Setbacks are universal. Every person, department, and organization experiences them. As long as the external environment is in a state of change, setbacks are inevitable. Also, completely unexpected occurrences will cause disruptions from time to time.

While the movement downward is significant, it’s an organization’s ability to bounce back—and bounce back quickly—that separates the best performers from the rest.

Clark Memorial Hospital in Jeffersonville, Indiana, is such an example. The organization has been recognized for excellence many times. Solucient listed it as a top 100 hospital. Studer Group has twice recognized it as Fire Starter of the Month. Other accolades include Best Places to Work, Kentucky Quality Award, and Economic Impact Award. It was an Indiana Excellence Award finalist. It received a Baldrige site visit in 2009.

Plus, the hospital’s results in Service, Quality, Finance, People, Growth, and Community have been solid for years.

So what happened? In the first quarter of this year, Clark had everything in place for an increase in patient care volume. But it did not come. A hospital that had always made money found itself, suddenly, in the red.

Here is what its leadership did, and they did it quickly: Senior leaders reduced their pay by 12 percent, and all other leaders reduced theirs by 10 percent until the organization was back on track. Not one leader left.

Staff focused tighter on all operations to improve productivity. In just one quarter they were back on track. During this time, staff turnover went down, productivity went up, and patient satisfaction stayed above the 90th percentile.

The organization is very transparent. It has been developing leaders for years and conducting employee forums. Leaders used their current methods to communicate all this information, the needed changes, and the “why” behind them. Their efforts paid off.

In summary, no one is immune to tough times. It’s how agile the organization is that counts. Having a strong foundation in place—one characterized by transparency, measurement, communication, hardwiring actions, and accountability—allows for quick action. Senior leaders lead the way with role model behavior.

In his newest book, Bounce, author Keith McFarland describes that every great organization faces adversity and setbacks—it’s how the organization bounces back that is the key. I agree. Over the years, I’ve seen his message played out by the organizations I serve…and I expect to see it proven again and again as we head into the future.

Sincerely,

Quint Studer, CEO

Studer Group

http://www.studergroup.com/

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Click here for more information on Quint’s new book, Straight A Leadership: Alignment, Action and Accountability.

For years, healthcare leaders have been evaluated by means of a “Does Not Meet/Meets/Exceeds” scale. The problem with this is that it doesn’t really tell you what the leader accomplished. I believe a far more fair method is the use of a clear, objective, and weighted evaluation based on specific goal achievement.

The evaluation makes use of a one-to-five rating system for each goal, with the leader who exceeds expectations earning a five. And every goal is assigned a weight – a percentage – based on its importance so that leaders know where to put the most energy. However, my work with hospitals across the country has taught me that implementation of this leader evaluation system can be challenging for some. The good news is that missteps can be fixed with an understanding of what went wrong.

Here are the top ten, most common mistakes made during the first year of rollout and how they can be avoided:

1. Inappropriately assigning organization-wide goals to middle managers. For instance, it’s not uncommon for a hospital to assign its overall patient satisfaction goal to middle managers who have nothing to do with direct patient care. Instead, these individuals should have goals relevant to their position in the organization.
2. Goals are over- or under-valued in their assigned weight. Make sure you assign weights according to the goal’s importance and impact on the organization. The more significant the goal is to the organization’s success, the higher its weight should be.
3. All leaders share the same weights for a goal, even when their responsibilities don’t impact the weights. Leader’s goals should be weighted according to what they’re directly accountable for. Why should a person with minimal financial oversight, for example, be given a budgetary goal weighted at 50%? Yet I’ve seen it happen.
4. Instead of the outcomes, tactics such as projects or processes are used as goals. Don’t confuse the two – a tactic is the process/project used to reach a goal.
5. Designating healthcare regulations as goals when they’re really expectations. Regulatory standards should be a presupposed life style in the healthcare world.
6. Leaders fail to accept responsibility for far-reaching organizational goals they directly impact. Any leader who has influence over whether or not an organization-wide objective is achieved should own that goal.
7. Lack of uniformity in measurement. Define the measurement criteria for achieving a goal and what success will look like. Otherwise, leaders will invent their own definitions, targets or metrics …which results in confusion and inconsistency across the organization.
8. Leaders are allowed to “cherry pick” the easiest goals to meet instead of the most important. Cherry picking the undemanding targets gives staff the opportunity to achieve its goals, the leader looks good, and there is cause for celebration. However, in the long run, the organization suffers when a leader fails to concentrate on the important goals, the ones that will make the most difference.
9. Setting numerical targets where all leaders move up at the same rate. For instance, an organization wanting to move patient satisfaction results upward asks every leader to be responsible for increasing the scores by ten points. One manager is at the bottom of the barrel with patient satisfaction at 5 percent, while another one has achieved an 85 percent approval rate. Yet both are expected to improve at the same rate. This puts the first manager shooting for 15 percent, hardly much of an upgrade. But the second one will have to hit 95 percent, a very difficult thing to do – plus it’s hardly fair. The organization needs to consider rate of improvement instead of targets founded on the baseline when setting goals.
10. The goal is achieving a prestigious reward as opposed to the outcomes themselves. Don’t put the cart before the horse: Outcomes and results should be the priority – the awards will come. Remember, it’s the journey which warrants a Malcolm Baldrige National Quality award or Magnet status…that takes the organization to a whole new place.

