This week on the Uncharted Podcast, Dr. Andy Roark is joined by veterinary practice management expert, Dr. Amanda Donnelly and together they tackle another question from the mailbag. In this episode, they take on the challenge of a veterinarian who, despite being exceptional with clients and production, struggles with efficiency in exam rooms, causing a backlog of duties. This backlog bleeds into other doctor's plates, having to have them finish his work yet the practice owner is hesitant to discipline for fear of losing this veterinarian. Dr. Amanda Donnelly offers her insight to strategize ways to set clearer job expectations, foster self-reflection, and provide effective feedback. Together, they explore external resources like mentorship programs and leadership coaching to enhance the vet's performance. Let's get into this….
Do you have something that you would love Andy and Stephanie to roleplay on the podcast – a situation where you would love some examples of what someone else would say and how they would say it? If so, send us a message through the mailbag! We want to hear your challenges and would love to feature your scenario on the podcast.
Submit your questions here: unchartedvet.com/mailbag
📚 Explore more about the book and veterinary leadership on Dr. Amanda Donnelly's official website: AmandaDonnellyDVM.com Dive into the world of veterinary leadership with Dr. Amanda Donnelly's insightful book, “Leading & Managing Veterinary Teams.” This definitive guide explores the essential principles of effective leadership in veterinary medicine. Discover practical strategies and valuable insights to elevate your team management skills. 🔗 Get your copy on Amazon: Leading & Managing Veterinary Teams
ABOUT OUR GUEST:
Dr. Amanda Donnelly, a speaker, consultant, and author with over 30 years’ experience in the veterinary profession. She is a second-generation veterinarian who combines her practice experience and business expertise to help practice leaders communicate better with their teams and clients. Dr. Donnelly is a graduate of the College of Veterinary Medicine at the University of Missouri. She is the author of Leading and Managing Veterinary Teams and writes the Talk the Talk communication column for Today’s Veterinary Business. Dr. Donnelly has won many accolades including being named the 2023 Practice Management Educator of the Year for WVC.
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Dr. Andy Roark: Hey everybody and welcome to the Uncharted Veterinary Podcast. Guys, we got a great one for you today. The one and only Stephanie Goss is off today, but I am pulling in an amazing guest, a mentor of mine, someone I look up to. I'm just going to keep her secret here for a moment until I introduce her.
But we have a great episode about a doctor who is really slow in the exam rooms. Really slow. He's been there for nine months. The practice owner just really doesn't want to write him up because, hey, we don't want to take off the doctors, but he's falling behind and he's not getting his medical records done.
And he's doing phone calls instead of coming to staff meetings. And worst of all, The other doctors are having to do some of his phone calls because people are waiting all day and he's not getting to them. And so other doctors are getting pulled in to help clean up and juggle these clients. And this is not good, but he just doesn't seem to see a problem with it.
Guys, this is going to sound real familiar for a lot of you. And we got a fresh take on tackling it today. So it's going to be a great one. Let's get into it.
Andy: And we are back. It's me, Dr. Andy Roark, and the one and only Dr. Amanda Donnelly. How are you, Amanda?
Amanda: I am great, Andy! How are you?
Andy: I am so great. I am thrilled to have you as my wingman and co host on today's episode. I have admired you for years. You've been someone who's been a mentor to me in my career. You are, for those who do not know you, you are a, you're a second generation veterinarian. You are a well renowned, world renowned, well renowned speaker. You've been the Practice Management Educator of the Year at the Western Vet Conference. You write a wonderful column in today's Veterinary Business Magazine that runs with the column that I write. And I always pull your stuff and want to read and see and see what you're doing and see what you're talking about.
You have probably written, probably I don't think I don't think I'm trying to think of anything that might compete with it. You have written probably my favorite book in veterinary veterinary leadership, veterinary management. It's called ‘Leading and Managing Veterinary Teams‘. I am thrilled to have you here. Have you been?
Amanda: I’ve been good. And thank you for all those wonderful accolades. I really appreciate it. I've been super busy. That's it. That's a good, that's a good thing. It's a good time to be in veterinary practice management and speaking.
Andy: It is. To you, number, so just a side before we get started, when, when you're talking about looking at practices and working with them, are you, are you. How much emphasis are you getting on going faster? Is this, are you getting a big push for increasing efficiency? Cause well I just came back from the VMX conference and that's what I heard about again and again was people saying, how do we go faster?
And I thought that was kind of odd, it wasn't what I was expecting. Do you, have you had that experience?
Amanda: Well, you know, what's interesting, what I have found is that yes, increasing efficiency is still incredibly relevant even now that we've come out of the pandemic years. But I am hearing a lot more reports about practices slowing down. So the efficiency point, you know, really That needs to happen But some of the practices at least some of the ones that i'm working with and that I talk to The, they're concerned about making sure that they are getting more clients in, you know?
Andy: That's why that's why I was surprised. So, so in Uncharted, you know, we always watch trends and talk, talk with our practices that are, that are members and things. And we had, in the last quarter of the year, we saw a pretty marked slowdown. It's very regional. Some people were like, we see no change, but we were having some that were having pretty substantial drops in their, in their clients coming in.
