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Tuesday, September 4, 2012

Reasons for Poor Performance

I have to believe when a supervisor thinks that he/she is dealing with problem employees that there is usually another explanation than the employee came to work that day to do a bad job.  Maybe 5% out of a workgroup have been allowed to be low performers so long that they are demotivated, and don't care, and are beyond salvaging.  These employees need intervention to be managed up or out of the organization.  See the blog on "Giving Feedback" on how to deal with what I was mentored to call 2/3 employees.  With this blog I want to talk about some of the other more common causes of lowered performance that may not be so obvious, but must be addressed for the organization to reach peak performance.

When an performance issue occurs, do you think that the employee came to work that day with the attitude to perform below expectations?  I just don't think so.  The Gallup Organization tells us that people thrive in an environment where they can do their best work every day.  So what factors could prevent people from doing their best work every day?

INADEQUATE TOOLS & EQUIPMENT

Early in my career, there were times when I was expected to make Chicken Salad out of Chicken Sh_t.  One of our roles as leaders is to make sure that our team members have the proper tools to do their jobs.  This process starts by interacting enough with them (i.e. rounding) to ask that question.  I started working on ambulances in the days when they were gasoline burners before they were switched to diesel burners.  The gasoline burners were notorious for overheating given the rigors of rapid response, followed by idling at the scene, followed by rapid transport.  Mechanical problems were certainly not rare.  Employees who spend hours upon hours of their shift repairing, switching out equipment, or looking for absent equipment tend to become cynical.  It is so easy for this cynicism to come out in their interactions with patients, customers, and co-workers.  I am not saying that the leader is responsible to provide the absolute best in class of every piece of equipment, but certainly, when we ask someone to do a job they must have adequate tools.

INADEQUATE ORIENTATION & TRAINING

One of the more telling assessments to make after an incident of poor performance is to simply ask, "tell me how you were trained to handle this situation." It has been my experience that you expose deficiencies in both your initial orientation program and your ongoing training when you hear the answer.  The problem is VARIATION.  We should be shooting for consistency in how our new people are oriented.  However, how it usually goes in a busy environment is that we put the new person with one of our more experienced "preceptors" or "field training officers".  These individuals may or may not have had formal training in how to precept others, and may or may not meet together as a group to work on interrater reliability to assure that they are evaluating new employees consistently.  Each new employee gets a little different orientation which results in wide variation in performance once each person puts their personal "twist" on how to do each job.  If there is one word that an Education Director or Training Officer should have as a motto, it should be CONSISTENCY.

Another issue present under this section is the drive to push people through a prescribed orientation process.  One of the best processes I have seen involves a careful assessment of where each new candidate is and then modifying their track of orientation to where they need the most work.  Some people, based upon their past experiences may be able to be competent in a new role in days where others may take months.

The last issue I want to address here is the tendency to put an item for increased focus in new orientation after an incident, but fail to add that item in ongoing annual re-training.  Higher reliability organizations train almost constantly.  Unfortunately, healthcare has not always apportioned sufficient dollars to training and education to get the results that are expected.






POOR SUPERVISION

So, this couldn't be it....you're reading a blog to sharpen your skills!  This is when your peers come into play.  Employees tend to perform at the lowest acceptable level.  This is influenced by both the lowest performing member of the employee group and by the most easy going manager in the management group.  Employees who continually see one of their peers getting away with something tend to migrate toward that behavior.  Sort of a "bad apple" effect.  With regard to the most liberal manager, if you are managing as part of a group, it is hard to hold to high standards if one or more of the group is trying to play buddy.  The management team needs to spend some time to agree upon the minimum standard behavior to eliminate the "bad apple" effect and to spend time on consistency within the group.

PERSONAL DISTRACTION ON WORK TIME

There are a lot of situations that could be used as examples here.  Some, the employee may not be aware are causing a problem in the workplace.  An employee who is not being productive to the level expected after the manager has assured proper training must be assessed for other reasons for poor performance.  Over the years I have been shocked by some of the things that employees have done that endangered their positions.  Some of the more frequent distractions seen today are:

  • time on phone with personal calls (This could be initiated by the employee or a needy significant other)
  • time on internet (email, shopping, chat rooms, gambling, games, facebook, etc)
  • excessive meal time and breaks
  • watching television
If there are performance issues related to personal distractions, the manager can look for engineering controls such as locking down internet access and installing surveillance cameras to monitor employee activity.  


FINALLY,

Once reasons for Poor Performance are identified, they must be dealt with.  The biggest danger is that other employees will begin to lower their performance to the performance they are observing in their co-worker.

REMEMBER, WHAT IS PERMITTED IS PROMOTED

Saturday, September 1, 2012

Managing Diversity in the Workplace

You will notice a couple of new features on the blog.  On the right hand side there is a tool to translate the blog content into multiple languages.  A little further down you will notice a Guestbook where I acknowledge the various location by country of where my readers are.  In examining the fact that there are readers in various countries; I am reminded of the power of the internet; the universality of the need for information on supervision, management, and leadership; and the continued struggle to support diversity in the workplace.  Just in doing this blog, it never occurred to me that I might need to add a "translate button," although it was available from the very beginning, for those who did not have skills at reading English or even preferred to read in their native language if English was their second language.  For years I have worked with employees who were ESL (English as a second language) speakers and readers.  Honestly, I had not given a great deal of thought to the struggles that they faced adapting to communication barriers created due to the subtleties of the English language.  One thing for sure, I came to love and adore their ability to interact with patients that spoke their native language when the patients presented for care and we were lucky enough to have a bilingual staff member present.

IT's NOT JUST ABOUT THE WORDS

What I noticed was that when a patient is dealt with in their own language, it's not just the words that help to assess and fully communicate in a two-way manner.  People from the same cultures, or who have been through the same type situations can IDENTIFY with each other and this aids communication.  Having an appreciation for people's need for this is the first step in understanding and managing diversity in the workplace.  Let me use a non-racial, non-language oriented example.

Example 1 - 20 Years in the Military Culture

You are interviewing a person who has just spent 20 years in the military.  If you don't have a lot of military people in your workforce, adding someone who has been part of the military culture for any length of time will have a different vocabulary, set of expectations from leaders, work ethic, and experience set from your other employees.  To match this employee with your workplace how might you explore this.  As with all other issues involving diversity, the first step is for the leader to become more informed.  With regard to military transitions to civilian life you can look to several documents such as the James Madison University Counseling Center Resource Page.  Once the leader is informed, my best suggestion is to have a mentor or preceptor for the new employee who also becomes informed about potential issues and is prepared to be honest with the new employee.  The problem that I continually run into is that other employees engage in "eating their young".  When I say young, I mean new to the team.  When someone new comes onboard, I would like to see the preceptor or mentor fully invested in making the new person successful.  If the new employee says something or does something that others feel is funny, quirky, or awkward this behavior is likely to continue until the preceptor is honest enough to say, "Hey, you are not in X anymore.  Our way of doing this is Y.  I wanted you to know because your role during orientation is to learn to do things a standard way."

A bigger organizational problem that I may deal with in another blog is the need for all work cultures to be open to new ideas and best practices.  Here again, the military is a good example.  The fastest advances made in trauma care have come from the military in times of war.  The first use of helicopters to evacuate trauma victims, Military Anti-Shock Trousers (went out of vogue in the 80's) but came from the military, blood replacement products, etc.  So why would it be that a military nurse just in from active duty would have a hard time fitting in?  Is the onus on the nurse or on the colleagues he/she is joining?  My answer is both.  Any person new to a group should expect to have their skills and abilities tested and observed.  To come in like a "know-it-all" would be a mistake for sure.  At the same time, when someone joins your team, the ability to assess for new knowledge from outside your center of activity is a mature approach.  We should all be able to value each persons ability to contribute to the team.  So from the first example, let's try putting together a diversity checklist and add to it as we look at other examples.


