Monday, January 31, 2011
The American Hospital Association issued a report this month on the status of wellness programs at the nation’s hospitals. It’s worth reading, even though the findings are less than encouraging.
As my HealthLeaders Media colleague Cheryl Clark notes, the AHA’s report, A Call to Action: Creating a Culture of Health, finds that most healthcare systems in the U.S. offer wellness programs of varying intensity and enthusiasm to their employees. Few, however, measure outcomes and fewer still have engrained healthy behaviors as part of their employees’ culture.
That sounds discouraging, but it shouldn’t be. The wellness movement in the workplace is a relatively new but simple concept: Improving employee health will reduce the growth of healthcare costs, and other ancillary costs, like absenteeism. The problem is not the wellness concept. That’s easy. Tens of millions of people who’ve tried to lose weight, or take up exercise, or quit smoking to improve their health understand the importance and desirability of wellness.
The problem is changing people’s less-than-healthy habits, like poor diet or sedentary lifestyle, learned over decades, and reinforced in everyday life – mostly during the two-thirds of the day that they’re away from work. (That’s why they’re called "habits," after all.) These habits took years to develop and it’s unrealistic to think that people will change their lives in the span of a few weeks or months with a "biggest loser" diet contest or discount rates at the local gym.
John Bluford, CEO of Truman Medical Center which has 4,000 employees in Kansas City, wrote the AHA report, and he was spot on when he told HealthLeaders Media: "This is not the program of the month. It’s a culture," and "You can’t do this for a year and think it’s a done deal."
In addition to the many suggestions that Bluford lists in his report – which you can read in Cheryl’s account -- I would also suggest that a little empathy goes a long way. If you are a hospital executive, not everyone on staff will have the same ability to embrace wellness.
Imagine how a low-wage, manual worker in environmental services at your hospital might view the idea. Maybe that worker has to get up at 4 a.m. every day to take a bus to work, where he’s on his feet all day wrestling with heavy objects. Maybe that worker has a second job to make ends meet, or he’s a single parent with two kids at home. That worker is probably not going to take advantage of your lunchtime Jazzercise class, or spend a couple hours after work running a treadmill.
Bluford talks about how important it is to have top leadership on board, leading your wellness program by example. He is right. However, I would suggest that while any wellness program should be led from the top, it should be designed from the ground up to be accessible for the lowest-paid employees.
Low-wage workers are often the ones who have the most to gain from wellness programs, because studies have shown that health issues like obesity – and all the ancillary problems overweight create -- disproportionately affect lower-wage workers. If you’re going to offer financial incentives for employees to get eat better, or exercise more, it’s unfair not to design programs readily available to everyone on your staff in a practical way.
You want staff to eat better, but do all of your workers have ready access to fresh fruits and vegetables, or even a decent supermarket? You’re offering a rebate to cover a partial cost of a health club, but what good is a rebate if you don’t live near a health club, or if you don’t make enough money to sign up for a health club in the first place?
That $60 a month for a gym membership might not seem like a lot to a hospital executive or clinician, but it can be out of reach for some folks on support staff. Exercise more? It’s hard to take a walk around the block if you live in a crummy neighborhood, or you don’t have sidewalks, or the streets aren’t lighted when you get home from work at night.
None of these problems is insurmountable, of course, and anybody who wants to improve his health has to take most of the initiative on exercise and diet. However, bad habits can be more easily overcome when everyone on staff feels a sense of ownership with the wellness movement.
If you want employees to embrace wellness, talk to them, all of them, including the environmental staff folks working the graveyard shift. Explain what you want to achieve with your wellness program, find out what is important to them, how they’d like to improve their lives, what they’d like to see in the program, and what limitations their lifestyle may impose. You probably won’t resolve all of their problems, but you’ve at least listened to their concerns, and made it clear to them what you’re doing. That’s a good start.
People want to be healthy. How many people enjoy being overweight, or enjoy smoking? If you want your wellness program to work for everyone, design it with everyone in mind.
Back in 2009, Dr. Amy Ship gave a moving acceptance speech when she received the annual Compassionate Caregiver Award from the Schwartz Center.The most memorable tag line from the speech was, "There is no billing code for compassion." This resonated with so many of us -- patients and providers -- in part because it set forth the proposition that compassionate care should be an inherent aspect of medical services. The idea that some portion of a doctor's or hospital's payment should be tied to such an essential human value seemed ludicrous. Or is it?
