Grit &

ResiliencYKeys Traits to Enhance

High-Performing Therapy Staff

Sharon Cheng, PT, MSPT, MBAMegan O’Malley, PT, DPT, NCSSteve Wray, PT

Combined Sections Meeting 2018 New Orleans, LA, February 21 – 24, 2018

Disclosure

No relevant financial relationship exists for

Sharon Cheng, PT, MSPT, MBA

Megan O’Malley, PT, DPT, NCS

Steve Wray, PT

Learning Objectives

❖Discuss how grit and resiliency can complement and enhance clinical competency.

❖Review methodology for improving staff satisfaction and engagement with two case studies.

❖Differentiate clinical mentoring from behavioral mentoring.

❖Examine strategies for increasing grit and resiliency with your staff in your healthcare setting

Introduction to Content

❖Describe Grit and Resiliency

❖Case Study 1

❖Case Study 2

❖Lessons We Learned

Predicting Success

During your initial evaluation, what are some signs that your patient will do well with therapy?

Remember a Favorite Patient

❖ Did you do their therapy for them?

❖ Did you tell them how they could do better?

❖ Did you help them get through a “bad” day?

❖Grit is sustained passion and perseverance

for especially long-term goals.

❖Hallmark of high achievers

❖1 in 5 cadets will drop out before graduation

❖5 – 6 % will drop out in the first two months

Whole Candidate Score

Grit Score

Which metric predicted who would stay?

You might have more talent than me, you might be smarter than me…

But if we get on a treadmill together, there’s two things: You’re getting off first, or I’m going to die.

It’s really that simple.

Grit requires effort

Deliberate Practice

Deliberate practice is a highly structured activity, the explicit goal of which is to improve performance. Specific tasks are invented to overcome weaknesses, and performance is carefully monitored to provide cues for ways to improve it further.

Grit requires deliberate practice

We claim that deliberate practice requires effort and is not inherently enjoyable. Individuals are motivated to practice because practice improves performance.

~K. Anders Ericsson

In general, the older you are, the higher your grit score. Millennials usually have lower grit scores. Why?

❖ Environment different by eras

❖ Focus gets better with experience

Getting Grittier

❖ Develop your interests before training your weaknesses

❖ Know the science of deliberate practice❖ Cultivate purpose. Be a part of something

larger than yourself.❖ Nurture a growth mindset.

Believe that you can grow and learn

Resilience

Preserving Adaptive Capacity

The ability to adapt to changed circumstances while fulfilling one’s core purpose

Increasing Group Resilience

❖ Cooperation and trust

❖ Cognitive diversity

❖ Decentralization with common oversight

❖ Strategic redundancy

Increasing Individual Resilience

The Power of YET

How to IncreaseGrit and Resilience in Your Team

❖ Purpose

❖ Deliberate Practice

❖ Power of Yet

❖ Strategic Redundancy

Case Study 1

❖High Turnover, especially with New Hires

❖Poor Connection between Staff and Management

❖New Group Interviewing Applicants

❖Poor Conflict Resolution Skills

❖Generational Gap

Mentoring

❖Not Telling Someone What to Do or Doing it for Them

❖Structure to Support Self-Directed Growth

❖Behavioral Modules

❖Group Discussion

❖Self Reflection/Homework

❖Feedback

Mentoring

1:1 Mentoring - You Can Do It!

Bottom Line: deliberate practice between the mentor and mentee

Traditional Clinical Mentoring

❖Orientation

❖Documentation

❖Best Practice

Behavioral Mentoring Modules

❖Conflict Resolution

❖Boundaries

❖Complex Decision Making

❖Active Listening

❖Action Plan

Bottom line: These are skills that will help staff succeed in a challenging healthcare environment.

Personality Inventories

❖True Colors: Blue, Green, Orange, Gold

❖Personality Styles: Introvert/Extrovert, Fast/Slow

Bottom line: Acceptance of differences and mutual respect help us handle the tough times when they come

Know our inherent strengths and be able to emphasize those

Mission Statement

❖Bungled mission statement development "allowed" for continued discussion of our mission. "Compassionate and innovative care to improve quality of life."