  1. Develop culture for onboarding success through preceptor or mentor program where preceptor/mentor is honest and supportive to newcomer.
  2. Culture supports both transmission of group knowledge to each member and supports sharing of new knowledge within the group.
Example 2 - Not From Around Here

You are supervising a team of 9 people that have been transferred under your direction.  One of the team members seems to be called out by the others during the first meeting you have with the group.  They call him  "New York".  When he tried to make a suggestion, one of the other team members said, "You can't listen to New York".  While speaking with the former manager, you learn that this has been an ongoing issue.  Robert, a.k.a. "New York" came on strong when he was first hired a year ago.  He has been the brunt of jokes about how fast he works and always has better ideas than everyone else.

In dealing with this issue, an investigation into how deep any harassment goes is necessary.  However, you will quickly find the need to look at your organization's policies that define "diversity".  Unfortunately, there is no generally agreed upon definition of diversity.  After a lot of searching, my favorite one is the State of Oregon's definition which they have decided to present adjacent to a definition for Cultural Competency.

Definition of Diversity

The concept of diversity encompasses acceptance and respect.  It means understanding that each individual is unique, and recognizing our individual differences.  These can be along the dimensions of race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other ideologies.

It is the exploration of these differences in a safe, positive, and nurturing environment.  It is about understanding each other and moving beyond simple tolerance to embracing and celebrating the rich dimensions of diversity contained within each individual.


Definition of Cultural Competence

Cultural Competence refers to the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, disabilities, religions, genders, sexual orientation and other diversity factors in a manner that recognizes, affirms and values the worth of individuals, families and communities and protects and preserves the dignity of each.

Operationally defined, cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes.
 
Let's just say after talking to Robert that you learn that his team started calling him "New York" because of his accent.  This is offensive to him because he is actually from Boston.  He corrected his co-workers for the first month and then gave up.  He admits to coming on strong and can provide 3 best practices that he tried to introduce but was basically told to learn how we do things here and not make waves.  

I hope you are saying to yourself, I cannot tolerate this.  This is definitely not a nurturing environment!  So in addition to our first two checklist items, I am going to suggest some additions:

3.   An expectation exists that each employee is accepted and respected in consideration of all their     differences.
4.   All standards, practices, policies, and attitudes reflect cultural competence to increase the quality of services, thereby producing better outcomes.

Example 3 - Black Female Applies for a Promotion

There are plenty of studies that demonstrate that the percentage of African Americans and the number of Females promoted to certain jobs falls behind other.  The culturally competent manager will have designed a hiring process that will have created a fair playing field for each applicant.  Let's say the hiring process consists of years of experience (20%), college degree (20%), score on job test (20%), Interview by co-workers (20%), Interview by hiring manager (20%).  There is at least a 40% chance for subjectivity involved.  Although interviewing tools and training are available, the interview is very hard to keep objective. The culturally competent leader will not consider black or female as items of importance to consider.  To his/her advantage, the resulting team will be diverse.  






TIME TO BE HONEST WITH YOURSELF:

Which of the following circumstances would cause you problems being non-judgmental?  Based upon behaviors you see, and things you hear, does your team need more training?

  • An applicant for a data entry position, is noted to have difficulty pronouncing words as she is just now learning English as a second language.  She passed the proficiency test on data entry and apparently can read and write better than she can speak English.
  • An applicant for a professional nurse position has earned her nursing license back after having it suspended while in a drug treatment program.   She is still subject to random drug testing as part of aftercare.
  • One of your employees comes to you and explains that he will be taking a leadership role in the city's gay & lesbian community.  

FINALLY, A COOL STORY

Lest you think I gained my expertise by doing everything right, let me straighten that out.  I have made all the mistakes.  The thing is, that is how I learn best!  But one thing I am proud I did right was a simple act of kindness on my part but the impact was much larger than I expected it would be.  I was the Administrative Director of Inpatient Medicine at a large academic medical center and I got a call from one of my nurse managers that two of our employees, a husband and wife nurse team, had completed their requirements to gain U.S. Citizenship.  She asked if I wanted to go with her to attend their ceremony at the U.S. Federal Courthouse.  

As you know, I think it is a great gesture to make a personal connection with your team members.  Hospital visits, going to funerals, writing cards, have long been part of my toolbox.  But I will have to say that seeing two Filipino nurses being sworn in as U.S. Citizens has been a highlight for me.  It made me wonder why all U.S. Citizens don't have to take the oath that I heard them take.  Sure, we all grew up with the Pledge of Allegiance and took U.S. History and Civics classes, but the requirements to be a U.S. Citizen for non-citizens are very impressive.  I'm sure Andre had rather have had his dad present, but in his words "he had his boss and he had his boss' boss."

One great part of the ceremony was when the federal judge read to the Naturalized Citizens their newly acquired Rights and Responsibilities.  One of our responsibilities as citizens is to respect the rights, beliefs and opinions of others.  It is the first time that it dawned on me that failure to respect diversity was also poor citizenship.

Wednesday, August 29, 2012

Micromanagement: aka "Driving Your People Crazy"

I have written before about how to delegate.  Here are some do's and don'ts for delegation as a review:




DO's

delegate tasks that can be done better by someone else.

delegate tasks that will develop another person.

delegate tasks that are repetitive in nature.



DON'T

delegate things that you just don't want to do.

delegate things that you are not willing to be responsible for if mistakes are made.

Leaders can be more effective when they get things done through others. For more information about delegation, see: Article

The most frequent way that delegation goes wrong is not by the person that the management activity or responsibility is delegated to.  It is, in fact, by the leader who delegates and then does not appropriately allow the subordinate latitude to handle the situation and in doing so subverts the process of delegation.  Sometimes the leader actually performs the work that has been delegated with a "nobody can do this better than I can" connotation.  This backfires in a couple of ways.  First, work that is delegated is intended to be shifted from one person's responsibility to another.  When the first person does the work, it was useless to ask another person to get involved and whatever potential time was freed up is now lost.  Second, for the person that has been delegated to, to have the work overly scrutinized or taken back and done by the leader is demoralizing.  Having things delegated to you is a compliment in your ability to handle more and more individual responsibility.  To then have that pulled back and done for you is embarrassing.

Wikipedia's entry on micromanagement has a great discussion on the pathology involved in those who micromanage others.  I recommend reading it in full.  The bottom line is that people who are micromanagers are workplace bullys or have severe narcissistic tendencies.  They also are unlikely to be able to self-identify their behaviors. 



The Road to Recovery

Mary has just received her results from a 360 degree survey.  The interpretation is that compared to other leaders she is below expected level as judged by her management team.  After meeting with her team, it is clear that she is seen as a micromanager.  She is working an 80 hour week trying to be present for all decision-making meetings and her entire management team is afraid to make a decision without her input.  She has been having individual meetings with each of her direct reports every week plus requiring a weekly written report.  Her management team has told her this is overkill and they don't feel that they have time to manage for having to keep her informed.  Mary has felt overworked but has not been able to self-identify any micromanagement issues.

After reading the Wikipedia materials, does it appear that Mary may have issues?

What steps could Mary take?

