One of my friends, Garrett, a graduate from the University of Pennsylvania School of Veterinary Medicine, texted me a few years back after completing a day externing at a Veterinary clinic and said, “I’ve never seen anything like this! The support staff is so bought into what they’re doing, and why they’re doing it, so well trained and so well leveraged, they drive the day.”
Each day a different “technician coordinator” sets the schedule and directs the technical staff through the appointments and procedures at this multi-doctor, rural hospital. Unlike many practices I’ve been in, where veterinarians spend chunks of their day deviating from what they’re uniquely qualified to do–diagnose, treat and prescribe-at this particular hospital, they’re allowed to focus on clients and patients while the support staff respectfully directs them. The practice owner and veterinarian swears by this model of staff leverage and autonomy and its positive impact on culture, patient care, client experience, and the hospital’s bottom line.
Think about conversations you’ve had with colleagues or your own experiences with a hospital leadership or management structure, and I’m willing to venture a guess that a common theme is a top-down management approach. The owner/veterinarian more than likely sets the goals, assigns tasks and responsibilities, and, in many cases, goes so far as to determine how the tasks she’s assigned are completed. I understand this model appeals to a lot of us as practice owners for the following reasons:
- We got into ownership because we wanted to set the vision, level of medicine, and team structure.
- It affords us a lot of control at the head of the hospital and allows us to make sure things are “done right,” exactly the way we want them.
- It capitalizes on our perceived sense of business savvy, creativity and knowledge base.
Refer to the old adage, “if it ain’t broke, don’t fix it?” Which begs the question, is this model broken?
Our industry is plagued by a high rate of costly staff turnover in addition to high levels of stress and low levels of staff engagement . . both of which we know impact patient care and client experience. Add to that the medical service gap many multi-doctor practices experience and overall poor levels of practice profitability, and it’s hard to argue the current model isn’t broken.
Reflecting back on Mr. Rockefeller’s quote “Don’t be afraid to give up the good to go for the great,” I would argue that in many cases we’re not even giving up the good. We’re just having to give up what we know. The norm. The status quo.
In one of the Veterinary schools in which I have the opportunity to teach, I had a student state, as we were reviewing industry norms and benchmarks, “I didn’t enter this profession to be average. I want to know what great looks like.” How do you define “great” in this profession? For me, it includes:
- Quality of patient care
- Client experience
- Team culture – a product of everything from leadership to trust to communication to a shared vision
- Practice profitability – still a dirty word to some in this profession, but show me an unprofitable practice and I’ll show you a practice that doesn’t practice consistent, thorough, quality medicine nor have the resources ranging from staff to education to equipment, to perform at the highest level.
As stewards of our hospitals, including our patients, clients, teams, and our own wellbeing, as well as our profession, I challenge us to strive for great. How can we as leaders achieve “great” as defined above? It starts with letting go. It starts with building a practice model that is a reflection of our “why,” medical philosophies and the legacy we want to leave, and thrives without us at the reins.
Before you get too upset and toss this in the trash, please understand that I’m not suggesting we shouldn’t set direction and provide guidance. I’m merely suggesting that if we do those two things well and surround ourselves with team members who are equally passionate about the clinic and represent various interests, we won’t need to have a hand in every single decision or action at our hospital. This style of management is often referred to as a “representative decision-making style” and represents a combination of a consensus and consultative decision-making approach.
Like the practice owner described in the opening paragraph, I’ve witnessed in my own hospitals, as well as hospitals of clients, friends and colleagues, the tangible positive impact of a management style that taps into the expertise and vision of the owner and elevates potential through the buy-in and leverage of the right team members.
How can we as practice owners achieve this? Let’s talk strategy.
Define Your Why
The transformation to “great” begins by defining what drives you. Please give some thought to your “why” as a practice owner.
Patient care? Your clients? Your staff? Your family? Next, consider your hospital’s “why.” Keep in mind, your “why” is not “treating pets like family” or “offering progressive, cutting-edge medicine.” I commonly see those phrases on hospitals’ websites and while those are worthy goals, they’re not why you do what you do. They’re “what” you do or “how” you do what you do.
