tag:blogger.com,1999:blog-29714394702526373052024-03-12T19:22:20.982-05:00Brent Lemonds' Healthcare Management BlogWisdom from a thirty year career in emergency services and healthcare management.
"Good judgment is what you get from experience, which is what you have immediately after using poor judgement." - Jim Horning.Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.comBlogger39125tag:blogger.com,1999:blog-2971439470252637305.post-43489390767691661102012-09-04T23:30:00.001-05:002012-09-04T23:30:29.564-05:00Reasons for Poor PerformanceI 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.<br />
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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?<br />
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<b>INADEQUATE TOOLS & EQUIPMENT</b><br />
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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.<br />
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<b>INADEQUATE ORIENTATION & TRAINING</b><br />
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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 <b>VARIATION</b>. 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 <b>CONSISTENCY</b>.<br />
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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.<br />
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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.<br />
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<b>POOR SUPERVISION</b><br />
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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.<br />
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<b>PERSONAL DISTRACTION ON WORK TIME</b><br />
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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:<br />
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<ul>
<li>time on phone with personal calls (This could be initiated by the employee or a needy significant other)</li>
<li>time on internet (email, shopping, chat rooms, gambling, games, facebook, etc)</li>
<li>excessive meal time and breaks</li>
<li>watching television</li>
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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. </div>
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<b>FINALLY,</b></div>
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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.</div>
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<b>REMEMBER, WHAT IS PERMITTED IS PROMOTED</b></div>
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Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com2tag:blogger.com,1999:blog-2971439470252637305.post-30828791789353549502012-09-01T00:16:00.001-05:002012-09-01T00:16:38.450-05:00Managing Diversity in the WorkplaceYou 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.<br />
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<b>IT's NOT JUST ABOUT THE WORDS</b><br />
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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 <b>IDENTIFY</b> 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. <br />
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<b>Example 1 - 20 Years in the Military Culture</b><br />
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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 <a href="http://www.jmu.edu/counselingctr/Resources/veterans.html">James Madison University Counseling Center Resource Page</a>. 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." <br />
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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.<br />
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<ol>
<li>Develop culture for onboarding success through preceptor or mentor program where preceptor/mentor is honest and supportive to newcomer.</li>
<li>Culture supports both transmission of group knowledge to each member and supports sharing of new knowledge within the group.</li>
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<b>Example 2 - Not From Around Here</b></div>
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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.</div>
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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 <a href="http://cms.oregon.gov/oha/oei/diversity/pages/definitions.aspx">State of Oregon's definition </a>which they have decided to present adjacent to a definition for Cultural Competency.</div>
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<i><b>Definition of Diversity</b><br /><br />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.<br /><br />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.<br /><br /><br /><b>Definition of Cultural Competence</b><br /><br />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.<br /><br />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.<br /> </i></blockquote>
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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. </div>
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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:</div>
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3. An expectation exists that each employee is accepted and respected in consideration of all their differences.</div>
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4. All standards, practices, policies, and attitudes reflect cultural competence to increase the quality of services, thereby producing better outcomes.</div>
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<b>Example 3 - Black Female Applies for a Promotion</b></div>
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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. </div>
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<a href="http://www.integritydev.com/diversitytraining.htm">Integrity Development</a></div>
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<b>TIME TO BE HONEST WITH YOURSELF:</b></div>
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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?</div>
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<li>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.</li>
<li>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.</li>
<li>One of your employees comes to you and explains that he will be taking a leadership role in the city's gay & lesbian community. </li>
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<b>FINALLY, A COOL STORY</b></div>
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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. </div>
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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."</div>
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One great part of the ceremony was when the federal judge read to the Naturalized Citizens their newly acquired <a href="http://www.uscis.gov/portal/site/uscis/menuitem.749cabd81f5ffc8fba713d10526e0aa0/?vgnextoid=39d2df6bdd42a210VgnVCM100000b92ca60aRCRD&vgnextchannel=39d2df6bdd42a210VgnVCM100000b92ca60aRCRD">Rights and Responsibilities</a>. 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.</div>
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Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-84990636331930663482012-08-29T18:53:00.000-05:002012-08-30T18:20:55.815-05:00Micromanagement: 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:<br />
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<strong>DO's</strong><br />
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delegate tasks that can be done better by someone else. <br />
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delegate tasks that will develop another person. <br />
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delegate tasks that are repetitive in nature. <br />
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<strong>DON'T</strong><br />
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delegate things that you just don't want to do. <br />
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delegate things that you are not willing to be responsible for if mistakes are made. <br />
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<strong>Leaders can be more effective when they get things done through others</strong>. For more information about delegation, see: <a href="http://www.businessballs.com/delegation.htm">Article</a><br />
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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.<br />
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<a href="http://en.wikipedia.org/wiki/Micromanagement">Wikipedia's</a> 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. <br />
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<strong><em>The Road to Recovery</em></strong></div>
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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.<br />
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After reading the Wikipedia materials, does it appear that Mary may have issues?<br />
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What steps could Mary take?<br />
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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:<br />
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1. Preplans the retreat with the facilitator.<br />
2. Evaluates with the facilitator how she is using the written reports that she is requiring on a weekly basis.<br />
3. Evaluates the benefit of weekly individual meetings with each direct report<br />
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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?<br />
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<b>NOT MICROMANAGING DOES NOT EQUAL "INATTENTION TO RESULTS"</b><br />
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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. <br />
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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:<br />
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<li>periodically checking in with the person the role has been delegated to</li>
<li>removal of barriers beyond the scope of that person to move forward</li>
<li>reviewing the results obtained on a regularly pre-established basis</li>
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<a href="http://feeds.feedburner.com/BrentLemondsBlog" rel="alternate" type="application/rss+xml">Subscribe to Brent Lemonds' Healthcare Management Blog</a>Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-72002129920028643922012-08-24T00:53:00.001-05:002012-08-29T19:24:41.542-05:00Priorities: The Management Team MeetingIf 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<br />
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<b> to improve the consistency of management actions experienced by the staff members.</b></div>
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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.<br />
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<b>THE WORK OF THE TEAM</b><br />
<br />
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<br />
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<b>CHALLENGE UP / SUPPORT DOWN</b></div>
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.<br />
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<b>AGENDA PLANNING</b><br />
<br />
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)<br />
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<b>ABC Management Meeting</b></div>
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I. Opening Remarks 5 minutes Brent<br />
(the leader should start and end the meeting on time)<br />
<br />
II. Reward & Recognition Opportunities for Staff 10 minutes Managers<br />
(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)<br />
<br />
III. Policy Change Needed Attending non-required 20 minutes Brent<br />
courses is not paid time<br />
<br />
(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.)<br />
<br />
IV. Issues from each manager 10 minutes each Education Manager<br />
Quality Manager<br />
Team A<br />
Team B<br />
Team C<br />
Site II Manager<br />
<br />
V. Adjournment total time 95 minutes<br />
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<b><span style="font-family: Trebuchet MS, sans-serif; font-size: large;"><i><br /></i></span></b></div>
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<b><span style="font-family: Trebuchet MS, sans-serif; font-size: large;"><i><br /></i></span></b></div>
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<b><span style="font-family: Trebuchet MS, sans-serif; font-size: large;"><i><br /></i></span></b></div>
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<b><span style="color: red; font-family: Trebuchet MS, sans-serif; font-size: large;"><i>Failing to Plan is Planning to Fail</i></span></b></div>
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<b>DOCUMENTATION OF MEETING</b></div>
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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.</div>
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<b>SPECIAL MEETINGS - RETREATS:</b></div>
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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.</div>
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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.</div>
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<img src="http://t1.gstatic.com/images?q=tbn:ANd9GcTHi3V4WmVN58LrrcTgWoFjdcLsl0Qpr-3AwcS0FKloVq72byT0FfDMS4GMvQ" />
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<a href="http://feeds.feedburner.com/BrentLemondsBlog" rel="alternate" type="application/rss+xml">Subscribe to Brent Lemonds' Healthcare Management Blog</a>Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-25560762820416055212012-08-22T08:19:00.000-05:002012-08-22T08:19:28.841-05:00Care and Feeding of your TeamThis 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 "<strong>People don't care how much you know until they know how much you care</strong>." 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<a href="http://www.constitution.org/mac/prince17.htm"> here</a>. 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: "<em>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</em>." 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. <br />
