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This Week on the Uncharted Podcast…

The team has been together for almost a year and yet they seem to be collectively saying “I've not been shown how to do that…” about many things. Simple things. Are you ready to pull your hair out yet? We can understand why! Dr. Andy Roark and practice manager Stephanie Goss understand the pain and frustration this mailbag writer has over this exact situation. Plus they shared that when their leadership team gives corrections to the group, it is met with feedback that they are being mean or bullying the team into doing what they want. Our writer asks “How do we hold them accountable, in a safe space, but still correct the deficiencies?” This is a FANTASTIC question so let’s get into this…

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Episode Transcript

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Dr. Andy Roark:
I have got to thank Banfield the Pet Hospital for making transcripts of this podcast possible. Guys, in an effort to increase inclusivity and accessibility in our profession, to get people the information, and to make sure everyone is included, Banfield has stepped up and made transcripts possible. You can find them at unchartedvet.com. Thank you to them. This is something I wouldn't be able to do without their help. And now, let's get into this episode.

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 diving into the mailbag, and we've got a great letter from a medical director who says, “What do I do when the whole team says, ‘I've never been shown how to do that?”
We're not talking about super-complicated processes or protocols in the practice. We're talking about the basic things. How to do the laundry, how to sweep the floor, things like that. It's a real solid question and one that Andy and I have a lot of fun diving into answering. So, let's get into this, shall we? And now, the Uncharted Podcast.

Dr. Andy Roark:
And we are back. It's me, Dr. Andy Roark, and Stephanie, you can do it, put your back into it, Goss.

Stephanie Goss:
Ooh, I really like that one. How's it going, Andy Roark?

Dr. Andy Roark:
It's good. It is good. Things are good.

Stephanie Goss:
Yeah?

Dr. Andy Roark:
Yeah, it was heading into the back part of summer here. I can see people starting to think about taking kids back to school and some normalcy returning. I feel like we're in the last waves of people going on vacation. I'm going on vacation with my wife, a pseudo-vacation next week. We're going to go do some hiking while the kids are off at their last sleepaway camps and stuff like that.

Stephanie Goss:
Nice.

Dr. Andy Roark:
One of them's going to their grandparents' house and the other one is at sleepaway camp, and I was like, “This is our shot.”

Stephanie Goss:
Fun.

Dr. Andy Roark:
And so, we're going to get out of here.

Stephanie Goss:
I like it.

Dr. Andy Roark:
So, yeah, it's going to be good. But yeah, how about you?

Stephanie Goss:
Good. I have insane children who are so excited for school to start again, and I'm like, “What is wrong with you? It's not even August.”

Dr. Andy Roark:
I know. That's crazy.

Stephanie Goss:
But they love their school, and they love their friends and their teachers, so they're super excited to get back. We've already started thinking in that direction and I'm like, “When am I going to cram going back to school shopping into the schedule and all of the things?” But we are in the middle of beautiful summer weather here in Western Washington. These are the weeks of the year that we all live for, and I am soaking up every bit of the sun. It is wonderful, so I-

Dr. Andy Roark:
That is good.

Stephanie Goss:
Yeah.

Dr. Andy Roark:
It is super-hot here. I was walking the dog this morning and some of the neighbors were out, and I was talking to them, and they were working in their yards, both of them. We all came together in the street, and we were talking there for a while. They were talking about the deer have been coming up and eating their [inaudible 00:03:13]. And I said, “Well, you know-“

Stephanie Goss:
I have a solution for this.

Dr. Andy Roark:
“I have not seen a deer in my yard in months.” I told them about chasing the deer away with the cowbell that I got from Mississippi State's College of Vet Medicine.

Stephanie Goss:
Did they ask to borrow it?

Dr. Andy Roark:
They did not seem sold on the idea. And I realized, I realized-

Stephanie Goss:
Shocker.

Dr. Andy Roark:
Yeah. No, well, let me just say, I realized that my solution might not work for everybody. It might be that my solution, which has worked like a charm for me, it might be that my solution worked just fine for me. Because maybe I don't have to convince the deer to leave. I just have to convince them that my neighbor's yards are…
I don't have to make a yard the deer can't eat from. I just have to make them less sure about my yard than my neighbor's yard, and then I'm golden. Especially when the neighbor's garden as well, I'm like, “Aha.”

Stephanie Goss:
Now they've become somebody else's problem.

Dr. Andy Roark:
Exactly right. I didn't have to figure… I just have to make it… It's like when a bear chases you. You don't have to outrun the bear. You just have to outrun the people who are with you, and that's the same thing with the deer.

Stephanie Goss:
Oh my God, I can't.

Dr. Andy Roark:
That's why I take you camping with me, Goss.

Stephanie Goss:
Because I just laugh and make enough noise.

Dr. Andy Roark:
Because you would… I would be like, “There's a bear,” and you would, “Hehehehehe.” And I would… I have longer legs than you do, and so, I think that I would… You are my primary bear deterrent because my legs are longer than yours.

Stephanie Goss:
Yeah, I mean I don't mind… Yeah, that is true, and you walk way faster than me. But I don't mind the wild animals as our backyard can attest. I was walking through the backyard this week, in fact, and I was like, “Oh, look, there's coyote poop, and deer poop, and bear poop. Come on, hang out in my yard.” So, you can send your deer over to my house, it's fine.

Dr. Andy Roark:
Yeah. Oh, yeah.

Stephanie Goss:
They're partying in the backyard.

Dr. Andy Roark:
Oh, boy. Oh, boy.

Stephanie Goss:
Oh, man. We have got a great episode this week. I'm excited about this one and I think it's going to be fun. I can't wait to see where your head is at. So, we got a letter in the mailbag from a colleague of ours who is a medical director at a practice, and they said, “Look, I have a team that has almost completely turned over about eight months ago. Less than a year in, it was all good reasons, and they really, I feel like, should be hitting the stride. They've been working together long enough now.
“I feel like this is the time where we really should take off, but we seem to be repeatedly hitting speed bumps where there are members of the team who are saying, ‘I've never been shown how to do that. Nobody told me that,'” kind of attitude about things that this medical director said are so basic that they have to have seen it before. They've all been in veterinary medicine for at least eight months. How could they not have seen this before?
And so, they were saying that when the hospital leaders, whether it's the practice manager, the medical director or one of their floor leaders, technician, team leader, or front desk team leader says, “Hey, why are you guys saying that you haven't been shown this before?” The team seems to be giving the feedback that the leadership team is being mean, or that they are getting bullied about things that they're doing wrong.
And so, the medical director is asking, “Hey, how do I hold people accountable in a safe space and still hold them accountable and correct their deficiencies because shouldn't they have figured this out by now?”

Dr. Andy Roark:
Yeah, this one spoke to me. It spoke to me for a couple of reasons I'll get into. Yeah, I really felt this. Let me start off by saying that this is wildly frustrating for me. This is my personality type, and so, I feel this in my bones when they're like, “We have all these people and I ask them,” I say, “Quick, do this thing.” And they're like, “I don't know how to do that.”
It reminds me of when my kids were little and I would look down at my watch and realize that we were going to be terribly late, and I would say to them, “Put your shoes on.” And I would say, “I don't know how.” And I would say, “What? What do you mean you don't know how?” “I don't know how.” Again, I don't mean to mock the people who don't know how, but that's how I feel myself when I'm going, “Guys, let's go.” And they're like, “We don't know how to do that thing.”
Let me tell you… So, anyway, let's get into headspace on this.

Stephanie Goss:
Yep, I like it.

Dr. Andy Roark:
The first thing on headspace is let me tell you why I hate this so much. It's because I want to get things done. I am a busy guy doing busy things, lots of people to see, lots of pets to fix. The fact that you don't know where we keep lint rollers is slowing me down and I have a fundamental knee-jerk reaction to this.

Stephanie Goss:
I laugh because that's the perfect example because we can-

Dr. Andy Roark:
I'm like, “You can't go in the room like that and then look like Chewbacca.” I'm like, “You can't go in the room like that.” They're like, “I don't know where the lint rollers are.” And I'm like, “Argh.”

Stephanie Goss:
That's the perfect example. Uh-huh, uh-huh, I get it.

Dr. Andy Roark:
Yeah. And so, it kills me, and then it happens again and again because if they don't know where the lint rollers are, they also don't know where other things are. Or if they don't know how to do a thing, they also don't know how to do another thing.
And this coming from the guy who didn't know how to put people on hold for the first year that I worked in a practice. I would just set the phone down because no one showed me how to use the phone. I just showed up and they were like, “You know how a phone works.” And I was like, “Of course, I do.” And then I hung up on the first six people that I tried to put on hold.
So, then I would just set the receiver down and be like… I would yell to the front, “Hey, front desk. Pick this phone call up.” And so, I throw stones from glass houses when I get mad at the staff for this because I am just as guilty as they are.
All right, so that drives me nuts. Then the other thing is I hear my own voice in my own head saying the thing that I say all the time, which is if you are surprised by a thing again and again, at some point, it's not a surprise anymore, it's your business model. Which is a favorite saying of mine, which I hate it when I say it to myself.
Haughty Andy will be in his own mind going, “Well, if you're surprised by this again…” I'm like, “Shut up, Andy.” I hate it because that's also the thing, right? So, when the whole team is like, “We don't know how to do this,” and it's not one person, it's all of the people around you, and they're all not knowing how to do different things. At some point, I can't be mad at them because having untrained people is my business model.
And then I'm like, “Dammit, it's me. This is my problem and it's my fault.” And I hate when I realize that it's my fault, but it's totally my fault. And then the last thing that I have… this is an emotional journey, I know. The last part of this emotional rollercoaster.

Stephanie Goss:
It's okay. I'm here for the rollercoaster today.

Dr. Andy Roark:
Oh yeah, the last part of the rollercoaster is the feeling of complete overwhelm when you are like, “Oh, crap. I have to teach a large number of people how to do everything,” and they get mad when I try to teach them all the basics because eight of them say, “How dare you teach us this?” And two of them don't say anything because they didn't know, and they needed to hear it. But I have to hear about, “How dare you make us sit through a class on how to use the telephone? What idiot wouldn't know this?”
But in all seriousness, it is overwhelming. And so, all of that comes around to the reason that you and I and our team is doing the Get Shit Done Shorthanded Conference in October. We're doing this virtually. In all seriousness, walk with me here, the reason I wanted to do this conference, Get Shit Done Shorthanded, is because that feeling of overwhelm when you're like, “Nobody knows how to do all the things and I don't know how to train a group of people to do everything.”
And we are so busy, and we are so frantic, the idea of starting over with, “Here is how you put someone on hold,” is soul-crushing. It just makes you feel like you are drowning, and honestly, it makes me want to just pack my things up and go home. I'm just like, “I just…” When you look at it and you're like, “Holy crap, we have not done training on any of this stuff, and the amount of work it's going to take to get everyone on board and all at the same levels where they need to be and to fill in all of these holes in everybody's knowledge is…”
It's Mount Everest. It is so demoralizing to look at. I have felt that many times in my career. I think a lot of people are feeling that overwhelm demoralization about a lot of things in their business right now.

Stephanie Goss:
Yes, sure.