It was, it was, that's why it was so interesting at, at VMX. I would talk to groups that were like, oh, we really beating the demand. It's going to be huge. And I. I thought, man, that's, that's not what I'm, what I'm sort of seeing. That's kind of why I was sort of fishing to see, see where your head was at.
I'm really sort of talking to people about go ahead, making sure you're gearing up your client reminders. You're getting your, your marketing back on point because we didn't have to deal with that for a long time. We had more work than we could do. But I think we're, it's time to start reengaging our client communications to make sure that if a demand for vet services starts to dip, the individual practices is, is taken care of as they can be.
Amanda: Yeah. Yeah. No, I couldn't agree more. And I have gotten a surge in the last six months of people asking me to help with client service and client communications. And nobody had time for that, you know, from 2020 to 2022.
Andy: do think that fell off. Yeah, I think I think you're spot on I think I think everything swings like a pendulum, you know, I think there's when everybody was swamped and trying to doggy paddle keep their head above water The client service part was not high on their priority list and you are swinging that swinging back.
I think clients are a bit more discerning right now. I think that they're kind of looking for reasons to keep their wallet in their pocket, not just in that medicine, but in everything. And I think that client service communication part, the education importance is climbing back up, which is good to see, but always changing.
Hey, I got a I got a case for you from our mailbag. And I thought you would be uniquely suited to come in and help me sort of break it down. Is that okay?
Amanda: Hit me with it.
Andy: All right, cool. So there's a little bit to it, but basically here goes so so we got an email from a practice manager and they're in a four doctor practice and they say they have a great culture and they got a fantastic team but they're having a hard time with one of the Doctors.
They said he's an excellent vet when it comes to clients. Most of them love him and he's pretty good producer too. He can sometimes run behind because he has his quote special clients unquote. That while they do spend a lot of money at the clinic, he ends up chatting with them for a long time. So I don't know.
Maybe you can make an argument that's concierge care. I don't know. We'll come back to it. We've tried extending his appointment times for those certain clients, but then he's still like whatever time he has, he just takes that time. Plus 30%. Like, so if you give him more time, it just seems like it gets, it gets longer.
He also has a bad habit of not finishing up his charts, and he runs behinds on phone calls, so he ends up using like, if they have a staff meeting, he's never there, because he's always trying to get his charts done or his phone calls. Stuff like that. It's frustrating to some of the other doctors. I think one of the things that would frustrate me is that some of the phone calls are falling on other doctors because clients are mad because he's not getting back to them, so the other doctor's having to call.
And so that's a problem. It sounds like these guys are running a really good ship. When they, when they talk to him about, about it, and they talk to him about running behind, he says that if he had more technicians, he'd be able to do more. But, but they've got a three to one tech to doctor ratio, which again, sounds really solid.
And the other doctors are making it just, just fine. And so anyway, I think that that's the main thing. They've brought up dictation softwares and, and he says he just, he, he thinks it's faster to type and it just, it seems like I've got a frustrated manager here who's really trying to throw everything at this doctor.
To get him get him out of the rooms and get him back on track And he's just not I don't know if it's a self awareness thing, but he's he just doesn't seem motivated. Now, I will also say, I know you see this a lot doctor retention is important at practices. Right now doctors are very hard to find and we all have the interest of keeping our cultures good and we want to motivate people the nice way and we like to retain our doctors if we can because it does sound like this guy generally is doing a good job and is popular.
It's just this point of frustration that's dragging them down. So. When I tell you all that, Amanda, sort of lay it down, let's, let's start with head space here. So, so put yourself in the shoes of the manager. What, what are you going to think of so that you can be productive in this situation? What do you think?
What do you think people need to kind of understand about positions like this?
Amanda: Well, this is an awesome question. First of all, I've just got to say, because I have heard similar challenges from other managers. So I love that we're talking about this and clearly it sounds like she's super frustrated and understandably so and, and stressed, you know, because now she has a doctor who should be doing his work, but she's having to spend all of this time trying to get him to be more efficient.
Which, you know, if he was doing his job, she wouldn't have to be spending time on that. And so that's a problem. Um, so, I mean, if I think about, you know, like, what is she thinking in her perspective, I'm assuming that she sees this as a lack of accountability. He's not doing the same thing that the other doctors are doing.
You know, maybe she even feels he's not being a good role model you know, for the rest of the team. So, but I think the main thing, you know, for the manager is just this frustration about how do I get this guy to do– this doctor to do what he's supposed to do,
Andy: I think you touched on one of the big ones for me is it's really easy to tell yourself stories about this. You know what I mean? Like, he's lazy. He doesn't, especially when you talk to the person, their behavior doesn't change and start to be like, he's, he's acting like he cares, but he doesn't care. He's not taking this seriously.
And My, sort of my, that's my part for Headspace, is I look at this and say, I really appreciate how this person wrote into the mailbag, because it does not feel like they have, they're frustrated, it does not feel like they have tipped over into the point of being just, enraged or, or just going down an aggressive sort of toxic path.
