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.

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Nursing Home Institution vs. Resident Centered Approach

The Next 10 years …

This all started about 2 months ago when my wife and I were on a walk, talking about my short career in long-term care.  I marveled that I had been with the same company (The Ensign Group) for 9 years.  AIT-Administrator of 3 facilities-AIT Program/Leader Development/Support guy …

That walk/talk stimulated a lot of reflection in what I want out of my next 10 years.  A strong desire (maybe need?) has risen to the surface to take my (and our company’s) experience and do something transformative with it for the benefit of today’s and tomorrow’s long-term care residents.  That could sound a little quixotic (side note: Don Quixote: One of my all time favorite stories/inspirations and a great motivating tool for staff) but I think it’s actually a pretty common experience for people in long-term care.  As I looked in the 9 year mirror I see myself on this curve:

Empathy Curve in Healthcare
Empathy Curve in Healthcare

 

As an AIT I started out like most — fired up, wanting to treat each resident like family, eager to learn and improve this embattled industry.  The empathy I felt was very high.  Feeling sorry for a lot of the long-term residents who had no family support.  Feeling a bit shocked at the scene of a resident being wheeled down on a PVC pipe roller chair to the shower room covered only with a sheet — leaving a trail of diarrhea.  Feeling nauseated by the smells during certain procedures.  How do I, having never worked in a nursing home before, get used to that?!  Feeling pretty impotent to change things for the better until I learn why they’re done this way in the first place.  What have I gotten myself into?

So what happens/happened?

You start to cope.  I suppose we all cope differently.  But as you cope, you ‘fall’ not just on the empathy curve but into a too-casual relationship with the profession.  Some signs of the coping fall …

  • You call Virginia in room 24 bed A by a different name: 24-A, ‘the hip’, Medicare Patient, etc.  This dehumanizing of ‘Virginia’ helps you cope with all of the residents you’ve let down some way.  It also speeds up communication with the others at the facility who don’t really know Virginia.
  • You are less shocked by the sights, sounds, and realities of life as a nursing home resident.
  • You rationalize away your loss of empathy as not a loss of empathy but as a better understanding of why things are always done that way.
  • You spend your time on delivering the things your company measures regardless of how in line with your values or vision those measurements are.
  • You don’t smell the smell that first-timers do.  🙂

You survive for a while and then you begin to thrive.  Your experience and success builds confidence to experiment, to find YOUR VOICE.  You begin to need more than simple survival.  Maslow’s Hierarchy of Needs illustrates a theory of the different levels of human need that you see in yourself as an administrator.  This analogy is a bit forced but you’ll get the idea.

You first need to survive.  That ‘Physiological’ need means you have to not lose your job 🙂  You need to learn, perform to how your measured, fit in, etc.  With some time and success your needs graduate to the ‘Safety’ need.  Here you pass some surveys; you put a team together; you learn from your mistakes; you change your style to be more effective.  You start to float between Safety and ‘Belonging’ as you find some balance in your life. you perform well financially; you’re recognized in your organization as an important partner.  The trouble is … this is the bottom of the Empathy Curve.  You may stay here for the rest of your career, quite comfortable.

Maslow's Hierarchy of Needs
Maslow’s Hierarchy of Needs

But with time, you start to feel a need to do more with what you’ve received.  You feel a need to not only run an outstanding facility, but to transform long-term care in the eyes of the residents.  You wrestle with some tough questions as you confront the brutal facts …

  • What truly makes us different from our competition (in the eyes of the community)?  Wouldn’t our competitors say that they are nice and caring just like we say?  What can only we say about being a resident here that our competition cannot?
  • Is it a significantly better experience to be a resident in my facility than at an average facility elsewhere?  In other words, is sleeping, waking up, getting dressed, eating breakfast, going to activities, going to therapy, receiving medications, etc. a significantly better experience than your average facility?

You feel a higher need pulling you up from the coping gravity to see things (again) from the residents’ perspective.  You are extremely proud of surviving and then succeeding at one of the most difficult jobs anywhere.  You are proud of how you’ve treated your employees (for the most part).  You are proud of the company you’ve helped grow.  You are proud of the facilities that have improved qualitatively and quantitatively under your leadership.  Now what?

Now you feel a new, familiar need to change the industry.  You feel a need to fight the CALF PATHS and the gravity that limits our vision of what we can and should do.

The difference between that need/empathy today vs. when you began is that now you have the knowledge and wherewithal (what a great catch-all word) to do something about it.

There are a handful of companies and leaders in long-term care that are ‘ahead of the curve’ (get it?) when it comes to changing the industry.  BUT, it seems like the movement is way too slow.  One major initiative is the resident-centered approach as illustrated here.

Nursing Home Institution vs. Resident Centered Approach
Nursing Home Institution vs. Resident Centered Approach

I love the concept.  I think it is on target to where we need to take long-term care.  But, the cultural, financial, and regulatory obstacles are real and in many cases prohibitive for an administrator to experiment with.

For my next 10 years I want to work at clearing those obstacles away.  AND, more importantly, I want to figure out how to lessen the slope and duration of the drop and bottom of the empathy curve for others.  Skilled nursing companies have to find the right people, find the right measurements and establish a culture of entrepreneurship and innovation in order to do more than simply survive.  We and our residents ‘need’ it.

Finding YOUR Voice

I love the book ‘What Got You Here, Won’t Get You There‘ by Marshall Goldsmith.  Our CEO introduced it to me/our organization a year or so ago.  As I see Administrators in Training (AITs) learn, grow, lead I see some of them not understanding a similar truth: ‘What got THEM THERE, Won’t Get You There.’  There are certainly lessons to learn from more experienced leaders that new leaders would be wise to not repeat the hard way.

