Talent & Leadership

Over the years I've been involved with leadership development from several perspectives:

1) The brand new, first time leader (mostly failures & school of hard knocks)

2) The new leader of a turnaround business (different set of skills needed)

3) Member of the leadership team for an organization

4) Director of Leadership Development, training over 50 individuals to become GM/business unit chiefs.

5) Lifelong student (MBA @ USC's Marshall School of Business)

While I love learning (reading, watching) from other experts, I can't help but apply all of that through my real-world lens that prevents me from swallowing everything put forth. And, since successful leaders are needed now more than ever in healthcare, I'll dedicate several posts to the subject here.

Recently one of my company's new, promising Administrator-in-training/CEO-in-training (AIT/CIT) questioned some of my statements/critiques of Marcus Buckingham's best seller, First Break All The Rules (Great Book) during a training week we affectionately call boot camp. My email response is below:

TO: Eric

RE: my rejection of Gallup/First Break All The Rules ... I like MOST of what’s in that book. I really like the 12 questions and the scientific basis for their conclusions. However, I think they ignore one major variable in the talent/success formula — chemistry with supervisor. Good to Great talks about ‘the RIGHT people on the bus,’ as you know. I think G2G also ignores this in determining what makes someone ‘right.’ I have seen (and seen in my partners) many times when someone was ‘great’ at what they did for one leader and then that same person was not the ‘right’ person for the new leader. If the person has the talent for the position, s/he should thrive according to both G2G and 1st Break. But, the reality is chemistry with the talented person’s leader is critical to his/her ability to thrive. Furthermore, where there is strong chemistry/trust, I’ve seen (again, many times) a great leader be able to help underperformers change and succeed. Instead of debating whether or not the person had the talent to become great, I believe we’re better served by focusing on creating rock-solid relationships with the people we lead — allowing them to become what sometimes only we can see them capable of becoming (the Dulcinea concept).

So, I don’t reject Gallup. Just like I don’t reject G2G. I just find their discussions of talent incomplete. Talent-mapping or profiling for a position is really tricky business. We came very close to attempting this for our Administrator in Training/Executive Directors selection a couple years ago. You can maybe find a few common characteristics of successful leaders in the company. How do we know that very different people can succeed here or do better than we’ve seen. This approach becomes even more troublesome when you see the huge difference in types of operations, geographies, rural/urban, size, demographics, stages of stability, etc. I would have a much harder time thriving in a small rural town than someone who is better equipped for that. Yet, we don't have luxury of knowing the nature of what opportunities will be available for the new CEO in Training when hired.

What I take from Gallup is playing to people’s strengths. We need to do a better job of this here. We’ve learned by sad experience that just b/c you’re very successful at one operation does not mean you’ll be successful at a very different one. What happened to our previously very successful leaders when they change facilities or market dynamics or people dynamic change significantly and then they fail? Didn’t they have talent? In other words, I find predicting success based on past experiences or exhibited talents incomplete. Fit and timing are more predictive in my opinion. I’m not saying past experience and talent is meaningless. Of course it’s useful. So, what do I look for in an AIT/CIT? I look for how likely they will fall prey to the factors of derailment below. I’ll take very different talents b/c we need all types and all types have been successful here. But, I don’t want the guy who appears to be perfect for the position who is clueless about his blind spots, weaknesses, and has never changed his approach based on learning from hard experiences. That’s what I focus on in my interviews.

See the article and book excerpt attached for a better explanation of this school of thought. I don’t see it far off from what Gallup or G2G is saying. I just think it’s a more complete viewpoint taking into account an individual’s chemistry, timing (peter principle), fit, and pride.

I’d love to hear your thoughts.

And, I'd love to hear YOUR thoughts too ...

'Speed of the leader ...

... is the speed of the team.' I heard that phrase for the first time about a year and a half ago when a young, new nursing home leader stepped into his first opportunity to run a skilled nursing facility in San Diego, CA. The opportunity was daunting ... the facility was old, beaten-down, beneath a freeway overpass, across the street from a strip club, and competing with some of the best looking and operated facilities in southern california. Takers?


This guy jumped in and 'owned' it from day one ... running fast. He modeled what he expected and later required from his staff -- putting customer service/satisfaction (for residents, patients, doctors, vendors, etc.) above everything but quality care. The census and financial performance naturally followed. A year and a half later, the facility is neck-and-neck with the competition -- enjoying clinical, census, and financial success like never before.

The speed of the leader is the speed of the team ... is true, but only part of the story.

