Challenges of Managing Physicians

header-mad-doctorAs the healthcare environment becomes more complex and malpractice litigation’s increase, the number of  physicians entering practice is decreasing. Currently there is a large disparity in the number of physician leaders needed and the supply of qualified candidates available. This has created a recent trend of non-physician administrators that manage physician groups which is almost the direct opposite of where healthcare began. In the past it was physicians who ran hospitals and were the clinical and non-clinical leaders in private practice and in hospitals operations management. In my experience thus far there are some challenges with this change and the acceptance of the change.

Main Challenges:

Physicians do not want to be managed by anyone let alone a non-physician administrator. Recently I was speaking to one of the few great physician leaders that I know and was asking him about this issue and I acknowledged that he had a good angle because he was a physician and a good manager. He laughed and said that as soon as he became a physician leader the other physicians didn’t take him seriously as a physician any longer and they just seen him as another manager. I was really surprised by his comment and thought that was a terrible thing that his talents were falling on deaf ears because of his new position and alignment with leadership.

Physicians are employed but are not employees. Working with physicians has taught me that the mentality of some physicians is that they are their own bosses and they know what is best for the customers and business. Both physicians and administrators need each other to be able to provide care to the communities in need. The very nature of the relationship in most cases is a version of the physician gaining monetary value from the healthcare organization and from my experiences that is almost the very definition of employment. With the changes coming in healthcare I foresee that  we will see an increase in the number of non-physician administrators that will be managing physician practices and groups within the public and private sector.

As healthcare continues to evolve and we see new roles develop in healthcare, patients can be assured that our healthcare providers will continue to provide quality care and the administrators will strive to reduce the cost of care while increasing the quality of care.

How I improved my Employee Satisfaction scores from the 31st%ile to the 96th%tile in less than a year! Part 4

Over the next six months the line managers and I would work through the action items with various levels of acceptance and success. The line managers and I started to publicly display our work calendars to gain clarity on duties outside of the department. We quickly discovered that our original idea of posting these schedules on white boards would not work effectively for each of us. The staff wanted the line managers schedules to be posted in their areas but wanted the white boards to be used for department statistics. The line managers wanted my schedule to be accessible to them through outlook as they did not see coming to my white boards as efficient for them. I decided to do both because the line managers would find it difficult to break away from their areas and the staff would want the schedule there in the case they dropped by while I were away and would know when I would return.

Staff huddles were more difficult to get ironed out. One of the difficulties that we encountered was that staff shifts were staggered so there was never a good time to perform the huddles. You could perform it early when we were slower but that was also when we had the least amount of employees on shift. We could wait until later but we were busier and also we missed the chance to disseminate any information early in the day that maybe important to the flow of the day. We were also hearing that what the staff called a huddle and what the line managers called a huddle was different. The staff thought that a huddle meant that everyone must be present and that everything must stop. In the new healthcare environment there is no such time where everything stops and everyone is present. The solution was completely around setting expectations for both the line managers and the staff around these huddles. The expectation was that the timing of the huddle would take place at 9 am each morning with notes being taken for those members that were not present to review at the beginning of their shift. This huddles took place in the work area so that work continued while information was being dispensed.

The next area of implementation under the communication section to was the use of communication books. The communication books seem to be one of the easier wins during this process and one of the biggest wins for staff. The communication book would evolve into a one stop shop for all communications but not the end all. This book contained printed emails, huddle notes, staff to staff notes, and the schedules for the line managers. This gave staff the opportunity to view communication when random free time would pop up without logging into a computer or contacting the line manager for updates. The next task was to purposely round on staff to make sure the their needs and concerns were being heard and addressed. I wanted to take this task on personally to further build my relationship with the group. I created a rounding tool that asked open-ended questions, was quick to avoid awkwardness, and the feedback was recorded which helped me to remain committed to quick and accurate feedback to concerns. This seemed to be effective but keeping a 100% routine proves to be difficult.