Dr. Andy Roark:
And so, all joking aside, when I looked at this thing in the mailbag, I go, “I know how that person feels and I have 100% been there. And it feels like it is an insurmountable obstacle to get out of this and to get everybody on the same page.” And so, anyway, that is the emotional journey. The first thing is being frustrated at the people, and the second thing is realizing that if it's happening across the board with a lot of different people, it's not them. They have been set up to fail or we have holes in our business platform and our structure and our models and our training.
The last thing is then to let the fact that you have what feels like a completely overwhelming problem to deal with. You have that sitting on top of the full workload you have right now, and you need everyone to go 30% faster than they're going right now. And you have recognized that you need to go back over and start over with the basics, and it is soul-breaking.
And so, anyway, that's why I get excited about this topic. I love to talk about this, I think this is really important. We have a whole conference that is aimed at people who, whether you're an owner or a manager or a head tech or whatever, if you're feeling that overwhelmed, if things like this just feel super daunting to you, the Get Shit Done Shorthanded Virtual Conference is coming up in October.
It is a three-day… I think it's spread across three days, and it is virtual. It's 250 bucks to register, something like that. It's super affordable, there's no travel, no nothing, but anyway, that's the type of stuff that we're doing. But that's why I really wanted to wade into that specific topic. It's because so many of us are feeling this overwhelm. And I go, “No, we can…”
We had played with the idea of calling it Get Shit Done When You're Overwhelmed. That was the other title that we worked with. And so, anyway, that's the subject matter that we're putting a whole conference aimed at because I just think it's so prevalent.

Stephanie Goss:
Yeah, I think it's about talking about solutions, which we want to do on the podcast, and at the same time, the most common feedback that we get about the podcast is it made me realize that I'm not the only one. That is a huge part of you and I's individual whys for why we do what we do with Uncharted, which that it's about connecting with your peers and recognizing you are not alone, and your problems and your clinics are unique.
And they are different than everybody else's to a degree. At the same time, the underlying things are the same, and like you, I am looking forward to being able to talk about some of this when we get to GSD. When I saw this episode, I had a lot of the same thoughts as you because… I laughed through your whole rollercoaster because I see it and I recognize it.
And it is frustrating, it is soul-crushing like you said. I'll tell you, for me, where the headspace has to start is you've got to take a deep breath because it is frustrating as hell and we know that when we get frustrated, we tend to reach, most of us, for the flaming raging sword of justice. And we just want to strike down everybody in our path and be like, “People, get out of my way. I've got work to do. I don't have time for this crap.” That's not the right answer. You got to take a deep breath and we got to get centered.
The thing that stuck out to me in the email here was that our medical director friend said that people are saying I've never been shown that for things that are so basic, they must have seen it before. I'm going to tell you something. I'm going to tell you guys a story and I'm going to give you some real true honesty.
I will tell you I consider myself a pretty okay manager, and I've done a lot of things wrong, and I've done a lot of things right in my career. I will also tell you I will 100% cop to the fact that I had great training protocols and processes and levels and all of the things that you're supposed to have, and I guarantee you that I had multiple members on my team who did not actually receive the exact same training.
It's just the facts even if you have all of those systems and structures and protocols and processes, it's different. Every time you go through it. And so, do you actually teach people the same thing every time? I would say that most of us don't because the situation changes, the day changes. The patient in front of you changes.
And so, the goal for a lot of us should be shifting our training to doing things over and over repeatedly so that it's not, “I showed you this one time.” So, that you even out those bumps along the way. We're going to talk about that when we get into things to try, but I'm going to tell you guys the story, which is laundry is actually not simple.

Dr. Andy Roark:
Yeah, that's a great one.

Stephanie Goss:
And I'm going to tell you, at my last practice, I came in one morning and some of the members of my team said, “Hey, the laundry room is flooded.” And I was like, “I'm sorry, what?” And they said, “The laundry room is flooded.” So, I put on a person-of-all-trades hat, and I go into the laundry room, and I roll up my slacks, and I dig into why is the laundry room flooded?
I'm like, okay, so the wash was totally unbalanced, and it started flooding, and okay, we've made this mistake. So, I called over the team members that were there that day who had been working on the laundry and they said, “Hey, this happened. There was a really big blanket because we had had a large patient euthanasia the day before, and they said, “It was at the end of the day, so we didn't stick it in last night. So, it went in first thing this morning, and it must have been too heavy, so it was off balance.” Okay, great. Problem solved, cleaned it up, no problem.
The next day I'm like halfway through my afternoon and I get an emergency page and they're like, “We need you downstairs right now.” I run downstairs, the laundry room is flooded again. I'm like, “What happened? Tell me what happened guys.” And so, they're like, “I don't know. Water started appearing.”
So, I came out, I'm like, “Okay, it's flooded here again, and I don't understand. It is a pretty big load. Okay, we talked about this yesterday. Maybe we need to have a repeat conversation because, oh, look, Caitlyn is here today, and she wasn't here yesterday. So, let's have the conversation again, and let's make sure everybody knows. Oh, today I'm going to post a message on Slack. Kate, by the way, if you weren't here, so everybody's on the same page you got to check and make sure it's evenly distributed.”
I'm not even kidding you, every single day that week the laundry room flooded, and I was like, “What in the actual hell is going on here?” And so, I get to the end of the week and I'm like, I don't understand. So, actually, the last day, the washing machine isn't even on. The only thing running is the dryer, and the laundry room was flooded again. I'm like, “What in the hell is happening.” So, as it turned out-

Dr. Andy Roark:
How did you guys flood the room with the dryer?

Stephanie Goss:
That's actually a thing that I didn't know was a thing because when you overload the washer and then you take the sopping wet stuff that was in the washer and you put it in the dryer, the dryer actually also has an overflow valve. So that when it drains too much water at one time, it has an overflow, and it can actually flood. That is a thing that I learned at almost 40 years old.

Dr. Andy Roark:
Yeah, I was today years old when I learned that.

Stephanie Goss:
Exactly, right? I thought, okay. I thought… All these thoughts are going through my head, and I'm thinking, “I have a team full of all of these people who, they live on their own. Most of them have partners or spouses, lots of them have kids. They're all in their 20s and 30s.” I didn't think that laundry was so hard. I did think this was a skill that I was going to have to teach, and yet, I spent, at this point, once we figured it out and got the whole thing solved, almost two weeks into this process, I'm like, “Oh, wow. Okay. So, it turns out laundry is not actually that simple.”
After that week, I was raging. Man, I was like, “I'm going to murder all of you, all of you chicks.” I'm literally in the treatment room bright red, ready to throw down with somebody because I'm like, “You guys, I cannot with this. Come on.” The reality is laundry is not simple, and we had to take the step back and say, “Have I actually ever shown them what doing laundry in a veterinary hospital looks like? What it sounds like. What does it smell like when it's done and it's actually clean versus when it's not clean?”
So, I started asking them, and as it turns out, all of them had had varying different degrees of introduction to our washing machine, our system, things that they should check for that are different in our hospital that maybe weren't the case in their last hospital, or they've never worked in a hospital before.
And so, when I stepped back from the anger and the frustration, what I was able to recognize is, okay, before I go pointing my finger in the treatment room at all of them, and I'm like, “I'm going to kill all of you.” I have to look at the fingers that are pointing back at me and my team because what I recognized in that moment was, “Oh. Okay, so there actually is some ownership here on my part because I can't just assume that they must have seen it before.”
Because that was the assumption I made. I thought these are bright, intelligent people, at the time a hospital full of women. So, all bright intelligent women who live on their own, who do their own laundry, who have been doing their laundry for years, who have children who they're doing their laundry for. I think that they could figure out how to do the laundry.
Actually, that doesn't absolve me as the leader of doing my part to teach them how it should be done in my hospital and with our equipment. And so, it was a huge light bulb moment for me. And so, I share that for two reasons. One is that, look, it happens to all of us. There is always going to be that moment for all of us no matter how tenured we are in veterinary medicine or as a leader, where we have to look at ourselves and say, “Oh, okay. I actually do have some responsibility in this,” number one. And number two, the laundry isn't always that simple.

Dr. Andy Roark:
Yeah. Well, I'll use an analogy that spoke to me years and years ago when I came across it. I was reading a book on the legendary college basketball coach John Wooden. And so, he coached at UCLA, a Hall of Famer. He's amazing. I read this book on him, it was talking about he's working with college basketball players at the premier school in the country for college basketball players.
The first thing that John Wooden would do on the first day when new players came onto his team, was he would teach them how to put on their socks. They would all sit down together, and they would go through the anatomy of the sock and putting on the sock. I'm not kidding, this is 100% a true story.
People would ask him about it. I think it was probably mostly for show to say, “You guys don't know anything, you're here to learn. And I don't care who you were in high school, we're starting over.” But they asked him about it, and he would say, “I don't know these kids, and I don't know what they know, and I'm assuming nothing. And so, we start with how to put on your socks and shoes the right way.” And he would do that.
I've never forgotten that because it's such an extreme example, but in another way, it also makes a point of, “Hey, we have our way that we do it here at UCLA.” I just always thought that that was really, really interesting. I think you're exactly right on how to do laundry is we make a lot of assumptions about what people know and what they don't, and everything is different.
You know it's funny, I see a lot of times just in headspace, and I'll say this is another reason that this exact problem bothers me so much because there is a spectrum in what our expectations are, and it comes a lot from who you are as a person. On one end of the spectrum is I want people to jump in, take initiative, figure it out, get things done. That is 100% where I live. I live on that side of the spectrum.
On the other side of the spectrum is there's a plan and a protocol, and everybody should be trained, and we should all know what we're doing and how we do it and how we move forward, and you need to do it the Blank Animal Hospital way. That's not bad, they're just different. You can't have, “Don't touch anything until you're trained,” and, “Jump in and figure it out and get it done.”
Again, everything is a spectrum. I am far on the first side of that spectrum, which is everybody should be able to figure it out. And so, the natural progression of living on that side is ultimately, you have a lot of holes. At some point, you're going to realize everybody has figured out different ways to do it, and there's not a lot of uniformity.
It works great when you're a startup. It works great when you have nine employees and you hire good people and you lead with a good positive culture, and the clients generally love it because they have no idea about the inconsistencies that are happening there.
It doesn't scale, and I think a lot of what we're seeing right here in this exact episode is these people started out small. They probably started out with a good culture and good people and good leadership and probably a good mission and purpose. And everybody jumped in, and they figured it out and they worked hard, and they did things. And now we've had this turnover and the practice has probably grown, but we are now at this place where the systems are broken down and we are getting big enough that people doing things different ways is becoming obvious because they're not able to communicate across this larger organization well.
And so, that's where I tend to see these things a lot. I know that this person said they had a lot of turnover. I think that creates it too, but generally, I see it, not with turnover. I see it with growth. I see it when practices hit 20 employees, and now we have a problem. That's where this comes to me.
But anyway, I'm just being honest about the fact that I hate this problem with a burning passion because it's one of my own weaknesses. Because I am such a mission-driven person and a, “Let's go…” I do great at empowering individuals to do what they're great at. I do much less well at setting systems to get people on the same page.
I still maintain that there's a spectrum there and you can go too far in the other direction. Stephanie Goss, stop laughing at me. Stephanie Goss who had… Stephanie, what's in your handbook, Goss as we call her.

Stephanie Goss:
Exactly, it is extremely painful at times, speaking from real life, as our company grows, and as we learn to scale. Poor Andy, when I say, “Hmm, that probably should be in a handbook. That probably-“

Dr. Andy Roark:
I get so mad. I get so mad.

Stephanie Goss:
That probably should be an SOP because he knows that there are instances where I'm right, and it's give and take, right?

Dr. Andy Roark:
Yeah, totally.

