Ready, Fire, AIM

ready fire aim

One of the most important lessons of the last 12 months for me has been the perils of firing before sufficiently aiming.  With the Myers Briggs personality preferences as context, its easy to understand why this can be a huge stumbling block for some (like me) while a no-brainer for others.

By aiming, here’s what I mean …

  • Taking the time to engage those who will be affected by the ‘fire’ in discussion, debate, persuasion, listening, reconsidering.
  • Creating a plan and …
  • Creating it WITH the people who have to implement the ‘fire.’
  • Taking the time to test, reconfigure, test some more, get a scoreboard of results to show the org. BEFORE flipping the switch to require the change.  This is particularly necessary when there are mixed reviews with the current state.

There’s a balancing act here.  On the one hand you can aim too long (analysis paralysis) and results may suffer from that inaction.  On the other hand (the one that I dealt with most during the last 12 months) to pull the trigger too quickly (even if the decision is logical and the right one) can lead to a botched implementation that prevents the ‘right decision’ from taking root.

Though somewhat against my nature, I’m working at ‘taking the time’ to talk with most involved parties.  I’m convinced this doesn’t have to be a slow process.  It just has to happen.  I’m reminded of what the book 5 Dysfunctions of a Team teaches on this topic … that without conflict/debate/dissent/discussion, real buy-in or commitment cannot take place.  But, with that pre-decision conflict, even those who disagree can come around and commit — knowing that their voices were heard AND having had a chance to better understand the rationale/intent of the other side.

Advertisements

Do you share financials w/ staff?

3 legged stool

 

I am all about analogies.  It’s a curse.  It’s my go-to.  I have a problem.  But, sometimes it really just works.  (I’ll get to it … hang with me).

Nursing Home Administrators are easily seen by their care-giver/clinician staff as only caring about the financial aspects of the facility.  Years ago I became very reluctant to share financial information with my staff out of fear that they would think that’s all I cared about.  I also feared they would mishandle the information.

As though they weren’t sophisticated enough to appreciate the need for the facility to ‘make money.’

So, instead of educating staff on the financial fundamentals and enlisting their help to eliminate waste and be efficient as co-owners of the facility and their departments, we ration out just enough information to get them to do what we want.  We give them a budget for hours or expenses for the month based on our projected census.  They toil away under your close management, trying to hit that budget WITHOUT understanding the larger picture.  I’m not saying that doesn’t ‘get the job done’ b/c in many cases it does.  But, they deserve more.  And with the trust you give them (along with the education), something powerful happens … they come alive and take MORE ownership of their responsibilities.  They take pride in their new understanding and they become more creative problem solvers, now that they see the whole problem to solve and not just their little piece.

Here’s what I’ve concluded …

… if presented properly, sharing the financial realities (challenges and successes) are an empowering, trust-building lever administrators should pull in their management of the facility.

The key phrase, of course, is ‘if presented properly.’  I’ve been burned by sharing facility financial information.  So … the best way I’ve found to empower my staff with this lever is to use the analogy of the 3 Legged Stool.  Here’s how the conversation went at a recent all-staff meeting at a facility that has been losing money ….

Me: What do you think I care most about?

Them: [Thinking: I’m not stupid enough to answer that question … Suspicious smile … long pause]

Me: Really.  It’s ok.  What do you think I care most about in running this facility?

Them: [Still Thinking: I don’t know him well enough to be honest.  He’s just like all the rest, probably.  Money.  The answer is money].  “Patient Care.”

Me: Yes.  What else?

Them: [Oh, there’s more than one answer.  I’ll say it …]  Profits.

Me: Yes.  What else?

Them: [What a dork.  He can’t care MOST about more than one thing!] Ummm … Customer Satisfaction?

Me: Yes.  But, how can I care MOST about more than one thing?  Have any of you ever seen a 3 legged stool?

Them: Yes, of course.

Me: Which leg is most important?  Which leg do you care most about when you sit on it?

Them: The one that’s going to break.

Me: Put yourself in my shoes.  If you were me, what would you say make up the 3 legs holding up our facility?

Them: Money, Patient Care … and … ?

Me: And … customer & employee satisfaction.  Which one do you think I think is most important?

Them: Whichever is weakest?

Me: That’s right.  That’s exactly right.  You’ve heard me talk a lot lately about some our financial challenges.  You’ve seen me tighten up our processes around approving overtime and tightening our belt in other ways too.  We’ve had to flex staffing to appropriate levels that match our lower census.  Our patient care is great.  Our customer satisfaction is high.  Our turnover is low.  But, financially, the facility has been losing money for a few months in a row because we haven’t adjusted our spending appropriately to our low census.  Right now, the leg that’s weakest … the leg’s that’s breaking is the financial one and we have to strengthen it.  Here’s what we’re doing (overview of efficiencies we’re trying to regain).  What else do you suggest we try?  What can you do to help?

