Coronavirus has brought swift, sudden change, and a new normal now prevails. Alan Robinson explains why businesses that hope to survive the present and thrive in the future must understand what these changes mean, and how to respond…
WE ARE ALL using a lot of new adjectives these days – like exponential, unprecedented and exceptional – and a level of hyperbole – such as pandemic, plague and apocalypse – not normally experienced in our daily veterinary lives, and fuelled by the mono-news of the press and social media.
Unfortunately, every day the news gets bleaker. By the time this article goes to press, the coronavirus crisis will be deepening, and the full economic effect will be starting to become clear. The latest headlines make for very grim reading. Nearly a fifth of small and medium-sized businesses are unlikely to get the cash they need to survive the next four weeks, in spite of Government support. What that means for veterinary practices, no one knows.
Additionally, mental health will increasingly become an issue. In China, the evidence suggests week four of the lockdown was unbearable for large numbers of employees. As you read this, events may seem increasingly bleak as many go through the stages one would normally associate with grief (Figure 1).
Interestingly, at the time of writing, this crisis was polarising businesses. I have spoken to practice owners whose revenues had dropped off a cliff and others who were busier than they’d ever been.
Regardless of the situation in your business, what’s needed now is a firm grip, nerves of steel and deep reserves of energy to get through the dip. As the boss, team member or family provider, your role is now to maintain energy and momentum. And it’s going to be exhausting, relentless and thankless work.
So, how do we all get through this? I have no idea. However, based on my experience, here are some things I am going to be focusing on.
Rethinking change
As many of you have experienced, implementing change in your business in “normal” BC (before coronavirus) times is immensely difficult; fraught with inertia, conflict, frustration and little progress.
Reams has been written on change management, with appropriate curves, graphs and tactics to seduce your team into altering behaviour at least, if not attitude.
Strangely, since this crisis began, nearly all the strategic, systemic and people initiatives to improve productivity and harmony that I have advocated to my clients, for as long as I can remember, have magically happened. This includes streamlining processes, pricing, products and services, as well as team communication and client interaction –even the holy grail of remote video consultations (at full price…).
What’s changed?
The size and direction of change has changed.
Normally, change of any size or shape is destabilising. It seems to have a massive negative psychological impact of fear and anxiety that can paralyse creativity and morale.
Scientists have proved this with lab rats that, at the slightest whiff of a cat, are unable to problem-solve their way out of a maze (and we’re hopefully smarter than lab rats).
Change-management theory posits that, more than anything, you need your team to be buoyant, creative and in full problem-solving mode. Your job as leader is to keep the team calm, informed and full of positive emotion. Your managers should be working out different ways to keep in touch with your team’s emotional peaks and troughs as they navigate the Kübler-Ross (K-R) curve. In BC times, the process typically went like this:
[1] Management decides it needs incremental change – for example, pricing, invoicing, team meetings, nurse clinics – all for very good business productivity or efficiency reasons.
[2] Get the team on board by managing anxiety and fear with endless discussions, meetings, training, dictates and memos.
[3] Implement the change, over time, with a step-by-step project plan…
Invariably this doesn’t work. Stage 2 is usually the sticking point, making implementation virtually impossible.
This time, it’s different
This time we didn’t actually have time to follow the process. Because of the urgency and criticality of events, we had to work very differently:
[1] Circumstances decided we needed massive change – avoiding people, staying home, emergencies only, washing your hands – for personal health, community and global reasons.
[2] Implement change – do this and do it now, or else.
[3] Get the team on board (or off board) with clear, but minimal, discussion – the reasons are obvious to all.
More significantly, we achieved this despite all the additional anxiety and fear inherent in this crisis. So, did we just bypass the “getting the team on board” stage? I don’t think so. I think we have only postponed this ticking time bomb for later and it will manifest as a far more difficult “getting the team through” stage.
If this implementation was so successful (so far), it’s worth exploring the factors affecting this change. I see four key influencers:
[1] urgency
[2] authority
[3] compassion for others
[4] self-interest
If we define anxiety = urgency × uncertainty, we have all the elements for massive anxiety yet still to come. The initial stage was pure urgency, with little time to reflect.
Although fraught with uncertainty and misinformation, the simplicity of the “stay home – wash your hands” imperative from Government, medical and international authority kept anxiety and fear within manageable bounds.
This was also tempered by a massive outpouring of compassion for the elderly (we all have older relatives), the NHS workers (uniquely British heroes) and our immediate families, which, together, resolved an acute common sense of purpose and meaning.
Additionally, this was not an abstract phenomenon like the 2009 economic crisis or a foreign war. This affects us all personally and, despite any uncertainty and confusion, self-interest compels immediate action.
It’s only now we are really getting into deep stage 2 of people management with its latent anxiety, with less urgency and increasing uncertainty. Add to that the stress of escalating moral and ethical dilemmas that day-to-day clinical, cultural, cash and client decisions entail. Add to that the potential for individual and national grief from human, psychological, monetary and identity loss.
According to our K-R curve, our current challenge is we are heading into the need for deep emotional support.
