The concept of actively crafting corporate culture has been the topic of many articles and seminars over the years, and these practices can be used to improve veterinary hospital culture. In 2016, the American Animal Hospital Association (AAHA) commissioned a study performed by the Daniels College of Business at University of Denver to examine how organizational culture impacts veterinary hospitals. Key areas of focus included the different subcultures that exist in veterinary hospitals as well as evaluating how hospital metrics are impacted by culture. The study evaluated eight areas of sub-culture, ranked in order of importance by study respondents. Most important to culture was the relationship with veterinarians, followed by training and career development, teamwork and staffing, employee involvement and goal setting, supervision, leadership skills and contributions and institutional fairness and communication. The lowest ranked factor impacting culture was rewards & recognition.
Findings of the study indicated that three measurements were strongly associated with hospital metrics: Relationship with Veterinarians, Teamwork and Staffing, and Leadership Skills. Relationship with veterinarians was defined as “the degree to which veterinarians maintain collegial relations with staff and respect staff contributions to care.” Teamwork and Staffing concentrated on “the degree to which the practice encourages teamwork and cooperation, and coordinates efforts across departments.” Leadership skills focused on “practice management promotes a commitment to high performance and quality.”
Metrics most impacted by team perceptions of culture were identified as production per full time veterinarian, number of employees, and gross income of the hospital. Key findings in this study were that staff in smaller veterinary hospitals reported more positive relationships with veterinarians, enjoyed enhanced teamwork and staffing, and had more opportunities to be an active contributor to the hospital culture and success.
The results of this study suggest that job function impacts the study scores relating to culture. Management and administration had higher aggregate culture scores than associate veterinarians. Factors that negatively impacted the culture scores among associate veterinarians were training and development, opportunities to contribute, employee involvement, and teamwork and staffing. Several conclusions and challenges can be extrapolated from this study, including the need to:
- Provide associate veterinarians with the ability to continually develop skills and to apply the skills in clinical settings;
- Provide opportunities for associates to meaningfully contribute to hospital success outside of production metrics; and
- Evaluate how veterinary teams function.
Challenges highlighted for hospitals with larger numbers of employees are to provide animal health care team members the opportunity to develop meaningful work relationships with veterinarians, where their contributions are valued and to provide a pathway for enhanced teamwork.
When it comes to strategies that highly impact veterinary team performance, culture often is the most overlooked aspect of veterinary hospital operations in many hospitals. Quite simply, culture has not been a priority for management for multiple reasons – from non-recognition of the impact of culture on all hospital functions to not understanding how to implement a healthy organizational culture.
To Improve Veterinary Hospital Culture, It Must First Be Defined
Culture is defined as “the set of shared attitudes, values, goals and practices that characterizes an institution or organization.” (Source: Merriam Webster Dictionary.) This definition relates to the cognitive, or intellectual culture of an organization. Cognitive culture is the most frequently recognized form of culture, expressed and reinforced verbally.
Rarely acknowledged is the emotional culture that co-exists alongside cognitive culture. This culture helps to dictate what emotions are shared in the workplace, and which ones are curbed. Emotional culture is communicated primarily through non-verbal signals such as body language, eye contact and our voices (pitch, tone, volume, and pacing). As 93% of communication is non-verbal, emotional culture influences teamwork, client relations, and even impacts how our patients respond to us.
Why Is Culture Important?
As seen in the AAHA study referenced above, a healthy culture is critical in creating an environment in which all employees can grow and thrive. Every workplace has both cognitive and emotional culture. Both manifestations of culture must be actively managed in the workplace. When healthy cultures are developed, a host of benefits crop up.
For example, workplaces with healthy cultures report greater employee engagement, job satisfaction and more effective teamwork. When organizational culture is not defined or actively managed, it creates fertile ground for discord among members of the veterinary team. This can lead to misunderstandings, confusion, and resentment among animal health care team members, resulting in higher rates of absenteeism, turnover and burnout, according to a Harvard Business review article. (Source: Barsade S, O’Neill OA. Manage Your Emotional Culture. Harvard Business Review, January-February 2016, 58-66.)
Tips on How To Improve Veterinary Hospital Culture
Step 1: Create Psychological Safety
Creating a work environment that feels safe to your animal health care team is the first step in creating a positive culture. Psychological Safety refers to the “shared belief by team members that the group is safe for inter-personal risk-taking.” In workplaces that create psychologically safe spaces, employees can learn, thrive, and contribute, all cultural factors that rated high in the AAHA study. When leadership creates psychological safety in the organization, it lessens the potential negative consequences of making a mistake. This increases creativity and initiative.
