Archives for category: Veterinary

I’ve been holding staff meetings in veterinary hospitals for 10 years.

That is a lot of monthly staff meetings.

It occurred to me perhaps others could use some of this information for their own meetings in the same way that I used this information from where ever I stole it from.

I’m envisioning this being an ongoing resource for those who have to come up with topics for discussion or team building.

You can find Part One on Customer Service here and you can find Part Two on Team Building Activities here.

I have removed a lot of the hospital specific information and so please feel free to add, rearrange, and generally change the information to suit your practice, or business.  I’m going to try and keep similar subjects together. This week we are looking at communication tools. There are a lot of pictures here which are either royalty free (from Pexels.com) or I have created so you are welcome to use all of them.  If you do end up using some of this I’d love to see your slide decks, pictures, or presentations.

ABCDE

We do a stressful job.

We, hopefully, try to keep the drama to a minimum.

We don’t always succeed.

When dealing with other people it often makes sense to question ourselves to help resolve an issue. If we intellectualize our emotional interactions it can help change behavior, and explain the connections between our actions and their consequences.

This system is based on Albert Ellis Cognitive Behavioral Therapy model, but it can be adapted to everyday interactions and is particularly useful for those who have a habit of repeating the same behaviors again and again.

ABC

A = An Activating Event. Something happens. It could be something another person says. It could be something that happens that to you:

  • It could be your spilt coffee,
  • or someone ran their car into the back of yours,
  • or your boss told you off for something that was not your fault.

These are all “Activating Events.” Things that are not in your control.

B = Beliefs about those events. When something happens to you, you have a belief about that event:

  • “I’m so clumsy and stupid I’m always spilling things,”
  • “That person who ran into the back of me can’t drive, or certainly should not be allowed to,”
  • “My boss is a jerk, I’ll show him, let’s see how he likes it when I go slow, and don’t talk to him unless I have to.”

C = Consequences of those beliefs. Having those beliefs leads to consequences:

  • A spilt coffee leads to questioning your ability to do anything, this makes you nervous when handling physical tasks, which in turn makes it more likely that you will spill or drop things.
  • You leap out of your car and immediately berate the person whose car just ran into yours, making sure that the person understands just how angry you are and how it is all their fault and that they can’t drive and should have their license taken away.
  • Your boss becomes exasperated with you as the quality, and particularly the speed, of your work deteriorates.

Consequences lead to more activating events that become self-perpetuating:

  • You stop doing any physical task with breakables or liquids.
  • When the police arrive you are placed in handcuffs for being disruptive and out of control.
  • You receive a written warning for insubordination, not being a team player, and having a bad attitude.

And in turn you have similar beliefs out these “Activating Events:”

  • “I’m so stupid and clumsy I can’t do anything, nobody trusts me and nobody should.”
  • “That guy and his crazy driving got me arrested, I’m going to get him.”
  • “What jerk my boss is, I’ll show him, I’m calling in sick tomorrow because I know they will be really shorthanded without me.”

abc

Activating events and the beliefs we have about those events lead to consequences, which in turn lead to more activating events which we have beliefs about which lead to more consequences.

abcabc

So how do we break this cycle?

It is important to understand that our beliefs about activating events are all in our head. They are what we think about the activating event, but they are not necessarily correct. Those beliefs that lead to consequences are really not connected to those activating events. We make those connections.

So when an activating event happens, we need to “D”ispute the belief we have about it if those beliefs lead to bad consequences, or consequences that get in the way of our happiness, career and general well-being.

abcd

By disputing those beliefs we gain new “E”xperiences. This in turn will lead to positive activating events which can re-enforce our new beliefs.

abcde

Our beliefs about activating events are a prism through which we see the world. We choose how to experience things. It is helpful to imagine a wall between activating events and beliefs. And it is our beliefs that act as a filter which leads to the consequences we want. We are responsible for our own experiences, and if we want to change those experiences we need to look at our beliefs about activating events.

[It is useful at this point to play out scenarios that staff members may have experienced, or that you all have experienced, and see how they fit into this model.]

 

Making your Job Easier – First impressions.

[This is very much a discussion based item. I am giving my opinions and how I would use them in this exercise. You may have different opinions and so may your staff. The point is to get people to understand that first impressions matter and that although it may not be right to base a relationship on first impressions, people do it all the time because of a lack of there data. If we can think about appearance and how others will interpret it we can at least have a discussion about presentation issues.]

First impressions matter.

They matter because you make decisions about other people and other people make decisions about you.  Now we can control whether we act on those decisions to a certain extent, but we have no control over how others view and act on their first impressions.

I believe that the better a first impression you can make the easier your job becomes. Your first impression is a tool that you can use before any other and it takes minimal effort.

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Who is this man? What are our first impressions of him? Is he at home? In his office? What kind of job does he do? How professional is he? Would we be happy going up and talking to him? What would we think if he talked to us?

What I take away from this picture:

  • Professional in a casual field (shirt, neat hair, type of laptop.)
  • Working away from his office (cell phone visible, laptop, and no cables to either).
  • Concentrating and busy, but seems approachable.

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Who is this man? What are our first impressions of him? How does he compare to the previous photo?

