| Steve Harden, President of LifeWings Partners LLC |
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The Pulse
A bi-monthly newsletter from LifeWings Partners LLC
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June 2007
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Sharpening the Saw:
A Message from The
President
"Why don't they do what they are supposed to do?"
In the last seven years I have personally worked with
over 40 healthcare executive and leadership teams. In
that time, it has become apparent that most
healthcare organizations, no matter their size,
location, or profitability, all struggle with the same
sorts of issues. One of these common issues is
getting employees and physicians to do what they are
supposed to do.
In our work with departmental and unit level
managers, one of the most often asked questions we
get is, "Why can't I get my folks to do the things we've
asked them to do?" Other versions of this question
are, "I am having trouble getting them to do (fill in the
blank), what advice do you have for me?" Or, "How can
I instill a sense of personal accountability in my
staff?"
Those of you that have worked with me before in our
Leadership Development Institutes know that I believe
in simplicity and formulas. My motto is "Keep it simple,
follow the formula!" And that concept guides my
answer to managers that ask those questions. When
answering, I tell folks there are essentially only four
reasons for non-performance. The key is to determine
which of the four reasons apply in each case and then
provide the remediation for that reason.
Reason #1: They don't know they are supposed to
do it that way. This is always the first question to
ask in any case of non-performance. "Am I sure they
know what they are supposed to do?" Go to the
employee and say, "Tell me what you are supposed to
do in this situation." See how closely their answer
matches up with your mental vision of what should
happen in the given situation.
In our work with management teams we often
hear, "Everyone knows they are supposed to do this,
it's just common sense." I think you will be surprised
at how often your answer differs from that of your staff
and how "uncommon" is the common sense you
thought everyone had. Correcting this disconnect will
fix many of your non-performance problems.
Reason #2: They know what they are supposed to
do, but don't know how to do it. This is essentially
an issue of "training." In this case, folks want to
perform, they just don't know how - because they
haven't been trained. Once you're sure they know what
they are supposed to do, the next question to ask
is, "Am I sure they have been trained to do it the way I
want them to do it?" We are always surprised at the
number of institutions that have added directive
language to their Policy and Procedures Manual and
then assumed that training has been done on how to
apply or comply with the new requirements. Managers
must give their staff the tools to be able to comply with
the requirements of the job.
Remember that "Telling is NOT Training." Just telling
someone they should "do it this way" does not suffice.
Effective training includes four elements, 1)
Explanation, 2) Demonstration, 3) Practice, and 4)
Reinforcement and Feedback. If what you have
called "training" doesn't have these four elements, you
haven't really trained.
Reason #3: They know what they are supposed to
do, but don't have the physical and/or mental capacity
to do it. In other words, no matter how much
training you give them, they can't ever do it - they don't
have the capacity to do it. Warning, this is the most
often misdiagnosed reason for non-performance.
Experts estimate that up to 80% of the time that
supervisors settle on this as the reason for non-
performance, they have picked the wrong
reason.
So, if you know for sure they know what they are
supposed to do and are absolutely sure they have
received plenty of effective training to do it, and are still
not doing it; ask this question, "Does this person have
the mental and/or physical capacity to do this
job?"
The answer may be they don't have the capacity to do
the job effectively with the amount of training that you
are willing to give them. Or, you may have in fact made
a hiring mistake and the person is not suited for the
job you have asked them to do.
Reason #4: They know what to do, how to do it,
have the capacity to do it, but choose (for a whole host
of different reasons) NOT to do it. This is willful
non-compliance. The non-compliance may stem from
these thought patterns:
- My way is better;
- Your way won't work;
- I don't want to change;
- I can't do it due to institutional obstacles;
- I don't want to do it; or
- I won't be supported if I do it.
The manager must find out why the employee is not
doing what they are supposed to be doing and attack
that reason. This response involves three
components:
- Provide convincing information that the
organization's way is better than the employee's
way;
- Provide positive rewards for good performance;
and
- Provide negative consequences for non-
performance.
