Hello, good afternoon and welcome back to today's HRO session today. We're going to cover part 2 of leadership for high reliability. My name is Victor Gonzalez with TMF Networks, and it is my pleasure to welcome you today.
Now, this is the sequel for sure. And as you both, or everybody knows here, W, W, we know that not all sequels should be made Greece, Karate kid just to name a couple.
But if you been to the box office lately, you know, top gun has been a big success. And we definitely, it brought up the big guns today so we'll get to the introduction in just a moment.
If this is your 1st time with us, this is going to be old hat. I'm going to go through it for those that are new to make sure that you are comfortable and know that you can participate in this conversation a couple of different ways.
We have turned on the chat feature for you to go ahead and send in your comments and questions. And in fact, our speakers are going to be prompting you to submit information there. Every time you share everybody benefits. So we welcome that.
And we encourage you to do that we're also going to be sending you some information in the chat links to check that. It's a 2 way communication. We hope that you take full advantage of it.
If you want to join the conversation, verbally, there's going to be opportunities for for you to do that. In fact, we are going to have participation from our audience today and we look forward to that. If you want to join the conversation, you'll see an icon to the right of your name.
There'll be a little hand there. Click on it.
You'll raise your hand, I'll find you in at the appropriate time on mute your line and bringing it to the conversation and it will be phenomenal.
All right, let's go ahead and get started. You see the smiling faces there, uh, from our safe and reliable partners. It is. My pleasure to introduce to you, Donna novella.
Donna is an, and experienced healthcare and patient safety expert who spent her clinical career in pediatrics in the emergency department.
She spent the last 15 years dedicated to quality and patient safety and health several operational leadership roles, where she designed developed and implemented patient safety programs, using high reliability concepts for both freestanding and academic children's hospitals in Connecticut and donna's most recent role as director of patient safety and quality for the Connecticut hospital association, she implemented large scale, statewide improvement projects in all of the acute care hospitals across Connecticut. She received her bachelors of science and nursing at Sacred Heart University in her masters of science and nursing from Yale University. Currently.
She lives in Sandy Hook, Connecticut. With her family, and I hear it is beautiful. There. She's joined today by Dr. Donald Kennerley.
Dr. Don Kennelly is a physician leader who has focused half of his 40 year career on improving the quality and safety of patient care after medical school and residency.
He was a, as a full time faculty member and internal medicine at University of Texas, Southwestern Medical Center, where he taught students in residents, did basic science research, and implemented a patient centered disease management program for parklands, 20,000 patients with asthma, seeing both the power and failings of healthcare led to executive work at the Baylor health care system where he developed patients, safety program across his 10 hospitals and many outpatient clinics, he developed and published methods to measure patient injury and let other improvements. His Baylor, chief quality officer. After leaving executive work, doctor, gentlemen has spent the last 6 years sharing lessons learned with consulting clients, committed to delivering care and we all that we all would want for our own families.
He has published 50 papers or book chapters received a variety of national awards in grants and helped found 2 patients, centered, nonprofit organizations. Dr. Kelly and Donna. Welcome to today's call. It's a pleasure to have you both on.
Thank you victor. It's really a pleasure to be here again. Um, good afternoon. Everyone I hope you've had a good holiday weekend and your week has gotten off to a good start.
If you live close by, to me in North Texas.
It's been really toasty lately and I hope your air conditioner is working really well, today we're going to continue and finish our 2 sessions on leadership for organizations that are on the high reliability journey. These really are challenging times for hospital leaders and everyone.
But as we introduced last in the last webinar, the times also offer a special opportunity to engage and activate other leaders and staff next slide.
So this is showing really the complexity of leadership. There's many things many things that leaders have to do, and we're going to be focusing today on more practical aspects of things.
Last time we, we, talked a little bit more about philosophy and how the leader can be helping to really punch up expectations for those on the team by focusing on mission driven activities that work towards higher reliability and make everybody feel good about their work. Next slide.
So, again, as I mentioned, last time, we, we covered some general topics and today in webinar, too, we're going to be talking about specific leader behaviors that support high reliability and some specific leader activities. And we're going to be talking specifically about 4 high leverage activities that you're going to be able to do next week. This is not something where you have to have us or somebody else come in for 6 months before you can get started.
You should be able to make a good start on based on the information that we're going to be sharing with you next slide.
So, again, going back over what we talked about last time, because some of you may have missed the last time, uh, we really emphasized that we spoke about our strong view that this is a unique opportunity to be bold.
So, as the hospital pressures of code would begin to decrease a little, you can aim for a new aspirational set of objectives, rather than just sort of saying Q, and let's go back to Pre pandemic state.
We're encouraging you to have sort of a reboot with an upgraded software new mindset to think about what things you might be thinking about doing because really, it's like, helping to form the concrete while. It's still soft.
Um, in order to do, so, um, hospital executives and other leaders need to act as really what we called a chief energy officers to communicate these new priorities that focus more on mission and things that matter what we mean, by what matters is the things that led us to work in healthcare in the 1st place, we encouraged you to avoid getting bogged down and seeking perfection which can limit your work on other important things, done to introduce you to some different leadership styles that you might have. And they're quite a variety of them. And encourage you to be flexible and to use styles that drive a strong organizational climate.
