Jim Rome, John Wooden, Skilled Nursing “Success”

When I was in High School, my buddies and I listened to a new, up-and-coming, cocky sports talk radio guy, Jim Rome.  He constantly played his verbal trump card against people critiquing successful players/teams.  He would simply respond by saying, “Scoreboard!

Does anyone have a better scoreboard than John Wooden?  The best coach in sport.  Scoreboard? 10 national championships at UCLA.  But, why do I love and respect and listen to the man?  Because of how he won.  Coach Wooden came to mind today because of a conversation with another guy who’s the “best” at his sport, my friend David Howell, a facility CEO for The Ensign Group in southern California. In my opinion, Howell’s one of the best SNF EDs in the country.   It’s almost unbelievable to see what he’s built out of his small SNF in a very blue-collar neighborhood.  His facility won Ensign’s highest total quality award today and he shared with me what he was planning on saying at the ceremony … Wooden, “C.S. Wooden” 😉

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I want to share these two thoughts from a talk Coach Wooden gave and that Howell shared today as well.  But, you really ought to watch the whole talk below.

  1. Winning is not in the definition of success.  Here’s what C.S. Wooden said success is: Peace of mind attained only through self-satisfaction in knowing you made the effort to do the best of which you’re capable. I believe that’s true. If you make the effort to do the best of which you’re capable, trying to improve the situation that exists for you, I think that’s success, and I don’t think others can judge that; it’s like character and reputation — your reputation is what you’re perceived to be; your character is what you really are. And I think that character is much more important than what you are perceived to be. You’d hope they’d both be good, but they won’t necessarily be the same. Well, that was my idea that I was going to try to get across to the youngsters.”

  2. This.  Poem by George Moriarty, called The Road Ahead, Or The Road Behind.”
    “Sometimes I think the Fates must grin as we denounce them and insist the only reason we can’t win, is the Fates themselves have missed.

    Yet there lives on the ancient claim: we win or lose within ourselves. The shining trophies on our shelves can never win tomorrow’s game.

    You and I know deeper down, there’s always a chance to win the crown. But when we fail to give our best, we simply haven’t met the test, of giving all and saving none until the game is really won;

    of showing what is meant by grit; of playing through when others quit; of playing through, not letting up. It’s bearing down that wins the cup.

    Of dreaming there’s a goal ahead; of hoping when our dreams are dead; of praying when our hopes have fled; yet losing, not afraid to fall, if, bravely, we have given all.

    For who can ask more of a man than giving all within his span. Giving all, it seems to me, is not so far from victory. And so the Fates are seldom wrong, no matter how they twist and wind.

    It’s you and I who make our fates — we open up or close the gates on the road ahead or the road behind.”

Congratulations to David, Lito, and the entire Brookfield team.  You’ve been a stunning SUCCESS for many years before winning the Flag today.

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“Bring your heart to work”

I shared this with an operator the other day and thought it would be a good topic to bring me back to LeadingLTC.com after so long …

Like most people I know, I’m inundated with data/articles/stories/information every day. So much so that I tend to skim the surface of a lot of stuff but I rarely take the time to actually pause and read/watch and think. This article and video caught my eye today and it reinforced for me that the most important thing in skilled nursing is “bringing your heart to work.” I can’t think of anything more important than deliberately, systematically, structurally driving this in the culture at every level of the organization at every location.

This is a great reminder and a powerful example of another healthcare provider. I hope it inspires you in some way too.

ARTICLE
VIDEO
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I just want to be … feared?

This video is a worthy 12 minutes to make us pause and reflect.  The danger I see in talking about leadership is that the “lessons learned” or the lesson “meant to be taught” usually overemphasizes that one aspect of leadership.  The responsibility of leadership REQUIRES several traits/skills/habits, not just one.  Even though this focuses on one, as long as we see it as a string in the tapestry of what leaders need, I find the concept here to ring true.

Making people who “work for us” feel safe seems to require taking the LONG VIEW toward your business and the co-people around us.  Ofttimes, a company’s culture will trump our better-inner-leader.  We perform according to how we’re measured and so its critical that we find a culture that allows for that.  Even better … its critical that we shape our company’s culture into one that fosters that long view as well.

Stooping To Greatness, Part 2

Yesterday, I ran into an “old” former colleague.  It had been years.  First thing he said: “How is that we look so old now?”  I never liked him.  Ha!  🙂

The truth is that it was great to reconnect.  Coincidentally, he’s in the midst of solving some of these same cultural puzzles for his new organization.  We talked about Part 1 over lunch.

