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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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 …