Finally, I encourage you as the, as the points of contact and liaisons for your hospitals, each quick work to meet with your senior executive sponsor, and perhaps have him or her listened to the recorded last month. A webinar that we provided.
Excellent. So now I'd like to take just a few minutes to have a short report back from you, I suggested a few homework activities, and hopefully you've had a chance to in the last month and maybe do 1 or 2. and we hope that you'll share your experience related either to talking to your execs.
I mean, what did they say when you talk to them rounding on the front line hearing what's on their minds thinking about leadership style yours or others?
And also, 1 of the things that I found incredibly helpful for me is I had priorities, but I'm not sure my calendar always reflected my priorities.
So, what I'd like to do is ask you to either raise your hand, or to describe what you did in the last month, in response to these suggestions into the chat.
So let's use this as a time to really learn from each other because no, 1 has it right? Perfectly Donna doesn't die. I mean, we all are learning here, so this is our opportunity to be sharing some learning and we budgeted some time.
So, uh, done anything else you want to say before we get quiet and give everybody a chance to contribute.
Oh, John, thank you for that. Great review and sort of the reminder of what we were sort of.
Expecting in terms of, um, reflections right now from the group from last time. You know, I think part of what makes these sessions really useful is putting some of the concepts we've learned into action.
So, I, I'm really excited to hear from folks and, as Dan said, we learn from all of you every time we do 1 of these sessions.
So I'm very excited to hear what you were able to work on and participate in over the last few weeks.
So, we're going to get quiet now and although silences sometimes uncomfortable we're providing the silence. So you have a moment to thought to think rather and then to share a few thoughts.
If you're wanting to put something into the chat, make sure it's directed in the 2 thing to everyone. So, just to be sure we all understand the assignment. We would love to hear, uh, if you've had an opportunity to talk with your executive leadership out uh, let's see, we have, um.
Do something in the chat here, but, um, let me just finish. So so, did you get a chance to talk to executive leaders around?
Some of the concepts, we discussed last time have you had the opportunity to talk with your frontline staff of what gets in the way and just telling us about how that was in terms of your experience reflecting on leadership styles.
That we talked about last time and, um. And what Don was talking about, how your time spent is sort of reflective of what your calendar is like.
Um, so let's see, uh, I, I see, um, something that says there was a common, um.
Expressed concern about staffing and that at times, uh, staff feel like there's a lack of teamwork that gets in the way of having a good day.
And I believe that was from, uh, please, uh, uh, correct me if I'm wrong. But I believe that was from, um, sherry.
Thank you sherry for that, and I think, uh, that's probably not an uncommon sentiment. Uh, now that staffing has been a real challenge for everyone.
And I've had a big part of staffing is not only sort of the how many do you have? But people who are new to your organization perhaps a lot of folks have had turnover.
And you've had a, um, people come in who are, you know, uh, asked to learn about your organization because they're, they're temporary folks is traveling nurses. And so that's especially challenging.
And the other thoughts. Okay, well, the chat will always be open.
So, um, I think we, in the interest of wanting to cover what we want to cover, we'll, uh, we'll move on, but we can come back to this. So, let's victor. Let's move on to the next slide.
So, uh, want to talk just a little bit about, uh, elevator speech.
Uh, we encourage you to have a, uh, sort of a quick reminder for you to be able to use, uh, about to communicate with other folks when you're on an elevator at a few minutes.
Just a, it's a 32nd summary that, uh, is short and sweet and it's a version of what's the big goal?
Why or how is high reliability we're going to help you to reach it as an organization and to invite others to be part of this journey. Um, Don, I know you've done a lot of this kind of work.
Did you find elevator speech communication useful?
I did, I think when we had a specific, um, a topic that we really needed to sort of gain some, uh, enthusiasm behind, or, um, really get people, sort of with a shared mental model around leadership would sort of craft what this elevator speech needed to contain it wasn't necessarily scripted, but here are like, the high points and then individually you would kind of put together your thoughts, you know, in an authentic way, a way that you would say them and, uh, and it was a really easy way to sort of quickly message.
Folks, uh, when you had an opportunity to connect to connect with people so I find this a really, actually, effective tool and, uh, the more you sort of practice it, the better you get at it.
And I would say that again, for those of you who were not maybe the executive leaders, but are responsible for helping, make change happen. The executives are often very receptive to people like yourselves, crafting something for them.
Um, don't expect them necessarily to come up with this. Um, and, uh, and they would love to get have you say what you think the main, uh, a 32nd elevator speech would be and then, uh, then you're good to go. I mean, you can put it everywhere.
Uh, not only in the elevators, but people say it put it in bathrooms and, uh, and that just helps everyone know what's going on and it really does build confidence in the change and gets people talking about it because it's kind of everywhere.
Okay Victor, next slide please. Um, so today, as I mentioned, we're going to be covering, uh, Don, and I are going to cover for specific strategies, uh, besides elevator speeches that can drive progress on your high reliability journey.
