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 …

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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 …