Stephanie Goss:
There are also instances where Andy's side of the spectrum makes more sense and I have to let go of that control and let go of that need for there to be organization and structure because sometimes the spectrum works because you have the fluidity there and you move up and down the spectrum as needed, and that's part of the challenge. That's part of the give and take of being leaders. And so, it is-

Dr. Andy Roark:
To me, it is about ebb and flow. I don't mean to be cheesy, it's the yin and the yang.

Stephanie Goss:
Yeah.

Dr. Andy Roark:
My experience, and just how I run programs and initiatives, are I do lean far into the, “Everybody jump in, let's figure it out. I believe in you. I believe we have good people. I've shown you the vision. I believe that we're all in alignment about why we're doing this work and this purposeful work.”
And generally, for me, it's that's how you start. What I've learned is you should start that way because we don't know enough to make systems. We've all worked in places where people start making systems that are stupid systems that don't work. And so, it is a great way to try new things, to figure out what works, to throw spaghetti against the wall, to leverage the skills of the group.

Stephanie Goss:
Yeah, see what sticks.

Dr. Andy Roark:
But then you have got to shift to the other side, which is now we've done this, it's time to systematize it. It's time to standardize it, it's time to get everybody on board and make sure that we all know what's going on. And so, I really do think it's that give and take.
And so, to the writers, I would say your frustration is 100% understood. I don't want you to lose heart, everybody goes through this, I think. Unless you start off making protocols, which you can if you came from a place that already had them or if you are just mega-organized person.

Stephanie Goss:
Even when you do that, I think you were spot on when you said everybody is going to deal with this at some point. So, I think the headspace piece really is you are not alone, and it is completely frustrating, and we see that and feel that. And so, you got to start with a deep breath and get it together because you can't attack this with frustration for sure.

Dr. Andy Roark:
Oh, yeah. And here's the sick twisted part of that is we say you can't attack it with frustration, but the truth, Stephanie, is you only deal with this when you are already overwhelmed and you're stressed and you're frustrated, right?

Stephanie Goss:
Yes. Yes.

Dr. Andy Roark:
Here's the thing. If you weren't getting your butt kicked, you wouldn't care that people didn't know things because then you would just take the time to show them. And you could walk along, and you could teach them as you went, and you wouldn't even notice you were doing it. The only reason that it hurts is because you're so busy and you don't have time to do this.
And so, it's funny, you don't have this problem if you have time to deal with it because you don't even know this problem is happening, you just fix it. You only have this problem when you don't have time to deal with it, which means by design, if you have this problem, you are stressed and frustrated, which is really hard.
The last part of headspace that I want to say before we start really getting into how to get out of this hole is it is hard to stomach this idea, but it is the best salve that I have found for my own irritation. Which is you need to believe that sometimes you have to slow down to go fast. You just do. You're sprinting and people don't know things and things are breaking and there's frustration every day.
I will talk to people, and I will say, “Look, man, you got a choice. You can keep doing this and dealing every day with the same problem again and again, and the fallout, and it's not going to stop. And you are going to be dragging this burden with you for the foreseeable future. Or you can slow down, and you can get your head straight, and in three months, you can make significant strides in actually putting this problem behind you.
“But for those three months, you are going to have to slow down, and that might mean you are going to have to find hours in your day to do training, or you're going to have to see fewer cases personally, or you're going to have to… Yeah, you're going to have to take your head technician off the floor seeing rooms and do training.” And people go, “But I can't do that.”
And I go, “Well, then you're going to continue to do what you're doing. Those are your two options. You slow down and work on the problem so that you can then get past it, or you can continue on as you're doing being overwhelmed and working with people who are angry then frustrated themselves because they're not getting trained. Which of the two poisons would you like to swallow? Because you're getting one of them.”

Stephanie Goss:
Yep, I love it. That feels like a good place to take a quick break and then come back and talk about, okay, so how do we actually hold them accountable?

Dr. Andy Roark:
Sounds good to me. Hey, Stephanie Goss, you got a second to talk about GuardianVets?

Stephanie Goss:
Yeah, what do you want to talk about?

Dr. Andy Roark:
Man, I hear from people all the time that are overwhelmed because the phones don't stop ringing, and I'm sure you hear from these people as well. Like, “Our caseload is blowing up and the doctors are busy, and the phones just don't stop.”

Stephanie Goss:
They never stop. That is a true story.

Dr. Andy Roark:
I'm amazed by how few veterinarians know about GuardianVets. This is a service where you have registered technicians who can jump in virtually and help you on the phones. You can flip the switch and GuardianVets can jump in and take some of the load off the front desk. They can handle your clients and get them booked for your appointments and give them support, and it really is a Godsend.

Stephanie Goss:
Pre-pandemic, it was amazing to me how many people hadn't heard about it for after-hours call help, but at this point, I can't believe how many people don't realize that they are offering help during the daytime as well. Which I would think right now is a huge benefit to practices because everybody is shorthanded, everybody is drowning in phone calls.
And so, we talk about it, we've talked about GuardianVets a lot on the podcast, and every time we do, we always get somebody who says, what is that?

Dr. Andy Roark:
Guys if you're not familiar with GuardianVets, if you think that you can use some help on the phones or at the front desk, check them out. It's guardianvets.com. And if you mention our podcast, me and Stephanie Goss, you get a month free. So, check it out, guardianvets.com
All right, let's get back into this and talk about what we're actually going to do with this. Have you got an action step you want to start with?

Stephanie Goss:
Yeah, for me, it goes back to the first part of our headspace, which is taking a deep breath. And so, I think you have to take a deep breath. And then because I think the first thing that you have to do is I think you have to look at your processes and your training and the teaching piece of it with some fresh eyes. You have to be able to look at this from that 30,000-mile view perspective, and you can't do that when you're frustrated.
So, give yourself the space, take a deep breath, get the frustration under control. And then, I think you have to take a look at what does your training process look like because, for me, a part of it is it goes back to the email that we got, which is there's team members who are saying, “I've never been shown that.” But they're things that are super, super basic, they must have seen it before.
For me, it's about asking yourself the questions like, “Does it define? Do my processes define clearly for my team what a great job looks like, what it sounds like, what it tastes like, and it smells like in my practice, in my building?” I think that there's two pieces to that. One is you have to define for yourself what a great job looks like, and I think part of it is in looking at what you have in terms of your training protocols and processes already.
And then the other piece of it is asking your team to tell you what they know. And that was painful for me when I learned about the laundry because I literally had to sit down with each member of my team and have a conversation and say, “Tell me how you do the laundry.” As I found, doing the laundry was a different process for every single member of my team.
Now, all of a sudden, I understood why the laundry room flooded for a week straight because I have 12 different people who are doing 12 different things. There's no consistency, and they weren't all aware of all of those pieces. And I would not have necessarily been able to see that if I didn't take a look.
I didn't tell them, “This is how you do the laundry.” I said, “Tell me what you're doing. I want to understand it. I'm going to close my eyes, I'm going to sit here. I need you to make me see it, I need you to make me smell it, I need you to make me taste it. What does that look like?”
In our practice, if you have done a stellar, I'm going to give you a gold star for having done this kind of job. What does that look like? And then the trick is you've got to be able to find the common ground, so you know what your idea of great sounds like. And now you've got an input from your team about what their version of great looks like.
So, how do you bridge the gap? Because usually there is a gap. You're over here, they're over there, how do I bridge these two things? Because it's not about reinventing the wheel. It's not about writing new protocols, it's not about necessarily writing new processes unless you look at this and recognize, “Okay, we don't actually have a process to teach people how to do the laundry or how to mop the floor or sweep the exam rooms after an exam.”
And you may find that you have deficiencies where you don't have protocols and processes. And that would be the exception where now here's your opportunity to use the same methodology and apply it to creating a brand-new protocol and say, “What does a great job for this look like in this clinic?” But otherwise, it's about figuring out what does that look like in your head, and what does it look like in the team's head, and where is that common ground?

Dr. Andy Roark:
Yeah, I agree with that. Okay, let me… Can I break that into some smaller pieces?

Stephanie Goss:
Yeah.

Dr. Andy Roark:
So, I'm going to lay down for you the steps that I have taken to deal with this in the past.

Stephanie Goss:
Okay, I love it.

Dr. Andy Roark:
Because it happens to me all the time. And so, I look around and people don't know things and there's holes in the system and people are doing things different ways. And it's because they have been buoyed on by my enthusiasm and by inspiring-

Stephanie Goss:
Not speaking from personal experience.

Dr. Andy Roark:
Yeah, my inspiring motivational speeches that I do.

Stephanie Goss:
Novels that you write.

Dr. Andy Roark:
Exactly, I do. By the pages and pages that I write into Slack to inspire and motivate the team. Okay, they-

Stephanie Goss:
We heard you, Andy Roark.

Dr. Andy Roark:
All right, so I've done all these things, and now people don't know things and we're not communicating. It's not working. All right, so I'll give you the Andy Roark process. Process number one, mourn. Mourn. You have to mourn. You have to mourn the reality where people just figure it out themselves.
I will tell you, for me, that is the longest, hardest process is just giving up on what people should do. It's me polishing the sword of justice and then putting it back away being like, “It doesn't matter that they should know how to do this. Who doesn't know how to answer the phone or do the laundry? I don't know.”
It seems like a failure of society to me, but I am going to mourn the imagined reality where people just knew what to do, and then I'm going to be like, “Okay, they just don't. It's acceptance of where we are.” And I say that in a joking but not joking way.
And then I have to say, “Okay, we are going to have to slow down so that we can ultimately go fast.” It is accepting that and saying, I am willing to make the short-term sacrifices, which are going to suck. But I am going to make those sacrifices because I believe this has to happen so that I can have the job that I want and the life that I want and the business that I want.
And then, I am going to go and recruit a process person. I'm kidding, not kidding.

Stephanie Goss:
Key step, mm-hmm.

Dr. Andy Roark:
Yeah, it is a key step because I am not a process person. I don't want to make a handbook. I hate it. I don't want to do it. I don't want spreadsheets, I don't want to do any of this thing. But I look at Stephanie Goss or I look at Jamie Holms who is my right hand for 10 years, and I'm like, “Hey, Jamie, what do you think about having a handbook?” And her eyes get big. It's like I looked at her and said, “Hey, Jamie-“

Stephanie Goss:
“Do you want a puppy?”

Dr. Andy Roark:
“… would you like a yacht full of puppies?” That's the look on her face when I say, “Would you help me get this organized?” And so, find someone whose heart flutters when you show them a spreadsheet with multicolored tabs and say, “Would you help me get this in order?”
I think you need to have that person. I think it's really hard if you don't have that person, so I would try to find that… I married that person. That was the best move I have made in my career. I highly recommend it. Not mine, she's taken, but find yourself-

Stephanie Goss:
Find your own.

