Making your management mark

Martha Cima was rather stunned. She had just returned with her husband from a brief vacation — only four days — to see her sister in a nearby state. Things were tense when she left, but when she returned she wasn't prepared for this. She asked Sarah to begin again.

Sarah Clinton cleared her throat, calmed herself and began again.

"Dr. Cima, you should have heard the things Janice was saying about you and some of the other girls. She specifically said that you had lost control of some of the people, were paying too much attention to unimportant details and had dropped the ball with several of the better clients. And, as usual, Janice was bossing people around right and left, the way she always does. She even made Dorene cry. After Dorene went home, Janice said she deserved it. She then told the others that Dorene should stay home until she takes better control of the front."

Sarah paused, bit her lip and continued. "Dr. Cima, there were a few clients in the waiting room when all of this was going on and they probably heard everything. The arguments were about the staff schedule and who should be off when."

"I made up the schedule before I left," Martha offered.

"I know," Sarah said, "but Janice and Toby changed it because they said Dorene was working too many hours. They both said that you make a lot of mistakes with the schedule. Janice said she always made out the schedule when Dr. Smith owned the practice, and it always worked."

Does your practice really need leadership?

"What about Dr. Jeffers?" Martha asked, referring to the new associate, Barbara Jeffers.

"Oh, she was right in there agreeing with Janice. And to make matters worse, some of the others were starting to take sides. But Joan and Diane were just listening on the sidelines and trying to lay low and not say too much."

Barbara Jeffers had been with the practice only a few months and had come with a history of frequent migration from one job to another. She interviewed well, but had taken to gossiping and coming in late in the weeks before Martha left. Martha, non-confrontational and ever the optimist, had hoped that Barbara would step up and take control of the management side while she was gone. She never thought Barbara would stoop to this.

"Anything else?" Martha squeaked in obvious despondency.

"Well, Dr. Jeffers made a few clients mad with her abruptness. She seems to be very good, but has some issues with anger when clients ask too many questions."

Martha cringed, realizing that she herself was slow and methodical in the exam room; but she prided herself in her ability to answer every client's question in a compassionate manner.

"Do you have any suggestions?" Martha asked.

"Maybe a staff meeting — something ... I don't know."

"Thanks, Sarah, for the heads-up," Martha said quietly as Sarah disappeared into an exam room.

Sarah was Dr. Cima's cousin and now a trusted staff member. But some staff members also considered her a snitch.

An ally or saboteur?

Janice Bolton had worked at Franklin Animal Hospital eight years and had been the main tech when Martha bought the practice a few years ago. At first Martha was grateful to have such a take-charge person around. Janice seemed to know all the ins and outs of the clinic. That would make up for her hesitancy to confront people and issues.

However, it soon became evident that Martha could not make the changes she wanted because Janice would not allow it. Initially, Janice would appear to go along with all of Dr. Cima's planning, but in the end she knew how to sabotage changes she felt were unnecessary by strategically placing emotional pressures among the staff. She even knew how to handle Dr. Cima if the situation demanded it. She was very cagey and knew how to play the game.

Now things were getting out of hand and Martha did not know what to do. She believed people could work out their differences if she would just let it ride for a while. But now, after her four-day absence, things were a mess.

Martha's husband called her a wimp when she brought staff frustrations home.

She thought to herself, "Maybe I am a wimp. I hate to confront and talk to people about these kinds of things. It's true: I am just a plain-and-simple chicken."

Throughout her life, at times like these, Martha would catch herself talking to the wall — any wall.

She thought about it some more, then stood up in her office and explained bravely to the wall: "I just have to talk to my staff!"

Martha, chin high, opened the door to her small office and saw Janice walk past.

"Well, hello, Dr. Cima. It is so great to have you back!" Janice purred.

Caught off guard by Janice's apparent regard and sudden respect, Martha blushed and walked back into her office. Her heart began to race. She was seized with angst and guilt. "Was Janice right? Am I out of touch and do I mismanage my staff? She seems so bright and cheery this morning. Is Sarah over-reacting here?"

Martha felt faint and sat down before she fell down.

