George M. Cohan brought a flutter to the heart as he sang "It's a grand old flag," and you can do it for your practice. You must build the emotions of support, which require sharing personal beliefs and a personal commitment to the staff and their goals. It requires stretching beyond personal comfort zones, and taking off your shoes before you try walking in their shoes.

As a backpacker, I can tell you, it is not the height of the mountain, but rather, the grain of sand in your shoe, that prevents the successful assent. Since the practice leader is the key to success, here are a half dozen factors that you need to do. "Taking off your shoes" is not always the easiest thing to do. To make success happen, establish the core values as inviolate standards, and then:

 You must understand that the needs of staff members, and not their wants, must be met before they will be dedicated to meeting the demands you have for the practice.

 You must accept that the needs of the individual and the needs of the group are not always in harmony. As a leader, you must be willing to continually restore balance, rather than ignore either aspect.

 You must find what excites each person, their "hot buttons", and what each person wants to achieve, plus how each wants to contribute to the practice.

 You hire for attitude. Every team member has attributes that seemed impressive, when hired, so you also need to tailor your staff utilization plan to the attributes of the team members. Allow them to build on their own strengths, and assume accountability as they develop competencies and apply their attributes to outcome performance(s).

 B-HAGS (Big Hairy Audacious Goals) are okay, but you must be willing to build on small, easy successes before you attempt those big challenges. Use baby steps for those who like the comfort of the status quo.

 You must be willing to commit resources, including dedicated training time, to build their individual self-image before they will buy into saluting the practice standards and philosophical "flag".

Setting the Vision

The vision for the team becomes a major reason for them to rally. We go beyond client-centered, when we empower our staff to operate independently. Authors like Deming, Juran, or Crosby have used the phrase Total Quality Management (TQM), but in healthcare delivery that becomes a misnomer. It isn't a management system, it is a provider-driven process. It is a caring and patient-directed process for each member on the healthcare delivery team, striving for continuous quality improvement in the areas each touches.

The concept of CQI is not unique to veterinary medicine. It has been taking hold in the human healthcare arena for the past two decades. There are even standards of care based on CQI that exist at every level of the human healthcare delivery system. CQI is based on core values, pride in performance, and clear expectations by management. When pride is the input desired, then quality becomes the output. If the practice builds the team and promotes the personal accountability (pride) as key elements of performance, then the quality outcome is free.

There are many reasons to build a team "flag" and to pursue CQI, but the bottom line is that it rewards our staff. It is a factor to increase net, and the net can be shared with the team, but the recognition and pride in personal performance becomes a stabilizing factor in the work force. With the low wages veterinarians usually pay, and the dedication of the staff who join the team, the ability to reward and recognize makes the difference between turnover and tenure. Look to your practice image, internally and externally, and see if it is something others can rally around.

Both clients and staff want to believe in the quality of care, and want to feel safe about the expectations they carry, concerning the practice. Build to that level of consistency and CQI, and the staff will be proud to represent the practice. When the staff is proud, the clients become proud. When the clients become proud, the market niche will develop within your community.

Are You an Effective Team Member?

"The team effort is a lot of people doing what I say. NOT!"

We often hear about the importance of being a good team player, but the term seems to be a cliché, since we rarely hear the qualities of a good team player defined. The analogy to sport activities is only a start, but don't get confused. Seldom does a sport involve life and death decisions. Rarely does overtime start after eight hours of demanding effort, or even the ten to twelve-hour push days, and there is no free substitution, when someone is having a "bad day". In veterinary practice, it is not a game, and you are accountable for the outcome of each event, not just a position. So let's take a look at what the experts in business relations identify as the qualities of a good team player.

1.  A willingness to sacrifice for the benefit of the team. For a healthcare team to be successful, the personalities must merge into one working unit. Yes, it is the doctor's license on the line, but seldom is this an issue. Staff harmony, patient care, and a client-centered focus are the primary issues. The emphasis is not one individual's recognition, when you are part of a healthcare team, and that is the way it should be. An exception may be when you have a specialist in the group, a "surgeon mentality", especially if it brings the clients because of a "name". If you are a good team player, lack of personal recognition or a star specialist won't bother you. You will be happy to bask in the glory of the practice and in the recognition the entire team gets in doing a job well.

