All rights reserved. CCHSE Jan 18,2005 Special Delegate Copy E.11 Presented by Brian Lee CSP HealthCare's Brian Lee CSP HealthCare's “Mr. Loyalty” Presented

All rights reserved.

CCHSE Jan 18,2005

Special Delegate Copy

E.11E.11

Presented byPresented by

Brian Lee CSPBrian Lee CSP HealthCare'sHealthCare's

““Mr. Loyalty”Mr. Loyalty”

Presented byPresented by

Brian Lee CSPBrian Lee CSP HealthCare'sHealthCare's

““Mr. Loyalty”Mr. Loyalty”

Change Your

Culture

Or Be Doomed to

Repeat the Past

Does Culture...Does Culture...

Eat Strategy

for Lunch?

Eat Strategy

for Lunch?

33

It’s been a 20 year question…..

It’s been a 20 year question…..

• 100 Hospitals later

• Begun every engagement

• With a Front Line...

• 100 Hospitals later

• Begun every engagement

• With a Front Line...

Focus Group Report

Focus Group Report

ExampleExample

Does Culture...Does Culture...

Eat Strategy

for Lunch?

Eat Strategy

for Lunch?So who really knows

what the strategy is anyway?

So who really knows

what the strategy is anyway?

66

2 More Questions2 More Questions

Would that culture support

• World Class Customer satisfaction?

• World Class Employee Retention?

• Or any other change initiative?

Would that culture support

• World Class Customer satisfaction?

• World Class Employee Retention?

• Or any other change initiative?

“Change Your Culture or be Doomed to Repeat the Past”

“Change Your Culture or be Doomed to Repeat the Past”

Conclusion:Conclusion:

88

PerspectivePerspective

• Addressing culture change like motherhood….

• My focus context will be customer & employee loyalty.

• To challenge and irritate you!

• & Recommend 8

“Breakthrough Steps”

• Addressing culture change like motherhood….

• My focus context will be customer & employee loyalty.

• To challenge and irritate you!

• & Recommend 8

“Breakthrough Steps”

MissionMissionThe New Role of the

Healthcare Administrator

in Becoming an

Employer and

Provider of Choice

The New Role of the

Healthcare Administrator

in Becoming an

Employer and

Provider of Choice

1010

What to ExpectWhat to Expect

1. There is no Market for Mediocrity.

2. Change Your Culture or be Doomed to Repeat the Past.

3. Behavioural Change Must be Cultural Change.

1. There is no Market for Mediocrity.

2. Change Your Culture or be Doomed to Repeat the Past.

3. Behavioural Change Must be Cultural Change.

Page #1Page #1

1111

4. The 3 Cornerstones of Culture Change.

5. The 12 Pillars of an Employer and Provider of Choice.

6. Breakthrough Recommendations Summary.

4. The 3 Cornerstones of Culture Change.

5. The 12 Pillars of an Employer and Provider of Choice.

6. Breakthrough Recommendations Summary.

1212

Our CreedOur Creed

“We make a difference

in the lives of people, who make a difference,

in the lives of people.”

“We make a difference

in the lives of people, who make a difference,

in the lives of people.”

Page # 2Page # 2

I. “There is no Market for

Mediocrity”

I. “There is no Market for

Mediocrity”

Page #3Page #3

1414

Meet My Mom ‘Margo’Meet My Mom ‘Margo’

“Your culture is either your competitive

advantage or long term disadvantage.”

“Your culture is either your competitive

advantage or long term disadvantage.”

-Brian Lee, CSP-Brian Lee, CSP

1616

The Vision:The Vision:

“To become an

Employer and Provider of

Choice.”

“To become an

Employer and Provider of

Choice.”

1717

“Very good is bad – it’s invisible.” – Anonymous

“Very good is bad – it’s invisible.” – Anonymous

1818

Employer of Choice:Employer of Choice:

An Organization which has:

• a high status & reputation,

• is always the first choice (or at least on the short list)

• of world class candidates


• a high status & reputation,

• is always the first choice (or at least on the short list)

• of world class candidates

1919

Provider of Choice:Provider of Choice:


• word of mouth reputation,

• the first choice for patients, families and payers.

• In your market area.


• word of mouth reputation,

• the first choice for patients, families and payers.

• In your market area.

