Moving Beyond Workplace

Moving Beyond Workplace
Soap Operas Creating A Culture of Accountability

Setting the Stage In 1853 in her recruitment add for women to serve with her in the Crimean War, FN wrote: “Sentimental nurses need not apply.” She also said this: “I attribute all my success to this—I never gave or took any excuse.”

We Need “Radical” Leadership
“Extreme” “Favoring fundamental change” “Revolutionary” Webster’s Dictionary “No excuses” leadership Florence Nightingale

Radical Leadership Shared Leadership Powerful Teamwork
Real Accountability Address Disruptive Behavior Courage

Radical Leadership You won’t be able to practice radical leadership without accountability We need a clear understanding of what it is & why it’s so important And our responsibility to make it happen… “Being accountable is a choice, not a condition.” M. Samuel: Creating the Accountable Organization

Objectives Discuss some of the challenges around accountability Define the 3 “building blocks” necessary to create a culture of accountability Explore ways to overcome the challenges of creating a more accountable unit/dept

Accountability: Current State
Instilling accountability is a huge issue in many hospitals & h/c organizations It has huge & worrisome consequences Creating an accountable culture is going to require strong, courageous leadership

Critical Questions Why are we struggling so much with the accountability issue? Why is it so hard to hold people accountable?

Why Are We Struggling So?
Holding people accountable takes time and energy Usually the people we need to hold accountable are the “difficult” people They’ve been “difficult” for a long time

It means addressing issues with friends & colleagues It involves conflict and “I don’t like conflict” Fixing it myself is just easier (but perpetuates & intensifies the problem)

It requires a skill set we never learned in our initial training & education Don’t want to be seen as a “battle axe” May lose people Hold them accountable for what? (so much needs attn/things change q day)

The Reality This is very hard work It requires real commitment
Just coming to a session is not going to “fix” things We all need to be in this together…

The Reality “When there is a lack of accountability, non-performers thrive while the rest of us do double work picking up the slack.” “People fall into a victim mode of fighting each other, rebelling against change and protecting themselves at the cost of hurting others and the organization.” Creating the Accountable Organization, Mark Samuel

The Result… Poor or no teamwork Negativity, nit-picking, back-biting
Finger pointing and blaming Lack of support for one another Poor outcomes, results, service, morale

It Affects Everything Quality Safety Service Satisfaction
Morale Teamwork R & R Productivity Communication Culture

The Solution: Accountability
Creating a “culture of accountability” Understanding what accountability means & how to create it Accepting YOUR responsibility to make it happen “Being accountable is a choice, not a condition.” Mark Samuel

Accountability Challenge
When you hear: “Our focus this year is going to be accountability.” “We want to instill, and insist on hard-wired accountability across the entire organization.” What is your reaction?

Accountability Defined
“Myth: Accountability is a way to blame someone for making a mistake, resulting in fear.” “Truth: Accountability is the key for increasing trust, reducing fear, and improving morale and performance.” Mark Samuel, Creating the Accountable Organization

A willingness to answer for results and behavior. A commitment to own, discuss and learn from successes and mistakes. An environment where individual & shared ownership produce outstanding results.

Accountability is a personal responsibility The responsibility to be accountable lies within the person—not an outside source, i.e. supervisor, manager, etc. “You have to hold your people accountable” is a fallacy People need to BE accountable

“Holding someone else accountable is like trying to eat their lunch for them.” Lydia Snyder, Independent Consultant

Mark Samuel, Creating the Accountable Organization

Victim (Soap Opera!) Language
Not my job, not my patient, not my responsibility Too hard/overworked/busy Will I get paid extra? How come I have to do this? I was on my break It would be a lot easier to do my job if _______ would do their job What did you expect me to do!?

Victim Language What I hear all the time! You don’t understand…
There’s nothing we can do … It’s been this way for a long time… That would never work here… We’ve tried that before & it doesn’t work… Nothing ever changes, no matter what we do…

Accountability Language
The theme of your conference… “Only the Best: Nursing Care that Women and Newborns Deserve” When you listen to our victim language, does it sound like “the best?”

Accountability Language
We have a problem that needs attention Let’s see if we can find out what happened here I was on my break, but let me investigate How can I help fix this? I knew this would blow up and I should have addressed it How did this happen and how can we prevent it from happening again?

“No Nonsense” Accountability
Nurses who understand what accountability means: Who have the knowledge & tools to create an accountable environment Who have the courage & commitment to make this become a reality

Application What’s not happening in your area that you want to happen? What’s happening that you don’t want to happen? What are your accountability challenges?

