What's This Episode About?
This week, Dr. Andy Roark and Dr. Dave Nicol talk about Nicol’s co-authored research piece Leadership Actions and their Effects on Practice Culture. They discuss the importance of culture, why it is so rarely prioritized, what effect increasing corporatization is having on veterinary workplace culture, and which actions leaders take (or don’t take) that most directly impact clinic culture.
Listen to the episode wherever you stream! You can also watch this episode's exclusive VIDEO content on Youtube!
Thank you to our sponsors! To learn more about this week's sponsor, GuardianVets, check out their website HERE.
Upcoming Events
April 21-23: The Uncharted Veterinary Conference, LIVE in Greenville, SC
The Uncharted Conference in April is our flagship event. In celebration of 5 years serving the veterinary profession, we have shifted the focus of this conference inward. You’re not looking to grow your business outwardly – you’re looking for ways to build resiliency and reignite your love for your career. During this 3-day adventure in beautiful Greenville, South Carolina, you’ll be discussing topics like hiring for culture, creating the story that becomes your path, and building smoother, more simple ways to practice. This event is open to members only. Registration for this conference closes on April 1, 2022. DO NOT MISS OUT – Snag your spot today.
A UVC MEMBERSHIP IS YOUR KEY TO FINALLY GETTING THINGS DONE AND GROWING YOUR VETERINARY PRACTICE.
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:
Hey everybody. My name is Dr. Andy Roark, and this is the Uncharted Veterinary Podcast. Guys, I got a great one today, a little bit different. It's me and my good friend, Dr. Dave Nicol. We are talking about some research that he's done recently, and it is on what leadership actions actually affect workplace culture and to what degree. And so if you're ever like, Hey, I know that leadership drives culture, but what does that mean? And what part of leadership drives culture? And what are the most important things for leaders in the practice to do in order to drive culture? That's what we're talking about. It is a great episode. Two quick things I want to shout out. Number one is there is a language warning in this episode. So if you really, really don't like salty language, this might be one to skip. And number two, I have got to give a huge shout out to Banfield Pet Hospital for making possible transcripts. That's right.
Dr. Andy Roark:
We now have transcripts of this podcast and the Cone of Shame veterinary podcast, because Banfield has made that possible. It is to increase accessibility to this information, to be inclusive, to bring all of our colleagues together and make these podcasts accessible and available and useful to them. And so, man, this means the world to me, I'm excited about it for 2022, we will have transcripts of the podcast. You can find them on the Uncharted website and Dr. Andy Roark website. You'll see them through social media, but thank you, thank you to Banfield for making this possible. It's such a super wonderful thing that they have done. So guys, without further ado, let's get into this episode.
Speaker 3:
And now the Uncharted Podcast.
Dr. Andy Roark:
And we are back it's me, Dr. Andy Roark and Dr. Dave, my brother from another mother, Nicol on the podcast, standing in for Stephanie Goss. How are you my friend?
Dr. Dave Nicol:
Really, really good. I'm sorry, Stephanie. I'm going to try and not wreck this thing. I'm good. I'm good. How're you man?
Dr. Andy Roark:
Stephanie is like, what have I done?
Dr. Dave Nicol:
No. When you said that my adrenal lines contracted, I got a square of adrenaline. I'm like, oh no, if I screw this up, then Stephanie's going to kick my backside.
Dr. Andy Roark:
People going to be like, he's no Stephanie Goss. But we know that none, none of us are Stephanie Goss. Here we go. Dave, so welcome. So you and I had known each other a long time. People often know me from goofy vet videos. And what they don't know is the first goofy vet video ever made was at your urging and with you as my wingman. And we made it at the CDC conference because those guys clearly have poor quality control at the time. And they allowed us to get in front of the camera and do what we wanted to do.
Dr. Dave Nicol:
As I recall, that was after I possibly one flight of tequila, too many at Cinco De Mayo.
Dr. Andy Roark:
People think it takes a lot of planning to make videos that come out on well, respected websites happen. That's not true.
Dr. Dave Nicol:
It takes a lot of time to plan them. It takes just literally seconds to ruin it.
Dr. Andy Roark:
So, that's how we got to know each other. And we've been friends ever since. I wanted to have you on, you've got a new study out it's called leadership actions and their effects on veterinary practice culture. And so, as a fan of leadership and culture and veterinary and practice. I wanted to have all of those things that are in the article. I thought that it would be a good time for us to get together and talk about, I just want to talk about what you've been doing and kind of what you're leading up to and what you're finding. So, leadership action affecting culture. Let's start at a high level and just talk to me a bit about that. What matters about practice culture, I guess is my question. And then how does that interface with leadership?
