Dr. Erica Pounds joins Dr. Andy Roark to answer a question about if, when, and how discipline and disciplinary actions should be systematized across practices in a multi-site organization. Is it fair that some people have stricter managers than others? Should everyone in every location expect the same response if they come up short in an important way? Let's get into this!
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ABOUT OUR GUEST:
My name is Dr. Erica Pounds, and I am an Area Chief of Staff for Banfield Pet Hospital in the Tennessee Market. I graduated from Mississippi State University in 2008 with a B.S in Biochemistry and Molecular Biology and then went on to receive my DVM from the University of Tennessee College of Veterinary Medicine in 2011. I started with Banfield Pet Hospital following graduation and will be celebrating 12 years with the practice in August.
My clinical interests include dermatology, internal medicine, and of course preventive care! Throughout my career with Banfield, I have been able to grow and develop from an associate DVM to Area Chief of Staff and even spent time as Interim Director of Veterinary Quality. I have a passion for development and love being able to see my hospital teams grow and achieve their goals. On the personal side, I am the mom of 4 amazing little boys and thrive in the land of Legos, Superheroes, and Soccer! I love running Spartan races with my husband and brothers. I am a big-time quilter and my sewing room is one of my most favorite retreats.
Do you have something that you would love Andy and Stephanie to roleplay on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag! We want to hear your challenges and would love to feature your scenario on the podcast.
Submit your questions here: unchartedvet.com/mailbag
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Dr. Tierra Price has supported practice owners in creating successful applications geared toward millennial veterinarians. This experience, combined with her own experience in her recent job search as a new graduate, has led to a compilation of factors to consider in order to recruit and retain millennials in veterinary medicine!
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Episode Transcript
Stephanie Goss:
Before we get into the episode today, I just have to say a huge thank you. I would be remiss if I didn't take a chance to say that PLS, the Practice Leaders Summit, is happening in just a few short days, when you're listening to this podcast episode. And that means we are all getting together in Greenville, South Carolina to celebrate the unique and wonderful position that is being a leader in veterinary medicine. We're getting together with some of the best and brightest practice owners, practice managers, and we are talking about the real challenges that face us when we run our practices day-to day.
And I am super, super excited. And this is a very different event. It is small, it is boutique, it is designed so that everybody who comes gets to meet every single other attendee that is there. We get to talk about the nitty-gritty in real time, about the challenges that we're facing as practices, the wins that we have with our teams, and really set a plan for the new year so that we can walk into 2024 set up for success.
And we couldn't do it without our industry partners. And we have some amazing ones this year. And I just want to take a second to say thank you from the bottom of our Uncharted hearts to our Anchor Club sponsors. We have different level partners, and we've got a lot of amazing ones, but this group, these guys, are fantastic. They stepped up in a big way and helped make us successful in terms of throwing the Uncharted events for you and your team. And I just want to say thanks. So to Nationwide Pet Insurance, Hill's Pet Nutrition, and Total Practice Solutions Group, thank you, thank you, thank you for being Anchor Club sponsors. Thank you for letting us go out on a limb, try some new and crazy things, like our Practice Leader Summit and for coming to Greenville and having a good time with us.
Okay, now we can start the podcast.
Dr. Andy Roark:
Hey everybody, welcome to the Uncharted Veterinary Podcast. I'm your host, Dr. Andy Roark.
Guys, I got a special one for you today. Dr. Erica Pounds is joining me to take a question about multi-site management. So if you don't know Dr. Erica Pounds, you're about to because she is amazing. I've been working with her for a couple of years. She is an incredible leader and trainer and teacher and she came to us through one of our Uncharted corporate programs. If you have a multi-site practice, we actually do programs specifically for multi-site practices. And she came to us that way and then she sort of moved up through the programs that we've done and now she's in our Train the Trainer Program where we work with multi-site leaders to be facilitators and managers across multiple locations and to help grow and develop other doctors.
And so anyway, she just continues to excel and be just such a rock star. And so I was like, “Hey, I love your insight on these topics, specifically multi-site management. Can you come in and break this one down with me and let's give Stephanie Goss a break?” And she did, and, boy, she crushed it. So anyway, this is a great episode. If you have ever wondered about managing multiple hospitals and kind of keeping them on the same page, you're going to really like this episode. So without further ado, let's get into it.
Speaker 3:
And now the Uncharted Podcast.
Dr. Andy Roark:
Welcome to the Podcast, Dr. Erica Pounds. How are you?
Dr. Erica Pounds:
I'm good, how are you?
Dr. Andy Roark:
I am so good. Thanks for coming on and doing this with me. I really appreciate your time. For those who don't know you, you are an Area Chief of Staff with Banfield. You have a passion for training and educating in leadership and communication. You and I have worked together for about three years now.
Dr. Erica Pounds:
I know.
Dr. Andy Roark:
Through one of our corporate programs that we have at Uncharted. And so you have been my wingman in a number of workshops and lectures and I just admire you. And I had a question that came into our mailbag that I thought, “I think Erica would be really insightful in this question.” And so I wanted to pull you in. Is that okay?
Dr. Erica Pounds:
Yeah, that sounds great. I'm super excited.
Dr. Andy Roark:
Awesome. So the question that came in was about consistent discipline across supervisors. So the question that was, it was from a manager, and this manager is part of a multi-site practice, so they've got a number of locations. And it seems like they're, again, this is me kind of reading between the lines in the question, it seemed like they're sort of a fairly young corporation that's got a couple of different locations, and there's starting to be a push inside their organization for consistency in discipline across locations.