At this stage, the real challenge is that our managed anxiety can give way to helplessness and depression for yourselves and the team. This volatile mix can exacerbate the fight-flight-freeze mechanisms and irrational responses from family, colleagues, clients and the public.
Endless articles have well-meaning advice on how to maintain team morale, such as daily communication with all employees, celebrating good news, showing understanding and compassion, making staff feel valued, being honest and transparent, and having a plan.
This advice is asking a lot from us as veterinary business leaders. We have always said veterinary school didn’t equip you for business in the “good times”. I’m not convinced it’s given us (or anyone else, for that matter) the psychological tools of empathy and compassion to deal with the multitude of human fall out from a crisis of this magnitude.
What are vets good at?
Maybe we can do something that we vets are good at – working things out from first principles. If we better understood the root causes of long-term anxiety and depression, maybe we could work out a better diagnosis, prognosis and treatment for ourselves, families and teams, and it may put the aforementioned advice into a more useful context for implementation.
Johann Hari in Lost Connections (2018) proposed some essential biological, psychological and environmental lost connections that can lead individually and collectively to mental distress. This was written before coronavirus, but the resonances are stark as they are salient to our “new normal”.
A few of the disconnections he discusses are:
[1] Disconnection from meaningful work. The act of being “furloughed” and by implication, deemed “unnecessary”; to the prospect of being made redundant from meaningful work that vet practice inherently provides. Shame, guilt and apathy will arise as different responses to long-term dissociation from work. Maintaining your teams’ connection to work and its meaning, regardless of their status, will be critical. Give people meaning.
[2] Disconnection from other people. For me, the biggest mistake in this whole crisis was labelling the primary protection strategy as “social distancing”. Not because I don’t believe people need to stay away from each other to control the infection rate, but, pedantically maybe, it is actually physical distancing that is critical. Social closeness, while physically distanced, is most critical to mental health in normal times, let alone a crisis. Keep people connected.
[3] Disconnection from meaningful values. As we escalate the isolation it will put pressure on the value of material possessions, and the limits of Netflix as a social substitute for many. Already we are seeing the emergence of connection, empathy and compassion at all levels. This can, and will be, disturbing and re-orientating as many people reassess their core values and relationships in the months to come. Work can be a place of safety in which these discussions can and should be allowed. Remind people of their value and values.
[4] Disconnection from status and respect. Because so much of our identity as “the vet” or “the nurse” is tied to our practice and status in our communities, as we restrict our access and make “hard decisions”, we may have to erode our positions of respect for the pragmatics of human safety and Government guidelines. Others may lose their business and identity altogether. Our investment in our self-esteem and self-worth may require rapid and permanent reappraisal. Many have already faced this existential reassessment when they sold their practice. Unfortunately for some, this is now a re-alignment they may have to make without the compensation of a hefty pension pot. Personally, I think this is a personal coaching process that needs greater discussion in the profession. Whatever their situation, people deserve respect.
[5] Disconnection from the natural world. Paradoxically, this may come to be the saviour for many people who will be spending more time with their children and pets at home. Although social places are limited, people will search further for “wild places” to get out, and move and exercise. Solitary off-road cycling and open-water swimming do it for me. The real danger is the enforcement of a stricter lockdown, further limiting outdoor activity and removing an essential safety valve for mental resilience. Get out (alone), move, reconnect.
[6] Disconnection from a hopeful and secure future – as businesses struggle, the economy contracts and pensions are reduced, people face an uncertain future. Fortunately, people tend to overestimate the short term – good or bad – and underestimate the long term:
we just get it wrong. The only secure thing about the future is that there is one. People need goals and wins leading to a hopeful future. The key is to chunk down your planning and expectations so actions and outcomes stay within your area of influence (internal locus of control), rather than just the uncontrollable area of concern (external locus of control). Demonstrate optimism and gratitude.
Stay connected
This is not to say no genetic, biological, traumatic or developmental reasons for anxiety and depression exist.
These are preloaded into the human system at this stage and only change our adaptive propensity for the way we respond to the current situation – everyone will react differently depending on their history and hypervigilance bandwidth.
In a few cases, medication may help, but the real danger is an overstretched medical system will default to the easy, but totally ineffective, generalised use of antidepressants, rather than addressing the issues of disconnection and ennui to come. This will almost certainly exacerbate the problem and delay the progression on to the next phase of psychological recovery of meaning, making and acceptance. You can choose differently.
Hari proposes anxiety and depression are not “diseases” of the brain; they are adaptive responses to life, not how it is, but how we experience it, however painful it is. The skill is to listen to the pain and distress the next few months may bring and adapt to how you experience the “new normal”.
Yes – it’s a crisis. And a big crisis at that. There’s no end in sight, which, psychologically, makes it much harder to bear. But there will be an end and we will thrive again. The most important thing is to hold your nerve, dig deep and find ways to survive these turbulent months. Above all, stay connected.
By Alan Robinson
Special thanks to VBJ – pages 14-16 in their May 2020 edition.