And it's again, you can be, one of my friends calls it justifiable anger. It's like you can easily justify this anger and also know that carrying that anger around when you plan to deal with this is probably just going to get in your way and reduce your chances of being effective.
Amanda: Yeah, it sounds like the manager has actually been incredibly helpful to try to help this doctor. So I agree with what you're saying.
Andy: I also, you know, I think they mentioned the team a number of times and you get into headspace and You know, I think one of the big things for me when we talk about Just management in general. I'm a big fan of the idea that we're all trying to achieve balance, which is I do want to support this doctor. But also I can't have my other doctors being mad because they're doing calls to frustrated clients who've been waiting all day to be talked to like that's not Okay.
And I'm a big deal. I'm a big fan of like medical records are part of being on the team, especially if we're in doing modern medicine, where we pass cases around, where we try to leverage our technicians, where the front desk is doing communication for us. You can't not write up your charts because you're really letting down the whole team.
And again, I don't think this comes from a, I have never seen an evil doctor. That's just like, I don't care. I just, I know that they're. busy, and I know they're getting behind. I just, for me you can hold two things in your mind at the same time. You can decide that this person's behavior is not okay, and also empathize and be like, hey, I know what it's like.
We're all, we're trying to do a good job. I suspect oftentimes when I see doctors like this, like relationships are a big motivator for them. You know, it's, it's, it's their, it's their love languages, relationships, and maintaining relationships, and so the idea of cutting people short. It's just, it's, it's very hard for them and it can also be unacceptable to our team.
Both of those things can be true.
Amanda: Yeah. I think what really jumps out at me when you talk about this case is, you know, what, what is the doctor thing? Cause they keep asking him to, to, to be on time and, you know, and he's, he's not wanting to change his behavior. And so what jumps out at me is that he probably doesn't think this is a big problem, or, or presumably he would have made some changes.
And what is fascinating to me, and I've seen this with other doctors in my entire life and career, is that they'll help one client and go overboard to help them, or I've had other doctors that run behind. Either because they don't have good communication skills or they chat too much with clients or whatnot.
And so, like you said, they have this desire to have this great relationship, but then what they forget is what about all the other clients that they're not taking care of? So, not doing the callbacks, not having the charts done. That is hurting those clients. And what about the clients that are waiting?
You know, so, you know, because you're running behind so we're really not, you know, serving all of the clients Well with his type of behavior and as you also said there's an impact on the team So I think that is I don't think he's really appreciating the impact on the team, the other clients, and then of course the business at large
Andy: Yeah. You're speaking at the Uncharted Practice Manager Summit on February 28th. It's a virtual conference that is only for practice managers. And so it's a one day event, you're doing a workshop called how to create a culture of accountability. And you mentioned accountability here as well.
Talk to me a little bit about what that culture of accountability would look like. So I think that's good headspace before we actually address this doctor. How does that, how does that sort of start to come together in the mind of the practice manager?
Amanda: Well, I think that, yes, you're right. I love talking about accountability and I'm happy to be able to talk about this at your conference. I think that so much of accountability is the doctor doesn't, is, is trying to figure out what is the underlying cause and, you know, with him, I think it's, it's a little different, you know, being in a doctor situation, maybe, but I think he doesn't understand the ramifications of his behavior, but also made, I don't know, maybe the expectations were never clearly established at the very beginning.
So we've got, you know, so one of the causes of lack of accountability can be lack of clarity. Now, they keep saying. You need to do your records on time, or you need to be on time, or we're going to pull you out of the room, you know, those kinds of things. But fundamentally, he's been practicing for whatever period of time and, and, and another cause of lack of accountability can be lack of consequences.
So if there's not any. ramifications or consequences for him continuing this behavior, he's going to keep doing it. And then I think what happens is the lack of clarity here might be maybe he doesn't have written job expectations. Maybe, you know, the parameters he has to work within haven't been established.
But also what happens so often is what I find is that managers or medical directors, they might talk to an employee, in this case, it's the doctor, but it starts to really sort of just be tuned out and sound like blah, blah, blah, blah, blah to the person who's receiving it because they're like, yeah, they're nagging me.
But, you know, I'm doing, you know, people like me, you know, I'm making the practice money. I'm helping these clients. And so they just, they don't see the big picture. So part of it is figuring out maybe from a lack of accountability is we have to set those what are the policies and protocols that a person needs to work within and what are the consequences of not doing it.
But I also think in this case, especially since he's a doctor, Andy, is he's in a leadership position and I don't, I think a lot, a lot of times associates don't necessarily think, oh, wait a minute, you know, I, I got that DVM and along with it, I got, I also had this leadership certification, whether I want it or not.
And so, that's where part of the lack of accountability piece also, you know, dovetails into self leadership and getting him to identify, you know, some of the things that he needs to do, which we can talk about some of the solutions, but I do think that that's a lot of what's going on here, too, is not just the lack of accountability, although there is that, that he's not taking ownership of, but then there's also a lack of leadership skills on his part.