Dr. Dave Nicol:
Okay, well, I might pull it back one step further and just go, why now? Why this? Because family practices have had culture and leadership for a very long time, but if you look at the world through the lens of some brutal truths, then you'd have to been hiding under a rock not to have noticed that it's kind of been a really hard couple of years. And so there's several brutal trips that we need to sort of face up to. There's partnership and the impacts that COVID has had that are beneficial in terms of volume of cases, but I'd say pretty hard in terms of an already stress system couldn't cope brilliantly is being hit with more cases. How many more? Is clearly a point for some debates, because there isn't really a point of truth information source, but certainly more puppies around and I think certainly over this side of the pond, some arching 4, 5, 6% seems to be about the right number.
Dr. Dave Nicol:
But then we've also got the economic uncertainty, inflation hitting us, the complexity of cases, the process efficiencies, the curbside caused. Culture is coming to focus because all these things are causing pressure and then education and burnout. And all this backdrop is just like this perfect storm. And so, we're seeing people burning out, we're seeing a contractor in the size of the profession, and we're seeing long range efforts to alleviate that in terms of increasing class sizes, more veterinarians. But I just think that's the wrong, it's part of the answer, but it's a really, really stupid answer if we haven't fixed something that I think is at the heart of the problem. And that is that the market's kind of voting with its feet. We've had relative wage stagnation for a long time. We've got a completely different setup in terms of when I graduated in '97, '98, we didn't have such intense scrutiny or glare from social media or the perception of it.
Dr. Dave Nicol:
And we didn't necessarily have the sort of felt like it was more of a safety net. We didn't have the ownership structures that we have now. So that a lot has changed. And I think that's where for me culture becomes so important because if we can create cultures where people thrive, then I don't think we have a problem. If you look at veterinary medicine, does it tick boxes in terms of meeting human needs in terms of certainty, in terms of significance, in terms of variety, in terms of growth, in terms of connection, in terms of purpose. It ticks every box, or it should do. So, why is it failing people to the extent that we see this recruitment and retention problem that we've got? And I think the answer is because we're not being intentional about cultures and when we're not intentional about cultures, we get agendas, and fighting, backstabbing, toxicity of many different kinds, all driven by fear, uncertainty, stress coming to the front.
Dr. Dave Nicol:
And it becomes almost a, the culture becomes a cult of personality within practices. And it's the person with the biggest personality. I think it was Sean McVey first heard use the term the mean girls that rule the rest. So, that's what veterinary and has been. AKA culture has been a hot mess that's just been neglected or been unintentional. So with the report, I thought it was really important to try and to put culture in a map, to define it, because it's a little hard for people to define and to link actions that leaders can take in order to manage culture proactively so that we can create a better future for ourselves as business owners, but also for our teams. And really we're only going to create a better future for ourselves if we have happy teams. So it felt really important to try and do that work to link, partly to empower those who feel a little bit hopeless or lost and what they could work on. Partly just to kick people up the butt to say, we can do this.
Dr. Andy Roark:
I like where your head's at. I think this makes a lot of sense, right? It's funny, I've talked about this many times in the past. Culture in the workplace is one of those kind of, it almost makes you sound like some sort of a guru when you talk about it, just because, and I think this is the trap, right? When you say to someone what's important about running a veterinary clinic? They talk to you about patient care. They talk to you about average client transaction. They talk to you about being profitable. They talk to you, you know what I mean about all of these things, medical standards, things like that. And culture and relationships and the way people feel about their job. Man, that's all kind of some warm, fuzzy stuff. It's hard to get your hands around. You can't really measure it. You know what I mean? You could absolutely measure the number of patients that you saw yesterday, right?
Dr. Andy Roark:
And you can measure customer service scores and we do. And it's one of those things in life, in the world, where there is a fundamental requirement that if you don't take care of everything else is going to struggle and suffer. And you're never going to know why, you know what I mean? The beatings will continue until morale improves and you go, you are just driving this so hard, but until you take care of people, it's not going to happen. Think about other relationships you have in your life, where you rely on this person or you work with this person. And if you don't maintain that relationship, then everything else is going to be exponentially harder when you come together. And you can wave your hands and lie to yourself and say, well, she's a professional and I'm professional. And so we're going to show up and we're going to do our jobs and we're going to get them done. That's just not how human beings work. And I think it's less so. I think that there's a changing role in work, in our lives right now.
Dr. Andy Roark:
I'm really thinking a lot about this, is that like man, our jobs. And I mean, all of our jobs, not just vet medicine, but our jobs are replacing a lot of social outlets that we've had in the past. Do you know what I mean? How many of us look at our job as our social circle? How many of us look at our job as part of our identity? How many of us look at our job for purpose? You know what I mean? And meaning, and I go, man, our job is really creeping into a lot of our lives. And so the idea that we're going to put our feelings aside and we're just going to be professional and investing into the underlying relationship to make these people function together and feel comfortable together. That's a big misstep, but it's really easy to make when you get myopic about this is a business, these are the metrics. This is what we're paying attention to.