A couple key points when beginning this new culture adventure …

  • There’s a huge difference between the sugar-rush, Diet Dr. Culture & Built-To-Last Cultures.

    Most staff have seen the Mission/Vision/Whatever that comes down from the Ivory Corporate Tower.  They are forced to attend the meetings and trainings, often delivered by corporate types or half-heartedly by facility leaders.  During those meetings, they are very quietly grabbing each others hands with a knowing nod: “This too shall pass.”  And, they’re right.  It won’t last because they (the staff) didn’t give birth to it.

No longer collecting dust on the wall.
No longer collecting dust on the wall.  You can’t make this up.  In the basement of my facility, I was looking around for some equipment.  I turned on the light and saw these artifacts from the prior facility occupants.  I don’t know what caused them to fail.  But they did.  Anecdotally, I’ve seen this play out time and again.  Where there is no vision, the people perish.  Without a vision/culture that actually inspires (or at least captures their hearts and minds), you’re programs become artifacts.
  • The GIVING BIRTH metaphor.

    I’m a guy.  I’m no expert.  I know.  But, I’m a father of 5, does that count for anything?!  Here’s the metaphor that fits so well here: Establishing your company/facility’s culture should be like giving birth.  There’s power in the creative process.  There’s a massive difference psychologically (for buy-in/commitment) if I’m able to participate in defining the culture (expectations, standards, rewards, etc.) as opposed to having Know-It-Alls present it to me.  If I go through the labor of wrestling with the words, values, mottos, standards, and behaviors that we want for our workplace, and then the delivery of agreeing to and training new hires in it, then I will be committed to the final product in a way that I simply can’t if it’s presented to me … let me illustrate:

    • Several years ago I went through this creative process for the first time at a building I ran in Orange County, CA.  Our before and after scoreboard made many in the organization take note and ask me to share our “secret sauce” as we went from worst to first in some key metrics like EBITDAR PPD.  I was more than happy to share.  It felt like I was on tour as I presented to more than 1/2 of our facilities.  I would spend an entire day with a facility’s leadership team – presenting to them the what, how, why, and when of World Class Service, which is what we labeled the culture we gave birth to.  The immediate response from those many facility teams was, by-and-large, enthusiastic.  They wanted to do the same thing at their buildings.  They wanted to do it right away.  I gave them our Mission & Standards documents.  I gave them our Orientation packet.  I gave them our Daily, Weekly, Monthly system for making the culture take root.Poster-BWC-[Converted]-Outline
    • Poster-BWC-Standards-[Converted]-OutlineAnd, then I left to the next facility.  I hit rewind and repeat.  Over and over again.  I personally felt tremendous excitement about making a difference beyond my facility.  I felt appreciation from ED/DNS partnerships who were looking for that missing thing to take them to the next level.  They found it.  They believed.  And, except for a handful of facilities, most of their efforts fizzed out within 3 to 6 months.Why?  I’ve thought a lot about that.  Ultimately, I believe two things are absolutely required in order to transform your culture into a transformative force:
      1. The Executive Director must be a “true believer(not the regional or the divisional or the owner at the home office)

      2. S/he must lead her/his facility through their own creative process.  They must reinvent the wheel instead of adopting someone else’s wheel (no matter how successful that wheel made that someone else).

If this is true, then the questions become what, why, how, and when to recreate the wheel.  The Birds And The Bees, if you will, of how cultures are made (I couldn’t resist).  Culture Birds & Bees.  That’ll be part 3 next.

Stooping to Greatness, Part 1

It’s ironic that I spend as much time as I do here and with colleagues on time management.  Ironic because I’m not naturally a very organized person.  The opposite is true.

I’ve learned the hard way (and the incredibly rewarding way) that the only way I can get to the VERY IMPORTANT x NON-URGENT stuff that will either transform a facility or take it to the next level is to become great at time management.

There’s a great thought in scripture that goes like this: Where your treasure is, there will your heart be also (Matthew 6:21).  Adapted to the nursing home administrator, we can say …

What you spend your time on, that’s what matters most to you.

