Hello, it's Anthony Chadwick from the webinar et welcoming you to another episode of Vet Chat, the UK's number one veterinary podcast, and I'm super honoured to have Garth Jordan on the line today. Garth is the CEO of AHA, the American Animal Hospitals Association. It brings back a bit of nostalgia to me because I can remember reading a lot of Jaha articles when I was doing my dermatology certificate, particularly Danny Scott's wonderful monologues on feline dermatology in the mid-seventies.
So Garth, great honour to have you on. Thanks so much for agreeing to come on and and have a chat with me. Oh, thanks for inviting me, Anthony.
I appreciate it and I'm looking forward to our chat today. Yeah, I mean, obviously God, just for people listening in, tell us a little bit about your background. How have you found yourself in this, world of veterinary, which, we, we sometimes think is, is a bit eccentric and, so on, but it's so good to get people coming in from the outside.
Sure, I, the 1st 3rd of my career was actually spent as, more in. My bachelor's, which is biochemistry and environmental chemistry, but this, the second, the, the, the remaining 2/3 of my career so far have been in professional and trade associations, both US focused as well as international. And so I've worked for a variety, mostly in human health care, OR nurses, medical group management, and healthcare finance and, again, in the US and also internationally.
Working to run, associations, professional and trade associations. So most people don't really think of working in an association as a career. A lot of us think about volunteering for our associations as part of our profession.
But there are groups of folks like me that run associations. I've been doing it for a little over 20 years now. And, given that I was working in human health and running associations when the Aha CEO role came up, I was able to apply and have a great conversation with the board of DVMs about what it might mean for AHA to have its first CEO that was not a DVM.
It was more of a professional association. Executive. And we had great conversations about it and.
Here I am, thanks to the board. Fantastic. And I think it's so important, we, you know, we talk about it a lot.
As a profession, we can be quite conservative, you know, we look inwards sometimes more than outwards. And so actually bringing people in from the outside, I think is is a way that we can grow and develop because if we only look at what's happening in our own industry, we can miss lots of opportunities. My, my thing with Webinar vet was basically because I went to an internet conference, saw somebody talking about webinars.
And brought that back into the profession 14 years ago when nobody knew what a webinar was, so it's so good that we look outwards and and bring skilled people like yourself into the profession. You know, I, I agree with you, navel gazing has its benefits. But also it has, has its challenges because we do get too focused on our own worlds and actually think that we are maybe, so different than the rest of the world when we can actually learn not only from the differences, but the similarities that we find between whether it's animal health and human health, or animal health and technology.
They're all different kinds of industries that are facing similar challenges. Like the one we'll be talking about today, retention, nutrition, staffing, culture, etc. But, I think it's been a, it's great to bring a unique perspective into the world.
I would say it's also got some challenges. I had a lot to have a lot to learn still. I've been in this role for 3.5 years.
I still have a lot to learn about veterinarians, the veterinary team, the culture. And as you pointed out, some of the uniqueness, which obviously exists, but also, you know, where that uniqueness is a strength and where maybe it can, get in the way or create a challenge for positive change. Garth, obviously we know about the Journal, I think most vets internationally would know about Jaha as a journal, but what, what's the sort of association standing for?
How does it differentiate itself in, in the American milieu? That's a good question. So when I started with Aha, 3.5 years ago, we.
Didn't really have a strategic plan per se. We had a mission, vision, kind of the traditional, you know, several 100 word description about who we are and what we were about. And we went through a process.
Some people call it design thinking, human-centered design, interviewing and observing well over 100 of our members to try to understand deeply what they really needed from their association. -huh, and What we landed on was 8 words that really guides our work every day. And those 8 words are simplify the journey toward excellence for veterinary practises.
The key in that is you don't hear the words member only. It's really, excellence is kind of defined by each of us in our own way. There's no one defining that for us.
It's a journey. There's not, it's not a destination, and the word simplify that we start that sentence with. It's important in today's world with the amount of time that we have, which feels like it's less and less every day.
And, it's important to simplify what we're doing every day, when we're trying to, when we're striving to serve our clients and serve our patients. So simple is not always easy, but, we're doing our best to, to support people in their journey toward excellence by simplifying. The way they bring content in, use it, and apply it in practise.
