Team culture in veterinary practice - why it's essential for success

This is article three in an RCVS Knowledge series of features on patient safety, clinical human factors, and the principles and associated themes of Quality Improvement (QI).

“Hey, let’s go for a drink after work?”

I’ve heard this a few times in my career after starting a new job, from managers or partners, and I’ve always felt a surge of relief. To me it says a number of things all wrapped into one – you're ok! And welcome!

This statement - and the warm fuzzy feeling it creates – is, if you like, one example of great organisational culture in action – a simple expression that communicates openness, warmth and a sense of belonging that is more difficult to define.

But a positive culture can be created without the need to invite every new staff member to the pub! After all, culture in a practice is continually shaped by the interactions that we have with one another: conversations that are friendly help to reinforce a healthy culture. Conversations that are a little ‘offish’, can eat away at it. And of particular importance are the interactions of leaders with their staff ¹,²:  frequent conversations that are open and supportive of the team can go a long way in communicating the values of an organisation as a whole ³.

A more traditional ‘textbook’ definition of organisational culture is, the ‘shared values, beliefs and norms’ (p.122) ⁴, of employees. These values, beliefs and norms influence the way people interact with one another, with clients and the way they think about the company they work for ⁵.

Culture has a ripple effect

Research from Ohio State University Medical Centre demonstrates the effect a concerted effort to change culture can have. A staff survey had found a culture of blame, poor teamwork and a tendency amongst workers to ignore constructive criticism ⁶. Over four years and a planned intervention to improve culture, the hospital has not only seen patient care standards improve, but has reaped material rewards too (to the tune of $300 million) ⁶.

To what extent does culture drive desirable organisational outcomes? For one highly successful company, the extent to which staff feel valued directly affects the degree to which clients feel valued, and this directly impacts business success ⁵.

Culture also plays an important role in patient safety. There is now a well-developed evidence base in human health proving the relationship between a strong ‘safety culture’ and higher standards of care ⁷.   In this context, culture acts like a lubricant – freeing up communication and helping teams have open and honest conversations about sometimes awkward topics, for example, in the case of a Significant Event Audit (SEA). But crucially, only through this type of dialogue can systems change, and a practice’s standards progress.

Culture is key for a healthy practice

Culture also affects staff wellbeing. While mental health in the veterinary professions is quite rightly under the spotlight at the moment, organisational culture plays a role here as well ⁸, and commentators have highlighted the importance not only of introducing support schemes like Employee Assistance Programmes, but of backing them up with a genuine commitment to combating psychological stress ⁹.

Culture, in the form of:

• open communication/allowing employees a say in the way things are done (so-called job control) and
• understanding and mitigating for the stresses imposed on staff in a fast-paced occupation

can materially affect employees’ wider mental health ⁸.

So, culture plays an important role in at least three areas of veterinary practice:

1. Productivity and financial health
2. Patient safety
3. Team wellbeing

We have seen in this summary that culture can affect important areas of veterinary provision, and embracing it is likely to ‘turbo-charge’ a practice’s journey to ever higher standards of care. Many books have been written on the subject (including the excellent The Culture Code by Daniel Coyle ³ offering advice on how to improve culture. The evidence base is growing all the time: culture isn’t a ‘nice to have’ but an essential part of organisational health and success. Perhaps in the past, culture hasn’t felt very important in the veterinary profession. After all, the priority for any veterinary practice is the animal in its care. But new research from human medicine is filtering through: if we are considering how to improve aspects of work, be it clinical standards, practice profit or staff wellbeing, thinking about culture is key.

Discussion point

How would you describe the culture within your team? Are all team members confident to speak up and challenge the status quo to provide valuable insights for team improvements?

Checklist - what you can do next

• You are fully bought into quality improvement, patient safety, positive team culture, but how do you move things along with the rest of your team? Listen to Shobhan Thakore during his session at SVPS/VMG Congress 2020.
• We talk a lot about what to do when things go wrong, but what about when things go right? Listen to RCVS Knowledge’s podcast by Suzette Woodward.
• In a busy work environment, it can be tough to have a moment to think about how everyone is feeling. The Rolling Take 5 system can help.
• Take the free RCVS Edward Jenner Leadership Development Programme. Suitable for all veterinary professionals, it covers key concepts specific to the veterinary sector. Delegates can work through the course at their own pace, whilst engaging and discussing learning with fellow online learners.
• “Healthy workplaces are good for us and for business”. Find out what it takes to be a Good Veterinary Workplace. 
• Listen to Alice Bird using a practical example, Alice talks through how to run a Significant Event Audit without apportioning blame.
• Listen to the emotive story by Margaret Mary Devaney and Anita Malana about QI, Safety Systems and Just Culture in the NHS.
• Read the guide by The Kings Fund on Embedding a culture of quality improvement.
• Check out Civility Saves Lives, a website run by health care professionals aiming to raise awareness of the power of civility in medicine
• Find out how to use root cause analysis, the 5 whys, contributory factors checklists and the cause and effect diagrams. Using a clinical example, you can see how these tools can help you to find the true cause of a significant event in practice and help steer your team towards a safety culture, and away from a blame culture. Free templates are available.

References

1. Sfantou, D. et al. (2017) Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5(4):73. Available from: https://doi.org/10.3390/healthcare5040073
2. Vogus, T.J. and Sutcliffe, K.M. (2007) The impact of safety organizing, trusted leadership, and care pathways on reported medication errors in hospital nursing units. Medical Care, 45 (10), pp. 997–1002. DOI:10.1097/MLR.0b013e318053674f
3. Coyle, D. (2020) An excerpt from the culture code [Daniel Coyle] [online]. Available from: http://danielcoyle.com/excerpt-culture-code/ [Accessed 27 November 2020]
4. Flamholtz, E. and Kurland, S. (2005) Strategic organizational development, infrastructure, and financial performance: An empirical investigation. International Journal of Entrepreneurship Education, 3 (2), pp. 117–42
5. Flamholtz, E. (2001) Corporate culture and the bottom line. European Management Journal, 19 (3), pp. 268-275. https://doi.org/10.1016/S0263-2373(01)00023-8
6. Financial returns from organizational culture improvement: Translating “soft” changes into “hard” dollars [Human Synergistics International] [online]. Available from: https://www.humansynergistics.com/resources/content/2016/12/08/financial-returns-from-organizational-culture-improvement-translating-soft-changes-into-hard-dollars  [Accessed 27 November 2020]

About the author

Mark Turner BVSc MRes MRCVS

Mark graduated from the University of Liverpool in 1996 and in 2017 completed a Masters degree at the RVC investigating patient safety culture in the UK veterinary professions.

The research project investigated contemporary knowledge of patient safety behaviours in practice including significant event reporting and auditing.

He has an interest in the application of patient safety as a tool for improving staff engagement and success. He has written for Vet Times, Companion magazine and appeared as a guest blogger for the BVA/RCVS Vet Futures project.