2.  A willingness to let the team leader lead. This may sound unusual, but many practices hinder the middle managers by restricting their leadership latitude, from either the top down or the bottom up. You should be willing to let the team leader guide the group (we called them coordinators in Chapter Six). If you absolutely cannot work for a team leader, say so at the onset and be ready to work elsewhere. Just as you were chosen for your special skills, the team leader was identified for an attitude and skills the management thought were appropriate. When the management has decided to trust an individual with directing the team, or part of the team, your choice is to support that leader and outwardly support that person one hundred percent.

3.  The ability to contribute your best as a team member. It is not uncommon to hear people say they can do it better or faster themselves, or that it could be done more effectively if they were left alone. However, these are not the attitudes that build a team. Maybe you have always been a "loner" and don't work well as part of a team. If this is the case, get out of veterinary healthcare delivery as soon as possible. The systems are already changing. When you join a veterinary healthcare delivery team, even under protest, you must contribute your best efforts. You were hired for an expertise that will help the team, provide better patient care, or keep clients coming back to the practice. Do your best to make all three occur. If you are going to be in conflict with the team leader, then ensure the practice's directing veterinarian has sanctioned the split away from the principles in #2 above.

4.  A spirit of compromise. Teams usually make decisions by consensus, when they are not healthcare-directed by the attending veterinarian. Everyone needs to be allowed to speak one's mind before the final decision is made. Good leaders ensure this happens with regularity. Once the decision is final, it is your obligation, as a team member and individual, to support it fully, in public and within the team. Usually, serving on a practice team means abiding by its decisions, and to arrive at those decisions usually means you must be able to compromise.

5.  A willingness to try something new. Good team members are like the early explorers. They are always looking for something new, those unknown horizons against which to test their skills. The old ways may be quite good and logical, but that does not mean there isn't room for improvement. The times and clients change. Therefore, CQI needs to be the rule. The best team members keep an open mind, and give their best effort willingly, when trying the new ideas or programs.

6.  The ability to see things clearly and to solve problems easily. Teams are often assembled without any attention to fit. In most practices, each person was hired for a set of skills, experience, or expertise, then thrown into the practice group. When a vexing problem needs to be tackled, one too complicated to be solved by an individual, identifying the problem in a clear manner is important. This means multiple brains address the issue from many perspectives. If you can accurately define the problem, it is half solved. Cultivate a balance and neutral problem-solving ability, and you will be asked for your opinion frequently.

Putting It Together

The above six qualities assume one thing: that each team member has developed good listening skills. Listening requires effort, and in most practices it does not occur. The conversation goes something like this:

"Do you have trouble hearing?" asked the doctor of a new receptionist who sat at her station.
"No, Doc," replied the receptionist, "I have trouble listening, just like you."

Since decisions are often made in secret, the inactivity of the staff is an outward manifestation of the doctor's "assumption" that everyone will understand intuitively why things are the way they are. We consult with practices that say they want a team, and we get them to delegate, but the boss never listens to the staff members. Or worse, they only allow the staff members to see "the tips of icebergs" and do not trust enough to let them hear "the rest of the story". Funny thing, most Americans are like this: independent and private. They hear, but they don't listen. The ability to listen is not an inborn trait. It takes a conscious effort to do it well. Successful team members are first listeners, and listeners are people who:

 Listen intently. Their minds do not wander. They concentrate on what the other person says. They hear the question behind the question, and the concerns behind the statements.

 Repress their own egos. They do not interrupt, nor do they formulate a response. They concentrate on what feelings are conveyed and try to understand that the other person is speaking out because they care about the practice.

 Are patient. Nothing is more annoying than a person who has no patience to hear you out. They interrupt and redefine the issues being discussed, rather than address the problems from the perspective of the team member speaking.

 Are concerned. They care about what the other person says, because they care about the person. The desire for team harmony and cooperation is more important than the "secrets" of the practice business.

 Hear the caring intentions. They accept the basic fact that no one is out to destroy the practice, and each comment and suggestion comes from someone who is really trying to help.

 Even when they disagree, they never make the other wrong. Concepts and suggestions are well intentioned, and that must be conveyed. The idea may not be realistic in the current environment, or the team may require additional training to make the idea attainable with the staff available. The measurement of success may not be based on the core values of the practice, or the standards of care defined by the healthcare delivery team. But the person speaking is never "wrong" for trying to help.