The Wagging Tail

Self evaluation is important for veterinarians.  We want to do the very best we can for our patients, clients, teammates and ourselves.  You probably already evaluate yourself informally, as you go through your day, and perhaps on the drive home.  Consider also periodically evaluating yourself formally, with a checklist of criteria important for success.  

Feedback is always helpful when determining what is working and what needs work.  For a well-rounded, accurate assessment of yourself, consider implementing a 360 degree evaluation in your practice, in which each person is evaluated by themselves, others on the team, and possibly even clients.

S:  Subjective variables that relate to success include relationship quality, communication skills and attitude. How are your relationships with your boss, coworkers and clients?  Do you communicate well?  Do you work together as a team?  How is your attitude towards your job, towards others?  How are others’ attitudes towards you?  Are there red flags of impending conflict?

O:  Objective criteria are easier to measure, but are also easier to oversimplify or misinterpret.  If the team is getting along well, and pets are well cared for but the number of patients you see a day is down from normal, have you succeeded or failed?  I would contend you are succeeding with room for improvement.  Fortunately, if subjective measures of success are positive, objective measures of success will usually reflect that.  As my Dad always says, “Practice good medicine, and the money will follow.”

So what are good objective criteria to measure and track?  A few to consider are number of patients per day and overall income for a day/week/month/year. Just remember that each statistic only tells part of the overall story.

A:  Assessment of the data is the next step.  Consider the subjective and objective data you have just gathered and determine what you are doing well and what needs improvement.  Again, using the 360 degree evaluation concept, either formally, with standardized questions prepared ahead of time, or informally, by asking others for their feedback on your performance, will help you develop a more accurate assessment.

P:  Plan how you are going to improve problem areas and maintain what you are doing well.  With your assessment in front of you, this is the time for goal setting, for dreaming even.  You are back where you started-envisioning success, but now it is even better, you are envisioning success with a personalized checklist of things to restore, develop and maintain.

Recheck:  If you have found that things are going pretty well, you may want to revisit your self-evaluation quarterly.  If you have problem areas that have been revealed, perhaps a weekly self-evaluation is in order until all is well.  Write out your plan and jot a note on the calendar on the date that you plan to revisit your self evaluation.

Sound familiar?  I thought it’d be easier to remember that way, Doctor.

Walking into an emotionally charged, stressful situation, especially one you are not prepared for, is not something anyone would volunteer to do, even if your communication-style is up there with the likes of Dr. Phil.  And yet, that is exactly what vets deal with when they close the exam room door and are face-to-face with an upset, sometimes, angry client. Being a vet means dealing with the pain of others who love their Pet; it goes with the territory. Day after day, clients enter your practice feeling distraught because their companion and friend is suffering, or dying, or both.  Their worry and sadness causes pain, and unfortunately, when humans hurt, they don’t always handle their feelings in the most productive way.  We tend to lash out, and it’s usually at the one who deserves it the least. In this case, you.

When someone is addressing you with an aggressive tone, it’s difficult to keep your emotions contained and not fire back in some way.  In fact, after a full day of seeing patients and trying to fit it all in, it’s easy, almost understandable, to retort with a knee-jerk response that stings in return…which we know is never a good idea.  At best, a tête-à-tête with a valued client will leave you feeling bad and, at worst, cause you to lose business. 

Veterinary schools offer helpful information on how to deal with worried, grieving clients, but once you’re out and running a practice of your own, you may find yourself focusing more and more on the physical needs of your patients and less and less on the emotional needs of your clients.

It’s natural to feel a bit angry when someone is hostile towards you, but what you do with your anger can make all the difference in the outcome of your interaction.  Below are two simple, but effective strategies that can help you bridge the communication gap between you and your client.

Pause for the cause

It’s been my experience that by merely slowing down the speed of a verbal exchange, I can actually raise the odds of a more positive outcome.   Just pausing momentarily before I allow myself to respond allows my brain to engage, evaluate and better diagnose the problem. Solving problems doesn’t happen when our emotions are in the driver’s seat.  Allow yourself a moment to process.  Create some space to regroup, rethink and redirect. 