What I take away from this picture:

  • Stressed!
  • Could also work in a casual field but difficult to tell if he is working or not (dress, stickers on laptop – note it’s the same laptop.)
  • Obviously in a coffee shop, but laptop is plugged in which seems to suggest given his demeanor that he does not want to be there as he has had to charge his computer.
  • Unapproachable.

These two individuals could be dealing with the same issue, in fact they could be communicating with each other. But from first impressions they are very different while essentially doing the same things and they could even be from the same company in very similar circumstances.

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What do we take away from this picture?

  • Businessman.
  • A successful professional (polished appearance and comfortable).
  • At a conference (lanyard around his neck)
  • Representing something (a company or organization pin on his jacket)
  • Listening and interested in what he is hearing, but not afraid of it.

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What do we take away from this picture?

  • Business man.
  • Does not look as successful (unpolished appearance – shirt is neat but almost looks like it does not belong given the ill fitting sleeves. Unshaven.)
  • Looks nervous – not enjoying the conversation.

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What do we take away from this picture?

  • Professional but casual.
  • Clean polo shirt, very neat.
  • Dentist (equipment in background)?

How does this picture compare to the last two? Is this how this dentist might look when coming into the office on his day off? Even so, do we trust him?

bodybuilder-weight-training-stress-38630.jpg

What do we take away from this picture?

  • Confidence
  • High self-opinion
  • Not very subtle
  • All about the impression – very loud and in your face.
  • Are you impressed?

pexels-photo-29172.jpg

What do we take away from this picture?

  • Doesn’t care what we think.
  • Some effort has been put into his appearance but on his terms (hair is neat, but unshaven, and an un-ironed shirt.)
  • Cigarette is a statement.
  • Are we impressed?
  • A tragic figure?

How we present ourselves to others has an impact. If all a client has to go on is a few short words with us then the non-verbal cues such as our demeanor and our dress are just as important if not more so in building trust.

I’ve been holding staff meetings in veterinary hospitals for 10 years.

That is a lot of monthly staff meetings.

It occurred to me perhaps others could use some of this information for their own meetings in the same way that I used this information from where ever I stole it from.

I’m envisioning this being an ongoing resource for those who have to come up with topics for discussion or team building.

You can find Part One on Customer Service here.

I have removed a lot of the hospital specific information and so please feel free to add, rearrange, and generally change the information to suit your practice, or business.  I’m going to try and keep similar subjects together. This week we are looking at team building exercises and games. If you end up using some of this I’d love to see your slide decks, pictures, or presentations.

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Blind Trust

Separate into pairs. One of the pair is blind folded and needs to be navigated to the other side of a room full of obstacles.

The obstacles can be anything. I’ve printed out pictures of lava, snakes, poo, etc. and then taped additional sheets of paper to the pictures to make the “obstacles” interesting shapes. If you have difficulty finding blind folds elasticated headbands work really well.

Have both members of each pair stand at the same end of the room. Have one of each pair put the blind fold on. Quickly rearrange the obstacles so that the blindfolded team member done not have the benefit of having seen the layout of the course. The un-blindfolded team member instructs the blindfolded team member through the “maze” while they remain at the starting point. Then the roles are reversed. If a blindfolded team member steps on an obstacle they go back the start and they try again. If you have candy or some other kind of reward it helps get the competitive juices flowing.

This is a fun exercise that teaches the value of listening to instructions and working as a team. It does eat up a lot of time so don’t cram it into a busy meeting, particularly if you have a lot of people.

What’s That Tune?

Have a deck of index cards with the names of very recognizable tunes written on them. Split your group into two halves. Give a card to victim / volunteer and have them share the name of the tune with the rest of their group. Have the volunteer tap out the tune and see if the other group can guess that the tune is. You can then have the groups reverse their roles a couple of times. Have anyone who thinks they know the tune out their hand up rather than shout out.

The group who know what the tune is will find that it is almost impossible to believe that the other group does not recognize the tune from what is being tapped out. But then they will realize how difficult it is when it is their turn to guess.

This exercise is used to explain “the curse of knowledge.” Context and knowledge are incredibly important for communication, but they can hinder. When a person has knowledge (such as the name of a song) it can sometimes be difficult for them to understand why someone who does not have the knowledge can’t understand a less than ideal description of that knowledge. Things that are obvious to staff that deal with the subject everyday are not so obvious to clients who do not.

Song Suggestions:

Star Spangled Banner

Star Wars Theme

Jingle belles

Game of Thrones Theme

Twinkle Twinkle Little Star

Tower Building

Get whatever materials you have to hand. Straws, paper cups, paper plates, sticky tape, etc. Spilt your group into separate teams and see which team can build the highest free standing tower within five minutes.

This is a great ice breaker and team building exercise that is cheap and does not take a lot of time.

Call My Bluff

Works better with smaller groups of less experienced staff. Have everyone sit in a circle and have a small table with a selection of brochures for the products / services you sell. Use a stuffed toy or something similar to designate who’s turn it is to speak.

Pick a person to start who chooses a leaflet from the table. They read out three statements relating the product leaflet, one of them should be false. If someone in the circle guesses which statement is false they get to pick who gets the stuffed animal and picks a leaflet next. If someone in the circle incorrectly identifies a true answer as false they get the stuffed animal and have to pick a leaflet.

This exercise not only allows staff to learn about the products and services you sell it also helps pinpoint deficiencies in training programs.

The Prisoners’ Dilemma

Two players.