Uh, we're going to be trying to, uh, help you help others, find more time by reducing low value work, uh, by helping, you understand, and, uh, to get started on different kinds of rounding that leaders can do for a variety of goals and different kinds of huddles that drive reliability and finally a few, um, fairly easy ways to drive a culture of safety and reliability beyond the things that we've already talked to you about.
These are gonna be very practical and we encourage you to, uh, to choose perhaps 1, and at most 2 of these, as for the, the weeks and months to come because we know you're busy and so better to do a few things and do them. Well, then to try to do too much next slide.
So, uh, this is the 1st, 1, we're going to be talking about finding bandwidth for you and your teams um, 1 of the approaches that I found incredibly helpful in my experiences as a hospital leader has been to help everyone find more bandwidth since there's just so much to do is this slide shows.
Our, our plates are absolutely full. So asking people to do new things, even though if they seem like they'd be really important is pretty unrealistic, unless we find some things to stop doing, or do less of 2 ways.
We do this, or are shown on the bottom on the left, um, is, uh, you can, uh, work on trying to sunset some, uh, policies and processes that are no longer use kind of just get rid of them.
The term that we call X innovation and on the right. Uh, what we do is, we want to you to encourage that you, if you're a leader, uh, give, uh, to, uh, permission to people to stop doing low value things.
If you don't give them specific permission, they won't do it, because they're afraid they're going to be looked on as slackers if they just stopped doing something that they think is low value. So, um, so you might ask well, how, how does this happen?
I mean, how do you make a program like this happen? And this is something I've spent a fair amount of time talking to a variety of organizations about and I'll share my thoughts here about them. It's fairly, fairly straightforward.
And that is, you ask people who work for you every 2 or 3 months, uh, to give you 2 or 3 things that they think are low value work that they'd like to stop, do less of or delegate for my team members. I found a nearly all of their suggestions to be very reasonable. There's no going on here, and I approved their suggestions and took those things off their plate and that when you do that, you not only give them some extra time to do things, but you also show that you care about their wellbeing and understand that. They need their load to be less, so I really strongly encourage you to consider this next slide.
So, here, we've got sort of the situation that is currently true in most organizations, although we tend to be fairly well aligned these arrows of what we're working on.
There's still some low value work, 10 or 15% of it. Um, and the part of the arrows that are in the right direction are then shown in black, which is about 85%, but if you're on this crew team on the right, you can't be 85% with the program. You've got to be 100 with the program.
Otherwise they're bumping into each other and following the Coxon, who is the leader who is calling out the time. So, this is just in a sense a visual illustration of what happens with a stop doing program. Excellent with a stop doing program excellent. So, uh, so what are the benefits of recovering time for your team? Here?
You've got on the bottom, you've got the Lego man with a wheel and he, or she is blown off by his or her colleagues who are just too busy to replace their Square wheel.
With a round 1, this is actually a pretty it's pretty common in healthcare because change is hard and many people are just more focused on putting 1 foot in front of the other. I call this kind of mentality.
The heads down mode. Meaning you're only looking at what's right in front of you and not further down the road.
And what might help you get further down the road when you help your team members recover time maybe can become less burned out. They're more likely not to leave the organization.
And they become more loyal to you as a manager or leader since you get it. You understand that their plates are too full and that you need to help them to be able to cope with it. This recovered time can be used to put new processes into place to improve care and doing.
That contributes really to a lot of professional pride. And in the spread Corps, in the in the unit, next slide.
So, let's talk about you thinking well, okay, you know, generally you told us all this, but, like, so does it really work? Um, and it does.
So, let me give you a couple of examples for when I worked in as a hospital leader in the 1st, is I used a survey and asked hospital senior execs to formally assess the value of 6 major patient safety strategies.
I was the corporate patient safety officer at the time, and basically I was asking them for the opportunity to be able to focus my work on what they thought was most important because they were ultimately the funders that, as the hospitals fun corporate operations. And so they strongly endorsed 5 of the, uh, of the programs we had. But 1 was felt really not to be as much value.
So I sunset that program and was able to redirect more than 1 of time to new and more important work. And I guarantee at that time there, all kinds of national requirements that were coming down.
And so we were able to do a much better job with that because heaven knows, we weren't going to get extra staff.
So then we, the 2nd is doing this at the departmental level, um, in, um, and so, in my 1 on 1 meetings with team members, every few months, I asked them about low value activities.
And what I learned was that some of the activities that they were doing, just took way too much time, and that these things needed to end, or be reduced by doing this, our department was able to deploy many new mandated safety and quality projects. And the mid 2 thousand's without having to add new staff.
And at least as importantly, it made it a better place to work because our as we did this over a year or 2, our department staff engagement scores rose to become the highest of all corporate departments. And I guarantee.
It wasn't because I was a magician, you know, or I just had, you know, uh, was so, uh.
You know, in sort of such a inspirational leader. It was really because I think they thought I got it. We had to get stuff off their plates and focus on the most important things.
