Archive for September, 2007

“Always” Leadership

September 19, 2007

Consistency seems to be an elusive item in health care. Some shifts, some days, weeks, or months run well. Then issues arise that negate the gains. These methods to create and sustain those gains so interested Wiley publishing that they led to the publishing of my new book, “Results That Last.” In this article, Bob Murphy of the Studer Group has written excellent recommendations for how to become an “Always” leader.

We appreciate your feedback. I am so pleased many of you wrote regarding how helpful Debbie Cardello’s article on butterfly leadership was. Enjoy Bob’s article.

As I travel around the country, it constantly amazes me how much the same we are, how similar the issues are that we face. Right now, whether you are a leader in a hospital, health system, or medical practice you are facing the realities of financial pressures, competition, quality and service mandates, and labor shortages in critical positions.

When I ask leaders whether they think that health care will be more difficult in five years, everyone’s hands go up. Leaders know that if we do the same things we are doing now, in five years our results will be less than they are now. Just like when you’re promoted to a new role, the skills that helped you be successful to this point might not be the same ones you need to be successful going forward. For health care leaders looking to make an impact over the next five years, they need to become “always” leaders.

A recent challenge introduced by the Centers for Medicare and Medicaid Services (CMS), is destined to change the way we think about our roles as leaders. The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) “voluntary” survey of patients changes our fundamental language and attitude of leadership. The HCAHPS survey asks patients to rate us on the frequency of how often we do certain things. This is an important distinction from previous patient surveys which asked about satisfaction. Asking how often they saw certain things is very different than asking how satisfied they were with the same things.

Patients are asked: How often did nurses treat you with courtesy and respect? How often did doctors explain things in a way you could understand? How often were your room and bathroom kept clean?

The possible responses are “Never”, “Sometimes”, “Usually” and “ALWAYS.” When the results are  compiled and published on the CMS website, the only results we will see is the percent of “Always.” When CMS uses the data in its calculation of our reimbursement, they will likely use the percent of “Always” to reward high performing organizations.

Because of these external pressures, we are being pushed from being “Sometimes” organizations to being “Always” organizations. That means we likely have to move from being “Sometimes” leaders to “Always” leaders.

What does an “Always” leader look like?

  1. An “Always” leader has a plan! High performing organizations and their leaders have leader performance evaluations that are measurable, specific, objective, weighted and time-sensitive. The goals set forth in the individual leader’s evaluation are linked to the organization’s overall goals. A good, measurable, specific goal aligns the leader’s behavior to the expectations of the organization. Most leaders really appreciate an evaluation like this because it helps set priorities and tells them in advance what is necessary for success. Leaders have told me that they want to know how they are doing and what else to do to succeed. High performing organizations use monthly report cards and 90-day plans to help a leader with all that is on their plate. A good evaluation provides a prioritization roadmap for the leader and keeps leaders focused on what is important. As a leader, I am pulled in many directions at the same time. A good evaluation tells me where to focus my time and helps when I am asked to do “other” work. I can bring my annual evaluation, monthly report card and 90-day plan to my boss and ask them to help me prioritize the new work. If it does not fit into my annual evaluation, I will likely not waste my time and energy. A good evaluation system allows senior leaders to continuously monitor eader performance and provides for organizational agility.
  2. An “Always” leader takes accountability for their own development. If we agree that health care is getting harder and we need to continue to grow our leadership muscle, an “Always” leader does not wait for their boss to tell them to get training. An “Always” leader evaluates their skills and seeks out new ways to learn. An “Always” leader asks their supervisor if they are on track, what are they doing well, and what could they do better.
  3. An “Always” leader uses evidence-based leadership (EBL) tactics when appropriate . An “Always” leader follows best practices in hiring,
    retention, communication, reward/recognition, re-recruiting high and middle performers and dealing with low performers.
  4. An “Always” leader has a balanced approach. Many organizations balance priorities and activities between the focus areas of Service, Quality, People, Financial Performance, Growth and Community. All too often our staff thinks that all we are concerned about as leaders are financial results.
  5. An “Always” leader connects the dots consistently to purpose, worthwhile work and making a difference. Many of the staff we work with have a calling. They choose to come to work every day because of the special feeling they get while taking are of patients or taking care of those who take care of patients. An “Always” leader taps into that core feeling of making a difference by the way we communicate, what we reward and how we lead by example. Methods include sharing stories from other parts of the organization that demonstrate worthwhile work, recognizing staff members when they demonstrate the behaviors we know make a difference to our patients. “Always” leaders use every opportunity to connect to the hearts of their staff. What we do is special. Our patients entrust us with their lives and that is special. We should take every opportunity to tell and show our staff that what they do is important.
  6. An “Always” leader follows a sequenced approach to improvement. Most everyone reading this article is familiar with CPR (Cardio-Pulmonary Resuscitation). If you were faced with a situation where CPR was necessary, you would follow the ABCs of CPR right? First is airway, then breathing, then circulation or compressions. It is understood that you may never get to compressions if you cannot open the airway. Why? Because the compression would not be as effective. The same thing applies to leadership in many ways. Some of the tactics we teach at the Studer Group are advanced techniques and require some foundations or basics in place first. Now, you can skip steps, but the likely outcome is that you will not be as effective, nor will you be as effective for long. We know that Hourly Rounding is a wonderful tool to implement to reduce decubitus ulcers, falls, call lights and the distance nurses travel during a shift, but we usually do not recommend it be the first tactic you employ. We usually first recommend Rounding for Outcomes on your staff and nurse leader rounding on patients before hourly rounding. Why? Rounding on staff and patients by the leader first role models the desired behavior. It helps the leader show that they are aware of the issues on the unit and what patients want before asking staff to do that. Rounding on staff helps improve the personal relationship between the staff and leader. Leaders find out what tools and equipment needs there are on the unit. Leaders find out what is going well and can reward and recognize staff for demonstrating desired behaviors. When rounding is done consistently by leaders, staff are less likely to push back.
  7. “Always” leaders take best practices and standardize across the organization. An “Always” leader is trying to find a way to do their job better and get great outcomes. We find in many organizations there are leaders already getting the desired results such as low turnover, great productivity, high service, but, for some reason, it is not well known throughout the organization. Sometimes other leaders in the organization are aware that there is a leader internally getting great results, but there is a reluctance to do what they are doing. An “Always” leader breaks down those silos and barriers and duplicates what is working well.
  8. Failure to always do desired behaviors. As organizations move to improve results, we commonly find that changing the behavior of hundreds of thousands of staff members is very hard to do. The easiest thing we can do is change our own behaviors first. That requires a good long look in the mirror. I’ve had to do that so many times in my career, and still do since I still make mistakes.