Each player should have no more than 25 coins. Tell both players that they can keep all the coins that they have at the end of 20 rounds as long as they play all 20 rounds.  However, warn them that you may play multiple games using the coins they have and they cannot reuse coins that they bet or win. Players can talk to each other but they need to hide their bet until both bets are revealed at the same time (behind or underneath a player’s hand is usually the easiest way to achieve this.)

Each player chooses whether to bet one, two, or three coins.  The player that bets the highest number of coins wins. If players bet the same they each get to keep the coins and they have survived another round.

A player that consistently bets three or two coins will run out of coins and therefore will not be able to complete all twenty rounds and will lose all their coins. A player that consistently bets one coin risks losing coins to the other player.

Ideally what should happen is that both players come to the realization that if they just agree to always bet one coin at the end of the 20 rounds they will both be 20 coins richer. However, there can be a temptation for one of the players to bet more at or near to the end. If this happens, then it is interesting to play another game with the same two players, or with a fresh player and the player who did not co-operate, and see how the cooperation goes this time.

The obvious goal it to show how working for the good of the group is actually in the interest of the individual as well. And while making a short-term gain can sometimes seem worth it in the long run everyone loses.

 

I’ve been holding staff meetings in veterinary hospitals for 10 years.

That is a lot of monthly staff meetings.

It occurred to me perhaps others could use some of this information for their own meetings in the same way that I used this information from where ever I stole it from.

I’m envisioning this being an ongoing resource for those who have to come up with topics for discussion or team building. I have removed a lot of the hospital specific information and so please feel free to add, rearrange, and generally change the information to suit your practice, or business.  I’m going to try and keep similar subjects together. This week we are looking at customer service. If you end up using some of this I’d love to see your slide decks or presentations.

IMG_8617 

The Client Centered Practice

Why should we care about clients?

We are here for the pets…

To help pets we have to invest in happy clients.

We are here to cater to Clients Our job is to make our clients experience exceptional and therefore to return.

1st impressions are formed in 7 secs. Be Likable: attitude, smile, eye contact, raise eyebrows, shake hands, lean in but stay 2′ away.

Ask clients why they named their pet what they named them. Open ended questions help boost engagement.

Be complimentary, thank clients for trusting you / us with their pet.

Any time you surprise clients you build customer loyalty. If you do something nice for them they will do something nice for us.

Tell clients stories about their pet. Make sure clients know what you do to make pets comfortable.

Upset clients are a chance for us to shine: “What I will do is…” “We appreciate your feedback…” “Let me see what I can do about that.”

Use the pets name in the conversation. Do not refer to he, she, or it. If you must refer to the sex… GET IT RIGHT!

Internal Customer Service

How we interact with each other is at least as important as how we interact with clients.

Every time we do not deliver excellent customer service to a co-worker there is a client, or patient, at the other end who is not getting good customer service.

Always try to view things from our client’s perspective.

A client’s reality is not ours.

Our clients should never suffer because internal issues.

Phone Based Customer Service

Every client who calls wants to come in.

Every client will call other places if we let them.

It is difficult for owners to evaluate the quality of veterinary services. They can’t use logic to evaluate services they only know how we make them feel.

55% of communication is visual.

7% of communication is content.

38% is how things are said.

On the phone we are already handicapped because of the lack of visual.

How we say things is doubly important.

The ROI of awesome customer service (15:00 minute mark to 20:25 minute mark)

 

Setting Customer Expectations

We don’t know what our clients are expecting.

Some vet hospitals do things differently than others.

Clients get upset because we do not do what they thought we should do.

A customer has a certain expectation of customer service when they visit Wal-Mart or a McDonalds.

A customer has a different expectation of the level of customer service when they visit Nordstrom or Starbucks.

A customer who goes to Nordstrom and get’s a Wal-Mart level of service…

(Give examples of online reviews and client expectation mismatch)

Zappos charge for shipping, and clients expect to be charged for shipping.

However, occasionally giving away free shipping to a client makes the client feel valued and grateful.

If we let client’s know what is going to happen and then we exceed those expectations they will love us for it.

(Clicking on the image above will take you to Amazon where a tiny percentage goes to help fund my book buying habit.)

“We have always had some influence over the justice system but for the first time in 180 years, since the stocks and the pillory were outlawed we have the power to determine the severity of some punishments and so we have to think about what level of mercilessness we feel comfortable with.”

So You’ve Been Publicly Shamed by Jon Ronson shines a, sometimes unwelcome, light on the unforgiving nature of Internet shaming. Ronson convincingly argues that almost 200 years ago we abandoned shaming as a form of punishment, not due a lack of effectiveness with rise of the larger towns and cities, but because it was seen as overly cruel.

Ronson has extraordinary access to those who lives have been ruined because of a bad out of context joke, calling out someone for perceived sexist comments, for making perceived sexist comments, and for being too irreverent in a selfie at a national memorial. The author also cleverly focuses on those less worthy of pity; the successful author who gets found out for making up quotes, and exposes our own attitudes to shaming. And then there are those who seem to have beaten the shame cycle; the UK publicist who went to war with the tabloid press, and the small town where almost a hundred of its citizenry where reveled to be visiting a local prostitute.