Dr. Dave Nicol:
Listen, and it's a business like ours, where there's so many things that demand attention, particularly as leaders. And I say that not because attention demands are not high for everybody else, but the primary job of a leader is not clinical medicine unless you're clinical leader, of course, but most leaders are team leaders. And as soon as you take that role on your primary job stopped being clinical medicine, your primary job started being team and team building and team wellbeing. And of course, that just isn't a skillset that you're trained with. It's not something that has an immediate payoff and it just seems to constantly be a thorn on your side. So clinical is partly retreat, partly highly addictive. It has immediate beneficial results for our wellbeing because stuff gets better relatively quickly. And there's a fairly straight connecting line between the work we put in as a clinician and the inputs and the outputs of resolved case, happy client, fixed pet and money coming in.
Dr. Dave Nicol:
It's addictive enough before that's being the case and it's profitable, it's what our businesses are apparently there to do. So it's very, very easy to hide out there, but it's such a giant mistake. So, time and what we spend on is absolutely critical.
Dr. Andy Roark:
Well, I mean, look at how we're trained, right? We're to practice the medicine and we're paid on production and neither of those things interface with team culture and leadership, you know?
Dr. Dave Nicol:
Well, it's funny. I saw a fun little infographic, which was describing as soon as your measures become targets, this used to be useful. And it is a measure of volume and the quantity of nails, and they were just tiny, tiny nails that had been made or a measure of.
Dr. Andy Roark:
The story on that is it was in communist Russia. And this is a real story, but it was communist Russia and the dictum came down that workers would be judged on, at first it was, they were going to be judged on the weight of the nails that they produced. And so we're just going to weigh the nails that you make and that's how you'll be paid. And so the workers just made these enormous nails that were completely functionally useless, but they weighed a ton. And then the higher up saw that and they were like, oh, no, no, no. Okay. We're going to fix that. We're going to pay you on the number of nails you make. And they just made a thumb tax and just cranked them out. And again, I got such a great illustration of you pick these targets and say this is what it is. And you miss the forest for the trees, man. That's such a great story.
Dr. Dave Nicol:
And possibly also why the KGB exists.
Dr. Andy Roark:
Exactly. It leads to interesting management structures we'll say.
Dr. Dave Nicol:
Exactly.
Dr. Andy Roark:
Let's get it to this, right? Actually, before we do, I want to ask you, so we are seeing a growth in corporate ownership of that practices, right? And in the UK, you guys are already what? You guys are well ahead of the US as far as corporate ownership, meaning was it at least half of UK practices? Right?
Dr. Dave Nicol:
Probably getting up to about 70% now.
Dr. Andy Roark:
And so my speculation is the US is going to be following that and will be at 50, 60%. That's kind of just, that's what my crystal ball says, but it's been a bit dodgy the last couple years, but anyway, I think that we're going that way. Does that make the problem better, worse or is it a net neutral?
Dr. Dave Nicol:
I love the question because it begs for an easy answer. And the easy answer is it's easy to kick corporate medicine.
Dr. Andy Roark:
Oh, yeah, totally.
Dr. Dave Nicol:
And it's the answer that I think a lot of practitioners want to hear because somebody needs to be at blame, at fault for all of this. But there are plenty of toxic independent practices, and there are plenty of very well run business units in corporate practice. I think it is my much more down to leadership skill and that comes down to individuals. It's not something that is particularly scalable in the way that technology is. It doesn't grow on trees. It doesn't arrive quickly. Heck, it took 15 years for me to get to this point of being fairly average in my leadership career as I see it. I started out with a model of leadership that was pretty hopeless. And now I think I'm better at it, but it's like everything and everything suffers the Dunning-Kruger effect. And the more I learn about leadership, I think I'm a reasonable leader, but the more I learn about it, the more I think, God damn it, I've only started touching the surface of this, could be so much better.
Dr. Dave Nicol:
But then I look back at where I was as a leader. I'm like, oh, no, but actually I think I'm pretty good at this now. And I've got the principles down, but I think that's part of the problem that exists in that corporate structures in theory, should create more space and introduce more professional managers and professional managers should have been exposed to better leadership skills and training because in vet medicine, we don't get exposed to anything. The reality is that corporate managers are generally completely over tasked, have far too many business units to look after, a few and far between and burn out just as fast as anybody else. And are also coming from other business sectors that as much as I don't buy the line that we're different because we're vets. I do think veterinary practices are still businesses and almost everything is still applicable from one business to the next, but where we are very different in is that we are absolutely purpose driven individuals who chose this profession.