Sometimes, I find it helpful to actually remove myself, physically, from a high-stress situation.  People are accustomed to medical practitioners coming in and out of examining rooms, so excuse yourself from the room, if need be,  take a few deep breathes then go back in with your emotions contained and your head on straight.   Creating a self-imposed “time out” is an effective tool to gaining composure. Increasing your awareness of your emotional thermostat during stressful times will allow you to adjust your internal temperature up or down accordingly and better prepare you to handle any situation.

Objects are larger then they appear

Before you walk into your next appointment, take a moment to remember that the people who come through your door (unless it’s for a routine exam) are there because they are concerned about a potential health problem with their family member.  And, this may not be the only issue they are dealing with.  Job loss, family problems and financial struggles might be swirling around in their head too. 

When clients are agitated, try to look past what is being presented and respond back with a softer demeanor. When you take a bigger picture perspective and strive to understand your clients better, you inevitably neutralize the tone, and consequently, the outcome of the exchange.

(Print and post a copy of these concepts and use the information to discuss “How to Handle High-Stress Situations” at your next staff meeting.)

Few things annoy me more than the phrase, “That’s not my job.”  Although I like for my team to have well-defined job descriptions, more than that, I like for them to see the big picture: that we’re all on the same team.  We all have the same ultimate goal: to help pets.  We all need to be willing to step up and help out whenever and wherever we’re needed in order to help the pets that are in our hospital.

Occasionally at hospitals a “war” between the “front” and the “back” will erupt where one group feels that the other isn’t carrying their weight.  The first thing I do to try to avoid these “wars” is to ban all such language.  There is no “front team” or “back team,” we’re all on the same team.  The “back” is called the treatment room.  Our “front” desk person is our Client Service Coordinator.  I also try to have all team members as least partially cross-trained so that they understand the value and hard work that go into every position on the team.  I doubt that it’s much more fun to make appointment reminder calls than it is to clean the fecal sink.

As a team, we all need to be mindful of the client flow so if there’s a back-up in one place we can step in to make things flow more smoothly.  Oftentimes, the PetNurses will go from treatment to reception to help check someone in or out.  We all, even the doctors, grab for the phone after three rings.  Sometimes, I need my client service coordinator to come into the treatment area to hold a pet for me.

If we all realize that we’re on the same team, we’re all here to help pets, we’re all here to get through the day, then we’ll all have much higher job satisfaction.  If we feel that the “other” team isn’t pulling their weight or that “they” don’t work as hard as “we” do, then we’re all going to be agitated by the end of the day. 

When I hear someone say “that’s not my job,” I realize it’s time for me to remind everyone that their job description includes being part of a hospital team and that means doing whatever is necessary to help the pets that we see. I keep a list of topics that need to be readdressed periodically, and this is one of them.  Periodically, I’ll schedule a team meeting where we can reset expectations and rebuild any lost sense of teamwork.  I wish I could have this meeting once and never again, but with the addition of new team members, new duties, new products, etc., it’s a good idea to revisit this topic (and other basics) every three to four months.

Is there discord or perceived job inequality between your front and back office team members? How do you approach these type of conflicts? Feel free to share your stories and any suggestions you have for fostering team harmony.

We all have disagreements in the work place, and disagreements can become conflicts that interfere with our ability to accomplish our work when emotions become involved.  These emotions often stem from primitive feelings of fight or flight and that is why they seem so vexing to resolve.  The key to resolving conflict is to recognize emotions, ours and theirs, create safety and focus on mutual benefit.

Here’s an example situation: I want to have Pets checked in quickly; Jane* wants to ask a lot of questions during registration at the front desk.  Emotions of conflict could build with my co-workers when I apply an underlying negative meaning to a given situation.  For instance, “Jane takes forever checking in Pets even though she knows it slows my work down.  Jane doesn’t respect my role.”  Now, not only am I behind in my work, from my perspective, but my co-worker is insulting me!  If this conflict has gone on a while, with me grumbling about “we sure could speed things up around here” with Jane in earshot, I should assume that Jane now has emotions about this, too.

