Toxic veterinary teams

In a world torn apart by employee in-fighting ... one cat ... a brave veterinary patient ... fights ... to live another day. (Shutterstock)You know when a veterinary practice is toxic. You can almost smell it, that tang of adrenaline from spiking anger. You can feel it when your stomach sinks when you walk in the door and realize all the same tensions with your coworkers are still there, hanging in the air.

Worse yet? You're fully aware that the toxicity can lead to bad medical decisions resulting from spite or exhaustion or vindictiveness. The fantasies run through your head when you think about quitting-or finally getting up the courage to fire the bad apple ruining the bunch. It all feels like a sickly gas floating through every client interaction, every treatment area procedure and every break room conversation.

You're not alone. And you're not crazy for facing it, living with it or struggling to fix it. Even the most high-level practices full of skilled doctors and team members can fall into bad habits, with interpersonal and management issues spilling over to negatively impact patient outcomes and customer service.

The human healthcare and veterinary healthcare worlds are increasingly dominated by team-based care. In the best situations, a solid team can result in improved outcomes and reduced costs. But toxic communication, toxic practices and, yes, toxic team members can make things go bad quickly, leading to medical errors and even patient harm.

The emotional ups and downs of veterinary practice, coupled with an unrelenting sense of urgency, can cause the seeds of toxicity to germinate quickly.

In veterinary medicine, practice teams handle anything from a new litter of kittens to a dog hit by a car in a single shift with no lunch break, says Bash Halow, CVPM, LVT, partner at Halow Tassava Consulting. The emotional ups and downs, coupled with an unrelenting sense of urgency, can cause the seeds of toxicity to germinate quickly.

Veterinarian: What toxic looks like to me

"Pet owners with double standards on patient care-they expect better care from us than they provide their own pets. Pet owners who openly criticize your surgery or medicine when you're not present to hear or defend yourself."

Source: 2017 dvm360 Toxic Teams Survey

“Many, many clients reach out to vet professionals and entreat them to open early, stay late, call on the phone, email, text and sometimes discount or treat free of charge,” Halow says. “Because it's hard for vet professionals to watch a patient suffer, they invest their own time and money to care for others' pets at the expense of their own well-being.”

But that kind of work can cause more harm than good, Halow says. Staff turnover increases, and team members are more likely to be rude, hostile or inappropriate with one another. "There are more patient care errors in environments where team members are debilitated by stress or where they're dividing their attention between working and fighting,” he says. “Practices in which team members can't get along make a negative impression on clients and kill client loyalty and compliance.”

Toxic trenches in human healthcare

There are a number of examples of the impact of toxic behavior on patient outcomes in human medicine. A study published last year in Pediatrics showed that rudeness alone was to blame for a nearly 12 percent drop in the performance of diagnostic and procedural work by neonatal intensive care unit (NICU) teams.

The research points to what many suspect: Stressors among caregivers in the medical environment can lead to increased patient risk. Rudeness and other toxic behaviors may seem harmless in the moment, but this study and others in the human medical field draw a clear correlation between those behaviors and adverse effects on patients and on the collaborative work of the medical team.

Team member: What toxic looks like to me

"When people are already dealing with frustration and anger, there's no more patience to spare and people are more harsh with patients."

Source: 2017 dvm360 Toxic Teams Survey

Communication is such a critical part of team-based care that when it breaks down, there are dire consequences. A 2004 research report published in Academic Medicine found that poor communication contributed at least in part to roughly 91 percent of the medical errors reviewed for the study.

Team member: What toxic looks like to me

"Multiple times we've had patients that staff wasn't sure had been medicated or lacked clear go-home instructions. If then takes time to hunt down the information from staff members, who sometimes have gone home for the day. It's embarrassing, and clients then wonder what kind of care we're actually giving the patient."

Source: 2017 dvm360 Toxic Teams Survey

Much of the work done in business-and in medicine-is based more on organizational habits than on deliberately developed, evidence-based practices, according to Charles Duhigg, author of The Power of Habit. In his book, Duhigg outlines how dangerous these organizational habits can be when they negatively affect free thought ("I'm not allowed to make decisions"), well-placed objections ("I'm not sure that's right, but we don't question") and checks and balances ("We're too busy to double-check") within the medical field. Duhigg relays a story of tensions at a Rhode Island hospital that became so entrenched they led to rampant medical errors and eventually a patient fatality.

Toxic trouble in veterinary practice

On the veterinary side, these same issues can occur. A study published last year in Frontiers in Veterinary Science looked at how veterinarians' and technicians' perceptions of toxicity affected the veterinary team as a whole. Four groups of veterinarians and four groups of technicians were interviewed in focus groups, and the common theme that emerged from all was the importance of communication. Toxic attitudes were described as disrespect, avoidance of change, lack of motivation, an overall negative demeanor, micromanaging and incompatible personalities.

“The impact of employees with negative behaviors and a negative work environment has been described in the veterinary press for many years, yet veterinary practices continue to be plagued with the recurring issues that cause these situations,” the study authors wrote. “Communication problems between veterinarians and with staff contribute to lower job satisfaction for veterinarians and affect job satisfaction and incidence of burnout in other members of the veterinary healthcare team.”

Highlighted in the study were complaints about veterinarians and team members saying, “It's not my job,” whether that meant cleaning up after a patient or answering the phone.

Team member: What toxic looks like to me

"Though no one would say it out loud, patients are seen as a job or procedure to complete by lunch break or closing. For example, recovery from anesthesia isn't monitored and bedding, and bathroom breaks for patients are haphazardly addressed."