The “open door” policy was the next action item on this list. I felt as though I had a great open door policy and that anyone could walk into my office and talk about anything that wanted to. The employees did feel that they could come and talk with me about things but the thing I found out was that my “office” was intimidating to people. Some of the staff was assured from past experiences with past managers that there was nothing good to come from going into the manager’s office. One of the actions that I perform now to offset this is to bring staff members into my office to praise them and to take difficult conversation to other areas. This has improved the comfort level of the staff to come to my office and over time I think it will continue to improve their connection to me and the mission.

The last area of action in the communication section was the use of a QA form. This form was to have multiple uses but was mainly geared around the inappropriate use of resources, especially human resources. Because we work in a service industry it is difficult to address concerns with internal customers when they maybe a little negligent in the use of resources for other areas. This form provided an opportunity for the staff to give details on events where resource consumption was not appropriate and it would be used for discussions within the senior leadership team. This helped the staff know that their concerns would be heard and taken seriously from all parties.

Recognition was the last section of action items to cover. First on the list was the use of hand written thank you notes being sent to staff at their homes. This is a task that has not received the level of focus that we would have liked. The difficulty of this is that the line managers do not have the time to sit and write the cards but I do and the other issue is because of my schedule I miss a large amount of good things that happen within the work group. By chance it happened to work out perfect because the recognition board talked about later was so successful that the thank you cards were not concern to the staff. Next on the list was to have some events that celebrated our successes or events that were timed around holidays to create an environment of family and team. Currently we try to perform at least one celebration a month or at a minimum a celebration / event one a quarter. Some of these worked great like some”secret pal” games but some did not such as offsite events.

The last two action items started separately but over time became very closely tied. The items were the Employee of the Month program and the recognition board. The employee of the month would be chosen from within the staff peer group for going above and beyond for our customers. The winner would receive a lapel pin with “Employee of the Month” etched into it, a plaque created by our employee satisfaction team, $25 gift card, and public recognition at the department meeting. The staff recognition board did not take off very well a at first and the staff thought it was silly. I worked with one of the staff members that had some artist ability and gave her free rein to create a  board that would allow the staff to publicly recognize each other for going above and beyond for their fellow employees. Her idea was great, she created what is now known as the “Busy Bee Board”. The board has a big bee’s nest with lots of bees pushed pinned to the board. In bold lettering it says “Stop and drop some honey to your busy bee buddies”. You can take one of the bee cutouts and write something nice and then pin it back on the board for all to see. This was a huge hit for the department and still sees lots of action. We select one comment from the board a month and give the nominee and nominator each a $10 gift card and public recognition at the department meeting.

Upcoming on Part 5: This will be the last of this series of blogs and will cover our successes, casualties of the plan, and where we stand today.

Please subscribe to my Blog as this was a great journey and I would enjoy to pass any take away’s along to you.

Micromanagement, the Killer of Innovation!

This is a short blog about the biggest barrier to innovation……and that is micromanagement.

First lets talk about definitions of both of these words. According to the Merriam Webster the definition of innovation is the introduction of something new or a new idea, method, or device. The same dictionary defines micromanagement as the practice to manage especially with excessive control or attention to details. Let’s talk about these separately for a minute.

We now know what the definition for innovation is but what is the practical application and practice of innovation. We all hear the same old terms that sound like “out of the box” thinks but do you really practice it. I always know when I am on the edge of innovation because I hear the sound growing by the number of people who are laughing at my idea. As adults our creative ability decreases each year because we continue to put up barriers around the boundaries of our minds. We start to decide we will not work, what is not possible, and use phrases like “it’s always been that way”. Innovation to me means that I keep dreaming of what could be and find ways to make the impossible a reality in some form or fashion.

Now lets talk about the mean cousin of innovation, micromanagement. How many times have you heard from your boss that he/she needs you to be creative / innovative about solving a problem but wants in done in a particular manner? That is not creative at all, that is almost the polar opposite of innovative. Micromanagement defies trust, creativity, and the ability for a person’s mind to break the barriers that held the previous thinkers to the current solution. To me this sounds like putting a bunch of race horses in a small area and telling the trainers that the expectation is that they all become Kentucky Derby contenders. Yeah they might become pretty fast and perform pretty well but what if they didn’t have the barriers and were able to run as fast as they could without being told to turn around. Micromanagement to me represents mistrust in a professional relationship and the demise of dreaming without limits.

