If you’ve owned, managed or worked at a particular veterinary practice for any length of time, you may be so used to the workplace culture of the practice that you can’t effectively define it, much less analyze its strengths and weaknesses. If that’s the case, that’s perfectly normal. Having said that, it makes good sense for your practice to conduct a culture audit where you examine the assumptions, values and beliefs shared by people in the practice. This allows you to develop the healthiest culture possible for your practice, where the veterinary practice and individual members of the team can thrive and grow, and where the best service possible is offered to clients and their companion animals.
Organizational culture is comprised of all the elements of the environment of your veterinary practice. This includes the life experiences of each of the employees, along with how these experiences blend together – as well as how they clash. Add to this mix the influence of the veterinarians’ belief systems and life experiences, and the result is the practice’s culture.
People sometimes believe that culture is created through the spoken messages provided, including the policies stated by the veterinarians and the conversations occurring among employees. This is partly true, but culture is largely formed by unspoken messages received about what is valued by the practice. So, to improve the workplace culture, you need to appropriately change messages received by your veterinary team via spoken word but also by observing the behavior of employees at the practice, and determining what is considered acceptable. To change the culture, you’ll need to change the behaviors that are determined to not be acceptable.
For example, your policy handbook may say that gossip about clients is not permitted. But if, in reality, employees roll their eyes about clients and then laugh – and if that is allowed to continue to happen – then your culture is pro-gossip, not anti-gossip, even if no words are spoken.
This example also highlights the importance of performing a culture audit. At its core, a culture audit identifies messages conveyed, and then assesses whether they are the ones you want to be imparting and how consistent/inconsistent they are. This information will help to provide you with the insight you need to develop a healthier workplace culture.
Before You Begin an Audit: Authenticity Matters
As you begin to read more about workplace cultures, you will find ones that you admire – and ones that you don’t. It’s good to be able to identify what you want as part of your own culture (and what you don’t!). But, as the CEO and co-founder of UrbanBound, Michael Krasman, points out in a 2015 article titled Successful Entrepreneurs Understand the Importance of Company Culture, “Be true to who you are. Don’t define your company’s culture by the catchphrase of the day.” He also warns against creating a “grandiose vision and mission” that isn’t true to what you’re actually doing.
Performing a Culture Audit
You can gather information for your culture audit in multiple ways, and it’s more effective if you use more than one information-gathering method. To begin, it makes sense to simply observe your practice. Now that you’ve got a watchful eye, what are you noticing about the messages that are shared among team members and between them and your clients? Are they ones you want to impart?
You can also interview employees of the practice, both individually and as part of small focus groups. You can provide employees with surveys where they can choose to stay anonymous; if someone wants to share information with you but isn’t sure how you’d respond, he or she will most likely feel more comfortable with an anonymous survey.
It often makes sense to hire a consultant to get an impartial observer’s impressions. You are so close to what’s happening in your practice that it may be hard to be objective. This is especially true if your culture needs improved upon, but it can also be true with a practice where the workplace culture is largely positive and effective.
Throughout this process, notice how people are behaving. Note what they do and try to determine why they are doing what they do. What belief systems are driving their behaviors? As just one example, are they not trying to improve processes in the practice because they’re convinced that others won’t change what they’re currently doing? If so, how objectively true is that?
Assess the current procedures. How well do they dovetail with the verbal messages you are giving relevant team members? Perhaps, for example, you are telling your receptionist staff that nothing is more important than the client who is in front of them at the moment. That’s a great message – but if, in reality, you expect the same person to answer the phones while checking in the new clients, how realistic is it for him or her to provide a client with his or her undivided attention?
Take a good hard look at how you are using your finite resources, including time and money, and compare that against your ideal scenario. How close are you to the ideal? Where do disparities exist? Look at how you reward employees, how you develop them as leaders and how you promote them. This is not a comprehensive list by any means, but it should get you started.
Additional Questions to Ask Yourself
Consider what your communication style is, and whether you’re happy with it. Do you simply make announcements and expect your employees to run with it? Or do you solicit feedback and empower employees? What is your risk tolerance? Does your customer service style match your practice’s stated vision and values? How do your customers talk about your practice? Are you happy with what you hear? What is your competition doing well? Not so well?