If you have any questions or suggestions on how to implement goals in your organization please feel free to email me at bill.bielenda@studergroup.com.
Yours in service,

Bill Bielenda, Studer Group Coach
Studer Group
http://www.studergroup.com

For more information on Studer Group’s Leader Evaluation Manager™ software tool that automates the goal setting and performance review process for all leaders, and to review sample leader goals visit http://www.studergroup.com/lem.

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If it doesn’t directly impact clinical care, is it still worth doing? That’s the question I was recently asked while speaking to a physician group.

(Before I go any further, let me say that I welcome having my beliefs questioned. It’s one of the benefits of being able to travel all around the country and interact with so many wonderful people. I have many opportunities to learn and to become better.)

Anyway, a physician in the room stated that he did not believe the patient satisfaction survey was of much value due to the fact that it does not impact clinical outcomes. He also felt that a patient could be very satisfied, yet not receive good clinical care.

Let me address the second comment first. I agree. It is possible for patients to rate their care high in a survey and still not receive great clinical care. This is where an organization’s values come in. I don’t know of any organization that feels good if patient satisfaction is high and quality is not.

The inverse is also true. Many times an organization’s clinical quality can be excellent but other issues can lead patients to feel they did not receive excellent clinical care.

My comment the other day to a group of physicians in an academic medical center was, "Let’s have the patient’s perception of care match the clinical quality you are providing."

Now, let’s go back to the challenge that started this blog entry: My first attempt to link the survey to the issue of clinical care was to read the questions. How well was your pain managed? How well were your needs responded to? How well were your questions answered? How well were things explained to you? How well were your home care instructions explained? I explained that I feel each of these can impact clinical care.

The physician disagreed, stating that these issues still may not change the clinical outcome. I then said, "So if a patient’s clinical outcome will not be impacted, then you don’t want your patient’s pain managed? Nor call lights answered?" The physician answered that of course he would want these steps to be taken.

That’s when it hit me. While I can connect the dots and also show more research that indicates a connection between patient satisfaction and clinical outcomes, the evidence really isn’t the point. There are times when even if actions do not impact the clinical outcome, certain behaviors and actions still need to be done.

Hospice caregivers do great work. Do their efforts change the clinical outcome? My first grandchild was stillborn. While the care and support given to my son and daughter-in-law did not change the clinical outcome, were they worthwhile? Yes, without a doubt.

Why do some people fight making some basic changes? I can’t take inventory for others, but based on years of experience, I do have some observations of my own.

For some people, it has to do with not being comfortable. If I am asked to do something that I am not comfortable doing and can come up with a reason not to do it, I have found a way to stay in my comfort zone. For others, I believe it is the fear of failure. They would rather not try at all than try and fail. I believe this is one reason best practices are hard to transfer in healthcare.

Some people may feel they are the voice for others. Have you ever noticed when someone is pushing back, he or she may often say, "Everyone," "Most people," or "Others," rather than coming out and saying, "Here is how I feel." Still others may feel they need more data before they can make a change.

It’s that last group of people, the data-seekers, who bring me back to the point. How much evidence is enough to make a change worthwhile?

I have come to this conclusion: There are times in life when we do the behavior even though there is not overwhelming research data to support it. We do it because it is the right thing to do. I can think of no reason more powerful than that one.

