Jan. 6, 2022

#59: Culture. With Drs Dave Nicol and Dermot McInerney

#59: Culture. With Drs Dave Nicol and Dermot McInerney
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Season 1

Culture. It can be hard to put your finger on it, yet in the setting of a vet practice, it permeates the work areas, floats into reception and beyond and ricochets off the walls. You can feel it when you walk in the door. Long ago I sat in the reception area waiting for my interview at a practice where I ended up spending many years of life.  I distinctly remember sitting there and thinking: "I don’t like the feel of this place." It took me more than a decade to figure out that what I felt that day was a broken culture. 

So what do we do about it? That's the question we ask of our guests for this episode. We're joined by Dr Dave Nicol - author, speaker, coach, doctor, practice owner, head vet, podcaster, and founder of VetX International and his teammate Dr Dermot McInerney. Dermot serves as the VetX International Head of Veterinary Partnerships and Research, and is the main author of the VetX research article "Leadership actions and their effects on veterinary practice culture", and it's this article and the concepts around it that we got together to discuss. Dave and Dermot answer important questions, like the current crisis that the vet profession finds itself in, the role bad culture in this crisis, what toxic workplace behaviour looks like, how leaders can help create thriving workplace cultures, and why you don't have to a 'leader' to influence culture. 

 

Go to thevetvault.com for show notes and to check out our guests’ favourite books, podcasts and everything else we talk about in the show.

If you want to lift your clinical game, go to vvn.supercast.com for a free 2-week trial of our short and sharp high-value clinical podcasts. And if you join up for an annual all-in subscription before 18 January 2022 we'll send you a free MiniVet Guide to help you start your year in top form.

We love to hear from you. If you have a question for us or you’d like to give us some feedback please leave us a voice message by going to our episode page on the anchor app and hitting the record button, via email at thevetvaultpodcast@gmail.com, or just catch up with us on Instagram. 

And if you like what you heard then please share the love by clicking on the share button wherever you’re listening and sending a link to someone who you know will enjoy listening.

 

 

