A few years ago, a veterinarian and friend of mine sold her tiny niche practice to a large corporation. My friend - we’ll call her Dr. A - had a special interest in rehabilitation and pain management and being one of few such practices in the area, her practice grew dramatically year after year. After 5 years, she was facing some serious burnout, so she eventually hired another doctor, Dr. S, to help with the caseload.
Dr. S was passionate about rehabilitation and joined the practice with enthusiasm to help it continue to grow. Dr. A and Dr. S quickly developed a new routine, made some changes to the practice and watched it continue on its previous trajectory of growth.
When Dr. A was ready to sell, part of the sale agreement was that Dr. A would prepare a transition plan for the practice to allow for expansion and continued growth. After the sale, Dr. A would stay on as a consultant for one year to help implement this plan, and Dr. S would be responsible for taking over patient care and the day-to-day operations of the practice. Together Dr. A and Dr. S hatched a plan that, if even loosely followed, would allow the practice to expand and better support its rapid growth.
After the sale, Dr. A met monthly with the leadership team of the new practice to help implement the plan. After a few months, it was very clear that the plan wasn’t being implemented as agreed and the practice was no longer growing, despite near zero attrition of Dr. A’s former clients.
Upon investigating this trend, Dr. A discovered that Dr. S was unable to discuss any of her needs or concerns with the leadership team. Her input was not welcome and was usually simply ignored. She wasn’t invited to any of the monthly meetings with Dr. A, nor was she able to schedule a discussion of her own with her leaders. Even a small request was usually met with silence. Dr. S slowly lost her enthusiasm, became disheartened, and eventually left the practice. In the absence of someone to run it, the practice closed.
What a kick in the nuts! In the course one one year, Dr. A watched her thriving, rapidly-growing practice wither and die. How did this even happen?! How does a thriving, turn-key, one-of-a-kind practice with more than 75% annual growth die within a years’ time?
While there are many factors, one that stands out is the lack of input from team members, particularly Dr. S, allowed by the leadership.
Giving Voice to Team Members Increases Resilience
This input - or voice - is the expression of concerns or new ideas about the functioning of the organization. Leadership practices that support an environment in which voice is encouraged contributes to creating more resilient teams.
The article that inspired this post included several studies that looked at the impacts of ensuring team members have voice during times of change. Specifically, how prohibitive and promotive voice contributes to resilience and has a protective effect against lost productivity during times of change.
Prohibitive voice refers to the expression of concerns about things that are potentially harmful to the team. For instance, when a practice manager asks a veterinary technician if the team can accept one more patient that day and the technician suggests that any additional cases may overburden the team - the technician is expressing prohibitive voice, based on concern for diminished patient care. During times of change, this type of voice helps prevent and manage mistakes during the initial stages following the change event - a time when mistakes are likely to be higher and productivity lower while team members adjust to the change and develop new routines.
Promotive voice refers to the expression of new ideas to improve the functioning of the team or organization. For example, in the above story, one of Dr. S’s suggested changes was to introduce a “cage-side” rehab service for hospitalized patients, rather than only seeing rehab patients on an outpatient basis. This would not only provide better patient care, but also would allow the rehab service to become more integrated into the hospital, supporting improved cohesiveness between services through shared patient care. Promotive voice is most helpful after the change event, when the team has started to adjust to the new environment and team members are on a trajectory of increased productivity.
The authors note that the degree of “protectiveness” also depends on the degree of change - that is, the greater the degree of change, the more important it is for team members to have voice, and the greater impact it has on resiliency and performance during times of change.
Change
As the old 90’s country song goes, “the only thing that stays the same is that everything changes.” Change is inevitable. And it’s disruptive. And sometimes, if not handled appropriately, it can be devastating.
Given the enormous changes facing Dr. S and the rehab practice, giving her voice during this time of change was imperative to the successful transition and integration of the practice into the larger organization. The lack of voice not only prevented a smooth transition, but also prevented the practice from restoring its productivity to pre-sale levels, and eventually led to its demise.
But, it’s not enough to simply include team members or give them a platform on which to voice their thoughts. Supporting psychological safety is key for voice to have the impacts described.
When Dr. S was finally included in planning meetings, she was met with an unwelcoming and often hostile environment. This lack of psychological safety made it difficult, if not impossible, to make her voice heard even when given a platform to do so. Any concerns she presented were met with blame and her ideas were dismissed without any discussion or exploration. Little by little, she grew more despondent, and it was no surprise when she confided in Dr. A that she was looking for another job and planned to leave the position as soon as she was able.
A Different Approach
While the lack of voice was certainly not the only issue with this transition, it was a fatal mistake for this practice. So, how can leaders use voice to support teams and improve resilience during times of change?
Create a psychologically safe environment for team members to share their concerns and ideas. When we create a safe environment in which there is no fear of repercussions, team members are more likely to share. This empowers and motivates team members, resulting in a more resilient team.
Encourage team members to share their concerns when changes are happening in the organization. This use of prohibitive voice is particularly useful for mitigating the decline in performance and reducing errors that occur immediately after the change takes place.
Encourage team members to share their ideas about improving the functioning of the organization. After a major change takes place, the return to pre-change performance can be improved through the use of promotive voice. This helps teams to explore novel behaviors or practices to adapt to the new routine after a change.
In short, when employees are given voice and a psychologically safe space in which to use it, the result is a more resilient team. This has endless benefits, but is particularly important for maintaining performance in the face of the inevitable changes all organizations must endure.
In a veterinary profession in which folks like Dr. S are leaving in droves, cultivating psychological safety and encouraging voice might just be the retention-promoting approach our community needs.