BreakthroughRecommendation #I

BreakthroughRecommendation #I

Make a formal commitment to

become both an

Employer and Provider of Choice™

Make a formal commitment to

become both an


BreakthroughRecommendation #II

BreakthroughRecommendation #II

Appoint or revitalize a Service Excellence

Council

Appoint or revitalize a Service Excellence

Council

2. “Change Your Culture

or be Doomed to Repeat the Past”

2. “Change Your Culture

or be Doomed to Repeat the Past”

Page #4Page #4

2323

Culture:Culture:

“An organization’s way of life.”

“The way we do things around here.”

“Unwritten rules.”

“An organization’s way of life.”

“The way we do things around here.”

“Unwritten rules.”

What words would your front line staff

use to describe your culture today?

What words would your front line staff

use to describe your culture today?

Question:Question:

2525

EmpoweredTop Down

Patient DrivenTask Driven

TeamThem vs. Us

EnthusiasmCynicism

Our Culture TodayLoyalty Culture

We Need

The Need for Culture Shift:The Need for Culture Shift:

2 Way CommunicationPoor Communication

Positive AttitudeNegativity

Attitude Alert!Attitude Alert!

Not everyone has the same positive attitude

as you...

Not everyone has the same positive attitude

as you...

2727

2%2%

Worker Attitude / Values Research ProfileWorker Attitude / Values Research Profile

SuperstarsSuperstarsSuperstarsSuperstars

““Slugs” Slugs” (2%-10%)(2%-10%)

Counter Productive!Counter Productive!““Slugs” Slugs” (2%-10%)(2%-10%)

Counter Productive!Counter Productive!This diagram visually depicts overall worker This diagram visually depicts overall worker attitude/values towards their employment/career.attitude/values towards their employment/career.This diagram visually depicts overall worker This diagram visually depicts overall worker attitude/values towards their employment/career.attitude/values towards their employment/career.

“Sinners”25%

• Do as little as possible•Want something for nothing

•Peer pressure/ culture important

“Grinners”50%

• Just get by/sit on the “fence”•Can go either way

•Leadership/coaching vital

“Winners”20%

• Desire to contribute• Progress, get ahead

• Make a difference

3%3%

“Grinners” attitude impacted by:

• Peers• Supervisors• Education• Communication• Involvement• Culture

2828

“The problem may not be

the ones who quit and leave

for more pay, it’s those

who quit and stay.”- Brian Lee CSP- Brian Lee CSP

“The problem may not be

the ones who quit and leave

for more pay, it’s those

who quit and stay.”- Brian Lee CSP- Brian Lee CSP

““I quit and forgotI quit and forgotto tell you.”to tell you.”

- Terri Kabachnick- Terri Kabachnick

““I quit and forgotI quit and forgotto tell you.”to tell you.”

- Terri Kabachnick- Terri Kabachnick

3030

Business Impact of an Engaged Workforce

Business Impact of an Engaged Workforce

• 50% - lower turnover

• 56% - Higher than average customer loyalty

• 38% - Above average productivity• 27% - Higher profitability

Source . Blanchard Seminars

• 50% - lower turnover

• 56% - Higher than average customer loyalty

• 38% - Above average productivity• 27% - Higher profitability

Source . Blanchard Seminars

3. Behavioural Change

Must Be Cultural Change

3. Behavioural Change

Must Be Cultural Change

Page #5Page #5

““In the final analysis, In the final analysis,

change stickschange sticks only when it becomes only when it becomes

‘the way we do things around here;’‘the way we do things around here;’

when it seeps into the very when it seeps into the very bloodstream of the work unit or bloodstream of the work unit or

corporate body.”corporate body.”

““In the final analysis, In the final analysis,

change stickschange sticks only when it becomes only when it becomes

‘the way we do things around here;’‘the way we do things around here;’

when it seeps into the very when it seeps into the very bloodstream of the work unit or bloodstream of the work unit or

corporate body.”corporate body.”

““Until new behaviors are rooted Until new behaviors are rooted in social norms and shared in social norms and shared

values, they are values, they are always subject always subject to degradation as soon as the to degradation as soon as the pressures associated with the pressures associated with the change effort are removedchange effort are removed.”.”

