When Dr. Jeffrey Canose moved up into his role as president at Texas Health Presbyterian Hospital Plano, he didn’t have to worry about healing any major ailments in the organization. He didn’t need to lead a major turnaround. And he wasn’t dealing with disgruntled employees causing problems.
Instead, his 1,600-person hospital was at the top of its game and had been recognized for such, and the culture was one of high-performance.
“Probably the single biggest challenge was coming into an organization that already had a great culture and already had a track record of many notable accomplishments and creating a burning platform for change and transformation in that kind of [environment],” Canose says. “People are already very high-performing, already have garnered a lot of regional and national recognition, but have to get prepared for a multitude of challenges that face all of us in health care, even in places that otherwise have a stellar track record for clinical excellence and customer service.”
So despite having a great organization already intact, he wanted to take it to the next level by increasing efficiency, and he did that by promoting communication, getting feedback and fostering a culture of collaboration.Communicate effectively
Two jobs prior to his current one, Canose was in his first full-time hospital administration position in North Carolina and had come from the North. A patient had died unexpectedly on the operating table, and he was asked to explain to the board why the patient had died.
“The chairman of the board was this little raisin of a man who had been out in the sun way too long, and he was a retired ATF agent, who I later learned had proudly drawn his gun and used it on numerous occasions when he was chasing down moonshiners in the mountains of western North Carolina and eastern Tennessee,” Canose says.
As he explained to the board, he reached the point in the story where it was clear that the patient wasn’t going to live, and out of his mouth came the phrase, “And the patient started going south.”
“The entire boardroom got deadly quiet, and everybody just sort of looked at me, and it was like the cartoon where you have that little word bubble you wish you could reach out and grab and stick back in your mouth,” he says.
The chairman then broke the silence by asking, “Son, what do you mean by that phrase, ‘going south?’” Canose was quick on his feet with an explanation so he wouldn’t have to find a new job so quickly.
“I replied, ‘Closer to heaven,’” he says with a laugh. “That’s called when you’re in the South, get rid of your Yankee vocabulary.”
While it’s a funny story, it’s also an important lesson that he learned in communication during his career: You have to be careful in the words you use to communicate your message and how your audience will interpret them.
Another lesson Canose learned in communication came when he worked in Pittsburgh when he was still a practicing anesthesiologist but was also charged with running the operating room. It was a challenge because he was learning insight into the administration side while also still practicing, and it was during this time that he realized a problem in his communication.
“I spoke in tongues,” he says. “I had this whole new vocabulary that administrators used. When you go out and you sit in a room with bedside nurses or the guys that keep the boilers and the air conditioning working, they don’t speak that language, and it doesn’t connect with them, so knowing who your audience is and figuring out how to connect with them, how to be able to present the information in their context and help them connect the dots, I think that’s an acquired skill.”
By learning to eliminate administration jargon from his vocabulary, he was able to more effectively communicate with employees.
In addition to learning how to communicate his message in ways that his audience understands, he’s also learned that consistency is key.
“Like any communications theory, No. 1, the message has to be consistent,” Canose says. “You’ll hear me say that over and over and over again, but at the same time, you have to deliver it so many different ways to reach people who have different learning styles and who assimilate information in different ways.”
He does this both in written form via the company newsletter and verbally via town-hall forums, and he’s mindful to make sure that his message is the same in both venues.
“There’s no difference whatsoever,” he says. “That’s where I’m always very focused on making sure it’s the same message just delivered a different way. We really do want to make sure that the key messages are always clear, that the content is consistent, that we’re maintaining a focus on our priority goals and objectives.”Get feedback
The cheerleader pranced around the hallways of Texas Health Plano in her short skirt and white ribbons in her hair, but if you look a little closer, you’ll quickly realize that the cheerleader is actually Canose. He promised employees that if he got a high response rate on the employee satisfaction survey, he would put on the cheerleading gear, and when he got an astounding 87 percent response rate, he made good on his promise to dress like a cheerleader for both the day- and night-shift employees.
“I can tell you that that did more for employee morale this summer, just the willingness to dress up in that kind of outfit,” he says. “Now the most frequent comment I got was that I have great legs, which my wife has known for 37 years, but it was the first time the employees found out.”
Feedback is critical to successfully leading, so he knew he had to do something good to get what he was looking for. Clearly it worked. Employees were amused for the day, and he got answers to critical questions 65 of them in total that ask whether or not employees think their leaders communicate the most important information, that leaders listen to them and that leaders identify the things they need the employees to work on.
The results the last time around indicated that the hospital was between the 78th and 87th percentile on the majority of categories compared to the national average.
In addition to getting feedback for the annual employee survey, he also says it’s important to gather feedback in the moment. For example, after a town-hall meeting, instead of sending out an electronic survey, he asks those who attend to fill out a survey before they leave.
