When the doctor doesn't see the problem

Marty Becker, DVM, was receiving adulation everywhere he went. Coast to coast and abroad, colleagues hung on every word he said about practice management. So he was surprised back in his Sandy, Utah, clinic when a team member took him to task one day.

When the doctors pet is not his shar-pei

"You don't walk your talk," she said as Dr. Becker's eyes flashed. "You have different rules for veterinarians. You wouldn't tolerate the same behavior from one of us. For us, you have the 10 Commandments; for doctors, you have the 10 Suggestions."

"Like what?" Dr. Becker asked defensively.

The team member minced no words. "Like arriving late for meetings and late for work. Like keeping work spaces cleaned up."

The day before Dr. Becker had scheduled a meeting with an associate who was consistently late for work. The team member's words hit home as the meeting approached. Ultimately, the associate was late for the meeting, and Dr. Becker fired him.

"I learned a lesson that day," Dr. Becker says. "From then on I treated associates and other staff members consistently."

If your practice team wants—as Dr. Becker suggests—to live the life of self-improvement, you must follow his team member's lead and find ways to approach the doctor about problems effectively. And keep in mind, you may be the only one in the position to see the issue.

True, it's not always easy to share your unique view in a way that others can see it. But great communication is like pilling a cat—you learn the tricks with practice. And creating a culture that makes communication easy could head off bigger troubles later.

Does the doc see what you see?

Pam Weakley, a Firstline Editorial Advisory Board member, has worked at Dickman Road Veterinary Clinic in Battle Creek, Mich., for 15 years. Shortly after she was promoted to practice manager five years ago, a team member approached her with a personnel concern.

"The problem really bothered the employee, but she was afraid to talk to an owner," Weakley recalls. "She made me promise that I wouldn't tell the owners who I'd spoken with. It got me thinking. If that person hadn't spoken up, this problem had the potential to become a huge issue and could've seriously hurt our team."

Creating an open culture begins with practice owners. At Dickman Road Veterinary Clinic, a chain of command provides some insulation to those who see problems and want to share their view. It's a team process the doctors encouraged when Weakley became practice manager. At the doctors' request, she developed a flow chart that explains where staff members should take their concerns and comments. Generally, problems flow through department heads to Weakley, who takes them to owners if a resolution isn't clear.

Weakley talks daily with the managing practice owner, and she solves most problems then. She brings major problems to the doctor's meeting and requests an owner-only session to discuss solutions with all of the owners.

Still, Weakley cautions, even an open culture may not be enough to encourage some team members to speak freely. "In veterinary practice, people often live from paycheck to paycheck. And if that's your situation, you can't afford to do anything that might compromise your livelihood," she says. "That's why it makes sense to create a system where team members approach an intermediate manager with their concerns rather than having to go to an owner."

Anonymity, she says, is sometimes critical to bring the problem into the doctor's line of vision. Weakley even provides her home phone number for employees who don't feel comfortable discussing a problem at work. "We're more concerned about fixing the problem than with who said what," she explains.

Dr. Becker remembers a revealing visual he found in an Ohio veterinary clinic that helps team members communicate with the doctor anonymously. Let's call it the Vet-O-Meter. It's a clock face with a malleable mouth that can be turned up into a smile, bent straight for a stern look, and bent down at the ends to illustrate a particularly bad mood. Staff members arranged the face each day to reflect the owner's mood—a safe way to show him how he was coming across to the team and to clients.

Humor, Dr. Becker says, is a good way to diffuse negative news. The Vet-O-Meter allowed team members to tell the veterinarian what he needed to hear, not what he wanted to hear, in a lighthearted way.

Fred Metzger, DVM, Dipl. ABVP, owner of Metzger Animal Hospital in State College, Pa., says he learned a lesson about listening long ago when he overlooked team members' complaints about an associate. "I finally asked the problem veterinarian to leave. Miraculously, staff morale improved and a great team member decided not to leave," he recalls. "Doctors need to take team members' complaints seriously, or they risk sending the message that they don't care."

