The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
As one begins to see oneself in a new light, perspiration from life experiences is often replaced by motivation to change from one's inner strengths. If there is not discomfort with where you are, change will not occur!
C = D x P x M < costs
or, in longhand,
Change = Discomfort/desire x Participative process x Modern model
The above formula has one last factor," less than the cost to change", which mathematically does not fit in an equation. But veterinary medicine is an art, as well as a science, as is human resource management.
Some people decide the "emotional cost" of change is too expensive, and build a very nice "fur-lined rut", which gives them a real nice, comfortable view through their "glass ceiling".
Some people decide the fiscal costs of change are too expensive, and build a very nice "fur-lined rut" in too small a facility, which gives them a real nice, comfortable view through their "glass ceiling".
The text Veterinary Management in Transition, Preparing for the 21st Century, published in 2000, has eleven self-assessment tools to monitor your own ability to change and adapt to a new staff-based environment. The text Building The Successful Veterinary Practice: Innovation & Creativity has both a trainer's motivation-style profile and a series of team creativity exercises to help with staff motivation and assuming the new free-thought process.
The above formula has one inviolate factor that many people miss. It is a multiplication formula. If any one factor is zero, the change effect will be zero. This is what happens with most all "gimmick management" type changes. One "great idea" from some conference is brought home, inserted into the practice flow, and within a month it has been forgotten. This gives rise to the veterinary mantra, "We tried that once, and it did not work." Well, DUH!
To be what we are, and to become what we are capable of becoming, is the only true success of life. - Robert Louis Stevenson
While "horse sense" is often stated to be the sense horses have to not to bet on people, as leaders we must learn to bet on people. That is why it is smarter to hire for attitude and train for the skills than it is to hire for skills and try to develop the attitude. No perfection of techniques will substitute for the lift of spirit and heightened performance that comes with improved motivation. The world is moved by highly motivated people, by enthusiasts, by men and women who want something very much, or believe in the adventure of life.
When building a team, there are fourteen basic leadership skills. There are three group forming skills:
Know and use the resources of the group.
Effective communication.
Understanding the characteristics and needs.
Two transitional skills:
Reflection, which is the balance between the group and the individual.
Representing the group, which means to the leadership and from the leadership.
Three basic group skills:
Effective teaching.
Planning.
Evaluation.
These skills can be taught, and they can be learned, but it takes time. They also must be integrated into everything a practice does to make them come alive to the staff. Team building does not replace the practice's mission, and it does not detract from the practice's business. It must enhance both. If team building causes chaos, that is to be expected during the new group development activities. It is called "storming" in group development, another of the fourteen basic leadership skills. Once started, a practice leadership cannot revert from team building, otherwise the staff loses its focus.
The inviolate core values must support the practice's effort to complete the mission focus, along with client-centered service and patient advocacy, and these tenets are expressed in the uniform standards of care in healthcare delivery expectations. These factors must stay in front of the healthcare team every step of the way.
Sure, every practice owner has a vision, though sometimes it is not expressed in a manner that inspires the soul of staff members. And we hope there are inviolate core values for intermediate managers and coordinators to depend on, though many times the owner makes an exception, not realizing what it does to the staff's confidence in the leadership. The staff knows they must support the practice's effort to complete the mission, with a common mission focus on each element of the tasks at hand, though again, owners and doctors make exceptions, putting the staff in a bad light in the client's eyes. That is why there are also four advanced group leadership skills, as well as two inviolate behavior-based skills, in the fourteen basic leadership skills listed in the VCI® Signature Series Monograph Leadership Action Planner:
Internal promotion, which is persuasive marketing.
Situational leadership, which is styles of leadership.
Group development, which involves morale and skill factors.
Personal relationships, the mandate for team harmony.
And two basic inviolate behavior-based skills for all practice leaders:
Set the example.
Continuous quality improvement (CQI).
Ambition should be so powerful a passion in the human heart, that however high we reach, we are never satisfied. - Machiavelli
When we speak of professional ambition, we're not talking about the old concept of ambition. Ambition in the traditional sense wears out with time and frustrations. Sometimes we call it "burn-out". But a zest for life and personal growth can continue until the last day of your life. Most humans cannot achieve the complacency of the Darwinian barnacles. People are worriers and puzzlers. They want meaning in their lives. As Robert Louis Stevenson said, "Old or young, we're on our last cruise."
Today you can't count on the traditional patterns of life. Meaning in one's life is built from the past, from the present, and from the dreams of what can be. There is only one person who can put it together: you. And it is based on your specific talents, your love, and the values for which you are willing to make sacrifices. Keep a sense of curiosity, discover new things, care, risk failure, reach out, or in short, be interested. Seek a life with dignity, pride, and meaning.
