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Dr. Kate Bailey Discusses Strategies for Change Implementation in Veterinary Practices - Ep. 4
378 Plays2 years ago
Does this situation sound familiar to you? You’ve attended a great conference or CE event (maybe even listened to a brilliant podcast), and you learned something innovative regarding anesthesia or pain management. You feel invigorated to implement these changes in your practice and try something new that will help your patients. However, as time goes on, you never get a chance to try anything new. You get stuck in a loop of limitless barriers, and you just can’t seem to get anyone on board to make changes happen. If this frustrating situation sounds familiar, then this episode is for you!
Host Dr. Bonnie Gatson is joined by fellow veterinary anesthesiologist and Vice President of Education and Quality at United Veterinary Care, Dr. Kate Bailey, to discuss strategies for change implementation in veterinary practice. Together they discuss how to navigate challenging conversations regarding change, implementing a culture of psychological safety, and how to best work as a team to ensure changes are implemented effectively with minimal emotional impact.
If you are interested in learning more about safety culture in veterinary medicine, check out this study assessing attitudes toward veterinary safety culture in an academic teaching hospital.
If you like what you hear, consider becoming a member of the North American Veterinary Anesthesia Society (NAVAS) for access to more anesthesia and analgesia educational and RACE-approved CE content.
Thank you to our sponsor, Dechra - learn more about the pharmaceutical products Dechra has to offer veterinary professionals, such as Zenalpha.
If you have questions, comments, or feedback regarding this episode, contact us through the NAVAS website.
You can expect a new episode on the 15th, or just after, of each month.
Special thanks to Chris Webster, Saul Jimenez, and Maria Bridges for making this podcast a reality.
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Transcript
Technical Issues and Introduction
00:00:01
Speaker
Hello, gas passers, Dr. Gatson here. Before we start the episode, I wanted to let you know that we had some technical difficulties before recording this episode, so the audio quality is somewhat subpar. Hopefully, that doesn't deter you from listening because, in my opinion, the content of this conversation is really fantastic.
00:00:23
Speaker
Second, just a quick warning that there is some minor cursing on this episode in case it offends you, or if you choose to listen to this episode with children around.
Challenges in Changing Veterinary Anesthesia Practices
00:00:33
Speaker
So without further ado, please enjoy this episode on changing minds and enacting change in veterinary practice.
00:00:44
Speaker
Hello and welcome to the official podcast of the North American Veterinary Anesthesia Society. I am your host, Dr. Bonnie Gatson, board certified veterinary anesthesiologist and proud gas passer. I am so glad you decided to spend your time with me today as we go through our anesthesia journey together.
Mindful Practice and Continuous Learning
00:01:03
Speaker
It does sound rather corny.
00:01:05
Speaker
But I call it a journey because anesthesia is a skill that we improve upon through mindful practice as we continuously and repetitively perform anesthesia. And what I mean by mindful practice is that we become better anesthetists when we reflect on what is going well and what we can improve upon with each anesthetic event.
00:01:31
Speaker
Through our practice, we learn vigilance, we learn pattern recognition so we can easily identify problems, and we expand our knowledge base. So as new equipment, new medications, and new research come to the forefront, we can incorporate these new ideas into clinical practice to help our patients.
00:01:52
Speaker
However, sometimes learning new facts or new skills can sort of feel like either a blessing or a curse. And what I mean by that is this, as anesthesiologists, we strongly advocate for practitioners everywhere to never stop learning and expanding your knowledge base, because ultimately that gain in knowledge is only going to help your patients.
00:02:16
Speaker
However, on a practical level, changing how you practice anesthesia to reflect any change in your understanding about how to best perform anesthesia, oftentimes
00:02:26
Speaker
It just doesn't happen. Does this situation sound familiar to you?
Incorporating New Anesthesia Practices
00:02:31
Speaker
Maybe you are someone who has gone to a conference or a C event, or maybe you've listened to the occasional podcast and you learn something new and exciting that you want to incorporate in your anesthetic practice.
00:02:48
Speaker
Maybe you show up to work excited and invigorated to make these changes, to do something new that you think will help your patients. And you just can't do it. You just can't make that change happen.
00:03:05
Speaker
You may be sitting on a great new idea or a new skill set and you just can't get through to your coworkers or your bosses. If you've ever had that feeling, that like hopeless feeling where you feel like you're not practicing at the best level of care that you know you can deliver, then this episode is
Implementing Change with Dr. Kate Bailey
00:03:26
Speaker
for you. I can't tell you how many times I've got into a practice to consult where I make a recommendation and the technicians are telling me
00:03:34
Speaker
We already tried telling the boss that, but maybe you can talk to them because we can't seem to get them to change their minds. Well, today I have an amazing guest on the podcast, fellow gas passer and an old friend of mine, Dr. Kate Bailey, who will provide some wonderful tips and tricks on how to help make the changes you want to see in your practice.
