Woe to the man whose heart has not learned while young to hope, to love — and to put his trust in life. Joseph Conrad
This is a very unusual quote for a veterinary practice management person to use. Our veterinary profession is based on caring. Whether it be a veterinarian, a nurse technician, a client relations specialist, or even an animal caretaker, people enter our professional sphere because they care about animals and want to participate in giving care to them. I know of very few people who have entered our profession for the financial rewards, although some do shift their focus after time. So why the quote?
AMERICAN/COMMONWEALTH HEALTHCARE
The average American or Commonwealth person enters their profession by free choice, unlike many foreign countries where the family heritage or pressure determines most careers. So when the healthcare industry surveyed their workers, they asked about why they were still there and what needed to be present for them to stay within the healthcare field they have chosen. The answers were varied, but the top six were repetitive themes (but not always in the same order): recognition, belonging, responsibility, money, respect, and the feeling of making a contribution. It was interesting to note that while compensation was always in the top six, it never made it to number one in any survey group, but each of the others did.
When they looked at foreign countries, belonging was usually the primary reason for employment within healthcare, while in America, the words that started with “R” were the most common responses as the key reason. That survey is the reason for the title of this article and the above quote is the challenge I provide to each employer (practice owner, manager, administrator, or veterinarian). There is one special text, Managing from the Heart, by Bracey, Rosenblum, Sanford, and Trueblood, ISBN 0-440-50472-4, published by Dell in paperback, that summarizes the concept most effectively:
Hear and understand me.
Even if you disagree, please don’t make me wrong.
Acknowledge the greatness within me.
Remember to look for my loving intentions.
Tell me the truth with compassion.
As a practice consultant, I am most often called in when the practice liquidity is disappearing, or when the staff is quitting so fast the practice cannot keep the doors open without stressing out the doctor. I start each consult by watching the interactions for a day, then I review 100 medical records the first evening. This allows me to ask the “right questions” during one-on-one interviews on day two to determine “why” things are as they are. The answers usually lie within the team, but as a consultant, I can summarize and fit them into working models which the practice owner and doctors will accept. This is the other reason for this article. It is based on one consulting job for a significantly complex and large facility and the common thread is distrust: for the staff upward and management downward. They had been in this cycle for a dozen years, had tried many ideas, but consistently reinforced the perception of distrust. They wanted a solution from me in the first week!
THE “R” FACTORS IN VETERINARY HEALTHCARE
This is the decade for the uncommon leader to emerge within our profession. The animal population is growing by a half-percent per year but the practitioner population is growing by six percent per year. The old ways are waning, the marketplace is diluted by multiple new practices, and the staff wants more than a pat on the head (or a kick in the butt). The current veterinary periodicals have displayed many concerns for the “R” factors: respect, responsibility, and recognition. The stories told by the young veterinarians, and those I hear from the practice staffs, all sound similar when assessed for “R” factors. So let’s review what can be done to enhance these traits.
Respect for the individual, for the client, for the patient, for the practice values, it does not matter. This is a core value of healthcare delivery. The respect for life. In the case of P-R-I-D-E, a set of core values that are easy to remember, it falls as the second letter. But please remember, core values are not weighted, they are equal: Patient – Respect – Innovation – Dedication – Excellence. The old adage, “Respect is earned,” is very important for new associates to understand, but for the staff members entering our individual practices at a poverty wage, it should be a given. Each person who joins a practice is hired for their strengths. Each carries with them the most important resource (another “R” word) for success, their mind. The respect for their opinion, the respect for them as individuals, and their respect for the values of the practice should be cornerstones of communication.
Recognition is something which most veterinarians didn’t experience in school. They were graded and ranked, they were expected to be at the beck and call of interns, residents, clinicians, and professors. For their first two years of clinical imprinting they were treated as cannon fodder, to be used up and discarded. It is the rare student who finds a mentor with enough influence to override the pressures of the clinical school years. This is the “technique” they carry into their first practice, which is either mediated by the new employer or enforced. Since most seasoned veterinarians expect a new graduate to be clinically competent, the pressure is on. Few realize that students seldom get to treat primary care patients. In today’s marketplace, primary care is “skimmed” by the private practices which have proliferated around the university town and only secondary and tertiary care are referred to the teaching hospital. The caring practice recognizes this, and recognizes that EVERY new team member deserves 90-plus days of training, whether they are a professional or paraprofessional. Behavior rewarded is behavior repeated (two new “R” words). All parents practice this and children soon learn this. Recognition, specific and directed, concise and meaningful, up close and personal, will reinforce appropriate behavior. It will also make the individual feel good. Recognition may be words, a food reward, titles, a targeted complement, business cards, and sometimes even money. When money is used as a thank you, don’t decrease its effect by trying to take credit for it as a “bonus.” Staff earns every penny they get. Performance or productivity recognition pay is what they get. Regularly give every staff member the recognition they deserve, when they deserve it, and the team will flourish and prosper. So will the practice.
Responsibility is the third “R” and usually follows the first two. Respect is an initial given and recognition is a training technique, but responsibility is an achievement and should be celebrated. Responsibility should be more than being given the duty of doing a specific set of tasks without supervision. True responsibility is becoming accountable for a specific set of outcomes, with the “how” and “who” being left to the team member(s). This method of assigning outcomes means the “boss” must trust the staff, must believe they will embrace the practice values in the pursuit of excellence, AND they must be allowed to stumble. Some will fail, others will make mistakes, and some will shun the assignment of accountability. Not all team members want to be accountable, many just want to support the team and belong. The role of support is an important responsibility, and this must be regularly conveyed by the practice leadership.
THE RIGHT LEADER FOR THE FUTURE
This was a therapeutic article, it was targeted toward practices our firm has supported. A micro-spectrum of the profession. This is also a landmark article since the internal mission statement for Veterinary Consulting International (aka Catanzaro & Associates) team members is: “Creating Leaders In The Business Of Veterinary Healthcare Delivery.” Our brochure and stationary tag-line is “A Covenant With Quality” and I believe these two concepts go hand-in-hand.
Leadership goes beyond management. The progressive veterinary manager learned to build job descriptions and procedure manuals during the last decade, which was a good start. As media writers, we forgot to tell them the rest of the story. They now need to be leaders. We tell practices to consider the job description as the minimum competencies required to do the job, and the practice commits to training each new staff member to that level of excellence: competency = excellence. The expectations are the same for healthcare delivery and should be attained in the first 90 days of introductory employment. If after 90 days the individual has learned the competencies and fits the team, they are then hired onto the team. Shortfalls in either area may be cause for release (dehiring) during the introductory 90-day period. After the 90-day period, two new expectations are added to every person’s “job” description: 1) solve/prevent the problem and 2) make continual quality improvements (CQI). If each team member is not empowered to unilaterally solve problems and make improvements, the status quo strangles the practice progress.
It is the uncommon leader who can repeatedly help each person stretch slightly beyond their comfort zone and help them be winners. It is the uncommon leader who tailors the job to the individual, rather than the reverse. It is the uncommon leader who nurtures responsibility with recognition, rewards, and respect. It is the uncommon leader who will survive and flourish in these post-recessionary times.