Mary decides to have a professionally facilitated retreat with her management team.  The results of the 360 degree survey will be presented as well as overall performance of the division.   Mary takes the following steps:

1.  Preplans the retreat with the facilitator.
2.  Evaluates with the facilitator how she is using the written reports that she is requiring on a weekly basis.
3.  Evaluates the benefit of weekly individual meetings with each direct report

Please comment on this blog.  Do you think Mary is a micromanager, do you think she is on the road to recovery?  What other steps should she take?


NOT MICROMANAGING DOES NOT EQUAL "INATTENTION TO RESULTS"

We looked at Lencioni's Model of the 5 Dysfunctions of a Team when I wrote about the importance of trust.  The peak of the pyramid in this model is inattention to results.

Functional teams will have both manager who are accountable for what has been delegated to them and leaders who pay attention to results.  The point here is that there is no need for the leader to continue to try to do the job of the manager and their own job as well.  Once a job or role is delegated, the leaders responsibility is shifted from actually completing every task to:

  • periodically checking in with the person the role has been delegated to
  • removal of barriers beyond the scope of that person to move forward
  • reviewing the results obtained on a regularly pre-established basis


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Friday, August 24, 2012

Priorities: The Management Team Meeting

If you are the leader or a member of a management team, this is for you.  Out of all the priorities that the management team has, taking time to meet together and get on the same page is one of the most important things that the team does.  If I had to state the most important reason for this, it would be

 to improve the consistency of management actions experienced by the staff members.

In just about every staff satisfaction survey, inconsistencies in the application of company policies and procedures and a sense of unfairness is cited as a problem in the workplace.  The only way that the management team can be consistent is to regularly discuss issues and talk through their philosophy on how to deal with particular issues.

THE WORK OF THE TEAM

The test of teamwork within the team is to assure that every member of the team is more committed to the work of the team than their individual opinions.  I like
CHALLENGE UP / SUPPORT DOWN
as a catchy way of remembering that when I am the leader of the team, I must remember to create an environment where everyone feels that they can challenge my thoughts and decision-making.  Inviting other's feedback is important to getting to a better decision.  The managers in the group have a responsibility to speak up and assure that all alternatives and issues have been fully explored.  Once a final decision has been made, everyone in the management team, must support the decision down to the staff.  There can be no "Brent said, we're going to....".  There can be no manager who says "Although I don't agree with this, we have to....".  Challenge Up / Support Down means that all of my issues are put on the table during the initial discussion, but once the final decision is made, my job is to represent, without hesitation, the position of the team.

AGENDA PLANNING

Everyone on the management team is busy. But management team meetings must be protected time with required attendance.  First of all, Challenge Up/Support Down is diluted if managers are not present to be involved in critical discussions.  Secondly, Managers are usually appointed according to divisions of labor representing certain staff member groups.  Failure to be present for management meetings means that the opinions and feedback of the employees affected by decisions may not be taken into consideration.  As hard as it is to preplan, I recommend a formal agenda with standing items and then current events that people need to discuss added in with a few minutes for each person during a "round robin" style format.  A sample agenda follows:  (Comments in parentheses are editorial)

ABC Management Meeting

I. Opening Remarks                                                       5 minutes                    Brent
     (the leader should start and end the meeting on time)

II. Reward & Recognition Opportunities for Staff            10 minutes                  Managers
    (some meetings deteriorate into bitch sessions about what the staff members will not do, a best practice is to start the meeting on a positive note harvesting things that the staff has done well since the last management meeting)

III. Policy Change Needed  Attending non-required         20 minutes                  Brent
      courses is not paid time

(This will represent a big change.  The discussion needs to be in the Challenge Up / Support Down style. A plan should be developed on how to discuss this with the staff.)

IV. Issues from each manager                                        10 minutes each            Education Manager
                                                                                                                         Quality Manager
                                                                                                                         Team A
                                                                                                                         Team B
                                                                                                                         Team C
                                                                                                                         Site II Manager

V. Adjournment                                         total time    95 minutes




Failing to Plan is Planning to Fail




DOCUMENTATION OF MEETING

Meeting minutes are a must.  There will be many times when you find yourself knowing for sure that xyz was discussed at a meeting and someone else has no recollection of that.  I have cut my meeting minutes down to bullets and combined them with the agenda so that the final meeting record is a document that includes the agenda, attendance, and minutes.  If you go to as many meetings as I do, this process has got to be simplified, but it must also be accurate to document agreements.

SPECIAL MEETINGS - RETREATS:

In the meeting example above, a controversial topic that would change historically compensable courses to noncompensable courses was put into a rather full agenda.  The topic was allowed only 20 minutes.  It has been my experience that subjects such as these take more time than this, because you end up having to teach sections out of the Fair Labor Standards Act that newer managers are not familiar with.  Let's change the scenario and say that you are a new leader and you have discovered several such examples that have been going on for years.  You can be heavy-handed and just make the changes, but you will have left some of your management team behind and unable to respond appropriately to questions asked of them by the team members.  Sometimes you have to go slow to go fast.  The best approach  to keep everyone on the same page when you have a large amount of content for the group to either advise on or to digest is to have a retreat.

Plan an agenda for a full day, off site that includes dealing with the issues you have to deal with plus an element of team building, and an element of management development for them.  Have a nice lunch and invite your boss out to meet and interact with the group.  I think it better to have an outside facilitator from your education department to lead through the day so that you can be a participant along with the rest of the group.  Even the highest functioning teams need retreats to recharge their batteries and have some significant, focused time together.

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Wednesday, August 22, 2012

Care and Feeding of your Team

This is an expansion on People First in case you missed that post.  I don't know who wrote it, but I'm sure you have heard that "People don't care how much you know until they know how much you care."  Some leaders subscribe to the Machiavellian principle of "It is better to be feared than loved".  I was horrified to hear this quoted by one of my colleagues in a meeting.  The reason that I was horrified was that he was misquoting Nicolo Machiavelli.  You can read the relevant chapter for yourself here.  As Machiavelli discusses the pros and cons of whether it is greater for a Prince to be feared for loved in running a kingdom, his final conclusion is: "a wise prince should establish himself on that which is in his own control and not in that of others; he must endeavour only to avoid hatred."  The modern day translation is:  When you have to exert your positional power to get something done, do so in a manner that does alienate your team. 

In leadership you sure can't plan on making everyone happy.  That is not a realistic goal.  However, being overbearing, rude, or mean is not called for either.  We are dealing with human beings and that means complex interactions at times.  Then, of course, you will have the unusual circumstances to deal with.  With this posting I want to give some examples of best practices for the human side of relating to your team.

