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FixingA Broken System
Craig J Mohnacky DVMVMG-Sponsored Management TrackAAHA Nashville March 2014craigmohnacky@mohnackyvet.com
Presentation Outline
1. Objectives 2. AVMA Veterinary Workforce Report 3. Practice Models (Segmentation) 4. Mohnacky Learning Systems 5. Guiding Behavior
Appreciative Inquiry Epistemology Customer Service Meetings
6. “MLS” Summary
1. Objectives
Maximize Return on Veterinary Education Eliminate “Burn-Out” Increase Productivity
Resolve staff, doctor, and business financial issues
Build Something to Last Maximize Practice Value Prevent Premature Practice Sales
Retention of Ownership with Residual Income.
2. 2013 AVMA Veterinary Workforce Report IHS Healthcare & Pharma Center for Health Workforce Studies
In 2012 90,200 DVM’s Supply exceeded demand by 11,250 FTE’s 11,250 Unemployed DVM’s ???? --No 12.5% of Veterinary capacity is being underutilized 53% of DVM’s feel they are working under capacity Are 47% of the DVM’s who feel they are at full capacity truly at
full capacity?? Excess capacity through 2025 of 11-14% Decrease Demand for Veterinary Services?
2. AVMA Veterinary Workforce Report
Likely Greater Potential for Excess Capacity Stagnating Incomes High Cost of Education Postponement of Retirement
“Inviting the Elephant into the Room”
Nine-Page paper authored by James F. Wilson, DVM, JD U of P School of Veterinary Medicine
Incited dialogue at: North American Veterinary Conference AVMA AAHA convention
Per James F. Wilson, DVM, JD “The Current Veterinary-School Model is Broken”
College Debt
Graduates shackled with large monthly payments and low starting salaries. Debt represents 184% of starting salaries
Most DVM’s are not recommending the profession to students.
The word is out that you have assigned yourself to utter poverty by entering veterinary college.
DVM Newsmagazine
Richard Vedder – Economist
The good news is they’re going to be veterinarians.
The bad news is they’ll be miserable.
Reality of a Veterinary Education
Pure Economic Standpoint Is it a good return investment?
Why not Face Reality?
Too disheartening It’s Political No one has offered up any easy or clear
solutions.
AVMA’s New Proprietary Software
Workforce Simulation Model Utilized by the Newly
Established Veterinary Economics Division of the AVMA Goal - Disseminate this
information to “Industry Participants” so best practices can be applied
3. Practice Models
Agrarian Model Veterinary Centered Model Ego Centered Practice Model Client Centered Practice Model Team Centered Practice Model
3. Practice Models
Agrarian Model Focus = the “Work” to be Done
Reactive vs Proactive Medicine Standard Way of Treating Most Presentations
(Shot-Gun) Hope to hit the therapeutic target
DVM Thinks he Should Know What is Wrong “Void of Diagnostics” Wellness Programs and Products not a Part of the
Practice
3. Practice Models
Veterinary Centered Model Is the Result of the Vision set in Veterinary School DVM has a “Pent-Up” Demand to practice
Veterinary Medicine DVM Has No Interest in Management – Just
Wants to be the Vet
3. Practice Models
Veterinary Centered Model DVM Makes All the Decisions
Single File Staff are underutilized
They are Overly Focused on “High Quality” but in Essence They are Unable to Achieve.
Results in a Multitude of Philosophies Existing in the Same Building – Confusion to Clients. Typically Highly Chaotic Practice.
3. Practice Models
Ego Centered Practice Model The Practice is an Extension of the DVM
Very Charismatic and Paternalistic Focused on Higher End Medicine and Surgery Standards in Place Reflect that of the Owner Owner of the Practice is Usually the Highest
Producer
3. Practice Models
Ego Centered Practice Model Controlling Owner
Staff has Little to do with Developing Relationships or Knowledge Sharing
Practice Struggles in Owner’s Absence.
3. Practice Models
Client Centered Practice Model The DVM and Team is Focused on the Client High Standards with Uniforms, Staff Training and
Meetings Stress High Quality Medicine with Lots of
Referrals to Specialists Goal is to Educate the Pet Owner and be an
Advocate for the Pet
3. Practice Models
Client Centered Practice Model This Practice has Wellness Plans, Geriatric Plans,
and Celebrate Pet Dental Month DVM can Oversee more than one Exam Room Exam Rooms are used by Techs Computer System is Usually Current and Updated
with Good Medical Record Keeping with all Team Members Updating Records.