A recent survey conducted by the Schwartz Center, entitled "The state of compassionate care in the United States," indirectly raises the issue. Those patients and doctors surveyed were overwhelmingly in favor of the idea that compassionate care was important to the successful treatment of patients. They agreed, too, that compassionate care makes a difference in how well a patient recovers from illness. Indeed, they believed that good communication and emotional support can make a difference in whether a patient lives or dies.But there was a gap between what patients said was most important to them, in terms of compassionate care, and what they actually experienced during recent hospitalizations. And, looking forward, both patients and doctors are worried that the changes being made in our health care system will make it more difficult for providers to offer compassionate care.Now, if we remove the word "compassionate" from the above discussion and instead insert "safety," "quality," "avoiding hospital acquired infections," or the like, our immediate response would be that we need to change the system of hospital and physician payments to provide financial incentives to change things for the better. Whether we might propose a pay-for-performance approach or some kind of global payment to encourage improvement, the current environment seems very comfortable with using the payment system to nudge behavior in the right direction.So, why not pay for compassion? Surely, we can name those aspects of care that are most closely tied to compassion, and we can likewise document whether they occur.While I will let this debate play out in the comments below, let me start it off by saying that I believe this would be a mistake. So many discrete aspects of medical care are already monetized that is hard to imagine a payment regime that would actually focus sufficient financial attention to motivate a doctor along the spectrum of less-to-more compassion. Beyond that, the idealist in me is offended by the idea of paying someone to, in essence, be more humane. In my view, this is not a matter of remuneration. It is a matter of societal values and a training program and ongoing supervision that imbues practice with those values.
But, let's hear what you have to say. Should there be a billing code for compassionate care?
Saturday, January 29, 2011
Friday, January 28, 2011
Last night, I attended our annual Friends of St. Joseph Dinner. Tim H. was exceptional as out Past President and I know that Steve B. will deliver the same effectiveness as our new President.
We had a real treat last night with Cynde G., our Chief Nursing Officer giving her presentation on Unwavering Advocacy. This is my 3rd time seeing it and the impact just keeps getting growing.
She reviewed some key information found in the Silence Kills study:
• 84 percent of physicians have see coworkers taking shortcuts that could be dangerous to patients.
• 88 percent of physicians work with people who show poor clinical judgement.
• Fewer than 10 percent of physicians, nurse and other clinical staff directly confront their
colleagues about their concerns.
The Silence Kills track teaches participants how to break this prevailing culture of silence by applying Crucial Conversations skills to the seven categories of conversations identified in the Silence Kills study:
1. Broken Rules
3. Lack of Support
5. Poor Teamwork
After recognizing the inextricable links between quality of the work environment,
excellent nursing practice, and patient care outcomes, the American Association
of Critical-Care Nurses (AACN) identified six essential standards for creating and
sustaining Healthy Work Environments.
The Healthy Work Environments track teaches participants how to apply Crucial Conversations skills to achieve the Healthy Work Environment standards identified by the AACN:
1. Skilled Communication
2. Authentic Leadership
3. Appropriate Staffing
4. True Collaboration
5. Effective Decision Making
6. Meaningful Recognition
Cynde finished with a story on how an Unwavering Advocate positively impacted her family.
She coined the term and we have adopted Unwavering Advocacy into our hospital's vision.
I always look forward to these speeches just to get a sense of some key messages. When discussing the past, he stated:
"That world has changed. And for many, the change has been painful. I’ve seen it in the shuttered windows of once booming factories, and the vacant storefronts on once busy Main Streets. I’ve heard it in the frustrations of Americans who’ve seen their paychecks dwindle or their jobs disappear – proud men and women who feel like the rules have been changed in the middle of the game. They’re right. The rules have changed. In a single generation, revolutions in technology have transformed the way we live, work and do business. Steel mills that once needed 1,000 workers can now do the same work with 100. Today, just about any company can set up shop, hire workers, and sell their products wherever there’s an Internet connection."
How many of you have seen the same impact in your personal and professional lives?
Then he brought us forward to what we can do, the responsibility we should take:
"And now it’s our turn. We know what it takes to compete for the jobs and industries of our time. We need to out-innovate, out-educate, and out-build the rest of the world. We have to make America the best place on Earth to do business. We need to take responsibility for our deficit and reform our government. That’s how our people will prosper. That’s how we’ll win the future. "
The first step in winning the future is encouraging American Innovation. None of us can predict with certainty what the next big industry will be or where the new jobs will come from. Thirty years ago, we couldn’t know that something called the Internet would lead to an economic revolution. What we can do – what Americans do better than anyone else – is spark the creativity and imagination of our people. We’re the nation that put cars in driveways and computers in offices; the nation of Edison and the Wright brothers; of Google and Facebook. In America, innovation doesn’t just change our lives. It is how we make our living."
