Tip 14: "Pardon me Doc, but can you tell me what we're all doing here?"

"Pardon me Doc, but can you tell me what we're all doing here?"

I know what you're thinking, "I certainly know what I'm doing here... I'm here to make the most impact possible in helping my patients to get healthy while feeling safe along the way."

Sounds good to me, but that may not be good enough for them. If you're a leader in your organization, what business do you think you're in? Case-in-point, when you ask executives at McDonalds what business they're in, they won't tell you the fast food business. No, McDonalds is in the convenience business and they do it better than anyone else... according to customers. So when I ask, as a leader, what business are you in? We need to take a page out of the McDonalds' playbook. Leadership is in the business of setting context. Why is setting context such an important leadership imperative?

In our full-contact, high stakes sport of healthcare, it's not uncommon for our highest performers to become overwhelmed, inefficient and fragmented. One physician executive I recently began working with, told me that in the 26 years he's practiced medicine, he's had more docs this year alone, approach him with a host of problems all related to dissatisfaction of their careers. A few of his younger physicians even suggesting that they might have been better off choosing a different career altogether. I think we all know that this isn't an isolated case of an unhappy physician or two. In fact, it's become quite the pattern in many of the organizations we get called in to evaluate. And it's not just physicians questioning their purpose, place and priorities, it's also commonplace among many nurses and frontline staff. What happens when purpose, place and priorities aren't clear? This lack of clarity can cause symptoms that can cost of small fortune to correct:

• reduced productivity
• decreased engagement
• lack of accountability
• preventable turnover
• Increased costs with recruitment and retention
• disruptive behavior
• early retirement
• ineffective team/patient communications
• increased job dissatisfaction with physicians and staff

It's clear that these human capital challenges chip away at organizational performance and have significant impact on both bottom line and care. What needs to be defined is why these symptoms occur in the first place, the root cause behind the pattern and what exactly leaders can do to alleviate and prevent them. 

Fortunately for you and I, these are not challenges that can be addressed with more initiatives and committees, or by working harder and managing people better. Didn't we all agree several issues ago that we can't add anything to our overflowing management buffet? Thanks to the help of the 100 healthcare CEO's I interviewed, we managed to expose an opportunity that can offer a more focused and efficient leadership practice by serving up context. Even with the limited time we have, our leadership has a greater impact when we work with our teams to provide context for the mission. If you are a leader in healthcare, you must realize that your customers are quite desperate for this context. Providing context is every leaders' answer to building clarity for your team's purpose, place and priorities. We've discovered that setting context is a critical part of your leadership practice that will set your organization on a course to building a Patient Accountable Culture. Do this correctly and your followers will grow in number as well as in their engagement.

Tip 14: "I'll have the context 3 ways please"

Step One to generating context; establish a "Shared Purpose" with your team/organization. This first layer of context informs everyone on how best to contribute based on what matters most. What happens when we aren't clear about our shared purpose and don't have an infrastructure that reinforces it? Organizationally speaking, look no further than to the list of symptoms above.

What does this mean for you as a leader? You'll be working harder than necessary to move and improve your people/organization. We all know what it feels like to be pushing our teams up hill in an "every man for himself" culture; if you're lucky, it will result in what I like to call "episodic excellence".  In my upcoming book "Heroes Need Not Apply," we show you first-hand how a leader systematically designs an organization through context and gives rise to consistent excellence not by doing more, but by establishing a "Shared Purpose".

Still a little fuzzy on what it means to create a "Shared Purpose"? You don't have to look far to find a situation and a team that is in need for greater context. Here is one we get called in to answer on a fairly regular basis... the concept of improved physician leadership. I say concept because while every organization seems to need it most, they aren't comfortable with the results. The process of creating context allows leaders to challenge assumptions and ask the right questions. In the physician leadership case, to help organizations realize the full potential of their physicians we must correct the assumptions we have made about physicians and about leadership. The questions we should be asking is, "How can physicians best contribute to the organization in a way that reflects what matters most to patients?" And, "What do patients want/need our physicians to become?" One thing we physicians agree on is what matters most to patients. We all can accept that patients require us to work as teams. They'll also tell you that becoming a "leader" in a traditional sense is not something most aspire to. Therein lies the problem for the context we must create. It's clear that we are talking less about the subject of leadership and more about how we can help successfully build a team....quite the difference if you're a physician that doesn't speak the language of leadership. What's the "Shared Purpose" in this case?