First of all, how do you say your surname?Damn it.I can only is it sir.Damn it.No, no, I've got a Terry of what's written on our team notice boards here.And it's been a running joke.That's the question.
Everyone's like, how do you say damn?Its name right?And and so it's written.It's Mac and are Ernie like a muppet.So something like this.Should we say, Welcome to the Real World.They've Cole and Dermot and Mac Ed Journey.
I'm Gerardo Pollard.I'm you became chat and this is the Vapor Rub.A profession in crisis.How often have you heard that in the last few years?
Here's something else.I heard recently never waste a good crisis now unless you've had your head buried in the sand, you know, that our guest for today is not someone to waste a good crisis dr.Dave Nicole author speaker coach, dr.
Practice earn ahead, read podcaster and founder of Medics International finally joins us on the vet fault and if you have Had your head in the sand and you don't know what Dave and his team does head to www.vitac.com international.com.
That's X like, X-Men not ex-husband where anyone interested in learning more about the sort of stuff that we talk about.In this episode can find leadership resources, including articles, studies podcasts and training courses.Also, joining us is one of Dave's teammates, dr.
Dermot mcinerney, Dermot serves as the vet X International head of Veterinary Partnerships and research It is the main author of the vet ex research article leadership actions and their effects on Veterinary practice culture and it's this paper that we got together to talk about.
Culture.It's hard to put your finger on it but in the setting of a vet practice it permeates the work areas flows into reception and Beyond and ricochets off the walls.You can feel it when you walk in the door a long time ago I sat in the waiting room waiting for my interview at a practice where I ended up spending many of my years as I said they're waiting I distinctly remember thinking I don't like the feel of this place.
It took me more than a decade to figure out that what I felt that day was a broken culture.You know what I'm talking about, right?So what do we do about it?Start by listening to this podcast, this is an episode like so many others that we've done that.
I wish I'd listened to 10 or maybe 15 years ago.But who's it for?It's definitely for anyone who owns or managers of it.Practice required, listening, I'd say it.Remember whether you're officially one of the practice leaders or not, as you live from this episode, anyone can be a leader especially when it comes to culture but I'll stop rambling and leave it to Dave and damn it.
But before I let you go, you know that I'm going to remind you about our subscriber exclusive series of clinical podcasts.Go to vvn.N dot super cars.com to get the details about what I believe is the most useful ongoing.Clinical learning out there in small is medicine surgery and ECC useful because you'll use it and because you use it you'll learn stuff and get more confident in your knowledge before you know it you'll be that vet in the clinic you know the one the one with all the cool insights and was totally up to date with what's new and what the cool kids in Wetland are doing with their patients.
And if you listening to this In the first half of January 2020, to we have a bonus for you.If you join us for an annual subscription on the all in package, we're going to gift you the most up-to-date mini wait, kind, which I think is the perfect companion to the right ventricle.
You got all the thinking and tips and protocols and explanations in your ear holes, and then you've got all the doses and the flow diagrams and the crib notes in your pocket.Get your free trial before January 18 at VV n dot.Super cars.com And if you sign up the mini vet guide is yours.
Now back to Dave and damn it and culture really use that intro issue.You can't change them out right away.Let's skip the welcomes it.So we're talking while we're getting together tonight.
Getting serious conversation about one of the biggest problems facing the red line.Okay, so we're going to get to it again, will we?Yeah you go go Schubert, this Dragon Gets serious David.You've been going around to practices talking about how you help people Dave.
You talk to vets all around the world.Before we talk about our topic tonight, which is culture, is it phrase that we hearing all the time?Now they took profession is in a crisis.Are we in a crisis?Oh yeah.Yeah.I think we're way past crisis.
I honestly think we're in something of a death spiral.A minute, we don't sort ourselves out and, you know, we started out.I think people have been calling it a recruitment crisis, and it's just like this, not a recruitment crisis and existential crisis.We can't have the number of people, the shrinkage in our professional populations at the same time as expansion and pet population and increases in practice practices opening.
NG and not see this as a gigantic problem.That's only going to stretch resources.Even thinner, there's not a practice in the US.For example, isn't running of are too short, you know, the average time to hiring is around about a year and a massive, massive number of vacancies remain unfilled and that wasn't wasn't like our Market was in really awesome shape for a lot of practices beforehand.
So this is, we can't blame the pandemic for this.That the pandemic, like it has been for so many other This has been like an accelerant on things that are already happening.And yeah, it's I think we do have a big problem that we need to get to grips with very quickly but there isn't a sudden, quick solution unfortunately.
So DD think that I suppose added as a profession, we were at the cast be if not over the cusp and then you like a Don 10% workload, 15% workload all around and that if we were a profession that Was prepared or I don't know, like had capacity then we could have consumed and and tackle that but but because it makes me think that a now just thinking about it, right?
20%, yeah, Don 20% all the sudden professionals collapses and it collapses, but starts to really struggle and can't can't get on top and feel like they're just not treating water but sinking, you know, I don't know.How did, how did we get to that or why couldn't we cope with the 20% more?
No and then I think a number varies as well, you know, initially it's funny looking at the data from my own, my own sources and looking the data from the US and avma Australia, Australia is a little different again, you know, I think, I think there was a certain noticeable rise, everyone screamed about it because it felt like inaudible rise, but a lot of the data suggests that it's actually just a huge drop-off in efficiency, particularly in the US.
Hmm.Because curbside became Such a thing.And you know, what might have been, you know, a 20 or 30 minute process, suddenly became this drawn out.Thing, with enormous opportunity, nor Miss opportunity for balls to get drops.If you think about the number one causes of complaints that you guys will be doing, with, in your practices, will be communication errors.
Like everyone says, oh, it's all about the money.This never is this communication of value.You just give me something here about something that's really a pain point, right?So when you re iterate over and over again about the doll, It comes across as the dollar is the emphasis on early, right?
And, and, you know, so we're wearing masks, we're socially distant or curbside.So we're reducing the number of communication tools, we've got available and a group of, you know, in a cohort of individuals professionals that aren't actually that good at communication.
The first place, they were really good at passing the exams.We're really good at problem-solving like figuring out puzzles.We're pretty damn good at clinical.Stuff as well, but we're not really that hot at communication, emotional intelligence, building Rapport.And that's an area that particularly, if you look at people who've been in the profession, for a couple of decades, you think, man.
Like they just have clients eating at the palm of their hand.They're so good at that report and communication because you have to be to survive in a service industry for very long.You look at graduates, no, super smart.I mean, just scare the bejesus out of me with how intelligent they are.
But also super scary.How lacking in airs and Graces.Sometimes they are with with other human beings and how quickly stressed that the our graduates become that and and the airs and Graces go out the window at that point to the clients are left with this sort of bad taste in our mouths and clients have become the enemy.