Where to Go from Here
Once the audit is complete, you can then compare your ideal culture to today’s actual culture, and identify where gaps exist. Once those gaps are identified, then you can begin to create a plan to improve your practice’s culture so that it’s a healthy one, and one that serves the practice itself, the members of the team, and the clients and their companion animals well.
If you’re looking for an experienced professional consultant to help you with your practice’s culture audit, contact us online, email email@example.com or call 908-823-4607.
What types of employee records do you have to maintain? How long do you have to retain copies of various employee records? Are there certain documents you need to save longer than others? Can you keep all employee records in one file? Should medical doctor notes or I-9 employment eligibility documents be kept in the employee’s “personnel file”? What about payroll and tax records? How about correspondence and records generated during an internal investigation? At what point can you start destroying records? When and how must documents be destroyed? Are there specific laws pertaining to document shredding?
The simple answers to all these questions are….. there are no simple answers. These are some of the difficult questions facing Practice Owners and Practice Managers responsible for interpreting and ensuring proper compliance with the dozens of federal and state laws governing employee records retention. Most of us realize it would be impossible to retain every employee record forever. One would need to devote a separate building just to store these records. While there is considerable debate about how long various employee records should be kept, employers should err on the side of retaining any employee records they think might be needed in future. It is also advisable to establish a schedule for auditing your Practice’s record keeping, including employee files, as well as a consistent program for records destruction. However, be cautious that even with such a schedule in place, if a discrimination charge or lawsuit is filed against your practice, all records relevant to the charge must be kept until “final disposition” of the charge or lawsuit. Examples of individual employee documents that may be needed in a lawsuit include:
- Official Employee Folders
- Application & hiring records
- Promotion documents
- Disciplinary records
- Performance reviews
- Training records
- Payroll records
- Medical records
- Polices & procedures
- Job descriptions
- Employee grievance & complaint records
- Job postings/advertisements
- Supervisor’s notes & records
There are other records and documents pertaining to all employees in the practice that should also be retained, including:
- Policies prohibiting discrimination & harassment
- Employee Handbooks
- Acknowledgements/Receipt of employee handbooks and policies
- Training records (for all)
- Decision-making documents
Why Retain Employee Documents
Several statues & regulations require employers to create and/or retain various types of employment records for varying periods of time. It is interesting, and confusing, to note that requirements for retaining the same or similar records are often required under more than one law. Unfortunately, the periods of time required to retain this information may vary from federal to state law or between one law and another. This paradox merely adds to the confusion over how long to retain employee records. Here is a listing of some of the laws that require employers to retain various employee records:
- Equal Pay Act (EPA)
- Fair Labor Standards Act (FLSA)
- Title VII of the Equal Rights Act
- Age Discrimination in Employment Act (ADEA)
- Family Medical Leave Act (FMLA)
- Employee Retirement & Securities Act (ERISA)
- Occupational Safety & Health Act (OSHA)
- Lilly Ledbetter Fair Pay Act (LLFPA)
- Uniform Guidelines on Employee Selection Procedures (UGESP)
Reform & Control Act (IRCA)
- Federal Insurance Contribution Act (FICA)
- Federal Unemployment Tax Act (FUTA)
Lilly Ledbetter Fair Pay Act
One piece of recent legislation has thrown a “monkey wrench” into figuring out how long to retain employee records. The Lilly Ledbetter Fair Pay Act, passed by President Obama during his first few days in office, extends the window of opportunity for a current or former employee to bring suit against an employer for perceived discriminatory pay practices. Lilly Ledbetter, a former Goodyear Tire & Rubber Company employee, filed a discrimination suit against her former employer based on her gender. Specifically, Ms. Ledbetter claimed Goodyear lowered her performance reviews which resulted in smaller merit increases for years. This case made it all the way to the US Supreme Court which upheld her claim, but limited the judgment award to discriminatory practices that occurred within the previous 180/300 days. However, in light of the passage of the Act, employees are now allowed to file suit for discriminatory pay practices that were instituted years prior. Thus, an employer may now need to produce employee records that go back for many, many years to refute the charge. If no documentation is available, the practice may not be able to rebut claims or provide an adequate defense for its actions. This will most likely result in the practice losing the claim and also having to be responsible for attorney’s fees & costs. Further, some evidence may be excluded without the proper and legal supporting documentation. Finally juries may think records that are not available would have only supported the claim made by the plaintiff.
