New (or Last) Year's Resolutions...Realistic Goal Setting

New Year's always makes me reflect on what I could do both the same and differently for the upcoming year. Fortunately for me, I make some of the same forecasts in October when my birthday hits. This actually allows me a couple of months to see the realities of my goals and, essentially re-forecast for a more realistic achievement of these goals when the next year hits.

For 2010, I have the following goals & resolutions:

Family and Friends:
- Spend more time with my family & friends (although they may have resolutions to spend less time with me)

Health & Wellness:
- Train for a personal record (PR) time when I run the Boston Marathon in April
- Compete in my first triathlon by the Fall

Professional and Financial:
- Understand the impact of healthcare reform for St. Joseph Medical Center and our surrounding community
- Participate in more community events
- Work towards financial independence (after meeting with a financial advisor, I understand that I am just 45 short years away from achieving this goal)

This past year, St. Joseph Medical Center has performed well around our goals. Some of our resolutions include:

1. Improving our patient satisfaction scores to the top quartile
2. Bringing on additional physicians to further our growth efforts
3. Furthering our employee engagement and serving as an employer of choice

I was reading some information on New Years Resolutions and wanted to share it with you (Source: http://www.tellinitlikeitis.net/):

“A New Year’s resolution is something that goes in one year and out the other.” ~ Author Unknown

At the beginning of each new year, people begin thinking about making and keeping a new year’s resolution, only to discover within a short period of time that their good intentions fall by the wayside each and every year, “in one year and out the other”.

The top new year’s resolutions rarely change from one year to the next, and in case you haven’t noticed yet, new year’s resolution statistics are not on your side. Unrealistic resolutions are doomed to fail from the start, usually due to lack of motivation, not being specific enough, being too ambitious with a list of new years resolutions that are bad for your health, bringing on stress, anxiety, hopelessness and even depression.

Top New Years Resolutions:

-Lose weight
-Manage debt/save money
-Get a better job
-Spend more time with family
-Quit smoking
-Eat right/Get fit
-Get a better education
-Reduce stress
-Going greener
-Volunteer to help others

“Many people look forward to the new year for a new start on old habits.” ~ Author Unknown
Goal Setting
Forget about new years resolutions and start focusing on goal setting. What is goal setting? Goals setting is a process that allows people to specify then work towards their own objectives, commonly referred to as life goals.

Whether it be personal goal setting or business goal setting, the importance of setting goals that are challenging, tangible, specific, realistic and have a time targeted completion date cannot be overemphasized.

Some people don’t know how to set goals or achieve a goal already set, so when they decide on setting a goal of one kind or another, each goal is quickly given up on until new years resolution conversations begin all over again.

“New Year’s Day: Now is the accepted time to make your regular annual good resolutions. Next week you can begin paving hell with them as usual.” ~ Mark Twain

How to Set Goals
What are your goals to set? Are they short term goals, long term goals, or both? Are they personal goals, career goals or vague life goals? Effective goals are very specific and measurable, involving goal setting motivation, while very vague goals such as “I want to lose weight” or, “I want to be the best person I can be” are not specific enough to help you in achieving goals in the short term or long term.

Goals give us direction, telling us what needs to be accomplished. Both long and short-term goals provide direction, but short-term goals appear to have the greatest motivational effects for change.

Finding your motivation through goal setting involves understanding why you want or need x,y,z in your life and what the goal means to you personally or professionally, thereby giving you the needed power and motivation to accomplish your goals once and for all.

S.M.A.R.T Goals
Writing goals down and tracking goals with goal setting is advocated by many experts in the field of goal setting, being very specific with each and every goal you plan to accomplish. “Smart goals” stands for Specific, Measurable, Attainable, Realistic and Time-bound, which helps people learn how to write a top quality goal they can and will stick to.

Specific – your goal should answer the What, Where, Why and How questions, written as simply and clearly as possible. Use action words to explain WHAT are you going to do? WHY is this goal important? HOW are you going to do it, etc?

Measurable – If you can’t measure it, you can’t manage it. Choose a goal with measurable progress so you can actually see the changes you are making, otherwise how will you know when you have reached your goal?