(I then asked if any of them had ever been ‘cancelled’ or sent home early from a shift.  100% of their hands shot up.  I asked if they understood the rationale for flexing hours.  If they understood nursing hours PPD and the state minimum requirements.  They did not.  I explained how the hours PPD number is calculated and we calculated it for our facility).  They saw – and understood – how high we were staffed.  They began to ask insightful questions about staffing for acuity and skilled mix and how we derive our goals/staffing targets (which the director of nursing determines based on acuity, by the way).

The feedback from the meeting was very positive.  They went to work the next day with a sounder understanding of what makes me/us tick and WHY we’re managing the financial side of things so tightly right now.  I finished the meeting focusing on the other two legs.  I reaffirmed to them where my heart/passion lie … in creating an environment where they are free to thrive as caregivers.  An environment that creates a surprising experience for our patients and their families.  I concluded with the Cab Driver story.  That’s at an all staff meeting.

1:1 meetings with department heads allow for deeper education on the financial management of the facility and their departments.  I recommend we stop rationing crumbs to the ‘leaders’ of the facility.  Let’s let them eat at the table.  (See?  I had to throw in another analogy!)  Let’s be more transparent with our P&Ls so they can take ownership, and eventual PRIDE in the successful operation they’re responsible for shaping.

“You Don’t Have Credibility”

Ouch.  No, really.  That hurt.

Can you hear more humbling words as a new leader?  That’s what our CEO told me years ago when I passionately made the case for him to have me train anyone in the organization who would listen about creating a world-class service environment in their facilities.

I had just gotten religion and like any new convert, I was ready to evangelize.

ritz carltonAfter attending a Ritz Carlton day-long training, I was convinced that becoming the ‘Ritz Carlton’ of skilled nursing facilities would be the ultimate lever to pull to transform and turn around a facility that had failed survey 8 years in a row (under prior ownership) and lost us a lot of money out of the gate.  Not only that, but I had found my voice as a young leader in long-term care.  I came back to my facility after that training and, with my team, created our version of a world class service culture.

(Remind me to post on the process later b/c the process is where the magic lies, not the outcome).

After just a couple months of establishing the new culture, I made my pitch to our CEO.  I can get pretty animated when I’m talking/debating/evangelizing something I’m passionate about.  I knew this was the answer for my facility and, therefore, all of our operations.

One thing you got to know about him is that one of his greatest strengths, in my opinion, as a leader, is how he encourages entrepreneurship, innovation, intelligent risks.  He rarely says no to the enthusiasm of his partners.  So … after listening to me go on and on about world class service being the game changer for our group and my desire to hit the road to train all of our facilities in it, he said (to the effect of):

“You don’t have enough credibility — yet.”

[Dramatic Pause]

I was a combination of offended/disappointed/humbled/surprised.  Initially, I thought he was stupid.  I thought to myself (and out-loud to him): “how can you argue against elevating, systematically and massively, the level of customer service in our facilities?!  It’s going to pay off!”

Looking back, I’m EXTREMELY fortunate to have had this lesson taught to me in such a poignant way at an early stage in my career.  He was, in fact, not stupid at all.  He was totally right.  At the time I couldn’t see it.  But, just 18 months later it was crystal clear…

The facility had transformed.  In about 12 months time it went from worst to first in the org. financially and passed survey for the first time in 9 years.  Customer satisfaction was high.  Turnover was low.  We had RESULTS.  Those results are what caused my partners throughout the org. to PULL me to their facilities to share what we had done instead of me trying to PUSH my way on to their radars.

He was right.  Ideas and passion are important when it comes to bringing transformative ideas/culture to a facility or organization.  But, if presented prematurely — before the results or proof to back it up — the idea or idea giver won’t take root and won’t make the difference s/he’s so passionately trying to make.

18 months later, I began each training session on world class service with the results – Before on the left side of the white board and After on the right side.  I then put a big question mark in between.  The stark difference in the before and after is what brings the credibility … and causes the DEMAND for you and your ideas.

The Other Day …

It’s easy now to look back and see the wisdom of my CEO’s candid rebuke.  But, at the time it was devastating ego-bursting stuff.  I recently interviewed someone who wanted to be a regional resource.  He has a magnetic, positive personality and he knows his stuff.  His problem, however, is that his on-paper results are sub-par.  We talked candidly about the huge challenge he would have coaching/teaching others without being able to say, “Do this because I did and look at my superior results.”  For him, like me years ago, the timing isn’t right.  I’m sure he’ll get his shot … when his results match his enthusiasm.

Credibility

Credibility: “the quality or power of inspiring belief” (webster)

Credibility may be the single most important thing a leader possesses in order to effectively lead. During the past 12 months I’ve learned the hard way this lesson, that on the surface seems obvious, but to those of us who suffer from inflated egos, can be a crippling blind spot …

Credibility is a non-transferable asset.