What to Do
What does this new law mean for practices and their recordkeeping requirements? In light of recent legislation, there is no longer a universal answer for how long to keep records. Each practice should develop its own records retention strategy based upon its own culture, risk tolerance, and available resources. Since the retention requirements of various laws overlap, employers should err on the side of retaining any employee records they think might be needed in future. As a minimum, each practice should take the following steps:
- Develop, examine &/or revise its record retention policies and stick to them; decide how long each piece of documentation should be kept, how it will be stored, and, ultimately, how it will be destroyed.
- Establish separate files for employee records, as follows:
- Official Employee Folder-one file for each employee
- Individual Employee Medical Folder- one file for each employee
- I-9 Folder-one file for current employees and one for terminated employees by year
- Health & Safety Training Folder (OSHA)-one file for each employee
- Review &/or update pay and performance management policies to ensure there are no indications of discrimination or unfair labor practices ensure electronic records policy is consistent w/hard copy records policy.
- If you retain records electronically, ensure your electronic records policy is consistent with your hard copy records policy since electronic signatures can represent enforceable agreements if they clearly & explicitly deliver terms of agreement.
- Train managers and supervisors on the new risks of unfair pay practices.
- Conduct an annual audit of all employee records
Developing a Records Retention Schedule
A records retention schedule will help a practice ensure that it keeps the records it needs, for as long as they may be needed, and then destroys them when they’re no longer useful. However, you have to know what you have and how long to keep it—legally and for your own business purposes—before you can establish an efficient records management system. That’s why it’s important to inventory your records and develop a schedule. Here are some guidelines for establishing your own records retention schedule:
Records # Yrs
Recom: all HR-related records 6
Any record to support pay diff: men vs women 3
Payroll records, incl comp p/week 3
IRS tax-related payroll info 4
FMLA/USERRA 3 after term
I-9 3 after DOH
Pension & welfare plan documents 6
OSHA logs & summary of recordable injuries 5
Employee exposure to toxic substances, incl MSDS 30
Employee workers compensation claims duration of employment + 30
Resumes & applications 1-2
Polygraph test results 3
Remember, retaining employee records is something every employer is required to do. What, how and for how long you save is dictated by law. While developing and adhering to your records retention policies may be cumbersome, think of it as insurance for your practice. Without having the proper records, you may become vulnerable to unfounded claims by former employees that could cost you considerable time and money. That’s why a little effort along the way can save you lots of headaches in the future.
Client complaints: all practices get them, although some more than others. Some complaints have a factual basis while others arise largely from emotion. Some complaints are large in scope, while many of them are relatively small. Despite the reasons why a client complains, it’s best to respond to them, early on. By doing so, you can often prevent a small issue from becoming a bigger one, and you can sometimes mitigate the damage done when there is a larger complaint. If, however, a client feels unheard, that can lead to veterinarians receiving letters from clients’ attorneys and state boards as the dissatisfied clients seek legal recourse.
In general, clients resort to litigation and/or state board action when they believe their veterinarian either acted negligently or failed to respond appropriately to their concerns. So, if your practice receives a client complaint, how should you respond?
Step One: Listen
First, focus your attention on the client and just listen. Your day is filled with numerous distractions, but if you can attentively listen when an issue first arises, many complaints can be effectively dealt with. Often, a client with a complaint is angry and just needs an opportunity to vent. If you listen and take notes, without interrupting, this can often help to calm the waters. Don’t interrupt the client, for two reasons: one, this will likely cause him or her to become angrier. And, two, this will probably interfere with your ability to gain a clear understanding of the facts.
Step Two: Remain Calm and Objective
Although it can feel challenging, especially if you’ve had a difficult day and/or the complaint feels unwarranted, avoid becoming defensive and/or emotional. If you react defensively, this may reinforce the client’s belief that you don’t care and that actions taken at the clinic really were inappropriate. Remember that the client is upset and probably needs to vent. If he or she criticizes your actions, they may or may not be justified. And, even if they are fully justified, this does not necessarily mean that any negligence occurred. Veterinary medicine is an imperfect science and veterinarians aren’t omnipotent.
Step Three: Communicate Your Response
In fact, communicate, communicate and then communicate some more, if that’s what is necessary. Many lawsuits are filed because veterinarians fail to adequately communicate with their clients. Often the client does not fully understand the diagnosis or proposed treatment of his or her pet and has unrealistic expectations of the veterinarian’s services and the respective outcome.