- John Kotter, Leading Change- John Kotter, Leading Change

““Until new behaviors are rooted Until new behaviors are rooted in social norms and shared in social norms and shared

values, they are values, they are always subject always subject to degradation as soon as the to degradation as soon as the pressures associated with the pressures associated with the change effort are removedchange effort are removed.”.”

- John Kotter, Leading Change- John Kotter, Leading Change

Special NoteSpecial Note

Culture change takes (at least)

3 years!

Culture change takes (at least)

3 years!

3535

How Culture Changes-

Louis Gerstner, CEO IBM

“Strategy and corporate culture are intimately linked. You can’t

talk a culture into changing. You can’t just talk people into being

different.”



“Strategy and corporate culture are intimately linked. You can’t

talk a culture into changing. You can’t just talk people into being

different.”

3636



“You’ve got to point to fundamental strategic changes you’re going to implement in an organization,and then drive the

execution of that strategy.”



“You’ve got to point to fundamental strategic changes you’re going to implement in an organization,and then drive the

execution of that strategy.”

3737

“It is in the execution of the strategy that the culture begins to change.”

“It is in the execution of the strategy that the culture begins to change.”





3838

BreakthroughRecommendation #III


A. Conduct an objective Service Culture Assessment

B. Conduct a comprehensive Best Practice Gap Analysis

A. Conduct an objective Service Culture Assessment

B. Conduct a comprehensive Best Practice Gap Analysis

3939



C. Conduct a culture check up via

• Focus Groups with front line staff, middle managers as well as

• Interviews with Senior Management Team

C. Conduct a culture check up via

• Focus Groups with front line staff, middle managers as well as

• Interviews with Senior Management Team

4040



Focussing upon the 3 Cornerstones of Cultural Change.

Focussing upon the 3 Cornerstones of Cultural Change.

4141

BreakthroughRecommendation #IV

BreakthroughRecommendation #IV

Utilize these findings to draft a 3 year

“D.O. I.T.

Employer and Provider of Choice Implementation

Plan”

Utilize these findings to draft a 3 year

“D.O. I.T.

Employer and Provider of Choice Implementation

Plan”

4242

Total Management Total Management Engagement Engagement

& Accountability& Accountability

D.O. I.T.D.O. I.T. Implementation Implementation

Enthusiastic Empowered Enthusiastic Empowered

Front-Line LeadershipFront-Line Leadership

The 3 Cornerstones of Culture Change

Quality & PatientQuality & Patient

SafetySafety


SafetySafety

Employer of ChoiceEmployer of Choice

Provider of ChoiceProvider of Choice

Execution

Excellence

Execution

Excellence

Page #6Page #6

4343

Total Management Total Management Engagement Engagement

& Accountability& Accountability

Cornerstone #1


SafetySafety


SafetySafety

Employer of ChoiceEmployer of Choice

Page #7Page #7

4444

Step #1Step #1

“Hardwire” for Performance

Accountability & Sustainability

“Hardwire” for Performance

Accountability & Sustainability

4646

50% of Success is being able to hold leadership

accountable for results by linking:

50% of Success is being able to hold leadership

accountable for results by linking:

Job descriptions & performance incentives through an annually negotiated goal for

patient satisfaction scores and employee retention results

Job descriptions & performance incentives through an annually negotiated goal for

patient satisfaction scores and employee retention results

4747

Step #2Step #2

“Soft wire” byInspiring

Leadershipto Implement

Best Practices



Best Practices

4848

Step 2Step 2



Best Practices



Best Practices

4949

BreakthroughRecommendation #V

BreakthroughRecommendation #V

“Engage your entire management team on cross functional, cross

departmental teams, to implement priority Best

Practices.”

“Engage your entire management team on cross functional, cross

departmental teams, to implement priority Best

Practices.”

5050

Enthusiastic Empowered Enthusiastic Empowered

Front-Line LeadershipFront-Line Leadership

Cornerstone #2


SafetySafety


SafetySafety

Provider of ChoiceProvider of Choice

5151

BreakthroughRecommendation #VI

BreakthroughRecommendation #VI

“Engage and train a representative group of the best of your best

front line staff to teach an annual Service Excellence Workshop to

all current staff and new hires and serve as a positive

role model”

“Engage and train a representative group of the best of your best

front line staff to teach an annual Service Excellence Workshop to

all current staff and new hires and serve as a positive

role model”

5252

Strategy Intentions Planning Execution

Care & Feeding

10

5

1

Imp

lem

en

tati

on

Eff

ect

ive

ne

ss

*With thanks to Jim Beaubien of Hope Systems

Strategy Execution Effectiveness Model*Strategy Execution Effectiveness Model*

5353

““For culture change toFor culture change towork just fine…work just fine…it must involve it must involve and be ledand be ledfrom the top and from the top and the front line!”the front line!”