Accountability Follow-Through Clear Expectations Rewards or
Consequences 30 30

Accountability Follow-Through Clear Expectations Rewards and
Consequences 31 31

Clear Expectations Clear expectations come from a clear purpose/idea re what you want to do They help you understand what you are supposed to do and why Clear directions are step #1 in creating accountable work environments 32

Clear Expectations The problem can be a “sender” problem
“Calls lights need to be answered promptly” “Our fall rate is too high” “We need improve our HCAHPS scores” “We need to reduce our med errors” “It takes too long to get stuff done here” “We need to do better on JC this year” “You’re not a team player” “I need you to do a cost/benefit analysis”

Clear Expectations Or a “receiver” problem
The sender is trying to be very clear about what s/he wants done The message doesn’t get through Does this sound familiar?

Clear Expectations What exactly are we supposed to do?
Why is this important? Who is supposed to do it? How does this fit in with other things we are working on? How do you/I do this?/get started? When does this need to be done by?

Clear Expectations When you say:
“People don’t do what we need them to do.” “Staff are not engaged” “There is no accountability” “There is no trust” “Morale is poor.” “There is very little autonomy.” “People cut corners a lot.” “Disruptive behavior is a real problem.” “Teamwork is poor.” “We have huge silo issues.”

Clear Expectations What does this mean?
What exactly do you want them to be doing that they are not? What makes you say morale is poor? Based on what observations? What does it mean when you say staff are not engaged? What makes you say “there is no trust?” What does good teamwork mean to you? Does your staff understand this? Agree with it?

Clear Expectations If you want these things to improve, you need to clearly define the problem and develop some clear expectations And then you need to discuss them with those who are responsible for making them happen There will be no accountability if expectations are not clear

Clear Expectations: Say What You Mean!
“Does it seem loud in here this morning?” “If you have time on your lunch break, check your mailboxes” “This bedside unit could be cleaner” “It seems to me that you are always late coming back from your breaks…” “I know I can count on you to do the right thing” “Everybody knows…”

Clear Expectations: Convey Commitment
“Here’s the latest from our QA people…” “The CNO wants us to reduce our pt fall rate…” “This is important…” “I argued against this, but I lost…”

Your verbal message and your non-verbal message must match

Only 7% of your communication occurs through words 38% is tone of voice 55% is body language Given the choice, people will listen to your non-verbal over your verbal—every time “Sometimes what you do speaks so loudly that I can’t hear what you say”

Clear Expectations: Understanding
Encourage questions Have them repeat back May need to be written down The power of signing & dating them

Clear Expectations: Agreement
Must get agreement and commitment From everyone! Watch for “wishy-washy” answers

Clear Expectations “We have to get the best EMR that we can, that everyone can easily understand, at the lowest cost, as soon as possible” “Let’s try to reduce our medication error rate by 10% by May 31” “In the next few mos, I want us to look into supply reprocessing”

Clear Expectations If people don’t understand expectations:
At best, they’ll interpret what you say in a way that makes sense to them, resulting in many different behaviors, which may/may not be what you want At worst, they will ignore you Outcomes, results, quality efforts are at risk

Clear Expectations The critical first “building block” in creating an accountable unit/dept/org You can’t hold people accountable if they don’t know what to do “There will be no accountability in an unclear environment.” M. Samuel

Clear Expectations: Application
What are your biggest challenges? What (exactly) is the issue? What is not happening that you want to happen? What is happening that you don’t want to happen? What (specifically) do you want to do about them? Do you need to get additional info? What should your first steps be?

Consequences 50 50

Meticulous Follow Through
Once people understand the expectations, your next job is follow-thru Do they have what they need to do this? What are some necessary first steps? When will you touch base on this again?

Check on progress Mentoring, coaching, guidance Feedback, encouragement, support Motivation, inspiration, perspiration

“How is the investigation of the wait times in the ED coming along?” “Are you feeling more comfortable with the new JC standards?” “How is your EBP project coming along?” “Last month we talked about…”

Focus on goals, behaviors, actions Don’t make it personal or punitive Don’t get emotional Always refer back to the expectations (this is why it helps if they’re written)

Why the follow through is a challenge: We get involved in other things We think they’ve “got it” The issue may become OBE “We got busy” Does this sound like “Only the Best?” “Care that women & NB’s deserve?!”

How to overcome this: Set up a simple F/U plan when setting expectations Put it on your Outlook Calendar Use the “buddy system” Make it a “quick check” item on your staff meeting agenda Do a “quick check” after report

Meticulous Follow-Through
You do not do follow through forever… You need to decide on your follow up strategies Discuss with HR How do you deal with the people who don’t meet the expectations?

