'Tambo Rule' makes care decisions easy

I have a secret to share. A secret method to solve problems within our offices.

This secret can unlock solutions to resistance to change, provide the motivation to staff to adhere to protocols, and eliminate generational conflicts.

Some years ago, the "Goodbye Sweet Tambo, Goodbye" article was published in this magazine. Tambo was a very special canine friend of mine. I used my special relationship with Tambo as the basis for the dedication of my text, "More Management for Results."

Tambo lives on as a simple practice philosophy to ensure the well-being of hundreds of my veterinary patients.

Tambo Rule

The Tambo Rule can affect your practice in a very simple way, with every patient. Merely ask yourself, "What can we do to ensure the health of Tambo?" We can easily find many Tambo's in our practices. The rule can be retitled to each practice's favorite patient.

The practice mission and decision-making processes can revolve around that simple rule: What is the best way to handle this issue as it will affect Tambo's health care?

Issue: Tardiness

How does tardiness affect Tambo's care? Answer: A smaller staff cannot provide each patient their medications and nursing duties in a timely manner. The added stress of increased duties for a "short" staff means Tambo's care is likely to be rushed, hurried, or administered by tense staff members.

Issue: Inattention to Protocols

How does an ignored protocol affect Tambo's care? Ignored protocols ensure the delivery of improper and poor health care. Protocol issues include staff positions and medical protocols. When clinic staff are out of "position" their duties might be completely ignored or forgotten. Tambo does not get the care she needs.

Issue: Internal Office Backbiting &Verbal Sniper Fire

Staff backbiting undermines staff morale which leads to a stressed staff. Stressed staff members will not have the attentiveness or emotional resources for empathy or kindness in the delivery of daily duties. Again Tambo does not get the care she needs.

Issue: Active Listening, a.k.a. Communication

When the staff is taught and trained in active listening skills, the honing of skills ensures that we hear all of the client issues and clues needed to facilitate Tambo's care. Tambo gets the care she needs.

Issue: Assume?

When we disarticulate the word assume it come out ASS- U- ME. In sentence form is comes out like this, when we assume, it makes an "ass" out of "U" and "Me". A corollary of this concept is a training issue, "we cannot complain until we train," and inevitably by the time we get done training there will be no complaining. So make no assumptions, be a proactive communicator and Tambo will get the care she deserves.

Issue: Specifically Morale

We can address morale as a living person. We all understand just how important positive morale is to the happiness and smooth function of a veterinary clinic. For the practice that specifically tends to and nurtures staff morale, happy days exist at the clinic. An "up" staff is going to deliver their best in attentive medical care to Tambo.

Issue: Fees, Money

If we fail to collect appropriate fees when we provide veterinary health care, we are unable to keep the clinic clean, we are unable to attract the best personnel, and we cannot afford continuing education and new updated equipment to give Tambo the best. Collect adequate fees and this part of the health care puzzle will not be the limiting factor for Tambo's care.

Issue: Focus

In a clinic environment, when staff is unfocused, important duties slip through the cracks and Tambo does not receive the attention she needs. Therefore avoiding activities, like playing call-in games on the radio are to be avoided, a work environment that encourages "focus" means Tambo gets her care.

Issue: Completing Tasks in the Appropriate

Amount of Time

Sloppy, speedy work ensures poorly disinfected and uncleaned items. Sloppy, speedy completed tasks ensure that Tambo will be the next victim of a nosocomial accident. When excessive time is taken to complete a task, such ensures that other tasks in the office will not be completed on time, or other members of the staff will be burdened with extra work as the slow poke is not pulling their share of the duties. The shift of duties to other members of the staff generates anger and frustration which sours the mood in the clinic, and Tambo has no desire to be handled by staff that is of a sour demeanor. Appropriate time for tasks ensures that Tambo will, at the least get appropriate veterinary care.

Issue: Staying Organized

One person's mess in a multiple person office creates anxiety and tension. When we humans work in groups we need some structure to complete our tasks effectively - when we permit mountains and piles of sloppy paperwork and jumbled duty lists, frustration sets in as it becomes impossible for the staff to provide Tambo the attentive and timely care she desires.

Issue: Appropriate Supervision

Staff needs supervision to sort out the daily duties and the priorities to ensure Tambo gets her needed care.

Issue: Excessive or Too Little

Supervision

Most staff that are overly burdened with excessive supervision quit. Oppressive supervision implies distrust and distrust generates ill will and unhappy workers. Give folks appropriate leadership and supervision and Tambo will get the care she deserves.

Issue: Fanatical Behavior & Personal

Agendas

When one member of a staff has an obsessive and compulsive nature about something it disrupts the general smooth operation of the office. Almost by definition, obsessive compulsive behavior, such as excessive micro-management, is unbalanced behavior and unbalanced behavior rocks the clinic "boat". In such situations Tambo is forgotten.

Issue: Attitude

Good attitudes foster dialogue and discussion of hospital health care issues that will benefit Tambo. Poor attitudes of pessimism and negaholics deliver negative energies to the clinic floor, such energies discourage happy staff that is needed to provide Tambo happy, uplifting care. Foster and nurture good attitudes and Tambo will maintain a happy attitude.

Issue: Body Language

Much communication is delivered by body language. The rolling eyes, the Betty Davis eyes, the soft and gently nurturing body language send a message to everyone, including Tambo. Monitoring the unspoken messages to encourage gentle handling of Tambo, and fellow staff members, during nail trims, draining anal sacs, recovery and such times of interaction all affect Tambo and staff morale.