Andy: I agree with that. I think that's a really good point. I like– you put your finger right on the doctor as the leader and sort of, you know, people, people have a responsibility because of their title. And so I think that's interesting. I want to unpack the self leadership part with you in a second. But have you so you I think you're spot on about a possibly just say a lack of clarity, clear job expectations. I think it's fair to say, Hey, our expectation is that clients get called back within a certain time that you write your charts up. That's a very easy expectation to set things like that, that other doctors don't have to step in and do parts of your work for you. Are there, are there other expectations? How do you set expectations for staying on time, Amanda? Because it's kind of, at least for me and my career, it's always kind of been a willy nilly thing of nobody really, it wasn't ever like, I'm sorry, Andy, if you have a 30 minute appointment.
And it starts at 2:30, at 3 p. m. you need to be out of that room. And I've never, I've never been held to that standard. And I think, you know, different cases involve different things. How do you set expectations for people staying on time? Have you ever seen something like that where there's a metric where, I mean, honestly, I, they have already done the thing of sending the technician in with a code to say, really, we need to move on.
But is, how do you set clarity around, hey, this is the pace we would like for you to keep up? Have you seen that?
Amanda: Well, yes, and no, I guess it's, I'm going to waffle a little bit because yes, I've seen the expectations be put in place, but, and I've seen people that run on time and people who don't because this reminds me, this reminds me of a relatively young doctor that I worked with a couple of years ago, who was, who was always 30 minutes or more behind and the rest of the practice was not.
And it was definitely how he managed his time, but all, but it was very specifically how he communicated with clients. So, the fix wasn't to say just the expectations are for you to run on time because he just, he couldn't, he couldn't adhere. I mean, he basically couldn't meet the expectations. So the fix wasn't just about setting expectations, it became helping him with some client communication skills and a few other strategies for how he could
be on time. You know, how he could change his client conversations maybe leverage the staff up a little bit, but I think part of this is going to be with this particular doctor is helping him with some leadership coaching and some client communications training and also. I think the question is, well, why do these expectations, you know, even exist?
And I still think too, another thing that we didn't really hit on is why can the other doctors all run on time pretty much? And he can't like, what is the difference? And I'm guessing that the difference is that he spends too much time in the room, but see, it might just not be chitchat. Maybe the staff thinks it's chitchat, but maybe he doesn't run an organized appointment.
Maybe he's all over the map. See, maybe he's like, Oh, we could do this. We could do that. And I don't know, you know, so there, there, there could be an organizational flow issue that we need to, you know, videotaping his appointments might be really helpful, but I think you have to drill into that. Yeah. And determine if there is something missing here that he needs help or training with why he can't do it, why he can't adhere to the same time limitations as the other doctors.
So I think there's that piece to maybe dissect a little bit. But then fundamentally, very much, this is going to be, I think, a coaching opportunity.
Andy: I, I, I like that a lot. I think that's a, I think that's a really good call out. Again, I said, you know, we yeah, be careful what the stories we tell ourselves. I think your idea of what if he's what if it's not chit chat? What if he really just does not have an organized way to approach his appointments or he's not he's not good at creating, you know treatment plans that are concrete and presenting them in an actionable way I think that's a really good call. So, you talked about Self leadership.
You said, you know, so I'm totally with you on the idea that, that the doctor is looked up to and, and is sort of setting a precedent and a tone sort of for the team. And by the role of doctor, you have certain leadership responsibilities. And so talk to me a little bit about the term self leadership, and ike, what is that? How is that different from just saying the doctor is a leader? Unpack that for me.
Amanda: Well, if you look at definitions, and I try to keep this pretty simple, but if you look at, like, what's the definition of self leadership, it's going to be that process of influencing your own thoughts and actions towards achieving your goals. And the goals, some of the goals here, of course, that we're referencing would be the hospital goals of seeing not only seeing all of our patients and taking care of them, but also excellent client care.
But it is that it's that process. It's that self process. So it's the process of influencing your own thoughts and actions towards achieving. You know, whatever the goals are your own personal goals or the goals that, you know, have been put upon you. So, in this instance, it would be looking at the piece that I think might be missing here for him is that I'm not sure there's any self reflection going on.
So, self leadership requires self reflection. What's working well for me? What's not working so well for me? How am I impacting others? You know, how am I how can I change? See, I don't think he, I don't think he sees the, from what we know, it doesn't appear that he sees the need fundamentally to change. He, he knows they want him to change, but I don't think he really feels the need.
And I think with self leadership what, what the action about is, is identifying, well, okay, what, what needs to change, you know, that would make everything better, you know, would help the team, would help my coworkers, would help the clients, would help. Cause see, he could actually see more patients.
If he was able to be more efficient. So it's, it's the self reflection of, oh, wait a minute. Okay. Maybe there is something here. They're not just nagging me and, and getting him to self-reflect. I think that's going to be a real important for him to see that his leadership, see doctors.
Associate doctors may think that their self leadership or their leadership role at the practice is just to direct traffic, which is, of course, true. You know, I need you to call this client. I need you to set this IV catheter, whatever, but it's also about. bringing a team together and, and he's creating chaos, you know, sometimes for the team, he's not bringing the team together.
He's not being a role model. So the self leadership part of that is helping him understand that, that it's not only about the medicine. And that's the part I think that associates miss is that whether they want to have the leadership role or not. They do have it as it relates to the team. It's not just about patient care and client care.