To give patients what matters most, physician's know that:

• Patients expect us to work in teams.
• Patient centered teams require coaches.
• Advancing coaching abilities is the primary role of physicians.
• A Physician Leader is a physician with coaching abilities.

As you can see, this "Share Purpose" provides essential perspective, informs every physician on how best to contribute, defines the outcome we all want to achieve, and is most relevant to our patients' needs. In the next issue, we'll continue to examine how leaders create context for purpose, place and priorities and create value for their organization. What do you believe is your team's "Shared Purpose"?

Email me or share your thoughts on our Facebook page.

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WHAT'S NEW @ THE BEDSIDE TRUST

Dr. Brian Wong's highly anticipated book,'HEROES NEED NOT APPLY' releases this spring.

Join us for an insightful "first look" conversation on The Leadership Focus Radio Show on February 20, 2013.Click here for info >>

Check out the new video interview with Brian Wong, M.D.

to access Dr. Wong's Q&A as he discusses "Heroes Need Not Apply," Click here>>

Radio Show - Heroes Need Not Apply: A Unique View on Accountable Culture

Dr. Brian Wong's highly anticipated book,'HEROES NEED NOT APPLY' releases this spring. Join us for an insightful "first look" conversation on The Leadership Focus Radio Show on February 20, 2013. Click here for info

Second River Healthcare Press is pleased to announce their collaboration with Dr. Brian Wong of the Bedside Trust to publish his first full-length book, Heroes Need Not Apply:How to build a patient accountable culture without putting more on your plate.

Everyone in healthcare knows that the lack of accountability negatively impacts care, and when accountability improves throughout your organization, care improves. What healthcare leaders don't know, is how to improve accountability and why it is so critically linked to improving patient care.

"Heroes Need Not Apply" not only eliminates the accountability dilemma, it provides the tools and approach healthcare leaders, physicians and nurses need to most impact patient care. And it does so without adding more initiatives or any extra work to their already full plates.

Based on true experiences during his twenty years of consulting with healthcare executives, Dr. Wong's Angels of Seattle hospital welcomes readers into a patient accountable culture in action. We'll witness his real as life characters step into the roles needed to define and attain accountability, and give patients what they need the most.

About Second River Healthcare Press: An award winning publishing company committed to providing educational, instructional and motivational books that address the areas of healthcare that are important to you.

For more information please contact:

For media inquiries: Please contact Jonathan Long - Managing Director, Bedside Trust 206.619.8088Bedside Trust, LLC 8838 Paisley Drive NE Seattle, WA  98115.,

For speaking inquiries: Please contact Sierra Weese, Director Innovative Healthcare Speakers Bureau. 406.586.8775 Phone 406.586.5672 fax - 26 Shawnee Way, Suite C Bozeman, Montana 59715

Tip 13: Leadership advice 5¢... The doctor is in

Leadership advice 5¢... The doctor is in

You and I both know philosophical leadership advice is everywhere. So let's focus on applying road-tested leadership insights and tools that lead to developing a solid leadership infrastructure for you and your team. Baseball legend, Yogi Berra, said that leading is easy... the hard part is getting people to follow. Yogi would also agree that the challenge with getting people to follow the leader is inextricably linked with accountability. Whether you require:

• teams of nurses to work better together,
• doctors to communicate with patients more effectively,
• improved engagement from your staff
• your team to follow the vision you've set...

No matter the issue, it all comes down to leaders providing context for the mission. If great leaders have one thing in common, it's the ability to provide context in the most difficult situations.

Getting people to follow is less of a challenge when leaders establish a shared purpose, convey the desired outcome and help the team envision the ultimate goal. Getting people to follow a shared purpose is especially important in the high stress world of healthcare. In medical school, there is a saying, "If it's important you'll hear it again". In a previous issue we determined that our struggle with accountability, or as Yogi say's, "Getting people to follow," isn't because healthcare is riddled with lazy people, but about the simple missteps in how leaders approach accountability with carrots and sticks.

