Medicina pediátrica en pequeños animales
PRESENTATION
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RUNNING A VETERINARY PRACTICE
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KEYS
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RUNNING A VETERINARY PRACTICE
Miguel Ángel Díaz Sánchez
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7 keys to successfully running a veterinary practice
VVaallu ueess
7 keys to successfully running a veterinary practice
Author: Miguel Ángel Díaz Sánchez. Format: 19 x 19 cm. Number of pages: 152. Number of images: 42 (illustrations). Binding: Hardcover.
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This book explains the seven key aspects that, according to the author, are necessary to successfully run a veterinary practice. These
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include, among others, working with objectives, discovering your values and making the most of them or managing conflicts. Each of these key aspects is addressed concisely and clearly, with numerous examples so readers can identify themselves with the situation. The book is also made much more practical with the help of suggestions and advice to solve or improve different critical aspects of veterinary practice management. Finally, at the end of each chapter, readers will find a section with key points and a QR code (a link in the case of the e-book) to download the exercices that will help them to put the knowledge acquired into practice. The book includes representative illustrations, which complete the information given and make the reading more enjoyable.
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7 keys to successfully running a veterinary practice
Presentation of the book The main obstacles encountered by vets in their daily work are not so much related to their clinical work, for which they have studied and trained, but to managing their practice, and especially to their relationship with their team. Vets must face a challenge: learning to be their own leaders to earn the right to lead others. Veterinary surgeons need an answer to numerous questions and concerns to face their daily work: how to deal with stress, how to manage a team, how to solve a conflict that affects the functioning of the practice, what objectives to set or how to improve communication with the team or clients, etc. Helping to solve some of these problems is exactly what the author aims to do. Readers should not expect magic solutions to the difficulties they may encounter, but rather an approach to the world of executive coaching, to help them learn how to use a series of tools that have been shown to be effective, and which are used by thousands of managers, business owners and leaders. Each topic is explained in a very simple and instructive manner, with numerous examples of real cases, which will help readers identify themselves with the situations and therefore understand them better. They will thus be able to analyse their own situation and know what their options are and how to take action. The contents are accompanied by illustrations, which contribute to making the book more pleasant, and by exercises to “learn by doing�, which will allow readers to put what they have learnt into practice. The author hopes his work will be of great help to readers, so they can improve their quality of life, work with greater inner peace, build healthier and more sincere relationships and enjoy a better work-life balance, among other aspects. This book is therefore an instructive work, which will be of great use to veterinary surgeons in their daily practice. It may also be used in any other area of the veterinary sector, including, of course, the team.
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7 keys to successfully running a veterinary practice
The author Miguel Ángel Díaz Sánchez Miguel Ángel Díaz graduated from the Complutense University of Madrid (UCM) in 1990. He is also a diplomate of the European School for Advanced Veterinary Studies in Internal Medicine in Utrecht, and an advanced AO diplomate in Orthopaedics and Traumatology. He is a pioneer in the use of CO2 laser. He has been the owner and manager of the Díaz de la Cebosa veterinary practice since 1992. Miguel Ángel is an executive coach certified by the Center for Executive Coaching (USA). He works as an executive and team coach. He is also a certified coach by the International Coaching Community (ICC) and a trainer certified by Bono Thinking Systems in the Six Thinking Hats method. More than fourteen years ago, Miguel Ángel started to use coaching in his practice as a means to bring balance to his life, improve his leadership skills and build his team’s skills. Since 2009 he has been offering his services as an executive and team coach to veterinary professionals through his company New Way Coaching (www.newwaycoaching.es). Miguel Ángel works with companies and directors who feel overwhelmed by their daily duties and want to enhance their leadership, achieve better results, improve and strengthen the relationships with their teams, and to enjoy doing it. From experience, he knows the positive impact of implementing the methods and tools that he provides to his clients, as he is the owner of a veterinary practice in which he has been leading teams for 25 years. This, in combination with his knowledge as a coach and the hundreds of hours of experience acquired through his coaching sessions, has allowed him to specialise in coaching veterinary professionals and provide highly valuable knowledge. He acts as a consultant to directors and their teams on a regular basis, and also gives conferences, seminars and workshops, both throughout Spain and at international congresses. He has been a speaker at a multitude of symposiums in Spain (Madrid, Barcelona, Valencia, Bilbao, Toledo, Guadalajara, etc.) and abroad (Russia, Greece, Portugal, Poland, Turkey), in which he has talked about the impact of coaching on companies with improved results and strengthened relationships. He is the author of numerous articles about leadership and coaching and their use in companies. His clients are from a wide variety of fields such as logistics, fashion, interior design, business, finances, marketing, consulting, teaching, technology, veterinary medicine, etc.