My advice:

When working with people invest your time in developing trust in the relationship. Let them fail on a small-scale! It will help train them to know what works and what does not but most of all lets them know that you do not have defined boundaries that they need to be innovative within. This all reminds me of the Edison quote. When asked about failing 1000 times at an attempt to make a light bulb, Edison responded “I didn’t fail 1000 times, I figured out 1000 ways how not to make a light bulb”.

How I improved my Employee Satisfaction scores from the 31st%ile to the 96th%tile in less than a year! Part 3

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After meeting with the senior leadership team it was time for HR to meet with the staff. Over the next several weeks our HR consultant met with each group of employees and collected confidential feedback from the staff. I met with the HR consultant after his wrap up session to  recap his finding so that we could start working on solutions. The employees generally were not satisfied with the line managers and thought that I needed a better understanding of their work flow.

The general complains with the line managers were that they did not know their locations throughout the day, they were often confused on developments specific for their work groups, poor treatment from a related work group, perception that line supervisors were not educated for their roles, staff did not get follow-up on questions and concerns, equipment need and repair, not around to interact with upset customers, no recognition / fun, and questions around roles and responsibilities. After hearing these issues, my boss and I knew that we had some work ahead of us with the line managers and it would take lots of training and mentoring  for them to become successful. My boss called a meeting with my line managers,the HR consultant, and I to talk about these concerns and discuss the direction that we needed to go in.

During the first part of the meeting we discussed the findings of the focus groups. HR started giving the feedback they had gathered from the staff regarding the line managers and myself. They were obviously very upset with the line managers and found there were some things that I needed to address also.  At first there was lots of denial from the a few of the line managers about who the staff was really upset with. One of managers felt strongly that the staff believed that I was the issue and the staff were not coming out and saying it because they were scared that I would fire them. They were not owning their part of the problem at this point and I could see that there was concern on my boss and HR’s faces. We decided to cool off and meet again in a few days to let everyone digest the information and come back with cooler minds.

A few days later my boss called us back in for another meeting to close out the briefing from earlier in the week. He and I met before the meeting and reviewed the message that the line managers would recieve. He wanted to make sure that I was committed to holding them accountable to the plan. This meeting had a much better tone than the last and it seemed that the line managers had time to think about the things we talked about and wanted to own some of the issues. My boss and I asked for full commitment to the plan, organization, and the staff. We let them know if they are committed then we will be successful but if they were not then we would need to find a different place for them. We gave the an option to walk away if the job was different from what they had thought but none choose that option and committed to the plan.

The plan for raising the scores focused on 3 main areas: Participation, Communication, and Recognition.

Below are the action items in our plan under the section that it pertains to.

Participation:

  • Review employee satisfaction results with staff.
  • Focus group facilitation for staff by section to give feedback on their issues and concerns.
  • Meet with management to review employee feedback and develop proposed action plans for any items related to direct management.
  • Focus group facilitation to review summary of issues, direct management proposed actions, and get feedback on how to improve morale.
  • Management to shadow staff in all sections and all shifts to better understand their work.
  • Role descriptions and expectations for all levels to be developed with staff to clarify roles and expectations of performance and behavior.
  • Distribute and get staff commitment on list that makes an enthusiastic team for all staff to hold themselves and each other accountable.

Communication:

  • All management will post their weekly schedule on white boards so that staff can locate where they are when attending to duties outside of the department.
  • All supervisors will huddle daily with their staff to last no longer than 10 minutes and place huddle notes on white board.
  • A communication book will be utilized in each section and will include any staff emails that have been sent along with any other communication needed between staff.  Staff will be held accountable for reviewing the information.
  • Management will be purposefully rounding daily with staff and utilizing a communication form to commit to any necessary follow-up occur within 2 business days to employees.
  • Implement “open door” policy and behavior learning with leaders to be approachable for staff to express ideas and concerns.
  • QA form will be utilized by staff to document inappropriate protocols which will be reviewed monthly at Management meeting. Meeting committee includes management and administration.  Form will include feedback from committee for employee.

