No more front vs. back

Perhaps you've experienced it—the knot in the pit of your stomach on Monday morning as you drive toward the practice. You love working with animals and you like the veterinarians and clients. So what's the problem? You're dreading spending another day in the emotional atmosphere created by the tension between people who work "in the front" and those who work "in the back."

Is there a problem in your practice?

Signs and solutions

If you look at a front vs. back split as a medical case, the conflict is really a symptom of something bigger. And, as you know, just treating the symptom may not fix the problem. Not sure what's causing the split in your practice? To identify the most common problems—and solutions—I talked to a dozen managers across the country. They say a front-back split typically arises when:

• Team members don't understand or appreciate each other's contributions. Rigid roles and fuzzy job descriptions cause confusion about each group's responsibilities. One solution: Cross-train team members on client relations, computer use, telephone courtesy, client education, client check-in, animal restraint, filling prescriptions, cleaning up accidents, and so on. Cross training illustrates the scope of each person's responsibilities and helps build appreciation for every team member's contributions.

• Team members feel insecure. Team members need to know where they stand with their supervisors and understand their value to the practice. If you wish you had more feedback, let your manager know. If you're a supervisor, make sure the people who work for you know how they're doing and what you expect. Frequent reviews are a good first step, but don't stop there. Think of yourself as a coach and a mentor, and help your team members grow professionally.

Haven't received enough management training? Ask to attend a management seminar, or ask the doctor to recommend a book that could give you confidence and ideas. (For more see "Team management: Step up to the challenge")

• Lack of training. Front- and back-office team members can help each other tremendously—if they know how. For example, during emergency phone calls, receptionists can help prepare the technical staff by asking clients specific questions about their pets. On the flip side, technicians can help take the load off the front desk by learning how to review an estimate with a pet owner.

Plan a team training session

To encourage such mutual assistance, hold regular training sessions on hospital procedures and include the entire team, even if the training is primarily technical or administrative. If you're an experienced team member, offer to lead the first session. (See the margin text at for one idea.) And if each session leader summarizes his or her presentation and the team discussion in writing, you can collect those pages into a training manual for new team members.

Also consider outside training, especially seminars that discuss team building and communication skills.

• Lack of direct communication. When hospital team members feel uncomfortable approaching each other or a practice supervisor about problems, the result is usually gossip. Combat this problem by establishing guidelines for resolving conflicts and outlining consequences for not sticking to them. For example, your policy may state that if one team member has a problem with another one, he or she may discuss the issue only with that person or a practice manager.

If you're a team leader and you discover that people are gossiping, call a spontaneous meeting with the people involved to resolve the issue. (For more on handling gossip, see page 13 in the June/July issue of Firstline.)

• Problems linger without intervention. Even minor problems can fester if they're not addressed. The first step: Write down your complaint and offer your supervisor at least one solution. This approach helps you focus on improvement and keeps you from sounding like you just want to gripe.

If you're a supervisor, try to be accessible. Develop a reputation for being even tempered and reasonable, and make it a point to invite constructive criticism. If people feel comfortable raising the issue when they get angry or frustrated, you and your team can defuse the problem before it's disruptive.

• One employee disrupts the team. In this situation, it's best for the supervisor to meet with the employee right away to explain what's expected and to discuss the problem. Perhaps the person is a poor fit for the job, or maybe the employee doesn't realize that his or her behavior is disruptive.

One caution: While it's important to work through problems, don't keep a disruptive team member around just because you're afraid of legal action. Thoroughly document problems in the employee's personnel file, and remain neutral and businesslike when discussing the issue. If the situation doesn't improve after frequent feedback and warnings, let the person go.

• Team members don't feel appreciated. Showing appreciation for team members need not be difficult or expensive. A simple thank-you can go a long way, and a written note about someone's extra effort can make his or her day—or week. For more elaborate rewards and recognition, brainstorm ideas at your next staff meeting. Consider spearheading a surprise Staff Appreciation Day, or suggest that your team plan an off-site retreat.

• Staff meetings become bitch sessions. To eliminate this all-too-common problem, set some ground rules, prepare a clear meeting agenda, and think of ways to keep meetings fun and positive. Handled well, staff meetings can help veterinary teams avoid and resolve problems.

If your team can't work out a deep-seated problem, you may want to get help from a communication consultant. These experts bring objectivity and conflict management experience to the table, and they can help resolve problems that are entrenched in the office culture.

• Doctors don't follow policies. Keep in mind, veterinarians are only human, and because they shoulder the ultimate responsibility for patient care and the practice, they face many stresses that other team members don't. Still, for the sake of the practice, this problem must be addressed.

It's up to the hospital manager or another practice leader to explain diplomatically that the veterinarian's behavior disrupts the rest of the team. Careful listening and a noncritical approach can help open the lines of communication and point the way toward a solution. (Also see "When the doctor throws a wrench in the works" in the February/ March issue of Firstline.)

• Personality conflicts. Again, communication is the key to conflict resolution. The most direct solution is for battling team members to talk about the problem, listen to the other's point of view, offer solutions, and agree on an action plan. If the exchange requires a facilitator, choose a supervisor, manager, or doctor with whom everyone feels comfortable.

Another idea: Provide training on such topics as communication styles or personality profiling to help team members understand each other. Five years ago, one veteran practice manager brought in an outside facilitator to interpret work styles using the Myers-Briggs inventory. She says the experience encouraged team members to embrace their differences and demonstrated that it takes all kinds of people to make a practice successful.

Keys to prevention

No one likes conflict, so the best approach is to avoid problems from the start. The managers I spoke with highlighted these critical preventive strategies:

• Hiring. Take this responsibility seriously. Ask applicants appropriate, legally permissible, open-ended questions about their previous experience and career goals. Invite them to work a day in the practice before they accept the position, and use a probationary period of three to six months. Emphasize teamwork from the very first interview, and discuss what skills and attitude the person will need to succeed.

During interviews, look for potential red flags. For example, let's say the applicant blames all of the problems at his or her previous job on someone else. Don't let the subject drop; ask strategic questions to see how the person will handle challenges in your practice. One possibility: "How would you feel if we worked an hour past closing time?" (Also see "Tips on team building from top performers".)

• Communication. The managers I spoke with agree that the biggest preventive measure you can take is to keep all communication open and honest. Encourage others to speak up about their concerns, and express your own without pointing an accusing finger at anyone. Also try these communication strategies during times of conflict:

1. Ask all of your team members to contribute their ideas. This approach gets people talking and shows that you value everyone's opinion.

2. Listen, and demonstrate that you understand the other person's point of view.

3. Focus on the problem—not on the person.

I know it's hard to resolve conflict, but the strategies I'm offering here are tried-and-true gems from people who've been there. You're not alone; teams all over the country face the same challenges. And while not everysolution will work for every practice, I hope you'll find some solutions that work in your hospital. Instigate change, and maybe you'll be able to say, "In our practice, there is no more front vs. back." ?

Cecelia Soares, DVM, MS, is a veterinary communication specialist, a consultant, and a speaker and workshop leader based in Walnut Creek, Calif.