Helping team members be their best: Assembling your team (Proceedings)

Hiring people and having them all work within the same 4 walls doesn't make them a team. Building a team that actually functions as a team, in other words working together to accomplish goals, is a great feat, in my mind. We all work in a pressure cooker environment that's a recipe for strained relationships, turnover and stress. It's not enough to hire the right people, although that's important, but you also have to train them, nurture them, lead them and correct mistakes. The first thing you have to realize when it comes to hiring and training is that you are going to make mistakes. Don't feel bad if you have problems – we all do!

I also am a realist when it comes to the employees I already have In my opinion, most things in life fit on a bell curve. Teachers you've had, books you've read, movies, clients – and, of course, employees. There will be a few really good, a few really bad and a whole bunch of average in between. As my husband says, "There's always a worst employee." So sit back and learn to enjoy the ride and the challenge, because there's no bigger one in business than hiring and keeping good employees.

That said, now what? Unfortunately, I think there's a lot of bunk out there when it comes to hiring that you might as well get over now. First, the myth that if you carry your business cards with you and give them to the nice waitress or the nice check-out girl and ask if they want to apply you'll get good employees. The reality is, they can make a lot better money being a waitress, so unless they have that animal care calling – and if they did they'd be working in the field already – they probably won't be too interested.

Secondly, I'm looking for someone who shares my team's work ethic and philosophy on pet care. That eliminates a lot of people right there. Just as 20% of your clients are your "A" clients who pay 80% of your bills because they treat their pets like children, only 20% of the people you interview will probably have that sort of match with my practice. They then must meet my other hiring criteria as well. In addition, they have to be willing to put in crappy hours when we're open on Saturdays and evenings. The pay isn't great compared to many other things they could be doing. The work is challenging and sometimes dangerous. The odds of that waitress or check out person actually turning out to be a good fit for my hospital, and staying for the long haul, are probably about 1000 to 1.

OK, now I'm depressed. Really, what do you do? Everyone has their own theories. Things that have worked for me: send your chatty receptionist to hang out at the dog park and talk with pet owners. Tap your local humane society. Strike up a conversation with the pet store employee. Think about clients who care about their pets, have their head on straight, and are unhappy with their current job. I think going straight to animal related places narrows your focus right away

Second myth: keep a prospective employee on the back burner at all times. Come on – people can't afford to wait for you to call. By the time you get back to them it's too late, they took another job. Better to hire them when you find them and wait for your worst employee to make their move. If the new person turns out to be good they'll find a way to make themselves useful. So hire 2 for every 1 you need – one or the other is sure to leave. Some of my best employees I hired on the spot because I thought they would be great to have, not because I was looking for someone.

Third myth: you should hire technicians to leverage the doctor's time. In my area, and probably in yours, you can't find a technician for love nor money. You have to train people to do as much tech stuff as possible, which takes a huge amount of time and effort. In a profession consisting primarily of women, tenure is a huge issue for us. People's lives and goals change. Again, take good people when you find them, and hope for the best.

Fourth myth – if you ask all those brilliant, probing questions, you'll be able to identify a winner. First off, job applicants lie. "What's your greatest weakness?" "I work too hard and care too much." Give me a break! If they sound like they're reciting a script, be careful.

I've seen hundreds of good interview questions that are supposed to reveal someone's true personality – but the people that write the questions seldom tell you what the right answers are or how to interpret them. Do I still ask the questions? Yes, but I take the answers with a grain of salt, too. I know the person may be lying, or they may be someone who interviews well or poorly without that being a true picture of their personality. You don't know if they falsified their resume – an amazingly high percentage of people do. You're always taking a chance.

Questions I ask and what I'm looking for: Tell me about the best boss you've ever had. Tell me about the worst boss you've ever had. If the best sounds nothing like me, and the worst one does, we won't get along. People that like a lot of sugar coating and hand-holding don't last long in my practice.

What did you like most about your past job? Least? Again, if they like a quiet, slow pace or having their own cubicle – not a good fit. If they like variety and a fast pace, that's good. If they didn't like the back-stabbing or gossiping at the old place, they won't contribute to it at yours, on the one hand, but if that's a problem in your practice, she may not stay. If they like routine, and steady hours – bad. If they don't like stress – double bad.

What activities and hobbies do you participate in? What issues are you passionate about? If they have none, they won't generally take home extra work, read up on something on their own time, volunteer for the dog wash or help anyone else out. The best employees are busy people. They volunteer at the shelter, spend time on charity work, go to classes, have hobbies or sports. Look for those go-getters.

Give me an example of the human animal bond and what it means. If they don't get the HAB, I won't hire them. I want to know a little bit about how they care for their own pets and how they feel about them. Everyone who applies says "I love animals," but that doesn't mean they take care of them or will encourage other pet owners to do so.

