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!

Defining Leadership

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I had an epiphany about a year ago.

I was sitting in a graduate school class called, “Leadership and Human Capital”. Having been through several leadership courses and programs, I knew what was coming. We were about to be challenged to define the amorphous concept of “leadership”. When we were asked to write down how we would define leadership, this time I had a rare moment of clarity.

In this post, I will tell you why I think this was the time where I found a definition of leadership that worked for me and then I will explain my definition.

I was sitting in class mere months after I took over the operations of our urgent care centers. We announced the transition in management from an outsourced partner to in-house management only months before. With so much to do already, the team also had to work fast, navigate a new out-patient environment, and produce results quickly. It was a tall order and one that required a lot of urgent and important work. On a daily basis, I found myself telling the team that we were going to have to, “Build the plane as we are flying it” and many of us could feel the metaphorical breeze and turbulence of an incomplete plane.

Taking you back even further, I had mentioned that I had participated in a number of leadership courses. From high school on, I was involved in several leadership development type programs. I will never forget my favorite one: As an undergraduate at Maryland, I had the good fortune of being accepted into the Rawlings Undergraduate Leadership Fellows program. Rawlings shaped my view of leadership and got me started on an important path of discovery and self-reflection.

The learning in Rawlings was experiential in nature. Professor Michael Speer taught my favorite class in the program. The average age in the class was 20 years old and the class was demographically diverse. When we arrived in the classroom, the desks were arranged in a circle. When class started, Professor Speer said, “My role here is a consultant. I will point out group dynamics as I observe them” and that was all he said. We stared at each other in silence for what felt like hours.

To break the silence, one of my classmates spoke up and said something to the effect of, “What exactly are we supposed to be doing here?”. Almost on queue, Professor Speer says, “It appears the white male in the group is trying to assert dominance”. What do you say after that?

After the initial awkwardness of the activity, we started to really notice and understand how to see unspoken group dynamics that exist among any group of people. Some of these dynamics are societal, some environmental, and some personal. But, I remember my biggest learning coming from that class in understanding that everyone brings something a little different into a group setting. To maximize the effectiveness of the team and build trust, it can be very important to talk about unspoken dynamics.

After graduating from Rawlings, I was fortunate to have many other similar experiences in other leadership programs. I picked up important guidance and tidbits from all of the programs, but it was Rawlings that introduced me to leadership theory, including servant leadership, which is a leadership framework that I believe in wholeheartedly.

In servant leadership, the leader is entrusted by his/her followers and the leader’s role is to help coordinate the group and help the individuals in the group achieve their potential. Servant leadership recognizes that a leader isn’t a leader if they don’t have followers, so the orientation of the theory, articulated by Robert Greenleef, is built around the followers. Simon Sinek builds on this in his book Leaders Eat Last, when he explains how treating employees well is a common denominator of successful businesses with longevity (he uses Costco as an example).

While I had been studying leadership theory and practice for years and had a pretty good sense of what I believed in, I had not managed employees yet in my career. While I had managed consultant relationships, I was going from having half of an employee reporting to me to close to 30. I remember telling my wife Sheryl at the time, “Well, I have been preparing for this opportunity my whole life, we will see if any of what I learned works!”

So, with that as prologue, I took my role as a new entity leader extremely seriously. I spent a lot of time reflecting on some key questions: What kind of leader do I want to be? What kind of leader do my employees need me to be? How do I lead for results while staying true to my values?

Thanks to that reflection and a lot of trial-by-fire experience through the transition, here is how I define leadership:

A leader is defined as someone who has followers. To achieve shared goals, each follower must:

  • Know where we are going
  • Know what their part is in getting us there
  • Want to be a part of it

To fulfill that definition, it requires work to establish a clear and shared vision/direction. It also requires spending time with every person and understanding their goals and to help people get excited about the vision/direction. It also functions to let them know that the leader is serious about it and not just paying it lip service or doing it temporarily.

I intend to lead in this way and believe that have been for the last two years. Merely coming up with a comfortable definition is an important exercise and has served as a helpful guide when making tough decisions. I owe a debt of gratitude to Rawlings and Professor Speer who gave me experiences to think about a reflect on even years later. Thank you.

TAKE-AWAY: Reflect and define what kind of leader you want to be well before you are in a supervisory role. If you are already in a management role, it is not too late. Ask yourself, “What kind of leader do I want to be?” and find resources that can help you explore different leadership approaches.