When I think about the overall impact healthcare reform, value based purchasing and hospital re-admission penalties, it is daunting. When I think about the fact that in my hospital alone, we have 1,300 associates, over 600 physicians and 800 volunteers, I am more than encouraged to know that we can and will make the necessary changes together. As the President stated, the changes are very painful at times. In the long (and short) run, it will be easier if we constantly look at the ways we innovate and do things differently to deliver the service and outcomes we expect as employees and consumers of healthcare.
The challenge of moving an organization in the same direction towards a shared vision and common goals is exciting and trying at the same time. Up for that continued challenge? What parts of our business and personal lives to not have that constant challenge over time. How we adapt and innovate will continue to be vital to our core.
I look forward to your thoughts. Enjoy your weekend.
Thursday, January 27, 2011
Lesson Learned – If we have as much sense as geese, we will stay in formation with those who are ahead of where we want to go and be willing to accept their help as well as give ours to others.
Lesson Learned – It pays to take turns doing the hard tasks and sharing leadership.
____ A lead goose ____ A backup goose ____ A honker from behind
____ Helper goose ____ Goose in need ____ Goose nurse
In what ways could you take on other roles?
Based on your experiences working with this team, which lesson is most important for the success of the group? Which lessons do the team need to learn?
Wednesday, January 26, 2011
An Excerpt from "The Right to Lead" by John Maxwell
WHAT GIVES A MAN OR WOMAN THE RIGHT TO LEAD?
It certainly isn't gained by election or appointment. Having position, title, rank, or degrees doesn't qualify anyone to lead other people. And the ability doesn't come automatically from age or experience, either. No, it would be accurate to say that no one can be given the right to lead. The right to lead can only be earned. And that takes time.
The Kind of Leader Others Want to Follow
The key to becoming an effective leader is not to focus on making other people follow, but on making yourself the kind of person they want to follow. You must become someone others can trust to take them where they want to go. As you prepare yourself to become a better leader, use the following guidelines to help you grow:
1. Let go of your ego.
The truly great leaders are not in leadership for personal gain. They lead in order to serve other people. Perhaps that is why Lawrence D. Bell remarked, "Show me a man who cannot bother to do little things, and I'll show you a man who cannot be trusted to do big things."
2. Become a good follower first.
Rare is the effective leader who didn't learn to become a good follower first. That is why a leadership institution such as the United States Military Academy teaches its officers to become effective followers first - and why West Point has produced more leaders than the Harvard Business School.
3. Build positive relationships.
Leadership is influence, nothing more, nothing less. That means it is by nature relational. Today's generation of leaders seem particularly aware of this because title and position mean so little to them. They know intuitively that people go along with people they get along with.
4. Work with excellence.
No one respects and follows mediocrity. Leaders who earn the right to lead give their all to what they do. They bring into play not only their skills and talents, but also great passion and hard work. They perform on the highest level of which they are capable.
5. Rely on discipline, not emotion.
Leadership is often easy during the good times. It's when everything seems to be against you - when you're out of energy, and you don't want to lead - that you earn your place as a leader. During every season of life, leaders face crucial moments when they must choose between gearing up or giving up. To make it through those times, rely on the rock of discipline, not the shifting sand of emotion.
6. Make adding value your goal.
When you look at the leaders whose names are revered long after they have finished leading, you find that they were men and women who helped people to live better lives and reach their potential. That is the highest calling of leadership - and its highest value.
7. Give your power away.
One of the ironies of leadership is that you become a better leader by sharing whatever power you have, not by saving it all for yourself. You're meant to be a river, not a reservoir. If you use your power to empower others, your leadership will extend far beyond your grasp.
In The Right to Lead, you will hear from and read about people who have done these same things and earned the right to lead others. Because of the courage they found and the character they displayed, other people recognized their admirable qualities and felt compelled to follow them. The followers who looked to these leaders learned from them, and so can we. As you explore their worlds and words, remember that it takes time to become worthy of followers. Leadership isn't learned or earned in a moment.~John Maxwell
Monday, January 24, 2011
I would like to recognize our SJMC team including staff, physicians, volunteers and "vendor" partners (I am not a big fan of the term vendor as it does not always reflect the true partnership and relationship with an organization). Here are a couple of Value Stories:
From Cherí C., Respiratory Therapy (re: Gary M. with Apria):
During the recent snowstorm, a patient was discharged and scheduled for an immediate delivery of Respiratory Therapy materials. The driver from Apria who received the call for set-up came out in the storm but could not make delivery to the residence because his truck could not make the hill. The driver walked to the residence, made contact with the patient and her daughter, then proceeded to hand carry all of her oxygen tanks and supplies to her house from the truck, which included the large oxygen concentrator machine.