Dr. Andy Roark:
Find yourself a partner. If you're me and you struggle with these things, find yourself a partner who loves the spreadsheet, and lock her down. Okay, get that process person and then you're like, “We're going to fix this.” That is when you look at the mountain of work ahead of you and you get overwhelmed, and then you're probably going to cry again and be like, “This is too far.”
The next thing that people really struggle with is you cannot just tackle the fact that people in your practice have holes in their knowledge. It is too big a… It's too big. It's just too big a problem. You have to figure out how to break this apart into pieces so that you're not so overwhelmed, and you have to forgive yourself…
And also, again, you have to accept that you can't do all the things. You're going to do some of the things. You're going to get started, and you're going to break this up into a chunk that you can attack and overcome, and then celebrate and feel good about. You need to do that, and that's where I think so many people just… They get option paralysis, they get overwhelmed, they just stop at the base of the mountain and stare at it.
You can't do that. You've got to do some priority setting, and so, there's a couple of different ways that you can do priority setting. So, one, I think it's funny, I think Stephanie mentioned it there, testing is not a bad idea. Especially if there's something you know you want.
Like the laundry, if you're like, “Hey, here's a quick test. Here's a laundry test. I just want you to run through it real fast. It's not for anything, I just want to see what you know.” Bang, and it's a quick way to just see, “Okay, we have some holes. We have some problems.” So, you can do some testing.
What is the most common headache that you have? If you have client complaints all day every day, you, my friend, have a common customer service problem. And if that is the most common headache that you have is sorting out unhappy clients who have dealt with your staff, that is the thing that I would do first. I would say we are going to work on our customer service protocols, and I would pull that out.
What is the most severe problem that you have? Oh, well, we had a pet die under anesthesia recently because we didn't have our crash cart ready to go, and everybody's really upset about it. I would say that, my friend, is your most severe problem, and maybe that is where we are going to start. Pick one. Something has to go first, but what is the most common, what is the most painful?
Do you want to do this by department? Is this a thing where you're going to say, “All right, the front desk is going to work on this, and the techs are going to work on this, and the surgery techs are going to work on this”? And then you can break it apart. Not everybody has to get trained on everything, especially at the beginning as you're developing this.
Maybe the front desk is going to develop the how to answer the phone protocol, and the surgery techs are going to develop the anesthesia pain management protocol that we start with. You can split it up by department.
And the last thing is you can split it up by focus and you can say, “Guys, we're going to work on customer service, and then we're going to work on anesthesia, and then we're going to work on our wellness plans and communicating about our wellness plans.” And you can break it up into focus, but you cannot do all the things at once. It's just too big for your own sanity.
And so you can feel like you're making progress you have got to break it out into these smaller groups. And then, once you've got that, you are ready to get started. So, once you've got your window, your area, “Guys, we're going to do customer service 101, and that's what we're working on.” Or, “We're doing anesthesia,” whatever it is, but you've got a bite-sized chunk.
Then I go to the team, and this is what Stephanie was talking about before because I don't know what they don't know. The other thing is the quickest way to screw this up, especially when you're starting with the basics, is to act like you are imposing this on them, and especially them as individuals.
We saw that with the writer being like, “Oh, they get offended when I say, ‘I'm going to teach you this basic thing.'” The way you get around that is you come to them as a group and say, “Guys, this is what we want to work on, and these are the objectives I want to achieve. And so, what I want to do is talk to you guys about what protocols do we need? What are the things that people do differently, not some might do them right and some might do them wrong, but what do we do differently? What are the steps that we need to take to check clients in, to get them into the exam room, to check them back out, and to get them out the door?
“What are the areas where you guys see pushback? What are the areas that clients get upset? When does that happen?” And I want to get them to reiterate, “Yes, we see this problem. Yes, we feel pain from this problem.” And I need them to understand, this is not about you personally, Donna. This is about the whole front desk staff coming together and us all going through the same program and getting on the same page about what we do and how we do it and recording that so that we can train other people in the future.
It is very much not about calling anybody out. It's about us coming together to figure out what we need to do to support each other, and what we as a group think is the best approach. And then recording that so that we can train other people in the future.

Stephanie Goss:
Yeah, I think you're spot on, and I think a lot of it has to do with this is an opportunity actually, even though it might be born out of frustration. This is an opportunity to develop a growth mindset in your team because the reality is there will always be change. That is the reality of life.
Someone will always get married, somebody will have a baby, somebody will move. There will always be change in our team, if not now, five years from now. At some point, it's every single one of us. It is unavoidable.
And so, we may be static. For as long as we are static as a team and work together as a team, it's not wrong to say, “We are doing a great job, and do we ever want to be better?” Because we could still be doing a great job and still want to get better. Those two things are not mutually exclusive, and where I think a lot of us screwed this up, where I have screwed this up more than once, believe me, is to look at it from the perspective as the leader of, “We are focusing on this because something is going wrong.”
If you develop a growth mindset in your team, it can be, “We are doing this right and we can still do better and leave room for ourselves to continue to grow as a group, as a team, as a hospital.” And so, we're going to look at it from that perspective.
And so, for me, this is a huge opportunity, and I think it goes back to what you were saying, which is that you take that step back and then you lean into talking about this with the team and really helping encourage them to develop that growth mindset.
Because let me tell you, the difference maker here, I have failed miserably at this, and every time I have failed miserably at this has been when it has been approached. Whether it's myself, a member of the leadership, or a practice owner. When it has been approached from the perspective of, “Everybody is doing the laundry wrong, and we need to fix this problem.”
That immediately puts everybody on the defense, gets everybody into negative headspace, and makes them feel like they are doing an insufficient job. And the reality is I did have members on my team who were doing an insufficient job. I also had members on my team who were doing a great job, and the reality was we probably were pretty balanced somewhere in the middle because the laundry room flooded every day for a week, but before that, I had months where we didn't flood the laundry room.
So, the reality is they were doing an okay job and we were in the middle. And so, when we approach it from that perspective of how do we ultimately do better as a group? Not because we were doing it wrong, but because there's always opportunity for improvement. That is a game changer.

Dr. Andy Roark:
Yeah, I'm really glad you said that. I think that's just such a great, great point. It's so important and I completely agree. Number one thing people get wrong is they pull the team together and say, “Guys, we are not doing a very good job. We are sucking this up. Guys, this isn't working. We've got real problems,” and everybody gets defeated. I've seen it a million times.
As opposed to saying, “Guys, you guys are working your butts off. I want to make sure we're all on the same page. I know how overwhelmed you are, and I really think that by getting some systems and programs in place and smoothing out what we expect from each other, we can go to the next level. And then we can make your lives easier because I know how hard you're working, and I don't want it to continue. I want to make things smoother and simpler for you.”
And that is 100% how I approach these conversations, not people are doing it wrong. And some people out there who are sitting cradling their flaming raging sword of justice are like, “But Andy, they did do it wrong.”

Stephanie Goss:
They are doing it wrong.

Dr. Andy Roark:
“And they should know about their failure. And the ones who did it right should know that they are superior to the ones who did it wrong.” And that I would say, “Continue to clean your flaming raging sword, just keep it in your office.” The truth is I don't give a crap about what happened last week, you know why? Because last week is over. It is unchangeable, it is chiseled in stone, it is in the books.
I don't care who messed up the laundry last week because that's done. You know what I do care about? I do care about not messing up the laundry next week. That's the only thing because I have control over that. I have no control over what happened last week, so no, I don't care who messed it up last week. What I do care about is I don't want to get messed up anymore.
And so, I'm not going to do the blame game. I see so many people who are like, “We need to figure out who did this.” And I was like, “No, you don't. Just fix it.”

Stephanie Goss:
It doesn't matter. Fix it, yeah.

Dr. Andy Roark:
Make it not happen again. And if no one ever knows who messed up the laundry, the world will continue to spin. And people are like… I know people whose heads explode. The idea of not Sherlock Holmesing this down until you're shining a lamp in someone's face, and they break and confess. I'm like, “No.” They're like, “That's how it has to go.” And I'm like, “No, it doesn't because there's no benefit to that over just bringing everyone together and saying, let's get on the same page and make this not happen anymore going forward.”

Stephanie Goss:
And I think the email speaks to that, which was their question was, “How do I hold them accountable?” In a safe way, sure, but how do I correct the deficiencies? I think that's because our human brains automatically jump to, if someone doesn't take responsibility for this, then I have not held them accountable. And those two things are not mutually exclusive.
You can absolutely hold the team accountable and fix the problem moving forward, without Sherlock Holmesing, without shining a bright spotlight on a person or persons. It is about… And so, this is where my answer for our writer was really, for this piece, especially when they're getting feedback from the team, that the leadership feels mean or feels like they're being bullied about things.
The transformation, for me as a leader here, comes when I personally chose to dig into the mean. That resonates with me because I have had that said to me. I have had people say to my face, “I think that you are being mean, and I don't like the way that you are approaching this.” And it's hard to hear that.
I'll tell you that on a personal level, the big change came from when I really let myself dig into that because the reality is I want change for them. I don't want to be mean. I didn't wake up today and say, “I want to be mean [inaudible 00:52:50] to my whole team.” I didn't choose that.
I don't know anybody who would. I'm sure there are some people out there who just love to be mean or love to be miserable, but most people I know, that's not the case. I didn't choose this, but I do want there to be change. When I can learn how to change the vocabulary that I'm using, and the body language that I'm using to convey the fact that I want to make change happen.
It's not about being mean. I'm not choosing to be mean. And so, I need to understand what they are perceiving as being mean or angry or bullying because it's a perception problem. You and I have talked about this before, I need to figure out, is it my tone? Is it the look on my face? Do I got some RBF happening? Did my tone reach into angry land? Am I raising the volume of my voice? Are my arms crossed? Is my body language…
And so, really, for me, it's digging into that and being vulnerable, and asking for some feedback from your team. And whether you do that with your leadership team because that's where you have safety, or whether you really generally do have safety with your team as a whole, and you can say to them, “Hey, look, I don't want you guys to think that I'm mean. I'm going to close my eyes. Can you please tell me what that looks like? When you feel that way, when I make you feel that way, what does that look like?”
And ask them to explain it to you so that you can see it. It's not about judging them, it's not about… “I hear you. I don't want to be that way. I'm not choosing that. I need you to help me to fix that behavior because I never want you to feel that way at work.”
You can only do that when you lean into vulnerability with your team, and you ask them for that feedback. But when you do that, then you have an incredible opportunity to say, “Oh, okay. I see now.” Maybe it is your tone, maybe it's your face, maybe it's your body language, whatever it is. Then that creates opportunity for you to address that.
And to your point, it is about talking to the team as a whole and saying, “How do we do better? How do we do this together?” Because it's not about Becky not knowing how to do this. It's not about Sherry as the new person being singled out in front of everybody because they're the only one doing it wrong and everybody else is doing it right.
It is about we always want to show up and give our best for our clients and our patients every day. So, how do we collectively as a group make sure that that happens? And if we're all doing things differently, if we've all been shown how to do things differently, maybe there's ways where I as the leader can help smooth that out.
But I don't know what I don't know, and you guys don't know what you don't know. So, until we talk about it and have that conversation, there's a lot of room for improvement on all sides left on the table if we don't have those conversations.

Dr. Andy Roark:
Yeah. No, I agree. The last thing that I want to say is about being perceived as mean, and also holding people accountable. So, the two things I want to just put down here right at the very end, holding people accountable is often seen as a negative reinforcement experience. Meaning I'm going to hold people accountable, which means they're going to get in trouble if they don't do what they're supposed to do.

Stephanie Goss:
Yes, they're going to get disciplined.

Dr. Andy Roark:
They're going to get disciplined, and then you're like, “Why do they think I'm mean?” I'm like, “I don't know, maybe-“

Stephanie Goss:
Because the only time you hold them accountable is when you write them up.

Dr. Andy Roark:
Right, exactly. Maybe because you have a whip, and you crack it on them when they don't do what they're supposed to. The two things for me that I put on the table to address this perception of being mean, and also to hold people accountable. Number one is remember to explain your why when you are asking them to do these things.
The why should mean something to them. If you say, “You are supposed to do this because that's the protocol.” And I know people who are genuinely process people who are like, “You're supposed to do it because that's the rule.” And they're talking to me and I'm like, “I don't care what the rule is. If that's the best reason you have-“

Stephanie Goss:
I don't care.

