Civil Wars: Front vs Back
Megan Brashear, BS, CVT, VTS (ECC)
VCA Northwest Veterinary Specialists, Clackamas Oregon
Until recently, how to deal with people was not commonly taught to veterinary technicians or veterinarians in school. While today’s students are getting lessons in personality traits, communication skills, and leadership, many already in the field are left to scramble and figure it all out on their own. While every new situation will include its own new lessons, there are some basic pearls to remember with every human interaction during the day.
First, it is important to understand who you are before you can connect and communicate with someone else. How do you receive information? How do you filter that information and then share it with the next person? There are many different tests that one can take to help determine their personality type and the most important part of any test will tell how YOU communicate. Once you better understand how you interpret the world, you can start to understand how others see a situation differently and you are better able to tailor your approach for a positive outcome.
Employees and managers alike should work to become self-aware of their emotions and what triggers those emotions. The goal is not to try to stop these emotions, but to be aware of them and control them. The initial reaction to a situation may be negative such as fear, anger, or embarrassment. A self-aware employee will recognize the negative emotion but be able to control that initial response while listening and attempting to gain a better understanding of what is happening. Resist the urge to act on initial emotions. Take a deep breath before responding. In written communication, write out a first draft and come back to it when the initial anxiety has dissipated. Decisions should be made based on facts and not based on reactionary emotion. Medical decisions are based on medical facts; communication should be viewed in a similar fashion.
It is important to realize communication differences in people and not be so quick to judge when they communicate differently than you. One way we can segment people’s personalities is to divide them into Thinkers and Feelers. Thinkers process information and facts. They are logical and often can efficiently move through a conversation with ‘just the facts’. Feelers filter everything through their emotions and may perceive someone as callous if only the facts are communicated. Know what you are, and realize that you communicate better with those similar to you. Once you understand better how you interpret the world, you can start to understand how others see a situation differently and you are better able to tailor your approach for a positive outcome.
When approaching any situation, it may be cliché but also important to view the situation from the other person’s perspective. Empathizing with someone else’s stress, fear, and lack of knowledge can help one explain things more thoroughly, better set expectations, and save the task of having to repeat the same information over and over again. Always assume good intent of everyone. Be careful of negative assumptions, as they will impede the ability to remain open minded.
Solid teamwork is a tenant to any successful veterinary practice. If employees and teams are communicating and working together the success is evident in the service provided to clients. Conversely, when teams are unable to communicate and harbor resentment for each other, client and patient service suffers. One of the most common communication challenges in the veterinary hospital is between the front client services team and the back technician team. When these two groups declare a civil war everyone suffers.
One of the biggest contributors to tension is misunderstanding between the front and back. The technicians have an expectation of what the front desk is doing and vice versa. When something falls through the cracks due to assumptions, each team blames the other. With the physical barrier between the front and back of the hospital these small disagreements can turn into hostility and gossip that can quickly take down the culture of the entire hospital. It takes work to keep communication open, and work to understand what each team is doing.
One of the first steps to resolving conflict within the practice is to find mutual ground. In this case, service is the common theme. Bring all employees together for a discussion on service. Begin by defining service. Solicit stories and feedback from the entire team regarding the basics of good service. Define service on the phone, in person, and decide the basics that every client will receive while in the clinic. Through this exercise, create a list of responsibilities for each team and each team member. By including everyone in the process, the teams see that client service is not the responsibility of only one team, but a key requirement of every employee.
Another helpful activity for the hospital is to ask each employee their reason for working in that practice. What are their core values? When the team members have discussed their personal values, discuss the core values of the practice. Allow everyone the opportunity to see the value of service and communication and to understand their role in carrying out the values of the practice. Team members should take the opportunity to see how their reasons for working mesh with the values of the practice. These values should be discussed with each new hire and reiterated at yearly reviews or if any service issues arise at any time.
Practice members need to place a premium on helping each other. While it is beneficial to foster comradery among small groups working together, do not let it turn into hostility for other teams. This can happen between shifts as well as between varying roles. Challenge employees to see each other as internal customers. Treat coworkers with as much respect as a client deserves. Encourage employees to participate in the training process. If a technician is having problems with a process that involves the front desk, a customer service representative can step in and help with the training process rather than waiting for the technician manager to respond. The technician team, rather than complain that the check in process is taking too long, can offer to help by taking phone calls or entering information into the computer.