So imagine that you've got, let's make it easy, I'm just going to say three locations, which is probably much smaller, but it's easy enough to hold in our minds to kind of work with. So imagine you've got three locations. And you're starting to get some pushback in one location where they say, “Well, you guys are much stricter on us over here and over at the other location they're getting away with a lot more. And we think that there should be consistency in how people get in trouble.” And so the question that came in is, “Is this a thing? Should we do this? How do we do this? What does this even look like?”
And so that's kind of the question that was asked. So let me just pause here for a second and kind put that to you and say when you hear this question, what are your first thoughts? I mean how many hospitals do you oversee right now?
Dr. Erica Pounds:
Yeah, so right now, just as we just recently moved, I'm down to one, but I've had as many as four at a time.
Dr. Andy Roark:
Okay.
Dr. Erica Pounds:
So three is a very real number that a lot of people in our position work with and this is very much a thing. Certainly as you move hospitals and you're coming in as that brand new leader to that location, you could deal with those differing opinions about the way in which maybe your previous leader led. Or if they know your other hospital locations to that point, “Well over there, that's not a thing. So why are you being so strict over here?”
Dr. Andy Roark:
Yeah. No, I think you're right. I hadn't really thought about a leader coming in, because way the question was framed up was this is something. Again, I suspect these were practices that were acquired and are kind of coming together underneath an umbrella, but the idea of, “Our last boss, our last manager, treated us this way and now here you are and I bet the other managers don't treat us or don't push this hard, they're not so strict or whatever.” I think all of that makes sense.
Let's start it at a headspace standpoint and just say, “Okay, we're starting to get some questions that people are saying, ‘Hey, why aren't we more consistent?'” And again, it's funny because this is specifically about discipline. It's like “When we get in trouble here, it's different than we get in trouble over there or we feel like we get in trouble faster or things like that.” So yeah, let's go ahead. When you start to just look at this and you're a leader coming in and somebody says to you, “Erica, we're thinking about trying to standardize discipline across our hospitals.” Where do you start from a headspace?
Dr. Erica Pounds:
Yeah, so I think kind of in two different camps. So I think that there's the systems piece of how in the world do we actually do this? What's our process? What does it look like from the step one all the way through to an end point? And then I think there's the people piece. So not only is it going to be the leader and individual that you're going to be having this conversation with, but it also has to do with the team's perception of how accountability is handled within the practice.
And I think a lot of times the team's perception around accountability really becomes a make it or break it as far as the culture around what that looks like and whether or not people are going to perceive these conversations as punitive and truly disciplinary or if they're going to take on, “This is because this leader wants me to grow. And right now there is something that is standing in my way of reaching my full potential and I have an opportunity to be able to course correct.” And so I think that really is where I center on with that discussion.
Dr. Andy Roark:
Okay. I love this. I think 100% from headspace there's something about accountability here we want to unpack. You put your finger on a little bit of it too. I think, and again, I don't want to be critical at all here, but when people start saying, “What is our disciplinary process?” My first thought is, “How often are you disciplining people? How big a deal is this?” As opposed to, “Hey, we've got some opportunity for improvement here. And we're going to work on your development plan.” And that framing of the issue, it may sound silly where there's a way of saying, when my kids make a mistake and they drop the ball, let's just say that my youngest daughter who's about to get her driver's license just blows curfew. She can get in trouble and be penalized or we could talk to her about a learning opportunity and a potential for growth and those things are often rolled together. But everybody can tell the difference in tone and how the culture feels when people are concerned about getting in trouble and other people getting in trouble versus being held accountable and how we grow and develop and push for improvement.
That's the first thing that gets into my head a little bit. I think it's really interesting, we started talking about their feelings about accountability, and I think that there's probably a diagnostic piece there first to be like, “Okay, where is this really coming from?” And just things that pop up into my head immediately, it's funny. There's people who they're worried about them getting in trouble and then they're also worried about other people getting away with stuff that they don't get away with. And I'm like, “What are we talking about here? Are you worried that the other practices are not applying themselves like you are? That they're on easy street and you're not? Is it that you feel like you're being held to a standard the other practices are not being held to? And what does that look like and what does that mean?”
And I think one of the first things you really have to do is try to get into this a little bit because, especially when you have multiple locations, people want to speak in big generalities. Like, “We need to hold people accountable.” And I go, “What exactly are we talking about here?” Because otherwise it's all theoretical hand waving of accountability and go, “What exactly is it? Was there a case where some person was written up for a behavior in another place? It happens all the time and nobody says anything. Is that what we're talking about?” Because I would say that the problems may not be consistency and discipline, but rather consistency in performance of those hospitals. I think you have hospitals that are not performing the same. And then the discipline will take care of itself if we fix the performance issue.
So there's a lot of stuff like that around where I'm like, “Be wary of going straight down to how do we punish people?” I just think that that's just dark bloody business. And then the other part is like, “What are we really talking about here?” I think it's also from a leader standpoint, I think another part of my headspace would be, just to throw this out at the very beginning, is the empathy component of, “Where's this coming from and how are they feeling?”