It's how they interface with, with helping the team and getting the best client service, the best patient care throughout the day. And that's the piece that I think he's not seeing that some of these individual actions have a greater, broader impact on the business. And specifically, you know, when I say the business, I mean, client care, potentially patient care, but very much the efficiency of the practice, the stress of the team, you know, now somebody is having to try to pull them out of a room.
And I think the biggest thing here, and we can get into this more, but I feel that this manager is perhaps thinking that this is like her problem to solve. And I'm like, wait a minute. It's like if they're if they're saying, oh, we could do dictation software and oh, we could, you know, we could give you more staff or oh, we could change this protocol or oh, we could get have, you know, pull you out of a room.
It's like the practice is doing all this work to try to help him. What is he doing? I mean, he's not taking ownership is what I'm saying.
Andy: Oh, I, I, you just blew my mind. I, I love that you called that out at some point. We've all probably been in a relationship where we work too damn hard to make the relationship work and we just didn't feel like the other person was, you know, was coming with their half of the relationship. And so I think, I think that's, I think that's a really good headspace.
I am chomping at the bit to dive into this a little bit and start to say, well, how do we actually move this case forward? Let's take a quick break and we'll come back and then we'll get into the action steps. Sound good?
Amanda: Yeah, that sounds great.
Stephanie Goss: Did you know that we offer workshops for our Uncharted members and for our non members? So if you're listening to today's podcast and you are not a member of Uncharted yet, you should be, but this is not a conversation about joining Uncharted. This is a conversation about all of the amazing content that we have coming at all of you, whether or not you're a member through our workshop series.
You should head over to the website at unchartedvet.com/events and check out what is coming. We have got an amazing lineup on the regular. We've got something every month, sometimes two or three things in a month coming at you to expand your brain, to talk about leadership, to talk about practice management and dive into the kind of topics that Andy and I talk about on the podcast every week.
So now's your chance. Stop what you're doing. Pick up your cell phone. I know it's not far from you and type in unchartedvet.com/events. See what's coming and sign up. They are always free to our uncharted members and they have a small fee attached to them. If you are not currently a member, you can get all of the details, pricing, dates, times, and register head over to the website.
Now I want to see ya there.
Andy: Alright, so let's, let's get in this unpack what our actual strategy is going to be.
So we've got this manager who's asked us, and I may not have mentioned at the beginning, this doctor has only been there nine months. It's not 90 days, but in their practice, it's fairly new. I feel a sense of urgency here. And I don't know if you would agree and you would say, no, that's not, it's not a problem for me.
I'm going. This feels like an important time, and if we kind of take our foot off the gas here, or just let it ride for a while, then some of these behaviors are going to really crystallize and be a problem later on. So I, I'm wondering if you're feeling a sense of urgency, but as we, we sit down and we've got this manager and we say, all right, let's decide what we're going to actually do.
Where, where do you start with this, Amanda? Kind of what's the first thing you'd say? This is on the action plan.
Amanda: Well, I think the first is so often we don't have a job description for veterinarians and that's going to be pretty streamlined because it's going to say the obligatory information about. You know, their patient care and if they do surgery and all of that, but what I'm talking about is what we want to put in writing, what are the job expectations?
And I'm, I'm referring to these types of job expectations that records will be written up in a timely manner. And of course you have to define, well, what is a timely manner? So you can't just say, you know, timely, cause that might be a week to them.
Andy: Sure, that's, that's, that's seven days, in my mind.
Amanda: But I do, I do think we need to start with putting the expectations in writing so that that could be given to him.
And of course, key point here, that expectation should be given to all the associates, not just him. But then I think the core crux of all of these action steps are mostly. Going to be coaching sessions with him and recognizing that it won't be a one and done. I don't see this as 1 conversation and oh, that's magically going to fix everything.
So I think it's going to be a series of conversations, which I would love to talk about some of those. The nuances of those conversations, but, but the reason I say that it's mostly going to be about conversations with him is this seems to be a people problem, not a systems problem because everybody else apparently is running on time.
And this is, this is a doctor, you know, whatever this doctor you know, it's their problem. So that's where we get into these one on one sessions and and I think with those one on one sessions, there are. Really two key components. One, we already hit on, which is that rather than coming at him and saying, we need you to do this, we need you to do that, which is going to sound like the nagging and it's kind of puts the, it's like, it's the practices job to solve this instead.
Fundamentally, that conversation needs to be about what will you do? What will you do to be on time? What will you do to get your charts written, you know, in a timely manner, just like all the other doctors? What will you do? So now he may not have all those answers in the first meeting. And in fact, I'm all forgiving someone time, you know, a day or two.
You know, a couple of days to think about that because they might, you know, and, and, and they might, this manager might get pushback. He might be, well, what do you mean? What am I going to do? I've, you know, I'm going to try to type faster, which we know doesn't work. So, that's one thing. But another awesome part of this that I think has to be touched on Andy.
Is to make this conversation about alignment with the core values of the practice. Now, you probably know I'm a huge fan of leading and managing by core values. I think most of chapter two in my book is about that. So hopefully this is a practice that already has core values in place. But even if they don't have them written and, and well defined, they still know what they are.
