Team Building Seminar at Children’s Services Council

Deposits and Withdrawals

In the book the 7 Habits of Highly Effective People, Stephen Covey talks about the importance of making emotional deposits in relationships. Like a bank account, he explains that healthy relationships thrive when there are more “deposits” made  then “withdrawals”. A relationship can weather life’s withdrawals with a healthy account.  Simple math, really.  However, if no or very few deposits are made in the relationship, but withdrawals constant (which can be displayed in an infinite number of ways), it can damage the relationship, often leaving it irreparable.  The relationship then becomes a ”delinquent account”.  Try getting cash from “zero balance”.  It just does not happen.  Have you ever experienced a one-sided relationship that got old real fast?

At the end of the program after teaching this idea, participants always express enthusiasm for learning of the emotional bank account.  I am excited at the value they see in practicing these principals, but remind them of one thing.  I caution them not to make what I call “transparent deposits”.  These are deposits made with the intent to gain something as a result of the deposit.  For example; if someone needs something from you, and they quickly attempt to “deposit” with the intent to make an immediate withdraw, this point is missed entirely.  I warn that this is not what the idea encourages.  It encourages that with the relationships you value, it is essential to practice making genuine emotional deposits to sustain them.

Character is much easier kept then recovered. – Thomas Paine

The Art in Healthcare (article)

The Art in Healthcare
By Kristin Mackey-DiObilda

Instilling a culture that supports your vision takes patience, time and yes, creativity.  A culture can be instilled through conscious initiatives or by default.  I tend to define culture as the way an organization’s associates independently and collectively behave.  A desire to foster new behaviors is on the wish list of every change agent and innovative CEO.  Recognizing and mastering the art in healthcare is the key to witnessing this intended shift before retirement!

Considering the service-oriented nature of healthcare, it’s surprising that it wasn’t until the last decade that patient satisfaction (an “after the fact” lag indicator) morphed into Service Excellence (a lead indicator) introducing a more proactive approach to patient satisfaction.  Patient and Family-Centered Care was then introduced as a new way to deliver care promising to reduce errors, while improving communication and trust.  These new approaches found their way to the desks of eager followers in the midst of stiff corporate cultures.

A Holistic Assessment

The focus of any business starts with its customers.  A toy manufacturing company knows the business of making toys for its customer, parents and children.  Knowing the expectations of both the child and the parent is important.  In healthcare, the same holds true.  If customer expectations are not met, that customer may choose another facility.  In our current competitive market, it’s critical to know what customers truly expect and instill a culture that upholds these values everyday when providing care.  However, pinpointing what a customer really expects both clinically and in terms of customer service is challenging.

Patient satisfaction research is the first step in knowing what customers value, but it does not tell the whole story.  Patient satisfaction research combined with surveys assessing community, physician and employee satisfaction offer a more holistic assessment of your customer’s values and insight into the current state of your culture when trying to meet these expectations.

A Holistic Implementation

Creating a culture involves everyone: nurses, physicians, leaders, staff and patients.  This is easier said than done in an industry that often has multiple governing bodies each desiring different outcomes.   At a recent leadership retreat, I used the following question to illustrate this point: “If your body had three brains, do you think your organs would get confused?”  In an attempt to use both humor and an appropriate analogy, I managed to communicate the importance of leadership alignment for successful goal setting.  Too many opposing forces simply cancel out well-intended plans.

Misunderstanding the role of leadership is also common.  Many leaders with good intentions overlook the difference between “supporting” and “driving” an initiative.  Too often leaders support the plan, but underestimate the power of their own actions in instilling new behaviors.  In order to drive a program, it is critical that leadership “walk the talk.”  Reviewing a document in a boardroom is an agenda item, not an initiative.

After years as a consultant on change management, conflict management and most recently charged with instilling a culture of Service Excellence for a healthcare system, I have come to know four basic stages of evolution when it comes to culture change.

The four stages of cultural evolution:

Stage 1:  VISION
Stage 2:  STANDARDS
Stage 3:  EDUCATION
Stage 4:  MEASURMENT

STAGE ONE:  VISION
Develop an enterprise vision.

In stage one, it is important to have the leaders of your organization collaborate openly on the direction of your enterprise. Utilizing broad market research to determine customer values is instrumental at this stage. By considering feedback from other surveys, focus groups and patient and family advisory councils, executives obtain a more accurate assessment of what customers expect.

Employee engagement and internal branding is also part of this stage.  Involving employees at all levels in the strategic process upfront will provide valuable insight, while encouraging staff to serve as change agents when things get challenging. Creating a brand that allows employees and other stakeholders to easily identify with your vision is essential to effectively delivering your message to a mass audience.

STAGE TWO:  STANDARDS
Establish standards of behavior.

Determining what qualities you are looking for in employees, holding those employees accountable and recognizing overachievers is essential to attracting and managing associates able to deliver your vision.  This is accomplished by identifying and communicating your organizations’ enterprise-wide standards of behavior. They become part of hiring screens, performance reviews (more specific measurable behaviors may be included on the department level) and integrated into rewards and recognition programs.  When an organization sets behavioral standards on service and requires its employees to meet such standards, a strong foundation for culture change is established.

However, dealing with shortages is often the reality.  Many managers feel they are forced to “allow for” less then standard behavior because they cannot afford a vacancy.  Coaching and counseling low performers is a first step.  In addition, many managers are promoted without the sufficient training needed to manage such challenges.  A cycle of incompetence can become an unfortunate byproduct of a complicated and constantly changing business.  It is important to recognize the intrinsic value of creating a learning environment, as well as, its positive long-term financial impact. Turnover, resulting in retraining employees and low morale, is not only expensive – it can be dangerous.