Fairness is a big deal for a lot of people and it would be very easy to look at this and say, “Well, this is just kind of silly. This person got in trouble here and this person just didn't get in so much trouble.” But the truth is there's a bunch of backstory here and the circumstances were all a bit different. And so this is just silly. And I go, “Well, perception of fairness to your point is really important.” And if the perception is that these hospitals are not the same and they're not being treated the same, that can affect people at an emotional level, that can make them sort of abandon rationality. And you end up with an absolute mutiny over nothing except people's feelings. And so I think you got to manage that.
Dr. Erica Pounds:
Yeah, for sure. Because the fairness perspective, again, I think we use our kids a lot as examples. And my oldest, he is a firstborn through and through, so his feelings of what is fair, what is just, is oh my stars. And I have to use that logic sometimes with the teams that I oversee because, again, you're going to have some people that you're never going to hear anything out of them. If they have a team member that perhaps is not carrying their weight one day, you'll never hear anything out of them. They're just going to do it, and potentially when you talk to them, they are going to do what we hope that everyone would do, is assuming that positive intent, that person did not wake up that day and say, “I'm just going to suck at my job today and make everyone's life miserable.” But they're like, “Something's going on with my teammate. I'm going to pick up the slack. It's okay.”
And then you're going to have the others that are like, “This is absolutely not fair. If I'm doing all of these things, why is this person not? And what are you going to do about it?” And they don't take the time to go, “Is there something more going on here?” Because oftentimes when you get into these conversations with the team, you end up finding out that there's something else that is driving the behavior response. They again, most people do not just say, “I'm just not going to do that because I don't feel like it.” There's often is it that they, did we check for understanding? Do they even understand their job role? Do they even understand what we're asking them to do? Do they have the ability to do what we ask them to do? There's so many things that you have to unpack when somebody is either not doing what we ask them to do or just failing to execute on performance.
But for the team, do they have the skill to be able to have that conversation or do they need to? No, but us as leaders, we're here to help manage that so that we can say, “It is going to be fair. We are going to be fair and mutual across the board when it comes to accountability conversations. And this is the way that this is going to look.”
Dr. Andy Roark:
Yeah. No, I think that that's really important. I want to go back to, you mentioned the team's perception of accountability. I think that's really important is there should be some consistency. Also, managing perception is often different from fixing a problem. It's like the way that they think about it or the way that they perceive it, it may not be accurate. And that happens a lot. There's a lot of people who are like, “Oh, that person gets away with everything.” And the truth is they don't. Or especially across hospitals, there's a lot of storytelling that gets done.
Dr. Erica Pounds:
So much.
Dr. Andy Roark:
It's like, “You're not there. You didn't see what happened. You invented details that were not true.” There's just so much of that. And I think one of the frustrating truths of leadership is, especially across multiple facilities, is you want to, and in a way you're right, but you want to say, “It's not your problem what happens over there and it's not your business.”
And that's true. And if you say that they will often continue to tell themselves stories and wind this up and you're going to end up with a massive human issue that you have to deal with, that my very logical people absolutely struggle with. They're like, “None of this makes sense. It's not their business.” It's like, “All of that's true. Do you want to be right or do you want to be effective?” Because you can be right and just hold what you got. Or you can be effective and figure out how to wade into this and help adjust perspective so that people can feel okay and kind of see more that this is not radically different.
I wanted to go back to the first thing that you said when you talked about the systems piece. And this is the thing that I'm really interested to hear from you on because I've wrestled with this for a long time. Okay, so let me lay out a thesis and I want you to punch it full of holes. Okay? All right.
I believe that in management, especially across multiple locations, we all want control. And as you add more people, and especially as you add more locations, your level of control, of direct control, it keeps going down. You're less of the sailor with this tiny little sailboat where you can grab all the ropes and more of this admiral of a fleet and there's multiple boats going different ways. You know what I mean? And they take longer to turn by far and just the immediate control you have just goes down less and less and less, as far as being able to grab the wheel and turn things. So I think a lot of people have that experience. And when people have that experience, there are forces, there are business gurus, there are consultants, there's just probably our innate desire to have control that say, “We need more systems. You need protocols. You need more rules because I'm losing control and I need to keep control, so I want to make more rules.” And when I say rules, I'm talking about protocols and checklists and things like that.
And they go that way, and of course if you are expanding and you're not adding in systems and you're not adding in protocols, you are setting yourself up for absolute disaster. But my thesis comes in here where I say, at some level you can go too far with systems and protocols. When you get down to the place where there is a protocol for someone to ask a question at a staff meeting, I'm like, “Do we really need to go that far down the order hole? Do we need that level?” Or can we just at some point say, “You know what? We've got systems that get us 90% of the way and then 10% of the way we're going to let people be autonomous. We're going to hire smart people. We're going to talk to them about why we're doing what we're doing. And we're going to let them make choices and have some flexibility on the ground to accommodate the specific people they're managing, their clientele, the way that they want to work, what they think is important, what their values are, what their vision is and stuff like that.”
So, yeah, that's kind of where I've gone over time is the push towards rules is interesting and the protocols is interesting and I think at the macro level it's good. But I do think that there is a tipping point where we start to make things, we take away people's freedom to make calls on the ground based on the nuance of the situation and who's involved and what their strengths are and what wishes and desires of the people they're managing are. I think we take that away.
The other part is, I think it's sort of funny is, when people are talking about managing other people, they're very pro rules. They're like, “Yep, we should have rules.” But when they themselves are being managed.
Dr. Erica Pounds:
They do not want those rules.
