SPEAKER_02 0:04

Welcome to the Veterinary Culture Lab, where science meets real-world application. I'm Andy Davison.

SPEAKER_00 0:11

And I'm Josh Weisman. Together, we'll show you an evidence-based blueprint for renovating culture in your veterinary team one episode at a time.

SPEAKER_02 0:22

Mistakes happen in veterinary medicine, but what happens after the mistake might matter just as much as the mistake itself. In this episode, we're digging into what research says about debriefing after things go wrong and how those conversations can either strengthen your culture or make things a whole lot worse.

SPEAKER_00 0:43

Hey Andy, good to see you again.

SPEAKER_02 0:46

Hello, it's always good to see you, Josh.

SPEAKER_00 0:49

I was gonna ask you how you're doing, but um, I I'm just gonna go right to how I'm doing. I have complete brain fry. I am like squarely in the state of like not gonna be getting great sleep or being super effective, or I like I feel like my life is currently revolving around the needs of a tiny little terrorist that lives in my home.

SPEAKER_02 1:12

Yeah, and I bet that terrorist spends a lot of time in the little playpen that I can see behind you in your office.

SPEAKER_00 1:19

Uh it indeed, Sateris does spend a lot of time in that playpen. She is not currently in the playpen because we determined that she is in desperate need of a nap. Um my wife and I did not have a child. Just to be clear, we are childless and will remain so for the remainder of our lives. But we did adopt a puppy. Yeah, puppies, puppies, puppies. I know. I if this were if we were working in our Slack, so listeners, our amazing director of operations, Tess Warner, has figured out a way for our Slack, um, like our the flourish Slack. If anyone ever writes the word puppy or puppies, it like automatically spits out a message with a puppy icon and it says puppies where it is amazing. So there's been a few of those in Slack recently. Yes, we adopted.

SPEAKER_02 2:10

It's been getting a lot of uh exercise in the in our Slack channel.

SPEAKER_00 2:14

Yeah, because I can't stop talking about our adorable puppy. Her name is Stella. She's I'm guessing probably around six months old. She's getting her first like exam with our GP next week. I'm pretty sure that she's got all her adult teeth, but she's also still squarely in the like clumsy puppy mouthing phase. So I'm guessing around six months. The paperwork claims she was born February 27th, uh, which is about six months ago. So that's that's what I'm going with, but we'll we'll see. She came from Soul Dog Rescue, S-O-U-L, and they're really cool. They do like uh wellness services, spay neuter clinics, and then they do adoption stuff as well, uh, with the uh the reservations in the Four Corners area here in the the West. Um they're they're pretty awesome. So we just adopted her a little over a week ago. Today is I think day eight with her in the house, and we're settling into a routine, and she is super, super cute, and we still like question why we make such terrible adult decisions, but that's because we're adults and we can right, we can have as many puppies as we want to. We can have as many puppies as our spouse is willing to allow us to, right? Speaking of Andy, it's been maybe what a couple years since you adopted a dog. Do you think it's almost time?

SPEAKER_02 3:29

Um, no, no, I'm happy with my little pack. Three's a good number. Um, Brody is just now starting to maybe make adult decisions. Not always, he still has puppy moments. Um, but our little pack is they're good. It it takes a minute for everybody to settle in and kind of figure it out. And we have three. Three is a happy number. And uh yeah, you were saying the however many until your spouse freaks out on you.

SPEAKER_00 3:59

That you've reached it.

SPEAKER_02 4:01

I'm about at that number.

SPEAKER_00 4:02

Yeah, got it. Understood. All right, Andy. I want to try something a little different with you today. Usually I try and like weave a dad joke into a story, and now like I feel like you're just like on to me, and every story I start to tell, you're like, clearly, there's gonna be a dad joke here. Um I'm just gonna read you a handful of dad jokes. Uh I have a deck, I have a deck of dad joke cards, which you can see, but the readers can't. And I'm just like they do exist. I just pulled them out and I'm just gonna start reading them to you and see what you think. Andy, what do Santa's elves listen to as they work?