So, in this case, the core values that I would say most practices, if not all, have, whether they're clearly defined or not, the three that immediately would come to mind in this scenario are going to be teamwork, respect, and client care. So I would come up with, you know, what's 1 or 2 of the core values that they either already have or fundamentally know that they have and get him to see that his behavior is not aligned with a core value because he's not fulfilling his role of the team.
He's you know, the team can't operate, you know, effectively because of his actions. Client care is suffering because now we've got clients that are mad that they're not getting their lab results on time or he's not they're having to wait because he's, you know, spending so much time with the first client.
And then all of that, you know, respect becomes an issue, you know, cause it's like I fundamentally just to be clear. I do not think this is a bad doctor in any way, shape, or form. I think he just doesn't appreciate, maybe, the ramifications and impact that he's having on this, on this team. And so, when I say, you know, respect, that's what he's got to, has to understand is that it is a lack of respect, though, when he just keeps on keeping on doing what he wants to do without regard to how it affects the rest of the team.
When you change the conversation to talk about the core values, Now all of a sudden it's a different conversation that takes it out. It takes away that nagging. So we're not just saying, Oh, you need to do this, which sounds like nagging. It's like, gosh, we need everybody to adhere to our core values. These are the ways in which your behavior is not aligned with those.
And then that, you know, so that's kind of the drop back. I guess is what I'm saying to the coaching conversations that we want to have with him.
Andy: Yeah, well, before the break, you were talking about getting him to sort of self-reflect and my question to you was really going to be, how do you do, how do you do that? How do you, how do you get that self awareness? I think there's a lot of people who struggle with doctors, but, but honestly, anybody on your team who just lacks self awareness, and you say, how do you do this?
It sounds like you're going to try to use the core values to push that self awareness component to say, this is, this is how you're being perceived, or this is the actions, this is what, this is the impact that your actions are having, trying to get them to trigger a look at their, at their own behavior.
Is that as, am I right on that?
Amanda: Yes. And to your– to the 1st, half of your question there, which I'm so glad you ask the really key part of this to get him to self anybody to self reflect. The beauty of that is through the open ended question, so you could have the open ended question has to be inviting them to tell you their story or inviting them to give you input or feedback.
So, if you say, you know, do you appreciate the negative impact this is having on the team? See, that's closed ended, right? Because they can go, well, no, but that's not what you want. We've got to change that and say, how do you think you running behind is affecting our other clients? How do you think you having to be called out of rooms or not running on time? You know, how do you think that affects our clients who are waiting?
How do you think that affects the team and then also part of the self reflection is you know? What are your solutions for how you can run on time? What are your ideas for? How you can organize your day And so that you are able to complete charts and appointments and callbacks, you know, when they need to be accomplished.
That's the self reflection– is you're asking that person for their thoughts, their ideas and their action steps. Remember the definition of self leadership, that process of influencing our own thoughts and actions. So that's what we're asking. But that has to be through an open ended question. And he's not, he, she, whoever, I don't know if we even know the who this associate is, but they they, they're not going to have all these solutions all at once.
So we've got, you know, we've got to assume that this is going to take multiple coaching sessions and maybe just one or two action steps at a time. We can't expect this doctor to just change overnight, but I do want. To emphasize what you said, which is if this person's only been working at this practice for nine months.
Now is a real sense of urgency to try to change habits because we can't, we can't change him. You can't force him to do anything. But what we can do is help him self reflect, help him with, you know, identify. some actions that would help everybody. And then one of the things we didn't touch on Andy was being clear on another way that that you can tackle this too is to try to be clear on what we think motivates him.
I'm not sure if you said at the very beginning most managers want to motivate their staff to take more emotion initiative or motivate them to. And so the question is, what are his motivators? Because fundamentally we can't really motivate people. There's a whole book on that, but what we can know is what are, what, what triggers them?
Like what, what is a trigger for them? And I mean, a good trigger, like what. What gets them up in the morning or what do they wish they were better at? So some doctors are really motivated by money. You know, they might be on production. They might, you know, they, you know, I'm not saying that they're bad doctors or that they do anything, but they, but, you know, they want to make a nice living and they want to work a little harder and make sure that they're doing everything that they can do you know, for compensation.
Some doctors—money doesn't mean anything at all to them. And they, it's all about the clients. Other doctors, it's all about the patients. Some doctors are really much all about the team. So the question is what motivates him? Because we want to help him see that whatever it is he wants, we're going to help him get what he wants as well as help the practice.
Because I imagine he wants much of what. The team wants, he sounds like he gets along with everybody, gets along with most of the clients, but what we have to get him to see is, okay, you want that? We're going to help you get more of that. Like him, we need him to see that running on time and doing, meeting his job expectations is a win win for everybody.
The clients, the patients, the team, everybody,
Andy: I think you did a good job here. I really like this plan in that the setting of expectations at the beginning in my mind, that's also when we're going to lay down the metrics of success that we're going to be watching to say, Are we getting on track? How do we know? Because otherwise, you know, he ended up saying, I feel like I'm going faster.