Give me an example of a stressful situation and how you responded. If I were working next to you, how would I know if you were stressed or upset? Then ask their references the same questions. Do they manage their stress or frustration or take it out on others? What frustrates them – is it things they will likely encounter in your hospital? Ask about strengths or weaknesses and again, ask references, too. If they are self-aware you will get the same responses.

I also give them scenarios to see how they would respond. "What would you say when: the client who dropped the dog off in the morning for a bath, specifically requesting that it be ready to go at 3 p.m., is standing in front of you, upset because it's 3 p.m., and the dog is not ready to go yet?" "What would you do if you forgot to give a customer the pet's medication on their way out?" Can they solve a problem? Do they have some idea of appropriate customer service?

For more good interview questions, I like Dr. Tom Catanzaro's book Building the Successful Veterinary Practice, vol. 3, Innovation and Creativity.

Back to the myths of hiring: Fifth myth: the want ad has an influence on who will apply for the job. I have tried about six different ad strategies and haven't noticed a difference in the quantity or quality of the resumes that I get. If someone has a study that shows it makes a difference, I'd like to see it. I think that what I get mostly depends on the hiring market and economy.

The bottom line is it's a gamble, always. I do it all – I ask the good questions, I have them come back for an observation day and a 2nd interview, I call their references every time, I try to make sure they are realistic about the hours, the pay, the stress, the amount of stuff they have to learn. Here's what else I do: I reward employees for recruiting new staff members - $50 when that person starts, $100 when they make it past their 90 day probation and $250 when they have stayed a year.

I provide business cards to the employees and ask them to be on the lookout for good people, just as I ask my clients for referrals. I always have applications up front and will always take an application or resume, even when I'm not actively looking for someone. I always have a tech ad running on WhereTechsConnect.org. If a tech walked in my door that I thought would fit the team I might hire them regardless of whether I could financially or logically justify it at that moment.

I pay my employees more than most clinics and include generous benefits. I have acquired good people because I gave them 2 weeks vacation the first year and offer more CE and pet care benefits. If you can't afford good staff, raise your prices and offer more services. Pay isn't why people like their jobs, necessarily, but it's often why they take a job and stay with it.

I get multiple team members involved. My practice manager does the first interview, I do the second, and we solicit opinions from everyone they worked with on their shadow day. For techs and associate doctors I have a couple staff members take the person to lunch at my expense, to get to know them a little better. Sometimes they come back with glowing reviews. Sometimes they say "Uh-uh." I don't hire anyone unless I have buy-in from multiple people. The team has to work with them, the team should have input.

If you get a flood of applications and need to winnow it down, or you have a questionable resume, or the person lives far away, do a phone interview first. If they can't talk on the phone to you, they won't be able to talk to clients either.

Technical skills are nothing. People skills are everything. If they can't interact well with others or don't fit your team, don't hire them. If they already work for you and have great technical skills, but can't get along with people, let them go. You already know that but I'm saying it for the record.

If you want to delegate hiring, start by training someone to hire kennel staff or part time employees. They'll make some mistakes – that's OK. I don't always agree with my kennel manager's hiring choices but they are her choices and I abide by them.

Train your team for communication skills, conflict resolution and coaching. These are skills that can be learned. Buy some books, do some team training, learn to coach and mentor and help employees set goals.

Don't put up with bad employee behavior. We all do it, we all know we shouldn't. Yes, it costs $10,000 each time you lose a trained employee and have to start over. Yes, techs are hard to find. Yes, it's not fun to sit down with someone and resolve a conflict or to send someone home for violating the dress code or your code of conduct. Just do it. After a few times you won't need to do it as much anymore.

Have high expectations of people. People will rise to the level of our expectations. Treat employees like intelligent, caring adults who will make intelligent, caring choices and usually that's what you get. Offer them CE and on-the-job training. Have staff meetings every week or every month. Involve them in hiring decisions, fee setting, cost control, training and client education. People want to be part of something bigger than themselves. The bottom line you are looking for is an employee, or group of employees, who have positive attitudes, like or love their work, and have self-esteem, compassion, communication skills, and a belief in the mission of the hospital. Hopefully they are also smart, can multi-task and are nice to others. It's really tough to find all these traits in one person, much less 4 or 10 or 24. We often sacrifice in one or more of these.

We also have to nurture and coach people to bring them up if they are low in certain areas. If they have promise and keep trying, I'll usually stick with them. If they give up are chronically unhappy, or making others unhappy, I let them go. It can be a really tough call whether they are going to make it for the long haul or not. Every employee, team or situation is a little bit different. Personal problems make their way into the group – divorce, a seriously ill family member. Everyone deserves a little slack during rough spots yet everyone also should be expected to maintain a high standard of behavior. These are all tough issues we have to deal with.

Every time you hire a new employee you will have some strife and adjustment to make. When you are putting a team of people together, the team will go through 4 stages. The first is Forming. People are feeling their way along, not sure if they are going to like the new people, not sure who is doing what, or how. They start to form a cautious affiliation and try to develop some objectives, goals or plans.