So I think that was happening in any case, put in some social distancing measures and a less effective, communication flow, where You're either communicating via telemedicine like because we're doing an interview now on the other side of the world, that's fantastic.
That's mind-blowing, we cool.But if we were doing an interview in person, how much more subtle cues with their be, how much more, how much richness would there be to the communication?If we were not speaking through this tiny little screen here and the answer is massive.
So we've lost all of that in an incredibly intimate moment.In the exam room in the consultation process, Which puts a lot of pressure, it opens up the gaps, for communication to fail and that increases stress and also everyone's level of certainty is just, you know, you guys have had it a bit easier, but of course, the show.
Like, I was gone through a pretty rough patch recently because it was kind of playing catch-up with vaccines and had to sort of successfully isolated to a degree.But how do you isolate against you know, all the Quran like that you can't defend against Omicron like that's coming together as all, you know.
Like however, mild or whatever it is, but you it causes disruption, it causes uncertainty.And all of those things have created a bit of a Tinderbox for, you know, an emotional struggle.And I think that's probably what we've got more than anything event.
In medicine is, we've got, we've got systemic things.We've got to deal with in terms of how we're burning people out, but a lot of burnout is emotional not physical.As, you know, the physical circumstances lead to the emotional You know, pressure and eventual porno.
So I think our system just wasn't well setup and it was never very efficient.Just it was go back to Australia was an increase of bit numbers.Like the u.s. like they didn't seen increased from what I understand like you numbers overall, is it right?
Or is what's a UK like?Yeah.Okay, so that's I think there's there's questionable.I think all of this is a wee bit questionable.It felt like it was a big increase to everybody said there.Again crease.So everyone believed there was a big increase then the avma did some work and they said, well actually there isn't really that big and increase the shelters aren't, you know, shelters emptied filled up again, people go back to work, you know, they're so actually they weren't seeing an awful lot of an increased like was being anecdotally reported.
And I think everyone's a little surprised by that, but it's very incomplete data because they don't they don't really track their own, how many puppies are getting bread.And I mean, The puppies are going into clinics and things like that.They were tracking it from shelter medicine, where they do get reliable data.And they said, actually, we're not seeing that bigger change and pet population.
So I think if the data is incomplete at best, I can say, from the practice there, I've looked at, we certainly did see an increase in pet ownership, but it was, it was more around the 5% in the UK and that that not that's a number, I've heard 45 percent from from contacts within bigger bigger, corporate, And isolations as well.
But that will only pertains to puppies as much as anything like that seemed to be puppies.That seemed to be the popular thing to to get sorry.Kittens done.Don't know why that's not what I mean, they probably do.But that's that's what was remark to pain.The truth is, I haven't seen anything that looks like super compelling to it one way or the other anecdotally.
My clients in Australia.Seem to report the biggest numbers from their price management, software's and that's, I've heard 20%.From Australia as well. 20% seems to be around there.The numbers that everyone's been discussing.So yeah, but that may be a convenient number everybody settled on as well.
So you know, it's hard to know what the reality is.What certainly true is, we had an inefficient system and it didn't take a lot to tip.It doesn't take a lot to tipping in efficiencies think about homeostasis in the body.It's tiny moves out of normal for acid base in your About Scrooge are right?
So it's, I think our systems not as resilient as we maybe thought it was so many problems but this got to be Solutions now.Oh yeah, and one of the problems with this whole situation you have this increased stress or even if it's perceived stress and then you have people dropping from the profession.
So what you can't have is a workplace that does not try and prevent that that's less than ideal workplace, because let's face it, I've been in this game, 20 years, I've worked, and some less than ideal workplaces.And the keyword, we want to get to you in this conversation is culture.
That's one of the things that you can influence.If you stressed, other clients are more stressed and you're not communicating well and things are going bad shape.And then you working in a culture that doesn't make you feel like it's home.Boom, then you're going to be gone.So let's turn this to culture.
So let's let's before we talk about your studies and the findings, guys, and all the fact, it's philosophize a little bit first.What, what do you how do you Find culture what is culture to you?Dave, I'm going to focus on you again, damn, it will come to you, but what is culture?Yeah, damn it, there, it's sterile good Endowment for the numbers that says study.
So I'm not going to crash his number study, there for sure, but cut, okay.I love I love this question because when we talk about, there's a number of things that we reasons behind wanting to do this study and and we wanted to tackle some of the opacity that exist.
Around terms, like culture and leadership in general there.Other kind of buckets into, which, a lot of stuff is chucked and talked about, but you ask 10 different, people have to Define these things, you'll get 10 different answers.So what are some useful definitions?We can put around it.
And so, I think, I think culture for me is the summation of the behaviors that play out between a group of people, the become the accepted Norm, So it's really where, you know, where one person does something that is either good or bad.
That's a behavior that can be a problem person.That can be toxic individual for that thing becomes the group.It's adopted as the group Norm group behavior, that becomes the culture.And so I like this definition because it, it offers us, some something empowering about the fact that if it's about Behavior, And behavioral flows from values that really gives us some useful tools As Leaders to be able to go actually culture can be really really intentional.
The problem is without a form definition or a useful, working definition, it's a question like horsell, what do we do to influence culture as leaders?And I think Beyond set in Your Vision, I think influencing culture is the second most important job of the leader.
Seeing a culture and sitting core values and things is, you know, knowledge is a part of be like business 101, you know, setting values is helpful.But then how do you tackle, how do you tackle getting rid of people who are in alignment with culture, when you don't have staff?
Right?So, and this is, this is this is the thing, that's, I think this was always the issue.Number one, you said something there, which is, it seems obvious when you know it and when you know what to do, like setting Vision selling culture is business 101.
But for example, we know from the study, we did that, that 45 percent almost of practices, have no articulated vision.So ever.And and the study we did, by the way, was from to management conferences, on two different continents.
So these are people who are interested in leadership and management.These are the people at the top end of the spectrum, like 45 percent of them had no vision.And I'm willing to bet that the other 55% are very large percentage of those had something they'd written down in a bit paper, sat in a drawer box, ticked and was not a useful Vision.
It was a hallucination as much as anything.So I think I think that's job.That is job.One is to actually articulate this.I think the I think you have to, you have to be so careful about who you let in the doors of your organization because it does take one rotten apple to spoil.
The whole cart.That is absolutely true.You can have a great culture, you know, we're probably all done it, had a great culture.We made one by a tire and you're like, oh crap.This is just now didn't make everybody bad, but the vibe just changed.And you know, you've got to With that, and if it's a values thing, good luck changing someone's values.