Communication services Web site Online visualisation of the sample chapter. Presentation brochure in PDF format. Author´s CV. Sample chapter compatible with iPad.
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Objectives Objectives
KEYS SUCCESSFULLY
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RUNNING A VETERINARY PRACTICE
Miguel ﾃ］gel Dﾃｭaz Sﾃ｡nchez
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Table of contents KEY 1: The power of working with objectives Your objectives as a journey: decide on a starting point and destination SMART objectives The success sequence: long-, medium- and short-term objectives Objectives versus expectations Leverage points The “Nemo” effect Action plans Key points Bibliography
KEY 2: Discover your values. Use them as a support to build the life you want to live The importance of values Discover your values The crisis of values Living in accordance with your values Achieving inner peace Key points Bibliography
KEY 3: Limiting and driving beliefs. Question your beliefs regarding what is possible and impossible Beliefs and the “Narnia” effect Do not be afraid of jumping into the void Create your own safety cushion Prepare yourself for a journey across the desert How to move from theory to practice Discover the secret of rewards Key points Bibliography
KEY 4: Conflicts. Turn them into a source of solutions Conflicts Attitudes towards conflict Types of conflicts How handle conflicts Feedback at the right time: the “key moments” Key points Bibliography
KEY 5: Inspire trust Trust yourself Trust those around you Admit your mistakes and stay away from arrogance Show respect Act responsibly Make decisions, keep your promises and dare to fail Key points Bibliography
KEY 6: The leader’s control panel The heavy burden of being a leader The one-sheet tool Vision: what is your vision for your practice? Mission: what is your practice’s mission? Values: what are your practice’s values? What is your practice’s competitive advantage? What are your key performance objectives? Choose the key initiatives to achieve your objectives Do you know what relationships are key for your practice’s success? How do you develop talent in your practice? Review, share and finish your leader’s control panel Key points Bibliography
KEY 7: Adapt to circumstances What is a team? Learn the basics to create a real team Natural phases of team development Learn to adapt your leadership style Earn the right to be a leader. Learn to give your team what they need Create the base for permanent success Key points Bibliography
KEYS
to successfully RUN
a veterinary practice
KEY 3
LIMITING AND DRIVING BELIEFS
Question your beliefs about what you think is possible or not Do you believe you should say Yes to everything your clients ask for?
Do you believe it is not possible to trust people, especially at work? 2
Do you need all the work to be done perfectly?
Do you forbid yourself to fail in front of your clients or employees?
Do you believe you have to have the answer to everything and always give good advice?
Do you think you need to be the most intelligent in the team?
