Beyond Burnout 3-Part Series // Part 2: Caught in the Middle - Why Veterinary Managers Feel Trapped Between Teams & Leadership

Practice managers are accountable for results they don't always have authority to control, caught between what their team needs and what leadership is asking for. It's a setup that breeds burnout — and according to a recent VHMA study, it's pushing nearly half of managers to consider walking away from their roles.

In Part 2 of our Beyond Burnout series, we dig into what it feels like to lead from the middle and what you can do about it. We cover why managers tend to report the lowest levels of wellbeing in any organization, how to maximize influence within the sphere you do control, and the fire-fighting trap: why some practices live in constant crisis mode and the one leadership behavior that keeps the cycle going. If you've ever felt like everything is urgent and all of it lands on you, this one's worth a listen.

Host = Brenda Tassava Medina

Panelists:

• Julie Squires, CCFP, CMLC, Rekindle Solutions
• Susie Crockett, CVPM, Director of Practice Management at Noah's Animal Hospitals
• Josh Vaisman, MAPPCP, CCFP, Founder and Lead Positive Change Agent, Flourish Veterinary Consulting

Thanks for listening!

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Transcript

SPEAKER_01 0:10

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SPEAKER_03 2:05

Thanks for having us.

SPEAKER_01 2:06

We're jumping back into the VHMA practice manager burnout study. And one of the most revealing findings was not exhaustion itself, but what is causing it. So the managers in this study reported internal workplace factors that significantly contribute to their stress, external demands contributing heavily to the stress. And I think these were things that we touched on on our last episode as we close that one up. Feeling caught between owner expectations and the team's needs. I think that is a real big one. And then spending excessive time putting out urgent fires instead of working strategically. And then finally feeling responsible for team morale, despite lacking authority perhaps over the root causes that are really bringing the morale down. So with all of that in mind, which is a big old ball of wax, I'm going to throw our first question over to Julie Squires. Julie, how can managers effectively lead when they're accountable for results, but don't always have authority over the decisions driving those results?

SPEAKER_02 3:17

I feel like that's the that's the age-old question, right? It's like you, you know, like what a what a what a big profound question because that is so much of the conflict or the friction is whether or not there's alignment with, you know, the practice manager is in such a unique position. They're sort of, I always think of them as like, they're like the conduit between the team and upper management and or upper leadership, right? And sometimes that's an individual, sometimes it's a board, sometimes it's a corporate group. And finding alignment with that, I think is really difficult because the practice manager is the one that's listening to all of the gripes and the groans and um of the team of the things that aren't working. And they're trying to serve those up, perhaps to you know, upper management who may have a different agenda. They may be looking at different things. So this becomes such a point of of not, you know, of of of stagnation, I guess, that this I think is such a big cause of manager burnout because they feel once again like, where am I supposed to move with this? This is what the team wants, but upper management is looking at different things, different metrics, and we're not able to actually move here. And and and perhaps that's why they need to bring someone like Josh in to help, you know, get some of those things aligned so that there is consistent vision and there is consistent um pathway forward. Like I don't have the answer to that.

SPEAKER_01 4:56

So I don't expect you to have all the answers, but but it is it is a tough one. And I think I I when I became a consultant and when I started working with practices, that was where I really saw the difference in terms of my role and I'm not a practice manager. And I didn't realize I was in such a tight spot between my team and my practice owner at the time. But afterwards it was like, oh, this is a completely different dynamic, actually working from a cons a place of coaching and consulting with practice leaders in this particular area. And I think it was easier for me to kind of point out those misalignments and help work through some of those tough spots. Susie, you have you're you're in a little bit of a different role in that you have nine practice managers that are working directly with you, and then you have your upper leadership to respond, you know, that you're responsible to. So how can how do you set your managers up effectively to succeed? Because they aren't 100% accountable. I mean, they're accountable, but they're not a hundred percent autonomous, if you will.

