Office Manager, Practice Manager, or even Hospital Administrator. The difference lies in the commitment, not the job description! - T. Catanzaro, DVM, MHA, FACHE

As a veterinary healthcare administrator, are you concerned about your career success? Do you look forward to expanding your daily responsibilities, moving to a larger veterinary facility that will let you expand your capabilities? Are you an individual who is interested in increasing your own effectiveness right where you are, so you can survive another year? There is probably nothing more interesting to an administrator than to increase one's own capabilities and enhance one's administrative effectiveness. What is effectiveness for a veterinary healthcare professional?

The Prime Thrust

In healthcare, effectiveness resides in the ability to direct the veterinary practice resources, by pinpointing the efforts of the paraprofessional team toward opportunities for significant results. In an administrator's development this approach increases the administrator's personal leverage, allows the responsibilities and accountabilities to expand, and makes the practice an effective veterinary healthcare delivery system in the community.

An effective administrator primarily focuses on opportunities, rather than problems. Crisis management never moved a veterinary practice forward. Secondly, the administrator puts effort into areas that have maximum impact on the effectiveness of the practice. Time is not mis-allocated to "process management". Rather, it is used to make the front door swing, the staff increases their pride, or do quality assurance "spot-checks" on cost benefit assessment of income centers. In veterinary practices across the United States, there has been fundamental confusion between efficiency and effectiveness. A good veterinary healthcare administrator wants to be effective, not just efficient. In medicine, it is called efficacy.

To paraphrase Peter Drucker, the efficient veterinary practice manager focuses on doing things right for the veterinarian, but the effective administrator focuses on doings the right things for the practice. The difference between doing things right and doing the right things is that the right things focus on what can increase the perception of wellness, caring, and service, while increasing the return of investment of time, staff and/or money. There is no need to hang on to sclerotic procedures, habits, or practices, because "This is the way we have always done it around this practice." A good veterinary hospital administrator puts effort where there is a real contribution to the practice, not just be satisfied with activity and people being busy. Rather, to help individuals make something happen for the needed practice results.

An effective healthcare administrator is concerned with the wellness outcomes, such as satisfied clients, proud staff, and net income, CQI by the staff, and individuals being good, rather than just looking good. Administrators understand that the front door must swing for the practice to be a success, that transaction rates are far more important than the value of an average transaction, and the "internal processes" must be fluid enough to promote client returns. Changes are made based on outcome evaluations, not input requirements.

Earmarks of the Downward Spiral

There are many practice-specific indicators of a failing veterinary hospital administrator, and they vary by practice and the practice owner. But there are also a few universal signs to be concerned about:

1.  High turnover of staff. If the veterinary practice is within ten percent of the community "average" for turnover, the practice is in trouble. Veterinary practices should have turnover rates far below the community average, because of the commitment of our teams to a caring profession.

2.  A reactor profile. Someone who lets occurrences, events, crises, and constant problems dissipate his/her time. Sometimes a reactor is concurrently an actor, and the action is masked. If there is a question about reacting to requests and events, evaluate the level of planning that occurs. Assess who is the one who thinks things through. Specifically, who establishes preventive procedures that routinize events, which allows other people to handle the issues in due course. A reactor does not plan objectives, does not set standards of performance ahead of time, nor knows what good work is until they see it! They have not clearly communicated the practice needs or personal expectations.

3.  Demand for conformity. A failing administrator needs emotional support for his/her authority. Disagreement is seen by "managers" as a threat, rather than an opportunity, so autocratic controls are established. Control of the environment becomes a primary goal of a panicked manager, rather than to get a return on the human assets invested. The "manager" is not after performance. That person only wants conformity. Administrators look at the outcomes, not the process conformity. The manager delegates specific task processes, while the administrator clearly defines the expected outcome and lets the team members doing the job decide the process, within limits and operational expectations. Open communication is based on the degree of agreement, disagreement, or opposing viewpoints. Managers label this communication exchange as "disturbing" or "counterproductive", while administrators call it "using the resources of the group". The manager is a person who always shares the blame by assigning it to someone else. The leader accepts accountability for the misadventures and nurtures the team.

4.  A loss of drive and increased absences. One of the things that will most always sink a ship is if the helmsman lets go of the wheel. Someone must steer, and trim the sails when needed. The helmsman must read the sea and prepare for the storm. This cannot be done in absentia, nor can it be done by abdication. It requires appropriate action, and the appropriate time, with the appropriate intensity, for the appropriate outcomes!