From a grateful patient:
I want you to know how much I appreciate the care I received at St. Joseph Medical Center. I especially want to thank the wonderful woman who called all over the Kansas City area to find a hand surgeon to put my mangled hand back together. She finally reached Dr. Cusick, who came from a dinner party to perform emergency surgery. Please let your entire emergency room staff know how much I and my family appreciate the care I received that evening. I really believe the Lord wanted me to come to St. Joseph because He wanted me to get the best care available.
Friday, January 21, 2011
Thursday, January 20, 2011
Do you and your team do the Safety Dance? Send in your safety dance pictures.
Wednesday, January 19, 2011
How do you find a balanced life when you’re overloaded with work?
How do you switch off work when you’re away from the office?
The answers to these very common questions are elusive. It’s never an easy thing. But once you do find this balance you’ll find enormous benefits: more enjoyment of life and better relationships and less stress and a better quality of life overall.
A reader recently asked:
“I’d love to hear advice on how people who work full-time jobs can still manage to attain a well-balanced life. Especially in roles that give you sales targets, monitor you, and can be very stressful. I know it’s best to switch off after working hours, but sometimes (as humans) it is tough.
In Hong Kong, part-time jobs don’t pay well here and are tough to find, and full-time jobs often require overtime and are very stressful (it’s the Hong Kong norm to squeeze out as much as you can from an employee). In this corporate jungle, a part-time would be a perfect job for me (say 9-3 everyday); however it’s very hard to find jobs like that – it’s just not how the job market here is in Asia.
So how does one keep their calm and be grounded and still make time & energy for family, friends, myself, hobbies, interests and let’s face it – sanity? How does one learn to ‘not keep goals’ when that is what is expected from 8:30 a.m.-6:30 p.m. 5 days a week? It’s tough to be 2 different people at work and outside of work.”
That’s a tough one. I should note that in many countries — including the U.S. — this is a common problem even if it’s not as pronounced as in Hong Kong (for example). We all face these problems whether we’re employees or self-employed or free-lancers or own our own businesses.
I’ve created a life where balance is intentionally built-in but it hasn’t always been that way. I’ve worked in the private sector (in the news industry) where they try to squeeze every bit out of employees and we were often asked to work longer hours without compensation. I’ve worked in demanding public service jobs where working into the night and weekend hours (again without more pay) were the norm. It wasn’t easy finding balance.
But don’t despair. Change is possible. These days I have created a life where I work less but on things I love. I make time for staying active and getting outside. I make time for playing with my kids and being alone with my wife. I find time alone for reading and walking and thinking. And as I do these things work isn’t always on my mind.
I have a few key tips that should help no matter what your work situation:
1. Set a time to shut off work.
Working all day and night means you are nothing but your job. Your life belongs to your employer (or if you’re the employer then your life belongs to your employees or customers). Take ownership of your life — find variety and ways to burn off stress and find enjoyment in life! Start by setting a time each day when you shut off work. Whether that’s 5 p.m. or 5:30 or 6 or 7 or 9 p.m. Some of you can set it even earlier if you start earlier — say 4 p.m. or something like that. Set that time and make it happen. After that shut-off time you will not do work or check email or think about work.
2. Find something to immerse yourself in after work.
What do you love doing besides work? Do you love to read or run or play sports or hang out with friends or play with your kids or build model ships or play games? If you don’t already have a passion then pick something that sounds fun and give it a try. It doesn’t have to be expensive — it could be as simple as hiking around your neighborhood or volunteering at a charity or helping friends with household projects. Schedule it as soon after work as possible. And while you’re doing it try to completely immerse yourself. Don’t think about work — only think about the after-work activity.
3. Learn to be mindful and present.
It’s not easy to just switch your mind off work but it’s a skill you can learn over time. The way to learn this isn’t to try to block work from your mind — it’s to learn to bring your mind back to whatever you’re doing after work. It doesn’t matter what you’re doing: it could be household chores or exercise or talking with someone or taking a bath or eating. Whatever it is … that’s all you want to focus on. Your mind will inevitably slip into something else. That’s OK. Bring it back gently and without reprimand. Slowly with practice you will get better at being present. Which means your work won’t always be on your mind.