It’s challenging! It means dealing with “difficult ” people They are very tough! So we back away… They win—& there is NO accountability!

It can also be extremely rewarding Watching your staff improve in their daily responsibilities & on critically important issues Seeing change & improvement in ALL staff, outcomes & results

If you ask me to do something, give me a special assignment, etc. and then never ask me about it again… What is my incentive to do this? What is my incentive to do the next thing you ask me to do?

Giving your staff clear expectations, and doing all you can to help them meet those expectations Firmly dealing with those who don’t meet the expectations THIS is how you create a culture of accountability; this is how things get done

Consequences 62 62

Rewards & Consequences
If you want to create an accountable organization, leaders must: Recognize people who meet expectations Confront those who don’t

We are bad at both rewards and consequences It’s not complex We know how to do it It is outside our comfort zone (both rewards and consequences)

Rewards Why is it so hard to reward people?

Rewards Why is it so hard to reward people? Remembering to do it
Outside our comfort zone How many times do I need to tell them they’re doing a good job… It’s their job to do a good job Keeping it sincere Keeping it timely

Rewards It does not take time; it takes effort, memory & practice
It does not cost anything It is not hard It’s one of the cheapest, easiest and best ways to improve act in your dept

Rewards Don’t make it complicated It’s the simple things that matter
Make sure there is a clear connection between the reward and the behavior

Rewards Say thank-you Mention what people are doing publicly
Celebrate steps along the way Search for the positive Acknowledge the strong workers & support those that struggle

Rewards Oriental Trading Company Kudos Snack Bars Life Savers
1001 Ways to Reward Employees Periodic fun events

Rewards Challenges: The good performers may be harassed
If this is different behavior for you, people may be suspicious Being overcome by the crisis mentality Falling back into our usual behavior

Rewards Challenges: Being accused of playing favorites
All people need to be treated fairly Not everyone gets treated equally Not everyone acts equally

Rewards If I do something, on time & very well and no one notices…
If I meet all the expectations of this job, day after day, and no one notices… I’ll stop working so hard or change to behavior that DOES get attention

Rewards “The more that people receive positive feedback for good performance, the more likely it is that good performance will be delivered.” Dick Grote, Discipline Without Punishment “Praise more than you think you should, and then triple it.” Kerry Patterson, Crucial Confrontations

Consequences This is the challenging part
It takes time, energy & focus We don’t like conflict We want people to like us Some of these people are tough!

The Usual Consequences
Document Re-educate Personal file Withhold a perk Reprimand Disciplinary counseling

New “Take” on Consequences
Address behavior that’s inconsistent with expectations Re-education Assign a mentor or coach Compassionate counseling

Compassionate Counseling
“I notice that you are struggling…” “How can I help you?” What do you need to meet the expectations? “Help me understand your response…”

“You always bring your problems to me, we talked about his last month. What is your plan for improvement?” “Everyone has taken on a responsibility in this project but you…” “We are trying to build teamwork in this dept and your behavior yesterday…”

Don’t make it complicated Don’t make it personal Don’t make it last Don’t make it punitive (initially)

Compassionate counseling does not go on forever! First time, compassionate Second time, compassionate but stern Third time: “If you want to stay here, you need to come up with a plan for improvement.”

If I’m supposed to do something, and don’t do it—and nothing happens There is no incentive for me to do the next thing you ask me to do You get what you tolerate! The result…

There has to be both rewards and consequences We know how to do both It’s challenging That’s why so many organizations are struggling with accountability…

Consequences 85 85

Instill Accountability
“Myth: It takes a year and a lot of resources to create a more accountable organization and achieve breakthrough results.” “Truth: It takes three to six months to increase accountability and achieve breakthrough results.” Mark Samuel

In the new world of “radical leadership” This is no time or space for victims!! People who are unwilling to own their behavior must be confronted If they can’t change, they can’t stay… This is what accountability looks like

Creating an accountable dept is a choice that you make, not something that happens to you This is the everyone’s responsibility The result: an environment where individual & shared ownership produce outstanding results

You CAN Do This!! It will take strong leadership—that’s you
It’s hard work, but when you get there, everything changes We can’t keep talking about this for another 20 years..

You CAN Do This!! “I learned in an extremely hard way that the accountability falls with me.” Stephen Baldwin

Ginny Beeson vrbeeson@msn.com Ginnybeeson.com
Good Luck! God Bless! Ginny Beeson Ginnybeeson.com

Moving Beyond Workplace

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