Watch out for dangerous assumptions

Many years ago, I managed the foaling department of a large thoroughbred breeding farm. In addition to foaling about 200 mares a year, I received shipments of either mares with foals at side or single mares waiting to be bred. Part of my daily routine was "walking pastures"—going into each pasture or pen and looking over each horse individually.

With so many horses and multiple large pastures, it often took two to three hours to complete this task. Checking a pasture meant looking at each horse from all four sides, asking each one to move off, and noticing everything: eyes, feet, udders, navels, attitudes, respirations—everything. It meant looking in the water trough, scanning fences, and checking gates.

When things ran smoothly, this was the best part of my day. But there were many, many days when my walkie-talkie summoned me back to the barn every 10 minutes. A mare decided to foal, a van arrived unexpectedly, a baby started colicking, or the teasing crew needed extra help. With these clamoring distractions, I was sometimes tempted to do a "drive-by" for the last couple of pastures. I could see the horses from outside the fence, after all. They were probably fine, right? ?

I never did a drive-by in the seven years I was there. This protocol was an absolute in our business. Each department head checked his or her horses every day: the breeding manager, the yearling manager—no exceptions. With so many horses, the statistics were against us: An illness or injury was likely to be lurking. So the care we exercised in checking our horses was nonnegotiable.

Expect the unexpected.

Every day your staff members weigh priorities and make judgment calls. Each is responsible for many tasks governed by multiple rules and policies, which are in turn challenged by daily circumstances. They must handle intersecting and overlapping duties involving patients, other staff, clients, doctors, and vendors in a daily square dance, and on a perfect day, they probably do quite nicely. But when did you last have a perfect day? More likely, you've recently experienced one of these scenarios:

• A drug you use frequently wasn't added to the inventory order board. You reach for it and it's not there.

• A client is upset by the bill for his hospitalized horse. He requested—but didn't receive—a notification when his balance approached a certain figure.

• A busy technician discharges a hospitalized horse ungroomed.

If you're fortunate enough to lead a group of golden individuals who never misstep and make everything look easy, congratulations, and high fives all around. A great many of your colleagues, however, are in the process of building a solid support team. Most of you, in fact, work with at least one or two team members who are in the early stages of training. As they learn the ropes, add skills, and develop judgment, you watch with fingers crossed, hoping someday they achieve the ultimate goal: total reliability. It takes a long time, and there are few shortcuts, but to help them get there eventually, you need to spell out the absolutes in your practice.

Your absolutes are the priorities and core objectives within each position that guide team members in managing the unexpected according to both urgency and importance (note the difference). There are some missteps that simply cannot happen—certain responsibilities must be achieved 100 percent of the time. These are the protocols that are carved in stone—no gray areas, no wiggle room, no "almost" about them. Can your staff point to those absolutes within their job responsibilities?

Some are obvious—the way a surgeon scrubs in, for instance. Even if you're rushing to get to surgery, you wouldn't skimp on sterile protocol. Basic safety rules are another example. You'd never throw the end of a lead rope around your neck, not even with a bomb-proof 27-year-old horse, not even for "just for a second" to give yourself two free hands. Hopefully that's self-evident. But what about priorities that are less obvious?

Don't assume. Train.

For new team members (particularly the increasing number of them who work part time), separating the "absolutes" from the "discretionary" takes time and supervision. On a very busy day, a patient may depart with straw in his tail. Not ideal, but understandable. On another busy day, a patient may wake up on your surgery table and there's no anesthetic redose prepared. Different story. Everyone is scrambling around looking for the bottles and using time you don't have. It's no comfort that this chaotic experience happens only rarely—your patient just tried to leave.

In this situation, the technician responsible didn't anticipate the consequence of her missed step—it was just one of a handful of tasks she'd helped with in the past but hadn't been ultimately accountable for. The senior technician in the room wrongly assumed that everything had been checked and everyone knew the level of importance. These tasks were never defined as absolutes.

You might think your medications protocol is more clear. Preparing, labeling, administering, and recording a drug a certain way makes sense, because once the medication is in the horse, it's in. If it's the wrong horse, if it's the wrong drug, or if someone overlooked the entry about last night's allergic reaction and the change in orders—well, that's not the same thing as forgetting to order bandaging material. The drug protocol is rote for a reason. We all do it the same way, every time, for obvious reasons.

However, I've begun noticing more equine practice employees coming from wider and more diverse backgrounds. Some of the best receptionists, for instance, come from food service jobs. They've juggled groups of hungry diners, kept everyone's order straight, noticed people trying to catch their attention, and watched everyone's drink levels, all the while being charming and friendly enough to secure a good tip. Their service skills are impeccable. But they haven't had to triage a phone call from a panicked client with a seizing horse.

Some equine veterinary assistants are hired on the strength of their experience in small animal practice but have little background with horses. Some horse owners are hired with solid handling skills but have almost no veterinary background. They might become practice stars, but their inexperience can make it hard for them to assess priorities from one responsibility to the next. And their strengths can lull you into assuming that they already know the critical priorities.

Spell it out—gently.

While all your policies are important, certain ones bear emphasis. Don't hesitate to clarify to team members which responsibilities require unequivocal exactitude. Try not to micromanage—you'll only take time away from your own responsibilities—but remind everyone that we all make assumptions, and maintaining a good safety net means you'll occasionally review employees' understanding of unconditional core practices.

You're most likely to make a new rule—or several—right after a problem occurs. But adding rules in hopes of plugging the most recent leak is not the answer. While too little structure leaves us wandering around cluelessly, too much structure clogs the flow we hope to create, and the most critical priorities get lost in the clutter.

As important as your rules are your vigilance and willingness to speak about the absolutes. You rely on individuals to sort through the often conflicting demands of the day and weigh the importance of what they're doing at any given time. If they've heard you refer to the practice absolutes in the past, it's easier to recenter on them when the cat herding is in full swing.

You don't expect perfection in everything. You just want to make sure that whatever slips through the cracks doesn't result in disaster. Your staff's judgment is significantly enhanced when everyone grasps the non-negotiables, so don't be caught wondering who fully understands them. Do it in a friendly, positive way, but don't be afraid to state them, restate them, and share why they're unconditional. Your team is in a "high-reliability" profession. Help them stay focused on the things you rely on most. ?

Tracey O'Driscoll-Packer is an equine management consultant based in Pismo Beach, Calif. Send questions or comments to ve@advanstar.com or post your thoughts on the dvm360.com community message boards.