The PWW Executive Institute · 2019-12-17 · Attendee License Agreement Once you (Licensee) register for and/or attend any PWW Media, Inc. (Licensor, hereinafter “PWW Media”)

The PWW Executive Institute

2016-2017 Program Materials

Leadership Sessions

© Copyright 2016-2017, PWW Media, Inc. All Rights Reserved. All Use Subject to Attendee License Agreement.

Attendee License Agreement

Once you (Licensee) register for and/or attend any PWW Media, Inc. (Licensor, hereinafter “PWW Media”) Event (including but not limited to abc360, The PWW Executive Institute and any PWW Media webinars), you agree to be bound by the terms of this License. This License covers

any information, materials or training that PWW Media provides, whether written, electronic or oral, and whether accessed directly or indirectly through attendance at a conference or access via the Internet (Licensed Materials). Licensee is permitted to print one copy of the Licensed Materials and/or keep one electronic copy as backup. Unless Licensee obtains Licensor’s prior written permission, Licensee may not:

Permit anyone but you to use a password or share a link to access Licensed Materials; Provide or forward any Licensed Materials in whole or in part to anyone else; Copy, duplicate or in any manner reproduce or rebroadcast any Licensed Material or use it to train anyone; Copy, modify, sell, distribute, rent, lease, loan or sublicense any Licensed Materials; Record any PWW Media Event (including presentations, questions and answers, individual consultations, etc.)

by audio, video, electronic or any other means; Use any Licensed Materials for any commercial purposes whatsoever.

All Licensed Materials are the Copyright of PWW Media, Inc. unless otherwise noted. All rights are reserved. No claim is made with regard to any governmental works or the works of any third parties used by permission. No part of this material may be duplicated, reproduced or distributed by any means.

Although Licensor attempts to provide accurate and complete information at all PWW Media Events, Licensor cannot guarantee it. Errors and omissions may occur. Therefore, Licensor presents all Licensed Materials “as is” and disclaims any warranties of any kind, express or implied. The Licensee acknowledges that the Licensed Materials are subject to change based on changes in law and agrees that Licensor is not responsible to update and/or supplement any of the Licensed Materials at any time. None of the Licensed Materials constitute legal advice or a definitive statement of the law and are not a substitute for individualized legal advice under an attorney-client relationship. Licensed Materials are for educational purposes only. Licensee is instructed to consult the official sources of materials from governmental agencies. Licensor is not responsible in any manner for any billing, compliance, reimbursement, legal or other decisions you make based in whole or in part upon any Licensed Materials, and Licensee hereby forever releases Licensor from any and all claims and liability of any kind related to Licensee’s use of any Licensed Materials. Any examples of documentation, coding scenarios and other teaching illustrations contained in any Licensed Materials are examples for illustrative purposes only. Licensor waives any and all claims, lawsuits or other actions against PWW Media, its principals and employees and all related entities. In all cases, you agree that the liability of PWW Media, Inc. is limited to any amounts paid by Licensee for registering for the PWW Media Event. This Agreement is governed by Pennsylvania law and any disputes hereunder shall be brought exclusively in the Commonwealth of Pennsylvania, County of Cumberland.

Licensee acknowledges that Licensor, nor anyone else on its behalf, made any representations or promises upon which you relied that are not in this Agreement. This Agreement constitutes the entire understanding between Licensee and Licensor and cannot be altered unless signed in writing by the principals of PWW Media, Inc. If any part of this Agreement is declared invalid, it will not invalidate the remaining parts. If Licensor does not enforce any part of this Agreement for any reason, Licensor does not waive its right to enforce it later.

License and Limitations of Use

Copyright Statement

Disclaimer

Entire Agreement

© Copyright 2016-2017, PWW Media, Inc.

Page 1pwwmedia.com ■ pwwemslaw.com ■ AmbulanceCompliance.com

IMPROVING ACCOUNTABILITY WITH 360 DEGREE FEEDBACK

Leadership Sessions

The Problem – A Few Examples

We Don’t Do Well at Getting Feedback 360 Feedback – What is It?

360 Feedback Defined

Multi-rater feedback, multi-source feedback, multi-source assessment

Solicits information from a wide range on a staff member’s work-related behavior and performance

360 Feedback Defined

Upward, downward and sideway sources Including – and especially – the patients we serve!



