As veterinary medicine matures, deconstructs, and reconfigures for the team-based healthcare delivery needed to meet ever diminishing discretionary income of pet owners, only uncommon leadership will guide the practices which will flourish. Process management and measurements of tangible results will continue to figure prominently as veterinary practice systems navigate the required transformation. That said, it has been shown in the human healthcare field, the uncommon ability to put forth a compelling vision, stir excitement and unleash human potentials will hold center stage as never before. The leader must be committed to the inviolate Core Values of the practice, and the example being set must be 24/7, 365, with NO double standards or whimsical exceptions as owners tend to do when justify variations from expectations!

Practice owners and their leadership team(s) must prepare for this overhaul by refocusing more of their energy on shaping their organizations vision, reforming the practice culture, and ensuring a balance system of outreach programs, while ensuring their practice core values are clear and inviolate. This is the real job of leadership!.

Real leaders will pry themselves away from the traditional metrics, process definition, and other tangibles that belong more rightfully within their practice manager’s domain. To help you understand, let me share my views on the most pervasive misconceptions and important truths, about leadership, formed from over 2 decades of travel to over 2200 veterinary practice settings.

MYTH ONE. – Leadership and Management Are the Same Dynamic.

REALITY: management is about processes; leadership is about relationships. Management is linear; leadership is non-linear. Management is about executing tactical plans, details and getting things done; leadership is about creating a vision, and inspiring people to rally around the new outcome objectives.

The veterinary profession is loaded with highly competent people promoted to one level above their comfort zone or training. [i.e., Peter Principle – The theory that employees within an organization will advance to their highest level of competence and then be promoted to and remain at a level at which they are incompetent. Peter, L.J. and R. Hull. The Peter Principle: Why Things Always Go Wrong. New York: Morrow (1969)]. Competent veterinary nurses, client relations specialists, and even doctors often falter when they move up into a leadership position because they don’t understand that a move from project or case management to leadership signifies a move from process issues to people issues. It is far more complicated than a pay raise, better office space, and a new title; it is now about developing other people through work, building on those relationships, and making others successful.

Relationships are built on trust and respect, which is one reason I have always advocated Performance Planning (changes, learning, improvements for 90 days in the future) rather than retrospective Performance Appraisals (here is what they did wrong 3 or 6 months ago, never do that again).. Building trust is understanding what the team members need, ergo, my quote, TRAIN TO TRUST! Staff members need a sense of belonging, shared purpose, and stability . . . their hope comes from knowing where the practice is heading and why. The WHAT and WHY is provided by the leader before the program is implemented, while the WHO and HOW comes from the team; the WHEN must always be a joint negotiation, so expectations and outcomes are shared before the changes begin. People follow the uncommon leader, not because of title or ownership, but because they believe in the person, they want to help the leader succeed, and they want to see the practice prosper.

In my consulting experience, successful practice leaders and managers need both sets of skills and abilities. When someone is in a leadership role or a management role, they can exert pressure on the balance of the qualities that go along with the position they are in and the outcomes desired. Any successful practice manager has to have some degree of leadership skill to get programs done through other people. As those people move from their original practice entry levels to program managers, the balance of skills and knowledge required tilts more towards leadership than just doing your job within the organizational behavior expectations Regardless, the best of the best always have an operational management perspective married to the leadership efforts.

MYTH TWO – Having a new and impressive title makes you a practice leader.

REALITY: there is NO relationship between titles and leadership.

Practice owner is a “title” and has abused in the veterinary profession since the first staff member as hired to bow to the veterinarian’s every whim. The nature of leadership can perhaps be best understood by turning the coin over and studying followership. Why do people follow leaders? If we can understand this, then we will be a long way down the road to creating those followers and hence becoming an effective leader. People don’t just follow anyone. You can’t just say ‘follow me’ and expect people to follow out of the goodness of their hearts. You have to give them good reason for them to follow. Key aspect of creating followers:
 The Leader-Follower loop: Leaders create followers create leaders.
 Five reasons to follow: From coercive push to the pull of inspirational vision.
 Followers and Respect: Both leader and solution are important.
 Followers and Trust: I will follow someone I trust.
 Followers and Liking: I will follow someone I like.
 Followers and Support: I will follow someone who supports me.
 Followers and Ideas: I will follow ideas, not objectives.
 Non-followership: Why people do not follow.

The principle of followership was summed-up by the 19th century British Prime Minister Benjamin Disraeli, who said, ‘I must follow the people. Am I not their leader?’