CRISIS:

In my work, my team members have been placed at significant risk to their emotional and personal lives.  If you get a call that one of your team members has been in an accident or killed it will be one of the worst days of your life.  Believe it or not a lot of eyes will be on you as to how you handle the situation.  All of the other employees are consciously or unconsciously wondering to themselves how you would handle it if it were them involved in this crisis.  Thinking back over the situations that I have encountered and what I feel I have done well and what I could have improved upon, I have put together some key points:

You are notified that an employee has been killed or died:
  1. Go to work.
  2. Notify your supervisor.
  3. Call for assistance from your Employee Assistance Program or a Counselor (Hopefully this has been prearranged)
  4. Determine how notification is going to made to the next of kin.  Assist with this if requested by officials.
  5. Notify your staff on duty and develop a plan for your off duty staff.
  6. Identify someone on your team to arrange staffing coverage for vacant shifts created.
  7. Make yourself available to your team members as they grieve.
  8. Identify the most gifted planner on your team to plan a memorial service or to liaison with the next of kin to notify other employees of the funeral plans.
  9. If the death was on the job, notify OSHA.
  10. If there are death benefits for the employee, assist the family with the death benefits.
An employee is involved in a wreck in a company vehicle and is seriously injured:
  1. Go directly to where the employee is, avoid the temptation to go look at the company vehicle first.  (This is highly symbolic to the remainder of team about your priorities)
  2. Make sure the next of kin has been notified.
  3. Notify your supervisor.
  4. Notify your risk manager or insurance company.
  5. Identify someone on your team to arrange staffing coverage for vacant shifts created.
  6. Obtain FMLA paperwork for injured team member.
  7. Visit team member while recovering in the hospital.
  8. If the person goes home from the hospital, you can call to check on them.
An employee approaches you with a financial crisis:

  1. Listen to his/her concerns.  This is very embarrassing for the employee.
  2. Guide the employee to emergency resources.  This needs to be worked out in advance.  There  is a 100% chance of need due to divorce, theft of money, repossession of cars, disconnection of utilities, etc.  Some programs are available through EAP's, Credit Unions, or possibly through the ability to "cash in" Paid Earned Time.  Pre-Planning is the answer to this situation.


Your employee comes to you and admits to taking drugs on the job.

  1. You have to follow your organizations policies regarding drug-free workplace if they exist.
  2. Arrange for self-referral into a treatment program (Have this information in advance).
  3. Notify your Human Resources department (follow their instructions).
  4. Notify your supervisor.
  5. If the employee holds a professional license, follow appropriate procedures to notify the license issuer.
An employee is hospitalized

  1. Go visit the employee unless you have word that the employee is feeling very ill and does not want visitors.
  2. Call, send a personal note or card.
EMPLOYEE LIFE EVENTS

Some workplaces lend themselves to tighter knit teams than others.  The important thing is whatever life events you can acknowledge, make sure you are consistent and can acknowledge for all of your team members.  With 400 team members now, I try to keep up with my management team.  If they are each taking care of their teams then all employees can be recognized for significant life events.  Here are some ideas.

Birthday Cards or at least e-mails
Monthly Birthday Cake for everyone who has a birthday that month
Baby Showers
Wedding Showers

REMEMBER:  Employees don't leave organizations, they leave Managers.  If you take the opportunity to show you have the capacity to care.  People will follow you with loyalty.

Leaders have no one to lead if no one follows them.

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Monday, August 20, 2012

Politics: Avoid or Embrace?

Some people seem to be a natural at politics.  Probably the most common statement that I hear with regard to why people avoid being involved in public politics is to avoid the intrusion into their personal lives.  It is true that we probably lack the benefit of a great many quality leaders on the state and national governmental level because of the mean spirited intrusion into people's personal lives.  Or, maybe it's fair for our elected officials to be a totally open book about every aspect of their lives. 

One thing is for sure, politics is not only manifested for elected positions.  The recruitment, selection, and maintaining of leadership positions involves politics.  Organizations usually put safeguards in place to make these processes as fair as possible such as requiring the posting of open positions for a minimum number of days and requiring written job qualifications upon which to judge applicants.  But for all the protections put in place, one does not have to look hard to find examples of cases where politics overcame fairness in selecting leaders.

Why do we have political appointees? The primary reason,
theoretically, is to assure political accountability. A secondary reason is to reward supporters who helped elect the President.
Initially, the spoils system ("to the victor go the spoils") reached down to the lowest echelons of the bureaucracy, and nearly all federal jobs were dispensed on the basis of patronage. In the post-Civil War years a professionalized, merit-based civil service system was established and, as refined and enlarged over the succeeding generations, now covers all but the senior-most layer of the federal government. The principle remains entrenched, however, and seems hardly ever questioned, that all the key policy-making positions and their immediate support staff should be filled by political appointment.
Amateur Government

Let's face it, there are jobs that you may strive for that you have to "know" someone.  Once you get that job, what are the tradeoffs that you would expect?  Will the person who helped you make the contact expect something special from you in your new capacity?

Remember my blog post "What People Don't Want - Fairness"?  People want to be treated unfairly to their advantage.  Secretly, we all want to be treated as a VIP at one point or another.  People call me all the time for physician referrals, can I get them in to see a physician more quickly, can I speed up their ER visit, can I get their first cousin once removed a job.  Sometimes it's a matter of good customer service, but sometimes what you are asked as a leader involves things that you simply cannot do.  

GETTING BURNED:

There are multiple ways you can get burned when playing in a political situation.  Like many of you, I have been asked to write letters of recommendation for people to get into programs and to get jobs.  The first time I was burned doing this, it made a big impression.  I get requests to do this for people I don't know very well, but in this case, I knew the person.  She had been a former employee and had done a good job.  I wrote a letter for her admission to a LPN training program.  Within a month, I got a call from the program director.  The former employee was admitted to the program and within the first two weeks it was obvious that she had a drug problem.  I was asked if I was aware of that when I sent a glowing recommendation.  Although I had not been aware, her admittance to the program knocked a qualified applicant out of a seat and we had one less LPN that term than we needed.  Of course, I am left to wonder if a recommendation from me would mean anything to that program director again.

In the workplace, sometimes you get in the middle of people who are having problems working together.  As hard as you try to remain neutral, there will be attempts to get you to choose sides.  I have only one piece of advice and it sounds a little crass:

The toes you step on today, may be attached to the rear end you have to kiss tomorrow!

Taking sides against a colleague is not a good idea.  As people's politics play out, you can get caught up a very bad situation that can be career altering - for you.  Even when you are absolutely certain that you are on the honorable, true, and correct side of an issue, organizations do not always react in honorable, true, and correct manners.  It is best to stay neutral.

I have had several lunch invitations from co-workers where it became clear that the AGENDA of lunch was to obtain information about someone else.  Someone who would do that with you, would get information about you from someone else.  Best move... play dumb.



DON'T TAKE IT PERSONAL

The most difficult personalities in the workplace are the bullies who like to identify everyone's buttons and push them constantly.  When you allow them to be rewarded by seeing that they are bothering you, you reinforce what they are better at than you are.  The personalities that enjoy creating political dilemmas in the workplace enjoy creating havoc and trying to make others take sides.  Try not to take it personally, because that meets their need.  Call on Steven Covey's philosophy of Seek First to Understand before trying to be Understood.  Listen carefully to the other person and articulate their position until they agree that you have fully stated their position.  This has a disarming effect when the other person knows that you fully understand their position.

THINK WIN / WIN

The best outcome is again one of the 7 Habits of Highly Effective People by Covey, Think Win/Win.  What solution to the politically charged solution can be developed where there are no losers?  Most politically minded people are fully comfortable with winners and losers just like you have in any political contest.  But true leaders will solve a political situation in a different manner demonstrating that political means is not as effective in the workplace.  When working with people,  collaborating is many times the best option for solving issues.







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Saturday, August 18, 2012

Manage with Facts & Data, Not Emotion

Everyone who had ever worked with me know that I am a data guy.  If you want to make a case with me, yelling and screaming doesn't work.  I'm immune to that, I won't go into why.  I do understand facts & data.  Track things for awhile, show me the results, and I can make an informed decision.  Over the years, I've seem some fairly sophisticated models developed.  Stacey Wilson was able to develop response time models for ambulances that told us exactly where to place substations to cut response time.  Using emotion, every small community wants their own ambulance, but if that's not where the calls are coming from, you don't get the results you are looking for.  Using Stacey's work on Demand Analysis, I just did a similar analysis on environmental services.