Feedback Needs to Be…

ConstructiveHonest and candidThoughtful – particularly with open-ended questionsAnonymous

Why Do It?

Change individual behavior for the better Improve individual performance Improve organizational performance

• Improve efficiency and reduce costs

Why Do It?

Reduce risk – improved risk management Improve accountability AND… Improve the patient experience!

Remember This?

The Big Reason

Technical skills are easy to measure – they have built-in feedback mechanisms and feedback is immediate

But for the people and business skills, it is hard to know if you are succeeding without input from other people!

Christian Vanek, Surveygizmo, “The Complete Guide to Running 360 Reviews”

The 360 Debate

Staff Development Performance Evaluation



What 360 Should Measure

Behaviors and competenciesHow others perceive the person“People Skills” – listening, communicatingTeamwork, character, leadership effectiveness,

courtesy

What 360 Should NOT Measure

Staff performance objectives If basic job requirements are being metBasic technical or job-specific skillsStrictly objective things – attendance, signature

compliance, etc.

Why It Fails

Lack of top-down supportQuestions too vague“Personal” vs. “Constructive” commentsNo action or follow up with results

Why It Fails

Inconsistent useLack of confidentialityFocus only on “weaknesses” and not “strengths”

Developing the Survey Developing Questions

Avoid technical skill questionsFocus on impact of behavior, not the person

themselvesChoose the right questions

• Open ended: what should the subject stop doing, start doing, or continue to do?



Developing Questions

Keep the survey shortBalance the questions (scale vs. open-ended)Use same scale for all (Likert 5 point most common)

Questions to AskSource: Christian Vanek, Survey Gizmo, 8/29/16

www.surveygizmo.com/survey-blog/guide-to-360-reviews-what-is-a-360-how-do-you-administer-360-feedback/

Leadership Skills (delegation, responsibility, vision, listening, approachability, coaching, decision making, change adaptation, risk management, service)

Communication Skills (listening, clarifying, speaking, networking, non-verbal behaviors, openness, consensus building, giving and receiving feedback

Questions to Ask

Team Skills (listening, questioning, helping, participating, peer feedback, reliability)

Organization Skills (project management, time use, logistical skills, attention to detail)

Creativity Skills (problem solving, problem identification, inventiveness, brainstorming)

Questions to Ask

Interpersonal Skills (empathy, confidence, stress management, attitude, approachability, group work, enthusiasm, personal appearance)

Organizational Alignment (understanding of community, values, mission, strategic plan, processess)

Sample Questions

Interpersonal Skills • “Effectively resolves conflict among crew members?”• “Demonstrates effective listening skills?”• “Encourages open dialogue among team members?”• “Adjusts to changes without frustration?”• “Preserves others’ self esteem and is empathetic toward

others?”

Sample Questions

Leadership/Motivation• “Effectively persuades others to build commitment for

ideas?”• “Helps people develop passion for their work?”• “Delegates authority and encourages independence?”• “Articulates the strategy in plain language?” • “Provides a positive example and walks the talk?”



Implementing 360 Feedback Steps to Implement

Gain organization-wide commitmentDevelop operational plan – how, when, where, how

results obtained and reported, follow-upDevelop surveys specific to the small selection of

attributes (can’t measure everything at once!)

Steps to Implement

Meet with the subjectMeet with the subjects supervisors, peers,

subordinatesSend out the review

Steps to Implement

Review data and prepare a reportDeliver the resultsDevelop plan for improvement or change in key

behaviors and to develop new skillsFollow-up

Navigating the Complexities to Implementation

1. Align Feedback System Around High Level Goals

Which needle do you want to move? If you want to improve communications between

patient care staff and patients, this should drive everything from the questions you ask to how you use the data



2. Design Feedback Around Key “Touchpoints”

Survey of communications center staff - should survey callers about the interaction with the communication center dispatcher with whom they spoke

Survey of patient care staff - should survey patients about the specific patient care experience with that crew

3. Establish Right Frequency to Survey

Can you collect it on a continuous basis and distribute it in “real time?”

More than once a year? Once a month?Entire crew or team, or specific individuals?