Sincerely,

Quint Studer

Passion and Gratitude: It seems that the more I don’t want to do something the better it is for me to do it. A good friend of mine, Marv Wopat of Milton, Wisconsin, for years has told people to sit down each day and make a gratitude list. It is what it sounds like, a list of what a person is grateful for.

I have also heard a phenomenon that when given the choice, the great majority of people would not trade places with someone else.

In healthcare a majority of people are in a job in which they make a great difference in the lives of others, work in relatively clean environments and like most of their colleagues, have good benefits and pay. When I ask healthcare workers, how many of you work two jobs to make ends meet financially, very few say they do. I understand this is not everybody, but most do not. In essence, healthcare workers do a job or provide a service in which they have a good aptitude and skill set. They make enough money that they don’t have to work another job to fulfill their passion. Not many people are this fortunate.

My father loved to duck hunt. He liked nothing more than to sit in a duck blind for hours on the Mississippi river, in cold weather, waiting for a flock of ducks to fly by. If he could, he would have done this every day of his life. So what’s the problem? He couldn’t find a professional duck hunting job. In order to afford the equipment to hunt with and to travel to his favorite duck blind and stay in a cabin year after year, my Dad had to work two jobs. During the week he worked in a factory, which covered family expenses, and on weekends he worked in a junk yard to earn money to fulfill his passion of duck hunting.

When I was last in Nashville, I asked some of the employees in the hotel what they were there for. Many said they were working odd jobs, like the one in the hotel, but they were really musicians or song writers or a publicist, etc. See, they have a passion. They also have talent, but in order to meet their goal they need to earn money doing something else.

Healthcare is loaded with passionate people, like you, who earn enough money doing what they are passionate about and can afford to live a fairly good life. We are some of the fortunate ones.

Marv was right. Every time I finish my gratitude list I feel better. Let me know if it works for you.

Thanks.

Sincerely,

Quint Studer

It’s true. If you ever want to laugh until you cry ask an ER nurse to tell you a story. If you ever want to be stopped in your tracks with your eyes welling up with tears ask an ER nurse to tell you a story. I worked as an ER nurse for awhile, as did my wife, so I have a great love and admiration for what ER nurses do.

We’re coming up on ER Nurse’s Day (October 14th) so I have been thinking a lot about ER nurses and their stories. Isn’t it amazing how stories, in general, can move us? If you think about it stories are how we learn. Probably your favorite teachers were those that told great stories and didn’t just read from a book.

What can we learn from ER nurse’s stories? First of all we can learn that within those stories there is much inspiration. I spend a lot of time encouraging people in healthcare to share their stories as I speak around the country and I talk about stories a lot in my book Inspired Nurse as well as in my blogs and on the Inspired Nurse Facebook page. I do this because I have learned the power of our stories. They connect us back to who we are, where we’ve come from and what we are “made of” as nurses.

So…how can we make the best use of the amazing stories that live in our ER? Wouldn’t it be amazing to have a few of the ER nurses in your organization write their stories, their greatest moments in the ER and perhaps even their funniest ones? After they’ve done this perhaps post them in your newsletter, highlight them at a celebration, have them read these stories at a board meeting or even post them in the ER for all to see? Why? Because these stories will inspire. They will remind us why we do what we do. They will bring us back to the foundation of what we are as nurses.

As I always say when I speak at hospitals across the country, our stories are our “bricks.” They are what built us. Often, we don’t focus on these “greatest moment stories” though do we? Usually we tend to share more of the most recent and negative stories. After awhile, it seems as if those inspirational moments are few and far between. But they’re not. It’s just a matter of focus and attention. When you focus your attention on the negative, well, that becomes our perceived reality. Maybe it’s time we focus on some of the other stories?

So, dust off those amazing ER stories. Find some creative ways to get them out there and share them with your team. It’s often said that great organizations are known by the stories that they tell. So are great ER Nurses. Honor your ER nurses this year by laughing and crying along with their stories. I promise you two things about those ER stories. They’re never boring and they’re always inspirational.

One more tip. If you are a senior leader, another great way to honor your ER nurses would be to make rounds in the ER on ER Nurse’s Day to thank the nursing staff for the great work they do every day.

Be Well. Stay Inspired.