Like, that's, that's just somebody who's I don't have a nice.Aunt, I've got an answer for you.I just don't have a nice answer.Palatable answer.Yes, for you.And I want to do with people like that.But I'll tell you what, if you don't deal with that individual or those people, you are not going to attract people for very long into your interior ongoing thing in your employer.
Brand is going to be mesh.So it this is all a long-term play.For intentional building of teams around of a set of values which are articulated you higher against you, you know, you train people, you set, expectations.
You don't just write down here, we value honesty, you you, right?Well, what does that mean?In our organization and you maybe come up with three things.We're honest about the skills and the services we can deliver we're honest and transparent about our pricing.We're honest when we screw something up and we own it you know.
Okay.So maybe there's three The cultural standards we can now measure performance with, and then we can get intentional, okay?So you define the values again, you see the visions of y'all know what we're looking for and aiming towards the values, which will help us get there and align us as a team.
It's like a guiding compass and then the new articulate exactly what these values look like in reality what they look like in practice, right?It's not a boring honesty, courage, and whatever, you know, like and contribution to each other, right?
It's like This is what it looks like.Exactly.Exactly.And it's hard and, you know, you mentioned like, you know, you write down 20 values.And that's, that's cool.You know, there's just hundreds of values and getting people to align, and when I first started doing this, I had 13 values.
And I can tell you that made recruitment really hard.That's gang.Another human being who shares her I've struggled, and struggled thinking of the four that I picked for myself, right?So, so we have six like, oh, oh, My business is like, what are the six that we are non-negotiables for us and what do they mean?
And then we figure that shit out as a team.We articulate rewrite it and that's our culture code like and and they become principals to make decisions and we can say, well, okay, if they're armed, it wants to try something out.And as part of his role, he wants to do some survey on this.
And one of our values is innovation, then as long as they stay accountable to the values, it doesn't really need to feel like he has to defend.I'm self or Justify himself.It will almost by definition be the right decision.Even if it goes wrong because he's lived a value.And I think for us when we placed such a high value on culture, we have to say, look, number one articulate values, right?
The behavioral standards so that they can become virtues because that's what value is when it's lived, it's a virtue and that's when virtues are played out real time.That becomes the culture and it takes time but when you do it, people start working much more.Harmoniously, I know the stories of how much fun it is to work in your place.
Come out.So, you know, you can go through cultural wobbles.But if you've got the courage to address those wobbles and then articulate, what good looks like.Number one, people can fall in line behind that, because now they've got Clarity and most people have never been told what's expected of them.
Hey, what do we do here?Veterinary medicine.We show up at 9:00.We go home at like whenever and we do it till the cases run out which is never, or we fall over in a heap, which Is frequently and we're just doing veterinary medicine, doing family medicine.And, and how do we do it?Well, whatever way works.
And so, you end up with a culture of personality and that gets pretty toxic, as everybody has their own insecurities and all this stuff gets played out in real time and then you have a hot mess a dumpster fire and that's why we've got problems retaining.That's why we're it's emotional stress of working, in locations, like that without support and the structural issues of like way too much.
For for, especially for the younger generation as they're learning and they need space to grow into their skill set.That's what the the root cause of why we're really struggling.Now, let's swing to yoga is reset to the role of leadership, obviously, planning the values and hiring the right people.
But are they what are the other things?How does the leadership team affect the culture?Obviously a lot, but how, and what specifically did you find?Some things do matter.Let's bring this to you.You guys did the study.What's your study called?I've got it written down, your leadership actions and their effect on the veterinary practice culture.
So are they key standard findings that we need to know about?Yeah I think so.I think we found some stuff that's useful to talk about.I suppose the we're obviously at these conferences and wanted to talk to the leaders about their practice.And the thing that I find digging into figures, there's loads of evidence in other branches of work.
So if you look at like human nursing, for example, and sort of cultural that comes in in that as a profession, there's loads of research done.You know, how culture affects things, like patient outcomes and We Know Better workplace culture improves in The Human Side of medicine, you get better culture outcomes from better workplace, cultures, and they've also done studies where they've implemented cultural changes toolkits within nursing Ward's to see whether or not they make a difference and generally across the board, they do, and they make an inference.
But it's something that whenever I started looking at the rectory, although we talk about culture a lot and how that affects everyone within the practice and the work, We do, there's not a huge amount of evidence behind so we really decided we would go myself and Dave sat down one after dinner with.
So we go to these conferences and dig into cultural little bit more and ask just ask the leaders through about four different factors and see whether or not they influence cops are very much through but we as you sort of touched on as over to our do is you do you have a clearly articulated vision for your practice in place?
Do you have the time to lead your team?Effectively?Are you comfortable and confident in addressing staff behavior that doesn't fit with your culture, sort of a described as an appropriate and how do you find hiring people?Can you get people into your clinic to work there?
And I'd all four of the factors that we looked at had a positive effect on workplace culture if you could do them well.So if you had a Clear Vision in place for your practice, you scored your culture higher if you had time, To work on leadership, work and work, bogged down in Technical and administrative things, your culture, tended, to be better.
If you were able to hire effectively, then your cost him through better.And the biggest one, and the one that had the biggest impact alone on the cultural score given was, you know, are you able to deal with toxic and inappropriate staff behavior?And that's the biggest one we that we find.
So we asked them to school.It was very simple score, squirt out of 10.So Hi, supported.You feel that your culture is and if you weren't able to deal with behavioral issues on average is called as a six-point 2010.If you could deal with behavior issues, it was a 7.5.
So you're talking over a ten percent increase in your cultural score just by looking at one factor, but I think the each four of them has an influence on its own.But what was really interesting for me.And I think probably the most interesting from the study was when you looked at them combined.So you looked at the group of people who had all of the four factors in place in their practice and the poop.
People who had none of the four because the school was distinctly different.So if you had, if you had time, if you had a vision, if you could deal with behavior and you can hire staff infecting on average, your cultural score was an 8 out of 10.It's quite intentional thing.You're working on a lot of leadership work and I think anyone would be relatively happy with me out of 10 on a coaster score when people had no time, no vision couldn't feel or didn't feel comfortable dealing with that behavior and couldn't hire that.
Ops 2 5 .3 10.And I don't think anyone would be happy one with if it was your practice and it was a 5.3 or 10 or going to work in there or if you work there.If you felt that your cultural school was almost, you know, half of what it should be.Yeah, makes sense, doesn't it you've listed for like that?
