April 3, 2021

#42: Burnout: The bigger picture. With Dr Ivan Zakharenkov

#42: Burnout: The bigger picture. With Dr Ivan Zakharenkov
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Our guest for today Is Dr Ivan Zakharenkov, or Ivan Zak as he’s better known. Ivan is a veterinarian and an entrepreneur committed to creating products that empower healthcare teams to live their passion.

If you haven’t heard of Ivan then there’s a fair chance that you have heard of, or possibly use his brainchild on a daily basis in your hospital: Ivan was the founder of the now-ubiquitous veterinary software Smartflow. It was Ivan’s personal journey as a practicing veterinarian for 12 years that led to the development of Smartflow, and eventually to his current mission.

Early in his career, Ivan experienced severe burnout, and it was that experience that has led him to explore the psychological triggers of burnout and business methodologies that veterinary organizations can apply to work against them. Researching this topic, Ivan obtained an MBA degree in International Healthcare Management and wrote a dissertation “Implementation of lean thinking to improve employee experience.” Today Ivan is leading Veterinary Integration Solutions, a technology company helping veterinary groups implement an operating framework for sustainable integration of practices with a special focus on burnout prevention.

Our conversation covers some of the highlights of the findings of the burnout study and his thinking about solutions to burnout. What I love about Ivan’s thinking that has flowed from the study is that the focus is not on how we as individuals can get better at preventing burnout - instead it focuses on the causes of burnout at a management and leadership level, and on practical solutions.

Ivan talks openly about his experience with burnout and how to identify it, we discuss the 6 triggers of burnout and strategies to mitigate it, Ivan gives us an inside perspective on how corporate veterinary practice works that might surprise you, and we talk about money and it’s role in job satisfaction and burnout, and much more.

 

https://vetintegrations.com/

 

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Even my dad just arguing about who's gonna have the last?Say it.Like you want, unless you can have another set, but I want to run.You asked me if I had anything and used just literally just over like this.I'm Gerardo Pollard.
I'm Ubud him strapped and this is the vent valve.But Valdez, welcome to another episode.It's a very special episode.We are recording this episode with Gerardo in hospital with Alex because they just had a new baby.
Congratulations, Gerardo.Thank you, Bert.We are super excited for the safe arrival of our Lorelai.She's ready feisty and that the rapper up at like a little Kebab, because she flails around the place and screams all day as Edward.
Commitment, the recording of pie Add cast a day after having your you don't have the baby but you played some role and played some role.That's right.We're juggling the busy Easter public holidays and baby time.So we'll get there.
Thanks Our Guest for today, is dr.Ivan as a colonel or dr.Ivan Zach as he's better known, Ivan is a veterinarian and an entrepreneur committed to creating products that Empower Healthcare teams to live their passion.
If you haven't heard of Ivan, then there's a fair chance that you've heard of or possibly used his brain, child on a daily basis in your hospital, Ivan was the founder of the now ubiquitous Veterinary, software, smart flow, it was Ivan's, personal Journey from practicing veterinary medicine for 12 years that led to the development of smart flow and eventually to his current mission.
Early in his career, even experienced severe burn out.And it was that experience that led him to explore the psychological triggers of burnout and business methodologies, that Veterinary organizations can apply to work against burnout.I haven't obtained.
An MBA degree in international Health, Care Management and wrote a dissertation on implementation of lean thinking to improve employee experience today, Ibanez leading Veterinary integration solution.Owns a technology company helping Veterinary groups Implement an operating framework for sustainable integration of practices with a special focus on burnout, prevention, conversation, covers, some of the highlights of the findings of the burnout study and his thinking about solutions to burn out what I love about Ivan's, thinking it is flowed from the study is that the focus is not on how we, as individuals can get better at preventing burnout.
Instead, it focuses on the causes of grown out at a management and Leadership level and Practical Solutions, I haven't talked openly about his experience with burnout and how to identify it.We discuss the sixth rigors of burnout and strategies to mitigate it and he gives us an inside perspective on how Corporate Veterinary practice works, that might surprise you and we talk about money and its role in job satisfaction and burnout.
If you are a leader in your team, then this is a must listen and remember whether you know it or not, you are a leader in your team.I want to say that I can guarantee that this conversation will give you some fresh insight.It's into the inner workings of our profession and provide you with my ideas on how it could and should work.
Please enjoy dr.Ivan Zach Ivan.Welcome to the show.Hi, thanks for having me guys.And I would just like to extend a really warm welcome to one of my good friends for many years back from the start of, I'm sure you guys would refer to this app.
It's called like smart smart sheet or smart, something that not just kidding.Let's mop like this, this guy white guy, it's called smart guy.After my God, this is hot guy made smart blood.Yeah, I have a story about this juror.I said to Ivan, when we started organizing the podcast when I bought my first iPad, I said I'd work when I do night shift, this is years ago, I don't know.
When's my first started and I was just going through the App Store, gang war.What cool apps are out there and I found this little thing called smart flow.It was very, very basic but it's just the hospital cash card but I loved it was like this thing is amazing.Raising and played with it a bit and used it.
And then a few years later, it's too that it's the thing.Oh, and I said I want the best thing is I got stuck on something and I emailed supports monthly support and this dude called I haven't emailed back into our support for the first like two and a half years.It was just me, it was sales support and everything else.
The funny thing is that when we went on a App Store just initially when we made the app, there was I think five or 12 something like you It literally count them apps in Veterinary domain.So that's why we, you know, it was so easy.
I know that's how I found you exactly what every vet does when they buy an iPad.They go.What's there for veterinary domain?You know, I remember you talking about your journey into that mind your an emergency veterinarian, right?And and what you said to me, we're not, this is true or not.I'm sure it's true though.
But you know, like where you learn where your business, where you learn more you stop regarding marketing and all your other stuff about trying to create a problem.Later, create a solution.Just everyone's problem was, like, you would drive back and forth to, to practice, like used to listen to business books, and tapes and CDs tapes back then, because you're that old, but maybe seeds, other night, and I was actually the tapes.
But no, but it was funny.I remember because I was the vet right in the in the business.So there's two of us, there was Pavel, who's who's a techie?So he was writing the code and then I had no idea what I supposed to do, I came up with the idea and the end of it was, you know, for me like, go do it for the techie guy.