As well as telling the story of the various victims of the modern age of public shaming, Ronson also tells us of his own journey and grappling with his own role in the shaming of others and of being of control of his internet persona. This does not hang together quite as well as the rest of the book. I have a hard time, for instance, that such a talented researcher cannot look back through their own Twitter history to see who they have previously shamed. However, this is minor quibble and a brave personal exploration and opening up about personal shame.

The book does end on a relatively positive note due to the miracles of Search Engine Optimization (SEO), however the real point of the book is for the reader to examine how they feel about this return of public shaming. Even for those whom it is hard to defend; the hunters seeking big game trophies, the Vet taking pleasure in shooting a cat with a bow and arrow, and the plagiarizing author, to name but a few – do they really deserve this level of life altering destruction?

For those who answer yes, this book is for you. “So You’ve Been Publicly Shamed” is, if nothing else, a testament to how much of a double edged sword internet shame can be, how cruel and destructive it is, and how uncomfortable we should all be with it. The Internet shows us at our best and worst as a culture – it is we who have to change.

Note: I have refrained from using the names of any of the subjects, or related people, in this post so as not to add to add to the problem.

By Mike Falconer

In the very short history of live streaming with mobile devices through apps such as Periscope, and perhaps more importantly Facebook due to its ubiquity, there have been number of notable firsts. Some have been amazing, some have been funny, and lots have been horrific.

The shooting death during a traffic stop of Philando Castile by a Police Officer, quite apart from being an awful tragedy which is still under investigation, had its immediate aftermath streamed live over Facebook as you have undoubtably heard if not indeed actually seen.

The debate, the police response, and I am sure the entire investigation, surrounding this shooting has been framed by one of the witnessing participants and their actions. Not that fact that a video exists but that a video exists and a significant portion of the population of the country, if not the world, will have seen and even taken part in the immediate aftermath.

There may actually be a lot of good that comes from the instant live streaming of events, even when bad things happen; however, we live in a pretty unforgiving world. And so it was the Philando Castile shooting that started me thinking about the wider implications not just for race relations and policing, but for how people will deal with difficult, or even impossible situations, and how that will impact those on the other end of those situations.

Social media, and its close cousin the online review, has created a culture that embraces the shaming of mistakes and, for the most part, rejects the idea of context. All to often these tools are used as instruments of revenge rather than as a tool to achieve resolution or inform other consumers. We don’t put people in stocks in the town square any more, but we do ruin their lives for a bad joke in ill taste or a photograph that seems to mock our most cherished beliefs. As Jon Ronson writes in his excellent – So You’ve Been Publicly Shamed – “We have always had some influence over the justice system but for the first time in 180 years, since the stocks and the pillory were outlawed we have the power to determine the severity of some punishments and so we have to think about what level of mercilessness we feel comfortable with.”

In business, we may yet yearn for the days when an unhappy client meant a vitriolic Yelp post at 2AM. All businesses prefer, or at least they should, clients to complain when they are unhappy for whatever reason. A complaint from a client is an opportunity to salvage a situation and gain a more loyal client at the end of it. However, when the complaint itself becomes an instrument of revenge and shaming how should, or indeed how can, businesses respond?

The nightmare scenario could take many forms, however in the veterinary world it could take the form of difficult conversation about quality of life, cost of treatment, and accusations of medical error live streaming across the Internet, with the client’s social circle providing encouragement and additional fuel to the fire. Add to that nightmare scenario that most people are nervous when on camera and that as a business you have little chance to respond due to social circles being closed and content being shared far and wide. Imagine your worst experience in an exam room and then add 10s, 100s, maybe even 1,000s of additional participants not as a moment on what happened, but actively participating.

In this situation, it will not be about customer service and it will not be about a complaint. It will be about damage control. This will be about the power of one person to control their environment, and those around them, by leveraging their social circle and social reach. This will no longer be a conversation with a client, it will become responding to a leader of an angry mob.

With power comes great responsibility, but also the potential for great irresponsibility.

As people who deal with the public at stressful times we all need to be comfortable with the fact that live streaming is here and what it could mean for all interactions. The time to be thinking about this is not as the person across from you says “by the way I’m streaming this on Facebook.”

I do not have great insights into how to deal with these situations other than the same insights as to how to deal with online reviews. Deal with them the same way as if the camera was not there. Easier said than done I know. Try and address your clients concerns, be accommodating, and try and deliver excellent customer service. Be the reasonable one – be the professional. It may mean that we all need to be comfortable on camera – how we sound, how we talk, and what to say and not to say.

Live streaming has huge potential and has already affected the world and how we view events. However, it’s greatest impact may be at the personal level and end, or a new appreciation for, personal privacy. Banning technology rarely works. Adapting and being prepared, however, is far better option that sticking ones head in the sand. Facebook will still see the rest of you if you do anyway.

A Very Fictional Exchange

By Mike Falconer

Dr. Try Ingtodomybest: Good afternoon Ms. Dis Satisfied what seems to be the problem?

Ms. Dis Satisfied: Problem? I’ll tell you what the problem is. I’ve been waiting to see you for 45 minutes and then when I do see you it is only for 10 minutes!

Dr. T: I’m sorry, we’ve been rather busy today and we we have had other cases that have taken longer than we would have liked – I’m so sorry for the delay.

Ms. D: You are just too busy, you don’t allow enough time for each appointment. You just try to pack us all in so you can charge as much as you can per hour. Oh and by the way you charge too much – been here 10 minutes and you want to charge me almost $200!

