The Follow-Through Formula is a framework designed to help managers develop initiatives, communicate them in a motivating way, create systems that support implementation, and identify common barriers to success.
Begin with Intrinsic Motivation
Nearly every successful initiative in a veterinary hospital ultimately generates revenue. However, revenue generation is rarely the most motivating aspect of an initiative for veterinary professionals.
When introducing an initiative, managers should focus on its intrinsic value before discussing its financial impact.
Intrinsic motivators are internal drivers. They tend to be experienced as “I want to” rather than “I have to.” They create an internal pull toward action rather than an external push.
Examples of intrinsic motivators include:
- A sense of accomplishment
- Personal growth
- Acceptance
- Belonging
- Part of something great, etc.
Extrinsic motivators originate outside the individual and include:
- Money
- Bonuses
- Gift cards
- Food
- Time off
- Prizes
- Tickets to an event, etc.
Both forms of motivation can be effective. However, intrinsic motivators generally create more sustained engagement and commitment.
For this reason, managers should engage team members in a thoughtful exploration of the intrinsically motivational ways the initiative will impact the hospital, its patients, and its clients.
- How does this initiative benefit patients?
- How does this initiative benefit clients?
- How does this initiative benefit the team?
- How does this initiative benefit me, the employee?
- How does this initiative benefit the hospital?
The answers to these questions form the foundation of the initiative’s story.
Example: Intrinsic versus extrinsic motivators
A Hospital Decides on the Best Messaging for Its Initiative
Consider an illustrative hospital: Oceanside Veterinary, a low-cost, high-volume practice in Mississippi. Many of its clients struggle to maintain heartworm prevention. The hospital sees heartworm-positive dogs regularly, some seriously ill.
An advisor suggests exploring an online option that allows clients to purchase individual doses on a recurring schedule. All of the following are true about partnering with an online pharmacy, but which would be best to underline to the staff?
- “Oceanside says we deliver expert care. Partnership with the right online pharm greatly strengthens the consistency of oversight of care for pets. We look like who we want to be.”
- “A study showed that clients purchased 140% more FTHW doses than those that didn’t.”
- “Using the online pharmacy means that we divert traffic away from Chewy and capture that revenue for ourselves.”
- “This goal represents who we are as a hospital and as a team.”
- “Roger, that Pit Bull we saw last week, died at age 6 because his owners said they couldn’t afford the meds. I think this goal should be for Roger.”
- “We run on very tight margins. Carrying fewer products on our shelves, improves cash flow and practice value.”
- “Every client you meet is a chance for you as an individual to make a difference. Our pharmacy is another tool. Use it when you see an opportunity to help.”
- All of the above statements are true, but it’s the first which instills a sense of mastery to team members, ‘I am part of something great.’
- The second also has impact; it offers team members meaning, ‘Lots of hospitals have mission statements, but we live ours.’
- Four gives the team a sense of connection to the mission, belonging, ‘I am part of a committed team.’
- The fifth is powerful as well, working for Roger shows staff members their work has meaning, ‘We don’t work for production, we work for patients.’
- Finally, the last one frames the goal as something everyone can participate in, regardless of employee class or tenure. Everyone has the autonomy to achieve this goal, ‘My job is to scan our clients for opportunities to help and to offer the online pharmacy as one of the tools that could make a difference.’
Building the Follow-Through Plan
Thoughtfulness and thoroughness are key elements of a successful follow-through plan. Here are seven questions to stimulate ideation on articulating the initiative in a motivational way as well as the things a leader should put in place to ensure ongoing momentum and follow-through. If you’d like to use a worksheet for this exercise, you can download a free one through this link: https://shorturl.at/NV6iQ
Purpose
Describe the initiative and explain why it matters.
Whenever possible, describe the initiative in terms of its intrinsic value to patients, clients, employees, and the hospital.
Ownership
Identify who is accountable for each component of the initiative. Responsibility should be assigned to specific individuals whenever possible.
Pathway
Describe the exact process by which the initiative will be completed.
Managers should be highly detailed in this section.
For example, if the initiative involves contacting clients with third-overdue reminders, the pathway should include:
- Who runs the report
- Which report is used
- When the report is generated
- Where the report is stored
- Who works the report
- How completion is documented
- How team members communicate progress
Many initiatives fail because the pathway is insufficiently defined.
Training
Identify the knowledge and skills employees will need to perform the initiative successfully.
Feedback Loop
Identify how progress will be monitored and discussed. Feedback loops will be discussed in a separate paper.