To ensure a better stream of communication, you can:
- Obtain informed consents
- Provide fee estimates
- Encourage questions and then answer them
- Provide handouts explaining services being considered
- Use plain English, not medical jargon; jargon can be both confusing and intimidating
Step Four: Show Sympathy and Concern
Clients whose pets have died, for example, are often emotionally distraught and, under certain circumstances, may seek to blame someone, sometimes their veterinarian, for their pets’ deaths. Veterinarians who are compassionate and attempt to comfort their clients are more likely to diffuse their clients’ perceptions that the veterinarian should be held accountable for their pets’ deaths.
Veterinarians should not hesitate to recommend grief counseling for clients who appear to have difficulty coping with the loss of their pets. Several veterinary schools have such hotlines, including the University of California at Davis, the University of Florida and Colorado State University.
Step Five: Coach Your Staff
Staff members can go a long way in helping to diffuse client complaints and should be coached in what to do and say when a client complains. As just one example, the staff should remain professional at all times and avoid offensive/defensive discussions with clients. These kinds of conversations are unlikely to be productive, and can be perceived as unprofessional (and therefore increase, not decrease, the client’s dissatisfaction). Moreover, some clients are less intimidated with staff members, as compared to the veterinarians, and the conversations therefore could become decidedly more hostile.
Step Six: Do Not Admit Fault or Offer a Settlement
When a client is upset, it’s only natural to want to apologize and/or to otherwise try to make the situation better. You should, however, avoid making apologetic statements or excuses and you should not admit fault, since this can be problematic if the client later files a lawsuit. Veterinarians with only a few years of experience are more likely to feel guilty and accountable for bad outcomes, even when there was no negligence, but veterinarians of all levels of experience need to be careful in this regard.
If the situation becomes more complicated and an actual malpractice charge is made, veterinarians should not offer to settle the charge or agree to any settlement offered by the client without first contacting their insurance carrier and attorney since it may be interpreted as an admission of fault, thereby prejudicing their case. Under certain circumstances it may be appropriate to reduce the client’s bill to try to amicably and expeditiously resolve a dispute, but without admitting liability. Your attorney can provide guidance in this situation, as well.
By following these six steps, you can significant improve client satisfaction and potentially reduce your chances of having a malpractice suit filed against your practice.
How does your veterinary hospital stand out from the other three down the road? Clients choose among veterinary hospitals based on a variety of factors and perceive quality of care in different ways than you might expect. The reality is that, no matter how outstanding your veterinary medical skills are, clients do not fully perceive quality of services until you convey how much you care about the client and the pet.
Here are ten ways to enhance client satisfaction. If you implement these strategies, it is reasonable to expect to strengthen the hospital-client bond and increase hospital loyalty and business.
Strategy #1: Make an excellent first impression.
How do clients first interact with your hospital? Typically, on the telephone. So, be sure to train the receptionist to extend a warm welcome to new clients and find out the specific reason why a client is calling. In the following example, the receptionist politely answers the call, referring to the client and pet by name, and makes it easy for the client to provide the information the receptionist needs.
Receptionist: “Hello, this is ABC Veterinary Clinic. My name is Susanne. How may I serve you today?”
Client: “Hi, this is Peter Oswald. I’m calling to schedule an appointment for my dog, Harris.”
Receptionist: “Thanks for calling, Peter. May I ask if you or Harris has been to our clinic before?”
Client: “We haven’t.”
Receptionist: “In that case, welcome to ABC Veterinary Clinic! We’d be happy to see you and Harris for an appointment. May I ask some questions about Harris to determine how we may best meet your needs?”
Strategy #2: Offer a welcome kit to new clients.
Nothing says “thank you” to a new client more than a goodie bag with free pet-themed items. A welcome kit serves to exceed client expectations (a value-added benefit), enhance the hospital-client bond, and offer incentives. Example kit contents include:
- A “welcome to our clinic” greeting card
- Healthcare brochures tailored to the age and species of pet
- Pet items with the clinic’s logo (perhaps a dog toothbrush, bandana, leash and/or pet dish placemat)
- Helpful articles, such as “Choosing a Pet Food Diet” or “Common Household Toxins”
- Incentives, such as a free nail trim at the next visit
Strategy #3: At the end of the initial client visit, offer an incentive to return for a second visit.