Dr. Andy Roark:
“… you and I are not going to get along because I don't care, that's what the rule is.” You need to convince me that this is worth something, and that's just how I am, and a lot of people are that way.
The why, when we talk about making policies and doing this training is not because you don't know what you're supposed to know. The why is because we want to provide great patient care and we want everyone to be on the same page, and we want to make our clients happy. And we want to get our staff out of here on time, and we want to have people being less stressed out, and we want to have people being less overwhelmed. That is why you are doing it. Not because that's your job, it's in your job description.
I'm not saying that that's what anyone said, but I have heard those things being said. And so, when we want to motivate people and have them be held accountable, you have got to talk to them about why they're doing this thing, and you have to use a language that resonates with them.
And the other part is remember it's a whole lot easier to positively reinforce culture than to negatively reinforce it. And so, rather than thinking really hard, “How do I catch people who are not doing what they're supposed to be doing?” Think really hard about, “How do I catch people who are doing what they're supposed to be doing and reward them and thank them and praise them?” And I promise you will have a lot, a lot of success, and not nearly as much pushback.

Stephanie Goss:
And when they feel the success and they participate in this, that look, the reality is… You spoke earlier about you're standing at the foot of the mountain and you're just looking up and you're like, “How am I going to climb this thing?” The reality is there will always be a mountain.
Protocols, processes, change in our practices are constant. There will always be something that needs to be grown and developed, and every single one of our practices is a never-ending cycle. As soon as you get the whole team trained, something happens, and you start all over again.
So, the sooner you accept that as a leader, and the sooner that you recognize that speaking their language, getting them to understand the why behind it, the sooner your job in the long run of climbing that mountain. You're climbing Everest for the first time and then you're climbing it for the second time.
The sooner you get to that place, the better off you are because then, when you have a team who understands the why and who's bought in, the next time you stand at the base of the same mountain, there are people on your team who are like, “Oh, cool, I know how to do this. I will take this piece on because I recognize this. We did this before. I will lead and I will take it off of your plate.”
And in the long run, it isn't you starting over without a group at the base of a mountain. Now, you've got some sherpas who are there to climb this mountain with you, who are willing to take on some of that burden. And that only happens when you really speak to them and get them to understand the why, and they're willing to come along that journey with you.

Dr. Andy Roark:
Yeah. No, I agree. All right, my friend. Thanks for talking this through with me.

Stephanie Goss:
Yeah, this was a fun one. Have a great week, everybody. Take care.

Dr. Andy Roark:
See you, everybody.

Stephanie Goss:
Hey, friends, have you been over to the website lately to check out all the fun and exciting things that are coming from the Uncharted Veterinary team? If not, you should stop right now and head over there because we have got some awesome stuff coming late summer and into the fall and winter, and I want you to be there with us.
We have our Get Shit Done Conference coming in the fall. That is happening in October. Before that, we've got a workshop coming in September from my dear friend Dr. Phil Richmond. He's going to be talking about avoiding toxic teams, how to create psychological safety in our practices.
We've got the amazing and wonderful technician, Melissa Entrekin who is leading a workshop in October about leveraging technicians. Making practice less stressful for you, them, and your patients. And all kinds of other fantastic things you are not going to want to miss out on.
So, if you haven't been over there lately, head on over to unchartedvet.com. You can hit forward slash events if you want to go straight to the events page. That will show you everything that is coming, and remember, if you are an Uncharted member, your membership gets you access to all of these workshops that we do on a regular basis for free.
And if you are not currently a member, you can check out the membership information because it will save you big bucks throughout the year on accessing all of the workshops. And [inaudible 01:01:15] you access to the conferences when we have them like Get Shit Done for less money. That's right, get a discount, and who doesn't love a good discount? Thanks so much for listening, guys. We'll see you soon.

This Week on the Uncharted Podcast…

This week on the podcast, we have a cross-over episode! That's right, this is a Cone of Shame episode. Imagine a CSR working from home, checking a client out and booking appointments from his home, or a technician live-chatting with three different pet owners through the clinic webpage from her apartment, or a doctor doing telemedicine appointments from another state? This isn’t fantasy. There are practices actually making these things happen today. Christina Freeman and Summer Burke-Irmiter join Dr. Andy Roark to talk about how their clinic is breaking the mold to give employees (and clients) flexibility like never before. Let’s get into this.

You can also listen to the episode on Apple Podcasts, Spotify, Google Podcasts, or wherever you get your podcasts.

Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.

Got a question for the mailbag? Submit it here: unchartedvet.com/mailbag

Upcoming Events

October 6-8, 2022: Get Sh*t Done Shorthanded Conference Event

Want to hear more from Summer and Christina about their virtual CSR model? You can at the upcoming Get Sh*t Done Virtual Conference! They will be doing a workshop and there will be 3 days of content all about how you can get sh*t done when you're shorthanded (who isn't?)!

While Uncharted Membership is always encouraged, you DO NOT have to be a member to join us for GSD! Non-members, here’s your chance to see what all the buzz is about and get a taste of the Uncharted experience.

August 10, 2022: Believing WE Can – Leading A Solution-Oriented Team with Senani Ratnayake

In this 2-hour workshop, we will:

• Discuss what leaders can do to set themselves, and consequently their teams, up for success in problem-solving
• Focus on tactics with a twist – activities that are enjoyable, engaging and unexpected. 
• Learn how to implement these activities to help the team explore being solution-oriented and action-oriented in fun ways.

All Uncharted Veterinary Community Workshops are LIVE! You will be able to ask the instructor questions that help you address your practice’s unique problems. This will not be 2 hours of silent screen time. Gear up for interactive, fun learning! 

Episode Transcript

This podcast transcript is made possible thanks to a generous gift from Banfield Pet Hospital, which is striving to increase accessibility and inclusivity across the veterinary profession. Click here to learn more about Equity, Inclusion & Diversity at Banfield.

Stephanie Goss: It's a crossover episode that's right this week we are sharing an episode from our sister podcast the Cone of Shame podcast. Andy did a discussion interview with two amazing women from Adobe Animal Hospital and I just thought it would be something that our audience would love to hear, because they talked about virtual team members, virtual csrs, using technology in amazing and absolutely nerdy ways that I completely love. So we are going to listen to Andy talk with Summer Burke Armature and Christina Freeman from Adobe Animal Hospital and nerd out about how Adobe Animal Hospital is doing work from home and virtual vet med.

Meg: And now the Uncharted Podcast!

Dr. Andy Roark:
Welcome to the podcast, Christina Freeman and Summer Burke-Irmiter. How are you guys?

Christina Freeman:
Good. How are you?

Dr. Andy Roark:
Doing really good. I am super excited for this conversation. For those who don't know you… Let me just say why I'm excited for the conversation, and then I'll introduce you guys through that. You guys work at Adobe Animal Hospital, which is out in the San Francisco Bay Area. You guys are part of Uncharted, which is a community that I love and get to run. And you have been for a number of years and you are one of my fanboy hospitals that I crush over because you do these cool, cool things. You were the first hospital that I was aware of that was an open hospital, meaning that people could go basically wherever their pets go.

Dr. Andy Roark:
My head hurt for a week after I first talked to you and really came to understand what you were doing and what that meant. You guys just, you do these things that get me excited and just remind me about what's possible, and that medicine can be very different from what it has been in the past. And so I am a huge fan of you guys and the work that you do. Summer, you are the hospital administrator and the owner. Christina, you are the remote manager, which is how we come to be here today. Summer shared with me a couple of weeks ago, a new program that you guys were rolling out with what you called video client representatives.

Dr. Andy Roark:
So I'm not talking about CSRs that are answering phones from home. I'm talking about you guys have screens in your lobby that people can see traditionally, a CSR, a customer service rep. That they can see the customer and they can check out with this video screen. And you have people not just answering phone, but actually dealing with clients in the building while they, the employees are at home. And that's amazing to me. And so I was like, “I want to talk…” First of all, I want to go through the system with you. I just want to unpack it and understand what you guys are doing.

Dr. Andy Roark:
I'm so impressed with just… And let me just say this too. I know this is a new program, you're only doing it for a while. I love that you are doing this and putting it out, and I just think that so many people, as we're looking at the great resignation and people changing jobs and also battling burnout and people being able to work from home. That has been shown to decrease levels of burnout, when people get to spend some time and say, “Hey, I'm changing my environment. I'm going to work in a more relaxed place. Even just a limited amount of time.” I am really looking hard at burnout. I'm looking hard at efficiency. I'm looking hard at making the jobs better and more flexible.

Dr. Andy Roark:
And I feel like you guys are actually out there in the wilderness doing the thing. I didn't say you were lost in the wilderness. I said you are out in the wilderness, more of a Lewis and Clark, like headed westward sort of feel. That's, how I feel about it.

Summer Burke-Irmiter:
Definitely.

Dr. Andy Roark:
Definitely. Those are the things I'm geeking out about, and so let's go through. I just want to go ahead and start to walk through the journey that you've made so far with you. Go ahead, why don't you guys tell me just a little bit about Adobe. I mentioned a very high level. Give me a clear picture of what you're working with as far as the hospital, what makes it special? Just so people can have a mental picture of Adobe and what we're talking about.

Summer Burke-Irmiter:
I'll jump in there. Adobe is a really amazing place. We have two hospitals here in the Bay Area, one, which is a 15-exam rooms, three surgical suites, full cat and dog ICU, full lab and pharmacy. And so we're big and I love it, 15 exam rooms. Overall between our two hospitals, we have 22 doctors and about 145 team members. Yeah, we're a big guy. We have a second location about 20 minutes away that's six exam rooms, ultrasound suite. They can still do major surgeries. They're open six days a week there.

Summer Burke-Irmiter:
You mentioned the thing that I think makes Adobe special and amazing, which is the open hospital. So clients can go with their pet to ultrasound. They can help us set up an x-ray and then step out. We do vaccines and blood draws in front of owners. And because of that, our have a different level of trust with us. And our doctors all practice the medicine, they feel as best. So as a business, we actually don't have a lot of hard lines with our medicine and what we recommend. We want the doctors to talk with the patients and the clients decide what the [crosstalk 00:07:15]

Dr. Andy Roark:
Talk with the patients too. You never know what you're going to get.

Summer Burke-Irmiter:
Where are they going, what their risks are. For vaccines, we don't say you give every puppy these set of vaccines. You talk with the owner and see what's going to be best for that puppy and for that owner. Those are the two big things that I think make Adobe in general. Christina, what would you add to that?

Christina Freeman:
Truly the open hospital, I think is one of the big things that makes Adobe different and drew me to Adobe. When I first read that applying, I was like, “Oh, that's awesome.” I had grown up in a little small town hospital where I got to go wherever I wanted to go, but yeah, I saw other people not be able to do that. So it important to me. It honestly gives a huge hospital that small town feel because you're part of your pet's care. I think that was definitely one of the things that drew me to Adobe.

Christina Freeman:
I'm not from the Bay Area, I'm from North Carolina, which is where I currently live. Why? I'm the remote manager, but I think what's kept me with Adobe is just the constant creativity and growth, and the fact that we're always changing things up to make things a little bit better for namely the pets. That's always the first and foremost. That's how we've gotten here, is keeping pets first.