Issue: Absenteeism

Rarely will a veterinary clinic be overstaffed. But if such a clinic would exist, absenteeism would not be a problem. Yet, for the majority, when a staff member is missing for a day, to complete the day's duties for Tambo will require the trauma and stress of finding someone else to fill in for the day or some duties will not be completed. Incomplete duties compromise the health care.

Issue: Excessive on

the Job Social Activity

It is essential that duties be completed in a timely and efficient manner. When we spend too much time permitting the social dialogue to interrupt thinking minds and working hands Tambo's care is delayed and incomplete; have fun, but get the job done.

Issue: Anticipation of the Next Step

Certainly a skill to promote is the anticipation of what is next. Good assistants and colleagues on a busy day learn to anticipate each other's next steps. When many of the routine duties are handled in this manner, smooth, efficient and stress-free delivery of Tambo's medical care is assured.

Issue: 5 p.m. Mentality

The 5 p.m. mentality has all staff members charging out the door with the 5 p.m. "gong". When the 5 p.m. mentality exists in a veterinary hospital, earlier and earlier in the day the crunch begins to make sure all lights are ready to go out at 5 and the door is locked at 4:59. In these situations, Tambo's care is rushed, hurried, insensitive and inattentive.

Issue: Dead-Time Use

Every week a clinic will have times of intense activity and periods of peace and quiet when little is happening-these quiet times are "dead-time". Practice personnel can keep on top of the little things like sanitation, cleanliness, changing soda sorb in the anesthesia machines, replacing scavenging filters and spot inventory control. Attentiveness to these details improves the safety and well-being of the environment that Tambo received care in.

Issue: Interruptions and Focus

Veterinary medical care focus is lost when staff receives too many interruptions. When one is interrupted halfway through a procedure, a thought process, or in the write up of a medical record, Tambo's care will be punctuated with mistakes and sloppiness. My favorite sign to discourage interruptions was on display on the door of the ICU at the Animal Medical Center in New York: No doctors allowed between 8 a.m. and 10 a.m.

Issue: Regular Review of Protocols

We can all admit it, as soon as a protocol is adopted, it becomes modified daily until it is no longer the original protocol, and thus Tambo receives care other than intended. Protocols reviewed in a timely fashion ensure that they are not undergoing an inappropriate evolution, or to ensure that a protocol does undergo a timely evolution. A favorite: The hospital heartworm protocol was still printing up Caparsolate when that drug had long since been abandoned.

Issue: Inattention to Protocols

The reality of a protocol is that the typical human mind is only going to remember most of the steps of a protocol. It is called being human. Adopting methods to ensure that protocols are followed, e.g. protocols in the format of a checksheet is a great way to go. When attention to details of a protocol are followed, Tambo gets the care that was intended.

Issue: Ignoring Words of Anger

Anger is triggered by frustration. Frustration comes in three flavors or stages: coping, fighting, kill. When things go wrong we either cope, get fighting mad, or seek to inflict hurt on another. Once a frustration is identified, the practice must figure out how to appropriately adjust to the situation to ensure that the delivery of care is healthy and that staff morale is positively affected when frustration arises. In other words, moments of anger and frustration have identified an issue that might affect Tambo's health. Seek to correct the situation that triggered the frustration.

Issue: Hiring Self-Starters

In medical situations so much depends on the desire and personal mission of individuals working together in the medical team. Self-starters can infect the entire staff with positive, attentive medicine. Such folks provide that extra edge to give Tambo those little extras, an edge for an emotional push, or that edge to find the occult disorder.

Issue: Healthy Building Syndrome

Stinky, smelly, unkempt, noise-polluted and poorly maintained buildings instill an illness on the staff called the Sick Building Syndrome. Poor ventilation and a depressing environment spreads the disease to the staff. Create the Healthy Building Syndrome-install nice telephone rings, put in soothing music, nice colors, clean floors, make sure ventilation systems are adequate to purge toxin and ugly smells. Animals are also very sensitive to the environment, and in a happy building Tambo will respond faster because she is happier.

Issue: Medical Records

Completeness & Accuracy

The intent of the medical record is certainly to record the medical activities surrounding Tambo's care. And in today's health care environment, team health care depends not only on accurate medical records but timely and proactive use of the SOAP system to enable all partners of the healthcare team to carefully and regularly review medical progress and plans. Inattention to the details of the medical record activities and plans leads to confusion, missteps and lapses in the care that Tambo needs to recover.

Issue: Reputation and History

Image is central to attracting the families who own "Tambos" to the practice. Tambo's family will be attracted to a practice with a reputation for providing attentive care for the Tambo's of the world. And the longer a practice is able maintain a terrific reputation, the more Tambos will arrive at the front door. Potential employees will seek to find the practices that provide TamboCare. And the prospects and future of Tambo Practices are excellent.

Homework for this month

Provide each member of the staff a copy of Goodbye, Sweet Tambo Goodbye and then begin to conduct staff meetings with the Tambo Rule as the only guideline to count: "What would we do to ensure the health of Tambo?"

Dr. Riegger, Dipl. ABVP, is the chief medical officer at Northwest Animal Clinic Hospital and Specialty Practice. Contact him at www.northwestanimalclinic.com, Riegger@aol.com, telephone and FAX (505) 890-6855. Find him on AVMA's NOAH as the practice management moderator. Order his books "Management for Results" and "More Management for Results" by calling (800) 598-6008. M