Instead of (or in addition to) a welcome kit, you can offer a free service to first-time clients. This serves as a small gift as well as an incentive for the client to return on a second visit. Examples include a free nail trim, free ear cleaning, or an item many pet owners are sure to enjoy: a pet “Driver’s License” (e.g., mypetdmv.com), which is a pet ID tag that comes with free registration on a lost dog registry.
Strategy #4: Extend the support clients need during euthanasia.
A 2004 JAVMA study asked clients to rank the most important factors in their experience of pet euthanasia. “Compassionate and caring attitude of hospital staff” ranked #1 among the clients’ list of factors. Interestingly, clients ranked logistical concerns (e.g., short waiting times and availability of grief resources) the lowest. Thus, staff euthanasia training should emphasize providing emotional support to clients. It may be helpful to supplement staff training by allowing new staff to be present during euthanasia conversations and the euthanasia itself. An empathetic and compassionate disposition is a vital component of the euthanasia experience for clients.
Strategy #5: Acknowledge the owner and pet by name.
What is a word that is music to your ears? Your own name! Greet a client as soon as he or she walks in the door with his or her own name and the pet’s name. How can your hospital accomplish this with every client? At a pet’s initial visit, take a picture of the pet and keep it in your records. When a client walks in for a scheduled appointment, the receptionist and greeter should acknowledge the client and pet by name based on skimming through that day’s medical record pictures.
Strategy #6: Send a quarterly newsletter.
A hospital newsletter – even if it’s just quarterly – personalizes the hospital and allows clients to feel as family in-the-know. Grab your audience’s attention by addressing popular owner questions such as how to choose a pet diet, grain-free pet food, dental care, or behavior (“Why does my dog/cat do that?”). In addition, be sure to introduce new staff, promote health awareness and hospital services, and demonstrate hospital strengths such as AAHA accreditation or recent awards. This is also your chance to offer incentives to current clients (e.g., a discount on your hospital’s grooming service).
Strategy #7: Outfit the reception area to suit clients’ needs.
While the waiting room may be a holding area in our eyes, clients need it to be much more. How does your reception area address their needs? Clients are burdened with hands full of pets on leashes, paperwork, coats and purses, and possibly accompanying children. To best serve your clients while they wait, provide a clean and quiet area with entertainment, a separate area for cats or exotics, a dedicated children’s table with coloring, and coat racks near benches.
Strategy #8: Send a pet birthday card.
Surprise your clients with a signed pet birthday card mailed the month of their pet’s birthday. This enhances the hospital-client bond and reminds clients of your services at a random time during the year (i.e., not in association with a vaccine reminder). Pet birthday cards do not have to be specifically ordered from a veterinary greeting card company; an ordinary birthday card with animals on the front will do!
Strategy #9: Provide a personal tour.
At a client’s first visit or at pet drop-off, offer that client a quick tour of the treatment and surgery areas or boarding facility. The dedicated attention his or her pet receives should relieve client fears of leaving the pet in an unknown setting. Furthermore, this level of transparency should strengthen the hospital-client bond. As an added benefit, a tour is a chance to ask the client for feedback and improve your practice based upon suggestions given.
Strategy #10: Text a picture of the pet to the client.
What a relief it must be for a client to view his or her pet in recovery! Send your client a photo via text of the pet after surgery to share how everything went well and to confirm the pickup time.
The best way to create the future you want is to set goals and then plan appropriately for them. Roadmaps are essential to your career plan! Here are key issues to consider and address during the early years of your practice.
Your days are likely to be busy as you care for clients and manage your team. It’s important, though, to sometimes step away from daily fire drills to focus on long-term strategic planning. A strategic plan provides an overall sense of direction directed towards future prosperity. To be effective, it should deliberately be put into practice, modified when needed, and reviewed regularly (often annually). Components of a strategic plan typically include:
- Mission statement/purpose
- Core values
- Long-term vision (perhaps 3 years, or 5, or 10)
- Strategic agenda (projects undertaken to move towards your vision)
- Project plans (for each item on the strategic agenda)
- Project milestones, and the metrics and measurements used
- Accountability plan (who will be responsible for what)
Fortunately, plenty of free resources exist to help you to create a viable strategic plan, including a 30-minute online training by the Small Business Administration (SBA) found here: https://www.sba.gov/tools/sba-learning-center/training/strategic-planning. This section of the SBA site also offers significant amounts of supplementary resources for strategic planning.