It sounds so nice and simple.So yeah, I can do that.Yeah.Devil is in the details.Yeah, let's start at number four with the toxic behaviors.They stand out.Toxic behaviors it again.That's a really that's a buzzword it's a popular world word and especially in our profession all this toxic behaviors.
Toxic this is my workplace is toxic.What does the toxic workplace look like Well, this is the many-headed beasts so there's there's I think a lot of the toxicity comes from deep-rooted insecurities agendas the pileup competition stress, just emotional meltdown moments.
I think I think a lot of where we come from is very high IQ individuals and I'm fingering that serious the principal people behind the toxic Behavior.But that's a little unfair.Everybody is capable of not being their best selves, but when we don't have Clear Vision and clear values, then, you know, values Drive our behaviors, you know, circumstances show up, they come into clasher or they hit our values and we interpret the circumstances insert ways, then certain behaviors follow as a result of that.
And I think the root cause you can look at humanity and say, humanity, is this hey, guilty, piggle T squishy.Hard to manage, very complicated.Uncertain thing that's never going to be easy.
Very, very hard and I would say almost impossible to manage.If your default position is, let's just see how it pans out.I think we know that there's going to regress to mean in that mean, it's going to be tribalism and you know, infighting and agendas and and that's Humanity.
There's there's there's Not going to change that as a mess.So I think what we've got to do is create our tribe, our own, something very very tangible from the outset and that means effectively you know, to heart back to olden times like getting your sigil your standard and you know creating it.
So it's very very clear and then boom banging in the ground of choice and saying this is us, this is what we stand for.This is the set of expectations, we have for our team.For individuals for we do this with standards of care of you, right?
Like, we're actually actually we don't even do it.Standards of care.Well, because we don't like to have these conversations and vets.Can't even can't even decide.What is best practice.Even though we've now got evidence-based medicine, we still have our own foibles and ego and things like that and it's always been thus in veterinary medicine or human medicine.
So that's the area where we've had the best stab at it, but we bring people in, we give them a day of on.Induction training.If there are lucky, we toss them into the environment of practice and we let them get on with it and if and they bring all of their own you know all we all bring baggage to the table and some of us are more effective at managing that than other.
So this high IQ individual called the veterinarian, often brings quite low EQ and we get in conflict and conflict should be a healthy thing.But most often it isn't Because it becomes much more about, I have to be right, rather than I have to get it right.
And that's that right.There is one of the most important things like we have to, it's almost becomes a never-ending competition.Like if I'm challenged, then it's important for me to be right writer in this moment and it's like, no, I it's much more important.We get it, right?And if you're being challenged, if you're being offered feedback, for example is just a great example, if you offer a veterinarian feedback, you know, the emotional intelligent good for your career, good for your personal development thing to do, is to accept the feedback even if it was offered clumsily, because we're not very good at it, and then reflect on it, consider it within the circumstances and put it to use in somewhere.
You don't always have to agree with it.You're allowed to your like to have an opinion on that feedback back, but if you're offered feedback and good feedback is is often database.So this is kind of objective the animal left animal dies there.You don't come, there was a less than awesome outcome.
Let's talk about that.The shouldn't be fear of character assassination involved in that but the way the feedback is offered is often brisk or it's about, it's not about the behavior or the circumstance or the outcome, it becomes about the person and we saw internalized being veterinarians that an attack on our clinical skills becomes an attack on us.
And the two things are not the same but that that requires an emotional intelligence to Have that position, which is not easy to acquire.It's a combination of the the the feedback not being objective.It's subjective.And the person is giving it has emotion and story behind it.
And potentially I'm with drama and not enough.Fact enough, clearly black-and-white fact, this was the situation.This was the behavior that you exhibited.This is the impact that it had.That impacted me personally.Yes, brother than impact, the circumstance and being perfectionists all around but Marion's hate having feedback.
Despite the fact that everyone says, yes, feedback is amazing.And I'll take feedback every day.It's absolute bullshit.There's no bigger liar in veterinary medicine.And yeah, I love feedback.I reckon one punch of this ain't all right.I think I've seen at least a couple dozen red to like I take feedback.
Please give me feedback well and not none of us like it because it is a critique of sorts.But, but we've gotten our head.I wish we'd stop using the terms negative and positive feedback.There is only feedback.It's just information.It's the story.You Has the word story, perfect.It's the story.
It's that it's the labeling the storytelling and it's the emotional or, you know, baggage that comes with what that means, what does that mean?It just means I'm receiving information that if I do the right thing with this can improve my game, can improve my circumstances.And listen, I'm not immune to this.
I don't like receiving feedback.I get neurotic.I got, I asked him for food back there.It's going to be like, your do you?He'll like not enough, right?But, and I don't, I don't like, To hear it but I've trained myself to set my hands and go absorb it.Let the emotional impact of that go and then listen to the lesson behind it because actually that be that would be useful.
And if I could give you one of the best examples of feedback and this is when I lived and worked in Australia, and there was a seventeen seventeen year olds, she was she joined the practice as I searched not even a trainee nurse, like almost our volunteer level at that point.
And And you know, she'd been a client at the practice.I'll shout it out.Galen you're a superhuman being love you to bits.Thank you for this Moment by the way, which she already knows, but I had not been my best self as a leader, we were having a tough day and things were not going well, and I pulled the team together and I basically give everyone a bit of a verbal and, and something had happened.
And it wasn't really fair the trigger for, it wasn't fair at the circumstances, we needed to up her game.The tool I picked up to try and, you know, Go get that to happen.Wasn't the right to own the right moment and they were I will Dad it wasn't fair.And and you know, when that happens, like the team's heads go down there, not like, you know, the engagement drops off and everyone knows they've done wrong, it's like the puppy.
That's had its nose rubbed in poop and knows this done wrong.It just doesn't know why I.So it's not effective feedback.No kahlan.She's 17.She's does not have an official position in the practice.But she approaches me and asked me if she can text share something with me.
Her boss over of a practice.And she shares with me the it impact that that what I just done has had on a couple of people and she shows me her concern about what that's done to the fabric, the culture, the relationships, and that she's got concerned about that.And I was like, you know, my initial response was, I wanted to Smite everyone down my righteous anger, right?
But luckily I have some emotional intelligence and and I thought Jesus Christ the seventeen-year-old, he's not an employee cares.Enough about this team and has the courage to come and approach the owner of the practice to offer that feedback.
Like that is a special individual right there and, and it was and Give me enough of and, you know, curiosity I say is one of my secret weapons or superpowers.I was able to move from being angry to go on our ship.What I need to do to fix this, because that's dead on.
That's right.I was able to make the call apologize.It didn't delegitimize the issue we had to deal with, but the way I dealt with it, did did delegitimize.The, you know, it took us all the way from the issue and it became about the relationships and that was wrong.So it was a matter of apologizing, you know, you know, Kissing and making up inverted commas and and just not getting back together.
