29 Jun 2017
<em>VBJ</em>'s Big 6 project saw a carefully selected panel discuss and debate the six biggest issues most likely to shape the veterinary landscape. In its first report, panellists discuss work-life balance and how this is changing practice.
James Westgate
Job Title
Throughout May, VBJ hosted an online discussion forum called Big 6.
Our intention was to provide readers with the insights and expert opinions of a carefully selected panel on the six issues we felt were most likely to shape the veterinary landscape, both now and in the years to come.
After much consultation – and taking our lead from projects such as Vet Futures – we decided to focus Big 6 on the following: finding a work-life balance, the implications of corporatisation, embracing future technology, the changing gender balance of the profession, growing the veterinary market and enhancing the veterinary career landscape.
Following what has been – at times – fierce online debate, we are proud to bring you the first in this series of groundbreaking discussions.
Achieving a fulfilling work-life balance is one of the biggest issues facing many veterinary professionals today. Long hours, high stress, relatively low salaries and increasing client expectations all combine to create an extremely challenging working environment. The ramifications of this can be profound, so read on to find what our panel had to say…
The growing struggle people have juggling busy work and personal lives has become a pressing concern for employers and employees alike in the past few years.
It is certainly not a problem unique to our sector, although it would be fair to say the problem can often be far more pronounced. The struggle to find that delicate balance between work life and home life can lead to career dissatisfaction and poor retention rates, but, more worryingly, it contributes to a disproportionately high suicide rate among vets1 and growing mental health issues2.
We asked our panellists (Panel 1) to discuss these issues, how they manifest in practice teams and how the profession can work together to address the problem.
The topic of work-life balance has been split into three sub-sections: working environment, selecting for success and effective leadership.
Moderators:
James Westgate – editor, VBJ
Ross Tiffin – veterinary business strategist
Panellists:
Lorna Clark – owner, Pinfold Vets
Jamie Crittall – director, Beech House vets; co-founder, Virtual Recall
Catriona Curtis – junior vice-president, SPVS
Andrew Curwen – director, XL Vets
John Dinsdale – group veterinary advisor, IVC
Tim Harrison – executive director, White Cross Vets
Richard Killen – group clinical director, CVS
Alison Lambert – managing director, Onswitch
Jill Maddison – professor of general practice, RVC
Adi Nell – senior partner, Medivet
Elly Pittaway – owner, Broad Lane Vets
Mark Proctor – partner, Willows Veterinary Group
Gudrun Ravetz – president, BVA
Vicky Robinson – director, Vet Dynamics
Julie Ross – commercial director, Pets at Home Vet Group
Helen Tottey – RVN and veterinary consultant
Many reasons dictate why members of clinical teams can start to feel a disconnect between what they thought life would be like in practice and the reality. A lack of preparation for the working environment at vet school, coping with the commercial pressures of private practice and the obligations placed on vets by the need to provide weekend and out-of-hours cover certainly contribute to the problem.
A practising first opinion vet and owner of Pinfold Vets in Nottinghamshire, Lorna Clark got the ball rolling with her thoughts on how to provide a more accommodating working environment.
She said: “To improve well-being in practice, staff need a clear expectation of their job role, an organised and fair rota, a robust HR structure/policies to deal with holiday entitlement, sick leave and other issues, and a system of feedback/appraisal for employees. A pleasant working environment helps, too.
“The difficulty is the varied workload and the inability to predict, to a certain degree, what can happen in a day – but with careful planning of diaries and realistic time management we should be able to manage this without everyone having to be at work all of the time.
“What I want from my staff is to give them a structured working week that is ‘the norm’ to be adhered to, but hopefully I’m a nice enough boss that when the sh*t hits the fan they won’t all say, ‘well, I’m off at five…’ and disappear. And they get any significant amount of time they have given us back.”
She continued: “Work-life balance is a personal responsibility, too. It’s all very well having a rota, but it is an individual’s responsibility to manage his or her workload. We should lead by example. Clocking off at the time we are meant to shouldn’t be seen as ‘weak’ or ‘shirking’. If we are meant to, and can, get out at 3:30pm, then why on earth shouldn’t we? But at the same time – there should be a realisation that it won’t, and doesn’t, always happen.”
