Culture: Every Practice Has One…But Is It the One You Want?
The concept of actively crafting corporate culture has been the topic of many articles and seminars over the years. In 2016, the American Animal Hospital Association (AAHA) commissioned a study1 performed by the Daniels College of Business at University of Denver to examine how organizational culture impacts veterinary hospitals. Key areas of focus included the different subcultures that exist in veterinary hospitals as well as evaluating how hospital metrics are impacted by culture. The study evaluated eight areas of sub-culture, ranked in order of importance by study respondents. Most important to culture was the relationship with veterinarians, followed by training and career development, teamwork and staffing, employee involvement and goal setting, supervision, leadership skills and contributions and institutional fairness and communication. The lowest ranked factor impacting culture was rewards and recognition.
Findings of the study indicated that three measurements were strongly associated with hospital metrics: Relationship with Veterinarians, Teamwork and Staffing and Leadership Skills. Relationship with veterinarians was defined as “the degree to which veterinarians maintain collegial relations with staff and respect staff contributions to care.” Teamwork and Staffing concentrated on “the degree to which the practice encourages teamwork and cooperation, and coordinates efforts across departments.” Leadership skills focused on “practice management promotes a commitment to high performance and quality.”
Metrics most impacted by team perceptions of culture were identified as production per full time veterinarian, number of employees and gross income of the hospital. Key findings in this study were that staff in smaller veterinary hospitals reported more positive relationships with veterinarians, enjoyed enhanced teamwork and staffing and had more opportunities to be an active contributor to the hospital culture and success.
Interestingly, this study suggests that job function impacts the study scores relating to culture. Management and administration had higher aggregate culture scores than associate veterinarians. Factors that negatively impacted the culture scores among associate veterinarians were training and development, opportunities to contribute, employee involvement, and teamwork and staffing.
Several conclusions and challenges can be extrapolated from this study, including the need to provide associate veterinarians with the ability to continually develop skills and to apply the skills in clinical settings, to provide opportunities for associates to meaningfully contribute to hospital success outside of production metrics and to evaluate how teams function. Challenges highlighted for hospitals with larger numbers of employees are to provide animal health care team members the opportunity to develop meaningful work relationships with veterinarians, where their contributions are valued and to provide a pathway for enhanced teamwork.
Culture is the most often overlooked aspect of veterinary hospital operations in many hospitals. This has not been a priority for management for reasons ranging from non-recognition of the impact of culture on all hospital functions to not understanding how to implement a healthy organizational culture. These proceedings will help to provide a roadmap for establishing a healthy culture in your practice.
WHAT IS CULTURE?
Culture is defined as “the set of shared attitudes, values, goals and practices that characterizes an institution or organization.”2 This definition relates to the cognitive, or intellectual culture of an organization. Cognitive culture is the most frequently recognized form of culture, expressed and reinforced verbally.
Rarely acknowledged is the emotional culture that co-exists alongside cognitive culture. This culture helps to dictate what emotions are shared in the workplace, and which ones are curbed. Emotional culture is communicated primarily through non-verbal signals such as body language, eye contact and our voices (pitch, tone, volume and pacing). As 93% of communication is non-verbal, emotional culture influences teamwork, client relations and even impacts how our patients respond to us.
WHY IS CULTURE IMPORTANT?
As seen in the AAHA study discussed above, a healthy culture is critical creating an environment in which all employees can grow and thrive. Every workplace has both cognitive and emotional culture; it intrinsically exists! Both manifestations of culture must be actively managed in the workplace. Workplaces with healthy cultures report greater employee engagement, job satisfaction and more effective teamwork. When organizational culture forms implicitly, it creates fertile ground for discord. This can lead to misunderstandings, confusion and resentment among animal health care team members. The impact on teams is often higher rates of absenteeism, turnover and burnout.3
ELEMENTS OF CULTURE
Creating a work environment that feels safe to your animal health care team is the first step in creating a positive culture. Psychological Safety refers to the “shared belief by team members that the group is safe for inter-personal risk-taking.”4 In workplaces that create psychologically safe spaces, employees can learn, thrive and contribute, all cultural factors that rated high in the AAHA study. As discussed in the article Psychological Safety: a meta-analytic review and extension, Psychological Safety has a direct positive influence on task performance by lessening the potential negative consequences of making a mistake, which increases creativity and initiative. “In terms of attitudinal outcomes, when employees feel safe in their workplace they are more likely to want to continue in their current jobs, with their current co-workers.”5
Veterinary teams are focused on accomplishing tasks, often many at one time. Proactive conversations about how our team members interact with one another are often overlooked and behaviors develop indirectly. “When divergent expectations are not explicitly discussed, we risk rupturing relationships. Unmet expectations and undeclared assumptions can cause the effectiveness of groups to unravel, resulting in irritation, distress and corrode transparency, trust and safety.” 4
Psychological safety can be consciously fostered in our veterinary hospitals by creating an environment that encourages guidelines that help direct the way the group works together. These guidelines direct all relationship-based activities and are actively discussed and reinforced. One example of guidelines developed for the human nursing community is the CENTRE model4, useful during group meetings and morning huddles. The acronym stands for:
- Confidentiality: What is said in the group stays in the group.
- Equal air time: Everyone has the right to participate in the conversation and contribute to the final product/decision.
- Non-Judgmental, respectful listening: Team members don’t interrupt and seek to understand each other before being understood.
- Timeliness: Respectful of others’ time and schedules.