We can, I think, often not deliberately, but complicate things, and I think simplification is always a good idea, isn't it? Yes, the, I'm a huge fan of the concept of simplification. I've actually studied it for a while.
I know that sounds a little, maybe sound a little odd to people out in the audience. but, the, the concept of simple is very, very challenging, and the, the, the thing that strikes me about the concept of simplification is if you start with simple, you build a foundation that upon which you can build much more complex systems that are much more stable. If you start with complexity, your foundation is a little bit more shaky and, a little, a little bit easier to, you know, find cracks or, or create challenges.
Simplicity really creates a very stable foundation. No, it's a really good point. I, I talk a lot about it with my own team and.
You know, if we're gonna try and sometimes it looks clever to make it more complicated, you know, and certainly tech people sometimes will do that, but actually if you make it so complicated that people can't navigate your site. Then of course you, you kind of lose the whole point of why you're trying to do it. So, yeah, no, I think simplification is really important.
And then obviously one of the beauties of being a vet, I think, is the curriculum is so wide, you know, we qualify as vets and then really we can go off and to so many different pathways. We set our own curriculum once we qualify, which. It's, it's not as formal as as the medical profession, and I think that's a, there's a joy in that, in that we have that ability to maybe be a bit more holistic and not have to specialise so much that we've, you know, missed the wood for the trees.
That's something that was new to me coming from human medicine, Anthony. I think that's a, it's a very, I'm sure for a lot of DVMs in the world, it feels very natural, but outside, that's something that is truly unique, I think, to, to this particular ecosystem. It doesn't happen as easily in human medicine.
To be able to be that, that, that general practitioner that can actually go out and explore all these different realms of what would in human medicine now be really confined specialties. Yeah. No, it's, it's really interesting and I suppose it brings us on to the, the white paper that you've you're about to publish, which we've chatted about, you know, before and on LinkedIn.
You know, from my view as a veterinarian, we have one of the best jobs in the world, you know, I've had a very satisfying career, obviously challenging at times. And yet we do have this attrition issue. And I know this work came about because almost when you came into Aha yourself there was some issues with that that you wanted to sort out, but then you came across the McKinsey report, so perhaps tell us a bit more around that background, please.
Sure, I, you know, I'm, I'm, I'm a big sharer. Sometimes I share stories that are a little, may, may seem that they're more private than, you know, or they should be more private than I make them, but when I started with Aha, we were really challenged. We We are in some regard a reflection of our own ecosystem.
We are not a a practise, you know, we, we, we don't treat animals in our practise, but we obviously work with practises every day. Our staff is comprised of many credentialed veterinary technicians, DVMs, you know, and, and other folks that have worked in veterinary medicine, particularly in small animal practise. When I joined Aha, we were experiencing about 30% attrition of our staff every year.
Year over year. And when I joined, I, I didn't know that until after I joined, so I can thank the board for for keeping that fact under wraps. but what I noticed about that attrition issue was it, it was very, very difficult.
To create any kind of sta stability and and or stable culture, which and and trust within and among the staff, which to me, trust and culture are are are very hand in hand, but a stable trust and a stable culture is really key to at least one key item for for retention. So we, we dug in a little bit and tried to understand prior to our study, prior to our study, we tried to understand what was happening. And we found out that we were underpaying some people, so we rectified that.
We found out that there were some trust issues, so we very purposefully started to work on that. we found out that there were some career development challenges. We weren't really giving people the opportunity to spread their wings.
So we worked on that, and, and there's a longer story to it, but the, the short version. We gave about half of our staff the opportunity to redesign their roles, their department. they took it upon themselves to design and build, if you will, their, their core aspect of our organisation, which is, is the process of accreditation.
And as they started to build that and take ownership of it, and realised that the leadership at Aha was confident in them, and, and cared about them, to give them that, that, if you will, responsibility and the authority over that responsibility. We went from 30% to less than 3% attrition, over the last now about 18 months. That's a big deal.
And, and while we're not a small animal practise, I think we're a fairly direct reflection of, of what was happening out in and what continues to be happening out in the world of those who we serve. It's always good to have a few surprises when you go into a new job, because otherwise it wouldn't be much of a challenge, would it? God, that is very, very true, yeah.
