Am I serving the group?

At work, I have been sharing with many teams lately about the concept of reflection as a reflex. The concept is about using what Viktor Frankl described in his book Man’s Search for Meaning as the space between stimulus and response. Stephen Covey also included this concept in The 7 Habits of Highly Effective People.

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At times in my career, I have found myself hesitating in meetings. Reflecting on it, I think I hesitate because of things like Automatic Negative Thoughts (ANTS), fear that what I say will sound obvious to the rest of the group, or that others in the room are smarter or more experienced than I am and I probably do not have anything of value to contribute. Is this something you struggle with too?

Over time, I have learned a quick “test” that has helped me and I hope will help you too.

Any time I hesitate to speak, I ask myself, “Will what I am about to say serve the group?”

This yes or no question gives me enough time to reflect without missing the germane part of the conversation and to make a decision on whether my comment will add value to the discussion. This question is also consistent with my personal definition of leadership and my desire to practice servant leadership. It gives me the confidence that even if my comment is controversial, it will be received in the right way because my motivation is service to the group.

I use this test in almost every meeting that I attend. It helps me to reflect in the moment and make sure that I am contributing at a high level. The test also keeps me centered. For example, the “test” prevents me from being too quiet or too dominant because my comments are always in pursuit of service to the group.

I hope you find value in this test as well and it helps you create better and more productive meetings.

KEY TAKEAWAY: Leaders can practice reflexion in most contexts, including meetings. Before you speak, simply asking yourself, “Will what I am about to say serve the group?” will give you the confidence to speak up and reflect the authenticity of your point of view.


Getting on the same side of the table

The 7 Habits of Highly Effective People belong in the category of must read classics like How to Win Friends and Influence People. Covey outlines lessons that are important for everyone to internalize and it is a great starting point for leaders. The first time I read it, I listened to the audiobook, which Covey narrates himself. It’s a wonderful way to take in the lessons in the book because you can hear his emphasis at different points.

The Seven Habits of Highly Effective People are:

  1. Be proactive
  2. Begin with the end in mind
  3. Put first things first
  4. Think win/win
  5. Seek first to understand, then to be understood
  6. Synergize
  7. Sharpen the saw

But that list only barely touches the surface of the wisdom and life lessons outlined in the chapters devoted to each individual habit. For the purposes of this post, I want to focus on one that I found to be especially vital.

7HabitsIn the world of patient experience, we talk a lot about communication. Communication with the patient, with appropriate family members, and between clinicians caring for that patient is an area of opportunity for the industry. Covey talks about a deep communication practice in his chapter on habit 5, “Seek first to understand, then to be understood”.

In habit 5, Covey touches on several key concepts including, “Empathic listening,” “Diagnose before you prescribe,” and “Understanding and perception”. These skills require self-awareness and the ability to pause and reflect on our behavior.

In the section on “Diagnose before you prescribe,” Covey provides the example of an eye exam. He writes that the doctor does not just take off his glasses and say, “Use these, they’ve worked for me for years!” He takes the time to help the patient explain what they see and he fits the corrective lenses for them.

Too often, we do the opposite. I catch myself in this pattern of behavior too often. Just because something worked in a situation we faced, does not mean that the same strategy and tactics will work for another person with different skills and different life experiences. Taking the time to diagnose what is going on will help us be better leaders and better people.

My favorite part of habit 5 though is the section called, “Four Autobiographical Responses.” In this part of the book, Covey summarizes a hypothetical conversation between a parent and child who wants to drop out of school. Covey presents the same scenario in three different ways. In the first, the parent tries to guide the child by lecturing based on the parent’s own experience. In the second scenario, the reader sees the child’s impression of the conversation and how the child feels ignored and misunderstood.

In the final scenario, the parent asks the child the right questions, listens to understand and does not pass judgement or lecture. By being more open, slowing down, and learning what the child is going through, the parent learns that the child wants to drop out of school because of a recently diagnosed learning disability. By listening and interacting with the child in an empathetic way, the parent learns what is really behind the child’s desire to leave school.

What happens next in the story is remarkable. The parent and child begin to problem solve together. Covey calls this, “getting on the same side of the table.” This concept spoke to me. Lately, I have been trying to find as many ways as I can to “get on the same side of the table” with the people I serve.

Getting to the same side of the table means problem solving, having healthy discussion, and collaborating in a way that builds the relationship, not taxes it. The more we can be on the “same side of the table,” rather than debate or disagree to win an argument, the better the world can become.

KEY TAKEAWAY: The 7 Habits of Highly Effective People is a foundational book in practicing leadership. Habit 5 discusses how we can “get on the same side of the table” with other people by engaging in”Empathic listening”, “Diagnose before you prescribe”, and “Understanding and perception”.