Yeah.But then it turns out you have to sell it.You have to Market it.You have to all of that stuff that I had no idea about.So then, and that, at some point I was frustrated because I was making money and then my buddy Pavel, he had to move back in with his mom because we did not have money.
So I was making money as a vet and then he was writing the code.And then, at some point, I was burning out again that burned a couple times.Throughout my career and I said, so how, why am I supposed to do Mark?And I have no idea how to do that.So he said, well, how do you think people learn about things?
And I said, I know read a book.He said, yeah, go read a book and I was like you best suit.So anyways, and that's what I ended up doing in this story is.Yes, I took the job, like two and a half hours away from where I lived.And then, it gave me 5 hours a day of dedicated time to, like, start learning this stuff and then, yeah.
And then it kind of old five years later into, you know, I Did do an MBA finally, instead of just the tapes in the car?So is that why you're a big fan of podcast?Where did you discover podcast back then?Because I find that and it means resource.When it on my drive, every conversation I have about anything starts with, I had this sometime podcast somewhere.
Yeah, no I actually like, I decided that this is such a great way to learn listening, so I ended up, I think it was eight years ago.Now, I ended up just Refusing to watch any movies or like any TV.Like, I don't I haven't seen a movie in eight years or listen to the music and I completely replace that with audible books.
So, on Audible, in the Amazon thing podcast was a little bit later.And then they were some blogs, that would know it was actually a podcast.Yeah, there was a Steve blank from The Lean Startup and all that stuff, so he had a podcast.Yeah, so podcast is the thing.
So let's skip ahead.Later.But I want to come back.You already mentioned the word burnout and I want to dig into that but I just want to try and figure out what are you doing now?So I know you were around smart fellow.I know that's the that's the big success story but you no longer associated with that and online.
You don't reach me integration Solutions and trying to get my head around.What exactly that is.What are you doing at the moment?Or what are you working towards?Yeah, so it's, you know, we were kind of pivoting a lot and at the beginning when I was trying to explain what it is, it didn't work.
It's like with any startup.If you doing something straightforward smart, it was easy.It's like replacing cage card with.Yeah, with the iPad, think it was easy, but then when we evolve, we were trying to explain the workflow operating system or so.Anyway, so when smart flu was sold to either X, I joined them, I run their software division for nine months and then I ran away from them because I can't deal with corporate and then When I came out of that, and I was thinking, okay, well, what can I do next?
And it was kind of the accumulation of different areas of Vishnu domain that I encountered.So one was, you know, Ved that the debt level, then multiple practices across the world.This is how I met Gerardo and went to Australia, three times.
I think it was there and learning about all kinds of workflows in the clinics, but then it was interesting at the sort of last, couple years of smart flow, the corporates, or the groups started.To pay attention to this.And then when you start talking to groups, it's a completely different conversation.
So you have, you know, you're selling to vet and I could, you know, I could sell smart, flowing, one conversation to it, because they get it and then you go to corporate and they have no idea.And then, it took me a while.And actually, maybe while I was at i2x is that usually groups have no idea what is required for operations, nor do they care?
Because for the most part it's the it's the sort.Of short-cycle invested money by private equity and then they really need to get a return on investment within three to five years.So therefore they need to buy and sell very quickly.That's the apply pressure, pressure, pressure, pressure, pressure hose, yes.So I heard this the other day that was news to me and I think a lot of people don't get it.
So except for a lot of those kind of those kind of corporates that goal is by itself.It's bioaccumulate and sell in bulk or most.Is that the business strategy?It's not so much.Let's turn this into a thriving.Find functioning long-term business.They might say that, but the reality is there's different, there's different sort of cycles of consolidation, of every industry.
And then in Veterinary right now, it's different in different parts of the world which is very interesting because you can see in your like in the UK and the Netherlands.It's 60% plus Consolidated.I don't know what it is in Australia.I don't know if you guys know the stats, what's the percentage?Not as much as that, but you got some pretty big corporates now in Australia now.
But when The a BJ be there, too, right?Because that was a part of the deal now, but I still think the vast majority is Independence.I would probably think like like 60/40 ish.Okay.And then in so, in North America it's about 20%.
So that makes it very interesting.Sort of isolated experiments in different parts of the world and see what is the agenda of these corporate.So, to answer your question, the value creation plan, for consolidator there's two parts you want is arbitrage, which is basically Buying a bunch of hospitals then resell them on multiple and different.
Multiple ibadah in North America, the clinics are traded right now around 10 ibadah maybe, you know, even five six years ago was six, maybe seven now it's 10 11.But then if you merge 10, 20 maybe 50 practices, then you can resell it at 2022.
We've been out, like, compassion first and big corporates just recently were quiet so on its own.If you can Bunch the Clinic's together and then sort of glue them and duct tape.Them then in like three to five years, when the cycle the money cycle, a lobsters on the private equity and this is why private Equity investment to it because it's a short cycle, as many as you can go land, grab and resell.
Now, when they go to get the money, they give the second part of thesis as well, which is a margin expansion.So, two parts Arbitrage, buy and sell clinics.And the second one is increasingly bitter.Because if you multiply ibadah, if it's the same three years later, then, it's one number.
More.But if you also expand the ibadah by cutting the costs and increasing the top line, then you are multiple and the ibadah that is inside of that, multiple is bigger.So that's more lucrative.The challenge is that most people that run consolidation, they are from, you know, from Finance World.
They don't know how to run the practices, and there's no window to really improve the practices.So they kind of say we're going to make life amazing.And then they buy a bunch and they go.Oh this is too hard.And they just resell them.Why window, being the amount of time, they really need to invest in building culture, you know, implementing processes and whatever may be to try to improve the team's and the quality is always saying white window like the time to into to build as opposed to just the time to flip.
What do you mean by white window?So three to five years, that's the private Equity agenda.So when you're investing money, they have to make a return on investment of the lenders of their investors.Within the window of three to five years, and it has to be within those five years.So they really have to push that and then, you know, business analysts looking around looking for opportunities to invest and then Vishnu medicine.