The threads of the practice.Because caring is a leader, really, really matters and your.You must hold your team's accountable but carrying matters every bit as much as accountability and and that's what Galen did for me.In that moment is one of the most powerful lessons I ever received as a leader.
And from that moment onward, I was like, right.I need you at the back of every meeting and she was like an emotional robber.I was just look at her and sometimes she'd be like she be like give me the thumbs up.Got no no your good and other times she'd be like waving her hands.Don't like no no.Back it off back and it was so funny.
And I value that that input that relationship so much but it was it was hard to initially here because we get emotionally triggered and we all have our triggers.So if that can be somebody and I consider myself a decent leader, Jeez.
Like when you've not had any training and awareness of it, you can see how it just explodes and it's a, it's challenging, but feedbacks, just feedback.We gotta learn to absorb it.You said two words, they about her that I really like care.
She cared enough to speak up and she had the courage to speak up.Those are tough things to come by.Sometimes it can probably comes back to one of the four things isn't.It is hiring the right people.Now, before we had this conversation, Dorado, and I were talking about the problem that we have as Vitamin E, leaders is often You got to find these people.
These people with high EQ and with care enough when they must be courageous and curious and all this, all see words or good see words and you're gonna find them.But then we've got this shortage, we can't find people.
So why do you do then?You're in this conundrum, where you have to work with what you've got because there's not like a hundred people sitting at the door saying, well, we better, we I'm more emotionally intelligent than that guy.Who's just reacted to your Feedback in a very negative way.Can you teach this?
Can you teach it to people?Yeah.No you hundred percent can, you know, emotional intelligence is, is a skill.It's much more malleable learnable buildable than IQ.And and I suppose, we must look at this.Like I'm not sure if we go looking for and I do is one of the things we do in our recruitment process.
As we will, we will test.But particular positions, really, really need it.Like like Option team members highly emotionally.Intelligent reception team members are so valuable because they can manage that, you know, they've got a hardest job in the practice other than maybe the practice manager, who everybody hates a lot of the time.
But the, but the club, you know, the clients can be really great or really awful depending on how you work with the clients.So I think that's a role as an example, it's important, but there's no roll, wouldn't benefit from it problem is it's not an abundant Supply.It is a skill.
I think we need to be thinking of this, in the same way as we think about clinical skills.You know, we don't necessarily have to look for people who are super high in emotional intelligence, nice, if you can find it, but good luck, finding a whole team full of that, but we should be focusing time and training on building skills of EQ and having conversations and, and teaching.
How do we the most important thing is, how do we address our trigger moments?So that when we are we are triggered Be go back to our basest of instincts, we can avoid that and divert the storm away.Your divert that the flood water away from the city during the appropriate Channel.
And we are still have a relationship basis, a basis of trust, which to address the issue because we mustn't Dodge around the issues.And this is where conflict connects to be a really healthy trust-building thing.You know, it galen's example, serves as how we should all approach this.Like we don't have to fire toxic people.
Not all toxic people are genuinely horrible.Toxic If people they've just not being shown.What is the expectation?So, if we do we care and have courage just like going when we're addressing in offering feedback, we are caring and having courage to have those conversations scaling modeled to me exactly how all of us can address the toxic behavior in our team's Dermot.
Can I have a word?I want to talk about this thing.Here's why I want to talk about it.Here's the thing.Let's talk about what different thing might be.That could be really great for all of us.Hear that.When you put it like that, it's not that scary.Advance to me when you said that toxic people, when I look at and I have shared This Way El Senor Veterinary team in Veterinary, leadership teams, the people that are on the leadership teams about a good 75 percent of them are the ones that were a painter freaking ass for years.
Yep.And it was like there were times when I was like, oh my God, you are so toxic.It's gonna fire you right now, right.Can't buy you right now because we've got a HR department and they make Everything relating to firing people impossible but then they go through a phase.
Yeah.And they come out the other end and they're like, oh well, I don't know.I listen to a podcast.Someone told me that I was like being a little brat.And yeah, so like so for me, I see the value in people when they go through this journey alone because in a way, the not necessarily toxic, but they kind of like stand up for something, but they haven't really learned how to express.
A voice in the right way.They haven't yet learned how to harness the implements that they generate in an effective manner to have effective impact and change.So, I always feel like as if that it's my responsibility or irresponsible use of leadership teams to find the influential people, the ones who, you know, kind of toxic at the start and then shift guide have tough discussions and what it may be.
But I did, you not?There are times when there were toxic people in our business from like the side that the hard one to manage is very often.They care and they have the courage, they care.They take care.That's exactly.
They have the courage to be a pain in your ass.Yes, exactly.Right.So, I like that, I like this.This is something that we can work with here.We need something that's a definition of toxic and what's not?Because I think some of the behavior you're describing is unchanged.
Annulled unbridled enthusiasm passion but it's not yet found its home, it's not your phone its direction and at that passion when there's when it comes out, that's Inflict and and people are garnering conflict was again, such a pain in the bum.Okay, that's I think.
Toxicity is where your, I think there are things that are is asking ourselves.A question, is this thing an assault on our culture and what we're trying to achieve here, and there's behaviors that are passionate and undone on either uncoordinated Bunch annulled or inappropriate.
And I would Gerardo, I would put myself Percent in that category, I must have been in a gigantic pain in the ass for every boss I work for and I'm doubtedly, I would have considered firing me.No, but it's just no question in my head because I was not, you know, I didn't Thursday as them to burn energy to burn.
Great fun.Absolutely.And you allowed?I'm sure he spoke up all the time.Such a pain in the arse and I'm left with values on my sleeve.But But always wanted was very loyal and committed to the practices.
I worked for anything.I did was because I wanted it to succeed there's such a difference between that and people who gossip for example like gossip to me is one of the most cardinal sins in the assault on a culture.An attack on the values is always, you know, there's a difference conflict.
Caring being passionate isn't an attack on values, it's maybe not in this core group of Ali's.One has or the practice has but it's just something that's being expressed and and that combined with the lack of emotional intelligence can can show up as a pain.
Now that that person that person is going to turn into the the user, the me's or whoever of Tomorrow, given the right Channel and given the right support, given the right experiences and that's probably our job as Leaders is to funnel and Bridal or direct or steer that energy in a way that that person can Factual eyes and become really useful and that may not be within our practice.
But man, if you can be a good part in that person's Journey, like I love talking about the practices I worked for when I was a graduate because they help me there.I don't consider every where I worked was an important part of making me who I am today.The good experience is the bad experiences.