Dr. Andy Roark:
Talk to me a little bit about the idea of remote work. When did Adobe start to really look at this as a concept? You guys were way pre pandemic when you started to kick this around. People are like, “Oh my God, look how far they've gotten in the last two years.” And I'm like, “No, you guys were way out ahead starting to work on this.” But help me really understand that, when did this idea of remote employees, when did that come together and why did that come together?

Summer Burke-Irmiter:
It's been some while so I always have to remind myself. I think it's eight to nine years ago we started.

Christina Freeman:
Yeah.

Summer Burke-Irmiter:
What happened is, here in the Bay Area, the cost of living is very high. A starter home within an hour of Adobe, you're going to be at least 600,000 plus. And so a lot of our staff already live farther away, and then if you're going to buy a home and raise a family, oftentimes our staff would move out of the area. And that's what happened, is we had a staff member who was going to leave the area and we didn't want to lose them. We all know how hard it is to get really great staff. And when we were faced with one of our staff members moving, we were like, “No, we need to make this happen.” I was like, “I need to make this happen.”

Summer Burke-Irmiter:
We keep good team members. They're part of our Adobe family, and so how do we do this? And why are we limited by our building? Why can't we do more? And so there's so much work to do. There's always work to do at Adobe, and so we just started figuring it out, really just one step at a time, lots of trials and errors, but it was to keep our team members. And so that original person did start out, I think like many hospitals now have a remote person, which is helping answer phones, helping call back clients for us. So it did start small and it just kept growing.

Dr. Andy Roark:
You guys also started to do remote communications with pet owners. Tell me a little bit about that. That's different from having people work from home. That's having pet owners stay home. How does that come into this?

Summer Burke-Irmiter:
One of the areas that I was really excited to explore was getting into chat. I don't know about you guys, but pre pandemic, I loved chat. I actually had apparel companies that I would chat with all the time back and forth. I was on Zappos once and buying shoes. And I was chatting with this CSR on there with a question about the shoes and we ended up talking her cute pit bull that she just rescued. And so I saw that you could have a connection and get really great, fast help. And so really started looking at different platforms, what could we use? That's where we initially settled on live chat, and this is where Christina actually comes in and I'll let you take it from here because you can give all kinds of information.

Christina Freeman:
Yep. That was Summer's crazy idea. I came to her and needed to move back for my family to North Carolina and she said, “Well, if you'll stick with me, I've got a crazy idea. What do you think?” And I loved it, and so we really started small. It was truly just, we had a couple people trying some things out, but when we first started chat, it was just me for the first couple weeks. And then we grew to a couple people and added one of our doctors who was remote at the time or starting in the remote world. We were shocked at how fast our clients adopted it. Through the live chat platform, we just popped a widget up on our website.

Christina Freeman:
And so whenever someone would come on the website, the way we started originally was very organic. We would ask the client if we could help them with anything. And they would say yes or no, or some were thrilled. We really found… I think at first we were all like a little bit worried it would feel impersonal, so we really tried to give it a good conversational spin and not using forms and things like that. Just really us talking because I really wanted to create the atmosphere that this was real people, real Adobe people who knew what they were talking about and we were not a robot, and it worked. And our clients adopted it and really quickly and started coming repeat back questions day after day after day, short, little questions.

Christina Freeman:
Little questions about the hospital, little questions about their pet. We love it because we can send videos and pictures back and forth. That really helps us triage, especially like a surgical patient. We can look at that incision site without the client having to drive in and we can get really good images too. So we were thrilled at how interactive we could be with the clients. Another thing that I think surprised Dr. Lau and I, when we were first doing this, we would cover a lot of the evening hours. And we had a lot of our senior pets or our hospice pets that would come day after day after day.

Christina Freeman:
We got really invested in these people and their pets and their journey through what they were going through and just really created a nice, comfortable rapport and atmosphere with the clients that you don't always have time for in the clinic. And so we really found it not only helped clients, but it sometimes enhanced their experience with us. That was really rewarding and kept us pushing. And as time went on, word got out. And so we became pretty overwhelmed pretty quickly with the load. And so we've grown our team from one to 24 in the last two years or three years, I guess and we've been really pleased at how the clients and the staff members love it.

Christina Freeman:
We have some staff who still work in hospital that help us with chat, some on a part-time basis, so they're part-time remote, part-time in hospital. And now we have a lot of people who are fully remote. And it's helped with people whose life has changed or a medical condition has changed. And so we've really been able to keep our good people and keep their skills in this field through this.

Dr. Andy Roark:
I have to point out the elephant in the room here, at least what it is for me can. One, help me understand what chat looks like. I guess what I'm saying is, what are the most common things that people ask? And then two, the reason I'm asking this is, when you guys are talking about chat and you're very excited about it and you seem to really love it. I'm imagining complete pandemonium in chat of like your own social network and people talking about their grandkids and and like a Friendster network on my webpage. Conviince me of the return on an investment of chat.

Dr. Andy Roark:
You have 24 people doing chat. As a business owner, I'm like, that sounds like a nightmare. Convince me of the value of this. I'm trying to get my head around what this really means for the pet owner and what it means for you guys from an efficiency standpoint. It like more, not less and I want to get my head around that.

Summer Burke-Irmiter:
And actually before-

Dr. Andy Roark:
You're both laughing real hard as I say that. I think I'm probably having all of the anxiety and the nerves and the worries that you had at the beginning. I'm having this now of… But first of all, my first thought would be, what if this fails? And my second fear would be what if this succeeds? And I can panic in both directions. Talk me down off this ledge.

Summer Burke-Irmiter:
Well, actually I'm going to add to that ledge just a little bit.

Dr. Andy Roark:
Holy crap.

Summer Burke-Irmiter:
It's not to brag and just really show how big this can get. Christina and her remote team, since we started the live chat in 2018 have helped 60,000 clients. They've taken 60,000 chats. And now that's not the back and forth that you can have. That's not counting each one of those. That's a single session with a client. I'm going to add that mind-blowing right there.

Dr. Andy Roark:
I feel like you're helping people in Brazil. That's what I feel. I feel like there's people who've just found you and they're like, “These people will talk to me. If you're lonely and have a pet, they'll talk to you.” That's what I feel like. Is that true?

Christina Freeman:
There was a handful. I think the farthest I've ever spoken to someone was Singapore when IAMS Pet Food stopped creating their vet diets. It became like this frenzy of finding people with these products. That's as far as it's gone. but for the, I would say 97% is our actual clients. We are careful, we don't, we do. Every time we start a conversation, we get the pet details. We look up their record.

Dr. Andy Roark:
Smart.

Christina Freeman:
If they're not our clients, we do recommend that they speak to their local hospital, just so that history is with them. We're not trying to push people off, but we do feel like, don't talk for me for 30 minutes about diarrhea and then go to your hospital and expect them to know what we talked about. That is one thing that we are pretty careful about. And the great thing about the chat is every single thing we say, every single thing we share, we upload into the medical record, so when that pet does come in a couple days later or later that day, it's all there, that history's there. So they don't have to go back through that again, our medical staff can read through that.

Christina Freeman:
Just a short thing on the ledge, and I know Summer can, can help remove people from the ledge quickly, but what we've done with our team is allow the in-hospital team to focus on the pets that are in the building, rather than you're sitting there helping a pet and you've got four people waiting on the phone that have a question for a doctor. We're able to take that load from them so they can focus. And we can seamlessly help the client. The client has no clue in cases that we're not actually in the building.

Christina Freeman:
We stay in constant contact with our doctors who are on the floor, they're feeding us advice. And so we're able to take that load off of the team in the building who need to focus 100% on the pets.

Dr. Andy Roark:
Okay. No, that makes a ton of sense.

Summer Burke-Irmiter:
And you bring up a good point there, Christina is one of the reasons we started looking at this in 2018 is at that time, if we all can remember past then. I know it's been eons, seems like a decade, not just three years, we were already experiencing that short staffing with technicians in particular. With the high cost of living in the Bay Area was compounded, and Adobe had always offered medical advice to our clients. We're probably way more open than most hospitals about that client calls. We will talk to them through, make sure there's no contraindications. And then if it's that vomiting lab, we'll go ahead and give them a bland diet, what to look for and when to call back.

Summer Burke-Irmiter:
And we were looking at losing that. That was something that I felt was really important to Adobe. And by figuring this remote piece out, we were able to keep something that I thought was part of Adobe and part of Adobe soul and just move it out of house. And that worked out really well. And yeah, to talk you off the ledge there, Andy, there are some tips and tricks behind the scenes with these chat systems that really make it helpful. One of which is, and this is good for everybody to know, they can see what you're typing before you hit enter. Remember that.

Dr. Andy Roark:
Really?

Summer Burke-Irmiter:
So when you're about to be like [inaudible 00:21:10], and then you erase it, they saw it.

Christina Freeman:
They see all that.

Summer Burke-Irmiter:
You see all that. So when you can already see somebody typing out about the diarrhea, and then what you're doing is there's scripts that Adobe did, ourselves, but you can have a diarrhea script. So as soon as that client is done, you press enter on the diarrhea script and it's got all the questions we always ask. How is their eating? How often? What's the color? All of that. So then that gives you a minute to either work on another chat. Our chatters who are super experienced can take multiple at a time. You can't take multiple phone calls at a time per person, but you can with chats.

Summer Burke-Irmiter:
Or it gives you that moment to either take a breath or to do another task, which is a lot of what the remote operators they're doing. They're then working on something else while that person fills in their answers with the diarrhea. And you're already seeing again what they're doing. So if you're like, “Ooh, they just said blood.” You're going to be ready for that and you're going to get them in the hospital. Or, this is where Christina mentioned Dr. Lau. We have two remote doctors for video visits, which came in 2019. And those doctors also help the remote team with advice, questions of, “Hey, what should I recommend for this?”

Summer Burke-Irmiter:
Or if it's more specific, “This client is asking a medication question that their dog's currently on. Can you help us with this?” And so that's where behind the scenes, they'll also with that. There's a lot of tools behind the scenes to help out with those 60,000 chats that they've taken.

Dr. Andy Roark:
Okay. I have some questions. Let me start to dig into this. The idea of having some scripts makes total sense, and especially like follow up questions of when they talk about diarrhea, here are the follow-up questions. That makes my innovative efficiency smooth workflow heart so heavy. And so that totally makes sense. Okay. Talk to me a little bit about chats uploading into the medical records. That sounds like it could be a Herculean task. It also sounds like it could be turnkey smooth as silk. Which one is closer.

Christina Freeman:
You're in the middle. One of the things Summer and I have been talking about recently is there are some pain points in some of this because we're starting at the very beginning. But the great thing about it is the companies are really listening to us that we're working with. We are feeding them our problems and they're helping us solve them. So that has been great. It's been challenging to be in it, but it also, we are discovering the problems as we go that need fixing. And so the companies are super helpful to help us. We are transitioning with companies major that reason. Right now it is manual, we do copy and paste this into the record, and we're talking about six key strokes to get it in the record.

Christina Freeman:
But the company that we're talking with now is going to make that automatic. As soon as we finalize that chat, it's automatically fed into the record. This has been fun to be on the innovative front of like, “Okay, here's our problem. Help me solve it.” And so that's going to speed us up. Summer mentioned, part of the glory of chat is we can do multiple things at the same time and we can help clients at the same time. When you're speaking medically, and you're looking for medical records, and you're having to bring up the pet of, if you're a seasoned chatter, three is tops because you need to be focused and make sure, like three pets at a time.

