The Speed of Trust

This is not a book review.

The Speed of Trust is a superbly TITLED book.

The writing itself was a bit too predictable, formulaic, and fluffy for my personal tastes.  I understand FranklinCovey is having success teaching its principles and I don’t mean to disparage the concepts or ideas expressed at all.  Just the opposite.  I believe deeply in what the title of the book, Speed of Trust, means to relationships and organizations.

Think about it in your own life.  I recently did.  Check out the quick back and forth between me and my wife about choosing a family photo to purchase from a recent family photo shoot.  Start from the bottom.

Thoughts?

Here’s how I see this exchange, through the speed of trust lens:

  • Even in the mundane communication(s), love is expressed, setting a positive, supportive, sincere tone.
  • My reply was honest and I thought it would be fun to have the kids ‘vote.’
  • Her response was SPEEEEEDY.  Cut to the chase.  No fluff.  No framing.  No setting the table.  No positioning statements.  Just her true, actual opinion.
How valuable, how precious to an organization or team or relationship to have true, actual, authentic, unfiltered, un-sugar-coated opinions and dialogue?!
If our relationship lacked trust, her response would’ve been very different.  And it would’ve been longer.  Maybe a little something like this …

You know, I really like the idea of printing them out.  I wish I could figure out how to do that myself.  Would you be able to do that for me this evening?  I wish I was as good with computers as you are [read: flattery leading up to a soft disapproval of your opinion to soften the blow] …. as far as the kids voting goes.  I love the idea.  On the one hand it could be really fun to see the differences in how they see the family.  On the other hand it might not turn out exactly as you/we might think/hope it would.  What do you think?  I could possibly see Caleb choosing the opposite of Madi just to be different.  You know what I mean?  I don’t know.  Maybe we can talk about it more tonight before dinner when you get home.  Maybe we could limit it or make it a blind test somehow so they don’t know which one they’re picking.  I don’t know.  You know?  I’d hate to see something that’s a positive possibly turn into a negative.  But, I love the idea of printing them out.  Can you do that for me from work or do you have to be home for that?  Thanks!

xoxoxoxoxoxoxox 

Now multiply the difference in the authenticity and speed of the response by the number of times you communicate as a team in department head meetings, in emails, in 1:1s and you come to realize just how critical it is to MAKE time to develop the trust as individuals and as a team.  A couple of books that I use and highly recommend to others (a lot less textbook feeling than Speed of Trust) are:

Leadership & Self-Deception (best for 1:1 relationship trust repairing/building)

5 Dysfunctions of a Team (best for team trust/dynamics issues)

Washington Healthcare Association

Presentation Summary in Brochure

I had a great time speaking at the Washington Healthcare Association conference last week.  Great vibe.  Great people.  Beautiful place.  It’s a class organization.  Several attendees asked for a copy of my presentation which I’ve posted here as it’s too large to email.

Download Here: Washington_It’sTheCultureStupid

Sister Mary Was Right

Sister Mary Jean Ryan
Sister Mary Jean Ryan

Several years ago, Sister Mary Jean Ryan, Chair/CEO, SSM Health Care spoke to a young, growing, for-profit nursing home company [see her bio here].  She leads SSM, the first Malcolm Baldrige award winner in Healthcare.

SSM’s story is impressive: The system began with five religious sisters who journeyed to St. Louis in 1872 from Germany to be of service to people in need. In their early ledgers, the sisters listed patients who could not pay for their care as “Our Dear Lord’s.” To this day, SSM ensures discounts for people without health insurance. Based in St. Louis, the system is sponsored by the Franciscan Sisters of Mary and owns, manages and is affiliated with hospitals and nursing homes in four states: Wisconsin, Illinois, Missouri and Oklahoma. In 2009, more than 2 million people came to us for care.

I was at that meeting several years ago.  She spoke for about 45 minutes.  I don’t remember what she spoke about, except for one key statement/theme.  Sister Mary said …

“No Margin, No Mission.”