It's all part of it.We don't get to change it.I'm not going to speak ill of it.That can be a valuable tool but toxic.Where people gossip toxic, when people attack toxic, where people start rounding up other people to believe that they believe in make their subculture that is a problem.
Okay, that's it.Like I think the nail in the coffin there, which is the subculture, this kind of group, within group.Yes, the group that sabotages the group, but the people who are standing up, you want to make a change.Yeah.Who want to step up and to make a difference?
Reference and then they kind of cut them down underneath and, and so forth.Yes, exactly.Those are the people that again, they have their own agenda, if you've articulated what the vision is and where you want them to be, you may get them to move your direction a little bit.
But but if the leopard spots keep showing up and they're not the right spots for your culture, then it's time to have the conversation the come-to-jesus moment where you're like, listen, it's time to make a decision, you're either part of this.So you're not Your choice.But what's happening now?
Cannot continue because if as a leader, if we allow that toxic Behavior to continue as Dermot said, our culture will degrade.We will look as Leaders like we are not that we're not powerful, that's not the right word but that we're not effective as leaders and Trust, in leadership from the whole team will degrade, because other people will be suffering from these effects of culture, and nobody wants to work in a toxic culture.
Some people are unaware of their contribution to culture.Some people are very aware and if they're very aware and not aligned with culture, that's a problem.Those guys to me have to go mmm, your point of we're scared to do it because how will we find replacements?
It's a, it's a were often like high performing high energy Rio who want to like boom.Boom, make a difference, right?So they were often really engage with the team.They're often reading Engaged with the clients and they, you know, they make the business money because they work hard, they work fast and they kind of connected, we good job, right?
So, there we go.There's there's a brilliant cultural Clash.We've got on one hand, I value perhaps it says we care.And then, on the other hand, we've got somebody who makes money, who blatantly abuses, We Care value, which was we make loads of money and actually, are our values and we care value is, we need to make money and we value our down time, that's okay to Valley.
You don't think if you like get rid of this person, you're going to have to work more to cover them.But isn't it?Coming from a mindset scarcity to say, I'll never find somebody who could be a better fit culturally A who we could grow into that role and do that.Or what about the other team members your operating?
2025 I've seen team members offering 50% capacity because they just can't work with a toxic person and they hate coming to work, who suddenly flourish.When that person is replaced, you know, it's a fear-based thing that we hold onto them, but it's also an expression of an actual deep value.
Our values are not in alignment with what we're saying, of our culture.We tolerate those people everybody sees It.And now everybody gets to call bullshit on your culture and now we don't have an employer brand, that's why we can't hire.People flip it around.Do the brave thing.
Take the pain short term, but tell your story as you go and you won't have problems hiring people.I got a question here.Okay, so you took your employer brand.Okay.So when you saying this person has a toxic influence on your culture and then if you don't get rid of them, it's going to impact your employer brand.
Is it because that the people because maybe 50 60 percent of the of the times people who come and work with you come because of someone else that's already been there.That is said, things about the practice and so forth that these these potential advocates Your business, these potential advocates for recruitment, don't want to speak up because of the fact that, you know, your brains, not out there but your Advocates aren't out there either.
Just on the like, we're looking at the numbers that we've been sort of studying within this like, we were looking at recruitment, you know, practices that have more, it looks and practices that are more effective, recruitment policies have better cultures but you could flip that right around and say well actually the practice it's the same.
The same number as the practices of better cultures actually have an easier time recruiting people into their practice and although there's a recruitment crisis going on when we talk to these practice leaders.There's, you know, four out of ten of the practices responded and said they had no issue with recruitment at all.
And there must be a reason for that so that, you know, six out of ten have trouble and that makes sense because it's widely reported.But actually, you know, just under half of these practices, don't have an issue as it is.And I think have the workplace Ensure that you have and the reputation that that builds for having, you know, for being a nice place to work for, you know, being a practice that you can, you know, get enjoyment and fulfillment of your job.
In must make the recruitment side of it easier and I imagine it's and it's a little of both.If you're a good and effective recruitment processes in place so that you can attract the right people, you'll have more staff and be better start and be better able to cope with the work that you're doing and that makes sense.
But also if you've got a good culture and everyone who works with That tells us everyone.They know about how much they enjoy where they worked.That's fine to me bringing people into the pets easier as well.You know, that the two are linked and there's probably no way to separate them completely.There's a whole like other our own employer brand, reading it because it's such a fascinating space.
Let's go party ran a cube.It's like a Magic ink on that topic.At any point, Dave of damage, if you've got to go let me know and we'll start wrapping up but we can literally go forever and all of This stuff.Have you got time for a quick left turn?Yeah, damn, it.
While you're talking I want to jump completely to the number two on the list time.If you have time, you can we dig deeper on that door first of all, just findings wise, how what did you guys find out about that?Yes.Um, some details on that.I mean I think I think time is often sort of the the elephant in the room when it comes to the ship stuff.
I spent most of my time every day talking to people who own the Run faxes or manages FedEx and everybody has a Time issue.But you know, nobody has the time that they want or they visit, they have enough time to do all of these ship stuff that they want to do.
And when we looked at time in general, it was the number one thing that people report as being the barrier to effective leadership and management.Particularly when you learn to practice owners, three-quarters of the best known as we looked at didn't have time to be to lead their team effectively, which means you've got three quarters of the most influential people who can build culture and just influence the practice in general, don't have enough time to do the work and I think that's something we find generally.
Just speaking to anyone with a leadership position, it's really quite unusual, profession in many ways that people, you know, the leaders In the practice aren't solely leaders, and lot of them feel of enormous clinical and administrative or role as well.I think that plays a part in the development culture, to, you know, it's bound to trickle down and influence everyone in the practice as well.
Yeah.And I we often we often Elevate people because they're high producers, but then they're not necessarily leaders, right?But if we give them tools and training but also the time because they do get caught between I'm a hybrid.
Ooh, sir.And you you're like like business owners almost expect these hybrid uses to keep them producing at the same level.While somehow a try, try to increase in Elevate the production of other people as well, and Performance Management.So unfair.Oh yeah, talk about certain people up to fail.
It's, it's a shock but we're also at we're addicted to clinical work as that it's like it's the way we Define our success as so.Imagine you spent 20 years to find in your success as a clinician.By the number of animals, you fixed the quality of your medicine, the amount of daily revenue, you generate and now you're given this completely different ballgame.