Dr. T: To be perfectly honest there is a certain amount of truth in what you say. We have to schedule based on the best use of our time with the most optimistic length of each visit. If we didn’t, your visit would be even more expensive.

Ms. D: Nonsense. My 10 minute visit should cost the same regardless of what else is going on in this hospital. I am only using 10 minutes of your and the staff’s time.

Dr. T: If only that were the case. You see you also pay for the down time; well actually to be more precise all clients do, just like you all pay for the overhead of the building.

Ms. D: Why should I pay for you doing nothing?

Dr. T: Believe me I don’t want you to, I want you to only pay for the time that you use, but in order for that to happen we need to keep as busy as possible. The busier we are the more efficient use of our labor which is 50% of our cost of your visit.

Ms. D: So what you are telling me is that your time is more valuable than mine?

Dr. T: Only in as much as you value it in that way. In order to make care for your pet accessible there is a balance to be struck between the average waiting time / length of appointment and the cost of that appointment. Let me put it this way, Would you be willing to pay more to guarentee less of a wait time and a longer, on average appointment?

Ms. D: That would be depend on the value of the appointment?

Dr. T: I am assuming that is value as you see it as opposed to how I see it?

Ms. D: Surely they are the same thing?

Dr. T: The value of a heartworm test to me is, other than it being good medicine and the best thing for your pet of course, is what you pay for it and the potential for finding other conditions. If we catch a condition early we can then treat with the better chance of a good outcome because we caught them early. The value for you of a heartworm test is piece of mind and it allows you to receive heartworm preventive which is what is the best thing for the health of your pet. Those points of view both have value, but if our view of value is too out of sync then you won’t get the heartworm test for your dog, neither of us has piece of mind and although your visit will be shorter and I can see another patient more quickly, I will not receive the fee for the test or the medication.

Ms. D: So what you are telling me is that if I want to have a longer appointment with you and less waiting time I would have to pay more?

Dr. T: Well of course. The basic rule of veterinary medicine as things currently stand is the whatever walks through the doors pays the bills. If not enough walks through the doors one of three things happens. We raise our prices, we lower our costs (wages are 50% of our costs remember), or we close.

Ms. D: You could always get more people to come through your doors?

Dr. T: Absolutely, but these are the other side of the coin of raising prices and lowering costs. Getting people through the door when they are not already coming in means lowering prices or raising costs – in other words marketing. If successful it solves the problem if it fails it, course just makes the problem worse.
Ms. D: But this just sounds like all you care about is the money?

Dr. T: The flip side of that is that all you care about is the money! Everyone in the building spends their days with pets and most have made it their career and for less money than they could get in other professions.

Ms. D: I’m tired of that argument – there is value in spending your day with pets most people would love a job like that.

Dr. T: Touche! However the reality does not always live up to the public perception. Hence the high burn out rate and other serious ills of the profession. I’ll give your visit today for free if you can name a television portrayal which matches what actually happens inside a real hospital.

Ms. D: ……

Dr. T: Do you like flying?

Ms. D: No I hate it, packed in like sardines, air travel used to be so stylish.

Dr. T: Why don’t you fly business class or first class?

Ms. D: Because I am not made of money – I come here too often.

Dr. T: A business class seat costs anywhere from 2 – 4 times the price of an economy priced seat because it uses the 2 – 4 times the resources of an economy seat. The most precious of which is, of course, space. Your hankering for the good old days of air travel was when all seats were business class. Lowering the barriers to air travel has meant we can now travel like never before; however, it also means that we do not value it in the same way.

Ms. D: So if I am understanding you correctly, you are telling me that as a Doctor you have to bring in a certain amount of money every hour like a quota. How can I trust you if you are doing this?

Dr. T: That is one way of looking at it. I would rather look at it as I have to carry my share of costs of having a facility like this so it can be open. As long as we charge appropriately the unwritten contract that we have where we charge based on our costs and in return we will make every effort to be cognizant of not taking you for granted and at the same time not letting you take us for granted, will mean that conversations like this will never have to happen in the real world.

Ms. D: Well thank you for your time and for your insights – can I get a payment plan for todays visit please?

(Clicking on the image above will take you to Amazon where a tiny percentage goes to help fund my book buying habit.)

 

A short book, Entangled Empathy puts forward the case that for upgrading our relationship with animals to one of responding to the “needs’ interests, desires, vulnerabilities, hopes, and unique perspectives” based on the context of their situation rather than focusing on animal “rights.”

What does context have to do with this subject? Gruen uses the example of man and his children entering a subway car where upon the man sits down and closes his eyes while the children proceed to become extremely disruptive. When eventually someone suggests to the man that he do something about the behavior of the children the man agrees, apologizes, and states that his wife had just died and they don’t seem to know how to deal with it anymore than he does.

Essentially, Entangled Empathy is a rallying cry to abandon ridged ethical principles when dealing with animals and move to a more empathic model. To do this we have to recognize that we already have complex relationships with animals and when it comes to their welfare a one size fits all solution can actually be harmful.

There is a lot of merit to what Gruen is talking about in Entangled Empathy; however, the execution leaves a little be desired. There are some rally quite interesting models used to prove ethical points (such as the man and the children on the subway); however these are not expanded upon with any great new insights. Rather they are broken down to component parts and never put back together again.