Dr. Dave Nicol:
And we did not choose it for money. And we've got corporate measures that are necessarily particularly because of shareholders growth, and when you've got this much private equity money swell into an industry, it has to be about money. There's the rub. So, I think that's an uncomfortable thing. That's a brutal truth for corporate practice to deal with. And if it doesn't deal with it, then it's got one hell of a balance sheet problem building up that doesn't show up in a balance sheet, but it is called the Goodwill between clients and vets. That's going to walk out the door. But it's certainly, that is a long way from saying that corporate practice is to blame for poor leadership. Poor leadership's been around for forever.
Dr. Andy Roark:
Oh yeah. No, no, no. And I wasn't trying to tee up and say, oh, corporates are making this work. I was genuinely asking the question, is this helping or not? I think my take on it is, I think everything you said is very true, right? So, let's just own the fact that leadership on the ground plays a massive role in the culture of the practice that you work in. Right? And so speaking and sweeping generalizations of corporate, non corporate, I think you and I are both 1005% in agreement that the culture on the ground, the management and the leadership you have in the building that so far exceeds what logo is on their jacket. It just does. I think honestly my take and again, you've known me to be a perpetual optimist, I agree with you. And when I look at culture in vet medicine, I think the historic cultural problems in that medicine have maybe been, it has been a passion, right?
Dr. Andy Roark:
It has been this calling of this is who we are. We do this for the love. And as a result, we struggle with burnout because we keep this to our self identity and we lean into it. And my optimistic view is that corporations coming into our profession may help to swing the pendulum a little bit. You know what I mean? You know what I mean? We're seeing them come in and they're offering job perks that weren't offered in the past. And they're pushing up wages in a way that wasn't pushed up in the past. And I think a lot of people find it easier to separate their work and their selves when they work for a company, as opposed to when they work shoulder to shoulder with the owner. And this is our little thing that we made together. And again, that's all speculation, but I don't know, I think you answered my question pretty well as far as mixed bag, but the shifting landscape I do think is affecting some of the work experiences that we're having.
Dr. Dave Nicol:
And some of those things I think it's important to touch on, those things are clearly positives. There are what I think one of the best ways to illustrate this, I'll refer to another bit of study work that we're working on moment, but it's very, very easy to increase pay when you've got a big bucket of money. And a lot of independent practices don't have that bucket of money. It's very easy to apply what could be seen as band aids fixes to issues. And I'm not saying that this is what corporate medicine is all about. I don't think it is, but it is still very easy to put things that are sweeteners on there, which will not help if culture is rotten. And one thing that corporate is not, has not got right at all and needs to deal with is the fact that when a practice is acquired, an owner stays on for a bit of time, but frequently we'll start checking out, because that's generally what happens when you sell a business or leaves after one or two years, and then who takes over.
Dr. Dave Nicol:
And it's not that common that it's somebody with a heck of a lot of leadership experience. So you're losing somebody with all that mentoring, all that Goodwill, all that just that relationship knowhow and smart. And now you're bringing in somebody who's a three or four year old graduate vet. Well, Andy, when you were a three or four year old graduate vet, I don't know what you were like, but I know that there's no way that, I wasn't even doing veterinary medicine very well at that point. So, to do that and then layer in the stuff on top, that's a big, big ask. And so we are seeing the leadership echelons being younger than they were, and asking them to take on a leadership role without great training in a stressful environment, without the best of support necessarily, at the same time as building a clinical skillset is an incredibly stressful thing.
Dr. Dave Nicol:
And so, I think that in theory things can be better, but in practice the shortage of talent, the shortage of available talent and the retention of talent beyond that sort of really critical five year point where we see people burning out in the first year and a half, we see them burning out round by that five year mark for slightly different reasons. But the leadership coming from a clinical base that has the clinical work established, that baseline established, and then building on top of that, the secondary skill set that is going to serve them. And it's completely different skillset. That's a really necessary transition that we've got to get a lot of people through order to right the wrongs. I'm utterly agnostic about practice ownership. Yes, I'm an independent practice owner, but I work with corporate practices.
Dr. Dave Nicol:
Doesn't matter if they want to make leadership better, I'm very, very willing and happy to speak to them because the more people we can look after and give a great experience of veterinary medicine, the more people we retain for all of us to be able to hire. So if I look after a vet and I'm a good stepping stone in their journey, and they move on to your practice, I want them to go to your practice and go, wow, it was great working with Dave. It was just what I needed at that stage of my career. Now I'm a happy, great resource, and I'm excited to work with you, Andy. And neither of us loses. If I blow it, I've had a bad experience with that individual. Maybe they leave, maybe they go at you grumpy, it's not a good long term place. I think leadership is important and leaders enact, or control or shape is probably the better word. I like the word farm, actually the farm culture. It's a very organic process. You have to do certain things and go through a process in order to intentionally alter culture.
