Management Matters – Performance Reviews – Part 3

CheerupGearup - Creating a Brighter Future

All of what we’ve done up to now adds up to the primary point of the interaction and the outcome of what a great performance review should look like.  In the first entry we talked about what a waste of time the “legacy” version of performance reviews are, and if their used the failure is squarely the responsibility of the supervisor.  In the second entry a process was outlined to engage and communicate with the staff, and encourage two-way communication about expectations and document the result.  Your focus is on what is right about each employee and how they can recognize what’s best about themselves and each other.

It seems to me the point of a performance review should be to improve performance.  The challenge, as discussed in the first entry is that it is virtually impossible to provide the kind of feedback that will elicit greater performance when the conversation occurs once…

View original post 668 more words

Manage on Purpose – Focused Talent

As we continue on the journey of “Managing on Purpose”, we come to people and their talents – clearly the most important variable not to take for granted or act on randomly.  Sure communicating expectations and providing “The Stuff” to get the work done well is an important foundation, but the people who show up everyday will make decisions and act to execute on that foundation.

Here’s a punch in the gut.  People are different.  There is no one size fits all, and even under ideal circumstances, different people will do even routine tasks differently and with different effectiveness.  This hold from the most complex to the most routine tasks.  The education, age, height, weight, and background makes no difference.  Everyone varies from everyone else in doing anything – and it holds every time.

Part of managing on purpose requires that you learn, understand and apply those difference in a way that leads to better outcomes.  This step is easy to do – but hard to carry out.

First, the steps for the easy part:

• Spend time talking to your people one on one talking about their past successes.  What did they do – who was there and what was their contribution to the success of the event.  It does not have to be work related – from winning the state championship in tennis to presenting their winning jelly at the fair – focus on success and their contribution.
• Observe the way they carry out their work.  Don’t judge or correct – just watch and look for the parts of their work they take the greatest pride in.  Is it in the actual repair of something broken, or is it in the interaction with the customer – or yet something else?  Watch carefully.
• Begin directing the work they are assigned around what they love to do and do best.

Second, the hard part.

• You’re going to have to be different.  As a leader you have an orientation to fix or correct – it’s true and undeniable.  To be successful at this you’re going to have to  be open-minded.  The old thinking – everyone can do everything as well as anyone else – is going to have to leave your being.
• You’re going to have to defend your actions.  The people, the union, your boss, even the team are going to think you are playing favorites and treating people differently.  They are going to think this because you are going to be playing favorites and treating people differently.  Gear up.
• No matter how well you listen and apply what you’ve learned, it is not going to work the first time – or the second or third.  It is not an event – it is a process and will take time, patience and humility.  You have to be in this for the long term.

There is no one size fits all solution for the people problem – that is who should do what.  To manage on purpose you have to put the right people in the right place – with the right expectations and the tools to be successful.  This is a three legged stool that will come crashing to the floor without all three.

We’ll talk more.

Manage on Purpose – The Stuff

The next step in the series on managing on purpose is to assure that you team has what it needs to do their work well.  Although it sounds easy, there is a lot to it and needs your complete attention.

The obvious first step is to ask you team if they have the equipment and materials to do their work well.  Although a good first step, my experience has shown that it is both unreliable and inadequate in meeting the objective here.  Here’s why:  Many of you have convinced your team over time that your company has no money – actually has no money to spend to do anything.  Yes, people believe this because you and previous leaders have taught them that.  You know, and I know and everyone else should know, that there is money – but it has to be allocated and dedicated to the high east priorities.

So, after the obiligatory question, “Do you have what you need?”, it’s time to dig further.  Here are some ideas to help you get to the nuts and bolts of the question.

• Work along side your team and see how they get things done?  Are they using the right tools, or have they developed a series of work arounds to make what they have work?
• Inpsect their tools.  Actually take them off the truck, out of the tool box, and into the open and look at them.  Are they worn, broken, complete, and most importantly SAFE?
• Work with supervisors from other areas of your company – actually visit them and work with their teams.  See what they use to get work done, and take good notes.
• Don’t stop at the tools alone – but check below the surface.  If someone has a working drill – what shape are the batteries in?  Do they have a charger?  What shape are the bits, nut drivers and even the case they carry it in?