SPEAKER_02 4:38

Don't know. What do they listen to?

SPEAKER_00 4:40

Obviously, rap music.

SPEAKER_02 4:43

Yeah, I should have known that's so good.

SPEAKER_00 4:45

Terrible, right? Um, Andy, what's what is the difference between a poorly dressed man on a tricycle and a well-dressed man on a bicycle?

SPEAKER_01 4:56

What is the difference?

SPEAKER_00 4:58

A tire?

SPEAKER_01 5:00

These are pretty good.

SPEAKER_00 5:02

Andy, have you heard the rumor about butter that's going on? I've not heard this rumor. Tell me more. Oh, well, I'm certainly not gonna spread it.

SPEAKER_02 5:12

This is a good quality deck of dad jokes.

SPEAKER_00 5:16

This, yeah, it's significantly better than the dad joke calendar that I'm what we're used to, and so that's why we are very used to rolling our eyes.

SPEAKER_02 5:25

These are actually, these are kind of good ones.

SPEAKER_00 5:27

They're they're not bad. They were they were worth the expenditure of this uh beautiful deck of cards that cost nine dollars. Um, okay, with that, I think we've had enough of that business. Uh, let's let's get to the task at hand, shall we? So I am gonna tell you a story. There is no dad joke tied to it. This is a real story with names changed. Uh, listeners, if you've read my book, you're gonna be familiar with the story. This story takes me back to uh like late 2000s, the first hospital I was a managing partner in, and we we hired a uh a CBT fresh out of school. She had just passed the VTNE and she was starting her career as a credential veterinary technician. And about a year after we hired her, she hit this place in her career that I think a lot of us are familiar with. You know, with when we start off day one as a as a technician, as an associate veterinarian, as a practice manager, whatever role it might be. Day one has this like incredible mix of pure terror and utter excitement. We're super joyful for the career that we're about to do, but we're also terrified about what we don't know and what we don't know that we don't know. And are we going to do well? And do we have all the skills and you know, imposter syndrome and all that kind of stuff, right? Interestingly, physiologically, both of those experiences are identical in the body. But anyway, as we start to do the work that we do, we get better at it over time. We start to build confidence. And about a year in, for it varies for from person to person, but generally speaking, about a year in, we start to like really feel pretty good about like I can do this. And that's where this technician was. And it's also the point in time where I think we start to let our guard down. Like at day one, when we're scared about how we're gonna do, we're also very meticulous and detail-oriented, and maybe take things a little bit slower. As we start to build confidence and self-efficacy, we start to kind of work off of muscle memory and we might miss things. And that's what happened with this technician. We'll call her Susie CBT. She ended up making like a massive drug dosing error. She she calculated, drew up, and administered 2.6 mils of um, I believe it was meloxicam of an injectable NSAID in a cat, and the correct dose would have been 0.26. So she gave 10 times the appropriate dose. Now that story, by the way, the cat turned out fine. Everything was fine with Susie CBT. I mean, it was a very traumatic experience for her, certainly, but that story is really to set the stage for what we're going to be talking about today, because it's not so much the medical error itself that is the big deal here, it's what happens next that seems to make a big difference in our practices. So, Andy, with that, you've been in veterinary medicine for a long time. You've been a credential technician for a long time. Your husband's a veterinarian, you've worked around these kinds of things. I am certain that you have seen, maybe personally experienced, have friends or colleagues that have worked in environments where adverse medical events have occurred. There's been medical errors, uh, you know, a patient died under anesthesia, and everything in between. In your experience, Andy, when those kinds of things happen, not what led up to it or why did they happen, what happens next? Like in most practices, what happens when things go wrong after the thing went wrong?

