Five lessons for being a Positive deviant

“Arriving at meaningful solutions is an inevitably slow and difficult process.  Nonetheless what I saw was: better is possible.  It does not take genius.  It takes ingenuity.  And above all, it takes a willingness to try.”  – Atul Gawande from Better

What is a Positive Deviant?

Atul Gawande, a surgeon and healthcare researcher, is one of my favorite authors.  His writings include the books, Complications, Better, The Checklist Manifesto, and Being Mortal.  In Better, Dr. Gawande looks at examples of excellence throughout medicine and asks what we can learn from these “positive deviants.”   A positive deviant is, “someone whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers, despite facing similar challenges and having no extra resources.”   Through stories, Dr. Gawande, introduces us to medical professionals who are making huge strides in improving care and outcome for patients. These improvements are not from genius but from diligence and clarity of purpose.  At the end of the book, he provides five suggestions for how all of us can aim toward being one of these positive deviants in the world of medicine.

I like to set New Years’ Resolutions each December 31st.  I find that the process of setting an intention, stating it, and writing it down, makes me much more likely to reach that goal. This year, I’ve been thinking about Dr. Gawande’s 5 suggestions and how to use them for improvement in 2019.

Here are the Five Suggestions for being a Positive Deviant

Ask an unscripted question:

It is easy if you are busy and just trying to get through your day, to stick only to the business at hand.  However, each time you ask an unexpected question to a client, a co-worker, or even someone new you meet, you create the opportunity to pause and learn.  These pauses for connection can give you a chance to breathe, to laugh, and to feel more part of a community.  This is probably easy for many of you who are extroverted.  I tend to be so goal-oriented that I can forget to stop and just get to know people.

The two biggest struggles veterinary owners have mentioned to me this year are retaining employees and dealing with difficult clients.  One possible approach to both of these is to resolve in 2019 to ask more unscripted questions.  Do you know your new technician’s favorite restaurant?  What movie your assistant loves?   Do you know how many siblings your receptionists have and where they live? Do you know what makes your associates smile the most? Asking these questions and taking the time to listen can help create more fun at work.

On the client side, when we have someone difficult arrive, our assistants often warn us.  I think we then automatically tighten up and put on our mental armor.  What if instead we could ask a question that changed that dynamic?  Something that showed that you wanted to know about them and their pet? Some way to be curious rather than judgmental?

In writing this blog, some of my best conversations were outside my normal realm.  I enjoyed speaking to my classmates, Lucy Tidd, and hearing her ownership story.  I learned a lot about cooperatives from Allison Morris, of The Veterinary Cooperative, and about ESOPs from Annette Engler, both of whom I emailed out of the blue. In 2019, I am hoping for more unscripted questions and new conversations.

Don’t complain:

It can be easy to have conversations that turn into whining, especially during a busy day or a hard time.  Often people say they just need to vent a bit.  But how does venting affect the new assistant you just hired? 

Being the one that changes the conversation can dramatically affect your outlook.  Is it possible to flip the narrative?  Often on emergency, we will complain about how busy it is or how many patients we have to treat.  Try changing the story to, “we are rocking and rolling today”, “we are saving so many lives”, or, “isn’t it great how many people trust us with their pets.” These comments may get you groans and eye rolls but probably also some smiles.

That doesn’t mean we don’t surface issues but instead look to present them for discussion and solutions rather than just misery.

Count Something:

This year has demonstrated to me how much veterinarians crave data and numbers.  Two of the blogs that got the most reads this year, who’s buying veterinary hospitals and who owns veterinary hospitals in Seattle, were both blogs in which I counted something.  It is crucial for our profession that we don’t just talk about consolidation and corporatization. We need to actually measure and trend what is happening.  We need to not only know how many hospitals are changing hands but also what percent of markets are controlled by individual groups. Veterinarians need to know where the money is coming from and what voice they have in control. Because over half of veterinarians are female, we need to measure and report the gender balance of the C suites buying our profession. I hope to contribute to this effort in 2019.

It is of equal importance to use data to understand and improve outcome from common diseases. We need to perform and publish prospective trials that are not 20 animals over one year but 1000+ patients over a number of years.   We need real collaboration not just in academic institutions but across large private practices with heavy caseload.

Individually, you can learn a lot about what you treat and what’s working if you are willing to query your own database and look for answers.  What disease do you want to know more about?  Do you use diagnostic codes in your practice?  Or could you pull an invoice item report that would tell you about a disease? 

Several years ago, we were able to use a diagnostic code report to pull our pneumonia cases from a 2 year period.  We determined that our outcomes were very similar to UC Davis.  We were also able to say that the prognosis in dogs under a year was over 95%.  This information allowed us to encourage owners with young dogs, even with severe disease, to try for treatment.

Write Something:

The challenge of writing a blog has been a real learning experience.  I am better than a year ago at using active voice!  I am less worried when no one reads something I am proud of.   Most importantly, the process of writing has helped me open conversations with lots of different people within the industry.

Writing is very important within our practices.  I challenge you in 2019 to specifically think about written discharge instructions.  How do you provide them?  Can you streamline them in your medical record system?  Can you work together with your doctor team to write them together? These written discharges and how you present them to clients may be a key to improving compliance.

Look for opportunities to change:

Change is hard.  However, some of the biggest frustrations in all of our practices are the “pebbles in your shoes.”  What are those small things that make you crazy most days?  Is it form that still has a medication on it you no longer carry?  Is it a process that you know could take 2 steps but always takes you 5?  Resolving to tackle and change 1-2 small things a month can make a big difference over time in how your practice works, in your outcomes for patients, and in your own satisfaction.

As Dr. Gawande states, progress in medicine and outcomes, is often not due to one study or one large leap.  It is the accumulation of small constant changes over time by people who care about improving lives for their patients.

My wish for you in 2019 is enjoyable striving toward being a positive deviant.