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Leadership Muscle Building – Taking Evidence-Based
Leadership to the Next Level
Lynne Cunningham, Studer Group Coach MTF Partner Meeting
August 10, 2011
Purpose, worthwhile work
and making a difference
®
Healthcare Flywheel®
Bottom Line Results
(Transparency and Accountability)
Self-Motivation
Prescriptive To Do’s
Execution Framework Evidence-Based LeadershipSM
Standardization Accelerators Must Haves®
Performance Gap
Objective Evaluation
System
Leader Development
Foundation Breakthrough
STUDER GROUP®:
Agreed upon tactics and behaviors to achieve goals
Re-recruit high and middle performers
Move low performers up or out
Processes that are consistent and standardized
Process Improvement PDCA Lean Six Sigma Baldrige
Framework
Software
Aligned Goals Aligned Behavior Aligned Process
Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results
Implement an organization-wide staff/leadership evaluation system to hardwire objective accountability (Must Haves®)
Rev 4.8.11
2010 Malcolm
Baldrige Na2onal Quality Award
Studer Group Mission
To make healthcare a better place for employees to work, physicians to practice medicine and patients to receive care.
“We define mission success based on
how our customers are evaluated by
their customers. The ultimate measure
of a healthcare organization is its
patients’ perception of their care.”
Studer Group Vision
To be the intellectual resource for healthcare professionals, combining passion with prescriptive actions and tools, to drive outcomes and maximize the human potential within each organization and healthcare as a whole.
1. Dots are not connected consistently to purpose, worthwhile work and making a difference
2. Do not achieve critical mass - Lack of balanced approach
3. Absence of an objective accountability system
4. Leaders do not have the training to be successful
5. Too many new behaviors introduced at once – need of sequenced approach
6. No process in place to re-recruit the high and middle performers and address low performers (highmiddlelow®)
7. Inability to take best practices and standardize across organization
8. Failure to have leaders “always” do desired behaviors (lack of verification systems)
Why Organizations Do Not Achieve Desired Results
Rev 3.08
OPO Flywheel
Mission/Vision/Standards/Values
Prehiring
Selection
Coaching
Cup of Coffee Conversations
Employees
Rounding
Thank You Notes
Stoplight Report
HML
Monthly Meeting Model
Unconsciously unskilled
(incompetent)
Consciously unskilled
(incompetent)
Consciously skilled
(competent)
Unconsciously skilled
(competent)
Phases of Competency
Even with positive change, there is resistance . . .
Phases of Change
PHASE 1:
The Honeymoon
PHASE 2:
Reality Sets In
PHASE 3:
The Uncomfortable Gap
PHASE 4:
Consistency
What to expect: § Sense of
excitement § Right “to do” list § Things will get
better (hope) § Quick fixes are
implemented § Skeptics
What to expect:
§ We/they
§ Inconsistency
§ Bigger than I thought
§ This will impact me
§ Some are getting it
§ Some are not
What to expect: § The performance
gap is evident § Tougher decisions
must be made § Process
improvement increases
§ Inconsistencies become obvious
What to expect:
§ High performing results
§ Everyone understands the keys to success
§ Disciplined people and disciplined processes
§ Proactive leadership
Leader Rounding for Outcomes
Build Relationships Harvest Wins:
“What is going well?” “Are there any individuals you would like me to
compliment?” “Are there any external stakeholders I need to
recognize today?” Identify Process Improvement Areas:
“What systems can be working better?” Repair and Monitor Systems
“Do you have the tools and equipment to do your job?”
Gallup's #1 retention strategy – “My boss cares about me as a person”
This relates to another Gallup retention strategy - Do you have a "best friend" at work
That's process improvement!
Ideas for revitalizing Rounding
WWW
What makes you want to come to work every day?
What one thing in your department is working well?
What have you observed or experienced that makes you feel positive?
OFIs
What could be working better?
What improvements have you seen in the last month?
What improvement project team do you think we need to establish and why?
Follow-up questions
What does that look like to you?
Where’s the gap?
Tell me more?
Help me understand?
How would you make these changes to have this work better?
Sample Rounding Stoplight Report
M
H
L
H
M
L
Gap is uncomfortable
H
M
L
Gap is intolerable
H
M
The Wall
Over the Wall
Copyright 2005
High
Middle
Low
PERFORMANCERESULTS
100%
50%
Standards of Behavior
Financial
Growth
Customer
Clinical
Staff
Out
Out
Different Seat
HML – It’s Both Scales
Studer Group’s Monthly Supervisory Meeting Model – Trust but Verify
Leaders bring the following items and results to their meetings with their immediate supervisor
1. Results from Rounding Who have you rewarded and recognized? What process improvement have you implemented? What Thank You Notes have you written? What percentage of your employees did you Round on in the
last month? 2. Monthly report card
What progress are you making toward achieving your goals? What action plans are you putting in place?
3. Linkage assignments from last LDI 4. Bring:
Rounding logs Thank You Notes log
5. Are there any people trends and issues we need to discuss?
Park Ranger Leadership
A Book to Recommend
What Does the Next Generation Want Control over their time
Straight-A Management: Appreciation, Acceptance, Attention, Affection, Allowance
Training
Opportunities for growth
Hospital Partners
What’s the Why?
Preference cards
Listening skills
Ask transformational
questions
CEO’s Top Issues - 2010
1%
2%
3%
6%
10%
11%
16%
28%
30%
31%
32%
53%
77%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Disaster preparedness
Issues about not-‐for-‐profit status
Governance
Capacity
Technology
Personnel shortages
Pa=ent sa=sfac=on
Care for the uninsured
Physician-‐hospital rela=ons
Pa=ent safety and quality
Governmental mandates
Healthcare reform implementa=on
Financial challenges Constant for years
Moves up and down
January 24, 2011; American College of Healthcare Execu2ves Announces Top Issues Confron2ng Hospitals: 2010; 542 Hospital CEOs
Leadership in Healthcare
Being a leader in healthcare today is like con2nuously walking up a down
escalator. If one stands s2ll
they go backwards.