Appropriate Financial Planning
Although “budget” appears as the last bullet point of the strategic planning process, it’s very important, as the funds generated by your practice will serve as the fuel of your success. There are numerous financial planning issues to consider, far too many for an article, but here are several high-level recommendations:
- Get a handle, early on, on your cash flow. Are there times of the year when cash flow increases? Decreases? How predictable are they? Are you paying your bills on a schedule that avoids late fees and takes advantage of any early pay discounts?
- Monitor your own time. If you’re having to work extra-long hours every week to be profitable, this isn’t a sustainable strategy. What changes need to be made to create a more realistic workload, long term?
- Ensure that you truly understand your profit and loss statements, and other financial documents. If you don’t, ask for help! Although there is nothing wrong (and plenty right) with having financial professionals assist with managing your financials, you need to thoroughly understand where your business stands.
- Look to the future:
- Determine the best retirement plan options for you and for your practice team. If you have no more than 100 employees and no other qualified plan, consider a Savings Incentive Match Plan for Employees (SIMPLE).
- Know that it’s never too early to create a succession plan (ownership-wise and management-wise) in case you become incapable of working or die; this helps to ensure a smooth transition at the lowest cost.
- Finally, save for a rainy day! If you never need to use these funds, then you’ve got a nice financial cushion that can come in handy if you decide to expand your practice or otherwise make large expenditures – and you don’t have to panic or go deeply into debt if an emergency does arise.
Creating Your Employment Environment
The people in a practice can make or break its success, so creating a success-friendly environment and company culture is crucial. Core elements of this environment include:
A mentor is simply a more experienced person offering guidance to a lesser experienced person. A workplace mentor serves as a role model, sharing knowledge that will help someone else chart his or her own successful career path. Mentorships can be formal or informal, and the roles can be quite fluid. For example, a more experienced veterinary tech can mentor a newly graduated one in job-specific duties, but the roles could shift if, say, conflict resolution skills are needed and the new tech has significant experience in that from another job or different context.
A healthy workplace has an engaged workforce – and engaged employees are those who are eager to participate in workplace activities and meet the challenges of the day. Engaged employees are motivated employees, and there are two types of motivation: external and internal.
External motivators include wages and benefits, and are needed to get people to work. Internal motivators go beyond that, and exhibit a much stronger pull. They include:
- Autonomy (control and decision making)
- Mastery (learning)
- Purpose (achieving personal goals)
To motivate teams externally, analyze what similar clinics are paying in wages and benefits, and pay the fairest amount you can. You don’t want to invest time and energy into an employee only to have him or her enticed away by a competitor who offered better compensation.
To internally motivate, provide autonomy, perhaps through flexible scheduling, incentivized earning programs and results-oriented managing (in other words, don’t micromanage!). Create a culture wherein practice members can master their favorite specialties through continuing education and teaching clients. Highlight purpose by noting what a difference a staff member is making in people’s lives, participating in charity events and building a culture in which praise and encouragement is given.
Finally, create a culture of transparent workplace accountability by clearly defining roles, and by focusing on teamwork. Clarify the importance of each person’s role in accomplishing team goals, and share and celebrate successes, while brainstorming how to overcome challenges together. Honestly evaluate processes and encourage practice staff to make suggestions. Reward integrity.
From a practical standpoint, organizational charts can help. Having a formal written organizational chart can help the growth of your practice in many ways, including serving as a:
- Roadmap for developing a management team
- Blueprint for hiring employees and developing their skills
- Method to improve flow of information throughout the practice
- Framework to boost efficiency
As you need to hire staff, give raises and otherwise manage a practice, having quality negotiation skills are important. Whenever two people have differing needs and interests – and each has what the other wants and needs – then a series of negotiations are likely to take place. For example, you want to improve the bottom line and so are watching expenses, but need the services and engagement of your veterinary technician, while the veterinary tech needs to earn more money for her family. So you need to discuss (negotiate!) a solution that will work for both of you.
