This week on the podcast…
This week on the Uncharted Podcast, Dr. Andy Roark and practice manager Stephanie Goss dive into a conversation about some worries that a practice manager friend had about their CSR giving out TOO much information to clients. This CSR hasn't had any medical training however they have been in their position with the hospital for a few years and they feel really confident talking with clients. While nothing bad has happened yet, this manager is wondering how they address it before unqualified medical advice might get shared, no matter how good the client service intentions are. Let's get into this….
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Upcoming Events
May 24: Trending Technology in the Veterinary Space with Jen Quammen
Have you wondered about using AI or wearable technology for pets as part of your practice? Have you wondered if those tools will really save you any time or energy? Communication within and among veterinary hospitals is the key to standing out in the veterinary space. The good news is that many unique, new tools are becoming available to support great communication, even remotely! In this workshop, Dr. Jen Quammen will tell you more about the real application of these growing opportunities and provide her insight to help you foster a loyal client base that will stay with your practice for decades to come.
Upcoming events: unchartedvet.com/upcoming-events/
Episode Transcript
Stephanie Goss:
Hey, everybody. I am Stephanie Goss, and this is another episode of The Uncharted Podcast. This week on the podcast, Andy and I are tackling a question from a manager who feels like they have a CSR who might be overstepping their bounds, and it's kind of happening repeatedly. They have been giving advice or getting into medical conversations with clients, and this manager is pretty concerned that it might go off the rails, although it hasn't happened yet. So before it does, they're reaching out for some help. This was so much fun. Let's get into this.
Meg:
And now, The Uncharted Podcast.
Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark and the one and only Stephanie my name is no Goss.
Stephanie Goss:
That's right. My name is no.
Dr. Andy Roark:
My name is no.
Stephanie Goss:
How's it going, Andy?
Dr. Andy Roark:
It's good. The spring is here in South Carolina and that makes me super happy. I spent the weekend spreading mulch in my yard. And I know that sounds awful, but man, I love it. I love being outside. I love just having a thing that I just do. It's one of those things where the time just flies by because I'm just kind of working and raking and looking around.
Stephanie Goss:
Doing your thing.
Dr. Andy Roark:
Yeah. I listen to music and I listen to audiobooks and stuff, and just kind of work outside. Yeah, it was pretty wonderful. How about you?
Stephanie Goss:
It is not. I mean, it is spring in Washington, but it is still freezing cold and my bulbs are an inch out of the ground and they're not going to get any bigger any time soon because it is still too cold. But it's good, it is busy right now. When we're recording this, we're a week away from our practice manager summit, and so there's a lot of craziness getting ready for that.
Dr. Andy Roark:
Oh, man.
Stephanie Goss:
And we've got a lot happening in our community right now and working on new content and so many projects.
Dr. Andy Roark:
For those who don't know how Uncharted is blowing up in 2023, we've got our practice manager summit, which is virtual. We have our April in-person conference, which everybody's coming to. You and I are starting a new thing called our development path, where we, you, and me, and Maria Pirita, meet with members of the community every two weeks. And we're going through workshops that we've developed over the last couple of years. And every two weeks, people can drop in, and we have some pre-work, and we have some actual work, and then some takeaway stuff. And we're just going to spend from now until end of the summer just working with the community members on some really key essential stuff, and so that's kicking off. We've got our handbook helper, where you and Ron Sosa and Maria work on helping people get their handbooks actually done and created. We've got our hallway conversations. We've got our workshops that are soon going to be carrying RACE CE with them, all this stuff is new this year. It is bonkers how much stuff we have going on. But man, the future looks bright, I'll tell you what.
Stephanie Goss:
Yes. It is very exciting and also, I was just working with Tyler. And she and I were working on some resources for some of the stuff coming up and having the conversation that I love being busy and I love chaos. I get bored really fast, and so I like it when we have a lot of things going on. It feels cyclical, and it was this way in practice too. I would be busy, busy, busy, and handling, handling, handling, handling. And then kind of really without knowing, it very quickly tips into the, okay, now I'm actually feeling panicked and overwhelmed. And I think I hit that point this morning and I actually sent you a message like, “I am feeling overwhelmed,” because I was literally working with Tyler. We're designing some stuff in Canva. I've got her in one earbud, and then I have a different set of earbuds in the other ear because I'm listening to a recording of a session that we just did to try and pull information to reply to an email. And it's just like, “Okay, this feels like I've hit that place of overwhelm.”
Dr. Andy Roark:
Oh, yeah. It's always that balance. You know what I mean?
Stephanie Goss:
Yeah.
Dr. Andy Roark:
The classic performance state is you want to be stressed. You don't want to be distressed. And you don't want to be bored.
Stephanie Goss:
Yes, yes.
Dr. Andy Roark:
But the idea that you're going to get to the right amount of stress to keep you motivated and engaged and not dip above it or below it, that's not going to happen. And so we know our business is cyclical. The first quarter of the year is always bonkers.
Stephanie Goss:
It's crazy for everybody. I think in the practice too because when you're in the practice, it would always be like, “Okay, it's the new year.” And for a lot of practices, I know December tends to be really quiet and even sometimes into January. For my practice, December was always bonkers, maybe because we did boarding, and so we had a lot of stuff around the holidays. But it would be crazy, and then you have dental month, and then you head into spring and the fleas start popping, and it's just a crazy time of year I feel like for everybody. And also, for anybody who is in vet med and has their own sport activities, or their kids are involved in sports, everything has started happening. And now I'm going different directions at the same time for the different kid activities, and it's a busy time of year.
