Fixing
A Broken System
Craig J Mohnacky DVM
VMG-Sponsored Management Track
AAHA Nashville March 2014
craigmohnacky@mohnackyvet.com
Presentation Outline
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1.
2.
3.
4.
5.
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Objectives
AVMA Veterinary Workforce Report
Practice Models (Segmentation)
Mohnacky Learning Systems
Guiding Behavior
Appreciative Inquiry
Epistemology
Customer Service Meetings
6. “MLS” Summary
1.
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Maximize Return on Veterinary Education
Eliminate “Burn-Out”
Increase Productivity
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Objectives
Resolve staff, doctor, and business financial
issues
Build Something to Last
Maximize Practice Value
Prevent Premature Practice Sales
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Retention of Ownership with Residual Income.
2.
2013 AVMA Veterinary
Workforce Report
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IHS Healthcare & Pharma
Center for Health Workforce Studies
 In 2012 90,200 DVM’s
 Supply exceeded demand by 11,250 FTE’s
 11,250 Unemployed DVM’s ???? --No
 12.5% of Veterinary capacity is being underutilized
 53% of DVM’s feel they are working under capacity
 Are 47% of the DVM’s who feel they are at full capacity truly at
full capacity??
 Excess capacity through 2025 of 11-14%
 Decrease Demand for Veterinary Services?
2.
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AVMA Veterinary Workforce
Report
Likely Greater Potential for Excess Capacity
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Stagnating Incomes
High Cost of Education
Postponement of Retirement
“Inviting the Elephant into the
Room”
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Nine-Page paper authored by
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Incited dialogue at:
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James F. Wilson, DVM, JD
U of P School of Veterinary Medicine
North American Veterinary Conference
AVMA
AAHA convention
Per James F. Wilson, DVM, JD
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“The Current Veterinary-School Model is Broken”
College Debt
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Graduates shackled with large monthly payments
and low starting salaries.
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Debt represents 184% of starting salaries
Most DVM’s are not recommending the profession
to students.
The word is out that you have assigned yourself to
utter poverty by entering veterinary college.
DVM Newsmagazine

Richard Vedder – Economist
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The good news is they’re going
to be veterinarians.
The bad news is they’ll be
miserable.
Reality of a Veterinary Education

Pure Economic Standpoint
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Is it a good return investment?
Why not Face Reality?
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Too disheartening
It’s Political
No one has offered up any easy or clear
solutions.
AVMA’s New Proprietary Software
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Workforce Simulation Model
Utilized by the Newly
Established Veterinary
Economics Division of the
AVMA
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Goal - Disseminate this
information to “Industry
Participants” so best practices
can be applied
3. Practice Models
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Agrarian Model
Veterinary Centered Model
Ego Centered Practice Model
Client Centered Practice Model
Team Centered Practice Model
3. Practice Models
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Agrarian Model
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Focus = the “Work” to be Done

