Practice in the Real World

Jamie Stevens held on tight as the large dog smeared saliva and grit over her left temple. She could feel the Newfoundland's rear legs gain a small purchase in the region of her own navel. Jamie could only hope that Tiny's nails would slide by her midsection without incident. Frannie Smith was sweating profusely on the other side of Tiny in an attempt to gain some form of advantage in what seems to have progressed to some sort of Greco-Roman wrestling match. Frannie's forearms bore fresh parallel bleeding grooves that evidenced the current skirmish taking place on the examination table.

David M. Lane DVM, MS

In the corner shouting expletives and criticism at the staff was Amy Walker. Amy had a love-hate relationship with the staff at Salisbury Animal Hospital. She loved each and every staff member until they had to square off against Tiny. Amy looked forward to the outcome but silently hated the staff during the process. This Jekyl-Hyde situation was a long established pattern that now is part of the lore of the practice.

Jennifer Salisbury, DVM held each leg and struggled to hold them still. Tiny's legs unceasingly moved up and down like powerful jackhammers. Before it was over, Jamie's new uniform was torn and bloody.

Finally Salisbury stood back and once again sighed at the termination of Tiny's annual pedicure.

Amy now raced to Tiny's side as if he had just won a gold medal. Jamie and Frannie smiled and examined the room before them. The examination table had moved over three feet from the center of the room. Hair, saliva and an assortment of canine discharges dominated the now-peaceful battleground.

This was the first time that Jamie and Frannie had worked in a common purpose for a long time. Jamie was surprised at Frannie's strength in holding her own with Tiny. She had to admit that possibly Frannie could be of some use around the practice after all. But that thought was only fleeting.

Jamie had complained to Dr. Salisbury for many months that Frannie was simply not focused on the job. She was upset that Frannie was a cut-up and did not want to concentrate much on her job. Jamie had begun to overuse the word "focus" in conversations around the hospital and was beginning to appear self-righteous to many of her co-workers. Jamie was a single mom with two children and, in her mind, had learned to value those who could focus on the endpoint.

Her concern about Frannie had boiled over last month when she had pointedly mentioned Frannie's lack of work ethic to Karen, the head tech. Karen had listened to this line of reasoning from Jamie in the past. These pointed criticisms were doled out mostly in passing and at well-chosen moments when Frannie would not be present.

Eight months ago, Frannie had been hired at a wage just a bit higher than Jamie's starting wage when she was hired about two years earlier. Though she liked Dr. Salisbury and loved her as a doctor, she held this issue against her. Dr. Salisbury was being "unfair".

Meanwhile, Frannie washed her wounds in the bathroom as Amy Walker paid her highly valued but small veterinary bill. Frannie was amazed at the number of wounds she incurred in such a short time from one animal. They would soon blend in with the other small scars that had appeared on her person over the past few months. Her thoughts turned to Jamie—Jamie was a wound that would not seem to heal. She knew her relationship with Jamie was tenuous.

Frannie's mind wandered to an event that happened last week. Frannie had worked several days in a row and was due to be off last Friday when Dr. Salisbury woke her up with a call at 6:30 a.m. It seemed that Jamie's youngest girl was vomiting again, and she needed to stay home with her for the day. Frannie was always the first to be called, and they needed her to fill in for Jamie.

From Frannie's point of view, she was already working several unusual shifts at the animal hospital. On the other hand, Jamie seemed to have the best schedule of anyone working at the practice. The group thinking of the staff was that Frannie was in the process of being cross-trained in several areas of the hospital. She had agreed to fill in at times when others could not work. Her schedule was chaotic, but she managed to get in about 40 hours. This was leading to a situation where Frannie was being used as a kind of "go-for" for everyone else.

Frannie had been called in twice this month already when Jamie's children were having some kind of medical issue. Jamie had not thanked her, nor had she offered to come in later in the day. She thought to herself, "Dr. Salisbury is a great person, but she is being unfair."

Karen had worked in the practice for more than 10 years. She had seen them come and go and was getting a bit tired of the bickering and backbiting that occurred. Her latest project was to quiet the storm that was brewing between Jamie and Frannie. Karen had begun to keep a silent list of grievances against the hospital in her head.

She worked often after everyone else had long gone and often opened the doors up before anyone else showed up to work.

Karen was now paid on a salary, and it seemed that she worked overtime without the benefit of added pay. She loved working for the hospital, but it was apparent that Dr. Salisbury did not want to deal with conflict. She avoided it at all costs. Dr. Salisbury wanted everyone to like her, and avoiding conflict seemed essential ingredient to that end.