The 7 Habits of Highly Effective People is available for purchase on Amazon for $30.00 (does not include Prime discount)

Tell Me More

Much of the literature on leadership emphasizes the importance of having core values. During difficult times when the future may appear gloomy, core values remind us to resist impulsive, “in the moment” decisions that may compromise us in the future. As I have begun to discover and define my own core values, one is apparent – Curiosity.

Curiosity is important to me for many different reasons. Curiosity allows leaders to accurately diagnose problems, searching for the root cause and asking important questions. It also forces leaders to challenge assumptions, often disrupting the status quo to explore new opportunities and be a force-multiplier for the organization. Finally, curiosity teaches leaders humility.

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In Stephen Covey’s 7 Habits of Highly Effective People, habit 5 is, “Seek first to understand, then to be understood”. In seeking first to understand, leaders have an opportunity to accurately diagnose situations. For example, if a department appears to be achieving good results, a leader could ask questions to understand how the group completed the work and whether their methods could be a best-practice, applicable to the rest of the organization. A leader could also ask questions to assess whether the department was lucky, good, or both to achieve their results. If a department is producing consistently bad results, the leader can also define whether the issue is personnel, lack of cooperation, silos, operations, finance, marketing, etc and recommend changes to help that department to improve its results.

Curiosity also encourages leaders to challenge the organizational status quo and change how people think about a recurring process or challenge. Some long-tenured employees at an organization may defend processes as, “but we’ve always done it this way” or “it’s best practice” or, my personal favorite, “but everyone else is doing it this way”. Leaders who I admire will not take this at face value and instead will explore the process curiously. A strong leader may go and see how the “everyone else is doing it” is impacting the customer and whether the process actually works to deliver them the quality product or service they expect.

Organizations, especially large ones, can often get stuck in a rut with how they typically do business. The examples of businesses that have been overtaken by disruptors and innovators includes Kodak and Blockbuster. Leaders should get ahead of the tendency of people to prefer prevailing practices in order to maximize their potential for success. This gets increasingly difficult as the leader stays in their job longer. Leaders can use curiosity as a systematic way of making sure the status quo doesn’t continue due to inertia.

To do the work of diagnosing and challenging the status quo first requires curiosity followed by other qualities like listening and good judgment. In this way, curiosity functions as a foundation of a building, which is why I keep it as a core value.

The first part of Covey’s 5th habit, “seek first to understand” requires not only curiosity, but humility. Sometimes leaders are encouraged to appear as if they, “know everything”. That pressure, combined with people treating you differently as a leader, can encourage people in leadership positions to actually believe that they, “know everything”.

Curiosity encourages leaders to stay humble. It encourages leaders to go out and learn things will remind them that there is a lot that they don’t know, even about their own organization. Challenging our own assumptions can be hard to do, but is necessary to be impactful in an organization.

Curiosity is a core value of mine and it is an essential part of continuous improvement. It is not a be-all, end all. Just as there is a time and a place for everything, sometimes it is time to stop asking questions, stop diagnosing problems, and act. Curiosity is not an invitation for paralysis by analysis. Instead, it’s a way to challenge other’s thinking and keep things fresh in an organization.

My professor and coach, Dr. Gerald Suarez teaches three powerful words, “tell me more”. These three words can express curiosity around a topic area.

I am working to develop systems in my life as a leader that encourage curiosity, so “tell me more”. What would you suggest that look like? Do you know of any good activities that promote going deeper? I’m curious!

KEY TAKEAWAY: Curiosity is a foundational core value of mine. Curiosity stretches us and our organization, in a healthy way. Coupled with active listening abilities, good judgment, and humility, curiosity can help organizational leaders stay fresh in their thinking and solve complex problems. 

Leading with Vision through Context

In previous posts, I’ve written about my own definition of leadership and the need for vision. However, I have not yet discussed how to actually achieve your vision. In order to achieve your vision, the first thing you must do is to put the daily activities that you undertake with your team into the context of that vision.

I remember having a conversation in the summer of 2010 over sushi (side note –  we were at Momiji, which I highly recommend) with a friend about President Obama’s first term. An enthusiastic democrat and an early supporter of President Obama’s candidacy, he was excited.

He had argued that the President had accomplished more in his first year and a half as President than most others. He cited progress in healthcare reform, environmental stewardship, foreign policy, and others. He could not understand why there was a group of people who didn’t appreciate all of the President’s accomplishments in such a short amount of time.

My answer to him was one word: Context. While, objectively, President Obama had completed many tasks, it was unclear to me, at least, how it was all adding up. The President had surely done a lot, but what vision of our country did it support? Why did he take on these specific initiatives and not others? Were the other problems facing our country not a priority in where our country was going? And if so, why not?