Rich Bluni, RN, Studer Group National Speaker

If you are looking for ways to celebrate this special day, seats are still available for the Nuts and Bolts of Service and Operational Excellence in the Emergency Department on October 14 – 15, in Phoenix, Arizona. You may also consider presenting staff a copy of Inspired Nurse by Rich Bluni or Excellence in the Emergency Department, which was just published by Studer Group coach Stephanie Baker.

It is not finding best practices – it is transferring them.

Recently I attended a think tank meeting in Washington, D.C. At the meeting a well-known political leader, who was very engaging, said that if hospitals learned from non-healthcare companies how to improve process, healthcare would be much better.

He passed out a whitepaper with regards to funding a study which combined 5 top healthcare systems with top academia experts in areas such as process improvement. The paper went on to show how implementing the processes used in academia would help improve healthcare. They show how a physician, in streamlining processes, improved clinical care and reduced cost. It is a paper that is hard to disagree with in its intent.

I have great respect for this person and agree that there is solid room for improvement in both quality and cost regarding healthcare performance. I just don’t think we need another study on what to do to improve or create high performing organizations. We see high performance firsthand and read about it all the time.

As we seek to improve quality and access and reduce cost nationwide, to me the real question is not finding new best practices. The critical issue is how to transfer already existing best practices.

Why has this been so hard to accomplish in healthcare? There are areas in which high performance is transferred quickly. This is particularly true on the supply side. When a technology or pharmaceutical vendor has new software, equipment or medication they are quick to push the product into the healthcare arena. The challenge is not in purchasing such items, for the vendor will show the return on investment, the challenge is maximizing the value of this product in the organization. So the supply side of healthcare pushes what they feel are improvements into organizations and spends millions of dollars to make organizations aware of items and the value of each.

Often, the best practices related to demand, efficiency and effectiveness may actually require less expenditure, not more. They likely don’t have millions of dollars in advertising or sales tied to them. In reading an example of a physician best practice outlined in the white paper, if all physicians implemented, some on the supply side would do worse financially. So for some best practices there may not be an avenue to promote them by private companies. I am sure suppliers are looking to improve healthcare, and I do not fault them for doing what they feel is right, which is to have the organization purchase their solutions. My point is many improvements in healthcare are around people, systems, processes and execution; these most always require behavioral change. It’s not in the use of a new tool or medication. Substituting one medication for another is not a new behavior. It’s not a new generation of technology or software but many basic behaviors that need to change.

In order to implement the changes that we identify a need for through TQM, CQI, Six Sigma and Lean, it will come down to the organization’s leaders’ ability to align behavior, drive or entice actions and to hold people accountable. There is not a shortage of sound examples in healthcare. It is the inability of an organization to transfer these examples within their own organization, or even harder, to transfer from other organizations to their own.

For the past 6 months we have conducted a survey with many healthcare organizations. One of the questions we ask leaders is to rate their ability to transfer best practices within their own organization. On a 1 to 10 scale, with 1 being the lowest and 10 the highest, less than 10 percent of the senior leaders rate their organization’s ability to transfer best practices a 9 or 10. The average rating is a 5.

In my new book, Straight A Leadership: Alignment, Action and Accountability, which will be out shortly, I address the challenging issue of moving best practices. There are some obvious points and some below the surface issues.

Here are a few we have learned:

Issues below the surface:

1. Leaders want their autonomy. By implementing some other way of doing something the leader will give up a bit of their autonomy.
2. Leaders fear that if someone shows a particular method to work and they fail to successfully implement it, that this will be a bad reflection on their leadership. We can learn a great deal from physicians here. They are quick to duplicate others processes if they feel it will improve patient outcomes.
3. Some feel they are different or suffer from the disease of being terminally unique. We are so much more alike in healthcare than different. This can also come across as rationalization.
4. Ego. By the time some people get to the C-suite they are better leaders than followers, thus to copy or duplicate another leader or organization is hard.
5. Too much change. There is so much change in so little time that the new way is not mastered and this feels like the practice did not live up to expectations or, because the execution was not crisp, it led to desired results not being achieved.