SPEAKER_02 8:39

There's usually a couple different things that happen. Normally the thing that happens takes place a little bit after the event, right? Because we have to deal with whatever is happening. But it almost always involves what I call calling them into the principal's office, right? And so whomever stumbled gets told that they need to be, you know, that we need to talk. And they get called into the principal's office. And it's usually a very one-sided conversation to remind this person of the way that things need to be done, that this was a mistake that happened. Clearly, this is how and why it happened. And in the future, we need to do it differently. And this is how we need to do it differently. The good old royal we, right? Now, if it's not a principal's office type of situation, because yeah, you're right. I've seen this happen a handful of times. Some of the other things I see happen often is the clinic-wide email, right? The clinic reminder. This one used to drive me insane. There was an error, something happened. Yeah. And whomever, you know, was it was whomever was in charge, the leader of the team, the the person up top sends out the now. We just need to remember. It came to my attention that, and I just want everyone to know. And that desire to just remind everybody is um, I don't know, maybe coming from a good place, but never ever lands well. The other one I see all the time is whomever was directly involved in the thing doesn't want to talk directly to the person that maybe stumbled. So they go to that person's supervisor and they go, Hey, Andy, one of your technicians made a mistake. This was the mistake. I'm gonna need you to go and talk to her about it. So there's a lot of avoidance, right? There's a lot of one-sidedness, there's a lot of blame, there's a lot of telling people when these conversations are going to happen.

SPEAKER_00 10:48

Yeah. Okay, this is so good. Listeners, if you don't know Andy Davison personally, like, for example, if you've never been in a lecture hall watching Andy deliver a talk, but here's something that you need to know about Andy. She's very animated. Like, she doesn't just talk with her words and her voice, she talks with every part of her body. And here's the really cool thing about it. She's so good at these animations that you could literally put her on mute and still have a pretty damn good sense of how she's feeling about what she's talking about. And let me tell you, I'm gonna go out on a limb here and say that these three things that Andy is saying typically happen. She's not that excited about those responses.

SPEAKER_01 11:26

I have some thoughts.

SPEAKER_00 11:28

Uh yeah, some thoughts and opinions, probably for good reason. Andy, I appreciate you sharing that. That's actually that's that's like spot on for what we're gonna be talking about today. Here's the thing when we have these adverse events and practices, we tend to think about them and talk about them like they're patient safety problems. And that's true. They they actually are, but we stop there more often than not, and there's so much more to the story, which I think is what's underlying maybe the thoughts and opinions you have about those three common responses you see. See, when these errors happen, when these adverse events occur, they're not just patient safety problems, they're also culture events. It's because what we do after these events, our response to them, is a signal to everybody in our organization that is answering questions for them like this. Hey, is it safe to admit a mistake here? Can I say things like, I don't understand, I need help? Am I allowed to suggest improvements in our system or our procedures? Can I admit that I'm struggling with something, right? Those are all questions that people have, maybe consciously, maybe subconsciously, and how we respond to these difficult events, these adverse events, are very clear answers to those questions for the people on our team. And that's what today's paper focuses on. It's focusing on this organizational story and its impact. See, the authors of this paper, they're basically asking a really interesting question, or at least a question I think is very interesting. Can the way that veterinary teams debrief after adverse medical events, can that actually be connected to cultural outcomes, things like psychological safety, job fulfillment, engagement, and yes, folks, even burnout. Here's the spoiler alert. The answer appears to be yes, that it is connected. But there's an important bit of nuance here. See, simply saying, oh yeah, we debrief, because technically, Andy, what you're talking about, those examples, the hey, step into the principal's office, that is a form of debrief. Sending out the email, hey, this thing happened. Don't forget, that's a form of debrief, right? This research is saying that simply doing the debrief is not enough. It's how we do that debrief that really matters. And that might be the biggest lesson, I think, from this paper. Andy, should we should we dig into this?

SPEAKER_02 13:46

Oh, we absolutely need to dig into this because I've got so many thoughts and opinions.

SPEAKER_00 13:51

Yeah, I'm I'm sure this paper will validate many of those thoughts and opinions. So the paper is called gotta fill my lungs with oxygen for this one. Well-executed debriefings conducted after adverse medical events are associated with psychological safety, work engagement, job fulfillment, and reduced burnout.

SPEAKER_02 14:13

Oh, whoa, you need a minute there?