Attainable – an attainable, agreed upon, achievable goal involves realistic goals that consider your current situation, financial and personal resources, as well as time available to achieve success. Set your goal to challenge and “stretch” you slightly, but don’t go too far out of your reach setting unattainable goals, otherwise you’ll become discouraged and give up, again.

Realistic – a realistic goal is a goal you can control and achieve, requiring effort on your part, a positive mindset, positive action, determination and consistency that will enable you to achieve and accomplish goals you set. Each time you achieve a goal, enjoy the satisfaction that goes with goal achievement, rewarding yourself appropriately.

Time-bound – a time-bound goal includes realistic time-frames, using dates and times as measurement towards successful completion of each goal. Setting a time frame for goals set gives you a clear and precise target to work towards. Without a set time limit, your commitment is too vague, open-ended, lacking a sense of urgency to take action now to accomplish goals.

If you are one of many who jump on the new years resolution bandwagon, make a New Year’s resolution to NOT make new year’s resolutions ever again. Instead, set goals that are not only reasonable and realistic, but measurable and attainable so that your current goals and any new goals can be accomplished once and for all.

Happy New Year everyone. I look forward to hearing about your resolutions and goals for 2010.

The Journey Towards Self-Actualization

For a majority of my healthcare career, I have worked in academic medical centers. More recently, I have moved into community settings. Once thing that I enjoyed in the academic settings was the constant push to better the medical center along with our own professional and personal development. It has been good to see a shift over the past several years for community settings as well...the academic mindset in a community setting.

There are constant challenges with increasing the percent of people engaged in the workplace. An old friend, Alan, told me years ago that he had very engaged employees. He would share with them, "Whether you are here by choice or necessity, you are here, and I am glad you are here. You will enter people's homes while they are in a state of panic and frustration. When you leave their home, it will be a better place for them to live.

Note: Alan ran a Pest Control Company.

I was reading some theories on motivation and came across a classic we all know... Maslow: Theories of Motivation
(Source: http://www.analytictech.com/mb021/motivation.htm)

Overview

At a simple level, it seems obvious that people do things, such as go to work, in order to get stuff they want and to avoid stuff they don't want.

Why exactly they want what they do and don't want what they don't is still something a mystery. It's a black box and it hasn't been fully penetrated.

Overall, the basic perspective on motivation looks something like this:

Needs ---->Behavior---->Satisfaction----->Needs

and so on.

In other words, you have certain needs or wants (these terms will be used interchangeably), and this causes you to do certain things (behavior), which satisfy those needs (satisfaction), and this can then change which needs/wants are primary (either intensifying certain ones, or allowing you to move on to other ones).

A variation on this model, particularly appropriate from an experimenter's or manager's point of view, would be to add a box labeled "reward" between "behavior" and "satisfaction". So that subjects (or employees), who have certain needs do certain things (behavior), which then get them rewards set up by the experimenter or manager (such as raises or bonuses), which satisfy the needs, and so on.

Classifying Needs

People seem to have different wants. This is fortunate, because in markets this creates the very desirable situation where, because you value stuff that I have but you don't, and I value stuff that you have that I don't, we can trade in such a way that we are both happier as a result.

But it also means we need to try to get a handle on the whole variety of needs and who has them in order to begin to understand how to design organizations that maximize productivity.
Part of what a theory of motivation tries to do is explain and predict who has which wants. This turns out to be exceedingly difficult.

Many theories posit a hierarchy of needs, in which the needs at the bottom are the most urgent and need to be satisfied before attention can be paid to the others.

Maslow

Maslow's hierarchy of need categories is the most famous example:

Self-actualization
Esteem
Belongingness
Safety
Physiological

Specific examples of these types are given below, in both the work and home context. (Some of the instances, like "education" are actually satisfiers of the need.)

Self Actualization
Home: education, religion, hobbies, personal growth
Work: training, advancement, growth, creativity

Esteem
Home: approval of family, friends, community
Work: recognition, high status, responsibilities

Belongingness
Home: family, friends, clubs
Work: teams, departments, coworkers, clients, supervisors, subordinates

Safety
Home: freedom from war, poison, violence
Work: work safety, job security, health insurance

Physiological
Home: food, water
Work: Heat, air, base salary

We have many employees looking to advance themselves personally and professionally. Many of our Emergency nurses are getting their Certification as an Emergency Nurse. Cynde, our CNO, is getting her PhD and Jane (#6), our Executive Assistant (both are pictured at right) just passed her certification exam and became a Certified Professional Secretary (CPS) through the International Association of Administrative Professionals, a test which looks harder than sitting for the Bar as a lawyer.