00:03:56
Speaker
I'm going to let her introduce herself, but before we get started, I wanted to let our listeners know that we both allude to in our conversation about our past careers. So just to be clear, I was a former clinical assistant professor and service chief at the University of Florida and Dr. Bailey
00:04:14
Speaker
was a former clinical assistant professor and service chief at North Carolina State University. But I'm going to let her talk more about what she's currently up to now and why she's the perfect individual to lead this conversation in changing minds.
Introduction to SMART Goals
00:04:30
Speaker
Also in the conversation, we are gonna talk about SMART goals. And for those of you who are not as familiar with the term, SMART is an acronym that stands for goals that are specific, measurable, attainable, realistic, and time bound. So without further ado, I hope you find some inspiration in my conversation with Dr. Bailey.
00:05:01
Speaker
Welcome, Dr. Kate Bailey. We're so happy that you're here to talk to us today on the NavVis podcast. I'm so happy to be here. I'm excited about talking to you, Dr. Bonnie Gadsen, because you're one of my favorite people. And I'm also just excited to participate in the NavVis podcast. Fun fact, I'm also on the NavVis board of directors. I actually feel like I did not know that, so it's good you said something about that. And can I find out?
00:05:29
Speaker
Probably people will may or may not figure this out as we keep going. Kate and I are good friends. I actually met her at iVets many years ago. I think somebody literally introduced me to you and said like, you would be friends with her. You should go talk to her. I remember that. I remember you, I had just recently become a faculty member and you were right in the middle of your residency, like right smack in the middle. Yeah. Yeah.
00:05:58
Speaker
And it's history since then. We've also done some really fun research projects together. We sure did. We sure did. We worked on a sea turtle project together. Yeah, and some bats. Yes, and bats. Yeah, so we've done, we go back. We go back.
Resistance to Change in Veterinary Practices
00:06:13
Speaker
I wanted to talk about this particular topic about changing minds, which is going to be like the overarching theme of this. And I was thinking of like who would be the best person to talk to about this.
00:06:27
Speaker
I feel like this is a problem that technicians when I go into practices to consulting, a lot of times I'll make recommendations and then the technicians will be like, yeah, we've been trying to tell that to you so and so boss for years. Maybe they'll listen to you.
00:06:44
Speaker
And so I feel like it's a source of frustration for a lot of technicians, maybe even potentially even a source of burnout because you feel like as a technician that maybe you gained all this knowledge or you have something to add to the practice. And when you feel like your hands are tied for whatever reason, that can be really frustrating.
00:07:06
Speaker
And so when I was thinking about who can I talk to about this topic that I think is super important, you were like the first person that came to mind. And it's just given back to the fact that I remember many moons ago when we were having a conversation about our careers, I just remember you telling me that you had a deep passion for teaching students and for some of the issues that come around with students.
00:07:31
Speaker
And so this was kind of an area I could see you being interested in. And maybe you could talk a little bit about what your interests were in your past career and now what you do in your, in your new career. Yeah. Just give us a little bit more insight into that. Yeah. So first I want to say I am humbled and honored to be considered to talk about this type of a challenge. Cause I think it is a huge part of
00:08:00
Speaker
what we do in the anesthesia field.
Role of Support Teams in Patient Care
00:08:04
Speaker
And because support teams are kind of the foundation of patient care often, but also not the primary pivot point sometimes for those patients, it can be really hard to make sure that everybody on the team, whoever the patient care team is, it can be really hard sometimes to make sure that considerations are thought of within the realm of the anesthesia component
00:08:29
Speaker
And I think that this is true in lots of other support services, and it certainly becomes true often, I think, for the people who can know our patients best, which is our technicians and a lot of our support staff. And I think what I can tell you is that throughout my career, one of the biggest challenges, whether it was, you know, as faculty at NC State or in my new role, is how do you convince someone to listen to the words you have to say and to support, even if it's evidence based, your suggestions?
00:08:59
Speaker
for patient care, for the way you run a hospital, for how we treat staff, how we rethink work schedules. Anything related to change I think can be very difficult for people and you have to be really strategic about it. And so I think first off, my very first grown up job out of my anesthesia residency was as a faculty member at NC State and my initial passion
00:09:24
Speaker
was definitely for teaching on the clinic floor. And that largely included interns, residents, students. I think Dr. Gatson and I have that in common. We were really passionate about that part. And this type of change management was true even back then.
Evidence-Based Changes and Education Transition
00:09:43
Speaker
So as new literature comes out, as we go to conferences and we learn new things, as new concepts arise,
00:09:50
Speaker
How do you take that information, package it and make it digestible for someone who didn't hear it firsthand with you? And for someone who's been doing that thing a completely different way for however many years. And I've watched a lot of people, including myself, get really frustrated when that initial attempt to make a change goes badly.