SPEAKER_00 14:15

I might need a moment after that one. Here's what's really cool about this one is um this was actually a veterinary-specific study. It uh the paper itself was authored by Lori Cogan, somebody who I'm a huge fan of, and she's in my own backyard here. She's out of Colorado State University, and Mark Rishnew from the Veterinary Information Network from VIN. The researchers, um, what they did was they surveyed just under 200 veterinarians currently working in clinical practice. And they they measured a whole bunch of stuff. I I want to share some of the important numbers that stood out from here. Okay. So one of the things they measured was have you experienced an adverse event in practice in the last year? And about 87% of these veterinarians had been involved in at least one adverse medical event during the prior year. 87%. Like that's basically everybody. And among the veterinarians who had experienced one adverse event, one or more, about 60% reported being involved in at least one event that caused serious patient harm. So these are like the really serious adverse events. The one I shared with Susie CBT, that was an adverse medical event, but it didn't result in serious harm. It could have. 60% of these uh participants said that they had experienced an adverse event that resulted in serious patient harm. So that's lesson number one. Okay. Takeaway number one here. This is not some bizarre once-in-a-career thing. Folks, if you're listening to this and you have experienced an adverse event, you are clearly not alone. It is relatively common. For many veterinary professionals, things going wrong is a very uncomfortable, but also a very real part of doing complex medical work. That's what we do. The researchers, they then asked about debriefing. Okay, so they didn't just measure how often is this happening, they also assessed what happens after. The definition here, though, is really critical. Okay. These researchers they defined a debrief as a guided discussion designed to reflect on and learn from an adverse medical event. And they looked at three general situations. Number one, debriefing after serious adverse medical events. Number two, debriefing after minor adverse medical events. And number three, just regularly scheduled things like morbidity and mortality rounds. And here's where things get really interesting. Only about half of the respondents said that their workplace often or always debriefed after serious adverse medical events at all. Okay, so 60% of these people have experienced a serious medical adverse event in the prior year, but only half of the respondents said that their workplace is actually debrief with any level of frequency after those. What about for minor adverse events? Okay, now it gets worse. Only about 27% of these practices seem to be conducting this structured debrief after a minor adverse event. And just about 13%, so not very much, one in 10, reported regularly scheduled MM rounds. Then the researchers looked at something that I think is even more important than whether the debrief happened at all. They actually measured the quality of the debrief. Some examples of the kinds of things that they assessed were things like was there respectful communication during the debrief? Did they discuss changes or takeaways? Did these debriefs encourage everyone involved to participate? Did these debriefs give space for discussing reactions and feelings? And then they measured outcomes, cultural outcomes, like team psychological safety using Dr. Edmondson's assessment tool, professional fulfillment, burnout, and work engagement. So here's the headline finding, okay? Just put it in one sentence. The quality of the debriefing experience predicted every single one of those outcomes. If they did high-quality debriefs, psychological safety seemed to be better. Professional fulfillment seemed to be more common. Burnout seemed to be lower, and work engagement seemed to be higher. Here's the part I really want to emphasize. It's not about doing it frequently, it's about doing it well. The quality matters. So this doesn't appear to be a more debriefing equals better culture kind of situation. It's more like better debriefing equals better culture. That's an important science caveat here, okay? Uh, and we should add another important science caveat, which is that this was a relatively small sample, less than 200 people. It was a cross-sectional survey and it used self-reported experiences. So this is showing associations, not causation. That's really important. We cannot say, based on just this paper, that good debriefings cause lower burnout or higher psychological safety. There could also be some chicken and egg happening here, right? Like it could just be that healthier cultures are better at doing debriefings. We don't really know yet. But this is still really interesting. And it's still something that we should focus on. Oh, one more caveat, Andy. The participants were all veterinarians. We didn't measure tax, we didn't measure CSRs, no other team members. So that's something we should keep in mind as well. However, I think we can still extrapolate some really important things here. So I want to dive into a few of those things really quick. The first one, adverse medical events seem to be more common than good conversations after the event. I really can't personally get over the gap in these numbers. That means that veterinary medicine seems to contain a lot of difficult experiences that people may simply be carrying around with them without ever fully processing through them. Andy, I'm really curious from your perspective and in your experience, why do you think veterinary hospitals just don't talk about these events in a structured debrief more often?

