Helping team members be their best: Individual training and CC (Proceedings)

Somewhere along the way, good veterinary team members figure out that one of the most important components of our jobs is to be a teacher. We teach clients how to take care of their pets, what signs to watch for, how to use ear ointments or trim toenails. We teach coworkers and employees how to do their jobs, use our equipment, explain our recommendations. We mentor, we coach, we train, we nag, we educate. In fact, we spend an immense amount of time at it. Today's successful veterinary practice can only thrive with well-trained team members. Staff training needs to be both effective and ongoing.

Unfortunately, just because we do it a lot doesn't mean we do it well. Most of us weren't trained to be teachers, we sort of fell into the trap without realizing it. We struggle every day with issues connected to this – how to train new employees, how to mentor new associates, how to get our clients to comply with our recommendations. Training people and managing people are complex, time-consuming and expensive.

There are two basic types of learning in a veterinary hospital. These are medicine, meaning the technical skills we need to have, what we do and how we do it and also the facts, figures and information to deliver to clients and utilize in patient care. The other type of learning includes everything else – communication, teamwork and customer service.

There are 3 ways that we can do training: individual training, small group training and general team meetings. Team meetings are all about keeping up with new knowledge, refreshing what's old, solving problems or planning projects. This lecture focuses on the individual training piece.

Before that new employee even starts you should have a training plan roughed out. Your plan should be based on where you need proficiency the fastest, who has time to train the new person and when, and what the person already knows. For example, I have had several employees come to work for me after working at our local humane society. They didn't have much training in customer service or communication, but they already knew how to restrain an animal for an exam or treatment, how to clean a cage and how to administer medications. I tend to start those employees in the back of the hospital where they will quickly feel competent and successful. Then I can move them slowly up front.

I may do the opposite with someone who has a lot of customer service experience. I'll put them at the front desk with the receptionist team, even if they are training to be an exam room assistant, and they quickly learn how to use the computer system, check clients out and keep the front area clean. I have found that I am much more successful if I give someone a small piece of the hospital to deal with at a time at first. That lets me focus on a few readily attainable skills, so they get up and running faster.

I also will explore a bit to find out who their trainer should be. I try to match the new person with an experienced employee whose personality style and rate of speed are complementary to theirs. I try not to pair my receptionist who talks fast, moves fast and jumps from one thing to the next with a new person whose style is more laid back. Even if the fast talker is a better match as far as skills I can always cross train later for what they miss. I want the new team member to have a buddy who she gets along with from the start. Just because a team member knows how to perform a function doesn't mean they should be a trainer. Your staff is your biggest asset. They deserve good teachers! If someone doesn't like training or isn't a patient communicator, they probably shouldn't be teaching anyone.

It's important to ensure that you have a plan for not only the training but the legal logistics of hiring. We have a protocol for the hiring process that is followed at the time of hiring. It lists each form that needs to be filled out, how to do it and where to put it once it's done – W-4 form, work permit, legal identification verification, etc. It spells out how to start an employee file, what goes in it and where it goes. OSHA requirements, give them an office manual, who gets keys to the building are also in it.

Most hospitals have a small number of employees wearing many hats, and HR is one of them. This protocol makes sure nothing slips through the cracks and you won't find yourself with a kennel caretaker who's been with you a month and you still don't have a work permit for them or they never did their OSHA training.

So, the employee gets their office manual at the time they start or, preferably, beforehand. In it is a section entitled FIRST WEEK ON THE JOB. To make this list you just need to walk through the clinic and make a room by room list of things that they should know – very simple things, like where to park (not in the best spot right in front of the door), where to hang your coat and put your purse, where to find another employee's phone number, etc. It's amazing how much we know that we take for granted and it never occurs to us to let someone else in on the secrets.

Next, we schedule an orientation with our OSHA coordinator, and make sure the new team member gets their OSHA materials. When we have more than one new employee we try to have a little class instead of an individual session.