00:10:10
Speaker
And I've made many mistakes, as I'm sure a lot of us have, in the realm of trying to convince somebody to look at a change that would be strategic, that might be a good idea, that has a lot of evidence behind it, and getting told, no. That's a really frustrating vote to be in. And I've made all the mistakes in the book, I would imagine, related to getting folks to listen to that advice. I think my first mistake was, if I just say the facts louder and get more passionate about it,
00:10:39
Speaker
they're going to listen. But it turns out that's not true, right? Because we all have our own different perspectives. And I was lucky enough, I think, to learn that lesson in a setting where people were open, but weren't going to accept a change that I just gave them at face value, but still remained, you know, collegial, and then we could work on those things in future. And what I found is my career went on. So, you know, Dr. Gadsen, you alluded to the fact that I made a career change. And so what I noticed as my career went on is I got more and more focused
00:11:09
Speaker
on the education units. How do we teach anesthesia? How do we teach everything in a way that our third year is moving into fourth year, have a good transition? And then how do our fourth year is moving into DVM land, right? Where they're expected to be the grownup and the expert and make all these decisions. How do we make that transition such that they have the education units they need in a way that they were able to use them because just giving people information and then the process of absorbing is different, right?
00:11:39
Speaker
feel like all this ties together. Yeah. And so I knew a job. I was recruited to be the Vice President of Education and Medical Quality at a company called United Veterinary Care.
Supporting Technicians and Overcoming Barriers
00:11:50
Speaker
It's a really neat group. It's a group that, you know, purchases hospitals and then delivers resources to them in a way that an individual hospital might not be able to access. And their main mission is to support, empower,
00:12:04
Speaker
and unite people and we joke around, sort of joke, but really mean like 2023 is going to be the year of the technician. So this is, our support staff is so tremendously important and they are so hardworking and they are burning out. I mean, burnout is all over the place, but they are struggling. And I think back to your comment, Dr. Gatz, and some of that is probably related to
00:12:28
Speaker
they're not feeling like they have a voice in the conversation and when they bring up a change that they think is logical and evidence-based and something that they see that we as doctors might not see because we interact with patients differently to be dismissed repeatedly is very distressing especially when you are advocating for patients and you're advocating for your team. Yeah.
00:12:49
Speaker
And so I'm able to hopefully use some of the skills that I, by some trial and error and by some reading develops on how to help people change in a non-dramatic, non-emotional,
00:13:01
Speaker
structured web. Yeah, you just covered so many things. I'm going to circle back to a lot of your comments for sure. I have many examples as an anesthesiologist where I wanted to implement change in a practice and it was met with
00:13:22
Speaker
some resentment or maybe not resentment because that alludes to there being kind of a negative type of or disrespect. It's not disrespectful sometimes. It might come from a lot of areas that I just don't even know, but anytime it's met with any kind of resistance,
00:13:38
Speaker
I mean, I think it does take a little bit of a hit to your ego and to the fact that you feel like you're coming from a place of advocating for patient care. And when that's met with resistance, it almost feels like you're just not able to provide a level of care that you really want for your patient. And if you are technically listening to this, I just want you to know that it happens to DBMs as well. Like it happens along the spectrum of people in the medical industry. So I don't want you to feel like you're alone in this.
00:14:09
Speaker
So I think first what I'd like to talk a little bit is about barriers. You know, what are the barriers to making those changes? I think maybe if we focus a little bit on the barriers or what are possible reasons that people are preventing kind of these changes to happen in the practice. And if you have any personal examples, you know, I'd love for you to share that as well if you're comfortable.
00:14:33
Speaker
Yeah, I completely agree. It's a great place to start because if we can think about the why behind the refusal, right? I say, look, I've got this really great idea. I just read this paper. It's really compelling. You know, I critically evaluated the data in this paper really suggests we should change, you know, practice X to practice Y.
00:14:58
Speaker
and you get resistance, there can be a lot of feelings around that. But I think it's important to remember that those feelings can be on both sides. And when you present things to somebody who they have never seen before, that they need time to digest, right? So the ability for someone to think through the complex process and make a decision, it doesn't happen immediately. And it definitely doesn't happen while you're staring at
00:15:24
Speaker
I think like that's one thing that I realized you have to give people a chance to digest what you've said. And so one barrier might be if you are in the midst of conversation number one, don't assume it's the only conversation you're going to have about it. That's the first conversation. And I would, I would suggest approaching it as the first conversation because one of those barriers is we don't and shouldn't be making decisions in an immediate way if it's not necessary.