Like I'm talking faster, you know, and I'm pretty darn sure I was closer to being on time yesterday than I have been in a long time. And so, so it's laying those things down. And I really like these coaching conversations. Amanda, how, how do you, so I'm not a patient person and I've, I've, I've struggled with, with that, and I've gotten, as I've gotten older, I've mellowed a bit, but what is, what is an acceptable turnaround time here, especially if, if we're having these conversations over, you know, over a series of days or meetings to kind of try to bring them into alignment?
And we're saying, Hey, look, he's been here nine months. We feel like this is an important time. How do you pace yourself so that you're not jumping the gun and saying, look, he's gotten 10 percent better in one week. And that's not nearly enough, or maybe 10 percent in one week is really good? I don't exactly know.
How do you, how do you pace yourself so you can decide? Yes, I see progress and I'm continuing on or I'm not seeing enough progress. Like how do you, I know there's probably no direct answer but how do you benchmark
Amanda: Well, I think, I think, I think you're absolutely right about trying to determine some metrics. And then how do we measure them? And what's a reasonable timeline? I mean, certainly the metrics is we can, we can absolutely, if they aren't already doing it, we can track wait times for sure. We can also set an expectation of.
The number of days or hours that a callback is supposed to be done or a chart maybe has to be written before you leave the building or by noon the next day, or, you know, whatever those. So those are either you kind of, you either did your charts. You did your callbacks by the deadline or you didn't.
So I think those are relatively easy metrics to get in place. I think the running behind though, you know, we really also– in this case, I would want to measure the use of his communication skill and his organizational strategies. So, like, for example, some doctors will find it incredibly helpful that they have their, you know, whoever, whatever their technician is, they
figure out strategies that that technician is going to keep them on time or help them stay organized. I'm not talking about, you know, pulling them out of a room. I'm talking about other organizational flow kind of strategies. So, maybe he needs some communication skills training for clients. Like, let's say he's having this chatty client.
Does he have the skill to know how to extract himself from the chatty client? Like, that's something I could help him with. Right? Because, you know, I can help doctors or team members know. How to be fully present with that client, but extract yourself and, you know, and to lead the conversation.
So those metrics are also things that we can measure, you know, is he using those skills now to the timeline? You know, I guess I would start with like a 3, a 3 month timeline. And what I mean by that is that there would still be some parameters within there. And I kind of chose. Three months just because you know at that point he will have been working a year but in regards to the timeline, I What would be best would be to set very small action steps that like what are you working on this week?
One or two things he's working on this week What are you working on next week and ideally hold I would hold meetings at a minimum every two weeks Maybe weekly with him because if we meet with him for short periods of time I would rather see short meetings frequently to keep the momentum and see if he has questions and how he's doing give him feedback asking what his challenges are That's going to be better than only meeting monthly because that's way too far out. You know, there's not an opportunity to do coaching.
So I would meet with them weekly, you know every you know 7 to 14 days. How are you doing? You know what's working and what's not and assess the progress? And then, I would kind of look at, you know, a monthly chunk of time, you know, and, and I would expect to see some very quick improvement on the timeliness of the charts and, and the callbacks, but I think the being behind in the rooms will just take, I think that's going to take a little longer.
And I think it's realistic to give him time, you know, for, for that change.
Andy: That all makes sense. I definitely am on board with that. You know this writer mentions, as well, that the practice owner in this case is not quite ready to write this person up for, you know, for fear of ticking the doctor off and, and having him lead. So whether it's a practice owner or a regional manager or the, or the medical director or whoever the, the appropriate person is in your structure.
I mean, how do you feel about that, Amanda? Is that a big deal? Is that not a big deal? Is this an interpersonal thing that doesn't really warrant a write up before this point? Where's your head at in
Amanda: Well, two responses. First of all, I'm not a big fan of write ups. Now, let me be clear, I am definitely in favor of progressive discipline, because at some point, we've got to have some warnings, some write ups, or, you know, and, and at some point that would lead to termination. So it has to be progressive, but what I mean about discipline is everything should be documented.
But you could document it where it's not a warning. You could document it as what I call a lack of accountability conversation or a coaching or a feedback session, whatever you want to call it. The reason the documentation is important is just to keep us organized and if we ever did have to go to termination that we would have our documentation there.
So I don't, I don't think we should look at this as, “Oh, we're going to write you up for this.” Just because that's not usually how I approach these cases because he is a good doctor. It sounds like the medicine's good and you know, if this is more of a you know his not so much his personality, but some of his leadership and communication skills So but what's important the second part of that is the fear of of terminating somebody or to your point What happens is so often in recent times because of our doctor shortages.
I see the leadership team, they don't even want to talk to the doctor because they're like, Oh, gosh, well, we can't afford to lose them. So we're not even going to address it. So here I'm going to say something very pointed, which is when we don't give people feedback. Now, I mean, effective feedback, not nagging, but if we don't give them very effective, positive and negative feedback, that specific and related to the core values, we are robbing them of the opportunity to improve.