You may protest.  You may say, “No, Dave.  The reality is I can’t get to what matters most to me because I have to spend so much time on this other stuff that keeps coming at me.”  As we climb up to the balcony and look down at our operations and at ourselves, we’ll probably see way too much work that is reactive vs. proactive.  Reversing that pattern is what separates the great leaders/facilities from the pack.  So …

  • First things first = First who, then what.  Let’s first surround ourselves with people more talented and driven than ourselves.  They’re there.  In every position.  If we settle for less than “A” talent, we will be settling for mediocrity and burnout.
  • Second (simultaneously), get the fundamentals in place.  Apply our Daily, Weekly, Monthly system approach to marketing, expense management, labor, clinical metrics/outcomes.
  • Third, control the monkeys before they lead to your downfall.
  • Fourth (and finally!), you now have time to dedicate to the fine-tuning, pro-active, culture building work that ONLY YOU can lead.

This post is the first of a series that I’ll dedicate to what I believe is the most important work of a healthcare leader: to create a powerful, unique culture.

Culture Model
My step-by-step, “how-to” reinvent the wheel. If you take your parent organization’s mission statement or use some other company’s culture stuff, you are missing the chance of a leader’s lifetime. There is a POWER that comes from the creative process. Or, the birthing process. What you collectively give birth to becomes your baby. You want to protect it. Nurture it. It becomes your competitive advantage that your competitors cannot replicate.

DOWNLOAD PDF Version Here: Culture Model

The title for this post, Stooping To Greatness, is stolen from a similarly themed article by Patrick Lencioni.  I’m a big fan of his books that illustrate simply and powerfully that what matters most to create lasting, quality success is the SOFT stuff.  The attention to people and culture.

“I’m a prisoner here.”

I just heard one of our patients say that.  He had been sitting in a chair outside my office for about an hour.  Quietly fuming inside.

About an hour earlier, he had pushed the elevator button when a therapist intervened.  It went something like this …

Where are you going?

Outside.

No, you can’t do that.

Why not?

You have to stay on your floor.

Oh, and why’s that?

Well, because we have to know where you are.  We’re responsible for your safety.

Ok.  I’ll tell you where I’m going.  Outside by the entrance.  I want to go outside.

No, you can’t leave this floor.  If something happens to you, we’ll get in a lot of trouble.

An hour later, his nurse and CNA both tried to get him to go to the dining room.  This time he was resolute.  He wouldn’t budge.  He called himself a prisoner b/c the staff wouldn’t let him leave.  I would’ve been the same way.  After a few back-and-forths about whether he would or would not go to dinner or even ever leave that chair, I stepped out of my office and said,

You want to go outside?

They won’t let me.

Who won’t let you?

The people here.

There must be some misunderstanding.  They probably meant that you needed to go with someone.

No.  They said, “You can’t leave this floor.”

Well … let me see what I can do.  [I went to the gym and asked the therapists about him.  They were thrilled with the idea of me escorting him outside.  They just didn’t want him to go alone as he still has a ways to go to get his strength back and is at risk for falling.  I came back with the good news.  He couldn’t believe it.]

We went down together and I pulled the bench into the sun.  Gorgeous day.  We talked for about 45 minutes.  WWII veteran.  married to a ‘saint’ for 60+ years.  A few kids.  He’s the last surviving child of 8 kids in his family.  He told me about his ‘crooked’ father in law who died with $500,000 in the bank.  We laughed.  I teased him.  He teased me back.  We talked about religion and faith and cashing in his chips after 92 years on the earth.  After a while, he said, “Well, is it time for dinner?”

Yeah, are you ready to go back in?

You bet.

He literally had a large smile on his face when he sat down to eat dinner (after everyone else had already eaten by this time).  It struck me as I sat back down in my office how differently that could’ve gone (and sadly too often does) … the nursing/therapy staff get frustrated by the patient’s “behavior” and start to treat him as an object more than as a person.  He becomes a problem.  Stubborn.  “Non-compliant.”  A pharmaceutical intervention is ordered and the man, the WWII veteran, loses a little bit of his identity and dignity and control.

As a facility leader, it’s my role to establish a culture within the facility where that latter scenario is avoided — when it’s avoidable.  We have to create a mission, a purpose for our staff that is larger than a paycheck or a task to constantly motivate them to SEE their brother, sister, mother, or father in the eyes of the patient sitting in that chair.  I saw the difference tonight in being task-driven/objectifying and human-driven/personalizing.

