CEO, Blue Heron Consulting
Stith Keiser is the CEO of Blue Heron Consulting and an adjunct faculty member at several veterinary schools. His passion for the veterinary profession extends into his role as managing partner in a handful of private hospitals. In his free time, Stith and his wife enjoy the outdoors with their dogs and horses.Read Articles Written by Stith Keiser
I was speaking at a veterinary conference when an attendee, a midcareer owner of a multidoctor hospital, asked, “If you could identify one factor that separates average or even good hospitals from the great ones, what would it be?” After a short pause, I responded with the caveat that my answer needed Part A and Part B.
Part A was the practice owner. Not necessarily their clinical skills as practicing veterinarians or technical skills if they are non-DVM owners, but their ability to inspire, lead, hold people accountable and build a culture based on personal and professional growth. Recognizing that not all owners excel at the aforementioned or are interested in it, I said Part B was the right manager. In my experience as a private practice owner and a consultant to hundreds of hospitals of all sizes and specialties nationwide, I’ve found the common thread at great hospitals is great managers. And great hospitals allow great managers to do their jobs.
The title of veterinary manager is not new to our profession. (Office manager, practice manager and hospital administrator are not the same thing. Each requires differing degrees of experience, skills, responsibilities and compensation.) What’s also not new is how many practice owners fail to leverage their managers appropriately.
What follows is a tale of two managers. While their names are fictional, their stories are real and play out in thousands of hospitals every day. I hope readers take away from this story:
- The importance of allowing your manager to be a manager. (It falls on us as owners.)
- Real-world tips and strategies for setting the right manager up for success, whether the person is a seasoned team member or new hire.
Sarah’s career in veterinary medicine reads like that of many of our support staff members. She started at the front desk of a small mixed animal practice after high school. Her personality, communication skills, attention to detail and eagerness to learn led her to succeed in her role. Her hunger for new challenges and knowledge eventually drew her toward an interest in becoming a veterinary assistant. However, the hospital didn’t want to lose her at the front desk, and after several meetings to express her desire for the clinical aspects hit a wall, Sarah quit and joined another clinic in town.
The new hospital chose to cultivate Sarah’s interest in becoming a veterinary assistant. Over the next several years, she moved to the skill level of a veterinary technician. Eventually, she found a passion for surgery, leading her to additional training and earning her the title of lead surgery technician.
Sarah spent several years in the leadership role, working closely with ownership and management to improve the mixed animal practice’s surgery department. From patient care to surgery flow to team training, the hospital got better because of Sarah’s help.
After about five years at her second clinic, Sarah was asked about stepping into a practice manager’s role and tapping into the traits, skills and drive that fed her past and current successes. She said yes and today is the hospital administrator at the largest veterinary hospital in the bottom two-thirds of the state where she resides. Over the past four years, she helped grow gross revenue by nearly $2.5 million, stabilized EBITDA (earnings before interest, taxes, depreciation and amortization) to near 20%, reduced the cost of goods sold by about 10%, supported a strong team culture (measured in various ways several times a year) and drastically improved patient care (again, measured objectively by what the hospital calls “medical excellence indicators”). Sarah is among the best.
The tale of our second manager, Bethany, begins much like Sarah’s. She joined a small clinic’s front desk after high school. Bethany did fairly well, learned quickly and was pleasant. After a few years, thinking her career had plateaued, she asked to move “to the back.” The hospital owner didn’t want to lose her, so Bethany moved into an assistant role. She was trained like many of our profession’s support staff members — with the best intentions but with a plan that lacked detail, accountability and the time to execute it. Nevertheless, Bethany fit in well with the other assistants, and, over time, her skills matched those of her peers.
Fast-forward a few years. The hospital’s “manager” of over 30 years decided to retire. The practice owner reviewed the existing staff and narrowed the search based on employee tenure and those who contributed the least to drama. Bethany made the list, and after a conversation about the promotion and a pay raise, Bethany was happy to accept.
Fast-forward three more years. Bethany and her hospital look much the same. The medicine is OK, although the mission statement says the hospital is “progressive” and dedicated to the “best medicine.” The practice makes ends meet financially, the team is fine, and the flow of clients is pretty consistent. Bethany is an OK manager of an OK hospital.
I hope two things are apparent in the two tales:
- Individual managers will always be responsible for part of their success or lack thereof.
- All the training, support, guidance and resources in the world won’t take managers from good to great if they’re not hungry for it.
As we move forward, we’ll assume that our managers want to improve. If they don’t, they’re either in the wrong seat on the bus or on the wrong bus. Either way, the responsibility to fix the misalignment falls on us as owners. Assuming that Sarah and Bethany wanted to be successful, the difference lies not in them as individuals but in how we set them up for success. That is what I want to emphasize: How does an industry that too often gives the title of practice manager to someone who’s little more than a glorified business assistant transform into one that develops the person into a great manager helping our hospitals do great things?
