by Doug Gray | Nov 12, 2015 | Leadership, Managers, physicians, talent
“How are you feeling, doc?”
“What do you need, nurse?”
I think that Healthcare Innovation starts when we ask questions like these. We need to take care of those who are providing our care.
Too often we get distracted by shiny technology, or efficient processes, when we need to stay focused on the quality of relationships between caring people. Here is a quick example.
Today I shared a panel with 3 brilliant people at an Interactive Case Study led by Mark Kenny (a client) and his team of professional actors at Hippo Solutions in Nashville, TN (see the link here). The theme was “Hospitality in Healthcare,” and this conference/ showcase occurred at Vanderbilt University. Imagine 3 scenes, 6 actors, 50+ in the audience, 2 skillful facilitators, seamless integration of the audience and the actors and the panelists, and you get a picture of how well this case study entertained and educated everyone.
My co-panelists included Paul Sternberg, MD, Chief Medical Officer, Chief Patient Experience Officer, at Vanderbilt University Medical Center, Darren Hodgdon, National VP of Strategy and Innovation at United HealthCare, and Connie Schroyer, PhD, VP at the Hay Group, based in Arlington, VA. And me. The expert on physician burnout, resilience, positive psychology and executive coaching. We focused on the emotions below the surface of behavior, and concluded that the simplest way to improve the quality of hospitality in healthcare is to ask for feedback, listen well, then support constructive changes.
Years ago we had buttons stating “Hug a Nurse” and “Hug your Doctor.” What happened to those buttons?
WHAT TO DO NEXT?
If you or someone you know is a healthcare professional and would like to know more about burnout and what can be done to help and prevent this Contact Us Here or Call Us: 1-615-905-1892
by Doug Gray | Sep 8, 2015 | Business, Leadership, Managers, strengths, Success, talent, talent assessment
The goal of coaching is behavioral change toward a desired personal or professional outcome. For instance, Sarah may need to develop her business development skills to grow her new franchise by 50% within the next 6 months. John may need to develop an assertive meeting style with his new manager, in the next 30 days, or risk opportunities for promotion. How do these leaders attain their goals?
Some leaders like to imagine the coaching process in the following 4 phases. My experience, since 1997 with hundreds of coaching engagements, is that coaching engagements rarely fall into the neat categories of these 4 phases. One reason is that learning is a messy process. The process is ongoing, iterative, client-focused, both an “artful craft” requiring practice, and a scientific management consulting process requiring expertise. The action learning process implies that coaches and leaders jointly learn what works, and why it works, so that the leader can do more of that behavior.
That said, the process of organizational development can be described in these 4 phases. (Source: Gallant & Rios, 2014).
Document2
- The start-up phase requires candid assessment of what is working, what is not working, and what is needed. The selection of a coach or consultant is crucial. Leaders should not select someone they like as a potential confidante or best friend. Leaders should select the most expert consultant who can help them master a new behavior. For instance, if a leader needs a woman who speaks Spanish to help prepare for relocation to Mexico City, then I am not qualified. The goal of this start-up phase is to define boundaries of the engagement, and to mutually agree on those boundaries in a written contract.
- The diagnosis phase includes learning what the leader thinks about their reputation, brand, strengths, and weaknesses. That self-assessment often conflicts with data gathered from others. Techniques include surveys, interviews, assessments, observations, and video. The word “diagnosis” is not accurate, because it implies a gap or deficiency that is static and needs correction. I prefer the words “development” or “focus” or “assessment” because they accurately describe the ongoing quality of coaching engagements that reinforce the strengths of leaders.
- The intervention phase is the core of any coaching engagement. The process includes ongoing assessment of the client’s agenda, review of behaviors, feedback, and constructive actions. There is both art and science involved in coaching. The art requires constant attention to the leader’s words and actions, following intuition, and what I call “dancing with curiosity.” The science requires ongoing consideration of recent research in evidence-based behavior or world-class tactics that may be useful to the leader.