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Standard Way of Treating Most Presentations
(Shot-Gun)
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Reactive vs Proactive Medicine
Hope to hit the therapeutic target
DVM Thinks he Should Know What is Wrong
“Void of Diagnostics”
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Wellness Programs and Products not a Part of the
Practice
3. Practice Models
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Veterinary Centered Model
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Is the Result of the Vision set in Veterinary School
DVM has a “Pent-Up” Demand to practice
Veterinary Medicine
DVM Has No Interest in Management – Just
Wants to be the Vet
3. Practice Models
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Veterinary Centered Model
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DVM Makes All the Decisions
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Single File
Staff are underutilized
They are Overly Focused on “High Quality” but in
Essence They are Unable to Achieve.
Results in a Multitude of Philosophies Existing in
the Same Building – Confusion to Clients.
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Typically Highly Chaotic Practice.
3. Practice Models
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Ego Centered Practice Model
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The Practice is an Extension of the DVM
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Very Charismatic and Paternalistic
Focused on Higher End Medicine and Surgery
Standards in Place Reflect that of the Owner
Owner of the Practice is Usually the Highest
Producer
3. Practice Models
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Ego Centered Practice Model
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Controlling Owner
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Staff has Little to do with Developing Relationships or
Knowledge Sharing
Practice Struggles in Owner’s Absence.
3. Practice Models
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Client Centered Practice Model
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The DVM and Team is Focused on the Client
High Standards with Uniforms, Staff Training and
Meetings
Stress High Quality Medicine with Lots of
Referrals to Specialists
Goal is to Educate the Pet Owner and be an
Advocate for the Pet
3. Practice Models
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Client Centered Practice Model
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This Practice has Wellness Plans, Geriatric Plans,
and Celebrate Pet Dental Month
DVM can Oversee more than one Exam Room
Exam Rooms are used by Techs
Computer System is Usually Current and Updated
with Good Medical Record Keeping with all Team
Members Updating Records.
3. Practice Models
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Team Centered Practice Model
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DVM Leveraging
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Focus on Systems Problems
Sharing of Metrics and Financial Results
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New Interface to Increase DVM Capacity
Knowledge Sharing
Rewards and Compensation are Based on Quality of
Outcomes
A Culture of Accountability Pursuing Key Focus
Results
3. Practice Models
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Pluralism
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Many world views in the same space
Pluralistic Society
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Agrarian World View
Industrial World View
Information Age World View
What’s The Answer
To Our Challenges
4. Mohnacky Learning Systems
“MLS”
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A New Business Model for Veterinarians
Multifaceted Approach to the Problems We Have Described
Changes in Workflow and Knowledge Sharing
Dedication to Change + Appreciative Inquiry
+ MLS = Preferred Future
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Shared Meaning
Cultural Transformation
Epistemological Growth
Old Model
DVM
Client
Staff
Client
New Model (Team Centered)
DVM
Staff
Staff
Contributes
to relationship
Building
Client
Client
4. Mohnacky Learning Systems
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Characteristics
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Team Centered Practice Model
Staff Educational Opportunities
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Proactive Medicine
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Health Maps
Multi-tasking – DVM Leveraging
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Career Paths
Knowledge Sharing
Enhanced Organizational Capacity for Positive Change
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Customer Service Meetings
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Appreciative Inquiry.
4. Mohnacky Learning Systems
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Course Work
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Pre-Employment screening
Orientation
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Mentorship
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Progress Plans
Technical Training
Reception Training
“Exam Room Advocate” Training*
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In depth study of medicine and surgery for the acquisition of
conversational capacity of the common maladies encountered
in Veterinary Medicine
4. Mohnacky Learning Systems
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Staff Development and Course Work
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Safety Training*
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Culture of Safety
Leadership Training
Accountability Training
Career Paths.
4. Mohnacky Learning Systems
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Use of Mind Maps
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Purpose
 Facilitates Staff Development and Knowledge
Sharing
 Clients Appreciate “Wholeness” of Health
Care Challenge.
The Mind Map Book
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Tony Buzan