My favorite new quote, he's immune to covid because it went down in April of last year.I don't know how it was in Australia, and then it's been up since.Yeah, exactly.So it's so it's a very, very hot area to invest money and then So if you have a CEO that you know I'm usually joking that if you're if you've been a janitor in the veterinary hospital and you come in and say I want to consolidate hospital because I worked in it, they'll give you the money because all you need to do is really by the clinics.
And then they also say we're going to improve these clinics but then if you fail at that, The Back-up Plan is just Arbitrage and resell.Seriously, there's a good safety there.So to this is a long answer to what we do.We really took it asked upon ourselves to create a method of G to acquire integrate and improve hospitals.
And we're writing the blueprint as well as creating software that will help to create the entire process.But this is all with the purpose of preserving, the experience that veterinarians and the nurses are going through because there's a lot of burnout triggers that happen during this acquisition process.
So so that's kind of I tied the two together.I rode the dissertation at the end of my MBA last year, it was about applying lean.Geez, to combat the burnout, but we added much more since then.So this brings us back to the burnout study, and I think what a lot of people I want to hear about and I don't want to rehash stuff that's that you've already said before.
There's a great podcast on the written review, find shout out to those guys, nice podcast and they dug quite a bit into the findings of this study so I don't just want to go over the same old ground but I want to make it a bit more personal because you've said that, you've experienced burnout several times.
Let's go back to your early career.So you are an emergency, vet and a Locum was that Right, that's how you started your life as of it and this is how I started my burnout as a vet.So first I wanted to be any are bad and that was my passion.Well, first, I actually wanted to be a radiologist but I'm not smart enough for that.
And then the ER was my passion and I was doing that.But you know as ER vet you can if you're not doing what yard of does within 50 hospitals simultaneously, then you you work sort of we were four on six.
Six off.So it's like a 10-day cycle, which gives you enough time for lifestyle, you know, for all this stuff, you make decent money so you can actually do things with yourself and that was great.But what I ended up doing them like, oh, I have six days off.So I can do some locums ml relief work and I ended up doing four shifts in the ER and then six more in relief work which is not a good recipe at all.
So what did it look like, suppose?What I want to get to is, what defines burnout versus just?I think to do some people wonder.Is it really for me?Should I be doing it?I don't enjoy it.How do you know whether it's that or whether it's genuine burn, our knowing what, you know.
Now, looking at, back at yourself back in those days, what were the characteristics about young Ivan that that, you know, now, yeah, that little dude was burned out So it's really, you know, that it was kind of an overlap of several events, but I think that the, the sort of short version is you stop to care.
Like, I didn't really, I distinctly remember, when the manager I was so fed up with everything.I'm writing these stupid notes, smartphone was part of the answers to it because I was like typing the records at night.I ate, and then you're staying, you know, five hours after the shift and then you totally feel.
Unappreciated because it's not the veterinary medicine, you're just typing, and then nobody reads that stuff.You know?Maybe sometimes they do and that ends up in court and then, you know, it's just like such a pressure and then you feel like you useless task and you become cynical.
You know you push through all of these euthanasias, Christmas is the worst day year and then whenever people, you know, people I had.I think my record was like 12 euthanasias on Christmas day.Yeah.And then and Some point.I started like I try to keep a tally of like, how many, how many animals I've killed?
I had Licensed to Kill live creatures, and I counted on a year 7.I think I was, like, up to 2800, just an average across the, you know, all the shifts that I've done.But the but you become cynical to because you can't cry over every pet.
And then some of these things, you just become callous and all of that stuff.And I remember the manager talking to me and she was trying, you know, she was trying to approach it from HR perspective and she's like, well, it's almost like you haven't don't care.Of course you do.And I turned back and I said, no, I don't.And I remember that like, today was just like, I actually and then I was like, well, I actually do not care.
I want to get out of here as soon as I can, and it doesn't go away.And that's a big difference between the compassion fatigue, and burnout.You know, compassion fatigue, is like you become that cows and kind of less empathetic.I would say.But then you go home and you forget about that stuff.Burner doesn't leave.Here you go home with it and it doesn't matter how many vacations you take.
You just hate what you do and that's sort of, you know, it's a pretty dark.Nice to be and bind it up.I remember I flip that someone on the plane it was a person sitting next to me and they were somehow it led to the fact that I'm a vet and then she's like, oh my God, you know, I always wanted to be a vet since I was six like every person's story right?
It's like a lie person that wants to be a vet and then she's like how is it is it lovely to be a vet?I was like, you know what?No and I just pour it in here.I was just like look everybody who sees you hates you, they were sitting at home, having a beer watching TV their dog starts.Puking.They're like, no, I need to see a vet now, it's a lot of money than they come in.
Then you tell them what they've done because they fed Pizza to their dog and his having pancreatitis.But then they hate you because it's, you know, 2,500 bucks to admit that to the hospital.Then they tell you, it's all about money.It's not you don't like animals and that.So it's just you and I totally just poured.
It at this lady, she was like, oh my God, this guy's a psycho.But yeah, when you get to that point it's no fun.Like you don't want to do that.There's a lot of it's at that point where I'm Sydney been there and you go Uganda social media websites and that's that's a very pervasive feeling when and again, that's what your research, proved, I think part of your research was to show.
Do we think we burnt that out or are we generally burnt out and you can't go to show?Yes, there's a high rate of burnout and red.Yeah, yeah.And you know, because I want well, it was a part of dissertation.I wanted first to prove that there's, you know, the industry is burned down and then if yes, then what Do we do about it, right?
That that was sort of the thesis because when someone commits suicide, it's, you know, it's bad, and it's loud and, you know, things like that happen, but I thought it was like a shark attack, you know?Yeah, it's big news but not actually, it doesn't actually happen that often and then know that's are burned out.
So it is, you know, the survey proven that.So, just a quick Interruption to remind you about our clinical series of podcasts, if you're struggling to find time to stay up-to-date with what's new, what's best for Your patients and you want tips and tools to make you a better clinician.
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Super cast dot Tech.Now, back to Ivan, I just had a conversation with our bet manager about feds and burnout and one of the things that I take on as a responsibility as a hospital director is not creating Pathways as early as possible and support systems as well as possible from try to facilitate new grads into emergency and set them up for success as opposed to like come as an emergency intern and will speak to out the other end as a broken veterinarian with gray hairs and and you know you look like you know, here is the mobile no has gray has no hair is like Ivan or you look like you're 30 years old like you but but so I'm actually 60 man.
