by Tony Chen

One of the key perspectives I've learning about as I read through Management Lessons from Mayo Clinic is to "act like a small organization even when you're a large one."

This is quite a task, given how huge Mayo is as a clinic. Think about how impersonal the service could be, how thick their policy book could be, how much bureaucracy there could be. So why doesn't it feel like a mammoth clinic to patients? It is because they allow, and in fact empower, everyone to relate to patients personally, respecting each one's individuality and uniqueness.

Read more!

by Nick Jacobs

The arts, tourism or health care; the profession didn’t matter. Volunteers have always been squarely in the center of my personal universe. No matter what the job, the challenge or the non profit profession, we have always worked very hard to create meaningful positions for volunteers. In fact, it has been our distinct pleasure to be intensely concerned with our volunteers over the years.

What have we discovered? There are virtually no boundaries, no Mission Impossible jobs, no challenges too great or too small and there is no end to what dedicated volunteers will do for any non profit organization. They need only to be empowered, encouraged and recognized. In fact, most of them will perform above and beyond the call of duty without even a nod and a smile.

The volunteer experiences that have become part of my personal history have been very unique but the essential ingredient for us has always been to be open, honest and thankful. It has been to provide them with a vision and ownership, but most importantly, it has been to embrace them as partners, as critical participants in our business, as key providers of the proverbial icing on whatever cake is being baked.

I remember once asking the father of one of my students to stand at the boy’s room and make sure that all went well there throughout an entire professional sports game where the students were performing. He never saw one minute of the game. I later found out that he was the president of a university? He had just told me to call him Frank?

Be it putting up tents in 100 degree weather, or making runs to buy the needed decorations required to top off the center pieces, we have always had people waiting in the wings to get it done. Our volunteers currently add at least 30 percent to our care giver numbers as they serve as greeters, are clowns, do hand massages, help family members, deliver communion, or sort files, our volunteers represent a bedrock element of our organization that would be impossible to replace.

Volunteers can make the difference between your patient’s happiness and comfort and their disgruntlement. They don’t have to do what they do. They do it out of commitment and caring, and your patients can feel that love, too!

by Nick Jacobs

From America Online’s Confessions of a Flight Attendant, “For example, half a day was spent with someone dryly lecturing us on four personality types and how to handle them; yawn?” Too bad, for him because this very same lecture changed my life. It taught me enough about human nature to give me an edge when dealing with people.

The journey started with a book by Daniel Goleman entitled, Emotional Intelligence: Why It Can Matter More Than IQ. It dealt with the concept of emotional quotient which is described as the ability, capacity, or skill to perceive, manage and assess the emotions of one's self, of groups and of others.

While working on a certification at Harvard University, we were actually tested and then placed in study groups of like personalities. It was disconcerting for me to be placed in with a group of M.D.’s who, because they hated details, simply closed their checking account when it didn't balance. Why? Because that’s exactly what I would do, and I'm not sure I'd want ME as a doctor.

What are the DISC personality profiles? Well, I’m not an expert, but the first is Dominant which can best describe someone who is a Driver, Direct, Demanding, Determined, Decisive and a Doer. They are typically independent, persistent, energetic, busy and fearless. They focus on their own goals rather than people. They tell rather than ask, and when they do ask, they ask “What?” General Patton was a “D.”

The next category is the Influential, someone who specializes in inducement, inspiring, interacting, who is interesting and impressive. They are very social, persuasive, friendly, energetic, busy, optimistic, distractible and imaginative. They focus on the new and the future. They may be a poor time manager as they focus more on people than tasks, but they tell rather than ask, and when they ask, they ask “Who?” General Eisenhower was a High “I.”

The next category is that of Steady, an individual who is submissive, stable, supportive, shy, status quo, and a specialist. They display traits of being consistent, stable, accommodating and peace-seeking. They enjoy helping and supporting others and are good listeners and counselors, have close relationships with a few friends, ask rather than tell, and when they ask, they ask “How and When?” Marilyn Monroe was an “S” forced to act like an “I.”

Finally, the category of Conscientious describes someone who is cautious, compliant, correct, calculating, concerned, careful and contemplative. They tend to be slow, critical thinkers, perfectionist, logical, fact-based and organized. They follow the rules, don’t show their feelings, are private and have few but good friends. They look for big-picture outlines and when they ask, they ask “Why and How.” Probably, your accountant would fall in here.