Knowing and using these four reasons for non-
performance have helped me tremendously during my
military career and in co-founding and leading two
successful businesses. Whenever I have been
confronted with non-performance I have asked
myself, "Which of the four reasons is this?" If it is
reason #1 or #2, I provide training to fix the problem. If
it is reason #3, it is best to let that employee go as
soon as possible. We don't do that employee or the
organization any favors to keep them in a job they are
not suited to do. If it is reason #4, and I am unable to
change behavior through positive rewards or negative
consequences, again it is best to get rid of that
employee as soon as possible.
Effective management of staff is not "magic." It is
taking specific actions to get the behaviors from
employees and staff that benefit the organization. It is
the "things managers DO" that influence people's
performance. If managers don't do the right things at
the right times, or in the right sequence, performance
outcomes will not be as expected. Use these reasons
for non-performance to help you do the right things in
the right sequence to get the performance you want.
Best regards,
Stephen W. Harden
LifeWings President
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Skills and Tools: Get Better Today
The Assertive Statement
Every healthcare provider should learn how to use an
assertive statement. If a situation remains critical and
the normal methods used have not attracted the
attention of the appropriate team member, it's time to
be assertive!
Many people are not assertive for fear of displeasing
others and getting yelled at by team members. By not
being assertive in the work place, you could
jeopardize someone's job, the organization's
reputation, or even a patient's life. In high-risk
industries, such as healthcare, communicating what
you really want in a clear, concise fashion is extremely
effective.
An assertive statement is brief, precise and has these
components…
Get attention. The easiest way to get
someone's attention is to call them by name. This
implies that all team members know the names of the
entire team. Using the full name (i.e.-"DR.
Strangelove") immediately telegraphs the
seriousness
of the situation.
Express concern. Express concern that is
personal and reflects on YOU. It sounds something
like this: "I'm concerned…" No one can argue
with you being concerned. This avoids defensiveness
from other team members.
State the problem. Be brief, objective, and
clear. Do not "hint and hope".
It sounds something like this: "The monitor indicates
a BP of 90/35."
Propose a solution. Assertion is not
complete if you have not proposed a solution.
The purpose is to get the team back on track during a
critical situation. YOU have to propose the solution
because YOU were the one to notice the problem and
have had more time to think of a solution. Your
recommendation can mean the difference between
action and inaction. Action should reflect a team effort
(I have a concern but WE can correct it). It sounds
something like this: "WE need to stabilize his blood
pressure."
These steps can be done quickly once they become a
practiced skill set.
Assertive Statement Re-Cap:
- Get Attention
- Express Concern
- State the Problem
- Propose a Solution
Example of an Assertive Statement:
"Dr. Smith, I'm concerned that the patient's blood
pressure is too high, the monitor indicates 200/120.
We need to stabilize her blood pressure."
Find out more about error-catching team skills.
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Success Stories: Reported Results from Organizations Implementing CRM-based Safety and Quality Programs
Healthcare Patient Quality Improvement: Pre-
procedure Antibiotic Administration Improvement with
Compliance Training and Tools Workshops
The President of a hospital called LifeWings to get
help improving teamwork and processes with the goal
of improving the rate of administration of pre-
procedure antibiotics.
Although the evidence is clear that the delivery of pre-
procedure antibiotics has a dramatic effect on post-
surgical infection rates, the hospital was having
difficulty in getting compliance with the protocol. Post
surgical infection rates were increasing.
The leadership wanted a way to create specific tools
and better communication patterns in the pre-
procedure brief to improve the culture of safety among
their clinicians and increase the compliance rate of
antibiotic administration.
Our compliance training and tools workshops
delivered the results they sought. The hospital has
achieved an increase in compliance, from 68% to
96%, and reduced post-surgical infections.
Read more about other results from hospitals using a CRM-based patient safety system.