Dr. Andy Roark:
I feel that the world has now opened back up post-COVID.
Stephanie Goss:
Yeah.
Dr. Andy Roark:
It took a long time. This was the first year. You and I have been going to VMX in Orlando and Western Vet Conference in Vegas pretty much every year, even sort of through the pandemic because they're just really big events and they're important in our industry. But this was the first year that I was there and I really thought I'm going to need to go to some more events this year, besides these two. I haven't done that in a couple of years. I've been like, “Yeah. I need to go out and get engaged at some other things that are going on,” because I can tell the industry is picking back up and life is kind of getting to normalize. And the same thing back at home life. We're looking at summer camps and things for our kids. And it's time for them to sort of reengage and do this. And I don't know if you feel this way, but I've really been trying to hold onto some of the perspective I got during the pandemic where I thought, “Hey, myself, my family, have been a bit over-scheduled.”
And there's just really great thing about being less scheduled, and I know that. And at the same time, as everyone around me picks up the pace and picks up the pace, I feel this vortex pulling me back into life as it was before the pandemic of, I'm not back where I was of every night, my family has something going on. But I can see it from here. And unless we say no to some things, it's going to be that way by the end of this year. And it's really been a test of what I learned in the pandemic, and I said I wanted … The default is not to stay on the sidelines. The default, at least for me, is to get sucked into the action. And I am really asking myself some questions about that.
Stephanie Goss:
Yeah. I feel that too. I was looking ahead at the calendar and thinking about summer and kid organization. And in looking at the calendar, I think there's literally two weekends the whole summer that don't have something scheduled, and between camps and travel and family time. And yes, some of it is family, quality family time and time unplugged. And it's all stuff that I want to have on the calendar. And at the same time, when I look at it and I look at that 12-week span, and there's literally something every weekend except for two, it does feel that slippery slope of overwhelm in the sense of: Are we going back to being over-scheduled and over-committed, and feeling like: When are we going to just kind of hang out and do the summer thing? You know?
Dr. Andy Roark:
Yeah. I saw this book recently, and I was sort of … It was an interview with the author about the book. But the title of the book was something like In Defense of Hanging Out, and this person just wrote about sort of … You remember when you were younger and your friends would come over. You would spend time with them.
Stephanie Goss:
Hang out.
Dr. Andy Roark:
And you're not actually doing anything.
Stephanie Goss:
Yeah, you're bored.
Dr. Andy Roark:
You're just bored together. And this person was making … They were pointing to the science of loneliness and connection and things. And they were talking about how that just being there and being bored, and not being on your phone, but just watching TV you didn't care about together, and mostly talking how much that means to us as far as making connections and friendships and feeling like we have a place. And I look at my own life, and I'm like, “Man, I don't hang out.” It's antithetical to kind of who I am and how I've been. But I also recognize that there's a downside to that choice, which is I don't have those friends that are just around, or I don't have friends I'd be comfortable just walking into their house. I don't have those friends. And of course, I wish I did.
But at the same time also, I'm not willing to make unstructured time in my schedule to not do anything. I don't know how that fits. And maybe it'll feel differently after the kids have grown up and kind of flown the nest. Maybe when I'm an empty nester, I'll have hang out time. But I just don't know. But anyway, all that stuff, it all kind of feels like it fits together in me and looking at life, and looking at being over-scheduled versus under-scheduled, and the benefits and the drawbacks. But it's been an interesting time as the pace has picked back up, and picked back up around me saying, “Am I engaging in this?” If I'm going to engage in it, which I think I am, I'm going to be real intentional about it and just really pushing myself to not say yes to everything that comes my way. But I am with you as far as feeling like the pace has picked up and picked up.
Stephanie Goss:
Yeah, for sure. Well, I am super excited about this week's topic of conversation. We have a practice where there is a CSR who seems to be maybe overstepping their bounds. They are giving advice or just kind of wandering generally into medical conversations with clients. And this is a CSR who does not have medical training, is not qualified to have medical discussions, although she has been in the vet field for a few years now. Right? So she's gained knowledge both intentionally through training to have some background in the practice, but also kind of unintentionally just as you do on the job observing veterinary medicine. And so they feel maybe more qualified than they actually are, and they want to really help the clients. And so clients are asking questions and they're getting themselves steered into conversations where the supervisors in the practice feel like you're not qualified to have these conversations, and you might be overstepping your bounds.
And nothing bad has happened yet. There hasn't been any catastrophe like a client's gotten wrong advice or anything like that. But the manager was looking at the situation and going, “I feel like this is heading towards potential disaster, and I'd love to know how to handle this kind of situation because I want the team to feel empowered. I want them to be able to problem-solve for clients. And I don't want untrained team members getting themselves into trouble giving medical advice or medical information out to clients that they're not qualified to give,” and so they're wondering. How do you handle both talking to the CSR about it without making them feel like they don't know how to do their job, and also implementing systems and protocols to support the front desk when they don't have that medical training?
Dr. Andy Roark:
Yeah. This is so common. And it's often the front desk. But honestly, I see it with assistants.
Stephanie Goss:
Or the kennel.
Dr. Andy Roark:
Or the kennel, yeah. But even some of the technicians can waver over that line into diagnosing things like that.
Stephanie Goss:
Absolutely.
Dr. Andy Roark:
So I see it a lot. And let's go ahead and start in headspace, and I think it's important to step back from this because I have seen people go right … They pull their flaming, raging sword of justice and say, “You're not qualified to make these decisions or give this information that may not be totally factually accurate. Or you're just sort of giving your theories here instead of having the doctor look at the pet and actually figure out what's going on.” And I have seen people just really get emotional and there's a righteousness aspect to this, and I get it. I do get it because it can be dangerous. There's real risk to the pet and there's real liability for the practice here, so it's not totally benign.