She looked at the wall and spoke directly:

"I fought the wall, and the wall won."

Learn to overcome fear of conflict

A number of practices I visit present with staffing issues that are fundamentally struggles for control, much like the fictitious story just presented. These struggles typically involve those who want control and those (doctors or doctor/owners) who are meek, indifferent or who do not see people for who they are.

Sometimes there are leadership voids at the top. Employees who are driven to have control happily fill this void. It is not a gender issue. Control vs. conflict avoidance crosses the gender gap.

It really relates to personality type and philosophy. It would seem that some who are attracted to veterinary medicine have personality traits that are of great value to the profession, particularly with regard to patient care. They are nurturing, thoughtful, reflective, studious, sensitive and professionally cooperative (willing to think in groups, i.e., "group think").

The tendency to be "cooperative" lives on the same side of the street as "conflict avoidance."

Though there are exceptions, these philosophical values and personality traits do not always propel veterinarians (or other small-business owners) into great leadership roles.

Sometimes, like Martha, they run into a wall.

Graduation from veterinary school does not guarantee one will be a good leader. Nor does a passing score on any number of state or national board exams provide sanctuary from the day-to-day struggles of owning a small business. Yet the owning and management of a veterinary practice is not unlike the management of any small business: It takes both leadership and patience. Some would say it is unfortunate that the day-to-day operation of a veterinary practice leaves precious little time for one's true calling — providing excellent patient care.

This is poppycock.

Leaders promote and demand excellent patient care through the structured placement of adequate business systems within the practice. Owners who seek to avoid conflict by refusing to meet business challenges head-on actually move from one conflict to another without realizing they are part of the problem.

If you are among these, then you also are part of the solution. Overcoming your fear of conflict will take time, but it must be done.

Veterinarians (business owners) must realize that some people play games and can be quite manipulative. They must be contained or removed from your practice. This may seem counterintuitive, because many of these people are great workers and have made themselves "indispensable" in other ways. They have created their own kingdom within your business.

Schools must teach leadership skills

The deans have their hands full in today's tight budget environment, but leadership training should begin in veterinary school. It should be outsourced — not an in-house job taught by someone on staff with little professional training in this area.

This training should have teeth and meaning within the overall professional program and not be considered an auxiliary item. This is vital.

Our young professional corps will need all the leadership training they can get to follow in the capable footsteps of those in the American Veterinary Medical Association and other professional organizations who have blazed the trail. It is likely that we will face destabilizing forces that will rock or even diminish the profession unless our young charges offer strong and viable leadership. It needs to start in vet school.

A well-run office earns respect

Clients can tell. Yes, they can. They instinctively know when your office is poorly run or administered. They might even believe that these miscues bleed over into your professional care.

Thus you need to be more than a boss. You must be the leader and be respected as such.

You will need to have a consistent vision and instill that both on an individual and collective basis.

This means having one-on-one meetings with your employees and organized and cooperative staff meetings (no pity parties).

Viable systems must be in place that create consistent outcomes for staff, clients and patients. You will need to be an encourager and try to pick your staff up even when things go south.

You must eliminate (yes, that means fire) people who consistently obstruct your leadership and vision. Your remaining staff will be ecstatic.

Leadership involves patient care

Becoming an effective practice leader doen't mean being "bossy" or overbearing.

Rigid, tight control may appear to work for a while but ultimately is not reflective of true leadership. Rather, it reflects a practice owner's insecurity, unwillingness to cooperate and to delegate tasks to capable staff members. That leads to burnout, another issue altogether.

You should be able to organize and lead patient care, starting with consistent medical/surgical leadership, case by case.

Your clients must see that you are leading with respect to the care of their pet. This breeds confidence in your recommendations and their overall satisfaction.

Leadership also means acknowledging mistakes and making corrections. This shows integrity that clients and staff can appreciate.

Dr. Lane is a graduate of the University of Illinois. He owns and manages two practices in southern Illinois. Dr. Lane completed a master's degree in agricultural economics in 1996. He is a speaker and author of numerous practice-management articles. He also offers a broad range of consulting services. Dr. Lane can be reached at david.lane@mchsi.com