To successfully negotiate:
- Understand the other person’s interests
- Be well prepared with factual information
- Determine where and how you can compromise
- Treat the other person the way you’d want to be treated; the goal is a successful long-term relationship, not a quick short-term win
A unique type of negotiation occurs with practice residents. Finding the right resident for your practice takes time, and you need to protect the investment you’ll make in your resident by including proper retention provisions in your residency agreements. At the core of a residency agreement: you are agreeing to pay for your resident’s training and living expenses in exchange for a certain amount of work after he or she is board certified.
Consider a carrot and stick approach to your agreement. At a minimum, require your resident to pay back the expenses you fronted if the residency is not passed in a timely manner or if your resident leaves your practice before the retention period expires. The carrot is optional, but serves as external motivation: if your resident successfully works through the retention period, he or she receives a bonus that is well-defined. And, it also makes sense to cultivate internal motivators with your resident. What autonomy can you provide? What mastery can you help to create, and what sense of purpose can you encourage?
Remember to take care of yourself! It’s crucial to create a healthy balance between work and the rest of your life – crucial for your health and well-being, as well as for the rest of the practice and your clients. Tips to help make this happen include:
- Mark important milestones on your calendar, perhaps your anniversary or child’s birthday, and arrange ahead of time to have time off to celebrate.
- Learn to prioritize and say no when you simply don’t have time to take on an additional task – or even something extra that would be enjoyable.
- When you get home, leave the workplace behind as much as possible. Try not to dwell on problems that happened or answer your email. Make your personal time truly yours.
- Track your time at work for a week. What tasks could you delegate to free up time? Or what isn’t necessarily a priority and can be put on a back burner?
- Consider starting a workplace wellness program. Participate!
- Lower your expectations at home. Incorporate more rest and enjoyable activities in your day whenever possible.
As a final piece of advice, during the early years of your practice (and, later on, for that matter), when you face challenges, reach out for help. Other professionals have been through similar scenarios and can provide guidance. You don’t have to go it alone.
Stories involving ethical decisions can frequently be found in the news, usually because someone’s ethics have been found wanting. And, although some people either intentionally make unethical choices and/or don’t spend enough time determining the appropriate behaviors, even the most ethical people can sometimes struggle with deciding what actions are most appropriate to take.
To add to the mix: in the professional arena, few industries have as many ethical and legal obligations to as many parties as those in the veterinary field. Veterinary professionals must consider:
- Wishes of their clients
- Obligations to:
- the animals
- the general public
- professional colleagues
In situations where all of the interests mesh, then ethical practices are fairly easy to uphold. But, when interests and obligations conflict, then ethical dilemmas arise. For instance, perhaps a client doesn’t authorize treatment that you know is in the best interests of the pet. What do you do?
When a moral dilemma arises, it’s important that you ensure you are thoroughly familiar with the AVMA Principles of Veterinary Medical Ethics, and then apply those ethics to the situation at hand. Note that collective ethical rules have, at times, been given the force of law when adopted by veterinary medical boards.
Also, what state laws apply? All fifty states have some statutory framework focusing on veterinary practices, creating licensing procedures and establishing basic governance of veterinary medicine. State boards of examiners enforce and administer the laws under the state’s practice act, and include these codes of professional conduct. Also, non-veterinary-specific state laws also need considered; malpractice laws are just one example. And, what local laws also need to be considered?
Although laws and professional codes are crucial to consider when making ethical decisions, these decisions often go beyond codification. They also include a person’s moral convictions, ones that aren’t – assuming that laws and codes are met – enforceable from an outside body.
Although no one ethical dilemma is exactly the same as another, we recommend the following eight-step approach to solving the ethical problem you’re facing.
- First, clearly define the core ethical question, typically framed using what “should” or “ought” to be done.
- Next, determine who is affected by this issue. Who are the major stakeholders? Minor ones?
- Take a look at each of the major stakeholders. What are each of their primary interests and/or concerns?
- Examine the facts you have. What else do you need to know? How can you get this information?
- Brainstorm! What are your goals? What potential solutions are available to you? Alternative courses of action?
- Now it’s time for moral discernment. Which moral values, principles and/or rules are relevant? How would you prioritize them?
- Go back to the list you created in response to number five and eliminate any alternatives that aren’t feasible. With your remaining list, how would you assess each of the solutions when evaluated using the values you prioritized in number six? Which solution is most acceptable when viewed through the lens of your priorities? Which one satisfies the greatest number of stakeholder interests? The solution that is doable, respects the broadest array of priority values and satisfies the greatest number of major stakeholder interests is the most ethical choice.