Many of these questions can be answered by explaining them using the vision as context. If, for example, the goal (vision) is to grow your business’ revenue by 10%, then your actions should be explained in that context. The team needs to know that the business is spending more on business development and adding positions in that department in order to try to grow revenue by 10%. In being consistent with communicating decisions in terms of the vision statement, investments in time and money make sense to every member of the team.

My favorite model for this work is Stephen Covey’s “Four Quadrants” (pictured below). Covey uses this model to talk about time management and how to put, “First Things First”. The same principle applies in leadership.

I find that our teams are usually focused on the many tasks that they have to accomplish on a daily basis (what is “urgent”). But, if we are going to build towards our envisioned future, those urgent tasks need to be accomplished with what is “important” in mind.

A colleague of mine shared this TED Talk with me, which illustrates this point using the example of a Phlebotomist interacting with a patient:

Without the important context, most people, in the midst of their busy-ness will complete certain tasks just to finish them or “check the box”. To be intentional, we want to overcome that urge and help them keep all aspects of the task, including its ultimate goal or spirit in mind.

One of the most important roles of a leader is to provide context for all the actions that team members are asked to deliver. If that is done right, not only are consistent and reliable outcomes more likely, but also your team can partner to create your envisioned future.

KEY TAKEAWAY: One of the most important jobs for a leader is to put the daily, “urgent”, actions of team members into the context of the vision statement.


Delivering Patient Experience Excellence Through Culture: A Case Study

“Never let a good crisis go to waste” -Winston Churchill

The situation was fragile: Disappointing financial results, low employee morale, high employee turnover, leadership in transition, and an uncertain future.

This was the challenge when I was asked to serve in the Director of Urgent Care Operations leadership role in 2016. Things needed to change and they needed to change quickly. As I began this new journey, I remember saying to my wife, “Well, I have been studying leadership theory and practice for my whole life. We will see if any of it actually works.”

There were no quick levers to pull. No big savings to realize through non-operational changes.

If the organization was going to turn around, it would require everyone who was there and some new faces to make it happen. I knew that I could not do it alone. But, how do you get a group of people moving in the right direction and fast?

I thought of my definition of leadership and used that as my starting point. The staff needed to know why we existed and had to be a part of making that vision come to life.

Urgent care needed to serve three important functions to accomplish the organization’s mission: it had to give excellent outpatient care; it had to help patients learn about our system and trust us with other aspects of their care at other entities; and it had to be financially sustainable.

To simplify that value proposition (or why we exist) so that everyone could know where the entity needed to go and help us get there, we simplified it as “POP!”, which stands for: Pipeline, Outstanding Care, and Positive Margin. Bringing POP! to the staff required a sustained and disciplined campaign to build a deliberate culture that would accomplish our goals. We launched that campaign to empower the staff to bring what POP stood for to life all day-every day-every patient.

FOCUS: Does it POP!?

One of my favorite authors, Stephen Covey, is credited with the concept “keep the main thing the main thing.”

For urgent care, POP! was our “main thing.” For many organizations, including for-profit, non-profit and government, mission creep and over-diversification are tempting. Disguised as opportunities or response to an urgent need, losing focus on the core mission and competencies of your organization can be devastating.

POP! functioned as a tool to keep the organization laser-focused on what needed to be done; fulfilling our core purpose or “Main Thing.” As one of the main decision-makers for the entity, staff would come to me with proposals for new tools, services, or offerings. When that happened I would always ask, “Does it POP!?” At first, I would receive a confused stare in response. If the answer was “no,” then my answer would be correspondingly “no” as well.

It was vital that we were disciplined in doing work that “POP!ed” to achieve our goals. Everything else was not necessity but, “nice to have.” My goal was to set an example for the other leaders at our entity to be just as focused and disciplined about achieving our goals.

REMINDERS: “Reflexion

I have previously written about the concept of reflection as a reflex. By making POP! as present as possible in the centers, we encouraged staff to keep “where we are going” at the top of mind. In doing this, staff could be empowered to make decisions and use their own judgment on urgent tasks within the context of POP! In other words, we encouraged their “reflexion” to be, “Does what I am about to do POP!?”

More than just the framework, it had to be deployed in a way that kept it top of mind.

In addition to putting up signs in the centers that explained POP! in simple terms, we also deployed POP! baskets for the staff. These care-packages (pictured below) had food items that POP!ed, such as Pop-tarts, Tootsie Pops, Popcorn, Pop chips, Ring Pops, etc., where the staff could help themselves.

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The team began speaking the language of POP! in emails and other correspondence. For example, “Team – for our centers to POP!, we must increase the number of patients we see every day. We do this by demonstrating Outstanding Care, which motivates our patients to give us positive online reviews.” Communicating that kind of alignment gives the staff a context by which to understand where leaders are coming from in presenting new initiatives and driving results.