To have a conversation about this conflict that will bring a positive resolution, it’s a good idea to follow these simple guidelines:

• Signpost the difficulty of the upcoming conversation
  Signposting is telling your co-worker to emotionally prepare for a difficult discussion.  This prevents a feeling that they have been ambushed and leads to more openness.
• Attend to the relationship
  For your co-worker to consider meeting you halfway there needs to be some good will in the relationship.  Your co-worker is more likely to work with you if they sense you want to get along with them, not assert your ideas over theirs.
• Speak to emotions
  There is nothing so powerful in a relationship as feeling like a colleague is trying to understand what it feels like, from the co-worker’s perspective.
• Focus on mutual benefit
  You want to enlist the co-worker in a project that will benefit both of you in your work.

Signpost difficulty:  “Jane, I know this may be hard to discuss, and I think it’s important.”

Attend to the relationship:  I have to have integrity without attachment.  I need to focus myself on resolving the problem so that we can both accomplish our work.  I need to let go of wanting to win.

Speak to emotions:  Focus on empathy.  “You want to make sure we have complete information before we start caring for the Pet.”

Focus on mutual benefit:  “I want to talk to you about our differences on how to get Pets cared for when they come to our hospital. We both want efficient and effective Pet care.  I want to understand why you see things the way you do and share with you my perspective and feelings.”

This approach often helps to ease conflict and develop constructive problem solving.  It is not always easy to do, especially when you feel angry or upset.  One additional benefit is that, when I use this approach, I feel that, whether or not I am successful with the co-worker, I have conducted myself with integrity.

How do these conversations go in your office?  What have you found useful in talking to your co-workers about conflict?

Some additional articles about resolving conflicts:

• http://www.essortment.com/all/coworkerconflic_rbhc.htm
• http://cars.unm.edu/PDFs/resources/Resolving_Coworker_Conflicts.pdf

*sample situation not intended to reflect on any actual persons

Do veterinarians practice evidence-based veterinary medicine?  In the human medical profession, evidence-based medicine (EBM) has become established and clinicians have accessible EBM tools to support clinical decision-making. 

What exactly does EBM mean to a practitioner?  EBM is the conscientious and implicit effort to apply current best research evidence to medical decision-making.  EBM should enhance clinical expertise in concert with consideration of patient needs and client circumstances.

For veterinarians, EBM is gaining momentum, but it is not widely employed in clinical practice. In addition to published research evidence, veterinarians still rely heavily upon textbooks, anecdotes, faculty expertise, and peer consultations.  Depending on the clinical question, these may be the only resources to utilize, but they are often inadequate, outdated, and unproductive.   Why has veterinary medicine been slower to adopt the practice of EBM?    Is it because there is less rigorous, controlled research conducted and published in the peer-reviewed literature?  These challenges create a gap between new knowledge and the practice of EBM in veterinary medicine. 

How can the veterinary profession close the knowledge-to-practice gap?  The gap represents a barrier to high quality care for individual patients. Where can veterinarians go to get evidence-based, synthesized information?   Who teaches veterinarians how to incorporate it into clinical settings?  The US Preventative Services Task Force (USPSTF) is well-known for providing physicians with recommendations and guidelines based on research evidence.  According to their website, the USPSTF is “An independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services.”  

Could similar guidelines for preventive care and screening be developed for veterinarians?  These guidelines would support the most efficacious screening for optimal pet care.  The BARK (Banfield Applied Research and Knowledge) team is using Banfield’s large database to generate new knowledge, in addition to critically appraising existing knowledge from a variety of sources, to create preventive care and screening guidelines for the common diseases of middle-aged and senior pets. 

Next month, BARK’s Research Medical Advisor Associate, Patrick Shearer, BVMS, PhD, will talk about periodontal disease.  Please join us, post your comments, and engage in a discussion about what we know about the disease and how as veterinarians we can promote the highest quality evidence-based dental care for the pets that we see.