Let's be clear, it's not that we're not accountable to our jobs and don't know how to perform our duties... the real challenge comes from not understanding the context - the desired outcome, how to act on it and how to become accountable to it. Great leaders I work with each day create contextual value for their team by aligning their teams' role descriptions with patient's needs. They help their team view the world through the lens of the patient. Patients require us to work as one team no matter your job... and this is what begins to establish context. These leaders challenge their team to consider the role they must play in order to contribute to patient trust regardless of our daily challenges.  One CEO wrote to me recently saying that his organization's mantra is "one team one fight". These are the simple communications that set invaluable context. When healthcare leaders help their teams and organizations establish a shared purpose and set the context, it results in what we call a Patient Accountable Culture. Establishing context begins with understanding our chief objective as leaders and aligning how we practice what matters most to patients.

Tip 13: Establish context and value.

As you may recall, I asked a 100 hospital CEO's and you "How much time do you have to lead?"

It's safe to conclude that you're not alone when we say that most of us in leadership don't have or make adequate time to lead people... we spend too much of our time managing. While I realize the act of leading is quite dynamic and a bit difficult to isolate from the many managerial duties that fall on our plate, it provides us valuable context as we begin to identify how best to contribute as leaders. Take a moment to determine which leadership competencies have the most impact on improving patient care. I asked these same CEO's to compile a list of leadership competencies they believed to be most important, but hard to accomplish day-to-day? Here are some of their candid responses:

• "Help my organization and staff deal more effectively with change"
• "Build trust and motivate my team"
• "Focus on people"
• "Help develop people"
• "Setting the direction"
• "Align people better"
• "Help people become more self-directed and proactive"
• "Create a culture of action"

We now know why Yogi says getting people to follow is so hard. These responses sound a bit intangible, yet they're critically important. With their collective wisdom, these CEOs identified the most important competencies a leader must acquire. Each has a significant impact on moving people and inspiring patient trust. Knowing what really counts can provide leaders context for setting the course for how to lead.  In our view, we overly focus on the individual characteristics of leadership and focus too little on the situational context. The focus on context leads to shaping your leadership strategy on what matters most to patients, and having an informed team. When you take the time to improve context through role descriptions, you will improve "followership" and alignment, without adding more work to your already full plates.

Email me or share your thoughts on our Facebook page.

---

WHAT'S NEW @ THE BEDSIDE TRUST

Second River Healthcare Press is pleased to announce their collaboration with Dr. Brian Wong of the Bedside Trust to publish his first full-length book, Heroes Need Not Apply:How to build a patient accountable culture without putting more on your plate.

Everyone in healthcare knows that the lack of accountability negatively impacts care, and when accountability improves throughout your organization, care improves. What healthcare leaders don't know, is how to improve accountability and why it is so critically linked to improving patient care.

"Heroes Need Not Apply" not only eliminates the accountability dilemma, it provides the tools and approach healthcare leaders, physicians and nurses need to most impact patient care. And it does so without adding more initiatives or any extra work to their already full plates.

Based on true experiences during his twenty years of consulting with healthcare executives, Dr. Wong's Angels of Seattle hospital welcomes readers into a patient accountable culture in action. We'll witness his real as life characters step into the roles needed to define and attain accountability, and give patients what they need the most.

About Second River Healthcare Press: An award winning publishing company committed to providing educational, instructional and motivational books that address the areas of healthcare that are important to you.

For more information please contact:

For media inquiries: Please contact Jonathan Long - Managing Director, Bedside Trust 206.619.8088Bedside Trust, LLC 8838 Paisley Drive NE Seattle, WA  98115.,

For speaking inquiries: Please contact Sierra Weese, Director Innovative Healthcare Speakers Bureau. 406.586.8775 Phone 406.586.5672 fax - 26 Shawnee Way, Suite C Bozeman, Montana 59715

Tip 12: Hey Scooby... turn-off the leadership mystery machine

Hey Scooby... turn-off the leadership mystery machine

Even with millions of pages and thousands of books written on the topic, leadership continues to evoke mystery. But why all the mystery and what makes achieving a consensus over its definition so challenging? Gurus on the subject try and offer leadership diverse secrets and complicated formulas for how to be a good leader. But if there was a secret sauce, I think I would have found it by now. Allow me to show some vulnerability for a moment concerning a valuable leadership lesson I've learned over the years. Although I just finished writing a book that happens to relate to the subject of healthcare leadership, early in my career, like most physicians, I perceived leadership to be the primary responsibility of administrators. A management thing that suits attended to when I was caring for sick patients. I didn't have the time nor the interest in seeking out the true meaning of the word and the subtle yet important differences. Most importantly, then and now, most physicians don't realize that leadership directly relates to improving patient care. It didn't hit me until later in my career that learning how to treat a Myocardial Infarction was no more important that learning how to inspire trust in my team. Fouling up either of these can cause significant harm to a patient. The age old principle of "First, do no harm" has just as much relevance in leadership as it does medicine. Edgar H. Shein might have said it best in his book Organizational Culture and Leadership,  "Much of what is mysterious about leadership becomes clearer if we separate leadership from management and link leadership specifically to creating and changing [organizational] culture...the unique and essential function of leadership is the manipulation of culture. Leaders work on the culture of the organization, creating it or changing it.  Managers work within the culture of the organization."Every medical school could use a dose of Edgar!