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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.<br />
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<strong>CRISIS:</strong><br />
<br />
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:<br />
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<strong>You are notified that an employee has been killed or died:</strong><br />
<ol>
<li>Go to work.</li>
<li>Notify your supervisor.</li>
<li>Call for assistance from your Employee Assistance Program or a Counselor (Hopefully this has been prearranged)</li>
<li>Determine how notification is going to made to the next of kin. Assist with this if requested by officials.</li>
<li>Notify your staff on duty and develop a plan for your off duty staff.</li>
<li>Identify someone on your team to arrange staffing coverage for vacant shifts created.</li>
<li>Make yourself available to your team members as they grieve.</li>
<li>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.</li>
<li>If the death was on the job, notify OSHA.</li>
<li>If there are death benefits for the employee, assist the family with the death benefits.</li>
</ol>
<strong>An employee is involved in a wreck in a company vehicle and is seriously injured:</strong><br />
<ol>
<li>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)</li>
<li>Make sure the next of kin has been notified.</li>
<li>Notify your supervisor.</li>
<li>Notify your risk manager or insurance company.</li>
<li>Identify someone on your team to arrange staffing coverage for vacant shifts created.</li>
<li>Obtain FMLA paperwork for injured team member.</li>
<li>Visit team member while recovering in the hospital.</li>
<li>If the person goes home from the hospital, you can call to check on them.</li>
</ol>
<strong>An employee approaches you with a financial crisis:</strong><br />
<br />
<ol>
<li>Listen to his/her concerns. This is very embarrassing for the employee.</li>
<li>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.</li>
</ol>
<strong><img alt="" class="rg_hi uh_hi" data-height="178" data-width="284" height="178" id="rg_hi" src="https://encrypted-tbn3.google.com/images?q=tbn:ANd9GcQDgNOoiuXABtg_aPsNZ-e9yvqKQh5FIqvKjq8ocuCyIYJxK9htcA" style="height: 178px; width: 284px;" width="284" /></strong><br />
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<strong>Your employee comes to you and admits to taking drugs on the job.</strong><br />
<br />
<ol>
<li>You have to follow your organizations policies regarding drug-free workplace if they exist.</li>
<li>Arrange for self-referral into a treatment program (Have this information in advance).</li>
<li>Notify your Human Resources department (follow their instructions).</li>
<li>Notify your supervisor.</li>
<li>If the employee holds a professional license, follow appropriate procedures to notify the license issuer.</li>
</ol>
<strong>An employee is hospitalized</strong><br />
<br />
<ol>
<li>Go visit the employee unless you have word that the employee is feeling very ill and does not want visitors.</li>
<li>Call, send a personal note or card.</li>
</ol>
<strong>EMPLOYEE LIFE EVENTS</strong><br />
<br />
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.<br />
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Birthday Cards or at least e-mails<br />
Monthly Birthday Cake for everyone who has a birthday that month<br />
Baby Showers<br />
Wedding Showers<br />
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<strong>REMEMBER:</strong> 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.<br />
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<span style="font-size: large;"><strong><em><span style="color: red;">Leaders have no one to lead if no one follows them.</span></em></strong></span></div>
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<a href="http://feeds.feedburner.com/BrentLemondsBlog" rel="alternate" type="application/rss+xml">Subscribe to Brent Lemonds' Healthcare Management Blog</a>Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-80865900726791733822012-08-20T10:56:00.001-05:002012-08-22T07:51:46.779-05:00Politics: 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. <br />
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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.<br />
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<em><blockquote class="tr_bq" style="text-align: center;">
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<em><blockquote class="tr_bq">
<blockquote class="tr_bq" style="text-align: center;">
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<em>Why do we have political appointees? The primary reason,</em></div>
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<em></em></div>
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<em>theoretically, is to assure political accountability. A secondary reason is </em><em>to reward supporters who helped elect the President.</em></div>
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<em>Initially, the spoils system ("to the victor go the spoils") reached </em><em>down to the lowest echelons of the bureaucracy, and nearly all federal </em><em>jobs were dispensed on the basis of patronage. In the post-Civil War y</em><em>ears a professionalized, merit-based civil service system was </em><em>established and, as refined and enlarged over the succeeding </em><em>generations, now covers all but the senior-most layer of the federal </em><em>government. The principle remains entrenched, however, and seems </em><em>hardly ever questioned, that all the key policy-making positions and </em><em>their immediate support staff should be filled by political appointment.</em></div>
</blockquote>
</blockquote>
</em></div>
</blockquote>
</em><a href="http://www.brookings.edu/~/media/research/files/papers/1996/2/bureaucracy%20cohen/amateur.pdf">Amateur Government</a>
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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?</div>
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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. </div>
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<strong>GETTING BURNED:</strong></div>
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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.</div>
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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:</div>
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<strong>The toes you step on today, may be attached to the rear end you have to kiss tomorrow!</strong></div>
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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.</div>
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I have had several lunch invitations from co-workers where it became clear that the <strong>AGENDA</strong> 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.</div>
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<img height="276" id="il_fi" src="http://static.guim.co.uk/sys-images/Money/Pix/pictures/2009/11/9/1257778983808/lunchtime-meeting-working-001.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="460" /></div>
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<strong>DON'T TAKE IT PERSONAL</strong></div>
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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 <strong>Seek First to Understand before trying to be Understood</strong>. 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.</div>
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<strong>THINK WIN / WIN</strong></div>
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The best outcome is again one of the <a href="http://ocean.tamu.edu/lcampbell/WIGS/covey_stephen_-_the_seven_habits_of_highly_effective_people.pdf">7 Habits of Highly Effective People</a> by Covey, <strong>Think Win/Win</strong>. 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.</div>
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<a href="http://www.constructionknowledge.net/people_skills/people_skills.php">Source</a></div>
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<a href="http://feeds.feedburner.com/BrentLemondsBlog" rel="alternate" type="application/rss+xml">Subscribe to Brent Lemonds' Healthcare Management Blog</a>Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-57870125080150829182012-08-18T19:11:00.000-05:002012-08-20T10:48:20.282-05:00Manage with Facts & Data, Not EmotionEveryone 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.<br />
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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.<br />
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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. <br />
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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!<br />
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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. <strong>Remember: Every process is perfectly designed to produce the results that it produces.</strong><br />
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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.<br />
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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. <br />
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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.<br />
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<p><a href="http://feeds.feedburner.com/BrentLemondsBlog" rel="alternate" type="application/rss+xml">Subscribe to Brent Lemonds' Healthcare Management Blog</a></p>Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-33123872255774370322012-08-16T11:26:00.000-05:002012-08-21T15:32:30.965-05:00Gifts & Talents: Know Yours and Those of Your Team<img src="https://encrypted-tbn1.google.com/images?q=tbn:ANd9GcStNM97I9SoKROeWLtljgtRP5ECrxvLaaG2SuF0trLmTGdGHpOr" /> <br />
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<span style="color: black;">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?</span><br />
<br /><span style="color: black;">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.</span><br />
<span style="color: #f1c232;"><br /></span><span style="color: #f1c232;"><br /></span><br />
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1 Peter 4:10<br />
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New International Version (NIV)<br />
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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.<br />
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<strong><span style="font-size: large;">Let's get things done, examples of how other's gifts and talents can be used in the workplace:</span></strong><br />
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.<br />
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.<br />
You have an employee who is a singer. She would be happy to provide entertainment for the Christmas party.<br />
Another employee loves to plan get togethers. Would a summer family picnic be right for your team?<br />
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.<br />
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?<br />
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.<br />
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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. <br />
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How To Identify A Gift or Talent<br />
You can do it or learn it easily<br />
You feel strong when you do it<br />
It comes naturally to you<br />
It brings joy to you and others<br />
You look forward to doing it<br />
You feel like you’re “in the zone” when you do it<br />
Time seems to fly when you’re doing it<br />
After you’ve expressed your talent you feel fulfilled<br />
After you’ve expressed a talent you look forward to doing it again<br />
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<a href="http://ianpaulmarshall.com/gifts-and-talents/">Source</a>Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-14818159037860589262012-08-14T22:13:00.000-05:002012-08-14T22:13:55.521-05:00Transformational LeadershipMany 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).<br />
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<strong>Characteristics of a transformational leader:</strong><br />
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* Charismatic<br />
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* Engaging<br />
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* Inspirational<br />
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* Stable<br />
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* Optimistic<br />
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* Encouraging<br />
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* Honest<br />
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* Motivational<br />
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* Respectful<br />
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* Positive<br />
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* Team oriented<br />
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* Effective communicator<br />
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* Empowering<br />
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* Reliable<br />
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* Trustworthy<br />
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* Empathetic<br />
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* Mentor<br />
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* Visionary<br />
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(Smith, Mary Atkinson, 2011) <strong><span style="font-size: large;">There are 7 principles to Transformational Leadership:</span></strong> <br />