It’s also important to note the power of mentoring programs in your organization, in addition to proper education and training.  A mentor can help a new manager navigate the political landscape, handle personnel problems and address staffing issues.  This relationship helps equip the new managers with the essential skills and resources necessary to be successful – including hiring, coaching and terminating unfit employees.

STAGE THREE:  EDUCATION
Educate everyone, everywhere.

I’ve been exposed to many well-prepared plans that overlooked the significance of proper education.  Great ideas and initiatives can flounder if the folks executing them don’t thoroughly understand the programs and their associated expectations. Well-organized training modules help decrease the misperceptions that can dilute your message.  Combining classroom style, web-based or role-playing methodologies can increase the probability of seeing those behaviors demonstrated in everyday exchanges.  It is ideal for initial training to be emotion-based, interactive and enterprise-wide.

For example: an item on the Press Ganey Associates patient satisfaction survey is “sensitivity to your fears and concerns.” There can be many interpretations of what it means to be sensitive and patients’ expectations vary.  Broad market research will help determine your population’s highest values, but good education will help clarify to employees what behaviors are ideal in meeting such expectations.  Different perceptions of a vision lead to different behaviors, which in turn create a segmented culture.
Interactive mass education for all levels of the organization is key.

STAGE FOUR:  MEASUREMENT
Implement a measurement system.

In stage four, the Balanced Scorecard, by Robert Kaplan and David Norton is a measurement system worth exploring.  It balances both lag and lead indicators and can play an important role in measuring the impact of change while deciding next steps.  As consumers rely on intangibles (such as a “kind physician”) when making decisions, the need to balance these intangibles with other business drivers is essential.

Ideally, a measurement vehicle is selected when the vision is established.  Individual, departmental and organizational goals aligned with the vision (and housed in a measurement system) will allow a very large and complicated organization to move together toward a common goal.

Example of departmental vision alignment:

Charged with instilling a culture of service, I first implemented a new service excellence model that focused on our hospitality.  With this model, clarified by our enterprise vision and supported by leadership, it was possible to make great strides in breaking down old cultural barriers by introducing a new way of interacting with patients and each other on the department level.

The Patient Relations role changed from “complaint takers” to a more proactive concierge role, which included the staff making daily rounds.  This change progressed in stages with proper education and support.  It required a new way of thinking and behaving on the part of the team and the areas they impacted.  Once successfully implemented, the role expanded to cover more waiting areas, deliver a Patient Safety brochure and follow up on discharge instructions.

Simultaneously, the previous feedback system that typecast the staff as complaint takers was also adjusted to reflect this new model.  Managers were now required to document, resolve and formally follow up on concerns in their respective departments within a specific timeframe. The Patient Relations liaisons supported this operational process to ensure policy compliance, but ultimately the managers were moved to be more proactive and accountable – which positively impacted overall patient satisfaction scores.

The Challenges

One of the greatest challenges organizations face when attempting to change a culture is managing the change over time – and it will take time!

A few guidelines to consider:

1. Keep what works, but shake things up –  Constant leadership changes can turn corporate goals into moving targets and decrease trust within an organization. Asking for buy-in and support on a particular direction then starting from scratch with a new leader leaves employees disengaged.  As changes occur at the executive level, ensure that proper consideration is given to what is already working.  Trust is essential in all four stages.  However, shaking things up and breaking some old cultural boundaries will generate fertile soil for the seeds of change.

2. Set reasonable goals and deadlines – Trying to satisfy the urgent requests for data and reported outcomes often triggers the least effective solutions to be put in place as a quick fix.  These “band-aids” are intended as temporary fixes but often overlook their long-term impact.  Proper long-term planning coupled with prompt adjustments is a sound approach.

3. Acknowledge emotion – Always underestimated due to its immeasurable quality, emotion is what drives people, their choices, behaviors and business.  Underestimating this powerful organizational driver can result in loss (turnover, errors and decreased patient satisfaction).  When leaders address fears and frustrations while enduring change, employees are validated; this helps temper negative emotions and the behaviors that can follow.

4. Align with vision – When the terrain is a large organization, grass root efforts are effective, low-risk method for getting smaller initiatives off the ground. Running a pilot test of a new process is also a non-threatening way to penetrate a stiff culture.  However, if the pilot is not aligned with the vision, it will have a hard time taking root.  Align. Align. Align.

Whether you are in the very beginning of an organizational change or just reinvigorating stalled efforts, awareness of the four stages may assist you in determining next steps.  Establishing a vision, determining standards, providing education and measuring outcomes will create the framework necessary to achieve the strategic goals of your enterprise.

This is certainly a simplified outline of an often complicated and challenging undertaking. It is also important to note that what can appear to be the linear stages of an organization’s evolution often develop in non-linear ways.  The very things we cannot easily measure, often play the largest role in successful change.  By fostering trust in leadership, encouraging open and honest communication and developing employees’ interpersonal skills, you create a transparent organization.  This transparency is essential for operating effectively in the constantly changing terrain of healthcare.

Although the science of medicine has inevitably shaped healthcare’s organizational landscape, the art of healthcare is now emerging.  An emphasis on hard science in the healthcare industry is vital to its revolutionary progress, but new ideas are needed to address the increasing needs of our customers.  Our challenge is to evaluate them and incorporate the best into our cultures.

Addiction or Preference?

In his book Handbook to Higher Consciousness, Ken Keyes encourages readers to have ”preferences” over “addictions” on the path to happiness. He shares that when we are “addicted to outcome”, we experience negative emotions and encourages readers to just prefer.

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