Guest Blogger: Megan Schramm BA, RN, CNOP, RNFA
Let’s Harness the power of your most valuable resource… your employees
In my last installment, we talked about the changes occurring in today’s healthcare environment and how we as organizational leaders need to adapt and change as well…. AND something that needs to change might just be our current leadership style…
So what exactly HAS been going on in healthcare? The ACA, Meaningful Use and Quality Based Care are all major buzz words right now, but they are not the only changes going on in our world. They are just the tip of the iceberg. When you get down to it, the whole way we deliver care is changing. Medicine gets more complex every day. Healthcare is a frantic and unpredictable environment where challenges and change are daily occurrences. In fact, many schools of thought say that we healthcare professionals are living at the edge of chaos. No, I do not mean the state of your desktop… I am talking about the belief that when a system, individual or group is faced with either a negative situation or a positive opportunity, they are pushed out of their comfort zone, where it is safe, stable and predictable. This disruption of normal flow creates an environment conducive to growth and learning. People are forced to think outside the box and be creative. This change in the environment means individuals must be innovative and inventive in order to thrive. As a leader, wouldn’t you like to harness some of that innovation, growth and creativity?
The thing is traditional management models are not based on the environment of chaos, change and growth potential that healthcare has become. Historically, managers sought to maintain order and consistency. Their aim was the control of complex processes and ensuring the organization remained focused on the end objectives and operated according to set rules and policy. It was all about maintaining status quo and NOT making waves…. Although this style of leadership is great for day to day operations, when looking at the whole picture, we leaders need to approach things differently in order to successfully deal with the unpredictable, chaotic and ever changing environment that our world has become. Not only do we have to ensure our organizations are following mandated regulatory standards, but we must also take the issues of cost constraints and increasing public scrutiny into consideration while still allowing for the delivery of quality patient care. That is a lot of plates to keep spinning! The shift of healthcare from a volume-driven, fee-for-service approach to one that rewards (and reimburses) quality and efficiency calls for a more integrated model of care with greater vertical and horizontal assimilation of services and the implementation of uniform, data –based quality standards as well as the overall reduction of costs while still providing value. What does this mean for us? It means that the success of our organizations will depend as never before on the quality of our leadership and our ability to adapt to these initiatives.
Ok, so we know we know what doesn’t work. We know it is time to re-evaluate our resources and figure out how to use them in the most efficient manner while still delivering quality patient care. So where do we start? How about with one of the most valuable resources we have at our disposal? I’m talking about our employees. It is time to harness the knowledge, experience, passion and enthusiasm of the clinicians who are out in the trenches every day- providing that exceptional care our patients need and deserve. So how do we do it?
In his volume aptly named Leadership, J.M Burns describes the concept of Transformational Leadership as a process in which “leaders and their followers help each other to advance to a higher level of morale and motivation.” Rather than initiate directives from the top down, we need to find ways that facilitate a collective decision making process where all members of the organization are made to feel that they have influence over its success. By following the basic principles of the Transformational Leadership approach, we can inspire the members of our facilities to change their expectations, perceptions and motivations and work together towards the common goals of the overall organization.
Ask not what your hospital can do for you, but what can you do for your hospital! As a Transformational Leader, you need to inspire those you lead to share your vision of success. Show them that running a healthcare organization is a team effort and they are a valuable and important part of that team. Show your understanding and appreciation for what they do on a daily basis. This will increase the value of what they do so that they feel that they are an important part of you organization. Knowing that administration realizes their efforts will help to inspire them to give 100%… 100% of the time.
Now that they realize their worth and that their leaders value them, it is time to empower your employees… Give them the ability to take a greater ownership of the activity of your institution. Give them a change to have a voice be an active participant in the creation of a better healthcare organization. Through your own actions, keep them interested and enthusiastic about organizational change- help them to see the benefits of change rather than the annoyance of having to learn something new.
Do you have what is takes? In order to be a Transformational Leader, you must inspire and encourage those who work for you to want to do their best for the good of the organization and, ultimately, their patients. You need to be a cheerleader, an innovator, an open minded listener. In addition, Transformational Leaders are… agents of change…. risk takers…. lifetime learners and visionaries. They have an open and sincere relationship with their employees. Lastly, they are led by their core values of their organization, and work to uphold its mission and vision.
Now that you know WHAT you need to be as a Transformational Leader, tune in next time when we talk about WHAT you need to DO!
Like many of us, I have worked at the staff as well as the managerial level at various points throughout my clinical career. Before getting into those leadership roles, there were many times that I felt that I was simply “following orders”. Another rule, mandate or policy that I never realized was being considered, let alone have the opportunity to voice an opinion about, would be communicated to me by my superiors and my job was to simply carry it out. As a staff nurse, how do you think that made me feel? It made me feel exactly like that- staff. That was how I was seen by management- someone who followed orders. I often did not feel I was seen as the educated and knowledgeable professional I truly was- with the potential to offer valuable insight to my organization’s leaders. With this in mind, it is important to note that people are also less likely to support something if they do not have a say about it. How often have you heard grumblings and complaints after setting new policy? Well, maybe it is more than “change management” issues…. Maybe we as leaders need to make some changes as well….