4. Take breaks at work.
Not everyone will have this flexibility but it’s worth doing if you can manage it. Basically if you’re working for 8 or 10 hours you don’t want to do it non-stop. You need to find balance even at work. So at least once an hour get up and walk around. Get outside if you can and take a walk. Stretch and massage your shoulders and get your blood moving. Do some squats or pushups if you want to start getting fit. Talk to someone. Drink water. Eat fruits and vegetables. Your break just needs to be 5-10 minutes but it’s important.
5. Increase your skills while at work — to prepare for leaving work.
If you are very skilled at what you do then you become worth more. In fact it’s often possible to quit your job and start your own business if you’re good enough. And it doesn’t take a lot of money to work for yourself — you can start a business with practically no money. I started mine while still working full time: my job funded my startup business. Even if you don’t go into business for yourself you’ll be worth more with a high skill level. So devote your work hours to learning and perfecting your work skills.
6. Find ways to increase your income while decreasing hours.
As your skills increase your value increases. Slowly pick jobs or projects that earn more money per hour. This often means changing jobs but it might be a promotion or change in roles. It could mean starting your own business or becoming a consultant. If you already have your own business or work for yourself then you should slowly be picking jobs or business projects that pay more for every hour you spend working on them. By increasing income you can decrease hours and free up more time for yourself.
7. Learn that you are not defined by work.
You can be happy without your job. Your value isn’t completely tied to your work. For example: I’m a writer but it’s not the only thing I am. I’m also a father and husband and know that those are my most important roles — not my role as a writer. I am more than that as well: I run and read and learn and help others and am constantly experimenting with life. I can do things other than my job and be fulfilled. So can you. And once you discover this you’ll free yourself to find a life outside of work. Then balance is simply a matter of logistics — you just need to make it happen by taking small steps.
Small steps is always the answer. You don’t need to be perfect at shutting off work or being present or pouring yourself into something after work. You just need to start doing it and in doing so you’ve already started down the road to balance.
The journey to a better balance is not an easy challenge, hence thr journey. This balance fits within the new years resolution I set on improving the health of our workforce.
Friday, January 14, 2011
I was talking to a friend the other day regarding the challenges he faces in his business. He shared some stories on internal arguments and working against one another. We've all been there..."he said/she said," "getting caught in the gossip," talking behind people's back...."
And it almost always comes back to bite the person who started the chain of events. It's called Triangulation.
Triangulation is most commonly used to express a situation in which one family member will not communicate directly with another family member, but will communicate with a third family member, forcing the third family member to then be part of the triangle. The concept originated in the study of dysfunctional family systems, but can describe behaviors in other systems as well, including work.
Triangulation can also be used as a label for a form of "splitting" in which one person plays the third family member against one that he or she is upset about. This is playing the two people against each other, but usually the person doing the splitting, will also engage in character assassination, only with both parties.
This can be a significant challenge for organizations. As leaders (and I do not just mean people in management positions), you need to set the example or watch is spread like wildfire...with staff, physicians (if in a healthcare setting) and even customers with staff. Most people would say they want to be told any concerns directly. In turn, we must be gracious and professional in how we accept and receive this true gift of feedback.
All too often the person receiving the negative information about the 3rd party may think the person delivering the news is showing "loyalty." The reality is that these same people will typically speak poorly about everyone so loyalty is not truly existent.
Wednesday, January 12, 2011
Sure, in golf we get mulligans and it is very cordial among players (most of the time).
How often to we get "do overs" with each our colleagues, customers, patients and families (in our hospitals). How do we create that comfort to allow a do over? After all, once things start poorly, many times it can escalate when all parties could benefit from a do over.
This morning Jane (#6), my superb and fearless Executive Assistant came into my office to get a file. I followed her out to discuss it and we seemed to have a tense exchange. I walked away and a minute later she walked into my office and said, "Do Over." I then said, "Good morning, Jane, how are you today." Followed by Jane stating "Good morning, doing well, thank you." And the day began again with a new fresh start.
Sure, there are times you can not not take things back or start again. However, there are probably more times than we credit when we could just have a "Do over,"start the situation fresh and decrease unwanted (and unneeded) tension.
Sunday, January 9, 2011
Friday, January 7, 2011
Sunday, January 2, 2011
The new year always bring on a time of reflection for me and my family. Of course, we go through the usual traditional questions:
My work resolutions include:
Continue to improve our Efforts as a High Reliability organization
Improve the Health of our Workforce
I look forward to hearing your resolutions.