Who's Got The Monkey??

I changed offices this week to accommodate some construction on our wing of the building and as I was cleaning out my closet, I found a box of little plastic monkeys, hundreds of them in a variety of primary colors.
  

Now you might be thinking that I'm running a little Tiki Bar out back of the hospital or maybe taking that 3-for-1 boat drink special at Happy Hour alittle too seriously, but in reality I bought those monkeys on purpose, to illustrate a very important management concept.

Back in 1974 (yeah, I've been around that long...), William Oncken and Don Wass wrote a classic article for the Harvard Business Review called "Who's Got The Monkey." Their notion was simple:  As a business manager, every time someone comes in your office, it is because they have a "monkey on their back", a problem that they need to solve and their goal is to get that monkey off their back by giving it to you.  

"Hey, Bob, I was wondering if you could help me finish my budget for 2013.  It's due on Friday and I've got so many priorities right now that I could really use your help!"  

"Sure, Dave.  I've already got mine done...it wasn't as complicated as I thought it would be...so I'd be glad to give you a hand."

Now as I watch Dave leave my office, I notice a curious thing:  He no longer has a monkey on his back.  Why?  Because he left his monkey with me and now its on my back.  

I've seen this happen thousands of times, particularly to new managers.  And especially in healthcare, because we pride ourselves on being "helpful" (hey, why else did you go into hospital work??) and so we're suckers when it comes to letting people leave their monkeys with us. 

Want to be helpful? Look at it this way:  If you successfully hand off your monkey, then your problem becomes my problem.  Then you don't have a problem anymore, do you?  And I can't help someone who doesn't have a problem.  So in order to be the most helpful to the most people I have to make sure they all have their monkeys.

Making sure everyone keeps their monkeys is just good management.  It is good personnel management because you hired that manager to do a particular job.  If you do their job for them, what are you paying them for?  It is their job to identify problems in their departments and to solve them.  And it is good time management.  If you do their job, who is doing yours?  Nobody.  So you get more and more behind in your own duties...not what you get paid for.  

So I bought my box of monkeys to illustrate the point to my Management Team.  We discuss the Oncken & Wass article, talk about times we've let this happen to ourselves and I leave each one of them with alittle plastic monkey to put on their desk to remind themselves "Monkeys:  Don't let folks leave your office without 'em!"

Read the original Oncken & Wass article at: Who's Got the Monkey? - Meilink.net

 

Where Are We Going? And Why Are We In This Handbasket??

One of the easiest jobs in the world is being a consultant:  Organizations pay you for your opinion and are therefore motivated to accept your advice.  You also enjoy the "Wizard of Oz" effect (discussed in one of my earlier blogs) of being the man behind the mirror who, through this consulting effect, uses existing staff (Dorothy, Toto and friends) and resources (Yellow Brick Rd) to accomplish the very task YOU were hired to accomplish (Back to Kansas!).

One of the hardest jobs in the world is to explain the customer, peers and clients the rationale behind your recommendations.  "We're going to do what? Why??

I'm basically a hired-gun change agent, specializing in organizational turnarounds.  Most of my work has been in hospitals, specifically specialty hospitals like psych, rehab, and long term acute care.  But I started out as a psychologist, so I look at things--including hospitals--behaviorally.  

My current project has gone very well.  I've been here about 10 months and the inpatient census has more than doubled, reaching record levels.  Yet, I was recently asked by the Board of Directors of the hospital to explain why I had chosen to focus on driving inpatient volume rather than patient & physician satisfaction.  And what's the focus for 2013??  I explained the entire concept with a single slide....

But first:  A little psychological history & systems.  In 1943, Abraham Maslow published his paper "A Theory of Human Motivation". His theories parallel many other theories of human developmental psychology, all of which focus on describing the stages of growth in humans. Maslow was unique in the field of psychology because he studied successful, optimized, highly functioning people like Albert Einstein, Eleanor Roosevelt and Frederick Douglass rather than mentally ill or distressed people.

Maslow theorized a hierarchy of needs (Physiological, Safety, Belongingness and Love, Esteem, and Self-Actualization) that needed to be met in order for an individual to grow psychologically toward "self-actualization"   His hierarchy is usually illustrated as a pyramid with the largest and most fundamental levels of needs at the bottom (physiological, safety) and the need for self-actualization at the top.  Maslow theorized that the most basic needs had to be met before an individual would desire (or be motivated) to achieve the next level of needs.  Simply put, Billy won't want to focus on his self-esteem (Esteem) if he's living in a cardboard box under the bridge (i.e., his Safety needs have not been met). 

Back to my story:  I've always thought organizations/hospitals are like people, particularly in the way they grow and change. And so I "borrowed" Dr Maslow's theory and applied it to organizations and gave it a really hip, important-sounding name:  The Hierarchy of Organizational Actualization.  

And here's what I told the Board of Directors about volume vs. patient satisfaction:  Just like in Maslow's hierarchy, its hard for an organization to focus on/want to improve patient satisfaction (a higher level need) when it is in imminent danger of closing (fundamental need). 

 We operationalized the Hierarchy into 5 key strategic goals for this year, the "High Five!', we call 'em.  And you can see our progress towards goals, having achieved both our "Foundation" needs and "Key Success Factors" needs and now focused on the "Values" needs of service, quality and pride, on our way to Vision.

So while my detailed "strategic plan" might be 68 pages long, it boiled down to this: Fix the fundamentals first, thereby building the foundation upon which we'd then build patient satisfaction and customer service, leading ultimately to an organizational "self-actualization" in terms of mission, vision and values.  

Class dismissed!