- Finally, it’s time for moral closure. Review your process. Have goals from step five been accomplished by your proposed solution? Are they compromised in any way? Have all parties’ views been represented, whether they were actively participating in the decision making or not? Can this alternative truly be implemented as proposed?
If a practice manager genuinely follows this pledge, then ethical decisions will naturally follow.
I pledge myself to:
- Comply with the principles and declarations of the Veterinary Hospital Managers Association, Inc.’s code of professional ethics.
- Maintain and promote the profession of veterinary practice management.
- Assure my continued growth and development as a professional by utilizing, to the highest extent possible, the facilities offered to me for continuing the professional education and refinement of my management skills.
- Seek and maintain an equitable, honorable and co-operative association with fellow members of the Veterinary Hospital Managers Association, Inc. and with all others who may become a part of my business and professional life.
- Play a fundamental role in maintaining excellence and quality of care to our clients and their animals.
- Place honesty, integrity and industriousness above all else, and gainfully pursue my profession with diligent study and dedication so that service to my employer shall always be maintained at the highest possible level.
- Keep all information concerning the business or personal affairs of my employer confidential, except as may otherwise be required or compelled by applicable law or regulation.
- Protect the employer’s funds and property under my control. Information gathered, maintained or produced within the veterinary practice is the property of the practice owner and will not be reproduced, shared or distributed outside the practice without consent of the owner.
This session will discuss multiple ethical scenarios such as: custody disputes, clients who do not pay, unauthorized use veterinary equipment, misuse of controlled substances, and more. Read two of scenarios below.
Ethical Scenario #1: Custody Disputes
When a couple is divorcing, plenty of complicated issues can arise. This can affect your veterinary practice, especially if one member of a couple is requesting irreversible procedures on a pet and the other may disagree. These procedures include euthanasia, spay/neuter, cosmetic (ear cropping, tail docking, and declaw), and relinquishing the pet for adoption. Furthermore, courts are increasingly considering animals to be subject to custody laws, rather than as personal property, which makes this an even more pressing issue.
Here’s a worst-case scenario: a longtime client, Mrs. Jones, is the documented owner of Olli, a ten-year-old male toy poodle. There is no mention of a Mr. Jones. One day, though, Mr. Jones bring in Olli for euthanasia because the dog is urinating on the carpet and barking too much. To make matters more complicated, a relief veterinarian was on duty; this veterinarian presented alternative options, but Mr. Jones could not be swayed and he signed the consent form.
People in the practice knew that this couple was in the middle of a heated divorce, but the relief veterinarian did not, and he euthanized Olli. Mrs. Jones subsequently filed a lawsuit against the practice, saying that Mr. Jones took this action to spite his wife.
Using the decision-making model described above, what alternate solutions would you have presented? What actions would have been reasonable, ethics-wise? What safeguard procedures would you implement?
Ethical Scenario #2: Human Medicine
It isn’t unusual for a frightened cat to lash out and, even when safe-handling procedures are followed, someone gets bit. So, how much treatment can a veterinary practice employee offer, given that veterinarians are not permitted to practice human medicine? Clearly, someone can assist the person with washing the wounds thoroughly with soap and water, and applying bandages, since procedures that any “reasonably competent” individual can undertake are not considered practicing medicine. And, as many veterinary practices have staff members certified in standard first aid, this is clearly within scope.
But, what about applying an antibiotic, such as cephalexin? It’s easy enough to apply and readily available, and saves time for the person who was bitten. To balance clinic inventory, a prescription could be written for that person’s animal. If all heals well and no one says anything, this is unlikely to cause problems for anyone. This, though, however well intended, violates multiple professional ethical tenants. These include practicing medicine on a human and writing a false prescription.
Run this scenario through the decision-making analysis. What conclusions do you have? Then, throw in this added twist: what if this happens during a raging blizzard and the wound looks fairly serious? Does this change anything?
- Tannenbaum, Jerrold. Veterinary Ethics. Baltimore: Williams & Wilkins, 1989.
- Rollin, Bernard E. An Introduction to Veterinary Medical Ethics: Theory and Cases. Ames: Iowa State UP, 1999.