That's a great way to look at it. But that's amazing and just listening to you, taking that attrition from, you know, 30 down to single figures. One of the things that came across there was, you know, don't micromanage people, give them autonomy and give them the ability that they're probably better at their job than you would be.
And I think he's then showing real appreciation to them and I know that kind of leads into the, The report, which I think is is a beautiful, sort of title for it, Stay please, the white paper. But perhaps just before you go into that, obviously the great attrition, was this, did the great attrition paper from McKinsey come after you'd sorted your own problems out in our heart, or was this something that you were reading about and obviously getting excited about and using in your, in, in the, in your own association? Yeah, that's a good question.
I think we were well on our way towards solving our challenge, our our particular challenge. And I became aware of the the great attrition paper, folks want to look, look it up. It was published in July of 2022 by McKinsey.
I came across that just a couple months after it was published. So this is now just over 2 years ago. And luckily, when I read the paper, it it.
It corroborated, if you will, some of the work that we were doing internally. And I realised there were a couple of charts in that paper. That, if people look at that and then look at our white paper staples, they will notice that we were inspired by the McKinsey research.
And essentially what we did was we took a handful of that research, and we reverse engineered it to develop our own research, that, that basically took the brilliance and the simplicity of the McKinsey output. And reverse engineered it so we could create the same output, perspective, and understanding of our ecosystem, and the differences that we may have when it comes to the factors that create retention or, you know, avoid attrition. Depending on how you want to look at it, in veterinary practises.
So it was, it was a great inspiring piece of research, and I hope ours is the same for folks. And I've obviously had a sneak peek at a couple of bits of it, but I think the charts, as you say, are very simple. They ask very simple questions.
And they may sound similar, but actually there is a subtle difference between them and being able to bring that evidence base in, you know, the results are not surprising in a sense, but it actually is great to bring that scientific, vigour to them that perhaps before we've said, well, obviously if you want people to stay, it's good not to shout at them every day. Right, for example. Yeah, it's, it's interesting, Anthony, because we're today, I realised the podcast will air later, but today we're just starting to dribble some of these results out with folks like, like in our conversation that you and I had, and the reaction is the same.
people love the research and they say, well, intuitively, it all makes sense. But you put, what the research does is it puts not only some numbers to it, but some order to it. So I'll just reveal a kind of a, an insight from this research, and that is there are We studied about 15 factors that that to try to understand what causes good retention, what makes people, what makes a practise sticky.
And or what causes attrition, what forces people to want to leave. Yeah. And the interesting thing among the 15 factors, things like, do I have career development opportunities?
Do I have a flex flexible job, right? I, can I work the right kinds of shifts or whatever, you know, am I paid? Well, of course, compensation is a factor.
One of 15 factors is not the only one. So we study these 15 factors, and what we, what we find is there are really out of the 15, there's about 7 or 8 that are ultimately the most important factors that are common across every role in a veterinary practise. So, the veterinary technician, the assistant, the DVM associate, the medical director, the hospital administrator, the even the practise owner.
Everyone places these 678 factors. Up at the top, what, right? But when they, when you ask them if they're staying in the practise where they want to stay.
They, they will tell us. That certain factors are more important to create practise stickiness or loyalty to the practise, whereas other factors are more important, they create attrition. They make me want to leave.
So, I, and I can get into some of those specifics, but but what happens when you learn that by not only across the practise, but by a role, you can start to and what we've done in the white paper is we've started to prioritise what factors to look at first, for example, if your practise is experiencing high high attrition, high turnover. Well, do these 3, look at these 3 things first. And if you're, if you're on in the, you know, 10 to 20% attrition rate, that's better than average.
Maybe you don't need to do those three things first, maybe you do the next 3 things. And so we're, we're able to get more of a pathway, as opposed to people looking at 78, or even 15 factors trying to figure out where to start. And I think it's interesting if a practise, you know, has medium attrition, probably if the leaders and maybe, you know, the people who are working in the, in the business as well, if they can get around and actually chat, they can obviously say, well, actually, You know, we feel valued, we feel appreciated.