SPEAKER_02 19:59

It's really scary and hard to admit when you've made a mistake, especially when that mistake is a life and death mistake, right? Which is what we deal with a lot. When we do admit some of those mistakes, in comes the shame, in comes the blame, in comes, you know, that voice in your head that's going to be really judgy and critical of you and of the other people that are on your team and involved with the situation. And that's no fun. That's no fun. And sometimes it's just easier to just move on and just not talk about it because we all know that it was bad and we all don't really want that to happen again. And we're all on the same page, right? And so then we just keep going on with our day.

SPEAKER_00 20:43

Yeah, that makes sense. Here's the thing, though, not debriefing or actually doing the debriefing in an ineffective way, which like if you lack the confidence, you might be worried to do that, can actually be interpreted as a form of silence. And that silence might end up communicating unintentionally to the team that we don't talk about mistakes here. And then, and then that actually like it's almost like a self-fulfilling prophecy. Like, I should not make a mistake, something must be wrong with me. And clearly nobody's willing to address it, which proves that I should never have made the mistake and it could add to the shame, right? Or even worse, it might leave people feeling like, hey man, you mess up here. You're on your own. You're on your own how to deal with this, right? That to me doesn't sound like a very healthy culture, and I don't think that's what we're really after. And it's certainly not a culture in which learning and growth can really happen effectively. So that's one of the big lessons that I take away from this paper is like we really need to start rethinking what it means to have a healthy, like growth oriented culture. We we call it the practice of medicine for a reason because we never fully master it. We're kind of always practicing it. And and one of the ways that we get better over time is by directly addressing and learning from the areas that were, you know, falling a bit short. And debriefs can really help with that. Uh the second takeaway. Way that I pulled from this paper is a debrief can be a learning tool, right? It can also be a blame meeting wearing a false name tag. This might be the finding that really stood out most to me. Doing a debrief on its own, like just the doing it, is not actually good enough, or at least that's what this study suggests. It's the quality of the debrief that really seems to matter. In fact, the authors explicitly point out that poorly conducted debriefings can actually cause harm, whether that's the intention or not. And that's important because organizations love checking boxes. Hey, we have a wellness program, right? We have performance reviews, we hold team meetings, we do debriefings. Cool. Are they any good? Is your wellness program making a difference? Are your team meetings effective? Do your debriefings help people process things and learn and grow? Because gathering everyone in a conference room after something terrible happened does not magically create psychological safety. Unfortunately, it's not how it works. You can actually unintentionally create the opposite. Like imagine this, Andy. Okay, everybody, we're having a psychologically safe debrief. Now, Susie, walk us through why you gave Fluffy 10 times the prescribed dose. Probably not gonna be a great debriefing, right? That feels to me like a firing squad with snacks. Yeah. Andy, what do you think separates a conversation that feels like a learning conversation from one that feels more like an investigation or a critique or just straight up judgment?

SPEAKER_02 23:31

Genuine curiosity. Absolutely. Absolutely. A lot of time we're on that fact-finding mission, right? I just want to know the facts about what happened. And there's no, there's no curiosity. There's no desire to learn from the perspective of the other person. There's there's no need to really dig deeper and really understand why. And I think that's what's missing a lot of time in these types of conversations.