Christina Freeman:
But as Summer said, you're stuck on the phone with one call, where with a chat. And also you don't get those visuals that we can get via chat. We can say, “Hey, could you go snap a picture of that?” The owner runs away and snaps a picture and comes back while we're helping another client, or we're picking up a phone call or we're answering an email. So there's a lot of other administrative things that we can do behind the scenes while all this is going on, while we're also helping pet owners via chat.

Dr. Andy Roark:
Cool. Who are the companies that you're working with on your chat?

Christina Freeman:
Well, we've been using live chat and we're transitioning to TeleVet. And TeleVet is a more veterinary-centered product that is helping us build the things we need and these automated things.

Dr. Andy Roark:
Hey, everybody, I just want to jump in here with a couple quick updates. If you're listening to this podcast and you're like, “Oh my gosh, vet clinics are doing stuff like this. This is amazing.” You should join Uncharted. The Uncharted Veterinary Conference and Community, that's where I met Summer and Christina, is where we learned about Adobe. This is the type of stuff that we talk about in there. Everything from open hospitals, where pat owners go wherever they want to virtual medicine, to work from home, to the classics about getting the staff to come together as a team.

Dr. Andy Roark:
Building culture, solving problems, growing people as leaders and communicators and visionaries. That's what we do in Uncharted. If you're like, “God, I want to live in this world. I want to practice medicine in this other way. I want to be the captain of my own ship.” Check out Uncharted. Guys, our April conference is coming up, April 21st through 23rd. If you've not been to an Uncharted conference, I promise you have not been to anything like this. We do choose your own adventure sessions where attendees make sessions on the first night that we then put on during the event, it is all networking focused.

Dr. Andy Roark:
You will make friends. You will talk to people who are doing incredible things. You will get re-inspired, you will get reinvigorated. You will learn techniques and tips and tricks and strategies for running a smoother, more efficient, more rewarding vet practice. That is what this conference is all about. The 21st to the 23rd, is in Greenville, South Carolina. I'll put a link in the show notes. You can become an Uncharted member. We have a vibrant online community. We talk constantly. It is not a thing where people get in there and it's a ghost town or where there's canned content.

Dr. Andy Roark:
We are constantly talking as a community about solving problems, about growing practices, about doing new and different things. About making our lives better and easier, about handling hard problems together as a group. That's what we do. So anyway, if you're not familiar, if you haven't tried out Uncharted and this episode is inspiring you, this is your call to action. This is what you need to do.

Dr. Andy Roark:
Gang, I also have to stop here real quick and just say, thanks again, to Banfield Pet Hospital. Through their help, we're able to have transcripts for episodes. And this is all about increasing accessibility, inclusivity in vet medicine, and making sure that everyone has access to the materials that we're putting out. We could not do this without them. They have supported The Cone of Shame and having transcripts and The Uncharted Veterinary Podcast, which is our other podcast. It's a business management podcast. But thanks to those guys for stepping up and leading the charge to make vet medicine more open and inclusive. They really are doing amazing things. Anyway, guys, that's all the announcements I got. Let's get back into this episode.

Dr. Andy Roark:
Talk to me a little bit about how the veterinarians support this. You've got veterinarians that do telehealth visits, and I want to put a pin in that and come back to that in a little bit. But let's just say that you have veterinarian behind the scene that is lending support. How do you back channel that? You've got someone and they're working remotely, I'm assuming, and then they're doing the chat, and then they're… How does that person feel supported and not feel like they're out by themselves? How are you handling that behind the scenes communication?

Christina Freeman:
It's been interesting. Being remote, we have built some closer relationships than we ever had in the hospital, which we… I've been working with Dr. Lau for three solid years all day, every day and I had never actually gotten to hug her until about six months ago. And we actually converged accidentally at the same time on a trip to California. She works and lives in Virginia and I work and live in North Carolina. We're close, but it just hadn't happened. But it is remarkable the trust that we've all built working together. We are in constant contact via… We use Google Hangouts a lot.

Christina Freeman:
We do a lot of remote training together with each other and with our new team members that we've grown so quickly where they are just on video all day with us, and they're just watching what we're doing or vice versa. We're watching what they're doing. So we are literally, virtually side-by-side all day, every day, which has been really good for team building and bonding and training. We've been really surprised at how the efficiency of our training through video. And it's also grown into like we're starting to train some in-hospital people through video because it is so efficient and we can be a little bit more open about times and hours and availability.

Dr. Andy Roark:
Let's let's follow that thread a little bit. So I said we were going to put a pin in the telemedicine doctor visit stuff. Let's follow the video path. So we've talked a lot about chat and then let's talk about how do you guys use video… I started off talking about the video client representative but let's go into the telemedicine part first, just walk me through your approach in video communication.

Christina Freeman:
A lot of our chats do generate into a video visit. So we're having a conversation with an owner and we're talking about new puppy owner. They've got a lot of puppy questions, but they also have got diarrhea going on at the same time. So pet stable, we've answered all the scary questions and everything's okay. So very natural progression to move into a video visit with one of our doctors. That lets the owner be at home, they don't have to come in, that lets the pet be at home, be comfortable. And we've seamlessly gone from the chat to now a video visit where they meet with the doctor. The doctor's able to see the pet and evaluate what's going on. Medication is needed or give a little bit deeper advice on how to get that pet back on track or what that puppy might be experiencing.

Christina Freeman:
Same thing on the senior side where owners contact us and they have a senior pet, got some concerns. We're able to move that into a video visit pretty seamlessly most of the time, same day. So it's very convenient for the pet owner, they don't have to leave the house. Sometimes we can go straight from a chat into a video visit if we have availability. Now that we have two doctors, that's quite often what we do. So a lot of our more, I don't want to say simple but more straightforward issues, that's how are born from chat into a video visit the natural progression.

Dr. Andy Roark:
Good. Talk to me about doctor scheduling for this. So again, I really appreciate you guys just letting me pick through this. So that's the other thing. People always say, “How do you have doctors…” I think that's a big hurdle for Telehealth is how do you make the doctor's schedules work? So do pet owners have the ability to make telehealth visits? And then also we flex chat appointments in to fill that schedule out. Is there a standby vet just support chat? Did that happen at the beginning? Or did you add in some Telehealth visits after you had built the chat up and you were having these conversations and you felt like, “Oh, now we've got enough of a caseload that would support this vet.”

Dr. Andy Roark:
Yeah. Share with me your thoughts on that because there's a lot of people who were like, “Oh man, we've been talking about Telehealth visits… I think for me, when I look at Telehealth, it makes sense if you can generate the volume. Because otherwise you've got that hanging out, not seeing appointments. And then if they go and start seeing appointments in the physical exam rooms and you say, “Well, how do we get them back out to be on time for these other things?” I think a lot of people are balancing these logistics and you've got this really neat outside around the way you have done this. And so yeah. Talk to me a little bit about doctor scheduling for these types of Telehealth appointments.

Summer Burke-Irmiter:
Okay. So yeah, with Dr Lau, who I have to give credit for, for finding our video visit platform. She found TeleVet and we originally thought we would go with a human-based video visit company because they were established, they had worked through the kinks. But it turned out that the human systems were super complicated and really didn't fit the veterinary world. So with TeleVet, the reason why we originally got excited about them is they had chat on their platform and we're like, “Okay, if we have chat and they have chat, this might work out well.”

Summer Burke-Irmiter:
And they were super responsive. What we didn't realize at the time is the reason they were responsive is they were I think a two and a half person company at the time. And it was the big male who was chatting with us. Straight awkward, but. But we loved the response, we loved how engaged they were, the platform fit well, and then as we onboarded and started getting used to it, they would make all these tweaks and changes that really fit us. And again, that's what called to my heart is we were making this fit for Adobe and that was really fantastic. So I'll stop there though and let Christina talk a little more about the scheduling and how the juggling that they do over there is amazing.

Christina Freeman:
Well, in the beginning it was just Dr. Lau and I, so we had luxury and the flexibility of being at home and so we worked when the demand was high. And so we were able to monitor the website and know when people came on the website and so when they came on, we made ourselves available and we were there to chat with them and help with them and I'd ping Dr. Lau and be like, “Hey, can you do a video visit?” And she's like, “Sure.” And scrambling together from whatever else she was doing. So we were very organic in the beginning in the fact that we just saw when our clients were needing us, and so that's what we did.

Christina Freeman:
As we grew, we needed more structure, we needed a life. We were available 24/7 in the beginning just to get this work in it had figured out. But then we really did discover the peak times that clients wanted and needed us. And so we built a Dr. Lau's schedule around that. And then as we added Dr. Nakamura as well, he balanced the other parts. So we do have a doctor available to our chatters and for video visits seven days a week between the two. And I guess truly what we did is we looked at the peak request times and managed our time from that. So if you want to get started small, totally able to do that, look at your clientele, look at when they're asking for things, just very generalizing. It's going to be early evening hours and sat morning hours when clients first get home from work and they discover there's a problem.

Christina Freeman:
So you get home from work at 5:30 and you're like, “Oh, my puppy has diarrhea.” Or you get home from work and you discover your senior has had some changes during the day that you need some advice. And so running some hours in the evening, two or three hours to fit in those requests between getting home and people going to bed. And then those Saturday mornings where you wake up and you're like, “Oh, I should have called the vet on Friday.” Everyone knows what calling a vet on Fridays is like, so that's the way we started in the beginning. But now as we've grown, we have the luxury of having 24/7 or 7-day a week help during our peak hours.

Dr. Andy Roark:
Gotcha. Okay.

Summer Burke-Irmiter:
And also, especially early on but they still do a ton now. There was a lot of duties that the in-hospital doctors were doing that remote is able to help with and Dr. Lau and Dr. Nakamura are able to help with. So they actually do a few things. They do a lot of the general refill requests, so that now goes on a live spreadsheet online that they can access so they can go through there, especially for doctors who are on vacation, who aren't going to be in for couple of days. So instead of the technician or the pharmacy tech having to go to that doctor at their desk and be like, “Hi, sorry, but you look at this heart garden prescription.” They actually do that first thing in the morning.

Summer Burke-Irmiter:
And so pharmacy gets in, they've got meds to fill or clients to immediately call back and say, “I'm so sorry, the doctor's really suggesting that we need to do this blood work first. We'll get you a couple days worth.” So they do a lot of that. They've also taken on a lot of doctor flow things in regards to, “You know what? It's that last day of your work week and you just did blood work on a patient. They need to be called the next day. It's not one that should wait until next week when you're back, the remote doctors will help with that.” And they also can help with bridging even if you have two doctors on a case, that's outpatient, then they can actually help bridge with some of those callbacks as well.

Summer Burke-Irmiter:
And so they've helped with a lot of in-hospital things. During COVID, we were doing our shelter in place here in the Bay Area. They also became what we call the COVID doctor would help with all kinds of things just because we did go curbside, which was a huge change for Adobe from open hospital. And so all that extra work, they really helped out a ton with that. So we did initially, they weren't booked with video visits all the time, they were helping with that. We've actually, over the last couple years had to reduce how much that they're doing of that admin work because they are getting busier and busier there.

Summer Burke-Irmiter:
And actually he's okay with me being pretty open about this. When COVID hit, Dr. Nakamura's immune compromised. He had to leave. And if we didn't have this option, he wouldn't been in the hospital for a year and a half. So we didn't lose the doctor, added a doctor. He sees exotics as well, and a lot of the husbandry for exams is really nice to do because you can see the tank, you can see what they're using, what they're set up is by using that video camera.

