Archive for June, 2007

Reflecting on What’s Right in Health Care

June 19, 2007

There were many reoccurring themes at this year’s national What’s RIGHT In Health Care conference. Two items were evident:

  1. Success depends on the combination of passion and well-executed prescriptions.
  2. There are tremendous financial pressures from many directions on health care organizations and, thus, on their CEOs.  One of the pieces that resonated with our CEOs in attendance was the very specific return on investment tactics shared that overall had a $127 million return on investment.  Of course, the ROI can only be replicated by combining passion with well-executed prescriptions.

Also presented last week were new toolkits with specific how-to’s that will help integrate safety into operations and collaborate with physicians. Additionally, attendees were provided with an action plan template so they can put new ideas into action when they return to their workplaces. Attendees also took home a new book featuring a story a day for the entire year to help connect each day to purpose, worthwhile work and making a difference.

You will soon be receiving very specific information on how to access presentations and other material from the conference.

As for me, I will be attempting to take July off to see children, grandchildren, spend time with my wife, Rishy, and by the grace of God, spend July 21st celebrating my father’s 87th birthday and my Aunt Mil’s 97th birthday.  Every fire starter needs to rekindle their flame.

Thank you for your passion, willingness to make a difference and for answering the call to work in a field that has great purpose, allows us to do such worthwhile work and to make a difference.  After last week’s conference, I received an e-mail from an attendee who, upon getting home, had a miscarriage.  As she wrote of her and her husband’s heartaches, she described the staff that she interacted with and who now share a bond with her and her husband. She ended with a note thanking those who cared for her, her baby and husband for answering the calling to health care.

I also thank you for being difference makers.  We must continue our journey to make health care better.  We can make health care better.  And we know how to make health care better.

Thank you.



Overcoming the Full Plate Syndrome Part 2: Tools to Create More Time

June 7, 2007

In my last blog, I talked about ways that organizations can reduce conflicting priorities for leaders and give them the skills they need to succeed for higher job satisfaction and better outcomes. Specifically, I recommended integrating measurable, objective goals into the organization’s evaluation system; weighting the goals to create clear priorities; and committing to leadership skill development. If you missed this blog, you can read it here.
In Part 2 on this topic, I’d like to urge leaders to proactively take charge of their own time by working smarter, not harder.

Not New, Better
Sometimes when Studer Group begins coaching an organization and introduces new leadership tools, leaders will tell us they don’t have time to do so many new things. We find that they feel more comfortable—and are even energized—once they understand that they are not being asked to do additional activities, but rather, to use a more efficient approach for current practices to get more satisfying outcomes.
Consider this list of practices most leaders already do and what works better to achieve outcomes:

Current Practices More Effective Approaches
1. Hold department meetings 1. Use Pillar Agendas at meetings
2. Talk to employees 2. Round for Outcomes
3. Employee reward and recognition 3. Write thank you notes
4. Employee selection and orientation 4. Use peer interviews and 30/90 day      meetings
5. Retain employees 5. Hold individual employee meetings
6. Talk to patients 6. Use key words at key times
7. Pre- and post-calls to patients 7. Pre- and post-calls to patients
8. Evaluations 8. Leader evaluations
9. Conduct leadership training

As you can see, the only new item on the list is leadership training. This is critical and necessary to ensure that leaders are growing the skills that move organizational performance and can manage their full plates. Aside from that, we recommend hardwiring more efficient tools that get better results for things leaders are already spending time on.

“Not New, but Better” also means that things leaders currently do on an occasional basis—say, holding a department meeting only when it seems urgent—now get done on a scheduled basis to ensure strong communication with an outcomes-oriented agenda that impacts organizational goals. Likewise, while some nurses may talk to some patients sometimes, we recommend standardizing the use of key words at key times.  Remember—CMS will soon be publicly reporting on whether your patients say you “always, sometimes, or never” are responsive to their needs. When every nurse every time uses the key words, “Is there anything else I can do for you? I have time,” patients answer “always” on their surveys. Read my blog on always here if you missed it.

So, not new but better. Studer Group coach Tonia Breckenridge recently presented some excellent suggestions on how to manage the full plate at the third Leadership Development Institute of a Studer Group partner organization and received excellent feedback from leaders. So I wanted to share her suggestions with you:

  1. Regularly evaluate your activity versus your outcomes. Meet with your supervisor on a scheduled basis to review your annual goals and 90-day plan. Discuss what you are doing that does not contribute to your outcomes and whether to continue these activities.
  2. Develop people.  When you delegate, you give others the opportunity to grow while opening up space on your own plate to take on key projects that will accelerate outcomes. Tonia cites a personal mentor who is masterful at identifying and capitalizing on the best strengths and skill sets of those he supervises, instead of trying to fix their weaknesses. As a result, his own capacity to achieve more is always increasing.
  3. Deal with low performers. Low performers eat up your time. Nobody ever wishes they waited longer to fire a low performer. Move their performance up or move them out of the organization quickly. It will save you time—and much pain—in the long run.
  4. Round for Outcomes. Even if you have as many as 60 direct reports, you can accomplish this in 30 minutes a day and connect with each individual at least once monthly. (This assumes you round on 3 individuals daily, spending five minutes with each person and allowing 15 minutes for follow-up on identified issues.) Hardwiring rounding will boost your employee retention and create a culture of problem-solving and recognition. You will get an unbelievable return on investment from this time spent with employees, physicians, and better patient outcomes.

Please add your comments to this blog and share your thoughts with our readers. We can all benefit from each other’s experiences.

Overcoming the Full Plate Syndrome Part I: How to Make Time for What’s Important

June 6, 2007

These are some words I hear a lot from leaders as I travel the country:
“I have too much on my plate. How can I possibly fit it all in?”