SPEAKER_00 23:58

Yeah, I totally agree. And the paper actually echoes that. The most commonly reported characteristics of what uh were described as positive, helpful debriefings. There were several of them, but the three that were most commonly identified were number one, respectful communication, which curiosity is like such an incredible form of respectful communication. You have something to teach me. I can learn something from you, right? That's what curiosity really is. Number two was clarifying the fact. So it's not just like fact gathering, but really understanding what's happening, how did it happen, what led to it, what might have changed it, right? And then number three was that high-quality debriefing, people identify opportunities for improvement. It's not just about what went wrong, but it's about what we can learn from this and what can we do differently next time. The least common characteristic, Andy, that it was structured at all. That the debrief was structured and organized, that there was like a process for it. So people knew what to expect and that it worked the same way every time. Only about 29% of people reported that there was structure. So maybe veterinary medicine doesn't simply have a debriefing frequency problem. Maybe what we have is a debriefing skill problem. And we're gonna offer some tools here in a little bit on how to help with that. Number three, there might be a loop here. Psychological safety might be both an ingredient and an outcome. This part for me gets really interesting from a cultural perspective. The strongest model in the study was psychological safety. Better debriefing characteristics were associated with greater psychological safety very strongly, which in my mind makes sense. But there's almost a virtuous psycho possibility here. You see, you might need some psychological safety for people to be able to say to your point earlier, hey, I made a mistake, or I didn't understand the instructions or the process, or I was scared to speak up, or our protocol just wasn't clear to me, right? Like that takes a certain amount of psychological safety to be able to say that. But every time that someone says something vulnerable like that, and the team responds with your word, Andy, curiosity instead of punishment, you're also teaching and reinforcing it is really safe to speak up here. That's proving that psychological safety exists and strengthening it. See, psychological safety is not a poster, it's not something we say in the handbook that we practice here. It's accumulated evidence. People are constantly collecting data about hey, what happens to human beings around here when they tell the truth? Right? So a debrief after something goes wrong, it gives the organization an enormous opportunity to answer that question productively in a healthy way. Okay, so this all begs the question then. How could this stuff be applied to ABC veterinary hospitals culture? Right. So let's get to renovating. But first, Andy, I want to be really clear here. I am not recommending that everybody build a hospital incident command center and appoint a vice president of debriefing, right? I think we can start much smaller. So here are some renovations that I think I would consider. Renovation number one, right off the bat, make the debrief purpose clear. So, first of all, do the debrief and then immediately make it clear. Before discussing what happened, what went wrong, tell people how this conversation is supposed to work. The paper actually highlights a very basic assumption that is often used in effective debriefing. High quality debriefs begin from the belief that the people involved are intelligent, capable, and trying to do good work. I want to repeat that. That is incredibly important. We need to adopt this mindset. If we're gonna facilitate a healthy debrief, we must go in believing that the human beings that we are debriefing with, even the ones that screwed up, are intelligent, capable, and trying their best to do good work. That changes the starting point. It shifts it from, hey, who messed this up? to hey, given that competent caring people were involved, how did we end up here? So to do that, to convey that at the beginning of a debrief, you might say something like, hey guys, listen, the purpose of this conversation is to understand what happened, to learn from it, and to decide what we can do to make the system safer next time. So we're going to be honest about errors and accountability, but this is not going to be about finding someone to blame. Right? We got to make that clear right off the bat. Those 20 seconds can dramatically change the conversation that follows. Renovation number two, I want to offer you a simple four F structure. No, this is not about screaming the F word four times loudly, as much as I sometimes want to do that. Although I'd get if that's what you felt like doing. Listen, it can be pretty cathartic. I know that from experience. No, instead, what I'm saying here is I I personally distilled the paper's recommendations into something like that teams might actually remember. It's the four F's frame, facts, factors, future. So you could think of this as like a debrief framework, right? The first one is frame. It's renovation number one. Why are we here? And how are we going to treat each other during this debrief conversation? Then facts. Okay, what actually happened? What is the actual story from everybody's uh perspective who was involved? Get everyone working from the same basic mental model before you interpret it. Not why did it happen, what happened. Then third is factors. What system or environmental factors made that possible? Right? This is where we get start to get really, really curious. Were there workload factors here? You know, with Susie, what it was is that she was the only surgery tech. It was a packed day. And the doctor she worked with was well known as the doctor that, quote, always gets out on time. Susie felt a lot of pressure under the workload. She was working too fast, right? So that's a factor. What about communication, training, workflow, equipment, staffing, unclear responsibilities, role ambiguity? All of these are factors that we need to investigate once we've identified the facts of what actually happened. Now, this part is important. This is not who is to blame. The factor section is about genuinely asking what made this outcome more likely to occur so we can learn what we need to change. And that's the last F. That's the future. What did we learn? What are we going to do differently moving forward? All it takes is one or two specific changes. Okay. We don't need to like a 17-item action list that's going to take, you know, a whole committee six months to do. So frame, facts, factors, future, the four F's. That's a debrief. Now, one thing I will add here, the authors pointed out that having a good facilitator really makes a huge difference here. And I recognize, Andy, to your point earlier, not all of us feel confident in that. I get it. There was a time I didn't feel very confident in that either. So becoming a good facilitator is important. And it turns out it's actually really not all that hard. You don't need to like take a deep, deep dive into, you know, uh debriefing facilitation skills. You don't need to go back to school and get like a master's degree in coaching psychology, right? There's some simple things we can do, and we're gonna share some of those things in the show notes. Okay. Andy, going back to the four F's, all right. Generally speaking, what do you think of the four F's, even if you're not screaming the F word four times loudly? What do you like about that? And what do you think might make that four F's even better?

