By definition, a leader gets things done through people and a manager does things right to get a project completed. A modern healthcare administrator promotes quality healthcare delivery, while ensuring adequate remuneration for the facility, while establishing a clear market niche in the community. To the administrator, it means letting staff do more than the job they were hired to do. Let staff solve problems, rather than just spend time doing their job. It means giving the staff members the freedom and logistical support required to put pride into their daily efforts. If the people on the payroll are to be the ones to make things happen, then they must become the problem solvers by believing they have the accountability for the solutions. A good healthcare administrator just keeps the impeding habits out of the way. A great administrator makes change and innovation the expectations for each staff member.

The basic operational questions, which effective veterinary practice administrators ask themselves each day, include:

1.  Today, what projects, what objectives, what needs can be accomplished in this facility? In what priority?

2.  What can I facilitate by removing obstacles from the path of our team? What will be the domino effect of that facilitation?

3.  How can I further my transition from the person with the great answers to all problems to an administrator who asks great questions of staff members that empower their solution-finding capabilities? What are the good questions I need to ask today?

4.  There are many skills still needed by individuals, and there are team skills needed within each zone. How can I best facilitate the coordinators and team members, asking for both concurrently?

5.  We need a deeper feeling of respect at the personal level. Recognitions (non-contingent) and rewards (contingent) must be increased to provide the positive feedback needed. How can those feelings be facilitated today?

6.  Since I am the steward of administrative talents for this practice, which staff members need my help today to develop their skills and success rates further?

7.  What is the practice standard that is being established? Do we want a team of people who don't stumble when they walk through their daily duties, or do we want to develop a team of runners who are marathon quality when attacking problems?

8.  When staff members walk through my door with a problem on their backs, how can I ensure they leave with both the problem and some alternatives still on their backs?

9.  The effective administrator does not solve the problems of the staff members. He/she is a sounding board, who helps the staff members think through their problems and discover alternatives themselves. The best administrator validates the thought process often enough that every staff member learns to solve problems and make the practice better, without asking permission and before the problem occurs. They make their environment for user, both staff and client, friendly on a daily basis.

In applying leadership skills within the practice's healthcare delivery team, the effective veterinary practice administrator follows the three Bs

 Team members are given a chance to be. To be a recognized somebody, rather than a nobody that is taken for granted.

 The second is to belong. To be part of the practice success system, rather than just a pair of hands.

 The third is to become capable of doing greater things, as an individual and as a member of the practice team. To be able to stretch one's neck out, without fear of injury.

A person who has captured and embraced all three Bs, as they were provided for in their environment by the administrator, may develop as a replacement or backup to that administrator. The person has had well-being nurtured and knows one can enrich oneself through work and practice progress, rather than just off-the-job education opportunities.

The human resources are the only practice asset that can be appreciated, rather than depreciated. The human resources are clients, as well as staff, and the savvy administrator treats both as valuable assets. The effective veterinary practice administrator becomes a "significant other" to each team member, not just a boss of the employees. We all need to remember that staff members were hired because someone in the practice liked their skills and attitude. A staff member with a bad attitude is one who has been depreciated by the practice, rather than appreciated.

In short, the veterinary administrator is a people person, while the manager is a project person. What do you want to be when you grow up?

Beyond Problem Solving

Obstacles -- those frightful things we see when we take our eyes off our goals. - T.E. Catanzaro, DVM, MHA, FACHE

Some practitioners erroneously believe that solving immediate practice management problems is the best way to change productivity and performance. Many times these are the same uninformed men who believe, when his wife asks him a question, the wife wants an answer. Women want discussion, not answers. The same for a veterinary health care delivery team. They want the "why", not just the "how". And since they are mostly women, just plan for a discussion every time a new program is introduced. You might read Dr. John Gray's book, Men are from Mars, Women are from Venus, if you haven't already. Remember, most old-time veterinarians are from the seventh rock from the sun.

A better approach is to cultivate ideas, in which the application and impact range go beyond the task of the moment. Overcoming inertia and getting things done rely on follow-through and breakthrough skills.