“If you get them done right there in the moment, you have the best chance of getting a good response,” he says.
While it’s not mandatory, he usually gets a 95 percent completion rate by doing it this way. Doing this allows him to see if employees actually understand what he says.
“We ask them whether they are experiencing a consistency in those messages and whether we are making it relevant to their daily work and do they feel like they’re getting the information they need in order to understand the strategic context for the very meaningful work that they do,” Canose says.Foster collaboration
When Canose gets up in the morning, there’s very little he can control for the day.
“I’m the first to confess that there’s not much that I control around this hospital,” he says. “I control how I act. I control how I react, and I control what clothes I wear when I come in in the morning, but aside from those things, there’s not a lot we can control.”
Because of this, instead of trying to control everything himself, he works to promote collaboration within the organization by knowing the right questions to ask and the right people to bring in to help solve a problem and achieve the hospital’s goals.
“It’s not a whole lot unlike when you’re practicing medicine and you recognize that there are people with specialty expertise who you need to consult to come in and help with the care of your patient, especially when they have a lot of complex co-existing medical conditions going on at the same time,” he says. “That’s my mental schema for how you identify what’s going on. You make an initial diagnosis. You figure out what kind of problem are we trying to solve. Then you decide who you need to bring in to that conversation in order to be able to solve the problem and create a sustainable solution and then move on.”
This is the approach he took when he realized that, at one point, the hospital had more than 90 committees. He knew he had to get that down to between 30 and 40, because far too much of his people’s time was being spent in meetings, so he brought in all of the involved parties and started a dialogue, asking what committees will help them achieve their priority goals and objectives and move the strategic plan forward. There are also others that are required by law. If a committee didn’t fall into either of those two buckets, it was gone.
In addition to having a team approach to reducing committees, he also took a team approach to changing the patient experience in the emergency room by creating three teams of front-line employees to redesign the whole experience. He started by bringing the right people together for those teams.
“We were looking at getting people involved who were sort of the doubting Thomases,” he says. “We wanted a number of them to participate directly in the process, because we wanted them to own it, and we wanted them to feel empowered to change it. We needed to know what their doubts were as we were going through this redesign project.”
He says to also look for your top talent, as well, so he found the high-performers across multiple disciplines but left management out. These people worked as a team to look at all of the processes and make recommendations to the management about how to improve. The implementation process took about 12 to 15 months to complete, and the result speaks for itself: The national average time from when you walk into an emergency room door to when you walk back out is four hours and nine minutes. At Texas Health Plano, it’s two hours and 30 minutes. At most hospitals, it takes hours of sitting in the waiting room until you’re assigned a room and seen by a doctor, and again, Canose can brag that his team does it in 18 to 20 minutes. Lastly, the average time it takes once you’ve been seen to get your discharge instructions and prescriptions is 67 minutes, but Canose’s team does it in 10 minutes.
“We didn’t try to make little incremental process improvements and see if we could make things 5 or 10 percent better. We made sure that we knocked Humpty off the wall, smashed him into 1,000 pieces and then put together three teams of front-line employees to put Humpty back together again and do it in a way that was focused on the patient’s experience and how we could help patients get in and out of the emergency room or get admitted up to the hospital as quickly as possible,” he says.
Canose has also seen other improvements that show he’s on the right track to raising the level of excellence. For more than a year, patient satisfaction scores in the emergency room have been consistently running in the top 5 to 10 percent in the country. Physician satisfaction scores are between the 82nd and 97th percentile, making the hospital in the top 20 percent in all categories and the top 10 percent in the country in things like the quality of care provided.
“That combination of patient, physician and employee engagement doesn’t happen by accident,” Canose says. “That means we spend a lot of time focusing on the kind of culture we have here in the organization, and I think it says that we’ve created an incredible environment for our professional staff to be engaged and empowered and energized to go do their professional best every day at the bedside, and it shows by the kinds of outcomes we’re seeing.”
But it’s not just the numbers that tell him he’s on the right track. He receives letters all the time, and the most meaningful one was from a Navy SEAL who Canose says was the size of an offensive lineman and as rough and tough as they come. He wrote a beautiful letter thanking Canose and his staff for the way they seamlessly worked together and didn’t panic and kept him calm when his wife had complications during the birth of their child. Both his wife and child were fine, but he was amazed at how the staff handled the one-chance-to-get-it-right situation.
“This can never be a command-and-control environment the success of patient care depends on collaboration and recognizing interdependency,” he says. “Some people would just come out and say that health care is a team sport, then my role as the head coach on the sidelines is once again to make sure everybody’s prepared when we go onto the field and to make sure that we’re communicating very clearly with each other and that everybody knows everything that they need to know and that they get that consistently, and we create that environment where they can do their professional best.”
How to reach: Texas Health Presbyterian Hospital Plano, (972) 981-8000 or www.texashealth.org