I just he's really good and so Deputy good.So I would knowing what you know now and I appreciate that.The research was not necessary to provide all the answers, you're not now a the guru the article as Ivan you should have a little help column ask.
I haven't had this world my brain but if you had to, if you could go back to Young Ivan again and and tell him how to do things differently to prevent that burnout.Is there anything that you could have done differently?So I this is the whole point of view is and I like where Gerardo went with, this is, is basically, I don't think it's on the veterinarian's.
I mean, we are who we are, and then this is a new generation.Now, this new generation of vets and just humans, they're not going to keep their job for lifelong careers like lawyers doctors vets, it's like, people change Fields very fast.I think it's on us as an industry to make changes.
And there's this is why I talk about, you know, very classic.It's like late 70s.I think Mass like Define six triggers of burnout and if you can work against those as the organization, whether you're, you know, single Hospital, several hospitals, or the consolidators then, I think we have a good chance of extending the experience and preserving the experience of veterinarians.
And I can go over those as this good time now, so six, and I can dive into those from the angle off consolidation, and why, I think that consolidation is support Of having the tools to deal with that.But also you can apply it at the level of, you know, six hospitals, One hospital.
But six triggers are so lack of control.So if people don't feel autonomy at work, that's one of the drivers and most people think that it's a lot of work which it's one of them, there's six triggers so lack of control at what you do value conflict.
If your personal values don't align with the values of the organization, they're not necessarily wrong.It there's just different.So when you hire people in the They need to align with what you believe in and you need to explain them to people, then insufficient reward.
So if people underpaid or taken for granted.So back to my feeling of, you know, nobody appreciates me writing records.That's that's one of those.You could be paid well, but then feel taken for granted really work overload.So if you work too much, so don't, you know, don't do emergency shifts and then relief work six days after that and then go back and then unfairness So if in the organization there's a feeling of favoritism and there's no sort of equal rights to everybody and breakdown of the community.
So there's no feedback system.So if you don't have a strategy or a framework and you don't deliberately teach people how to give feedback and you don't have one-on-ones regularly, every 90 days, and you just don't give that opportunity and then no conflict resolution strategies.
So that's the six, the six.Horseman of the Apocalypse.I was seven.Exactly.I wrote done, seven, man, who got a good control.Naughty conflict.Underpaid work overload, and unfairness, here, nervous breakdown.
And then, using the last one, which was so break down, all the community has kind of two components of the classically.Described one is lack of feedback loop.And the second one in that category is the no conflict resolution.So I think that any management and the reason why we go into consolidation is because we could you know, I could become a big burnout Guru and go out and give lectures and podcasts on this thing but it's going to influence One hospital at a time.
I think that we have a better chances industry and this is the lucky moment we have consolidation.There is now organizations that have 30 50 100 thousand hospitals.So now you can reach because I researched this in the last two years in the human hospitals.And they you know, I Research lean, we apply way more than lean, but the way they could apply Lena's, because one organization in Boston, General Hospital is it.
There's thousands of people working there, and it's a big hierarchical structure.So you can deploy one methodology onto organization with that hospitals.There's small brick and mortar with your big.You're up to maybe 100 people, but it's 20 people.So if you go one at a time, it's almost like selling smart, folks, One hospital at times.
So I think that having now consolidation, They have the instruments to influence and and for the most part, you know, some people say, well, do they care?Because they want to just flip the hospitals.And this is where the moment in time is very important right now because the biggest problem that consolidators have they acquire hospital with the, you know, to producers that pushy, Bedell, the 18% and then you can accelerate that if you implement, you know, certain Top Line, bottom line you know strategies you improve efficiency, vendor management, you know, marketing.
Okay and then these two producers will push he bit off from 18, maybe 222 maybe to 25% but if along the acquisition process, one of them goes, screw it.I don't want to work here anymore.You lose everything you lose that producer, not the percentage that they produce.
So right now consolidators starting to pay very close attention.How do we retain the workforce?Because globally, there's more pets than vets that can supply.So there's demand is higher than Supply.So now consolidated A more looking into how do we preserve this experience.
So they sort of unit that produces value for our investors is actually happy working and producing value.So I think that now if they will work against these triggers, see if they preserve the experience, then they will therefore execute on their value creation plan and then the Vets are happy and the consolidators are happy.
So I think this is the happy formula.You said lean a few times.While I was it something is drive from together or something while.Back or something, like how would you explain the lean methodology?So so lean comes for, you're right.
It comes from Toyota, from many manufacture.So to apply lean in veterinary medicine.You make a drive-through window where you push the dog into the first window and it goes, I'm just kidding.So I thought that was real deep fried.
You're right.So it comes from Toyota and there's a real cool guy that I met.He's like the father of leaning in healthcare, he's name is John Tucson and this is the guy who inspired me actually to greet the is as well as the dissertation.So they created an organization called catalysis then, Appleton Wisconsin, small town.
I've been there, got the bed bugs in the hotel but true story was a horrible.I've never had bedbugs and it was live for a week, explain that to your wife when you come back home, So, anyway, so he created an organization called catalysis.
So he was an internal medicine specialist and then he was a CEO of Wisconsin, medical organization, and he wanted to change something, he wanted to implement efficiencies.And then we unite people behind something new, so he to clean from different Industries and wanted to apply to Medicine.
It kind of work for the first year or two, and then it broke down.People kind of followed the process and then they felt, you know, If they didn't, they didn't follow.So he was questioned himself.He said why such a great system that works in manufacture doesn't work in healthcare and then he changed lean a little bit and he created six principles of lean, which a couple of them are taken from lean manufacturer, but the most important ones were well, starting with the purpose that's very important.
So one of the principles, its Unity around the purpose.If you create the process, that's great in have any process you want in any organization?But if people don't join You because of the reason why you are doing this so Unity around the purpose, it was one of those principles and respect for people that do the work.
Because a lot of people think about leanest, like, okay, eliminating waste and, you know, limiting people firing people.It's not about that the most important thing and lean for healthcare is is Unity around the purpose.It is a continuous Improvement.It's flexible, regiment is not rigid, but the most important respect for people.
