The Coach Leader highlights regular front-line coaching conversations to provide you with new insights and perspective on how to improve care coordination and lead your organization to a more Patient-Accountable Culture.
Tuesday, February 25, 2014
Tip 29: If you’re talking you’re not listening
If you’re talking you’re not listening
Last time we reviewed research that showed a clear correlation between leadership effectiveness and frequency of asking for feedback. We applied this crucial skill to improve the physician-patient relationship. The key take away, if you're a physician, clinic manager, nurse, PA, manager, in a position of leadership, you’ll be rewarded handsomely if you know how to ask for feedback.
Q: But where to start? Before we tackle specifics on how to create the right conditions for feedback, let's address a question that's on the mind of most leaders I know. One CEO asked, "I know we all benefit significantly when physicians encourage patients to share their thoughts and encourage them to take part in the decision making. But it get's a bit fuzzy for leaders when hierarchy exists. How realistic is it for an employee to offer true feedback if the employee doesn’t feel secure knowing that their answers won’t elicit negative blowback?
A: As leaders we often wield a lot of power. And attacking something head on may not be the most effective way to get results; in fact, it may be interpreted as abrasive. Leaders must first create comfortable conditions for a patient or staff member to share feedback so that any questions won’t be interpreted as potentially harmful to them. Let’s take a look at the factors that contribute to our current context and see why we might struggle with this skill:
Healthcare is a knowledge based industry; we’re trained to give answers rather than ask more questions.
Our culture rewards and recognizes us more for the technical proficiency of our jobs and less for the important role we must play as part of a high performing team.
We’re taught leadership is the business of giving answers rather than encouraging group problem solving.
Let's consider the following suggestions from management and communications expert Scott Berkun’s five keys for eliciting feedback from your team.
Who you ask. Start with a peer or someone you report to. If you’re a physician, start with a patient you trust and know well, and ask them for feedback on something small. Let them know that you value their opinion. Use this as a momentum builder and eventually you’ll find yourself creating conditions that encourage patients/staff to share their concerns, ideas and insights.
How you ask. Don’t ask big, vague questions like, “Did I listen well to all your concerns?” Ask specifics that they can easily answer. When you ask for suggestions, let them know that the more specific their suggestion, the better.
When you ask. Whether you’re a physician or a leader listen and don’t interrupt. Give them a chance to give a thoughtful answer. If you’re a leader asking for feedback from staff, don’t put them on the spot - ask them the question ahead of time, so they have time to truly consider it and answer thoughtfully.
Where you ask. Consider the setting. Again, establishing comfort gets you better results - in this case, a more informal setting will lower the tension. As a physician, I learned to share something about myself with new patients, this exchange reinforced that I was here to interact with them not transact. If you’re an administrator, consider getting coffee outside of the office rather than sitting opposite the employee, behind your desk.
How you respond. This might be the hardest part, but, Berkun writes, “If you really want feedback you have to be prepared to shut up and listen.” You really want to show that you’ve taken what they’ve said seriously. So create space to think on it. When the time is right, let them know what you did with the feedback.”
I think this last point regarding feedback is the most important. Make sure there is a purpose for the feedback. This shouldn’t be an exercise that helps us validate how good we are. Make sure the patients you interact with and the staff you talk to understand you’re asking because you care about improving.
In The News...
A Patient Dies. A Hospital Heals
By Bill Santamour
H&HN Managing Editor
A fictional account of a tragedy and how a hospital changes for the better.
A patient dies after surgery despite the fact that checklists and other cutting-edge policies are in place to prevent such a tragedy. The clinical staff become defensive. Physicians close ranks to deflect blame. Nurses know that if somebody has to take the fall, it will, no doubt, be one of them. The hospital CEO understands that the fault lies not with individuals or policies, but with a staff too focused on their own task-filled workdays to see the bigger picture and too cynical to believe that things can ever fundamentally change. And the CEO herself is so overwhelmed by putting out everyday fires that she has no time to think about long-term solutions.