As health care leaders, it is our responsibility to move our organizations from “Sometimes” to “Always.” The journey will be hard work, but one that is achievable if we use proven tools and techniques to guide us.

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


Butterfly Leadership. Does It Keep You From Achieving Desired Results?

September 11, 2007

Debbie Cardello of the Studer Group, former COO of Baldrige winner Robert Wood Johnson University Hospital Hamilton (NJ), recently used the term “butterfly leadership.”  I asked her to write more on this important topic.  I hope you find her article interesting and helpful.  Your comments are appreciated. 

You are probably wondering, what is butterfly leadership?  And what does it have to do with achieving results?  Picture a butterfly as it flies from flower to flower, tree to tree, then quickly flutters away in search of sweeter nectar.  As healthcare leaders, we face similar temptations.


I think back to days (I should say years) gone by when I was very frustrated that quarter after quarter, patient satisfaction scores stayed the same.  Sometimes they even got worse, despite how hard we were working to improve.  What I ultimately realized was that the team’s actions weren’t always aligned with goals and the “flurry” of activities prevented us from focusing on what mattered most . . . patients, employees, and physicians.


Good leaders in good hospitals experience these challenges every day. We also know that there is no magic bullet; and as caregivers, we will always find problems to solve and systems to improve.  On the other hand, if our energy is consistently diffused, our ability to be an effective leader is at risk.  We could experience a decline in performance, burnout, or worse yet – leader turnover.


What can we learn from the example above to help us focus and align our priorities, accelerate our performance, and avoid “butterfly leadership?”


Use the 90-Day Plan to identify what matters most.  We’ve all heard this great advice: don’t confuse activity with results. It’s so easy to do in the busy world of healthcare. Begin by identifying what’s most important. This is where a good 90-day plan can help.


A 90-day plan that outlines three to four action steps is manageable and helps us focus on next steps that will move us closer to desired results. Review the plan monthly with your supervisor to ensure you stay on track, and to get and give feedback on how to best spend your time.  Ask yourself on a regular basis, am I spending my time on value-added action steps, or is activity simply finding its way on my calendar?


Use Rounding to hardwire behaviors that matter most.  We know that changing behavior is one of the most challenging aspects of being a leader.  Behavior rarely changes by writing an email, sending a memo, implementing a policy, posting a flier on the bulletin board, or communicating it once at a staff meeting.


It is a process that happens one day at a time, and one person at a time through our rounding on staff and helping them connect their work to the mission and goals of the organization.  Praise staff in the presence of others when you see them doing the behaviors that you are trying to hardwire. By doing so, you communicate what behaviors are most valued and important to patient care on our unit, and in our organization.


In order to reduce variation, we must manage performance.  Most likely, you’ve already recognized your high and some middle performers for using desired behaviors.  You also have a pretty good idea of who is not.

Next is a most important step if you are challenged by consistency issues.  This is the time when many of us get frustrated and are tempted to “flutter” away, try something new, move on to another initiative, or throw up our arms in defeat and accept average results. Average results in healthcare could mean that a number of patients could still contract an infection in the hospital or be harmed by a medication error which consistent improvement efforts could have prevented.

Circle back and visit staff members individually to clarify that using the desired behaviors is not an option, it is a requirement.  Give your staff an opportunity to discuss why he or she hasn’t complied – it may be due to a lack of understanding or training.

End the meeting with the understanding that the behaviors will need to become a regular practice to avoid further action.  In my experience, a leader would have to do this with only a few staff – the rest figure out how serious you are, what’s negotiable, and what’s not negotiable.

Use Reward and Recognition to communicate what matters most.  A simple rule to remember in communication is that once is never enough.  We all need to hear information multiple times and in a variety of ways in order to truly understand.


Reinforce desired results with fun and interactive exercises that reward and recognize key behaviors.  Share the top three organizational or department priorities at employee forums or department meetings.  Ask employees to talk about one action they could take in their department to get the desired result.  Encourage staff to share success stories.  Give out fun prizes to volunteer participants.  Employees are more likely to relate to important information when they can apply it to their own job.


While butterflies are most productive when they are “fluttering” from activity to activity, healthcare leaders could benefit from focusing their actions on identifying, rewarding, hardwiring and communicating what matters most. The result is so much more than meeting a goal or a score – it’s making a difference in the lives of those we serve.


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