The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
There was a time when a young lad, who had been on his own fiscal development system since age twelve, was in high school. He had to earn every penny in his pocket since age twelve, and that meant mowing lawns in the summer, raking leaves in the fall, shoveling snow in the winter, and two newspaper routes, one early every morning of the week, and one late in the afternoon once a week. When he turned sixteen, he became part of the retail clerks union and stocked shelves until late most nights. At the end of high school, he was able to get a summer job in the steel mills, from a contact he had met while acting as night custodian of a carnival site.
His teachers always thought he was an "underachiever". Yet, in junior high school, his math teacher saw something, and got him into an experimental math course for high school. But the counselors still thought he was an "underachiever". Although he was in a University of Illinois experimental math course, his high school counselors thought he was not only an "underachiever", but he had better take the vocational education course, since he would never get into college. At high school graduation, he was in the middle of his class, but his four years in the University of Illinois Experimental Math Program had awarded him with a full year of college calculus credit and an engineering scholarship at University of Illinois.
His dad disowned him, due to gang colors being found in the back of his closet. So this young man, after a summer in the steel mills that earned him a lot of money earned in a short time, got on Route 20 and headed west. It was not long before he was at Fishing Bridge in Yellowstone Park, at dark. As he lay back on this car hood staring at the sky, he discovered that stars really did "twinkle". He had always thought the poem was just saying, "Twinkle, twinkle, little star, how I wonder what you are..." He was so amazed, he immediately knew he had to call his high school sweetheart back in Illinois and tell her they really "twinkled"! His girlfriend, a National Honors student, told him they only twinkled because of the elevation, no air pollution, and the darkness of the sky.
He turned north at West Yellowstone, and found the Gallatin Valley, surrounded on three sides by the Rockies, and opening westward. He looked around, found Bozeman, and set out to find a job. His Vo-Tech background came in handy, when he started by building barns for folk, often designing them first. He usually ate at least two meals on the ranch, so his food cost was minimal. Then he found an affinity for livestock, and eventually got Montana State College to accept him on probation. Poor grades, remember?
He spent the first two years at MSC on probation, never pulling great grades but never failing, before they got tired and removed him from the probationary roles. He was holding at least five jobs at a time during school: dormitory dishwasher, where he had all the scrap food he could eat; building barns; clerk in a music store; clerk in a Gold Bond Stamp redemption store; and after hours, running a juke box route up and down the valleys, changing out records and maintaining the machines. In the later years of college, MSC became a university, so he was then attending Montana State University (MSU), the agricultural land grant college in the state.
He started out in General Agriculture, not knowing what he wanted to do as a profession, and in the summers, went back to the steel mills in Chicago to earn enough money to survive in Montana for nine more months. The first summer back, he gave his fraternity pin to his high school sweetheart, who was attending nursing school in the Chicago area. The second year at MSU, he transferred into range management, because it sounded like what he wanted.
He still never excelled in grades, but made it the Bridger Bowl before noon every day of the winter, because he had ski lessons to give. He had started skiing the year before, and took to it pretty well. So, he had the opportunity to teach the basic ski classes every day, and loved it, BUT it also meant that his college classes had to be over by eleven every morning of winter quarter. His multiple jobs gave him an excuse for not studying, and by spring he entered the Little International Livestock Show in Range Management Judging, and won first place in the practical dirt and weeds evaluation competitions. He also had trained a yearling thoroughbred at the halter and won first place in his class at the Little International Livestock Show that same spring. He found horses far more fun than dirt and weeds, so he changed his major to Agricultural Production.
The summer after his second year, when he was working in the steel mills in Chicago, he "broke up for good" with his high school girlfriend. This was the fourth time they "broke up for good", but it seemed like it would be the last, as she had started running with the Northwestern University crowd and really found a niche in the fast lane, which no longer fit our "Montana Cowboy". He made a self-commitment to date a different girl every weekend, just to see what he had been missing. Came to find out, not much. He wanted someone to talk to, and the Chicago gals did not understand Montana values or interests.
During the third year of college, he established a string of sixteen horses that needed gentling, not breaking. He had met an old California horseman, who taught him to gentle horses, taught him to read their body languages, and build a bond, rather than bucking them out. It worked better in Montana to gentle a horse, because if they got spooked on the trail and "sun-fished" on you, the next "step down" could be five hundred feet down a mountain side. A gentled horse would stop and trust the rider, which is exactly what was wanted.