• Each month thereafter, the BARK team will blog about topics such as:
• EBM and evidence dissemination initiatives in the profession
• Strategies to best apply evidence in clinical settings
• Current and future research initiatives at Banfield

Let us know if you have ideas about questions or topics that are of interest to you, especially in relationship to evidence-based medicine and getting new knowledge to our patients!

Further Reading: Click on the links below for two articles on EBM that recently appeared in the Banfield Journal. The current edition of the Banfield Journal can always be viewed online at www.banfield.net/banfield-journal. 

• Banfield Journal May-June 2009
• Banfield Journal July-Aug 2009

No way around it. If you’re part of the workforce, occasional disagreements and problems between co-workers are inevitable. And although differences of opinion will always be a part of human interactions, we know that the more effectively we can communicate our thoughts to each other, the less conflict we experience.  And the less conflict we experience in the work environment, the more productive we will be. 

During my research into conflict resolution and practice management, I came upon numerous and useful resources that I’d like to share with you. I could list all the great ideas that I found useful, but I find that the two I list below are the best. Not only are these initiatives innovative, they are practical and easy to implement.

Anticipate problems and prepare.  Reduce the likelihood of disagreements by instating a Principles of Mutual Respect Policy (PMRP). In a non-threatening manner, this document can provide clear expectations, define desired behavior, and more importantly, acknowledges that every team member is important and the practice is dedicated to open communication and treating everyone with respect. Brenda Tassava, CVPM, has an excellent example that she implements as director of operations for the Broad Ripple Animal Clinic and Wellness Center in Indianapolis, Ind. 

Distribute and discuss the PMRP at your next internal meeting and, on an on-going basis, make sure all new team members receive a copy.

Get out and eat some lunch.  My second favorite idea comes from Florence Sanford, CVPM, practice manager at Nassau Veterinary Clinic in Nassau, N.Y., and she describes it as “When our team’s resolution skills aren’t enough to manage conflicts, I’ve sent feuding team members out to lunch together with $25 to talk out their issues. Neither person is welcome back unless there’s a truce. This has happened four times in 15 years and each conflict resolved. Some feuding team members even became good friends.” 

I’m convinced this idea of removing quarreling co-workers works because I have done the same thing with my husband on those rare occasions when we continue to revisit the same disagreements with no resolution in sight. I take him out to dinner and discuss the issue.  I know I am much better at communicating when I am “in public” and he is much more receptive to hearing my concerns. There’s something about sitting in a neutral place and sharing a meal that can allay bad feelings and open our minds to understanding others.

Each of us has unique life experiences, personalities and perspectives that shape the way we interact with our world and, consequently, impacts the way in which we communicate.  Keeping these differences in mind, it’s easy to see how problems and animosity among colleagues can occur. Communicating expectations up front and listening to each other over a roast beef sandwich, might be what your team needs to work through bad feelings and improve team member relations. 

References

http://veterinaryteam.dvm360.com/firstline/Communication+Strategies/Bring-peace-back-to-your-practice/ArticleStandard/Article/detail/529606

http://veterinaryteam.dvm360.com/firstline/Veterinary+team/4-ways-to-keep-the-peace-at-your-practice/ArticleStandard/Article/detail/642323?contextCategoryId=37267

Several weeks ago, I showed up early at the hospital on my “day off” for some paperwork. 

I first noticed that the rest of the hospital also seemed to be closed when operating hours had already started.  All of the exam room doors were closed, lights were off, no one was at the front desk and a pile of trash in front of the counter.

I was a little upset.  I imagined clients, both potential and current, walking the other way so I went about picking up trash, opening exam rooms and turning on the lights. My receptionist walked out of the treatment room a moment later and greeted me enthusiastically while helping me finish opening everything up. She also explained that a team member had called in sick, which was why she had to go in the back to help secure a Pet and could not set up shop right away. She assured me she had only been gone for a few moments.

Before I left the store, I gathered the team to discuss the situation in order to avoid this from happening in the future.  We discussed how my team did not prioritize the hospital’s appearance with the rest of their duties, and while much of the reason was that the team was distracted with other morning tasks, we all knew that we could do better.