At the same time, I really do think it's important to be honest and step back and look with grace on the people who are doing this because here I am every week on this podcast and on the other podcast I do, Cone of Shame, talking about leveraging your paraprofessionals, leveraging your support staff, the technicians taking work off of the doctor plates, and the front desk being the mouthpiece for the practice, and really helping us streamline communication, which is a huge time burden on a lot of doctors. And so let's at least look at this and say, “Okay. I understand how overstepping here happens,” and quite honestly, I would much rather have the conversation to kind of rein some people back in than I would having the conversation of, I need you guys-
Stephanie Goss:
To step up.
Dr. Andy Roark:
To do something beyond taking a message.
Stephanie Goss:
Right, and passing it along.
Dr. Andy Roark:
And telling the client that I'm going to call them back because that's soul-crushing to me after a while. And it's a burden that I can't bear. So I would much rather rein in someone who's trying to help than I would try to motivate someone who doesn't have that inclination at all, and just wants to pass the conversation off to somebody else. And so I think that's a good opening position is to go, “All right, there's a spectrum of how much we want, or how much we're able to support people, and who's able to support people.” And it's not help them or don't help them, it is understanding what that spectrum is. And where do I engage? And then where are the limits where I need to not engage even if I have clear ideas about what happened. And I want to give grace again to the front desk or the techs here.
How many times do you take a message from the pet owner? You know what the doctor's going to say because you've heard him say it a million times. And then you go and you ask the doctor, and the doctor says exactly what you thought that they were going to say.
Stephanie Goss:
Right.
Dr. Andy Roark:
You know what I mean? And then you come back and you tell them exactly.
Stephanie Goss:
You're like, “I could've saved myself that time.”
Dr. Andy Roark:
How long does it take before you say, “I know what they're going to say. I'm just going to tell them.” And the truth is, there's subtle differences. And that one time you go, “I know what they'd say,” but you're wrong because this one's a little bit different, and you didn't catch the difference. And now we've got a real problem.
Stephanie Goss:
Yes. And I think there's a real Jedi mind trick there when it comes to training. So when we get to action steps, I want to circle back to that because I think there's an easy way that you can train the team on what to say that will help keep them feeling empowered and feeling like they are actually moving it forward, but also creating the space for someone who does have the medical training to double check them.
Dr. Andy Roark:
Yeah. I want to shout out to this manager that reached out as well because I know a lot of people who would know this was going on, but they would not motivate themselves to intervene until-
Stephanie Goss:
There was an actual problem.
Dr. Andy Roark:
Maybe it'll be okay.
Stephanie Goss:
Right.
Dr. Andy Roark:
Or we'll address it when there's a problem. And they wait until something bad happens and then they have sort of this come to Jesus talk sort of thing. And I go, “I love the fact that you're seeing this before it has blown up. And your intention is to actually intervene now.” And I think that takes some discipline and I am super happy with the question of, before this, before something bad that forces us to deal with this comes up, I would just like to go ahead and get this back under control, so I like that a lot.
Stephanie Goss:
And before it feels like something punitive, where you're getting in trouble for something that you did, versus, “Hey, I see you doing this thing, and I appreciate you wanting to help the clients.” And so here's how we wrangle that. Right? You have the opportunity here for it to be nothing but positive for the CSR, or the kennel assistant, or the assistant in the sense of their growth and development. And I think that is huge and that is key, and I also love that they are looking at it proactively because I think when you have to have that conversation in the negative, it changes everything for how that conversation is received, how you have to impart the training at that point because then it's just like, “Well, now I'm just teaching you so that we can fix your mistake,” and that doesn't feel good to anybody.
Dr. Andy Roark:
That conversation is easier to have. It writes itself. When there's a problem and it is a punitive conversation, you're like, “Well, how can she argue when I say, ‘You did this, and it blew up, and this is the outcome. And this is why you can't do this anymore.'” You go, “Oh, well, that's a much easier conversation than, hey, nothing has happened so far. And I need you to change your behavior without hurting your feelings.” It takes much more grace to have the second conversation than the first. However, I don't want something punitive to happen. And there are consequences to something punitive happening, which is probably a pet having a bad experience, which we really don't want.
And the other thing is if you do it right, you can do this very gracefully and just avoid a lot of pain. I think a lot of people just don't know how to have this conversation, and so they wait until something bad happens, and they don't have any choice but to have the conversation, and they point right to the thing and say, “This is what happened and we need to make changes.” And a lot of times, that's a horrible conversation for the person who made the mistake because they're being held accountable for something bad that of course they didn't mean to have happen.
I think that's another part of the head space is empathizing with the person at the front desk who's doing this. Everybody wants to grow. Everybody wants to take on more responsibilities. Well, a lot of people want to take on more responsibilities. Everybody wants to feel like they're growing and developing. Everybody wants to help. Everybody wants to feel valuable and feel like they are-
Stephanie Goss:
Contributing.
Dr. Andy Roark:
Yeah, they're contributing. And so when we say, “Well, why does this happen?” And you look at those, you go, “Okay, this is generally not coming from a bad place. It's not an arrogant place.” I'm assuming it's not that the doctor is a doofus, let me tell you what you should actually do. That would be a bad place. But that's not what see. You know?