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<strong>Simplification</strong> <br />
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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.<br />
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<strong>Motivation</strong><br />
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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.<br />
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<strong>Determination</strong><br />
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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.<br />
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<strong>Mobilization</strong><br />
<strong><br /></strong>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.<br />
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<strong>Preparation</strong><br />
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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.<br />
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<strong>Facilitation</strong><br />
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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.<br />
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<strong>Innovation</strong><br />
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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.<br />
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<a href="http://smallbusiness.chron.com/seven-principles-transformational-leadership-42552.html">Adapted from</a><br />
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(1) Barker AM, Sullivan DT, Emery MJ. Leadership Competencies for Clinical Managers: The Renaissance of Transformational Leadership. Sudbury, MA: Jones and Bartlett; 2006. <br />
<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-9096104104531069182012-08-11T00:52:00.000-05:002012-08-12T20:28:10.955-05:00The Manager's Gold Standard of CareYou 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.<br />
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<img alt="" class="rg_hi uh_hi" data-height="201" data-width="251" height="201" id="rg_hi" src="https://encrypted-tbn3.google.com/images?q=tbn:ANd9GcRilYxqd1LGGUbkcVakMfwOvJ0dGYRaHFBgHSxefc-5nL70K7LYdA" style="height: 201px; width: 251px;" width="251" />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.<br />
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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. <br />
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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?"<br />
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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!<br />
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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!<br />
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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!<br />
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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.<br />
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<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-68744131686441506832012-08-09T23:12:00.003-05:002012-08-10T23:40:39.474-05:00Situational LeadershipWelcome 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.<br />
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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.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgJNEa1KcWyYNnUyDROGt9N-wo5KLDSejSbW8DVcLygUnoEahdrGuXb2vaZxNhVJkU7R26TUv3oxB6x0lRxGfDzA-l1LANOKGEljUqWZnMWnsNAvByzE3peFUMKXb1fjJIhyphenhyphenUau8zIGY9G/s1600/Situational%2520Leadership%2520Model4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="382" kda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgJNEa1KcWyYNnUyDROGt9N-wo5KLDSejSbW8DVcLygUnoEahdrGuXb2vaZxNhVJkU7R26TUv3oxB6x0lRxGfDzA-l1LANOKGEljUqWZnMWnsNAvByzE3peFUMKXb1fjJIhyphenhyphenUau8zIGY9G/s400/Situational%2520Leadership%2520Model4.jpg" width="400" /></a></div>
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.<br />
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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.<br />
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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.<br />
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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.<br />
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DEVELOPMENT LEVEL<br />
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According to Blanchard, D1-D4 represents the development level of individuals across a continuum. D1 is low competence/High commitment (Directing)<br />
D2 some competence / low commitment (Coaching)<br />
D3 moderate to high competence / variable commitment (Supporting)<br />
D4 high competence / high commitment (Delegating)<br />
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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.<br />
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A nursing model that I like is the Benner model on development. Simply stated it is Novice to Expert.<br />
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.<br />
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<a href="http://en.wikipedia.org/wiki/Situational_leadership_theory">Situational Leadership Theory (click here)</a><br />
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<strong>COACHING:</strong><br />
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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.<br />
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A coach is a person who teaches and directs another person via encouragement and advice. (Lamb-White, J. 2008)<br />
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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)<br />
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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)<br />
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Sets mutual goals – defines expectations<br />
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<a href="http://www.google.com/imgres?hl=en&biw=1093&bih=493&tbm=isch&tbnid=9ZzSNWXRnXHeCM:&imgrefurl=http://managementcraft.typepad.com/management_craft/2005/04/get_great_coach.html&docid=pzy0G7vM9oFfaM&imgurl=http://managementcraft.typepad.com/photos/uncategorized/figure_12_1converted.jpg&w=600&h=670&ei=aA0jUKH1KI3m8gSH14GoDQ&zoom=1&iact=hc&vpx=95&vpy=138&dur=9703&hovh=237&hovw=212&tx=127&ty=260&sig=112817657016000729325&page=5&tbnh=140&tbnw=125&start=59&ndsp=15&ved=1t:429,r:5,s:59,i:348">Three Ways to Influence Others</a><br />
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<strong>MENTORING:</strong> 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. <br />
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Mentoring refers to the developmental relationship with a more experienced “expert” and a less experienced (and usually younger) protégé. (Lamb-White, 2008)<br />
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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) <br />
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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)<br />
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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)<br />
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<img height="266" id="il_fi" src="http://www.inboundlogistics.com/cms/userfiles/mentoring_feature_0610.jpg.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="400" /><br />
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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!Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com1tag:blogger.com,1999:blog-2971439470252637305.post-24556204411925838782012-08-04T21:27:00.000-05:002012-08-10T23:39:46.110-05:00Errors Should Be AdmittedI'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?<br />
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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.<br />
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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.<br />
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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. <br />
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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.<br />
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<strong>LISTEN TO THE PATIENT</strong></div>
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<div style="text-align: left;">
Betty Ann Bowser of PBS NewsHour in April 2011 reported the following:</div>
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<br />
•A study published in Health Affairs examined the records of 795 patients at three teaching hospitals.<br />
<br />
•354 of the patients had experienced medical mistakes.<br />
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•“90 percent of all hospital mistakes go unreported.<br />
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”To read the entire article, click on <a href="http://www.pbs.org/newshour/rundown/2011/04/new-study-finds-medical-error-rates-are-underreported.html">New Study Finds Medical Error Rates are Underreported</a>. To read the entire study in Health Affairs, click on ‘<a href="http://content.healthaffairs.org/content/30/4/581.abstract">Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured</a>.<br />
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<img height="269" id="il_fi" src="http://www.perfectapology.com/image-files/medical-error-disclosure.gif" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="442" /><br />
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<a href="http://perfectapology.com/">PerfectApology.com</a><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3zCzF9dxSH1K1ZgyDCHjw7b8vOcy5lk8C76bMNB3FTOKX1Js-9TaM6g9KzH5uk_lqRt8NTB0Oh_RIJI5w4Tf-QjEIhGbP7IliiEiO4wBnizmXLIKXX571aTIYvUJza6O8FijdPhRft9up/s1600/medical+error+xray.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" eda="true" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj3zCzF9dxSH1K1ZgyDCHjw7b8vOcy5lk8C76bMNB3FTOKX1Js-9TaM6g9KzH5uk_lqRt8NTB0Oh_RIJI5w4Tf-QjEIhGbP7IliiEiO4wBnizmXLIKXX571aTIYvUJza6O8FijdPhRft9up/s400/medical+error+xray.jpg" width="400" /></a></div>
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<strong>DISCLOSING MANAGEMENT ERRORS</strong><br />
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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. <br />
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References: <br />
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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. <a href="http://jme.bmj.com/content/31/2/106.short">http://jme.bmj.com/content/31/2/106.short</a><br />
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Gallagher, T. and Lucas, M. (2005). Should we disclose harmful medical errors to patients? If so, how? JCOM May 12:5 <a href="http://www.turner-white.com/memberfile.php?PubCode=jcom_may05_patients.pdf">http://www.turner-white.com/memberfile.php?PubCode=jcom_may05_patients.pdf</a><br />
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Gallagher, T. and Studdert, D. (2007). Disclosing harmful medical errors to patients. N Engl J Med. 356:2713-9. <a href="https://secure.muhealth.org/~ed/students/articles/NEJM_356_p2713.pdf">https://secure.muhealth.org/~ed/students/articles/NEJM_356_p2713.pdf</a><br />
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Greene, L. (2008). More apologies to families follow medical mistakes. St. Petersburg Times. <a href="http://www.tampabay.com/news/health/medicine/article775911.ece">http://www.tampabay.com/news/health/medicine/article775911.ece</a><br />
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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.<br />
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Kraman, S., Hamm, G. (1999). Risk Management: Extreme Honesty May Be the Best Policy. Annals of Internal Medicine. December 21: 131:963-967. <a href="http://www.blogger.com/goog_1615365742">http://www.annals.org/content/131/12/963.short</a><br />
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Lamb, R. (2004). Open disclosure: the only approach to medical error. Qual Saf Health Care 13:3-5 <a href="http://qualitysafety.bmj.com/content/13/1/3.extract">http://qualitysafety.bmj.com/content/13/1/3.extract</a><br />
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Liang, B.A. (2002). A system of medical error disclosure. Qual Saf Health Care. 11:64-68. <a href="http://qualitysafety.bmj.com/content/11/1/64.short">http://qualitysafety.bmj.com/content/11/1/64.short</a><br />
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<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-47648314353642443032012-08-02T23:04:00.001-05:002012-08-10T23:39:18.830-05:00Rounding for Outcomes<a href="http://en.wikipedia.org/wiki/Undercover_Boss">Undercover Boss</a> 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.<br />
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<img height="200" id="il_fi" src="http://xfinitytv.comcast.net/api/entity/thumbnail/TvSeries-104637/640/320" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="400" /><br />
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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.<br />
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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:<br />
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<ol>
<li>Approach your employee and ask for a few minutes of their time.</li>
<li>What is going well today? Start with a positive question or all you get will be negative stuff.</li>
<li>What is not going well today?</li>
<li>What can we improve on?</li>
<li>Is there someone I should recognize for doing great work?</li>
<li>Do you have the equipment to do your job?</li>
<li>Are there any systems that need improvement?</li>
<li>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:</li>
</ol>