5.  Paralysis by analysis. Sometimes it comes from the "imposter syndrome", when someone has been elevated from within. The person feels they are unworthy. The person has the experiential "software" to do the job, but no one has provided the opportunity to access the "hardware" needed to build on solid knowledge. When the person comes from the outside, it is often a "fear of failure". The hardware is there to do the job, but no one has loaded the software needed to respond in this environment. No "system" can work in isolation, and integrating skills and knowledge, bolstered by a positive mental attitude, will pave the way to timely and appropriate value-based decisions.

6.  Lack of mistakes. One of the worst signs for a veterinary practice administrator is to maintain the status quo. This is often caused by the veterinarian(s), but the practice reality is that it decreases initiative, avoids risk, and avoids confrontation. Sometimes it is because no one is willing to risk telling the manager anything. This type person makes all the decisions and does not want new ideas. The staff waits for signals and signs from the manager, before taking "safe" action. It is often manifested by people being really good at "whatever they are told to do", but never volunteering or taking initiative to make improvements.

Signs of a Winner

As with a failing administrator, successful administrators are those who exceed the expectations of the veterinarian/owner. The requirements are highly variable, but again, as with earmarks of the downward spiral, there are some common traits of winners. Please review the text Veterinary Management In Transition: Preparing for the 21st Century for the ten skill areas of an advanced veterinary hospital administrator.

The following are six indicators of a healthy practice attitude that has an upward spiral of "winning ways":

 Accountability. This is not accepting responsibility and authority for delegated tasks. Rather it is a skillful veterinary practice administrator who looks beyond the task and process. This winner assigns outcome-oriented accountabilities that allow every team member to take ownership of some element of practice success. The true leader fully faces failure. Within the team structure, the leader gives credit and takes blame. Every "failure" is a gain in knowledge, and is used to plan a better tomorrow, so it cannot be just failure. It has significant value in the practice improvement process. This CQI concept allows pride to become the individual's input, while the client's perception of quality becomes the output at ninety days (see the VCI® Signature Series Monograph Leadership Action Planner).

 Commitment. A winner commits to excellence. Performance competency is equated with doing the best job possible. Performance appraisals are based on a single standard of achievement for competency (excellence). Gone are the days of fair-good-very good-excellent-outstanding. A single standard of performance is established for the task, not the individual. Appraisals are used to drive additional training at the individual level. The veterinary practice's administrator accepts the commitment to ensure each team member is offered the opportunity to train to a level of competency that sets the standard for the profession in ninety days (see the VCI® Signature Series Monograph Standards of Care in Bond-centered Practices).

 Performance planning. Hospital zones have coordinators, who ensure the needed resources are available, and concurrently ensure training needs are identified. They are facilitators of excellence. Planning requires a clear task definition, a realistic inventory of resources, a mentor to help brainstorm alternatives, a "coordinator" to help plans A and B get written, and a well-informed implementation team. The planning includes expected outcomes, and they are evaluated to determine success. On a quarterly basis, individuals do their own "performance planning" for what they want to accomplish in the next ninety days, and then evaluate how well they did in achieving their target actions during the past ninety days (see the VCI® Signature Series Monograph Performance Planning & Goal Setting).

 Time management. The effective veterinary facility administrator allocates time by investing it, rather than spending it. They know what an hour of time is worth to the veterinarian, to him/herself, and even to staff members. They accept the fact that time does not stretch or shrink, and the skilled administrator sees time management as simply scheduling events in a more effective manner. Overtime is well controlled and space is utilized by plan, not by tradition or chance. When time becomes dissipated by process, poor planning, inadequate space utilization, or crisis management, the performance of the administrator and staff is also dissipated. The skilled administrator understands there is a fourfold payback for training/planning time. One hour of planning saves at least four hours of mistakes and corrections

 Guts to cut. A competent and confident veterinary practice administrator should have the courage to amputate those activities, non-contributing projects and processes that dissipate time, that waste resources or frustrate the clients. There is nothing that will kill a career or personal effectiveness more than practice appendages that sap strength. This is the role of the administrative surgeon: to cut wide, deep, and early to remove the cancer that can eat the practice from the inside. To stop people from doing things they are attached to, whether it is veterinarian or staff, requires a calculated and caring process of information sharing, negotiating slowly to form discomfort with the habit, then to offer the alternative(s) that could solve the habit-based problem. These are the traits of an effective veterinary practice administrator (see the VCI® Signature Series Monograph Profit Center Management).

 Knowledge development. In a winning practice, the quest for knowledge is continual at all levels, for all staff and doctors. Continuing education is a quest by staff and doctors alike, both from regular in-service experiences and special outside experiences. On-line learning and advanced degrees are sought. The administrator is setting the example by earning a CVPM, or an advanced degree to allow board certification, and they promote every staff member to have a distance learning event occurring most every quarter. The quest for excellence is not based on yesterday, it is based on tomorrow (see the VCI® Signature Series Monograph Strategic Assessment & Strategic Response).