Breakthrough Skills

As a team leader or a team member, you must first learn how to present your ideas in a comprehensive and enlightening manner:

 Strategic assessments. Ensure you know/have a three-year plan for where the practice will be positioned in the community in the coming years, with quarterly objectives. Inside that, have the one-year, month-by-month, transition plan for the coming twelve months, to move you to the next level.

 Cover your bases. Before you show off your personal planning skills, make sure you are seen as doing a good job with your current responsibilities. If you don't have time to think beyond the immediate concerns on most practice days, delegate the more repetitive day-to-day responsibilities to dependable staff members.

 Network. Before you suggest an idea at a team meeting, try to get a feel for the other team members' interests and concerns. Use all the brains you can find. Know the problems they face and the solutions they have developed, and address the issue at hand in terms that include their interests.

 Seek opportunities. View problems as opportunities to solve challenges. A strategic thinker sees multiple alternatives to events that others view as crises or failures. Nurture this attitude within the practice team.

 Be positive. Make your suggestions in a non-confrontational way. If your idea impacts others, soften your approach with phrases like, "What are your thoughts on ---- ?" Remember, the staff within most every practice cares, they want to help, and their suggestions most always come with good intentions. Look for the caring intention before you evaluate the idea(s).

 Know what is needed. The capital expense budget is a plan to buy the equipment needed for the next level, but each piece of new equipment must have its own job description written before procurement. If the equipment does not perform according to the job description, it needs to be "de-hired", the same as a staff member who does not grow with the practice. Wants are not needs. Needs meet a healthcare delivery plan, which providers, patients, and clients can appreciate.

 Don't limit yourself. Do not hesitate to make suggestions that are not related to the bottom line. Clients must believe you care before they believe in your healthcare plan. The value of an idea to a practice is measured in quality of life, as well as quality of care. Practice benefits can and should go beyond the cost-saving or profit-producing ideas.

Follow Through Skills

Planning a project can be completely different from its implementation and far more difficult than ever anticipated. When projects stall, everyone becomes frustrated. Projects stall for many reasons, but the obstacles that initiate the stall have some commonality. The first secret to pro-actively enhance the follow-through is to recognize obstacles of your own making:

 Fantasies. The mind can envision how well a plan will work, and it is far happier than when overseeing the actual implementation hassles. You need to set the fantasy aside and get your hands dirty. Edison had a vision of how a light bulb should work, but had to build over one thousand of them to turn his vision into reality. Are you ready for nine hundred ninety-nine failures to become famous for your new ideas within the professional or client-based community?

 Fear of failure. Fear that results will fall short and often cause us to let a project quietly die, rather than live with poor results. Remind yourself that concrete results, even those that fall short of expectations, are far better than none at all.

 Invisible ruts. A common pitfall is mindlessly following old habit patterns. We have learned from what went before, and know what works. But the practice plateau, or lifestyle stagnation, is caused by "non-change", rather than the pursuit of unique or new experiences. Ask if those old stale protocols are important and determine "why", if the tendency is to retain them. If the why" is simply, "We have always done it this way," then bypass them, as necessary, to get things done.

 Comforting mythologies. Don't fall prey to the slogans or comforts of tradition. Southern California community needs are different from the rest of the USA. Suburban needs are different from small town, rural America. Marketing gimmicks must be tailored to the community needs, not to the practice, by some article or consultant, who has not even been in your practice. If you believe everything is fine, as long as everybody is busy, you might overlook the benefits of new projects.

 Egotism. Thinking that your own intuition and insights are infallible cuts you off from your colleagues' ideas. Doctor, paraprofessional, or animal caretaker, it does not matter. Everyone has a mind, and each mind has unique ideas to share, if harvested in a caring manner. Objectively review all suggestions, including your own, and implement the best.

