The Practice Success Prescription: Team-Based Veterinary Healthcare Delivery by Drs. Leak. Morris Humphries
Thomas E. Catanzaro, DVM, MHA, FACHE, DACHE
Most people formed the methods to get along with professional associates in veterinary practice in their youth, along with many of other basic personality traits. Most families are now considered dysfunctional by the "experts," so we ask, "Where do the dysfunctional family people go when they leave home?" The answer: "To Your Practice!"
Sibling rivalry can turn out to be adult rivalry. Loyal siblings often do not want to compete in the adult world, or the "two partners fight like kids." These conflicts are expected events in the scheme of things, but they need to be kept in perspective.
The veterinary marketplace has developed disposable veterinarians, caused in part by the perceived decreasing work ethic of many of the new graduates. Their wanting a balanced life as an expectation of employment is normal for this Generation-X population, so just accept it as fact. It's also caused partly because of the workaholic traditions of the veterinary profession, which was one man, in a truck, running the roads, twenty-four-seven. We see associates fired, rather than taught, and we see corporate America buying up the practices, so they can hire these "short-term" commitment veterinarians at a competitive salary and keep the ownership profits that veterinarians used to take home on a regular basis. This concept may be applied to the associate veterinarian, the staff, or even the clients, for those who care to think about the changes.
Mending Your Ways
"Competition is inherent in all aspects of life," says Elissa Benedek, past-president of the American Psychiatric Association. "Even nations compete, so it shouldn't be any surprise individuals do also."
According to Harvard psychiatrist Lawrence Hartmann, MD, "Part of the basis of rivalry is the feeling that you are not getting enough from other aspects of your life, work, or the world in general." Conflict, battling, and rivalry are symptoms that must be addressed to find the cause to allow a person to live in greater harmony with self and others.
Many people learned some of the harder lessons in life as a youth, such as people don't always tell the truth, people can be devious, and some people don't mean what they say. These lessons are valuable, but should not taint the partnership. Here are a few skills to develop to help any partnership or professional team to work better:
1. Be honest enough to admit to yourself that some of your feelings toward your partner or teammates are not always generous and caring. Within reason, such feelings can be normal. However, when you experience deep-seated hostility or alienation, you have a problem that must be faced immediately.
2. Try to get to the real reason you and your partner or teammate are on the outs. Is it really because one of you messed up the surgery pack contents, or is it something more important and less obvious? The real insult could have been weeks or months ago. Maybe you can't even remember when you first became angry. Mind-sets can get stuck, regardless of age.
3. Take note of when the rivalries seem most intense. Is any certain person usually around when it happens? Any special recurring time or event? It could be caused by stress from outside the partnership relationship.
4. Look at your own attitude. Have you started to look for nastiness in others' comments or behavior, even when it may not be there? Often the perception of a partner or workmate causes the problem, rather than an actual condition.
5. Be especially careful during times of practice crisis. The most stressful time is when things are in turmoil. It is easier to blame than confront and solve. Stressful times are when regressing to previous bad times can most easily occur.
6. If the problems with a partner are long-term and severe, ask yourself, do you really want to have a better relationship? If so, communication must improve. Make it one-on-one, with no other players, and no other agendas. Ensure you both read Crucial Conversations, by Patterson, et. al., before you come together. Meet in neutral territory. If a better relationship is not desired, maybe a second facility is the answer.
7. Avoid small talk. Do not dwell on the spouse, the kids, the fishing, current events, or the weather. You are meeting to solve a specific problem in your relationship that will affect the health of the practice. Give it the direct attention you would any critical patient.
8. Keep the conversation focused on getting both "stories" on the table before discussing alternatives. Find the common thread, then fill in the holes. Integrate the perceptions and assumptions of the two stories into a common core value that both can respect. The conciliatory purpose of the meeting is to find common ground and build from there. Make it clear that you want to put the differences aside and try for a better relationship. Try to convey genuine good will. It should go a long way towards harmony.
