Leadership and management in veterinary practice

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Leadership and management in veterinary practice




CHAPTER OVERVIEW


Leadership and management are valuable commodities in any organization, and are crucial components of organizational success. This is also true in veterinary organizations because as an organization grows in size it requires a broadening range of professional skills and expertise, such as leadership, in order to remain effective. The aim of this chapter is to distinguish between the concepts of management and leadership, and to provide the reader with insights into the various leadership styles discussed in extant literatures. Leadership is investigated at various different levels ranging from its more externally observable or ‘tangible’ dimensions, as described in the traits, skills and styles approaches, to the more intangible or psychological dimensions, as described in the transformational and cultural models.




Introduction


Traditionally, veterinary practices have been established when a vet ‘puts up their plate’ and opens for business. In this model of veterinary practice the business founder acts as the main ‘operator’ or deliverer of professional services in the early stage of the business’s development. At this stage of the business’s life cycle, the need for sophisticated business and people management is less crucial. However, as the practice grows and the demand for its services increases, the business founder is faced with a choice, which creates challenges as well as potential benefits. The sole-charge veterinary surgeon has to choose whether to stay as a sole-charge vet or to take on new members of staff including more veterinary surgeons, veterinary nurses or receptionists. If the business founder decides to recruit additional staff in order to grow the business, he or she must know how to manage the spectrum of personalities, competences and agendas that inevitably accompany this transition. In other words, the business founder must now act as a leader and thus deal with the core challenge of leadership; how does he or she get the members of the team to work effectively together in pursuit of a common goal? Of course many, if not most, leaders and managers work within organizations and teams, which they themselves did not create. However, the challenge they face is exactly the same.


This chapter aims to explore some of the theories and models that have been used to explain the characteristics and strategies that leaders apply to meet the leadership challenge. The chapter explores how each theory relates to veterinary organizations ranging from the sole vet entrepreneurial set-up to the multi-site corporate chain. This, however, is not a straightforward task. While the literature on leadership in general is relatively broad, the literature specifically relating to veterinary leadership is virtually non-existent. In order to circumnavigate this problem, the key models of leadership and people management will be described, followed by the author’s own interpretation of how such models can be applied in the veterinary context.



Operators, managers and leaders


It is important to begin by recognizing the different perspectives, orientations and skill sets of operators, managers and leaders (Bennis and Naus, 1985; Kotter, 1990; Rost, 1991). Operators can be defined as the people who carry out the actual production or delivery of a business’s services. In veterinary practice, these are the vets that perform the consultations and surgical operations as well as the nurses and the receptionists who support them. A manager is the person who supervises and assists the operators. Managers are focused on the efficiency and accuracy with which certain outcomes are achieved by the people and the systems that deliver them. There are many potential outcomes that can be measured in veterinary practice; these include clinical outcomes (e.g. number of postoperative wound infections), commercial outcomes (turnover, profit, number of transactions), client outcomes (satisfaction scores and willingness to recommend the practice) and staff outcomes (morale, ability to perform certain tasks). Each of these outcomes is called a key performance indicator (KPI). While some KPIs are commonly used to measure performance within the veterinary profession, such as commercial outcomes, there is no absolute list of KPIs which all veterinary organizations adopt to track their progress. Indeed, in the author’s experience, a manager can make an immediate impact within their veterinary organization by simply identifying and defining which KPIs they wish to measure, and then making efforts to improve them.


It is, of course, possible for the same individual to act both as an operator and a manager, and this is very common in the traditional owner-operator model of veterinary practice. It is increasingly common, however, for individuals to act only as ‘professional’ managers within the veterinary profession, fulfilling roles such as practice managers or middle and senior managers within larger corporate groups. Professional managers such as these are drawn from a range of occupational backgrounds. Some originate within the veterinary industry, such as veterinary nurses and receptionists as well as veterinary surgeons, while others come from a non-veterinary background. This variety of backgrounds is often reflected in the KPIs, which different managers use to track the success of the veterinary businesses they manage. It is reasonable to suggest that the most effective managers within the industry will be those who use a range of KPIs to monitor the systems, which are critical to achieving a range of effective outcomes within the profession, i.e. clinical outcomes, client outcomes, financial outcomes and staff outcomes. The specific combination of KPIs that a manager uses is often referred to as their ‘dashboard’.