You have a lot to overcome here.  Time has convinced people that they have to work with crap because there is no money – they continue to work with worn and obsolete tools that are unsafe because they are used to them, and finally you are the likely the first leader that has asked or cared about them or their tools.  Anticipate some skepticism.

n my current role I began asking people early on if they have the tools and equipment that they needed.  At one point on employee actually chastised me continuing to ask the question every time I saw the team.  Interestingly, it took a few months, but I finally got some ideas about what needed to be done.  Some things were replaced – some were repaired and put back into use – but at the end of the day, the team has what they need to provide Safe and Reliable service.

We’ll talk more.

Manage on Purpose – Expectations

In the last entry I talked about the difference between leaders – front line leaders – that work according to the nonsense they have been taught in seminars and classes and rely on developing processes and luck.  If you want to count on luck, play a slot machine – if you have a serious and important business to run with important and worthy goals – follow the steps.

During my days at the Gallup organization I was introduced to the Q-12.  As an intellectual tool it is a work of true genius – a masterpiece in the real world of business.  The questions cut to the core of making real progress in workgroups – which is the core itself of making real progress on business strategies.

The first of the Q-12 questions is “I know what is expected of me at work”, and would be rated on a scale of 1 – 5, where higher scores mean greater engagement.  The result of the survey tells you were you are now – the gap between where you are and could be measures your ability to grow.

You will recall in the first entry I listed, “Define and communicate to the team what needs to be accomplished and why.” as the first step for first line leaders to deliver on the great strategy the executive team develops.  My definition is an extension of what Gallup asks, and builds on it.

• Define and communicate, and
• Why it is important.

Most first line leaders get their marching orders from their job description – the list of tasks they and their team do on a daily basis.  Interestingly, what you want and what you ask for are usually very different.  The job description might read, “Take an X-Ray”, or “Fix an Appliance” – but the real explanation is to engage the customer.  If you what you want is to create a customer experience so exceptional and exciting that you win a customer for life – why do your people walk in ready to relight a pilot light and run.  Easy – because that is what they think you want.

Tell your team what you want – no matter what it is.  I use the term, “Best Gas Company in America” as the lead in line when talking about performance, then let that flow to “our entire world revolves around safe and reliable service”.  It is an easy Segway from the best in the nation to safe and reliable.  It answers the questions every time.  Is what we are about to going to lead to “Safe and Reliable” service?  If so it leads us one step closer to being the best gas company in the country.

Define what right looks like in your role and team.

• The friendliest hospital in the nation.

Make sure it is saturated in the “Why”.

• A smile for everyone, because everyone matters?

Now what about you?

We’ll talk more.

Manage On Purpose

This post is inspired by a conversation I had with a friend who is both sincere and hard working – but somehow misdirected on how to get things done.  During a recent conversation he told me his plan for progress with his team which included laying out the work and then a “we’ll see what happens” approach.

As many of you know my life took a strange twist about two years ago.  I left a role as a consultant after discovering the company I worked for practiced the equivalent of voo doo science and returned to a position in first line supervision.  It seemed strange only to those that didn’t read my posts or hear my talks.  My focus for improvement in business lies solidly at that point in the management continuum – the first line supervisor.

Back to my friend and his approach to work.  Although troubled it is what most first line leaders do – that is they put processes in place and see what happens.  Some, the ones that consider themselves clued in, even make course corrections when things go wrong.

Here’s a better idea – and it isn’t that hard:

• Define and communicate to the team what needs to be accomplished and why.
• Be deliberate about making sure they have what they need.
• Learn a lot about each person and what they do best – and give them that work to do.
• Talk a lot about what is working well.
• Start over and do it all again.

Notice there is little room for micro management here.  Little room for ego or the 14 essential steps of supervison you read about today on LinkedIn.  There is room for talent, and growth, and autonomy and positive feedback – and most important the requirement to truly care about your team.

What are your plans to accomplish your goals?

We’ll talk more.

