Friday, November 9, 2012

Tip 9: Accountable to no one....well maybe the patient?

This issue of "accountability" continues to grow in popularity and isn't going away anytime soon. Not a week goes by where I don't hear real concerns and questions that directly relate to a lack of accountability from boards, administration, physicians, and most importantly, our patients. Such as:

"Are these nurses that are caring for my sister even talking to one another...accountability seems to go out the door with each shift?"

"How do I get my medical staff to abide by our code of conduct?"

"How do I get our physician leaders to take a greater interest in our strategic plan?"

"How do I get those guys to participate in the pre-op time outs and checklists?"

"How can I get my clinicians to take ownership of more patient safety initiatives and participate in our risk management processes?"

"How do I get my docs to attend RCA meetings where they are directly involved?"

"Why aren't these folks communicating better with our nurses and staff?"

Sound familiar? I'm guessing most of you experience or have experienced similar challenges. So why is accountability a regular top of mind issue for so many of us?

Let's drill down on this seemingly widespread concern of "accountability". For the purposes of this discussion, let's assume we're in agreement this lack of accountability is ambiguous. Beyond this, it's not just about perception, but a real challenge that we must meet head on. Let's attempt to clarify where it originates (the root cause), understand the impact on care (context), and how best to address it.

In the last issue of Coach+Leader, we spotlighted the phrase "But that's not my patient".... talk about a lack of accountability.  And we determined that statements like these don't happen by accident, but are a key indicator that our culture is not where it needs to be. More specifically, it's a tell-tale sign that we have a disconnect with where our role ends and begins.

Here is where it get's interesting. This challenge of accountability has real and deadly costs. The lack of accountability we all see, hear and feel accounts for a good number of the 187,000 preventable deaths in the U.S. last year. To find out where accountability issues originate, you have to keep asking why.  So why aren't we accountable to each other? Is it because we just don't care? Are we just too overwhelmed and don't want to play nice? I know that's not the case, as we didn't all get into healthcare to avoid accountability. I know we all care about our patients.  My across the room diagnosis is that we're simply too busy and forgot to identify the infrastructure and standards needed to guide how we must show up and work together in a patient centered way. In other words, if we were just as deliberate and intentional about setting the standards for how we must work together (An Organizational Role Description) as we have been about managing our jobs, duties, tasks, etc. we'd realize a significant level of accountability and unprecedented advances in patient centered care.

Tip 9: "Building a leadership infrastructure that breeds accountability."

We now know that the challenge of accountability has little to do with bad people and everything to do with the need for role definition (the root cause). And that's all fixable. First, if you want to create a culture of accountability, physicians, administration, and nurse leaders must work together to build consensus, beginning with a relatable definition of patient centered care. I say relatable because I see too many leaders assuming consensus exists and that we've done a good job communicating what this allTrusted Cardmeans to staff. I've helped leaders to provide a relevant definition of patient centered care that relates to their team roles, and seen them influence accountability resulting in improved team care. Once we're all on the same page with establishing an organizational definition of patient centered care, we can begin to identify which skills and competencies hold us accountable to the outcome we seek. To sum up this tip in one sentence, what matters most to patients determines how we practice as leaders. When you align what matters most to patients to a well defined organizational role description, everyone experiences accountability in a direct and personal way. Use the T.R.U.S.T.E.D. card to guide some of these initial Role Description conversations with your team. To request a card, email us and we'll be glad to send you one.

In the next issue we'll discuss specifics relating to how to build an organizational role description that becomes the foundation of your leadership infrastructure.

Feel free to join me on Facebook to further this conversation - I'd be happy to visit with you about how you'd see your organization implement a role description.

Visit the Patient Driven Leadership Site.
Brian Wong, M.D.The Coach Leader is a bi-monthly series of ready-to-use tips to assist you in developing a concrete leadership practice that has the most impact on improving patient care.  Why become a Coach Leader?

  1. Patients expect us to work as teams.
  2. Patient centered teams need a coach.
  3. Every leader has a coaching role.
It's a straightforward point of view that focuses on best utilizing your time as a leader by emphasizing your role as a coach. As a Coach Leader, you'll gain the ability to mobilize your people into patient centered problem solving teams and have the most impact on improving care.

Brian WongEveryone is looking forward to Dr. Brian Wong's upcoming book. After years consulting with hospitals across the country, Dr. Wong's unique perspective and deft storytelling takes us inside a hospital fraught with the day to day challenges Physician Leaders, Managers, and Nurses all face, and introduces cultural strategies to overcome them without adding more work to our overburdened days. Dr. Wong has created memorable, real-life characters illustrating today's most pressing challenges in a dramatic hospital setting every reader will recognize.

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