Theories on leadership


Acting as a leader is distinct from acting as an operator or a manager, even though the same person can perform all three functions at different times. Leadership is often spoken of as if it were simply advanced ‘management’. The presumption is that whatever the manager can do, the leader does more of and does it better. To equate management with leadership is to miss an essential difference between these two modes of working; it is like saying that vets are just more qualified nurses, when in fact they have different roles with different orientations and focus. Capturing the essence of that difference has been the subject of much research and debate, resulting in many different conceptualizations within the literature about what leadership actually is. The aim of the discussion below is to highlight the key features of each of these theories, particularly in relation to how they help us meet the leadership challenge, i.e. getting members of the group to work effectively together in order to achieve a common goal.




The trait approach


Traits are defined as habitual patterns of behaviour, thought and emotion (Kassin, 2003). This approach to understanding leadership evolved from the Great Man approach as a way of defining and identifying the personal characteristics which enable leaders to get people to work effectively together towards a common goal (Bass, 1990; Jago, 1982). Various researchers have identified a range of traits, and some of these are summarized in Table 4.1. Within the veterinary literature some authors have listed traits which they assert are critical to leadership and management within the veterinary context (Little, 2011; Sheridan and McCafferty, 1993); these are also included in Table 4.1.



The trait approach is intuitively appealing as it is tempting to conceptualize leaders as possessing specific talents that enable them to take charge and motivate themselves and others to do extraordinary things. This model is applied by identifying, recruiting and installing people with the ‘right’ traits into positions of command. This approach was common in the military. However, the weakness with the trait approach lies in the weakness of trait theories as a model for understanding and predicting how people behave in general (for a review see, for example, Dweck, 2000). Traditionally, trait models described people’s behaviour without explaining how those patterns of behaviour develop in the first place or how they might change (Costa and McCrae, 1994; Goldberg, 1990; McCrae and John, 1992). Many trait theorists assume our traits are rooted in our biology and, as such, they assert that we cannot change very much (Costa and McCrae, 1994; Eysenck, 1982; Loehlin, 1992). Trait theories of leadership therefore assume you either possess the right traits for the job or you do not. Traits are assessed using self-report psychometric questionnaires whereby participants ‘identify’ their own patterns of behaviour, thought and emotion by rating themselves against the questions asked. Self-report questionnaires have been criticized, however, as a very inaccurate method of identifying an individual’s actual talents. Similarly, trying to determine another person’s traits over a short period of time (such as during an interview) has also proven to be inaccurate. Furthermore, it has been known for some time that the presence or absence of many of the key traits listed in Table 4.1 does not predict how effective a person will be as a leader across a range of situations (Stogdill, 1948). Few veterinary organizations within the UK currently use formal psychometric profiling techniques to identify and recruit staff in general, and leaders in particular. This has led to a lack of empirical data with respect to determining the usefulness of traits as a model for leadership within the profession. However, in the author’s experience, most veterinary employers rely heavily on their own evaluation of a colleague’s ‘attitudes and traits’ when they are deciding whether someone is suitable for a leadership role such as partnership. This is understandable; it is difficult to ignore your gut instinct when evaluating other people. Recent advances in psychology, however, are shedding light on how traits evolve and even change. Over the past few decades more and more psychologists have challenged the assumption that we are born with a set of predetermined traits. For example, a branch of psychology called attribution theory has demonstrated that the ‘mindsets’ which determine our behaviour are much more learned (i.e. acquired) than had been originally assumed. It has been shown that people learn different reasons (or attributions) why certain events turned out as they did. Seligman and Maier (1967) have demonstrated how people ‘learn to become helpless’ when they assume, erroneously, that their circumstances are beyond their control. This is the basis of Seligman’s theory of learned helplessness. While this theory and others like it (Dweck, 2000) were originally focused on resilience and well-being, the view that many of our key ‘traits’ are learned, as opposed to genetic, is also being applied to leadership (see below). As a result, most researchers no longer ask ‘Can leadership be learned?’ Rather, they are asking ‘How is leadership learned?’



