What You Permit, You Promote

Liz Jazwick and I have been colleagues for more than 10 years. We first met at Holy Cross Hospital in Chicago, IL.  Liz is a great presenter and a difference maker. My favorite thing I learned from Liz is, “What you permit, you promote.”

When I became president of a hospital in 1996, 23 percent of employees had late evaluations. I became aware of this issue when I mentioned to some employees our organization’s value of respect. An employee said, “If we are so respected, why is my evaluation late?” Thus, my search led me to find that 23 percent of our employees were waiting for an evaluation to be completed and some had been waiting for weeks and months. If an employee’s evaluation was late, nothing happened to the leader who did not complete it by the deadline.

I guaranteed all staff that in 60 days there would no late evaluations. I put in systems and consequences, positive recognition to leaders with no late evaluations, and connected the dots on why an on-time evaluation is crucial to show staff respect and retain employees. Sixty days later, there were no late evaluations nor were there any while I was there. I believe the system of on-time evaluations and results is still strong.

A few years back, we had a meeting with Studer Group staff members and posed the following question: “What are we permitting, thus promoting?” When people are asked that question, one will hear some good feedback and some ways to improve. For example, one may hear, “You are permitting us to hire our co-workers, thus promoting responsibility and ownership for new hires.” We also heard that we needed to do a better job walking the talk in some areas, and this caused us to tighten up. While the journey was not comfortable, it was worthwhile and made us better.  

In our travels, we find that many organizations are not fully aware of what they are permitting, thus promoting. Here are some examples:

• A leader who consistently is not meeting patient satisfaction goals is not dealt with, or worse yet, still gets a good review. We are promoting poor performance. 
• A vice president who is not sharing information that others are sharing.  We are permitting inconsistent communication.
• Staff not following agreed upon and signed standards of behavior (performance). We are permitting staff to not live the behaviors agreed upon, thus hurting the organizational results.
• Allowing a physician to intimidate staff. We know from research that if staff are scared, they may not address patient issues with the physician. By allowing intimidation, we are not providing staff or patients the safest environment.
• A leader keeps blaming the data for results. We are permitting, thus promoting, excuses.
• A person is on his or her BlackBerry during a meeting. We are permitting lack of respect, thus promoting lack of attention.

You get the gist of it.

Ask yourself: “What am I permitting, thus promoting?” At your next senior leader meeting, put on the agenda “What are we permitting, thus promoting?” At the next department head meeting, take some time to ask leaders what they feel the senior leaders are permitting, thus promoting. At your next staff meeting, ask staff what is being permitted, thus promoted. While you may be disappointed in what you hear, you will not be disappointed in the opportunities presented to improve the organization or the outcomes that will be achieved.

Once you address what you are promoting, leaders may feel they need more training.  It may be that at times leaders permit things because they do to not know how to handle them.  For tips to help your team, click here to access the article Communication Transparency: Clarity Creates Trust by Beth Keane, a Studer Group expert.

Financial Transparency: There’s Nothing to Hide

One of the joys of my job is meeting top leaders in health care and other industries who are on the cutting edge in managing their organizations. I never stop learning.

Today’s senior leaders in health care often find themselves constantly walking up a down escalator when it comes to budgets and finances. They may have a fantastic fiscal year only to find themselves in a hole the first day of a new fiscal year. Below is an example of a system I recently visited:  

• Medicare and Medicaid impact will mean $30 million less in collections if the same amount of care is provided. The patients keep coming but not the reimbursement. 
• Pay raises kick in – a $6 million cost increase.
• The projected increase in charity care is $8 million.

The hospital will have to improve its operation $44 million to have the same results this year as last, which is still a small margin.

I have found that many managers do not understand how the organization can be okay one day and then face such a fiscal challenge the next day or the next budget cycle.  In our work, we have found that most managers and staff do not have adequate knowledge and understanding on the financial condition of the organization, how health care finances work, and the pressure the organization is under. I believe one reason may be that we generally have strong top leadership in health care. For many years, a few senior leaders through excellent strategy, tough negotiations, and tight controls could keep the situation from getting to an unmanageable point.  They would prevent staff from noticing the financial issues beyond the toughness of receiving an FTE at times, tighter purchasing requests, small staff reductions, and our annual budget pain.

The days of a few senior leaders being able to pull, push, drive, or will an organization to success are over. Today, we need all leaders and frontline staff on board, or enough to reach our tipping point, to be successful.  I have found that key steps are transparency of data and education of all leaders and staff to understand the organization’s financial position. For example, very few people realize that the cost of pay increases each year to retain staff puts more pressure to perform operationally. Yes, we must pay market salaries to attract and retain staff, but we must also improve operations to make the additional payments. Each year an organization must be that much better just to stay even.   