However, the very essence of leadership is wonderfully defined by Warren Bennis in his classic, ‘On Becoming a Leader.’  He says …

“…no leader sets out to be a leader per se, but rather to express himself freely and fully.  That is, leaders have no interest in proving themselves, but an abiding interest in expressing themselves.  The difference is crucial, for it’s the difference between being driven, as too many people are today, and leading, as too few people do.” On Becoming A Leader,” pg. 5

On Becoming a Leader, Warren Bennis
On Becoming a Leader, Warren Bennis

A friend of mine who is in his second semester of his first year in the school of hard knocks shared this with me and it rang true as I talk to new leaders who are trying to duplicate the ‘voice’ or the ‘vision’ or the ‘religion’ of other leaders before them.

My advice for the new Executive Director is to …

  1. Take the time to earn CREDIBILITY with your team/employees.  How?  Using the 3 Signs of  Miserable Job framework, spend the first couple months with each of your direct reports to get to know them deeply (Anonymous), helping them see the importance of their job (Relevance), and deciding together how to best measure their performance (Measurement).  This shows them how much you care for them and their success.  It builds trust.  It lays the foundation for loyalty.  Which prepares you to establish, with them, the WHAT/VISION.
  2. Instead of using someone else’s vision (unless your passion for it matches or surpasses its creator), empower your team to create a shared vision or direction for your operation.  This process usually takes a couple months if done right.  The creative/participatory process earns the vision/direction immediate buy-in that force-fed vision/direction lacks.

Taking the time to establish the credibility and forming the relationships of trust is the lubricant that allows the establishment of a successful, shared vision of the future.

Talent & Leadership

Over the years I’ve been involved with leadership development from several perspectives:

1) The brand new, first time leader (mostly failures & school of hard knocks)
2) The new leader of a turnaround business (different set of skills needed)
3) Member of the leadership team for an organization
4) Director of Leadership Development, training over 50 individuals to become GM/business unit chiefs.
5) Lifelong student (MBA @ USC’s Marshall School of Business)
While I love learning (reading, watching) from other experts, I can’t help but apply all of that through my real-world lens that prevents me from swallowing everything put forth. And, since successful leaders are needed now more than ever in healthcare, I’ll dedicate several posts to the subject here.
Recently one of my company’s new, promising Administrator-in-training/CEO-in-training (AIT/CIT) questioned some of my statements/critiques of Marcus Buckingham’s best seller, First Break All The Rules (Great Book) during a training week we affectionately call boot camp. My email response is below:
TO: Eric

RE: my rejection of Gallup/First Break All The Rules … I like MOST of what’s in that book. I really like the 12 questions and the scientific basis for their conclusions. However, I think they ignore one major variable in the talent/success formula — chemistry with supervisor. Good to Great talks about ‘the RIGHT people on the bus,’ as you know. I think G2G also ignores this in determining what makes someone ‘right.’ I have seen (and seen in my partners) many times when someone was ‘great’ at what they did for one leader and then that same person was not the ‘right’ person for the new leader. If the person has the talent for the position, s/he should thrive according to both G2G and 1st Break. But, the reality is chemistry with the talented person’s leader is critical to his/her ability to thrive. Furthermore, where there is strong chemistry/trust, I’ve seen (again, many times) a great leader be able to help underperformers change and succeed. Instead of debating whether or not the person had the talent to become great, I believe we’re better served by focusing on creating rock-solid relationships with the people we lead — allowing them to become what sometimes only we can see them capable of becoming (the Dulcinea concept).

So, I don’t reject Gallup. Just like I don’t reject G2G. I just find their discussions of talent incomplete. Talent-mapping or profiling for a position is really tricky business. We came very close to attempting this for our Administrator in Training/Executive Directors selection a couple years ago. You can maybe find a few common characteristics of successful leaders in the company. How do we know that very different people can succeed here or do better than we’ve seen. This approach becomes even more troublesome when you see the huge difference in types of operations, geographies, rural/urban, size, demographics, stages of stability, etc. I would have a much harder time thriving in a small rural town than someone who is better equipped for that. Yet, we don’t have luxury of knowing the nature of what opportunities will be available for the new CEO in Training when hired.

What I take from Gallup is playing to people’s strengths. We need to do a better job of this here. We’ve learned by sad experience that just b/c you’re very successful at one operation does not mean you’ll be successful at a very different one. What happened to our previously very successful leaders when they change facilities or market dynamics or people dynamic change significantly and then they fail? Didn’t they have talent? In other words, I find predicting success based on past experiences or exhibited talents incomplete. Fit and timing are more predictive in my opinion. I’m not saying past experience and talent is meaningless. Of course it’s useful. So, what do I look for in an AIT/CIT? I look for how likely they will fall prey to the factors of derailment below. I’ll take very different talents b/c we need all types and all types have been successful here. But, I don’t want the leader who appears to be perfect for the position who is clueless about his/her blind spots, weaknesses, and has never changed his approach based on learning from hard experiences. That’s what I focus on in my interviews.

See the article and book excerpt attached for a better explanation of this school of thought. I don’t see it far off from what Gallup or G2G is saying. I just think it’s a more complete viewpoint taking into account an individual’s chemistry, timing (peter principle), fit, and pride.

I’d love to hear your thoughts.

 


And, I’d love to hear YOUR thoughts too …