Dr. Andy Roark:
They do not want endless rules because then that's being micromanaged, right? I remember doctors, when we first started to see corporate medicine or multi-site practices and stuff in vet medicine, boy, the doctors really raged against what was called cookbook medicine and “Don't tell me how to do it. I don't want to follow this recipe.” And it was a strong pushback of, “Don't take away my autonomy,” is really what it was. And so I feel that from a management standpoint on some degrees of you can have some consistency, but I do think if you ever got to a point where everything was written down in a protocol form, that would be a miserable place to work work and people would hate it. So all right, that's my thesis. Shoot it full of holes. Am I right? Am I off? Where does this break down?
Dr. Erica Pounds:
Yeah, so I think for the vast part of that, you're spot on. Because, as leaders, and we could all think of times like this, where maybe you're not getting the potential outcome that perhaps your line managers or those that you're reporting to are wanting, and so here comes a way to track your progress and a way to do this and a way to do that and a way to do this and a way to do that.
And we're not all the same. To your point, the nuances within a hospital context as you're leading them is going to look different. There have been so many times where I will have hospitals that are on polar opposite ends of the spectrum. This one is struggling with this while this one is a player and vice versa. And so if I sit here and I just say, “I'm going to do the exact same thing in both hospitals.” Well I'm going to get nowhere because the people that are doing well on this hand now feel micromanaged, and the people that are over here, again, they might not have the skill or ability or understand what I'm even asking them to do because their contexts are so different. And so with leaders, I think that there is a balance in which you can have enough of a structure and enough of a system that you know here's step one to step two, to step three, to step four. However, you're given the freedom and the ability to lead the way that you need to lead for your hospitals.
There have been times before where I might be in a situation and I'm like, “Well, I could proceed boom, boom, boom, boom. Step 1, 2, 3. And we're going to go straight through. I do not think that that is the right call here.” Because if I'm leading my people well and I know what is going on with them, I know what their motivators are, I know what is disengaging to them. When I really take that holistic picture into this, is going straight through a disciplinary action protocol just like it is on paper, is that the right call? Or is this an opportunity for me to do a very, very, very, very important step here, which is to take partnership and manage up to those that you report to of, “Hey, here is the situation. As I take this all into perspective, this is how I want to handle this situation and these are the outcomes that I am looking for in this timeframe. If that doesn't happen, absolutely we're going to check and adjust and we're going to dial it back, but I really feel, as I'm leading in this context, this is the way that we need to go.”
Dr. Andy Roark:
Yeah. Okay. So let me say this back to you, and again, we're still sort of in a headspace and really right now we're sort of talking about management across multiple hospitals, which I always think it's interesting.
So would you agree that when we start getting into action steps here, I think that there's more about management of hospital leadership in individual locations then there is about management from the manager down to the staff below. And so what I'm saying is this, I'm completely in agreement with you here. You started talking about objectives and you say, “Okay, great. So let's say that I'm the practice manager, I'm the medical director, in one of these hospitals.” There's a situation. I'm going to communicate up, “Hey, this is how I plan to handle this and these are the outcomes that I'm looking for.” And I think the outcomes that I'm looking for are absolutely really critical because when we start talking about standardizing disciplinary actions, we're talking about processes, and standardizing processes, and there's no flexibility there at all.
I am a much bigger fan, and this is kind of where I'm going to go when we get into action steps a bit more of saying, “What is the outcomes that we're trying to achieve and then how do we manage those outcomes? And if a practice is not getting those outcomes, we need to lean on the leadership in that practice so we need to support those people, we need to make sure that they have clear expectations of what's going on.
So for example, let's say that in Hospital A people get penalized pretty harshly if they don't show up for work or they show up late for work. But at Hospital B, they don't seem to get penalized for showing up late for work and it's much more lackadaisical. And the people in Hospital A are frustrated with that. I get that. I'm not convinced that making a formal process that says, “Hospital A has got to write up people if they're late, no ifs, ands, or buts.” I think the actual play is to go to Hospital A and say, “Hey, we're looking at these metrics which are absenteeism, it's tardiness, it's things like that. And you guys are really winding this up in a way that we don't have at our other hospitals. What's the plan for getting this back on track?”
And then I can say to the people at the other hospital who are starting to complain and say, “Hey, you know what? This is being addressed. I don't know how they found out that this was actually a systemic problem, but if they did, this is being addressed. We're going to work on it.” But I would push back and say, “I don't think that standardizing discipline for people who are late is the answer.” I think it's talking to hospital leadership and saying, “Great. This is where we are with our other practice. You can see that you're a significant outlier here. You guys know your team, you know how you lead, you know what your styles are. I don't really care how you do it. I just need you to come in line with the other practices. Let's work together and come up with a plan. And you can think about it, come back. I'll think about it. We'll come together. I'll try to support you.” But I think that's how your regional leadership supports your practice leadership there. But I don't know, does that track with where you were going?
Dr. Erica Pounds:
Yeah, absolutely. Because I think the biggest part of any conversation, whether you're talking to a whole hospital unit or whether you're talking on that individual basis, if you just go in and you're like, “You're not meeting this performance standard.” And again, that could be a whole spectrum of things from showing up for work on time to performance operations, but if you just go in and you're like, “You're not meeting this. This is what we're doing. You're getting written up,” and all that. That's not going to necessarily give you the outcome. Now they're doing it out of fear versus really understanding and having this belief in what you are trying to accomplish.