But nobody's actually sat down and told you the effect of impact value of that.And I think when we were talking to leaders about this, we ask people to think and rank the things they do in their day and attach the value.So, what's a ten-dollar, an R-value task, which a hundred dollar value, it's 1,000 10,000 100,000 Dollar an hour value and the higher up the leadership tree.
You go the higher that dollar value per hour, potential can be like what's the dollar value of creating Vision that's got to be in a hundred thousand dollar an hour work.What's the dollar value around building out your recruitment process?For sure that's in ten thousand dollar an hour work, what's clinical stuff, it's in thousand dollar in our work.
Roughly speaking or hundred if you're doing consults but but you see an immediate return on that time investment.Feel so good as well, isn't it?Because because the other stuff you talked about I've even find it with my work and not even clinical work, the nuts and bolts started job, finish it, wrap it up, stuff, feel so important and it feels so good because you get it done.
When it's something like let's great the vision for where I practice feels feel so Theory land, doesn't feel that worthwhile.This is said, it's very hard.It absolutely doesn't exactly so we don't so we don't invest in it or we investors a lesser amount of time than it deserves and having culture where it look with the thing.
That's breaking the whole freaking industry right now, culture or / culture.I mean there's just Amicus issues as well.It's not all culture but its massive Parts culture and we're not able to find time to put this other thing down.We have a reflex to clinical work.
That is it's almost like the The, the the desire to breathe when you're underwater running out of breath, it's so overwhelming to vets.And it's so damaging that that's one of the first things that we work on breaking with, with leaders.Is you have to let go, you have to let go and as soon as you took a leadership role, your primary responsibility, stop being Animal Care.
And we need some kind of Hippocratic Oath that leaders.Take that says my primary, my soul regard is for the well-being welfare of my team's of my ER, and if we took that with the same level of responsibility and the same level of commitment, then we would create the space to learn to grow to.
There's no problem with vets learning these skills.These are just skills, leaders are created, they're not, they're born freaking awesome.It's a skill set, you can learn it, whether it's emotional intelligence, delegation feedback, Vision, creation there, just bloody skills.So fast can do this but we are we are we are we are reflex Lee prioritizing thousand dollar in our work and leaving aside because we don't recognize it and we don't see the immediate dotted join.
You know the joined up link between this effort here and that reward or going to go over there.Yeah and that's hard, that's how that's a hard sell guys but it's true.It's gotten kind of worse.Rolls back to the same question which is like what do you do when you have a toxic person that you want to give it up?
But you have no team members to recruit.It's the short-term pain over the long term game.Well, kinda I'll tell you one thing.Like if you, if we have I have this conversation.I had this conversation with what first I was coaching.You said, I can't, I can't get rid of the person because I, you know, I can't cause I can't reduce my hours.
I can't take myself off the roster schedule.And I'm like, well, can you really not know?No way.It can't do it.The clients just keep coming said, what if you got covered tomorrow?You were laid up in a hospital for a month and you couldn't get really fat cover like, would you what would happen?
I would have to close the practice and okay, so you could do it under the circumstances.If you're really neat, if you were forced to do it, if the decision were taken away from you, it could happen, right?Yeah.It could happen.Okay.Well, there's a spectrum and it would really was this.
This absolute bloody mindedness to commitment to the norm to what is normal.But let's say the worst case happened and you got rid of your Toxic person and you had to downsize or right, size, your business for a while so that your your p&l count didn't look very healthy, but it wouldn't mean that, you wouldn't make any profit because if you lost a few people and you needed to lose them while you're just in a different phase of the business cycle.
But here's what our Perfection is brains.Can't handle a backward step to go forward because that looks like what big F word failure.All those other the referee was like fuck sorry it's unusual.
I'm the one swearing the least.I couldn't think of another effort that quick that's that's that itself requires someone packing, Gerardo failure.Failure of what like our expectations comparing ourselves against our peers.
So what are you willing to do?Burn yourself?I run yourself in a grind and are En masse willing to do that at the expense of this profession.We all love not, that's, that's crazy.But it requires boldness.And listen, you covid taught me.
Some very interesting lessons, one worse, when we were mandated to stop doing a lot of any routine work, when covid first happened overnight, my clinic Revenue dropped 75%.Yeah.Right that.Wow.
Now we were going through this transition, which, which had meant that we were going.We were, you know, a lot of team members were leaving at the end of a journey and we were rebuilding a team for a New Journey.In a sense, I was really fortunate in that timing because the wage Bill dropped significantly as well.
And so the practice actually benefited from from that transition in that moment and we were then able to rebuild a team and go right?Well not actually got masses of work coming in we do have the luxury of get this right?
Get this really really right from here and that's what we did in rebuilt now and and now you know the practice is up 20% where it was before and the team is happy and and poised for a good year this year with a Interesting plant.
Yeah that couldn't have been possible.What's possible.No wouldn't have been possible before with with the team that was built around the first mission and that's okay.I think practices it is, okay, for you to have a defined mission that comes to an end and you make decisions about who's on the team who's not in the team moving forward.
I think that's how normal companies do things in Project teams.We have a project in veterinary medicine and it's to do veterinary medicine and the project last forever.That's the definition of fucking exhausting.We're just scared to actively manage our businesses.
Mmm, and and the pain that's associated with managing people.Yeah, that is super freaking painful, but it is but it has listened to her.It's also super freaking awesome when you see them growing and and yep.
We're just, we're all crazy.Like, every single one of us on this planet is crazy in her own way, and it's always going to be a mess if you don't.If you don't manage to people, you know what, you just going to be doing the same.I said over and over again and you like you're not replacing yourself.
I suppose, speaking of time, we are probably running out of it.We need some more.I want to ask I wanted to ask about influencing culture when you're not a leader.That's a whole new topic.Like they're people that heap of people listening to this.You're not really sure how to do that in effective in on politicking way.
Mmm.But again, we'll have to go back for that.Yeah, and then Kailyn do that when she gave me that feedback on.There you go.She took, she was such a powerful leaders as a seventeen-year-old kennel assistant in that moment.Hearing Carriage.
Aha, damn it.Thank you for joining us this.Hey Dave.Nice to see you again, man.Pleasure mate, I'm so glad you're feeling better, buddy.The problem with driving back and forth, form is now.He's back to not shutting up and fucking.I know you're an editor is nightmare.
I'm already thinking It's Dave and never thank you so much for your time.
This has been awesome.My company, we haven't done before.Again, I just said you're going to be showering us and love to get you guys crossed and jump under the biscuit session as well.If you are a practice manager or an iron it and you're looking for easy and affordable, CPD options for your team, get in touch on red belt, but not at gmail.com about a discounted practice membership to our clinical broadcasts.
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Drs Dave Nicol

Dr Dave Nicol

DrDermot McInerney

Dr Dermot McInerney