Pay is fair, so we're doing those things well now what's the next level? What's the next stage to do? And as you say, sir, I'm, I'm sure some businesses won't have those very obvious values and and a really set culture.
So sometimes it's also going back to basics and saying, well, what sort of practise do we want to create, you know, are we kind to each other? Are we appreciative of each other, etc. The values and the culture.
Well, the culture always happens whether you want it to or not, and it's whether you as the leader of the practise set, you know, a good example of a culture that is fun, you know, it's exciting to work in that place. It, it's, or, or otherwise if you don't want to set it, somebody else sets it in the business, it might be if you're negative or it could be one or two negative people if allowed to stay in the business can very quickly corrupt and make it toxic, can't they? Yes, I, I'm a big believer in the, I don't know where it came from, and I wish I was the one that said it first, but I wasn't.
I'm a big believer in the phrase that the culture you create is the culture you tolerate. Yeah. and, cause it's going to happen with or without you.
And I, I do believe that culture is a design. We can design it. It, it's, it's not like designing a product or a service.
But it's a design with, with purpose, with attitude, with conversation, and especially with how you treat people, as you pointed out. And, and the research that we, that we conducted, for practises that are experiencing high turnover, you use the word value, in there, Anthony, I want to poke at that and focus on it. For those That, in, in this kind of stepwise process in our, in the white paper that we have, we, we say for practises that are experiencing high turnover, kind of stop the bleeding, right?
Think about it almost like a patient, right? got to stop the bleeding. We look at really the top four factors are fair, to stop the bleeding, our fair wages, showing appreciation for work, offering people decent career development opportunities.
And demonstrating caring leadership. Those are the four factors. And if you look at them together thematically, what they really are about is demonstrating that you value the human beings who are working in your practise.
You value them financially, you value them emotionally, you value them for the work that they contribute. It's really about demonstrating, you know, that you appreciate the value that they bring to the table every day. And, And so I, I, I appreciate that you use that word.
That is a key thematic word in that first, if you will, the first big step if you have to stop. The second one, which I'll just throw out there for fun, is if, if you're looking, if you, if you don't have 25-30% attrition, if you're maybe 15 to 20, maybe you aren't necessarily, if you will, bleeding like other practises are. Maybe you want to create a more sticky practise.
That's really about helping people feel like they belong. There's a little bit more value there, but how do I belong? You know, I've, I've got a place that, that's flexible to my needs.
You know, flexible workspace. Maybe some of my well-being is supported, but the most important factor in there is that I feel like I'm part of the team. The teamwork came right top of the list, didn't they?
Absolutely to the top of the list in creating a sticky, sticky practise, attrition, compensation kind of rises to the top of the list when people are thinking about leaving. Compensation is, is foremost in their minds, as well as career development, those things where it's demonstrating personal value. But when people are saying I'm staying this practise, I love it.
It's very sticky to me. The thing that rises to the top, why I'm staying is not because of compensation or career development opportunities, it's because I'm part of a team. Also in that category we had meaningful work and good quality medicine as well, so obviously people want to work in a practise that is seen as a high quality place to work in as well.
Right. So that would be step 3. So step 1 is stop the bleeding.
Step 2, so to speak, is, is find room for improvement to improve stickiness. And, that includes the, again, the making sure you have a high functioning team and etc. But, the third step is really about turning your practise team into champions.
And the way you do that, especially with your kind of your core clinical team. veterinary technicians and associate DVMs share these, factors and these values around these factors of meaningful work and practising modern medicine. We're not dictating what modern medicine is.
It can be about process, it can be about technology, it can be about a variety of things. But the, the DVMs and the technicians who, who say, I love my practise, I'm staying, and I'm a champion for my practise, meaning they'll be your best recruiters. They will be the ones who, who set the tone in your culture that, on top of and, and right, right alongside of working on a functional team, they, they say that practising modern medicine and finding meaning in their work.
Makes them, it's kind of like I'll never leave, and I will bring the best people to us. And I imagine that if you have all those champions working for you, right? Absolutely, and I'm gonna do a little plug for education at that point because I remember seeing a paper at BSAVA Congress, a, a poster, and it was very much a positive stress that was seen as that they were receiving good quality training and education and continuing education, post qualification as well, so if you.