Stephanie Goss:
Yeah. No, it's generally coming from a place of good intention, of I want to problem solve, I want to help this client, or I want to resolve this situation for someone. To your point, it comes from that desire to help, really. And so it's easier to slide the flaming, raging sword of justice back into its sheath when you think about, okay, this person really wants to help take care of the clients. And as a manager, isn't that the number one golden quality you want in a CSR, is someone who wants to help take care of clients?
Dr. Andy Roark:
Yes.
Stephanie Goss:
For me, it is. Hell, yeah. So let's nurture that and it just might need a little bit of wrangling and a little bit of direction. You know?
Dr. Andy Roark:
Yes. Yeah. I completely agree with that. It needs some wrangling and some direction. And so the next part of sort of head space before we go in there is, we need to figure out what that wrangling and direction really is because if you go in and you say, “Stop saying too much to the clients,” the obvious question is-
Stephanie Goss:
What does that mean?
Dr. Andy Roark:
What is too much?
Stephanie Goss:
Right. What did I do wrong?
Dr. Andy Roark:
Do you want me to not say anything? What do you want from me? And I think that very much can lead toward frustration. I have seen paraprofessionals, techs, front desk people, put in a bad spot where they get in trouble for overstepping, but they don't know what constitutes overstepping. Or they'll be given one example, and they're like, “Is that the only time, or are there other ways?” And so you get them into this fearful head space, where they don't know what they're allowed to say, and so they either just go, “Forget this. It's just a job. I'm going to ratchet way back and I'm not going to tell them anything.” Or they say, “I'm going to help them and I'm going to look over my shoulder every time because I'm worried that I'm not supposed to tell them this bit of information.” And we really, really want to avoid that.
And so the next part of this is making a plan of how you're going to have the conversation. So the first thing is just for you, just for you the manager. I always do this with pen and paper. It helps me to write things out. But what are the risks here? What are my concerns? Do I have any examples not from this person, but from places I've worked, or things I've seen in the past, where I say, “Here's the type of thing that I've seen. Can we talk about the risks to the patients and the liability?” And a lot of times, the liability is easier to talk to because then I don't have to say, “Hey, I'm afraid you're going to screw this up.” I can say, “Hey, you can do everything right, but if it comes from you and not from the doctor, even if it's correct information, once it crosses into that medical diagnosis, treatment, adjusting treatment plans frame, we're opening ourselves up to get really punished.” And you may not make a mistake at all, and a lot of times, that's much easier for people to hear than, “If you screw this up, it could get really bad.”
I would mention if we have a technician or a front desk person who gives inaccurate information and they miss a detail that was important that the doctor would've spotted as different from what the norm is, that's how we get real problems as well. And so I would start to say, “What are the risks here? What are my concerns?” And I would talk about my concerns from a medical outcome standpoint, and then also a customer service perception. What do the clients think? What's their perception? Do they think the doctor knows what's going on and the doctor does not know what's going on, and they find that out?
And then last, but not least, from a legal liability standpoint of: Are we getting exposed here to where we can get in trouble through no real fault of our own necessarily? And sort of frame it that way. But that's kind of how I'd start to set that stuff up, so I know when I go in, I can tell them the why. And I think the why is important. I don't want the why to be, “Hey, you're just a front desk person. You don't get to tell the pet owners this.” That's a terrible why.
Stephanie Goss:
Nobody wants that job.
Dr. Andy Roark:
Nobody wants to hear that. And of course, none of you hopefully would ever say that. But I have heard things that kind of … That's the flaming, raging sword of justice response is, “You're at the front desk. You don't answer questions about medications.”
Stephanie Goss:
Well, and there are, to be fair, and to leave space, every practice operates differently, and there are practices out there that operate very successfully, where the front desk does not have anything to do with medical questions. And so there are protocols and workflow that supports the front desk not having any involvement without it coming across as, I'm the receptionist at the law firm. Dr. Roark's office. Can you please hold? That's not their job. They're still doing an exceptional and very important job at the front desk. And there are lots of practices that have people at their front desk who are playing a dual role and have training and workflow and processes hopefully in place to support those team members doing those things. So it's not to say that you can't have a practice where that is the case because I think there's probably practices listening to this who are going, “Well, my CSRs don't do anything with medicine and I don't want them to do anything with medicine.”
And I think it's important to say we're not trying to say it should be one way or the other. And when those things are successful, regardless of how you have it set up, it is because there is the why, and everybody understands, and everybody's on the same page. And to this manager's question's point, there are policies and protocols and processes from a workflow perspective that support everybody rowing in the same direction.
Dr. Andy Roark:
Yes. Yeah, I agree with that. Yes, I completely agree. In that same vein, the last sort of part of head space for me is: What is the protocol going to be? Right? It's much more challenging to talk to this one technician or one front desk person and say, “You're not able to say this thing,” than it is to say, “Guys, front desk, CSRs, let's come together. Let's talk about what medical questions fall into the front desk purview, and what needs to go to the technicians, and what needs to go to the doctors, and how we triage these calls, and what information we're willing to give over the phone and what information we're not.” And then just start to lay that down because if your system is, hey, every time the phone rings, you're just going to make a judgment call and see if it feels good, or it feels not good.
Stephanie Goss:
Yep, game-time decision.
Dr. Andy Roark:
Yeah, game … Yeah, exactly right, a game-day decision. We answer the phone, see how you feel, feel it out. If you think you might get in trouble, you should send it back. That's not good. You should have some type of guidelines for them. And so I think that holding people accountable for what they say without giving them some sort of base guidelines of what is acceptable or what we want in the practice, I don't know that that's really fair. And that does make us stop and we have to have some honest thoughts and conversations about what is appropriate for the front desk to talk about, and what needs to go to our technicians, and what needs to go to our doctors. But I like … We're going to talk about when we get into action steps about how to sort of build those and figure out what they are.