00:15:49
Speaker
So timing, I think timing can be a big barrier. Another barrier that I've noticed is, if you approach somebody who's been doing something the same way for a really long time, and I think about myself, because, you know, like you mentioned, Dr. Gadsen, there are definitely times where I've been approached about a change, and my immediate response is, nope, we don't do it that way. Oh yeah, for sure. I have lots of examples of that, but on my own, like on my side. Yeah, so I can think of one,
00:16:16
Speaker
when we started talking about like, so horse recovery, I think is a big one, because horse recovery is a point of stress often. Yeah. And there's a lot at stake often. And so when people start talking about, you know, I think we should change the way we recover horses, because this is how, you know, there's some evidence to suggest that maybe this method would work better. Yeah. I mean,
00:16:41
Speaker
the spoiler alert, there is really no correct way to recover. Yeah, absolutely. I have, I have almost the exact same story. Yeah. I also think that we are uncomfortable being uncomfortable, right? If you change something that's already a bit high stress, or you suggest changing something that's already a bit high stress, the level of discomfort can be too much, right? And so I think
00:17:06
Speaker
even just letting people let that wave of discomfort wash over them and then again approaching that conversation at a different time can be a helpful tool because you know you can translate this to things that are the not anesthesia sport too like riding a bike a certain way or playing an instrument in a certain way if somebody comes up and says a cat actually be better if you held your hands this way that can be a life shattering change if you've been doing it that same way for a really long time and so I would say that like inherent
00:17:35
Speaker
the inertia problem. It might not be that they don't want to do it, it's that they can't see around the inertia of trying to change this thing that maybe already causes them some anxiety. And so the next thing I think I would talk about is assuming positive intent. And so when we assume, and this isn't to say that every single time something like this happens that it is actually the positive thing, but for argument's sake, if you actually, if your goal is to make the change happen,
00:18:05
Speaker
Then you have to assume positive intent, you have to assume that that person that is saying no might be saying it for what seems to them to be a very legitimate reason and you don't want to discount that because if you discount it and dismiss, it's the same feeling as them dismissing you and you're not going to get anywhere. So if your end goal is to make that change, then you have to assume positive intent and that's where you have to start asking the questions.
Successful Change Through Partnership
00:18:30
Speaker
What and even ask them like what obstacles do you see to this change? Is this something that you're worried about from like a staff utilization standpoint? Are you worried about what your clients are going to think?
00:18:42
Speaker
Are you worried about that you won't be able to do it? Are you worried that the outcomes might be worse? Or even costs, like sometimes like a cost barrier as well that I think sometimes goes unrecognized. But I love that you were talking about positive intent because so I used to, like I used to be a service chief like in my past career.
00:19:02
Speaker
And I think when there was conflict, either between services or within the service, I think the two biggest source of conflicts always were communication breakdowns and then not assuming positive intent, assuming nefarious intent of some sort. And I totally agree with you. I feel like having that conversation with you, ask somebody like, I think we should make X, Y, and Z change. And that person just automatically goes with resistance.
00:19:32
Speaker
I think a lot of people feel like, oh, they're just doing that because their ego is being hurt. That might be possible. It might be that they're feeling anxious and maybe it is a little bit of an ego hit, but at the same time, maybe you can have that conversation with them in an open way. Just like you said, what are some changes? I think even personally on the other reciprocating side might be surprised to feel like it's actually, maybe it's coming from a place that they didn't even think about.
00:19:57
Speaker
Yeah, I think you bring up a really good point, which is that change has to be a partnership. Yeah. Change doesn't happen in a vacuum, not successful change, right? Like you can shove a change down someone's throat, but if you don't encourage them to come with you and have input, like this would be another major barrier that you have to consider. If you try to put a change in place and you don't allow those who will be affected by that change to have any input, they're not going to adopt it.
00:20:24
Speaker
Oftentimes what I see and I'd love to know your opinion Bonnie about this is we get into, we hear about something, right? And it's very compelling and there's a lot of good evidence and we're excited about it. And we want to go change that thing because it really seems like this is going to be the right way to go. And then you implement it, right? Like let's say you're in a position of authority to implement a thing. And then you say, great, it's implemented. Here it is. And then you walk away. That will absolutely fail.
00:20:52
Speaker
100% of the time, if you plot something in someone's lab and you don't give them input and you don't make them a partner and you don't hear out the why behind where that initiative might stumble, it will die. That initiative will die. It needs to be adopted by the people who are going to be affected by it. And you can't ignore the fact that other people will be affected by a change that you're instituting.
00:21:18
Speaker
I also think one of the barriers is often if you get to the implementation phase, even if you can get people excited and enthusiastic about that change, keeping that momentum when things go wrong, because inevitably there's going to be rubble and friction and hurt feelings and a little bit of hard times when you change a workflow of any time. I agree to sue the servants who requests anesthesia, but is not a typical anesthesia service requester.
00:21:45
Speaker
Like the difference between their ability to get through the anesthesia workflow versus like the soft tissue surgery service who uses that service all the time. It's a new workflow, right? And so it feels bad. Everything takes longer. Everyone's frustrated. It feels like you're doing it for the first time every time. So that would be like, I don't know if you guys who did your myelograms at UF for your horses, but our medicine, our equine medicine team would do our myelograms.