Step 3 – Rinse, Lather, Repeat.

You’ve come to the end of the three-part series that simplifies the improvement of your hospitals patient scores – and all without a master’s degree or ridiculous gimmicks.

We started learning more about less.  Finding out where the problems exist reveal that most of your department is doing great and does not need any fixing.  Good for you.  This is the toughest step – and a real paradigm shift for most leaders.  One sheet of paper replaces reams of reports – one sheet of paper tells the story you never got before.

When you knew the problem you could focus on it when you took it to the street.  By including the people who do the work – getting and acting on their ideas and having daily discussion on progress and posting scores for accountability, you finally saw real and meaningful change.

Now, for the part that most executive leaders miss – or skip, or ignore, or get distracted with something else and never get to.  Rinse, Lather, Repeat.  The best advice you can get from a bottle of shampoo is the last step in patient satisfaction improvement.  After you begin seeing meaningful change, start over from scratch – begin again – start with the data and learn more about less, then take it to the street, then . . . .   You guessed it.

This is the step you’ve been missing the whole time.  This is the step that creates what you have wanted from all the nonsense you’ve been spending your money on all this time installing and encouraging gimmicks and other crap that has just meant meager changes and longer contracts with a worthless vendor.  Yes, this is where you create a culture of “sustainability”.

Yes, you read that right – a culture of sustainability.  When you stop what you’re doing, start over and rediscover the next issue, you are instilling a process of constant review and therefore improvement.  This is a spiral upward – improvement, review, improvement, review.  Soon you will move to new departments and floors – because in the first unit you have people who are experts.  People that can walk the talk.  You’ve create a model of success.

Congratulations.  If you need help with any of the steps, give me a call.  239.595.1780.

We’ll talk more.

Step 2 – Take it To The Streets

In the first step I made the argument that most of the dissemination of data around patient scores to all level of stake holders is vague and worthless.  Knowing that your doctors are in the 57% percentile tells you nothing about what you’re doing right, what you could do different and better and what you should be doing next.

The only way to know what to focus on is to know more about less.  Is the challenge in your ER younger females at night, or medicare patients on the weekend?  How do different people perceive the quality of the food and the cleanliness of the room?  When you know what you’re doing right, that is where and with whom the scores are high, and where you fall short, and should focus attention, you can act intelligently.

And acting with intelligence is the next step.  When you’ve done due diligence with the data – and I can tell you with certainty that almost nobody has – can you “take it to the streets” and begin the execution of an improvement strategy.

This step is best understood with an example.  A couple of years ago I worked with an ER on the east coast.  Their overall scores were terrible – bottom quartile, very little good news.  The director of the department of 40 years was racking her brain at what to do next to improve – they did everything stupid on earth – rounding, scripting, phony smiles and every other gimmick – and they were worse off than when they started.

When I began to dig into the data I uncovered some interesting things in the first few minutes.  When the demographics were taken apart, there was a single time of day, and single demographic that led to patient disengagement.  In fact when I pulled out the time of day, and profile of the patient in question the scores jumped into the 87th percentile and became one of the best ER’s in the state.

Now, before I go on I want you to consider something.  If there was a single VERY dissatisfied demographic, that means that almost every other demographic was not only pleased but delighted with the care they received, would that affect how you approached patient satisfaction?  Put another way, only one small part of the patient mix was “broken”, yet this hospital spent hours, days, and weeks thinking up strategies to improve the scores of all patients – does that make sense?  It’s absurd – why fix what is not broken – most patients – the vast majority, most of the time were raving fans – but the data and how it was displayed and interpreted only showed a failing ER. Sound familiar?

So, pray tell, what is that single time of day and single demographic that served to drag down the scores of the whole department?  Females, between 19 and 35, between 11 pm and 5 am.

With that we will ease into step 2.  Take it to the streets.  When I presented my findings to the director, she did what almost all of us would do.  She started making guesses as to why that patient and that time was an issue.  But I ended the conjecture and said “Let’s ask the team.”  And we did.