Habit Formation
Managers should identify ways to incorporate the initiative into daily routines, workflows, meetings, checklists, software systems, and accountability structures.
The objective is to make the desired behavior part of normal operations. Remember that meetings create buy-in, repetition creates habit. Help team members settle into a routine of participation in your goal.
Leadership Habits and Attitudes
Managers should identify the actions they will take to support the initiative.
When initiatives struggle, leaders often focus on employee behavior. It is equally important for leaders to evaluate their own behavior and determine whether their actions are supporting, undermining, or having no effect on the initiative.
Exploring Common Reasons Initiatives Fail
Initiatives fail on individual and group levels. Here are some of the common reasons why individual employees lag behind others or fail in their attempt to support a hospital’s initiative.
Outside Stressors
Financial concerns, family challenges, health issues, anxiety, depression, substance abuse, and other personal difficulties can reduce focus, motivation, and performance.
Think of the cat that arrives at the hospital after being jostled in a carrier for thirty minutes. When you open the carrier door, the cat may be frightened, defensive, or uncooperative. You did not create that emotional state; the trip to the hospital did.
The same is true of some employees. Managers often assume that resistance, distraction, or poor follow-through is a reaction to the initiative itself. In reality, the employee may be carrying stressors from outside the workplace that are consuming their attention and emotional energy.
In these situations, the manager and the initiative are not the problem. The employee may simply be struggling with circumstances that originated outside the hospital and continue through their work at the practice.
This does not eliminate accountability, but it should remind managers that not every performance problem reflects a lack of commitment, motivation, or ability. Sometimes the issue is not what is happening at work, but what the employee brought with them to work.
Lack of Clarity
Employees may not understand the specifics of what they are supposed to do.
Let’s say that you have agreed as a group to start calling all clients with lapsed reminders. The meeting goes swimmingly, and everyone leaves seemingly bought in and eager to hit the ground running with this new hospital initiative. The following day, you show up to find that no one has called a single client. Why?
- The start date was not specified
- No one knew how to generate the call list
- It was unclear when this initiative would start, who would make the calls, when and how
Competing Priorities
Employees may understand the initiative but have difficulty balancing it against other responsibilities.
Think of a client care representative busy tending to obvious tasks: checking clients in, answering an incessantly ringing line, invoicing, or addressing emotional pet owners. To this employee, asking ‘how did you find out about us’ or stepping aside to call up clients with lapsed reminders may seem like a very low priority or entirely impossible given the sum of her responsibilities.
Lack of Training, Tools or Systems
Employees may lack the resources, processes, or support necessary to perform the task consistently.
Let’s return to that lapsed reminder task. If you’ve never made a lapsed reminder call to a client before, how do you know what to say? What if the client picks up and says, “We left your hospital years ago. The service was terrible? (Which happens every now and then, btw.) What if you want to call the lapsed reminders, but the sheet that everyone was supposed to work from is missing or poorly notated and the person taking over the task doesn’t know where to begin?
Lack of Feedback
Employees who receive little feedback often struggle to determine whether they are succeeding or improving.
Let’s consider that lapsed reminder task we discussed. An employee dutifully calls 50 clients and leaves a message with all because not a single person picked up the phone. Exhausted from the tedium, she calls it quits for the day and then…nothing. She never learns if anyone called back to schedule an appointment, whether or not her efforts amounted to anything substantial, or even if anyone noticed that she had completed the job!
Common Reasons Teams Struggle
Sometimes the problem is not the individual employee but the system surrounding the employee.
Examples include:
- Internal bickering
- No systems in place to organize individual efforts
- Staff shortages
- Members of the team attempt to sabotage the initiative
- Disrespectful or ungrateful leaders, or leaders that manage failure poorly
Managers should investigate these issues before assuming that poor performance is solely the responsibility of individual team members or a team that is ‘afraid of change’ or reluctant to try.
Solve Problems Inclusively
Exercises for the Whole Staff
When investigating why initiatives fail, take a group approach to exploring both possible causes and potential solutions. The people closest to the work often have insights that managers alone may miss. Involving the team not only improves the quality of the analysis, but also increases ownership of any solutions that emerge.
Three exercises are particularly effective at generating ideas and encouraging participation:
Fishbone Diagram
The fishbone diagram, sometimes called a cause-and-effect diagram, helps teams identify the many possible causes of a problem. The “head” of the fish represents the problem being investigated, while the “bones” represent categories of possible causes.
For example, if an initiative to increase reminder compliance is failing, the team might identify possible causes related to the following categories:
- People
- Training
- Communication
- Workflow
- Technology
- Policies
- Equipment
- Leadership
The goal is not to identify the correct answer immediately. Rather, the goal is to generate as many plausible explanations as possible before deciding which causes are most likely contributing to the problem.