Dr. Andy Roark:
Well, let's talk about the interface of leadership on the ground with culture. Because we both sort of come back to this too, is the biggest driving factor is going to be, what is the leadership on the ground as far as how your experiences at work? So you guys put out this new study and I'll put a link in this show notes as well, so people can definitely check it out. But so when we talk about leadership on the ground, what are we talking about as far as the behaviors that matter? What affects people's experiences?
Dr. Dave Nicol:
So, we looked at four factors and their impact on culture and looked to assign a sort of a quantitative score to what that action actually was bringing to the table in terms of impact on culture. And so the four factors that we looked at were a really clearly articulated vision, the ability to manage time and prioritize, particularly prioritize leadership activities, the ability to deal with toxic staff behavior and the ability to hire effectively and effectively is one of those withy words. So, hire people who are the right technical and values fit for your organization in a timely way.
Dr. Andy Roark:
Okay.
Dr. Dave Nicol:
When you do those four things, your leader score, we created this and I'll say a couple of things about the numbers in a second, but the culture score of practices where leaders did not do those four things was a 5.3 out of a score one to 10. The culture score for leaders who did those things was an eight out of 10. And I think the slightly, the interesting things are that we did these surveys at two conferences, one across here in the United States and the other at conference in the US. So, it's great to get the data from wide locations, but these were management conferences. So these are practices that are actively interested in these subjects who care to answer the questions. And also there's an element of self grading here. So who's going to give themself a three out of 10, right? So, I think the scores are probably scoring a little higher than they should, but the differential is clear. You score slightly above a 50% if you do not look after these things, that's a hot mess for culture, but you can get up 80%.
Dr. Dave Nicol:
And in actual fact, we measure the culture scores for people when we've gone through and worked with them on those four specific areas in much more detail. And we know that we can get them much closer to nine. We get them to about an 8.9 out of 10, once they do these things and they're executing on it really well. So, the data is really compelling to say, well, actually, the two challenges with leadership from the culture, one, what is leadership? and what is culture? And there's so many things that could be defined as leadership, how my best place to spend my time. And so the message from this was really clear. You have to create a really clearly articulated vision that consists of a purpose, a mission, and a set of values. You have to use that set of values to hire effectively. You have to learn to put down the things that call for your attention, like clinical work and rebalance your time so you make time to work on things like vision.
Dr. Dave Nicol:
And if you've got some toxic people and mostly those are values clashes, then you have to deal with those regardless of how much pain that might cause you in the short term. That toxic staff behavior was the number one impact that made the biggest difference. Out of all four things, it was dealing with toxic behavior, the biggest impact on culture. But it's really hard. You can't set cultural tone, unless you've got a vision, you can't create a vision unless you create the time to work on that. And you can't really hire well, unless you've created the vision as well.
Dr. Andy Roark:
Okay. So all that makes sense. Unpack for me what it means when you say the number one thing that affect workplace culture was the ability to deal with the toxic employee. Give me some examples, paint me a picture of what that looks like. Give me conflicting, here's what I want. I want contrasting examples. What does it look like when a leader does not have the ability to do this, or doesn't have the desire to do it versus when they do? Can you help me see that image?
Dr. Dave Nicol:
So a good example would be the leader. Let's say, you have a very effective technician on your team. And it could be a veterinarian. I don't want to beat up on technicians, as a team member, choose your poison. Okay? So, I'm going to think about a technician who is very influential. Who's very, very good at their job. They know where everything lives. They get stuff done on time, but they don't like change. And they're vocal about not liking that change, but they're also behind the scenes. They're going to undermine that change that you want to put in. And so that person seeks to sow the seeds of doubt. They tell people why they should resist the change. They build up opposition to whatever thing that you're wanting to work on. And they create a verminous moment or situation in your practice on this one issue but perhaps on many issues. They might be doing that because they feel threatened by it. They may be doing that because, and that's the number one reason why people resist change is because they're scared.
Dr. Dave Nicol:
What does this mean for me? What am I going to lose? What I mean of less of something, not against something. What does this mean for me? And so we tend to resist things that we don't understand, even if they might be good things for us to do in the long term. So, that that person creates and sows distrust. Now, they're not going to get everybody to resist, but they're going to sow doubt in people that might have gone with you, are going to be a bit more resistant. They're going to look for allies and other people who don't want this change, whatever it is. Let's say you're into using a new anesthesia protocol and you want to start using different drugs, or you want to go to using fluids or blood testing as a standard beforehand. But that narrative flows through and now the doctors are not behind it. They don't actually. And you know when a doctor doesn't get behind something, doesn't fully believe in something, that doesn't come across. It's disingenuous and the clients see through it in a heartbeat.
