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!