So I've been in San Francisco, General Hospital, we visited.The the executive team runs lean there, and everything they do is transparent, everything they do is visual, everybody can walk up to CEOs, whiteboard and see what they're doing today.They visit the hospital, they go around and they check with people once a week, which is called gemba.
They, you know, they're present where the work is actually happening.So it's a, it's an entire methodology and there's, you know, it's great, but we kind of added more to it.We had attraction, you know, traction Davis, and then if you still use that.Yeah.And I, we are heavily embedded in traction.That's actually the thing that's actually made a successful to be honest.
Yeah, yep.Yeah.So traction is a huge part of what we actually do.So we mixed lean traction that I also became over the last year certified in safe.So safe is a completely different, feeling it's in technology.So safe is scaled agile framework.And I've been just amazed with it basically Amazon AT&T went through the transformation using safe and it's it was initially focused on the tech industry, just like lean was focused on manufacturer, but I looked at it.
And it's a sort of a 3/4 layer organizational structure from Team to program level to portfolio.So we mimic that onto consolidation and said, okay, how can we run better, quarterly planning?How do we have winter interdependencies between the initiatives in the organization at home?
The metrics Cascade up and down.So we mix 34 methodologies together and then we kind of put them against the burnout triggers and that's the VIS methodology that we arrived to and now we're having Stammers and there's consolidators that are embracing.
Its oh wow, that's awesome.I love.That was always over speaks me, mate.That's how I feel.I am the, the, the quiet co-host via the humble, your The Humble one, right?He said, I'd invite you to stuff and then forget to actually invite with never mind as a rules tools.
One of the moment night, I was going to say, it's got bedbugs Way, I love that on so many levels but I just want to make sure I understand it.So you are saying there's burnout, it's not necessarily the Vets fault, we can train with in resilience and personal growth and all that as much as we want.
But if their work environment, doesn't lend itself to a better work environment.It's not going to work, which I really like, I was part of a meeting about exactly these same topics recently.And and And everybody had to come with their what they think that they made pain points are.
And I said, I feel sometimes like we are even at University level.There's a lot of talk about, you know, making the Vets better equipped to face the work environment and I hadn't deserve this vision of like, back in the first world war, we had the trenches and you can train those soldiers as well as you want, but you send them over the edge and they run into the machine gun fire.
They just going to get my own down.It doesn't matter how well-trained there and I feel like, Have some sometimes.So you saying, let's change the business has to be a better place to work in.And the way to achieve that is by consolidation and is that because it I was a business owner for about seven years.
And I think I get it because you, you know, there's all these things you need to do as a small solo business owner.I'm not stupid.I know what I'd love to do for the team and I need to get better as a leader, but there's only so much you can do and only so much money you have as a single individual business owner.
So I you Guys, working towards saying that the answer is having a centralized better organized system that can run in the, in the correct way.Is that?Is that basically it?Yeah.So so this is where I would want to kind of revert back to the six triggers and just explain my vision from the consolidation point of view.
So if we're talking about the lack of control, think about the veterinarian, who sells the hospital to consolidator, that's exactly what happens.And then in your mind, you're basically, you're selling your business that you've build you.Getting paid and rewarded and you continue working in this business as an employee.
You know, it's awesome.You don't have any more concerns and your continued psychologically.What happens is that the person loses all power and then this was a community event that had the clients that was a leader and then one day he comes or she back to the hospital.Says hi team.
I love you all, we're family, I just sold you and then they don't have control.So what consolidators do a lot of the times they will say, we're not going to change anything.There's this agenda right now at East in North America, we going to buy you and change nothing.So then that believes in that and they comes back, you know, to the team and says, look don't worry, I'm selling the hospital because as I'm close to retirement but they promise that I'm going to change anything then a year later.
They come in and say we're going to change Pimm's.We're going to change lab equipment, we're going to change medications that you use and we're going to change your benefits and then everybody looks up to the vet and says hey you said nothing will be changed and he can't do anything, she can't do anything so you have complete lack of control and I think that if You have a consolidation that is a walks, the walk.
So when they say they are going to change anything, don't change anything or say, you're going to change things because you can improve business without changing anything.That's the purpose of consolidation to improve things and change, but say it and then the same thing about the incentivisation of the person.So don't, you know, don't acquire hundred percent, maybe, you know, acquire some portion of it and there are Consolers that do that right now, 30 40 %, the leave behind, so the person is all still empowered.
And then also incentivized to continue being a leader.So that's one of those things value conflict.Almost none of consolidators are doing the purposeful culture, fit assessment, because when you're buying, think about like pathway, the about 250 hospitals in the US within three years and I think they assessed the culture of what was going on there, and it doesn't mean that everybody who you buy has to fit the culture, but if they don't you To articulate what your culture is, and it doesn't, it has to be, not the writing on the wall, we have these core values, and jarden, you're falling.
Traction is the methodology behind it.You need to, you need to practice what you speak.So if you have those 57 core values, you explain them during acquisition to the entire team.And then if some people don't fit with that, and they feel internally that they can't work in this organization, that's okay.
They can find another place to work, but at least they know that there's misalignment of core values and explain that if we are misaligned, Then you can burn out and then just articulate and say, this is one of the triggers, make sure that these fit with your internal me, you know?So then the third one and sufficient reward, not that corporate.
Sometimes paying more after the acquisition, they never pay less.But the other thing is that people might have had some promises from a previous owner and if those were not transition into the new ownership than maybe I worked there for 20 years and I was promised this whatever that is, but then people don't do this.
Diligence.And then another thing is that right now, when you require practice, you implement, most of them Implement new Inventory management system, new marketing and someone has to do it.So someone like a hospital manager or another nurse or someone gets new extra things to do without necessarily being rewarded for it.
So there's your insufficient reward work, overload comes with it unfairness.Again, if you were promised something by the previous owner, he sold the practice, I don't care.And then there's unfairness and how their career Rest.And then the feedback and the conflict resolution just something that needs to be taught.
And it's not that hard, you can put it into learning management system and deployed across 250 hospitals.It's not that hard, but you work against six triggers and I think that's, you know, that's sort of short pieces of what we do is we more to it.But I think that's, I truly believe, that's the path.
