You Hear Me??!!

My old friend, Dr John Ewing, a Scottish psychiatrist and chair of the Department of Psychiatry at UNC Chapel Hill, tells the story of coming to the psychiatric hospital one day and reviewing his dictation from the previous day.  He does a quick-take when he reads in an History & Physical:  "Patient became despondent upon returning home and finding her husband in bed with his power mower." 

Dr Ewing thinks, "Surely I would have remembered THAT!"  Then he remembers what he actually dictated:  "Patient became despondent upon returning home and finding her husband in bed with his paramour."  

While the story is both funny and true, it points to the importance of being heard correctly.  As behavioral health professionals we, of all people, should be experts in listening and making sure people are heard correctly and understood.  I was taught in graduate school that there are “5 Keys to Active Listening”:

1. QUIET.  You can’t hear what others are saying when you are talking yourself.  Just as important is an “inner quiet”, that is, keeping your inner voice quiet as well so you are focused 100% on what the other individual is saying.

2. LISTEN.  Duh, thank you, Dr Obvious J .  But, kidding aside, by “Listen” I mean employing “active” listening techniques that assure (a) you are getting the message correctly and (b) the individual knows their message was received correctly.  We do this by:

3.  EVALUATE.  What is the person saying?  How are they saying it?  What are they trying to communicate?  What does their non-verbal behavior suggest?  Evaluate the message, how it is being communicated and what you think it means.

4. ASK.  Ask questions to clarify the message and to indicate to the individual that you are listening.  “When did that happen to you?”  “How did that make you feel?”  “What did you do then?”

5. REFLECT.  “Reflect” or mirror the individual’s message back to them to make sure you are getting it correctly.  “So, you said this happened two years ago and it made you feel angry?” 

The way I remember these techniques is the anagram:  Quiet L.E.A.R.  Try them today and see if they don’t improve the way you communicate with patients, families and colleagues. 

    

The Mayonnaise Jar & Two Beers

A professor stood before his philosophy class and had some items in front of him. When the class began, he wordlessly picked up a very large and empty mayonnaise jar and proceeded to fill it with golf balls.

He then asked the students if the jar was full. They agreed that it was. The professor then picked up a box of pebbles and poured them into the jar. He shook the jar lightly. The pebbles rolled into the open areas between the golf balls. He then asked the students again if the jar was full. They agreed it was.

The professor next picked up a box of sand and poured it into the jar.  Of course, the sand filled up everything else. He asked once more if the jar was full.  The students responded with a unanimous 'yes.'

The professor then produced two beers from under the table and poured the entire contents into the jar effectively filling the empty space between the sand.  The students laughed.... 

“Now, said the professor as the laughter subsided, 'I want you to recognize that this jar represents your life. The golf balls are the important things---your family, your children, your health, your friends and your favorite passions---and if everything else was lost and only they remained, your life would still be full.”

“The pebbles are the other things that matter like your job, your house and your car.  The sand is everything else---the small stuff.”  REMEMBER:  “If you put the sand into the jar first,' he continued, 'there is no room for the pebbles or the golf balls and the same goes for life. If you spend all your time and energy on the small stuff you will never have room for the things that are important to you.”

“Pay attention to the things that are critical to your happiness:  Your children, your parents, your grandparents.  Take time to get medical checkups. Take your spouse out to dinner. Play another 18. There will always be time to clean the house and fix the disposal. Take care of the golf balls first---the things that really matter.  Set your priorities. The rest is just sand.”

One of the students raised her hand and inquired what the beer represented. The professor smiled and said, “I'm glad you asked:  The beer just shows you that no matter how full your Life may seem, there's always room for a couple of beers with a friend.”One of the students raised her hand and inquired what the Beer represented. The professor smiled and said, “I'm glad you asked:  The Beer just shows you that no matter how full your Life may seem, there's always room for a couple of Beers with a Friend.”

The Chicken Squad!

A guest column by Anthony Cirillo

In September, I attended a local American College of Healthcare Executives (ACHE) event around customer service. The two-behemoth health systems were represented as well as one other local competitor. However, the person who stole the show was the local franchise owner from Chick-fil-a, Rob Rogers. While others droned on about evidence-based patient experience and role-playing, he got to the fundamentals.