3. Practice Models
Team Centered Practice Model DVM Leveraging
New Interface to Increase DVM Capacity Knowledge Sharing
Focus on Systems Problems Sharing of Metrics and Financial Results
Rewards and Compensation are Based on Quality of Outcomes
A Culture of Accountability Pursuing Key Focus Results
3. Practice Models
Pluralism Many world views in the same space
Pluralistic Society Agrarian World View Industrial World View Information Age World View
What’s The Answer To Our Challenges
A New Business Model for Veterinarians Multifaceted Approach to the Problems We Have
Described Changes in Workflow and Knowledge Sharing Dedication to Change + Appreciative Inquiry
+ MLS = Preferred Future Shared Meaning Cultural Transformation Epistemological Growth
4. Mohnacky Learning Systems “MLS”
Old Model
DVM
S ta f f
Client
Client
DVM
S ta f f
Client Client
S ta f f
C o n tr ib u te sto re la t io n s h ip
B u ild in g
New Model (Team Centered)
Characteristics Team Centered Practice Model Staff Educational Opportunities
Career Paths
Proactive Medicine Health Maps
Multi-tasking – DVM Leveraging Knowledge Sharing
Enhanced Organizational Capacity for Positive Change Customer Service Meetings
Appreciative Inquiry.
4. Mohnacky Learning Systems
Course Work Pre-Employment screening Orientation Mentorship
Progress Plans Technical Training Reception Training “Exam Room Advocate” Training*
In depth study of medicine and surgery for the acquisition of conversational capacity of the common maladies encountered in Veterinary Medicine
4. Mohnacky Learning Systems
Staff Development and Course Work Safety Training*
Culture of Safety Leadership Training Accountability Training Career Paths.
4. Mohnacky Learning Systems
Use of Mind Maps Purpose
Facilitates Staff Development and Knowledge Sharing
Clients Appreciate “Wholeness” of Health Care Challenge.
4. Mohnacky Learning Systems
The Mind Map Book Tony Buzan
How to Use RadiantThinking to MaximizeYour Brain’s UntappedPotential
Mind Maps
4. Mohnacky Learning Systems
“Exam Room Advocate” Training
Tools SWANS
Smart Work Hard
Ambitious
Nice
Standards of Care Internal Parasites Dermatology Ectoparasites Nutrition Client
Communication Physiology
“Exam Room Advocate” Course Outline
4. Mohnacky Learning Systems
Vaccinations Dentistry Otology Heartworm Socialization Anatomy Leadership
Course Completion Staff are promoted to
“Exam Room Advocate” Receive a certificate Business cards White scrub top for
differentiation Increased compensation.
4. Mohnacky Learning Systems
4. Mohnacky Learning Systems
“Exam Room Advocate” Role is to Oversee: The Plan Medical Record Hospital Patient Flow
4. Mohnacky Learning Systems
Bicycle vs Sports Car
4. Mohnacky Learning Systems
Tools of “MLS” Customer Service Meetings
Appreciative Inquiry Affirmative Topic Choice
Metrics Create Motivated People
Staff Training and Development Desirable Careers
Cultural Transformations Epistemology Guiding Behavior.
5. Guiding Behavior
All Business Needs To: Direct Guide Influence Behavior
Why Guide Behavior: Reasoning or Problem Solving Ability Alignment Maturity Ability to make Meaning in Life.
5. Guiding Behavior
Tools For Guiding Behavior at MAH
Appreciative Inquiry* Epistemological Growth* Customer Service Meetings* Language and Communication Acclimation of New Employees Cognitive and Moral Development
5. Guiding Behavior
A Practical Guide to Positive Change
By Diana Whitney and Amanda Trosten-Bloom
Appreciative Inquiry
5. Guiding Behavior
Beliefs of Appreciative Inquiry The images we hold of the future are socially
created and, once articulated, serve to guide individual and collective actions.
Words create worlds. We see the world that we describe.