SPEAKER_03 6:09

Yeah. And that's exactly kind of where my brain went with this question because I think it really depends on the structure of your practice. So if I'm working for a small practice, single independent owner with three doctors and 15 staff, this answer is very different than if I'm working for a multi-site company that's independent or a large corporate with a hundred practices across the country. And I may not even know who my upper management even is. And so I think you have to start with where you are. Because if I work for a smaller practice, truthfully, the first thought I had is ask for what you need, because I may only have one person that I'm reporting to. And I think sometimes we forget we're in this position because we're trusted. And so tell them what you need. Um, and sometimes that helps. It doesn't always help. Um, and if it doesn't, then the next thing, and I tell my managers this um, because they are responsible, but they don't have all the authority. I try to give them as much as possible, but focus on what you can control. You can only play the hand that you're dealt. And I think sometimes people are really trying to keep going, go fish, go fish, go like you get the cards that you have. Um, so what can I do with that deck? And so, how can I make sure that my communication is appropriate with my team on the vision and the goals of the company and let them know the why behind the how it's very much the same as in clinical skill. I can tell you how to draw this or how to intubate, but I need you to understand why. Um, and so telling your team why we're doing certain things. I think that's really, really key. Um, and making sure that you control the work processes in your practice and are you doing them, are you executing them well? Those are things you can control. You can't control that patient visits are down across the industry. We can't control the state of the financial health of the country. Um, so we're not why put my energy in that space? Let me put my energy on the things that I actually can make a difference to.

SPEAKER_01 8:07

Great points. Because I think being perfectionists, you know, we might tend to um internalize a lot of those things that we can't control. Great, great points. Josh, what's your take on this particular question?

SPEAKER_00 8:20

Yeah, um, the first thing that I was thinking about as you brought this up. First of all, I think that the title caught in the middle is so apropos. Uh, there's a meta-analysis that I read, I don't know, sometime in the last couple of years. It's a relatively recent study that was done, and they looked at essentially uh well-being metrics, like workplace well-being metrics, uh, through the prism of three different strata. So you could think of this as sort of like those on the ground. So this might be our technicians. By the way, this was not a veterinary study. This was a generalized, you know, industry agnostic study. But to put it in veterinary terms, you could think of our CSRs, our technicians, our associate veterinarians, our kennel tech, so on and so forth, right? Folks on the ground. Then our middle management folks. So this might be like our technician manager, our practice manager, office manager, medical director, so on and so forth. And then senior leadership. So this could be hospital owner, it could be, you know, a regional director, it could be CEO, C suite, whatever, right? Um, fairly consistently, on average, the lowest levels of well-being tend to occur in middle management. And it's interesting when I think about this, I think to myself, like, that actually kind of makes a lot of sense. The folks on the ground, like they said, they know what they're getting into. They know that they're gonna be expected to do a lot of stuff and they're not gonna have a lot of authority over how things are done, right? Like you sort of you kind of go in getting that, and that's not fun, and nobody loves when that happens. But you know, if you have the mindset you understand that that's what it's gonna be like, you can sort of accept it or learn to live with it or tolerate it to a certain extent. Pretty consistently, the folks at the top tend to have the highest well-being. So that makes sense to me too, because you know, they've got the most power and influence within the organization. They they have a lot of autonomy to control the direction of their day-to-day experience. Totally get it. Again, to use your words, Brenda, middle management is literally caught in the middle. You have all these expectations and demands, and you feel as though you should have a certain amount of autonomy and influence to deliver on those demands, but often you have less than you want. And that tension creates a lot of problems over time. So, my advice is going to wholeheartedly echo what Susie said. Uh, I think that there's two ways to kind of think about this. I'm just gonna use like slightly different words to say exactly the same things that Susie advised. I think of role constraints as like the the extent to which I have decision latitude within my role. It's like, what is the bubble around me that I can move around in? You know, an associate veterinarian is gonna have a certain amount of decision latitude. They get to decide, you know, what they I don't know, what differential list they pick from in a particular patient. They get to decide what medications they prescribe. Like they have a certain amount of decision latitude that a technician is not going to have, right? That that technician is also gonna have a certain amount of decision latitude. This is how how big is the bubble I get to move around in. So the first piece of advice to to practice managers is instead of thinking it in terms of thinking of it in terms of autonomy and control, think about how can I maximize the influence within my bubble? How can I make sure that I'm really filling the bubble to its full extent and use whatever influence I have to help me achieve my goals? And that influence goes in both directions. It's what is the influence you have over the team day to day? How can you use that influence for good so that you can push good outcomes that you're after? It also means managing up. How can I maximize the influence I have with the people who have more status and more power than me in the organization to ensure that they are helping me achieve the goals that they expect of me and that I want to achieve, right? So use influence, maximize the bubble. That's the first thing. And then the second thing, 100% echoing what Susie said, ask for what you need. And think about it bi-directionally as well. Like ask for the for what you need from the team to help you achieve your goals. I mean, that could be as simple as sitting down with somebody who works for you and say, listen, you and I are on the same page here. We want to make sure that we're maximizing patient care and outcomes here. What I need from you is to help me figure out what you need to succeed, right? Like, you know, ask for that. And then we can do that up as well. Susie, you've asked me to achieve XYZ this quarter. Um, what I need to be able to do that is four hours of admin time uninterrupted at home each week. Is that something you can offer me? Right. Like I can ask for that and see what she says, but I'm using my influence with this is what you've asked me to achieve. This is how I plan to achieve it. This is why I need that to achieve it. That's using influence. Now Susie gets to decide if she's going to let me do that or not, right? And that's out of my hands because I don't have that control. Uh so yeah, again, maximize the bubble, use your influence both directions as much as you can, and ask for what you need in both directions.