That’s the set-up of Heroes Need Not Apply, Brian D. Wong’s fictional account of Angels Hospital and the aftermath of a patient’s death, a death that could and should have been prevented. Wong, an M.D. and founder of The Bedside Trust, paints a familiar picture of today’s hospital staff, in which the sincere goal of putting the patient at the center of everything they do can get lost in the crush of workloads, silos, egos, long-standing hierarchies, skepticism and plain fear. His vivid cast of characters includes a brilliant but intransigent surgeon, a young doctor with conflicting loyalties, an outspoken nurse, a new CEO and the person she brings in to help change the culture.
OK, I can see you rolling your eyes at the term “change the culture.” But by getting inside each individual’s mind and allowing us to listen in on their thoughts and conversations, Wong avoids consultant jargon and preachiness. He presents a true-to-life scenario of personality conflicts common to all hospital staff and the endemic skepticism that often straitjackets any leader’s efforts to foster meaningful change. And he shows how a hospital CEO can overcome those obstacles to, as the book’s subtitle puts it, “build a patient-accountable culture without putting more on your plate.”
The crux of that culture change is eliminating the chain-of-command structure and moving to one in which listening and respect across job titles and individuals can lead to true team care. As someone at Angels Hospital says, “No one person, no matter how smart, was nearly as smart as a roomful of people.”
In his introduction, AHA President and CEO Rich Umbdenstock writes that Wong’s story “brings a human element to the equation and underscores the importance of making patients and their families full partners in the care process."
Heroes Need Not Apply is an excellent resource for you and your physicians, nurses, C-suite and board members. Might even make a good stocking stuffer. For more information, click here.
The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.
Improved care coordination is essential to gaining the efficiencies required in this healthcare reform era. To move metrics in patient safety, experience, and quality, we must become effective at delivering coordinated team based care.
In his new book, Heroes Need Not Apply, Brian Wong MD, uncovers the reasons why many of us experience spotty improvements in patient safety, episodic service excellence, and insufficient engagement and accountability. To make sustainable improvements, we need to know how to migrate from a system that can best be described as uncoordinated (i.e. poor hand-offs, suboptimal staff interaction, medical hierarchies, etc.) to one that delivers consistent coordination of team based care.
The purpose of Heroes Need Not Apply is to give healthcare organizations a template for creating a strong foundation for effective coordinated care. This “how-to” book gives every executive, physician, nurse, and clinical team member the tools to make specific changes at the local level, and uses relatable characters to showcase effective patient-centered skills to improve efficiency, decrease costs, and improve the patient experience. If your hospital is looking to accelerate improvements in care coordination and improve team care,Heroes Need Not Apply is a timely resource designed to equip your organization with the practical skills required for improved care coordination.
The book has already caught the attention of many top physicians, nurses, and executives as an innovative resource to lead our industry into a new era of value based healthcare that is both cost effective and accountable to patients.
Dr. Wong's Heroes Need Not Apply is receiving praise by noted physician leaders and industry experts throughout the country...
“Heroes Need Not Apply examines the root causes of healthcare’s most pressing safety and quality challenges. It offers practical strategies to improve communication among staff, dismantle silos, and build high-performing teams.” — Richard J. Umbdenstock, President and CEO of the American Hospital Association
“I believe this book will help save lives, improve quality, and recommit healthcare providers and patients to new levels of trust.” — Sue Collier, MSN, RN, FABC - Performance Improvement Specialist, Patient-Family Engagement, NC Quality Center/NC Hospital Association
“Dr. Wong’s book “Heroes Need Not Apply” breaks new ground as a field manual for what WE can all do on the front lines to be leaders as opposed to “reactors’ of healthcare transformation.” — Stephen K. Klasko, M.D., M.B.A., President and CEO, Thomas Jefferson University Hospitals
"...[Dr. Wong] speaks the truth of what we must become as leaders in health care."
— Jeff Selberg, EVP and Chief Operating Officer, Institute for Healthcare Improvement.
“Amazing! Timely, accurate, stunning, motivating, frightening. More than reading, I consumed the book. What a wonderful story of cold truth.”
— Jack Cochran, MD, Executive Director, The Permanente Federation, LLC
“On the journey to team-based and patient-centric care the evolving healthcare system is indeed a place to which Heroes Need Not Apply."
—Joseph S. Bujak, MD, FACP
“Dr. Wong draws the reader into the world of the hospital and an understanding of the cultural barriers that contribute so much to preventable medical error.”
— Gordon R. Clark, President and CEO of iProtean