Importantly, clinical leaders maintain some form of clinical role, and work in a collaborative style with other health professions and non-clinical leaders to achieve improvements in clinical care (Edmonstone, 2009). Their focus is on the patient or service provided, rather than on the organization itself, which tends to be the role of healthcare managers; in the veterinary context, this is the practice manager. As Treasure (2001) is keen to point out, however, leadership can be mistaken for ‘being in charge’, particularly by medical consultants who may be in charge of a team, without considering that they are part of a service and care network. This could also be true in veterinary practice, where a leader is often the owner of the practice and seen to deliver orders rather than actually lead a multidisciplinary team effectively.

It must also be remembered that leaders are even better placed to exert power and influence, and so these abilities must be used carefully so that privileges are not abused (Anderson, 2011). The personal power of clinical leaders could be much greater than that of non-clinical leaders, because of their perceived credibility by fellow professionals (Edmonstone, 2009). Professionalism and leadership could, therefore, be seen as intrinsic to each other; indeed, within the veterinary profession, there is more of a tendency to discuss the latter.

Leadership and management

It is important to consider the difference between leadership and management, particularly in veterinary practice where the two roles may overlap to a large extent. Three main scenarios exist:

1. A non-clinical manager is employed to oversee the day-to-day running of the practice and manage human resources. The practice manager in this situation is the employee of the individual who owns the practice, and varying amounts of autonomy are given, with the owner ultimately retaining the leadership role.

2. A veterinary surgeon (likely to be the practice owner) may manage the practice, and also have a clinical leadership role during client- and patient-facing activities.

3. In the corporate-owned practice, veterinary surgeons may lead and manage clinical activities but leave non-clinical management jobs to a central management team. Veterinary surgeons are more commonly becoming part of this central team, for example as regional operations managers within a corporate structure.

The differences between leadership and management are debated extensively in the literature, with some resistance to definitions which categorize them as distinct entities, often citing management as systems and process based, and forgetting that leaders also ‘must ensure that systems, processes and resources are in place’ (Long, 2011). It is certainly true that a badly managed practice may also suffer from poor leadership, and vice versa, but ultimately whichever role a veterinary surgeon adopts there will be similar skill sets, which need to be developed in order to influence a successful team approach to patient care. The small size of many veterinary teams means that individuals often take on different roles, many of which require leadership skills. There is some discussion around the ethical nature of leadership and management, with the implication that leadership is more ethical than managership, because of the tendency of the latter to be more ‘dictatorial’ in style (Ross, 1991). Whether or not this is true, it is worth considering that leadership may be a more realistic approach in the ethical minefield that is the veterinary practice.

Table 3.1 illustrates the different characteristics required for management and leadership. Veterinary surgeons are likely to need to develop characteristics from both the management and leadership list as they perform a dual role in many situations.

Table 3.1

The different characteristics of management and leadership

Aspect	Management	Leadership
Style	Transactional	Transformational
Power base	Authoritarian	Charismatic
Perspective	Short-term	Long-term
Response	Reactive	Proactive
Environment	Stability	Change
Objectives	Managing workload	Leading people
Requirements	Subordinates	Followers
Motivates through	Offering incentives	Inspiration
Needs	Objectives	Vision
Administration	Plans detail	Sets direction
Decision-making	Makes decisions	Facilitates change
Desires	Results	Achievement/excellence
Risk management	Risk avoidance	Risk taking
Control	Makes rules	Breaks rules
Conflict management	Avoidance	Uses
Opportunism	Same direction	New direction
Outcomes	Takes credit	Gives credit
Blame management	Attributes blame	Takes blame
Concerned with	Being right	What is right
Motivation	Financial	Desire for excellence
Achievement	Meets targets	Finds new targets

Source: Long (2011, p. 4).

It is thought that clinical leaders are more likely to take evidence-based, reflective views on healthcare, and that this may be in conflict with the scientific–bureaucratic model promoted by non-clinical managers (Davies and Harrison, 2003). This can lead to ethical dilemmas for the practising veterinary surgeon, who is trying to balance clinical leadership skills aimed at improving patient care and animal welfare with the need to manage a practice and make a profit. Equally, there is potential for practice managers to come into conflict with veterinary surgeons employed as assistants who are more junior clinical leaders. These individuals will need to develop their leadership skill set in order to convince a more bureaucratic manager of their actions, which may be more patient centred than practice centred. Ultimately, it is the responsibility of both to ensure the culture of the practice is effective, and to develop a good working relationship allowing everyone to work as a cohesive team.

The complex nature of the veterinary team

The veterinary profession has undergone a considerable number of changes over the last two decades. The changing nature of animal ownership and farming practices has increased the numbers of specialized small, large and equine animal practices, and reduced the number of traditional mixed practices, which are usually run by one or more partners. Practices are now commonly owned by shareholders within a corporate management structure, and ownership by limited company is common even in the more traditional partner-led organizations. This has meant a readjustment in management and leadership of these practices. Practice managers are often now a part of this environment, along with numerous other professionals and paraprofessionals working alongside the veterinary surgeons (Figure 3.1). Some larger practices have embraced these changes fully and now employ professionals other than veterinary surgeons and nurses, with the aim of developing a wider scope for offering different services to clients and patients. Other practices have maintained a more traditional veterinary team, and communicate with other professionals contributing to patient care as and when required.

Figure 3.1 • An example of different team members in a small-animal practice.Liz Mossop retains copyright to her original illustration.

To an effective clinical leader, both types of team can be challenging. The veterinary surgeon may assume that everyone working in the team is aiming for the same ultimate outcome of excellence in patient care. However, tensions can develop when this is not the case, and communication and negotiation are of the utmost importance. The first step is to actually take on the responsibility of ‘leader’, which may not be a role every veterinary surgeon feels inclined to adopt, and some veterinarians may even leave leadership to the client. However, once the responsibility is identified, the second step is to decide how best to lead this complex team, and develop the skills and behaviours necessary to do so. This is required of even the most junior assistant. The different teams illustrated in Figure 3.1 must interact and communicate effectively. Leadership from veterinary surgeons is therefore essential.

In the situation illustrated in Figure 3.2, which depicts a more complex team, the vet may come under the direction of both owner and client, or these may be the same person. Leadership skills are very important if such a team is to function effectively, and the vet is ideally situated to lead this team.