Dr. Andy Roark:
Yeah. So that makes a ton of sense. So we've talked about chat, we've talked about video consultations. What are some other jobs that you guys are doing now remotely at Adobe?

Summer Burke-Irmiter:
Yeah. I've actually got the list in front of me. Christina, do you want me to read it-

Christina Freeman:
Go for it.

Summer Burke-Irmiter:
… off real quick? Okay. So with our entire remote team, they do voicemails. So this is doctor voicemails transcribing them into an online live document. Doctors, go on and say, “I'll call this one, I'll just call this one back and do a recheck.” They'll then go ahead and call that client. They're doing our advice lines. So we do allow clients to still call in if they be to for medical advice and or triage. And so they're doing those advice lines, they're doing live chat, they're also looking and using TeleVet, especially for prepping clients for their video visits, things like that. They do pharmacy. We actually have a large pharmacy group now of pharmacy technicians who do all the admin work for on the floor pharmacy techs. Surgery, this is actually, I want to say something here. Surgery scheduling. Sorry.

Dr. Andy Roark:
Okay. Yeah. That's appears [crosstalk 00:41:50] like virtual surgery.

Christina Freeman:
Little robotic arm.

Dr. Andy Roark:
Yeah, exactly. We have a robot and they log in with a PlayStation controller.

Summer Burke-Irmiter:
Well, actually that's our next, that's where we're going to.

Dr. Andy Roark:
That's where we're going next. Yeah.

Christina Freeman:
We're headed there.

Summer Burke-Irmiter:
Is robot doctors. But until then. So surgery scheduling has been an issue in Adobe since I started 14 years ago. We've always had our surgery team on the floor who scheduled. And then we had one full-time scheduler in-house. Pre pandemic, it was sometimes embarrassing to admit this. It was up to 14 days before you might get a call back to schedule a surgery. And we were just so busy, the team was busy, our single scheduler was busy. And with all of our different doctors, it's not easy to schedule. And it's not because of the team. The team is just busy. And so we have now through a year long process, fully moved this over to remote.

Summer Burke-Irmiter:
We have a surgery scheduling team. They schedule all of our surgeries. We are within actually a couple of days of them. 100% taking it over after training and a prolonged period there, they got to same day callbacks within less than a week. So they now do same day call back for all of our surgery scheduling, take care of the entire process. We do now still have our surgery scheduler in-house when she came back from COVID and maternity leave. So get this, during a time when we're all short staffed and crazy, we were actually able to add a service. So be because this full-time scheduler is not doing any of the emails or voice messages that we're getting for surgery, she's able to go directly into the room. If somebody wants a schedule right now, she's in the room and she's scheduling it. So we have an in-house in-room scheduler because we have this team taking care of everything else.

Dr. Andy Roark:
Yeah. That's amazing. Let's go ahead and unpack here at the end where we started. Talk to me about the video client representative and how that works and how you rolled it out and what the reaction has been to you having virtual CSRs, actually working with clients who were in the building.

Summer Burke-Irmiter:
Yeah, I think it's probably the craziest idea my team has let me do.

Dr. Andy Roark:
I saw photos and I was like, “This is bonkers.”

Summer Burke-Irmiter:
Yeah. When I brought it up, I think they all thought it was crazy. You could have beat it, Christina.

Christina Freeman:
Nope, totally on, totally on. It was born out of true necessity. We just didn't have enough people in the hospital to cover the front desk. And so, someone and I were talking one day and we're like, “Why don't we just turn one of those screens at the front desk around and put me on it?” And that's what we did. And we tried it out. And so it grew into… It started out with we wanted to do in-room checkouts. So each room has a computer, the doctors use to access the medical records. And so we just hijacked that computer and added a camera on. And so that was where we wanted to start, but it grew into the whole process being a virtual. So each exam room, we just added a camera to the screen. So super easy and take a lot of extra tech to do.

Christina Freeman:
And so now when you're finished with your visit, one of us pop on the screen and we are able to talk about your private address and getting all of your personal information correct in the system, your phone number, your email address, things that people don't like shouting out in the lobby. So we're able to go over that. We're able to talk about the finances, which is not great to talk about in the lobby. You're able to stay in the room with your pet, you don't have to juggle the leash. You're able to pay. We have TeleVet that we work with got really excited when we wanted to do this and so they've helped us build this process but we have credit card terminals in the rooms. And so you're able to pay.

Christina Freeman:
So the checkout process has been a real value add to the client. Clients are thrilled, they enjoy it. They're like, “Oh, this is so nice.” And we've seen adoption. I have not run into someone yet and we've been doing it since November, that's been displeased with that. So that has been nice. Now the front desk video screen is a little bit harder to sell because people are used to having a person up there, but it works. And we are able to do everything via this screen that we would do in person, the only thing Summer and I teased about, but she solved that problem too. I was like, “Well, we can do everything except clean up the pee in the lobby.” And Summer's like, “Oh, there's robotic-

Summer Burke-Irmiter:
Roomba.

Christina Freeman:
… Roomba.

Dr. Andy Roark:
Like a Roomba. Yeah. With a wet-

Christina Freeman:
A mop.

Summer Burke-Irmiter:
Right.

Dr. Andy Roark:
A wet mop Roomba.

Christina Freeman:
So if there's a problem, we keep figuring it out. But so when clients come into the hospital, there is a monitor there on the front desk with signage that says, “Check in here.” And it's cute. Clients smile and also they recognize us. So a lot of us used to work in the hospital, or all of us right now used to work in the hospital. So they're seeing familiar faces, they're hearing familiar voices and they're like, “Oh, I missed you. How are you?” And so we're able to keep connecting with our clients.

Christina Freeman:
And so it doesn't… I think Summer and I both had the worry that the monitor on the front desk would feel a bit impersonal. We've actually found this the opposite. We're chatting of, they're holding up their little pets, we're chatting with the dogs as well and so we've been pleased with the adoption. And also with COVID, it's been a safety measure as well, a surprising safety measure. We're able to speak to them without a mask, they're able to hear us because we're remote. And so that's helped with this process.

Dr. Andy Roark:
Yeah. I imagine it's like self checkout at the grocery store. If there's a cashier standing there, I'm going to that person. But as soon as there's two people in line, totally self checking out.

Christina Freeman:
But imagine that self checkout with a human talking to, because that's the problem, you get your broccoli and you don't have your code number and you're like, “Ah.” But you've got a human there to help you with your broccoli. So we are-

Dr. Andy Roark:
Well, I know it. That's it, they can recommend ice cream flavors. All right guys, where can people learn more about Adobe and your amazing hospital?

Summer Burke-Irmiter:
Yeah. So few different areas. You're welcome to come our website, adobe-animal.com. And you'll probably see our chatters on there. If they are busy, they'll ask you to leave a message that they will respond to. And so that's the other thing with chat is you don't have to take them live by That moment if things are busy. And then also I think we sent over some picture.

Dr. Andy Roark:
Yes.

Summer Burke-Irmiter:
You guys, and so you can check out some pictures. Because I know initially when we talk about VCR, it can seem like this big wild concept. Once you see how simple it is. I feel like it's the post-it note for veterinary hospitals right now. Everybody in a year or two is going to be like, “Oh yeah, VCR, whatever. We're all doing it.” Because it's so easy. But right now it can be hard to conceptualize and so check out those videos where you'll see Christina and her backdrop in her home. Yep. With our lovely vinyl background, that's the background of our reception areas, and fools a lot of clients. And then you'll also see though pictures of her on the monitor around the hospital, checking people in.

Dr. Andy Roark:
That's awesome. So I'll probably put a link to our blog post about the episode and then I'll put the photos in there for sure. Also guys, we are posting podcast episodes as YouTube videos. And so we're going to drop them in there as well if you guys like your podcast as YouTube videos, you got to see photos there. Last question, Christina. I have thought the whole time that you were in some remote location because there's an Adobe Animal Hospital, big logo on the wall behind you, and that's your house?

Christina Freeman:
Yes. This is my house [crosstalk 00:50:52] here in North-

Dr. Andy Roark:
What does your family think about the fact that you have a work logo? Your husband was like, “What the heck is this?”

Christina Freeman:
Honestly, they love it. It's been a very exciting crazy journey which is my life is, but one of the great things is I'm here. I have three children, they know exactly what I do. They see it, they hear it. Sometimes they're… Actually, my five-year-old got a pencil from the pencil box while we were talking. But so that's been a great thing for myself and my family. If your kid grow up and don't know what you do, but they know exactly what I do. And it's cute because in the background, they'll be like, “Shh, mommy's helping a pet with diarrhea.” And they've learned so much too. They're like, “Are you going to tell them about the bland diet?”

Dr. Andy Roark:
Yeah. I could totally see that. I would be getting advice from my kids in no time. And they would be like, “Dad don't forget.”

Christina Freeman:
Yeah. Oh yeah, they keep me on track too. So live chat has little auditory cues when you have an incoming chat. And so it says in a British accent, “Incoming chat.” Now guys. Nope, nope, Nope. [crosstalk 00:52:05]

Dr. Andy Roark:
Now they're making appear on camera. Okay. All right. The wheels are coming off here. Yeah. I know how that goes. That's-

Christina Freeman:
Hi, darlings, now you heard what I said, y'all have to go downstairs.

Dr. Andy Roark:
That's me. That's my life all day, every day. I love it. It's so true.

Christina Freeman:
They heard me. I'm sure they were downstairs like, “What's she saying?”

Dr. Andy Roark:
[crosstalk 00:52:24] She's talking about us let's go.

Christina Freeman:
Like, “It's her chance roll the ball.” But they made up Carol of the bell at Christmas, incoming chat, incoming chat. So they'll run behind me and sing that and freak me out. Because I'm like, “Where?” Because once you've been chatting forever, you know the words incoming chat, [crosstalk 00:52:47]

Dr. Andy Roark:
Where you're here and just-

Christina Freeman:
Exactly. Start to salivate, so.

Dr. Andy Roark:
All right.

Christina Freeman:
They love to sneak up behind me and go, “Incoming chat.”

Dr. Andy Roark:
Oh, so cruel. I love it. All right guys, thanks for being here. Guys, thanks for listening to the podcast. I'll talk to everybody next week.

Stephanie Goss: Thanks for listening to podcast I'll talk to everybody next week. Hey, if you loved this episode and you want to hang out more with Summer and Christina you can you can hang out with them at ‘Get Shit Done' that's right, ‘Get Shit Done' is happening in October. It is October 6th through the 8th come join Christina and Summer and I AND Andy AND everybody in the Uncharted community from the comfort of your couch or your bed or your front porch because ‘Get Shit Done' is virtual. That's right! You do you and come hang out with us and talk about how do we get stuff done, particularly how do we get stuff done shorthanded. I think talking about virtual csrs is exactly a step in that direction and I'm super pumped for that workshop and more you can head on over to the website at unchartedvet.com to find out registration information, can't wait to see you there.

Stephanie Goss: And, we have to just say thanks to a generous gift from our friends at Banfield Pet Hospital we are now able to provide transcripts for all of our podcast episodes. Our friends at Banfield stepped up in a big way and said, “hey we are striving to increase accessibility and inclusivity across the profession”. To check out the transcript and find out more about what Banfield is doing to increase accessibility and inclusivity across the vet profession head over to unchartedvet.com forward slash blog and you can find each one of the podcast episodes and a link to find out more about equity inclusion and diversity at Banfield take care everybody.