He also enrolled in advanced ROTC, because for one afternoon a week drill, it paid him enough money to pay his monthly rent. As an Agricultural Production major, he started doing A.I., and got a "License to Inseminate", written in big red letters, and in the fine print, it said "artificially". Hard work for a big-handed guy on heifers, but it paid good money. He also was intrigued with lambing, and spent many a night in the lambing barns, grafting the triplet onto another ewe, since it increased survival rates.
Times were good. This is what he had wanted all along. He kept his juke box route, but quit washing dishes. He clerked less frequently, but it was always an extra few dollars, so he never closed those doors of opportunity.
Winter ski season saw him on slopes, teaching again, and having fun, like college guys are supposed to do. He was not drinking or smoking yet, so he did a lot of driving for the other guys in the fraternity on the weekends. He was dating gals from Montana and Wyoming, and finding a new horizon in companionship.
At the Little International Livestock Show that spring, he came in second in livestock judging, as his pig breeds were not that good. Nevertheless, he not only won the Horse Division, he won Grand Champion Showman. This gave him his pick of campus jobs in the College of Agriculture, so he picked the horse barns for the next twelve months. This was also the year he spent on Student Traffic Counsel, and impressed the campus police so much, that they offered him a weekend foot patrol job. It was the best paying job on campus, and it was 10:00 p.m. to 6:00 a.m., Friday, Saturday, and Sunday nights, so he had good money coming in now.
He couldn't work in the steel mills after the third year, since his ROTC requirement now included a summer boot camp in Washington. Having poor grades, he was still in the middle of his class, and he had not qualified for Distinguished Military Graduate (DMG). However, after his leadership showing at summer camp, he was awarded the DMG for practical applications. The DMG qualifies a ROTC graduate for Regular Army commission, and usually, a first station of choice.
Senior year was a "bust butt" year, if he wanted to graduate on time, so he took twenty-one credits a quarter, and finished his degree in four years. Spring quarter, when working with students, who were training horses for the Little International, one dumb cowboy, when no one was around, hooked his horse to the fender to teach it to lead, and nerved the jaw. This required the Cooperative Extension veterinarian to make a barn call, and while working with Dr. Jack Catlin, it all crystallized into a clarity that was amazing. Tom Cat discovered he wanted to be a veterinarian.
TC graduated and now had to enter the military. It was the mid-1960s and this meant a tour of Viet Nam. He was told he had to do two years in the combat arms, but was also told he should be Medical Services, due to his college training. Tom Cat wore "Armor" brass, during his commissioning at MSU, but when he opened the papers, he found that he was just commissioned in the Medical Services Corps. They told him that was the reserve commission, and the Regular Army commission would come through as Armor. Tom was back in Illinois, waiting for the commission and travel authority. And, yep, he had married his high school sweetheart after all! When it arrived, his Regular Army commission was also Medical Services Corps, and he had orders to report to Fort Sam Houston, Texas, Army Medical Field Service School, in just seven days. Now let's make this story go quicker, shall we? To recap:
Told he could get no money from home at age twelve, so he earned it himself.
Told he could not graduate from high school, yet he did, with a scholarship.
Told he could not "make it" in college, but he did.
Told he could not be a DMG, yet he did.
Told he could not be Medical Services, but there he was.
Told he could not ever get Hawaii as first choice tour assignment, yet he did.
Told he could not get to Viet Nam as a volunteer, but he did.
Told he could not get Colorado on return from Viet Nam, yet he did.
Told he could not get into veterinary school, but he did.
Told he would not graduate from veterinary school, yet he did.
Told he could not get an accompanied tour overseas, yet he did.
Told he could not get into Baylor for an MHA, but he did.
Told he could not get into American College of Healthcare Executives, yet he did.
Told he could not sit for boards as a veterinarian, but he challenged them, and did.
Told he could not advance to fellow, yet he was the first veterinarian so honored.
Told that he could not open a full-time veterinary consulting business, yet we did.
Told we could never operate out of an amusement park, but we have for sixteen years.
Told he would never build the "& Associates" team, but he did.
Told that we would never get published, yet this is book number fourteen.
Told that there was no better valuation formula, but we built a better one.
Told that we would never be unique, yet we have become exactly that.