Showcase your common goal

Creating a culture where you can openly address sensitive issues is tough. "People are worried you'll kill the messenger," says Dennis Cloud, DVM, a board member who owns four practices in the St. Louis area. The solution, says Nancy Allen, practice manager at Olathe Animal Hospital in Olathe, Kan., is to show that you support the same goals and want to help.

For example, Allen remembers a sticky problem she addressed successfully with an associate. The veterinarian was rushed and presented a diagnosis and treatment plan so quickly the pet owner didn't have time to digest it. Team members had to take the client aside and explain the situation more fully.

"The veterinarian got carried away with technical talk, and the pet owner just couldn't process it all," she says. "When I spoke with the doctor about it, she said she could see what I was describing. Now she's working to bond with clients and to build trust before she presents the treatment options."

The secret to her presentation, she says, was asking the veterinarian to imagine herself in the client's shoes. "Introducing a new perspective, in a nonthreatening way, can help anyone think about how his or her message may be coming across," she says.

But don't look for a one-size-fits-all solution, Allen cautions. Nine years as a practice manager have taught her to craft an approach that fits each doctor's personality.

One key strategy: Watch to learn how the person processes information. For example, Allen's practice owner was an engineer before becoming a veterinarian. He tends to focus on the facts. Yet other veterinarians may respond better when you emphasize how the problem makes staff members feel.

"A seasoned old-school veterinarian will take things differently than a recent graduate," she says. "Some doctors want to see all, know all, and control as much as possible. Others like to incorporate staff members' input and build consensus. The key is to know the doctors you work with and adjust to their styles. When you do that, you get better results."

Removing the blinders

Ready to open your boss's eyes? Use these three steps to improve communication with doctors:

1. Reinvent the suggestion box. Weakley embraces the suggestion box because it allows team members to comment anonymously. She sometimes receives typed suggestions in the box, making them even more difficult to trace. Weakley publishes the suggestions in the minutes from staff meetings. The key to making a suggestion box work, Dr. Cloud adds, is that managers must respond promptly to suggestions.

2. Create situations that encourage your boss to listen. "Listening is difficult," Dr. Cloud says. "We all naturally want to avoid confrontation. That's just human nature." To zap your doctor's duck-and-cover instinct, you may need to create a forum that encourages discussion.

Staff meetings give you a good place to speak up and improve communication, provided the atmosphere is right. Just don't let these meetings turn into free-for-all gripe sessions.

Allen assembles staff members in a circle during meetings. Then they go around the room, and everyone has a chance to comment. At her practice, the meetings also offer team members a chance to share positive feedback about their work and each other.

Dr. Cloud uses staff meetings to collect feedback with an exercise he calls "the five things to change" list. The assignment: "Imagine you owned this practice. Now write down five things you'd change." Then team members discuss their ideas.

3. Develop rapport with the owner. Weakley says good communication makes it easier to bring your concerns to the doctor. She likes to present problems this way: "Here's the problem, and here's the solution I've come up with. What do you think?"

Finally, remember that you must share your vision in a way that helps the doctor gain a new perspective. With the right communication skills, you'll be prepared to approach your boss with your unique view—and maybe you can shed some new light on a problematic situation.

Bringing bad news

No one wants to be the bearer of bad tidings. But if the job has fallen to you, consider this advice from Lifescripts: What to Say to Get What You Want in Life's Toughest Situations (Wiley Publishing Inc., 1996): Rather than hold a deadly postmortem about what went wrong, quickly turn the conversation to a discussion about what to do now.

Doctors are more likely to respond to your concerns if you offer realistic solutions.

Just the facts

Want the owner to take you seriously? Fred Metzger, DVM, Dipl. ABVP, says the best approach is to document your complaint and include specific examples of the problem.

John Lofflin is a freelance writer in Kansas City, Mo. Please send your questions to: firstline@advanstar.com