To track our progress in achieving POP!, we created a daily dashboard that was distributed to the entire staff both via email and was discussed in newly instituted daily team huddles. The dashboard was composed of seven metrics that we used to track whether we were achieving POP! goals and used a stop-light (red, yellow, green) to allow staff to understand our performance on a daily basis.

Through these initiatives, staff had a consistent stream of communication about where the entity was going (POP!) and whether we were getting closer (daily dashboard).

RECOGNITION: Giving credit in a consistent manner

To bring POP! to life, we deployed both formal and informal recognition to the staff to show appreciation for their hard work and to keep them motivated.

At daily huddles, I would present small tokens of appreciation to the staff that were demonstrating behaviors that helped us POP! Sticking with the theme, I would purchase a Funko POP! figurine (see example pictured below) for a specific team member. In a public setting (usually at a huddle), I would speak about how that team member’s actions make us POP! and then would give them the figurine as recognition.

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More formally, the leadership team came up with a recognition program with a $100 monthly bonus attached to it. Team members nominated each other for the monthly award, but had to nominate via a form that asked how the nominee created a pipeline, delivered outstanding care and helped generate a positive margin for the entity. Again, the idea was for the nominator to think in terms of POP! so that the team was all working together in pursuit of a common goal and vision.

PARTNERSHIP: Leadership development

To be successful, our leaders needed to be our most enthusiastic POP! ambassadors for it to “stick” with the staff. They needed to use the language of POP! while communicating with the staff and giving examples on a daily basis of how our work contributes to that overall vision.

In addition to coaching via weekly 1-on-1 meetings and taking and sharing the results of our DISC assessments, the leadership team read several relevant articles and books together and discussed them in weekly leadership meetings. These outside readings helped us not only learn from authors, but helped us take ideas and make them our own to bring POP! to life.

For example, the leadership team read The New Gold Standard and discussed it prior to our first retreat. Out of that discussion, the team defined a new approach to team-member selection and created a plan to deploy it. Under the new selection criteria and “leadership system,” which included a new, day-long, urgent care specific orientation, as well as a plan for engagement and leadership development, we dramatically reduced employee turnover.

From that discussion also came months of work to put together an urgent care “Credo Card,” which is pictured in the photo above with the Funko POP! figurine. We solicited feedback from staff at all three locations over the course of five months of facilitated discussion. We asked the staff how we bring our organizational values of Respect, Integrity, Service, Excellence and Stewardship to life every day in our centers. We synthesized the comments into a card that staff must carry with them at all times.

One panel of the cards are reviewed at every staff huddle, every day, to keep those behaviors top-of-mind. The card has become a part of the team’s identity as an entity and they proudly wear them on their name badges.

RESULTS: The path to POP!

While urgent care had not yet achieved a positive margin when I left to take a new role in the company, our results in just 12-months speak for themselves:

-Revenue growth: 56%

-Improvement in net margin: 15%

-Online review improvement: 20%

-Reduced labor expense by 1% while fully staffing each location.

-Second in the company on financial outcomes relative to budget (in real dollars).

REFLECTION: KISS, pride and gratitude

KISS is short for, “Keep it simple, stupid,” and is some of the best advice I have ever come across. By aligning our work under the ongoing theme of POP!, everyone could understand it and get on board. It wasn’t complicated or confusing or business-speak. It was just simple and easy for our audience (the whole team) to understand.

In setting out a new vision or direction: keep it simple, keep it focused, and keep it fun…stupid.

As I mentioned earlier, this was my first real shot in a professional leadership role. While I had been an observer and a student of leadership for as long as I can remember, in this role I got to actually be in the arena professionally. I am so proud of what the team was able to accomplish and that we did our work with positive spirit and integrity.

I feel immense gratitude to the leadership team: Charity Dorazio (IT), Sara Ehrlich (Quality, Patient Safety, Education), Jennifer Harrison (Administration), Perry Johnson (Manager), Vonnie Johnson (Financial Manager), James Lanier (Manager), Patrice McCall (HR), Shanna Muschik (PR/Marketing), Nichole Reilly (Manager/Business Development), Dr. Richard Samuel (Medical Director), and Susan Savery (CFO). This group of leaders demonstrated incredible passion, resilience, honesty, and team-work on our journey together. They are some of the best professionals that I have ever been around and I am so proud to have been on a team with them.

Team, if you are reading this, thank you.

KEY TAKEAWAYS: By creating a simple and easy to understand direction and consistently reinforcing it through many different avenues, leaders can inspire and empower the whole team to partner with them to achieve shared goals. Create a clear focus, align systems, processes and behaviors and then make it happen!