00:22:10
Speaker
but they didn't do anesthesia stuff a lot. And so they would literally bring the orthopedic surgery technicians with them because they did to make the work feel better. It's like, if you don't have a plan for that change and propping it up and keep that change going, it will fall down. Yeah. I think the other thing, which I mean, maybe you're going to get to this as well, which is like actionable goals. And I think that's another really big thing. Sometimes what I mean, I guess what I mean by that is like,
00:22:39
Speaker
If you want to make a change, so let's just say, for example, your practice doesn't carry a full mute agonist. You know, you are using buprenorphine for every small amyl anesthetic case. And you're like, you know, there might be some cases where hydromorphone might be more appropriate.
00:22:57
Speaker
And let's say you're practicing with a veterinarian who's been using buprenorphine for years, and they don't see a problem with buprenorphine. And that's a conflict right there whereby maybe the technician feels like they could use this phlegmum agonist to provide pain relief and that veterinarian practitioner maybe is not practicing the best quality of medicine. So there's already a huge rift there in the technician to veterinarian relationship.
00:23:25
Speaker
So I think if you're dealing with a situation like that,
00:23:29
Speaker
and you want to incorporate, you know, hydromorphone, maybe trying very small, like compromises, maybe being like, okay, well, we don't need to give hydromorphone to every dog or every cat that like walks in the door. Maybe we could try it for like this one case, maybe purchase like one bottle of hydromorphone, and then maybe we could try it on this one case. It's very healthy, stable animal, and we'll try it together.
00:23:57
Speaker
And we'll see how that works. You know, as opposed to going in there and saying like, we need to give every dog and every cat that has surgery a hydromorphone. And I feel like if you are willing to make these small actionable goals and then follow up. So after the hydromorphone was used, let's say for that one case.
00:24:18
Speaker
maybe having that conversation. And that's just what you were saying, Dr. Bailey, about making sure that you just plop a change down and then it happens. Having a conversation about how did that go for you? Was it bad? What were the problems? Maybe there's some solutions. Maybe the dosing was off. Maybe we could try lower dosages. Maybe we could try different dosing routes.
00:24:40
Speaker
You know, things like that so that together you can make changes. And then the other thing, of course, is not just blaming the change as being the force of everyone's problems. Yeah. Oh, such a good point. So first off, oftentimes people will refer to what you're talking about and you're going to know
Implementing a 90-Day Policy for Change
00:24:58
Speaker
what I mean. And then I say it's like a smart goal, right? So setting a smart goal, making sure it's actionable and making sure like within that there's a timeline.
00:25:07
Speaker
And we all know what the timeline is. So I was just talking to, so back to your, the point you just made, which is like, we can't then decide again, assume positive intent. Let's not assume that this change is the source of all problems. Like I couldn't find a parking spot this morning and it's because we're using hydroborphone now. That doesn't work. But when you have that feeling, and so one of my very strong practitioners, he was a medical director up until recently and he's actually the president of the companion animal parasite council.
00:25:39
Speaker
about change management and what, in a general practice setting, things that he has adopted in his practice. And one of the things that he uses is called the 90-day no-bitch policy. Yeah, let's talk a little bit about the 90-day no-bitch policy. So let's talk about that a little bit more. So what this means is, okay, so first off, everyone's part of the conversation because this change will affect the whole practice, right?
00:26:06
Speaker
Doctors get in line first. Everyone has to help make a decision together. The doctor team as a unit talks to the rest of the team about the why and the how and have a plan, have a smart goal, have it all in place, have a timeline. And then for 90 days, no one gets to complain about it. With the knowledge that in 90 days, you can say whatever you want.
00:26:28
Speaker
about the process, what you don't like about it, what isn't working, why isn't it working. Obviously this all goes out the window if it's like affecting patient outcome or patient care or comfort those like so your example of buprenorphine switched to hydromorphone is perfect right. There are things that have to happen to do that like there's DEA implications, there's workflow implications, there's learning new doses, learning new side effects like there's a lot potentially that goes along with that change but it doesn't mean you don't make the change.
00:26:57
Speaker
It means if you're smart about it and you say, in his advice, 90 days, no bitching. With the promise that at the end of 90 days, everybody gets to put it all out on the table and to your original point, everyone feels supported and heard. And there is psychological safety within that group so that everyone feels like they can say exactly what they need to say about the process without getting retaliated against or without getting dismissed. It's all talked about.
00:27:25
Speaker
And I think that when people get the chance to be part of it, it's way more successful. Yeah.
00:27:32
Speaker
I think that something you brought up, which I didn't really think about, but probably is a huge barrier to change or people may be making recommendations to change are either assuming retaliation or feeling that they don't have a voice.
Psychological Safety and Open Discussion
00:27:48
Speaker
So do you want to comment a little bit about how people can get around feeling that way or if there are any resources people can turn to if they are feeling that way in the workplace?
00:27:59
Speaker
Yeah. So safety culture, I mean, my hope is, at least in my world, and I'm hoping that this is true in others, we're talking about it more and more because it's become very obvious that hierarchical medicine is not going to survive and shouldn't because we are wasting a lot of good information by not allowing folks at all levels of the system to feel heard and to feel supported.