The next stage is Storming. People are starting to butt heads about who is supposed to do what. There is conflict, competition, disagreement. People haven't figured out how to work well together and they push each other's hot buttons by mistake. "I can't believe she said that to me!" They start pissing on things to mark their territory. "This is my desk area, stop leaving your soda cans there!"

Stage 3 is Norming. There is a growing closeness, team members are learning to compromise, and they are focusing on getting along. They bring donuts, show each other pictures of their children, do the bonding thing. Unfortunately, they often don't get much work done at this stage.

Stage 4 is Performing. Tasks get done collaboratively, the team has gelled and is working well together. Conflict is minimal, everyone feels good about work, and a lot gets accomplished.

Unfortunately, when you add another person or 2 you have to go through all 4 stages again. Sometimes it feels like all you ever have is storming. The good news is that you can manage or orchestrate these stages to get to effective teamwork much faster.

During the forming stage, the leader assigns projects, desks, tasks. The leadership style should be very directive. People will get comfortable much faster is they understand what they are supposed to do right from the start. The better your training program, the faster you will make progress toward the next stage.

During the Storming stage, the leader must be patient, listen and help resolve conflict. Conflict is inevitable, and the better you handle it the faster it will go away. Ignoring it doesn't work. Confront the conflict and encourage people to build on their own strengths. Praise helpfulness and accomplishment, help people figure out their role in the team.

During the Norming stage you can become more of a coach, just getting people back on track when they get distracted into the food and photos thing. A Performing team needs an advisor to help out when needed. You shouldn't have to still be telling people what to do at this point, they should know when they are getting stuck and be able to determine what help they need to get unstuck again.

The ideal size for a team is 5-8 people. In larger hospitals we tend to have the receptionist team or the technician team because a team of 20 people doesn't function well. We try to stay within this 5-8 person number when organizing work groups in our hospital – the new employees being trained, the compensation plan group, the management team.

Make sure you or a leader in your practice has goals and a vision for where the practice is going. These must be shared with the team. The adage "If you don't know where you are going you'll probably end up somewhere else" is true. People don't like to be kept in the dark, and if they don't know what's going on they start to make stuff up. "No one has told me I'm doing anything wrong so I must be a great employee." Every team needs to have at least one leader. If that's a problem in your team then leadership training is needed. The owner of the practice doesn't always have to be the leader. If they're not, though, they must be willing to give that role up to someone else in order to have a successful team.

Cecilia Soares wrote an article for Vet Econ that has some excellent information about teams (January 2000). She says: "A workplace can become an unhealthy system... To understand the dynamics of a work group, you must understand each team member's role in the group; the rules, both overt and hidden, governing their interactions; and the natural balance of that system. Be aware that the pattern of interactions within the work group is more important and more powerful than the individual psychology of any staff member."

"Healthy systems support and encourage the growth of individuals, while unhealthy systems prevent it." Do you do enough training and CE?

"Communication in healthy systems is direct, clear, specific, internally consistent, non-blaming, and non-shaming. In unhealthy systems, communication tends to be unclear, indirect, and inconsistent. In such a system, staff members often feel singled out, humiliated, and blamed for practice problems." Survey your staff. Is this how they are feeling? Do you need team training on communication?

"The rules in healthy systems are openly and clearly stated, public, widely understood, up-to-date, and have the flexibility to change when needed. Rules in unhealthy systems are often unspoken and hidden, out-of-date, and rigid. In addition, staff members may face negative consequences for speaking out." What are your rules? Are they written?

"In healthy systems, team members exhibit confidence and competence, which leads to desirable and constructive outcomes. In unhealthy systems, staff members experience low morale, low self-esteem and lack of confidence, with little chance for improvement. When new staff members join an unhealthy practice team, they are often enthusiastic – until the negative system dynamics drag them down." Again, ask them how they feel. Then decide if you need to do something about it.

"Healthy systems encourage new ideas from excited and enthusiastic team members, which leads to increased creativity and innovation. In unhealthy systems, team members discourage new ideas, leaving employees feeling stifled, bored and burned out." What do you see? What happens when someone floats a balloon in your practice?

"In healthy systems, people exercise tolerance. They tend to overlook or work around each other's shortcomings, idiosyncrasies or mistakes. People in unhealthy systems tend to judge, criticize, blame and gossip." Is this behavior the norm or the exception?

Does any of this sound familiar to you? Do you have cliques at your hospital? Recurrent problems that just keep resurfacing? Are they talking behind your back? If so, you have some work to do to restore teamwork. You will probably need a 3rd party to intervene and help everyone to find more effective ways to communicate and interact. You may need to disassemble your team and rebuild it in order to make a substantive change.

Teamwork, like marriages, needs constant upkeep and nurturing. It isn't always easy – in fact, it's probably a lot more difficult than actually practicing medicine. A good team, however, is worth just about every effort to develop.