SPEAKER_02 32:08

I love the structure of it, right? I love that it gives you that path to go down because these are difficult conversations. They really are. And so to have a framework that you can follow along is really helpful. You know you're gonna start with frame, then you're gonna gather the facts. You're gonna get curious about it and you're gonna gather the facts. You're gonna really think about what factors came into play and then talk about what that means for the future. My favorite one is frame because I've seen it happen so many times and I've been guilty of it too, right? You start this conversation, you just sort of jump into the conversation, and nobody really knows what to expect. Nobody really knows what's expected of them, what's gonna end up, where we're going with this conversation. And I really think that that alone will make these go better because people will know what to expect. And it won't be a big surprise. So I love, I love all of there is because of who I am as a person, one thing that I would add to a conversation that I was facilitating like this. And it's because I love positive psychology so much, right? I would add in a fifth F somewhere in there, and I think my fifth F would be flip because yeah, something happened that wasn't awesome. And I bet you in there somewhere there was a strength used that something happened that made it go well. It may not have, you know, it may not have gone the best, it may not have produced a really fantastic outcome, but there was something in there worth recognizing that made that situation go well. And I think it's worth pointing that out because then you can reframe a little bit and take that moving forward. You know, yes, Susie drew up the incorrect medication and we we had a we had a really big near miss, but you know what? She felt confident enough to come and tell you about it. And that's a win. Yeah. And so to me, that's a win, that's a strength, that's a thing that we can do again in the future.

SPEAKER_01 34:20

Yeah.

SPEAKER_02 34:20

Because we know we're gonna have these things happen again in the future. So remembering to look deliberately for the strengths that inevitably show up in the middle of chaos can be a really nice way to flip.

SPEAKER_00 34:32

That's awesome. I loved, I love adding the flip to that. Uh, so now we have the five Fs, which um, in my version of Fs uh feels even more cathartic. Thank you for that.

SPEAKER_01 34:43

The more Fs, the better.

SPEAKER_00 34:45

The more Fs, the better. I agree. Let's see if we can get this to 15 Fs. I'm kidding. Right. That would be excessive. All right. Last culture renovation here that I took from this paper is that anyone can become a culture carrier after something goes wrong. We don't have to wait for like the master debrief facilitator in the hospital. We don't have to wait for the medical director or hospital owner or regional uh operations manager to come to the practice and lead a debrief. We can all do it. You don't need to be the person in charge to influence what happens next. Anyone on the floor can ask, hey, Andy, would it help us to talk through what just happened? You know, a technician can say to a doctor, hey, can I share something I noticed about the workflow earlier today? Right? A CSR can say, hey, there's a piece of the client communication that might be really important here, and I want to share it. Someone can notice a coworker struggling after a difficult experience and say, hey, wow, that was rough. How are you doing? Can we talk through it? Right. And perhaps most importantly, everyone can resist the gravitational pull toward gossip and blame. Culture isn't just whatever the practice owner does, culture is the thousands of small messages that people send one another about things like, hey, what do we do around here when things go wrong, when stuff gets hard? One caveat again, this particular study only surveyed veterinarians. So the evidence doesn't tell us directly how these relationships operate for every veterinary role. But come on, culture certainly doesn't stop at the DVM credential. If we're going to renovate veterinary workplaces, the entire team needs ways to learn together when something goes sideways.