How to Use Radiant
Thinking to Maximize
Your Brain’s Untapped
Potential
Mind Maps
4. Mohnacky Learning Systems
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“Exam Room Advocate”
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Training
Tools
SWANS
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Smart
Work Hard
Ambitious
Nice
4. Mohnacky Learning Systems
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“Exam Room Advocate” Course Outline
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Standards of Care
Internal Parasites
Dermatology
Ectoparasites
Nutrition
Client
Communication
 Physiology
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Vaccinations
Dentistry
Otology
Heartworm
Socialization
Anatomy
Leadership
4. Mohnacky Learning Systems
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Course Completion
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Staff are promoted to
“Exam Room Advocate”
Receive a certificate
Business cards
White scrub top for
differentiation
Increased compensation.
4. Mohnacky Learning Systems
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“Exam Room Advocate” Role is to Oversee:
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The Plan
Medical Record
Hospital Patient Flow
4. Mohnacky Learning Systems
Bicycle
vs
Sports Car
4. Mohnacky Learning Systems
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Tools of “MLS”
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Customer Service Meetings
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Metrics
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Create Motivated People
Staff Training and Development
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Appreciative Inquiry
Affirmative Topic Choice
Desirable Careers
Cultural Transformations
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Epistemology
Guiding Behavior.
5. Guiding Behavior
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All Business Needs To:
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Direct
Guide
Influence Behavior
Why Guide Behavior:
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Reasoning or Problem Solving Ability
Alignment
Maturity
Ability to make Meaning in Life.
5. Guiding Behavior
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Tools For Guiding Behavior at MAH
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Appreciative Inquiry*
Epistemological Growth*
Customer Service Meetings*
Language and Communication
Acclimation of New Employees
Cognitive and Moral Development
5. Guiding Behavior
Appreciative Inquiry
A Practical Guide to
Positive Change
By Diana Whitney
and Amanda TrostenBloom
5. Guiding Behavior
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Beliefs of Appreciative Inquiry
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The images we hold of the future are socially
created and, once articulated, serve to guide
individual and collective actions.
Words create worlds.
We see the world that we describe.
5. Guiding Behavior
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Appreciate & Inquiry
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Appreciate
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To recognize the best in people and the world around us
To increase in value
Inquiry
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To ask questions
To study
To search, explore, delve into or investigate.
5. Guiding Behavior
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Combine Appreciate and Inquiry
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Has a powerful effect on leadership and
organizational change
Creates self organizing enterprises
We become what we study.
5. Guiding Behavior
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Epistemology
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A philosophic theory of the method or basis of
acquiring human knowledge.
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The process by which we make reality or
meaning.
5. Guiding Behavior
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Four Epistemological Orders
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Subjective, Magical Mind
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Concrete Mind
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Ten - Twenty years of age
Socialized Mind
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Infant to ten years of age
20 to 25 years of age
Most people live their lives here
Bound by cultural and dictated norms
“Self Authoring” Mind
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25-50 years of age
Writer of reality that we become faithful to
5. Guiding Behavior
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Concrete Mind
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No attachment to cultural values or norms
Choice is limited to what they have seen or
experienced directly or concretely
Don’t see their actions as having any lasting
effects on people
Huge Problem for Parents and Employers
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Young DVM’s
Need to advance from “Concrete” to “Social”
Mind.
5. Guiding Behavior
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Customer Service Meetings
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Practical Use of Appreciative Inquiry
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Supports moving from the concrete level to the
socialized level
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Transformational Epistemological Event “TEE”
Creation of knowledge in a group setting
Turns Independence Into Interdependence
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What is best for the group?
5. Guiding Behavior
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The “Customer Service Meeting”
 Sole purpose is the client and not the staff
 Mandatory attendance
 Staff sits in a circle
 Mandatory that everyone speaks
 Initiation of the culture to new staff members
 Positive language in a group setting
 Accelerates the “TEE”
5. Guiding Behavior
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Customer Service Meeting
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Creates Appreciative Positive Language
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Creates opportunities to dream and share a common
vision for the future
Supports people to act on behalf of the client, pet and
business
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Creates Images That Inspires Action
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What we study is fateful.
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Great Client Experiences
Safety in the Workplace
Team Based Environment
“MLS” Summary
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Create Desirable Futures
 Career Paths
 Take People Where They Want to Go
Resources for Guiding Behavior
 Epistemological Advancement & the “TEE”
 CSM
Cultural Transformation (Team Centered Practice Model)
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Knowledge Sharing
Enhanced Customer Experiences - Loyalty
Changes in Work-flow – DVM Leveraging
“MLS” Summary
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Ultimate Outcome
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Enhanced Quality Relationships
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Through Knowledge Sharing
Increased Practice Value
Those With the Smartest Clients Win
“MLS” Summary
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Building Something Bigger Than “I”
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Visionary Company
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Core Values
Shout out your “Why”
Develop your “How” and
“What” people
Maintain ownership and cash
flow in your practice

Prevent a Premature Practice Sale
“Morning Surf” Mario Simic
Getting Results
Individual & Joint Accountability
Craig J Mohnacky DVM
craigmohnacky@mohnackyvet.com
AAHA Nashville March 2014
Presentation Outline
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7.
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9.
10.
Definition
Why Accountability
Victimization
Focused Results
Results Pyramid
“Job Descriptions” A New Paradigm
Accountability Chart
Feedback / Eliminate Feedback Filters
Individual & Joint Accountabilities
Summary
1. Old Definition of Accountability
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As a Negative Term
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Obliged to give reckoning based upon previous
actions
Something that happens to you when things go
wrong
What management does to you – to get you to
perform
Reporting on actions and not results
Another word for punishing people for poor
performance.
1. Definition of Accountability
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A personal choice
To rise above one’s circumstances
And demonstrate the ownership necessary
For achieving the Pre-determined Key
Focused Results
1. New Definition of Accountability
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As a Positive Term
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Describes commitments that have been kept in
the eyes of others
Social Contracts / “Buy-In”
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Leads to stronger relationships
Fosters trust
2. WHY Accountability?
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Accountability is the key to obtaining what
you desire:

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For Yourself
For your Team
For your Organization
Built to Last
3. Victimization?
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Biggest Obstacle Confronting Accountability
Strangleholds Any Business
Eliminate the Victim Cycle
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Improve Individual and Organizational Results
Example of rejecting Victimization
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Nelson Mandela
Mandela (message #1)

“That window, you know, was actually a
window to the world, because I could see
quite a lot. I could see my mental horizons
expand”.
Mandela (message #2)

