This one is for Roxanne Eilers, who helped a team to heal and be their best.
There are moments in veterinary medicine that do not just stay with you. They change the way you see hospitals, leadership, culture, and the slow erosion that happens when no one is willing to hold people accountable.
Gallup research has documented for years that managers account for roughly seventy percent of the variance in team engagement, and that weak accountability is one of the most reliable predictors of turnover. Across the hospitals I have owned, the doctors I have worked alongside, and the team members I have coached, I have watched that research play out in real time. When accountability disappears, good people leave. Sometimes they leave the building. Sometimes they leave the profession. Either way, the cost is real.
Years ago, I worked as a regular relief veterinarian at one hospital that made me question my life decisions. I had built and worked in highly successful hospitals. I knew what good culture felt like. I knew the difference between normal veterinary chaos and leadership-created chaos.
This was not normal veterinary chaos. This was something else entirely.
My first shift at this hospital, the team knew I was coming, and yet when I walked in, the practice manager was not there to greet me, show me around, log me into the systems, or help the team integrate a relief doctor into the day.
I was just there, floundering around like a lost golden retriever in a parking lot.
The team was at a loss, but what struck me most was that they were not surprised. There was no visible shock. No sense of "this is unusual." They had already absorbed it as normal.
That told me almost everything I needed to know.
The practice manager arrived late every day. At five minutes past her start time, the quiet mumblings began. By fifteen minutes late, there were full conversations. At some point, someone hinted that there may have been a betting pool on her arrival time, which would have been funny if it had not also been a fairly devastating employee engagement survey in real time.
And the chaos did not stop at tardiness.
One day, after the last appointment, I noticed several employees lingering in the hospital. That was unusual. This was not a team that stayed late for fun. They had lives and errands and families waiting for them. When the work was done, they left.
But this day, they were waiting after their shift had ended, hanging around the treatment area because the person responsible for the schedule that would begin tomorrow had not posted it.
That is not a scheduling issue. That is a leadership failure wearing a name tag.
This was also the same practice manager who, while the team was visibly stressed under a monumental caseload, would sit on the treatment room counter and discuss the latest antics of her child. Or she would begin bottle-feeding whatever new litter of foster kittens she had brought in that week. Meanwhile, her team was drowning. Phones were ringing, patients needed care, and clients were waiting on callbacks. The person whose job it was to lead, organize, support, and remove obstacles was physically present but functionally absent.
To be clear, I am pro-kitten. I have nothing against bottle babies. But there is a time and place for everything, and bottle-feeding kittens on company time while your team is being buried alive by the appointment schedule is not a leadership strategy. It is not even good optics.
A fair question is whether the expectations were clear. Yes. They were. This was a hospital with clear rules around tardiness, personal pets, work expectations, and what should and should not happen on company time. The standards existed. The handbook existed. The policies existed.
What did not exist was accountability.
Without accountability, policies are just decorative documents that live in a binder somewhere, occasionally dusted off when leadership visits.
The morale in that hospital was awful. On my very first day, I left for lunch and did not want to come back. I wiped a few tears from my eyes in the parking lot because I knew there were better versions of veterinary medicine than this. I had lived them. I had helped build them. I knew hospitals could be busy, imperfect, emotionally intense, and still be healthy places to work.
But this is what happens when standards are written down and not enforced. Good people carry the weight. Poor performers learn there are no consequences. Resentment grows until the team realizes the problem is no longer one person's behavior. The problem is that leadership is allowing it. One bad apple really will ruin the whole orchard if no one is willing to address it.
Eventually the practice manager was dismissed for performance reasons, but it took far too long. By then, some really great employees had already left. That is one of the most painful parts of weak accountability. By the time leadership finally acts, some of the people you wanted to keep are gone.
A new practice manager stepped in, and she was excellent. Strong work ethic. Comfortable holding people accountable without making accountability feel punitive or personal. She showed up. She followed through. She helped the team understand that the rules were real.
The change was almost immediate. Morale improved. People who had been underperforming started to rise. Some became rock stars. The team showed up on time, ready to work, ready to do a good job. The building did not change. Veterinary medicine did not suddenly get easier. The leadership changed, and with it, the expectations became real.
When Leaders Exempt Themselves
I saw another version of this later, with a doctor who showed up late every day. Not occasionally. Every day.
We were peers. We had agreed on the hospital rules. We had a clear handbook every employee had read and signed. We had also agreed that accountability had to be timely, fair, and consistent so small problems did not become a toxic culture.
What I did not anticipate was that I would have to go behind another leader and make sure they were holding themselves accountable. That sounds naive now. At the time I assumed that a lead veterinarian understood that leadership begins with personal behavior.
The first real clue came from a client complaint. The appointment was running late because the doctor was not even in the building. Then I noticed the team trying to cover for them, which told me the issue was no longer just punctuality. When a team starts covering for a leader, the culture has already been compromised.
