Practice in the Real World: The Sermon

Stanley Dillon looked at the chart. Several charges had been missed the last time Janet Johnson was at the hospital. It seemed so obvious to him.

"Why can't his staff just deal with this? Why can't I just be left alone to do veterinary medicine?" he muttered under his breath.

Today Stan was becoming emotionally cranked. He was a good veterinarian but hated dealing with problems beyond the needs of his patients. Yet even with his clients, it seemed that he was balancing thousands of issues at once. It was driving him crazy.

He walked over to the coffeepot. As he eased the carafe from its seat, he noticed his right hand shaking.

"Was it the coffee, or am I just emotionally exhausted?" he thought as the mahogany-colored stream wiggled erratically into an oversized mug bearing the now weather-beaten moniker of a long forgotten animal ear medication.

Several thoughts came to him at once like a blizzard of disjointed pieces of paper.

"We must have a meeting. I need to lay the law down to staff. We need to get serious around here about a lot of things. We gotta quit giving away our services. We need some sensible protocols. Jamie needs to get her act together. Someone needs to find out how to get more clients in the door. We need to have a meeting—today!"

Jamie Peters walked around the corner with a stack of papers in her hands. Three pencils stuck out of her hair like porcupine quills. They dangled a few centimeters south of a horn-rim barrette that she often wore to work. Jamie was hard working and employed at the Dillon Animal Hospital for about three years. She knew more about the systems and ecology of the hospital than Stan. She had been a warrior from day one. She was under appreciated above all.

She almost bumped into Dr. Dillon as he abruptly pulled to nervous stop right in front of her face.

"Jamie, we need a meeting today. Find some time and call all the staff. We need our annual conclave in the break room ... maybe at 1 p.m."

"Dr. Dillon, we have only half our staff here at any one time," Jamie intoned fully cognizant of the reply hanging on the nip of Stan's tongue.

"Call 'em all up. We need a meeting!" He turned and grabbed a piece of paper and started scribbling an agenda on the back of a client handout.

Jamie stood there watching. The last annual meeting was about 18 months ago when three staff members had quit in the span of four days in October. Since then, Dr. Dillon has often referred to it as Black October.

Jamie hastily assembled the staff. It seemed that most could reluctantly attend. Prior to the meeting trepidation emerged from their murmuring voices like the drying essence of alcohol applied to the skin. Their voices became dry and strained as the sympathetic nervous system of the entire staff was now working in group mode.

Jamie and the few that had been on staff for longer than a few years knew what was in store. Jamie had once described Dr. Dillon's approach to staff meetings as something akin to the incarnation of both J. Edgar Hoover and Billy Sunday.

Jamie put a big sign on the front door. Basically clients either had to turn around and go home or wait until the meeting was over. The phones were put on hold, and the lights in the front were extinguished. This was the general approach for each of these irregular summits. The clinic was now bunkered in and secure from the whims of the unpredictable and demanding public.

The staff members were now sitting on a hastily assembled group of mismatched chairs and stools. As they took their places, Dr. Dillon roamed the sidelines like a building cold front on a winter afternoon. Very soon he would burst forth and rain on the sequestered assemblage.

Dr. Dillon started slowly but built up steam as he waved various scraps of paper in front of him like he was swatting flies. What was on these pieces of paper was largely unknown to the audience because Dr. Dillon's penmanship was mostly unintelligible—even to him. What could be determined, however, was that the general theme of the sermon seemed to be summed up in a recurring sentence within the rambling diatribe: "Things are gonna hafta change around here!" He ended with a thinly cloaked warning that "heads would roll" if things didn't change. He smiled and seemed satisfied that this was his best performance to date. He thought to himself that Vince Lombardi must surely be proud somewhere in the nearby vapors.

Soon the tension broke a bit, and Dr. Dillon walked to the center of the room and proclaimed triumphantly: "Are there any questions?"

Dr. Dillon's 12-year-old daughter, who was present quite by accident while getting the family cat, inquired, "Can we breath now?"

Muted snickers could be heard but Dr. Dillon seemed to take no notice.

"OK, let's get back to work."