And so if we miss the checking for understanding point, if we do not go in from a curiosity state and say, “Hey, I noticed XYZ. I'd love for you to just say a little bit more about what's going on.” There's so much power in say more and then just sit back. Because that is often where then that human aspect, now we get the context, now we get the backstory, now we're understanding what's driving the behavior. And then we can solve for that. If we're solving sheerly off of some type of number or some type of goal, we run the risk of getting it completely wrong, disengaging the individual and the process, having the team thinking that we're not following up on anything, and here we are in a muteness situation where we have now zero control because it's just gone off the rails.
Dr. Andy Roark:
Yeah. No, I like that a lot too. And I think you're also spot on about how we motivate. I've heard the quote, and I can't remember where it was, but it's basically like, “If you motivate someone with fear of getting in trouble, they're going to do just enough to not get in trouble.” They're going to check that box to avoid the punishment and they're going to go on. And if we go in and we talk to them about what we're trying to accomplish and we try to get them to buy into where we're going and motivate and praise and positively reinforce and celebrate, we can get them to go above and beyond that.
All right, I want to square this sort of headspace with you a little bit because I like your position on measuring and overusing those sort of numbers of measurement. So I think when I look at this and we're about to go into action steps here, but when we start talking about our action steps, to me part of it's got to be, what are we trying to accomplish? And so do you think that when we say, “Okay, what are we trying to accomplish in this hospital?” How critical are setting objectives and measurements for that?
So for example, we talked about tardiness. And that's an easy one. You just look at when people clock in and when they're supposed to clock in and you can figure out a tardiness rate or measure, whatever. But when we're talking about providing the client experience, if we're surveying our clients and we're getting client feedback, that's something. When we talk about having a good staff culture, if we're doing employee engagement surveys to see how engaged people are, I think that's good. And then we also look at our retention. But I think that looking at numbers like that to say, “Okay, we've got lower engagement at this location. We've got lower retention at this location.” I don't know that going in and standardizing punitive behaviors inside that location is going to be nearly as effective as saying, “All right, what's going on holistically? And let's look at this.” But I still think that those measurements are really important. Do you line up with that or do you think I'm overstating the importance of these metrics?
Dr. Erica Pounds:
No, I think they're incredibly important. And the hard thing is, is that we are constantly, especially as medical leaders but operational leaders too, but as medical leaders, we are always walking this tightrope and this balance line of discussing a metric or a number or a measure, versus a lot of times the medical team, you will hear them often say, “Oh, all you talk about is numbers, blah blah, blah.” And they will all of a sudden hackles up and they can't hear anything that you say because, “Here we are. You're just measuring where we are again, and you're not looking at other things. It's just our ability to hit a metric.”
And I think that the way in which I use this with my doctors all of the time, and I think we use this with the outcomes that we'll talk about in the action steps with this too, you can use it in the same token. How do I know that a patient is healthy? As a doctor? Well, I do an exam. We're observing the team. We're taking in the information and all the things. And then I'm going to do diagnostics to back up my assessment and to help me know that I'm right. And those diagnostics are going to be lab work, they're going to be a fecal exam, urinalysis, so on and so forth. And guess what? All of those are numbers. And those numbers are super important indicators to me to let me know the health of that patient or where I need to press in.
And so the same thing goes when we are looking at metrics and measures and the way in which we help to translate that to the team. How do I know that our team is healthy? Well, if I never ask you an engagement question, I'm sheerly going off of the way that I feel, but I have nothing to actually validate that and say, “We're a very healthy, highly functioning team.” We could say that to kingdom come, but if we can't back it up, then again, how do we actually know?
And so I think a big piece that I think we'll hit on in a little bit for the team is this perception of follow-up. If you're going to hold somebody accountable, how do we know that you held them accountable? Do you actually see the follow-up? And so I think when we're talking with the teams as well of the overarching theme of disciplinary or accountability conversations, the measure point afterwards is the way in which we know that we even make any movement forward. Otherwise we're just going to sit and spin our wheels. So I do think the measures play a huge role in how effective these conversations are.
Dr. Andy Roark:
All right. I like this a lot. I think you're laying this out really nicely. Let's take a quick break and then we're going to come back and let's just get into our action steps. And I know we're sort of talking in general terms of how do we set this up, but I think you and I have kind of laid out where we're coming down and it's going to be a balance of some accountability work, but it's a balance is going to be of systems and then also asking people questions that's going to give them some autonomy to fix what's inside their own specific clinic. So let's take a break and we'll come back.
Stephanie Goss:
Hey, friends. What are you doing on Tuesday, December 12th from 1:00 to 3:00 PM Eastern? So that would be 10:00 to 12:00 Pacific. If your answer was nothing or taking my lunch break or having a few minutes of free time or you would like to join in an awesome webinar that we are hosting, well, you should head over to unchartedvet.com/events because we have the wonderful and amazingly talented Dr. Tierra Price joining us. For those of you who have not had the pleasure, Tierra is a all around wonderful human being. She is a practicing veterinarian. She is the founder of Black DVM Network and she is a superpower dynamo in veterinary medicine and she's going to lead another workshop for us. She did a keynote for us and is very impressive as a speaker and I'm super excited about this one because she is going to come talk about recruiting and retaining Millennials and Gen Z.