00:28:26
Speaker
And so when we think about safety culture, there are a couple of different bits. This could be like a whole other podcast on its own. I think it's tremendously important for patient outcomes, for improvement of patient care and for mitigating patient care errors that you have a safe culture. And if you don't have a safe culture, what happens is folks who see things don't feel comfortable bringing that up and then mistakes are allowed to happen.
00:28:53
Speaker
But it's also true kind of as a prong of safety culture is psychological safety, meaning that anyone in the team is equally able to and should bring up problems that they've identified or suggestions that might help with a problem or just help with a new way of doing things in a better way. One of the ways that you can promote psychological safety is to actually meet with your team.
00:29:20
Speaker
So here's the problem. I think a lot of us were so busy. I mean, half of us barely get to go to the bathroom or drink water during the day, but taking the time to meet with your team regularly, whether it's every week or every other week, or, you know, I wouldn't go a whole lot longer than that. Maybe once a month, you gotta let people discuss what they see and what they are experiencing. Cause there's a really good chance that not everybody in the team is seeing and experiencing the same things. Right.
00:29:50
Speaker
And it's so important to change that everyone is on board and feels part of it. So that psychological safety is really important because if you don't have it, what happens is you sit for the meeting and you say, what does everybody think? And then no one opens their mouth. Right. And that's like the death silence. That's a, that's a problem. Like everybody should be jumping to open their mouths. And if they're not, you might want to identify why they don't feel safe too.
00:30:17
Speaker
or why they don't feel like they should bother. If people are interested in looking at some resources potentially for helping with kind of this workplace safety culture, Dr. Bailey will provide those links for us. Absolutely. Dr. Bailey, let's say we are trying to talk through a change with somebody.
00:30:38
Speaker
And we have an idea that, you know, we want to try to implement some kind of change in the practice. How do we navigate through that conversation?
Communicating Change Effectively
00:30:49
Speaker
Yeah. So I think there's a couple of things that I, especially in the initial conversation we're trying to do. First off, what I do is I try to make it really clear, like, even if you have to use the words, depending on how, you know, how much of a rapport you already have with this person, I will literally say,
00:31:05
Speaker
I want this conversation to be bi-directional. I want your input. Your input is just as important as mine, but I want to talk you through a potential change that could improve
00:31:16
Speaker
patient care, hospital workflow, you know, client service representative, talking points, whatever the thing is, so that they already feel your intent, right? So stating your intent at the top, and that helps them get into the frame of mind of positivity, right? So you're not coming to them with a problem. Bonnie, I was also a service chief, as you know, and so both of us are probably simply feeling where you're like, you get the text message that starts with so dot, dot, dot.
00:31:42
Speaker
or like we have a problem period or are you gonna handle this question mark and your immediate feeling is probably not a just unbridled joy and positivity and enthusiasm right? No it's like everything inside of you goes cold instantaneously. Everything gets a little still and you're like do I want to drive to work today? Because those text messages also come at 6 30 in the morning like before you've gotten in the car.
00:32:06
Speaker
Oh, yep. Or like when you're just like you've packed your bag.
00:32:13
Speaker
And so the good news is that that probably means that your team feels a significant amount of psychological safety and that they can share things, which is fantastic. Great start. But what would probably make it easier for people to solve problems and hear information is if we start with intention. My intention is to have a bi-directional conversation. I want to make sure that we are both a part of the decision making process, but I have this really great opportunity to share with you
00:32:39
Speaker
About a change we can make to help with patient care and I want your opinion and I want to I want to partner on this together I want to collaborate
00:32:46
Speaker
Oh my gosh. I wish anyone would have started a conversation like that with me. I feel like if anyone started a conversation with me, it makes me feel like I'm a part of that conversation. Like I'm a part of that change potentially, as opposed to it just being like, we should do blah. Why don't you do this? Or why aren't we doing this? You know? Or a very typical, well, you know, surgeon so-and-so just did X and we need to change that immediately because it's awful.
00:33:14
Speaker
Yeah. And while that might, it possibly is a correct statement. It already sets the tone of anxiety and emotion, and it makes it tough to grab onto the actionable items within whatever the changes you want to create. So you set your intention.
00:33:32
Speaker
And then I think my next favorite rule is the platinum rule. So people talk about like the golden rule, treat people as you want to be treated, but it turns out you're probably better off treating people how they want to be treated because it might not be the same as you. And there's a lot of really interesting literature out there and some great articles and some podcasts. So I'm, I mean, we're doing a podcast right now. I'm a huge fan of podcasts where we know based on maybe your generation.
00:33:57
Speaker
or maybe just your personality type, which, you know, there's a lot of interesting neuroscience just surrounding that, how you want to hear information. So one of the other things I really recommend for teams is to invest in some sort of personality type workshop. Right. There's so many brands out there, like so, so many ways you can do this. There's a couple of really good ones. One of the ones that I really like, because it's very simple, is called Neurocolor.