4. Encourage Honest Feedback and Protect Staff Who Answer Candidly

Eliminate fear by rewarding and honoring staff who raise difficult issues

Give more recognition to those whose feedback supported or helped move the missions forward

5. Let People Speak in Their Own Words and Capture Emotional Cues

Open ended questions, text analytics, and sentiment analysis capture interactions more vividly and compel leaders to act

“To hear a paramedic who’s deeply empathetic to the patient trying to explain a complex medical condition – to feel them struggle is painful”

6. Act on the Most Important Feedback and Communicate What You Are Doing

and Why

When using feedback to create specific actions or plans, let them know!

Publish the plans that grew from staff feedbackLet staff see who’s leading the effort, view timelines,

and track progress!

Case Study“Listen to Your Employees, Not Just Your Customers!”

Beth Benjamin, Sr. DirectorMedallia – Global Customer Experience Management Software

Harvard Business ReviewAugust 15, 2016



Staff and Patient Feedback Essential

Linking staff feedback system to the patient feedback system can flag interactions where staff and patient perceptions were different

Linked system gives insight into customers and can be used to coach staff, assess tools and resources and identify people with innovative ideas and leadership potential

Customer vs. Employee Feedback

“For every dollar spent on employee feedback, companies spend hundreds of dollars on customer feedback”

Troy Stevenson, VP of Customer Loyalty, eBay

Connecting the TwoConnecting both staff and patient feedback loops can

engage staff and help your company adapt to changing customer expectations

Frontline employee survey:• 56% - have suggestions for improving company practices• 43% - said insights could reduce company costs• Yet 1/3 said they were surveyed once a year or less

and over half said Co. did not ask the right questions!

Two Immediate Surveys Given

Customers were asked:• Was your problem solved?• Are we easy to work with?• Did you enjoy the experience you just had?

Two Immediate Surveys Given

Employees were asked:• Did you solve the problem?• Was it easy to access the tools and resources you

needed to solve the problem?• Did you feel proud to represent our company in the

interaction?

Benefits of Linking Feedback Loops

Keeps staff “on their toes”Can improve performance and reduce errors



Benefits of Linking Feedback Loops

Can create improved patient satisfactionRecognizes staff who are often not recognizedPut simply, encourages good, professional

behaviors!

The Best Reason…

“At the end of the day, alleviating patients’ fears, reducing their anxiety and displaying compassion should be part of our core mission. And if we’re not actively measuring whether we’re achieving that mission, we’re probably not going to know when we fall short – or how to do it better.”

Jay Fitch, EMS1 News, Sept. 12, 2016 “When it comes to measuring the patient experience, EMS falls short”

Points for Discussion

What are the barriers to 360 feedback?What will the costs be?What will the savings be?What questions will we ask?

Points for Discussion

How do I prepare our staff for implementation?How do we logistically get it done?How do we compile the data?What do we do with the data?How can we measure change based on the data?

Another Approach: “Pulsing”

Using short, frequent “check ins” to get valuable feedback – 1 or 2 questions at a time

“What 3 words would you use to describe our culture”

“What would be our company theme song and why?”

Resources and References



Source: www.forbes.com/sites/ericjackson

Source: www.custominsight.com

The Ultimate Goal…

THE SIX BOLDEST PRESIDENTIAL DECISIONS EVER MADEAnd the Lessons EMS Leaders Can Take From Them

Leadership Sessions But…

Presidential leadership is leadership at the highest level

Leaders at all levels can learn lessons from some of the boldest actions taken by presidents over the years



The DecisionsWashington’s Two Term Limit Jefferson’s Louisiana PurchaseLincoln’s Emancipation ProclamationTruman’s Use of the Atomic Bomb JFK’s Naval Blockade of CubaObama Orders Bin Laden Raid

Washington’s Two Term

Limit

Washington’s Decision

Washington was inaugurated on April 30, 1789

As the first president, every decision he made was precedent-setting

As a revered figure from the Revolution, many wanted Washington to be crowned King

Historical Context

Up until then in world history, no leader had ever voluntarily given up power before either death or military defeat

Most of the world was ruled by monarchs prior to the American Revolution

The idea of American democracy was a bold, untested experiment

But Instead…

Washington chose not to run for president again after completing two terms

Washington abhorred monarchy and felt that American democracy should truly be a government of the people – not of a ruling class



Upon hearing of Washington’s plans to relinquish power and

peacefully transition the government to a new, democratically elected

President, King George III said…

“If he does that, he will be the greatest man in the world.”