So so that that sounds like the the the teachings were, you know, what you're talking about.There is kind of angled towards The veterinarian who is going to sell or the veterinarian.He's thinking that's going to start to, you know, consolidate and so forth.
But what would, how would you change your advice?What would you say to a veterinarian who is about to be, you know, sold like whose practice is about to be sold to a corporate and they are feeling like I don't know that.I have two questions.One is what would you say to a veterinarian?
Who's about to be sold to a corporate, right?Like like they are working with In the practice and to what would you say to a veterinarian who feels burnout?What should they do?And they're not the owner, they don't they're not the owner.So so the important things would be to look at what are the values of organization asked for their thesis.
What did they show as a presentation?So, I constantly now we work with consolidators and we have private Equity reaching out.We have consulted as reaching out my first question to them.Send your investment deck, your investment deck that you show to your private Equity or your present.Action deck that you show to the seller.
And then in there, just try to parse it and understand what are the core values?They usually talk about them.Do they practice them and practice them again, going back to traction.Okay, your core values.How do you deliver that to the clinic that you're about to acquire?Do you have the cultural meeting to you go through these and, you know, in traction, it's you hire fire and review people using those.
We do that all the time.In every organization I worked in the last, you know, seven years.So, how do you practice Practice, that mask that.And then, what is your purpose?And this is, this is the most common thing right now.So in North America, the shift is happening from Arbitrage, only towards caring about the Vets, but I feel that right now, they started talking about caring about the Vets.
They didn't necessarily start caring about the vets and the very easy question to ask them.So there's, you know, we start with control and ago.We all about people, we're all about helping veterinarians.We all about, you know, From their lives.What are you doing?How do you measure that?
How do you measure that?What is Your Balanced scorecard?At the top of the organization that you look at weekly on your level 10, meeting that determines, how your people are happy with you.So I guess this is like it.What is your in PS4?Your visual staff members?
Yeah, yeah.So just running PS quarterly and then ask your employees how much you would recommend that for your family member to work here.That's one and two to bring their pets.Here, very simple.And then do you look at that at the top of the organization?Not only at your, you know, revenue ibadah and cogs and labor costs.
But do you look really at the top?We are from 80s.We stopped looking at finances only in the big corporations, the balanced scorecard consists of money, customer satisfaction employee satisfaction and growth opportunities, which any hospitals look at money.
So so split your vision and then into the balanced scorecard.Measure it.And then when you go to the by the clinic, say this is how we are looking after our veterinarians, we measure their success.Their, you know, their burnout use the, I use the pfic professional fulfillment and x16 questions to determine if the person is burned down or not run that every three months just ask them survey use Survey Monkey.
That's it.Well it was obvious.It was actually hey you know but the other question would be We talked about what the three questions you ask yourself, like would you recommend your family to send their pets?Your clinic?Yep.
The other question was, was your other question?Would you recommend your family member to work here?Like your brother or your father, actually in?That's true.That's right.Yeah.And the one thing I would say about that question is that when I think about some of my family members and friends, I was like, they couldn't handle emergency.
I wouldn't recommend the work here.Right.But then the question is a tricky one?Because it's kind of like have we set the environment enough?That if they loved it so much, that anyone who wanted to work, it could thrive in it and that's really super freaking hard, especially in emergency.
Yeah, but I'm just thinking about our listeners, who are not business owners who are not selling businesses, who are vets in practice, who are listening to To what you said earlier about what burnout looked like for you and then going.Yeah.
I, that's me.I feel like that.Is there any advice for those guys for what they have a bit of a loss of that power?They don't have much control over the situation at all.What's the advice there?Yeah, so if I just want to bookmark that and there's very important thing that I want to add to the associates that work with you.
Okay, in most Mas, I'm going through a mini course, right now, and in most mma's, when the CEO is really a decision The executives, right?But as soon as the decision is made to do an MA a lot of the time, CEOs would talk to their management team and say, are you guys with me?
You know, there's, they're trying to get it by in how to vets announced the sale of the practice.You just say I just sold it.I just told you all of you guys, they never go back to their Associates and say, look, I'm planning to sell this practice.The ownership will change.
How would you behave in that scenario?Because what if the you know, you're selling for vet practices?Otis.And then as soon as you sell a flip, and three of them, leave everything that you were gonna gain after the sale is not going to go away.So I think that may be announcing to everybody is it's a big deal, but and you don't do that.
I'm going through cases right now like US Airline selling to American Airlines and, you know, IBM selling to Lenovo, they don't announce the entire organization, but the management teams are getting the buying and they're deciding what's going to happen after.So, why don't we do that in veterinary medicine?
So I think The associate point of view, the sellers should circulate that idea, especially if you're incentivize post-acquisition to still generate value for yourself as well as the corporate, make sure that you have buy-in from people that work for you, maybe they will just flip and say I'm leaving.
That's just, I just wanted to add that.This is where you stay on for two years to keep on generating revenue.And if you continue to generate the certain amount of profit, then you will get this amount of what a turn or something like that.Well, that's the seller.So you incentivize this seller to.
There could be a there's a lot of mechanism there could be a or an out.There could be a you just keep your percentage.You could roll your Equity into the parent organization but a lot most of the times it's centered around the seller, not the associates.
So Associates are really hard people and if drought If you hired me you know I like you I want to work for you and then two months later I didn't know that you were planning to sell the practice and you needed a body to fill in the night shift and I'm like, Gerardo, you're screwing me.You just left your One on your yacht, you know, and then I'm going to be working here.
And then I have a new boss.What I'm looking for a job.I'm looking for someone that I will work for and I haven't to be with that person.Not someone who you sold me to, that's important.I'm sure that's how you gonna do it.Yeah, so so then back to your question who bird.
So in terms of the burnout, I mean I this is, I'm truly not, you know, I learned a lot about it.I'm not this psychologist a psychiatrist, you know, to give suggestions so I don't want to be prescriptive about anything I say.I just think that to me, I had to leave, I had to stop practicing and it's, you can like if you'll say to someone who is working, you know, has two kids and wants to work seven days a week, 24 hours because he's buying a new house and all this.
The last thing that he will or she listened to your recommendation is to stop working, but if someone is on the path, I almost feel like it's irreversible unless you completely disconnect, I was forced medically to do that.And then that was I believe the only time in my life that I actually dedicate to my psychological State, like I had to go through mindfulness practices spirituality, a lot of things just to discover like a lot of things that I would never go.