❖Personal mission

Mission Statement

❖Relentless focus on mission despite unsavory topics such as productivity.

❖Community: We are in this together. Yes we have to focus on productivity and staffing and all of these other things but we are in this together and focused on improving lives.

Mission Statement

Bottom line: Relentless focus on mission despite unsavory topics such as productivity helps build resilience.

Huddles

❖Community building. We need to be in proximity with each other after being apart all day. Family dinner.

❖Encourage each other in our work and successes.

Huddles

Feedback about how we are doing with key measures such as productivity, Jt Commission prep, etc. Feedback is given about outcome measures, discussion about what skills to do/try, go do the tasks, return for feedback on how we did.

Bottom line: Deliberate practice in action. It can be boring, but helps with outcomes.

Good to balance this with strong focus on mission.

Case Study 1Employee Engagement Results

4.20

3.883.73

3.85

4.50 4.57

4.294.38

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Overall Share Opinions Resources Supv Involved

2015 2016

Case Study 2

May 2013

❖Creating a culture of working together as a team to serve our patients and each other

❖Possibility for career advancement

Initial Reactions

❖Not hostile

❖Resiliency defined – the entire staff got beat down at work everyday but somehow kept showing up the next day for more.

❖ No grit - please just tell me what to do so I won’t get in trouble

❖No role models, but willing to change

Year 1: Warm Bodies

Establish Professionalism

Therapy Commandments

I. You shall not abuse the contract staff

II. You shall not abuse the scheduler

III. You shall not abuse the therapy techs

IV. You shall not covet your neighbor’s

scheduling tags or schedule slots

Establish Professionalism

❖Deliberate practice

❖Build cooperation and trust

❖Teach staff how to talk to each other

Advocate for Staff

❖Team conference

❖Saw a full caseload

❖Down in the trenches

End of Year 1

❖Successful Solidarity

❖Development of Senior Staff

Year 2

Developed Mentoring Program

❖Case studies

❖Professionalism discussions

End of Year 2

❖Established Interdisciplinary Practice Council

❖Quality Improvement Emphasis

Year 3

❖Support Role on Projects instead of Lead

❖Updated Mentoring Series

❖Team Rotations

❖Set Goal of becoming a Joint Commission Stroke Certified Facility

End of Year 3

Celebrated

Becoming a Joint Commission

Stroke Certified Facility

Case Study 2Employee Engagement Results

3.683.77 3.82

3.95

4.58 4.644.48

4.36

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Teamwork Supv Involved Expectations Value My Opinions

2013 2016

Lessons Learned

What are your Strengths as a Leader?

You don’t attract who you want, you attract who you are

~Sam Adeyemi

A leader is a role model for the ideal member of

the group

Increasing your Grit and Resilience

❖ Know your strengths

❖ Engage staff who have complementary strengths to round out your team

❖ Make it easy for staff to give you REAL feedback.

Developing Your Team

You can’t make a best team if you focus on a

poor team

~Marcus Buckingham

Imagine time spent with a best team, how it

felt, did they push you? Your job is to build

more teams like your best team

How to IncreaseGrit and Resilience in Your Team

❖ Purpose

❖ Deliberate Practice

❖ Power of Yet

❖ Strategic Redundancy

Developing Your Team

❖ Leader Rounding

❖Help people find alignment between their personal goals and the mission of the organization.

❖ Consistent coaching and ensuring deliberate practice

❖ Describe your vision over and over: See people, places and things not just as they are, but what they can be

Leader Rounding

❖Motivational Interviewing

❖Connection Culture

Select the Right Staff

Use behavioral interviewing questions that show grit and resilience. Are they learning from failure?

❖Tell us about a specific time when you got to work

and the schedule was not what you expected it to be.

What process did you go through and what was the

outcome?

❖What was the most serious mistake in care that you

have been involved in and how did you respond?

