Become a Leader Without Knowing It All: How to Improve Employee Engagement Through Leadership Standard Work

by Bill Kirkwood | January 23, 2014 11:29 am
How many years have we been hearing and reading about the decline in employee engagement?  If the research and surveys are to be believed, close to half of employees are unengaged in both their work and their employer.  There are countless solutions out there, yet the employee engagement numbers are holding steady. What can we do to get our employees on board?
Leadership standard work (LSW) can be a powerful response. It is a cornerstone to a Lean management system.  LSW specifies a leader’s daily, weekly and monthly practices that bring a disciplined focus to process, improvement opportunities and measurable outcomes of processes. This standard work is not ad hoc but rather documented with defined frequency of practice or, should I say engagement.  Importantly, these practices, which include a formal review of active performance improvement efforts and current performance against agreed to targets, takes place at the workplace—at the gemba.  Why at the gemba and not the traditional conference table preferred by many leaders?  Because that is where the work takes place by those unengaged employees.
A core element of LSW is coaching and teaching.  It is within the coaching process that leaders change the organizational conversation by engaging employees in the process of continual improvement. Think of what is being communicated when a leader shows-up in the workplace to conduct a review and coaching session.  In many cases this conveys the message “we are no longer in Kansas,” the past approach to work is no longer sufficient to assure success and conveys you and I are in this together.”  It affords a larger number of employees the ability to actively participate in a new way of talking with the leader about the problems they are confronted with and to share their ideas for continual improvement.  When done well, coaching in the gemba:

• Provides employees an opportunity to contribute their ideas for improvement
• Clarifies what is expected of them
• Takes on real-time development opportunities with employees engaging in small tests of change
• Provides recognition for work well done
• Demonstrates a sense of genuine caring from the leader.

How many approaches to rounding have you initiated in your organization?  LSW provides a very important ingredient to overcoming leader reluctance to rounding.  Speaking from personal experience, rounding was intimidating because I thought I had to be all knowing and going to the workplace could expose my ignorance.  Many leaders having earned their stripes by being  perceived experts and giving orders from a distance. It worked, or so they and I thought. Going to the gemba violates that comfort zone.
LSW, with its coaching approach, allows leaders to mentor and teach using the Socratic method. It removes the responsibility of being all-knowing.  Coaching shifts from one way “communication” to active inquiry and teaching.  The many leaders I have worked with over the years find this a positive challenge and not an onerous task, once they know there is someone to coach and guide them.  It is our role as Lean coaches and advocates to coach and mentor leaders; to make it acceptable not to know everything; and to coach and teach them on understanding the PDSA cycle, quality and Lean tools.  The return for these efforts are engaged leaders and employees.

---

Today’s post was written by Bill Kirkwood, Ph.D., Director at HPP.

Bill has 30 years healthcare leadership experience in both system and individual hospital settings in the Mid-West and North-East, and oversight of change management activities and Lean Transformation engagements.  This experience includes serving in an executive capacity in Quality, Operations and Human Resources. 

Source URL: http://www.leanhealthcareexchange.com/?p=4125&print=0

Embedding shared decision making in primary care

Sharing decision making with the patient benefits individuals and the NHS as a whole

Making shared decision making a reality can be acheived if it is streamlined into routine NHS processes. Photograph: 3M

Overview

"No decision about me, without me" is the fundamental principle underpinning many of the current changes in NHS healthcare. Healthcare professionals may fail to recognise how knowledgeable patients are, or to understand the beliefs of individuals and groups. By engaging in balanced discourse, clinicians not only help a person come to terms with their needs and the potential gains and losses from different treatment approaches, but also broaden their own understanding of what is important to people.

The principle of engaged patients being well informed and taking a central role in all decisions made in their care is neither new nor revolutionary, but some patients may be passive receivers of care and many medical professionals, inadvertently or otherwise, are paternalistic in their delivery. Sharing decision making with the patient, referenced to understandable evidence and timely support when selecting investigation and treatment options, benefits not only individuals but the system as a whole.