THE CASE OF HOWARD Howard is a veterinary surgeon who has owned a veterinary practice for over four years. He works together with a receptionist and a veterinary nurse, who has recently joined the practice. This is the third veterinary nurse who has worked in the practice this year. Howard has a limiting belief that is conditioning his life. He thinks people cannot be trusted and he is the only one to do things right. As a result, he almost never delegates work and is constantly making reproaches to his veterinary nurses, who never seem to be doing things well enough. Howard does not realise the impact that this way of thinking is having on his life. He spends so much time supervising or even doing tasks that should be his employees' responsibility that he barely has time to dedicate to his most complicated cases, to study or to have a pleasant conversation with his clients or employees. He clips the patients' hair for surgery, places IV lines, calculates the doses of the medication they are going to receive, orders the drugs and other disposables materials and checks all the delivery notes, radiographs, analyses... If he does not do these tasks himself, he supervises every little thing the vet nurse does. The consequences of acting in accordance with this highly limiting belief are beginning to appear. Howard needs to
KEY 3 LIMITING AND DRIVING BELIEFS
“Whether you think you can, or think you can't, you're right.” Henry Ford
always be at work and his income has reached a plateau as he does not have time to perform more tasks. In addition, he never seems to be satisfied with his vet nurses. Very few of them stayed in the practice for more than six months. And Howard views this as something that confirms his belief: “Employees cannot be trusted!”. The very high workload and personnel turnover are taking their toll on his personal life. He has almost no time to spend with his wife and children, and does not enjoy the short moments shared with them. He cannot forget about his work. His mind keeps focusing on all the tasks he has to perform at the practice. He feels tired and is often in a bad mood, both at home and at the practice. He always seems angry; he never smiles. He does not sleep well, eats whatever and whenever he can and suffers from heartburn as well as from neck and back pain. If he could see himself, he would realise that he has been walking with a hunch for a few months. He has a sad look on his face and lacks energy. Thanks to his wife's advice, Howard starts to work with the help of a coach to overcome his belief that employees cannot be trusted. Together, they visualise the impact that this belief has had on his life. That is the first time Howard is aware of the path he has taken. His coach invites him to imagine his life in two, five and ten years' time if
he does not choose a different path. He finds it hard to picture himself living the same life in two years' time, and thinking about going on like this for five more years feels so distressing that Howard almost breaks down. Now he is ready for change. This is the time to start working on a driving belief to cancel the highly negative effects of believing that employees cannot be trusted. The coach helps Howard to reformulate his belief and they agree to work on the following assumption: If I provide them with the tools, resources and appropriate training and spend time with them, my employees will do their work properly. Howard has taken a different path. Endless possibilities lie ahead of him. He has gone from a limiting belief to a world filled with opportunities He has specific tasks on which to focus and which depend on him. It is the first time in a long time he feels happy; he is aware that he can change his life and that of others in a very positive way. How will he do it? What advice will his coach give him?
3
KEYS
to successfully RUN
a veterinary practice
BELIEFS AND THE “NARNIA EFFECT” Our beliefs are the rules by which we live our lives. They can be divided into two types: driving beliefs and limiting beliefs. To some extent, our beliefs are self-fulfilling prophecies; we
Driving beliefs: they inspire us and encourage us to achieve our objectives and live in accordance with our values. Limiting beliefs: they make us think we cannot reach our objectives and create inner noise because they prevent us from living in accordance with our values.
end up building our reality according to them. If you believe that you cannot trust people, you will act accordingly: you
Next you will find Table 1, in which I list the examples that
will not delegate, you will control every little detail and you
I most frequently encounter in my professional practice as
will be in the same situation as Howard, the protagonist of
a coach. I encourage you to complete it with at least five of
our case study.
your own beliefs in Exercise 1.
The good thing is that you can choose in what you believe.
In addition, so you can see how beliefs can change over time,
Remember the quote at the beginning of this chapter:
I encourage you to think, for each example, about when you
“Whether you think you can, or think you can't, you're right.”
were 20, 30 and 40 years old (if you have not reached 40 yet, or like me, you are older than that, I recommend you include
4
Have you seen the film The Chronicles of Narnia? There is an interesting scene in it. The protagonists, as they try to escape danger, get into what they believe to be an ordinary wardrobe. In the back of the wardrobe there is a door and, without knowing how, by going through it they are taken to a whole new world, to a reality that is entirely different from the one they were living. Sometimes, changing our beliefs does not only result in a problem being solved, but also leads us to a new world filled with opportunities in many different aspects. This is what I call the “Narnia effect”. In a way, overcoming a limiting belief can take you to a higher level. It should be highlighted that, in order to achieve this, the first step is to become aware of what our potential limiting beliefs are.
the age you prefer).
KEY 3 LIMITING AND DRIVING BELIEFS
Table 1. How our way of thinking changes with time.
Limiting belief
At 20 years old
At 30 years old
At 40 years old
I need to be loved, accepted and popular I am not good enough I cannot trust anyone. You cannot say no to a client. I need everybody to be perfect Nobody understands me Everything bad always seem to happen to me If I did not spend my whole day at the clinic things would not get done right
The idea is to become aware of how our way of thinking about things can change over time.
5
Many of these great professionals are limited by beliefs such as: •
I am a veterinary surgeon, I do not have to act as a leader.