The Two Tails

People in the bottom tail represent the biggest opportunity to improve performance in your company, and the top tail

will teach you exactly how

to realize that opportunity.

~ Lazlo Bock

❖ Keep challenging them❖ Make sure they know when to say stop❖ Monitor frustration levels (often with

others)

High Performers

❖ Find projects in their area of interest

❖ Work closely with them on their projects

❖ Monitor their frustration level (may be with themselves)

Average Performers

Low Performers

❖ Define success in detail❖ Figure out the REAL problem(s)❖ ID and monitor deliberate practice❖Make sure they know you believe in

them

Increasing Team Grit and Resilience

Real and sustainable change in people’s lives begins with a change in their sense of identity.

~Sam Adeyemi

What is your TEAM’S vision of who they are?

Increasing Team Grit and Resilience

Whatever people see and hear consistently over time will enter their hearts and put them on autopilot. To change your followers from the inside out, change what they see and hear

Describe your vision over and over: See people, places and things not just as they are, but what they can be

Increasing Team Grit and Resilience

Set up a structured training system. Help people find alignment between their personal goals and the mission of the organization. It deepens commitment to the organization.

Model the transformation. People try to reach a standard they can see.

~Sam Adeyemi

Clinical Mentoring and Behavioral Mentoring

You need both. Use multiple modes.

❖ Didactic❖ Group Discussion❖ Self-Reflection❖Mentor/Mentee 1:1 Relationships

Behavioral Mentoring

First, Do a Needs Assessment

❖ Communication❖ Conflict Resolution❖ Reassessment Rounds

Behavioral Mentoring Example

❖Driven❖Detail oriented❖Left former facility because not growing

clinically❖Felt like the only one who cared about

doing things “right”

Personality Inventory

Gold (Detail-Oriented), Introverted, Fast Processor Conflict Resolution Style: Compromise

Developing Grit and Resilience

❖Start the change in YOU!

❖Know yourself well and surround yourself with people who complement your strengths

❖Build on your successes

❖See people, places and things not just as they are, but what they can be

Contacts

Sharon Cheng sharon@sharoncheng.com

Megan O’Malley MOMalley@bir-rehab.com

Steve Wray Steven.Wray@BSWHealth.org

References

Adeyemi, S. (2017). Leading from the Inside Out. Presentation, The Global Leadership Summit 2017, Chicago, Illinois.

Bock, L. (2015). Work Rules! Insights from Inside Google that will Transform how you Live and Lead. New York: Hachette Book Group.

Buckingham, M. (2017). Reinventing Performance Management. Presentation, The Global Leadership Summit 2017, Chicago, Illinois.

Cain, S. (2012). Quiet: The power of introverts in a world that can't stop talking. New York: Crown.

References Duckworth, A. (2016). Grit: The Power of Passion and Perseverance. New York: Scribner.

Dweck, C. (2007). Mindset: The New Psychology of Success. New York: Ballantine Books.

Ericsson K, Krampe R, Tesch-Romer, C. The Role of Deliberate Practice in the Acquisition of Expert Performance. Psychological Review 100 (1993), 3:363-406.

Fine, Alan. (2010). You Already Know How to Be Great. New York: Penguin Group.

References Miscisin, M. (2015). Personality Lingo: Use the Power of Personality to Transform Relationships, Improve Communication and Reduce Stress. South Carolina: CreateSpace Independent Publishing

Patterson K, Grenny J, Maxfield D, McMillan R, Switzler R. (2011). Change Anything: The New Science of Personal Success.New York: Business Plus

Sandberg S, Grant, A. (2017). Option B: Facing Adversity, Building Resilience, and Finding Joy. New York: Alfred A. Knopf

Sandberg, S. (2017). One-on-One with Sheryl Sandberg.Presentation, The Global Leadership Summit 2017, Chicago, Illinois.

References

Stallard, M. (2015). Connection Culture: The Competitive Advantage of Shared Identity, Empathy, and Understanding at Work. Virginia: Association for Talent Development

Zolli, A. (2012). Resilience: Why Things Bounce Back. New York: Simon & Schuster.