The team exits the exam room shaking their heads. The client waited months to bring the pet to the clinic. The team agrees that the pet didn't need to suffer with this condition for such a long time because treatment is readily available, and they question why anyone would wait to bring in the pet. What is the client's excuse for the delay? They were afraid of the potential diagnosis and what they might have to do about it. This is a classic example of the fear of finding out (FOFO).

Down the hall, the practice manager prints the reports from the practice information management system (PIMS) and accounting software and hands them off to the practice owner, who promptly places them in the bin on the desk. Last month's reports looked "off," and the owner wants to wait for more time to review the statements. Based on the stack of reports in the bin, this was the same decision for the last few months. This is a classic example of "out of sight, out of mind." Or is there something else going on here?

Unfortunately, FOFO is not limited to medical fears. FOFO is also very real when it comes to business management. FOFO is a psychological barrier that stops a person from learning more about a potential problem because they are afraid of what they will discover.¹ Just as the client was afraid of the potential diagnosis, the practice owner (and manager) was afraid of the potential problems they would find in the reports. Just what are they afraid of? Isn't part of managing a business the responsibility to dig into the numbers and identify problems? Yes, but fear can be a huge factor in not taking action.

Perhaps the owner and manager know there are problems with data entry, and the reports are a mess of miscategorized services and inventory items. They fear they don't have the time or resources to deal with it, and as soon as one problem is fixed, they fear a whole host of new ones will come to light. Or they may understand what needs correcting but need to know how to do it without causing other problems with the accounting software.

In addition to worrying about not having the time or resources to deal with an issue, other reasons for a person's FOFO include the fear of challenging the status quo, revealing personal failures, appearing weak or not in control, even being pressured to make changes. Are you reading this rolling your eyes, and discounting the power of FOFO? Consider a few more examples that may be occurring in your veterinary practice right now.

The doctor tells the lead tech that the new hire is not "working out" in surgery. Instead of dealing with the root cause of the performance issue (FOFO), the lead tech avoids scheduling the new hire in surgery. Why? It may be the fear of revealing a failure of their ability to hire appropriately or train thoroughly or fear of raising the truth about the doctor's role in the performance issue.

The inventory manager discovers that the controlled drugs inventory doesn’t match what’s in the logs. Instead of bringing this to the owner’s attention immediately, he decides to wait until the end of the month, “just in case” he made a mistake in his count. When the count is still off at month’s end, he hesitates to report the problem, fearing the business will get in trouble. Months later, a doctor is discovered stealing drugs.

In another example, the practice is experiencing turnover and having trouble hiring for open positions. The manager has read about conducting stay and exit interviews, but FOFO prevents doing either interview. Why? Those interviews may reveal that people are leaving a bad manager, the manager lacks the authority to change what is causing the staffing problem, or she needs the help of a consultant or accountant to tackle the root cause.

While you may think FOFO is a personal issue, it can result from the hospital culture. According to Harvard Business School professor Michael Beer, FOFO persists inside organizations because of the following:²

● Unclear communication about strategy and values

● Conflicting priorities

● Leadership behavior

● Ineffective or inadequate leadership team

● Low capacity for honest conversations (i.e., address the elephant in the room)

Sometimes, the culture teaches the attitude, "if it ain't broke, don't fix it," or "ignorance is bliss." Maybe the culture is one where they "shoot the messenger." Any of these will fuel the FOFO syndrome. So, what can a person (or the entire hospital) do about FOFO?

The first step is to create a culture that encourages feedback and promotes the idea that knowledge is power. Encourage the team to present ideas, troubleshoot, and brainstorm. Two easy methods to accomplish this are daily huddles and debriefing sessions.

Daily huddles, especially before office hours, allow the team to identify potential snags and develop a clear strategy together. No fear here; merely an open discussion of where the group sees a potential to run behind schedule or need more time to deal with a particular case. The team has an action plan because they looked for problem spots in the appointment book.

Debriefing sessions help the team identify ineffective protocols, standard operating procedures, or training on a procedure, especially after a situation involving poor client service or patient care. It must be safe for team members to bring up issues and problem-solve. Identifying what caused a problem this time helps the team prevent it from happening again.

Another critical element to reducing FOFO tendencies is appropriate leadership and management development. Promoting a nurse or CSR to a management position without providing training in the leadership skills needed for the role is far too common. In addition, too many are promoted without the authority to take action when needed. Add to that a lack of open and honest communication, resulting in inertia within the leadership team whenever there is a problem. Prepare the leadership to ask the right questions, find out the information and address the issue without fear of repercussion.

Finally, seek professional assistance. Using the services of a business consultant, accountant, or attorney is not a sign of weakness, nor should the results of those services be feared. While these professionals may shed light on inconvenient truths, the benefit of correcting costly problems in the practice far outweigh the FOFO what the experts identify and help you to fix.

FOFO is alive and thriving in many veterinary practices - in how clients recognize the need to seek veterinary care for pets and how practice owners and team members handle job responsibilities. Ensure patient care and business performance are not adversely affected by FOFO.

References

¹  What is FOFO and How Do You Fight It? Justine Bariso. Inc.com https://www.inc.com/justin-bariso/what-is-fofo-fear-of-finding-out-emotional-intelligence.html

²  Does your Company Suffer from the Fear of Finding Out? SWAE blog. Available at https://swae.io/blog/employee-engagement-voice/does-your-company-suffer-from-the-fear-of-finding-out-fofo/