Hospital Detox, Part 2: Culture

Words by:

Dave Shuey, LMSW, DMA — IndeVets Veterinarian Social Worker

In Part 1 of this series, I discussed the undeniable impact of the sensory exposure of working in a hospital. As we continue to explore toxic work environments, how they affect veterinary professionals, and suggestions to create positive change, we tackle veterinary workplace culture.

Culture, by its simplest definition, is everything that is thought of by a group of individuals. It contains all of our ideas, modes of expression, values, hopes, fears, assumptions, and misconceptions that define the quality of how we live and work together. The quality of each of those items (and countless others) gives a sense of the health of a culture and where changes ought to occur. For our purposes, we think of quality as both a way and a goal, guided by the values of doing no harm, improving life, and granting people the right of self-determination. From an organizational perspective, the quality of leadership determines the quality of the culture, and in turn the health of the workforce.

Toxicity Revisited

Where does a “toxic attitude” really come from? How we show up at any given moment is the sum total of influences that occur in the immediate to distant past. No one is to blame for that, as I hoped to show in Part 1. Sometimes those influences result in someone being so angry or so afraid that they have to hurt themselves or others to feel safe, whether it’s through passive aggression, silence, dominance, substances, acting out, or misuse of the power of position. In psychoanalytic terms, a toxic attitude is a symptom of having turned the stressors of the environment inward. We lose our hold on the most critical element of well-being which is our social bonds. In our solitude we begin to believe that the world is inherently unjust, if not actively trying to kill us, and then we reach for whatever coping that’s near to hand, which is usually defensive. Toxicity is not evil. It is a sign of loneliness.

Then there is the organization or “macro” perspective. In a previous blog on culture I mentioned a Hebrew phrase meant to apply to a community or organization which I quote in context here:

The Fish Rots from the Head

This old Hebrew saying bluntly declares exactly how workplace cultures fall ill and perish. Leadership creates and maintains the cultural environment and resources of the organizational community. Remember that culture is everything “thought of” by a community. In the same way, an organization’s mission, vision, core values, brand promise, and so on are the raw materials of that organization’s culture. A competitive environment of scarcity, conflict, isolation, and despair, or a collaborative one of support, communication, reward, and fulfillment flows directly from the nature of those values. We might engage in some healthy questioning of all our values. Do they favor competition, or collaboration? Are they hopeful phrases artfully framed on a wall, imposing themselves from the outside? Or do they naturally come out in our daily practice from our deeply held beliefs about work? What are those deeply held and mostly unconscious beliefs anyway? The answer to these questions, in veterinary medicine, is found in the relationships, health, and behavior of the caregiving staff, as well as the public’s experience of that care.

Perhaps the deeper question is: do our leaders show humility and acceptance in the face of objective reality? For collaboration to take hold as a guiding principle, leaders need to place the principle of honest engagement with the people of the company, which includes admitting doubt, not knowing, and directly embracing mistakes, above any goal of material success. The more one clings to an ideal of infallible authority and status, the more the culture suffers.

We often think of leaders as strong, unflappable and invincible. Research in the last two decades concludes that the capacity for leaders to show vulnerability plays a critical role in creating a place where their teams feel safe enough to take risks and share where they are struggling. Author Patrick Lencioni also emphasizes the importance of vulnerability in leadership in his book The Five Dysfunctions of a Team: A Leadership Fable. “Leaders who are willing to admit their mistakes and be vulnerable are more likely to create an environment where team members feel comfortable sharing their own challenges and learning from each other’s experiences. This, in turn, leads to greater innovation, productivity, and success.”

Cultural Health Hazards

With the dual perspectives of the individual’s inner life and the organization’s needs, we can begin to identify behavior that presents a potential hazard to the person, much like OSHA does when they look around the facility.

Part of the research we’re doing into veterinary professional well-being includes the Areas of Worklife Survey (AWS), which is paired with the Maslach Burnout Inventory (MBI). The survey lists six areas of worklife that the participants answer questions about, and discover whether their work environment (and therefore culture) meshes with their values and reasons to pursue professional goals. The report that each participant receives gives interpretations based on the degree of fit or mismatch. Here is what the report says about each area in the case of mismatch. I have converted them to “I” statements, because this is what the sufferers are saying to leadership:

Workload: I feel the workload is not manageable: too much work to do in too little time. The job requires me to work outside of my skill set without the necessary support to develop these skills. The work regularly interferes with my personal life, interrupting the recovery cycles necessary to stay actively involved in a demanding profession.
Control: I feel buffeted by policies and procedures developed without my perspective or participation. They constrain my professional judgment. Paperwork and meetings interfere with doing effective work.
Reward: I feel others ignore my contributions or take credit themselves. I may feel the pay is inadequate, the work is tedious, supervisors are dismissive, and patients/clients are unappreciative.
Community: I may identify this organizational environment with conflict, some level of hostility, or one-upmanship. Negative community environments are susceptible to bullying, abuse, or intimidation, or they may be lonely places of isolation and closed cliques.
Fairness: I feel that arbitrary workplace decisions are delivered without explanation or rationale. People are unsure of receiving fair treatment on decisions regarding resources, compensation, or career development. I may find that people are rude to one another, showing little appreciation for diverse values, lifestyles, or cultures.
Values: I feel a profound disconnect between your personal values and the organization’s values or actions. Furthering the organization’s mission means frittering away my time on trivial, meaningless tasks. To a greater extreme, furthering the mission means acting in a way that is actually destructive.

I hope I have shown in these two blogs both the simplicity and the depth of a few essential needs of a thriving veterinary community. Below are some practical suggestions to get you thinking and perhaps seeking positive change in novel ways.

Practical Suggestions

Respect time and energy by keeping your staff well fed and scheduling appointments around their workflow and not the other way about.
This is a Doctor’s Office, not a Starbucks.
Respect human limitations by reducing the need for multitasking.
Respect each other with frequent informal gestures of support and gratitude.
Respect quality by doing all of the above.

For Leadership

Appreciate the potential for healing just by identifying and living by basic agreed-upon norms of human collaboration that place the person first.
Embrace cultural health as the top priority.
Implement radical ideas to improve the inner health and life of the workforce and the organization.

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