5. Guiding Behavior
Appreciate & Inquiry Appreciate
To recognize the best in people and the world around us To increase in value
Inquiry To ask questions To study To search, explore, delve into or investigate.
5. Guiding Behavior
Combine Appreciate and Inquiry Has a powerful effect on leadership and
organizational change Creates self organizing enterprises We become what we study.
5. Guiding Behavior
Epistemology
A philosophic theory of the method or basis of acquiring human knowledge.
The process by which we make reality or meaning.
5. Guiding Behavior Four Epistemological Orders
Subjective, Magical Mind Infant to ten years of age
Concrete Mind Ten - Twenty years of age
Socialized Mind 20 to 25 years of age Most people live their lives here Bound by cultural and dictated norms
“Self Authoring” Mind 25-50 years of age Writer of reality that we become faithful to
5. Guiding Behavior
Concrete Mind No attachment to cultural values or norms Choice is limited to what they have seen or
experienced directly or concretely Don’t see their actions as having any lasting
effects on people Huge Problem for Parents and Employers
Young DVM’s Need to advance from “Concrete” to “Social”
Mind.
5. Guiding Behavior
Customer Service Meetings Practical Use of Appreciative Inquiry
Supports moving from the concrete level to the socialized level Transformational Epistemological Event “TEE”
Creation of knowledge in a group setting Turns Independence Into Interdependence
What is best for the group?
5. Guiding Behavior
The “Customer Service Meeting” Sole purpose is the client and not the staff Mandatory attendance Staff sits in a circle Mandatory that everyone speaks Initiation of the culture to new staff members Positive language in a group setting Accelerates the “TEE”
5. Guiding Behavior
Customer Service Meeting Creates Appreciative Positive Language
Creates opportunities to dream and share a common vision for the future
Supports people to act on behalf of the client, pet and business
Creates Images That Inspires Action What we study is fateful.
Great Client Experiences Safety in the Workplace Team Based Environment
“MLS” Summary
Create Desirable Futures Career Paths Take People Where They Want to Go
Resources for Guiding Behavior Epistemological Advancement & the “TEE” CSM
Cultural Transformation (Team Centered Practice Model) Knowledge Sharing Enhanced Customer Experiences - Loyalty
Changes in Work-flow – DVM Leveraging
“MLS” Summary
Ultimate Outcome
Enhanced Quality Relationships Through Knowledge Sharing
Increased Practice Value
Those With the Smartest Clients Win
“MLS” Summary
Building Something Bigger Than “I” Visionary Company
Core Values Shout out your “Why” Develop your “How” and
“What” people
Maintain ownership and cash flow in your practice Prevent a Premature Practice Sale
“Morning Surf” Mario Simic
Getting Results Individual & Joint Accountability
Craig J Mohnacky DVM
craigmohnacky@mohnackyvet.com
AAHA Nashville March 2014
Presentation Outline
1. Definition
2. Why Accountability
3. Victimization
4. Focused Results
5. Results Pyramid
6. “Job Descriptions” A New Paradigm
7. Accountability Chart
8. Feedback / Eliminate Feedback Filters
9. Individual & Joint Accountabilities
10. Summary
1. Old Definition of Accountability
As a Negative Term Obliged to give reckoning based upon previous
actions Something that happens to you when things go
wrong What management does to you – to get you to
perform Reporting on actions and not results Another word for punishing people for poor
performance.
1. Definition of Accountability
A personal choice To rise above one’s circumstances And demonstrate the ownership necessary For achieving the Pre-determined Key
Focused Results
1. New Definition of Accountability
As a Positive Term Describes commitments that have been kept in
the eyes of others Social Contracts / “Buy-In”
Leads to stronger relationships Fosters trust
2. WHY Accountability?
Accountability is the key to obtaining what you desire: For Yourself For your Team For your Organization
Built to Last
3. Victimization?
Biggest Obstacle Confronting Accountability Strangleholds Any Business Eliminate the Victim Cycle
Improve Individual and Organizational Results Example of rejecting Victimization
Nelson Mandela
Mandela (message #1)
“That window, you know, was actually a window to the world, because I could see quite a lot. I could see my mental horizons expand”.
Mandela (message #2)
“I have attempted to colour the island sketches in ways that reflect the positive light in which I view it”.