- Right to Pass: Acknowledgement that the person in the group might not have anything new to contribute to the conversation or might need more time to think.
- Engagement: Being fully present for the group, and the conversation.
Once employees feel safe in the workplace, animal health care teams can build vulnerability-based trust. Being vulnerable can be uncomfortable for our animal health care team members. In exposing themselves, they fear being emotionally hurt, judged or seen as weak or lacking by their fellow team members. When vulnerability-based trust is fostered, the need to hide weaknesses or mistakes evaporates as each team member can be accountable for their performance without fear of shame or ridicule. Teammates are completely comfortable being transparent and honest with each other and can freely admit mistakes, ask for help and say, ‘I’m sorry.’ This shared belief leads to a deep bond between teammates, with the belief that each person has each other’s best interests at heart. This concept allows team members to focus on the collective good, which in turn creates a deeply positive culture.
Trust is built slowly and deliberately, in a non-threatening way. Trust can only truly form when members of the team really get to know and understand each other. One trust building activity is the hand exercise6, seen below:
By learning about our teammates’ foundations, we can better appreciate some of the traits that manifest in their adult selves. Examples of other trust-based activities can be found on-line. Regardless of the activity, the importance of these exercises is to build common ground and develop a shared comfort level in sharing information within the group.
Creating a unified culture requires an understanding of the team’s common values. These shared beliefs influence how we do our work and how we interact with one another. Defining shared ideals helps create a framework to guide our daily work, in a manner that is consistent with the group’s collective standards.
Below is an exercise that I have used with my own team, as well as with clients’ teams as a consultant, in determining the values that unite and define workplace culture:
- In written and confidential format, every member of the team answers the following question: “What are the top 3 words YOU would use to describe the personality of ___________Animal Hospital?”
- The words are then combined into common terms (example: educator and teacher).
- From these words, the team chooses the top 4-6 shared values that best describe the organization’s identity as shared by the team.
These ideals give a voice to qualities that define the organization. Shared values are used to govern every aspect of the hospital, from hiring and firing to personnel development and business strategy. This is a living document; as the business evolves, variations might occur in the organizational core values. Leadership changes are one example of a catalyst that might result in a transformation of shared values. To ensure that the values are representative of the team, this exercise should be repeated after such changes or every 3-5 years.
ACTIVELY MANAGING CULTURE
Actively managing culture requires that the leadership team has a clear understanding of what they want their culture to represent and to accomplish. While the leadership team works to reinforce the desired culture, each team member has a responsibility in upholding the culture and being accountable to their role in creating a psychologically safe work environment where employees can be transparent with one another and stay true to the shared company values.It is incumbent upon the leadership team to create opportunities that strengthen the team’s commitment to maintaining a healthy culture. Some ways that culture can be supported daily include:
- Morning Huddles: These inclusive, all hospital huddles are not strategic in nature, but designed to provide space for management and team members to acknowledge the emotions that they are bringing to work that day. By asking each team member “What emotions are you bringing to work today?”, management can understand and shape the daily emotional undercurrents present in the workplace.
- When emotions are constructively welcomed into the workplace, team members can seek to understand each other in more constructive ways. One example of this is ‘cognitive reappraisal,’ a technique that can be taught to our teams to help them re-examine their views of a co-worker’s actions. By considering benign plausible explanations for a colleague’s behavior, they will be less likely to fixate on negative explanations that could send them into a negative emotional spiral. The upside of this is that they can then be more supportive of that individual, showing caring and compassion.
- Talking about how the group will work together to accomplish needed projects throughout the day. This may be best accomplished by quick morning meetings within each of the functional work units daily. For example, technicians, assistants and doctors responsible for surgery will have a brief meeting to discuss work flow, patient needs, client management and team member concerns. These meetings should follow the CENTRE guidelines discussed under psychological safety.
Veterinary hospitals that have embraced and cultivated healthy cognitive and emotional cultures understand that it is transformational. In today’s highly competitive employment environment, offering a workplace that is free of drama, encourages collaboration, supports personal and professional growth while inspiring team members to be their best self is irresistible. A healthy workplace culture is the single biggest factor in creating a highly successful veterinary hospital. Is culture a priority in your hospital?
3. Barsade S, O’Neill OA. Manage Your Emotional Culture. Harvard Business Review, January-February 2016, 58-66.
4. Cave D, Pearson H, Whitehead P, Rahim‐Jamal S. (2016). CENTRE: creating psychological safety in groups. The Clinical Teacher,13(6), 427-431
5. Frazier, M., Fainshmidt, S., Klinger, R., Pezeshkan, A., & Vracheva, V. (2017). Psychological Safety: A Meta‐analytic Review And Extension. Personnel Psychology, 70(1), 113-165
6. Kerry Plemmons, AAHA Executive Transformations Workshop Florissant, CO October 2012
About the Author: Wendy Hauser, DVM is AVP, Veterinary Relations, Crum & Forster Pet Insurance Group. In 2015, she established Peak Veterinary Consulting, after working as an industry Technical Services Veterinarian. With a DVM from OK State in 1988, she has practiced for 30 years as an associate, owner and relief veterinarian. She is highly engaged in AAHA leadership and currently serves as the AAHA Delegate to the AVMA House of Delegates. She is the co-author of “The Veterinarian’s Guide to Healthy Pet Plans.”This is a restricted article sent to you for educational purposes only and may not be copied or disseminated without written consent from Peak Veterinary Consulting, LLC
Posted March 8, 2019