Growing your practice in a stalled economy (Proceedings)


Become a learning practice.

We may have the time to reinvent ourselves.

     • Practices are often failures at implementation and don't know why.

     • We may have to delay or modify financial projections.

     • Now more than ever we need to find and keep good people on our team.

     • We suck at management development.

Become a Learning Practice

     • Pinpoint areas to foster knowledge sharing.

     • Develop new ideas.

     • Learn from mistakes.

     • A "Learning Practice" is one where employees excel at creating, sharing and transferring knowledge.

Barriers to Learning Culture

     • In the early 90's this term was coined by Peter M. Senge in his book, "The 5th Discipline."

     • The goal was to create flexibility and rapid response to business climate change.

     • It was, and is, a good theory, but difficult to impossible to implement:

           o Veterinary practices spend all of their time working in the business instead of on the business.

           o Managers could not identify the sequence of steps to move the practice forward.

           o Concept was aimed at leaders instead of front line employees and mid level managers.

           o Standards and tools for assessing progress did not exist.

3 Keys to Learning Culture

     • A supportive learning environment.

     • Concrete learning processes and practices.

     • Leadership behavior that reinforces learning.


Learning Practice

     • "Supportive learning environments allow time for a pause in the action and encourage thoughtful review of the practice's processes."

     • So what if...

           o You could "score" your practice and compare it to other learning organizations?

           o You could compare the learning environment of different work units in your practice?

           o Have a broader view of how your practice reacts to change and challenges?

Learning Practice

     • An online tool created by HBR.

     • Practices do not perform evenly across the 3 building blocks.

     • Each building block can be viewed as a separate developmental stage so each unit may require specific tools to improve. Even in a "small" practice people learn differently and respond to different stimuli.

Building Block 1: Supportive Learning Environment

           o A Supportive Learning Environment has 4 distinctive characteristics: Psychological Safety.

           o Appreciation of differences.

           o Openness to new ideas.

           o Time for reflection.

Psychological Safety

     • To learn, team members cannot fear being belittled or marginalized when they disagree with peers or authority figures, ask naïve questions, own up to mistakes or present a minority viewpoint.

     • They must be comfortable their thoughts about the work at hand.

Appreciation of Differences

     • Learning happens when people become aware of different ideas.

     • Recognizing the value of competing functional outlooks and alternative solutions increases energy and motivation.

     • The result is fresh thinking and the prevention of lethargy and drift.

Time for Reflection

     • Veterinary practices often have environment that does not reward reflection.

     • Owners and DVMs (by nature) are seldom curious about human nature and rely too much on science to achieve success.

     • Team members are measured by archaic standards (or not measured at all, just subjectively and randomly evaluated). Number of hours worked, gross revenue, tasks accomplished.

     • When people are overly-stressed and overly-scheduled, their ability to think creatively is diminished.

     • They are less able to diagnose problems and learn from their experience.

Case and Point

Children's Hospital and Clinic of Minnesota: A "blameless reporting" policy.

     • Replace threatening terms such as "error" and "investigation with less emotional descriptions like "accidents" and "analysis."

     • The hospital culture needs to be one of everyone working together to understand process and priorities and report on them without fear of blame.

     • The result was increased productivity and engagement and improved patient outcomes and satisfaction.

There is a message here for veterinary practices.

Building Block 2: Concrete Learning Processes and Practices

     • A learning practice is not achieved effortlessly, but arises from a series of concrete steps and widely distributed activities. In our business, examples would be: logistics, billing, compliance, health care plan delivery...

     • For maximum impact knowledge must be shared in systematic and clearly defined ways.

     • Knowledge must flow laterally and vertically.

     • Can be internally focused with an eye toward corrective action or externally focused as in focus groups or employee surveys.

     • All of this should result in information moving quickly and efficiently into the hands and heads of people who must implement.

Case and Point

     • After Action Review (AAR) now commonly used in service organizations.

     • A systematic review of every service, activity, mission or critical mission.

     • 4 simple questions...

AAR Questions

     • What did we set out to do?

     • What actually happened?

     • Why did it happen?

     • What do we do next time?

Building Block 3:Leadership That Reinforces Learning

     • Organizational learning is strongly influenced by leadership: DVM's, Managers and Team Leads.

     • When leaders ACTIVELY question and listen to employees (prompting dialogue

and debate) people in the practice feel encouraged to learn.

Case and Point

What message do you send? Do they know that you know that these things are important:

           o Problem Identification or Symptom Reporting

           o Knowledge Transfer or CYA/No Training

           o Autopsy or Blame.

The result of Unconventional Wisdom can be:

           o Emboldened Employees

           o Higher Productivity

           o New Options

Do you want them to have the right answer (be right) or do you want them to think about the problem the right way (be correct)?

Unconventional Wisdom

Questions to generate discussion: What criteria did you use?

     • Why did you come to that conclusion?

     • What alternatives were considered?

     • What was your primary motivation?

     • What value/mission is supported by your thinking?

The Building Blocks

Meant to reinforce one another and to some degree overlap.

           o Supportive Learning Environment (Easier for Managers and Employees to Execute).

           o Concrete Learning Processes and Practices (Smooth Operations, Measurement and Accountability).

           o Leadership That Reinforces Learning (Provide Opportunities for Leaders to Cultivate Learning).

This "Circle of Learning"

The Online Tool


     • Complete Tool:

     • FREE TOOL

Designed to answer 2 questions:

           o To what extent is your practice (team, employee, DVM) functioning as a learning organization?

           o What are the relationships among the factors that affect learning in your practice?

     • Data is stratified into quartiles

     • Identify areas of excellence or needs to improve.

Do group and or individual assessments to pinpoint:

           o Cultural/habit differences and commonalities

           o Things to be learned from one another.

Address specific problems.

Before and After Results

     • Ask each participant to score themselves and the team in each area on a scale of 1-100 and then compare to actual. What will you discover? Mean Scores for Service Businesses:

           o Leadership: 76

           o Concrete Learning Process: 74

     • Supportive Learning Environment: 71

Helps to clear the fog between intention, cultural myth and reality.

Before and After

     • Help employees better understand what critique and analysis really looks like.

     • Tests assumptions in a quantifiable way.

     • Creates the background for having productive debates and seek out dissenting views.

     • Identify critical development areas for the business.

     • Used to initiate conversation and self-reflection, but is not the sole cure for what ails your practice.

The Unconventional Wisdom Is:

     • Leadership alone is insufficient. The cultural and process dimensions of learning require more explicit, targeted interventions. This requires more attention in veterinary medicine to do more than modify or change the leadership structure.

     • Practices (in spite of a common mission) are not monolithic. Groups or individuals vary in their learning maturity and their focus.

     • A one size fits all approach for building "team" is not likely to work.

More Unconventional Wisdom

     • A high score does not indicate a competitive advantage but rather an awareness that of the concept and a belief that these things are paid attention to in your hospital.


More Unconventional Wisdom

     • Learning is multi-dimensional.

     • You can enhance by attacking one or more of a multitude of factors.


David A. Garvin, Amy C. Edmonson and Francesco Gino

March 2008 Harvard Business Review

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