I would like to host a lunch in February with 10-15 people who are advancing themselves personally and professionally. Please let me know if you are interested. You can contact my office at 816.943.2680.

Merry Christmas

Christmas is a time of giving.This season can also be stressful with work, vacation schedules and many planned activities.

I had a chance to take my family to the beach this week and came across some of those very stressors we sometimes experience while on vacation. We had several flight changes leading up to the travel date and ended up with only a 35-minute layover between two flights...the planes were at opposite ends of a large airport. We were trying to come up with better alternatives prior to flying out but met a lot of resistance from the airline. Fortunately, here in our very own Kansas City, Sheila from Continental Airlines pulled me aside and let me know she had booked an alternative flight in case we didn't make the existing flight since every other flight to our destination was booked solid. She found another route that would have taken us a couple of hours extra but we would've arrived at our destination the same night. In this day and age, it is not often that we come across exceptional service and I wanted to share this.

On a service note, St. Joseph Medical Center has continued to see strong improvement on two of our medical/surgical units, 4 South and 4 West.

Our overall Outpatient scores have also continued to rise since last year.

I want to thank all our associates, physicians, volunteers and auxiliary for your continued support of SJMC and Carondelet Health.

Merry Christmas.

Hospital Environmental Services Workers Contribute to the Economy

I just read that research carried out by UK think tank New Economics Foundation (NEF) indicates that workers who clean hospitals are worth more to society than bankers. According to the study, bankers are a drain on the country because of the damage they caused to the global economy; they reportedly destroy $11.25 of value for every $1.50 they earn. In contrast, hospital environmental services workers create $16.00 of value for every $1.60 they are paid!

Some of the feedback I hear most about SJMC is how clean our hospital is. If you've ever been hospitalized, you know how important cleanliness is, both in terms of infection control and also in terms of general comfort. Here at St. Joseph Medical Center, we are all aware of the enormous value our Environmental Services (EVS) associates provide to our business. Our patients, their families and our staff depend on them and they do a fantastic job.

The NEF study also claims that advertising executives "create stress" and are "responsible for campaigns which encourage overconsumption."

We have been working diligently on reducing our consumption of the earth's resources here at the hospital. Our "Green Team" meets regularly and we recently celebrated our first pick-up of recycled paper – 3,000 pounds. This amount is not being sent to the landfill for disposal and equals money saved in disposal fees. Our Green Team certainly creates value and we appreciate their efforts.

What parts of your business don't just make money but also create value?

BR...I cut myself!

I recently read an interesting blurb in Modern Healthcare referencing a study conducted by the National Electronic Injury Surveillance System (NEISS). According to statistics, bagel-related injuries (BRIs) were responsible for 1,979 Emergency Department visits in 2008. After putting aside my surprise that such a surveillance system even exists, I thought about our own Emergency Department and our "big ticket items," especially at this time of year.

We see about 3,500 patients per month in our Emergency Department. A good number of these patients come to us for serious, life-threatening issues such as cardiac and neurovascular symptoms. Approximately 20 visits per month are for chest pain/cardiac symptoms and about 40 are for stroke symptoms. However, during the cold winter months, we do see an increase in falls on the ice, cold/flu and even, around the holidays, pumpkin injuries and chicken and turkey-related incidents (choking, lacerations from slicing).

This bears out the NEISS's statistic naming chicken as the Food Most Likely to Send You to the Emergency Room (3,463 ED visits in 2008). Bagels came in second and pumpkins third.

We are not likely to start collecting data around which foods are responsible for the most ER visits at St. Joseph, but for your own safety, I consulted bagel experts Steve and Nancy Kashman, owners of Kashman's Place in Scottsdale, Arizona. According to Nancy (AKA "Mom") the safest way to cut bagels is to put your hand on top of the knife, keep your fingers open and slice away from yourself. Since I don't have a video of the actual process of cutting a bagel, please follow these instructions at your own risk.

I wish everyone a happy and healthy holiday and watch out for those BRIs.