Psychological safety can be fostered in veterinary hospitals by setting guidelines on how the team works together & communicates. A model for how to do this was created for the human nursing committee, and it’s known as the CENTRE model. The CENTRE model sets specific and clear ground rules, including:
- Confidentiality: What is said in the group stays in the group. Equal airtime: Everyone has the right to participate in the conversation and contribute to the final product/decision.
- Non-Judgmental, respectful listening: Team members don’t interrupt and seek to understand each other before being understood.
- Timeliness: respectful of others’ time and schedules.
- Right to Pass: acknowledgment that the person in the group might not have anything new to contribute to the conversation or might need more time to think.
- Engagement: being fully present for the group, and the conversation.
(Sources: Cave D, Pearson H, Whitehead P, Rahim‐Jamal S. (2016). CENTRE: creating psychological safety in groups. The Clinical Teacher,13(6), 427-431; Frazier, M., Fainshmidt, S., Klinger, R., Pezeshkan, A., & Vracheva, V. (2017). Psychological Safety: A Meta‐analytic Review And Extension. Personnel Psychology, 70(1), 113-165)
Step 2: Foster Trust
Once employees feel safe in the workplace, animal health care teams can build vulnerability-based trust. Being vulnerable can be uncomfortable for our animal health care team members. In exposing themselves, they fear being emotionally hurt, judged, or seen as weak or lacking by their fellow team members. When vulnerability-based trust is fostered, the need to hide weaknesses or mistakes evaporates as each team member can be accountable for their performance without fear of shame or ridicule.
Teammates are comfortable being transparent and honest with each other and can freely admit mistakes, ask for help, and say, “I’m sorry.” Trust leads to deep bonds between teammates, with the intent that each team member has each other’s best interests at heart. This approach creates a deeply positive culture.
Trust is built slowly and deliberately, in a non-threatening way. Trust only can truly form when members of the team get to know and understand each other. One trust-building activity is to have each team member share their thoughts, feelings & beliefs on their personal foundation, vision for the future, things they do that irritate others, commitments in their lives, and vulnerabilities/fears.
The open sharing of each team member’s thoughts facilitates more understanding among the veterinary team members. There also are a variety of trust-building exercises can be found online.
Step 3: Promote Shared Values
The creation of a unified culture requires an understanding of the veterinary team’s common values. Shared values help create a framework to guide the daily work of the team, based on the group’s collective standards.
One exercise that I often deploy to create understanding & agreement on shared values is to generate and distribute a confidential questionnaire that asks the following questions:
- What are the top 3 words you would use to describe the personality of the animal hospital?
- The answers are then compiled & analyzed to find the common trends & patterns.
- The collective answers from everyone are then presented to the group – followed by a facilitated discussion & decision-making process to jointly agree on the top attributes the group thinks are both accurate and positive. The shared values are then used to govern every aspect of the hospital, from hiring and firing to personnel development and business strategy. The exercises and exploration of shared values should be revisited every 3-5 years, or in the event of changes in leadership.
Step 4: Actively Manage Culture
Once a clear understanding of the desired culture has been established, the leadership team is responsible for actively managing and reinforcing it. Some examples of ways the leadership team can actively reinforce culture include:
- Morning Huddles: These inclusive, all-hospital huddles are designed to provide space for management and team members to acknowledge the emotions that they are bringing to work that day. By asking each team member: “What emotions are you bringing to work today?,” leadership can better manage the daily emotional undercurrents present in the workplace.
- Cognitive Reappraisal: This technique that can be taught to team members to help them re-examine their views of a co-worker’s actions. By considering benign plausible explanations for a colleague’s behavior, they will be less likely to focus on negative explanations that could result in a negative emotional spiral. This also encourages team members to be more supportive of each other.
- Group Planning: A discussion about how the group will work together to accomplish the day’s projects, such as workflow, patient needs, client management, and team member concerns.
Veterinary hospitals that embrace and cultivate healthy cognitive and emotional cultures learn first-hand that it’s transformational. In today’s highly competitive employment environment, management teams that work to improve veterinary hospital culture are able to offer a drama-free workplace that encourages collaboration, supports personal and professional growth, and inspires team members to be their best selves.
About The Author:
Wendy Hauser, DVM is the founder of Peak Veterinary Consulting and has practiced for 30+ years as an associate, practice owner, and relief veterinarian. She also has worked in the animal health industry as a pet health insurance executive and as a technical services veterinarian. Dr. Hauser consults with both industry partners and individual veterinary hospitals. She is a regular presenter at veterinary conferences, facilitating workshops on hospital culture, associate development, leadership, client relations and operations. She has written & published more than 100 articles related to the veterinary industry, and she is the co-author of “The Veterinarian’s Guide to Healthy Pet Plans.”