So why is it necessary to expand our conversation into this poorly defined area we call leadership? Up to this point, much of our discussion in Coach+Leader focused on how defining our role can change a culture. Past issues helped us distinguish between our unique jobs and the patient centered role we must all be accountable to in order to achieve improved care. It's critical that we know our role and even more important that leaders and doctors have the ability to help guide/coach us in that role. In short, if we're going to experience a sustainable culture change, leaders must inspire trust. This is ever so important in the ultimate team sport we call healthcare. It's no secret that healthcare leaders face some pretty unique challenges, and with those challenges comes an opportunity to rethink our approach to how we practice leadership. While I alone can't teach you all there is to know about leadership, we can certainly provide a much more practical, user-friendly definition and approach, so that we're all on the same page. If we as an industry do a better job identifying it, more and more leaders will have the confidence to share it with others... and have a greater impact on patient care.

Tip 12: How much time do you have to lead?

What do a hundred hospital CEO's have to say about leadership... their answers might surprise you? In my quest to demystify leadership, I've spent the last few years compiling responses on leadership questions from CEO's whom I've had the pleasure of working with at executive retreats, workshops and in my coaching practice. While I've asked many leadership and management related questions, and gathered some awesome wisdom, one question seems to generate the most eye-opening responses. And I'll pose it to you: How much of your day do you spend managing? That is putting out fires, organizing, performing daily tasks and solving other peoples problems? While there are always a few outliers, a large majority of CEO's reported that on average, 85% of their day could be categorized as management related activity. While that may not surprise the average busy healthcare professional, the follow-up Q and A might.

Keeping the number 85% in mind. How much time does that give you to lead? For most of us, especially CEO's, the numbers don't sound right. For one reason or another, we expect to offer a different response. Some of us thought we had a more organized leadership approach, or a better defined idea for what leadership is and does in the first place. This is about the time when a leadership consultant comes in and says, "We're going to turn those numbers around people!" Wrong. I'd suggest they haven't spent much time in healthcare. The question we should be asking is not how we are going to reverse those numbers, but how to make the most of the limited time we have throughout the day to lead. Let's get that 15% right! So how much time you have to lead each day? Email me or share your thoughts on our Facebook page.

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WHAT'S NEW @ THE BEDSIDE TRUST

FOR IMMEDIATE RELEASE

January 7, 2013 Bozeman, Montana

Second River Healthcare Press is pleased to announce their collaboration with Dr. Brian Wong of the Bedside Trust to publish his first full-length book,Heroes Need Not Apply: How one physician coach transformed a hospital's culture. His soon to be released book puts you in the center of the conflict every hospital struggles with, and a small group of dedicated leaders who resist the status quo to change it... to give patients what they need most.

After a decade consulting with hospitals nationwide, Dr. Brian Wong leverages his experiences to bring us the story of Jack Martin MD, a physician coach from a Montana Hospital & clinic who transformed the culture in one of Seattle's largest hospitals. Join Jack, CEO Jane Carolli, and their medical staff to discover how building patient trust led to improving care throughout the entire organization.

About Second River Healthcare Press: An award winning publishing company committed to providing educational, instructional and motivational books that address the areas of healthcare that are important to you.

For more information please contact:

For media inquiries: Please contact Jonathan Long - Managing Director, Bedside Trust 206.619.8088Bedside Trust, LLC 8838 Paisley Drive NE Seattle, WA  98115.,

For speaking inquiries: Please contact Sierra Weese, Director Innovative Healthcare Speakers Bureau. 406.586.8775 Phone 406.586.5672 fax - 26 Shawnee Way, Suite C Bozeman, Montana 59715

---

Visit the Patient Driven Leadership Site.

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.