The phrase “Servant Leadership” was coined by Robert K. Greenleaf in The Servant as Leader, an essay that he first published in 1970. In that essay, he said: “The servant-leader is servant first… It begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. That person is sharply different from one who is leader first, perhaps because of the need to assuage an unusual power drive or to acquire material possessions…The leader-first and the servant-first are two extreme types. Between them there are shadings and blends that are part of the infinite variety of human nature. The difference manifests itself in the care taken by the servant-first to make sure that other people’s highest priority needs are being served. The best test, and difficult to administer, is: Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society? Will they benefit or at least not be further deprived?”

In his second major essay, The Institution as Servant, Robert K. Greenleaf articulated what is often called the “credo.” He said: ” This is my thesis: caring for persons, the more able and the less able serving each other, is the rock upon which a good society is built. Whereas, until recently, caring was largely person to person, now most of it is mediated through institutions – often large, complex, powerful, impersonal; not always competent; sometimes corrupt. If a better society is to be built, one that is more just and more loving, one that provides greater creative opportunity for its people, then the most open course is to raise both the capacity to serve and the very performance as servant of existing major institutions by new regenerative forces operating within them.”

Leadership, or followership, has NOTHING to do with titles or position, it has everything to do with how you connect with and engage other people. It is nice when the practice owner and leader are the same person, but face it, veterinarians were only taught “case management”, not leadership, in school . . . they were taught that their license was on the line for every decision, so total control was REQUIRED every step of the way . . . this does not lend itself to the tenets of leadership or followership. The question always comes down to, “Who inspires the team members?”
Practice put a lot of bright people into “leadership roles”, and they don’t always succeed because the practice ownership seldom does a good foundation job on the knowledge and skills needed in their new “tool kit” for the new position. Here are some other references:
• Zaleznik’s follower typology: Based on control and activity.
• Kelley’s follower typology : Five different types.
• Kellerman’s follower typology: Five different types.
• Chaleff’s follower typology: Based on type of support.

MYTH THREE – Leaders can always motivate others.

REALITY: all humans are 100% motivated.

Humans are always motivated to do things that they find the most meaningful, and they will follow most anyone who provides an environment where they find that meaning. Most people in veterinary medicine are here because it was a ‘calling’, formed in childhood, and nurtured by some system or aspect in their development. This is the reason most all of us work for such depressing levels of compensation, and always look out for the patient’s welfare in terms of the client’s welfare.
True, you can motivate with fear, it is how we were taught in veterinary school (current research shows students have a 25% increase in fear between enrollment in veterinary school and graduation). But fear only works for short periods. Effective leadership motivates by creating an environment that unleashes the individual’s potential.
Motivation through compensation is most often based on tangible measures, and threatens to take the soul out of veterinary healthcare delivery. We have been looking at measurements that have so little to do with the subjective feelings of our providers and teams that we have been removing the true meaning from our practices. Without meaning, motivation begins to revolve primarily around money, and for Gen-Y staff, around the balance in their life rather than the patient’s. Leadership is not about the traditional metrics of gross turnover or average client transaction rates; it is about inspiring others to be the best they can be (e.g., continuous quality improvement – CQI) in the lives of clients and their four-footed furry friends.
MYTH FOUR – Leadership is easier than management.

REALITY: leading others is extremely complicated.
The hard work comes in large measure from the fact that true leadership is primarily about the development of relationships, and creating good relations requires enormous emotional intelligence. The infinite complexity of human beings makes building these relationships a daunting responsibility; it takes a savvy practice owner to understand that the human personalities within the practice do not fit into the step-by-step procedural methodology of the sciences.
Sure, in my Leadership Tools (Volume 1 text by Wiley & Son, and my Signature Series monographs from www.vin.com bookstore) I provide 14 leadership skills that can be studied and incorporated into a practice owner’s management system . . . yet very few incorporate them into their daily lives to become a caring leader.
For this reason, practice owners need to understand the differences in personality characteristics between the groups with who they interact. And personality characteristics are mediated by behavior traits within each unique environment or cultural setting (e.g., home behavior is usually different than practice behavior, which varies from volunteer work behavior, while the basic personality characteristics have remained stable). For true leaders, this metamorphosis between groups is a marvelous skill to watch, and for those learning, it can be very painful.
MYTH FIVE – Leadership is function of academic success.

