“relational answers to operational problems” ©2010 The Bedside Trust October 14, 2010 10:45 –...

“relational answers to operational problems”

©2010 The Bedside Trust

October 14, 201010:45 – 11:45 am

Hospitals and Physicians: Creating a Shared Vision of Excellence

Brian Wong, MD, MPH, Chief Executive Officer,

The Bedside Trust

Supporting Sponsor Parker, Smith & Feek, Inc.



Physician – Hospital Collaboration: Creating a Shared Vision of Excellence

Brian Wong, MD, MPH

CEO

The Bedside Trust

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Limited License for The TRUST Cycle™:

Permission is granted from The Bedside Trust to all

WSHA Annual Meeting attendees to use any and

all exercises contained in this syllabus, provided:

1. They are solely for your INTERNAL use.

2. You neither repackage nor resell this patent-

pending intellectual property for your own financial

gain.



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Top Ten Issues Facing WA CMOs

1. EMR

2. Call coverage

3. Compensation

4. Strategic alignment

5. Employed vs. independent physicians

6. Primary care vs. specialists

7. “flight” to employment

8. Reduction in residency work hours (work ethic)

9. Creating safe conditions for patients

10.Cost and waste reduction



“90% of success is showing up.

Woody Allen

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“100% of success is HOW you show up.”

And that begins with role clarity.

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In the absence of role clarity, we say,

1. “ do your job.”

2. “Just do your job!”

3. “Just do your f***ing job!!!”



Realizing Role Clarity: Step One

Determining the root cause of your challenges.



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Physical History

Differential diagnosis Treatment

The Medical Workup: for every patient, every time, everywhere

Part IThe ideal state

Part IIOur current state

Part IIIWHY is our currentstate the way it is?

(why, why, why, why, why?)

Part IV• Countermeasures in the next

90 days• Expected benefits


The Operational Workup: every problem, every time, everywhere



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Here’s the drill (if we had 2+ hours together)

1. Organize yourselves into teams of 3-4

2. You will be asked seven questions today

3. Each time, consider the question, as an individual first…

– Take about 30 seconds to jot down 3-5 ideas/responses/answers

– Do it silently

4. Share what you have with your team for about 2 minutes

5. After hearing from everyone, forge a consensus of the 2 or 3 best ideas

6. Be prepared to “shout out” your answers

7. At the end of each exercise, some of you will move to form new teams



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Question #1: My best team experience… EVER(context: our daily working relationships); n = 265

1. Teamwork and synergy

2. Everyone involved in a common goal

3. Trust in each other; Having each other’s back

4. Open communication

5. Mutual respect and camaraderie

6. Good sense of humor (in high stress situations)

7. Calm

8. Enthusiasm and high energy; FUN

9. Nobody kept score

10. We had enough resources



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Question #2: Benefits of our best team experience… EVER

1. Increased patient and staff satisfaction

2. Improved quality and safety

3. Increased effectiveness/timeliness

4. Less stress

5. Positive attitudes

6. Fewer issues; No drama; No animosity

7. Our jobs become easier

8. Everyone goes the extra mile

9. Improved communications among: patients, families, co-workers and physicians

10.SWEET!



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Question #3: The things that drive us crazy in the current state (context: our daily working relationships)

1. Negativity; No positive feedback

2. Lack of respect; “It’s not my job”

3. Slackers & “dead wood” in warm bodies

4. Management by crisis intervention

5. Lack of space; Lack of resources; Lack of training; Can’t find anything

6. Poor communication; Incomplete written orders

7. Productivity demands trump patient care

8. Too much ******* bureaucracy

9. Unapproachable; Poor listening

10.Gossip; Profanity; “spite talking"



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Question #4: The cost of the things that drive us crazy in the current state (context: our daily working relationships)

1. Poor quality

2. No productivity; Higher cost

3. More stress; Poor employee health

4. A negative, toxic environment

5. Apathy; Low morale; High turnover

6. Shutting down; isolating ourselves

7. Low employee and patient satisfaction

8. Outmigration

9. Poor community reputation

10. Loss of revenue; No job security

11. Loss of trust; Loss of pride

12. We go home and “kick the dog”



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Community Idiocy vs. Community Intelligence

• Community Idiocy:

– None of us is as dumb as all of us

• Community Intelligence:

– All of us is smarter than any one of us



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What drives us crazy today Our best team experience… EVER

1. Negativity; No positive feedback2. Lack of respect; “It’s not my job”3. Slackers & “dead wood” in warm bodies4. Management by crisis intervention5. Lack of space; Lack of resources; Lack of

training; Can’t find anything6. Poor communication; Incomplete orders7. Productivity demands trump patient care8. Too much ******* bureaucracy9. Unapproachable; Poor listening10. Gossip; Profanity; ”spite talking"