ROI on Patient Satisfaction
Source: HFM magazine, Issue: October 2008, pg 76, Looking to Improve Financial Results? Start by listening to patients, By: Melvin F. Hall, PhD,
Goal: Very Good
1 Very Poor
Sample distribution of patient satisfaction score responses to achieve excellence
2 Poor
4 Good
5 Very Good
1% 1% 5% 19% 74%
3 Fair
99th Percentile Hospital
* Press Ganey Report
You are already a good organization. What percentile would this hospital be in if responses were 74% Good and 19% Very Good?
How Do We Spend Our Time Communicating?
Studies show that we spend: 9% of our time writing
15% of our time reading
35% of our time talking
And 40% of our time listening!
How Well Are We Listening?
God Gave Us 2 Ears and 1 Mouth for a Reason
Additional Thoughts About Listening
Make listening your new default mode – replacing the “waiting for my turn to talk” mindset.
The 12 second pause.
First, think about what you’re thinking.
Be interested; not interesting.
Be Quiet, Be Heard
When communications goes awry, the result is often retreat. But communication abhors a vacuum and so this avoidance is filled with negative assumptions and ill will. If the silence is broken, it is too often packed with the relentless noise of people making their own points over and over again. One sad truth remains: no one is really listening to anyone else.
Trust is not a prerequisite for communications; trust is a byproduct of communication.
The trouble with letting sleeping dogs lie is that we have to keep stepping over them.
To foster a culture where praise becomes a norm, we must make it acceptable to receive praise as well as to give it. Like all communication, gratitude is a two-way street.
Ask Transformational Questions
If you could change one thing about the direction of your company, what would it be?
If there is one thing I can do to help you move more quickly toward your goals, what would it be?
What’s the one thing you’d be proudest to accomplish?
If you did know, what would you do?
What about x seems impossible to change, yet if you could change it, you would be much more satisfied?
Two Books to Recommend
Community Partners - A Book to Recommend
The external environment is changing – ACO, VBP, HCAHPS, OWA
Keys to Thriving Great Quality
Great Execution
Fast Acceleration
Flawless Consistency
Sustainability
Customer
Staff
“If the other guy’s getting better, then
you’d better be getting better faster than
that other guy’s getting better . . . or
you’re getting worse.”
Tom Peters - The Circle of Innovation
No rest for the weary….
Potential Donors – A Book to Recommend
Use data to drive decisions
Adopt a bias for “YES”
Two Words That Make a Difference
Accountability – that’s the glue
Mandatory – when you really mean it
FY 2006 – Goals
Issue Reduce Costs /
Improve Financial Performance
Provider of Choice (patient
satisfaction)
Employer of Choice (employee
satisfaction)
Improve Care (Quality, Safety,
Effectiveness)
Information Management
Goals
Achieve financial margins of: – 4.0% in FY ’06 – YTD 4.6% more detail> – 5.0% in FY ‘07
Achieve organization wide average patient satisfaction scores of:
– 93.7 for “Overall quality of care / services”
– YTD 93.5
– 76.1 for “Would you recommend”
– YTD 73.5
Reduce overall turnover of:
– “permanent” positions to11%
– YTD 14% more detail>
– “permanent” core RN positions to 13%
– YTD 16%
Achieve 90% compliance with CMS measures: Community Acquired Pneumonia 3>90% - 5<90% Surgical Infection Prevention 1>90% - 2<90% Heart Failure 2>90% - 2<90% Acute Myocardial Infarction 5>90% - 2<90% Achieve 90% compliance with evidence-based practice for prophylaxis of the following: DVT/PE, Post-op UTI, Post-op Pneumonia, Post-op AMI, Pressure Sores, Post-op Sepsis
– Implement Employee Satisfaction Assessment process during 2005
– Create projected time line for the implementation of the Advanced Point of Care (APOC) clinical system
Leader Evaluation Results – 2006
10.3%15.9%
73.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Meets Exceeds SubstantiallyExceeds
Service
Increase Patient Satisfaction
(Inpatient) K Goal = 62nd
Current = 51st
Reduce Annualized Turnover
Goal = 14.5%
Current = 16.7%
Increase Employee Satisfaction
K
Decrease Mortality Index
Goal = .77
Current = .77
Operating Margin Goal = 5%
Current = 5.6%
Reduce FTE per Adjusted Discharge
Goal = 1.15
Current = 1.15
Increase Inpatient Admissions
Goal = 2.7%
Current = 7.6%
Increase Outpatient Visits
Goal = 5%
Current = 8.0%
People Quality Finance Growth
Excellence
Increase Patient Satisfaction (Ambulatory)
Goal = 62nd Ambulatory = 65th
FY 2007 - Goals
Leader Evaluation Results - 2007
12%16%
41%
20%
4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
<1.99 2.0-2.74 2.75-3.74 3.75 - 4.4 <4.44
Note: Percentages noted account for 93% of the leaders who have entered data as of 6.7.07.
Mandatory – Required – Expected Sample Compliance
When you hear this word…do you think “must” or
“should”?
A Book for the Executive
Passionate curiosity – an infectious sense of fascination with everything around you.
Battle-hardened confidence starts with the right attitude.
There are three things that matter: competence, confidence, caring.
A Message for All Seasons
“It isn’t hard to be good from time to time, what’s tough is being good
every day.”
- Willie Mays
Hardwiring
Those who say it cannot be done should not interrupt the
person doing it.
-Chinese Proverb