REALITY: while academic credentials are important, they are not the only determinant of leadership success, and in fact, are often the distracting aspect in the pursuit of leadership excellence.
Although most practice owners have a lot of cognitive intelligence, successful leaders also need high emotional intelligence as well. Leadership is an ART, with a small bit of science attached (it can be learned). The military lives on developing leaders, which is why the USA Soldier is so feared – the next guy in line can step forward and take command. In the case of the bad guys, when you shot the leader, the group fell apart and could easily be routed. Transition that to the marketplace of 2010:
One of the biggest frustrations within the veterinary learning community is the concept that conscious competence is good enough. In today’s difficult economy the competition for the fewer dollars available puts a premium on skill and what was good enough yesterday has become today’s minimum expectation. It’s time for the veterinary learning community to raise the bar and establish unconscious competence as the new goal of every learning opportunity. This will require the commitment of the corporate decision makers, those who coach the learners and the learners themselves. FYI, my third book was originally titled the “veterinary learning organization”, but the editors changed it to Volume 3 of the series, telling me the title was not user friendly. :>(

To many practices, learning opportunities have conscious competence as the goal. The learner can execute the skill with a great deal of concentration and conscious effort. Most amateur golfers can relate to the effort that is required to remember all the things necessary to hit a golf ball correctly. If they consciously concentrate they are able to execute the shot successfully. A similar syndrome occurs when nurses are learning how to do I.V.s. But the slightest lapse and the shot goes astray. The same lapses in practice business savvy cause regular breakdowns in communication, client service, reduced sales, tougher negotiations, leadership deterioration, etc. So the new standard of unconscious competence is both desirable and required in today’s ultra competitive veterinary practice environment.

Cricket players will say they are “seeing the ball”, a basketball player is “in the zone”, a soccer team is “in rhythm”, a dancer “feels the music” and an actor is “in character”. Obviously unconscious competence is as difficult to describe as it is to achieve. While it will vary depending on the skill involved, a success point must be established as the goal for both the coach and the learner. So a broad brush definition, a skill/competency that appears to be executed effortlessly on a consistent basis, might be a good starting point.

Now that the destination (goal) has been established, the next step would be to establish the current level of performance (in wellness healthcare delivery, what I promote as WRITTEN STANDARDS OF CARE for Risk Level 1 patients). Both the coach and the learner must be in agreement as to the goal and the starting point before beginning this journey to unconscious competence. Differences in either one’s perspective will make this journey difficult if not impossible.

The gap between where we want to be and where we are provides the coach and the learner a target rich environment. Prioritizing is essential. Start with the low-hanging fruit and work your way up that priority tree until all the fruit is harvested. The coach brings discipline, observation and feedback to the process. The learner brings commitment, perseverance and energy.

As the bar is raised more muscle memory is built and the transition from conscious to unconscious is underway. The more muscle memory built the more the shared ownership of coach and learner switches to sole ownership of the learner. Therefore maintenance becomes more the learner’s responsibility and less the responsibility of the coach. The coach remains on call to deal with specific challenges the learner cannot accomplish alone and to provide independent perspective on the development process.

The good news is the learner is approaching unconscious competence. The bad news is the process is not complete and will never be complete. That paradox is the difference between an amateur and a professional.

The worse news is that whenever the coach makes an excuse for violating the expectations, or deviates from the commitments made to the team, regression is immediate and divisive.

Amateurs practice until they get it right, professionals practice until they can’t get it wrong.

There is a huge difference between conscious and unconscious competence but it’s worth the extra effort it take to reach unconscious competence. The learner has created a sustainable competitive advantage that is transportable and applicable in both their business and personal lives. This is where veterinary practice is going – in the training terms of the military:

LEAD – FOLLOW – OR GET OUT OF THE WAY

MYTH SIX – Leadership is about being liked.

REALITY: trust and respect trump being liked when leading others.

Those who believe everyone must like them when they are practice owners, medical directors, or leaders of a healthcare team, are in for a major shock. Real leaders don’t worry about being liked or disliked. They worry about doing the right thing for the right reason at the right time, while motivating those around them to move forward and excel.

When it comes to effective leadership, making unpopular decisions and being attacked for those decisions comes with the territory. Some doctors consider the Risk Level 1 Standards of Care to be an infringement on their self-ordained right to thumb their nose at their employer, at the staff who needs consistency, and at clients who want the same wellness story from each provider; these self-centered prima-donnas have put themselves before the wellness of the practice and a leader must act fast and decisively to bring them back into line, or put them out on the street.. Staff members are your first and most important clients, and you cannot allow anyone to cut their knees out from under them with arbitrary changes in the SOC expectations.

So, if other people’s attitudes are going to affect your decision making for the good of the practice team, clients and community positioning, you are probably not ready to be a leader. If you are thin-skinned, you are going to be in bad shape almost constantly. When you represent the practice, you are the head of the healthcare delivery system, you are expected to be the leader, trying to move a mass of people (clients and staff) to a different level, and some people are NOT going to like the changes and new direction, and therefore not like you. In this case, you cannot worry about what the vocal minority think of you; the top 30% of your clients leave 80% of the practice liquidity. So as a leader, focus on the client wants and needs, address clearly their pet’s needs, and in turn, the practice needs will be addressed effectively.

MYTH SEVEN – Leadership means you have a lot of friends.