“I have attempted to colour the island
sketches in ways that reflect the positive light
in which I view it”.
Mandela (message #3)
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“I would like to project the idea that even the
most fantastic dreams can be achieved if we
are prepared to endure life’s challenges”.
Mandela
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Rejected Victimization
Became Accountable to:
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Himself
Fellow man
Country
Goals
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Provide tools for Creating Accountable
People
Teach How to Recognize and Reject
Victimization
Build Something Bigger than Yourself
4. Focused Results - Attributes
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Pre-determined
Clearly defined

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(Specific)
(Front-Loaded)
(Clear Expectations)
Without pre-determined and clearly defined
results, confusion and excuses prevail
representing “Below the Line Behavior”
4. Focused Results - Attributes
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Meaningful
Measurable
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Memorable
4. Focused Results
Meaningful
It must connect to the
context and vision of the
business
4. Focused Results
Measurable
It must be Quantifiable
& EVERYONE knows it
4. Focused Results
Memorable
IE:
Starbucks “2000 by 2000”
5. The Results
Pyramid
Why?
5. The Results Pyramid
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Beliefs Summary
 Experiences shape beliefs
 Beliefs influence actions
 Beliefs are opinions / perceptions only
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
not factual
Beliefs should not be taken personally
Use beliefs to understand why people are
reacting
Focus on belief systems to better understand
actions
6. Job Descriptions
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New Paradigm

Job


The Key Focused Result
Job Description
Role played in achieving The Key Focused Result
Example
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Football Team

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Job is to “Win”
Job Description is the “Position”.
6. Job at MAH
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Job (Key Focused Result)
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Build Relationships
Manage our Reputation
Grow our Revenues Through CE
Recognize and Reward Others for a Job Well
Done
Each Employee’s role may be different but
not the end result
7. Accountability Chart
Where
action
happens
Confusion
Inactivity
Ineffective
Blame
Game
7. Accountability Chart
Confusion
Inactivity
Ineffective
Blame Game
7. Accountability Chart
Where action happens
7. Accountability Chart
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“See It” Accountable Actions:
Finding the Courage
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Obtaining the perspectives of others
Being open and candid in my communications
Asking for feedback
Hearing the hard things so that I openly see the
reality of the situation.
7. Accountability Chart

“Own It” Accountable Actions:
Finding the Heart

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
Being personally invested
Aligning my work with desired company results
Acting on the feedback that I receive.
7. Accountability Chart

“Solve It” Accountable Actions:
Obtaining the Wisdom
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Creatively Dealing With Obstacles
Obtaining Necessary Information and Knowledge
Developing New Skill Sets
Taking the Necessary Risks.
7. Accountability Chart

“Do It” Accountable Actions:
Exercising the Means
Fortitude

Doing the things I say I’ll do



Sustaining an Environment of Trust
Focusing on the top priorities
Staying Above The Line by Not Blaming Others.
8. Feedback


Old Definition of Feedback
A New Paradigm for “Feedback”

Receive vs Give

Embrace vs Reject

Initiate vs Wait
Feedback
Filters
8. Feedback

Initiate receiving our own feedback in order to
rise “Above the Line”.

Imagine a culture where feedback is embraced /
improving other people’s experiences and beliefs.
8. Focused Feedback

Rather than filtering the feedback you
receive, ask:


“Is that a belief I want them to have?”
If not, then change the experiences.

See Results Pyramid
The Results
Pyramid
8. Focused Feedback

When receiving feedback



Your job is seeing it from others perspective.
Ask questions in order to understand their point of
view.
When giving feedback it must be
constructive.


Intent is to help that person
Holding back feedback can stifle a career
Individual Responsibilities
Responsibility
Responsibility
Responsibility
= Clients
Joint Accountability
Responsibility
Responsibility
Accountability
Accountability
Responsibility
Accountability
= Clients
Summary for Accountability


Specificity
One Owner/One Task



A team can’t own a task
Assign by Competencies
Accountability Chart


Vision Chart
Keep up to Date
Thoughts On Implementing Change



Involves the Willingness to be Imperfect
Courage to Proceed Without all the
Information or Answers
Fortitude to Move On in Adverse or Hostile
Conditions
Four Types of People
Those that make it happen
 Those that watch it happen
 Those that wonder what happened
 Those that never see it happen

Which one do you want to be?
Recommended Reading

The Oz Principle


Winning With Accountability


Connor, Smith, Hickman
Henry J. Evans
Built to Last

Jim Collins