- The transition phase occurs at the end of every coaching session, in monthly written summaries, after any feedback session or observation, quarterly frequency reviews, and opening and closing meetings with the leader, HR business partner, direct manager, and the coach. Those 4-way meetings insure that behavioral outcomes have been exceeded. As a 4th step in this model, the transition phase reminds all stakeholders that coaching has a beginning and an end. There are some “executive coaches” who boastfully declare that they have provided value to a leader for years. I sincerely hope that they regularly review the behavioral outcomes and business needs so that each phase of that engagement is closed. If not, they may be describing a dependent relationship that has little to do with a leader’s need for behavioral change.
This neat model with 4 phases may be useful for those who like structure. Accountants and engineers and some HR managers may find them useful.
One final thought: if the client needs a more fluid model, then these 4 steps can be twisted into a circle or a spiral.
Call us if you need to assess step 1 above, the start-up phase.
If we cannot help you, then we will refer you to someone who can do so.
Reference:
Gallant, S. & Rios, D. (2014). The organization development (OD) consulting process. In B.R. Jones & M, Brazzel (Eds.), The NTL handbook of organization development and change (2nd ed.) (pp. 153-174). San Francisco, CA: Wiley.
by Doug Gray | Aug 16, 2015 | change, healthcare, Leadership, Managers, physicians, strengths
Every U.S. citizen has a vested interest and an opinion about the quality and effectiveness of healthcare delivery, a $3.8 trillion industry with rapidly escalating costs.
The fastest-growing industry in healthcare is telemedicine, which is now used in over 50% of the hospitals in the U.S. to promote remote access to healthcare. Examples range from tele-surgery to tele-emergency care to tele-psychiatry. The reasons for telemedicine abound. It allows specialized care to be distributed from a central hub to a rural location or an underserved population, efficiently and at lower costs. For instance, in 2012, the Veterans Administration (VA) documented over 1.5 million telehealth sessions, for over 35% of veterans.
Problem statement and opportunity
The primary problem with telemedicine is low user adoption rates because many people resist organizational change. The result is massive waste that can be reduced. Telemedicine technology and processes exist. However, organizational readiness for telemedicine results from two variables: 1) ability to change, and 2) motivation to change. The innovation diffusion curve (see Figure 1) demonstrates an immediate opportunity for telemedicine initiatives to move from the early adopter phase to the majorities.
Organizational readiness for telemedicine can be measured. The key variables for organizational readiness include 1) executive sponsors who champion the ability and need to change, 2) buying agents convinced by case studies or ROI data of the economic value for the change, and 3) consumers driven by a compelling need for effective, inexpensive health care outcomes. The need for organizational leadership innovations in telemedicine programs is immediate.
Figure 1: The innovation diffusion curve (in Rogers (2003) Diffusions of Innovation)
Unique opportunity: Tennessee
Although resistance to telemedicine is a global problem, we have a unique opportunity to provide a solution from Tennessee. Described as the “Global Center of Healthcare,” Nashville, TN has over 400 healthcare companies, spawned from Healthcare Corporation of America (HCA). On January 1, 2015, Tennessee became the 21st state to enact “telemedicine parity” legislation requiring that insurers reimburse licensed health care providers for services delivered remotely just as they would for in-person visits. On February 15, 2015 Tennessee added law stating that telehealth providers will be held to the same level of care as direct care providers (SB 1223). That law “opened the door” for telemedicine services to be delivered remotely, at lower cost, to rural minorities in Tennessee. We are in the right time at the right place to lead innovation in telemedicine.
Sadly, there is resistance to telemedicine from consumers and administrators who do not trust the government, or the technology, or the financial benefits. A telemedicine visit may cost $50 and take 10 minutes (e.g. MD Live, Teladoc); an ER visit may cost $150 and take 3 hours; a hospital visit may cost $15,000 and take 3 days. Telemedicine has demonstrated a 10X cost savings. Unless, of course, there is organizational resistance to change, in which case telemedicine is a waste of time and resources.
One administrator said, “We have 3 telemedicine kiosks sitting in a storage room, hidden by sheets. The vendor who provided them no longer exists. The technology may be extraordinary, but I cannot get my physicians and nurses to use it.” His experience represents hundreds of wasteful healthcare initiatives.