Each major bone serves as a catch-all category for a possible source of failure. These categories help the team organize its thinking, identify broad areas of concern, and then explore more specific causes and solutions within each area. Download the fishbone diagram for use at your practice here.
The Five Whys
The Five Whys exercise helps teams move beyond symptoms and uncover root causes.
The process is simple. Begin with the problem and ask “Why?” Repeat the question for each answer that follows.
For example:
Problem: Employees are not completing third-overdue reminder calls.
Why? Because the report is not being worked consistently.
Why? Because team members are often unaware that a new report has been generated.
Why? Because there is no system for notifying them.
Why? Because responsibility for communication was never assigned.
Why? Because the implementation plan did not specify who owned that task.
In this example, the problem is not employee motivation. The root cause is a gap in the process design.
The Five Whys is an exercise that invites creative thinking and discussion. It pushes people to go beyond autopilot answers about why jobs are not getting done (e.g. ‘People are afraid of change’), and encourages team members to explore specifics. Hence, groups come up with solutions that are more targeted to what is actually going on and that are more likely to succeed.
Design Thinking
Design thinking asks teams to examine a problem from another perspective, in this case, the pet-owner client.
In veterinary medicine, one of the most successful examples of design thinking occurred when hospitals began evaluating care through the eyes of the patient. Looking at veterinary visits from the perspective of dogs and cats led to meaningful changes in handling techniques, hospital design, and patient care. Moreover, it sparked ideas more in line with the hospital’s mission as well as thoughts on other services hospitals could offer clients. As a result, Low Stress Handling became not just a way to make veterinary care more comfortable for patients, but also a way to collaborate more extensively with clients and to grow new sources of revenue.
Managers can use the same approach when evaluating initiatives. Team members can be asked to view a process through the eyes of a client as a way to challenge our assumption about the service we provide and generate new ideas for how an initiative could be accomplished.
For example, if a hospital is struggling to attract new clients, the team might ask: “What does the experience of contacting our hospital look like from the perspective of a pet owner seeking care for the first time?”
Viewing problems from a different perspective often reveals barriers and opportunities that are invisible when viewed solely through the hospital’s lens.
Together, the fishbone diagram, the Five Whys, and Design Thinking help managers and teams move beyond assumptions, identify root causes, and develop more effective solutions.
Ignition Levers: The Spark that Makes Change Stick
Research and real-world experience point to three reliable “ignition levers” that reignite team engagement:
1. Gamify It
Make progress visible, fun, and winnable. A simple leaderboard or streak tracker can turn a dreaded task into a game.
Measured Madness
Determine the amount of milliliters or height of a sample. If you increase compliance, state the increase in volume or height. For example, ‘Because we increased our parasite testing compliance by 10%, we sent an additional 3 feet of stool to the laboratory. Seems absurd, but these kind of creative perspectives spark humor and thoughtfulness.
Personal Poem or Song
Do shoutouts to team members as a Medieval poem or a song set to a popular tune. For example. Take the name of the employee and their success, then give it to ChatGPT to turn it into an epic poem or song. During the staff meeting, have a leader read it or sing it in praise.
Bells are Ringing!
Was there a positive behavior that you or another team member observed in real time? Have small bells (you can usually buy them at any tourist shop) around the hospital. Any team member can ring a bell to acknowledge a positive action they want to reinforce. Fun, funny and effective.
2. Make It Meaningful
Connect the task to a patient’s story. Staff are more motivated when they see the “why” behind the work.
- Help the staff see the activity as making an impact on the specific patient or client. For example:
- “Because we forward booked 10 appointments today, we increased the number of pet feet in our hospital by 40.”
- “This month, we increased parasite testing by 15%. That means that statistically three more patients were caught with an underlying condition that we otherwise would have missed.”
3. Co-Create the How
Instead of dictating process, invite staff to shape how it gets done. Ownership fuels follow-through.
When managers introduce even one of these levers, resistance softens and energy builds.
Conclusion
The Follow-Through Formula is designed to help managers move initiatives from ideas to sustained action.
Managers should begin by identifying the intrinsic value of an initiative and communicating that value clearly to employees. They should then create a detailed implementation plan that includes purpose, ownership, pathway, training, feedback, habit formation, and leadership support.
Finally, managers should recognize that failures in follow-through may originate with the individual employee, the hospital system, or both. Understanding the source of the problem is often the first step toward developing an effective solution.