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Leadership Toolkit: Skills for Sustaining an Enduring Cultural Change
10 Critical Steps to Maximize Quality of Care and
Teamwork Training, Part II
In the last issue of The Pulse,we took a look at
the first five steps to maximize quality of care and
teamwork training. Here are five more guidelines to
follow when implementing any kind of quality system
in your organization:
Realize that the initial training is only a first step -
follow up. Refresher training, practice, and
feedback are critical to lasting change. Mission
effectiveness is improved with "one time" teamwork
training; however, refresher training, practice, and
feedback from all sources is imperative for project
success.
Put systems and "Tools" (checklists, procedures,
protocols) in place, so that both require and
support the behaviors learned in the training (make it
easy to do the right thing and hard to make a human
factors mistake).
- Obtain "buy-in" and support from departmental
leadership;
- Provide a vision of what the "systems" look like
and their benefits;
- Customize the tools to fit the needs of the unit;
- Create the tools;
- Create the educational material for the tools and
train staff;
- Require, in writing, the use of the tools;
- Revise assessment criteria and forms, assess
performance;
- Measure: design, collect, analyze, and publish
data on the use of the tools; and
- Develop system to follow-up: ensure what gets
fixed, stays fixed.
Lead and manage the program. Designate
the leader who is responsible for success, assess all
leaders/managers based on contributions to
program, and determine the "attractors" for physicians
(establish them).
Institute quality control procedures to ensure
training effectiveness. Collect data to ensure
you are doing what you think you're doing. The
Internal Project Coordinator can collect data and
develop his/her own tracking system to fit the needs of
the unit.
Deal with project failures. Project "failures"
should be considered as disruptive to effective
operations as any other personal or technical deficit.
These" failures" are as much a deterrent to mission
effectiveness as any personal or technical problem.
If you missed Part I of "10 Critical Steps to
Maximize Quality of Care and Teamwork Training,"
please click HERE to check it out.
Find out more about Leadership Develoment.
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For Further Reading: Our Featured Article
Patient Safety in Labor and Delivery: A Team
Approach to High Reliability
Paul G. Preston, M.D.
Introduction
Labor and delivery (L&D) should be one of the most
rewarding places for an anesthesiologist to work. The
opportunity to assist people in the miracle of birth -
occasionally helping to save a young life and
frequently receiving profound thanks - what's not to
like? Yet concerns about safety and legal liability may
temper our enthusiasm for L&D work.
Click HERE to read entire
article.
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News You Can Use: To Implement a CRM-based Safety and Quality Improvement Program
Here are a few resources that may be helpful when
thinking about implementing a patient safety of quality
program in your facility…
"SBAR Technique for
Communication: A Situational Briefing Model" is
a helpful tool / technique that stands for Situation-
Background-Assessment-Recommendation, that is
used to improve communication between the
members of any healthcare team.
"Leader Standardization and
Repetition" is an article written by Quint Studer,
CEO of the Studer Group. "About one year ago an
observation hit me, and over this past year, it
continues to be something that I feel keeps health
care organizations from reaching full potential as an
employer, and most importantly, being a provider of
care."
Free website registration may be required.
"Focus on Five:
Strategies for Enhancing Physican-to-Physican and
Staff-to-Physician Communication" is an article
put out by the Joint Commission on Accreditation of
Healthcare Organizations that stresses the
importance of communication in the healthcare
industry.
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Ask the Innovators: Road Blocks of CRM-Based Project Implementation
This month we are introducing this new section of
The
Pulse, so our readers can get advice directly from
our
clients. Readers can also start contributing to the
newsletter by sending us questions you would
like to see answered (see details at the end of this
section).
Q:
What has been the biggest challenge with
implementing a CRM-based project in your
organization?