 Failure to delegate. You may be shouldering the whole burden, because nobody else is as effective as you are, or because you don't want to share the credit after a project is completed. Either way, you place the project at risk. Your odds of success increase greatly after you take on only the tasks that suit your abilities best, and let others take on the rest. Train each person to a level of trust, then delegate the accountability for the outcome to them, not just the process. Let them improve the program(s)

 Inflexibility. When an approach is not working, substitute something more positive. If your staff does not implement your ideas, ask them for alternatives. Let them develop unilateral plans and put those into action, then evaluate at ninety days for benefits. Never veto ideas just because they are not yours! Flexibility often requires taking a step backward, but ends up being more productive.

 Love the intrigue. They are either with you or against you, right? Put aside petty intrigues and enlist everyone's help. A "them versus us" practice staff will never be a healthcare team. Only "we" can cause harmony and success. If you love intrigue more than progress, or you prefer to take credit and give blame, rather than take blame and give credit, go into politics or the spy business.

Power Up for Problem Solving

For those practices that do not have computers, or their computers are not friendly, the two texts by Roger von Oech, A Kick in the Seat of the Pants, or A Whack on the Side of the Head, (ISBN 0-06-09024-8 and 0-446-39158-1, respectively), provide exercises, stories, tips, and techniques to help you strengthen each of your own creative skills. The books are sold separately, but sometimes you can find them together, with a deck of innovation cards, and the set is called a Whack Pack. These aids can be used to awaken these skills in your staff, since they are the best problem solvers we have. Then all you have to do is capture the great ideas from the flow of innovation.

In our seminars we teach mind-mapping as a form of written brainstorming. Tony Buzan is probably the most noted author in contemporary literature on mind-mapping. See his titles The Mind-Map Book, Head First, etc.

Doug Hall is a lesser-known author (Jump Start Your Brain), except on the teaching circuit. He offers some great explanations for implementing the innovation and creativity published by James Higgins' books, 101 Creative Problem Solving Techniques, Innovate or Evaporate, and Escape from the Maze.

And my personal favorite is Bill Costello, who wrote Awaken Your Birdbrain, a true veterinarian's primer, using critters of all sizes and shapes to explain the diversity needed to be truly creative.

New software to enhance creativity and innovation comes out almost every month. The Internet has some public domain mind-mapping and creativity software that is totally awesome. There are many other products coming available to help problem solving, innovation, and creative thinking for the average computer user. It is a smart idea to stop at the local software store and discuss your needs with a computer guru on the staff. Do not buy the software product until you have booted it up yourself, fed in a current problem or idea, and see what the program can do for you. Not all programmers have the same logic tree as you, and very few understand healthcare delivery, much less veterinary medicine. These programs are usually just a well-developed logic tree that can be used by most decision makers, who want assistance in innovative and creative thinking.

Doing Gets It Done

When a project stalls, making a new beginning can provide the spark that lets a project catch fire. Inactivity leads to inertia, then the consultant must be called in to break the paradigms that formed the inertia. Picture your practice as a giant boulder, resting on level playing field. Time has caused it to settle into a depression. With all the strength available, the boulder may only be moved an inch or two. If something isn't immediately added to the depression, the boulder will return to where it was. On the other hand, if something, such as an "idea rock", was added to the void created by moving the boulder, it will not be able to return to the "old position" and just sit there. Each movement of the boulder allows another idea rock to be added to the temporary void. In time, the depression will be filled with new ideas, and the boulder will be moved elsewhere on the level playing field in whatever direction is needed, and with a lot less effort than ever before.

With or without a computer, use your brain's natural logic for a five-minute "boulder-moving effort", when searching for the breakthrough, or follow-through, ideas. If you are stuck, make an agreement with yourself that you will start to work on a task at a particular time and will continue with it for five minutes. At the end of the five minutes, determine if you want to continue another five. Make the same determination again, and so forth. This enables you to take focused action, rather than view the project as a behemoth. This method helps to build immediate response rewards. If all else fails, stop, relax, and remember the words of Isaac Newton:

"If I have ever made any valuable discoveries, it has been owing more to patient attention than to any other talent."