Train more and if you give the budgets and if you show that that's important in your business, then vets will become better, nurses will become better, technicians will become better, and they're more likely to continue to love the job because when they walk into the consulting room, they, they feel they've got a better chance of solving that person's problem than if they were untrained. I, I, I'm really, really happy you brought that up because. There's, that's a solution, right?
The idea of making sure that everyone on your team has an opportunity for ongoing professional development. In the first place, when we look at the data by role, every role appreciates the opportunity for career development. They may appreciate it with a different priority and intensity, but every single role appreciates it.
And when you think about the idea of career development opportunities, it supports a couple of different factors in a couple of different ways. It supports the career development factor that's important. To try to eliminate the the the things that that cause attrition.
Right? You just, it's clear because it's, this is career development, we support it, etc. But it also supports that latter factor practising modern medicine.
We're all getting the latest education. We're working together while, while we may or may not have the latest equipment, we're actually learning techniques, we're learning, it's right. So one solution like education can support two different factors.
That are part of the journey of improving retention and eliminating attrition. One of the charts I really liked was. You know, I'm planning to leave, please Value me and.
That was against all of the roles that you might see in a hospital, and I think it's one of the big strengths I would suggest that our heart that you've got that breadth of everybody within the practise is represented within. Ah ha, and that helps, I'm sure to create. Better teamwork because, you know, from this survey you've got the, obviously the medical director, but also the hospital administrator, practise manager.
DBM non-owner, technician, tech assistant, CSR. It's, it's a great way of, you know, if you only look at the practise in terms of what the vet thinks or what the nurse thinks. You're missing a trick, aren't you?
Yes, so the. At Aha, our, our members are the practises themselves, so they're organisational members. So we have, as members then as individual members, anyone on the practise team can get access to the, the content, our, our guidelines, etc.
That we have to offer. And so in that, we basically feel like we represent the entire veterinary team, not just one role. Which that's not a criticism of, of associations that are about, you know, a slice of the profession.
We feel like we represent the team holistically. So this research was conducted with the entire team in mind. We have almost 15,000 respondents across all of the roles, statistically significant responses from every role.
So, the good news about this research is, when we published this white paper, the charts in the white paper we're hoping to be interactive so you can actually look at, you know, responses based on are people staying or leaving, different factors that make them want to stay and leave and interact with this white paper, right? But the good news about it is you can look at The this research from the perspective of retaining the entire team with just like a handful of larger initiatives, or you can say, hey, if my practise is really challenged with retaining credential technicians and DVM associates, I can focus on the factors that are most important to them, which, like I said earlier, the top 7 factors, 8 factors are really common across every role. But when you look at people who are saying, I'm staying or I'm leaving, those factors by a role might change in priority and intensity.
So it's good to know, both by role as well as holistically, what's going to draw people in, what's not going to push them away, what's going to make your practise sticky. Just maybe one final point to finish, because I think it's something that I, I think quite a lot about just recently, and it's that whole idea, and I, you've mentioned it in the report, flexibility. You know, are we still wanting to hold on to a very .
Inflexible way of working, you know, you have to work 9 to 5 or 9 to 7 or whatever the hours are, you know, 40 hours a week, we don't want part-time workers in. Maybe that, you know, one of the things I hear when talking to my members is, gosh, it's really difficult to do training at the moment because it's a 5 vet practise and there are only 3 vets in the practise. So that is, you know, a challenge, and you can look at that and say, well, we need to find two vets, or you can look at that and say actually what we need to do is think of new ways of working, of promoting our nurses more, of using technology, etc.
To, to make things, to make things easier. The, that's, that's a really interesting example that you bring up. The .
Job flexibility. We try in our white paper to give people some ideas to think about if they are challenged with any one or multiple factors, right? So, for example, A simple one, it sounds simple, is compensation, right?
You can go out and do a compensation study and figure out if you're paying people what they're really worth, what, what they feel like they're valued, right? Or at least try to close the gap, to some extent. But to do that also requires that you are with the people that you employ, are operating, if you will, at the top of their skill set.