Recognition:

  • Management to send handwritten thank you cards to employees to their home for exceptional recognition.
  • Develop a schedule of department events for staff to participate and have some fun at work such as potlucks, games, scavenger hunt in new area, secret pals, etc.
  • Recognition Board will be placed in department for all staff to have the ability to publicly recognize each other.
  • Create Employee of the Month program.

Upcoming on Part 3: I will talk about the the good, bad, and ugly of the plan implementation. We will also talk about what action items worked, which ones did not, and how we adjusted.

Please subscribe to my Blog as this was a great journey and I would enjoy to pass any take away’s along to you.

How I improved my Employee Satisfaction scores from the 31st%ile to the 96th%tile in less than a year! Part 2

"You can't handle the truth!"

“You can’t handle the truth!”

I took the next few days to internalize the scores, define my strategy for the employee  focus groups, and prepare the initial meeting message for the employees. My strategy was to meet with the whole group to review any concerns they may have with my line managers and then I would have either HR or my boss to talk with the employees about concerns with me. After meeting with HR and my boss it was agreed that the best approach was for me to talk with the whole group and then HR would meet with the groups broke out by job class. My message would  be around promoting the survey results as being truthful, their intent for wanting to improve the team, and my desire for specific feedback.

On the day of the meeting I had prepared a few PowerPoint slides with a little bit of data around the top 10 strengths and top 10 opportunities. The last thing that I wanted to happen in this meeting was to get caught up in the data and not get “with the people”. It reminds me of the saying “paralysis by analysis”  and leaving this meeting without some feedback was not an option. As the employees filed into the conference room there was an uncomfortable tension in the room and I am sure they could read my body language that I was anxious also.

After everyone was in the room and signed in, I started the meeting talking about our strengths. All the strengths were focused around our mission and work group strengths without any indications of strengths in the leadership team. It was a pretty quite room without any smiles or indications that the employees were happy with our strengths and it seemed that they were waiting to talk about the opportunities. I then started talking through our opportunities and I could visually see my people starting to sit up in their chairs or shift around uncomfortably.

I explained the structure of the meeting and this was the time to talk to me about any concerns that they have around the line managers. The room was almost silent and no one was attempting to talk or was sending me any body language to confirm that they wanted to be asked to talk. After a few minutes of coercion, the dams broke and I was in the middle of feedback central. The employees stated that they did not have any issues with me but all there issues were with the line managers. I made sure to “manage down” immediately by letting then know that there was no way that they could be happy with me and unhappy with my leaders. They were very confused as if they didn’t think that I was listening to them until I explained that a failure by the line managers was a failure by me because I was hired to lead them. They understood my point but wasn’t 100% satisfied that I was taking the heat for the line managers.

So as I continued to pull back the layers it was apparent that there had been lots of trust issues from a great deal of the staff around one of the line managers from the time the manager was a staff member through their entire time as a line manager. The staff had concern for all three managers in the areas of communication, recognition, and participation. I received feedback that two of the managers had been hired for reasons other than their aptitude for management or their love of working with people. One was hired because he was told by previous management that the job was 80% technical and 20% managerial, imagine that, a manager that was told he only had to be a manager 20% of the time. The other was told she could have the job if she was willing to work a specific schedule so that she could be present to interact with difficult stakeholders and situations.

Of all these concerns being mentioned, some were new to me and some were not. The trust issue was not a new issue but the trouble with that situation was that I didn’t know who was the cause. There were a few “bad eggs” among the staff and I could see a few undesirable characteristics in the line manager but nothing that could not be worked on. It seemed to be a lot of she said / he said types of moments between her group and her. The communication, recognition, and participation issues were ones that I took to heart because I knew that they were areas that I had room to improve on and that I felt strongly about. I took these on specifically so that I could make some personal changes and then I could champion the line managers to do the same. Seeing the data and talking to group prepared me for my meeting with senior leadership.