00:34:25
Speaker
And basically what it does is it simply takes some of your personality traits or some of your tendencies and it kind of codes them into not one color, no one's really one color, but it gives you an idea of like what things, what are ways that you like to communicate with others and what are the ways that they like to be communicated to or how do you like to be communicated to. So some people really like facts, lay the facts out, say them directly, don't like skirt around it and then walk away. If there's a fact,
00:34:55
Speaker
There are some people that really thrive on that and others, if you did that, they would actually just burst into tears.
00:35:01
Speaker
Yeah. I think the other thing too, just to build on that is if you are not doing those types of workshops in your practice, but you know how you want to receive information, you should just voice that to the person who's telling you these things. It's okay. Like if someone's just walking up to you with a paper and being like, we should do this because that's what they said on this paper. And that stresses you out.
00:35:28
Speaker
I mean, I think it's totally fair to be like, I hear you, but the way you're presenting this information to me, it's extremely overwhelming. Yeah. And I think that's totally legit and fair to say that. 100%. I, with 100% certainty can say that most people don't actually have great awareness of how they sound when they're presenting information.
00:35:50
Speaker
And again, back to assuming positive intent, it is highly likely that the person who like bullets, points and facts, and then walks away has no idea that that is stressful, or that it feels like you're getting yelled at, or that they didn't mean to yell at you, like the vast majority of the time. And so they don't mean it. And if you can point out to them in a kind way, that that is how it felt, then they in that moment,
00:36:17
Speaker
especially because they communicated to you that way, oftentimes they are more than fine getting communicated to that way. If you give them that fact, that interaction was uncomfortable for me because I felt like you were yelling at me. Oh man, Kate, I just felt personally attacked because literally that's how I get information. I'm a bullet pointer and I like just like just say what needs to be said.
00:36:40
Speaker
It took me a long time in my career to realize that that was not the way other people like to get information. And that really came through beautifully through some of my technicians that I had when I worked at UF. Some of them would pull me aside and they'd be like, I just saw you totally took over that conversation or you totally just jumped in on that case. Did I do something wrong?
00:37:02
Speaker
Absolutely not. It's me, it's not you. That was just an area of personal growth that took a long time. Again, it just came through from making a decision that I didn't want to. I wanted to have good conversations with my technical staff and that was personal choice, but it did come from a lot of feedback.
00:37:24
Speaker
that comes through from technicians. So I just want to say, if you are a technician or something like that, I think it's really important that you, in a very nice way, not in a accusatory way, because just like you said, assume positive intent, but in a way that gives people feedback as far as the way they present information and whether or not it is in a way that you can digest that is really important.
00:37:50
Speaker
A hundred percent. So same kind of story, different problem. I have a tendency when unchecked to go off on tangents, get distracted by shiny objects, start a conversation when I'm in the middle of another conversation. I don't always make things very black and white. I'll say like, well, you could do one of these three things or you could do this. Really? There's no wrong answer. How do you want to do it? But they have specifically come to me for an answer.
00:38:14
Speaker
And if you are someone who thrives on detail and thrives on black and white and really needs to feel assured that you have an answer that's going to fit, that was very stressful for people. You know, I would have team members say like, I just need you to answer me. Like I, I just need you to help me make that decision. That's why I'm here talking to you. And I had to learn while it's not my default way of making decisions or communicating, that's what helps them be less stressed about a case. And so knowing those personality types.
00:38:42
Speaker
knowing them of your team, knowing them of yourself, whether you do a fancy test or not, just the knowledge.
Generational Differences in Communication
00:38:48
Speaker
People think through things and communicate things differently can be super helpful. The next one is generational. And this is, you know, I think we often assume a lot of negative intent around certain generational qualities, some of which are true, some of which are exaggerated. I did a lot of reading on this recently because what I have found is we have a significant number
00:39:12
Speaker
of boomer generation medical directors. You have a significant number of new grad DVM starting their career, millennials. Right. Or even very, very soon, some Gen Z-ers are going to come out there too. Yeah. And we already have some really enthusiastic, excited technicians coming into the field that are Gen Z. And if you have
00:39:36
Speaker
anytime at all, I would recommend taking a couple minutes just to read up on what is motivating for the different generations and how they like to receive information and what types of changes you can make to the way you are giving information or need a change to happen to help them get on board. So for example, boomers often are concerned with legacy. So you have a hospital that you started from the ground.
00:40:03
Speaker
and you are a boomer, you are more likely to jump onto a change or accept a statement if someone can tie it to the legacy of that practice.
00:40:11
Speaker
and how they will continue the legacy of your practice and growth with whatever that changes. If you are trying to hire, everyone is trying to hire right now. So if you're trying to hire a brand new anesthesiologist or you're trying to hire a practitioner who's a millennial, they are very concerned and focused on impact. What is a way that they can make an impact and how do they make it right now?