•
If my employees are not motivated, this is their problem and not mine.
they are of the importance of learning to lead themselves
•
Having meetings with my team is a waste of time.
and their team with emotional intelligence. It is not unusual
•
I own a veterinary practice, not a company.
to find cases of excellent surgeons who, nevertheless, are
•
My boss only wants to manipulate us, he is not interested by people but by results.
•
Young people do not make as many efforts as they used to, they have no motivation or interest.
I often observe a pattern when coaching veterinary colleagues. In general, the more specialised they are in an area (orthopaedics, dermatology, neurology, etc.), the less aware
tyrants to their nurses and even shout at them.
KEYS
to successfully RUN
a veterinary practice
DO NOT BE AFRAID OF JUMPING INTO THE VOID. Imagine you are on the tenth floor of a skyscraper. The fire
If you are like most people, you probably would not jump
alarms suddenly go off. You try to rapidly go out of the build-
that easily. You would first analyse the situation: the risk of
ing but the lifts are blocked off and the stairway has been
breaking a bone as you hit the cushion, the possibility of the
rendered unusable due to the flames and smoke. The room
firemen reaching the room with a long ladder or of the fire
you are in still seems to be safe. There is almost no smoke
being miraculously controlled, etc.
coming through the door and it has a window on the exterior. As you look through it, you see that the firemen have
Now imagine that at this moment, the door collapses and a
prepared an air cushion and are encouraging you to jump.
lot of smoke and flames suddenly enter the room. You can
Would you do it?
barely breathe and the flames are about to burn you alive. Would you do it?
6
KEY 3 LIMITING AND DRIVING BELIEFS
As occurs with this hypothetical situation, overcoming a limiting belief means jumping into the void. And to do so, we need the reality of living according to this belief to be so unbearable that we are willing to take the risk of jumping into void with the hope that we will find a better future.
Economic impact What is the economic impact for Howard's practice of him not trusting people and doing everything himself? Howard becomes aware of the time spent on the tasks that a properly trained assistant could perfectly do. If he spent this time investigating cases into greater depth and listening carefully to his clients' needs, he would probably increase his income per visit. And, therefore, his profits.
How do I find the force to take the plunge? A very effective
What would happen with the quality of the services he offers?
way to convince yourself of taking the plunge is to become
His clients would probably perceive greater value during the
aware of the impact of not doing it: it is necessary to create
visit if they could have more time with him to share their
an emotional state of mind that associates the smoke and
concerns regarding their pet's health.
flames with the limiting belief and allows you to envision what the consequences of believing we should not jump will be.
What would happen with the costs of the services he offers? The cost per hour of a vet nurse is lower than his. The more
GOING BACK TO HOWARD'S CASE
tasks he can delegate to the vet nurse, the lower the cost of
Once the limiting belief has been identified, the next step to
Personal cost
overcome it involves helping Howard associate his belief with
After analysing the costs of not being able to trust people
the room on fire.
from an economic point of view, the coach invites Howard to
the service will be.
analyse the situation into greater detail. What is the cost of Jumping from such a height is very risky and may, of course,
the situation regarding his personal life? Not trusting people
result in breaking a bone. The only way of making him jump
leads to him spending the whole day at the practice and con-
is to make him feel how the smoke is asphyxiating him and
stantly making sure everything is under control. How does
the fire is burning him. The coach invites Howard to explore
he feel about this? How much time can he spend with his
the impact of not jumping, of living according to the belief
family? When he is at home, is he really present or does he
that people cannot be trusted and he is the only one who
keep thinking about the numerous issues he has to control
can do things right.
daily at the practice?
7
KEYS
to successfully RUN
a veterinary practice
Fan club
Have you ever heard what runners say? They say they have
Someone once wrote: "I would like to be the kind of person
the feeling of starting to run with ten problems in mind and
my dog thinks I am".
of finishing with three. They also say that running helps them to think more calmly and with perspective.
Who always shows you support? Who has always been at your side? Who makes you feel special and encourages you
How can you reduce your stress levels? Here are some ex-
in every project you work on? Who has the ability of filling you
amples: by getting up early enough so you do not to start
with energy?
the day in a rush, by doing yoga, practising sports, receiving massages, listening to music, etc.
Try to make a list of the people who will help you to turn your new behaviour into a habit.
Make your own list of the measures you will take to reduce your stress levels in Exercise 5 . Do not worry about choosing "strange" measures. What matters is that it works for you.