I recently partnered in a two-doctor, mixed animal practice and my partner and I, as private practice owners, didn’t come in with a set corporate vision or mission. Instead, we talked about why we’re in Veterinary medicine and why we chose this practice. I lead my consulting clients through this same exercise. Setting direction starts with determining why we do what we do. After you’ve determined your why, it’s time to engage the staff.
Achieve Team Buy-In
As a practice owner, you’ve really only got two options when it comes to incorporating your why.
- Set the practice’s why based on your why and expect your team to get on board.
- Share your ‘why’ with your team, then provide them a platform to share their ‘why’ and craft the hospital’s mission together.
I’ll admit, option #2 is more work. Why might it be worth it? In two words – “staff engagement.” Through sharing their why and contributing ideas, staff members will see themselves as change agents thereby developing a sense of ownership and responsibility in the growth of the practice. A workplace survey conducted with 20,000 participants found that employees who felt connected with their company’s mission were 55% more engaged at work. Those that derived a sense of meaning and significance from their jobs were 93% more engaged.[1] Why does engagement really matter? “Actively Engaged” team members, who represent about 42% of the workforce, use about 83% of their talents and ability. Disengaged employees, 23% of most teams, use 65% of their talents and ability. The “actively disengaged,” 35% in most workplaces, use only 27% of their capacity.[2] What does this actually mean in our hospitals? Consider a staff of 10 working 40 hours/week. That equates to 400 hours of staff time for which you and I are paying. If we use the numbers above, it means we’re paying for 164 hours of lost productivity. Do that math based on your payroll.
After your team is bought into the collective why, one of the hardest parts of our job is done. We’ve given the ship a heading and we’ve got a crew that buys in. Once the team is onboard, the next step is to evaluate each members’ strengths, weaknesses and aspirations to ensure we have the right people on the right seat.
Conduct 360 Staff Evaluations
360 staff evaluations are a tool that can be used at any time whether you’re taking hold of the reins in a hospital you’ve just purchased or you’re a seasoned owner with staff you’ve known for years. When I conduct 360 evaluations, whether at my own hospitals or for others, I use two separate documents. One is a self-assessment completed by each staff member and the other is an assessment to be filled out by each member of the team on each member of the team, owners included. If you’re conducting these internally, you’ll need to work with your manager so that she can review your assessments and you can review hers. Without security in confidentiality, this exercise won’t work. I ask the staff to place their 360s in a sealed envelope and deliver them either to me or the manager (or a combination thereof so that I don’t see mine and my manager doesn’t see his).
Upon receiving the teams’ 360s, I recommend reading through with an eye out for trends. Is a particular team member consistently praised? If so, for what? Is someone consistently criticized, if so, for what? I’m also trying to better understand what motivates each member of the team and to identify any untapped potential or interests that could benefit the hospital. After reviewing 360s, I suggest a sit-down meeting with each member of your team. While I would never share a copy of anyone’s 360s with anyone else, I do summarize the trends and use it as an opportunity to praise, coach and set goals.
When administered appropriately, 360s:
- Provide an opportunity to build a community where everyone is heard
- Provide insight and information that you most likely wouldn’t otherwise have
- Encourage mutual respect
- Provide actionable improvement opportunities
A few words of warning for those considering leveraging this powerful tool:
- Don’t ask questions that will produce only the answers you want to hear – ask questions that will solicit answers to what you need to know. Ask for constructive feedback, suggestions and opportunities for the hospital.
- Don’t ask for input and ideas if you aren’t going to do anything about it. While every suggestion may not be relevant or actionable, we’ve got to have a system in place to acknowledge we’ve read and considered the feedback.
- Don’t confuse a performance evaluation with a 360 review. Some hospitals do use self-assessments as part of their performance evaluation process, but the strategy defined in a 360 is most efficient when not tied to a performance review. This is a fact-finding and strategic planning mission.
Understanding your team members, and subsequently making sure they’re in the right seat, is paramount to creating an environment conducive to team-based medicine, with each staff member performing at capacity, as described by Garrett.
Lastly, during the 360 evaluations, consider introducing the concept of another piece of the puzzle on the road to achieving ‘great’-– a leadership team.
Build Your Leadership Team
A leadership team is a group of staff members, typically representing each area of the hospital, responsible for identifying hurdles to, and creating solutions for, accomplishing our goals based on our why.