Speaking of change, how many of you are feeling the effects of the recent healthcare reforms and federal legislation? As Meaningful Use, the ACA, updated CMS standards and other mandates become more a part of everyday life, those of us in healthcare leadership will have (and already have!) many new challenges to face. Now more than ever, we need to look at the care our organizations provide in terms of quality rather than quantity as well as re-examine available resources and find ways to utilize them in the most productive, yet cost effective manner possible. All of this will mean thinking out side of the box in order to define new and innovative methods of care provision. Part of this organizational assessment includes analyzing our current methods of leadership and decision making. Are they the most effective practices for the healthcare environment of today?
What is YOUR leadership style? Are you autocratic, democratic or laissez- faire? Do you consider yourself a visionary, coach, pacesetter or commander to those who report to you? Are you the primary decision maker for your organization or do you consider this process to be more of a group effort? If so, who is included in the decision making process?
Tell me if this sounds familiar…. Historically, healthcare management has been based on methods that worked in the past (“This is what we’ve always done!”), intuition and educated guesses. The decisions of the organization’s knowledgeable superiors were rarely questioned publically by those under them.
As time went on, the 20th century saw hospital-based care become the primary mode of healthcare delivery as well as an increased need for specialization of disciplines and skills. In order to keep track of everyone, what did we do? Most hospitals followed a centralized leadership design- each different department was run by a manager, who reported to a higher manager and so on until finally reaching the organizations CEO. Is this how it is at your facility?
Now is this type of leadership effective? Sure! Everyone knows who they are accountable to and information from the lower rungs of management is funneled up to the top… eventually. However, this vertical management structure IS a bit one sided… information is reported UP and decisions are sent DOWN. What about direct input from your frontline care givers? What about supporting the development of innovation or quality improvement right at the level of service? How can different departments integrate functions or share ideas if communication only happens vertically and not horizontally as well?
So is there a need for leadership style change in your institution? Is it time for you to look at your current leadership style and maybe have a little personal change management occur? How can you better leverage one of your most valuable resources- your staff? Tune in next time when we continue our discussion on how to be better leaders by being better followers….
Think you know who nurses are and what they do. I bet you’ll see and think about nurses a little differently after you take the Time to Care and spend 7 minutes listening to Carolyn Jones. Carolyn is a photographer. In the video below she recounts what she learned over the two years she spent profiling the American Healthcare System. Her new book “The American Nurse” is a treasure!
If developing your nursing workforce into a competitive advantage isn’t part of your strategic workforce management plan…you’re going to lose in the world of value-based healthcare! Food for thought…
Enjoy the video…Susan
This week the Philadelphia Orchestra found themselves stuck on the tarmac at Beijing Capital Airport in China. The flight to Macao was delayed three hours when several members of the orchestra decided they could use their mobile devices to solve one of the problems – the increasing stress the passengers were experiencing. So they managed in the moment.
We are not talking about providing a distraction with mobile phones or tablets. We are talking about the unique mobile devices with which the orchestra works. We are talking about their musical instruments!
Several members of the orchestra provided an impromptu performance for the passengers and crew. Their performance is posted here and on YouTube.
It’s a great story and a great lesson in the importance of mobile devices. I should clarify. It is really not the device that is so important it is what you can do with it. Just as these musicians used their mobile instruments to provide the music whose “charms…sooth a savage beast”, managers in healthcare can use their mobile phones and tablets to access workforce management information, taking the Time to Care, to make those in the moment critical decisions about staffing or scheduling.
Whether you’re a musician stuck on the tarmac in China or a third shift House Supervisor at the local community hospital – Our Lady of Perpetual Chaos – tools to help you manage in the moment are essential to success!
Like you, I have, as a distant observer, been deeply affected by this week’s tornado and its aftermath in Moore, Oklahoma. The television reporters and their stories have created a continual hum in my house. Every once in awhile one actually draws my attention and I turn the volume up and pause to watch and listen. There were several stories reported that made me pause today.
There was the reporter at the bedside of a teacher with spinal injuries and a fractured breast bone. She was gentle in her questioning. Listening attentively as the teacher recounted the terror of the ordeal and the profound sorrow she felt having lost seven of elementary school students. She laid in bed on her back unable to move from right to left, unable to lift her arms she stared at the sealing as she spoke. The tears welled in her eyes and slowly pooled before gently rolling down her cheek. I myself welled up with tears.