Years ago a plant operations employee told me that he appreciated seeing the organization’s monthly financials. He felt included and could get a good idea of potential overtime based on the financials. I find leaders who see and understand the financials and the impacts are better communicators and leaders. It also takes the “we/they” out of conversations because the leaders know what is going on within the organization.

We encourage organizations to share monthly financials and implement educational sessions so all leaders and staff know and understand organizational issues. Personnel should understand all key areas, including financial performance beyond the sharing of results at monthly departmental meetings. Owners know the data. The transparency of financials creates ownership behavior that we all seek from the workforce.

Senior Leaders:

1. Do all leaders understand the financial pressures, the financial performances, and steps needed to be taken and why? Recently, I was at a fairly good organization that polled the leaders on their understanding of finances. It was quite a wake up call.
2. Do you have a system in place where leaders clearly understand and have the ability to take the information to their staff in a constructive way?
3. Do you have a way to verify it is being done? I follow the late President Reagan’s philosophy: trust and verify.

Leaders:

1. Have you taken ownership to learn your organization’s financial operations, pressures, and next steps?
2. Do you have the skill set to communicate the financials, next steps, and why certain actions are necessary in a non blaming way to staff?
3. Are you comfortable asking senior leaders for information and education so you can do a better job?
4. When you share information with staff, do you create the culture in which you expect staff to contribute with ideas and solutions and follow guidelines that demonstrate behavior to improve operations?

Staff:

1. Do you provide ideas and solutions to improve financial performance?
2. Do you take time to read and listen to information on financial operations?
3. Do you role model for other staff stewardship of resources?

Help Us to Help Others:

If your organization has a system in place that works well to teach and cascade information, please send us your tactics and strategies.  We will give your organization full credit as the source.

We are all in this together.

Tips for Communicating with Senior Leaders: How to Get Your Message Heard

When I travel the country, I sometimes talk to leaders who say they feel frustrated because their boss does not listen to them, is not receptive to their ideas, or does not implement their suggested improvements. In my experience, one thing that is helpful is adjusting your communication style. Here are some thoughts on how you can get better buy-in for your ideas and create advocates internally.

When a CEO or vice president asks you—as a leader in the organization—that simple question, “What is going well?”, how do you respond? Before I was a vice president, I used to offer a lot of detail about the steps I was taking and the tools I was using to get results. I wanted leaders to understand I was committed to achieving our goals and I thought this approach helped.

However, consider the following examples of two medical unit managers, Leader A and Leader B. While both communicate the same results, they deliver them differently. Then ask yourself which message the senior leader would better hear.

When asked, “What’s going well?”, Leader A replies that things are fine. He explains that since he read an article on hourly rounding in the American Journal of Nursing last month, they’ve implemented hourly rounding on the unit. “All staff have now been trained,” he says, “and we have systems in place to round on patients every hour from 6 am to 10 pm. We especially pay attention to pain, potty and positioning.” Then he adds, “Some of the staff pushed back at first, but now they see the benefit. The call lights go off much less frequently, so the staff can spend more time doing what they love: taking care of patients instead of crisis management.” He finishes by explaining, “We have been tracking the results, too. We’ve reduced falls this quarter from a historical average of three to just one. Because we’re more efficient, overtime has decreased from 4.5 per day to one hour volume-adjusted. This will save us $4200 per month or $50,400 on an annualized basis…not including the reduced expenses and better risk exposure from reducing falls.”

Leader B, when asked the same question replies, “Things are fine. In the last quarter, we’ve reduced volume-adjusted overtime by $4,200 per month or $50,400 annualized. Patient satisfaction is now up to the 89th from the 59th percentile while falls are now one per quarter versus three.”

If you think that CEO or vice president perked up quickly when she heard Leader B’s results, you’d probably be right the majority of the time. Because leaders juggle so many challenges and responsibilities, they are especially grateful to get a quick overview of results first. If you start with the outcome, they will often ask to learn more or how they can help. In the first example, Leader A opened with the process and finished with the outcomes and probably lost the listener’s attention before he got to the good stuff. In the second example, Leader B delivered the outcomes first. He immediately created an engaged listener in his senior leader.

In working with many organizations daily across the country, I notice that many leaders use the Leader A approach. Instead, I recommend you always lead with outcomes for better communication.

Use these tips:

1. Open with results and outcomes.  Make sure you can quantify what you achieved. Good effort is no excuse for lack of results.
2. Be prepared to explain more.  Once a listener has been provided the results, be ready to outline “the how” if asked. This helps the listener know the key steps for success. Great organizations always look for ways to replicate strong results in other departments or take them system wide.
3. Show calculations if requested. For example, by lowering the left without being treated from 3% to 1%, 554 patients received care that otherwise would not. With an average collection of $276 (554 x $276 = $152,904) an additional revenue of $152, 904 is generated. (Be careful not to overstate results, however, as you risk your credibility.)

Give it a try. Next time you are talking with your supervisor or staff, begin with the outcome. You will be rewarded with more engaged listeners and learners.