Like, oh, I need to learn how to meditate.I would never think about that stuff, but I was medically forced to do that and then I don't know what to suggest to the vets that are burning out.But the main thing, I think, again, back to your common, Gerardo on, ER, vets those who manage the, our van, It's and those that understand the burnout.
You just can't allow them to work seven days a week, just just say you can't, I'm not going to pay you for it, whatever it is because they will burn out.And some of them will commit.Suicide were the only profession profession that is that close to the drugs that will kill us, you know, you can burn out in any other industry.
But the in vets is just we see it every day and it's very close to reach out for that drug.It turbine definitely is in Australia, is a shift towards having a locked up.It's too Let's have it.I have access to where it's locked up but there's a mighty or Mighty shift towards supporting vets who are going through burnout.
You are going through tough times because we are acutely aware of the risks associated with stress burnout and everything that we do in been professionally.Yeah.Well, you know, it's supposed to be locked up in North America to but usually the key from the safe is on the nail next to the same.
And so, So because you needed, you know, every other appointment so you know, the people are most affected by it Veterinary.It's and you have access to the site for veterinarians is like it's really kind of hard to stop so exactly.So yeah.So it's really not it's you know I saw this bridge in Toronto and they have this bridge, she's close to downtown that actually people used to jump off a lot so they build this whole thing around it preventing but it's you know it's let's let's work on not how to prevent them from jumping off the bridge but They do that.
That's really the key.I think it in the six triggers, you talked about remuneration about money, a couple of times Can-Can, a decent salary.Make you more immune or can it prevent burnout?
I don't know how to put that.Does it does it help or not?Really.Now it's, it's well, it's, you know, it's like you're someone who is burning out from work overload, disconnected.Core values.He lack of control and everything else.Let's start paying them more the payment.
So this is actually my new thing that I'm applying within our organization and it's pretty deep.If you guys want to record this this is but it's actually interesting.I think that money is driving only first two levels of the Maslow's pyramid and hierarchy.
Yeah, so so you goes basic, needs safety, then sense of belonging.Then you go to the next one.Where you?Steam and accomplishment and then creativity, right?So that's the hierarchy.So, I believe, especially with the new generations gen Z and Gen Y.
They Millennials, is that the first two is, of course, and that's the money.So, of course, you need to be paid.Of course, you need to have decent pay and of course, you don't want to compare yourself to someone else in a different clinic.So, basically, I think that money question is of course, and that's how we do it in our.
So I read an awesome book.If anything I could recommend here is rules Up no rules.It's about the Netflix culture and they have this culture where they don't do reviews and raises.Basically, if you find if you were recruited, if someone calls you and says, hey do you want to come work for us?
Then they directly come to their boss and say I was just ping, you know, from another hospital, they offer me that much more money.They just match it.Just go.Okay, we'll just match it.No questions asked.They actually encourage their staff to work to people, to talk to recruiters.So they match the pace.
We're doing the same in our company, if they find it.Somewhere else we just go here, that's your pain.So that eliminates actually quarterly necessity or annual resusci T to increase the pay because if now you're a top, even though you're working 20 years here, we can't continue raising your pay because the market cap is there.
So that's what we do.So that's the first two level.So your basic needs and safety.Then when you want to build the sense of belonging and love love is, you know, only some people at work Creed that relationship, but the belonging is that the organization that you created the core values, and then that's how you build that community.
So I think that the third level of Maslow's hierarchy is really that sense of belonging you create the community team family, feeling whatever it is.You can create that at work and then for specifically for Gerardo because he's a Gen Y and Millennial.The rapid goal achievement is one of the characteristics of Our Generation narcissistic entitlement and the All achievement, those are the three for Millennials.
So the quarterly goals and I don't know, invent hospitals, it's hard to set quarterly goals other than the money but you need to be creative.Learn a new skill, do something different, you know, take this course.That next step of the Maslow's hierarchy is accomplishment, and a steam could be achieved through quarterly goal-setting.
They don't have to be renew, marinated money is, of course, belonging then goal setting.And if you rapidly achieve those goals in your appreciated for that, At and you're recognized for that, then you become creative and happy at work at the top of the pyramid and that's how I actually run the organization where, which we're in right now.
You said so many things that made incredible since then and highlighted to me because like we were like with Simon sinek spoke about why.And then you know, you got to take money off the table, all that kind of stuff, right?If my CEO came to me and said, I'm going to give you a money and do this.
I would be like, I'd feel stressed and I would feel like as if I wouldn't be able to perform and I wouldn't be able to complete the pain that I've evolved my own position and my own role within the company to demonstrate value.But every time I do that, I do know that I then release some kind of responsibility around that.
So for him to go, yeah, yeah, he is 50% extra to be able to take this on extra.I'll be like, no, I think we're we get stuck and I'll just say it and leave it at that, is that, that second level of the Triangle that comparison thing where a lot of its feel like they feel undervalued compared to other professionals to go.
Well I'm getting yeah.Fifty eighty thousand dollars less than my friend who studied for three years less and they and I know that because again, that's out on the socials, I see conversations about it all the time.People feel undervalued and it comes does, it's not about the money, but the money gives you that feeling that I'm not actually valued as a professional.
Okay, okay, this is my take.Is it Business owner, as a veterinarian, Your Role has three or four functions.One is this of the pit to is to serve the business?3 is Serve Yourself and then the fourth is a serve your team.And you just have to understand that it's you, if you're in there in the consultation room, when you say, when you speak, when you deliver, when you talk about estimates, we talk about money, it's not just about you, it's about everyone else in the whole entire team and When when you understand that and you value yourself so that what they're doing is they can potentially comparing themselves to people of of other professions and all the stuff, but they still haven't haven't shifted.
Their perspective of value of themselves and gotten over the how they perceive money in the value that they bring in all that kind of stuff.And I've heard it so many times and I've listened to so many consoles and And especially in this world, where locums are paid so much more than the veterinarians who were there and offering value, when it comes down to the locums you like you're sure you might have the power but you have to still demonstrate the value to the business, you still have to demonstrate value to the team, you sought to demonstrate value to the the pets and their owners.
