Moving veterinary medicine beyond the status quo
A miracle has happened in veterinary medicine. All educational debt is gone, everyone is making triple his or her current salary, and no one works more than 35 hours a week. Oh, and no veterinarian is ever double-booked, and clients can afford everything.
Josh Vaisman, co-founder of Flourish Veterinary Consulting, asked: “If this did occur, do you think in a flip of a switch, everyone in veterinary medicine would be thriving? Would we all be fulfilled?
He said: “In 10 or 20 years, all the things that make our work hard are not going to disappear. It’s always going to be a difficult field.”
In his talk, “Lead to Thrive: The 4 P’s of Positive Leadership” at the AVMA Veterinary Leadership Conference, Jan. 6-9, Vaisman said problem-solving in the profession isn’t enough. Instead, veterinary organizations need to cultivate the things that contribute to workplace well-being.
Vaisman is a former practice manager and hospital owner with more than 20 years of experience as a veterinary technician. He also has a master’s degree in applied positive psychology and coaching psychology. And he’s a self-admitted “bad leader,” which led to his burning out and leaving clinical practice.
The BIG veterinary leadership “problem”
Vaisman suggested that it’s not enough to pay underpaid staff members more or give fewer hours to overworked staff members—that’s just the baseline. To be thriving at work means feeling engaged, fulfilled, accountable, and like you are growing. All of this requires an environment that enables the best parts of a person. Positive leadership helps leaders cultivate precisely that environment, he said, and helps practices retain existing employees.
“It’s not possible to motivate another human being” in an energizing way, Vaisman said. Leaders can, however, cultivate conditions that make that kind of motivation possible. “We create an environment in which enthusiastic motivation is possible” because it supports the employee’s core psychological needs.
Self-determination theory represents a broad framework for the study of human motivation and personality. According to the theory, three core human needs are autonomy, connection or relatedness, and competence, or “the capacity to lean into the discomfort of whatever challenge you’re facing and knowing there’s a support system around you as well,” Vaisman said.
With these three things, intrinsic motivation is possible. People want to do something, and the more they do it, the better they feel, so performance and well-being improve. Without these things, there is demotivation or apathy. Vaisman also pointed out that this is not extrinsic motivation, where a person feels forced or compelled to do something. This may work to a point, but it is difficult to stay energized.
In veterinary medicine, Vaisman said, “We focus too much on compliance, rewards, and policies and procedures. Like, ‘If I get into the nitty-gritty of what I expect from them, they’ll do it every time.’ But it doesn’t work, at least not in the long term.”
The four P’s
The four aspects of positive leadership, which Vaisman is currently writing a book about, are as follows:
- Psychological safety.
Psychological safety means people feel safe to take interpersonal risks. The need for psychological safety “doesn’t disappear when you clock in. If anything, it’s exacerbated,” he said.
He cited a study by Amy Edmundson, who followed teams of nurses across several hospitals. Her hypothesis was that the highest-performing teams would make the fewest mistakes. The data showed, in fact, that the highest-performing teams seemed to make the most mistakes.
“They (high-performing teams) developed a culture to navigate the awkward space where, on one hand, nurses are human beings and aren’t perfect, but also, in the medical profession, where mistakes are a big deal,” Vaisman said. “It turns out they weren’t making more mistakes—they were admitting to their mistakes more openly.
“The only way we can make systems better is to see where we need to be improved, and we can only do that if we’re being honest. If you withhold the opportunity to learn, that will get you in trouble.”
Having high psychological safety at work results in less employee turnover, fewer medical errors, and higher efficiency, according to studies Vaisman referenced.
Purposeful leadership is about taking advantage of the fact that what people do matters and then showing them how it matters. Experiencing meaningfulness results in engagement, motivation, and satisfaction.
“The more we have this, the more we report having a sense of fulfillment in what we do. And meaningfulness is a vaccine against burnout,” Vaisman said.
Practices of purposeful leadership involve noticing people, whether by making eye contact or learning about their interests; affirming people by highlighting their strengths or recognizing the impact of their contributions; pointing out how employees matter to the team; and showing team members how their tasks connect to things that matter.
He gave the example of training new customer service representatives and going through their daily checklist, which includes calling all clients who had appointments the day before by 10 a.m.
Vaisman said: “What if you did that and added, ‘The reason we do this by 10 a.m. is because the docs take their lunch between 10 and 2, and they’ll know during the break in their day if there are clients to follow up with then and not at the end of the day. Also, one of our values is service, so calling them shows we take service seriously.’”
Following the right path
The third P, path, is primarily about clarifying expectations to empower employees. That is, employees understand what is expected of them, they have meaningful control over how to meet those expectations, and they have the tools and resources they need to succeed. The best way to ensure these things is a consistent and effective, structured, one-on-one program.
“This means you as a leader are routinely off the floor, undisturbed, and are checking in with your direct reports at least monthly,” Vaisman said. The meetings should have an agenda, rarely be rescheduled or canceled, happen routinely, and be for the benefit of the employee. The last means the meeting is not a performance review but a chance for the staff member to feel empowered or ask for resources.
Vaisman worked with a large emergency practice in the New England area, which implemented a monthly check-in system for staff members. Those who reported feeling resilient, prior to the program, stood at nearly 50%, while 12% said they were really struggling. Eight months later, those who were struggling totaled only 4%, and those who felt resilient increased to 74%, Vaisman said.
Finally, the partnership aspect of positive leadership means leaders care about their employees, genuinely want them to be successful and support them, and show appreciation.
“I’m not advocating for creating a coddling relationship. You can’t be everyone’s best friend. If we are the person with all the answers and take care of someone all the time, we remove autonomy and create learned helplessness,” Vaisman said. “On the other hand, don’t be a dismissive leader, saying: ‘Don’t bring me problems. Only bring solutions.’”
Vaisman recommends that leaders pick one of the four P’s to work on, then plan out how to go about taking action. Start with considering what it is you’re trying to accomplish or what the goal is, he said. Then think about which practice or tool to experiment with, why this change is important to you personally, and how you will measure progress.
“Shifting from where we are to where we want to be can feel like a chasm,” he said. “You need to build a bridge, but this happens one plank at a time.”
A version of this article appears in the Feb. 15, 2022, print issue of JAVMA.