- Brian Lee CSP- Brian Lee CSP

5454

D.O. I.T.D.O. I.T. Implementation Implementation

Cornerstone #3


SafetySafety


SafetySafety

Execution

Excellence

Execution

Excellence

Page #8Page #8

5555

“Through monthly staff ‘D.O. I.T.’ meetings, provide everyone an opportunity to become involved in the process of continuously improving their customer’s moments of truth.”

“Through monthly staff ‘D.O. I.T.’ meetings, provide everyone an opportunity to become involved in the process of continuously improving their customer’s moments of truth.”

BreakthroughRecommendation #VII

BreakthroughRecommendation #VII

For Example…For Example…

5757

San Clemente D.O.I.T. examples:San Clemente D.O.I.T. examples:

Post discharge survey.Toasters for graveyard shift.Telephone directory upgrades.Acute rehab scheduling.Same day surgery family pagers.Hospital map.Who-called-the Doctor Board.

Post discharge survey.Toasters for graveyard shift.Telephone directory upgrades.Acute rehab scheduling.Same day surgery family pagers.Hospital map.Who-called-the Doctor Board.

5858

D.O. I.T. # 6 “InsanityD.O. I.T. # 6 “Insanity

…is doing the same thing, the same way & expecting a different outcome.”

- Stephen Covey

…is doing the same thing, the same way & expecting a different outcome.”

- Stephen Covey

5959

Recommendation Recommendation

Skip the Learning Curve and Adapt

(not adopt) proven Best Practices.

Skip the Learning Curve and Adapt

(not adopt) proven Best Practices.

6060

““If you have a problem, If you have a problem, make it a procedure, and make it a procedure, and

it won’t be a problem it won’t be a problem anymore.”anymore.”

-- Wayne Cotton-- Wayne Cotton

““If you have a problem, If you have a problem, make it a procedure, and make it a procedure, and

it won’t be a problem it won’t be a problem anymore.”anymore.”

-- Wayne Cotton-- Wayne Cotton

6161

BreakthroughRecommendation #III-B

BreakthroughRecommendation #III-B

Conduct a comprehensive Best Practice Gap

Analysis.

Conduct a comprehensive Best Practice Gap

Analysis.

6262

Your

SMART Tool

KitConference

CD

Your

SMART Tool

KitConference

CD

6363

Question:Question:

Which Best Practices to implement?

Which Best Practices to implement?

6464

Recommendation - Focus On the

“Pareto Principle”Recommendation - Focus On the

“Pareto Principle”The concept of

“the Critical few

OR

the Trivial many”

The concept of

“the Critical few

OR

the Trivial many”

80/20 RulePareto Principle

6666

The 12 Pillars: The 12 Pillars:

The “12 Pillars of an

Employer & Provider of Choice”

Proven

Best

Practices

The “12 Pillars of an

Employer & Provider of Choice”

Proven

Best

Practices

THE 12 PILLARS OF AN EMPLOYER AND PROVIDER OF CHOICE

“O.A.S.I.S.” Service Leadership Team Best Practice Projects(Operationally Advanced Service Improvement Systems)

EMPLOYER OF CHOICE PROVIDER OF CHOICE

I. PERFORMANCE ACCOUNTABILITY VII. SERVICE STANDARDS1A. Performance Measurement Process 1. Service Standards Development1B. Job Description Revision 2. Service Scripting Development1C. Performance Appraisal Measurement 3. Service Excellence Training

1D. Performance Recognition/Incentive Linkage 1E. Quarterly Review Process VIII. SERVICE RECOVERY

1F. Ninety Day Work Plan 1A. Service Recovery Policy1B. Service Recovery Education

II. STAFF RETENTION & RECRUITMENT 1C. Service Recovery Tool Kits1. Employee Satisfaction Measurement & Response 1D. Service Recovery Reporting System2. Market-based Timely Compensation Review & Compensation