Dr. Dave Nicol:
It's not sold well, it's not presented well. And so the thing doesn't happen and it's real easy. Oh, the clients aren't really into this so maybe we should stop doing it. Or that person, there's the side chats that are happening and you walk in a room and everything stops talking. And suddenly you feel like you're an enemy in your own practice. That kind of carry on happens every day, up and down country. You leave that person in place because they're not that bad. And they're really good at their job. So let's just leave them be, but who really controls the culture? Who's setting it to own and the pace for the practice culture right now? It's not you as the owner. There is leadership happening, but it's not coming from you. You're leading by abdication because you just want it to be okay, because it's really hard to hire technicians. And if I lose this person, they're going to burn this whole place down and that could be true. I've experienced it.
Dr. Dave Nicol:
Now you compare and contrast that against the person who gets it, who understands where you're going with the vision, their agendas is your agenda, because both your agenda is a shared purpose, because you've cooked this purpose up together as a team. I think actually this is one of the challenges you have with corporate practice when you've got the big board level, C-suite mission, vision, values, all of that stuff. And you've got the words, the values, integrity. And then you've got a whole host of people who are not necessarily interpreting that, but just trying to get by an action, start happening, that start grading or violating those values and everyone calls bullshit. And now we just do it, we're our own little enclave here. So we've got a very, very solid local culture of them and us against the corporate machine. And we're going to do veterinary medicine really well, but we are not aligned really with that thing up there, our purpose is we're a Merry band of squash buckling pirates, doing our thing on the high seas, but we're not part of the Navy as it were.
Dr. Dave Nicol:
So, back to your example, so that could be one toxic behavior. You could have another person who is a veterinarian, let's choose a veterinarian who explodes, who has anger issues. They're really, really good at their job. They create tons of value in terms of doing cases, but they blow up or they bitch and they moan about the technicians openly to a colleague to another vet. And it just crushes the technician team lose confidence. So they refuse to work for that person. Or it's so stressful. You've got absenteeism or people not showing up to, they're calling in sick, they're leaving. You've got Mary go around a staff, walking in the door, these things hammer culture. And of course every time someone new comes in the team reverts to the storming phase of Melbourne's team curve. As you've got forming, storming, norming, performing and adjourning on the Bevin's team development curve and anytime a team go through change, you go through this curve. So if you've got a toxic team, your team is always stuck in storming phase.
Dr. Dave Nicol:
And if you've got team members leaving and coming in, that will add to the storming phase, because nothing ever gets to be normal in a way that's functional or maybe, and actually I would put myself in this bracket as I would describe myself, not it would never have been described as toxic, but I was always going to do it my way. I was really resistant doing it according to the process. The standard operating protocol? Not me, sir. No way I've been taught to do it this way and that's the way I'm going to do it, or hell mend you. That's toxic. Looking back and I think God, that was really ego behavior.
Dr. Andy Roark:
Well, I think you and I both came from that place and I think it's part of the growth of a leader, right? Especially if you're someone who makes your own thing or you start the practice or you start the business. And I think that's both of our personalities is, we have very strong ideas about how things should be done and how we're going to do it and how this is going to work. And they're driven by passion and they're driven by a vision. I think the life cycle of the business is I think that works really well up front. You know what I mean? When you're getting something started that person who says, Nope, this is what we're doing. This is how we're doing it. They're really valuable. They really get things up and going. I think you and I both had the painful experience of growing our businesses to a place where it's not just us anymore. And it's not just us and two or three other people, it's enough people that you can't just do what you want to do anymore.
Dr. Andy Roark:
There's too many people affected by the ripples when you splash around. And so process ultimately rises up, when you zoom out and you look at startup culture and entrepreneurship and things like that, that is a classic lifestyle or life cycle of the entrepreneur. Is you come in, you move fast, you break things, you do things, you do them in weird ways and you get the energy up and you create the experience. And then after that generally process people sort of take over, and we standardize and we streamline and we systematize. And a lot of times the entrepreneurs sort of people, they either grow into that system or they chase against it. And they often leave. And so I think that is a life's cycle growth project for a leader.
Dr. Dave Nicol:
It definitely is. But that's a real challenge for depending on what you're, if you're in a startup vet practice, that's where it will be for many of us. And if you've got a more mature business and now I own a clinic that's been around for 15 years. I've not owned it for that long, but it's been there for a while and this team has been together and one guys or another for several years now. That's a different beast because I don't go in it. I'm not there ever. So the cultural tone might be set by me, but that culture's formed by a team, a group of people who we came together and said, right, what do we want this practice to be about? And we literally built the vision, a four year vision in this case. And everybody was involved. All the senior leadership team was involved. And so now everybody's behind it and we want that. We're going to make that thing happen. Lo and behold it's happening. And do we hire people sometimes aren't great fit for it? Yes.