Gruen does use a couple of examples from her own life, and work, but they are never fully explored in any meaningful fashion. Anyone who reads the book and expects to finish with a set of tools to better handle animal welfare based on entangled empathy is going to be sorely disappointed.

While certainly interesting, and it gives some food for thought, there is little in the way of answers here which makes Entangled Empathy much more that a statement of principles bordering on “we can do better.”

By Mike Falconer

(Clicking on the image above will take you to Amazon where a tiny percentage goes to help fund my book buying habit.)

“Lean” is a way of thinking about business and business operations based on the Toyota Production Method. Often linked with Six Sigma much trumpeted by GE, Lean focuses more on employee engagement than the statistical analysis of Six Sigma.

A full description of the benefits of Lean, or even Lean Vs. Six Sigma, or Lean Six Sigma are out side the scope of this blog post (for that you can check out the author’s own excellent blog post on the subject of Lean Sigma and Lean plus Six Sigma here.) However, I should probably give some background on why I want to read this book and my interest in lean.

The simple answer is that I had become aware of the short comings of much of the veterinary specific continuing education when it comes to larger hospitals – particularly when it comes to employee engagement and communication. I’ll never forget sitting in on a not very good seminar on internal communication at a veterinary conference and then finding out that the speaker’s hospital had less than ten employees. There is nothing wrong with practices of that size, but the ideas were not scalable – I have supervisor meetings larger than ten people! Because of these issues I started to look to the human healthcare world for ideas and inspiration.

I did this with some trepidation.

Human healthcare has some serous issues and in many ways could learn a lot from the veterinary world – not lease in the use of resources and customer service which seems at times to be virtually non-existent. Having said that, lots of others have similar feelings about human healthcare and there are a number of people trying to make major changes hospital wide.

One of those people that I came across was Mark Graban, the author of Lean Hospitals.

I had been communicating back and forth with Mark over Twitter about healthcare and process issues that interested us both and so I decided to give “Lean” a serious look.

I should make clear, that Lean Hospitals is very much a human healthcare book. For those in the veterinary profession, a significant amount of translation and out right rejection will need to take place. However, for those with large facilities to run and with hopefully a mandate to improve, there is a lot to learn from Lean and the Lean Hospitals volume that I am imperfectly reviewing here.

Lean is about reducing waste. Not just physical waste, but the waste of your employees and your patients / clients time and resources. The general principle is that by harnessing the knowledge of your employees about what they do, and by actually looking at and standardizing how your employees work you can create internal systems that not only save time and money but that are safer for patients and employees. Coupled with this is the idea of a culture of continuous improvement and error proofing of the workplace.

A lot of these ideas will be familiar to anyone who has attended a management seminar in recent years. What seems to make lean and Lean Hospitals different is how it is all held together and that is has real processes and tools for implementation and analysis.

As a book, Lean hospitals takes the form of a workbook, with each chapter giving not only a formal conclusion and lesson points but also a list of questions for group discussion. Although, Mark primarily works in the human healthcare world now, Lean Hospitals is written almost from a lay persons perspective and so the use of human medical terminology or assumption of knowledge of those processes is kept to the bare minimum.

On the downside, Lean as a process, is replete with jargon which mostly takes the form of Japanese words or phrases originally inherited from the Toyota Production method. Although there seems to be no real reason to have to use these terms, other than that some of the ideas need a name of some type, they can be a little off putting and require a certain amount of referring to the glossary (which is excellent!)

Lean Hospitals is also a little expensive for a business book, although cheap by text book standards, but makes up for this by being an excellent read throughout.

The most insightful passage in the book relates that healthcare is full of brilliant dedicated people that daily have to battle with broken systems and goes on to quote Fujio Cho, the Chairman of Toyota Motors: “We get brilliant results from average people managing brilliant systems. Our competitors get average results from brilliant people working around broken systems.”

For those looking for an introduction to the world of Lean, or even just a set of interesting ideas from progressive human healthcare to cherry pick, Lean Hospitals is an excellent starting point.

In this ongoing, and occasional, series I discuss the process of learning to be a manager. Since my background is for the most part in the veterinary field we will mostly focus on the peculiarities of that industry; however, the majority of points made here are transferable to other professions / industries.

In the previous post, we looked at the initial steps in becoming a new manager. In this post we look at potential areas of responsibility.

New managers, or rather managers who are new to managing, can face a couple of dilemmas in their first few days in the job. The unlucky ones face both!

The first is being overwhelmed by all the areas of responsibility that have now landed squarely upon your shoulders. The second is not knowing what your responsibilities actually are, and therefore, not really knowing what your job is.

Take a deep breath and relax.

The first is easy – you will be overwhelmed, you will always be overwhelmed. It is the middle name of all managers. Split your days up, as much as you can, by focusing on different areas each day (see below), and prioritize.

The second is also easy – the buck stops with you. If it doesn’t, then you need to act like it does unless instructed to by your owner, or a more senior manager. You may not know anything about Information Technology (I.T.) other than it is a fancy term for computers. But if the computers are not working then you are the one responsible and in all likelihood fixing them or calling the person who can.

I have identified a number of areas that managers may, or may not, be responsible for. Depending on your particular circumstance, some of these will not apply, or you may share the responsibility with another person. If nobody is looking after that area then guess what? That area is now your responsibility.