So, oftentimes, at least in the US we're not using veterinary technicians at the top of their skill set. If we do, it actually frees up a significant amount of DVM time. Where then they're, they're able to work on perhaps more fulfilling tasks themselves or work themselves.
And maybe even work that is drives more revenue. So you can afford to pay your technicians more. There's, these are, these are actors that interact with each other.
Yeah, definitely. I do have one more thing to say about flexibility as an example. Compensation, well, going back to compensation, if you do a compensation study, that's usually driven by the owner or, you know, someone in that kind of C-suite type of level.
But something like flexibility, you know, depending on the goals of the practise. Maybe you want to be open 6 days a week, 10 hours a day, you know, just for whatever, just as an example. It would be easy to assign the hospital administrator, the scheduling, and just say go schedule it.
What's, what's more challenging, but I think a better route to go is to bring the staff together in some kind of meeting and say, we're going to co-create our schedule. We have a goal of being open 6 days a week, 10 hours a day, right? But if we co-create our schedule, and we all have ownership in what that schedule looks like and we try to accommodate.
The needs of our staff to the best of our ability. Now we all own the schedule together. We understand where we do and where we don't have flexibility as a team and also individually.
And you have people more invested in in the schedule itself and also more understanding of it. And maybe you try that out for a few months, and then maybe you try to redesign the schedule in another co-creation effort together. But bringing people in with intention.
And with that idea of co-creation can also help solve and work on some of these factors. And I think flexibility is an example of one of those factors where we can do that together as a team, and then guess what, that supports our teamwork, our teamwork effort. But people feel that you're listening to them rather than there's a command comes from up above which says you are now going to work these hours and of course, If there's no discussion on that, people don't feel valued and eventually they leave that practise, particularly those hours that they've been doled out, do not meet with their lifestyle.
Exactly, exactly. Yeah. No, this has been really good.
I think it's it's great to get this evidence base to it, because as you've said, people feel it's intuitive. But actually to look at it in a very scientific way and say, look, here are the things that you really probably need to look at as a business that's. You know, got attrition at 30% as opposed to 15%.
There's different things that you can look at. I think this is a really interesting and useful tool, and I hope it's going to be well used by the profession and, and thank you so much for making this research available to your cousins across the pond as well. Well, it'll, it will be, anyone worldwide can download it.
We, you know, of course, we did this study focused in North America. I believe it's got applicability across the pond and across many other ponds, right across all of the ponds. we deeply believe that, unfortunately, in the US we're experiencing about an average of 30% attrition.
And, and more than 30% of the, the veterinary team at any one point in time is thinking about leaving their current practise. And a large chunk of that is thinking about leaving veterinary medicine altogether. So plugging that hole is important, and we believe if we approach this holistically.
not just at the individual practise level, but as an ecosystem, if we approach this holistically, we think we can get to 90% retention, which is really a, a bellwether mark when you see the best ecosystems, the best industries, the best companies, they're at 90% retention or better. There's no reason we can't get there together. There's really no reason.
And what happens then of course, is that the practises that take this on board are at 90% attrition, retention, and the other ones who decide not to look at it in some ways. You know, none of us deserve to work in a toxic environment, in an environment that's just not working for whatever reason. Having that ability to stay within the profession and move to a a new practise rather than say.
The veterinary profession is not for me and leave it, which I think is happening, is, is a great gift if if we can make that come to fruition, so, . Garth, I know it's not only your work, thank you to everybody who's been involved in it. And I'm looking forward to reading it in a bit more detail when it's revealed.
And perhaps we can share some more conversations when we meet up at, God willing, BMX, in 3 or 4 weeks' time. Well, hopefully we share conversations and not our kennel cough. Yeah.
Yeah. I'm, I'm sure it will be gone by then until we get another one. Right, exactly.
Thank you so much for your time. I know how busy you are, and I really appreciate that you've been able to come on and and share some of this wisdom with the listeners at that chat. So thank you so much.
My pleasure, thank you so much and I hope, hope, hope we, we can do this again. Thanks, Scott. Thanks everyone for listening.
This has been Vet Chat, the UK's number one veterinary podcast. Looking forward to seeing you on a podcast, a webinar, or who knows, even face to face sometime very soon. Take care, bye.