Where to from there? Let's look at a new employee who has little or no veterinary experience who is coming to work at your hospital. Where and how do you begin? I believe that before you can start training you need to have some idea of what knowledge base and experience you have to work with and design a program specific to that employee. One size rarely fits all. Teachers know, too, that different people have different learning styles and will do better if information is presented to them in the way that they learn best.

Whoever we have designated the trainer/mentor for the newbie usually has a meeting with me, or me and the practice manager, to prioritize the training from here on out. Sometimes I'll tab and label an office manual for the order of topics to cover in individual training sessions. (Our manual has protocols for almost everything we do, some of which should be covered in the short term and others, like how to put a food order together, she may never need to do.) We plan time for individual training in both of their schedules, so they can sit down together and do information dumps. We also make list of tasks the new staff member can do on their own, and update it every couple of weeks.

What does the listener have to do to take information away? In general, if all we do is listen to someone explain something to us 48 hours later we will only remember 10% of what we heard. This is the most common form of training in most hospitals but it is the least effective. If we read something we remember 30%. If we take notes we can increase that to 50%, which is why I require my trainees to have a notebook and to use it. Teaching or telling someone else what you learned gets you up to 75%, which is what makes role playing and the Socratic method so effective. If a student is asked for an answer or is asked to repeat something back or rephrase it as if talking with a client, he or she will remember that information much better. The best way to learn is to use the information right away. Actually doing something is possible with hands-on training such as how to run a test on your in-house chemistry machine but it doesn't work well for theoretical or in-depth medical knowledge. Role playing, scripts, cue cards and cheat sheets help to get people from knowing something to doing something with that information, which is the most important step.

Visual people do best reading about a subject. Most of us learn more and faster reading than hearing information, but some do better when told than if they read it. Kinesthetics like to learn hands on. They rarely learn well until they have done something for themselves. This works well for skills like putting in catheters but not so well if you want that employee to memorize exam room scripts. We try to utilize more than one type of training material – for instance, an interactive CD on safety in the veterinary hospital and our procedures manual. We assign CE materials for each employee over the first few months, depending on their experience level. The Brain Likes Pictures and stories, and it Dislikes Words. With any teaching that you do, think of an image to fit your message, use visual materials, relate information to specific patients or tell a story that illustrates the information.

Educational tools such as videos or DVDs, audio CDs, on-line courses or teleconferences can be used to augment your teaching. Be aware, however, that if they are passive, in other words the student doesn't have to participate, answer questions or take a test on the material, they will nor be very effective. These sorts of tools don't get people from learning to doing very effectively.

We have skills lists for each job in the hospital – receptionist, assistant, technician. Each has different levels. The assistant ones have different areas, for example x-ray, laboratory, in-patient. Each new employee's skills lists are posted in our work areas so we can see what they are working on. We review those lists at every job review, ideally every 3 months. We also base wages on them, which we will talk about later on today.

There are also a set of skills that every employee should know. This list, too, is fairly easy to create or you can use ones from other sources. You'll need to decide what skills are appropriate for each level at your hospital and how you will divide them up. It's basically a matter of writing down baby steps.

Technical skills are not the only skills we expect someone to have or learn. In fact, they are often not the most important! I am usually more concerned with the new team member's philosophy, their conduct and manners, and I am especially interested in making sure they have communication skills. So, I look for these types of things right from the start, and I try to make our expectations clear. If a new person cannot accomplish these goals in the first few months they won't stay. If I teach them nothing else, these are the things I expect them to learn and do. Our set of goals for the first few months looks like this:

30-60-90-180 Day Goals and Expectations

The First 30 Day

Below are listed the things we expect from you right from the beginning as you start your new job and begin to be trained.

1) Dress and appearance

_____Dress is conservative, businesslike and professional. (Remember that anything that draws attention to yourself detracts from the client hearing the messages you are delivering about pet health care.)