She unknowingly left the dirty work up to Karen, and Karen resented this.

Karen has a case ... the others may not. Either way, the practice is in choppy water without a rudder.

Are you unfair?

Just because you have a great employee handbook (that you haven't looked at in years) and try hard to relate to your staff doesn't necessarily make you a great boss in their eyes. Employees can be very self-absorbed and petty at times, and this shows up in your practice in the form of factions and thinly veiled office politics.

The problem in most hospitals that I visit is that the employer tends to avoid conflict. And it follows that the employee-management approach is unstructured and revolves around appeasement strategies. This often leaves the owner indicted for the crime of being arbitrary. It is not surprising that on these visits I find that issues of fairness seem to rise to the surface.

The owner/veterinarian is often oblivious to all of this. It is totally amazing to everyone that what seems so apparent to staff is not so apparent to ownership. A lot of this has to do with the pressure that an owner/veterinarian will place upon himself/herself to please everyone in all directions. Very few veterinarians wake up each morning with a burning desire to run and manage their practices. They wake up and want to practice medicine and surgery in a progressive and pleasant environment. This somewhat naîµ¥ attitude leaves a lot to be desired with respect to watching and monitoring the health of the enterprise itself.

In addition, very few employees have the ability to see the big picture. Often they see situations that develop within the hospital as unfair and unbalanced with respect to their job and the value they place on their performance. Unfortunately some of this has to do with pecking order.

The unique niche

Whether we like it or not people tend to grade and value or devalue each other in order to place themselves in some form of perceived unique place in their working environment. Without proper job and staff counseling, this leads to an unseen pecking order that bears little resemblance to any kind of organizational chart that management might draw on a sheet of paper. Staff left to themselves will align themselves into these pecking orders in order to deal with dysfunctional and non-management efforts of an owner/manager.

Do not be mistaken: There is a pecking order in your practice. It is not always the pecking that is bad—but simply the order. Your job is to make sure the order is proper and fair and that the pecking is constructive.

Pulling your head out of the sand

Veterinary owners don't tune in to the local radio station (WSTAF). Mostly they are tuned to WCLIENT and to WVIN or other stations that broadcast on their unique wavelength. This means that a lot of stuff that goes on doesn't even register on the local owner synaptic pathways.

It always comes a great surprise when a longtime staff member, such as Karen, asks to talk with the owner/veterinarians for a few moments. These moments are initially awkward. Nevertheless, Karen has rehearsed her speech and usually gives a fairly reasonable explanation of her motives as she tells her boss why she is leaving. The real reason for leaving might be forever buried in the cloistered soup of everyday stress, miscommunications and misconstrued notions of unfairness. The scene is the final curtain call for a drama that has been playing for some time in the hospital right under the nose of an unsuspecting owner.

It is time for the owner to tune in and pull his or her head out of the sand. Bottom line: If management is done in a vacuum, then the perception of fairness soon will disappear.

Damage control

The following suggestions will help create a positive working environment and to reduce staff anxieties concerning fairness issues.

Write an employee handbook. A good starting place is to purchase the basic format from AAHA and modify the handbook to your needs. They have an excellent set of templates. Do not copy the handbook as is; your hospital is unique and has unique applications. Each employee should be given a copy of this handbook

Seek counsel from an attorney ahead of time when writing your employee handbook. Ask him or her to review the final document.

Develop a stragey to resolve conflicts quickly

Indicate somewhere in your working contracts and employee handbooks that although management will try to deal with all workplace issues in an even manner, special situations will arise that will need individual solutions. All workers need to understand this.

• If a situation develops that creates and unbalanced work situation for individuals, then an apology is in order and adjustments will need to be made is some fashion. Employees need to know you are concerned.
• It may be advisable to create "work descriptions" rather than job descriptions. Job descriptions lead to divisions within the system. Write work descriptions and assign people to those descriptions. This allows you to move people around in the system.
• Act decisively on work issues. Procrastination is seen as owner laziness or incompetence from the employee standpoint.
• Meet with your employees regularly to encourage them.
• Have regular staff meetings where employees can submit issues and feel part of the process.

Surprise!

People often spend more time at work than they will with their families at home.

Therefore the need for a quick and decisive resolution to conflict is very important. Ignoring dysfunction in your work family will most assuredly foster discord and ultimately chaos.

And so a little time spent in the care and feeding of your work family will pay off.

I think that's fair—don't you?