· The High “D” will Build respect to avoid conflict

· The High “I” will be social and friendly thus building the relationship

· The High “S” will be genuinely interested in them as a person

· And the High “C” will warn them in time and generally avoid surprises

If you take the test, have your loved ones take it, your fellow employees take it and then sort out the results, you will know who you are working with, living with and interacting with on a daily basis. When you return to the workplace and know that the person beside you is a High “C,” it will help you interact with him in a meaningful way.

The same is true of interactions with your customers or patients. If someone displays all of the descriptors of a High “D,” and you don’t respond accordingly, the result will be “Lead, follow or GET OUT OF THE WAY.” Of course there are also those who have a combination of at least two of these areas, for example, a High “D” over “C." So do your homework.

By the way I’m a High “I.”

Surprised, don’t be.

by Tony Chen

Over at the hospital impact social network, there have been a few very insightful comments about hospital culture:

Mike said: "Hospital cultures are very segmented as well. Not only are they segmented by profession i.e. nursing, medicine, ancillary services etc. but also intra-professionally within in each discipline i.e. Nursing - ER, ICU, Med/Surg; Medicine - Surgery, ER, Attendings Residents and the list goes on. Each group has their own expertise they bring to the table and each are jocking for position on many issues depending on the impact. Bottom line hospitals have very dynamic cultures."

Isn't it this type of culture that breeds the "not my job" type of attitude? And when the "not my job" is running point for a patient's care, devastating things happen.

Jane had an interesting solution for this particular problem:

One of my answers is..return the role of "head nurse" to its original purpose. That is, overseeing the care given to all patients on a unit, teaching nurses how to improve their practice, engaging other members of the care team in true care planning, making rounds with physicians and talking with families. Not managing a budget, finding staff, sitting on innumerable committees and spending almost no time actually on the unit.

This comes down to investing in additional resources to the head nurse with the many administrative tasks. While I like this idea, I think there are some administrative/strategic initiatives that only the "head nurse" who knows what's going on could really implement.

Speaking more generically about hospital culture, I saw this very interesting insight from Denny:

"For leaders, the most critical thing they can do to shift a "culture" is find out what the conversations are that their people are having. Not only is it important to know what people are saying to each other, but also what are they saying to themselves about the way things are. When a leader knows what people are saying about "the way it is around here," the leader then has an opportunity to address the issues and make a difference."

I like this explanation because everyone can grasp this. Hospital culture isn't some warm fuzzy thing that only consultants talk about - it is the unwritten norms of behavior and the frank conversations. Of course, this means that the people trust the leader enough to share!

by Nick Jacobs

Giving people permission to care in the health care environment may be one solution to positively changing the manner in which we run our hospitals, nursing homes, clinics and ambulatory centers. If we carefully examine what the current behaviors are and how the stakeholders are punished and rewarded, it’s an eye opener. Having worked in this field for over 20 year, I know that profound caring is just beneath the surface and relatively small changes can begin a process of managing and changing expectations and behaviors.

How is this accomplished? Our first step was to provide enough information and education to every employee, physician and administrative leader so that they had no questions what-so-ever regarding the organization’s goals. We did this by offering open meetings over all shifts to every stakeholder. We then offered classes and workshops in Emotional Quotient (EQ), Disney, Planetree, and general Sensitivity training. We paid for a week-end visit to the Ritz Carlton for the head of housekeeping and maintenance, and sent four employees to Disney University.

By the second year, we had built a comprehensive evaluation matrix for patient satisfaction and patient responsiveness into our employee’s annual appraisals. We then created an opportunity for about 10 percent of the employees (including our senior leadership), to find employment elsewhere. Although this was a difficult time, it was clear that these individuals had no interest in providing the type of compassionate care expected in our organization.

Finally, each and every year for the last nine years, we have continued to enforce our commitment to the philosophy of transparency, patient and peer compassion, and spiritual openness. Integrative health, access to clergy, 24 hour visiting, and a commitment to creating an environment that encourages a nurturing attitude have contributed to making our facility a true center for healing.