I think your point earlier was really good. There's not a right answer to this. It really is. It's your practice model, it's the style of medicine that you practice. It's the personnel that you have. If you have a bunch of CSRS and your really short on techs and doctors, then figure out how to empower the CSRs. And there may be a training part of this that gets them up to these places where they can have these conversations. You would run that differently than if you have two CSRS and a bunch of techs and doctors. I go, “Well, send that stuff to the techs. Get it off the front desk.” They're trying to answer phones and check people out. There's no reason for them to be answering medical questions. Kick that stuff back. So there's not a right way to do it other than to look at your liability and say, “People at the front desk should not be diagnosing, prescribing, recommending treatment plans, things like that.”
Stephanie Goss:
Yeah, yeah. I love that. And I love your point about knowing the why and starting there. Why are we doing this? Because I think that helps each of us address that individuality in our practices. Why do we have it set up the way that we have it set up? And if we don't have a strong answer to that why, it may open up opportunities for us to look at it and be like, “Well, maybe what you just said is right. Maybe when we started doing this, we had seven CSRs that all rotated through the front desk. And now we're down to two.” And maybe we didn't really have a why, or the why that we had was different than it is now. And it creates that opportunity to define it. Why are we doing what we're doing?
Dr. Andy Roark:
Oh, yeah. Or maybe when we were smaller, everybody was cross-trained.
Stephanie Goss:
Right, yes.
Dr. Andy Roark:
Maybe the techs and the assistants moved up and worked the front desk, and so when someone at the front desk answered, they also had a significant amount of time in the back, and they had medical training that we don't prioritize now. Those things change over time.
Stephanie Goss:
Yes. And I was going to say I think where I really commonly see this as a pain point for practices is when you are small, one or even two doctor practices, cross-training is a necessity because usually you have a smaller team and people are wearing dual hats. And as we hit and shift into that multi-doctor, 10 plus team member, then you start to develop more niche roles within the team, and that's where we tend to have struggles because, to your point, there was somebody who was cross-trained at the front desk, and now we've got some front desk team members that don't have that cross-training. And now we're realizing that we need to develop these policies and protocols. And so it doesn't always occur as a result of someone doing the wrong thing. Right? Sometimes it's just about our growth as a practice and sitting down and thinking it through.
And I love what you said as a manager, to start with the pen and paper. And say, “What are the risks? What are my concerns? What am I worried about?” And then write it down from there and say, “Okay, if this is what I'm worried about, what information would I want the front desk to give out?” And then what is the why here? And then moving it along and saying, “Hey, practice owner, partner, or medical director partner, or doctor leadership teams, this is what I'm thinking about from a nonmedical perspective. What do you think? What is your why?” And layering it in so that you have that transparency on both sides, to your point where: If the doctor looked at it, are they going to view it slightly differently? Because you don't know, none of us know what we don't know. Right? And if I'm a manager, maybe like in my case, I have medical training, and so there was lots of times where I could anticipate what my doctors were probably going to ask about because I had that training.
But when I was working with colleagues who were new managers, who didn't have the medicine training, I had to really force myself to think. What do they not know? Right? I can assume lots when it comes to customer service, but I can't assume anything when it comes to the medicine because things that I would instinctively think to ask, they're not necessarily going to know to ask because they don't have that training, and really thinking about that and having somebody else look at that stream of consciousness kind of writing was really instrumental for me in helping try and figure out what my policies and protocols should be.
Dr. Andy Roark:
Yeah, I agree. Let's take a break and then we'll come back and jump into some action steps. Let's fix this problem.
Stephanie Goss:
That sounds great. Hey, friends. I want to make sure that you know about an upcoming workshop that you're not going to want to miss. And I know I say that about a lot of our workshops, but I mean it about this one. Well, I mean it about all of them, let's be real. But this one holds a special place dear to my heart. Two reasons, one, my friend, Dr. Jen Quammen, is leading the workshop. Number two, it's about technology. And if you've listened to the podcast, you know what a techno nerd I am. I am super excited to have Jen with us thanks to our friends at TeleVet. She is going to be talking on May 24th at 8:00 PM Eastern, so 5:00 PM Pacific, about trending technology in the veterinary space.
Now I love technology. We talked about it on the podcast. We've had guests on the podcast. And one of the conversations that has been going around and around in a lot of the groups I'm in lately has been about ChatGPT or artificial intelligence, AI. And so if you've ever wondered about using AI in your practice, or if you have wondered about wearable technology for pets, communication tools and techniques that use artificial intelligence, or advanced technologies, those are the kind of things that Jen is going to dive into during this workshop because most of us have wondered when we've talked about those technologies, if they actually will save us any time or energy, or if they're just a new trend. So Jen is going to dive into some of the things that have come to market, some of the things that are actively being used in veterinary medicine that you might not know about, and ways that we can incorporate technology into the veterinary space in a way that works with us and not against us.
So if this sounds like something that you'd love to get in on, head on over to the website at unchartedvet.com/events to find out more. We'll see you there. And now, back to the podcast.
Dr. Andy Roark:
All right. So it occurred to me recently, you and I used to talk about SAFE conversations in basically every episode. And then I think we did, after 200 episodes, we were like, “I think everybody's got it.”
Stephanie Goss:
Everybody knows.