1. Teamwork and synergy2. Everyone involved in a common goal3. Trust in each other/Having each other’s

back4. Open communication5. Mutual respect and camaraderie6. Good sense of humor7. Calm8. Enthusiasm and high energy; FUN9. Nobody kept score10. We had enough resources

Costs of the current state Benefits of the ideal state

1. Poor quality2. No productivity; Higher cost3. More stress; poor employee health4. A negative, toxic environment5. Apathy; Low morale; High turnover6. Shutting down; isolating ourselves7. Low employee and patient satisfaction8. Poor community reputation/Outmigration9. Loss of revenue; No job security10. Loss of trust; Loss of pride11. We go home and “kick the dog”

1. Increased patient and staff satisfaction2. Improved quality and safety3. Increased effectiveness/timeliness4. Less stress5. Positive attitudes6. Fewer issues; No drama; No animosity7. Our jobs become easier8. Everyone goes the extra mile9. Improved communications for everyone10. SWEET!

MTSJH (n = 265): “community idiocy” vs. “community intelligence”



Question #5:Why is the current state the way it is?Why do we all suffer from “community idiocy”?Why… why… why… why… why…?

Don’t forget to change tables

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Initiative overload □Excessive bureaucracy & regulation □ Hurry, hurry, hurry, more, more, more □

Treating the symptoms

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Why do we all suffer from “community idiocy”?Why… why… why… why… why…?




It’s not my job Rigid/Intolerant/Impatient Whining/complaining/blaming

Bad attitude & disrespect



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“Every man for himself” “Get out of my way” “Leave me alone” “Tribal warfare”





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Unsafe conversations“Don’t even go there” □

Callousness □“Just do your _______ job” □





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Callousness □“Just do your _______ job” □





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Insanity is doing the same thing… over and over… …and expecting different results






Callousness □“Just do your f***ing job” □



Initiative overload □External mandates beyond our control □

Hurry, hurry, hurry, more, more, more □


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The Dystrust Cycle(the default condition)


Dystrust is the root cause of our pandemic of “community idiocy”



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“Relational answers to operational problems…

and operational answers to relational problems”

Overcoming our lack of default condition…

Every man for himself Unsafe conversations

Bad attitude & disrespect Treating the symptoms

The Dystrust CycleThe definition of insanity…

Defines and creates role clarity

Have safe conversations

Diagnose, THEN treatBe T.R.U.S.T.E.D.

Find common ground

The Trust CycleSee one, do one, teach one...



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T. = Team player (makes me and others better)

R. = Responsive and respectful

U. = Understanding (listens & learns w/o judgment)

S. = Safe (easy to approach; invites my opinion)

T. = Talented (knowledge, judgment, proficiency)

E. = Executes (gets things done; gets results)

D. = Dedicated (work ethic)JOB

RO

LE

Our Most Trusted Colleagues

Un

iversal U

niq

ue



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“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.”

• Rigid

• Inflexible

• Poor listener

• Disrespectful

• Arrogant

• Intimidating

• Threatening

• Judgmental

• Unforgiving

T. = Team player

R. = Responsive/Respectful

U. = Understanding

S. = Safe

T. = Talented

E. = Executes

D. = Dedicated




Leadership in the First Person

April 30, 2008

1. The curse of resentment

2. The paradox of vulnerability

3. The importance of role clarity

27©2010 The Bedside Trust





Callousness □“Just do your f***ing job” □



Initiative overload □External mandates beyond our control □

Hurry, hurry, hurry, more, more, more □


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And the root cause of The Dystrust Cycle is…

The Dystrust Cycle(the default Cultural Operating System)


lack of role clarity



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Physical History3. What drives us crazy in the current

state in our daily working relationships with each other?

4. What are the costs of the current state (to all of us)?

1. What is the ideal state in our daily working relationships with each other?

2. What are the benefits of the ideal state (to all of us)?

Differential diagnosis Treatment5. Why is the current state the way it is?

(Why? Why? Why? Why? Why?)

• Hint: a lack of role clarity which drives a cycle of “Dystrust”

6. What are the potential benefits of role clarity (to all of us)?

7. What is my personal commitment and contribution to role clarity?

The Medical Workup and The Operational Workup


“…and the 7 questions that matter.”



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Current State (physical) Ideal State (history)

1. Teamwork & collaboration toward a common goal

2. Everyone engaged; every voice heard3. Alignment of goals with a clear focus4. Everybody pulls together5. Respectful exchange of ideas6. Trust with a clear vision7. Focus on the problem; not on turf8. Patients’ needs trump EVERYTHING9. Taking ownership10. Appropriate use of our resources

Root Cause (differential diagnosis) Countermeasures (treatment)

Question #1: The Ideal State for Providence Physicians



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1. Tribal warfare2. Apathy and resistance to change3. Lack of teamwork and misaligned incentives4. Lack of clear & open communication5. Lack of planning and participation6. Lack of humility and objectivity7. Personal goals above organizational goals8. Misaligned goals leading to lack of

engagement9. Lack of relationships leading to mistrust10. Ego and passive aggressive BS




Question #3: What drives us crazy in the current state



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Question #5: The root cause of the things that drive us crazy






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T. = Team player (makes me and others better)

R. = Responsive and respectful

U. = Understanding (listens w/o judgment)

S. = Safe (easy to approach; invites others)

T. = Talented (knowledge, judgment, skill)

E. = Executes (gets things done; gets results)

D. = Dedicated (work ethic)

Countermeasure #1: Establish Role Clarity (Be T.R.U.S.T.E.D.)






