The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
Empowerment of Outcome or Process?
Now, please be careful. Each member of any practice team is empowered at some level of healthcare delivery, and in some practices it has been centered on "turning the crank," while in others it has developed decision makers who allow the doctors to spend more time in medicine and surgery. A "manager" tends to empower getting the process done, while a "leader" empowers people to achieve the outcome.
Managers get work done through people
Leaders develop people through work.
The most common veterinary syndrome has been when no one seems willing to take the risk of doctor alienation. Everyone just wants to be told the process they are supposed to do. This is often called "other duties as assigned", and then they just wait to be told what to do, and abdicate accountability for outcomes.
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Fact #1 |
Staff members have been taught that they are not independent, and in fact, they feel they are not trusted to think or stretch outside the established process. This is why leaders must start with sharing the "WHY" of the vision. |
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Fact #2 |
Staff need information, and when that information has always been closely held, even when establishing fees, they just wait. Leaders need to get the team to rise to a new level and revive the thought process. But like a trek up the mountains, it is one step at a time. And the steps do not stop the progress, it is the grain of sand in the shoe that causes people to quit their trek, those small, aggravating, distractions, those small fears that are enlarged, when they are hit with a lightening bolt from a doctor.
 First concept: Most all veterinary practices have good, caring, dedicated people, and they have the power and knowledge within themselves. A leader's job is to let this power out and put the light of leadership approval on their efforts.
Second concept: Leaders need to promote autonomy, but there must be limits placed on the team's autonomy. Limits are like river banks. They are needed to make the river move in the right direction. Without limits, a river is either a swamp or puddle. What is the "motive" to do this?
M = Mission focus, the client-centered patient advocacy.
O = Organizational systems, the transition plan "what".
T = Team roles, the transition plan "who".
I = Image, that self-esteem and pride, plus regular recognition, by the boss.
V = Values, the inviolate beliefs, standards of care, safety to staff.
E = Excellence in competency, CQI, learning, and organization.
Third concept: Image only comes when each person sees that his or her contribution is making a difference. Empowerment requires the leader to teach each person things he or she can do to become less dependent on directed process. Every mistake is an opportunity to increase competency. The secret is in the question, not in the answer. Give them the resources and information, then only ask questions to get them to offer two "yes" options. If both are equally good, ask an integration question and tell them to "have at it". Each issue helps them become more of a self-directed operational team. The freedom to act carries with it accountability for ensuring the outcomes. Pride is seen, when they exceed expectations, so ensure you start with small wins! |
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Fact #3 |
Leadership changes must have a beginning, and the trek will be at least a year. When hiking the Rockies, there is acclimatization at three days, three weeks, and again at three months. The staff members need a leader's endorsement early in the process, so they know what course is expected by the leadership, and they need to know who is heading each operational team. Three weeks into the process of empowerment, they need individualized recognition and follow-up support, so they know the new issue/system will not be forgotten. At three months, new programs will be seen as better alternatives, or they will be tweaked to become better. The appendices and leadership skills in Building the Successful Veterinary Practice: Leadership Tools will all come into play. |
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Fact #4 |
A leader sees the vision of what can be, and must keep it in focus for all others. The clarity of a self-directed team means a leader cannot go back, the team can only go forward. An empowered team must become accountable for independent thought from the information a leader provides (outcome and limits), and responsible for implementing the plan of action needed to achieve the desired outcome(s). The trek will be a celebration of small wins, and the true leaders must lead the cheering section. |
Hopefully, the first part of this helped you realize the importance of putting first things first, and how to utilize the people within your sphere of influence to capitalize on the opportunities and changing community environment.
This must be mediated by reviewing the experiences of other healthcare community industries.
This must be responsive to community growth patterns, mores, and public policy issues.
You must know your own numbers, and translate them into "programs".
Programs for the welfare of the patients, or improved client service, become rally points for most staff members. Dollar sign rally points are most often a turn-off, but that does not mean they do not want to earn a living wage, and they rarely can connect that one follows the other.
You must define the key elements required to achieve better results, in terms that the staff can impact on a daily basis.
You must have written practice/business goals that are reviewed monthly and adjusted quarterly.
You must resist the Ordeal of Sisyphus! Sure, this was Greek mythology about a shrewd and greedy king of Corinth, who was doomed forever in Hades, to roll uphill a heavy boulder that always rolled down again. But it sure sounds like veterinary medicine to me! Veterinarians have bemoaned the lower income levels, but have not changed their practice habits. Most veterinarians perceive themselves to be entrepreneurs in their own business, but seek analytical perfection before initiating a major change. These same practices continually add small projects to tweak their systems, and in turn, lose focus on the long-term goals. Job satisfaction decreases when the outcome measurement of success keeps changing daily. The definition of insanity, as shared earlier, is, "Doing the same thing again and again, and expecting different results each time."
We can get control of the Ordeal of Sisyphus, and there are alternatives. Yes, it is a difficult soul-searching process, there is a need for speed, and it is hard making the tough choices. Remember, that while technology changes, core strategies do not need to change. And while communities are always changing, well-developed, long-term strategies do not need to change. But to break the habits, five "or-put" elements are critical in the strategic assessment process:
Organize the time commitments to make it happen.
Refocus on the practice strengths for process and approach.
Pay attention to the roles and structure.
Use the best information available.
Trace results and reward new performance.
Why "OR-PUT", as in "or put yourself back into the same problems you have always had!"? As Tom Catanzaro, DVM, MHA, FACHE, has printed on his business card, "Whether you think you can, or whether you think you can't, YOU will make it come true." It is a matter of personal commitment to excellence and change. This does not mean that strategic assessment is as easy as saying it will be done. There is a series of problems within the process and approach that often cause poor outcomes, and they include:
Inappropriate goals.
Barriers of past paradigms.
Risk aversion.
Inadequate data.
Isolation from decision makers.
Lack of personal fortitude.
Poor communications.
False consensus.
Lack of monitoring.
Wheel spinning.
Self-befuddlement.
Analysis paralysis.
Poor facilitators.
This is a learning process, and it provides insight at the personal and organizational level. The process must begin with the end in mind, as in core values are inviolate, mission focus is clear, market niche is desired, etc. To this end, we have developed the VCI® Signature Series Monograph Strategic Response and Practice Positioning, available at www.drtomcat.com.