We discussed the importance of first impressions, consistency, friendliness and overall exceptional service.  Everyone understood that we needed to put certain protocols in place to prevent this from happening in the future.  Amongst other things, we decided that, as a team, we should walk around the counter to make sure the hospital front looks clean. Because whether we’re seeing a new or an established client, saying “I’m so sorry about the mess” with an excuse just doesn’t cut it.  While an established client might still continue to come to our hospital because we have solidified a positive first impression and they know that this situation is not typical, a new client’s first impression would most definitely be a negative one.

As I departed my hospital a few minutes later, I felt much better. Not only did I make sure to prevent a problem that is easy to fix, but I effectively communicated the needs of my hospital to the rest of the team. While I had not expected the need to communicate something that I thought was so simple to the rest of my team, I took this as a good learning opportunity on interacting with my team as well as stressing the importance of first impressions to clients.

Want your paraprofessionals to be the best they can be? A good technician, receptionist or office manager is extremely valuable. Where can you get one, or how can you develop one? The latter question is more important.

Everyone has great worth and infinite potential, so growth depends only on desire, will, circumstances, and education. As a leader, you have little control over desire or will, but you have some influence over circumstance and education. Education should be part of the culture at your hospital. Having a library of accessible books, manuals, and references is the most basic sign that your hospital encourages learning. Ensure that there are charts, pictures, handbooks, and technician’s manuals in easily accessible places. Everyone should come to work with the expectation that they will learn something new every day. As a leader, try to take yourself to as many formal education events as possible. When you come back, share what you’ve learned with your team members.

Banfield, the Pet Hospital streamlines and facilitates training through the online Banfield Learning Center modules. These are of extraordinary benefit in providing education to team members. I make it a point to ensure my team has the time to take advantage of this training.

Many veterinary practices encourage technicians to attend Continuing Education (CE). Is this a possibility in your hospital? Several PetNurses subscribe to veterinary technician magazines and associations. Litter your break room or coat area with these publications. Similarly, there are online technician’s courses available through accredited sites. I recommend the VetMedTeam, or those provided by Colorado State University, the Ohio State University or Tufts University. Given the benefits of continued education, you might even consider reimbursing your paraprofessionals for the cost of one of these classes.

When all is said and done, all the training in the world will not replace good hiring, recruiting and placement practices. In order to practice the best quality medicine, hire those who take their job seriously, especially those who have experience or who have acquired formal training (such as a relevant undergraduate degree or a veterinary technician’s degree). This will provide better patient care and a more effective hospital overall.

Don’t be afraid to think outside the box.  I once heard about a veterinarian who insisted upon hiring elementary school teachers to be veterinary receptionists or office managers. He reasoned that elementary school teachers are not only compassionate people, but that their communication skills are superb and they are accustomed to a workplace in which emotions run high and chaos is commonplace. Sound like a medical facility?

In an interview, try to identify a person’s worldview, personality traits and how they handle themselves in order to know how they might work under pressure or how they might respond to an angry client, a crashing patient, a lobby full of sick patients or a kennel area full of howling dogs. A lot of us enter our dream job only to discover we are not very well suited to it. Make a point to hire people with experience in the veterinary field, who are also open-minded and flexible.

Remember no matter whom you hire, patience, persistence and dedication to learning will make any practice grow.

“Holiday Puppies” are a common present at Hanukah or Christmas. Shelters routinely brace for the surrender of these dogs a few months later. And while dogs are relinquished for a variety of reasons, one of the most preventable is “behavioral issues.” Here are some simple tips you can give to your clients at the first visit with their new puppy that will help mitigate some common behavioral issues, smooth the transition of the new family member and ensure a lasting bond.