SPEAKER_02 36:24

This just means that somebody hasn't researched this in technicians and CSRs and veterinary assistants yet.

SPEAKER_00 36:31

Yet. Exactly. Well said, Andy. Andy, in closing here, this paper has really helped me personally refine my thinking in a way that I kind of wish that I had years ago. There was a time that I thought that my job as like the hospital owner or the practice manager was to create a mistake and bad outcome-free hospital. That I was supposed to make it so that the system, the training, the people were perfect. But that's like a utopian goal. It's unreasonable. It's not possible. Of course, we're all going to do things that we can to minimize harm, but the truth is that it's called the practice of medicine for a reason. It's complex work that we do. It's sometimes very messy. There's so many factors and variables involved. It's very unpredictable and it's highly interdependent. Mistakes will happen. Bad outcomes will happen. Period. One way to prepare for that is to prepare to do good quality debriefs when those inevitabilities occur. Because those things, they don't define the culture as much as what we do right after. Right? When something goes sideways, can people tell me the truth? Can they ask difficult questions? Can they acknowledge how it affected them? Can we examine the systems in which we work together openly and curiously? And can we learn how to do better together next time? This paper, it really suggests that a debrief shouldn't be an autopsy of the person who messed up. A debrief should help the entire system improve. And doing that well, that might actually be connected not only to better, safer patient care moving forward, but it might be connected to the human beings in the system, helping them feel safer, more fulfilled, more energized, and less burned out in the very difficult but meaningful work that they do. And that that for me is culture renovation worth making. Now, speaking of culture worth celebrating, I think you might have a um cultural icon to share a story about.

SPEAKER_02 38:47

So this week's Florida Man headline is Florida man caught feeding wild alligator resists arrest, saying, quote, he's a good boy and he loves bagels.

SPEAKER_00 39:01

Oh my God. Was he a New York alligator?

SPEAKER_02 39:04

I I mean South Florida, so it's very possible. So apparently, this particular Florida man was caught feeding alligators, which is illegal in Florida, and he was given a citation, you know, don't do that. And he resisted. He argued so much that he was arrested for resisting arrest. And he just kept saying that his 10-foot-long alligator that he apparently named Hank was just a good boy, and he loves bagels, and he just wanted to feed him the bagels because he was a good friend.

SPEAKER_00 39:36

Now, the most important question here is what kind of schmear does an alligator want on their bagel?

SPEAKER_02 39:44

Right?

SPEAKER_00 39:45

I'm gonna guess, I'm just taking a guess here. Salmon and cream cheese schmear.

SPEAKER_02 39:50

That's a that's a pretty good one. And I would put that on an everything bagel. Um if I was gonna feed it to my alligator friend.

SPEAKER_00 39:57

100%. I cannot wait to see the pictures, hopefully, in this article.

SPEAKER_02 40:02

Never disappoints.

SPEAKER_00 40:03

No, Florida, Florida Man is deliberate efforts. Yeah, like I said, cultural icon. There is no debrief needed after that one. Listeners, thank you so much for joining us for this episode. Hey, if you liked it, hopefully you did, or you found it helpful, let us know. Leave us a review. Like, we we want to see like what's what's helping here. What do we need to do more of? What do we need to change up for you? We want to benefit you. Thank you all for being here. Chat at you later, friends. Take care, be well.

SPEAKER_02 40:31

Bye. Thanks for hanging out with us in the Veterinary Culture Lab, powered by the science of workplace well-being, and brought to you by Flourish Veterinary Consulting. If today's episode sparked an idea, made you smile, or got you thinking, hey, I should totally try that. Let us know. What do you think? Be sure to subscribe, share, and remember a thriving veterinary culture is possible. And you don't have to build it.