What can you do to increase adoption of telemedicine?
by Doug Gray | Aug 10, 2015 | book review, change, Coaching, Leadership, money, Personal Development, talent
(Disclosure: I am a fan of Marshall Goldsmith because he is an enthusiastic role model for countless executive coaches. When I shook his hand at an event hosted by the Center for Creative Leadership, I told him so. And when I was given four copies of this book to distribute to our largest CoachSource clients, I told them something favorable. Marshall Goldsmith has celebratory cachet as a thinker and a champion.)
I wanted to love this book, but it fell short.
Triggers can be defined as “any stimulus that defines our behavior.” That broad definition enables Goldsmith to go beyond Skinnerian behaviorism, or beyond antecedent-behavior-consequence, or Duhigg’s cue-routine-reward model. The “Circle of Engagement” model includes five steps: trigger-impulse-awareness-choice-behavior. The primary focus of the book is to “help others achieve lasting positive change.”
Structures help us define individual behavioral change. Goldsmith defines three structures: the AIWATT question, the “Six Engaging Questions” and the “Wheel of Change.”
- The AIWATT question can increase engagement. Ask yourself, “Am I willing, at this time, to make the investment required, to make a positive difference on this topic?” Am I willing at this time… is the short version.
- The six “Engaging Questions” can be useful early in a coaching engagement, and when measuring behavioral trends. The questions are: 1. Did I do my best to set clear goals? 2. Did I do my best to make progress toward my goals? 3. Did I do my best to find meaning? 4. Did I do my best to build positive relationships? 6. Did I do my best to be fully engaged?
- The Wheel of Change can be described using two axis or four spokes on a wheel. One axis is the Positive to Negative axis, which “tracks the elements that either help us or hold us back.” The second axis is the Change or Keep axis, which “tracks the elements that we determine to change or keep in the future.” This descriptive model encourages clients to explore what they may need to create, eliminate, accept or preserve in order to achieve their desired behavior change.
The remaining content includes anecdotes from Goldsmith’s broad client base. His charming, self-effacing style often made me smile. The inclusion of the Buddhist anecdote reminding us that anger is always directed at “an empty boat” is a perfect reminder to stay focused on our internal locus of control in the moment. The resounding feeling I had is that the book made me feel good, consider using some of these structures, and then wonder “Now what?”
There are no citations of published works in this book. However, an emerging body of academic research does exist. Positive psychology provides the theoretical construct that the profession of executive coaching sorely needs. There is abundant research in well-being. Seminal leaders include Richard Boyatzis’ Intentional Change Model and studies using neurobiology, Mihaly Csikszentmihalyi’s Flow and optimal experience research, and Martin Seligman’s work in PERMA (positive emotion, engagement, relationships, meaning and purpose, and accomplishment.) These are evidence-based thought leaders, with broad following, who are not referenced by Marshall Goldsmith. That fact makes me wonder, why not?
According to the International Coaching Federation, there are now some 50,000 professional coaches in a $7 billion industry with little consistency. (Disclosure: I have been certified at the ICF-PCC level since 2006.) The Conference Board 2014 survey, from 142 companies, defines external executive coaches compensation ranging from $600-200/ hour depending upon the size of the company, developmental needs of the leader, and seniority. The average investment for 6 months and 40-45 hours is $25,000. The 2014 ICF survey states that the average salary is $214/hour. The market realities and financial value of executive coaching are significant.
My experience of countless “coaches” is that the profession sorely needs a) a scientific evidence-based backbone and b) a theoretical backbone. Without such theory, science, and applications, the profession of executive coaching is at risk.
In hindsight, I realize that I wanted Marshall Goldsmith to provide some leadership or insight into these aspects of executive coaching. Marshall Goldsmith’s book Triggers does not address any of these academic, social and market realities. Hence it fell short of what I had expected. I can imagine him chuckling and retorting, “OK, so what are you going to do that would make you happier?”
Perhaps that is the subject for a different blog.
