences development of PMP.

ANICURA QUALITY 46 REPORT YEAR 2017 ANICURA

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