Entering the New Playing Field

In 1987, Tom Peters wrote Thriving on Chaos: Handbook for a Management Revolution, and in 1989, Richardo Semelar wrote "Managing Without Managers" in the Harvard Business Review (Sept-Oct, 1989, pp.76-84). Yet, we saw articles like "Changing the Role of Top Management: Beyond Structure to Processes", published in the Harvard Business Review (Jan-Feb 1995, pp. 86-96), as if we didn't take the hint during the previous decade.

The fact is, in veterinary medicine the superstores and corporate practices are moving into the neighborhood, because no one was willing to change the practice culture to meet the emerging client needs. The chaos created by this change in delivery modalities can be controlled, but not prevented, especially if practices are willing to cause their own chaos in their community's veterinary healthcare delivery systems.

Tom Peters said, in a 2003 interview, "I was among the worst in believing the limitlessness of it all (E-commerce, reinvent everything, the power of the WEB). Living in Silicon Valley, I bought the act. We're going to have crazier times than even the crazy times we've been through. People who can move fast will excel . . . the first of the eight principles in the "Search of Excellence" was a bias for action; we know that is still true today, only more so!"

The modern veterinary practice will be based on a triad formed by the healthcare provider, the staff, and the client as royalty. Words such as "competitive", "robust", "patient advocate", "fast", "dominant", "flexible", "adaptable", "fun", "innovative", and "caring" will be used to describe the winners. Pressures such as alternative providers, the knowledge explosion, litigation, resource scarcity, competitors, market changes, regulations, cost of technology, and uncertainty will cause five key leadership areas to emerge before the end of this decade:

 Client focus: Easy access, rapid SCR, decreased costs, increased quality factors, remove the negatives, add to the value perceived, friendly facilities, greater market service, addressing wants, and meeting needs.

 Systems controlled: Redesign jobs, re-engineer functions, streamline cycle time, lead the benchmarks, brass-tack toughness to values and vision, solid measurements for outcome expectations, and success celebrations.

 Associate empowerment Hired doctors and staff unilaterally serve the client and improve the system, increase training and nurturing for individuals and teams, respect-recognition responsibility, increase utilization and freedom.

 Uncommonly led: Grow the PCA, fit the organization to the users and doers, listen to clients and staff, believe in innovation and creativity, get results and ideas rather than just status, and "just do it" (JDI) become the requirements.

 Values driven: Effervescent culture and vision, kill problems, rather than ideas, fun and celebration, bias for action and JDI, creative chaos, increase speed and adaptability, decrease barriers to change and innovation.

The real secret of empowerment is to simply get off the back of the staff. Stop undermining the team. Take down the "electric fences" caused by the, "Why did you do THAT?" questions and the "We never did it that way!" statements. Put into place the B-HAGs (Big Hairy Audacious Goals). A "Do It" project for any B-HAG has thirty days to get solved. Warp speed is real in change management. (See the format provided in Building the Successful Veterinary Practice: Innovation & Creativity.)

If a problem can't be solved in thirty days, it is redefined into smaller pieces, which can be. The minimum "idea goal" for any veterinary practice that desires to excel in this decade needs to be one B-HAG for every staff member every quarter, with a seventy-five percent staff participation annually. In the first year of the process, the B-HAG goal needs to include monthly ideas, and the staff participation needs to be seventy-five percent quarterly. A fast scale-up is required to be successful.

The "intellectual capital" of a practice team is an "intangible asset", but like a force field, it is real. Just because we have poor management systems does not mean that there is no value. Citibank^® has estimated its "intellectual capital" to be three to four times the book value of its business.

Remember Mother Nature? Look to her for the secrets of innovation and creativity. Human intelligence is not located in a specific part of the brain. It emerges with neural conversation, millions of messages expending energy to get a thought. If we expand the concept, then organizational intelligence would be the result of staff and client conversation. Who's got the brain power?

Staff Relations and Recognitions

Our staff is one of the few resources on which a veterinary practice manager, or the coordinator of coordinators, has any influence on a day-to-day basis. They represent a high, semi-fixed cost, but provide the greatest practice management variable on profit. Veterinarians can produce the "gross", but it takes a great paraprofessional team to produce the "net". We cannot really make clients enter our doors on the schedule we prefer, nor can we control the economy, inflation, or even the fees our competitors charge. We have some control over animals in our facility, but the client still gets to select the scope of services provided. Our staff is important to our success, and this one fact makes the human resources of a veterinary practice our primary concern. In the new American Veterinary Practice, most everyone hits a "wall" in management and leadership at some time during the growth cycle or in the change cycle, since no one every taught these skills to the practice owners.

Gain-sharing (profit sharing) is not sharing gross as an increase over the past year, as expenses change, too. We promote a monthly celebration based on exceeding the program-based budget, not expense-based. See the dinner bell chart, explained in the VCI® Signature Series monograph Profit Center Management. We also promote a quarterly cash profit sharing, first explained in Chapter 4, Building The Successful Veterinary Practice: Programs & Procedures, and then further developed in the VCI® Signature Series Monograph Profit Center Management.

This quarterly program is based on a fixed percentage of gross sales being guaranteed to the staff on a quarterly basis, when the staff assumes the role of tracking, and entering for invoicing, all workload done for all patients. The practice team stops missing charges, since a percentage of all sales is the staff's compensation.

Gain-sharing is not paying to work harder. It is based on team-based healthcare delivery, staff leveraging the doctor's time, and recognizing those who produce the real net, the staff members. When the doctors return to their key functions, diagnosing, prescribing, and doing surgery, the staff assumes all other facility functions and increases productivity per doctor, as well as practice compliance to the inviolate core values, consistent standards of care, and pursuit of the mission focus in every program being offered.