Project Aims and Methods

Making shared decision making (SDM) a reality for patients can only be achieved if it is systematically streamlined into routine NHS processes, steering clear of lengthy bureaucracy. Nationally, a number of tools have been produced which now need to be rolled out locally and regionally. In order to support this work in the south of England, a 'community of interest' has been established to enable interested clinicians, who want to know more, to access training, ideas and peer support to try things out in their own clinical context.

Activities in the community of interest include a focus on integrating shared decision making so it becomes an integral part of the patient pathway and clinical behaviours. As well as embedding shared decision making from the provider perspective, SDM needs integrating into policies, commissioning systems and consent procedures. A particular focus therefore for the community of interest is to provide information, insight and advice about how clinical commissioning groups (CCGs) can deliver on their statutory duties, including practical tools and processes, and indicators of what "good commissioning of shared decision making would look like" at CCG level. A range of different activities have been delivered since the community was established, utilising new technologies to spread the word through different channels.

Findings

Twenty-two clinical commissioning groups across the south of England responded to an initial survey. Ninety-five per cent of respondents asked for more information or support on shared decision making. Fifty-six per cent of respondents definitely understood what SDM is trying to achieve and 63% indicated that SDM featured in their CCG plan. In relation to CCG plans, 45% included SDM in planned care (specifically MSK) and 35% in relation to long-term conditions. Fieldwork indicates that, in reality, CCGs are at very varied stages in their development which can be categorised as:

• Interested in SDM and currently developing an understanding of how to implement in practice
• Interested and with some engagement to introducing SDM in an identified clinical area
• Have a full SDM plan with internal accountability for delivery

The implications for the community of interest are to develop a wider suite of options to address the variability in practice. Regular WebEx updates from practitioners, tailored visits and expert mentorship to support specific initiatives, and the development of materials for patients and clinicians, are all part of the range of offerings needed to move individual CCGs on from their various starting points.

Recommendations

The wider implication for policy from the work carried out in the South of England is that more time and resource needs to be given to supporting the CCG community with practical help for implementation.

This includes developing an evidence base of the impact on patients of the use of patient decision aids and option grids, as well as assessing the impact on patient satisfaction of commissioning changes. Peer learning and clinical engagement are critical to embedding deep change in relation to shared decision making.

Working with Thames Valley HIEC

This project was carried out by the knowledge team, with project support from Pfizer Ltd and funding from NHS South of England and Pfizer Ltd. Pfizer are supporting the project as part of their commitment to work together for Britain's national health through partnership.

We can help you by:

• Involving you in the Community of Interest for shared decision making in the south of England
• Advising you on the appropriate level of support to help you meet your current CCG aims for SDM
• Signposting you to the national tools and approaches.

Thames Valley Health Knowledge Team

Contact: Email: knowledgeteam@tvhiec.org.uk

http://www.theguardian.com/healthcare-network/healthcare-innovation-partner-zone/shared-decision-making-primary-care

NA Regional Hospital reduced ER waiting times by 40% in 30 days

NORTH ADAMS, Mass. — A month-old initiative to lower Emergency Room waiting times is already paying dividends at North Adams Regional Hospital.

 

Between Aug. 20 and Sept. 18, the average time it takes to enter a room in the ER dropped from 15 minutes to six minutes, and the average time to see a doctor after entering the building dropped from 27 minutes to 19 minutes.

 

Not surprisingly, the decreasing waits are increasing patient satisfaction. Earlier this month hospital officials announced that the emergency room would have a greater focus in the hospital's operations.

 

On Tuesday morning, the "Lean management" team created to assess and improve the ER reassembled to talk about the process, the changes and the tangible results so far.

 

The group was encouraged by a dramatic improvement in the hospital's ER's rankings according to the most recent Press Ganey patient satisfaction survey.

 

For the period from April to July of this year, the hospital's ER ranked in the 63rd percentile in the Northeast for overall satisfaction. for August, it ranked in the 97th percentile. Nationally, NARH ranked in the 72nd percentile for the previous four months; in August, it ranked in the 94th percentile.