Another way of putting that is “No Profit, No Purpose.”  There’s a persistent debate in long-term care about what’s better, for-profit (FP) or not-for-profit (NP).  I’ve seen arguments from the NP group that their care is superior because they don’t have to meet shareholder ROI expectations.  The implication is that FP providers will cut needed services down to the bone and sacrifice quality care in order to make more money.  I’ve seen arguments by the FP group that NP providers take care of such a low-acuity patient base that comparing the two provider types is apples to oranges.  “How hard is it to have great surveys and clinical outcomes when you’re only taking care of long-term care residents?”

It’s not about For-Profit or Non-Profit

At times the NP vs. FP providers seem worlds apart.

They think they’re so different.

But, they’re not.  In order to be built to last, both NP/FP operators need to follow Sister Mary’s guidance:

  1. Be committed to quality care (MISSION)
  2. Make money (MARGIN)

I now see two types of operators.  The two types are not FP and NP.

The two types are the ones who are Built to Last (Margin & Mission) and those who are being purchased by the Built to Last operators.

Pat Lencioni: Stooping to Greatness

I’m a fan of Pat Lencioni.  I’ve used his ‘5 Dysfunctions of a Team’ and ‘3 Signs of a Miserable Job’ many times over the years.  While he certainly points to ‘things’ to watch and focus on as a leader, he also subtly makes the point that the influence of the leader is great.  His December newsletter (below) makes that same case — without blatantly making it.  The leader(s) of the organization’s personality (passion, measurements, values) has a direct impact on the organization s/he leads.

I’ve become far less worried about having ‘secret sauce’ stolen b/c, at the end of the day, it’s the people living and executing that secret sauce that really makes it happen.

It’s this SOFT stuff that separates the good from the great.  Anybody can grow census.  Anybody can manage expenses.  Anybody can provide adequate care.  But, to become great takes a concerted effort to synthesize the values & desires of a leadership team into a common mission and way of work.  And then … to stick to it no matter what.

Pat’s December newsletter:

Stooping to Greatness

Earlier this year I had the opportunity to spend time with the CEO of one of America’s most successful companies, a legendary organization known for its employee and customer satisfaction, as well as its financial performance. I attended their company’s management conference, listened to various presentations about their culture, and the extraordinary, homey and sometimes slightly wacky practices that distinguish them from their competitors.

Overwhelmed by the organization’s simple and powerful behavioral philosophy, I asked the CEO a semi-rhetorical question. “Why in the world don’t your competitors do any of this?” The CEO thought about it for a moment and said, “You know, I honestly believe they think it’s beneath them.”
And right away, I knew he was right.

After all, every one of those competitors, the vast majority of whom are struggling, knows exactly what this company does, how it works, and how much it has driven its financial success. The company’s cultural approach has been chronicled in more than a few books. And yet, none of them tries to emulate it. In fact, based on numerous interactions I’ve had with employees who work for those competitors, I’d have to say that their attitude is often dismissive, even derisive, toward this company and its enthusiastic employees.
And this dynamic exists in other industries, too. A fast-food company I know has remarkable customer loyalty, as well as unbelievable employee satisfaction and retention, especially compared to the majority of their competitors. The leaders and employees of the company attribute most of their success to the behavioral philosophy and attitude that they’ve cultivated within the organization, and the unconventional yet effective activities that result.

One example of that philosophy is the action of the CEO, who shows up at grand openings of new franchises where he stays up all night with employees, playing instruments and handing out food to excited customers. Few CEOs would be happy, or even willing, to do things like this, but this executive relishes the opportunity. These, and other activities that most MBAs would call corny, are precisely what makes that company unique.

This happens in the world of sports, as well. There is a well-known high school football team where I live that is ranked near the top of national polls every year. They play the best teams in the country, teams with bigger and more highly touted players, and beat them regularly. The secret to their success, more than any game strategy or weight-lifting regimen, comes down to the coach’s philosophy about commitment and teamwork and the buy-in he gets from his players. That philosophy manifests itself in a variety of simple actions which speak to how the players treat one another on and off the field. For example, players pair up every week and exchange 3×5 cards with hand-written commitments around training and personal improvement, and then take responsibility for disciplining one another when those commitments aren’t met.

