What the corporates get wrong
Successful, happy practice is more about commitment than compliance.
Consolidation, a normal occurrence in successful, fragmented, healthy, profitable industries, has come to our profession. I would argue that the positives outweigh the negatives. That said, most corporates don’t get one critical issue.
The dominant consolidators in our profession come from the manufacturing sector, specifically the consumer packaged goods (CPG) industry. In CPG, efficient, repeatable, monotonous, line manufacturing rules. While much can be learned from the industry and from the brilliant, well-funded and well-intentioned minds it’s brought to our profession, they can’t help but bring a manufacturing mindset to the table. I believe this most dramatically shows up in the compliance culture adopted by the big players, perhaps inadvertently, as it’s the culture from which they came.
The medical professions, as obvious as this might sound, are not manufacturing. Let me explain. In manufacturing, line workers are called on to follow a strict set of procedures to ensure high-quality, consistent, cost-effective products. Line managers tell line workers what to do, when to do it and how to do it. In support of that objective, a hierarchical, top-down, command-and-control culture has necessarily evolved. This compliance approach does not translate well to a highly educated, highly trained, free-thinking, professional medical services industry.
Army vs. Air Force
To better explain, I’ll employ a military analogy. The corporates view our profession like an army general views soldiers. In this example, the veterinarians and teams (line workers) are the soldiers taking orders. Corporate leaders (army generals) lead their soldiers in a top-down manner. As a result, a classic compliance culture is appropriate.
This model served corporations well when hourly line workers produced their CPG product, but it doesn’t work when the product is complex health care services provided by highly educated medical professionals and delivered to individuals with unique needs. The model could work with a subtle shift in the corporate paradigm.
What they don’t get is this: They’re not leading the army, they’re leading the air force. In the air force model, generals lead a sophisticated, multidimensional operation delivered by a highly trained officer corps of pilots (veterinarians and teams) as opposed to order-abiding army soldiers. In this analogy, the corporate air force generals need only to ensure that the bugs are cleaned off the windshield, the jets are fueled and the planes are in good working order, and then they get out of the way so that the highly competent team can fly into the wild blue yonder. It’s not leadership by directive from an on-high hierarchical structure. Rather, a commitment culture best reinforces the mission.
Corporates need to understand that they are in the air force, not the army. They would be wise to aspire to a commitment culture, not a compliance culture.
Compliance vs. Commitment
Compliance thinking is thinking small and being motivated by doing what must be done — a minimalist approach. Commitment thinking, on the other hand, is thinking big and being motivated by what can be done or dreamed. It’s a maximalist approach. Compliance cultures develop followers who maintain the status quo. Commitment cultures create great leaders and open doors to new ways of doing things.
Here’s the hard part: A commitment culture is much more difficult to build because it requires a foundation of trust. Trust requires listening, understanding, credibility, transparency, authenticity, reliability, independence, interdependence and time to grow. Failure frequently occurs in building a commitment culture, but that’s OK. It’s been said that winners and losers no longer exist — only winners and learners.
In a commitment culture, autonomy is required, and with it comes accountability. Most of us are eager to sign up for autonomy. Accountability, on the other hand, is a harder sell.
Compliance cultures — “my way or the highway” — are much easier to build and maintain. The boss/line manager tells the line report what to do, and it does or doesn’t get done. This results in compliance, defiance or, worse, ambivalence. One or two directive conversations and the top-down line manager is done. Check the box and move on. Things get done willingly, unwillingly or not at all.
In a commitment culture, trust must be present, multiple conversations are required, and the head and heart must be engaged. While leading in a commitment culture is initially much harder to establish, once achieved it is much more rewarding. Once trust is built (no easy task) and commitment is obtained, commitment cultures are a joy. In a commitment culture, teams choose accountability and high performance without having to be told.
I see it like this:
Checklists and Protocols
Corporates have taken the manufacturing compliance culture they came from and struggled to imprint it on a commitment-driven health services profession. This approach is seen in day-to-day practice through multiple clipboard-toting, middle-level managers whose role is to enforce compliance. Think medical middle managers, human resources middle managers, business middle managers, checklists, protocols and, sadly, placing policies before people. At the extreme, the corporates default to running a factory when they could be leading a family.
Compliance cultures often frustrate medical professionals who long for autonomy in a top-down environment built to discourage it. This is not to say you can’t have success in a compliance culture. It is often comfortable for new or recent graduates who emerged from an academic environment that rewarded compliance. Inexperienced practitioners might benefit from the guardrails inherent in a compliance environment. For many, however, a compliance culture becomes restrictive and self-limiting over time.
Compliance is not necessarily a bad thing. As medical professionals, we know of situations where compliance leadership is critical. For example, when a shocky, bleeding, unstable patient is admitted, immediate top-down, compliance, situational leadership is required. Compliance has its place.
Further, compliance cultures are not limited to large corporate practices. Most of us can think of independent practices that embrace a compliance mindset. A compliance approach can work in the medical professions, but not optimally.
The Future Is PetGen
I submit that the majority of large group practices have intentionally or inadvertently adopted a compliance approach when a commitment approach is far better suited to idealistic, highly educated, independent and naturally committed veterinary professionals.
Do all large organizations ultimately and inevitably migrate to a compliance culture given enough time, success, layers of administration, legal and human resources requirements, and the like? I hope not. We’re determined in our WellHaven Pet Health practice to build a family of practices based on commitment. Can we do it? It’s early, but so far, so good.
Finally, in support of a culture of commitment, it’s what the PetGen (millennials plus Gen Zers) is looking for. After all, PetGen makes up our dominant workforce and consumer. Today’s veterinary professionals are seeking careers that deliver commitment and purpose. I love that about PetGen.
Get this: According to Gallup analytics, millennials rank opportunities to learn and grow above all other factors. They want to commit. They’re looking for a like-minded community of colleagues who welcome challenges and embrace a commitment culture in which they are free to express their passion. The result is happy teams, happy pet owners and happy pets.
I Choose Commitment
As a highly educated and skilled medical professional, given a choice to work in a compliance culture in which I work FOR a line manager versus a commitment culture in which I work WITH a trusted partner, I choose the commitment culture despite the difficulties.
I’m reminded of a quote by former Starbucks CEO Howard Schultz, who said, “When you’re surrounded by people who share a passionate commitment around a common purpose, anything is possible.”
When I chose to enter this profession, I chose commitment. What’s your choice?
Creative Disruption columnist Dr. Bob Lester is chief medical officer of WellHaven Pet Health and a founding member of Banfield Pet Hospital and the Lincoln Memorial University College of Veterinary Medicine. He serves as vice president of the North American Veterinary Community.