On the day of the senior leadership meeting we met in the conference room next to the CEO’s office (never good). Besides myself in attendance there was the CEO, VP of HR, VP of my section, VP of Operations, HR consultant, VP of an unrelated section, and my boss. Just to be clear this was not only for me, any leader that scored under the 50th%tile of the survey had a similar meeting but knowing I was not alone did not make it any less intimidating. I took full responsibility for the scores and conveyed that it was a complete failure on my part but with their support I could turn it around before the next survey. My VP and the VP or operations was supportive in talking about the multiple projects that I had been working on and their suspicion that my line leaders were “soft” in their ability to manage. The outcome was exactly what I thought it would be, and that was to “Fix It”! The leadership team would meet back monthly to hear reports on progress and to review monthly results from an internal home-grown survey so that we would have a leading indicator before next years survey.

Although it was never said, I knew what failure would result in. Some people might think that my senior leaders were very cold in their expectations but they are great leaders that live the mission and love their people but with that said, you still have to win. Like I have said previously, management is about results and without results there is a lack of management / leadership.

Upcoming on Part 3: I will talk about the feedback I received from HR after talking with the employees regarding concerns for me, the tough love meeting my boss and I had with the line managers, and the action plan for a culture change.

Please subscribe to my Blog as this was a great journey and I would enjoy to pass any take away’s along to you.

How I improved my Employee Satisfaction scores from the 31st%ile to the 96th%tile in less than a year! Part 1

Press_Ganey_logo

In late June 2012 I received the Employee Satisfaction scores for my department, a day that I could have done without but was necessary. My boss showed up with paper printouts of the scores for him and I to review. I could read by his facial expressions that we had not done well and that he was concerned about the results. I had lots of excuses why I could have slipped in scoring but in management there are no excuses, just results. We had The Joint Commission inspection, state inspection, and I was managing a 9 million dollar expansion but as I said before, no excuses.

We reviewed the top 10 areas of opportunities as defined by Press Ganey though the employee scoring. The top 3 areas for opportunity by descending order was “My direct manager can be trusted”,   “My direct manger communicates effectively” , and “It’s easy to talk to my direct manager about things that go wrong on the job”. As you can imagine this was really hard for me to swallow when I first read it. I was upset and embarrassed by the scores and started to ask myself why the staff didn’t talk to me if they were this dissatisfied so I could work on these issues. I came to the conclusion that I was less available than I had been in the past year and delegated lots of my management responsibilities to my line managers due to the aforementioned projects.

The Direct Manager category on the survey consisted of the line managers and myself. The Systems and Leadership category was composed of my boss all the way through the CEO of our multiple state organization. This is how leaders were defined by my leadership in our organization but there seemed to be lots of confusion from the staff about who was in each category because it could be defined at the department level. Depending on what department, hospital, or service line you worked for the categories could all be very different.  The previous leadership for my area was very decisive about having the leaders categorized as I listed above.

My boss and I started talking about next steps and started to set up meetings with the staff all together and then in smaller groups by work sections. About the same time I received emails from my HR department and the CEO requesting ongoing monthly meetings to review my action plan and outcomes. I was expected to being a defined plan with actionable items that were defined through employee focus groups and the leadership team. Although this was a little intimidating and embarrassing to know that I had to meet with the CEO each week to review my action items and progress, it was also nice knowing that employee satisfaction was important to them also.

Upcoming on Part 2: I start to describe the  initial meetings with the staff and senior leadership, feedback from the employees, and expectations from senior leadership team.

Please subscribe to my Blog as this was a great journey and I would enjoy to pass any take away’s along to you.

How I improved my Employee Satisfaction scores from the 31st%ile to the 96th%tile in less than a year!

Over the next few weeks I will be giving everyone a play by-play of sorts on how I changed the culture in my department of over 60 employees. One year ago when we were compared to  100 other hospital departments that were similar, we were ranked 66th. In less than one year of hard work between leadership and the team we climbed the ranks and now hold the 4th overall spot when compared to the same peer group. In my most recent staff meeting I heard phrases that I would not have heard a year ago like “I love this place”, “It is so much fun to work here”, “I enjoy coming to work”, and “I can tell that the culture has transformed”.

I will release a new portion each day or each couple of days depending on the amount of  total content and complexity of the subject that I want to explain. We will start the posts at the time when I received our low results a year ago through  just a few days ago when we received our new results. This post will have some specifics that relate to the healthcare industry but I truly believe that anyone from any industry will be able to gather some great information and ideas from our documented journey to high employee partnership.