Uniting the front and back teams

dvm360dvm360 April 2023
Volume 54
Issue 4
Pages: 36

Resolving practice discord means getting to the root of surface issues

Andrey Popov / stock.adobe.com

Andrey Popov / stock.adobe.com

The day starts on a good note, but tension builds as the hours pass. You overhear one veterinary technician in the treatment area grumbling to another, “If only the front desk knew how to schedule better, we wouldn’t be so backed up.” Taking this cue, you head out front to see what is going on there, only to hear the customer service representatives (CSRs) saying to each other, “If only those techs in the back would stop chatting and get to work, we wouldn’t be so backed up.”

Both groups are finger-pointing and complaining about the same thing—being behind. Why can’t they work as a team? Why are they divided into the front vs the back of the practice? It seems so easy to place blame; however, it is important to remember the saying, “When you point your finger at someone, there are 3 fingers pointed back at you.” What could you be doing or not doing that causes the battle between front and back?

Many will say the main culprit in this example of discord between the front and back sides of the practice is the appointment book. However, these types of disagreements are often rooted in the practice culture, poor communication, a lack of understanding of each side’s role in client service and patient care, and even leadership errors.

Root causes of discord


Culture is unique to your group and determines how members work together. It fosters stability and drives thinking and behavior. It tells everyone in the practice what, when, where, and how to do things. Think about that client calling your practice at 4:54 pm about a sick pet. Are they automatically told to come in, or are they referred to the local emergency hospital? Is there a “dance” around asking for permission, tiptoeing around those who will say no in favor of someone who will say yes? Your culture may be causing the battle between front and back.


Communication is always a primary suspect when there is discord. Research has shown that 85% of an individual’s success at any job can be attributed to soft skills and interpersonal skills.1 With only 15% of work success based on technical skills, why do so many training sessions concentrate on those and ignore the people skills? Communication is vital to patient care, client service, and team performance. Assess communication gaps when the finger-pointing starts.

Client service

Lack of understanding of roles, responsibilities, and pressures is common. Think about the team’s different roles—nurses give full attention to patient care, whereas CSRs focus on client service. There will be times when the roles can seem incompatible. Without working in every part of the hospital, understanding the pressures of each department can be difficult and may lead to unrealistic expectations from coworkers in other areas. Unrealistic expectations lead to conflict.


Check the pulse of your team with a quick survey

Example 1

Rate your work experience today:

1. Did you have all the necessary tools you needed to do your best work?

2. If you encountered a problem or unusual situation, did you know where to go or whom to ask for a solution?

Example 2

Rate your work experience today:

1. What did we do well today?

2. What do we need to improve?

Errors in leadership are another possibility— remember those 3 fingers pointing back at you, the manager. Error No. 1 is refusing to accept personal accountability. The buck stops with management and how the team is held accountable. Other leadership errors include failing to develop and train team members, taking sides, managing everyone the same way, being a buddy and not a boss, failing to set standards, condoning incompetence, and forgetting the power of communication. Management may be the cause of the tension between front and back.

Knowing that there are different root causes to explore does not mean the solution is out of reach. However, it will take some effort to get everyone aligned and working as a team. Consider asking the team via a short survey or creating a means to give quick feedback (see Sidebar). Use that information to address problems and expand what works well.

Potential remedies

Upon examining these common root causes, it is possible to initiate remedies that may address several at once. One such remedy is the daily huddle. This is a 5- to 10-minute meeting to assess what will happen throughout the shift, troubleshoot potential problems, and agree on a game plan. Everyone understands their distinct roles and expectations, communication is clear, and the team knows the goals for the shift.

Team meetings are another tool for quelling discord between front and back. Have the different areas submit challenges, clinical inefficiencies, and other problems. Divide into groups, of which each includes technicians, CSRs, doctors, ward attendants, etc, and brainstorm together. Bring up their unique perspectives and work together to achieve the best solution. If the different areas hold separate meetings, bring in the lead person for the other area—they can listen to concerns, give input from their perspective, and work on solutions. Team meetings are also an excellent opportunity to reward members and conduct team-building activities.

Another solution is cross-training or job shadowing. Cross-training is not always possible in some situations, such as training a receptionist to do the job of a certified veterinary technician in surgery. Still, the receptionist can gain an understanding of the position by job shadowing and assisting the veterinary professional. Scheduling team members to work a shift rotation in other areas will not only help them to understand the roles, responsibilities, and pressures associated with that area, but it will also give them an idea of how the roles can complement each other and when it may be necessary to step in and help—even without being asked.

Remember to pay attention to shift leaders, supervisors, and managers. These team members need additional tools for communication and tips on how to avoid management errors that erode team unity.

Building a cohesive team requires policies and procedures. Review and update any standard operating procedures and job descriptions. Create checklists and ensure collaborative workflows across all areas of the hospital.

Building a united team

Looking back at the morning disagreement over the appointment schedule, consider a procedure to map out certain appointments for sick, well, and urgent patients. Conduct a huddle at the beginning of each shift to update the team on the appointments and the game plan to mitigate problems that may arise. Involve the team in a debriefing session afterward to discuss what worked well and what did not, or send out another survey to get feedback.


Discord, drama, disagreement—no matter the label you use, it is a problem that needs to be stopped before negativity spreads and affects client service and patient care. Clients see and hear. They sense the tension, receive the exasperated sighs and the apologies, and wonder what level of care their pet is receiving.

Give the team the tools to successfully work together and deliver exceptional patient care and client service.

Louise S. Dunn, is the owner of Snowgoose Veterinary Management Consulting in Winston-Salem, North Carolina, and a former practice owner. She has taught practice management workshops at 10 veterinary schools and publishes and speaks nationally. She is a founding member, past board member, and officer of VetPartners, formerly the Association of Veterinary Practice Management Consultants and Advisors, and a member of other professional organizations.


Kelly M. How good is your hiring process? Forbes. October 16, 2019. Accessed March 7, 2023. https://www.forbes.com/sites/forbescoachescouncil/2019/10/16/how-good-is-your-hiring-process/?sh=50b6fca527bc

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