SPEAKER_01 13:15

Love it. Love it. And and think about it from I I love the the influence versus control, right? Because we we only have so much influence, right? But we don't leverage it often enough because we're frustrated we don't have control over the situation.

SPEAKER_00 13:32

Yeah, and it's unbelievably like psychologically painful when you're looking for control and someone takes it away. But when we use influence and don't get what we want, we can accept that. We might not be delighted with it, but we can at least accept, hey, I maximized my influence, it didn't work out this time. I'll try again next time.

SPEAKER_01 13:51

Absolutely. So, Julie, what systems or leadership behaviors create a constant firefighting culture? Because I see that everywhere. It's just uh I don't have time to meet with you, I'm putting out fires today. How do practices break that cycle?

SPEAKER_02 14:10

Yeah, there's a lot of putting out fires. Um yeah, I mean, how do practices break that cycle? Well, I I guess part of that is it's important to look at what are the things that they're putting out fires about all the time, right? Like that's valuable information in and of itself. And if the things that we're putting out fires about all the time are things that are, you know, that that shows us where we're missing in training, that shows us where we're missing in resources, that shows us where maybe we're hiring the wrong people, right? If we're constantly putting out fires about, you know, people calling out and calling out in the morning versus, you know, giving notice, like all of that stuff. I think the fires are valuable information and are probably the first places to really start to uncover this is where this team, we need to shore things up.

SPEAKER_01 15:06

I love that because it's data. I mean, right? You you just need to look at the data and learn from it. Yeah. Susie, from your perspective, are there any systems or leadership behaviors that are creating the cycle?

unknown 15:20

Yeah.

SPEAKER_01 15:20

And how do how do they break that cycle?

SPEAKER_03 15:23

100%. And the biggest one um is the leadership behavior of not holding your team accountable. Um, and then we take on the extra burden um and we carry it all on our own on our own. And that leads to just more burnout, more burnout, more burnout. And so, but it's hard because people look at accountability as conflict, they look at accountability as punishment, and it's not. The other thing that it typically is is a systems problem and not a people's problem. So, to Julie's point, let me do a diagnosis of the systems in my clinic and my practice and say, what can we fix and improve on? Um, and reduce that capacity overload that we have, um, fix that process first, and then things will start to fall into place. But to me, the biggest leadership behavior that perpetuates this is not holding people accountable. And sometimes it's not holding ourselves accountable for being honest about it, um, because we don't know what that looks like. Maybe we haven't had an example to show us what that looks like. Um, a lot of people are still just given this job and said, have fun, you know, good luck, Godspeed, you know. Um, and so the accountability piece to me is a huge foundational um necessity to fighting this.