In team-based healthcare delivery, "getting it done" means more than a "ka-ching" at the cash register. It means the patient is in an improved condition, in health, or protection, or both. It means you have exceeded the client's expectations, which causes greater word-of-mouth referrals every time. It means the staff is proud of the healthcare delivery as it was done. Staff pride is perceived by clients as quality, and most all will happily pay more for the peace of mind that comes with quality. And it means that there is some net income from the encounter, something tangible to show for the team effort.

Attitudes - Save Your Dream

Success is founded in being true to your vision. - Dr. T. E. Catanzaro

Everyone suffers from an occasional case of stress, negativism, and overall frustration in the daily grind of veterinary healthcare delivery. Most of the staff will benefit after the leader redefines the brick wall that causes the stress or frustration into the "challenge of the day". Since veterinary practice offers challenges to every staff member, every day, and in many different ways, the astute leader must be anchored in a very clear vision of what is to be. The dream of the future must live in every mirror the leader sees. Only the leader should worry about the vision. Everyone else must be able to draw strength from the leader's certainty in the dream. When facing the current challenge, it is critical to put it in the appropriate perspective, based on the practice's vision and the leader's dream.

Attitudes - Behavior - Perspective

There is an emotional triad that exists in each person, which affects the way each person sees a challenge. This triad is composed of attitude, behavior, and perspective.

The individual's attitude is very internal and often stems from values learned in childhood. Very few leaders can effectively change someone else's attitude, but they can change the environment where the attitude exists. This is called the perspective. It is the old story of, "Is the cup half full or is it half empty?" In veterinary practice, a half-full cup needs to be filled, so just quit arguing why it is only half filled and do it!

One of the unique facts of business life is the boss establishes the environment, which includes the outward behavior requirements. How the phone is to be answered, in the words, the tone, and the caring feelings, can be rehearsed until they sound authentic. Most practices just don't take the time.

Conversations with destructive gossip to negative feedback can be curtailed by a leadership team that immediately says, "We just do not allow that type of talk during the duty day," and the boss must back them one hundred percent every time.

The "clean-as-you-go" attitude can be a required behavior, so the facility always looks spotless. Many practices have delineated the duties so clearly in job descriptions that the answer is usually "It's not my job", when cleaning is needed.

The traditional veterinary job description was seen as the answer to this, but in most practices, the job description is used as a "duties of the day" list, rather than a minimum set of competency standards on which to build. The last two lines of any job description should be added after the introductory period of the candidate's employment, after the candidate has learned the basic competencies. Those two phrases are:

1.  Meet the challenge, solve the problem.

2.  Expect it all to change, make the improvement!

Gone is the traditional phrase, "and other duties as assigned", which means to most, we do not want initiative, we want you to stand there at the ready, until I tell you to do something. Just vibrate in place and wait!. Behavior is a term of employment!

Every day is an opportunity to bring this emotional triad into clearer focus for every team member. The center of the emotional triad is the practice vision, the dream of the leader, as well as the core values of the practice. The recent years have caused too many practices to shift their focus from the client to the profit and loss statement's bottom line. Virtually everyone entered veterinary practice because they cared about animals. Some even cared about people. When they selected the profession, very few ever thought it was a fast way to make millions of dollars. The frustration and stress builds, when the original dream becomes diluted with business concerns. What is the perspective, and the required behavior, in your practice? Who is the advocate for the animal? What is needed for wellness? How do we offer the needed care to clients, so they clearly know they must now make a decision?

In the 1998 text Building The Successful Veterinary Practice: Innovation & Creativity we introduced the concept of hiring teams, and even provided interview questions and checklists to highlight how to hire for attitude. If you hire for attitude, you can train for everything else. But we saw practices take their own paradigms into the hiring process and start hiring for resume skills, without concern for attitude. Some were lucky, most were not. Now we ask hiring teams to describe the "emotional attributes" of someone who works in the designated area for which they are hiring, and then we move into "attitude" questions. It seems to make better sense to them. Look at the interrelationships of attitudes and training goals in maintaining the veterinary practice's business model:

Figure 10: Interrelationship of Attitude and Training Goals