Each team needs the opportunity to train on any changes that occur in the practice. Even changes that seem to affect only the front or the back can have an impact on patient and client flow. Ensure that changes are communicated throughout the practice with the opportunity to train prior to the change taking effect. This process allows for questions to be answered and for any potential pitfalls to be discussed. Often, a change the seemingly affects one group may cause major problems for another, and rather than argue in front of a client or after a major mistake has been made these problems can be sorted out in a team meeting. If managers of multiple teams have the opportunity to meet on a regular basis they can attempt to allay these issues before the change is brought to the floor.
Cross-training between the front and back creates an opportunity for understanding and empathy. The front desk team should have the opportunity to observe procedures and appointments from the perspective of the medical team. In many practices, the front desk is responsible for booking appointments but may do so without full understanding of how long procedures may take, or how some appointments can affect the flow of the day. The opportunity to observe can also be an opportunity to train on objective duties like preparing lab work for submission, walking patients and feeding certain patients. Under the direction of the technician team, customer service representatives can be empowered to help keep things moving by helping with patient care. The knowledge gained can help them with client questions and scheduling.
Conversely, the technician team should spend some hours at the front desk. Observing the multi-tasking between the phones, money, clients, and patients will bring a new appreciation of the role of customer service. Technicians can also be trained to perform duties such as appointment making and data entry to help keep clients moving through the lobby. The goal of cross-training is not to have a group of people who can all do every job in the hospital, but to create a group of co-workers who can help out in busy times and have a working understanding of all areas of the hospital.
While the front desk handles the majority of client interactions, client satisfaction is a team effort. If there are communication issues between the front and back staff, clients will recognize that. Working well as a team requires that both halves of the hospital have an understanding of what the other half does, and are willing to back up their coworkers. A client that is nervously awaiting their pet to be returned to them, or news of their pet, will feel better with a kind explanation of what is happening. Technicians and doctors can pre-empt the barrage of questions by proactively updating the front desk on how things are progressing with a patient. Teams need to put a priority on client satisfaction and all work towards the same goal.
Cross-training will help teams communicate, but division of labor is important and will allow front desk employees to focus on their strengths. Medical questions, even those over the phone, should be handled by technicians. Discharge instructions should be performed by veterinary assistants or technicians, allowing the front desk staff to focus on waiting clients or new phone calls. Duties of customer service representatives may be dictated by staffing elsewhere in the hospital, remembering that they should not spend large amounts of time away from the desk.
Implementing every idea mentioned in this talk will not magically fix all communication problems. Veterinary work can be stressful and comments will be overheard, feelings will be hurt, tempers will be short. All employees must remember to be flexible. The battle cry of “that’s not my job” only deepens the division between teams. A flexible customer service representative sees a medical team woefully behind and offers to take out the garbage and walk the crying dog. A flexible technician offers to load exam rooms or picks up a phone call. Stifle the impulse to ask “what are they doing up there?” or “what is taking so long back there?” to yourself, and walk to the front or back and check in. When a CSR asks for an update on a patient realize they are asking for the client, not for their own knowledge. They know you are busy; a simple “5 more minutes” is all that needs to be said.
Create a hospital culture that appreciates and empathizes with clients. Do not allow complaining about or making fun of clients. While this may seem like an activity that bonds the staff together, it bonds them as a group against the clients. Gossip should not be tolerated, and that includes gossip about clients. Once that behavior is allowed to occur, it can quickly lead to inappropriate conversations overheard by clients both in person and over the phone. Speaking badly of clients will also erode morale and can create feelings of anxiety about being at work. Encourage all employees to treat clients with the same empathy as their pets and do not dwell on confrontational experiences.
Always assume good intent from those around you. Your mindset is the most important part of your interactions. If you are burned out, still smarting from a not so great client interaction, worried about your upcoming review, or unsure of yourself, all of that insecurity and anger will show through your communication. Providing great service means that you have enough emotional reserve to get through a long day with people. Know yourself, and communicate with your team. Compassion fatigue occurs when you can no longer muster the energy to provide compassion. It does not have to be a permanent state, but it can greatly interfere with your ability to provide service. Understand the signs, understand yourself, and take care of yourself. Remember that a smile comes through in your communication. Even if it starts as a fake smile, work on making it permanent and it will carry through to your words. Remember that we are all in together, and a hospital divided cannot stand. Great customer service comes from a commitment from the entire team.
Think of communication skills as another organ system to be mastered. Surgical skills were not learned overnight, and if not practiced IV catheter placement skills will deteriorate. Good communication takes study, practice, and a commitment to continuing education. Remember that clients do not often judge a veterinary practice on their medicine, they judge it on their communication skills. Focus on the medicine and the communication to find success and happiness at work.
References Available Upon Request