"You know, Mary, we have really been working on patient satisfaction. What are you doing to <br />
assure that our patients are having an excellent experience."<br />
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<em><strong>LEVERAGE:</strong> 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.</em><br />
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9. Is there anything I can help you with right now?<br />
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<img alt="" class="rg_hi uh_hi" data-height="194" data-width="259" height="194" id="rg_hi" src="https://encrypted-tbn3.google.com/images?q=tbn:ANd9GcR4J8vtOuk0mI2jNCVpSCPpSy9OzBadPCdiaHfwQnOXnWMbu2dHUg" style="height: 194px; width: 259px;" width="259" /><br />
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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.<br />
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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.<br />
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<span style="font-size: large;"><strong>OMG, #9, what if they ask me to help them with something?</strong></span><br />
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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.<br />
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<span style="font-size: large;"><strong>What if they just start complaining?</strong></span><br />
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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.<br />
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<strong><span style="font-size: large;">What kind of records should I keep?</span></strong><br />
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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.<br />
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<span style="font-size: large;"><strong>What if I want to round on patients?</strong></span><br />
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Great idea, different questions, download the form from pages.<br />
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<strong><a href="http://www.youtube.com/watch?v=Jt-yrS_cyq4">You Tube Example of How To Screw This Up</a></strong><br />
<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-87166644078395587212012-08-01T17:43:00.001-05:002012-08-01T17:44:21.670-05:00Creating A Positive Work EthicI 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. <a href="http://www.city-journal.org/2009/19_3_work-ethic.html">To read a great history on the change of the work ethic over the years, click here.</a><br />
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To compete for talent we have to create a positive and engaged workforce <a href="http://changethis.com/manifesto/show/78.06.happinessadvantage">(Achor, 2012)</a>. It's not, If you work hard, you'll be happy...It's if you are happy, you'll work hard. <br />
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<span style="font-size: large;"><strong>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.</strong><span style="font-size: small;"> </span><a href="http://changethis.com/manifesto/show/78.06.happinessadvantage"><span style="font-size: small;">(Achor, 2012)</span></a></span><span style="font-size: small;">. </span></div>
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<span style="font-size: small;">"To help these people capitalize on the Happiness Advantage, I often recommend that they keep one</span></div>
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thing in mind: the number 2.9013. This may seem random, but a decade of research on high and<br />
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low performance teams by psychologist and business consultant Marcial Losada shows just how<br />
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important it is. Based on Losada’s extensive mathematical modeling, 2.9013 is the ratio of positive<br />
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to negative interactions necessary to make a corporate team successful. This means that it takes<br />
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about three positive comments, experiences, or expressions to fend off the languishing effects<br />
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of one negative. Dip below this tipping point, now known as the Losada Line, and workplace performance<br />
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quickly suffers. Rise above it—ideally, the research shows, to a ratio of 6 to 1—and teams<br />
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produce their very best work." (Achor, 2012). <br />
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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. <strong> IT IS MORE FUN TO CATCH PEOPLE DOING THINGS RIGHT THAN TO CATCH THEM DOING THINGS WRONG.</strong> <strong></strong> 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. <img height="554" id="il_fi" src="http://1.bp.blogspot.com/_i3dor6fRVmM/SwCzcGZahOI/AAAAAAAAFS4/NR1aunCliLA/s1600/WorkEthics+-+%2301-736347.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="553" /><br />
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When the leader takes time to compliment the team on teamwork....that teamwork will be repeated. <strong>WHAT IS REWARDED IS REPEATED</strong>. 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:<br />
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<em>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</em><br />
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<a href="http://wiki.answers.com/Q/What_does_it_mean_to_have_positive_work_ethic">Source</a><br />
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<strong><span style="font-size: large;">I want to end with some tips about the newest working generation. I found this great piece which covers the work ethic very well:</span></strong><br />
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Millennial (Generation Y). Born between 1981-2000.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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Employment Expectations <br />
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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.<br />
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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).<br />
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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.<br />
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Work Ethic / Loyalty<br />
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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.<br />
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Millennials are accustomed to new ideas and situations, a constant opportunity to learn (or more accurately find out).<br />
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Praise Millennials often – daily even… and for sure… coach them.<br />
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<a href="http://brucemayhew.wordpress.com/2011/06/27/work-ethics-in-the-workplace-generation-differences/">From Bruce Mayhew Blog</a><br />
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<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-81970915254709370802012-07-31T14:18:00.003-05:002012-07-31T14:21:14.266-05:00People First<img height="255" id="il_fi" src="http://www.studergroup.com/content/tools_and_knowledge/fundamentals/associated_filesandimages/5pillars.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="340" /><br />
Many organizations use five or six pillars to represent the supporting structure of their organization resting on top of a firm foundation. Those pillars may include Service * Quality * Finance * Growth and a combination of other supporting principles, but will almost always include the <strong>People Pillar</strong>. In an article today in Wharton at Work titled People First, Strategy Second a book by Ram Charan called The Talent Masters (Crown Business, 2010) is highlighted. In the book, he highlights the importance of investing in people and identifying those with growth potential. The best companies in the world have learned that it is best to recruit from within. Senior leaders are heavily involved in recruitment at all levels, new talent is observed for in the ranks, judgements on leaders are based upon hard evidence and cross-checking by observations by multiple people, leader development is as aggressive as delivering financial results.<br />
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I have heard all my life that the church is not a building, it is the people that go to gather in the building. Many organizations forget the their very organization is made up of the people that work there. <br />
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<strong><span style="font-size: large;">I have always said that the patient is my first priority, the second is the people that care for the patients.</span></strong></div>
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This guiding principle has helped me through many decisions. The first time you say that to a group of employees, they don't like it. They want first place. But when you explain that no one would work the night shift if the patient was not in first position, it begins to make sense. It has been equal for me to the Ritz-Carlton's "<strong>We are Ladies and Gentlemen serving Ladies and Gentlemen</strong>." It does say to me how I think employees should be treated. I think they should be treated the way I woud want to be treated. They are a valuable resource. They should be carefully selected. My friend and author Tom Hornsby wrote in his book New Roles for Leaders that leaders should H.O.G. (Help Others Grow). I have been repayed many times over for spending extra time with people to help them learn something new.<br />
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The balance of course is accountability. People have to be accountable for their actions. The more clear we make our expectations, the easier it is to hold people accountable. If an individual understands their role and chooses not to perform their job, they should expect that they would be held accountable for that. If they are dishonest, they should expect to be be held accountable for that. Remember, I have talked about 2/3 team members and low performers. Leaders don't have to be drill sergeants, they have to be coaches and scorekeepers. If you have tried to coach someone and they cannot do the job, it becomes a matter of self selecting off of the team.<br />
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<img alt="" class="rg_hi uh_hi" data-height="193" data-width="261" height="193" id="rg_hi" src="https://encrypted-tbn1.google.com/images?q=tbn:ANd9GcSBRQMZFYdCx1YV6-36qt4Ve3NCl5CJzAkBBbUTx7hJvSDakaxP" style="height: 193px; width: 261px;" width="261" /><br />
<a href="http://www.google.com/imgres?start=114&hl=en&biw=1024&bih=663&tbm=isch&tbnid=eBvVQVhOf8uL3M:&imgrefurl=http://nothingbychancecoaching.com/&docid=3dKORRTaVlwQEM&imgurl=http://nothingbychancecoaching.com/wp-content/uploads/2010/10/accountability-leads-to-accomplishment.jpg&w=411&h=304&ei=zysYUNXlKoza9ATJ2YGACA&zoom=1&iact=hc&vpx=719&vpy=121&dur=844&hovh=193&hovw=261&tx=155&ty=121&sig=113414498455596743666&page=7&tbnh=121&tbnw=164&ndsp=19&ved=1t:429,r:9,s:114,i:99">Source</a><br />
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You owe it to your other employees to hold those not pulling their weight accountable. Remember, the chances are, lower performers will bring other employee's performance down to their level.<br />
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<strong>IDENTIFYING HIDDEN TALENT IN THE RANKS</strong><br />
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So how do we identify those hidden talents out there? They are watching you. They are trying to do a great job and hoping that someone is noticing. They are not negative, but they may make helpful suggestions. They would be great to serve on a committee to get a particular task done. They are people that you could delegate additonal tasks to and they would not even think of complaining - it would be a reward to them. They would be happy to learn more and do more. If they need more skills, you might need to invest in some training, or at least suggest what training they need. Promoting from within is a great idea. People who work their way up have great stories to tell.Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-22121141294329544932012-07-30T23:34:00.001-05:002012-08-10T23:38:57.493-05:00Customer Service in HealthcareI've given you some tools to help you provide excellent customer service, but let's review a little bit about the basic concepts of why customer service has a place in healthcare. Earlier in my career, there were debates in the professional literature about whether "patients" were really "customers". That always seemed strange to me. Except those patients who are severely ill or injured, patients exercise choice. Therefore, they enter into a customer supplier relationship with healthcare providers. There should be no doubt in anyones mind now that payors are beginning to reimburse providers based upon those customer satisfaction ratings. We care what customers think and must understand that their perceptions of quality differ from our perceptions of quality. More importantly, healthcare providers have to learn and understand that perception equals reality for the customer. Your employee may not think he or she is rude, but if the customers think that, the employee has something to work on.<br />
<br />
<div style="text-align: center;">
<span style="color: red; font-size: large;">Perception = Reality</span></div>
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<div style="text-align: left;">
To help employees appreciate how others perceive the services they receive, it is important that they see the data that is collected. Posted trend charts of satisfaction surveys should be readily available. The data should be discussed in staff meetings. It is good for employees to have some education on what customers expect. They want the same things that the employees want when they are customers:</div>