The skills approach


In contrast to the traits approach, the skills approach focuses on a leader’s areas of competence as opposed to their personality. Katz’s (1955) ‘three-skill’ model represents the classic approach to the skills-based theory of leadership and management. According to Katz, effective management and leadership depend on three essential areas of competence: technical, human and conceptual. Katz asserts that the relative importance of each varies between different management levels. For example, lower (or supervisory) managers require mainly technical and human skill; middle managers require a significant component of all three, whereas upper management levels require higher levels of conceptual and human skill. In other words, the higher the leadership position, the greater the challenge of getting members of the group to work effectively together towards a common goal. Leaders therefore need increasing levels of ‘human’ and ‘conceptual’ competences to address this challenge as their level of leadership increases. A key premise of Katz’s model is that since skills are ‘learned’ behaviours leadership is open to anyone motivated enough to develop the breadth of skills that enables them to get people to work together towards desirable future goals. This view is in contrast to the Great Man and earlier trait models, which assume leaders are a select group fortunate enough to be born with the right characteristics.


This model can be applied to both traditional veterinary practices and corporate groups. Assistant veterinary surgeons working in traditional independent practices often follow Katz’s model of leadership development as they progress towards partnership. For example, they may become the ‘core vet’ at a branch surgery when they take on sole-charge responsibilities. This could be likened to a lower-level management position whereby they are in charge of the day-to-day technical and service operations, without having a say in higher management decisions such as purchasing decisions, pricing or profit objectives. Leading a branch is a very useful training ground for partnership as it helps a vet ‘prove’ their technical competences as well as their ability to deal with common ‘people’ issues. ‘Common people issues’ in veterinary practice often means getting on with the range of personalities and skill sets that are commonly found within the practice as well as an ability to resolve common client complaints.


Middle managers are common in many corporate veterinary chains in the form of territory managers who oversee a group of practices. Middle managers represent a crucial link between the staff working at the customer interface and the ‘central’ corporate managers. They therefore require at least some understanding of clinical systems in order to understand the impact of changing operational protocols. They also require enough people skills to communicate effectively with the vets, nurses, receptionists and administrators. In order for corporate strategies to be understood, adopted and implemented successfully, middle managers also need a higher level of business management knowledge (conceptual skills) than lower-level managers. For example, they need to be able to read and produce budgets as well as have an understanding of how their behaviour affects other commercial objectives.


Top-level managers within corporate practices, however, require a much deeper understanding of the conceptual models, systems and strategies which are central to commercial enterprises, irrespective of the particular industry in which they happen to be working. Technical competences are therefore less important at this level because clinical matters will be managed by the veterinary surgeons in the practices. Instead, they need to be able to blend their conceptual knowledge with well-developed people skills in order to communicate, persuade and negotiate effectively with various stakeholders, especially financiers, key suppliers and the middle managers, with whom they work. Traditionally, an MBA (Masters in Business Administration) has been seen as the higher-level management qualification whereby aspiring upper-level managers learn these skills. It is, of course, possible to act as a senior executive in any organization without any formal business qualifications, as many self-made entrepreneurs have demonstrated.


While the skills model may help us understand which of the basic minimal competencies people in veterinary businesses need in order to be effective as managers within their organizations, it does not always follow that having these skills automatically results in effective team work in pursuit of a common goal. This is because the skills model does not address the impact of values and ethics within the organization. Indeed, it is entirely possible for two people with exactly the same skills and competencies to have entirely different opinions about a particular situation and the action that needs to be taken. For example, managers whose career progression depends on delivering good financial results may not always see eye to eye with veterinary clinical staff whose priority is to resolve clinical issues with less regard for profitability.

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Oct 9, 2016 | Posted by in GENERAL | Comments Off on Leadership and management in veterinary practice

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