Fact Sheet2. Complaint & Corrective Action System

3. Customized Scheduling & Structured Staff Scheduling IX. MOMENTS OF TRUTH4. Front-Line Suggestion System 1. Communicate Patient Satisfaction Survey5. Nursing Stress Audits Results to Staff6. Open Book Communication 2. Discharge Satisfaction Survey7. Retention Best Practices 3. Internal Support Service Score Card8. Recruitment Best Practices9. High Performance Retention Program10. Red Zone Service Triggers11. Resignation Recovery Protocol

4. Long Term Care Satisfaction Survey5. Clinic/Physician Office Satisfaction Survey6. Survey Results Recognition Process

X. DISCHARGE SATISFACTIONIII. PEER SELECTION & PERFORMANCE REVIEW 1. Administrator Patient Welcome Visits

1. Synchronize Front-line Job Descriptions & Performance Review

2. Senior Nurse Complaint Rounding3. Patient Discharge Phone Call

2. Peer Hiring Screens Utilizing Service StandardsXI. OUT PATIENT SERVICE EXCELLENCE

IV. ORIENTATION & ONBOARDING PROCESS 1. Facility Service Audit1. New Hire General Orientation Renaissance 2. Personal Service Care Diary2. New Hire Service Excellence Training3. First Year New Hire Onboarding Process XII. EMERGENCY BEST PRACTICES4. Nurse Externship Program (& Job Shadowing) 1. Exit Interview / Survey Process

5. Internship / Mentorship / Preceptor Program 2. Best Practice Gap Analysis/Rapid Action Plan3. Service Work Process Redesign

V. AWARDS & RECOGNITION1A. Awards & Recognition Process HealthCare Employer of Choice – Designation (HCEOC)

1B. Celebrating Effective Leadership Practices To earn a HCEOC designation, your organization must:1C. Service Summit and Professional Awards Successfully implement Pillars I to VIII, and

Be rated in the 80th %tile of your employeeVI. PHYSICIAN SATISFACTION satisfaction benchmark survey for 2 consecutive

1. Physician Satisfaction Plan surveys2. Physician “Citizenship” Policy Review & Survey3. Service Excellence Education for Physicians HealthCare Employer & Provider of Choice –4. Win-Win Assertiveness Education for Nurses Designation (HCEPOC)

To earn a HCEPOC designation your organization must: Successfully implement Pillars I to XII, and Be rated in the 80th %tile of your customer

satisfaction benchmark survey for 2 consecutivesurveys

5.0

Page #9Page #9

6767

Pick Up Your “SMART” CardPick Up Your

“SMART” Card

6868

Who Reviews the Patient Satisfaction Data?

Who Reviews the Patient Satisfaction Data?

Source - Hospitals &Source - Hospitals &

Health Networks,Health Networks,

Aug 2000Aug 2000

Source - Hospitals &Source - Hospitals &

Health Networks,Health Networks,

Aug 2000Aug 2000

Page #10Page #10

Informal Front Line Survey

Understanding Validation Survey

Informal Front Line Survey

Understanding Validation Survey

7070

BreakthroughRecommendation #VIII

BreakthroughRecommendation #VIII

Schedule 2 semi-annual “Service Summits” to create peer accountability for results as well as celebrate achievements and maintain momentum.

Schedule 2 semi-annual “Service Summits” to create peer accountability for results as well as celebrate achievements and maintain momentum.

8 BreakthroughRecommendations to Become and


8 BreakthroughRecommendations to Become and


170170

Employer and Provider

of Choice™

D esignation

Page#11Page#11

7272

Your

SMART Tool

KitConference

CD

Your

SMART Tool

KitConference

CD

RecommendedReading

RecommendedReading

Page #12Page #12

Post your Mini-posterPage #13Page #13

P.S.P.S.

There is a need for commitment….

There is a need for commitment….

AcknowledgementsAcknowledgements• Malak Sidky

• Bibi Lollmahamud•Brock Hovey

• Malak Sidky

• Bibi Lollmahamud•Brock Hovey

Documents

All rights reserved. CCHSE Jan 18,2005 Special Delegate Copy E.11 Presented by Brian Lee CSP HealthCare's Brian Lee CSP HealthCare's “Mr. Loyalty” Presented