This is such an important issue that I’d like to address it in two parts. First, I want to share Studer Group’s experience on what organizations can do to increase the effectiveness of all leaders. In my next blog, I will share specific tactics for individuals that are highly effective.

In my seminars, when I ask attendees “How many of you have a full plate at work?”, almost all hands go up. In fact, I suspect that the people who aren’t raising their hands are feeling so overwhelmed they feel they don’t even have time to raise their hands. 

Senior leaders in the C suite say that responding to financial pressures eats up their day. Managers say they just have too much to do. But here’s the thing…when I ask seasoned leaders if they feel they had a full plate 10 years ago, the same hands go up. I can see them thinking, “I had no idea know what a full plate was back then.”

A Brief Look at History
So what was keeping us so busy ten years ago? Well, we were coming off re-engineering and were trying to learn how to do more with less staff. The Balanced Budget Act and managed care pressures were requiring us to do more with less money. Then there was the physician issue: Should we employee them? Not employ them? We were also agonizing over the aging healthcare workforce and how to meet the needs of the aging baby boomer population. Sound familiar?

We may call some of these challenges by slightly different names, but the pressures today are really just the same and just as urgent. We feel pulled in too many directions and frustrated by our inability to use our time to meet our mission.

But here’s a secret: We will always have full plates because we are passionate about what we do in healthcare. We’re also achievers. So even if something falls off the plate, we’re quick to add something new. Because we’re compassionate in healthcare, we’re also not very good at saying no when people ask us to do something.

The thing is, once we accept that the plate is always going to be full, we can be more effective managing it. In his book, The Road Less Traveled, the late author Scott Peck noted that “Life is difficult. Once we accept that, life is not as difficult.” The Big Book of Alcoholics Anonymous says it too: Ones’ serenity is in direct proportion to ones’ acceptance.

So What Can We Do?

If we agree that our success is measured by our ability to realize the organization’s mission through specific organizational outcomes, then we have to find ways to spend the bulk of our time on the priorities that impact these outcomes. Sometimes our desire to accomplish a lot clouds our priorities with excess activity.

In working with many organizations to create evidence-based leadership, Studer Group has found that the keys to achieving outcomes are alignment, execution and accountability. In other words, goals and actions are aligned across the organization and consistently executed.

 Leaders that we coach benefit from three key actions:

  1. Integrating measurable, objective outcomes into the evaluation system.  When we begin working with a new organization, we frequently find they are using a subjective, competency-based evaluation system. By themselves, these systems do not typically achieve the organization’s desired outcomes. Here’s why: Competency does not assure consistent execution. Competencies are the “what” that we do. Measurable objectives, on the other hand, show leaders expected outcomes. As a result, they also reveal the competencies required to achieve those outcomes.Competency-based evaluation systems are no doubt easier to put in place and receive less pushback from some leaders than objective evaluation systems do, but in the end they frequently do not achieve the outcomes the organization desires. We find that when organizations implement our leader evaluation system there is an immediate breakthrough in results and performance gaps are quickly identified for swift action. Many organizations also find them to be an excellent succession planning tool. It becomes clear what a leader needs to accomplish to move up in the organization.
  2. Using a system to prioritize these measurable outcomes. I recently heard a hospital president in New York—Jon Schandler of White Plains Hospital Center—explain that leaders tend to gravitate to their comfort zones, which frequently do not match the organization’s needs. The way to deal with this: Weight outcomes on a leader’s evaluation so priorities are clear.Here’s a situation Studer Group coaches frequently see when reviewing evaluations: An organization is focused on improving patient safety. Leaders are familiar with the CMScore measures being reported on. And yet, leaders who can most impact these clinical outcomes do not have a goal on their evaluation that would make this a high priority for them. Weighted goals in objective leader evaluations are what aligns the time the leader spends to the desired outcome.  In fact, a CNO I know recently credited the organization’s use of Studer Group’s Leader Evaluation ManagerSM for bringing the focus needed to cut ICU central line infections by 46% (a $432,000 annual savings). You can read another case study here.
  3. Building leadership skills.  If we all agree the external healthcare environment will continue to get more difficult, then it follows that more skilled leadership at all levels of the organization is necessary for success. Developing skills in our leaders is the lynchpin to making gains and sustaining excellent outcomes. Just as many organizations host “skills days” to validate clinical competencies, so must we validate leadership skills.Senior leader teams that take the time to identify the skills their leaders need to achieve specific outcomes and have methods in place to attain and assess these skills will do well in the future. While it’s true that any new skill requires some extra time to master initially, the return on investment of time is huge as we improve. Rounding for Outcomes, for instance, requires a little time to become efficient, but it gives leaders back hundreds of hours when low performers move up or out and repetitive, routine problems are finally fixed once and for all.Isn’t reducing leadership variance at least as important as standardizing purchases through approved vendors? Or use of the corporate logo? I wonder, because I find that many organizations spend more time on these things than they do reducing leadership variance. High-performing organizations create clear leadership expectations for service and operational excellence and hold leaders accountable for meeting them. But they also provide a road map on how to get there with training on specific leadership competencies. From training managers how to hire the best employees to teaching strategic change leadership to senior leaders, leadership development matters.

Hardwire It

At Studer Group, we use the term “hardwiring” to describe the process of putting systems, skills, tools and techniques in place to assure consistent execution. Leadership training and an outcome-based evaluation are two of the most critical tools to hardwire. When an organization puts a structured management system in place with these elements, it creates the kind of accountability that assures the culture will outlast the people in the room.

The reality is that my plate and your plate will always be full. But we can manage it with confidence and success if we have the right tools.

As always, I am interested in your thoughts on this. Please share your comments.