The day starts on a good note, but the tension builds as the hours go by. You overhear two veterinary nurses grumbling in the treatment area: “If only the front desk knew how to schedule better, we wouldn’t be so backed up.”
Taking this cue, you head out front to see what is going on only to hear the CSRs saying, “If only those techs in the back would stop chatting and get to work, we wouldn’t be so backed up.”
Both groups are finger-pointing and complaining about the same thing—being backed up. Why can’t they work as a team? Why are they divided into front versus back?
Identifying the Problem
It seems so easy to place blame; however, it is important to remember the saying, “When you point your finger at someone, there are three fingers pointed back at you.” What could you be doing or not doing that causes the battle between front and back?
Many will say the main culprit of this discord is the appointment book. The truth is that it goes much deeper. It is about the culture, poor communication, a lack of understanding of each side’s role in client service and patient care, and even about leadership errors.
Culture
Culture is unique to your group. Culture determines how the group works together; it fosters stability and drives its members’ thinking and behavior. It gives the strategy of what, when, where and how to do things. Think about that 4:54 p.m. client calling your practice about a sick pet. Is it automatically told to come in, or is it referred to the local emergency hospital? Is there a “dance” around asking for permission, tip-toeing around the people who will say “no” in favor of someone who will say “yes?” Your culture may be causing the battle between front and back.
Communication
Communication is always a primary suspect any time there is discord. Over 80% of a person’s success at any job is due to communication skills. With only 20% of their success based on technical skills, why do so many training sessions concentrate on technical skills and ignore the people skills? Communication is vital to patient care, client service and team performance. That’s why it is important to assess communication gaps when the finger-pointing starts.
Lack of Understanding
Lack of understanding of roles, responsibilities and pressures is common. Think about the team’s different roles—nurses give full attention to patient care, CSRs focus on client service—there will be times when the roles can seem incompatible. Without working in every area of the hospital, understanding the pressures of each area can be difficult and may lead to unrealistic expectations from co-workers in the other areas of the hospital. Unrealistic expectations lead to conflict.
Leadership Errors
Leadership errors are another possibility. Remember those three fingers pointing back at you, the manager? Error number one: refusing to accept personal accountability. The buck stops with management and how the team is held accountable. Other leadership errors can include failing to develop and train people on the team, aligning oneself with a side, managing everyone the same way, being a buddy and not a boss, failing to set standards, condoning incompetence and forgetting the power of communication. Management may be the cause of the tension between front and back.
Knowing that there are different root causes to explore does not mean that the solution is out of reach. However, it will take some effort to get everyone on the same page and work as a team.
Potential Remedies
Upon examining common root causes, it is possible to initiate remedies that may address a few root causes at one time.
Daily Huddle
One such remedy is the daily huddle. The daily huddle is a five-to-ten-minute-long meeting to assess what will happen throughout the shift, troubleshoot potential problems and agree upon a game plan. Everyone understands their different roles and expectations, communication is clear and the team knows the goals for the shift.
Team Meetings
Team meetings are another tool to quell discord between the front and back. Have the different areas submit challenges, clinical inefficiencies and other problems. Divide out into groups (groups must include nurses, CSRs, doctors, ward attendants, etc.), brainstorm together, bring up their unique perspectives and work together to achieve the best solution. If the different areas hold separate meetings, bring in the lead person for the other area—he/she can listen to concerns, give input from his/her perspective and work on solutions. Team meetings are also an excellent opportunity to reward the team and conduct team-building activities.
Cross-Training/Job-Shadowing
Another solution is cross-training or job-shadowing. Cross-training is not always possible in some situations, such as training a receptionist to do the job of a certified veterinary nurse in surgery. Still, the receptionist can gain an understanding of the position by job-shadowing and assisting the veterinary nurse. Scheduling team members to work a shift rotation in other areas will not only help them to understand the roles, responsibilities and pressures associated with that area, but it will also give them an idea of how the roles can complement each other and when it may be necessary to step in and offer assistance (even without being asked).
While on the topic of training, pay attention to shift leaders, supervisors and managers. These team members need additional tools for communication and tips on how to avoid fatal management errors that erode team unity.
Building a cohesive team does require policies and procedures. Review and update any standard operating procedures (SOPs) and job descriptions. Create checklists and ensure collaborative workflows across all areas of the hospital.
Maintaining a United Team
Looking back at the morning fight over the appointment schedule, consider a procedure to map out certain appointments for sick, well and urgent time slots. Conduct a huddle at the beginning of each shift to update the team on the appointments and the game plan to mitigate any problems that may arise. Involve the team in a debriefing session afterward to discuss what worked well and what didn’t.
Discord, drama, disagreement…no matter the label you give it, it is a problem that needs to be nipped in the bud before the negativity spreads and impacts client service and patient care. Clients see and hear; they sense the tension, receive the exasperated sighs and the apologies, and wonder what level of care their pet is receiving. Give the team the tools to successfully work together as one and deliver exceptional patient care and client service. +