Other issues:

1. Leaders who have best results and best practices are reluctant to promote them. The majority of leaders in healthcare are humble individuals who will say they are just doing their job and do not see what they are doing as special. So they do not promote them. Due to little money budgeted for a vendor the leader does not have a public relations and research arm with a sales force to take their practices elsewhere. Thus, best practices can be missed in an organization.
2. Some may feel it is the leader and not the process. Often, leaders who discover, create and or implement best practices are high performers in an organization so the focus is on their skill and not the practice. This is many times part of the equation so the actual practice is missed or underestimated.
3. The leader downplays what they are accomplishing. In healthcare I find that leaders are reluctant to take the spotlight and will downplay what they are doing. I have example after example of this. When I go to an organization I review data. I then visit a leader with outstanding results. When I ask them what they are doing, the first response is “nothing different from anyone else.” I then dig deeper with more specific questions and then I hear, "Well, we are doing this . . . " This then starts to identify processes, tools and techniques contributing to the high performance.
4. The leader is reluctant to teach others. When the high performing leader is asked to present what they are doing to others in the organization, they are reluctant. They often say they don’t want their peers to feel they are saying they are better or they don’t want others to feel bad. If they do present they tend to hold back and even give reasons why they can do it but it may be hard for others to do. They feel uncomfortable separating themselves from others. In fact, they will do a better job explaining what they are doing to people from another organization versus their own.
5. The leader fears they cannot sustain the success if word gets out.

Tips:

1. When a leader’s results starts to separate into better or high performance take time to view and diagnose what is being done. This needs to encompass any change in process, tools or techniques. Just as important, diagnose any change in the leader’s behavior.
2. Take time to document the findings in Tip 1.
3. Create on paper a best practice transfer system that outlines outcomes, process and answers to any push back that will come from others. This is why best practices in one organization are so important. This takes away geographic and demographic excuses or items like staffing, pay, benefits, physicians and corporate. If this leader can do it here so can others.
4. Assess needed skills to implement best practices: The person who created or implemented the best practice first has some skills that others may not. Assess what skills a leader must have in order to implement the practice successfully. They do not likely have an early adopter personality so skills that are there with the early adoptor are not there and must be acquired. If the leader does not have these skills, you may have to change the leader.
5. Accountability: The best practice is meant to improve performance.  Are the desired outcomes included in the leader evaluation that monitors and evaluates performance? If not then the best practice becomes an option and will likely not be optimized.
6. Are behaviors spelled out and sequenced for success? This will avoid making changes too much and too fast which leads to transfer failure.
7. Put in validation systems. Tools that validate implementation are critical to measure implementation. Trust but verify.
8. Spotlight with recognition those areas that are doing well in implementation. Ninety-two percent of people will move to what is being recognized. Use meetings, emails, letters and other avenues to spotlight those areas that are implemented well as milestones are reached. If you wait until you achieve the ultimate goal before acknowledging, you may never reach it. Those areas being recognized feel good and others who are not will notice and most likely move to the desired behavior.
9. Identify the why and keep in front of the organization. In healthcare, when changes are being made, there are valid reasons and plenty of why. Make sure the why is communicated often; such as improved care to save more lives, better access to help more people, lower expenses that provide better organizations and staff security. In healthcare the “why” drives the “what.”
10. Have a firm plan in place for those who do not have the will, the skill or both. If a leader has the skill to implement a best practice then the question is does the leader have the will. If they have the will, the question is do they have the skill. If they have both will and skill, success will be there. If they have one and not the other, ask yourself whether they can acquire the other, how fast and at what cost. Decide if the time and cost are worth the investment. If you feel it is not, then move quickly to remove the leader from this position. Over the years many best practices have taken a bad rap for lack of leadership.
11. Standardize the steps and learn from your organization’s experience. Make sure you have in place the best technique to transfer best practices generated within your own organization and also those you learn from others.
12. Relate, don’t compare. There is not a shortage of better ways to do things in healthcare, nor is there a lack of desire to share. A great characteristic in healthcare is the willingness for organizations to teach and learn from each other. While there will always be differences, the similarities will outweigh them. Relate on how to transfer.

Healthcare can spend lots of money to study non-healthcare organizations (who by the way are also not doing that well), to bring outside learning into healthcare (already done), or they can solve the real issue: how to transfer high performing leadership characteristics, tools, processes and techniques that increase access, achieve high clinical outcomes and lower cost throughout all healthcare organizations. There is not a magic pill or process. It is an organization’s ability to standardize high performance into their daily operations.