There was the elderly woman standing in the rubble that was her home recounting taking shelter in a bathroom with her beloved dog. Now alone and amazed at her own survival she speaks about her experience with a reporter. As she describes the events she is most concerned and sad in the belief that her dog is forever lost and expresses her desire to simply find him. As this painful story unfolds on camera, a voice off-camera can be heard saying “the dog…there’s the dog!” and with that the camera pans to find the dog slightly visible under a large piece of metal – and he’s alive! The joy of that moment came right through the television as the elderly woman reaches to remove the rubble and free her beloved dog. The camera clearly captures her looking off camera and asking – “help me, please!” as she struggles to move the debris. Again, I welled up with tears.
Thinking back on these two experiences I found myself asking an interesting question: if nursing is a described as a helping profession, could the reporter talking supportively with the injured teacher and the reporter who was assisting the woman remove the debris entrapping her dog be considered “citizen nurses”? They were exhibiting some of the qualities we associated with nurses. Or do nurses have not just these helping instincts, but something more?
After much thought, I realized that nurses are different. If I had not known these were reporters in each story and had to decide whether the person was a reporter or a nurse, could I? YES! I could. Let me tell you how I could tell the difference.
The reporter in supportive conversation with the teacher would have sought to be closer to the teacher holding her hand as they spoke and gently dabbing her pooling tears. She would have anticipated this most basic need to use a special sense to convey support and caring.
In the second story, the person off-camera being asked by the woman to help was clearly not a nurse. A nurse would not have needed to be asked to help, but would have sensed the limitations of the elderly woman and intervened.
You see, a lot of people do great and deeply touching nurse-like things and as a society we are eternally grateful, as are the people of Moore, Oklahoma. But a “nurse” is a very special person who goes a little bit further and uses a “sixth sense” that only “nurses” possess – the sense of oneness with the patient.
I am thankful for the “citizen nurses” in Moore, Oklahoma and forever appreciative of what they have enabled me to articulate in this blog post is a unique quality of a “Professional Nurse”. For all those who take the Time to Care, whether unexpectedly in a time of crisis or routinely as part of one’s life work, the human spirit is uplifted by what you do!
Our decisions are reached using guiding ethical principles. Among those principles is beneficence which supports the belief that our actions should promote “good”. The result of beneficence is nonmaleficence which is to do no harm. These culminate in an overarching guiding ethical principle which many consider to be the highest ethical principle – respect for others.
There is a very thought provoking article in the May 2013 issue of the American Journal of Nursing entitled: Telling patients about staffing levels. The author, Douglas P. Olsen PhD, RN, presents a case study of an understaffed unit and challenges the reader to decide “to tell or not to tell” the patient.
Here is the Case Study he presents:
“It’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.
Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?”(Olsen, 2013)
Read the authors discussion of the decision-making process that takes place when deciding “to tell or not to tell” by following this link: Telling patients about staffing levels
If you were short-staffed to the degree that Mary Evans describes and it was hard to find the Time to Care…
What would you do?
Olsen, D. (2013). Telling patients about staffing levels. American Journal of Nursing. 113(5), 62-64. doi: 10.1097/01.NAJ.0000430239.60186.d1
This past week I had the pleasure of traveling to the United Kingdom for Kronos. Our healthcare time & attendance, e-rostering (scheduling) solution for the National Health Service – produced by SMART – was hosting a customer conference and I was asked to speak at the meeting. Never having been to London, I was very excited for the opportunity.
I arrived early in the morning after a long overnight flight. Certain that jet lag would soon be upon me, I decided to go out for a walk to begin the process of resetting my internal clock. As I left the hotel, I was startled by the sound of an ambulance siren and then the sight of St Thomas Hospital directly across the street from the hotel. It didn’t hit me at first, but it wasn’t long before I made the connection.
I was in London. It was in London that Florence Nightingale started her school of nursing. Her school was started at St. Thomas Hospital. Could I be staying across the street from “THE” Florence Nightingale Training School? I was…
Once I realized the serendipity of my trip to London, I circled back toward the hospital for a longer more meaningful look at the place I had learned of so many years ago in nursing school. I was thrilled to find that within the hospital was the Florence Nightingale Museum!
It’s a small museum, but packed with artifacts and stories. I fully expected to find a reference to “The Lady with Lamp” as she is often described. And I wasn’t disappointed, but I was surprised. Every drawing I have ever seen of Florence Nightingale with a “lamp” has rendered the lamp to look like a “genie lamp” with a long spout from which a flame emerges. What I discovered in the museum was that the lamp that she would have carried on her nightly rounds of the wards would have been a “fanoos”!
A “fanoos” is a Turkish lantern. It was used in Scutari during the Crimean War when Nightingale tended to the soldiers. I’ve included a picture of a “fanoos” that I took at the museum. It has forever changed my mental image of Florence Nightingale.
As we celebrate Nurses Week, May 6th – 12th, this little known fact is fun to share!
To all the nurses past and present “thank you” for continuing, as Florence Nightingale once did, to keep watch on those in need. We at Kronos are in awe of what you do…and we will continue to help you overcome the obstacles in the workplace that interfere with your ability to find the Time To Care!