When you move from one group, team, division, or company to another, you start over. You start over … if you’re smart. If you’re blind to the fact that credibility is a non-transferable asset, you assume that these new people who you need to develop relationships of trust with will pick up with you where your former group, team, division, or company left off. Or, you assume that the new group, team, division, or company will quickly see in you what the former did. It doesn’t work that way.

So, what inspires belief? For me, a leader’s true intention must be made clear. Second, his/her actions must match that intention. Third, those actions must lead to the desired results.

Some questions I wish were more front and center for myself this last year …

* Am I taking the time with each individual to articulate my intention and related plans?
* Am I acting as though I already have their trust prematurely (i.e., making unilateral decisions, trusting that they will buy-in b/c the decision is coming from … me)?
* Am I holding myself accountable for the results?

The number of initials that follow your name, the resume, the references … they get you through the door. But, once you’re in, you START OVER at earning the credibility of those you lead and those that lead you … if you’re smart.

Mothers in long-term care

I was asked to speak in church today.  Mother’s Day.  No pressure.

As I prepared for my talk, I remembered a classic, inspiring, true story of a taxi driver who picked up somebody’s elderly mother late one night to take her to a hospice facility.  It didn’t end up fitting into my talk, but I wanted to share it here.  I’ll be sharing it with the staff at the two facilities in Denver I’ve been helping with this week.  Enjoy.  And, pass it on.

“Twenty years ago, I drove a cab for a living. One time I arrived in the middle of the night for a pick up at a building that was dark except for a single light in a ground floor window.

Under these circumstances, many drivers would just honk once or twice, wait a minute, then drive away. But I had seen too many impoverished people who depended on taxis as their only means of transportation. Unless a situation smelled of danger, I always went to the door. This passenger might be someone who needs my assistance, I reasoned to myself. So I walked to the door and knocked.

“Just a minute,” answered a frail, elderly voice.

I could hear something being dragged across the floor. After a long pause, the door opened. A small woman in her 80’s stood before me. She was wearing a print dress and a pillbox hat with a veil pinned on it, like somebody out of a 1940s movie. By her side was a small nylon suitcase.

The apartment looked as if no one had lived in it for years. All the furniture was covered with sheets. There were no clocks on the walls, no knickknacks or utensils on the counters. In the corner was a cardboard box filled with photos and glassware.

“Would you carry my bag out to the car?” she said. I took the suitcase to the cab, then returned to assist the woman. She took my arm and we walked slowly toward the curb. She kept thanking me for my kindness.

“It’s nothing,” I told her. “I just try to treat my passengers the way I would want my mother treated.”

“Oh, you’re such a good boy,” she said. When we got in the cab, she gave me an address, then asked, “Could you drive through downtown?”

“It’s not the shortest way,” I answered quickly.

“Oh, I don’t mind,” she said. “I’m in no hurry. I’m on my way to a hospice.”

I looked in the rear view mirror. Her eyes were glistening.

“I don’t have any family left,” she continued. “The doctor says I don’t have very long.”

I quietly reached over and shut off the meter. “What route would you like me to take?” I asked.

For the next two hours, we drove through the city. She showed me the building where she had once worked as an elevator operator. We drove through the neighborhood where she and her husband had lived when they were newlyweds. She had me pull up in front of a furniture warehouse that had once been a ballroom where she had gone dancing as a girl.

Sometimes she’d ask me to slow in front of a particular building or corner and would sit staring into the darkness, saying nothing.

As the first hint of sun was creasing the horizon, she suddenly said, “I’m tired. Let’s go now.”

We drove in silence to the address she had given me.

It was a low building, like a small convalescent home, with a driveway that passed under a portico. Two orderlies came out to the cab as soon as we pulled up. They were solicitous and intent, watching her every move. They must have been expecting her. I opened the trunk and took the small suitcase to the door. The woman was already seated in a wheelchair.

“How much do I owe you?” she asked, reaching into her purse.

“Nothing,” I said.

“You have to make a living,” she answered.

“There are other passengers.”

Almost without thinking, I bent and gave her a hug. She held onto me tightly.

“You gave an old woman a little moment of joy,” she said. “Thank you.”

I squeezed her hand, then walked into the dim morning light. Behind me, a door shut. It was the sound of the closing of a life.

I didn’t pick up any more passengers that shift. I drove aimlessly, lost in thought. For the rest of that day, I could hardly talk. What if that woman had gotten an angry driver, or one who was impatient to end his shift? What if I had refused to take the run, or had honked once, then driven away?

On a quick review, I don’t think that I have done anything more important in my life. We’re conditioned to think that our lives revolve around great moments. But great moments often catch us unaware—beautifully wrapped in what others may consider a small one.”

– http://kentnerburn.com/archives/391