 

"This is the best the Emergency Department has ever performed," said Paula Markland, the hospital's patient relations manager. "We've been with Press Ganey since their beginning. We were the 30th hospital that joined their system, and now they have thousands."

 

Indiana-based Press Ganey is partnered with 10,000 healthcare organizations nationwide, according to its website.

Markland was one member of a "cross-functional" team that spent four days this summer doing nothing but developing a new plan for the hospital's emergency room.

 

The group followed the "Kaizen" model, named for the Japanese words Kai, which means "change" and Zen, which means "good." Kaizen systems look to constantly improve systems in businesses; the approach dovetails with the Lean management approach expounded by Northern Berkshire Healthcare CEO Tim Jones.

 

"[Lean management] is understanding what customers value and looking at the processes that deliver services," NARH Director of Lean Transformation Brent Drennan said. "Tim Jones got us thinking about what the patients want. In the Kaizen process, we asked, 'What is it that's bothering patients?' It's that they're waiting too long to see a provider."

 

Drennan served on the Kaizen team along with Markland, interim Emergency Department Director John Aufdengarten, ER nurse Cherie Ericson, housekeeper Theresa Rondeau, physician recruiter Bonnie Clark, ER physician Dr. Fernando Ponce, admissions officer Renee Eastman and information technology specialist Samantha Ritcher.

 

"The key is to bring everyone into the discussion," said Dr. Jonathan Cluett, an orthopedic surgeon who stood in for Ponce at Tuesday's meeting.

 

The participants described the four-day process as intense, tiring, challenging and productive.

 

The most noticeable change that emerged -- from a patient standpoint -- is the transformation of the triage room.

 

Before Aug. 20, that room was a way station where incoming patients would spend anywhere from two to 15 minutes answering 30 questions as the triage nurse went through 50 different computer screens -- all before the patients were allowed to enter a room where they would receive care.

 

Now, the model calls for a 15-second triage that speeds patients directly from the waiting room to the treatment room and prevents backups that used to subject some patients to very long waits in the reception area before they even saw a nurse.

 

From a staffing perspective, the new model allows more nurses to focus on patient care, Ericson explained. No added staffing costs were associated with the changes.

 

"At peak times, from 11 a.m. to 9 p.m., we have five RNs on duty," she said. "[Before] we had a triage nurse who took no patients and a charge nurse who took a reduced load, maybe half a patient load. So before we had 3-1/2 nurses at peak time seeing patients."

 

Now, four of those nurses are seeing patients and one assigned as the charge nurse to manage patient flow and do the 15-second assessments.

 

"If you ask a nurse how long it takes to tell how sick a person is," Drennan said. "It should take about 15 seconds."

 

That is not to say the things that used to happen in triage -- like taking a full medical history -- are ignored.

 

"The rest of it still gets done," Drennan said. "But it gets done later in the process."

 

In the meantime, patients feel more like their concerns are being taken seriously and progress is being made toward addressing their complaint.

 

"A patient's perception of staff changes dramatically," Markland said. "When a nurse cares enough to take you to a room right away, you perceive that that nurse is kinder and more interested."

 

And, in the end, more patients seek help.

 

Prior to implementation of the changes instituted by the Kaizen team, on average one person every other day left the NARH ER without seeing a physician. That was a measure of the frustration created by waiting room times.

 

On Tuesday, the hospital marked a run of 18 days since the last patient walked out without seeing a physician. It's a small sample size, but an impressive trend in the right direction.

 

The Kaizen group continues to meet weekly to discuss what works and what needs to be tweaked to improve ER performance, and the Kaizen model is going to be replicated in other parts of the hospital, Drennan said.

 

The next area to be addressed: how to do a better job serving the 10 to 12 percent of ER patients who are admitted to the hospital.

 

"We asked the Emergency Department nurses what we could do to help them, and their top response was, 'Please get people upstairs faster,' " Brennan said. "The next step is to work on admissions from the ER."

http://www.iberkshires.com/story/44779/NARH-Reduces-Emergency-Room-Wait-Times.html