Dr. Andy Roark:
Yeah. But we continue to gain listeners and gain listeners. And I'm like, “All right. We should bring the SAFE conversation back every now and then, just so people remember it.” All right, so you got to start these exercises with your safe conversation. So SAFE, S is for smile. Can you sit next to this person and can you smile at them? And if you can't sit next to this front desk person, or you can't sit across from them and genuinely smile at them, you're probably triggered, and today is probably not the day to have this conversation. If you're triggered, frustrated, upset, you are going to be less effective than if you are not. You might need to put this conversation on the calendar for two days from now, so it does not get skipped because you will feel better and that's an easy way to not have the conversation. So put it on the calendar, but make sure you can sit next to this person and you can smile at them.
A is for assuming good intent, or assuming noble intent is a way I've been saying it recently. And I just assume that this person is doing their best and they're trying to help, and they have good intentions. And you and I, I think we laid that down in head space when we said, “Everybody wants to help. They're trying to help the pet owners. They're trying to help the practice.” They have good intentions. And so let's not get mad at them for being awful. They're not being awful. They're being good. They're just making a mistake or they're behaving in a way that we need to make some adjustments. Let's assume the best possible intentions on the part of the person we're going to talk to. F is fail.
Stephanie Goss:
For the A, the other thing too, there's one thing that I would add to that because sometimes, and I've been there as a manager, where I'm looking at it and I'm like, “Okay. I know they were trying to help the client,” but I'm asking myself. “What were they thinking? Why were they telling the client what they were telling them?” Right? And I can totally hallucinate a place where you're looking at this going, “I literally have no idea why they would have told the client what they told them.” I truly don't understand it. And I think that in assuming good intent for having the SAFE conversation is: Can I ask them, “Tell me what you were thinking”? Can I smile at them and say, “Tell me where you were going with this. Where were you going?” So that you can really, truly try understand because I think that assuming good intent sometimes we can, sometimes we absolutely can be like, “They were just trying to help the client.”
But sometimes I have sat there and been like, “I literally have no idea why they did what they did.” And it's really hard to assume that good intent because I have no understanding. And so for me, sometimes I have to replace that with, “Can I just ask them, tell me more? Where were you going? What happened? Where were you going with this?” To be able to get to that place where I'm like, “Oh, okay. Now I understand and I really can feel like you were trying to help the client, even if I would've done it completely differently.”
Dr. Andy Roark:
Oh, yeah. Yes, I'm glad you said that. So F in SAFE is failure. Has this person been set up to fail? And what here is my fault? And I have those thoughts of, “How has this person been set up to fail?” And then what here is my fault? Because the more of this I can take ownership of, the more likely this person is to hear me and hear what I'm saying. And so if this person is answering these questions, but we have not clearly laid out guidelines for what the front desk should say, or what the expectations are about what they send back to the doctors and what they don't, then that's on me. Right?
Stephanie Goss:
Yes.
Dr. Andy Roark:
This person has been set up to fail because they weren't given guidelines. They were told to help the pet owner without clear guidelines about what our liability concerns are, or what the doctors want to have happen. And if I'm the manager, that's my fault. It's my fault for not having a policy in place. Now I'm not going to beat myself up about it too much, but by me saying, “I recognize that there's no policy,” and that's on me, it often helps people to be less defensive because they don't feel like I'm trying to say there's a terrible problem and it's your fault. I'm saying there's a problem.
Stephanie Goss:
You're sharing the responsibility.
Dr. Andy Roark:
Yeah. And I own a chunk of it, but let's figure out how to fix it. And so that's F, and the last thing is E. What is the end result? And what does the end result look like? And that's one's going back to why I said I always sit down with a piece of paper and say, “What is the end result?” Is it the front desk sends everything back to the techs and the techs elevate it?
Stephanie Goss:
[inaudible 00:40:54].
Dr. Andy Roark:
Yeah, hopefully not. Is it that there are categories that we agree on, where this goes to this person, and this stays up front, and you guys are empowered to answer these questions but not those questions? [inaudible 00:41:07] is probably about kind of where I would try to go. But what is that end result? And you should know what you want to have happen before you go in there because I have seen people do this conversation and they go in, and they're like, “You can't do that.” And the front desk says, “Well, what am I supposed to do instead?” And they're like, “I don't know, but not that.”
Stephanie Goss:
And then it goes nowhere.
Dr. Andy Roark:
And then it goes nowhere, and everyone ends up angry and frustrated. But I joke, but I have seen that and you probably have too.
Stephanie Goss:
Yes, yes. Okay. So we're going to start with the, we want to have a SAFE conversation. Right?
Dr. Andy Roark:
Totally.
Stephanie Goss:
And we're in a good head space. And we're ready to talk this out.
Dr. Andy Roark:
Totally. So roll in and start with the positives. Talk about everything we talked about, about assuming good intent and giving grace to this person. Do that to them. Don't go in and say, “Hey, look, we've got to talk. There's a problem. You're messing this thing up.” Go in and say, “Hey, I really appreciate all the work that you're doing at the front desk. I understand you have a lot of knowledge to share and it is wonderful to have someone at the front desk who generally knows how our practice runs, and has so much experience and familiarity with our cases. And I really, really appreciate that. And that's a real asset that you have and that you bring.”
And just start by laying down the good stuff. And the next step for me is I would ask for help. I like to ask for help. I would say, “I need your help. When we're looking at how calls are getting handled up at the front desk, we have some liability concerns, and this is what they are. We get questions that come in, and when they're medical questions, and they get answered at the front desk, there is a chance that if these things go wrong, or if the pet owner's not giving us all the information, and let's say that you take the call and they don't give you all the information, but the information they give you seems pretty straightforward. If you tell them what to do, and it turns out that because they didn't share information, their pet ends up in the emergency clinic, they can come after us in a big way because someone at the front desk told them they didn't have to do anything, and now they're at the emergency clinic.” And there's real liability there.