Rogers definitely impressed me because he boiled employee and customer experience down to basic human values. (Although you may not agree with the corporation's values, keep in mind he was speaking as a franchise owner with his own views and values.)

So what was this franchise owner squawking about? Here goes.

He cares for his employees
You're thinking that I'm writing about "the old caring and compassion thing" again. Well, yes, in a way. You see he hires people of all ages, from 16 to 75 years olds. And he's there for those hard to handle teens, getting to know them and taking an interest in their grades, for example. Even in a 50,000-employee organization, directors and managers can do the same. After all, this franchise owner has 78 direct employees. How many direct reports do you have? When he truly takes an interest, he gains loyalty from a workforce that truly wants to help him succeed.

He constantly communicates and demonstrates his vision
Just like Cleveland Clinic CEO Toby Cosgrove, M.D., never misses a chance to talk about or demonstrate his commitment to patient experience, our chicken man never misses a chance to walk the talk. Each franchise is independently owned and he puts his own stamp on his store. And it's not about selling chicken. It's about creating great experiences. He is on the floor and involved.

He sets high expectations
Not much to say here except to mention his take on business and the setting of expectations--we aim too low and don't expect enough. Set the bar higher.

He focuses on the core four
Rogers asks his employees to follow the "core four" (and makes some of his hiring decisions based on how prospects do or don't incorporate them during the interview process):
1. Assess the mood
2. Make eye contact
3. Smile
4. Maintain the relationship

In other words, be mindful of the person the entire time they are there. As a customer (think patient) walks in the door, assess his/her mood. Prepare your approach accordingly. Check in with them and stay connected until they leave the store.

These sound like simple things yet it took two years for him to drill down some of these basics. And guess what? Chick-fil-a vetted him for five years before they allowed him to buy the franchise. How often do we get that right with the 16 percent CEO turnover in the hospital industry?

People often ask me about innovation in healthcare and patient experience. Sure, I can talk about some of the best practices inside and outside of the industry and make my own predictions.

But you know what? I think innovation might just come from simplification.

Throw out the scripts and role-playing. Concentrate on a few core behaviors. Empower your employees to make them their own. Use the core four.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting, which specializes in experience management and strategic marketing for healthcare facilities. He also is the expert guide in Assisted Living for About.com.

Leadership Lessons From LEGO

My colleague Ken Perlman is a devoted father of two girls. He feels that many of the lessons learned in fatherhood apply, on a certain level, to teaching our clients change leadership. Here he shares the parallels between building a complex LEGO set with his daughters and coaching a client through transformational change.

As my daughters and I tackled a three-day LEGO project, I realized that what makes these projects so fun and satisfying are the same things that help my clients love leading change in their organizations.

Now, we all know “love” and “change” don’t get used in the same sentence very often, but some of the same principles that made for a wonderful, LEGO-filled weekend with my girls are also at work with my clients. These principles are present with my larger clients (thousands of employees around the globe) as well as my smaller ones (a few hundred employees in one location).

So here they are – lessons in leadership courtesy of LEGO.

Lesson #1: Start with what success looks like. LEGO provides a complete – and exciting – picture of the final product right there on the box. It always looks AWESOME. There is little mention of the number of bags, number of pieces, number of steps, and so on (which would only deflate your excitement). You fall in love with the end result before you even buy. After buying the set, you feel that the finished project is just a few steps away because you already know what success looks like – and it looks AWESOME. Many times, executives outline the daunting and time-consuming strategies required to get from today to tomorrow – deflating excitement – rather than building momentum around the picture of the finished product. Most fail to paint or show a clear (AWESOME) picture of what success looks like. It’s this picture that makes people fall in love with the idea; that makes them eager to spend their time putting all the pieces together to make it a happen.