REALITY: leadership is lonely.
I spent many years as a rapid deployment force commander for veterinary activities around the world, and I had to be able to make strong personal connections with my team leaders and the soldiers I was deploying into “harm’s way”, but there was always a barrier that you cannot cross as a leader. Leaders are able to make emotional connections, but they also need to keep their distance. As a practice leader, you’ll be alone with your thoughts a lot, which is why every practice owners and leader needs a solid network of confidants outside the practice and catchment area.

Leaders are able to develop relationships with people, and those relationships cause people to want to accomplish what needs to be done. But those relationships are based on respect, not friendship, and sorry to say, new graduates do not know the difference, and some practice owners are no better – they are still classmate relationships instead or practice leadership skills.

I will have two partners, talking to me about the same issues, who give me completely different and opposing opinions/reasons/excuses for what appears very valid reasons to each of them. At that moment, I am very lonely as a consultant leader because I am the one who has to give a weighted opinion and substantial advice for a practice resolution. As a consultant, often my answer is a probing question, making them “peel the onion” back to a core where there is true consensus, then together we can rebuild each layer using core values until we are back close to the surface of the issues (well outlines in the text by Patterson, et. al., Crucial Conversations). Once the decision is made, if the leader has built a strong relationship in the organization based on respect and trust, the team will understand and accept the change and new direction, with a willingness to execute the plan to the desired outcome(s).

The decision time is always lonely for a leader, but once past that, you know everyone is going to work together to make it happen. If someone decides they are above the practice decision, and desires new horizons not in keeping with the leadership decisions, it is time to de-hire that person, with no delays. In most all cases, when the friction person is removed, as difficult as that is for a caring leader, the practice culture improved immediately and the leader is seen as a relationship savior.

MYTH EIGHT – Leadership is all about the “soft stuff”.

REALITY: human capital is far more hard and complicated than management.

When people tell me leaders must deal with the “touchy feely stuff”, I tell them that most of history is about people and countries going to war over “touchy feely stuff”. No one ever goes to war over a balance sheet. Most followers and neophyte managers underestimate the complexity of human behavior, especially in complex organizations like a healthcare delivery setting. When the tangible metrics are good, they are seduced by the numbers, assuming in turn they must be doing a good job, because numbers do not lie. The challenge is that everyone might just hate each other and be preparing to leave to take a new job with another veterinary practice, or even with an industry partner.

Practice leaders must spend as much time on human capital as they do on fiscal assessments . . . good leaders understand that if they cannot be the human capital mentor, they must hire someone who can serve that role. There is NOTHING soft about human behavior; it is very hard!

MYTH NINE – Leadership is about the tangibles – i.e., the traditional metrics and making money.

REALITY: leadership is about the intangibles.

When people tell me they know a good leader when all the tangible metrics are better than expected, I know they are holding bucket with a very big hole under their thumb. Linear metrics is NOT leadership. Leadership is about unleashing human potential for the greater good, it is about building a level of pride that makes staff want to come to work, and it is about causing clients to refer neighbors (great practices have about 60% of their new clients coming from word-of-mouth referrals of clients – at a rate of 30 new clients each month per FTE doctor). The managers are the ones who meet or beat all the numbers, while the leader’s job is to inspire those managers and other workers to exceed expectations.

Leadership is primarily about driving change, and the ability to drive change is more critical today than ever before! We are entering into an era where cost of technology must be balanced with the quality of healthcare outcomes, while ensuring appropriate remuneration of providers and owners, concurrently with establishing the community market niche.

It is interesting to note, the credo of most MBA programs is to maximize the profits to the corporation, while the MHA program credo states the mission is to ensure quality of healthcare delivery, with appropriate remuneration of providers and owners, concurrently with establishing the community market niche. The healthcare leader’s job is to communicate this type three-level vision and create the environment that will allow those things to happen at each and every position on the team.

MYTH TEN – Everyone can be a leader.

REALITY: innate capacity defines leadership potential.
I have traveled the world, and trained leadership in many venues, and I believe that not everyone can become a true practice leader. I do believe most people can strengthen their leadership awareness, and strengthen themselves to bring leadership skills to bear on their daily lives. Everyone has some leadership potential, but not everyone can be a Kennedy, a Gandhi, or a Sir Douglas Nicholls . . . the trick is to find out what your potential is . . . are you a Ferrari or a Volkswagen? You have to figure that out and then maximize your own potentials.

In veterinary medicine, we have been seduced by the tangible metrics, but even now more than ever before, leadership needs to trump management. It is going to be a very hard road. Asking for the national average must stop – the average is only mediocrity – the best of the worst, or the worst of the best – neither is the material that savvy practice leaders will embrace. We need people who will inspire other people to perform at their best for the good of the client, patient and practice.