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“100% of success is HOW you show up.”

Letter Attribute

T. Team Player

R. Responsive and Respectful

U. Understanding (w/o judgment)

S. Safe (inviting; approachable)

T. Talented

E. Executes

D. Dedicated

Grand Total


T.R.U.S.T.E.D. as a condition of employment



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The Universal Attributes of a T.R.U.S.T.E.D. Colleague

Letter Attribute At my best

T. Team Player 10


10


10


10

T. Talented 10

E. Executes 10

D. Dedicated 10

Grand Total 70


T.R.U.S.T.E.D. as a condition of leadership



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The Universal Attributes of a T.R.U.S.T.E.D. Colleague (Brian Wong at his worst; October 1991)

Letter Attribute At my best(score)

% of time at my best (frequency)

T. Team Player 10 20%


10 20%


10 5%


10 5%

T. Talented 10 100%

E. Executes 10 100%

D. Dedicated 10 100%

Grand Total 70




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The Universal Attributes of a T.R.U.S.T.E.D. Colleague (Brian Wong at his most typical; October, 1991)



“Typical” = score x frequency

T. Team Player 10 20% 2


10 20% 2


10 5% 0.5


10 5% 0.5

T. Talented 10 100% 10

E. Executes 10 100% 10

D. Dedicated 10 100% 10

Grand Total 70 35




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Leadership in the First Person(Brian Wong at his most typical; December 1991)




T. Team Player 9 95% 8.55


9 95% 8.55


9 90% 8.1


9 90% 8.1

T. Talented 10 100% 10

E. Executes 10 100% 10

D. Dedicated 10 100% 10

Grand Total 66 63.3




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Job One…

• “ do your job.”

• “Just do your job!”

• “Just do your f***ing job!!!”

1. “Understand your role”



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The Two Drivers of the TCP: Redefining Our Role and Our Job“How we show up and how we solve problems together”




T. Team Player




T. Talented

E. Executes

D. Dedicated

Grand Total


Physical (current state) History (ideal state)

3. What drives us crazy in the current state?4. What are the costs?

1. What is the ideal state?2. What are the benefits?

Differential diagnosis (root cause)

Treatment (countermeasures)

5. Why is the current state the way it is?

• Hint: a lack of role clarity which drives a cycle of “Dystrust”

6. What are the benefits of role clarity?7. What is my personal commitment to

role clarity?



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Question #6: What difference could we make if all 300 of us had role clarity (to be T.R.U.S.T.E.D.) at MTSJH? (n = 265)

Eliminate the negative:

• Rigid

• Inflexible

• Poor listener

• Disrespectful

• Arrogant

• Intimidating

• Threatening

• Judgmental

• Unforgiving

Accentuate the

positive:

T. = Team player


U. = Understanding

S. = Safe

T. = Talented

E. = Executes

D. = Dedicated ©2010 The Bedside Trust



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Question #6: What difference could we make if all 300 of us had role clarity (to be T.R.U.S.T.E.D.) at MTSJH? (n = 265)

• Higher quality; better outcomes

• Job satisfaction; Higher morale

• More efficiency

• Better patient satisfaction

• We would accomplish more

• A healthier environment

• Communication would be better

• Improved community reputation and trust

• “the ideal state”



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Question #7: What is my personal commitment to be T.R.U.S.T.E.D.?

Eliminate the negative:

• Rigid

• Inflexible

• Poor listener

• Disrespectful

• Arrogant

• Intimidating

• Threatening

• Judgmental

• Unforgiving

Accentuate the

positive:

T. = Team player


U. = Understanding

S. = Safe

T. = Talented

E. = Executes

D. = Dedicated ©2010 The Bedside Trust



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Question #7: What is one thing I could work on to be more T.R.U.S.T.E.D.? (n = 265)

• I will be more understanding

• I will be less judgmental

• I will be more respectful

• I will be less rigid

• I will listen

• I will be more patient

• I will be less resentful

• I will be more responsive and accountable

• I will be more safe and approachable

• I will eliminate negativity

• I will be less arrogant

• I will be less threatening

• I will have a positive attitude

• I will be more forgiving

• I will become more knowledgeable and talented

• I will be a better team player

• I will be more flexible & open

• I will be a role model



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“relational answers to operational problems” ©2010 The Bedside Trust October 14, 2010 10:45 –...

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