And then I would start to ask them and say, “I want you to be engaged,” and go back to my list of the things that I want. I want you to be helpful. I want you to keep taking work off the doctor and the technicians' shoulders. I want you to share your knowledge. I want you to feel like you're developing, and I want you to know that you're a big part of this team. And I need to figure out how we can set up some guidelines and a system so that you know what to handle and what to send back, so that you're safe and we're safe and the pets are safe, even if the pet owners are not being communicative or they're not giving us all the information.”
Stephanie Goss:
Yeah. I think for me, the approach to this conversation, you do a workshop about getting team buy in. And part of what you talk about is getting people on board, especially the people who might be of a different opinion than you, and how to get those people on board. And so when i think about framing this conversation, and I think about this person, I'm aware of this because I feel like this is a challenge with this person. And at the same time, this person might be able to be my superpower for getting the team as a whole on board, and also for unlocking what other challenges might be present because maybe this person is trying to help, and that's their motivation. And so they're storming ahead without all the information.
And also, if I go into this conversation really open and open wide, and ask them to tell me about how you're running this. Where's your head at? How are you approaching it? I also could totally see a place where, as a manager, my thought is, “Well, are they asking their team at the front desk for backup? Are they fact-checking each other? Do we have places where communication is potentially breaking down?” It opens up the door to other potential areas of challenge in the protocol and process here. And so now I have the opportunity to take someone who I am concerned about because I feel like they're kind of just charging ahead and giving the clients information, and I know it's coming from a good place, but I also have the potential to rope them into being a helper for me in having the conversation with the front desk as a whole and getting the team's buy in on, “Hey, guys, let's talk about this from a liability perspective. Are there other things that we can do, easy things, that really are just a double check?”
Maybe it doesn't have to be I'm just going to take a message and pass it on to the technician. Maybe it is, can we say, “Is there somebody else at the front desk that you could fact check it against before you give the client … ” Can you put them on hold for two seconds, say, “This is the question. Am I missing anything?” To your counterpart sitting right next to you. Or maybe the front desk can work together as a team and come up with a flowchart for: How do we answer some of these common questions? There could be lots of opportunities, and by asking, trying to recruit this person, who you have a problem with, to that discussion, not from that punitive place of you're doing this thing wrong and this is why we're having the conversation, but from that place of, “Tell me how you feel like this is going for the front desk because I have some liability concerns and I would love to know your thoughts.”
You are recruiting them as an active, I want to know what you think, kind of person, and that elevates them internally a little bit. Now it's not I'm in trouble for this thing. But it's, oh, she's asking me for my help and she wants to know what I think. And that is one of the first keys that you teach about unlocking that buy in feeling with the team. Right? You're taking someone who could be a detractor and you're getting them on board. And you're getting them excited about solving this problem together.
Dr. Andy Roark:
Well, yeah. Thanks for saying that. But that is absolutely it. And the reason I shouted out the manager at the beginning of the podcast is because since nothing bad has happened, I think you can pull this off pretty well. You can even say, “Nothing's happened. We are all in the clear as far as I know. But I'm having this concern. I want to talk to you guys about it.” And that just further takes it away from you screwed up. No, nothing has happened. I'm going to be upfront about that. But this is the thing where I'm having these concerns. I've seen this things. And what do you guys think about it?
One of the other tools that I really like about this is when you're sitting there with your pen and piece of paper, and you're trying to say, “What are the guidelines? What are the policies?” Coming up with some examples, some cases, and saying to yourself, “Okay. If the squinting dog calls, what do we do with that? Where does that go?” If the Yorkshire Terrier who's been in again and again and again for diarrhea calls, is it okay for me just to tell them to use the FortiFlora that they have at home? Or do I need to tell them to come in? And I think coming up with some cases of these types of phone calls that you worry about, and maybe some of them that you don't worry about, and come up with a list of some cases and some examples. And that's going to help you figure out where those lines are because if you're like, “I'm fine with them answering these questions, but not those questions,” once you know that, then you can dig in and say, “Well, what is it about these questions that makes them okay, that makes these other questions not okay?”
And then the last thing is that when you have that conversation with the front desk, you can say, “I've got some examples and I want to kind of run them by you guys and see what you would do with them.” And then give them the examples. This person calls and this is what they say, and this is the information that they give to you. What are you guys feeling about this case? How do you think that something like this should be handled? And just do it, I would do it as a small group discussion and low stakes. And just say, “I just want to kind of hear where you guys are,” and let them talk. Don't say, “What do you guys think? I'll tell you what I think. I think this should get referred to the doctors.” No, see where their heads are.
Stephanie Goss:
[inaudible 00:49:10] on your hands.
Dr. Andy Roark:
If they say something you do not agree with, don't say, “I don't agree,” say, “Tell me more about that. Tell me why that's your decision. Tell me why you feel that way.”
Stephanie Goss:
Help me understand.
Dr. Andy Roark:
Because now what I'm looking for is: What is the thought process that they're using to make this decision? Because if I say to them, “This is the case,” and they say, “Well, I would answer it.” And I say, “No, that's wrong, you'd send it back.” Next question.
Stephanie Goss:
They're going to shut down.
Dr. Andy Roark:
Yeah. They don't understand why.