The speed of the leader and team are both dependent on the quality of care. What this San Diego leader and team had going for them, that many in their situation don't, is a stellar Director of Nursing and care outcomes. That is basic and fundamental before attempting any radical transformation.

One of the secrets to their success was the personal attention the leader gives to doctor relationships. He, along with his team, work hard to convince skeptical doctors to send them a patient to 'prove' the hype is not hype, but true. Once that doctor's patient arrives, her satisfaction becomes priority #1 which leads to a changed reputation for the facility ... 1 MD at a a time.

Thou Shalt Not!

One of the biggest challenges in providing the highest level of service in healthcare is to undo the years of phrases and vocabulary that is so common and so destructive. We've all heard the following:

"She's not my patient"
"That's not my job"
"The other shift didn't do it"
"There's no supplies"
"There's no time"
"I'm in a hurry"
Etc.

When we started our transformation, we started here ... with vocabulary. We introduced Communication Guidelines in the form of "THOU SHALT NOT SAY ..." All of the staff could relate to saying or hearing each one of the 10 phrases at some point. Like with all our training, we made it fun/funny as we introduced the new requirement.

Then ... we laid down the law. We stated that saying any one of those prohibited words/phrases would be cause for termination. We were serious. We don't want to lose any of you. Etc.

When we termed a CNA for saying "She's not my patient," the entire facility found out about it and realized we were, in deed, serious about the experience our patients/customers receive. After the employee was termed, behaviour changed ... big time. There was a noticeable difference in the verbal communication with people in the facility ... more polite. More aware.

Everyone's been told not to say those things before. But, it is the full committment of the leadership of the facility (meaning willing to lose people) that is required to see the change take effect.

Guardian Angels

The Guardian Angel program is a great way to accomplish several objectives at the same time:
* Provide an additional "friend" or contact for the patient
* Get to know the patients better
* Proactively solicit feedback daily from all patients
* Communicate with patients' family weekly
* Check room for safety

Each department head is assigned as the "guardian angel" for a few rooms. Each day the GA is to visit the residents and patients in each of those rooms with the primary goal to build a good relationship. Get to know the patients, family members, etc. While there, the GA should be checking the room for safety and inquiring about customer service issues.

One great bonus for having this in place is during survey time. When the department of health asks you to arrange for a meeting with the patients of your choice, your guardian angels will be able to provide a broader perspective and deeper knowledge of the best candidates for that meeting due to the daily contacts.

A photo of each guardian angel is placed in the corresponding resident room with a brief description of the duties of the guardian angel (check out example above).

Secret Service

One of the biggest complaints in hospitals and nursing homes is how long it takes to get the help you need. A fanatical commitment to world class service is the right way to solve this symptom. AND, there's a way to cut call light/wait time in half while improving morale between direct-care staff -- join the secret service!

Picture it ... you're a patient recovering from surgery. You are experiencing severe pain. You push your call light for the nurse. 3 minutes later, a nurse's aide walks in and asks what you need. She tells you that she'll go get the nurse for you. Unfortunately for the nurse aide and for you, the nurse is in her secret hiding spot in the facility where she can actually get some of her documentation done. The aide looks up and down the hall. No nurse. She goes to the med cart. No nurse. How is the aide feeling toward the nurse? More importantly, how are you feeling about the aide, the nurse, and the whole facility?

The best solution I've found to that (and hundreds of other) scenarios is a pretty simple technology that the secret service uses to protect the president. And ... of course, we have a lot of fun telling the hospitals, doctors, and prospective residents that "if it's good enough for the president of the United States, it's good enough for our residents."



Imagine having each of your nurses and aides with the secret service ear piece in one ear while they work. Then, that scenario above plays out like this ... you ask for pain meds. The aide immediately presses her microphone button under her scrubs and says, "Roxanne, Mr. Jones needs a pain pill." (Everyone hears that in their ear) Roxanne -- in her secret hiding place -- responds on her undercover mic, "Tell him I'll be right there."

Math
Let's do the math together to drive the point home:

Let's take a 99-bed facility with 90 residents (high acuity). The day shift has the following in nursing: 5 licensed nurses, 10 nurse aides, 1 RNA. How many times during her shift does the nurse or CNA look for someone for assistance (ie, help with transfers, pain pills, showering, ADLs, wound care, room change, etc., etc., etc.)? Let's say 20 times. On average, how much time does it take to find the person you're looking for? Sometimes 20 seconds. Sometimes 10 minutes. Let's say 5 minutes. Now let's do the math ...