Lesson #2: Consider interchangeable parts. It’s rare, but occasionally, there are missing LEGO blocks. Instead of stop-mode, these challenges put my daughters into innovation-mode – they pull out their bucket of spare parts to find what we need and we keep building away. How many times have our colleagues said, “That won’t work because …” or “We’ve already tried that”?  Although these excuses occasionally save us some time not repeating old mistakes, it’s unusual that we go back to see what pieces (lessons, learning, accomplishments, etc.) can be reapplied. Often times people, tools, resources, and lessons are there for the picking, it’s just rare that we go back to those buckets to get them.

Lesson #3: Instructions are only so helpful. The instructions are great, usually. But there are cases where you simply cannot tell which round peg goes into which square hole (with LEGOS, literally). Whereas I turn the instructions round-and-round, flipping ahead to get another view, my daughters simply put things together as best they can. They say, “Let’s try it and see if it works.” This fearless experimentation is a critical element to accelerating innovation. What’s the worst thing that could happen? With LEGOS, the consequences are nil. In many business or organizations there are real risks. But, more often than not, the main risk is not the unforeseen consequences, but in the risk of being seen as wrong. By eliminating that fear, we increase our ability to iterate in fast cycles. It is key for leadership to encourage and reward those who experiment, learn, and build.

Lesson #4: It’s more fun when more people are working together. Working on a LEGO project on your own is great. But sharing the experience with my daughters (or more specifically them sharing it with me) is so much more fun. My clients find it easier to get 100 people to volunteer one hour each than to get any one person to find 100 free hours. The different people, perspectives, and experiences make for open collaboration. Each volunteer brings different strengths, allowing the innovation to go faster, further, and freer.

Lesson #5: The quality of the final product relies upon the input of imagination. When I was growing up there were few custom LEGO parts, perhaps a wheel or a windshield. Today, there are a huge number of set-specific parts (e.g., tools, flip-up cockpits, weapon launchers, etc.). Yet my daughters still make modifications or, in their words, “improvements.” One daughter built a LEGO motorcycle which was destroyed when she sent it down hardwood stairs. Instead of being bummed out, she saw an opportunity. “Now I can make it better,” she said. “It was too heavy to go as fast as I want it to.” She stripped it down, leaned it out, and launched it again. At the end of the day, it all comes down to the builder’s imagination.

Look, as a leader, you set the tone for how your employees experience large-scale change. You could be the one that enables fearless (but informed) innovation and experimentation – or you can be the one holding up the instruction book saying, “That’s not how we do it.” The choice is yours.

By the way, friends at LEGO, Star Wars X-Wing … Best. LEGO. Ever.

Ken Perlman is an engagement leader at Kotter International, a firm that helps leaders accelerate strategy implementation in their organizations. Follow Kotter International on Twitter @KotterIntl, on Facebook, or on LinkedIn. Sign up for the Kotter International Newsletter.

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This article is available online at:
http://www.forbes.com/sites/johnkotter/2013/09/24/leadership-lessons-from-lego/

LEAP AND THE NET WILL APPEAR

I spent almost 25 years running psychiatric and general hospitals.  While the work is not always fun, it is always exciting and I enjoyed the daily challenge of trying to improve hospital operations.  More importantly, I enjoyed leading a team and I valued the friendships that developed at each hospital over the years.
                                                                                                                         
So, it was with great difficulty that I considered leaving the relative stability of hospital administration for the challenge of consulting.  I had worked with David Cawley and Jim Johnson earlier in my career, so that was not an issue, but I was anxious about the unknown, my future, and whether I’d like the life of a consultant.  I thought deeply about my decision for weeks. 
                     

                                                                                                                                                                          
In the end, a simple card from my wife made my decision for me.  Alina had watched me struggle with my decision.  One day, returning from a trip to the mall, she handed me an envelope.  Inside was a card that said simply:  “Leap and the net will appear.”  I decided to take the leap...the support and encouragement I needed to succeed did indeed appear...and I have never regretted the decision. 
                                                                                                          

And it’s like that in healthcare.  We struggle with rapid and significant change...the fear of the unknown....uncertainty about the future.  But a bright future awaits each one of us who is willing to embrace change and not falter.  Here’s the best advice I can give you:  “leap and the net will appear.”