Wednesday, November 28, 2012

Tip 10: “Why are we here?" Answering the accountability dilemma.

"Why are we here?" Answering the accountability dilemma.

homework eating catI must have struck a nerve in the last issue of Coach+Leader. A number of you sent thoughtful questions and personal stories citing inadequate accountability throughout your organizations. It seems that every healthcare leader I talk to is searching for real solutions to improve organizational wide accountability. Your questions and stories reinforced the need to continue addressing this accountability dilemma.

Let's take a few moments to further develop our understanding on how to build the foundation of an accountability based, patient-centered culture.

One email that caught my attention was from a veteran CEO that I met at a conference several months back. I asked his permission to share the message with you. He wrote: "Dear Dr. Wong, I thoroughly enjoyed reading your position and plan for improving organizational accountability. This is certainly a challenge that myself and other CEO's speak about and contend with daily. While I certainly agree with the premise and need for the development of a role description, I couldn't help but think about many of the measures we've already put in place. Just last year we revamped our code of conduct, performance evaluations, 360 reviews and a host of additional HR tools to encourage greater accountability and engagement. In addition, we recently brought in an outside resource to help our leadership update our Mission, Vision, Values. As far as I can tell, these investments have provided very little accountability improvement... leaving us with the same issues you detailed.  I don't want to come across as pessimistic, but if we can't improve accountability with these efforts, I'm a bit anxious about continuing down the road and expecting different results. Where are we going wrong and how are the solutions you're proposing different from what we are currently doing? "

Much of what we are doing in healthcare to encourage accountability and promote better engagement relies on reactive strategies, tactics and tools (i.e. code of conduct, performance evaluations, 360 reviews, etc). I have found that these tools are often perceived by staff as corrective, top-down measures...none of which initiate collaboration and better align leadership, physicians and staff.

You might be wondering, "But what about the recent investment in revamping his Mission, Vision, Values. Couldn't this be classified as a proactive/preventative measure that should be helping to improve workforce accountability?" Maybe in theory. The fact is, even the most well intended mission,vision,value statements fall flat when it comes to engendering personal change and improved accountability.

While I believe an organization's Mission, Vision, Values statement is important, it's a stretch to suggest it will set the personal standards, expectations and behaviors needed for an organization to achieve an accountability based, patient-centered culture. If you spend a lot of time in hospital executive offices, you'll often see organizations' visions, missions and values written down somewhere, often in the main lobby for you to ponder as you pass through. Other likely spots: the cafeteria, the doctors lounge ( if we are so lucky), and of course the homepage on the website. Yet, senior executives are often blind to the impact these guiding principles actually have and how well they are understood (or not), outside of the executive suite. That is, if you asked the average physician, director or nurse, my guess is that they might not even know the mission, vision, and values, much less it relates to their own work in taking care of patients.

In the last few issues of Coach+Leader we concluded that the lack of accountability we all see isn't caused by a shortage of people that deeply care for patients, but a deficit in what we identified as our leadership infrastructure. We determined that if we are going to produce sustainable gains in organizational accountability, then we must become intentional about setting the standards and communicating those standards on how we must work together. An Organizational Role Description will become a key tool as you progress to an accountability based, patient-centered culture.

Tip 10: Giving value to our mission, vision, values statement.

Lets take a closer look at what makes a Role Description the answer for improving organizational accountability. As you evaluate each quality, I suggest comparing and contrasting how it's different from your organization's mission, vision, value statement. I find this helps clients gain context and perspective for how a Role Description can benefit you and your organization.

1. Articulate specific targets: 
Studies in other industries show that engagement and satisfaction improves when leaders clearly convey what the shared goals of every work unit are. Physicians and nurses are no different. They don't get impassioned by fuzzy mission statements. They want to line up behind concrete goals that they can fulfill together.

Here's an example of a real team target taken from a client's Role Description: "To help improve the patient's experience, I must take listening to my colleagues and staff just as seriously as I would my patient". In a nutshell, drop the buzzwords and corporate speak, and use easily understood and unambiguous terms.

2. Make it personal:
Unlike mission,vision,value statements which can be perceived as big picture and often nebulous, Role Descriptions focus at the individual level much like a Job Description. At any level in the organization (physicians, administration, staff), employees are challenged to try to convert the vision of the organization into our day job. Your Role Description identifies and engages individuals in specific actions and behaviors that bring the vision and mission statement to life. We all know that the most compelling leaders communicate the organization's vision effectively. A Role Description goes one step further by helping you clarify how team members can best contribute, and convert the concepts into a usable practice. When leaders take the time to co-develop a role description with staff, we help everyone gain clarity as to how to personally have a greater impact on improving care and overall team performance.

This part of your leadership infrastructure allows us to bridge the gap between the vision of the organization and create a solid practice that guides our working relationships and easily translates into actions in our day-to-day job. Here is a sample of a Role Description taken from a Medical Staff that demonstrates this quality: "As a physician I need to make it safe for staff to speak up so that we can continue to prevent errors".

3. Create patient value.
I can't tell you how many times I've seen eyes roll when someone says "Are we really putting the patient in the center?" A role description leaves those "big audacious goals" where they belong and requires us to define the competencies, expectations and behaviors that have the most impact on generating patient value. This is where patient-centered care begins.

Trusted CardHint: Begin with the T.R.U.S.T.E.D. card.
We have found that these attributes contribute greatly to improving patient trust and care. This process aligns our role with what matters most to patients and organically develops accountability. To request a card, email us at and we'll be glad to send you one.

Bottom line: You can't force accountability... but you can certainly create conditions that produce and encourage it.

I look forward to continuing to discuss how best to build an accountability based patient-centered culture and sharing more road-tested ideas.

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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