Sincerely,

Quint Studer, CEO
Studer Group
http://www.studergroup.com/

I was reading a story in a book about a person who turned his life around. One sentence just jumped out at me. The person said he used to reduce his goals to fit his behavior. His life turned around when he changed his behavior to fit his goals.

Right away I thought of healthcare. Over the years I have met thousands of people in healthcare, been in hundreds of organizations, and spent countless hours with senior leadership teams. I reflected on what I had read; do we change the goal or the performance? To me, this is one of the key characteristics that separates high performing organizations and individuals from those that are not high performing.

High performing organizations do not lower the goal; they increase their performance. They understand this will mean changing actions (behavior).

Other organizations spend their time discussing why they are different and lowering goals to fit their performance.

Which type of organization do you work for? What do you do? Do you change the goal or change your behavior?

I found these to be real gut check questions.

Organizations that make discharge phone calls reduce non-reimbursable readmissions between 20-30%. Research shows that patient/family likelihood to recommend a hospital is above the 90th percentile when they receive a discharge call. Research shows litigation goes down when a patient receives a phone call after discharge.

So how do organizations execute discharge phone calls?

Who to call:

When to call:

Who calls:

What to say:

Why:

Discharge calls produce better clinical outcomes and are the right thing to do for patients and families. It’s a great way to verify that patients understand post-care instructions which reduce preventable readmissions. Most importantly, lives are enhanced and saved.

For best practices and frequently asked questions about discharge phone calls, contact Rachael Johnson.

The research is clear – teamwork, communication and a collaborative work environment each directly impact patient safety, patient satisfaction, employee and physician turnover, and even healthcare costs. The expectations upon healthcare organizations to address these issues are also clear. With the Joint Commission Sentinel Event Alert last summer, leaders must create and implement a process for managing disruptive and inappropriate behaviors.

What is less clear is how well-trained healthcare professionals are in addressing and managing the types of unprofessional behaviors that undermine these same outcomes. In partnership with Vanderbilt University Medical Center, the Studer Group is launching what we hope will be the largest ever study of disruptive behaviors in healthcare. Our goal is to identify the types and frequency of these behaviors and the tools and skills you have to deal with them. Whether you deliver direct patient care, provide support services or serve in an administrative capacity, I invite you and your colleagues to take part in this study.

This study was first announced in our monthly newsletter and remains open through Friday, June 12th. Click here to complete the survey. The 20 minutes of your time to complete the survey will provide insight into the training and resources needed in healthcare organizations to address disruptive behaviors that affect the well-being of staff and the outcomes of the patients we care for. We commit to sharing the results of the study broadly and free of charge this summer.

Every day, each of you makes a difference in the lives of the patients and families you care for. Thank you in advance for taking the time today to make a difference in your work environment by spending a few minutes to tell us about your experiences.

Yours in Service,

Craig Deao
R&D Leader
Studer Group

Have you personally experienced disruptive or intimidating behaviors in your organization? Or have you been in a position where you were aware of others” unprofessional behavior and found it challenging to manage? If the answer to either is yes, were you knowledgeable of your organization”s policies and practices in place to address these behaviors, and did you have the skills for managing the situation?

Effective January 1, 2009, the Joint Commission has a new leadership standard of “zero tolerance” for intimidating and /or disruptive behaviors in accredited organizations. We want to hear about your experiences with disruptive behaviors in your work environment and how well you feel supported to address and manage those behaviors.

In partnership with Vanderbilt University, the Studer Group is launching what we believe will be the largest ever study of disruptive behaviors and managing them in healthcare. Our goal is to identify the types and frequency of disruptive behaviors in healthcare and the tools and skills you have to deal with disruptive behaviors. If you work in health care, whether you deliver direct patient care or provide support services, I invite you and your colleagues to take part in this study.

Click here to complete the survey by Friday, June 5th. The 20 – 30 minutes of your time to complete the survey will provide insight into the training and resources needed in health care organizations to address disruptive behaviors that affect the well being of staff and the outcomes of the patients we care for. We commit to sharing the results of the study broadly and free of charge this summer.

Every day, each of you makes a difference in the lives of the patients and families you care for. Take the time today to make a difference in your work environment by spending a few minutes to tell us about your experiences.

Yours in Service,

Quint Studer