Donna, before you take the next 2 topics on rounding and Huddles are the things you'd like to add about this.
Yeah, thanks Don. I, um, I think this is really, really important and I do think that sometimes people feel like this is not something that's available to them. You can practices at the unit level for. Sure.
Um, you can if you are a nurse manager or director, and you have, uh, you know, assistant nurse managers, talk with them, what are we doing? That doesn't really help us. Uh, you know, is it running certain reports?
Is it you mean, even doing things at that level of sort of relieving people? There's a couple of benefits from it.
1, is that you're obviously making time for things that matter, but the other is, you're really engaging the staff in sort of the kind of BI, directional conversation that, that you care as a leader, and that it's important to you. And, um.
So, anyhow, I think this is really important, and you can even start it sort of in your own with your own team, and then sort of expand it out as you feel more appropriate or confidence in speaking with senior leaders about it. So, I think it's important. Thank you don, especially now.
I think everybody feels so overwhelmed right now.
Okay now turn this over to you, Donna for the next couple of, uh, of options for strategies. Great. Thank you. So we can go to the next slide.
So, as Don, sort of introduced in the beginning, and we're going to talk a little bit about leader rounding and a little bit about huddling. So really um.
Lead around the sort of overarching concept of getting out there and rounding is is to connect with your teams to ensure that you have alignment with what your mission is and to really bring awareness around certain topics. And when we think back to our, our, um, sort of attributes of a high reliability organization, 1 of them is sensitivity to operations.
And there's no real better way to demonstrate that as a leader than to be out and about on your unit connecting with your teams. And listening to what they have to say, there's, um, as you can see on this slide, there's a book here by Stephen Covey.
I don’t know if any of you read any of his, his work. But it's, um, it's actually really.
Uh, not dense and heavy to read. It's actually a really enlightening, um, enlightening book, and this really focuses on trust and I think that with, um, trust is obviously foundational to any relationship. Right?
So, your relationship as a leader to your staff needs to be built on trust and rounding is 1 of those sort of underpinning, uh, activities that help promote, um.
Help promote trust, we're going to talk a little bit in more detail as we move on and rounding to influence, which is really a way to target a specific topic when you're rounding.
Um, and then really being out around and people seeing you, and having very meaningful rounding activities, you know, you're a visible leader and it shows people you value the work that they're doing. Um, I think it's.
Pretty important not to have your rounding be just kind of high. How are you rounds? They need to be, you know, we just talked about doing things that are meaningful having time in your schedule for rounding. That's meaningful.
Rounding is important. Don, I don't know if you have anything to add to any of that.
Yeah, I I think, I think what you said is really important and, and you'll talk a little bit about different kinds of rounds. But I think, um, most leaders think that their work focuses on being in their office making decisions.
And I think the more successful leaders spend more of their time going out, and, uh, in order to better understand what's going on and to test drive their ideas and to encourage people to, uh, to be able to do some of the new things that they're asking them to do, and to be sympathetic, because again, uh, they, they won't really trust you until they talk to you and see what you're like. Building that connection is really important. Thank you. All right we can go to the next slide. So, there's all different types of rounding, uh, there's rounding that focuses on an individual, uh, interaction and then there's rounds that are really, uh, enterprise wide.
So you can see here, there's a 4 different examples of types of rounding when to focus a little bit of rounding to influence, but just in review you have rounds, like, patient safety rounds um, if you're a quality leader or a patient safety leader on this call I'm sure there's times that you are out and about chatting with a, you know, small groups of people and few people trying to surface safety concerns.
There's, um, there's a rounding calling, that type of rounding, which is going to Gamba. That's a lean term. Gamba is going to where the work happens. This is another way that you demonstrate sensitivity to operations. You are out there at the sharp end, observing and understanding what it is really like, for the people on the front lines.
And then there's, um, town hall meetings, which are again an enterprise wide, uh, meeting usually led by senior leaders or executives, and, uh, it's a really wonderful way to, uh, to encourage and display transparency of the organization a way to share priorities.
Um, with the, the, you know, your team at large, and I'm also a time to surface concerns so we'll talk a little bit more about those. We can go to the next slide.
Oh, I'm sorry can you go back 1? I'm sorry I wanted to focus a little bit on rounding to influence here.
So, um, I have to say that I, I used Randy to influence in, um, in a couple of the organizations that I worked in and I found it extraordinarily effective and I'm done, please chime in on this. But, um, it takes practice. Um, but once you get this down, it's a really effective way to use your time when chatting with your team members and so the, the premise of routing to influences that you're rounding with a specific goal in mind.
So, let's say you're rounding because your quality rates are up, or your rates are up and you want to spend a little bit of time with your team members on the front lines discussing why it's important to really focus on those particular objectives.
So, you would a, it's a very short conversation, but it's very targeted and you connect you connect what you're doing, what you're rounding on to sort of the greater mission. So you would say something like our quality rates are up the reason. It's really important for us to focus on. This is dot. However, you want to fill that in it's a patient safety concern.
Uh, we know that patient's stay on average 3 days longer than they should in the hospital, or it's a public reporting measure.
