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Seek to understand why staff think innovations or changes do not align with the existing culture and mission. The CEO told these leaders to take two steps: first, listen to the doctors and staff to understand why they perceive misalignment between the myriad of changes and the values of the organization; second, reframe and strengthen the connection between innovations and the core values of the hospital, so it no longer seems like a misalignment.
Elsewhere, a CEO of a large integrated health system told us about seeking to understand staff perspectives through weekly rounds. In one case, he listened to nurses express resistance to a new process for end-of-shift patient handoffs.
Many nurses thought the new process took much longer and hindered the exchange of information. The CEO addressed their concerns by focusing on the improvement in patient care. He highlighted that with the new process, patients were more engaged in their care and better understood the need for medications or procedures, which in turn affected the ultimate outcome of patient health.
Once the nurses accepted the rationale, the focus of the conversation shifted to logistical barriers that kept them from adopting this change e. Alignment of common values enabled and motivated them to work through this change adoption together. Engage employees with data to explain the problem, its urgency, and how to address it.
Data and metrics can create an awareness of problems, a means to explore them, and a goal post to measure progress. Based on data from the Centers of Disease Control and Prevention CDC , on any given day, about one in 25 hospital patients gets at least one health care-associated infection. A common cause is poor hand hygiene: The CDC suggests that, on average, health care providers clean their hands less than half of the times they should.
The leader of a large integrated hospital system shared with us how they used data to change existing norms and routines and drive more hand washing. A safety group collated this data by unit and included it in a posted weekly report.
During morning huddles, unit and division leaders shared the data and started conversations about potential reasons behind the numbers. This weekly dialogue not only kept the problem in the forefront, but also engaged employees in diagnosing the barriers and factors outside of their control that made change hard to implement.
In one discussion, employees shared that when the batteries in the hand sanitizer dispensers died, it decreased handwashing until workers from another floor could replace the batteries.
A simple change of moving spare batteries to the units and allowing anyone to replace them eliminated a critical barrier to improving adoption. Pay attention to the behaviors you reward and tolerate. As part of the same hand washing initiative, hospital system administrators created a Speak Up program, which empowers and trains nurses, staff, and doctors to call out anyone failing to wash their hands, on the spot, as they moved from patient to patient.
For the campaign to work, no one, regardless of level or status, was immune from a reminder to wash his or her hands. Engrained cultural norms and power relationships about speaking up needed to be shaken e. The weekly huddle meetings became a time to acknowledge those who bucked the existing power norms and reinforce the new behaviors.
At these, the CMO handed out Starbucks gift cards to the staff that spoke up to physicians and others when they did not wash their hands. Rewarding new behaviors that contradicted the existing norms reinforced the message that it is safe to act in new ways.
The change would not stick if doctors were exempt from feedback about noncompliance. Doctors were also encouraged to thank anyone who spoke up to them when they forgot to wash their hands. When physicians negatively reacted to feedback from staff and resisted the culture change, an administrator reached out to them. The status quo persists when bad behaviors at any level of the organization are tolerated. When leadership understands that turning a blind eye to one bad behavior can decimate the adoption of innovation by others, they may be more willing to hold difficult conversations with the highest-status employees in their organization.
For example, my chief strategist and one of our hospital CEOs were both passionate leaders who cared deeply about improving our system but they were always on opposite sides of key organizational and strategic issues. By getting them to dig deep and talk about their own personal motivations, it became obvious that they actually shared the same overall vision. This helped them to identify what they each wanted to do to contribute to our larger agenda and helped us define their distinct roles and responsibilities more clearly.
That sort of work had a remarkable effect on bringing leadership together, helping us to communicate with each other more openly and candidly, and making it faster and easier for us to innovate and execute.
But how do you make something like that happen at scale? Purpose is not a canned or artificial HR program. Discovering it is deeply personal and almost therapeutic. When close peers face high stakes, real problems and interpersonal challenges, the work of discovering and sharing purpose seems to galvanize their sense of team almost magically.