We will look some of these areas in more depth in future posts, but for now, welcome to your new world…

The Building

I have worked in buildings that are over 100 years old and in buildings that are brand new and they all had one thing in common: things always break down, never worked properly, or need upgrading. In other words buildings, and the equipment inside them, need looking after. Few things can grind a business to a halt as quickly as a building problem. Having no water, no electricity, or no access to your building, means that in very short order you are closed. This does not mean that you have to understand plumbing, electricity, how quickly concrete sets, or the basics of I.T. (however a little knowledge is very useful) but it does mean you need to work closely with those that do and ensure that you trust them. You do also have to listen to them, and not just hear what you want to hear. They know nothing about veterinary medicine, for example, so they know more about their field than you do.

Staff

We are going to cover managing people in a future post; however, it is important to note that the staff look to you to be there for them. Remember the only stupid question is the one not asked and communication can never be a bad thing. So encourage the staff to talk to you.

H.R.

Human Resources (or H.R.) is the general catchall term given to the hiring, firing, benefits, coaching, and disciplining of employees. It is usually a job that requires a lot of paperwork and attention to detail. Depending on your circumstances, H.R. can make up a significant proportion of your time and it can also land you in hot water if handled incorrectly. I consult colleagues regarding H.R. issues more than any other subject.

Payroll can also sometimes fall under H.R. although this may be more of a support roll to either an outside company or in-house accountant. If you do find yourself handling payroll in its entirety and you do not know what you are doing – STOP! There are computer programs, companies, and accountants who can all help with this. Nothing will undermine you quicker than getting payroll disastrously wrong. 

Belonging to an organization such as your local SHRM (The Society for Human Resource Management) chapter is also a great way to get tips, C.E. and to build a support network in what in itself can be an overwhelming area of the manager’s responsibilities.

 Financial

You don’t need to be an accountant to have a significant interest and impact on the financial management of your business. The days takings need to be reconciled and deposited with the bank. Credit cards need to reconciled both daily and monthly when the statements come in. If they are not already in place, controls need to be developed so that nobody, including you, has too much access and unsupervised control over any financial area. Bills need paid, money put aside for taxes and payroll, but an eye also need to be kept on how the business is doing. Are we doing better than last year or worse? Not are we busier, but is more money coming in the door?

Marketing

I’ve covered starting a marketing program in this series of posts; however it is important to remember that marketing can be as simple as making sure that your opening hours are correct on the front door and, for a veterinary hospital, that your vaccine and appointment reminders are going out.

Inventory

Supplies need to be ordered, expired stock needs to be removed / returned, and checks and balances need to be put in place so that pilfering can be noticed and stopped.

Safety

Safety is more than making sure that all of OSHA’s boxes are ticked. Although this in itself can be a monumental task depending on where you are starting from. Being responsible of the safety of the employees, and your clients, means that you have to be the bad guy. It is not enough to tell staff to wear the proper Personal Protective Equipment (PPE) you are now responsible for ensuring that they do.

San Juan College have a great presentation on OSHA and the veterinary practice that forms part of their Veterinary Technician program – well worth checking out.

Scheduling

Even if you do not handle the mechanics of your hospital’s schedule, you may well have to give guidance as to staffing levels and when is a good time to give vacation time and when is not – for example. It may not be your fault that you do not have enough staff on a busy day or time of year but it is your responsibility.

Regulatory Compliance

Taking a critical eye to a practice, or any business for that matter, and ensuring that things are being done in a correct and legal way can be a seriously challenging task. This is particularly true when you may be asking people to change how they have done things for a significant period of time. However, it is part of the job and is one of the areas where getting it wrong can have significant consequences for both the business and you personally.

State Veterinary and Pharmacy boards vary widely in how helpful they are in response to questions about interpretation, but as a rule it never hurts to ask.  Certainly reading the practice acts that govern your state is a great start and reaching out to other managers through a local organization as we discussed in the last post will also be extremely useful.

Clients

All businesses are ultimately about clients. You can have the best veterinary practice in the world but without client’s you’ll close. Ensuring that they are looked after and that they have a great experience at your facility is outside the remit of this post; however, it is part of yours as manager. If you want a starting point take a look at this earlier post of mine about getting the basics right.

Managers can have an extremely wide, and challenging, portfolio of responsibilities. The most challenging ones; however, are the ones you don’t know about.

Remember, the buck stops with you. 

Did I miss anything? Let me know in the comments!

For those looking for more on being an existing manager and starting a new position, this may be for you.

Additional Resources:

Be Safe! Manager's Guide to Veterinary Safety by Philip J. Seibert, Jr. CVT

Click on the image to take you to the AAHA Press page for this book.

It is hard to beat Philip J. Seibert, Jr. CVT when it comes to putting together an OSHA program and this single volume, Be Safe! Manager’s Guide to Veterinary Safety which I reviewed here, although pricey is a great place to start your program.

Just like Phil is hard to beat when it comes to safety, it is hard to beat Scott Stratten when it comes to customer service. I strongly suggest seeking Scott out on YouTube; but for those of you who might like the written word The Book of Business Awesome / The Book of Business UnAwesome is for you and my review is here.  

As always, clicking on the pictures will take you to Amazon and where Amazon may give me a tiny percentage to help my book buying habit.