While the focus of discussion on this subject was largely centred on how working environment impacted on vets, the entire practice team can suffer if conditions are not right.
Helen Tottey, RVN and consultant, explained it was not just veterinary surgeons who struggled to find a work-life balance.
She said: “Thinking about well-being, it has to be the whole practice team and not just the clinical teams. When training and talking to many reception teams, you learn these people generally come from outside of the vet industry – NHS, retail, finance, a whole host of jobs – and with that an experience of how other industries work and are supported.
“What they are always surprised about is how lacking in training their new vet industry role is. Training is minimal (there is the kettle, phone and computer…) and support for what they will see is generally non-existent.
“On a recent training day, one receptionist was really upset by a euthanasia she had helped support the client with the previous week, but feeling she was among friends (as all other delegates were receptionists), she opened up and spoke about how this upset her.
“So whatever we should be doing better for our clinical teams we should not forget the non-clinical teams who come into this environment with more rose-tinted glasses, but who go home at night worrying about things they have heard and seen – but don’t speak out as they don’t feel they can.”
For those responsible for the well-being of hundreds of staff across many sites, trying to deliver a working environment that nourishes well-being rather than neglects it can present even more of a challenge. As group veterinary advisor for Independent Vetcare, John Dinsdale has a significant role to play in ensuring staff at more than 300 sites across the UK can get that balance right. For John, fear of competition and the need to match rival offerings can have a negative impact on well-being.
“I have always had positive uplifts in staff by cutting slack, using and seeing time off as a benefit, seeing sensible working hours as normal, putting vets and nurses and support staff who want to and benefit from working nights in night clinics, listen to them and move them when it does not suit,” he said.
“We all compete for our businesses and fear not being open 24/7 and not doing what the neighbouring practices do, but is it the public driving this? No.
“The profession and the public apply the pressure in equal amounts. We can change the business driver, but changing the public pressure is harder to achieve, and perhaps, as always, as vets we are good at thinking we know what the public wants – but do we? We think we know what [people] want to pay, too. We have a lot to learn from the other models of the profession. We also have to take responsibility for our own well-being.
“There are a large number of vets, and now nurses, who as regulated professionals fear the regulatory bodies, the risk of complaint and being judged. Moving to a no-blame culture must be a positive.”
The most shocking manifestation of the well-being crisis in British veterinary practices is the suicide rate among vets, which currently stands at four times the national average1.
In the week the Big 6 forum closed, the issue once again made national headlines3, with some calling for a screening process for those applying to study veterinary medicine in order to select candidates with personality traits more suited to the stresses of veterinary life.
While none of our panellists backed such controversial plans, Vicky Robinson, of Vet Dynamics, outlined some of her concerns about the readiness of undergraduates for practice life, following a visit to final-year students at the RVC.
She said: “It was pretty eye opening on many levels; the anxiety that most of them have to actually go into a consult room without the back up of their tutors and peers is huge, and most of them freely admitted they hadn’t really experienced any failure in life so far (assuming they pass) and have no idea how they’ll deal with that in practice (hopefully a supportive one).
“Many of them have never had a job of any sort, so have not had the benefit of dealing with the public and delivering any form of customer service, or asked to exchange money for a product or service.
“The stress levels are high before even starting a job; it’s no wonder so many crash and burn, and some are already saying they aren’t sure if this is the career for them. If they go into a practice that isn’t supportive and considers work-life balance and well-being, what chance do they stand? So while I totally agree we should be more supportive in practice, aren’t we just recruiting kids who haven’t been conditioned and are unlikely to be resilient?”
She added: “A final, and I think extremely disturbing, take-home from the RVC was from one student, who for personal reasons had spent seven years there, and during this time, five of her peers had committed suicide. We worry about suicide in practice, but shouldn’t we be doing something about this as a priority?”
In response to Vicky’s post, professor of general practice at the RVC Jill Maddison agreed more could be done to prepare undergraduates for the stresses of life in commercial practice. But Jill, who is responsible for the RVC’s CPD programme and is also director of clinical extramural studies (EMS), made it clear she felt responsibility for preparing students for working life should not lie solely with the vet schools.