- 16 staff in nursing x 20 searches for help x 5 minutes per search = 1,600 minutes/60 minutes = 27 hours.
LET THAT SINK IN! On one shift alone, your nursing staff is spending a collective 27 hours "looking for someone to help." It's insane! That equals:
- 54 hours/day (treating the next two shifts like one day shift due to fewer staff)
- 68 days/month
- 818 days/year

If you really want to pull your hair out, calculate the wage cost of that "looking for someone to help." When I show this to Directors of Nursing, they have heart attacks. If your nursing staff/DNS is pushing back at all to the idea, do that math with them and you'll see a change of heart. Just think of how much more care can be delivered if you had 54 hours/day more of nursing time available?!

The radios & headsets we use have benefited us in several ways ...
- improved communication between nursing staff
- more efficient use of our time
- created buzz in the patient & labor market
- eliminated the hated/annoying overhead paging

Externally ... this has been HUGE for us in our community for marketing. The DC planners, doctors, vendors, etc. are thrilled that a SNF is so progressive/pro-active to this very common problem in healthcare. If you preach/market customer service as your distinguishing characteristic and are able to back it up with the secret service ear piece action ... buzz, buzz, buzz.

Post a comment/question or email me to find out more details about this solution. I have no vested interest in any technology solution provider by the way. I just can't imagine delivering healthcare any other way anymore.

"Buy A Bus"

In October of 2004, we acquired a facility in Orange County, CA called Palm Terrace. It was there that the idea of "becoming the Ritz Carlton of skilled nursing facilities" first struck us ...



A couple weeks before we took over the facility, the Dept. of Health called us in to their office to talk. It was there that we first realized what type of facility we were getting ... a train wreck. DHS informed us that PT was their worst facility in the county in terms of complaints and surveys (annual inspections). When I asked them why they thought it struggled so much for so long, their response surprised us ... "It's because you're in south orange county where the cost of living is too high for a lot of nursing home employees to live there ... so, you have to take what you can get." When I asked what they recommended, they said "buy a bus and bus them in from Santa Ana and Anaheim." After years of "dealing" with that facility, DHS saw buying a bus as the most feasible option! What immediately followed, ALMOST made me take up their advice ...

A few weeks after we took over, DHS showed up for our annual survey. And, in keeping with tradition, we failed it. Fines, penalties, and denial of payment for new admissions ... not to mention the stress in preparing for a re-survey. You gotta love it! By the start of the second quarter, we were in the hole and tired. Looking back, that thrashing was really necessary to "prepare the soil." Because of that experience, we were desperate not to repeat the same failure year after year and we started looking for what would address these pains we were feeling:

- Survey/Department of Health
- New Management
- Growing Census
- Feeling "Stuck" (internally & externally)
- What makes our building different from our competition?
- Recruiting
- Staffing
- Morale
- Financial Stress
- Survival Mode
- Customer Complaints

I think most SNFs experience these to one degree or another. We just happened to feel them all intensely at the same time :)

We identified something that would, theoretically, address all of those pains -- and we found it at a training offered by the Ritz Carlton hotels. I attended their training that summer of 2005 in Los Angeles and was blown away. The initial skepticism ("We don't look or smell like a Ritz") and ("Their customers actually chose to be their customers -- unlike our patients/residents") started to melt away as the day went on. My "yeah but" turned into "I wonder if" to "why not?" In addition to the Ritz, we studied Disney and the Four Seasons ...

We knew that radical change/commitment would be needed in order to become the ritz carlton of SNFs. But, frankly, we couldn't see any other way out. We developed our own framework -- including our Mission, Employee Promise, Motto, Customer Communication Guidelines, Service Definition, Guardian Angel Program, and Standards. We also developed training modules for each of these which included a test at the end of the training that every employee/and new hire had/has to pass in order to continue employment.

I'll go into more detail later about the model ... but, the results have been awesome as we've seen major improvements in the following:

- Staffing/Recruiting
- Reduced Complaints
- Improved Surveys
- Reduced Turnover
- Stronger Reputation & Census
- Provided hard, written standards to hold staff accountable and promote excellence
- Improved communication flow through Q Shift stand-ups
- Improved Financial Performance



What sounded good/right on paper turns out to be good/right in practice in this case. No remodel, re-landscaping, re-naming, re-anything could have the powerful impact on an organization that a fanatical commitment to world-class customer service standards can and does.

I hope this blog will serve both you and me to discover proven strategies and principles to bust out of the mediocrity in healthcare and achieve world class results.