That night we pulled together a group of late night nurses and techs – between 19 and 35 and told them what we found.  The response was stunning – and here is a summary:

•  Women that age coming to the ER at that time have to be really sick – otherwise they would wait until morning.
• Many will have children they will need to bring along.
• The parking lot is dark and scary – and depending on how busy the ER is it can be a long walk.

After a few more questions we discovered the following:

•  The department did not have diapers available for patients to use for their children.
• Also no formula, bottles, mats for a nap or a babysitter for when mom had to go for a scan.
• Nearly every third shift nurse was a male.

Let me take you for a moment back to the worthless report you get every millennium from your quality person.  Does any of this stick out as obvious?  In fewer than ten hours working with the data and the team we figured out the disengagement of the lowest scoring customer.  Dude?

Working with the team a number of things occurred:

•  A sign was placed above the entrance offering valet parking after 9 pm.
• The department was stocked with diapers, formula, a breast pump, coloring books and crayons, and sleeping mats.
• The entire ER team was made aware of the scores and given ideas for sensitivity to this important, but vulnerable patient.

Although a good start, it is not finished.  The leader, that is the director did a daily lookup in their patient scores to query how this patient at these times scored the ER and posted the results in plain sight.  Every night shift began with a short 5-10 minute huddle on how the team would accomodate younger women with children and make them feel more comfortable and at home.

You guessed it.  The peeling away of the data, the daily discussion and the accountability to the results turned the ER scores around.  Being sensitive to a hurting and scared patient became second nature for this team.  The problem wasn’t everyone, or everything the staff did – it was one type of patients that the data did not reveal, without knowing to look.

Then step three began – “Lather, Rinse, Repeat.”

We’ll talk more.

Step One – Learn More about Less.

In the first entry in this series I suggested that most patient improvement strategies that come from consultants and “experts” is more than a waste of time, it is actually highway robbery and the only winner is the expert that convinces you to hire them to teach grown people how to talk and act.  Poppycock.

At the end of the first entry said that there was a single focus point in the equation of improvement in patient scores – and that only three steps were needed to enact improvement.  Real improvement – sustained improvement.

Step one is to learn more about less.  In the hundreds of hospital I have worked in, I have never met a leadership team that had a good understanding of patient data – and never knew enough to enact positive and sustainable change.  The reason is that they looked to widely at the results.

Looking widely at the data is going to sound familiar.  Imagine you show up for a meeting – weekly (weakly?) or monthly or quarterly.  A “summary” is handed out and your quality “expert” (I hate that term) begins telling you about what changed from the last period and why.  You glance to the top of the page, see your hospital or department is in the top half of the country and since there is really nothing else meaningful, you feel okay – smile sweetly and head back to work.

Your periodic routine may be similar, a little different or a lot different, but in the end you never really understand what needs to change to make meaningful and sustained change.  Not until now.

It starts with questions and raw data.  It can be a little work the first time through, depending on the measurement vendor you use, but you have to learn to ask the right quesitons – to get to the right answers.

The best way to teach this is with an example.  When working with an ER at a California hospital the overall data showed dismal results.  Compared with system peers they were among the lowest scoring on an index of ER questions.  After a little digging into the data, we discovered that if one question was a driver for the visit for a specific demographic of patient.  If the data was cleansed of the one demographic, this ER became one of the top in the system.  And here is the interesting thing – none of your experts would have predicted it – or even given it the time of day when reviewing ER data.

Patients 65 or older (that is medicare patients) when answering the question about whether someone spoke to them about their financial matters actually drove the success of the entire department.  When they said “Always” to an explanation, they tended to score the rest of the survey higher.  When any other response was provided their responses were lower, and consequently drove down the results from the entire department.

Now, glance down at the meaningless report you get from your quality or patient satisfaction person.  Is there a single clue as to what is driving your success or failure? I didn’t think so.  When you know the issue is seniors and money – that is easily solvable.  Not to get to far ahead, the team at this hospital began highlighting financial data, circle things that were important, asking questions and explaining to family members as well as getting interpreters to help.

Next, Step two.  Involve the stakeholders.

We’ll talk more.

Go!

