Practice in the real world "Managing chaos"

Aanet Sizemore waits in the back for Carrie to come out of the room. Carrie is writing in all the particulars about Caleb, a forlorn looking Great Dane with chronic vomiting and persistent elevated white counts. Janet has seen Caleb in the past for this and an assortment of other maladies but has been able to totally stop the irregular vomiting.

Linear versus Radial

Carrie finally wanders out with a rather thick chart and starts collating history and lab printouts in order to make some sense out of it all. On top she has written a rather lengthy synopsis of the current situation.

Janet moves slowly to the counter and looks over Carrie's shoulder and begins reading. Janet emits a low whistle as the job at hand moves into its final phase.

"That is a lot of history — some of that has to be from Dr. Wilson. I had forgotten how many times Caleb has been here," Janet says.

Bayer mulls next move with FDA poultry decision

Just then, Mary Needham, a senior technician, appears and starts complaining bitterly about Sarah who happens to be working in the front that day. She goes on about having to answer the phones because Sarah cannot seem to control the client flow in front. She laments that there are two other people working in front as well, and she still has to answer phones and be drawn away from her other duties.

Janet ignores her and walks into the exam room to see Caleb.

When the door is shut, Mary begins to bend Carrie's ear in earnest. Carrie picks up the ball and by the time Dr. Sizemore had come back out of the room, they had managed to carve out a fairly large piece of Sarah's hide.

As the banter continued, Janet stared straight ahead and didn't comment.

"I need to set up for X-rays and some blood tests to an outside laboratory," she said to anyone listening in the vicinity.

Mary jumps to the task, and Janet moves on to another room.

In about 15 minutes, Janet exits the other exam room and heads to the small office in the back.

"Dr. Smith, this is Janet Sizemore. I hope you remember me from small animal medicine classes. I would like to refer a vomiting case up to the university."

Janet listens to Dr. Smith's response, smiles, hits the side of her head and hangs up. She walks briskly into the first exam room and explains to Caleb's owner, Mrs. Johnson, that she has just talked to one of the specialists at the university. The university wanted her to try a different approach for Caleb. Within a few hours a diagnosis of megaesphagus, chronic pneumonia and hypothyroidism had been made. The client was grateful. Janet was proud. She had used the resources of the university to leverage a positive outcome for her patient. She told Mrs. Johnson that she would get on the Internet and work out a therapy plan within the next few days.

Just then, Dr. Sherry Wilson, the owner of the hospital, walked into the side door and started her usual routine of moving through the cage area checking the various conditions of her patients. She darted from small project to small project. She mostly asked the staff various questions about patients and clients that had called while she had been out for an abbreviated lunch. Dr. Wilson was a poster child for multi-tasking approach to veterinary care.

Janet had taken her lunch early because there had been very few morning appointments for her prior to seeing Caleb at 1 p.m. She was eager to tell Sherry about the change in Caleb's situation. As she began to relate her phone call to the university and the change in direction of the case, she noticed that Dr. Wilson was only partially listening.

At first, she noticed Dr. Wilson was noticeably happy with the change of events for Caleb. But she seemed somewhat distracted as usual by the number and complexity of her own patients and the increasing complexity of her veterinary practice since she had hired Janet last year.

To Janet, her indifference to the seismic shift in Caleb's case and prognosis was troublesome. How could this otherwise good veterinarian be so distracted by the business of the practice? She was puzzled by practice owners in general. She began to wonder if owning a practice was just a slow, sure way to lose your way in the profession.

Janet Sizemore wanted to stay on top of her game, and that meant concentrating fully on veterinary medicine — not on the day-to-day management of the business. She also began to view the employees at Dr. Wilson's hospital as average, at best. They often did not share her joy in the diagnostic process and were often plagued with personal problems that held them back. She was also disturbed by the occasional chaotic nature of her current practice. It all troubled her. She would keep her ears open for a potentially better work opportunity. In her mind, the purpose of veterinary medicine is being fulfilled only now by the technological advances at the university and at the emerging super practices around the country. A new day was dawning, and she wanted to stay on top of it all.

Wednesday morning

Dr. Sizemore walks into the practice at precisely 8 a.m. expecting to begin her rounds. Something is wrong. The practice is a mess. Staff and clients are swirling in what seems like a frenetic dance amid the cacophony of unfed patients and a mountain of dirty towels. Although Dr. Sherry Wilson is almost never gone, she has a long overdue dental appointment this morning and will be in until after 10 a.m. She is the one who handles these kinds of problems.

Dr. Sizemore wades into the melee as others swirl around her as if she isn't there — the effect is quite eerie. Finally Carrie explains to Dr. Sizemore that Sarah did not show up for work this morning and that one of the other staff members called in sick.

"It is just chaos around here. I think Sarah has quit because of Mary!" Carrie said in distress. "Well, what I am going to do about my patients? I must begin before my appointments arrive."

"It is too late. You have an emergency walk-in, and Mrs. Johnson and Caleb are in another exam room. Mrs. Johnson says that Caleb has been gurgling for about an hour and also been almost lifeless for the past 30 minutes."

Dr. Wilson's new day has dawned, and it is not a pretty sight.

Chaos

Chaos in the workplace is inevitable and is the rule without system development. All managers and business owners routinely develop systems to deal with the chaos that ensues when a business is opened. A manager or veterinary owner that does not systemize the way they approach the daily grind will end up in the loony bin or the soup line sooner or later.

There are all kinds of books available to help manage chaos. Also advice abounds in the popular press as to how to manage the systems within a workplace. However, most good managers read the problems and develop viable and permanent systems that will work over time. In most cases, there is no real cookie-cutter approach. All businesses develop their own approaches to problem solving and systems development (formally or informally) within their own external and internal environments in order to function. The business that develops workable systems will thrive — those that don't will fail.

What is a system? It can be something as simple as an office memo or as involved as long-range planning and system analysis by an outside consulting firm. Employee handbooks and "office protocols" have their places within the development of systems.

Who is responsible for system development? The short answer is everyone. System development comes from constant communication within the workgroup including regular staff meetings. Associates need to help out, too.

Understanding the need

So, what do owners need from associates (in addition to providing high-quality medicine)?

Owners need associates to understand the dynamics (ecology) of the environment in which they work and to grasp the whole vision of the business beyond the technical operations of animal care. This means taking more than just a casual interest in the operations around them.

Associates can integrate themselves into the whole of the system by:

• Seeking to inquire and obtain feedback from staff concerning operations and problems.

• Buying into the philosophy and mission of the practice.

• Participating in operational projects through staff meetings and protocol development.

• Taking on small managerial or operational tasks from the owner veterinarian assuming that the owner has the foresight to delegate.

• Understanding that good management always impacts good medicine.

• Keeping the "learning hat" on in order to learn from everyone around you.

• Learning not to take sides in staff and owner issues but to become a mediator by understanding both sides of an issue and offering sound advice.

• Remembering your growth as a practicing veterinarian is directly proportional to your ability to work with people in many situations.

Finally, associates need to realize that changing jobs does not always solve the issue of improved career performance. Your ability to solve clinical, operational and personal problems with the help and assistance of other people will impact your personal growth as a veterinarian regardless of your environment. Learn to love veterinary medicine wherever you are. Jump into the whole of veterinary medicine.

One last thing: Taking the big-picture approach to your job will quickly increase your chances of a partnership or ownership. Understanding the operational environment that a veterinary owner has to work with will help you understand and grasp the "baton" when the time comes. If you help out along the way, this life transition will be much smoother.

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. Dr. Lane also offers a broad range of consulting services and can be reached at david.lane@mchsi.com