However, you want to connect it to sort of a greater mission and then then you ask them in that same conversation. Um, I just want to be sure that you understand that we have a science, you know, an evidence based bundle that we're using for quality prevention. Do you know where that is? Where to find it um, is there anything about it that's hard to do?
Do we need different equipment? Do we need to stop things differently? Really sort of in a very brief conversation stating why it's important. Eliciting from folks that you're talking to the person you're talking to is this working is what we have set up working and if it isn't, why not? And then wrapping up the conversation by sort of getting a little bit of a commitment from them. You know. I know this is really, you know, thank you for taking the time to speak with me about this. I know I have your commitment to really working on Cody, you know, in the next, you know, next month. So, we can get our rates down something along those lines. I've, I've done this. I've taught this.
I feel like it's a really, really effective use of time as a leader, especially when you're advocating to target a specific goal again, takes a little bit of practice gets a little clunky in the beginning.
But once you sort of get it down, it's almost like that applying that elevator speech methodology and meeting with people 1 on 1. it's a really great way to engage your frontline staff. So I'm done.
Do you have any anything to add to that specifically? Oh, I, I totally agreed on it and I, I think it's, um. If people haven't done it, um, you know, there are a few examples out there, um, on YouTube. They're not great ones. But, um, but I think what Donna has shared is really good. It's it's 1 on 1. You don't try to talk to 10 people at once and you don't expect to really spend more than a minute and a half or 2 minutes with each of them and find out what?
And if if they're doing it and doing it well, at the end, uh, the thing you can do is not only to thank them for for doing this. Uh, but also to say, hey, you know, uh, maybe could you talk to 2 or 3 of your colleagues and see if you can see how they're doing and coach them.
Um, and, uh, and if they're not doing it fully, then then what you do is say, hey, you know, can you take a, can you work on this?
And I'll be back in a 2 or 3 weeks to sort of see what your experiences and so, that notion of saying, you're going to come back and check on it, not because you're checking up on them or whatever, but more because you care. Um, and I think that that's very powerful.
Thank you John Tracy commented in the chat that, uh, the round, at least every other week. Um, which is fantastic. I think actually, calendaring rounding time where you block it off on your calendar. Not only sort of. Saves that time, but it's, it's a motivator for you as a leader to really commit to getting to going out there and hearing what's going on. Um, you know, 1st hand. So great. Thank you Tracy for that. Can we go to the next slide? Please.
All right, so some very practical tips. This isn't rocket science guys. You're all leaders, you know, this, it's important to actively listen and we underlined really listen because what I have found is, um.
Words really matter, and people will tell you something without really telling you something so you have to really listen to what they're saying, really have your ears on and listen to what the message actually is, which can sometimes be like, different than what they're saying. Um, of course, using appreciative inquiry and, you know, listening continued conversation, expanding on an idea is important. Uh, Don mentioned this and it's also a really good time. Um.
To, and not, this would not be during rounding to influence necessarily. This would be maybe a different set of rounding, but really connecting with them as people, um, you know, encouraging them. Um. And any type around, and you're, you're doing, people should feel like they have your undivided attention, which means, you're not checking your phone or, um, you know, looking off at someone else that's doing something down the hallway that you're really sort of focused on the person, you're speaking with, or people that you're speaking with, um, you know, if they're if they are someone who's working hard if they are someone who's trying to make a change if you remember, from our last session we had the whole talk on 1st followers and how important it is to encourage 1st followers again, appreciate people who are making change happen. It's really, really important to acknowledge them.
And then writing things down while you're speaking with them, if you actually say to them, you know what I want to make a note of this, because I'm going to follow up with you on this in a couple of weeks. What Don just said, or I'll get back to you when I can get some answers to your questions, but writing it down. Makes people feel like you're taking the seriously does not like, kind of a walk through and that you're not really going to do anything about it.
Um, it's important obviously not to interrupt someone as they're speaking. There's a difference between clarifying and then kind of sabotaging the line of thinking. So really, I'm not interrupting. I think this next bullet is probably the hardest 1 for any leader, especially nowadays where we are leaders are constantly, just putting out fires, which is having an immediate and quick solution to whatever they're bringing to your attention, defer to their expertise team up with them on how to solve the problem reflect think about it a little um, I think, you know, really encouraging them to participate and problem. Solving is very helpful on many levels.
Um, and then most importantly, I think I mentioned this earlier is be authentic, you know, don't sort of set and go out there and sound like you're, you're reading a script cause that's not helpful.
And it doesn't feel good to people, and, you know, again, words matter people pay attention to this, going out there as yourself.
And being authentic, and your connection with that builds trust. Um, and I think makes it much more worthwhile activity Don, any, any tips on a rounding with your frontline teams.
I think you've covered them all. I think, um, it's just, uh, important to, uh, go out and do it. And it's hard.
But, um, I actually, uh, set up a thing with my assistant to make sure that I spent a certain amount of time, every week out on the units.