Told that there was no succession possibilities, yet we now have six owners of Catanzaro & Associates, Inc., dba Veterinary Consulting International® (VCI®).
TC believed marriage was forever, a grin-and-bear-it legacy of youth, but found there was a more important life after sixty, dedicated to his son's recovery, which was facilitated by his divorce after forty-five years from his high school sweetheart.
Let's return to storytelling for now, and allow us to share a little insight, and see if it matches what you have learned so far.
How do you define an unstoppable spirit?. Progress is one outcome from unstoppable people, but making dreams come true has a value also. In our case, we watch tired practitioners catch the spirit and rise from the ashes of despair into practice being fun again. With our consulting incubator, we give some people, with diversified backgrounds, the ability to enter the national consulting scene, without years of personal anguish and personal expense. We obtain great joy in giving to others, and helping others succeed. It is what makes TC feel best these days. Puppy breath was very special, during his clinical years, but he was also developing people through work in those days, which was a joy.
This is leading us somewhere. You know from Chapter Four that TC is not that "normal", according to many in this profession. Do you have to be born with superhuman abilities not to give up? Some research shows that there is a genotypic aspect that may come into play, just as the family experiences from age two to twelve help form the core thought process for problem solving and life skills. We can tell you, from hundreds to thousands of practices and people, these are skills and mind-sets that can be learned. We all have had our share of disappointments and frustrations, but it is what someone does, when they happen, that makes the difference. It is like the old saying on the dairy farm during 5:00 a.m. milking, "Don't cry over spilt milk, just go find another cow to milk!".
What separates the unstoppable people from the masses? Which characteristics enable them to keep going, when others would throw in the towel? Ten characteristics have surfaced over and over, and when more of them are present before we start, the faster a transition plan evolves.
Unstoppable people:
Devote themselves to their true vision.
Follow their heart's passion.
Believe in themselves and their ideas.
Maintain inviolate core values on which others can depend.
Get excited about making others successful.
Plan/prepare for challenges.
Ask for help and build a support team.
Standards of care are based on patient advocacy.
Seek innovative solutions.
Persevere, no matter what the challenges.
With all this said and done, now is the time to put it together. With your trusted team members, take the following "Alignment of Accountabilities" and use it as a work sheet. The tasks are simple:
1. List the attributes of someone in each position.
2. Do not align it to existing staff, just to how the "position" needs to work.
3. List the support each position needs, from above, below, and lateral.
4. When all the above are done, have each zone team select a coordinator for a ninety-day test, which cannot be changed for ninety days. The person selected will be allowed to run the distance.
Alignment of Accountabilities
Zone Coordinators are developed as coordinators of outcomes and people, by functional areas of the practice. See the VCI® Signature Series Monograph Zoned Systems & Schedules. These people work regular shifts, and are in the trenches. Usual coordinator positions include:
Coordinator of coordinators: __________________________________
Client relations coordinator: __________________________________
Outpatient coordinator: ______________________________________
Inpatient coordinator: ________________________________________
Surgery coordinator: _________________________________________
Laboratory coordinator: _____________________________
Imaging coordinator: _______________________________
Animal care coordinator: _____________________________________
Training coordinator: ________________________________________
+/- Spa/resort manager: _____________________________________
Program managers are developed as managers of programs, often for medical or surgical services, or operational facility functions. See the VCI® Signature Series Monograph Inventory & Maintenance. These people work regular shifts, and are in the trenches. Commonly, manager positions may include:
Inventory manager: _________________________________________
DEA manager: ____________________________________
Nutritional manager: ______________________________
Boutique manager: _________________________________
Dental hygiene manager: _____________________________________
Behavior counselor: _________________________________________
Parasite prevention and control advisor: ________________________
www.npwm.com (2x4L) manager: _____________________________
"Over-Forty" manager: ______________________________
"Golden Years" manager: ____________________________
Genetic predisposition manager: ______________________
Safety manager: _____________________________________
Client outreach/newsletter manager: ___________________________
Pet parent awareness training manager: ________________________
The people who have the will can develop these characteristics. They are virtually all attitude-based. I have taught nineteen leadership courses in three countries over the past twenty years. The leadership skills can also be learned, they are classified as behavior-based. (see Appendix B, Building The Successful Veterinary Practice: Leadership Skills). It can be done, and being the type person I am, I always believe our team can help most anyone.
Live large, live long, and prosper!