The analysis starts with collection of data for 6 months by hour of day.  Excel spreadsheet is the best way to tabulate and display the data.  The red line shows the staffing overlaid on the peak demand for bed cleaning.  Have you ever heard that a picture is worth a thousand words?  For years, we have noted a problem at 3pm with shift change.  As it turns out, the picture shows that we are in our peak of turning over beds, but our staffing drops off for shift change.

The next step is to model using the blue dashed line what the ideal staffing would look like.  We still want to have people available early for morning cleaning, but we need to extend the shifts until later in the day.  The spreadsheet allows us to tell how many hours we have to add to get the resulting change and at what cost. 

From there, it's all about choices.  The case is clear.  Do we want to make the choice to spend extra funds to be more efficient with our staffing, or not.  This is the way of healthcare today.  I believe that the leader who knows how to present facts and data will have an edge on the leader who goes in and just says, "Look, I need this, or people will die."  People who continually make grandiose threats lack credibility because that's what they have always done.  The only tool they have is a hammer and all their problems are nails!

From an earlier blog, I put in a control chart.  You can buy a statistical program to produce control charts, but more importantly, you need to understand that concept that a process in control will remain in control unless acted upon by an outside force.  In this example you see a process that has been changed.  If you do simple run charts with your data, you can imagine control lines.  You can be assured that your in control process is not going to change until you make a change.  Remember:  Every process is perfectly designed to produce the results that it produces.



As a leader you deal with a budget and have finite resources.  Just about everyone who approaches you has an opinion about how to spend the organization's money.  We need new vehicles to do this, two new people to do that, a 3% raise, a new computer system to do this.  I find it easier to deal with these requests to ask for the facts and data and to be transparent about the requests versus the resources.  In talking to staff members, I think a lot of them are clueless about the business side of the organization.

I remember the first time I started sharing the monthly financials with my team.  I started to see lightbulbs come on as people realized how tight we were operating according to budget.  At that time I was operating ambulance services.  I talked about the impact of the crews talking a patient out of being transported.  No transport = no revenue.  Our no transport volume began to decrease.  I believe that transparency of operations with the team is important.  It is good for people to understand the costs of operations.  Even simple things like the fact that full time employee benefits are worth an additional 25% on top of their hourly rate are good concepts for people to understand. 

I realize that not everyone is into facts & data like me.  I know that I have to be careful of what I say or I will stomp on people's emotions.  When it comes to business decisions though, the leader must not be blind to the relevant facts & data because they represent a point of stability.  Emotions are all over the board and opinions are as numerous as your team members.


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Thursday, August 16, 2012

Gifts & Talents: Know Yours and Those of Your Team



Leadership is not about one-man shows.  If anything it's about being a conductor of an orchestra.  Helping to  bring together the talents of of others to make things happen.  The gifted leader knows his/her own limitations and realizes that there are members of his team that have diverse interests that can be put to work in creative ways to help reach business goals.  One of the best ways to find out about hidden talents is simply to ask team members about their interests and abilities.  One of the Gallup Poll questions you will remember from an earlier posting was whether an employee got to do their very best every day.  What better way to help people do their very best than to incorporate their known talents into their work?

Knowing others talents helps me know who to delegate to.  If I know a particular employee is good with spreadsheets or databases, that's who I call when I have needs in that area.  But remember, before I can delegate, I have to get past that nagging feeling that I have to do everything myself if I want it done right.  I can accomplish more by recognizing others talents.




1 Peter 4:10


New International Version (NIV)


10 Each of you should use whatever gift you have received to serve others, as faithful stewards of God’s grace in its various forms.





Let's get things done, examples of how other's gifts and talents can be used in the workplace:
You have vehicles to maintain. One of your employees used to be a mechanic and understands about parts and billing by estimated time. They may be good to enter your preventive maintenance records into a computer tracking system.
You have an employee who is a part-time minister. He/she is interested in calling on your sick and injured employees to make sure their needs are being met.
You have an employee who is a singer. She would be happy to provide entertainment for the Christmas party.
Another employee loves to plan get togethers. Would a summer family picnic be right for your team?
You really need someone to take the lead on planning for disasters. One of your employees is totally into preparedness. What about delegating these responsibilities to this employee and having less meetings with him/her so that you can be updated.
Keeping your policies up to date is a chore. You have 5 employees who are very detail oriented and concerned about the policies. Is this an opportunity for a small workgroup to advise you on the policies?
OK, let's face it. You are not good at community outreach, but you have employees who get a lot out of doing that. What a great tradeoff.


I have seen such powerful examples of quality work done by team members on behalf of their organization that have been value added when the leader has empowered the individual to go for it.




How To Identify A Gift or Talent
You can do it or learn it easily
You feel strong when you do it
It comes naturally to you
It brings joy to you and others
You look forward to doing it
You feel like you’re “in the zone” when you do it
Time seems to fly when you’re doing it
After you’ve expressed your talent you feel fulfilled
After you’ve expressed a talent you look forward to doing it again

Source

Tuesday, August 14, 2012

Transformational Leadership

Many organizations need more than minor "tweaking".  They need to be transformed from one thing to another.  This requires a talented leader who possesses certain traits and skills.  Transformational leadership is a theory that was developed by James McGregor Burns in 1978. He developed this theory to further address the aspects of an organization that lead to success, encourage enthusiasm among an organization's employees, and identify the values employees place on their work(1).

Characteristics of a transformational leader:


* Charismatic

* Engaging

* Inspirational

* Stable

* Optimistic

* Encouraging

* Honest

* Motivational

* Respectful

* Positive

* Team oriented

* Effective communicator

* Empowering

* Reliable

* Trustworthy

* Empathetic

* Mentor

* Visionary

(Smith, Mary Atkinson, 2011)   There are 7 principles to Transformational Leadership:  

Simplification

The transformational leader speaks in a clear and practical manner while explaining the direction the team is heading. Specifically, the plan for each project should include more than what needs to be done at the moment. The desired end result should also be vividly communicated so employees know where they, and the project, are heading. By knowing and effectively relaying what the project needs to transform into the anticipated result, you eliminate miscommunication and misunderstanding.

Motivation

Employees need motivation to perform at their best. Under the principle of motivation, you gain the agreement and commitment necessary to elevate your vision. By understanding your employees’ likes and dislikes, you know what motivates and what doesn’t. For example, recognizing and applauding their accomplishments, providing training to increase their knowledge base, establishing a pleasant work environment,  can motivate employees into performing at their highest level.

Determination

Determination means having the tenacity to finish the race regardless of the hurdles that come your way. The principle of determination requires you to depend on your courage, stamina, strength and perseverance to realize your vision. By displaying endurance, you show employees that hard work pays off in the end.

Mobilization

You need the right people to elevate your vision. Transformational leaders know how to assemble the appropriate team to get the job done. This includes enlisting, empowering and equipping qualified team leaders and other willing participants who do not have leadership roles. The transformational leader understands the importance of assigning tasks based on participants’ characteristics and abilities.

Preparation

The principle of preparation requires transformational leaders to be infinite students. You must have the introspective ability to keep learning about yourself, alone or with the assistance of others. To maintain a flourishing bond with your employees, you must always be prepared to nurture and support the relationship. This means looking outside yourself, concentrating on what’s best for the team, and transferring this energy to your employees so they emulate this behavior.

Facilitation

The principle of facilitation requires you to provide your employees with the proper learning tools to elevate the vision to its greatest height. Specifically, workers need stimulating work that challenges and expands their minds and facilitates the desire to keep learning. As a transformational leader, you recognize this principle and work toward improving your employees’ intellectuality.