It Starts with Why
The concept isn’t new, but for our teams to be successful, they must understand our vision (our “why”) and how it influences the hospital’s mission. I love involving my hospital teams in the process, but that’s for another article.
My teams know that I define success at the hospital level on four specific pillars of success:
- An engaged team of highly skilled, leveraged, self-accountable leaders who have fun, work hard and make a tangible difference. That’s a big part of culture.
- High-quality medicine that is offered and delivered consistently.
- A positive and memorable client experience that revolves around a sense of partnership.
- Sustainable and ethical practice profitability that allows consistent reinvestment in the hospital and a competitive return on investment for the hospital owners.
Our “why,” our mission, should be our North Star. When I examine highly effective owner-manager relationships, they start with a clear understanding of where both sides are and where they want to go.
The first step in exceeding expectations is to know the expectations. I’ve lost count of how many times I’ve heard (or said, embarrassingly), “So-and-so just isn’t living up to my expectations.”
We recently promoted a lead client service representative — let’s call him Jason — to practice manager at one of our satellite clinics. It’s not a large hospital. One doctor and a solid support team do about $1 million a year, and a second full-time associate will join us after graduation.
During the interview, we talked to Jason about his motivation for considering the role. Additionally, after he shared his understanding of the job, we asked Jason to explain how he’d evaluate his success as the practice manager. Finally, we set an expectation that at his 30-day check-in, we’d like to see his list of priorities for the remainder of the year. I’ve found such an approach effective in allowing managers with a clear bead on the North Star to own the expectations for themselves and the position.
Setting expectations without providing the support to accomplish them is a recipe for frustration and disappointment. To that end, hospitals that tend to groom great managers have systems to evaluate and develop leaders continually.
In Jason’s case, we provided a skills self-assessment, which was a simple Excel document listing the traits and skills we felt a manager needed to possess to excel in the position. Jason went through the assessment and ranked himself using a 1, 2, 3 scoring system. We then built a customized training and coaching program for him.
Such a sequence works well not only for up-and-coming managers but for experienced managers as well. Regardless of their years of management experience or even the letters after their names — CVPM, MBA, etc. — I’ve found that when we don’t use a formal process like that, assumptions are made, expectations aren’t clear, and someone ends up upset.
Metrics for Success
Expectations should center on responsibilities and successes. High-performing hospitals tend to have clear definitions of success for every team member, from the kennel assistants to the owners. While metrics will vary from clinic to clinic based on what’s deemed important, every job description should have them.
Thinking back to Sarah, we created metrics for success (with her input) around each of the four pillars mentioned earlier. Sarah credits the growth and improvement of all four to the fact that she had a clear definition of what winning looked like. As a result, she could prioritize her time and efforts on accomplishing lasting results.
On the other hand, Bethany probably would link her lackluster performance, at least partially, to being given a standard practice manager job description that focused on tasks and responsibilities and lacked clear definitions for measuring success.
The 1% Rule
One of our team members reviewed the book “Atomic Habits” during a staff meeting. While the book had several interesting pearls of wisdom, my biggest takeaway was the concept called “The 1% Rule.” In studying top-performing teams and individuals, the author, James Clear, submitted that the best are committed to doing 1% better every day. It’s not about going from 0 to 60 overnight. Instead, it’s about a continuous commitment to improvement. Every. Single. Day.
In practice, that commitment falls on two parties. First, managers must have a growth mindset. Assuming they do, we’ve got to provide them with a structure and the resources to improve.
In talking with managers at Veterinary Hospital Manager Association conferences, I’ve found that those at the top of their game and who seemed most engaged at work had a clear path for professional development. It ranges from continuing education and certifications to more informal tools, such as weekly management meetings with hospital ownership.
As owners, we can’t expect our leaders to grow and develop without having the resources, namely training, financial support and time.
Stay Out of the Way
This concept is simple. Ownership must stay out of the way if it has a manager with the right mindset (attitude and aptitude), clear expectations, the metrics for success, and a training and development program. I am not suggesting you turn a blind eye to everything a manager does. (I’m a big fan of the philosophy “inspect what you expect.”) The difference involves awareness and transparency on one side and micromanaging on the other.
When it comes to managers operating more as business assistants than actual managers, failure usually isn’t their fault. It’s ours. It’s all of us Type A independent practice owners who aren’t willing to let go.
If you want glorified assistants, hire them and don’t pretend they’re something they’re not. But if you want a true manager, a Sarah from our story, I hope I provided a framework to allow you, your manager and your team to reach new levels of greatness.
The Veterinary Hospital Managers Association asked members why they would not recommend a career in veterinary hospital management. Among the responses:
- Tough hours.
- Pay isn’t commensurate with the job duties or what other fields pay.
- Lack of retirement benefits.
- Difficult work-life balance.
- Angry, difficult or unappreciative clients.
- Limits to career advancement.
- Lack of training.
- Have to be able to manage negative people.
The percentage of respondents “likely” or “extremely likely” to recommend a career in veterinary practice management, according to a 2021 survey by the Veterinary Hospital Managers Association.