Source: 2017 dvm360 Toxic Teams Survey

“When people refused to perform certain tasks that would reasonably be considered part of their duties, others felt they were exhibiting a toxic attitude,” the study notes. “For instance, RVTs in several focus groups were frustrated with veterinarians who refused to answer the phone or see clients during lunch breaks, and with receptionists who did not want to talk to veterinarians directly. When people refused to assist with these duties or tasks, other staff members often considered this a control or ego issue. The participants felt that people with this attitude were not contributing properly as team members.”

Whether these doctors and team members are "too good" to help out or were too busy with their own tasks to help, the message is clear: People aren't communicating enough to help work out resentment like this.

“Mood polluters” were another common source of workplace toxicity identified in the study, coming in the form of a difficult pet owner or a problem that starts the day off poorly and sets the tone for the remainder of the shift. Mood polluters may also be chronically negative coworkers who are burned out.

While the idea of a toxic work environment may seen more relationship- than medicine-based, it leads to overall communication breakdown and a lack of confidence in personal skills and in leadership at the practice. Toxicity can compromise the function of the practice as a whole, according to the report.

Toxic trouble starts at the top

Practices that turn toxic can come back, though. Halow says many companies are now turning to civility guidelines at work as a reminder to employees of core values and the importance of honesty and respect.

“Seems crazy, but team members benefit from a reminder to make eye contact and say good morning, to thank others, to share, to be inclusive,” Halow says.

No matter how difficult it may be, Halow says, the practice owner or manager has to take charge and make difficult decisions where necessary to save the practice.

"I can count the number of times I regret terminating a toxic employee on one hand and still have all five fingers available for more counting."

“Some vet leaders turn a blind eye towards toxic members because they believe the offenders will quit and leave the practice shorthanded. Big mistake. I can count the number of times I regret terminating a toxic employee on one hand and still have all five fingers available for more counting,” Halow says. “As I've gotten older, braver and more experienced, I calmly inform all team members of the rule-we can spend the whole day listening to all the reasons why you believe it's okay to behave badly in the workplace and at the end of the day, you're still not allowed to behave badly in the workplace.”

Jim Wilson, DVM, JD, has worked as an associate, a practice owner, an educator and a consultant, and he says the key for practice leaders is to find out what's creating the toxic environment and address it head on.

“When you know you have a bad apple and the staff knows, you'll never have anything but a toxic environment until you get rid of the bad apple. Vets who are relationship-based personalities tolerate bad apples because usually those bad apples have some great skills,” Wilson says. “But one particular skill does not overcome the attitude that toxifies the environment. Staff loses confidence in leadership when you keep bad apples around. When you fire them, you restore confidence in the ability to lead, and staff members know that skills are not as important as harmony in a workplace environment. Culture is more important than skill sets.”

Team member: What toxic looks like to me

"We have one very toxic staff member. The practice owner chooses to not deal with the bad attitude issues because when the bad apple is here, she's busy the entire time. The practice owner doesn't see that it's not always a productive business and that she's costing him more than he's saving. I have written my resignation a few times. It's on the agenda to turn in this afternoon."

Practice owner: What toxic looks like to me

"I struggle to maintain peace, because I feel bad firing employees just for personality conflicts and don't want my unemployment insurance rates to increase. It's rolling of eyes and the silent treatment most of the time if employees don't get their way. Nothing big enough for just cause, just tension."

Source: 2017 dvm360 Toxic Teams Survey

In the past, when Wilson had employees who couldn't resolve a conflict, he would send them to lunch with the clinic credit card to eat and each have one drink, bring the receipt back and present him with a plan for how they planned to move forward.

“I must have done that three or four times," Wilson says. "Frequently, one of the two would actually leave or resign voluntarily because it was their problem to solve, not mine as the boss.”

Other times, Wilson eventually would be forced to fire someone if they simply couldn't find a way to professionally work together: “You can't force people to get along, but you can force them to work together in synchrony.”

Treating toxicity means taking charge-finally

While there are many reasons-and many solutions-for a toxic work environment, Wilson says it's usually something that happens because the boss allows it. Owners should not set the tone that they are the only ones that can solve all of the clinic's problems, he says. Wilson says he used to tell employees who came to him with problems to go and think up three solutions, then come back to him to discuss. Empowering employees to look for solutions on their own can help them develop confidence and provide much needed delegation for the owner.

One of the most taxing things about being a practice leader, he says, is to be attacked by employees in crisis as you start your workday. From a broken machine and supply problems, to late coworkers, complaints first thing set the tone for the rest of day.

"I finally set a law that when I arrive to work in the morning, the only thing I can hear about is a problem that can't wait 5 to 10 minutes because a patient is in distress."

“When this was driving me crazy in my younger days as a practice owner I finally set a law that when I arrive to work in the morning, the only thing I can hear about is a problem that can't wait 5 to 10 minutes because a patient is in distress," Wilson says. "For everything else, they had to wait until I got on my lab coat, got to my desk, took a deep breath and allowed myself to adjust to that level of attention and stress management.

"And I have to say when I finally learned to do that and my staff learned-oh my God, it changed the days thereafter remarkably. If you can walk through the door and leave everything behind before you start taking things anew, you can face it with a different level of tolerance and understanding and patience.”

Many times, personal struggles outside of work are brought in to create the toxic environment. Wilson says he repeatedly recommends The Four Agreements as a guide to overcome negative learned behaviors and achieve greater personal happiness. The book, written by a surgeon-turned-shaman after a near-fatal car accident, is based on four principles: 1) Don't make assumptions. 2) Don't take it personally. 3) Be impeccable with your word. 4) Always do your best. Putting philosophies likes these into practice transforms both your work culture and your personal life, Wilson says.

Rachael Zimlich is a freelance writer in Cleveland, Ohio, and a former reporter for dvm360 magazine.