00:40:35
Speaker
They want a catnograph because Dr. Bailey told them to stop what they're doing and go tell the general practitioner who's trying to hire them to buy a catnograph, you're probably more likely to keep that person and get them to work in your practice if you think it's a good fit and you can say, we're going to work on getting you that catnograph. Like maybe it's not right now, but if you can make them feel heard, make them feel supported and listen to them when they explain why they want it,
00:41:00
Speaker
and talk about how you want to help them make that happen, they know that you're probably interested in helping them make an impact, and they're more likely to listen to that message. If you need them to change how they're doing something, tell them the impact of it. They're more likely to go with you. So there's a lot of interesting things out there under that platinum rule, I think, that you can use to help bolster your argument. And it's not shmarmy.
00:41:27
Speaker
It's just talking to someone the way that they want to be spoken to so that they can absorb the thing that you need them to hear. Right. Right. That's super fascinating. You know, I never thought about the generational effect. Maybe it's just something that I've kind of always had in the back of my, my minds, but I never really, I mean, you so eloquently like explained it.
00:41:49
Speaker
So thank you. So to wrap up our conversation, why don't we just take like from your perspective, like maybe the top three to five kind of takeaways.
Key Takeaways and Conclusion
00:42:03
Speaker
How do we implement change in our practice in a way that makes everyone feel heard and everyone a part of the team when we make those changes?
00:42:13
Speaker
Yeah, that's a really good point. So I think first thing, I say this about most things, but I do think it's extremely important to assume positive intent because without that you, you aren't going to get people to follow you and certainly aren't going to support the change you need most of the time.
00:42:31
Speaker
Second, make sure that you are leaving a realistic timeline and that you're holding people accountable for that timeline. So if everyone has agreed and everyone has said yes, again, the vast majority of change initiatives that fail aren't because people haven't agreed to them. Like usually you get over that stumbling block. It's often because the implementation part falls flat because we dropped something in someone's lap and then we didn't give them a plan. So back to your point, Dr. Goetz, and I think the next, so number one, assume positive intent. Number two, make some smart goals.
00:43:01
Speaker
Identify what your item, your action items are going to be. Make sure that you have a realistic timeline. Make sure you have identified the correct people to be in the correct roles, to make that change happen. And then keep reassessing it. Yeah. And kind of also in that sense, identify kind of the leader, like who is going to be responsible for these smart goals and making sure that the smart goals are accountable. Yeah. Who's the champion? Who's the excited person who is going to keep the momentum going? Yeah.
00:43:30
Speaker
Because you're in my instances in both accounts, we don't stay in one hospital, right? So like when you leave, someone has to be held accountable for being the champion of the process and making sure that they're checking in with everybody. Exactly. And then the third thing, honestly, I think is I really like Dr. Marenson's 90 day no bitch policy because I think you can't really tell if a change is going to be successful for a bit.
00:43:54
Speaker
There's gonna be bumpy parts, but if you get through that 90 days, the complaints that are left, the concerns that are left are likely legitimate and things that you really should address and talk about. Well, I think those tips are excellent. This was an amazing conversation. I just wanna thank you so much. Of course, I expected to have an amazing conversation with the Dr. Bailey, my friend.
00:44:16
Speaker
So, Dr. Bailey, where can people find you if they want to find you? I have sort of, I have a desk job now, which means that if you guys have anesthesia questions, consults, like most of the people listening to this podcast are probably hooked up with a really great anesthesia support system. But if you're not, or if you want to talk more about change management, because it can be complicated, my email address is kathedvm at unitedvetcare.com.
00:44:40
Speaker
And then the other thing I wanted to share is that, you know, if you're listening to this novice podcast, it's likely you've already found a lot of fantastic novice resources. There's a lot of great things out there on the novice front, including blog posts. And there's a novice, you know, conference that's virtual. There's a lot of really great stuff out there. So do some exploring. It's worth your time.
00:45:05
Speaker
But if you like what you heard today, I encourage you to check out NavAss and consider becoming a member. As a member of the North American Veterinary Anesthesia Society, you get tons of benefits, including access to CE events, blog posts, fireside chats with boarded anesthesiologists as well as specialty technicians, and just so much more. Visit www.mynavass.com.
00:45:32
Speaker
n-a-v-a-s dot org, to advance your anesthesia journey today. Also a huge thank you to our sponsor, Decra, without whom this podcast would not be possible. They market products such as Medivax, Isoflurine, and Ceboflurine, formulations of carprofan and meloxicam, and of course, most recently, Zenalfa. So please contact your Decra rep if you are interested in these products for your practice.
00:46:00
Speaker
I want to again thank our very special guest, Dr. Kate Bailey, for spending time with us today to share her insights on this really important topic. And a huge thank you to all the gas pastors out there who choose to spend their time with me today on the NavAss Podcast. Becoming a skilled anesthetist is a lifelong journey of learning and self-discovery, so I hope you consider listening in the future. Until next time, I'm your host, Dr. Bonnie Gatson, and thank you for listening.