Feel free to copy the tips below and distribute to clients:

Contented Confinement: I suggest that every dog should be trained to accept confinement in a portable kennel as early in life as possible. (Prepare her now for boarding or hospitalization later.) For “gone to work” confinement, the ideal setup is a portable kennel connected to, or inside an indoor “exercise pen” with newspaper or fake grass as a toilet. This setup is safe for 8-10 hours at a time and limits the puppy’s access to everything it might do wrong. The best way to introduce the closed kennel is to pair every entry into the kennel with a toy containing a fresh dab of peanut butter. If the puppy cries later, first do a “Needs Analysis” and if elimination, exercise and other needs have been met, it will be necessary to let the pup learn that tantrums don’t work.

Chew Training: A few chew toys inside the kennel during confinement teach the puppy that these are his items to chew. Other times the owner should actively put these chew toys in the puppy’s mouth and praise any chewing.  Start with very easily chewed toys such as Greenies and work up to compressed rawhide that has one end soaked in water to soften it up.  Booby trap unacceptable targets with mouth wash or underarm anti-perspirant.

Reward Based Elimination Training:  Punishing house soiling teaches, “Don’t eliminate when he’s watching!”  This approach makes proper training more difficult because the goal is to BE THERE outside to praise correct elimination.  When home, begin with confinement in a closed kennel which inhibits elimination.  Take the pup out every few hours when awake, and no food or water inside the kennel overnight.  If the puppy does not eliminate, just put her back into the kennel and try later.  She will learn the way to get freedom, play and other rewards is to eliminate in the right place.  Make her urine or feces so valuable she won’t want to waste it indoors.  When she routinely asks to go out, she has earned her indoor freedom.

Leash Training:  After successful elimination, suggest the owner take the puppy for a walk as reward.  This habit of rewarding elimination on the owner’s property reduces the future need to bring baggies on walks.  If an outdoor walk isn’t possible, suggest an “indoor walk” i.e. hold the leash INSIDE the house during post elimination play periods.  This is a positive leash association, and makes it easy to catch the pup if mouthing something inappropriate, or if about to eliminate again.  In the evenings, use the leash to tether the pup next to people to bond, and to prevent sneaking away to trouble.

Following these simple steps will go a long way in making the “Holiday Puppy” a permanent member of the family.

No question about it – these are trying financial times. Fortunately, the stature of the family pet has never been higher, and more than 80 percent of pet owners DO NOT intend to spend less on their four-legged family member in 2009. The American Pet Products Association (APPA) expects pet spending in the U.S. to increase 5 percent this year. In spite of a serious recession, that’s amazing! The APPA predicts the biggest beneficiaries of this year’s growth will be the veterinary care and pet food categories. Dogs and cats must eat, and pet owners have a propensity to bring their pets in for veterinary care.

The ever-present challenge for veterinary professionals is to demonstrate the value delivered. According to a PiperJaffray study of 248 companion animal practices, “While we were impressed with overall growth expectations, we would highlight that nearly 70 percent of the clinics we surveyed believe pet owners are deferring some treatment this year.” The BNResearch PetPoll 2008 concluded that “…with household budgets getting tighter due to the economy, clinics can expect more scrutiny and questions related to the cost of veterinary services. If pet owners do not understand the value of the services they are receiving, hospitals are at risk of facing both unsatisfied and lost clients.” Clearly, it’s never been more important to clearly explain the value you deliver.

So, how do you communicate value?

• See patients and clients on-time. Your client’s time is valuable and finite
• Articulate the comprehensive physical exam as conducted
• “Show and Tell” clients what you see, hear and feel
• Spend adequate time with clients, and probe for pet health questions
• Cliché, but true, a picture is worth a thousand words. Show Me!
• Demonstrate the cost of non-compliance:
  • Obesity likely results in osteoarthritis, shortened longevity, expensive NSAIDS and lab tests
  • Periodontal disease only worsens without veterinary intervention. The systemic risks are significant (see Dr. Glickman/Purdue CVM study of 60,000 dogs linking gum disease with heart disease)
  • Heartworm disease, as well as other diseases, is MUCH less expensive to prevent than to treat

Dogs and cats don’t know or care that the economy is weak. Their health care needs remain unchanged. As Dr. Marty Becker has said, “Your job is to be the spokesperson for the pet’s best interest.” Your oath is to protect human and animal health. Be the pet’s advocate, and everybody wins!