-King George III, on learning of Washington’s plan

to retire after two terms

Post-Script

Every U.S. president followed Washington’s two-term precedent until 1940, when FDR ran for his third term

The 22nd Amendment to the Constitution was ratified in 1951 and limits the president to two terms

Lessons for EMS Leaders

Sometimes the greatest exercise of power lies in self-restraint

Those who are given authority do not necessarily have to always exercise it

The skills, talents and abilities of others can be nurtured when they have to rise to the challenge of leadership

Lessons for EMS Leaders:Know the Difference!

Authority: The ability to force or coerce someone to do your will, even they choose not to, because of your position or your might.

Power: The skill of getting people to willingly do your will because of your personal influence. It is always based on service and sacrifice to others.


There is a difference between creating a leadership vacuum and creating an environment that fosters others to develop as leaders in their own right

Some EMS agencies tend to retain leaders for long periods of time, which has advantages. But sometimes, fresh blood can bring fresh perspective.




Remember that your leadership legacy mattersYour actions set precedents, just like Washington

did

Jefferson’s Louisiana Purchase

Jefferson’s Louisiana Purchase

Prior to 1803, the United States consisted of the original 13 colonies, plus additional territory, virtually all East of the Mississippi River

Historical Context

In 1802, Spain controlled the Louisiana TerritoryBut it determined it did not have the military

capacity to effectively govern itSo, in 1802, Spain transferred the Territory back to

the French

Historical Context

The transfer of the Louisiana Territory from Spain to France was universally seen as a threat to the United States

Spain had allowed U.S. vessels unrestricted access to the Port of New Orleans, a major military and commercial port for the U.S.

France revoked America’s access to this vital port

Historical Context

In 1803, Jefferson sent (future President) James Monroe to Paris

Monroe’s assignment was to purchase New Orleans so that the U.S. could resume use of the port

But, when Monroe arrived in France, he was surprised to receive an offer from Napoleon to purchase the entire Louisiana Territory



Historical Context

The French decided they could not maintain the Louisiana Territory due to:• France’s failure to quell a slave rebellion in Haiti• Impending war with Great Britain and British naval

blockade of France• France’s financial difficulties

Historical Context

However, Jefferson had only allocated $10 million for Monroe’s New Orleans negotiations

Knowing of Jefferson’s wishes, Monroe negotiated purchase of the entire territory for $15 million

The purchase was nevertheless quickly ratified by Congress

The Result

This bold, swift move added 827,000 square miles to the United States

This doubled the size of the country and triggered Westward Expansion

The first states in the new Territory started getting admitted to the Union in 1812


Leaders should make sure their subordinates know and understand the organization’s shared visions, objectives and values…

…and empower your subordinates to act accordingly. The results may be transformative!


Sometimes, there are opportunities that are just too big to pass up

Leaders must recognize when those opportunities can further the interests of their organizations

Sometimes we think on too small a scale when bigger opportunities are there before us


When it comes to growth, it is vital to know:• Are we ready to grow?• Do we have the capacity to manage the growth?• Is it in the best interests of our organization?

Look for opportunities you may not have initially considered (MIH, merger, acquisition, etc.)



But we recommend sending Lewis and Clark to do your due diligence first

Lincoln’s Emancipation Proclamation

Historical Context

When the Civil War began in 1861, 11 of the 33 states of the Union had seceded

Historical Context

Of the remaining Union states, President Lincoln had to walk a very delicate balance • Some were slaveholding states that bordered the

Confederacy but were loyal to the Union• Had Lincoln moved to outlaw slavery at the start of the

war, those states might also have seceded and tipped the balance of power in favor of the Confederacy

Historical Context

Lincoln’s primary objective in the Civil War was not to free the slaves –it was to preserve the Union



Historical Context

As public perceptions of the war changed, people came to realize that slavery really was the central issue