Dr. Dave Nicol:
But it's really obvious really soon. And the team has the confidence to say, this is not the right fit, time to move on from that person. And it never goes straight to that, but we're also really clear about this is the expectation. This is how we do things here. And these things are, hiring effectively. There is not a job ad that doesn't reference our vision and values. There's not a person works that hasn't been through a value assessment and three or four other steps in the recruitment process. So, it gets it right more than it gets it wrong. And this is what we've got to do to make veterinary medicine sustainable. It's been sustainable from a profit point of view for forever. It's been sustainable from a clinical point of view for forever. We tick the boxes there. It's not been sustainable from a team point of view. And increasingly business owners now are struggling with sustainability, and that's partly what's driving them to sell practice because it's just too hard.
Dr. Dave Nicol:
But the difference between a practice that is an absolute delight and a practice that's a total nightmare is the vision, and culture flows straight out that vision. It's just not this E throw, oh, I don't know how to make folk culture. It's really easy, create your vision. And a part of that vision will be articulate your values. I wouldn't have more than five or six. Don't just articulate them in a word, articulate what that word means in your culture and in your setting, and then tell everybody what those things are. Better still, come up with that code of conduct yourself. But if you've got six values and you've got three things that you, three definitions of what that word means, integrity, what does that mean? Best practice. What does that mean? What does innovation mean for you? Because it will mean something different for me than it does for you. And that's fine.
Dr. Andy Roark:
Sure.
Dr. Dave Nicol:
But just define it and then stick to it. And I was onboarding a new team member today and we went through part of the training exercise. We talked about what our values are, what they mean, when you should use them. And I cannot dream of bringing anybody onto a team where we do not, call it brainwashing or indoctrination or onboarding or whatever, but there is no way that-
Dr. Andy Roark:
Indoctrination has gotten a bad rap. Indoctrination has gotten a bad rap, that is a loaded word.
Dr. Dave Nicol:
Brainwashing?
Dr. Andy Roark:
That's sort what we're talking about. I mean, brainwashing has been out of favor for a while now but it's coming back. It's all- [crosstalk 00:40:51]
Dr. Dave Nicol:
I mean, pulling back because there's just a lot that you can kind of focus on. It's interesting, the things that came out of the study that were really interesting to me were there were certain, I don't know if I should call them hidden gems or complete shockers, maybe both. But if you at a conference ask people what their vision was, it's funny. We found 40 just about 45% of practices have absolutely no vision at all. I either just showing up and doing veterinary medicine day after day, after day, after day, no wonder people are exhausted. Three quarters of practice owners have no time for leadership behaviors. Interestingly, only four hours-
Dr. Andy Roark:
That always blow that always blows my mind. Right? That's the working in the business versus working on the business trap that our friend Peter Weinstein likes to talk about.
Dr. Dave Nicol:
Well, and it's so it's so clear why it happens is because the clinical work that they're spending time on is so overwhelming and so never ending. And so what they know what to do, it's the comfort blanket and it also generates revenue but it's-
Dr. Andy Roark:
Oh yeah. You can justify seeing cases all day long. Right? And the other part, I didn't think a lot about this recently. Well it, and it's the sunk cost thing too. You're right. Like I gave eight years of my life to do training, to be able to do these things. And now you're telling me I shouldn't do them? Someone else should do them. That feels wrong, I think at a deep level. But like, yeah, that is what I'm telling you.
Dr. Dave Nicol:
40% of practice are the ones we spoke to have, what they describe as toxic behavior. And coming back to your point, the reason people don't deal with it is because they're scared to deal with it. We're conflict averse as well, or it's not the right moment. I'll just do that in a day or two and then the clinical work gets in the way again. So each of these four things, it's really hard to separate them out. But the number one thing, the first step is for the leader to take the mental leap to say, I'm going to put this thing here down, not completely down, but let's say instead of doing 90% clinical and 10% absolute firefighting, how about I drop to 60% clinical? And I can do 10% leadership and 20%, 10% firefighting, 10% pro active team management. What would happen if I did that? Oh, I might have to hire somebody new. Yes. And then you might also see your family and your friends and it's great. You can't be the richest person in the graveyard. What's the point in that?
Dr. Andy Roark:
Well, the other part too, that again, it kind of goes back to that whole working on the relationship is not immediately visible and apparent, you know what I mean? There's other things that are clearly much more visible and measurable, but that culture work, that relationship work. Same thing with people are like, ah, but then I have to hire someone else. And I would say, every time I have hired someone else, I have gnashed my teeth about it. And then my business has expanded to, you know what I mean? To generate that revenue plus more. It is just getting to that place where I go, God, I need more help. And then getting more help and getting the right help. It has always worked out.