We decided to implement a similar process among other teams, and then cascade that throughout the organization. Then we selected 50 of these people and divided them into four model teams. Next, we set these teams to work on defined areas of organizational need — Quality, Clinical Operations, Administrative Operations, and Associate Engagement. Each of these teams went through the same team development program as my senior leadership team.
For example, one front-line nurse was incredibly dedicated to patient satisfaction. Joining the Quality team gave her a way to bring her personal perspective on best approaches to patient care to that group and helped her to see how directly her individual efforts could contribute to our larger goal.
Next, we gave these teams the freedom to identify organizational problems in their area of concern. This efficiency is a key driver of operational costs but also a leading indicator of patient satisfaction and quality since prompt discharge means clinical best practices are being applied and quality outcomes achieved.
Our Clinical Operations team was composed of nine people who represented every area of the hospital that touched throughput, from the ER to the wards to pharmacy and administration. Whereas before they might have seen their roles as siloed from one another, now they worked collaboratively to solve bottleneck issues across the system. Sometimes this work surfaced tensions so it was important to facilitate and coach people through their conflicting points of view.
Team members who were initially at odds were always able to reach a collaborative solution because they had spent time getting to know each other and they understood that everyone shared the same priorities around improving patient care. The vulnerability and openness the team-building process established made it easier to get aligned. This new group became the implementation team charged with executing on the strategy. The original team members who remained were responsible for bringing new team members through the team-building process.
The team members who were recused were assigned to new teams where they also helped lead and develop team cohesion in those new groups. Team members had grown close and wanted to stick together. But by dispersing them to other teams, we created a process of leaders teaching leaders that cascaded throughout the organization, with increasing numbers of people aligned around a shared purpose and focused on solving meaningful challenges.
Our focus on meaningful problems was critical. Our approach engaged people on developing tangible solutions that would contribute to our vision. It reinforced alignment, helped build our capabilities and led to actual improvements in organizational performance. Not everyone was touched by the work right away, but the network effect was powerful.
I was amazed by the level of commitment and passion that grew throughout the organization. We moved faster and made more significant progress because we combined the power of purpose with project work that was designed to improve organizational performance. We made sure to track and measure progress and status frequently. We also measured operational metrics like quality, safety, satisfaction and financial scores to gauge our progress compared to national standards of excellence. And we continued to take the temperature of the organization by conducting surveys on employee engagement and culture.
Measuring in three areas helped us to avoid letting personal experiences or perspectives cloud our judgement of how well we were doing as an organization. We also kept rounding and conducting listening forums and town halls to make sure we surfaced and were aware of every concern.
The rich understanding that we developed enabled us to employ very crisp and targeted responses to problems and concerns that were tied to our strategic priorities.
For example, we changed our leadership when it did not reinforce or align with our vision and new approach. We also altered our staffing approach and increased compensation in select areas to improve performance.
For the top executive group, the work of being a leader also transformed. The approach we put in place forced us to listen and learn how to support people rather than dictate or direct them. We became actively engaged in collaborating with our people as they worked to solve the problems of the organization. Sometimes we were coaches, sometimes mentors, sometimes facilitators.
In breaking out of our own administrative silo, however, we were also very visible and open to scrutiny. We knew that cynicism in employee ranks was long-standing and any time we fell short we would be reinforcing old perspectives. So we articulated our promises clearly — even writing them down in memos — and we matched those to outcomes that people could observe and track, thereby linking what we said with what we did.
Within our leadership group, we also defined new behaviors that would support our new approach to leadership and I took it on myself to continue to observe and coach our team to stay on track.
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Team leaders should talk about it at every opportunity and ensure all team members are working towards it in their day-to-day work. All teams move through different stages of development, . Each healthcare provider is like a member of the team with a special role. Some team members are doctors or technicians who help diagnose disease. Others are experts who treat disease . Sep 20, · Change Management: Why It’s So Important, and So Challenging, in Health Care Environments. Medical professionals excel at finding solutions in patient care. “We are great at .