Tip 11: Closing in on the knowing doing gap

Closing in on the knowing doing gap

In the past few issues we've been closing in on the "Knowing Doing Gap". I was first exposed to this idea early in my career as a physician when I began to ask the question "What really matters most to patients?" It became much more clear after being exposed to Jeffery Pfeffer and Robert Sutton's, Harvard Business Review book called, "The Knowing Doing Gap: How Smart Companies Turn Knowledge Into Action." While you can apply these lessons in many contexts, there is no wider "Knowing Doing Gap" than what we see in Healthcare. Readers of the Coach+Leader may have taken the time to stop and ask "What matters most to patients?", but many leaders and physicians have not. Again, it's not for a lack of caring, it's more about simply being too busy/focused on the "operational" factors to listen to the patient. So we naturally fall short in the delivery.

I had an insightful coaching conversation with a Chief Medical Officer last week. He told me that he was moving forward in working with his medical staff to develop role descriptions to improve physician leadership. While discussing some of the specifics in a meeting with some of his docs, he told me he made the mistake of using the word "accountability," because it seemed as if it was, or has become a dirty word with his physicians. He said that it seemed to instantly change the mood of the conversation and it took a while to get the discussion back on track. "I don't understand why I got that reaction," he stated. So, why did a group of highly accomplished physicians frame the word negatively? And as their CMO stated... "These are my good guys".

Well these so called "good guys" have a point. As soon as the "A" word was uttered, they were asking, "Accountable to whom... you, the CEO, the Board?" "Is this one more thing to do?"

They're reacting to the notion that we leaders believe we must hold people accountable for their performance and the results of their actions. This top-down approach to accountability doesn't often work out in anyone's favor, and is indicative of the "command and control" business environment that dominates healthcare. We should be asking ourselves: Do you see accountability as a challenge or opportunity? Is the idea of accountability being promoted as a carrot or a stick?

If you recall, our last Coach+Leader issue concluded that so many of these so called "accountability tools" are often perceived as top-down measures, punitive systems, corrective tools, etc. So naturally when we hear the "A" word being uttered by our bosses, it comes across negatively. How do we work around that? We need to shift from that old mindset to one that acknowledges and celebrates individuals that demonstrate the behaviors that matter most to patients.

Tip 11: How to close the "knowing doing accountability gap": Putting the patient in the center.

A few weeks ago you might recall our Coach+Leader issue titled: Accountable to no one... well maybe the patient? There's a hidden lesson in that title that's counter to the command and control way we've been getting things done. First we need to determine how and why this accountability conversation became so challenging? Then, we need to center the conversation on patient accountability.

If we're going to have a successful conversations on the subject of accountability, no one can argue that it must be about the patient. Think about it, when you put the patient in the center of your accountability discussions you remove the "command and control" barriers that dilute involvement. This puts fear and egos on the back burner and allows you to engage staff in a more personal and relevant dialogue. When we take the middle man (organizational leadership) out of the equation, the conversation is directly about the role we must play to be accountable to the patient.

Framing the conversation around being patient-accountable, shifts the purpose of accountability from a negative to a positive. I'm not suggesting that the word "patient" has magical powers, but I have used it many times to shift a seemingly top-down conversation directed at medical staffs, to a highly collaborative discussion that helps us acknowledge our need for improved accountability through a lens based on putting patients first.

Understand also that the "A" word does not need to result in a conversation about what do do, but more about how to show up with the behaviors that create the right conditions to reduce harm and improve care. Working with your staff/team to develop a role description to improve accountability can't be a conversation of what I (the leader) want from you, but a conversation of accountability based on what our patients require from all of us. You'll discover that this ongoing challenge of improving accountability becomes much less of a lofty conversation about what we leaders wish our staff would do, and more about the role we must all play to gain our patient's trust.

One final thought: For leaders that successfully collaborate with staff and build a role description, there is NO "Knowing Doing Gap"... everyone is clear about what matters most to patients, because it informs their day-to-day work and how they practice as leaders.

The Coach+Leader will return after the first of the year. Enjoy a happy and peaceful holiday.

Brian Wong, M.D.

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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.

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.

---

COMING SOON!

Everyone 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.

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

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

I 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.

Hint: 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 bedsidetrust@me.com 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.

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.

---

COMING SOON!

Everyone 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.

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 allmeans 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 atbedsidetrust@me.com 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.

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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.

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.

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COMING SOON!

Everyone 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.