And she would, uh, she would, uh, mercilessly hassling me if I didn't. So, uh, so it was and I was really grateful because I wanted to do it. And if you don't, if you don't make yourself, do it, uh, it's easier to stay in your office.
And Don, I think I'm a good point. It starts somewhere if you can't do it every week, you know, and if it's every other week, like, cause, it's too hard to start every week, do it every other week just. Just do it just get going and start it and block that time might give yourself an hour to get out there. Um, and I think you'd be, uh, it's actually really fun. I used to love to around cause it was just a nice way to sort of connect with my team as well.
And, uh, you feel like it's really meaningful time spent so next slide please.
Um, when you're rounding with a group, so, you know, if you're out there and you're doing that Denver rounds or patient safety rounds, and you have a group, again, it's a great way to model psychological safety.
This is the perfect time to make, uh, you know, created an environment with your team where they're, um, they can say what's on their mind.
Uh, they, they are respected, they can share a concern and you can join them, uh, in in, in a way. Um, it's also important, uh, important way to get meaningful feedback.
It's sometimes people feel a little bit more comfortable in a group of a few versus a single person, depending on the topic. So, this is another effective way to really understand what the concerns are.
It's important that this is a BI, directional activity, so it's not just you standing talking to people, but really they should be doing more talking than you in these situations.
Um, I think Don just mentioned the Pro tip at the bottom of his slide, which is really scheduling and structuring these types of activities into your calendar.
Um, is very helpful, especially for a busy leader. So, thank you next slide. Alrighty. So, um, we are going to talk a little bit about town hall meetings.
And, um, so, uh, I, I would love for folks to come off mute or. Put in the chat, if they are currently in an organization that uses town hall meetings to.
To, um, connect with teams, um, I know that, um, lots of organizations, perhaps we're doing this Pre. I'm wondering if it happened virtually during or if people have resumed, um.
This sorry, I'm really allergic today some sneezing and. My nose is running. I apologize.
So, town hall meetings are, are you all in an organization that runs a town hall meeting town hall meetings are normally very large, sort of like, enterprise wide meetings that are run by the executive leadership. Um, this is a really, I think, very effective tool for executive leaders to communicate directly to lots of people.
At the same time. It kind of level sets things around what's going on in the organization. Are there things that are happening that are going to affect people that they want to have sort of a communication around?
You know, do they, it's a time to talk about organizational performance.
There's 2 different ways where I've seen feedback being solicited during a town hall meetings. 1 is ahead of time. Uh, you have a sort of a virtual suggestion box or question box where people can submit questions for the meeting. And then the leader will read the question.
And answer, and I've seen them also where you just have sort of an open mic where people can come up and ask questions. And that's really sort of culturally dependent on how your, your leadership wants to handle that.
But I'm wondering if there's anyone on the call who participates in town hall meetings, or has an organization that is either in the past, has done with town hall meetings, or is currently doing town hall meetings.
And how do they, how does it feel? Are they are they a worthwhile activity? Is it important? Are they well attended so if you all can just put that in the chat or come off mute, we would really appreciate hearing from you on this.
Yep, he is saying, raise your hand and we could take you off mute. So I would love to hear from folks on this 1. I was a part of a very large academic medical center, um, for many years, and we did town hall meetings, uh, quarterly and they were, we all looked forward to going.
They were, uh, a really effective tool for us. I'm wondering if anyone else has that experience.
Seems like folks are still recovering from there. 4th of July weekends. What do you think, Don, any thoughts on meetings. I'll add something, uh, just while we wait for others to hopefully share their thoughts.
I think the most effective ones I saw was, uh, was they were run by a nurse who was the CEO of a hospital and, um, and she was, you know, had established a very good culture.
Um, and, uh, so, uh, 1 of the things she did was, she asked she not only was very transparent, uh, talked about sort of what was going. Well, it's going well, what was coming up.
And, um, she had a section on it that that had to do with asking people what they thought were sort of dumb things they had to do and she actually called it the stupid list.
And so she made herself accountable for taking things. People offered either verbally or in writing and coming back to them with either why it was something we had to do, or getting stopping it.
And so she had an official thing called the stupid list. Um, and it was, um, it usually was very well attended because people wanted to hear what she was going to do about the, and it was a, she did a great job with that. And it was a 1 of the higher performing organizations within our, our group.
Great, I mean, that's really being open right? And transparent was being willing to listen so that's awesome. It was almost a little bit of a combination of the stop doing concept because she wanted. Right. Um, and she realized everybody was busy and they needed to know what was coming, but she also needed to know what was wasting people's time.
And if it wasn't the way she needed to explain why it was something that simply had to be done required, right? Yeah, thank you.
All right, well, please feel free if you are, uh, an organization that does town hall meetings to put your thoughts in the chat, we're going to move on to the next topic, which is Huddles. We can go to the next slide.
So, uh, I think 1 of the most transformative things that an organization can do is get Huddles. Right?
I think this is a, a very, very important, uh, leadership activity, um, huddles, and I'd like to say, actually, are not just for, uh, units, providing clinical care huddles, or for anybody working in the organization.