9. Concentrate on each other's feelings. Explain how it felt in the early years, while trying to build the practice. Share real feelings and then ask, "Can you tell me what it was like for you?"
10. Try not to use blaming techniques or sharing the blame percentages. Instead of complaining about what was, try to put the problem into a different perspective. Explain things in terms of the other's strengths and your personal feelings. Lessen the blame, explain your thoughts, and build toward a better tomorrow. You cannot change the course of past events, and your partner will feel less defensive, if you build toward the vision of a "new tomorrow".
11. Assume that your partner or work-mate has an equally good "side of the story." After you get your issues on the table, step back and let your partner have an uninterrupted say. Listen intently, without any negative body language.
12. If the problem is especially serious, find professional help. Partners who avoid issues and hate going to the practice, usually pay the price. Burnout, isolation, or referred family stresses are common symptoms.
13. Live your own life as fully as possible. Develop outside interests that bring feelings of success and self-esteem. Your family and friends will outlive your practice career, so keep the balance in your life.
14. Learn to be tolerant and flexible. Try to overlook a certain amount of antagonism or disagreement. Focus on the positive as much as you can. You don't have to like everything about your workmates or partners, but on the whole, it is important to maintain a decent relationship with them.
15. Above all, remember the positive side of your partnership and practice bonds. It has supported you, during the tough years of building the practice. It has likely been a sustaining emotional support system in the past.
If you can keep the partner and working staff relationships on a caring plane, you may discover that your mental health improves significantly. Close relationships have been found to reduce depression in the later years of life. As the culture of the practice affects everyone within the walls, so does it affect the clients, when they are inside your facility. Close relationships with clients are common for both the Client Relations Specialists and Outpatient Nurse Technicians, and many practices have found the clients to be very perceptive in identifying stress or depression in the team. We have said it many time before, but for one more time: How you treat the staff is how the staff will treat your clients.
Rivalry in Your Staff
As the boss goes, so goes the staff. The best of practices will develop paraprofessional rivalries, sometimes because of practice growth and sometimes because of personal shortcomings. As a general rule, the larger the staff, the more frequent the problems. Along with the above fifteen principles, there are six more for your staff management techniques:
1. Develop a tolerance for the normal jesting that goes on within your staff. structure. Try not to overreact every time they disagree or get steamed at each other. As long as it does not affect patient care or client relations, let your staff learn to work out their own rivalries and petty disagreements.
2. Have a zero tolerance for negative gossip. No coordinator should ever let it start, much less continue. Gossip will build an undercurrent that will drag the practice into the depths of despair, and no one will know why.
3. Don't try to force a good relationship between your staff members. There are always stars on every team. Some practice managers are so anxious to prevent disagreements, they hinder personal growth and development, creating the very problem they try to avoid.
4. Don't foster competition by comparing the accomplishments of one against the other. Be sure to show each staff member that you remember the strengths for which they were hired, and they are valued for themselves. They need to grow compared to themselves, not compared to others.
5. Use "skill level" credentialing to recognize improvement from knowledge and education application. EMT training has defibrillation and IV therapy as two separate advanced skill levels, getting special recognition. Does your practice do similar programs? The dental 1+ prophy skill is a credential level, just as 2+ will be. The 3+ and 4+ are special oral surgery levels of dental hygiene competency.
6. Try to give each staff member what the individual needs. Some need more direction, others need more freedom. Some need steady work, while others want the latitude to create and try new things. Try to respond to their needs on an individual basis.
There is a third level of rivalry, and that pertains to those who were around as you built the practice. Many of these were friends, and some may still be friends, but most were left behind, due to distractions in an already too-busy work schedule. Others from the "old-timers" are now on continual discount, but have no allegiance to the practice and refer no one to you. Why are they still on discount programs? While the above principles are important for fence mending, there are a few more ideas that can be shared.