Who's in control?

Someone is in charge at your practice. If you're the owner, it should be you. But you might be surprised to learn that the de facto leader of many practices isn't the person whose name is on the deed—it's a team member given too much power by a boss who doesn't want to manage or is afraid to. This team member manipulates everyone to his or her benefit and to the detriment of your practice's finances, your team's morale, and your medical care. I see it all the time, and it always stuns me.

Illustration by Val Bochkov

I encountered an employee like this on a recent consulting visit. Kim (name changed to protect the guilty) had been with the practice since she was a teenager, starting off as a kennel assistant and working her way up to practice manager even though she didn't have any formal management training.

Mark Opperman, CVPM

Kim had unbelievable control in this practice—you were either with her or you were drummed out of your job. If you didn't agree with Kim or her way of doing things, she and her fearful followers would make your life miserable until you quit. She'd give you the worst schedule. She'd ignore you. Kim lived by her own rules. She came in when she wanted, left when she wanted, and coerced others into doing her work for her.

You may wonder where the practice owner was during all of this. Well, he was afraid of Kim too. He believed (because Kim led him to believe) that if she was happy, then he was happy, and the entire practice was happy. Also, this doctor didn't like conflict, and when Kim got mad, he paid for it. She'd storm around the practice and make life hard for everyone. So a high school graduate with a bad temper and poor leadership skills was running a multimillion-dollar practice. How did it happen? The owner let it happen.

Be an owner and a leader

Kim's reign of terror began when the owner informally turned over control of the practice to her. The problem? Instead of delegating, he abdicated. When you hire or appoint a practice manager, you still need to oversee that person and make sure he or she is doing the job and doing it right.

If the owner of Kim's practice had ever conducted an exit interview with a departing employee, he would have had an idea of what was going on. But this owner was a "nice guy" and wanted to be everyone's friend. He chose not to get involved, and in doing so, he hurt his practice and the rest of the team. Projects he thought were getting done weren't; Kim sabotaged any idea she didn't like and ordered other employees to do the same.

The practice took in millions, but it wasn't growing—its revenue was actually declining. The owner wasn't aware of this problem, and Kim didn't pay attention because she said she wasn't interested in finances—she had a bookkeeper, who was under her thumb, for that. She was concerned "only about the well-being of patients," an argument she used any time she was against a new policy or procedure, even one that came from the owner.

Rules for owners

Kim got away with this because she was good at telling her employer what he wanted to hear. She was pleasant and charismatic when she needed to be, and she kept him isolated from the other employees. As a result, he had no idea what was going on—but he let that happen too. There's an old adage that says, "Don't expect what you don't inspect." Owners need to keep their eyes and ears open and monitor clinic operations.

If you're an owner, don't forget that it's your practice. You have the right to talk to anyone you want to and ask questions. Build in feedback controls. Are you receiving daily computer-generated financial reports, client reports, and itemized audit trails so you can track practice health? Do you have an open-door policy for team members to talk to you about employment issues? Do you request daily, weekly, or monthly reports from other team members in your practice? Keep a finger on your practice's pulse.

Develop a hierarchy of authority

Kim was the authority in her hospital. What the practice needed, however, was a hierarchy of authority. In a large hospital with many employees, the owner or owners should be at the top of the hierarchy, followed by the practice manager, office manager, head technician, kennel manager, and so on. But the owner needs to stay in touch with that entire hierarchy, and team members should know they can go to the owner if there are problems with their managers. You don't want to undermine your managers, but you need open lines of communication. Let team members know they can come to you and that you won't "tell" on them and get them in trouble with the rest of the team.

At Kim's practice, the owner was uninvolved. He came in, saw some clients, talked to Kim and his associate doctors (they were also afraid of Kim), and left. If he'd spoken with other employees or checked to see whether projects were getting done, he'd have been better informed. Unfortunately, this owner still has "hope" for Kim, although he's looking for a replacement.

Don't ever isolate yourself as a practice owner. And don't let just one or two employees be your only information source.

Watch for puppet masters who aren't managers

Practice managers aren't the only ones who can pull the strings. I've seen associates, receptionists, technicians, veterinary assistants, and even bookkeepers play the puppeteer. These employees were all given power or they took it, controlling others by intimidation or passive-aggressive manipulation. Basically, these types of team members want things done their way and make life difficult for anyone who wants to do things differently.

Recently, during a consultation, I had dinner with the owners of a practice. During our discussion, one owner blurted out that he was afraid of his employee "Devin." He pointed at his partner and said that she was afraid of Devin, too, and that their third partner was also scared but wouldn't admit it. I asked what they were so afraid of. It turns out Devin would launch into terrifying emotional outbursts when things didn't go her way. She screamed at people, burst into tears, and even threw things. The owners made plenty of decisions just to avoid her wrath. "So why is she still there?" I asked.

They proceeded to tell me that Devin was a great employee. She'd been with them more than 10 years and "really knew her stuff" as a technician. If there was an emergency, Devin was the one they wanted by their side. She came in anytime she was needed, and for the most part, they could depend on her.

On the other side of the coin, Devin intimidated other team members and did what she wanted, when she wanted. The owners had created a job just for her in the large animal section of the hospital so the small animal practice owners wouldn't have to deal with her. Most of the time, they said, she was "counting needles," which meant no one knew for sure where she was or what she was doing.

During the all-hands team meeting we held at the end of my consultation, Devin was absent. She'd had a "family emergency." Still, other team members who had been trained to fear her spoke out about the practice's new business plan, saying things like, "Devin's not going to like that." Devin even had power over the practice in her absence.

The owners clearly had not looked closely at the positives and negatives that Devin brought to the practice. In situations like these, I counsel owners to weigh an employee's good traits and bad traits. When the negatives outweigh the positives, it's time to let the employee go. When these practice owners finally put Devin on the scale, it was obvious which way the balance tipped. Devin was having a terrible effect on the practice and holding everyone back from achieving greater success. The owners made the right decision regarding Devin's future at the practice—there wasn't one.

I recently spoke on this topic at a conference, and at the end an owner came up and said the seminar had changed her life. She could see now that she'd been managing from a position of fear and realized she couldn't do that anymore. She was going to take control of the practice and not be intimidated. She would make the hard decisions. She felt confident she could do it and knew it was the best thing for the practice.

If you're an owner, watch out for employees who resist change, want control of everything, and smother other team members' initiative. You may think you can't run the practice without them, but you—and everyone else—will do much better when they're gone. Don't be afraid to snip your overbearing team member's strings and manage your own practice. After all, it's yours.

The bottom line

Cut those strings

Has one of your team members taken over your practice? It's time to take it back:

> Oversee your entire staff. Don't rely on reports from one employee.

> Check the numbers. Monitor daily computer reports to keep tabs on your practice's financial health.

> Weigh good and evil. If a team member's negatives outweigh the positives, it's time to say goodbye.

Mark Opperman, a Veterinary Economics Editorial Advisory Board member, is owner of VMC Inc. in Evergreen, Colo. Send comments to ve@advanstar.com