With that, the sun cracked for a few seconds through the steel gray clouds, and everyone moved back to their various parts of the clinic with counterfeit enthusiasm. The departing thoughts for many in the group were this: "If he wants change around here, maybe the most appropriate change is for me to leave."

Far fetched?

I don't think so. I had a young woman working for me several years ago that described her previous veterinary employer's meeting in such a way. His meetings were more frequent, yet even more excruciating than Dr. Dillon's, i.e. he yelled a lot.

It is sad but most veterinary hospitals do not have regularly scheduled staff meetings. When meetings become inevitable, they are usually one-sided affairs with management trying to fix problems that are in fact a reflection of poor management from the top. The view from the top is seldom clear.

Often the owner's approach to problems is to speak in generalities. Nothing gets fixed with general statements. Most real issues are unspoken and well recognized at the staff level. Yet they have little influence if the structure of the organization is bureaucratic in nature.

How things work

Without specific guidelines and oversight, systems evolve within the business to their lowest common denominator (i.e. perceived efficiency of the moment). This is a form of group think, which means that whatever is unmanaged is allowable or even desirable because it means less work. This is just human nature. This is not good for the patient or the business, but it is certainly expedient. For example, it is easier for a new client to see dirt (perceived filth) in an exam room than for a long-time staff member to see the same dirt who has grown used to management neglect. A new client is likely not to complain but is more likely to, in short order, seek a cleaner hospital for their pet. However, when things get bad enough, management finally steps in "hyper-reactive mode" as in the case of Dr. Dillon. This is just plain and simple poor management.

Group think:

Moving toward the ideal

The whole idea is for the staff to take pride in the veterinary hospital and to have a real stake in the organization. In fact this should be one of your goals—to make staff part of the ownership model by allowing them ownership in some of the management details of the practice. You also want your staff to be the best marketing tool you have. If your staff is not sold on the value of the services your hospital offers over other hospitals in the area, it will show in your bottom line.

How?

To do that, they must be invested in the process. One of the easiest ways to accomplish this is to let them take control (gasp!) of the meetings themselves. This can be mind expanding for staff and ownership as well.

The number one thing to understand is this: a lot of the problems that occur (and recur) within a busy veterinary organization are completely unknown or misunderstood by management. The little things that be-devil the receptionist or the assistant are often unnoticed by management because they hide within the gaps in the training provided. These gaps are there because management is not doing these particular jobs themselves. In other words, all the various work descriptions in the veterinary hospital (including veterinarian) have unique interfaces with the public and the work-related systems of the company. Therefore, the staff member has unique knowledge of the problems that hamper his or her own efficiency.

Now when these problems are brought up during a busy workday to a decision-maker, it is often ignored because it is misunderstood or marginalized as trivial. At this point, staff feels unappreciated and work performance gravitates to the lowest common denominator. This is a big mistake. Enter the egalitarian staff meeting.

Every-person's meeting

Every person working in a veterinary hospital should be encouraged to bring problems and ideas to share with everyone else at a regularly scheduled meeting. The practice managers and practice owners are simply participants in the process and should not try to run the meeting.

Meetings should be a time to brainstorm and bring ideas for constructive change. A moderator should be picked for each meeting and that person facilitates discussion. When constructive ideas and changes are brought forth, management should be in position to delegate certain projects to individuals or small groups to take action on the proposal or situation.

SOME POINTS TO CONSIDER ABOUT MEETINGS

• Staff meetings should be conducted regularly and often (at least monthly for smaller offices and weekly for bigger offices.

• Everyone must be encouraged to attend (meaning there must be food).

• Meetings should not be hijacked by management.

• Management should use meetings to gather more information than they disseminate.

• Delegate almost everything possible to those making suggestions.

• Meeting notes must be kept and posted after each meeting.

• Use this time to have fun and some laughter.

• It is a good time to introduce new pet medicines and delivery models to staff.

• Try to find a way to fix at least one problem each meeting that has been nagging the practice for a while.

• Give praise and encouragement to those who have made contributions that may have gone unnoticed by others.

• The rewards of constructive staff meetings go beyond better management; it means better staff relationships.

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.