So the I T, folks should be huddling, the environmental services should be handling so not just for clinical units. Um, they're really important. It's a few minutes a day and it really sets the tone for a shared mental model.
People are all on the same page. It gives you an opportunity to look back at what's happened in the last 24 hours and raise any concerns. It gives you an opportunity to talk about where you are today and what you need to know for the day.
Um, it can be done. Done you know, I think most effectively in front of a learning board or a whiteboard or a, if you have 1, um. It's a way to get everybody again. A sense of is free to core get everybody sort of, on the same page and I think, really importantly, identify and mitigate potential risks. Um, you know, if you are, if you have a procedure that's happening on the unit, that is something you haven't done for a long time, or you've never done before, or you have a patient that's particularly challenging or a task that you need to do.
If you're non clinical, that's sort of out of the norm. It's important to sort of talk about it in this in this venue and make sure everybody's sort of on the same page again. It's another.
Really, really effective way to create a sense of team, uh, for leaders to be transparent and to engage, uh, with their staff next. Uh, slide please. So.
What's important about a unit huddle and 1 of the most important things it's got to be like, super standardized in its framework?
It should be in the same time at the same time in the same place every day it should really not extend beyond this says, 10 to 12, even 15 minutes. Max. So this is a really quick sort of stand up meeting.
We're not sitting around the table chatting. This is all of us gathered together, I would say, as inclusive as possible. So if you are on an inpatient unit in the hospital, and you have environmental services worker, that's there.
They should be standing at your huddle listening to what's going on or physicians. Absolutely. If they can should be involved in listening in and participating in Huddle.
Um, and again, as I said, you should be if you're if you're a inpatient unit, you should be looking for an emergency department looking at the past 24 hours, looking at the current day ahead and then thinking about anything that's upcoming that, you know about for tomorrow. You should be thinking about what do we need to escalate? What do leaders need? What does our leadership need to know about if we have a concern? Um, it's a good time to recognize, you know, great job guys. You know, an emergency department leader might say something like, you know, we saw record number of patients last night. No enough that being seen excellent job.
I mean, like, literally that quick, but you should have a very standard agenda. So it should be why I'm looking back. I'm looking ahead. What do I need to escalate?
What are my acknowledgements and really running through that every day at the same time in the same place? And, and really kind of getting very, uh, very slick with how you deliver that information. It becomes almost like.
You kind of can't even imagine your day without it, which, um, you know.
When you, when you 1st, start them, they feel like it's going to be impossible to do this every day and then soon you'll find it's almost hard to not have 1 happen. You feel so connected to that time with your, with your team.
Next slide please, um, there's all different types of huddles that would we just talked about, was sort of a unit based Huddle. There's a hospital level safety Huddle.
So this is 1 of if you're in a hospital that uses tiered huddles, you have your unit based huddle and then your hospital wide huddle. Um. You have a, you can huddle and ambulatory areas. We are very familiar. Most of you are very familiar with the preoperative or Pre procedure. Huddle really?
Expanding on the idea, beyond the who checklist and really thinking about other things you want to fold into that making it a little more personal to the patient that's having the procedure done is important.
It makes it more connected for people, um, you know, debriefing post op, post procedure using this, in the ambulatory care setting where you're looking at scheduling or challenges for patients or procedures.
I mean, you guys get the gist here. Um, it's really just a few minutes a day that leaders dedicate to kind of being sensitive to operations.
Talking with their teams, making sure that they can do everything in their power to sort of make things run smoothly that day along with aligning. Everybody's thinking and getting a shared mental model.
Go ahead to the next slide please. Up and Don, I think I'm handing it back off to you. Right now. I don't know if you have any comments on huddling and then it's back to you.
Oh, great, great job on the huddling. It's, it's really important. And, uh, every place can should do it. Um, it doesn't have to be done everywhere to be done in some places. So, just getting it started is really a good thing.
We've talked a lot about the, the, uh, about what drives culture and things like psychological safety and respect and those sorts of things.
And in this 1 slide, I just want to very briefly, uh, talk about some things that can do some, as I say, 3rd dotting the i's crossing the t's on culture giving us their offers. A lot of things that we can still do.
Um, so, on the left, I've listed some things that are innocence goals and on the rights and things that can help with those.
I think the notion of speaking up, um, is really important because if people are concerned that something harmful may be happening. Um, this is really a way to develop and extend psychological safety.
An option for an organization to consider is something called the stop, the line program where a policy basically says that, uh, someone who has a concern along those lines needs to speak up.
Must speak up, not just can speak up, but must speak up and there is 0 tolerance if say a nurse speaks up to a physician and says, I'm just concerned that this is maybe not the right thing to do.
Uh, then, uh, there's just 0 retribution. In fact, the punishment goes to the person who tries to.
To Institute, retribution being able to, um, use some of the what we call critical language uh, the, uh, program, for example, is 1, that we don't have time to go into.
But this is a wonderful thing that was developed in airlines where, in a sense progressive escalation talking about, I'm concerned, I'm uncomfortable. This is a saved.