Mandela (message #3)
“I would like to project the idea that even the most fantastic dreams can be achieved if we are prepared to endure life’s challenges”.
Mandela
Rejected Victimization Became Accountable to:
Himself Fellow man Country
Goals
Provide tools for Creating Accountable People
Teach How to Recognize and Reject Victimization
Build Something Bigger than Yourself
4. Focused Results - Attributes
Pre-determined Clearly defined
(Specific) (Front-Loaded) (Clear Expectations)
Without pre-determined and clearly defined results, confusion and excuses prevail representing “Below the Line Behavior”
4. Focused Results - Attributes
MeaningfulMeasurableMemorable
4. Focused Results
Meaningful
It must connect to the
context and vision of the business
4. Focused Results
Measurable
It must be Quantifiable
& EVERYONE knows it
4. Focused Results
Memorable
IE: Starbucks “2000 by 2000”
5. The Results Pyramid
Why?
5. The Results Pyramid
Beliefs Summary Experiences shape beliefs Beliefs influence actions Beliefs are opinions / perceptions only
not factual Beliefs should not be taken personally Use beliefs to understand why people are
reacting Focus on belief systems to better understand
actions
6. Job Descriptions
New Paradigm Job
The Key Focused Result Job Description
Role played in achieving The Key Focused Result Example
Football Team Job is to “Win” Job Description is the “Position”.
6. Job at MAH
Job (Key Focused Result) Build Relationships Manage our Reputation Grow our Revenues Through CE Recognize and Reward Others for a Job Well
Done Each Employee’s role may be different but
not the end result
7. Accountability ChartWhere action happens
Inactivity
IneffectiveConfusion
BlameGame
7. Accountability Chart
Inactivity
IneffectiveConfusion
Blame Game
7. Accountability Chart
Where action happens
7. Accountability Chart
“See It” Accountable Actions:
Obtaining the perspectives of others Being open and candid in my communications Asking for feedback Hearing the hard things so that I openly see the
reality of the situation.
Finding the Courage
7. Accountability Chart
“Own It” Accountable Actions:
Being personally invested Aligning my work with desired company results Acting on the feedback that I receive.
Finding the Heart
7. Accountability Chart
“Solve It” Accountable Actions:
Creatively Dealing With Obstacles Obtaining Necessary Information and Knowledge Developing New Skill Sets Taking the Necessary Risks.
Obtaining the Wisdom
7. Accountability Chart
“Do It” Accountable Actions:
Doing the things I say I’ll do Sustaining an Environment of Trust
Focusing on the top priorities Staying Above The Line by Not Blaming Others.
Exercising the MeansFortitude
8. Feedback
Old Definition of Feedback A New Paradigm for “Feedback”
Receive vs Give
Embrace vs Reject
Initiate vs Wait
Feedback Filters
8. Feedback
Initiate receiving our own feedback in order to rise “Above the Line”.
Imagine a culture where feedback is embraced / improving other people’s experiences and beliefs.
8. Focused Feedback
Rather than filtering the feedback you receive, ask:
“Is that a belief I want them to have?” If not, then change the experiences.
See Results Pyramid
The Results Pyramid
8. Focused Feedback
When receiving feedback Your job is seeing it from others perspective. Ask questions in order to understand their point of
view. When giving feedback it must be
constructive. Intent is to help that person Holding back feedback can stifle a career
Responsibility
Responsibility
Responsibility
Individual Responsibilities
= Clients
Accountability
AccountabilityAccountability
Responsibility
Responsibility
Responsibility
Joint Accountability
= Clients
Summary for Accountability
Specificity One Owner/One Task
A team can’t own a task Assign by Competencies Accountability Chart
Vision Chart Keep up to Date
Thoughts On Implementing Change
Involves the Willingness to be Imperfect Courage to Proceed Without all the
Information or Answers Fortitude to Move On in Adverse or Hostile
Conditions
Four Types of People
Those that make it happen Those that watch it happen Those that wonder what happened Those that never see it happen
Which one do you want to be?
Recommended Reading
The Oz Principle Connor, Smith, Hickman
Winning With Accountability Henry J. Evans
Built to Last Jim Collins
Recommended