They were not covering because everything was fine. They were covering because they had built a workaround that kept everyone safe. They did not want to upset the doctor. They had seen people come and go. They did not want to get caught in the middle. So they adapted to the dysfunction, which can look like loyalty from a distance but is usually fear wearing a polite little hospital-branded fleece.
When I reviewed the security footage, I saw this doctor strolling in more than an hour late in the morning and taking lunches that regularly stretched to ninety minutes or longer. We did not just have an accountability issue. We had a lost revenue issue, a client service issue, a team trust issue, and a leadership credibility issue.
The biggest damage was cultural.
Once the team sees that rules can be bent arbitrarily for certain people, it becomes very hard to hold anyone else accountable. Why should the receptionist be on time if the doctor is not? Why should the assistant follow the handbook if leadership does not? Why should the technician hustle to stay on schedule if the person with the most power in the building creates delays and no one addresses it?
People are quick to notice hypocrisy.
I was at fault in that situation, too. Even though we were peers, that did not absolve me of responsibility. I saw the impact too late. I let it run too long. I underestimated how closely the team was watching.
Accountability is not only something we apply downward. It must apply across, upward, and inward.
How to Actually Hold People Accountable
Accountability does not mean ambushing people. It does not mean public embarrassment. It does not mean waiting until you are so frustrated that the conversation qualifies as a weather event. Done well, it is structured, clear, timely, and fair. Here is what that looks like in practice.
1. Make the expectations clear. You cannot hold people accountable to standards they do not understand. That means written job descriptions, attendance policies, scheduling expectations, communication standards, client service protocols, and rules around personal pets or personal tasks on the clock. The handbook is the starting point, not the finish line. The team also needs to hear the expectations in plain language and know what will happen when the standard is not met. A signature on a handbook does not create accountability. Leadership follow-through does.
2. Pay attention to what is actually happening. Leaders cannot manage from assumptions. Are people arriving on time? Are lunches reasonable? Are schedules posted when they are supposed to be posted? Are callbacks completed? Are medical notes closed? Are leaders modeling the same standards they expect from everyone else? Culture is not what the handbook says. Culture is what actually happens when no one intervenes.
3. Address issues early and privately. The first accountability conversation should be private, direct, and curious. Not a lecture. Not a hallway comment. Not sarcasm delivered with a smile while everyone pretends it was a joke. Try something like, "I have noticed you have been arriving fifteen to twenty minutes late several days a week. Help me understand what is going on." Sometimes there is a real issue. Childcare. Transportation. A medical concern. A scheduling problem that needs to be solved. Accountability should include curiosity. But curiosity is not avoidance. If the expectation is reasonable, the conversation has to move to clarity. "This role requires you to be here and ready to work by 8:00. Beginning tomorrow, that needs to happen consistently. We will check in again in two weeks."
4. Document the conversation and the expected change. Documentation is not about building a case against someone. It is about creating clarity and protecting fairness. Capture the specific behavior, the expectation going forward, the timeline for improvement, any support being offered, the consequence if the behavior does not change, and the follow-up date. Vague accountability creates vague improvement. Specific accountability creates a path forward. When the time comes for a harder conversation, the goal is to be clear, not cruel. Rip the Band-Aid, not the skin.
5. Follow up when you said you would. This is where most leaders fail. They have the uncomfortable conversation, feel temporary relief, and never return to it. The follow-up is what makes accountability real. If the person improves, acknowledge it. If they do not, escalate appropriately. If the leader does nothing, the team learns that accountability was just a mood, not a standard.
6. Apply accountability consistently, especially to leaders. The higher someone sits in the organization, the more important accountability becomes. Leaders set the permission structure for everyone else. If a kennel assistant is late, that is a performance issue. If a practice manager is late every day, that is a culture issue. If a lead doctor ignores the standards, that is a leadership credibility issue. The team will forgive a leader who makes a mistake and owns it. They will not respect a leader who acts exempt.
The Hard Conversation Is Usually the Kindest One
Many leaders avoid accountability because they do not want to be mean. But avoiding accountability is not kindness. It is conflict avoidance dressed up as compassion.
It is unfair to the person who needs coaching, because they are never clearly told what must change. It is unfair to the team, because they absorb the consequences. And it is unfair to the business, because inefficiency, turnover, and resentment become normalized.
Accountability, done well, is not an attack. It is a form of protection. It protects the standard, the team, the clients, the patients, and the people who are doing the right thing when no one is watching.
The work is already hard enough. We do not need to make it harder by allowing preventable chaos to become the culture.
The strongest hospitals I have known were not perfect. They still had conflict, bad days, and people who needed coaching. But they had leaders willing to protect the standard. They had leaders willing to have the conversation.
They had leaders who understood that accountability is not the opposite of compassion.
Accountability is what allows compassion to survive.
— Dr. V
The Gray Oak Journal
Dr. V is a veterinarian with over twenty years of clinical and operational leadership experience. She has owned and operated several veterinary hospitals, has weathered many shifts in the industry, and served on advisory councils. She writes The Gray Oak Journal at grayoakjournal.com.