She said: “I agree vet schools must do more to prepare students for life in practice [see Panel 2]. Trust me, we are all trying very hard – from the application and interview process to explicit learning outcomes related to professionalism in the curriculum, reflection sessions on EMS experiences, constant feedback during clinical rotations about professionalism not just knowledge and much more.
“However, what we constantly see with students is that, because many do not yet really understand why comms skills, professionalism, ethical training and business skills are important to them, a good proportion of them simply will not engage. They think it is all ‘common sense’ and a waste of their valuable learning time.
“So we definitely need to get better and more creative at embedding professionalism and all that it entails into the undergraduate learning cycle.
“However, I would also say quite a few wonderful, empathetic, highly skilled students graduate and go into practices that break them. Practices that don’t support them, leave a new grad in sole charge for days in their first week or first nights on call, misrepresent working conditions, have no meaningful appraisal systems in place, provide very little support for CPD and generally just don’t ‘have their backs’.
“The RCVS mandates that students spend 26 weeks doing EMS in addition to a similar number of weeks in intramural rotations. One would hope that in these 26 weeks of work placements the students would get to see the realities of practice and are guided and supported by the practice team about the importance of professional skills, not just scientific and clinical skills.
“I receive critical feedback from placements about student attitudes or behaviour yet, when I discuss the issues with students, they so often tell me the issues were never raised with them at the time and if they had they could have learned and done something about them.”
She added: “I absolutely appreciate that it is easy to give positive feedback and really challenging to give critical feedback. But just like when training a puppy – feedback on behaviour is most meaningful at the time of the misdemeanour, not weeks or months later. As they say – it takes a village to raise a child. One could amend that to say it takes a profession to raise a vet.”
– as supplied by Jill Maddison
Practising vet and owner of Broad Lane Vets in Coventry, Elly Pittaway went on to discuss the idea of student selection as a means to help produce more resilient vets. “I believe we really need to address this at the root of the problem – surely at least part of the answer is to select vet students who are well-rounded individuals from varying backgrounds to better reflect pet owners and society in general?” she said.
“It might also be a good idea to streamline the course to choose farm/equine/small animal from the start, or part way through, and choose those students appropriate to their ultimate destination… perhaps one for Big 7?
“The universities are starting to teach soft skills, but they can build on this by providing much better training in communication skills integrated throughout the undergraduate course. This would surely produce vets who have more realistic expectations of what lies ahead of them, are more resilient, and better able to keep themselves physically and mentally well.”
A number of universities are already moving in this direction and, according to Alison Lambert, Nottingham is making a better fist of it than most. Alison is a qualified veterinary surgeon and managing director of consultancy firm Onswitch and in this capacity she has worked with Nottingham to help improve its candidate selection process for veterinary degrees.
She said: “The Nottingham entry criteria include an online filtering process that asks about in-practice and on-farm/yard experience and an online form asks lots of questions that then filters candidates to the next stage and eventually to an interview day.
“The interviews, teamwork session and manual dexterity tests all feed into an overall score of suitability for a place, then the interview weeds down to those who will fit with the Nottingham style of teaching, then a place will be allocated based on all data.
“Having interviewed from day one I am now seeing students I recommended an offer to, actually graduate. Great to see the full cycle; the last one I knew through the five years has gone to do farm and cattle work.
“The process can be better, but it will never be perfect, as people evolve change and are impacted by others.”
One thing that also became clear during discussions around well-being was the need for strong and effective leadership from the veterinary schools, veterinary associations and – more importantly – in practices themselves.
Well-being is a culture and unless that culture is clearly defined by those leading the team, problems can occur at all levels of the practice. But despite the concerns, former SPVS president and Medivet senior partner Adi Nell clearly felt there were many reasons to be positive about the future.
He said: “If most of us look back on our careers, we’ll probably remember more bad employers than good ones. We’ve all learned what to do and, just as importantly, what not to do, from those experiences. We’re learning.
“We’re learning about non-clinical skills, the kind that get just a tiny look-in at undergraduate level. That’s not to place blame: our most important task, the one our clients pay us for, is making animals better – so that’s what our training focuses on. But there is a cost in terms of how we relate to people (clients as well as staff).”
He added: “If people are struggling with the basics of survival, there’s little time or energy or resource left to be kind to our staff or get back to that request for EMS. That’s not because these are bad people or bad vets, it’s just the pressures they’re under.