<ul>
<li><div style="text-align: left;">
to have some control</div>
</li>
<li><div style="text-align: left;">
respect and dignity</div>
</li>
<li><div style="text-align: left;">
fair treatment</div>
</li>
<li><div style="text-align: left;">
friendly, warm, caring service</div>
</li>
<li><div style="text-align: left;">
to feel safe and secure</div>
</li>
<li><div style="text-align: left;">
honesty</div>
</li>
</ul>
<div style="text-align: left;">
Employees who help develop strategies for superior customer service are more likely to follow through with those strategies:</div>
<ul>
<li><div style="text-align: left;">
exceed customer expectations</div>
</li>
<li><div style="text-align: left;">
demonstrate empathy</div>
</li>
<li><div style="text-align: left;">
fully discuss alternatives</div>
</li>
<li><div style="text-align: left;">
follow through</div>
</li>
<li><div style="text-align: left;">
keep promises (promise low, deliver high)</div>
</li>
</ul>
<div style="text-align: left;">
When a customer complains they have needs as well:</div>
<ul>
<li><div style="text-align: left;">
to be taken seriously</div>
</li>
<li><div style="text-align: left;">
immediate action or reaction</div>
</li>
<li><div style="text-align: left;">
someone to be punished (customers are rarely gratified on this one)</div>
</li>
<li><div style="text-align: left;">
to be listened to</div>
</li>
<li><div style="text-align: left;">
acknowlegement of their feelings</div>
</li>
<li><div style="text-align: left;">
followup</div>
</li>
</ul>
<div style="text-align: left;">
Data shows that customers who have filed complaints and recovery was handled well are more likely to return for more business than those who never filed a complaint. However, their are pitfalls to handling complaints:</div>
<div style="text-align: left;">
<br /></div>
<ul>
<li><div style="text-align: left;">
defensiveness</div>
</li>
<li><div style="text-align: left;">
citing policies</div>
</li>
<li><div style="text-align: left;">
poor listening</div>
</li>
<li><div style="text-align: left;">
passing the buck (we are busy)</div>
</li>
<li><div style="text-align: left;">
over reaction</div>
</li>
<li><div style="text-align: left;">
siding against the organization</div>
</li>
</ul>
<div style="text-align: left;">
There are many strategies to improve customer satisfaction, but if you were the Ritz-Carlton, that would be setting the bar too low. What you really want to do is to build <strong>LOYALTY</strong>. You want customers who will always return to <strong>you</strong> for service. The equation to do that sounds simple. You need to build relationships and deliver zero defects.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-OxZgheIkGa1Cz8kgNBPvuR0KDynW5OlD9n79TeN6u_h1BhiV5bkL6xmoEWEFAdX6cIecpJjQcpUbH1JHlBbluOOYF6ewYsfMXrRfCAO8Bzz46bezjy7rPgZbmd8jdW3peR85BjUE-UxU/s1600/Loyalty.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" eda="true" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh-OxZgheIkGa1Cz8kgNBPvuR0KDynW5OlD9n79TeN6u_h1BhiV5bkL6xmoEWEFAdX6cIecpJjQcpUbH1JHlBbluOOYF6ewYsfMXrRfCAO8Bzz46bezjy7rPgZbmd8jdW3peR85BjUE-UxU/s320/Loyalty.jpg" width="320" /></a></div>
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<div style="text-align: left;">
When I think about my own customer experiences, the fact is, I have chosen places where defects are at a minimum. I get very consistent technical service. So relationships count very high. You think along with me:</div>
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<br /></div>
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</div>
<div style="text-align: left;">
<ol>
<li>I have been seeing the same dentist for years mainly because he is on my insurance plan and both he and his hygienist are friendly to me.</li>
<li>I go to a dry cleaner that does not have a drive thru window (inconvenient), but every employee calls me by my name.</li>
<li>I go to the same Mexican restaurant because every server knows to bring me both cheese dip and guacamole dip.</li>
<li>My neurologist always brags on my headache log and reminds me to call her if I need anything.</li>
</ol>
</div>
Organizations can nail the quality side, but without relationships they still will not be able to build customer loyalty. I cannot emphasize too much that having satisfied customers does not mean you will be building your customer base for repeat business. With healthcare facing a shrinking dollar, <strong>LOYALTY</strong> will be the phrase of the future. Organizations will be looking for ways to separate themselves from the competition.<br />
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<img height="568" id="il_fi" src="http://simpliflying.com/wp-content/uploads/ritzcredo1.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="340" /><br />
<a href="http://www.google.com/imgres?hl=en&biw=1366&bih=616&tbm=isch&tbnid=Eye5xxW5xVB7CM:&imgrefurl=http://simpliflying.com/2008/best-lessons-in-customer-service-for-airlines-from-ritz-carlton/&docid=V7tjL_R0BfTEFM&imgurl=http://simpliflying.com/wp-content/uploads/ritzcredo1.jpg&w=367&h=613&ei=Kl0XUK6DFJDa9AT4r4B4&zoom=1&iact=hc&vpx=936&vpy=64&dur=27971&hovh=290">Ritz Carlton Credo</a><br />
<br />
The Ritz Carlton Hotel has a simple concept for it's employees to follow: "We are Ladies and Gentlemen serving Ladies and Gentlemen." Within that short sentence is embodied the concepts of respect for the customer, service, and respect for it's own employees. It is a formula that works setting the Ritz-Carlton apart as a service leader.<script type="text/javascript">
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</script>Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-67213945097751215082012-07-28T09:16:00.001-05:002012-07-28T09:21:54.917-05:00Giving FeedbackGiving feedback is an important leadership skill. High performers deserve our praise because we constantly need to be "re-recruiting" them to our team. If we fail to do that, they will be successfully recruited to someone else's team who knows how to reward and recognize. Personal thank you notes, movie tickets, bonuses, or simply a few minutes of your time telling them how much they mean to your team will go a long way. Remember, people don't leave organizations, they leave managers.<br />
<br />
Lower and middle performers are also in need of your feedback. The most compassionate thing you can do for someone who needs to improve is to tell them so. If they are not doing well, your unhappiness with them will affect how you interact with them. They will be unhappy as well and their performance will continue to suffer. Let me give you several examples.<br />
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<div style="text-align: center;">
<strong>"That's just Mary"</strong></div>
<br />
When I hear of an employee's behavior that is unacceptable and someone tries to defend their behavior by saying "that's just the way they are", words of my psychology professor ring in my ear. All behavior occurs because it worked for that person in the past. Some employees have developed a pattern of bad behavior that has been tolerated over the years. No one has cared enough about the person to bring it to their attention. Yes, you heard me right. No one cared enough. I was rounding in a new area of mine once and I observed an employee being very rude to a new co-worker. When I asked the manager about that, I was told, "That's just Mary." My confidence level in the manager for dealing with the situation was very low. She had just accepted Mary's behavior failing to realize the impact Mary was having on employees new and old. Mary had to have a plan of correction. When I spoke to Mary and told her my concerns, she became tearful and told me that no one had ever told her that she was perceived as loud and rude. What a disservice we do to colleagues when we don't share with them how people feel about them. People cannot improve if they are not given an opportunity to know what needs to be improved.<br />
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<img height="400" id="il_fi" src="http://smallbusiness.chron.com/DM-Resize/photos.demandstudios.com/getty/article/129/146/79166550.jpg?w=600&h=600&keep_ratio=1" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="600" /><br />
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<div style="text-align: center;">
<strong>I wouldn't want him working on me!</strong></div>
<div style="text-align: center;">
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<div style="text-align: left;">
An employee who lacks the technical skill to excel on the job needs to have that feedback. In healthcare, we tend to eat our young instead of build them up. That strategy is not helping us to meet the challenges of the aging population and the need for more healthcare workers. Our turnover rates are over 20% per year. We need to be about building skill in a mentoring way. Training programs of all types are not always effective at turning out persons completely skilled in all areas. When we encounter an employee who is struggling, the most compassionate thing to do is to provide the feedback and design a way for the employee to skill up. The most exciting way for employees to do that in healthcare is through simulation. The newer technology allows employees to practice their skills in a safe environment simulating the real environment without putting patient safety at risk. </div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: center;">
<strong>John is great technically, a great team member, but he is terrible with customers!</strong></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
My friend Julie Kennedy would refer to John as a 2/3 team member. People tend to excuse him. He is dependable, a rock star technically, he just has one flaw. He pisses people off. (excuse the frankness) John is a complaint generator. He is gruff with patients but they all want him to start their IV because he is so dang good at it. He works 60 hours a week so just about everyone is afraid he will quit. The doctors all love him and refer to him as a supernurse. But as his leader, you know that you are having to clean up after him all the time. He is a 2/3 employee. John needs that feedback.</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
When you sit down with John, his arms will be crossed as if daring you to say anything negative to him. But as a leader, you have to provide the feedback. The feedback is this. You need the full package out of everyone. He is great at teamwork, and he is technically skilled, but his customer service skills are lacking. You need him to improve. People in the department think he is a good nurse, but you classify him as a 2/3 employee.</div>
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<div style="text-align: left;">
All of the air will be sucked out of your office. A wide range of emotions could be exhibited. But it has been my experience that John will either address the concern, or he will self select to another workplace where he is not held accountable for customer service.</div>
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Source: Julie Kennedy: The Studer Group</div>
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<strong>PLANNING TO PROVIDE FEEDBACK (</strong>Reference Jim Pichert)</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
When preparing to give feedback think about how to handle various responses. What would you say if the employee had any of the following responses:</div>
<div style="text-align: left;">
<br /></div>
<ul>
<li><div style="text-align: left;">
Denial</div>
</li>
<li><div style="text-align: left;">
Anger</div>
</li>
<li><div style="text-align: left;">
Requests Help</div>
</li>
<li><div style="text-align: left;">
Attacks another employee's performance</div>
</li>
<li><div style="text-align: left;">
Attacks your performance</div>
</li>
<li><div style="text-align: left;">
Tries to change the subject</div>
</li>
</ul>
<div style="text-align: left;">
It is good to practice in advance with someone else who can help you plan your responses. Decide how you will "stay on your message."</div>
<div style="text-align: left;">
<br /></div>
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<strong>PLANNING THE FOLLOWUP</strong></div>
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<br /></div>
<div style="text-align: left;">
For complex issues, a followup discussion should be planned. People who have been given feedback will be wondering how you feel about their performance in a week, a month, and so on. New issues should be addresses as soon as possible. You can't change other people, but they can choose to change themselves. If that is accomplished, they need to hear positive feedback from you, the successful leader who did not ignore the problem.</div>
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<img height="426" id="il_fi" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3AR4yksNgTiajfFG4Clbs4n6cEzkoNnEsijiyxS694_n5kq1OzWoOAfJ4-EP00AfMXXM_x4afLIUbS_j0hpDCV68nOmOxSjJuazt7N-G8X60IFen2r0ZYZEca9oD2K1W8Ox-CxdfmtYD5/s1600/who-is-awesome.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="554" /></div>
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Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-31299022009541852032012-07-27T20:10:00.002-05:002012-08-10T23:38:19.074-05:00Have High StandardsEveryone 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.<br />
<br />
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. <strong><span style="font-size: large;">What is permitted is promoted.</span></strong> 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. <br />
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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. <br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRe1JG0gF_b_8HJroaIYn3wh1_s28ywFkVY9jvp4s7-X9QgJfta6Ud86T5iFY4o7avwztk82duB_0z953WB1TSaH0gOzuUm3D2qiDE_OVD4NbeElM5vdBBxvAADgdUDiU0XueEfvqZMoml/s1600/High+Standards.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" sda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRe1JG0gF_b_8HJroaIYn3wh1_s28ywFkVY9jvp4s7-X9QgJfta6Ud86T5iFY4o7avwztk82duB_0z953WB1TSaH0gOzuUm3D2qiDE_OVD4NbeElM5vdBBxvAADgdUDiU0XueEfvqZMoml/s400/High+Standards.jpg" width="283" /></a></div>