GOING BACK TO HOWARD'S CASE Howard chooses his wife. She has always seen the best in 16
him, even when he is not able to do it.
HOWARD HELPS YOU WITH HIS EXAMPLE Howard discovered that massages, especially head mas-
Reducing stress
sages, make him feel at peace for several days. In addition,
Stress affects our ability to control situations and make
he has managed to get a discount by paying for several mas-
choices. It is easier to follow the judger path than the learner
sages in advance.
path (see Chapter "Conflicts").
Table 6. How to reduce stress.
Tactic
Starting date
Specific example
Receiving a relaxing massage
Monday, X/X/X
On Mondays at lunchtime, body massage. On Fridays at lunchtime, scalp massage.
KEY 3 LIMITING AND DRIVING BELIEFS
Coaching
can draw, use pictures, magazine clippings and make a col-
If you are reading this book, you may already have an idea of
lage of your vision. As an example, here is Howard's vision:
how a coaching process can contribute to introducing positive changes in people's lives.
Vision
HOWARD'S VISION
A long time ago I had an ankle injury that lasted for five years.
I have hired another vet and a vet nurse who make it possible
They said I would never be able to do sports again. In my
for me to enter the operating theatre with nothing to do other
down moments I imagined myself crossing the finish line of
than put my gloves on. Once the surgery is over, I do not
a marathon and hugging my children. This powerful vision
have to worry because my colleagues are in charge of waking
helped me not to throw in the towel during this very long
up the patient and cleaning up the room.
recovery period. When, years later, this vision came true, it was like watching a self-fulfilling prophecy turn into a reality.
I do not have to place orders myself and only have a meeting
If you can envision it, you just have to find the way of reach-
once a week to make sure they do not need help.
ing it. I have been working together with my team for several years You can give shape to your vision by using your most rational
and the other veterinary surgeon has gained the trust of our
or creative thinking. Describe your vision of what will be pos-
colleagues and clients. I no longer have to work in the even-
sible when your new belief/behaviour becomes a habit and
ing or two Saturdays a month!
the previous belief has less power over you (Exercise 6 ). You
"Thanks to this free time, I feel better and more relaxed, I get better results and the relationship with my team has improved".
17
KEYS
to successfully RUN
a veterinary practice
Preplanning
Applying the method of anticipating situations in which we
This is one of the most effective ways of turning a new belief
act in a reactive manner and choosing to respond in a proac-
into a habit.
tive manner is one of the best decisions I have made in my life. Its impact in terms of quality of life and improvement
Have you ever realised how some dogs automatically bark
of the relationship with my colleagues has been fantastic. I
when they hear the doorbell ringing? How some drivers react
hope this also has an impact on your life.
aggressively if someone sounds the horn at them? Have you ever seen people who thought they were not able to do some-
Make a list of the people, situations, days, times of the day
thing before even trying?
and any other things that push you to act according to your previous belief. In your list, include the stimuli that will lead
We can prepare ourselves to prevent this from happening.
you to act in an unproductive or automatic manner, as you
The idea is to be aware of how certain things, people or situ-
did before. Then, think about how you will act to keep mov-
ations make us go back to our previous beliefs or behaviours.
ing forward (Exercise 7 ). To help you start your list, Table 7 shows you what Howard has done.
18
HOWARD FILLS IN THE TABLE Table 7. Definitive table of the change of beliefs
Stimulus The vet nurse is worried about the patient being uncomfortable, he does not manage to draw blood or place an IV line.
How I usually act
How I will act
How will things improve?
Examples of success
- The vet nurse I ask him to - I apply the training method: - If he learns how to do administers injections, restrain the patient "I do it, he watches me doing it, in the future he will draws blood and be able to do part of the and do it myself. I it - we do it together, etc." tasks I currently perform performs analyses also snort and pull - I ask where he gets stuck while I carry out and this will build the a long face. and help him to overcome consultations. trust between us. the challenge. The vet nurse is praised It paves the way so that - I am attentive to any he is more eager to learn by a client for the progress made and praise good work and care and wants to perform him. provided. more tasks.