And so if any of you are hiring right now, and most of us probably put our hands up because who isn't, most of us are drawing from a talent pool that includes a lot of Millennials and Gen Z as they make their way into the workforce. And so I think it is really really important for us to talk about this topic and Tierra is going to bring it together for us before we're done with the year. So if you don't have anything on your calendar, add that right now and you can do it by heading over to unchartedvet.com/events and signing up. It's free, as always, to our Uncharted members and if you're not currently a community member, it's $99 for the workshop and we would love to see you there. And now back to the podcast.
Dr. Andy Roark:
All right, so I think this has been really good headspace. I like our thought patterns here. I think we've both sort of laid out concerns we have about going straight to disciplinary standardization versus other things. So we've laid all these things out and we've walked one way and then back the other way and I think we circled around and made this sufficiently muddy to bring across the nuance of the situation.
All right, so let's go ahead and start to talk about what we actually do from action steps. And so for me, I'm going to start with one that I always start with is clear expectations. I think if you don't communicate clear expectations to the leadership in the practice, in this individual practice of, “This is what we care about. And this is what's important. And these are the behavior standards of the staff that we expect. And this is how we expect our practice to run. And this is the experience that we expect to treat our clients with,” I think you're setting them up for failure.
And that may sound silly or redundant, but I see that a lot, especially when you have practices that are established that have come together under an umbrella. And I understand wanting to give those groups autonomy, but if you bring them in and say we're going to give them autonomy and we don't communicate expectations for them to strive toward, one, we can demotivate those people because hey don't know what they're supposed to do and they're kind of feeling lost. And then the other thing is we can make them really, really frustrated because all of a sudden we're coming down and saying, “Well, you're not holding people accountable for these things.” And they say, “I never knew that was a thing.”
I remember early in my career I was a brand new veterinarian, brand new veterinarian, and I ended up working at this startup satellite clinic and it was just me and a technician. And then we were out there for a couple of weeks on and off and all of a sudden I get kind of brought in and they're like, “Roark, you have not set up the surgery suite in this way and you haven't done these other things.” And this was all absolute news to me. And they were like, “Also, the technician has failed to do these things.” And I remember saying, “I'm sorry, am I her boss?” They were like, “No, you're not her boss, but you are being held accountable for these performance things,” that were news to me. I just remember how frustrated I was to say, “Look, you sent me out there to take care of the clients and I did. These other operational organizational things, they were never communicated to me, and now I'm being taken to task over them.”
So anyway, for me, it's just you got to figure out what is our clear expectations? What are we trying to accomplish overall? And is everybody on board with that and are they all communicating that? Because honestly, a lot of times if we can just communicate clear expectations, that's to the management, that's from the management down to the team, clear expectations oftentimes they make a lot of the disciplinary stuff go away because people go, “Oh, that's important and I didn't know it was important.” So anyway, that's where I'd start.
Dr. Erica Pounds:
Yeah, absolutely. Because the expectation piece, if they don't know what you're asking them to do, then how can you expect to hold them accountable to something that they had no clue about? And to your point, it was incredibly disengaging when they were like, “Hey, why aren't you doing these things?” And you're like, “Because I didn't know. No one ever had that conversation with me.” And so obviously this is a piece where we can get this wrong. And this is a spot where we as leaders have to really press into that vulnerability piece to say, “Guys, I messed this up. I got this a little wrong. Let's dial this back a little bit because I would like to reset some expectations.” So if you've already traveled down this path a little bit and you're not really getting the results that you need, this is the point where you can be like, “It's okay, I can dial it back.” Because we're all going to do that at some point in time across laying down expectations.
I think too, this is another really good place to really help the team to understand what is being accomplished when you're having to have these follow-up conversations. Again, if we're coming from a place of disciplinary action, disciplinary action will always evoke this negative kind of connotation and, “This seems punitive and I'm going to get punished and I'm in trouble,” and all of these things. And that can set up that space where, “This is not a psychologically safe environment anymore. If I'm so fearful that I'm going to get written up about something, if I make a mistake, am I going to come forward and say, ‘Hey, my bad. I messed this up.' Or am I going to be so fearful that that's going to result in me getting written up that I'm going to say nothing?” And that is not a good space to live in.
So really helping the team to understand as you lay down these expectations, “When we're talking about accountability, this is because we care about each other as a team. I care about you as your leader. I care enough to have a difficult conversation with you so that you can grow and achieve your highest potential. This is all because I care about you.” And I think in every single conversation that I have, if it's small or if it's something larger, I always lead with that. “Hey, we're going to chat today. I'm going to give you some feedback. Always, know that as I give you this feedback, this is coming from a place of caring. I care about you and I want to check in because I'm seeing X, Y, and Z happen. Can you share a little bit about what's going on?”
And creating that space for them to be then able to talk. And I think as we set the expectations, if we can lay that as the groundwork of, “This is how our practice is going to function around accountability,” I think that then that will help to open up that feeling of grace from the team of like, “This is a safe space to grow.” Even if it's a tough conversation.
Dr. Andy Roark:
Well, You did so many things in that beautifully. So I love the phrasing. I love the word choice. I love the psychological safety of, “Tet's talk about this.” I think that that dove tails into the next step for me, which is the shift in focus a little bit to outcomes. And so what it means is I like to try to figure out how to move away from being punitive and more developmental. Meaning, without knowing specific behaviors it's hard to lay this down and say, “This is the outcome I would look for.” But basically, what are we trying to accomplish, what is our mission, and where are we trying to go? And then what I would say is, “How is this behavior detrimental to the outcome that we're trying to achieve?”