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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.</div>
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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. </div>
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<strong><em><span style="font-size: large;">Insanity: doing the same thing over and over again and expecting different results.</span></em></strong></div>
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<strong></strong></div>
<div style="text-align: center;">
<strong><br /></strong></div>
<div style="text-align: center;">
<strong>Albert Einstein</strong></div>
<br />
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. <br />
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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. <strong>No amount of encouragement to try harder will make the change occur.</strong><br />
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<img border="0" height="186" sda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5DIsL0C5554TQ6envdPKtH1y25m0cLczPgHJ6WzD_XUomdC0rbMLwBCXuUzUeLUOVC_qyeNp68HP04gB3HSP_caewLhcY_OxSSMG4iZvgP6gDddWHF4fYMHCAxpr4c7bZQLhLWYyz0DUl/s400/control+chart+process+in+control.jpg" width="400" /></div>
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<a href="http://www.google.com/imgres?hl=en&biw=1366&bih=616&tbm=isch&tbnid=GdmlbyEm2OREdM:&imgrefurl=http://en.wikipedia.org/wiki/Control_chart&docid=nk5GQFPro_UpEM&imgurl=http://upload.wikimedia.org/wikipedia/commons/thumb/f/f7/ControlChart.svg/520px-ControlChart.svg.png&w=520&h=244&ei=SykTUJn6I5HO9ATIoIGIBg&zoom=1&iact=hc&vpx=266&vpy=308&dur=172&hovh=154&hovw=328&tx=152&ty=89&sig=110832942205186354822&page=1&tbnh=81&tbnw=173&start=0&ndsp=19&ved=1t:429,r:7,s:0,i:95">Source</a><br />
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.<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRnkCsNtRU6fuV9lAIkDINEsXNPUzXsQ4IM11qGR0GZaQU_bH8dVSyuLUlkzMYmTDDCXPLtMpKymvl_PLtpJdPTlZ78HNFcNsx6p6ysbfaoQpq9d9arhjgbLD5vinAtz9G2kqX1-fVUV5s/s1600/Control+chart+process+improvement.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="300" sda="true" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhRnkCsNtRU6fuV9lAIkDINEsXNPUzXsQ4IM11qGR0GZaQU_bH8dVSyuLUlkzMYmTDDCXPLtMpKymvl_PLtpJdPTlZ78HNFcNsx6p6ysbfaoQpq9d9arhjgbLD5vinAtz9G2kqX1-fVUV5s/s400/Control+chart+process+improvement.bmp" width="400" /></a></div>
<a href="http://www.google.com/imgres?hl=en&biw=1366&bih=616&tbm=isch&tbnid=QSXLH21F-dkfpM:&imgrefurl=http://support.sas.com/rnd/app/qc/qcspc.html&docid=J6aw7-8y_s2HtM&imgurl=http://support.sas.com/rnd/app/qc/images/shwclms.gif&w=570&h=428&ei=SykTUJn6I5HO9ATIoIGIBg&zoom=1&iact=hc&vpx=115&vpy=288&dur=109&hovh=194&hovw=259&tx=142&ty=95&sig=110832942205186354822&page=1&tbnh=130&tbnw=173&start=0&ndsp=19&ved=1t:429,r:6,s:0,i:92">Source</a><br />
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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. <br />
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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".<br />
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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.<br />
<br />
<strong><span style="color: red; font-size: large;"><span style="font-size: x-large;">IF</span> a 1% error rate was acceptable....</span></strong><br />
6 drug errors per hospital pharmacy would occur per day<br />
870 airline crashes in the US would occur per day<br />
20,000 wrongful convictions would be made per year (The real error rate is 0.5% 0r 10,000) !<br />
200,000 patients would have wrong site surgeries performed each year (The actual rate is 0.00000893)<br />
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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.<br />
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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. <br />
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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. <br />
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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.<br />
<img alt="" class="rg_hi uh_hi" data-height="191" data-width="231" height="330" id="rg_hi" src="https://encrypted-tbn0.google.com/images?q=tbn:ANd9GcS6MTH13XinWYb5tA0VGZ1s8W_Fsvi7A2MWxavA8E8bId26Lx5GdQ" style="height: 191px; width: 231px;" width="400" />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-75453725033464390732012-07-26T13:36:00.003-05:002012-08-10T23:37:42.838-05:00Ethics & Professionalism<span style="background-color: black; color: yellow; font-size: large;">Thanks for coming back! I appreciate the Worldwide Audience. ;-)</span><br />
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When we see someone in our field acting in an unethical or unprofessional manner we feel like our own reputation is being affected by the other person's behavior. That is guilt by association. When we see people act badly it makes you wonder why they got involved in the healthcare field. Most people in the healthcare field started out wanting to help people. Many find their role in helping people to be a calling, not a job.<br />
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<strong>Ethics</strong> is from the Greek "ethos" meaning "character". It's the discipline dealing with what is good and bad and with moral duty and obligation. Webster's says that ethics are the principles of conduct governing an individual or group.<br />
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Our ethics get tested in the workplace due to our rapid pace, too many priorities, our work/life imbalance, poor leadership, poor interpersonal communication, and a staggering workload (Boyd, 1997). The results of this can yield physical and psychological reactions, sleep loss, headaches, weight loss or gain, and panic attacks.<br />
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<strong>Professional Behaviors:</strong><br />
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<ul>
<li><strong>Integrity</strong> - consistent honesty, ability to complete assignments</li>
<li><strong>Empathy</strong> - showing compassion and respect for others</li>
<li><strong>Self-Motivation</strong> - taking initiative to improve or correct behavior, not requiring constant supervision, accepting constructive feedback</li>
<li><strong>Appropriate Appearance and Personal Hygiene</strong> - clothing neat, clean, and well maintained. Good personal hygiene.</li>
<li><strong>Self-Confidence</strong> - Exercises good personal judgement, awareness of strengths and limitations.</li>
<li><strong>Communications </strong>- Speaks and writes clearly, listens actively</li>
<li><strong>Time Management</strong> - Consistent punctuality, completes assignments on time.</li>
<li><strong>Teamwork and Diplomacy</strong> - Placing the success of the team above self interests, not undermining the team, remaining flexible and open to change.</li>
<li><strong>Respect</strong> - Being polite to others, not using derogatory or demeaning terms, not behaving in a manner that brings discredit to the profession.</li>
<li><strong>Advocacy</strong> - Not allowing personal bias to interfere with actions you take with people. Protect and respect other peoples confidentiality and dignity.</li>
<li><strong>Careful Delivery of Service</strong> - Mastering and refresing skills, performing equipment checks, following policies, procedures, and protocols.</li>
<li><strong>Tolerance</strong> - Ability to accept people and situations.</li>
<li><strong>Functions under Stress</strong> - Maintains professional composure in stressful situations in spite of inappropriate actions on the part of others.</li>
<li><strong>Attitudes:</strong> Is actively concerned about others, maintains a positive outlook toward others and toward assigned tasks. Recognizes and admits mistakes. Seeks and accepts feedback and uses it to improve performance.</li>
</ul>
(Source unknown)<br />
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Unprofessional behaviors have become such a frequent problem in adverse event analysis that The Joint Commission released a Sentinel Event Alert on the Subject in 2008. Read the entire <a href="http://www.jointcommission.org/assets/1/18/SEA_40.PDF">Alert Here</a><br />
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The Joint Commission Sentinel Event Alert </div>
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Issue 40, July 9, 2008</div>
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Behaviors that undermine a culture of safety</div>
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“Intimidating, disruptive behaviors can foster medical errors, contribute to poor pt satisfaction and preventable adverse outcomes, increase costs…. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.<br />
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Have you ever heard that "the bad apple can spoil the barrel". Individuals who chronically display bad behavior can impair the whole groups functioning. (Felps, W. et. al 2006) It is much more likely that the low performer will bring the groups performance down to their level than the group will be able to lift the low performer up. It is critical that the leader deal with the low performer.<br />
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Disruptive behavior creates a culture of fear, confusion, apathy, burnout, distrust of leaders, errors, and communication problems. (Pickert, Jim)<br />
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There are great courses on how to deal with "special colleagues" who create disruptions in the workplace.<br />
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<img height="320" id="il_fi" src="http://kevin.lexblog.com/uploads/image/Professionalism.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="400" /><br />
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When you go about your work, who are you trying to please? Does a supervisor have to oversee everything you do? Do you take personal pride in the work you do?<br />
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<span style="color: blue;">Colossians 3:23-24</span><br />
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<strong>"Whatever you do, work at it with all your heart, as working for the Lord, not for men, since you know that you will receive an inheritance from the Lord as a reward."</strong><br />
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I try to do the best I can at whatever I am asked to do. Not every task I have is fun, but most are necessary. If someone has to do it, it might as well be done well.<br />
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Early in my career, I noticed that others were watching me. (No, I'm not paranoid) As an EMT responding on an emergency call, people watched my every move, that was understandable. On a routine call, they watched how I cared for their family member, what I said, how carefully I drove. As a nurse, my peers watched how I handled pressure situations. Was I cool under pressure? Families and patients watched my every move. I learned that a smile was reassuring. In leadership, I learned that team members needed to have confident but compassionate leaders.<br />
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As you are being watched in whatever role you now have or aspire to have, remember to pay attention to your ethical and professional foundation. People will remember those things about you and come to depend upon your consistency in those areas.<br />
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<img height="310" id="il_fi" src="http://futurestartup.com/wp-content/uploads/2012/03/professionalism-best.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="416" /><br />
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Note: Special thanks to Jackie Ashburn and Jim Pichert for assistance with content for this posting.Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-50047487484785083702012-07-25T11:21:00.001-05:002012-08-10T23:37:09.529-05:00Take a Look at the Forest<div style="text-align: center;">
<span style="color: blue; font-size: large;">You Can't See the Forest for the Trees!</span></div>
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Has anyone ever said that to you? Ever thought about what it really meant? It means when you are in the middle of a forest, you can't appreciate it, because all you see around you everywhere is....trees. In many healthcare environments today, all we can see around us are trees. <br />
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There is work to do everywhere and shrinking resources to accomplish the work at the high standards we have set for ourselves with which to guide our practice.What's all this talk about high standards? We do a lot of very costly things in healthcare that are not evidenced based although facilities such as the one I am working at have been moving rapidly in tools to accomplish just that, we still spend the majority of healthcare dollars in the final months of a person's life, we have instant access to amazing imaging, etc. <br />
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The other cliche that comes to mind is that when we step back far enough to see the forest we need to see, and help our team member see, <strong>THE BIG PICTURE</strong>.<br />
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For healthcare to start making more sense, every person in every job role as to see their place in the big picture. The healthcare organization's largest expense is labor including salary and benefits. Each employee whether full time has to begin to see where they fit. Let's just talk handwashing for a minute.<br />