“The pressures of running a practice have increased while the rewards have lagged behind. That leaves less time to focus on people and getting our work-life balance right. Success comes from great teamwork, each person keeping a focus on what he or she does best: clinical work, client complaints, financial oversight, social media, IT support, nurse training, young graduate support, and so on.
“I’m very optimistic about our future, at least in part because we’re gradually moving away from trying to do it all ourselves and are starting to realise the value teamwork brings. And with it, better work-life balance.”
Andrew Curwen, chief executive at XL Vets, added: “The ‘soft skills’ that are so much a part of this topic can indeed be ‘hard to acquire’ and ‘hard to find’ in a profession that focuses its attention on valuing clinical knowledge above all else. But that’s changing. Just last week I was with a group of vets learning non-directive coaching skills to enhance their ability to mentor and support the next generation. The plethora of initiatives in these areas makes me positive that we’re on the right track.”
Several initiatives have been launched in the past few years to address the wellness issue in UK veterinary practices, including RCVS’ Mind Matters and SPVS’ Wellbeing Awards, which launched last year. The well-being awards were introduced to reward practices that created a culture of well-being for staff, and among the first winners was White Cross Vets.
The family owned practice group took the inaugural honours in the large practice category and, according to practice owner Tim Harrison, good leadership has been key to their success.
He said: “I think leadership and management is a crucial area in the well-being of the team. I fully recognise the nature and pressures of the work mean we are ‘at risk’ of serious well-being challenges. I believe as an industry we are very poor at management and leadership. Often we appoint managers and leaders because they are good clinicians.
“The fact is that medical professionals do not usually make good people managers or leaders. The fact that vets are highly intelligent, often academic, in their approach and also are scientists leads to the ‘softer’ people skills being absent. In the clinics where we have experienced well-being issues, there is often a correlation with the skill set of the local leadership.
The Big 6 panel thought:
“This doesn’t happen all the time, but too often to be coincidence in my opinion. We need to train and develop our managers and first of all we need to select them very carefully and not just based on clinical ability or the fact they are the most successful vet.
“Many of the larger groups are waking up to this and I note from Veterinary Times the likes of IVC and CVS are developing leadership and management programmes, as well as others.”
Practice managers and owners should also embrace flexible working for their teams to foster enhanced well-being, according to BVA president Gudrun Ravetz.
She said: “I don’t think vets necessarily want to work 9am to 5pm. That shift doesn’t help with the school run, you commute in rush hour and you miss all the light hours in the winter if you want to run on the fell or ride a bike. What is missing is flexible working.
“It is often argued that this is not compatible with practice, but I think that is a misunderstanding of ‘flexible’. Flexible includes part-time working and can be as simple as alternative shift patterns, core work hours with flexibility dependent on business need etc.
“When we have surveyed vets there is a significant desire for flexible hours and many vets that are working full time want to work part time and I suppose the risk is that if they can’t they will leave.
“I think the universities do an excellent job and the graduates are superb, but we know we have challenges.”
While it was clear from our panellists’ comments there are unresolved issues around well-being in practice, it was also clear there is a real will and appetite to tackle these issues head-on (Panel 3).
Life as a vet or vet nurse can be tough and will always present unique challenges to those who choose to pursue this path, but it also provides unique opportunities for an extremely rewarding, well-balanced and fulfilling career.
Lorna Clark, of Pinfold Vets, summed this up best when she said: “Lots of us run very nice, successful practices our clients love coming to and our staff enjoy working in. We think hard and care about our business, about the future, about the people who work in them, about the pets and clients that visit us.
“We go to shows/conferences, talk to other practice owners, do CPD (clinical and non-clinical) – all in a bid to keep us up-to-date and our businesses successful. Most of our practices make us a good living and pay the wages of our staff too – and with more like us, the badly managed practices will become a thing of the past, as will the 50 to 60-hour weeks (no one works anywhere near that in our practice), and hopefully work-life balance will improve and flexibility will become nation/profession wide.
“Let’s tell the good news story that the profession knew it needed to change – and guess what? – it has started changing…”
If you would like to have your say on the topic of work-life balance, VBJ would love to hear from you – email [email protected] or tweet us at @VBJMagazine.