And let me be really clear here, and you and I sort of touched on this a little bit earlier in the first half I think, is people do not want to hear about their revenue generation numbers. That's not an outcome I'm talking about. They don't want to hear about it. They don't care about it. If absenteeism is causing us to have high wait times and our clients, they're just waiting. If our staff is feeling burned out and stressed and doctors are working through lunch and we're having to really watch people to make sure they get their lunch breaks and things and push them out the door, those are the outcomes that I'm going to focus on rather than, “Hey, you really screwed up.” It's, “Hey, these things are really important and we need to make these things happen going forward.”
And so a lot of times, again, I really like to push things into the future tense as opposed to the past tense. So when we talk about discipline, we're talking about how you messed up yesterday versus development is, “Hey, what are we going to do different in the future to make sure this doesn't happen?” And then if it continues to happen, ultimately we may have to have disciplinary conversations, but it's going to be, “Hey, if we have disciplinary conversations, it will be because we've talked about this a number of times and your behavior's not changing and we are not accomplishing this thing that's really important to us.”
And so anyway, it's just a way of starting to frame that up, but starting to switch to the outcomes. What are we trying to accomplish? And then make sure that your clinic leadership knows what the outcomes are that you're trying to accomplish, and then make sure that the staff knows, and that they know it and it's framed in a way that they know, “This is about providing great healthcare. This is about having a great culture and taking care of each other and taking care of patients.” And so getting those outcomes out there where everybody can see them and see how behaviors interface with those outcomes, I think that that's really important.
Dr. Erica Pounds:
I think that sometimes the hard ones will be for our intangible outcomes, so to speak. So I don't know how many times we have all as leaders, and the conversation is not necessarily about somebody's quantifiable performance, but it has to do with their attitude, and it has to do perhaps with the way in which they're interacting with the team. So it becomes this interpersonal dynamic that sometimes is causing breakdowns, then inefficiency and communication and the success towards the day. And I think a lot of times as we are trying to provide accountability and coaching and development in those situations, being able to try to work with that individual to say, “This is the situation. This is what we have seen. How are you feeling about that?” And then also really involving them in the process of like, “If we were to work on this for the next two weeks, what does success look like to you?” When we don't have that quantifiable measure, how are we going to know that we even got anywhere?
I think a lot of times I think about doctors that get very stressed in surgery and the teams will say, “This doctor, they are being so mean to me. They're not talking to me.” And it's all about their perception of maybe the doctor's tone as they're directing at that time and these kinds of things. And when you really drill that down, the doctor is not meaning to be that way towards the team. They just have other things on their mind. But we still have to address this situation. And so sometimes it's those outcomes and those action steps for this individual of how do we signpost for the team? How do we engage them in a conversation to say, “Hey, this is nothing to do with you guys today. I just need to stay a little focused right now and then we'll be able to kind of move on.” Because I find that often when I am trying to have conversations, the quantifiable measures and the quantifiable performance outcomes, those are the easy conversations. The hard ones are the people piece and the interpersonal dynamics.
Dr. Andy Roark:
Yeah, I agree with that. I think those are also really hard to put disciplinary actions around. As much as I would like for people to get in trouble for not getting along, that is an absolute quagmire to get bogged down in. It very quickly turns into the old, “The beatings will continue until morale improves.”
Dr. Erica Pounds:
Yes.
Dr. Andy Roark:
And it just goes right to that. And again, trust me, I get it. Emotionally, I get it. It's so frustrating when you're trying to balance, again, interpersonal stuff. And punishment is a very hard tool to use in this regard. You can lean into giving people feedback and you can have conversations and you can look for patterns of behaviors and you can start to call things out in a nice and supportive way. And then measure progress, I think is where we were getting to, is starting to watch how we're doing. And if we continue to fall back and we're saying, “Hey, I don't know what happened. I wasn't there. You've told me what happened. But we talked about this two weeks ago about you and Michael not getting along. And now here we are again with you and Michael having these problems. And the problem doesn't seem to be getting better and we're going to need to start making some adjustments.”
We've got to be able to have those, as you said, the signposts of, how is it going, where are we going from here, and things like that. I still, I'm a big believer that you've got to give leaders on the ground some autonomy to fix the problem. And you can only build protocols and systems that go so far down before they really start to become handcuffs that take people's enjoyment away and also that don't account for nuance and just become things that people fight about. So I think that's a big part of it. And so I would go from there, I think, and this is where I would really start to look at this issue, I think a lot is, we need to be having a good relationship from above with our site managers and having expectations for them and then having accountability conversations with them.
And when I say accountability, again, I don't want to go back to the idea that the manager should get in trouble because their people aren't doing what they're supposed to be doing. It's what are we trying to talk about? Does this person have a clear view of what success looks like? Do they know how they're doing and how they're performing? Do they understand the strengths of their team? Do they understand the weaknesses of their team? Do they have support that they need to try to address the weaknesses? Because a lot of us don't know. We struggle in this area and it's probably something that I'm not innately good at, which is why I don't know exactly how to fix it. I don't think there's any shame in that. That's just being a human being and recognizing that we've all got different strengths and skill sets.