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<img alt="" class="rg_hi uh_hi" data-height="194" data-width="259" height="194" id="rg_hi" src="https://encrypted-tbn2.google.com/images?q=tbn:ANd9GcTZsJOhBgPBQX-1KVuWxFUBA98F9JKYT291rVrDhpWt37UZ8KIe" style="height: 194px; width: 259px;" width="259" />Now I really go waaayyy back here. I actually remember when we did not carry latex gloves on ambulances. In fact, when HIV was identified in the early 80's and universal precautions was recommended by the CDC, there was a backlog on getting latex gloves for ambulance services. The only gloves we had on our units were in the OB kit, and if you used those, you had better come back with a baby! <br />
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But really, 2012, and we don't have this one nailed yet? Everyone on the team has to step back, see the forest, and realize that they are the potential vector of a deadly infection when they come into contact with an immunosuppressed patient. Every person entering and leaving a hospital room must wash their hands. As leaders, we have to identify how to show people the big picture. Here are some ideas:<br />
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<ol>
<li><strong>Announce it in a staff meeting</strong> - worst idea. Nobody is listening to you in a staff meeting. Seriously, do you remember how bad retention is during a lecture session. Best estimates are that people only remember 10% of what they hear.</li>
<li><strong>Do a demonstration</strong> - a little better. People remember about 20% of what they see and hear. Handwashing is a good example. You can show them how long a 15 second hand wash is and how to get between the fingers and to get the nails good, oh and don't forget to turn off the water with the paper towel.</li>
<li><strong>Have the employee do a return demonstration</strong> - now you are talking. People will remember 30-40% of what they hear, see, and immediately apply. Here is where you have to be a leader. No joking around. They really have to demonstrate competency. No shortcuts.</li>
<li>Now that you are up to the 40th percentile, if you want better performance, the hard work really begins. <strong>You, the leader, have to INSPECT what you EXPECT</strong>. Remember, your team members are lost in the trees. You have to continually show them the big picture. This is not about numbers. This is about lives. This is about their role in the healthcare system. You have to observe on a regular basis to see those numbers come up.</li>
</ol>
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I talk to a lot of people who are stuck at about the 1/2 way point of compliance. Usually what's missing is leader attention to detail. Our employees are busy with the trees. They must have the leader articulate on a regular basis that whatever is being measured is important and is part of the big picture. Further, the employee has to be able to connect with the big picture.<br />
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One phenomenon that I am interested in with the attention on evidenced based practice is how hard it is for nurses and physicians to change practice. In our rollouts, we have presented the evidence and found that even in the face of strong evidence compliance seems to be more related to pressure from leadership than knowledge of the evidence. To me, it should be enough to know that hourly rounding by nurses decreases falls, decreases call light use, and decreases pressure ulcers. However, to get these tactics hardwired, it took management presence on the unit on an hourly basis observing for the hourly rounding to be done. Our knowledge of what needs to be done and what is done is conflicted when in the midst of the trees.<br />
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Recently, nurses were surveyed and it was found that nurses had <a href="http://content.healthaffairs.org/content/30/2/202.abstract">widespread job dissatisfaction</a>. It is frustrating to feel that you cannot get accomplished all of the tasks you know you need to accomplish. So, it is possible that adding management pressure is simply confounding this situation and causing those items with measureable outcomes that we feel are important to improve while something else has to be left undone. This idea needs more study. However, as our very funding now is dependent on performance on identified metrics, it is likely that we will be continuting to measure and have to perform on those metrics. See what metrics are important to your hospital because they are 1) publicly reported metrics and can drive patient choice and 2) are affecting payments from payors at: <a href="http://www.hospitalcompare.hhs.gov/">http://www.hospitalcompare.hhs.gov/</a><br />
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Outstanding performance is possible. I am proud and amazed at the Vanderbilt Adult ED Nurses. Since April 2005, they have scored at the 100th percentile (i.e. best in the nation) for courtesy and respect shown toward the patient and family member. This translates to over 67% of their patients marking Excellent when asked that question. 20% mark Very Good, 2% mark Fair, and 2% mark Poor. Even being the best in the country doesn't mean that you can't improve in some areas. Horst Shulze, President of Ritz Carlton said that you should not compare yourself to others in the same business all the time. <strong>You can end up the best of a group of poor performers.</strong> For example, if you are trying to be the best at a turnover process, study the Indy pit crews. They know how to change all the tires, refuel, and get the car back on the road in seconds!<br />
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Right now, one of my departments, Environmental Services is working to improve a score on:<br />
Patients who reported that their room and bathroom was "always" clean. Our score is 67 with a State average of 72 and a National average of 72. This one score is adversely affecting our hospitals funding.<br />
It is fairly important that leaders in this area, help the team members see the big picture. As is the case with any team, for scores to move up, everyone has to be rowing in the same direction. The ability to see the forest helps greatly for everyone to have the perspective to do the right things right..<br />
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<img height="404" id="il_fi" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEis7mCHWZQthuZzDghUSUp5nn2xeqdWoRZ5IYSL3jy_Io5ApVmgS6zSE3lbTzlxjomLcDNEGZLkUdJZD67QSkZQa6LA7YauO1ap-EVigQtsL60HZN9VT4Dd4KrmEzYrk93xrg8uvw1OmWM_/s1600/forest_of_trees-565.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="611" /><br />
<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0Nashville, TN, USA36.1666667 -86.783333335.7564632 -87.4150473 36.5768702 -86.1516193tag:blogger.com,1999:blog-2971439470252637305.post-58257256299163439642012-07-24T19:19:00.004-05:002012-08-10T23:36:25.499-05:00Be Thankful for Bad BossesAs you develop your leadership style, you will do well to watch other leaders around you. From those excellent leaders take those traits that you admire. If you admire their coolness under pressure, file that away for some time when you are involved in a pressure situation. If they are the best rounder that you have ever met, become like them. Invariably though, we mere humans have faults. We all do! As you develop your own leadership style you have the opportunity to note those faults in the leaders around you and to simply say to yourself, "when I am in a leader role, I'm not going to do that"<br />
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When you sit back and think about mentors that you have had, don't leave out the bad ones. I actually learn quicker from my mistakes than from my successes and I have noticed that I can learn effectively from the mistakes of others. The worst boss that I ever had is a man that I must be thankful for. To the extent that I know how important it is to make a connection with people, I have to be thankful for how it made be feel that he never made a connection to any of his employees except the ones in his family. I saw how favoritism existed in the workplace and that gave me a strong sense of how importance equality and fairness were to my own values. We were in a regulated business and I watched as he cheated on inspections. His lack of integrity spoke volumes. As a boss, I don't think he taught me one single thing TO DO, but he taught me hundreds of things NOT TO DO. <br />
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When you are involved in the depths of struggles with overbearing or psycho bosses, you can do one thing. Take mental notes of what not to do when, and if, you are in a leadership position. <br />
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<img height="321" id="il_fi" src="http://www.theage.com.au/ffximage/2007/05/31/boss_art_wideweb__470x321,0.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="470" /><br />
<a href="http://www.google.com/imgres?num=10&hl=en&biw=1366&bih=616&tbm=isch&tbnid=7XCtzl9lyQbX3M:&imgrefurl=http://www.theage.com.au/news/national/the-enemy-within-your-psycho-boss/2007/05/30/1180205338499.html%3Fs_cid%3Drss_age&docid=rAPrw-z4TYTnvM&imgurl=http://www.theage.com.au/ffximage/2007/05/31/boss_art_wideweb__470x321,0.jpg&w=470&h=321&ei=wzIPULKcLIe29QSTh4GwAQ&zoom=1&iact=hc&vpx=619&vpy=148&dur=6069&hovh=185&hovw=272&tx=101&ty=101&sig=110832942205186354822&page=1&tbnh=127&tbnw=169&start=0&ndsp=22&ved=1t:429,r:3,s:0,i:85">Beware of the Psycho Boss</a><br />
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A <a href="http://www.huffingtonpost.com/2011/10/11/psycho-boss-survey_n_976562.html">2011 study</a> reports that bosses are 4 times more likely to show psychopathic tendencies when tested than the general population. This has been interpreted to be indicative of their lack of empathy and remorse for their actions making them well suited for their rise to the top. This is not to say that there are not quality, well balanced people in leadership positions. As you take a look at political, religious, organizational, law enforcement leaders you will see examples that you may not want to emulate in your own personal leadership style. <br />
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You know what you like in a leader. I've blogged about what I think is important, but you and I probably don't agree upon everything. Decide what you like about the leaders around you and begin to do what they do. Meet with the ones you really admire and see if a mentoring relationship would be acceptable to the both of you. <br />
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I wish I were there with you, but as I list some random leader traits, who do you think of? Which of these traits do you want for yourself and for your team members to experience from you as a leader?<br />
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<ul>
<li>Honest</li>
<li>Competent</li>
<li>Will step on others to get to the top</li>
<li>Inspiring</li>
<li>Condescending</li>
<li>Just</li>
<li>Dependable</li>
<li>Partial</li>
<li>Responsible</li>
<li>Aggressive</li>
<li>Compassionate</li>
</ul>
<a href="http://www.nwlink.com/~donclark/leader/leadchr.html">Adapted from</a><br />
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Your career as a leader will last for your entire worklife. Whether you are a leader by title (positional authority) for you are an informal leader, the traits you develop will be seen by others and emulated. Yet another reason to consider what character traits you exhibit. <br />
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<a href="http://www.nwlink.com/~donclark/leader/leadstl.html">Check out this webpage for a review of Leadership Styles</a><br />
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<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-45619374577851364752012-07-23T16:56:00.001-05:002012-08-10T23:35:37.275-05:00Do you have the equipment to do your job?Kudos to my new environmental services director Shane Fulford. When he asked his employees if they had the equipment to do their job, they all looked down. Not at the floor in disgust, but at their heavy, hard to push, no longer lockable, stainless steel cleaning carts. The fix was not hard, but had to be recognized, and paid for. $450 durable plastic cleaning carts. You should see the smiles. We all have to have equipment and tools to do our work.<br />
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For some of us, we have to have the iPhone or iPad and the latest app to be able to prepare the best meeting minutes. I remember when we had strict policies on what job positions merited the use of a cell phone, wait a minute, those were bag phones. <br />
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Our job frustration can climb and climb if the basic equipment we need is not made available for our use. Police officers need patrol cars and working radios. Firefighters need protective apparel. The problem is, as leaders we have to make tough decisions about what is affordable in an area where there is an endless request list of equipment and supplies available for purchase.<br />
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<blockquote class="tr_bq">
</blockquote>
<strong><span style="font-size: large;">"Gadgets come from the fertile imagination of a practitioner, are delivered to the greed of the entrepreneur, who have sold the devices without proper research"</span></strong><br />
-Paul B. Magnusen<br />
-From the 1938 Scudder Oration <br />
"Fundamental versus Gadgets in the Treatment of Fractures"<br />
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<br />
Given the need of healthcare organizations to limit spending in anticipation of financial cuts from Medicare and Medicaid dollars, healthcare leaders cannot invest in "gadgets" without demonstrated returns on investment. As revenues per patient visit/discharge go down, expenses per patient visit/discharge must decline as well for healthcare organizations to remain solvent. <br />
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During budget meetings I've been in the middle of a lot of catch 22 situations. You have to spend the money to create the additional revenue. However the equipment is so expensive, it takes years to see your return on investment. Funding is never sufficient to meet the needs. In many healthcare organizations, equipment purchases get down to patient/staff safety issues before the dollars can be released to make the purchase. Let's look at a few examples.<br />