Three Steps to the Best Patient Scores in the Country

It is amazing and disheartening when paging through all the so called “patient experience experts” that come up on a search of the web.  Although they all seem a lot alike in complexity and cost (both are too high), they also share an interesting characteristic that needs to addressed before choosing someone to help you improve your scores.  Nearly every technique is an insult to the hard working and well trained people that darken the doorways of your hospital everyday.

Ouch.

Some vendor morons want you to teach your teams to use certain words at critical times to grown people that deal with complex diagnosis of very sick people.  If your people are not really people go ahead and give this a try.  If your people are actually human, leave that one by the curb.   Grown people can choose their won words.  Telling them what to say is an insult to their dignity.

Another vendor moron wants your hard working staff to keep detailed notes and logs on what they do, how they do it, and list ideas of improvement that can be shared with the rest of team to improve.  Do these morons understand how much charting is done now?  Do they understand how many patients a nurse or PT see in a day and the overhead paperwork required as part of their work?  Do they really understand how busy the typical healthcare professional is?  Absolutely they do not.

I could go on, but I’ll have a TIA if I do.  I hate tricks and gimmicks and there are well known businesses that have grown wealthy on such crap.  The companies that claim to be experts in patient satisfaction are mostly designed around creating a process to bill you a fortune with no guarantee of success or any positive change.  If you contract with one of these sharletons you will get exactly what you deserve – a bill and nothing more.

There is a solution – and it focuses on a single point in the patient care event.  It involves only three steps in it’s life cycle.  Instead of getting large and into every corner of your operation, it is driven by the data into a single, laser like focus.

Here are the steps:

1.  Learn more about less.
2. Take the Message to the Streets, and
3. Rinse, Lather, Repeat.

Interested?

We’ll talk more.

 

What will you do with your Millions?

Recently I was listening to a group of folks talking about a recent lottery winner.  It seems there is a following for the people that actually choose the right numbers, at least for a time after they hit it “rich”.  The crux of the conversation was how the new lucky winner said he would use his new found fortune.  “I ain’t never going to work again, that’s for sure.  And I’m going drive a new car every year.”

Well, the group gathered saw little virtue in the ambitions of the new millionaire, and after a thorough tongue lashing they gave their plans if a winning jackpot hit them in the face.

“I’m going to help people.”  Or, “I’m going to start a business and make a mark in the world.”, and on and on.  My play on the whole thing is that the young redneck that won is more honest and noble than the rest.  I think he’ll be broke in a couple years, but he will drive a new car and likely never work again.  As for the arm chair millionaires – if they hit it big they would just do what they are doing right now, just bigger.

Here is what I mean.  The people that spend at least some time helping others and expecting nothing in return, might actually do something for others.  Those that have tried to start a business or have started a business will do so again.  But those who got by day by day, lived for themselves and bemoaned their lot in life, will in time, do exactly the same thing, even with untold wealth.

So, here’s the point.  What are you doing now that is making others better, improving your lot in life, or enriching your community?  If you’re struggling for an answer, you are underselling your potentional since you alread sit on untold wealth.  That’s right, you are currently sitting on literally millions of dollars of intellectual assets, that if properly applied, could benefit you, others and the world in ways that boggle the mind to consider the impact.

Let’s talk about those assets – How about your ability to learn?  You can read, write, listen and understand.  What about your ability to empathize?  You can can understand, consider others, their needs and desires.  What about your ability to reason, or plan or convince or just show up and work?  What’s about your greatest talents?  Are you and achiever?  Are you Disciplined?  Do you have a side of you that focuses on a single outcome and won’t be defeated?

No matter who you are, you do something better than others, and how you leverage your talents and gifts to help others, start a business, enrich yourself or advance a cause is a clear measure of what you do with your untold Millions.  My guess is you do with you millions what almost everyone does with theirs – watch reality TV and wish you life had turned out different.

You’re not going to win the lottery, but your riches lie right in your own shoes, between your own ears.  Deciding that what is, is not enough is the first step.  Step two is deciding to make something happen – with the talent you have, that is discovering and embracing that talent for the good.

We’ll talk more.