Innovation

Change in a business environment is inevitable. Under the principle of innovation, you courageously recognize the need for change and initiate it accordingly. For example, innovation may include learning and adapting to an upgraded accounting system, or adjusting to an employee who has just been promoted to management. As a transformational leader, you effectively show employees why the change is needed, how it will benefit them and the company, and how to embrace it.

Adapted from




      (1)  Barker AM, Sullivan DT, Emery MJ. Leadership Competencies for Clinical Managers: The Renaissance of Transformational Leadership. Sudbury, MA: Jones and Bartlett; 2006.

Saturday, August 11, 2012

The Manager's Gold Standard of Care

You are a manager.  I'm betting that you have a way of articulating to your team members what your expectations are with regard to the standard of care you expect for the patients you serve.  If not, maybe you need to go back and visit a prior blog on "Have High Expectations".  I believe that I have been consistent over the years and said that I expect we will provide care as if we were caring for our own family members.  That's not been a bad Gold standard for me, because my family members and myself have been the recipient of care at the hands of my employees.  It's those times when you are glad that you don't have to worry about who might be working on that shift.  If you manage each day so that your team is always ready to care for a member of your family it is really hard to go wrong.

Next Tuesday, I'm having surgery.  I'm one of those consumers who knows too much.  I know about how hard it is to get 100% of any group of professionals to wash their hands between patients, I know about medication errors, I know about the push to turn over surgery rooms as fast as possible because time is money.  I won't drone on.  What I hope for the manager's that oversee the staff that will be attending to me is that they are serious about the recruitment and selection process.  I hope they come out of their offices and visit with their employees and know who is not acting right, who may be overly stressed and may need a break.  I hope they have been brave enough to deal with the employees who have had persistent attitude problems.  I hope that they are on top of each employees competencies.  Yes, I really hope that they are assured that everyone on their team can take care of me as well as if I were a member of their family.

Can we depend upon outside agencies?  Just about every hospital is Joint Commission accredited.  What does that accreditation mean?  The survey is a weeklong exhibition of everything we do to meet their standards.  I'm sure things would be not very good without those standards in place.  But that exercise reminds me of Horst Shultze comment about being the best of a group of poor performers.  The fact is that bad things still happen in Joint Commission accredited hospitals.  For Nursing, Magnet verification by the American Nurse Credentialing Center verifies that the hospital meets standards for the work environment for nurses.  Magnet hospitals are the best places for nurses to work.  Nurses find an environment of shared governance, support for research, an engaged leadership, and multidisciplinary committee work.

Quality Awards, regulatory agencies and inspect and organizations can meet their minimum standards at a point in time.  But a culture of meeting a Gold Standard on a daily basis is something an organization has to live.  It is not something that passes with an inspection or a survey.  It takes inspiring leadership to create a culture of "this is the way we do our work."  I have tried to not say, we are doing this or that because of the joint commission.  The better leadership statement is "We are doing this for our patients".  The fact that it is a Joint Commission standard is secondary.  Every joint commission standard is related to a risk for a patient.  Another good point to remember is when an employee is objecting to doing something new the leader can simply ask "What is bad about this for our patients?"

This week I got to meet with some of our Patient Transporters.  They get it!  They know that in their 24 minutes of transporting a patient to or from a diagnostic test, they have an opportunity to visit with the patient and lift a spirit.  They know that it's not about them, it's about their patient.  This is who I want to care for my family members!

I rounded on some of our environmental services staff yesterday.  They proudly showed me the rooms they had just cleaned for the next patient.  They knew their role in good hand hygiene.  They enjoy interacting with the patients and just checking to see if the patient needs them to do anything to their room.  This is who I want caring for my family member!

Last week I met with a whole room full of dietitians.  You wouldn't believe the complexity of their role.   The premature neonates have to have banked breast milk managed.  I attended a meeting and watched as the geriatrician, the pharmacist, and the nutritionist agreed on the medications and nutrition for the geriatric patients.  This is the team I want caring for my family members!

If you set the Gold Standard of Care, your personnel's performance becomes much more clear.  Either you would be OK or not OK with them caring for your family member.  If not OK, better start coaching.


Thursday, August 9, 2012

Situational Leadership

Welcome to the new blog subscibers.  The reach is much further than I ever thought it would be.  We just passed 1000 visits to the site.



I was moving my office today and came across an old binder of Ken Blanchard's material on Situational Leadership.  I took a minute to thumb through and was reminded of the relevance of the material.  It reminded me of the famous saying "If the only tool you have is a hammer, all problems look like nails".  I know a lot of managers just like that.  They have only one tool at their disposal.  The problem is, as Situational Leadership teaches, different situations call for different leadership skills to handle in the best way to create the best outcomes.  Let's take a look at the graphic used to illustrate Situational Leadership.

In Quadrant S1, or Leadership Style 1 is Directing.  This is more one way communication.  It is involved in telling people what to do and how to do it and then supervising performance.  This is totally appropriate for some leadership roles.  If you are a fire chief you don't have time to be very supportive at the fireground.  You have to give orders.  The question is, if the fire chief has the skills to shift to another quadrant when the leadership skill required is not a life or death emergency.

In Quadrant  2, you find Coaching.  Coaching is still high on the directive axis but his also high on the supportive axis.  Supportive behavior is how a leader uses two way communication, listens, and provides support and encouragement.  How does he involve the followers in decision making.  If the fire chief from the earlier example were holding a staff meeting about uniform options and was including firefighters in the decision-making process instead of simply announcing a decision, he would be using Coaching skills.

Quadrant 3 is Supporting.  More slanted to support and less to directive behavior.  This might be useful if a workgroup has been given appropriate boundaries but are being given a great deal of lattitude to deal with a particular aspect of the workplace.

Quadrant 4 is Delegating.  Ideally, items that are delegated are given to someone who have the competencies to perform the tasks even better than the leader could.  Those entrusted with the task see the extra responsibilities as a reward.  The do not require very much direction or support, although occasionally rewarding or recognizing them would definitely be a plus.

DEVELOPMENT LEVEL

According to Blanchard, D1-D4 represents the development level of individuals across a continuum.  D1 is low competence/High commitment (Directing)
D2 some competence / low commitment (Coaching)
D3 moderate to high competence / variable commitment (Supporting)
D4 high competence / high commitment (Delegating)

Feel free to submit a comment if you have an opinion why people lose commitment as their competence increases.  This does give you a hint though as you are developing someone how to coach them as they progress.

A nursing model that I like is the Benner model on development.  Simply stated it is Novice to Expert.
At every point we become a Novice we have to have to develop again to gain expertise.  Consider the OR nurse that transfers to the ER.  That nurse just became a Novice once again and has another competency curve to be coached through.

Situational Leadership Theory (click here)




Wednesday, August 8, 2012

Coach & Mentor Others

Do you like to see that moment when someone learns something new and the light bulb comes on in their eyes?  I believe that it is part of professional responsibility to share your knowledge with others.  One of the best ways to do that is to be constantly developing your employees.  Employees need to be given more information than they typically are given about the operations that they work within.  The supervisor says "Do this", and "Do that".  The leader says "Here is why we need to do this or that".  Team members with a greater understanding of the objectives that are to be accomplished come to the table with rich ideas and input as to how to reach the objectives.

COACHING:

A process of facilitating an individual’s development through giving advice and instruction, encouraging hands-on experiences, observing performance, and giving honest and immediate feedback (Manion, J. 1998). Coaching is purposeful and targeted and usually short-term.


