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Columns, Leadership

Shift Work, Medical Errors and Drop-Offs

Opening Shots columnist Dr. Ernie Ward answers your questions.

Shift Work, Medical Errors and Drop-Offs
In some cases, it’s best to not respond to an angry email.

Q: I have two associate veterinarians who do a good job, except they disappear when their shift is over. Even if we have patients to see or tests to run, they leave, sometimes without saying goodbye. I’m worried that they’re not truly committed to our practice. How do I tell them they need to be “doctors” and set a better work example for the team?

A: I get it; you sacrificed a lot to own your clinic and probably have worked late and long for years. Me, too. However, the difference between business ownership and business employment is huge. In simplest terms, an employee is paid to complete a specific set of work parameters, while an owner receives the profits. They do the time, you pay the dime, and anything else is voluntary. If you want your associates to work longer or harder, you’ll probably have to pay them more or provide additional incentives. The problem with exchanging more money for more time is usually more problems.

My advice before you say anything to these veterinarians is to critically analyze your business fundamentals: appointment capacity, revenue and profitability, employee and client retention, trend lines, and so forth. Then, find a way to pay all your staff more. Perhaps the most critical lesson I learned in the early 1990s was to pay my employees as much as possible. That management focus helped boost team morale and propelled profitability for decades. If you want commitment from employees, first commit to pay them well and provide ample benefits. Want a better “work example”? Lead with compassion and generosity.

Money aside, get real about work. You can’t expect employees to work more than they’re scheduled or paid to do. Leaving on time is one of the foundations of a healthy lifestyle, and this sort of management guilt and shame is fueling our burnout crisis.

Q: I had a scary situation when two of my employees made a huge medical mistake that nearly killed a patient. As the practice manager, I advised the owner to reprimand the employees. She agreed that the two were negligent and should be written up, but she refused because she feared they would quit. Finding good veterinary help is hard, but is it better to risk losing two people than ignore medical negligence?

A: Your story reminds me of that old kid’s riddle: If a patient is injured by a medical mistake and no one knows, did it really happen? By kid’s riddle, I mean I made it up to buy time to answer. However, it does apply here. Veterinary practice leaders must prioritize patient care and safety above all. Chances are the two employees and your whole team know of the blunder, but it still needs to be acknowledged by supervisors. Otherwise, did it really happen? And how will you prevent it from happening again?

If the duo ditches you, you’re better off. The hallmark of a good employee, or human, is the ability to accept mistakes and learn from them. The wonderful news is the mistake wasn’t fatal, so appreciating it as a teachable moment is essential for your team to progress.

As a long-time veterinary employer, I ranked my chief responsibilities as patient well-being, employee satisfaction and business solvency. Medical mistakes threaten all three. Take your situation seriously, address it directly, and don’t live in fear of doing the right thing. In my opinion, reprimanding them is an appropriate step.

Q: I’ve heard you lecture many times, and you stress the importance of scheduling everything. We did until the pandemic hit, and now we’re overbooked and understaffed. To accommodate appointment requests, we use drop-offs so that we can see more patients. Unfortunately, we have more drop-offs than we can handle in addition to an overbooked schedule, resulting in us staying two hours late nearly every day. Can you help?

A: Sounds like a case of good old drop-off dumping. No matter what you call it — day appointments, in-clinics, drop-offs — you’ve got to be strategic in how you use such scheduling fixes. Otherwise, you risk frustrating your staff, providing poor patient care and ultimately creating more problems than you solved.

The first step is to analyze the types of appointments that can be handled most efficiently through pet drop-offs. Excellent choices often involve patients that require advanced or time-consuming diagnostics, those with chronic conditions, and those with previously detailed medical histories.

The temptation is to admit the itching dog, vomiting cat and other “quick” complaints, but those cases often require the most client communication. Nothing sucks the time out of your day more than the back-and-forth barrage of client calls clarifying symptoms and gaining permissions. I’m not saying you can’t do these sorts of drop-offs, but I’m urging you to critically analyze your drop-off capacity and tilt toward efficiency as much as possible.

Next, train staff members who answer calls to get the information that can help determine whether a drop-off will work. Many drop-offs originate from a desperate pet owner pleading to team members who are doing their best to solve the problem. You can’t accommodate every pet at a moment’s notice, and your employees need to deliver less than ideal news compassionately. Communication training can help veterinary professionals to empathetically and effectively explain tough situations. Encourage creative and strategic scheduling tactics, and be mindful of your team’s caseload.

Finally, establish a process and alternatives before admitting drop-offs. Sometimes, a video consultation for a follow-up issue will work, or a medication refill might be the next best option, or after speaking with a familiar voice, the client agrees to come in the following day. In other words, replace the default position of “Just drop her off” with “Let me check on what we can do. Can I call you back within an hour?” And keep scheduling everything, including drop-offs.

Q: I listened to your podcast about job applicants who ghosted their interviews. Then I did it, too, by changing my mind about the opportunity and not doing the interview. The practice manager sent me a nasty email saying that she rearranged her day to interview me and that they weren’t interested in moving forward with me. I would like to tell her a thing or two, but what should I say?

A: “I’m sorry.” That’s what you should say. You probably heard us in the podcast saying that to get respect, you must give respect. In your case, regardless of the reason, you disrespected another person’s time without an explanation. A simple pre-interview decline would have made things right. At this point, an apology is due.

If you find yourself in a similar situation, resist the urge to one-up another person. It’s community, not competition. We need to do our best to treat others with empathy and consideration. And own our mistakes.

On the podcast, I advised managers to ignore an applicant who ghosts them. Perhaps put the job seeker on a list of folks the practice isn’t interested in for whatever reason.

The employer reacted out of hurt in your situation, though I wish she had taken the high road and skipped the email altogether. You probably feel provoked by her response and want to retaliate, but hold your fire. You never know when your paths might cross. Don’t be stingy with an apology, especially when you’re at fault.

Opening Shots columnist Dr. Ernie Ward (drernieward.com) is an award-winning veterinarian, impact entrepreneur, book author and media personality. When he’s not with family or pet patients, Dr. Ward can be found contemplating solutions during endurance athletics and meditation and on his weekly podcast, “Veterinary Viewfinder.” If you have a question about practice life, personal well-being, leadership or veterinary careers, email [email protected].