Dr. Dave Nicol:
Well. Right. And that's because you've invested time and energy in the skills to allow that to happen. So, if you fear it and then you hire badly and the person doesn't work out, it's too easy to say, well, that don't work or give up, but there's millions of businesses around this world that are working just fine on that basis. So, why are you special? The answer is you just didn't focus on the right skill set. But if you take the time to think about why you need this person and you take the time to think about what skills they need and what values they must have, and how you're going to assess, select for those. And then you put time and energy into that recruitment process. I describe that as 10,000 or maybe even a hundred thousand dollars in artwork, the problem is it doesn't have a dotted line straight to the revenue line of your accounts or the end of day takings. In fact it has a negative impact on your immediate end of day takings, because you're not doing clinical work when you're doing it.
Dr. Dave Nicol:
So it hurts a little bit. And then you grow because that person shows up, does a good job. And now you've got space. And then you've just got to deal with your guilt about not doing all the work in your practice because that's another thing that vet leaders carry. We see a source of power being able to do everything and know everything. And that's how people respect us. And as we help people grow and we bring people into the business and suddenly there's not that much pressure on us. It's like taking time off. How many veterinarians feel bad about taking time off? They feel edgy. They feel like I should be doing something. And it takes me 5 to 7 days to get over that feeling of being away from work-
Dr. Andy Roark:
And then it's over.
Dr. Dave Nicol:
Right? Exactly. So, I'm like I'm good.
Dr. Andy Roark:
I can have one day, and then I go back.
Dr. Dave Nicol:
Exactly. But as a leader, if you can. Listen, if you love doing the clinical work, get somebody in to do this for you, but commit 10% your time to working with them so that the culture they want to grow on your behalf, you're not one of the people resisting it. If you love big picture strategy work, put some of the clinical down and get into this stuff because it is incredibly good fun being in charge and have this blank sheet that is your business. Our businesses don't own us or they shouldn't own us, but frequently they do. I feel like they do.
Dr. Andy Roark:
No, I completely agree. Dr. Dave Nicols, Dave Nicol, you and Dr. Dermot McNerney wrote leadership actions and their effects on veterinary practice culture. I'll put a link in the show notes, where can people find you if they want to learn more from you?
Dr. Dave Nicol:
So two best places. So all of the work that we're doing is published on the VetX International website @vxinternational.com. I've decided, so my new year's resolution this year Andy is to spend less time on Instagram. I have to say, I'm going to make Twitter my place to hang out this year.
Dr. Andy Roark:
That sounds like a terrible idea. Twitter? Are you going to hang out on Twitter? [crosstalk 00:47:41] I'm sorry. I have very strong negative Twitter emotions.
Dr. Dave Nicol:
I know. And I feel like-
Dr. Andy Roark:
Instagram is negative.
Dr. Dave Nicol:
It could be a horrible thing.
Dr. Andy Roark:
It's like Florida's too hot, let me go to hell. That's the analogy that I heard.
Dr. Dave Nicol:
Well, I'm enjoying the conversation and a bit of the back and forth. And obviously I feel like that's going to be about a month until I feel absolutely like, this was a horrible idea, but I'm I also, at Dr. Dave Nicol, spelled N-I-C-O-L, anywhere on the socials I will be, but I will be actively managing my Twitter account. Others will be actively managing my other accounts. So if you want to reach me, Twitter's the one to go for.
Dr. Andy Roark:
Oh man. All right. Thanks for being here my friend.
Dr. Dave Nicol:
It's a pleasure. Thanks for having me, Andy. I appreciate you brother.
Dr. Andy Roark:
And that is our episode. Guys, I hope you enjoyed it. I hope you got something out of it. Thanks to Dave Nicol for being with me. I love that guy. It's always hard to schedule because he's on the other side of the pond talking to me. And again, I appreciate him making time to hang out. This episode will be on YouTube. That's right. Dave was very gracious in letting me use the video feature on our software for the first time. And guys, I'm playing around with the idea of putting some podcasts on YouTube. I know a lot of podcasts get a lot of listenership. A lot of people like to be on YouTube and they can consume podcasts that way with sort of the video component of it. It's not super exciting video, it's just me and Dave talking to each other, but we'll see how it goes.
Dr. Andy Roark:
If you are a big a YouTube person, you're like, man, I just wish that Andy would put some podcasts on YouTube. So I could just listen to them there. Check out the Dr. Andy Roark YouTube channel, and we're going to see how this goes for a little while. So anyway, exciting times over here. Gang, take care of yourselves. Be well, talk to you later. Bye.
Facebook Comments