This is the safety issues, the 3 letters of cuss, and recognizing the courage it takes to stop. The line is a great is a big deal.
We had every quarter people who stopped the line were brought together the senior executives thanked them.
They got a special, uh, T shirt that said, uh, I'm a lifesaver and they got a plaque because, uh, it was really a, and then the pictures were shared and stories were shared with the board and in the publications, the 2nd general area is a gaps in communication your score data likely shows, uh, that, uh, there are some opportunities for gaps in communication, either within your unit or between units. And what I, what we mean by that are misunderstandings time is when you sort of think somebody's going to do something, but they're not.
And so, uh, what I would encourage you to think about doing very simple is on your unit, just collect, um, examples of misunderstandings for a week.
And then, in the 2nd, week, take a look at them and decide which 1 or 2 things might be things that might be fixable. Um, either by people sort of being more clear in their communication or writing things down or saying that if this is a, if this comes up, I need to get confirmation of something.
So, uh, really works really well. Um, the 3rd area is dealing with difficult people and this is not an easy thing, but I'm sure everybody can think of, at least a few people who are just playing hard to work.
Work with who make it difficult to do your job, because they're kind of abrasive, or they may even get in the way of good care. So, 1 of the, uh, this is a hard thing to take on.
And I'm not suggesting this is not sort of for early on, but it's something to sort of think about at some point. And I encourage people who particularly medical staff leaders and nursing leaders to read Robertson’s book. The no a*** rule, which is not.
Comedic, it's not funny, it talks about why you cannot tolerate having people like this in your organization and how harmful they are to your organization and ultimately the way in which, uh, organizations, uh, move along. This is to gradually start ramping up that the rules apply to everybody, you know, just because you're a big or whatever, uh, doesn't mean that you get a buy on being able to do things and a physician, uh, per physician. Uh, there can be what's called a behavioral compact, which I've seen worked really well, and finally 1 of the things has to do with whether we really respect everybody as much as we should.
And I'm 1 of the things I've seen in a couple of places, uh, we're leaders would suit up, uh, to look like their member, turn their badge over and then, uh, shadow them and sort of say, they're just sort of learning watching and learning the job or somebody in transport and to see how those people are treated. Oftentimes, they are, uh, sometimes it.
Great okay. And, uh, the senior executive, then armed with that kind of feedback can go back out and say we've got some work to do. So that's a way to really move the needle on respect.
Next slide and we're, we're winding down to the home stretch here. We're almost done, but, uh, 1 of the things that's important is to have recognition and celebration. And it isn't always just at the end of a major project. But even along the way, if there's a project going across the whole organization, get some of the units together to sort of showcase where they are, and what they've learned along the way.
In our organization and many others, uh, every 6 months or a year, they have a quality or learning fair where the successes or the barriers overcome or encountered are shared in small informal posters, uh, in a section of the cafeteria. For example. And, uh, and then people can come and learn to see what's going on. And what, uh, what's happened. It's a great place for spreading good things.
And, uh, 1 of the things that is true is that this was a very much appreciated thing for board members because they were able to talk directly to people, uh, at the front line to see kind of what was going on. And how hard some things were.
So, it's also a great place to be able to recognize, uh, and, uh, adopted people or people who are adopting new practices. Um, we put a list of the on time surgeons on the scrub sink if they were on time uh, in all their cases.
In the last month they got on that, uh, we didn't say anything about the people who didn't, but all of a sudden the surgeons wanted to be on that list, because they thought that was a good thing. So, uh, so again, it's about finding ways to use, uh, leverage recognition.
Excellent. Uh, and so just quickly we've covered a lot of things that we need to wind up. But, um, is that we, uh, here are the 4 things that we talked about today.
I think recovering a staff bandwidth is pretty easy to do and is very powerful. And happens fairly quickly leader rounding, uh, you can just start with 1 or 2 leaders doesn't have to be everybody, uh, to do that.
And it's very beneficial huddling. Uh, again, you'd like it to be done everywhere but you can start small. You don't have to have it everywhere. Uh, and it takes a little longer to probably have impact, but it's really good.
And, uh, and as I mentioned the dotting the I's of culture and things that you can do just little bits and pieces of, uh, if you, um, have the time. And as I mentioned earlier, don't try to do all these things at once, try to pick 1 or at most 2 of these things.
Because really, I think being ambitious is great in concept. But, uh, starting in a focused way. Usually gets things done is more successful in the long term next slide.
And I think it's our last 1, which is just simply to remind you that we're in the middle of the score survey. Uh, we understand that the, uh, the deadlines have been extended for a while. So, uh, keep on with that. We really appreciate that.
I think you'll find the, uh, information helpful and we'll have specific data feedback and ways you can use that data in a September webinar.
Um, and, uh, we'll be having a, uh, uh, improving, uh, team level communications discussion, uh, in a month from now. So, uh, really want to thank everybody for participating today.
And more importantly to thank you for all you do because you're really an important part of the foundational care that people get an awful lot.
Aw, awfully great area in Texas and Arkansas, so thank for you for what we do. So we'll sort of finish it there. Thank you very much.