A coach is a person who teaches and directs another person via encouragement and advice. (Lamb-White, J. 2008)

Coaches do not need any specialist experience within the area in which they are offering support. They do not offer “professional” advice. They are skilled in questioning and teaching. (Clutterbuck, 2004)

It is the coaches’ role to enable the individuals to find answers within themselves and is dependent upon each individual’s motivation to succeed. (Clutterbuck, 2004)

Sets mutual goals – defines expectations


Three Ways to Influence Others



MENTORING:   Defined as a person who gives another person help and advice over a period of time and often teaches them how to do their job. Mentoring is a more rare and random experiences.

Mentoring refers to the developmental relationship with a more experienced “expert” and a less experienced (and usually younger) protégé. (Lamb-White, 2008)

Mentors are usually experts within their particular field and have a wide-ranging and recognized wealth of experience within the field in which they are advising and supporting others. (Clutterbuck, 2004)

The mentor supports and guides the individual as part of a developmental path (helps to open doors, shares experiences, provides contacts/resources and widen networking opportunities) (Clutterbuck, 2004)

Mentoring relationships can go on for a long time, seeing progress through many stages and often survive through numerous relocation and career changes (Clutterbuck, 2004)





As a leader, you have a responsibility to coach those under your care, yes I said it, under your care (your employees) to their peak performance.  If people are not growing under your leadership either they have a problem or you do.  If you are fortunate a few of them will approach you and want more.  They may ask you to enter a mentorship relationship.  Mentors are selected by mentees.  Agreeing to mentor someone is answering a high calling and it is a big responsibility.  It means you really have to careful of your actions on a bad day.  Oh nevermind, people are already watching you anyway!

Saturday, August 4, 2012

Errors Should Be Admitted

I'm having surgery on my ankle for the second time in a few days.  The first surgery was two years ago for a spiral fracture of the fibula after a fall on snow and ice.  No, it was not a fun ski trip, just one of those home accidents when your front yard is a 45 degree incline.  After the surgery, on the lateral side of my left leg, I always complained of pain on the medial side of my left leg.  It never got better.  For two years, I have literally had "pain and suffering" complete with afternoon swelling of the left ankle.  My ankle was misaligned.  So finally, I went to get the famous second opinion.  The orthopedic surgeon took one look at the x-ray and said, "They didn't fix your deltoid ligament."  What, that obvious?

In the medical field mistakes get made.  Unfortunately, sometimes with grave consequences with patients.  At the end of this blog, I have listed several evidenced-based sources that back up the position that early disclosure to patients and family members is not only the right thing to do, but also leads to less monetary costs for the healthcare institution.  Best practice hospitals are disclosing errors and offering settlements early to patients who have been harmed.  This helps to restore trust in the healthcare institution on the part of the patient.

I have sat in discussions with families when these disclosures were made.  As difficult as the words are to say, the family members need to hear them.  I would have bet that the families would have filed medical malpractice suits, but in these cases, what they want is to be assured that proper measures have been taken to prevent this from happening again.

I have also been present when it was obvious that nothing was going to be disclosed to the family yet they knew that things were not right.  Their anger would be dealt with.  If the medical professionals fail to deal with patients and family members, the legal professionals will. 

I met a gentleman last week who was on crutches and in a cast.  I asked him what happened and he told me how he broke his foot, then he told me about the doctor that put his cast on too tight.  He lost feeling in his toes, called the office on a Friday and was told to come in to have it checked on Monday.  He went to the ER and was found to have cold toes.  The cast was immediately removed and after his circulation was restored another cast was applied.  That was a close call that could have resulted in a loss of toes or a foot.  Frequently is the case that bad outcomes occur when medical professionals simply don't listen to what the patient says.

LISTEN TO THE PATIENT

Betty Ann Bowser of PBS NewsHour in April 2011 reported the following:


•A study published in Health Affairs examined the records of 795 patients at three teaching hospitals.

•354 of the patients had experienced medical mistakes.

•“90 percent of all hospital mistakes go unreported.

”To read the entire article, click on New Study Finds Medical Error Rates are Underreported. To read the entire study in Health Affairs, click on ‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured.





PerfectApology.com




DISCLOSING MANAGEMENT ERRORS

For those of you thinking that there is nothing in this posting for you, here it is.  If you manage people, and you make a mistake early disclosure is the best course of action.  The stakes can be fairly high.  Make an error with payroll and you can be liable for corrective action going back 3 years.  I have had the opportunity to sit down and speak with Ladies and Gentlemen about HR issues that needed to be addressed.  Our workforce is more intelligent than some want to give them credit for and when we lay issues on the line and explain what our needs are, they are willing to meet us half way.  People have to experience our honesty to have an opportunity to respond to it as professionals. 

References:  

Berlinger, N. and Wu A. (2005). Subtracting insult from injury: addressing cultural expectations in the disclosure of medical error. J Med Ethics. 31:106-108. http://jme.bmj.com/content/31/2/106.short


Gallagher, T. and Lucas, M. (2005). Should we disclose harmful medical errors to patients? If so, how? JCOM May 12:5 http://www.turner-white.com/memberfile.php?PubCode=jcom_may05_patients.pdf

Gallagher, T. and Studdert, D. (2007). Disclosing harmful medical errors to patients. N Engl J Med. 356:2713-9. https://secure.muhealth.org/~ed/students/articles/NEJM_356_p2713.pdf

Greene, L. (2008). More apologies to families follow medical mistakes. St. Petersburg Times. http://www.tampabay.com/news/health/medicine/article775911.ece


Kachalia, A., Kaufman, S. Boothman, R., Anderson, S., Welch, K., Saint, S., and Rogers, M. (2010). Liability Claims and Costs Before and After Implementation of a Medical Error Disclosure Program. Annals of Internal Medicine 153:213-221.

Kraman, S., Hamm, G. (1999). Risk Management: Extreme Honesty May Be the Best Policy. Annals of Internal Medicine. December 21: 131:963-967. http://www.annals.org/content/131/12/963.short

Lamb, R. (2004). Open disclosure: the only approach to medical error. Qual Saf Health Care 13:3-5 http://qualitysafety.bmj.com/content/13/1/3.extract

Liang, B.A. (2002). A system of medical error disclosure. Qual Saf Health Care. 11:64-68. http://qualitysafety.bmj.com/content/11/1/64.short




Thursday, August 2, 2012

Rounding for Outcomes

Undercover Boss is a television show that originated in the U.K. in 2009 and has now had versions in several other countries.  It is very appealing because it features CEO's disguising themselves as front line employees and spending time learning the jobs that connect directly with their customers.  On the episodes that I have watched they have learned a great deal about what really goes on at the front line of their company.  They have seen how hard it is for employees making minimum wage to pay their bills, seen the tools needed to do the work, and have heard how the employees feel about top management.



Some of these bosses are hopelessly disconnected from the workers on the front lines.  Although it may be sobering for them to put on a set of coveralls and go clean port-a-potties for a day, the best way to stay connected to the front lines is to be intentional about Rounding for Outcomes.  I was orienting a young lady today who I am now precepting about how to round.  She found the experience, even as a role play, invigorating.  Just spending 5-7 minutes with an employee can inform the leader of needs at the front line, opportunities for reward and recognition, important intelligence about what is going well and what is not going well, and create an open path of communication.  What was a little disconcerting was that this role play was the first time that this nurse had been rounded upon.  Her manager is an undercover boss of a different kind.  Undercover as in undercover police officer.  One you don't see!  Maybe on a stake out, around a corner, hidden away in an office.  You can't manage today's workplace without interacting with your employees.

