It is not the scientific nor the technical, which make successful veterinarians, it is their leadership and life skills that are the defining success factors. - Workshop for Veterinary College Administrators, Educators, and Practice Management Consultants National Commission on Veterinary Economic Issues.

We awaken in others the same attitude of mind we hold toward them. - Dr. Tom Cat

We have all heard the question, "Are you doing the right thing?" or Are you just doing things right?" This is the question every leader must ask with most every decision or action. Professionalism is part leadership, part image, and part attitude, and yet there is a bit of a difference in a veterinary practice. The pursuit of money is a staff turn-off, while the pursuit of quality healthcare as a patient advocate is laudatory. That said, the staff still would prefer to have enough compensation so they do not have to live at home, or have to have a roommate.

For a healthcare provider to be followed by staff, respected by clients, and be considered a professional in the community, the provider must:

 Look confident and professional.

 Stay client-centered.

 Understand why certain bio-ethical decisions have been made, yet talk of what the animal needs or deserves, rather than recommend, which confuses the client and reflects poor professional confidence.

A good leader is committed to developing people through work, rather than just getting work done through people. Every doctor, coordinator, and manager must accept this leadership mission focus, when it comes to the human resources of the practice. The days of disposable staff and disposable associates are over in veterinary medicine. The smartest of the smart are making new commitments to their healthcare delivery teams. A key to effective leadership is to maintain effective feedback from the team. Stanford did the original communication research that has been so often quoted by consultants:

 Seven percent of communications are in the words we use.

 Thirty-eight percent of communications are in the tones we use.

 Fifty-five percent of communications are non-verbal.

There are three basic leadership skills used in developing any group, and two transitional skills, which need to be in effect before a "team" can be expected to operate effectively. These skills are explained in detail in Appendix B, Building The Successful Veterinary Practice: Leadership Tools:

 Knowing and using the resources of the group.

 Effective communication.

 Understanding the characteristics and needs of the group and Individual.

 Reflection -- the balance between individual needs and group needs.

 Representing the group -- upward, downward, and laterally.

Delicate Dialogues

In healthcare, especially veterinary healthcare, where patients cannot speak, personal values become a major factor in decisions. Practice values must be compatible with personal values, and the core values of the practice must be inviolate to create a safe environment for individual decisions. As such, many discussions are very delicate, since they involve deeply ingrained personal values, which may not wish to be shared, but shade every healthcare discussion. Effective communication is therefore based on understanding the parameters discussed in this chapter, at all levels, before trying to "build the team" in the leader's image:

 The example set by the leadership speaks so loudly that most staff members cannot hear what is being said.

 Each team member deserves respect from day one, as does each client, each patient, and each discussion.

 Knowing and using the resources of the group means each person has strengths that should be built on, and positive reinforcement and growth must be nurtured, with additional mission-specific training and assignment of clearly defined outcome responsibilities.

 Leadership is situational, and the development of the group, the "newness of the task" and the stages of the individual development, continually cause the parameters of personal interaction to change.

 Every mother, as well as every savvy leader, knows that "behavior rewarded is behavior repeated", so the importance of frequent and specific recognition is critical in developing a self-healing practice team.

 The getting and giving of information is different from "beating" on people with facts and data about their weaknesses. In healthcare delivery, the lines of black and white clarity are continually shaded by the bio-ethics of the medical or surgical situation, as well as the evolution of knowledge.

The Distracting Environment

The USA Today newspaper ran a cover article about doing things wrong. I read it with great interest, and then realized the challenge was not "doing things wrong," but rather, leaders not doing the right things for the right reasons. Look at the list that was developed by interview and survey of more than thirteen hundred American workers:

Top Five Unethical Behavior Actions

1.  Cut corners on quality assurance factors.

2.  Covered up inappropriate incidents.

3.  Abused or lied about sick days.

4.  Lied to or deceived customers (clients).

5.  Put inappropriate pressure on others.

We have seen the recent findings against insurance companies who "falsified" their products to senior citizens and must make amends. The companies blame this on the sales people, but every insurance policy ever issued is reviewed by the underwriters. After all, what was their charter?

We have seen practice owners blame it on the technician or receptionist, who were just following the "policy" of the practice. We see practice managers, and never call these people "leaders", blaming the changes in their business flow on the other practices in town, or on the super-size pet stores in the area, and who don't accept the simple fact that, "If you are meeting the client needs, they will not go elsewhere!"

Ethics start at the top of any organization, and the ethics the staff perceives are generally due to the tone set by the owners and bosses. Seldom will these people be considered "leaders" if the image is covert or there is unethical behavior. Our understanding of the environment, the patient needs, and the history, as well as the scientific evolution of the healing professions, have established bio-ethics. Together with image, these ethical and bio-ethical values offer the foundation for professionalism, a perception of those viewing the behaviors and actions within the practice and in the healthcare delivery programs.