Call me if you’d like to discuss this book?
by Doug Gray | Aug 1, 2015 | change, Coaching, healthcare, Leadership, Managers, talent
Physicians with resilience have:
- Increased career satisfaction
- Higher personal life satisfaction
- Enhanced performance and efficacy
- Engagement with lifelong learning
- Skills that may be modeled and directly transferable to patients (e.g., CBT)
Thankfully, resilience can be taught and developed.
Resiliency can be defined as “the capacity to adapt successfully in the presence of risk and adversity.”
Take this quick self diagnosis for burnout and resiliency:
Take a moment to write down where you think you are on a scale of 1 (low) to 10 (high) on these two measures. Note that burnout and resiliency are directly related and inversely related. Like any coin with two sides…
A self-diagnostic question is “How do you know if you are avoiding burnout behaviors?”
An organizational-diagnostic question is to ask your team if they have noticed you being less compassionate, hopeful and caring lately?
Or if you are daring, ask your team if they have noticed you being more abrupt, judgmental, or impatient lately?
(We are often hired to assess the degree of burnout or resiliency in a practice group.)
My experience is that these bullets are 5 reasons for you to do some work. “Physician heal thyself” is axiomatic. As a species, we need to make more anabolic choices than catabolic choices.
CBT is cognitive behavioral therapy, a psychological process that recognizes choice, personal strengths, and includes reqular behavioral feedback.
I hire a dentist when I need dental work; why wouldn’t you hire a psychologist when you need to develop resilience for your self or your team?
by Doug Gray | Jul 6, 2015 | Business, change, Coaching, Leadership, Managers, strengths, Success, talent, talent assessment
How do you measure learning and development?
The Greeks believed that the “rope of one’s life” was defined by three fates, who spun the thread of life, measured it, and then cut it.
Instead, imagine that your career can be described using a 10’ long piece of rope. If you dropped the rope at your feet it would look like several messy loops. Most of us choose to believe that we have some impact on the “rope of our careers.”
Now imagine that you have a work team of 5 people. If they each had a 10’ long piece of rope and dropped those ropes at your feet, then how would you describe that messy image?
Talent management is a cyclical model frequently described with three loops: attraction, development and retention. Some of those key metrics include efficiency, effectiveness and outcomes. A tremendous resource for talent managers who want to demonstrate accountability, like any CFO or business leader, is at www.centerfortalentreporting.org
The ultimate goal of talent management should be to retain desired employees, not all employees.
There are actually 6 loops in talent management. Think of your process as 6 inter-related loops that include: talent acquisition, learning and development, leadership development, performance, total rewards, and succession planning. Here is a definition of each loop, plus some comments.
- “Learning and development” services support all of the organizational activities aimed at improving the performance of individuals and groups within the organization. The learning and development process includes addressing gaps in skills, knowledge and competencies, and then building the strategic talent capabilities of the organization through a systematic focus on competence required to meet business objectives. Aspects of learning and development may include job profiles, competency mapping, knowledge management, behaviors, skills, ability tracking, learning content, training, coaching and assessments.
Despite the trend toward digital content delivery, adoption of digital content remains below 20% in most industries. Make certain that you are using short, sensational videos, interactive quizzes, and social followers or gamification to promote goals of instructional designers. The bottom line? Be careful if investing in digital solutions and expecting high user adoption rates.
The 70:20:10 model for learning and development is a guideline or frame of reference that is now used to both 1) promote learning and 2) restrict learning. Let us assume that learning results from 70% on-the-job or self-directed learning, 20% from managerial or client feedback, and 10% from courses and reading. Then what does that mean in your organization?
- Do you expect to foster innovation internally, by engaging employees or actively managing their professional development plans?
- Do you restrict that manager who spends more than 20% of her time and energy on that direct report that has high potential, but lacks procedural knowledge of customer delivery?
- Do you invest in external coaching and consulting for your top 20% producers, as a development tool to increase retention some 14 months on average?
We do not need any insight from the Greek fates to measure the impact of learning and development on the “rope of our careers.”
We do need to foster learning communities in order to increase engagement, retain desired employees, and serve our clients and customers.
If you need help measuring the impact of learning and development for individuals or organizations, then contact us today.
Recent Comments