This year’s Western Veterinary Conference, in my adopted home town of Las Vegas, is a great time to catch up with old friends, former colleagues, and new friends who I had only met online.

One of the conversations that I had over a very nice dinner, was with a former colleague wanting to know about my world – the world of practice management – and how to start down that path.

This was more difficult than I imagined – mostly because my own route into office management / practice management / hospital administration was so accidental. I therefore thought; “there is a good idea for a series of blog posts if ever I heard one,” and so here we are!

Because my world is the world of veterinary medicine and practice management this series will concentrate mostly there. However, it is my hope that this series, much like my blog in general, will also work for anyone in a relatively small business looking to move from the trenches into management.

A Brief Recap

Before entering the world of veterinary medicine I had a very successful career in the world of entertainment lighting (theater, television, events, etc.). Within that pretty specialized and small world I worked in London’s West End as an electrician, a Company Manager (someone who corals actors and worries about when the show is going to close), a touring production manager, a console programmer and operator, sales and technical support for lighting suppliers, marketing of lighting products, and ultimately an industry writer and commentator.

After being in the industry for almost 20 years I decided I wanted a compete change. I moved to Arizona and took a job in a tiny veterinary clinic to keep myself busy, feed my DVD habit, and allow me time to figure out what I wanted to be when I grew up.

I really enjoyed working in a veterinary hospital and it seemed I was well liked there too by both the doctor and the other staff. When the office manager announced that she was moving, on a few months after I had arrived, my name was suggested as a possible replacement. The rest, as the very overused saying goes, is history.

I knew a little about veterinary medicine, some things about people management, not near as much as I would have liked about financial matters, and almost nothing about human resources. I did know about marketing and customer service, and I knew what I hated about going to the vet with my dogs. Mine in not a path I would recommend for everyone, and I made a lot of mistakes. However, I feel I have been at this long enough that I have some insights about getting to where I am and how others can get there too. If they want to!

Terminology

One of the things that is very annoying about my job, is that I am routinely described by titles other than the one on my business card and employment agreement.

Officer Manager

The generally accepted definition of an office manger is of a reception supervisor who also may handle scheduling and other areas such as accounts receivable. More than a lead receptionist in other words, but less than a practice manager.

Practice Manager

A Practice Manager oversees all the areas of hospital in addition to reception, may also handle payroll and other human resource functions.

Hospital Administrator

The job of a hospital administrator is one of having overall finacial and management responsibility for all areas of the the whole hospital, with the direction and supervision of the owners.It may also include all the functions of an office manager and practice manager. They will be involved in the hiring process for doctors and may also have supervisory responsibilities over them. There will also be a significant strategic and planning element to their function.

In all likelihood, managers start as office managers and then progress to practice management and then hospital administration. There is not right or wrong way, however, as long as the needed skills and / or experience are there. It should also be noted that all hospitals are different. I have effectively been a hospital administrator at three different practices and my job and responsibilities has been different at each.

Education

I am a big believer in education. That might sound strange coming from someone who hates actually taking classes themselves and does not have a degree. The bottom line is that your life will be easier with a degree and more doors will open with an MBA. Trust me I know from experience. It is not impossible to be successful without those things it is just harder. If you are planning on learning a lot of new skills, whether as DVM interested in practice ownership, or a technician or receptionist looking to get into managment, you may as well get some letters after your name for the effort.

Becoming a Certified Veterinary Practice Manager (CVPM) is a qualification designed for the job at hand. Several times I have considered getting the qualification myself. If you are having problems as a new practice manager, or making the move from office management to practice management, this qualification is for you.

If formal education is not an option, or just not you, then CE, CE, CE. Continuing education wherever you can get it: online, locally or nationally. It all helps. Speaking of which…

Get Help

I would not be the Hospital Administrator I am now, and would not have the career that I have had, if it was not for my local hospital managers association whose meetings I attended every month while I was in Arizona. Being able to meet with other mangers, find common ground, and being able to talk issues out that you might be having was incredibly useful. If you don’t have a local managers group look for other business groups, including the chamber of commerce, that might be able to help support you. It is a cliche but still true – it really is lonely at the top.

Resources

Throughout this series I plan to give some reading suggestions. The two books below tackle the difficult issues of enthusing others about your ideas, and how to make things change. One of my current favorite sayings that keeps rattling around in my head is “As a manager it does not matter how good your ideas are; it is your ability to implement them that matters.”

I have reviewed both these books before and other than providing a very basic introduction I have just provided links to the reviews. As always, clicking on the pictures will take you to Amazon and where Amazon may give me a tiny percentage to help my book buying habit.

“Made to Stick – Why Some Ideas Survive and Others Die” by Chip & Dan Heath

The title pretty much says it all: not all ideas are created equal and how we present things can have a dramatic impact on whether ideas take hold or not. You can read more here.

“Switch – How to Change Things when Change is Hard” by Chip Heath & Dan Heath

You’ll note that both these books are written by the same pair of authors and therefore they work perfectly together as the two sides to the same coin. You can read more here. These books are, at their core, about the nature of communication. If you can’t communicate as a manager then you can’t manage.

For those who are looking to get into management I’d love to hear from you, and for those who are already there I’d love to hear how you got there. Comment away!

Next Time – Part 2: Time to Focus

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