A:
In my opinion, the greatest challenge that we
anticipated was getting physician buy-in. This
anticipated challenge turned out to be no challenge at
all. There were certainly skeptics and "naysayers", but
at the end of the day even they complied with the
program. The single greatest factor in addressing
those, that for whatever reason, wished not to
cooperate was unwavering top-down support from the
highest levels of Medical Center Executive
Leadership. Additionally, the Chairman of the
Department of Anesthesia made it clear to his
providers that they were expected to be leaders in
compliance and support the surgical teams if their
surgeon was not cooperating fully. All this served to
create a climate that encouraged full participation.
Another challenge, but no less important was
empowering the surgical teams, nurses and
technicians, to speak up on safety issues. The
hierarchal environment of an operating room has the
potential to dissuade subordinate team members
from speaking out for fear of being castigated by the
surgeon. LifeWings taught us that this way of thinking
and behaving encourages misadventure and we all
bear a responsibility for a safe outcome. However it's
not enough to teach staff this, the staff has to have the
tools to make it happen. The LifeWings
implementation team provided that to us, helping
develop comfortable scripts that guided the pre-
procedure brief, which set the stage for the rest of the
case. As important, was the tool given to the staff by
the CEO and the Senior Vice President for Medical
Affairs. That tool was the ability to say NO. "No,
Doctor, we will not proceed without a pre-procedure
brief "or "No, Doctor, we will not proceed because it is
not safe to do so". To the best of my knowledge that
tool has yet to be used, but knowing that they (the
teams) are empowered and supported in creating a
climate of safety has really been the key to our
LifeWings success.
Paul L. Corish RM MS CNOR
Director, Surgical Services,
Vassar Brothers Medical Center
Recent Innovators:
The University of California Health
System-CA
Surgical Services
Middle Tennessee Medical Center-Murfreesboro,
TN
Operating Room
Memorial Healthcare System-Hollywood,
FL
Surgical Services / Cath
Lab
St. Luke's Episcopal-Houston,
TX
Surgical Services
Mt. Carmel Health System-Columbus,
OH
Operating Room
Southeast Georgia Health System-Brunswick,
Georgia
In Patient and Out Patient
Operating Rooms
Got a question that you would like to see
answered in one of our newsletters? Well, tell us
about it! Send your question to
kdebra@SaferPatients.com with the email
subject as "Road Block Question."
If you would like a reference for any of our clients,
please contact K.C. DeBra at
kdebra@SaferPatients.com or (901) 844-
9226.
Forward this newsletter now!
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Streams in the Desert: Thoughts and Stories to Inspire
Top 10 Stress Reducers
1. Go to bed on time.
2. Delegate tasks to capable others.
3. Pace yourself. Spread out big changes and
difficult projects over time; don't lump the hard
things all together.
4. Take one day at a time.
5. Separate worries from concerns. If you can't do
anything about a situation, forget it.
6. Get enough exercise.
7. Everyday, find time to be alone.
8. Laugh.
9. Develop a forgiving attitude (just realize that most
people are doing the best they can).
10. Remind yourself that you are not the general
manager of the universe.
(Article source: Food for the
Soul, Janis & Friends Hepatitis C Support
Website.)
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Our Gift To You
SPECIAL GIFT OFFER!
Call or email K.C. DeBra now at (901) 844-9226 or
kdebra@SaferPatients.com and your name
will automatically be placed into a drawing to win a
FREE copy of "Crew Resource Management: The
Flight Plan For Lasting Change in Patient Safety"
(a $99.00 value)!
This book is a step-by-step guide to implementing
strategies which have helped other healthcare
providers achieve startling improvements. Co-
authored by LifeWings President Steve Harden and
former astronauts / practicing physicians Dr. Drew
Gaffney and Dr. Rhea Seddon.
The drawing will take place at the end of June and the
winner will be revealed in the the August issue of
The
Pulse.
Read "Top Gun Pilot Shows
Caregivers How to Avoid Mistakes," from
advance For Respiratory Care Practitioners.
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Personalities: From Outer Space To Healthcare
Read about LifeWings' consultant, Dr. Rhea Seddon
in the May 2007 edition of HealthLeaders Magazine.
Read article here!
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