A Model Community

In a recent blog entry, I discussed the employee engagement surveys. The survey is taken across all Ascension Health ministries across the country.

Locally, we will develop our plans around the key priorities from this most recent survey.

In today's SJMC leadership and Town Hall meetings we will discuss one of Ascension Health's strategic goals under Call for Action-we are focusing on solidifying this goal at St. Joseph Medical Center:

Ideally, associates, volunteers and physicians will take their own gifts and values into these strategies and understand how they contribute to our mission.

The goal we share with Ascension Health is: To Serve as a Model Community of Mission-Centered, Health Associates or Inspired People.

Attributes of Inspired People:
Mission-focused
Capable
Flourishing

There are 8 focus areas on the way to achieve a model community and attracting and retaining talented, inspired associates:

1. Culture of High Reliability-ensuring safe and clinically excellent care
2. Formation, Learning and Development
3. Selection
4. Diversity (and inclusivity)
5. Engagement
6. Recognition
7. Health and Well-Being
8. Workplace Spirituality

I look forward to hearing how you inspire your associates or other important people in your life.

A 12 Year old is looking for his mom...Just a Drill

We performed a Disaster Drill today. The Joint Commission, the accrediting body for our hospital, requires two disaster drills per year. This was our second. The scenario was around a tornado with mass casualties. Thank you to Larry, Shirley and Mike for orchestrating the drill. Lee, you did an exceptional job as Operations Chief - especially just being on the job a few short weeks.

(L to R) Shirley, Larry, Mike and Lee

I was pleased with the level of participation especially given that the overhead announcement was not heard well at the start. There were certainly things we will improve as a result of this. A debriefing will take place this afternoon. After the holidays, we will have an in-service on things that make a real disaster run smoothly, radio etiquette and key staging areas.

In previous blog entries, I spoke about being prepared for any type of situation. Typically, I hear people say that things always work well in a 'real' disaster. In many ways, I agree. These drills have always helped prepare me further for situations which may arise at work and outside of work.

There was an odd occurrence...it seemed we had a 60+ year old serving as the "12 year old" trying to get connected with his parents and the parent wanted to know "her role" once she was with her child...never a dull moment during a drill with unpaid actors.

Constant Change

In the November 10th issue of Hospitals & Health Networks magazine, Molly Joel Coye, M.D.., the CEO of the Health Technology Center in San Francisco wrote an interesting article entitled, "From Ellington to Einstein: Leaders have the courage to ask why - any why not - and then to act." In one section she wrote, “Change that is big enough and important enough to matter is disruptive. It threatens long standing relationships and processes.”

This is an important issue to manage as we ride the “constant change” roller coaster in the healthcare arena and most businesses as well. And though we all know that change happens, it does not always make it easier when change arises. We have seen this through changes in leadership, physician groups, clinical protocols, vendors, etc. We even saw this with a certain vegetable soup we served (which I thought was outstanding). When we switched (to one that I thought was even better)...the "regulars" wanted the original version and back we went. Though this may not seem like much, it pales in comparison to changes that impact us more personally and on a daily basis - again, typically relationships and processes as Dr. Coye describes above.

The past two years, SJMC has realized a lot of changes (some have been referenced in prior blog entries). Though we also have “constant change,” we have a few constants: very loyal and dedicated employees; an exceptional nursing team that has achieved Magnet recognition and is praised daily by our physicians; a volunteer workforce that brings the equivalent of over 54 full-time employees to our hospital; a very strong and devoted medical staff; and people who I know will speak up at every Town Hall meeting to share what we are doing well and how we could do better as an organization.

In the November Workforce Management magazine, an article references a May survey by Watson Wyatt of 1,300 workers at large U.S. employers which found that the engagement levels for top performers fell close to 25% over the prior year. Employees overall experienced a 9% drop in engagement. According to the article, the most common step to improve this has been increased communication, which can be in the form of briefings about the organization’s financial strength, staffing plans and business goals. It stated that by and large, companies do not appear to be tackling the engagement issue in a comprehensive way that creates a more inspiring work climate and give employees what they want.