I'm a bit of an introvert, believe it or not, so I have to have a formula for my rounding.  I'm going to share it with you.  When I started out, I had a form that I used for rounding.  If you want a copy, download it under pages.  Rounding for Outcomes is not the same as Managing by Walking Around.  This is not about you being seen, this is about you being effective, so there is work and followup involved.  Here is what you do:

  1. Approach your employee and ask for a few minutes of their time.
  2. What is going well today? Start with a positive question or all you get will be negative stuff.
  3. What is not going well today?
  4. What can we improve on?
  5. Is there someone I should recognize for doing great work?
  6. Do you have the equipment to do your job?
  7. Are there any systems that need improvement?
  8. Take an opportunity to coach.  This is the outcomes part.  You have been gathering intelligence up to this point.  Now it's time to help achieve some goals.  Talk about something important to the organization.  Example:
           "You know, Mary, we have really been working on patient satisfaction.  What are you doing to
             assure that our patients are having an excellent experience."

LEVERAGE:  A great idea is to have your entire management team rounding on the same initiative  each week.  If the employees are hearing from all managers about patient satisfaction during week 1, handwashing during week 2, legibility during week 3, and HIPAA during week 4 they will all be on the same page as to what initiative is under focus.

      9.  Is there anything I can help you with right now?



This whole encounter should take only 5-7 minutes.  If you are consistent with this, you will get a lot of information.  Warning:  You must follow up on this information or people will not share with you.

After the rounding session, take the time to followup and to send thank you notes to the people mentioned that should be recognized.  You will be on your way to a new level of connection with your team.

OMG, #9, what if they ask me to help them with something?

Well, on the Undercover Boss TV Show, the CEO's did whatever they were told to do.  Some of them had poor performance and were told that they were not working out!  The question for you is this.  What is it that you are asking your employees to do that you are not willing to do?  Unless you don't have the appropriate licensure or competency to do something, it would speak volumes if you would pitch in.  Most of the time, my staff does not have any request of me.  They are flabergasted that I spent a few minutes one on one with them.

What if they just start complaining?

If they are complaining, you need to hear about it.  Unhappy employees will not provide their very best work or provide the best service to your patients.  If it looks like their issues are going to take longer than 5 minutes, schedule a follow up meeting.  Remember to ask them "What's going well?" as the first question.

What kind of records should I keep?

I keep a rounding log so that I don't forget to followup on issues.  Some people keep a logbook to assure that they round on each person every month.

What if I want to round on patients?

Great idea, different questions, download the form from pages.

You Tube Example of How To Screw This Up

Wednesday, August 1, 2012

Creating A Positive Work Ethic

I think every generation believes that the new generation does not have what it takes to enter the workforce. After all the new kids didn't have to walk to school for 5 miles, up hill, both ways!  How could they know what it's really like to do what it takes.  The new kids have new skills.   They grew up using computers and if they don't know an answer they know where to find it.  They don't expect to spend 10-20 years at one place of employment.  They will be mobile and go where the opportunity is.  To read a great history on the change of the work ethic over the years, click here.

To compete for talent we have to create a positive and engaged workforce (Achor, 2012).  It's not, If you work hard, you'll be happy...It's if you are happy, you'll work hard. 

The “happiness advantage” is the discovery that nearly every single business outcome improves when a brain is positive as opposed to negative, neutral, or stressed. (Achor, 2012)

"To help these people capitalize on the Happiness Advantage, I often recommend that they keep one


thing in mind: the number 2.9013. This may seem random, but a decade of research on high and

low performance teams by psychologist and business consultant Marcial Losada shows just how

important it is.  Based on Losada’s extensive mathematical modeling, 2.9013 is the ratio of positive

to negative interactions necessary to make a corporate team successful. This means that it takes

about three positive comments, experiences, or expressions to fend off the languishing effects

of one negative. Dip below this tipping point, now known as the Losada Line, and workplace performance

quickly suffers. Rise above it—ideally, the research shows, to a ratio of 6 to 1—and teams

produce their very best work."  (Achor, 2012).

I have written about the importance of giving feedback.  The fact is, it is easier to catch people doing things wrong than doing things right.  Looking at it another way, though, it takes a more skilled leader to remember the importance of the Losada Line and invest time with employees to give positive feedback on all the things that are done right.  IT IS MORE FUN TO CATCH PEOPLE DOING THINGS RIGHT THAN TO CATCH THEM DOING THINGS WRONG.   Your employees will be shocked when you pull them aside and you give them a list of all the things that they are doing right.  Probably for years, no one has done that.  I have had people tell me that they have worked for 10, 15, 20 years and they have never had anyone tell them they were doing a good job!  Are you kidding me.  Does the workplace really have to be that way?  Surely not every job has to be a thankless job.  

When the leader takes time to compliment the team on teamwork....that teamwork will be repeated.  WHAT IS REWARDED IS REPEATED.  Any work group is only as successful as what can be accomplished when everyone begins to pull in the same direction.  Creating a shared vision of what needs to be accomplished and then rewarding progress goes a long way toward creating the desired results. According to Answers on-line, this is the definition of a positive work ethic:


To follow all company policies and procedures completely, arrive on time if not early, take breaks and lunches at agreed times and do not be late back, dress smartly, always give 110%, be honest and trustworthy, be friendly and helpful, maintain positive working relationships, respect your superiors, no tattos or piercings on view, minimal jewellery and make up, meeting deadlines, keeping work area clean and tidy, not bad mouthing the company

Source

I want to end with some tips about the newest working generation.  I found this great piece which covers the work ethic very well:


Millennial (Generation Y). Born between 1981-2000.


Millennials have the reputation of having lazy work ethics and being hard to motivate which isn’t true – they just want interesting work that will make a difference.



They grew up in a culturally diverse school and play environment, are tech-savvy, enthusiastic, confident, well networked and achievement-oriented. Millennials are the best educated generation in history.



Thanks to mobile technology their very attentive “helicopter parents” were rarely out of reach. Their parents introduced them to almost constant education and well supervised activities. Their busy schedules and expanded educational opportunities are the root of their confidence and need for variety and challenge.



Millennials have been told by their parents that they can do anything. They’re often called the “Everybody Gets a Trophy” generation because their parents’ insisted that their childhood experiences be positive (everyone wins), and that everyone has a valid opinion and deserves to be heard.



Employment Expectations

Millennials do not expect to “pay their dues.” They are not shy and expect their opinions to be heard. They want to know they have access to an open door to ask questions. Millennials want to know their work is valuable to the company and / or environment… as well as to them and their career. They are driven less by money and more by accomplishment… for now at least.



Millennials want to express their creativity and be able to complete tasks using their own methods. They are learning-oriented and if they’re doing something wrong they want to know about it now so they can learn from it, but will not dwell on failure (because everyone wins).



Just like when they were young, Millennials like working in teams and being coached, need lots of praise and need to be told often they are on the right track and doing a great job.



Work Ethic / Loyalty

Millennials need detailed instruction about what you want – but let them determine how to get there. Make the work relevant and important to them and the company. If you engage them the right way they will be loyal and work hard. If they’re not satisfied they will quit now and find that job later – and if that doesn’t work out they can get support from their helicopter parents.



Millennials are accustomed to new ideas and situations, a constant opportunity to learn (or more accurately find out).



Praise Millennials often – daily even… and for sure… coach them.

From Bruce Mayhew Blog