Rather have a book, or an e-book?

Friday, July 27, 2012

Have High Standards

Everyone likes to be on a winning team!  The only winning teams I have ever heard of are those with very high standards for themselves.  Our facility just went through a week long Joint Commission visit.  One of my areas was so ready for the inspection that they were a little disappointed that they didn't have a thorough review.  They knew they were up to the standards of the Joint Commission, but more importantly, they were up to their standards for themselves.

In an earlier blog, I discussed the phenomenon of people in a group lowering their performance to the performance of the lower performers in the group.  This is a leadership problem.  What is permitted is promoted.  It is demoralizing for employees to see others get by with substandard performance.  Why should one member of the team work their butt off when everyone else seems to be slacking off through the shift.  To prevent this from occurring leaders must either reward the higher performers or be actively working on the performance of the lower performers. 

During my worklife I have actually had co-workers ask me to slow down or change this or that, because I was making them look bad.  The peer pressure usually forces conformance to lower standards. 

When I round on employees I like to give them an opportunity to show me their best work.  For nurses taking care of 3-4 patients, I might say, which one of your patients will tell me what EXCELLENT care you are taking of them.  The nurse is free to steer me away from someone if they wish, but almost always they say, "I'm taking care of these patients talk to anyone you like!.  With a Food Service employee I ask them "What do you think I should sample today"?  Environmental Services, "Show me how great you have cleaned a room."  Putting a positive spin on rounding makes the encounter with the staff member enjoyable, but there is still no doubt that you are there to check on how things are being done.  When things are not up to standard coaching can be implemented.

When employees talk to each other, they are proud to be on a team that has high standards.  They are proud when they are being measured and they see the scores come up.  As leaders we have to put the data in front of the employees and give them the tools and best practices to help them excel. 

Insanity: doing the same thing over and over again and expecting different results.

Albert Einstein

When a team is stuck and cannot reach the standards set for them, the problem is usually one of not making a significant change.  Here is what I have seen:  Mediocre performance is occurring time point after time point.  The leader comes before the group and announces, "we are not doing as well as we can, please try harder."  Nothing significantly changes so the mediocre performance continues. 

I believe strongly that you cannot improve something that you cannot measure.  A run chart is a simple way to look at data but a control chart explains why mediocre performance continues.  When a process (even a bad process) is in control (i.e. within upper and lower control lines) that process will stay within control unless acted upon by a change in the process itself.  No amount of encouragement to try harder will make the change occur.

Once a significant process change occurs you will see sequential points above or below the center line and the upper and lower control limits will need to be recalculated.


The key point is that achieving high standards is unlikely without process change.  Leaders must have the skills to identify entrenched processes and lead through changing those processes to ones that demonstrate measureable improvements. 

Once the team experiences success with this a few times change comes easier and easier, but making changes is not for the faint of heart.  Review the June 5 blog on "Executing On Change".

So let's think for a minute about the alternative.  If you lower your standard just a little bit, how would that play in other industries.

IF a 1% error rate was acceptable....
6 drug errors per hospital pharmacy would occur per day
870 airline crashes in the US would occur per day
20,000 wrongful convictions would be made per year (The real error rate is 0.5% 0r 10,000) !
200,000 patients would have wrong site surgeries performed each year (The actual rate is 0.00000893)

So 99% may sound like having high standards, but it is really not that high.  When we are the customer, we want everything done correctly every time.  As leaders we have a responsibility to put systems in place to drive the error our of our processes.  As stated in an earlier blog, variability is the enemy of quality.  Looking back at the control chart, you will notice that as variability decreases, performance improves, and the control lines reset.

One of the most consistent teams that I have seen work is the Level I trauma team.  Upon a 5 minute notification, the whole team assembles in the trauma bay and suits up with protective apparel.  A chart on the wall used to teach new members shows where each team member stands and what they are supposed to accomplish.  When the patient rolls in, the airway is verified, the patient is moved to the emergency department stretcher and team members all around the patient quietly and competently work to assess and save the seriously injured patient.  The patient is sedated, intubated, blood is administered, an x-ray is taken, an ultrasound is completed and the patient is readied for transport to CT Scan or to the OR depending upon their injuries.  All of this happens, day after day, consistently in 17 minutes.  I have seen other teams work with disorganization, raised voices, and frustration. 

Seeing this team work demonstrates several points.  A high functioning team can come together from different disciplines and meld together in an instant if everyone knows the protocols, if the standards are set high enough that everyone knows the expectations and are commited to meeting those expectations, if there is a clear leader that is in control, and finally if the team has sufficient volume to act together to remain practiced.  That last point is important.  Much has been written in the last few years about minimum volumes of certain procedures that should be done by physicians for them to be competent to continue doing them on patients. 

Any team works better when it is well practiced.  In those circumstances where your team may be called upon infrequently to complete a critical task, it is your responsibility to conduct drills so that some "muscle memory" develops that can be called upon when the real thing happens.  Part of that is quizzing your team to see if they remember the steps to take if a particular event occurs.  Having high standards means being ready for any eventuality.  When I was in Johnson City, we were a primary trauma center for a nuclear fuel depot.  We had to have the staff ready 24x7 to use plastic and paper to wall off the emergency department to be able to accept nuclear contaminated patients.   Formal drill once a year, yes, but keeping everyone knowledgeable about what that big cart was with huge rolls of paper, etc was a constant chore.  Pressing toward the highest standard requires constant engagement from the entire management team.

No comments:

Post a Comment