And yet, whenever I explain this and similar practices of the team to other coaches who are curious about their success, I encounter that same sense of dismissiveness. They get a look on their face that seems to say, “listen, I’m not going to do that. It’s silly. Just tell me something technical that I can use.” As a result, few teams actually try to copy them.

Some skeptics might say, “come on, those companies/teams are successful because they’re good at what they do.” And they’d be right. Those organizations are undoubtedly and extremely competent in their given fields, and they have to be in order to succeed. But plenty of other organizations are just as competent and don’t achieve great levels of success, and I honestly believe it’s because they’re unwilling to stoop down and do the simple, emotional, home-spun things that all human beings — employees, customers, players — really crave.

What’s at the heart of this unwillingness? I think it’s pride. Though plenty of people in the world say they want to be successful, not that many are willing to humble themselves and do the simple things that might seem unsophisticated. Essentially, they come to define success by what people think of them, rather than by what they accomplish, which is ironic because they often end up losing the admiration of their employees and customers/fans.

The good news in all of this is that for those organizations that want to succeed more than they want to maintain some artificial sense of professionalism (whatever that means), there is great opportunity for competitive advantage and success. They can create a culture of performance and service and employee engagement, the kind that ensures long term success like no strategy ever could. But only if they’re willing to stoop down and be human, to treat their customers and one another in ways that others might find corny.

Administrator-Director of Nursing Diagnostics

During the last couple years I’ve visited with over 50 nursing home administrators and their department head teams to assist them
  1. Define their facility culture,
  2. Implement world class service practices,
  3. Strengthen their teams, and/or
  4. Improve their marketing efforts
I’ve had the pleasure of working with leaders at facilities everywhere across the spectrum of performance (from beginning of turnaround to market leaders).  While I find my work fulfilling and important, I’ve concluded that those numbered areas of focus above are SECONDARY to the area in the facility that is really the FOUNDATION of everything is the relationship between Administrator and Director of Nursing.  In fact, as I look back at most struggling situations (clinical, regulatory, financial) the vast majority of them involve a weak, strained, or dysfunctional ED-DNS ‘partnership.’
The opposite is also true!  Where there is a strong, trusting, caring relationship between the administrator and the DNS, real transformation can take place – given competent, inspired leaders.
All efforts toward cultural change, implementing higher standards, or improving the facility must come AFTER the ED-DNS relationship is solid.  Otherwise, the initiatives will be planted on a weak foundation and will fall by the wayside after a few months.  Unless there is a unified front where the ED-DNS are on the same page and are authentically committed to the initiative regardless of what it is, no change will be lasting.
In healthcare we rely on DIAGNOSTICS to identify the problem.
Diagnostics
Diagnostics
I’ve developed a cultural diagnostic tool for administrators and directors of nursing to assess how strong their relationship is.  Scoring themselves on a series of statements will not only give them a grand total but it serves as a powerful basis for conversation as the two most important facility leaders take steps toward that optimal ED-DNS relationship of trust.
A sample of the statements to be scored:
(Scoring:  3 = Always         2 = Sometimes          1 = Rarely)
  • We run decisions for hiring, firing, and discipline by each other regardless of position. We give each other a ‘heads up’ so there are no surprises.
  • Our loyalty to each other is greater than our loyalty to anyone else in the facility.
  • We leave meetings/conversations confident that we are both completely committed to the decisions that we agreed on, even if there was initial disagreement.

You get the idea.

We often wonder why bright ideas, great programs, change initiatives fail after 2 or 3 months in the facility.  This is why.  No matter how brilliant the program/system, if the ‘top’ is not first committed to each other and second committed to the brilliant program/system, it is destined to fail.  Get this relationship right.  You get the change (culture, clinical, etc.) you desire.

Of course, this assumes competent, inspiring administrators and directors of nursing to begin with.  More on how to find and retain those all-stars later …