<br />
1. Item: Cleaning carts<br />
Useful Life: 5 years<br />
Years in Use 10+ years<br />
Cost to replace $450 each ($10,500)<br />
Comments: Locks are broken<br />
Regulatory Issues: Unsecured chemicals<br />
Safety Issues: Child Hazard, Suicidal patient hazard<br />
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2. Item: Replacement of Cardiac Monitor/Defibrillator<br />
Useful Life: 5 years<br />
Years in Use: 12 years<br />
Cost to replace $12,000<br />
Comments: Cable sockets not longer working. Cannot get a clear reading.<br />
Regulatory Issues: Undependable equipment<br />
Safety Issues: Patient Safety<br />
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3. Item: Disaster Mobile Tent<br />
Useful Life: 5 years<br />
Years in Use: New<br />
Cost: $ 3400<br />
Comments: Will allow for continued operations in the event of facility loss.<br />
Regulatory: Addresses disaster planning<br />
Safety: <br />
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Imagine you have been given a list of 20 items! OK, we will just talk about these 3. If you were just given an equipment budget of $15,000 some tough decisions would have to be made. Do you risk putting off purchasing any disaster equipment for yet another year? Do you buy some cleaning carts and plan on buying some each year until you eventually eliminate the hazards. Is item 2 an obvious must have? <br />
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We haven't even talked about capital (usually over $3,000 - $5,000) and non-capital equipment. The approval processes on these items are totally separate.<br />
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In any case, leaders are supposed to be asking the question, Do you have the equipment you need to do your job? When the answer is no, leaders are to try to make something happen. Sometimes it is to borrow, sometimes it is to lease, but hopefully it is to provide the tools necessary to do the job.<br />
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My hat goes off to the LifeFlight Communicators. They constantly track the position of ground and air ambulances and coordinate a million details. Do they need equipment to do their jobs? Just as much as the Environmental Services tech that is keeping our patients and staff safe from a deadly infection. They both need the appropriate equipment and tools to do their job.<br />
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I have gone into some work situations, where the equipment and tools needed were some modest creature comforts. A break room, a microwave oven, a coffeee maker. Maybe this fits under "Respect for People" more than "equipment", but a need is a need. When I am trying to build rapport with my team members, I always want to know about what they need to do their jobs, even if it just to make their break time more of a real break from work. In one of my prior jobs, the employees had assembled a break room right in the middle of the action area of a busy Level I trauma center. The designated break room was like a ghost town. The employees could grab something fast and get back to their patients. It was a true win/win. This became integral to the design in the Vanderbilt "A" pod. The break area is 12 feet from the trauma rooms.<br />
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The Marco equation says that <a href="http://www.startribune.com/business/101194729.html?refer=y">Happy employees equal happy customers</a> (Nelson 2010). Small things such as the temperature of their workspace or having to work on an ailing computer can become big things if left unattended to. More on questions I ask when I round on employees later.....<br />
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<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-66963467436533891222012-07-18T10:17:00.002-05:002012-07-23T19:54:49.479-05:00Integrity is Integral<span style="font-size: x-large;"><strong>in·teg·ri·ty </strong>/ɪnˈtɛgrɪti/ [in-teg-ri-tee] </span><br />
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<span style="font-size: large;">noun </span><br />
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1. adherence to moral and ethical principles; soundness of moral character; honesty. <br />
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2. the state of being whole, entire, or undiminished <br />
(Dictionary.com) <br />
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In previous weblogs, I have talked about honesty and ethics, but the word integrity really brings it all together. A character trait that leaders must possess is one of integrity. Disney teaches their employees (excuse me "characters" to be "on stage" in front of the public and to be "off stage" only when out of view. For leaders, integrity is a 24 hour a day gig. Our consistency in decision-making sets the tone for our leadership style. It determines whether others feel they can depend upon us or not. This is one of the most important factors in retaining employees. It is said that <strong>people do not leave organizations, they leave their managers</strong> (Buckingham & Coffman 1999). <br />
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<img height="333" id="il_fi" src="http://laurajul.dk/wp-content/uploads/2011/12/integrity.jpg" style="padding-bottom: 8px; padding-right: 8px; padding-top: 8px;" width="500" /><br />
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If you are feeling the need to do some personal development of integrity. Check these 10 Steps out:<br />
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1) Identify aspects of your behavior that require change. Reflect on your interactions with others in the workplace, at home and in social situations to determine specific areas in need of improvement. For example, if you are late for work every day and feel guilty about creating excuses for this behavior, this may be an opportunity to develop greater personal integrity.<br />
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2) Determine your reasons for not behaving with greater personal integrity. For example, you may be pushing unpleasant work tasks on to other employees instead of being honest with your boss about your inability to do the tasks. You may be afraid to admit to yourself or to your boss that you do not possess the right skills or that the job is not the right fit for you.<br />
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3) Face the obstacles that cause you to lie or violate your moral code. This might involve finding a more suitable job, facing your fears about how others may perceive you and/or seeking out counseling to address emotional challenges and insecurities.<br />
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4) Practice truthfulness. Consider all of the relationships at home and work that will benefit from greater truthfulness. For example, if managing a team of employees, be honest and direct with each individual about your expectations and employee performance. Avoid backbiting or gossiping. Refrain from causing harm. Part of developing personal integrity is gauging when and how to deliver the truth. Be careful not to confuse truthfulness with anger-driven and brutally honest confrontation.<br />
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5) Make a list of tasks and behaviors in which you will become more trustworthy. The list might range from basic tasks, such as taking out the trash as promised to repaying large sums of money in a timely manner.<br />
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6) Respect the property of others. Consider any complaints you may have received in the past about using another person's belongings, parking in someone else's parking spot or littering on another person's property. Make a concerted effort to respect other people's belongings.<br />
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7) Listen to and respect the opinions and decisions of others. Part of possessing personal integrity is acknowledging the human rights of others. Respecting diverse thoughts and decisions is a sign of open-mindedness and integrity.<br />
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8) Help others in need. If you are in a position to contribute to the development of others or help them to do something they cannot accomplish on their own, make an effort to assist.<br />
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9) Assess your progress. Developing personal integrity is a trial and error process that requires persistent effort. Ask yourself on a daily or weekly basis if you are making progress.<br />
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10) Enlist the help of others. Colleagues, relatives and friends who know you well and have your best interest at heart can assist your progress by providing objective feedback on a daily basis about the personal changes you are making.<br />
<a href="http://www.wikihow.com/Develop-Personal-Integrity">http://www.wikihow.com/Develop-Personal-Integrity</a><br />
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<strong><span style="font-size: large;">ORGANIZATIONAL INTEGRITY </span></strong><br />
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Can organizations have integrity? Do you remember ENRON?<br />
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<img alt="" class="rg_hi uh_hi" data-height="120" data-width="240" height="120" id="rg_hi" src="https://encrypted-tbn2.google.com/images?q=tbn:ANd9GcSPvrdoOq6xqLU9CHarIo2iF_HmKMWXZchd7PxR7AXWzNgUATLw" style="height: 120px; width: 240px;" width="240" />Stakeholders lost billions of dollars when accountants and board members turned their backs on corporate misdoings. Retirement funds were lost forever. The lack of transparency in business dealings with power residing only in a privileged few led to the disastrous consequences. Larger organizations have corporate integrity programs, most with hotlines to report suspected wrongdoing or compliance officers. Federal whistleblower laws protect and in some cases incentivise those who expose curruption.<br />
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In what ways to Healthcare Organizations behave with integrity?<br />
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<ol>
<li>Operate within compliance with state and federal laws and regulations.</li>
<li>Follow proper billing procedures.</li>
<li>Follow generally accepted rules of accounting and use outside accounting services for auditing.</li>
<li>Provide for appropriate separation of duties when handling money.</li>
<li>Follow its own policies.</li>
<li>Follow appropriate bid processes according to policy.</li>
<li>Avoid even an appearance of special favors or partiality between the organization and vendors.</li>
<li>Treat employees fairly and equitably.</li>
<li>Use only qualified providers of services.</li>
<li>Train employees in compliance.</li>
</ol>
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<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0tag:blogger.com,1999:blog-2971439470252637305.post-9807057958987926862012-07-18T10:16:00.000-05:002012-08-30T02:29:03.228-05:00What Employees Want....Quint Studer wrote in Hardwiring Excellence that employees want to find PURPOSE, to have WORTHWHILE WORK, and to MAKE A DIFFERENCE. In prior blogs, I have connected how different job roles are all critical to the provision of healthcare. Healthcare is a team sport. If any team member is removed, the absence is missed quickly. I have recently dealt with some issues where some of my employees are not feeling valued by other team members. That is really sad. Every member of the team has value and should be reminded of their importance. <br />
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<img alt="" class="rg_hi uh_hi" data-height="236" data-width="160" height="400" id="rg_hi" src="https://encrypted-tbn3.google.com/images?q=tbn:ANd9GcSvuaQ-uojoHdl1zmYOBXvmfdqFWycgeGWMCCJ3XWB_HmWz20QB" style="height: 236px; width: 160px;" width="271" /><br />
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The Gallup organization provided a list of what employees wanted in a workplace. <br />
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<ol>
<li>to know what is expected of them</li>
<li>to have the materials and equipment to do their jobs correctly</li>
<li>to have the opportunity to do their best every day</li>
<li>to receive recognition or praise for doing good work</li>
<li>to have a supervisor or someone at work that cares about them as a person</li>
<li>to have someone at work that encourages their development</li>
<li>to have their opinion count</li>
<li>to have the mission/purpose of the company make them feel their job is important</li>
<li>to have my co-workers committed to doing quality work</li>
<li>to have a best friend at work</li>
<li>to have someone at work talk to them about their progress every 6 months</li>
<li>to have opportunities at work to learn and grow</li>
</ol>
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Notice that in this list, pay did not make it into the top 12. It's not that pay is not important. Employees are just telling us as leaders that there are so many other things within our control that are important besides compensation. Good supervision means paying attention to these things not just waiting for the organization to adjust pay levels.<br />
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I have never believed that anyone comes to work to do a bad job. If there are performance problems with an employee, it exists because that behavior has worked for them in the past. For it to change, someone must address it. For most employees, to have them experience worthwhile work, making a difference, and purpose in their work, it starts with excellent leadership incorporating concepts from the Gallup list above.<br />
<br />Anonymoushttp://www.blogger.com/profile/05774707729415697735noreply@blogger.com0