The practice owner who skims cash never trusts his staff. The doctor who lies to the client always believes the staff members are lying to the doctor. The doctor who is unsure of the problem and guesses at a treatment protocol, rather than offering and running the needed diagnostics, always suspects other practices in the area of "just treating symptomatically". The doctor who does not trust technicians to do what they were trained to do is often the same one who does not have the confidence to tell clients what is needed for the animal. This is the same doctor who X-rays the wallet and covertly makes decisions for the clients! If you look at the top ten factors in the USA Today survey that may trigger unethical behavior, the picture may become clearer to the veterinary practice team:

Top Ten Factors Causing Unethical Behavior

1.  Need to meet sales, profit, or budget goals.

2.  Little or no recognition of achievements.

3.  Politics within the workplace.

4.  Poor internal communications.

5.  Balancing work and family.

6.  Poor example by the top management.

7.  Work hours -- work load.

8.  Lack of management support.

9.  Personal financial worries.

10.  Insufficient resources to get the job done right.

In the USA Today survey of one thousand three hundred twenty-four workers, fifty-seven percent said they felt more pressure to be unethical than five years ago. Forty percent said it has gotten worse over the past twelve months. Retail stores now "plan to lose" more from employee theft than to customer theft. Surveys show that entry-level restaurant and fast food workers admit to stealing an average of $239 per year in cash and merchandise. A chief of detectives, speaking to a veterinary audience, stated that approximately sixty-eight percent of the practice staff have stolen something sometime. Her challenge: review the medical records and review how "current" the preventative medicine sales are for their own animals. Some try to explain this away as being a result of our forefathers being dregs of the earth and were sent or escaped to the United States to get out of prison or flee incarceration. I don't buy this!

The "expected" unethical behavior is what disturbs me and most consultants in the veterinary profession. We just do not expect unethical behaviors. The problem in veterinary medicine, and other healthcare professions, is that if someone is outspoken, challenges the status quo, and embraces new methodologies, some peers automatically label that person as unethical, without understanding the "why" of the actions. The medical and surgical routines and protocols learned at the feet of our professors give us a feeling of safety and with an inherent fear of failure in case management, change is slow and difficult. This fear of rapid change need not infect human resource management, or fiscal management, or other business management issues. But it is difficult to change the long-standing paradigms of doctor-centered case management, when looking at non-medical issues, ergo, the control freaks.

In this same USA Today survey, seventy-four percent of the men and seventy-eight percent of the women stated they feel their families have been neglected to some extent, due to workplace pressures. To curb unethical behavior, seventy-three percent believe that more open dialogue would help, and seventy-one percent say they need to see a more serious commitment by management.

These numbers look low to me. These are the unmet needs of most every veterinary practice team member in America. It is the uncommon leader who dedicates adequate time to open feedback, meaningful ethics discussions, and commitment to staff, who support daily veterinary practice activities. To reinforce this idea, please review the "Introduction: New American Veterinary Practice" in the leadership text, Building The Successful Veterinary Practice: Programs & Procedures. The pursuit of excellence must start with building the team. Setting the example and creating the safe environment are critical support elements of this equation.

Elements of a Safe Practice Environment/Culture

 Shared leadership vision of the future for the practice.

 Inviolate core values for unilateral decision making by staff.

 Frequently reinforced mission focus in programs and projects.

 Consistent standards of patient care, with active protocols.

 Regular in-service training and train to a level of trust.

 Medical record continuity of care between providers.

 Respect, responsibility, and recognition by leadership for all.

 Client-centered patient advocacy, every day in every way.

What does all of this mean to a veterinary practice? In simplest terms, in trying to keep the lions from the door, some practitioners are "making exceptions" as to what they really believe in, while trying to get the books to balance. The leadership has been replaced by gamesmanship. They grasp at straws and confuse their staff members. The people who join veterinary medicine, from the doctor to the technician, to the receptionist and animal caretaker, have all joined the practice because of a "calling" of sorts. We don't pay enough to keep them, because of their financial greed, so there must be an underlying value or trait they continue to preserve and makes them stay. As a consultant, I have found those traits, beliefs and values, to be the building blocks for rebuilding a practice.

The leadership of a practice must awaken the lions within, instead of fearing those at the door. They must lead by example, they must regain the ethics that drew them to this profession, and they must nurture the team harmony. In the VCI® Human Resources Pocket Card, we state the doctors/leaders have three "Rs" they need to follow: Give Respect, Give Responsibility, and Give Recognition. Staff and doctors have three behaviors that must be displayed as terms of employment: team fit, competency, and productivity. The entire healthcare team has two operational commitments: be client-centered and be a patient advocate.

In Building The Successful Veterinary Practice: Leadership Tools, I attempted to provide the foundation for the skills and knowledge needed to be an effective practice leader. In the Appendix, I provided a series of tools to assess how the attitude and environment evolve after the commitment is made public. In short, leadership is a new way of life. Think about it!