Those that apply themselves too closely to little things often become incapable of great things. - Francois Duc de La
As I mentioned back in Chapter One, the text Building The Successful Veterinary Practice: Programs & Procedures was actually the first text we wrote for our clients. The consulting team advised me we used a lot of "team" expectations, so we better write some type of leadership text, which became Volume 1, and the volume to precede the nuts and bolts text, which became Volume 2. After we had Volumes 1 and 2, it was obvious that some staff had taken the bit into their teeth and really wanted to run with the what they had started. So we wrote Volume 3 to make innovation and creativity acceptable in daily operations.
Volume 2 provides an overview of the "New American Veterinary Practice" in Chapter 1, then builds the client image for the front desk staff in Chapter 2, and continues with our single most important continuity of care factor, the medical records, in Chapter 3. In Chapter 4 we introduce "Program-based Budgeting". Chapter 5 has "Internal Promotions", and Chapter 6 provides the basis for performance planning, not appraisals. Chapter 7 is the vision and belief needed by practice owners to set the leadership principles of Volume 1 into play. There are also appendices that support these chapters, with forms and formats. Some are available in the VCI® Signature Series Monographs, since the material lends itself to CD-driven formats for the do-it-yourself practice:
Client Relations (Volume 2, Chapter 2).
Medical Records for Quality & Profit (CD; Volume 2, Chapter 3, form formats).
Fundamentals of Money Management (CD; Volume 2, Chapter 4, chart of accounts).
Profit Center Management (CD; Volume 2, Chapter 4, management charts).
Tips & Tricks for Marketing (Volume 2, Chapter 5, persuasive marketing).
Performance Planning (Volume 2, Chapter 6, individual planning forms).
Leadership Action Planner (Volume 2, Chapter 7, and Volume 1, leadership planning tools).
Actually, the text Veterinary Healthcare Services: Options in Delivery was written by the Veterinary Consulting International team clinicians to expand the programs in Building The Successful Veterinary Practice: Programs & Procedures. This provided the using practices more alternatives to where they might want to start, or how far they may want to go, in this quest for new programs.
Now, on to Part 2 of the true story we began further back.
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A True Story: Part 2
The ninety-four-hundred-square-foot hospital was dysfunctional, the staff was unhappy, and the owner was stressed. That is why he called Catanzaro & Associates, Inc., into his world for a consult. With three doctors and fifty staff, a practice manager, and an office manager, most would think it would be a nice doctor-to-staff ratio, and easily controlled with all the wall fenestrations. Nothing could be further from the truth.
This was one of the most doctor-centered practices ever encountered. The owner described his "perfect practice", where everybody saw clients and patients and referred him just the interesting cases. In fact, he would always pull staff in his wake. He respected no one, or the job they were trying to do. If he wanted someone, he pulled the person into his delivery team. He was the true black hole, sucking the people and patients into his void, and no longer had sufficient time to do decent diagnostics. This doctor-owner would come in at 5:00 a.m. to start surgery, and expected his surgery team to be there by 4:00 a.m. He would cut beyond the beginning of appointments, so the day started out "late". At least one client walked out every day, because they could not wait any longer. Only forty percent of his patients had returned in the past twelve months. He did not know it, and when we informed him, he made an excuse for that loss rate.
When told his behavior was the major cause of staff disharmony, he made an excuse. When we showed him the money he was losing by discounts, which was over $200,000 in the past year, he made an excuse. When we showed him the resource drain caused by the practice manager operating a "no cost" cat spay/neuter clinic and adoption service from his practice, he made an excuse. When we showed him the inventory problems caused by his wife, who never was in the practice, taking three days to find "best price", he made an excuse. When we shared these same observations with the practice manager, a twelve-year tenured colleague, she made excuses. He had created a "mini-me" of conflict avoidance in his manager, so he never had to hear a discouraging word nor the truth.
This is a great example of past-tense thinking. This was a successful practice in most people's minds, because they look at the gross, but it was not fun, it was not rewarding, and he called us in for diagnostic assistance. He made no time to listen during our initial, four-day, on-site visit. After the last day, he asked to join us for drinks after 8:00 p.m., when he was getting off of work. His question, would I guarantee success, and my answer was a blunt, "No, if you do not change your ways!" If he could not leave his doctor-centered, self-centered approach to practice operations, and change his own past-tense habits, he was condemned to repeat the past, not improve, nor prosper in the future. |
He who speaks the truth, must have one foot in the stirrup.