The war was going poorly for the North in mid-1862Union commanders were allowing escaped slaves to

fight for the Union armyLincoln recognized that emancipation had therefore

become a military exigency

Historical Context

Lincoln waited to issue the Proclamation until the North won a military victory that could show that the Union was prepared to back up the Proclamation with military force

At the Battle of Antietam, Lincoln got that chance

Historical Context

In fact, the Emancipation Proclamation actually freed no slaves • It applied only to “states in rebellion” (which the Union

did not yet control)• Did not apply to slaveholding border states still loyal to

the Union, since they were not in rebellion

Historical Context

However, the Proclamation did serve as a critical military strategy

It led to almost 200,000 slaves serving in the Union army and navy• And, at the same time, it deprived the South of the

services of those slaves who had been forced to provide food and make materials for the Confederate war effort

Historical Context

The enlistment of freed and fugitive slaves in the Union war effort was one of the decisive factors in the ultimate Northern victory



Post-Script

It was feared that the Emancipation Proclamation would have no continuing validity once the war ended, since it was based on President Lincoln’s war powers as commander in chief

The Thirteenth Amendment was adopted in 1865 shortly before Lincoln’s death and then ratified a few months after his death


It is important to understand – and to communicate – the ultimate goals and objectives of your organization and its mission

It is critical never to lose sight of the bigger picture in exercising your leadership


Sometimes it is better to be patient and wait until you have the proper leverage to make the larger, transformative decisions


Sometimes the best way to accomplish your goal is by proceeding incrementally until you know your people, your organization and your constituents are ready and the right environment is in place to help make change succeed

But remember, it is almost always impossible to please everyone!

Truman’s Use of the Atomic Bomb



Historical Context

During WWII, the U.S. launched a top-secret project to develop atomic weapons

Called the “Manhattan Project”This was a massive undertaking

• The theory of splitting the atom was still a theory• Even if it worked, nobody knew if it could be harnessed

or weaponized

Historical Context

In fact, it was so secret, President Truman wasn’t even told about it while he was Vice President

He was told 12 days after President Roosevelt died and Truman had become President

Historical Context

After the bomb was developed, some of the world’s leading scientists (including some of those who helped develop the bomb) sent President Truman an urgent letter warning that it must never be used

Using the bomb in war would usher in the atomic age and expose the world to previously unknown threats

Historical Context

Yet, after 4 years of war and facing the prospect of having to launch an Allied invasion of the Japanese mainland, fortified by 2 million Japanese soldiers, President Truman had to decide whether the cost of a Japanese invasion could be justified in light of having the bomb at his disposal• It was estimated that up to 1 million Allied casualties

would have accrued had an invasion of Japan been undertaken

Historical Context

Truman gave the order for the bomb to be utilized against Japan• The first was dropped on August 6, 1945 on Hiroshima,

instantly killing approximately 70,000 people• The second was dropped on August 9, 1945 on

Nagasaki, instantly killing approximately 40,000 people• Hundreds of thousands suffered the effects of radiation

poisoning

Post-Script

Historians and ethicists continue to debate Truman’s decision to this day

The United States remains the only nation that has ever used atomic or nuclear weapons in war

President Truman viewed the use of the bomb as a tragic necessity, but never regretted using it




The most difficult decisions are the ones that will end up on your desk• Otherwise, someone else would have made them!

It is your job to weigh the pros and cons, and then make the decision


Even if you think you’re not the most qualified to make the decision, if it is yours to make, you must make it

And then, stand by your decision if you believe it to be correct

When Franklin Roosevelt died, I felt there must be a million men better

qualified than I, to take up the Presidential task. But the work was mine to do, and I had to do it. And I have tried to give it everything that

was in me.-Harry S. Truman, Farewell Address,January 15, 1953

JFK’s Naval Blockade of Cuba

Historical Context

In October 1962, the Soviet Union placed nuclear missiles on the island of Cuba

These missiles were only 90 miles off the U.S. coast and would have been able to reach key U.S. cities in mere minutes

Historical Context

This was at the height of the Cold War between the U.S. and the Soviet Union

Americans lived in fear of a potential nuclear attack by the Soviets



Historical Context

In 1961, the Soviet-backed Cuban army had humiliated the newly-inaugurated President Kennedy when a CIA-backed Cuban coup attempt in the Bay of Pigs was easily defeated by Cuban President Castro