SPEAKER_01 16:36

Yeah. When I think of the firefighting, I tend to go in the direction of being on this hamster wheel, right? Because that's that's the way I picture it in my mind is this constant hamster wheel that's just keeps you running and running and running and going nowhere. And it's so frustrating to me to see people do that to themselves when I just need them to take a step off of that wheel and and breathe for a moment and really take a look at the situation. Josh, systems, leadership behaviors, what's creating that culture and how do we break the cycle?

SPEAKER_00 17:11

Yeah. Um, I think I think everybody on this on this podcast will agree with me when I say this. Um, I think the vast majority of people who come to veterinary medicine, whether they're coming into a leadership role at the beginning or they start in vetmed and end up in some sort of a leadership position, like a practice manager, are like really good people with really good intentions. Like we actually really care about each other and we want to do the best that we can for each other. And so once we get into that position of management, we we view ourselves as caretakers of the team around us, right? I think that is one of the most magical things that gives us this power and gift to be the exceptional human beings that we are. It also makes makes us susceptible to Susie's point, taking everything on ourselves, right? And so we tend to view like the quote unquote fires around us as flames threatening to burn down the building. Everything is urgent. And if everything is urgent, nothing is urgent. But we're just constantly, again, Brenda, to use your term, running on a hamster wheel but not getting anywhere. So, like one of the things that I've really started to recommend to folks in positions like that is um creating a system to categorize urgency. Like the the simplest one I can think of is one that we uh we helped somebody do recently, which is um come up with a uh a category, um, three categories for uh for needs around the practice. You know, the the stuff that people are knocking on your door and coming in a million times throughout the day, or the things that you see happening around the hospital. People are like, oh my god, oh my god, oh my god. Um, red, yellow, and green. And defining what each one means and what the action will be based on that category. So for example, like um, I don't know, uh the anesthesia machine is broken and we only have one anesthesia machine in the hospital. That's probably gonna be a category red, right? And the action is gonna be I will stop whatever I'm doing, and I'm gonna make sure that we get you know functioning anesthesia as soon as possible. Cool. Uh, you're gonna have a yellow category, maybe an orange category, whatever, define what are what are things that are in that category, what's the action that's gonna happen. So, in other words, when you come to me with something, I'm gonna ask you, is this red, yellow, or green? And you're gonna tell me, and then I'm gonna know exactly how I need to respond based on that color. So if it's a green thing, then I can say, hey, you know what, Brenda, thank you so much for letting me know. I'm gonna circle back with you next week when I have a couple hours of time. When it's a red thing, I know that I need to stop whatever I'm doing on the computer and go do that. If we have some categorization in common language, that can really help slow down the hamster wheel a little bit, right? The second thing is we just absolutely need to get better at identifying the tasks, categorize, categorizing again the tasks that have to be me, that maybe should be me, that don't need to be me, and that absolutely should not be me. And then any of the tasks in the lower two categories, I'm sorry, pardon my French, get them the hell off your plate. Somebody else should be doing those tasks. Any of the the tasks that's in that second core category maybe should be me. Identify somebody who's an emerging leader in your practice and teach them how to do that. Only the stuff that absolutely has to be you should be the things that land on your plate.

SPEAKER_03 20:30

I love just the first point because to me, we hear this like put it in language that they understand. What you're talking about is triage. It is the exact same system we have in our ERs. It's triage, it's red, yellow, like red, orange, yellow, green. Like, and that's I'm I love that.

SPEAKER_01 20:46

That's your next staff meeting, right? I mean, great staff workshop. Come up with that language and learn how to triage the problems within the practice together, right? Yeah, I love it. Well, thank you all for joining us again today, and thanks for flying with us on Flight Plan Quick Consults. And thank you to our generous sponsor, Pirina. If today's insights helped you climb to new heights, be sure to subscribe, leave a review, and share this episode with your crew. Be sure to tune in next week as we tackle part three building practices that support leaders instead of draining them. And in the coming week, keep your mission clear, your team aligned, and your practice soaring.