I mean, there's people that you could bring into your practice who would immediately look at your systems and your protocols and say, “Oh, we can fix this and this and this.” And I'm not that guy. But I can wade into a practice where people are arguing, we've got some interpersonal stuff, we have a sense of people are unengaged or they're detached and I can bring them back and get them excited about the work and I can generally kind of push them into getting to work together and come together as a group. But I'm not your operations guy and if you've got an operations problem, you may have to support me in that because that's not my natural strength or skill set.
Dr. Erica Pounds:
I think that that's the hard part right, though, for us as leaders is you do have to get to that point of being comfortable. To your point, there's no shame in saying, “Hey, this is a space that I don't feel that natural tendency to be able to lead in. I feel uncomfortable in these situations.” And being able to go ahead and reach out for help. I mean, quite honestly, we joke about this all of the time, my husband and I, because in my personal life I will avoid conflict like the plague. Like, “Nope. Absolutely not. Let me walk away. They can just chill out. It's okay. I'll come back later.” But I will avoid conflict. At work, I'm like, “Hey, everything cool? I feel like something's going on here. Let's go ahead and chat about it.”
And my husband all the time, if he comes by to pick me up for lunch or something like that, there's been a couple of times where he has observed the, “Hey, what's going on?” And he was like, “Who is this person?” And I'm like, “Well, the thing is is that that was something that when I was a leader early on, I really had to work on getting comfortable with the uncomfortable, getting comfortable to have that difficult conversation.” But again, as we've talked about many times during this conversation, my viewpoint and my vantage point going into these conversations as a manager is key to the way in which I'm going to feel in that situation.
If I'm going in saying that I'm going to have to get somebody in trouble, I'm going to struggle really, really hard because that conflict aversion is going to come out some kind of fierce. However, if I go in and I'm like, “this is because I care about you. This is for your development. I see something in you and we need to hone it and we need to refine it, and this is how we're going to do this together,” all of the sudden that's my space that I'm comfortable in and I can have that conversation and I can help them and we can get to the outcomes that we need to.
So for me, that was a huge thing of this is not a space that I feel comfortable in. This is not a space that I feel good in. But I was able to say, “Hey, I need help with this,” and have been able to work on it. And again, that vantage point of going into the conversation is going to have a huge impact on how the conversation goes.
Dr. Andy Roark:
I just want to give you an amen. You just spoke directly to my experience as well. It's exact same thing. I don't like conflict. I like to be popular, with my team, and I want them to like me and to working for me, and that means a lot to me. And I feel like they don't like working for me? That's a hard burden for me. I don't handle that well. And so I also, I struggled so much with holding people accountable until I was able to frame it in my mind as, “I'm helping you, because if I don't say something to you, this behavior's going to continue because no one's going to say anything and you're going to keep doing it. And it's probably going to get worse and ultimately you're going to end up getting fired, or this place is going to become a toxic swamp and we're going to continue to fail and there's going to be this other punishments that come down or these negative repercussions or the clients are going to be upset and then I'm going to have to deal with them.”
But ultimately I came to the place where you sort of pick your poison. Do you say something which is uncomfortable or do you not say something? And I guess part of it was just the experience of saying, “Oh, I now know what that path looks like and it is equally bad or generally worse.” But I really love the way that you frame it. You're exactly right. In my mind when I give someone feedback, it's because I care about them and I'm trying to help them and I'm trying to move them forward. And if I had to frame it in my own mind of I'm going to have to punish this person. I really don't want to do that. And I would also really struggle with that. It would take a lot of enjoyment out of it for me.
And here's the other thing too, is I don't know how to say to somebody, “Hey, I'm saying this to you because I care about you. And also can you sign this piece of paper that says that you accept the terms of this reprimand or whatever?” It kills so much of what I'm trying to build as far as a good work culture. So anyway, I am right there with you. I really love it.
The last thing I'll tell you, I had this really wonderful conversation over the weekend. And I asked a very thoughtful veterinarian who lives in California and she's so successful and she's just so wonderful. And we were hanging out together. It was sort of a retreat that we did. And there's a number of us there. And I asked her, ‘Do you think that people change?” I said, “Do you think that people change?” And she thought about it for a while and she said, “No.” She said, “I think that you are who you are. You are the person that you were when you were a child. However, we learn how to show up differently in different situations and at different times in our life. So in your essence, you are the same person you've always been, but you do learn how to show up. And the way that you show up can change depending on who you're with and what you're doing and where you are.”
And so when you were telling the story of being conflict averse, but then when you're there, you say, “Hey, can we talk about this?” I say, “You, Erica Pounds, are the same person you always have been, but you have learned how to show up in this role in a way that's effective and it works.” And so I just wanted to call that out because I think a lot of people see themselves as leaders or managers and they say, “Man, this is not who I am. I really struggle with this.” And I would say, ` And I don't know, that really spoke to me. So I thought it was really great.
Any way, Dr. Erica Pounds, thank you so much for being here. You are amazing. I really appreciate you talking through all this with me. Guys, everybody else, thanks for tuning in and listening. I hope you got something out out of it. Take care of yourselves, everybody.
And that's it. That's the episode. That's what I got for you guys. Thanks to Erica Pounds for being here. She is amazing, as you know. If you like the podcast, if you get a lot out of it, do me a favor and do all the stuff you're supposed to do for podcasts that you like. And mostly that's tell your friends, text, share the episode with them, and write us an honest review wherever you get your podcast. If there's a five star button, hit that button. And it just means the world to me and Stephanie and everybody on the Uncharted team. So anyway, guys, that's what I got for you. Thanks for being here. I'll talk to you soon.