KEY 3 LIMITING AND DRIVING BELIEFS Written reminders I remember watching one of Rafael Nadal's tennis matches a few years ago. During a break, the camera zoomed in on his hand, and I remember seeing three words written in the palm of his hand. I do not know what these three words were, but I believe they were written reminders of things he had to do during the match, such as "BACKHAND" to remember to play high balls to his opponent's backhand. Leaving reminders in strategic locations can help you keep concentrated and focused on the change you want to implement.
DISCOVER THE SECRET OF REWARDS There is something wonderful about being the creators of our destiny rather than the victims of stories written by others. Unfortunately, there are people who live their lives based on excuses. They live in accordance with limiting beliefs that make them think and make decisions depending on what the other think and do. Examples: "I cannot take a single afternoon off, clients will go to competitors", "I don't trust my boss, he will exploit me until I feel totally burnout and then he will hire someone else", "there's no point in me teaching him surgery, once he has im-
Examples of written reminders: sticky notes, written words on
proved his skills, he'll open his own practice and he'll leave".
your hand, reminders in your mobile phone, notes on your
19
computer, on the bathroom's mirror, etc. You can make your
The reward of overcoming a limiting belief is that of living a
own list in Exercise 8; to do so, you can use Table 8 with
life that is more in accordance with our values. In a way, it is
examples of what Howard wants to do as a reference.
not so much about knowing oneself better but about building oneself. The reward is in the journey, it is a learning and
LET US BREAK THE ICE WITH HOWARD Table 8. Examples of written reminders.
Where will you put it?
What will it say?
At the bottom of the computer screen in the consultation room.
"You can and they can"
On the most visible wall of the operating theatre
"You can and they can"
building journey. It may have a highly contagious effect if you are generous enough to share it. Can you imagine living your life according to these beliefs? "If we educate our clients and create effective work protocols, then we will be able to take at least one afternoon off every week". "If I learn to say 'No' when I consider I'm being asked too much and suggest alternatives to overcome difficulties, then I will have a more sincere relationship with my boss". "If I invest in resources in the form of time, money and training so he can improve his surgical skills, then we will make a better team and I will be able to have more time off work for myself".
KEY 3 LIMITING AND DRIVING BELIEFS
KEY POINTS
Practice what you have learnt, download the exercises for this chapter. http://goo.gl/I2HfiK
1 Our beliefs are the rules by which we live our lives. 2 They may be limiting or driving. 3 The “Narnia effect”: overcoming a limiting belief opens the door to a world of opportunities. first involves being aware of the past, current and future cost that living in 4 The accordance with this belief implies. 5
The second step is to visualise the benefits and the world of opportunities that lies head if the limiting belief is changed for a driving belief.
6 Changing this belief usually involves changing a behaviour. are very effective strategies not to give up when the previous belief/ 7 There behaviour tries to take control. 8 9
The reward turns us into the protagonists of our lives rather than in the victims of scripts written by others. Do not be afraid of changing and helping whoever asks you for help to change in a positive manner.
BIBLIOGRAPHY O´COnnOr, J. & Lages, a. Coaching con PNL. Urano, 2005. TimOThy gaLLway, w. El juego interior del tenis. Sirio, 1997.
whiTwOrTh, L., Kimsey-hOuse, K., Kimsey-hOuse, h. and sandahL, P. Coactive Coaching. Davies-Black Publishing, 2009. neiTLiCh, a. Coach Master Toolkit, Center of Executive Coaching, 2013.
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The publishing strength of Grupo AsĂs Editorial Servet, a division of Grupo AsĂs, has become one of the reference publishing companies in the veterinary sector worldwide. More than 15 years of experience in the publishing of contents about veterinary medicine guarantees the quality of its work. With a wide national and international distribution, the books in its catalogue are present in many different countries and have been translated into nine languages to date: English, French, Portuguese, German, Italian, Turkish, Japanese, Russian and Chinese. Its identifying characteristic is a large multidisciplinary team formed by doctors and graduates in Veterinary Medicine and Fine Arts, and specialised designers with a great knowledge of the sector in which they work. Every book is subject to thorough technical and linguistic reviews and analyses, which allow the creation of works with a unique design and excellent contents. Servet works with the most renowned national and international authors to include the topics most demanded by veterinary surgeons in its catalogue. In addition to its own works, Servet also prepares books for companies and the main multinational companies in the sector are among its clients.
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