Now that you have read about leadership, dreamed about an easier way of running a practice, being a volunteer, or working within a civic group, and, maybe, have even started to dabble in using the leadership skills, how do you know that you have achieved some level of proficiency? In veterinary medicine, insanity is most often defined as doing the same thing over-and-over, and expecting different results on the subsequent tries. For the culture to have changed, the paradigms of the practice must have shifted, and the old responsibilities for process had to be redefined as outcome accountabilities, with delegated authority to make it better. Standards of performance have been shifted from process to continuous quality improvement (CQI) of expected outcomes.

Paradigm Shift starts with believing A² = G²
If you Always do what you have Always done, you are going to Get what you have always Got!

Adult learning occurs at teachable moments. And, believe it or not, that is who works in a veterinary practice: those people we call "caring adults". Remember our reference to "Effective Teaching", Building the Successful Veterinary Practice: Leadership Tools, and the VCI® Signature Series Monograph Leadership Principles & Skills? The culture must embrace the "Five Disciplines" for innovation and creativity to occur from the training:

 Systems thinking: A veterinary practice is an entity, just like a patient on a consultation room table, and as such, has multiple systems operating concurrently to keep it well and prosperous.

 Core values and vision: A leader shares these factors as inviolate "safe haven" boundaries, where decisions can be made without regard to preexisting bias and paradigms.

 Participative process: A leader ensures the principles of evaluation are at the forefront of all projects, and while the leadership defines the "what", explains the "why", and jointly negotiates the "who" and "when", it is the well-trained and trusted staff doing the project(s) or program(s) who determine the best "how".

 Attitude of personal mastery: When "training to trust", the indicator of excellence is the self-belief in personal mastery.

 Mental models: To leave what is comfortable, often that fur-lined rut, there must be a clear picture developed in everyone's mind of the better life available after the changes are made.

Concurrently, operating and healthy systems, working together for the whole, are how living organisms survive. In veterinary medicine, we have seen such linear thinkers for so long. With our approach to "management gimmicks", we have almost forgotten that a practice is a living and evolving entity, and all the systems must be functioning well together. The above five disciplines have been defined as a "change model" in some of our VCI® references: Change = D x P x M < costs.

 Change = new outcomes.

 D = dissatisfaction becoming desire for something else.

 P = participative process, so all are involved.

 M = mental model of where we could be.

 < Costs = fiscal, mental, and social.

So now is the time to look closely at the operational structure of your practice. This diagram was first published as Figure 1.3, Building The Successful Veterinary Practice: Innovation & Creativity:

Figure 8. Operational Structure of a Practice

The above is "held in place" in the traditional practice by a vast number of job descriptions, checklists, standard operating procedures, staff manuals, and other procedural documents. Process is so well established that evolutionary change cannot occur, and independent thought for continuous quality improvement (CQI) is almost always greeted as operational heresy. The real disappointment in the traditional model is that the number of reading pages increases, as you get farther way from the most educated people, until it becomes overwhelming at the lower levels of the practice organization, as in the above staffing model. In most veterinary practices, the inverse is also true. The higher the organizational level, the less "expectations for consistency" exist.

The new American Veterinary Practice requires a new leadership model, and has embraced a completely different approach and appearance to its organizational structure. This was discussed in great detail in Chapter 1, Building The Successful Veterinary Practice: Programs & Procedures, and Chapter 1, Building The Successful Veterinary Practice: Innovation & Creativity.

We now begin to see the use of new empowerment phrases and operational concepts such as:

 Coordinators: Key staff members, who work in the trenches and ensure resources are available for others in that practice zone.

 Problem-Change-Activities (PCA): Where the zone team initiates actions before a challenge is perceived by the clients or leadership.

 SCR: Service-client-response, as shown in the VCI® Signature Series Monograph Models and Methods That Driving Breakthrough Performance.

 JDI: Just Do It! An attitudinal bias for action.

 CQI: Continuous quality improvement at the individual's level.

Figure 9. Healthcare Delilvery Model

The above practice model is scary to the casual observer. It has no "chain of command". It is a healthcare delivery model, where every provider is trained to a level of competency (excellence), so each can operate independently with client-centered patient advocacy, rather than the doctor-centered, "Let me go ask" scenario.

Chapter 1, "Evolving Perspectives of Veterinary Practice", Building The Successful Veterinary Practice: Innovation & Creativity, provides substantial discussion on this entire concept. For larger or multi-doctor practices, Veterinary Management in Transition: Preparing for the 21st Century provides the additional insights needed to embrace these evolutionary delivery systems.

None of the fourteen skills, dozen traits, twelve principles, five systems, or even four indicators listed in Building The Successful Veterinary Practice: Leadership Tools could be done alone. All require a group to become reality. The major success effort at 3M has always been centered on what they call their eleventh commandment: Never Kill An Idea. The practice group will form into a team, when certain operational questions can be answered truthfully and consistently by the leader. Below is just a starting point of specific questions to ask yourself:

 What excites me today?

 When I turn around, who is following my lead?

 What can I do today to improve myself?

 my practice?

 my relationships?

 my community?

 What do I have to be grateful for today?

 Who loves me, and whom do I love?

 What do our clients perceive?

 What are our hospital's strengths?

 What are the three objectives for today?

 this week?

 this month?

 this quarter?

 this year?

 What have I done to help someone else personally grow today?

These questions lead to discoveries that the fourteen leadership skills can impact. The leadership skills can be learned, and they can be applied within any veterinary practice. Sometimes an outside facilitator may be needed to overcome the traditional paradigms, as well as show the new paths available. The secret during application is that each skill must be applied at the appropriate time, for the benefit of the group and the practice. They must be used as a set of true inner beliefs (values) and operational concepts, not individual "quick fixes" to meet the crisis of the moment. When used as the tenets that set the leadership tone, they are the foundation of team building. A team is the strongest force possible in veterinary healthcare delivery.

When it is all said and done, there are but only two objectives of veterinary practice leadership:1) accomplish the practice mission, and 2) ensure the welfare of the people on the team. - Dr. Cat

Each of us has a choice in life, and we may approach it as:
A creator or a critic
A builder or a watcher
A lover or a hate
A giver or a taker
Now, The Choice is Yours. Now Just Do It!