So as a veterinarian, I claim would be your my my hope would be that That you look at it from the perspective as how can I improve myself, so that I am improving.Everything else not just myself or advocating for just myself, I'll let you know, I think I think your rights but I don't know if Hobart you meant the comparison to the locums of or more.
No, no 23 other Professor proficiency, so you have that, not the, not the logo of it.You have your hard-working employed way to looks at his sister's celery and she's like, yeah, I think, you know, I don't know if I ever felt under pay because I'm not a human Doctor, I don't know if actually compared myself to that to me is that it's a different profession.
So you know, I may be paid less than CEO.I don't know Microsoft, but I'm not doing that.So I think it's within the.So this practice that we really Embrace from rules of no rules at Netflix.It's really when you compare yourself to somewhere else just make sure that their organizations matches that and then that's really the rule and it's been actually a really great experience because when we read it in We were like, oh we negotiate it celery with someone cheaper than in another place.
Well that will go only for so long before they find out how much they could be paid there.So why don't you match that?And then these people will not think about the money.They will be just not a question that they need to worry about and then they will perform at maximum because they know the now they are paid maximum for what they do.
And then the goal setting should be matching the rapid sort of, because I think that the Visionary, it's becomes routine and become sort of an everyday thing.And I went to emergency For novelty.But then after you know, five years while you've had all the spleens out that you wanted to hear you had all the, you know, hit by cars and you saved enough call as if you're in Australia.
But you know, it's is never enough of that.I'm just saying that that I really like, I don't know if we can do that because you know if we can match, but I think in the ER and I think it's I think it's something to look at.I definitely do that in my organization because we had it personally.
Leave and then because we were like, okay, well, that's, yeah, he's underpaid under Market, let's set the goal for the guy to reach the market and the guy left before he reached that, although he loved the organization and everything because he was focused on completely different thing, he was not focused on the money.So to me, match the pay of what you're qualified for is of course don't be happy that you negotiated with the vet or whichever organization.
You're in to pay them less than someone would pay in another organization because that will last only so long and back to the question, can you motivate by paying More.Yes for like a month because you lifestyle matches what you make, you know.And then at that point and and actually through my burnout experience, I went into a deep hole financially and then you just match your level where you at, you know, I was successful as the, ER, vet and the Locum.
And then I dropped significantly.I went to almost bankrupt and, and basically, that's the lifestyle that I had to match.So, it goes both ways down or up, you know, you go up to your new celery and it's the usual thing you have.Now have this type of Car.Now you go to these vacations and it's Norm.
So you can continuously accelerate that and try to use that as a motivator has to be more than that.It has to be an object assignment.Same thing.Why starts with Y?Something you heard recently from a good mate of mine?He said something the other day that really resonated with me.
I just want to share this because it made me really think about myself and it was like, are you a you a veterinarian of ten years experience but doing the same 10 years every year ever after year, or you a 10 year experience veterinarian, where every year you built upon your experience and someone will value a veterinarian who build upon their experience year after year after year as opposed to someone who felt like as if just because I've been a veterinarian for 10 years and Done the same stuff every year after year and I can't do anything more right.
There is a completely different value there.And I don't know where that fits in with this conversation, but it's something resonated with me and made me, re-evaluate my value, and my worth and, and what am I worth as a dollar per hour.What am I worth is a Locum?
What am I worth of this?Is what can I bring to the practice if I can still do the same?Am I doing more than I could do as a graduate to three years out, if I can't then maybe I'm not worth the 10 years.That I think I'm with ya now.
I, yeah, I think it fits with the one of the findings of my research was that the younger vets are more burned out that to the older ones.So 30 and under we're more burned-out than Baby Boomers and such and I think that what you just said really fits the generational qualities that we have now.
I can do one thing for 10 years.I mean or 10 is probably the cap.I can't go back to do vet, maybe because I burn out couple times doing it, but I used my vet thing to build a IT company.I used my IT company to switch into business.
I switch that to building something else because this rapid goal achievement, that's what it is, but set the new goal set the new goal and always look forward when you're close to this goal because 10 years.After when we go to vet school, it's hard.That's Cole is one of the hardest, I heard between the human medicine law school.
And then the amount of grit that we use to push through vet school, then you start working.It's a day-to-day thing.And then if you're not challenged anymore in your scene, okay, in the first 35 years, you've seen every case you wanted to see, there's no more, there's no more, you know, anything you achieved, so setting in Gold.
It's it's super important to be setting personal goals, and they can't be monitored.They could be monetary but associated I'm with the experience.That's a separate topic too.Like personal goal, setting and achievement, but it's something also important in the career.
Not only is vegetarian.But as anybody else the Korea, any Curry Island.I'm done, I'm done.Let's rev it up.That was spectacular.You talking about so many Fantastic things where can people go and find out more about what you're doing at the moment.So specifically on well, actually on all of these topics.
So, both burnout and the Consolidated methodology, go to vet Integrations.com and then browse through, we have blog posts, we have a new podcast there and we have the whole study actually also published there with the There's a tool where you can Flex the metrics and look up things through the survey that we've done so you can actually play with it and kind of slice the data the way you want.
Yeah.So that would be the best thing but you can also reach me if you can spell my last name and find me on LinkedIn.Yeah, it's definitely not Zack and go listen to listen to the podcasts, this these two days, consolidate that, and I've drawn a blank on the name of the other one, which I actually really enjoy a veteran Innovation podcast.
Thank you so much for joining us.Thank you for your time.I know you.But the world to go and Conquer, but I appreciate you spending this time with us.Thanks.Thanks guys.Get to see you again Jared.Oh thanks.Scotty didn't say Hubert I really meant it right?Okay.
You know, those conversations that you have at conferences, back in the day, when we still had big bed conferences and people are chatting to the lectures and asking questions, and you hear things like this isn't really in the books.But here's what I think it's in those kinds of conversations that the best nuggets of wisdom appear, the nitty-gritty of real-life details that you can only get from here is and years of experience.
And it's exactly those kinds of conversations that we try to emulate on the vent valve, the clinical podcast we don't want later.As we want to hear about the challenges, the tips, the stuff UPS there.This is how I do it.Go to VV n dot supercars.
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Dr Ivan Zakharenkov