During the 360-evaluation process, ask the team to nominate four individuals to be part of this leadership team (they can nominate themselves). I typically do not allow my veterinarians or managers to be member of the team, nor am I a member of it in my own hospitals, because as soon as you drop a “supervisor” in the mix, it changes the team dynamic and staff members tend to take a back seat. I may have a manager, medical director or associate sit in on a specific meeting for a specific reason, but you shouldn’t need a ‘supervisor’ present at every meeting if you select the right leaders and provide them guidance and structure.
Having worked with leadership teams in close to 40 hospitals over the past couple years, a few consistent themes stand out. In order to be successful, I’ve found it’s helpful to select staff members who can identify problems and then focus on solutions. They must have the ability to impact opportunities and drive change, though they do not necessarily have to be current ‘leads.’ Effective members are also powerful ‘cheerleaders.’ Remember, change is hard, even when the staff has requested it, and it’s up to us as owners and our leadership team to remain positive, optimistic and realistic. In other words, we can’t succumb to viewing the world through rose-colored glasses, but we must be steadfast in leading, and having a leadership team that leads, through hurdles.
To back up my anecdotal experience, research shows us that 89% of leadership effectiveness comes from four behaviors[3]:
- Solving problems effectively
- Operating with a strong results orientation
- Seeking different perspectives
- Supporting others
The leadership team should consist of staff members who demonstrate, ideally, several of these behaviors. When I’ve seen leadership teams struggle, it’s often because we’ve picked ‘leaders’ without the aforementioned traits or we’ve failed to provide structure and guidance.
Setup for Success
In the early stages of a leadership team, a once-a-week meeting, complete with an agenda and assigned ‘secretary’ to take minutes, seem to work best. I’ve seen leadership teams used in practices ranging from one doctor, six staff member hospitals to 15 doctor practices with over 50 support staff. Don’t let the size of your hospital serve as an excuse not to execute. Over time, and I recommend not for at least six months, some teams will decrease the frequency of their meetings based on the tasks at hand.
Starting off on the right foot is a key to success with the team. We start each meeting by affirming our ‘why’ as a hospital and a shared commitment to the goals at hand. We review our roles as leaders, including ground rules for communication and disagreement as a team, define how we’ll approach new projects, provide a status report on ongoing projects and then work on the tasks at hand that day. Following the meeting, there should be a protocol in place to review decisions with ownership and communicate relevant projects to the staff. This last piece is often overlooked among new leadership teams and can create a sense of “them” versus “us.” Without proper communication with the rest of the staff, resentment can begin to build as teammates see the leadership team meeting and leaving them to pick up the workload. With proper structure and communication, both of these are easily addressed.
Leadership team objectives will vary based on the goals of the hospital, but I rely on teams to brainstorm and help implement strategies to improve daily operations, patient care, client experience, revenue, efficiency, and culture. They gather input, concerns, and ideas from co-workers and decide upon the best plan of action. After creating proposed solutions, we review together and then they implement changes and ensure follow through.
Giving up the good for great isn’t an easy journey nor is it one we as practice owners can make alone. The journey must start with us acknowledging that if we’ve picked the right team members, we’re stronger as a diverse unit – each team member with strengths, interests and weaknesses. If you can provide guidance and structure, then step back and not meddle, you’ll see your practice reach new heights in staff engagement, productivity and retention, more consistent thorough patient care and, ultimately, increased financial success. As veterinary professionals and stewards of our hospitals, who can say no to that?
[1] The Quality of Life @ Work Study by The Energy Project and Harvard Business Review. Accessed 1.26.18. https://uli.org/wp-content/uploads/ULI-Documents/The-Human-Era-at-Work.pdf.
[2] 2012 Employee Job Satisfaction and Engagement. Society for Human Resource Management (SHRM). Accessed 1.26.18. https://www.shrm.org/resourcesandtools/tools-and-samples/policies/documents/12-0537%202012_jobsatisfaction_fnl_online.pdf.
[3] Decoding leadership: What Really Matters. Claudio Feser, Fernanda Mayol, and Ramesh Srinivasan. McKinsey. January 2015.