Our most recent Employee Engagement survey reflected some of these changes. Though there were several areas where we scored well, there were other areas where scores were lower than prior years and it was certainly disappointing to me. I will make sure that our senior executives and hospital leadership team continue to do the following:

- Offer additional forums for enhanced communication including more one-on-one communication with associates (e.g., Cynde, our CNO just completed her formal CNO rounds this past week and will schedule these on an ongoing basis)

- Listen more to associate ideas and ways to make SJMC the best place for our patients

- Continue to share the strategic direction of the organization (e.g., we have posted our mission vision and strategies in key areas throughout the hospital, we send out monthly highlights, provide bi-monthly town hall meetings and a new Carondelet Health system publication is underway).

Though it was not referenced, it will be my continued personal mission to ensure that everyone in our organization (associates, volunteers and physicians) understands his/her role and the importance of that role in helping SJMC advance and exceed the goals of our organization.

And while we have seen improvements in our facility, we will ensure that we are fanatical about the cleanliness (e.g, Kevin, our new Regional Director of Environmental Services and Linen Services has new plans, processes and training which will be put in place for everyone on his team).

More than 80% of our associates completed the engagement survey and I want to thank each and every one for their very direct and honest feedback.

As always, I look forward to hearing from you.

Rubber Bands, Anyone?

Last week, an email went out that read, "The Copy Center is in need of rubber bands. If you could please send any surplus rubber bands you have in a routing envelope to Chanda in Materiels Management, it would be much appreciated."

Our Chief Medical Officer let me know, in a light-hearted way, that if we need to ask for rubber bands, then we could be in trouble as an organization. I tended to agree at first. Then I thought about what we spend on supplies each year and how many of these rubber bands go right into the garbage. That's several thousand dollars each year.

In the Intensive Care Unit, Pam, our Unit Secretary, led the charge to have physician order forms and blank progress notes available for printing right through our intranet. This will provide over $5,000 in annual savings along with a more efficient and effective process.

SJMC spends almost $30 million each year on supplies alone or around 15.4% of our net revenues. Just think, for every 1% improvement we make, we would save $2 million dollars which gets reinvested in our services, employee education, equipment and facility needs just to name a few things.

Organizations typically need to make 4-7% in order to reinvest in capital each year. In your own household, if you made $30,000 after taxes, 4% would be $1,200 in savings. Out of that savings, you then take part of it for any capital needs (e.g., new dishwasher, car, home upgrades, etc). That money goes quickly and the list of needs seem unending in our personal and professional lives.

So thank you Pam and Chanda for serving as great stewards of our resources.

I look forward to hearing other ways you save on supplies while ensuring the quality of your organization (or home) stays strong.

And remember, if you have any extra rubber bands, just send them on over to Chanda.

Three Steps Forward...Two Steps Back

Many (or shall I say most) days, running a hospital is a balance of positive advances mixed with setbacks. Of course, the goal at the end of the day is to make sure we are a stronger organization than when we started.

Monday started out with some very good updates from our executive team. Following our Monday "stand up" meeting, Susan, our Regulatory Readiness Specialist, let me know that we had made some great improvements in our Regulatory focus areas. She indicated that we had several key performance improvement initiatives underway with time lines and accountable leads. This all refers to that "positive advancement" I referenced above.

Then I was informed by our Chief Medical Officer and Regional Director of Surgery that the first two cases of one of our surgeons was delayed--and it certainly could have been avoided. Needless to say this was a setback. No one, and I mean no one, seems to feel great when we "look into things" though it certainly is acceptable with prompt action and follow up. I was pleased to see that by day's end our Director had some of these issues addressed with a well-thought-out plan on how we would see through process changes in the next 30 days. Thank you Alan.

The evening was filled with evening rounding led by Cynde, our Chief Nursing Officer. I had a chance to round with Cynde, Jane, our Executive Director of Cardiac, Neuroscience and Vascular Services and Larry, our VP of Facilities Management. The evening group of associates was pulling together with some challenging patient cases and a busy ER. These folks are always very welcoming to us and asked to see us even more (some even mean it!).

By evening's end, it felt like we were truly making St. Joseph Medical Center a better organization than when we started, even though we experienced some setbacks.

We must all understand our role in the patient experience. In the next several months I will continue to discuss our strategies, direction, top priorities and focus for each department and with each employee, volunteer and physician.

I look forward to hearing from you.