Amanda: So we are doing the doctor an actual disservice if we do not address this in a more meaningful way. And so, I think if you run your business based on fear, and that's easy for me to say because I'm not in the trenches anymore, but if you run your business on fear, that's never going to work well. And to your earlier point, if we address it right now, It'll be a lot easier than trying to address it 6, 12, 18 months from now.
So, I would just try to put the fear off the table and say, We need to have meaningful conversations with this doctor about how he needs to change, make him a part of that solution. And I can't imagine if he's, if he, you know, he's getting along well with the staff and likes the clients, it's not like he's going to walk just because you talk to him, you know, you know, so that's not going to happen.
Andy: But I see that fear, like I 100 percent there's the idea, but if we talk to him, he'll walk away and I think you're, you're right to point it out as that would, that would be what then people do irrational things, but that'd be wildly foolish. And I completely agree. You oftentimes as a manager, we pick our poison.
And so. Do you want the poison of, I don't know, he might freak out and walk away, or do you want the poison of, we, we have no input into this behavior because we're afraid to have this conversation. Like, I'm not, I'm not living my life that way.
Amanda: Right. Well, and plus, sometimes when we don't have a conversation, whether it's a doctor or some other employee with job performance, then the, what about the rest of the staff? You know, we, so we don't address problem with one person and then the whole rest of the staff be starts becoming disgruntled.
Andy: Well, I think this is a solid plan for, for getting up and getting going. I think at this point you kind of have to wait and see how they respond before you, before you kind of figure out where, where to go from here. But I do think this is a really good way to sort of open the door, get some systems in place.
I really liked the job expectations up front. I think the series of conversations is a good way of setting expectations for our manager friend to say, “Hey, Rome is not going to be built in a day.” We're just, we're going to, we're going to go through and have these conversations. We're going to circle back the open ended questions to get this person to sort of demonstrate some self reflection and awareness, pulling in the core values.
I'm totally there with you leading by fear and just sort of taking that off the table. I think that's an excellent strategy. I feel pretty good about, about this, this plan overall. Are there any final points, words of wisdom, advice that you want to give to people or that you'd give to this person?
Amanda: Yeah, I do think a couple of things to mention. I think first of all, there's so many fabulous books out there. So we could identify some books. Can't make him read them, but in books, not just books for him, but books for this manager to help her know how to navigate these conversations, her or him. And so, that's one option: leadership coaching for both of them.
And so, you know, how to navigate these conversations because we've got some great leadership coaches in our profession. I am not a certified coach, but I do approach much of my, you know, remote consulting in a collaborative coaching manner. So we've got great resources there within the profession, or they could get somebody outside the profession.
We've got several veterinarians that have their own companies. that do mentorship for younger veterinarians. So that might be an option. So I think those, I guess my point here, Andy, is it's not just all on this manager. I would recommend that this person avail themselves of outside resources. It could just be a doctor in the practice that would mentor them, you know, somewhat about how they run their appointments on time.
Andy: I think that makes a ton of sense. I really like that. Yeah. It's always nice to have the realization that you don't have to be the one who does all of the lifting.
Andy: This is fantastic. I really appreciate you being here. I really appreciate you tackling this case with me.
For those who don't know you and want to learn more from you, like I said, your column in Today's Veterinary Business comes out every other month. It's an excellent column. Your book is one of my favorites on the business of vet medicine. It is called Leading and Managing Veterinary Teams, and you're putting it on sale.
We talked before, and the plan is it's going to go on sale on Amazon starting the day of the Uncharted Practice Manager Summit, so that's going to be February 28th. It's going to go on sale for a couple of days, and people, if they've been holding off on grabbing it, should jump on, put it on your calendar, set an alarm.
Andy: Make sure you jump in and grab it.
Amanda: Exactly. And just so everybody who's listening to this knows, the price that they will see on Amazon as of the 28th is 10 less than it normally is. So it won't say, hey, this is a sale, but just know that in three days after the conference, approximately, that cost is going to go back up.
So that's the promotion that we're doing. And I do want to mention Andy hopefully by the time this airs and whatnot I did a complete update, refresh, design update and everything to my website. So I am super excited. Probably by, oh, I'm going to say certainly by the end of January, the, the new websites there.
It's, you know, it's very similar in terms of content but just new photos and new design and super, super cool.
Andy: I will put a link to that in the show notes. Dr. Amanda Donnelly, thank you for being here. Guys, thanks for tuning in, everybody. Take care of yourselves, gang. Be well.
Amanda: Thanks, Andy.
Dr. Andy Roark: Oh, man. Guys, that's so fun. Thank you to Dr. Amanda Donnelly for being here. If you have not registered for the Practice Manager Summit, the Uncharted Practice Manager Summit, and you're a practice manager, what are you waiting for? It's one day. You can do it from home. You can even work part of the day and then jam out on this summit.
It's going to be awesome. But Amanda will be there talking about a culture of accountability. We've had a number of other workshops. There's going to be a lot of discussion because it is a summit, but you're going to get to meet a lot of other practice managers. It's a really good time.Also, that's when her book will be going on sale. That's February the 28th. Jump on Amazon and grab a copy. You'll be glad that you have it. It is a phenomenal resource. All right, team. Take care of yourselves, everybody. Talk to you soon.