_____Keep uniform clean, wear it at all times

_____Your Hair style and color should be businesslike, neat and conservative (straight part, well groomed, not wet from the shower, off the face)

_____Jewelry should be minimal and conservative

_____Nails are short. Beauty aids such as makeup and nails are in colors that complement normal skin tones

_____Shoes are low heeled, quiet, clean and conservative

2) Conduct and manners

_____Keep your temper, do not allow clients to see stress or frustration

_____Be willing and able to take direction/correction from teammates, accept constructive feedback

_____Be willing and able to take direction/correction from supervisors, accept constructive feedback

_____Try hard to correct problems once they are pointed out

_____Keep your sense of humor when stressed

3) Have the knowledge base to perform job tasks

_____Have a desire and willingness to learn, enthusiasm. If you are a doctor, CVT or have other veterinary experience we still expect you to learn how we do things here at BFVC, cheerfully

4) Take personal responsibility

_____Do what you say you will do when you says you will do it

_____Be on time - or early

_____Make the client happy

_____Make the pet comfortable

_____Volunteer for extra things or help others with their tasks, do more than just the minimum

_____Use task lists consistently and conscientiously to keep the team running smoothly

_____Use time wisely, do not waste time with idle chit chat or purposeless activity

_____Don't gossip or spread tales, does not speak negatively about clients or teammates

How do you want people to behave in your hospital? Set those expectations, grade by them or give raises and performance evaluations based on them, coach everyone on your team over and over again about what you expect to see, and you're a lot more likely to actually see that type of behavior. If someone lets you down, call them on it. I think way too often we don't want to cause disagreement or trouble and so we let things go. If you let things go with a new employee you are setting the stage for making bad behavior a long term problem.

You, or someone in charge, needs to be sitting down with new employees at least once a month to review what skills they've learned, where they are on the ladder with regards to all these items we've just looked at, how they are feeling about the practice and their role in it and to trouble shoot any problems or difficulties.

I have found that the 90 day probation period sounds real good and logical but in my experience the 3 month mark is often the worst hump to get over for a person with no veterinary background. They are often extremely frustrated and down on themselves at that time. I have extended probation periods for several employees at this stage because neither we nor they were sure whether we could stand to go on for the long haul. Everyone is different and maybe it's easier at other people's hospitals but I've always found this a tough period. I think it is better to call this a "Benefits Eligibility Period" instead, which also helps to protect you from a legal standpoint should you decide to fire this person after the first 90 days.

Things go much better of the new team member has experience, especially if it's been at another good quality practice. They need to get up to speed on our protocols and may still have some rough spots fitting in with the group but not nearly to the extent that inexperienced people do. I still try to find the time to chat with them frequently the first few months, just to see where they are at.

Your trainers mean well but they are often not experienced trainers and don't organize well. I sit down with them every couple weeks, with or without the person they are training, and review where they are and where they are headed. I've figured out who is the best trainer for particular things, who sucks at being a trainer and should be answering the phones while the training is going on, and who turns it into a power trip or a buddy buddy festival. I may change trainers in mid-stream if either party is getting frustrated.

The bottom line with all this is that to train well you have to manage the process. You can't just throw the new person into the pool and expect them to swim. They won't, and your clients will see it and hear it, your patients will get a lesser standard of care and your staff will be continually frustrated. Lack of training, even with all that we do at my hospital, is still a complaint of employees and affects turnover, efficiency and net profit. Your employees are your biggest expense and your biggest asset. You have to be willing to take the time to make it work.

• When training your staff:

• Tell them what you expect of them

• Schedule for training time, both individually and in groups

• Train your trainers, give them the materials to use and coach them when they get stuck or frustrated

• Require trainees to carry a notebook

• Monitor/Question them about what they've learned

• Assign homework

• Review (weekly)/Test

• Set goals (weekly)

• Sit down with them often to see how it's going

• Expect a lot and you'll get a lot