Our great challenge is to systematically enable our great staff to personalize their residents’ and patients’ experience …

The Biggest Bonus I Ever PAID

In a cluster of Colorado facilities I’ve been a part of these last couple months, we’ve been talking about how to create a culture — within our cluster/company and within our facilities.  It’s a topic I feel passionately about and one that I’ve personally participated in at a couple facilities and at a ‘corporate support office’ setting.  I’ve personally seen MASSIVE strides forward as teams dedicate themselves to a deliberate defining, planting, growing, and nurturing of a unique culture.  The process of creating that will be covered in another post.

Part of growing and nurturing a culture relates to where the rubber hits the road or when staff can see you put your carrot or stick where your mouth is.  The most powerful example of that is a story I’ve shared a lot in training settings about establishing a culture — a story of the biggest bonus I ever gave.

Several years ago, my new team and I had just defined our new culture.  Our mission, promise, motto, standards, etc.  It was time to show that it was real.
The culture was starting to do what it’s supposed to do — produce results (clinical and financial and resident/patient satisfaction).  After a solid month, I asked my department heads who “lived the culture in your departments the best.”  I received a handful of names and emailed my payroll manager the following:
On payday, please bring me the paychecks of Maria, Cathy, Jennie, Don, and Debbie. (names have been changed).  I’d like them to pick them up from me directly.  In addition, please create separate bonus checks in the following amounts:
     – Maria: $200
     – Cathy: $500
     – Jennie: $300
     – Don: $1,000
     – Debbie: $150
When payday came, Maria went to the payroll manager to pick up her check.  Here’s what went down …
Maria: Hi, can I have my check?
Payroll: Oh, no.  Sorry.  Dave has your check.
Maria: [struck with concern] But, why?
Payroll: You know … he didn’t say.  But, he wants to give it to you himself.
Maria: No.  Really.  Why?  What did I do?
Payroll: No idea, Maria.
     – Maria did not come to my office.  She spoke with the other housekeepers.  She confirmed her fear … they had all received their checks.  She was worried.  Was she going to lose her job?
     – Finally, after her shift was over, she came to my office.
Maria: Hello, Dave.
Me: Maria, come on in.  Have a seat.
Maria: Ok. Payroll tells me you have my check.
Me: Oh, right.  Yeah, have a seat.  [we sit down and I reach into my desk for her check(s)]
Me: Do you know why I have your check, Maria?
Maria: [Visibly worried] No.  Did I do something?
Me: [Smiling] … Sort of.  But, it’s not what you think.  See, last month was a very busy month here.
Maria: Yes.  Lots of room changes!
Me: That’s right.  You guys were very busy making room for the growing census.  Well, when we get very busy like that, we do better financially.  And when we do, we like to share it with those who were so important to making it happen.  So, last week I asked your supervisor, “who lived our culture [me pointing to the newly defined culture poster on my wall] this last month the best?”  Do you know who he said?
Maria: [Recognition coming to her of pending good news] Maybe me?
Me: Yes!  He said you.  In fact, here’s what he told me about you (related the specifics to the newly defined culture on the wall).
Maria is becoming visibly happy.
Me: So, yes … here’s your paycheck. And, here’s another check. It’s a small token of appreciation for being a great example of what we’re trying to become.
Maria: [she opens the bonus and immediately weeps.  As a housekeeper, she had never received a bonus before.]
We talked about what she’ll do with the money.  She’s SO grateful.  I tell her that compensation and bonuses are confidential so please don’t share this news with anyone.

This happens to be the best way to get the word out 🙂  Why?

= Her colleagues already know she didn’t get her paycheck and they’ll be anxious to hear why she had to get it from me directly.  She’ll tell them.  And, that’s exactly what I hope happens.
I hope that the message spreads fast that you can get a bonus when 1) we do well as a facility and 2) are modeling the behavior/culture we are striving to establish.
It’s the biggest bonus I ever paid as measured by its impact on our facility culture.  Here’s why:
  • Everybody was stoked for Maria
  • Communicating to Maria that she got it because of her supervisor built loyalty between her and her supervisor instead of between her and me.
  • Her supervisor, my direct report, was grateful that I made him look like a thoughtful, generous boss.
  • The staff began to believe that we really were committed to the mission we had collectively defined.

Now … multiply that by the other people who received bonuses that month and the subsequent 6 months and you can see how putting your money where your mouth is will ACCELERATE the momentum we need to as we’re looking to transform or strengthen the facility cultures we’re responsible for.