Stephanie Goss:
Yeah. No, I think that's great. And the other thing too I think is, especially if you are a manager who came from the patient care side of the hospital, there is a whole big tangly, messy world at the front desk. And if you haven't done that job, the best thing that you can do is recruit them to help you understand and have them … Because I promise you, your list will not be inclusive of all of the variables that clients throw at the front desk all day, every day. If you don't have that perspective, if you are a manager who came from the front desk, you might be able to come up with all the scenarios yourself and you're really going to have to force yourself to do what you said and kind of sit on your hands and bite your tongue, and let them talk. And that is a really hard place to be, but force yourself to do it because the benefits you get from letting it come from them far outweigh you getting to share your idea.
And if you're in the middle, I think it's hard because you understand it from both sides, and that was the hardest for me. I had to tell myself sometimes ahead of time. Okay, there's duct tape on your mouth. Do not try and solve the problem. Let them do it. But I do think that there's those variables and the insight. And it never ceases to amaze me how even when I sit down, even after all this time with all of my experience, when I sit down and try and come up with the variables, how often the team still throws something out there that I'm like, “I wouldn't have even thought about that. That's fantastic.”
And so I think that there is huge value in letting them be a part of figuring it all out, from the process to: Where are those boundaries, to where are the areas of concern? Where are things breaking down? Where are we having trouble? Because they may be the first ones to point out to you, well, there's never a technician available when we need to ask those questions because we only have one, and they're in surgery. And so we're not quite sure because what we're doing now isn't working. But interrupting them in surgery isn't working, and so we feel like we can't win. You get those kind of details when you ask them, “Tell me more.”
Dr. Andy Roark:
Yeah. I really like that a lot. I think you go into this meeting. You do everything that we just sort of talked about. You take notes. You seek to understand. And then you say, “Thanks, guys. I'm going to go think about this. I think we've got really good ideas. I think I understand where you guys are coming from. I'm going to look at this a little bit and try to come up with some guidelines and a policy. And I'll be back and we'll go over them together.” And then step away and come up with your policy. What is your policy for front desk handling incoming phone calls? And try to give them some concrete guidelines. They don't have to be perfect, otherwise, you're going to have a telephone book of rules, if this, then that. And if this, that flowchart. No, just try to give them some basic guidelines.
And then bring it back to them and say, “Hey, guys. These are sort of the guidelines I came up with. What do you think about them? Do they make sense?” And then talk it through. And then the biggest thing is, I would set the expectation that this is, we're going to try this. And if it turns out that this is way too conservative and guys are not being able to answer basic questions, and things are getting to the techs that they don't need to be handling, we'll make some adjustments. And if you guys feel like, hey, I'm getting put in these positions, and by the guidelines, I should be handling this myself, but I'm not comfortable doing that, we'll make those adjustments. But we're going to start with this. These are our guidelines to get started, so let's commit to doing them and see how it goes. And we're going to start these at the end of this week. And give it to them.
And then just start to enforce the policies and enforce them gently, but clearly, and just sort of say, “Hey, this is what we're looking for. Hey, that's not the policy that we set. Come on, help me out.” And I would not set the policy and then start enforcing it with lead pipe cruelty. But I would enforce it. You can be gentle and consistent. And if someone continues to not follow the policies, now we're starting to have not a problem about what you're saying to the clients, but about the fact that we made this policy, we made it together, and you're not supporting the policy. You're not following the policy. And we're having this problem about a willingness to follow our practice, policies, and protocols. And then we would have that conversation, and that's a bit of a different conversation than you're not qualified to make this decisions. And so I think it's an easier conversation.
Stephanie Goss:
And I think in that ground that exists between figuring it out as a team and setting up this is where we're going to start and this is how we're going to approach it, I love how you laid that out. And looking at: How do you guys do your job really well and provide value? I think that often, that is where the F in the SAFE conversation becomes really clear for you as a manager because this is your opportunity to help them sink or swim. And a lot of times, we struggle with the training, and the true training, and the true strengthening of those protocols, and supporting. And a lot of times, there's a challenge like this, we'll talk about it as a team. And then because the craziness that happens day to day, and there's no bad intention here, but things fall through the cracks. Then we're like, “We did some training. We talked about it. We even did maybe some role playing on how we would answer these questions when they come in, but it was a one and done.” And then we don't have consistency in the follow through.
And to be able to expect, particularly new team members to actually learn from one and done is really a failure on our part. It's a place where I've failed as a manager repeatedly and that's honestly kind of why I'm bringing it up. But I think it's really important place for us to look at. What are we doing to set them up for success? Because if we don't look at it from that perspective and have a plan that goes beyond this one conversation or this one set of conversations, if we don't have a plan that includes training and consistency, then we are setting them up to fail.
Dr. Andy Roark:
I agree. Well, cool. I think that's all I got. You got anything else?
Stephanie Goss:
No, I think this is a fun place to end.
Dr. Andy Roark:
Yeah, cool. Well, thanks, guys. Thanks for tuning in. I hope that was helpful.
Stephanie Goss:
Take care, everybody.
Dr. Andy Roark:
See you, guys.
Stephanie Goss:
And that's a wrap on another episode of the podcast. As always, thank you for spending some time out of your week with us. We really enjoy spending our time with you. And before we go, I just want to say a very big bottom of the heart thank you to some of our industry partners who help make our Uncharted events possible. In specific, we are heading into our April Uncharted conference. Can't wait to be together in Greenville. And we have some very special anchor club sponsors that I want to take a quick second to say thank you to. To our friends at Nutramax, Nationwide, CareCredit, Chewy Health, and Hills Pet Nutrition, thank you so much for being anchor club sponsors in 2023 and help making our April conference one of the best. Can't wait to see everybody in Greenville. Take care, everybody. See you next week.