Historical Context

This led some in the military to question whether President Kennedy had the toughness to take on the Soviets and win the Cold War

Some in the military held Kennedy in open contempt

Historical Context

Emboldened by their victory in the Bay of Pigs, the Soviets installed nuclear missiles in Cuba in October 1962

Historical Context

President Kennedy was being urged by almost all of his military commanders to launch immediate air strikes against Cuba to take out the missiles before they became operational

Even though time was of the essence, President Kennedy did not want to be forced into making a quick decision with irrevocable consequences

Historical Context

President Kennedy had misgivings about the Bay of Pigs, but had placed his advisers’ advice over his own best instincts

He was a student of history and knew that a series of small miscalculations could lead to large-scale war between nations

Historical Context

Against mounting pressure from inside his own government, President Kennedy chose to implement a naval blockade of Cuba to prevent nuclear weapons from reaching Cuba

This gave the parties a chance to “cool off” and negotiate a diplomatic solution – avoiding the possibility of a nuclear World War III



Post-Script

The diplomatic solution was hidden from the public for over 30 years

The U.S. agreed to remove missiles from Turkey in exchange for the removal of the Soviet missiles in Cuba


Leaders usually get to be leaders because of the qualities they possess:• Judgment• Temperament • Self-discipline• Wisdom • Experience


One of the toughest things a leader has to do is make a decision they know is right – even when everyone seems to want you to do something else

If you make a decision just because that’s what everyone else wants you to do, that’s not leading –it’s following


Leadership – divorced from ethics – is reduced to mere management

Do not let your own judgment abandon you when the tough decisions have to be made

In the grand scheme of things, EMS leaders only carry the torch for a relatively brief period of time in the life of

an organization.

Strive to leave it better than you found it.



Obama Orders the Bin Laden Raid

Historical Context

Osama bin Laden had been identified as the mastermind behind the 9/11 attacks on the United States

Almost 10 years had gone by and he had not yet been brought to justice

Historical Context

It was very difficult to obtain the necessary intelligence to determine bin Laden’s precise whereabouts

Precise certainty was impossible

Historical Context

The best available intelligence placed bin Laden in a compound in Abbottabad, Pakistan

There was no definitive confirmation of this fact

Historical Context

Two previous U.S. presidents may have had opportunities to target bin Laden, but he escaped before troops could get it done

Clearly, he was “Enemy Number 1” of the United States

Historical Context

When presented with this evidence in 2011, President Obama was still in his first term and would be facing a tough re-election contest in 2012

Any mistake or failure in a mission like this could cost him the election• In fact, the failure of an attempted rescue mission in Iran

in 1980 may have cost President Carter re-election



Historical Context

President Obama asked his military commanders tough questions about the plan – and their preparedness – and in the end trusted his military to do the job

He decided that the national interest was more important than his own re-election

The mission succeeded, and President Obama was re-elected in 2012

Post-Script

While the mission was underway, one of the military helicopters crashed

President Obama must have had flashbacks of President Carter helplessly watching his soldiers die in the Iranian desert in 1980, calling it “the longest 40 minutes of my life”

Yet, there were no American injuries in the mission


Surround yourself with good people – and then don’t be afraid to entrust them with the welfare of the organization

If they subscribe to the organization’s shared values, they won’t let you down


Sometimes the consequences of a decision are inescapably large

Doing what’s right may even cost you a jobBut we must remember that our mission is truly

bigger than any one of us


Our decisions as leaders will leave a lasting legacy –and we should always strive to be on the right side in every thought, word and deed



“EMS is the most noble of all

professions.”James O. Page1936 - 2004

Six Honorable Mentions

The Monroe DoctrineRoosevelt’s Panama CanalLBJ’s Civil Rights Act of 1964Eisenhower’s Interstate Highway SystemChester Arthur’s Civil Service Reforms JFK Declares Moon Mission

Recommended Viewing and Reading

Documents

The PWW Executive Institute · 2019-12-17 · Attendee License Agreement Once you (Licensee) register for and/or attend any PWW Media, Inc. (Licensor, hereinafter “PWW Media”)