Healthy changes Featured

8:00pm EDT August 26, 2008

About two years ago, Telford W. Thomas was faced with the grimreality of the competitiveness of the health care industry. If The Washington Hospital did not evolve to face the demandsput on it by its customers and the market, it would cease to growand possibly start losing business — and talent — to the competition.

“What is happening in the health care industry is we, like otherinstitutions, have been attacked for patient trust in the organization that has been dropping over the years because of errors thatare made ... and not paying attention to what the patient feels theyneed,” says Thomas, president and CEO of the hospital, which had2007 revenue of $225 million.

“We felt in order to stay viable, given we are in a competitiveenvironment with other health care institutions and businesses,that we had to make that change. Our intent certainly is to be thehospital of choice in our community for the patients and the doctors and our employees to work here.”

As a result, Thomas and his team started looking at ways theorganization could reinvent itself to better meet the needs of itscustomers and increase staff accountability. The emphasis wouldbe on getting better feedback from patients to help the hospitalprovide better care.

“We, as health care providers, don’t always know what is best forthe patient,” he says. “We’ve got to involve them in it. The effort to dothat and make the cultural change has to be through our educationand work with our employees to encourage that participation.”

The patients weren’t the only ones who needed more attention. Togenerate excitement about the changes and to get the staff of 2,400to buy in to them, Thomas and the upper management team neededto do a better job of paying attention to employees and giving themthe recognition they were due. Only if the employees were on boardwith the changes could patient care ultimately be improved.

Provide proper training

Thomas and his management team based their changes on thebook “Hardwiring Excellence: Purpose, Worthwhile Work, Making aDifference” by Quint Studer.

“Most of your good managers and employees want to improve,” hesays. “Once they had read the book, there was a lot of enthusiasm.Then it is a question of it not being viewed as one more thing to dobut it becoming a part of your daily work plan and schedule to workthis change in so that it is a change in how you do the work.”

Any issues that needed to be addressed because of the changeswere incorporated into the monthly management meetings and,sometimes, daily meetings.

“We were trying to roll it into their normal meetings, and thenwe implemented a few more (meetings) just to get it started,” hesays.

Thomas also brought in a coach from the Studer group to assistthem in implementing the program.

“We implemented a leadership development institute where we take our managers for a day and present different components ofwhat our journey in service excellence might look like,” he says. “Wetake them for a day and bring in speakers and also utilize our ownmanagers where they have best practices and have made a majorchange in how the perception has been evaluated by our patients.”

The organization identified which managers would be speakingbased on patient surveys. Those who had demonstrated they couldget results would share their methods with the rest of the managers.

“You talk to each individual patient and employee and engage themand try to learn more about them — what their needs are, their fears,their inhibitions, whatever it may well be,” says Thomas.

Any problems or issues are documented in a log and thenaddressed by managers and vice presidents.

However, with managers interacting with patients on a more frequent basis, that can set up an environment where employees arelooking over their shoulders. That’s why you also have to visit withemployees consistently so it becomes part of their routines.

“This is supposed to be done frequently, therefore, it’s not just aonce-in-a-while occasion,” he says. “So, the expectation is that it willoccur.”

Leaders should also begin with positive questions when visitingemployees, such as asking what is working well for them, how theirchildren are, or if there is anything management can do to maketheir job easier. The conversations can benefit an organization byidentifying a problem early before it becomes a major issue.

“Standard questions like that don’t drive a negative environment,”he says. “The more you do that, you’re there and you’re not seen asan interloper. The more you do it, the more they understand this isnothing new and this is the way it is.

“It’s not done in a confrontational environment. You try to get theemployee to be at ease so you do learn what is going on within adepartment and what needs to be addressed or is certainly a concernon their part that you need to deal with.”

Recognize good employees

Recognizing top performers in an organization is key to improvingcompany morale, which leads to improved treatment of customers.

“There is a different feel, there is a different behavior in an environment like that versus constantly hearing the bitching and moaning, if you will,” Thomas says.

Through documentation, the organization now has records of whois doing what, which helps distinguish between the high, middle andlow performers.

While lower-level employees have annual evaluations, managersmust show vice presidents how they as managers will fit into theorganization and how they will succeed.

“In many cases, what we have done is tried to align the wholeorganization, and we’ve done it under what we call pillars,” he says.“It’s service, quality, people, growth and finance. We develop it for theinstitution, then each one of our managers will present a plan on howthey fit into those particular goals and pillars and how they would

contribute to that. Then they are evaluatedbased upon the results of that.

“There is the expectation that each vicepresident approves those goals of the managers, and sits down every 90 days and evaluates, where are we with this plan? Are weaccomplishing what we had planned to do?Do we need to make adjustments or are wemeasuring the wrong thing?”

Thomas says leaders can sometimes spendtoo much time dealing with low performersand ignore top performers.

“You have to engage in the employee andrecognize when they do a great job,” hesays. “Because we know, unfortunately inmanagement, our low performers who arethe ones we spend a lot of our time withbecause they bring up the complaints, theissues, you name it.

“We don’t spend enough time recognizingthose who do a great job. So, it’s a move toswitch that time spent with your low performers to the high performers in encouraging them and recognizing the great jobthey do. So, that sets the example foreveryone else.”

Though the hospital does provide recognition through merit increases, it’s not alwaysabout money.

“It is recognition that ‘I am doing a goodjob’ because in many cases we didn’t evenrecognize them before,” he says. “Theyweren’t the squeaky wheel so we didn’t evenacknowledge them. So, a lot of it is acknowledgement. Thanking them verbally, in writing, encouraging them to continue andimprove because we all can do that — recognizing them in forums in front of their coworkers. When you can pat somebody onthe back, you do that publicly .”

While spending more time with top performers is important, you don’t want totake your eye off the low performersbecause they can have a negative effect ontop performers.

“Your good performers and midperformers, they know who the low performersare,” he says. “When you don’t deal withthem, it creates more work for them tocover that and they, again, saw that theyare the ones that got all the attention.”

In the past, Thomas says dealing with lowperformers was hard to do because thedocumentation was haphazard.

Now that there is documentation, it’s moreconsistent.

“We indicate where we feel they are notperforming up to par or what our expectations are and then outline for them the way to improve,” he says. “They are given anopportunity to improve, unless it’s severe. Ifthey don’t, we do counsel them out.”

Sometimes, low performers, as well assome high and middle performers, will alsobe slow to adapt to a change or may reject italtogether.

“How that was handled is, ‘We understandyour comments, we understand your questions, but this is where we are going, and wewant to have you on our journey. But, if youchoose not to, that is entirely up to you. Thisis the direction we’re going in,’” he says.

Thomas says there were some employeeswho wanted to do the best job but didn’tthink the change Thomas and his team wanted to make was the right way to go. Some ofthose employees are no longer with theorganization.

“We gave them an opportunity and, afterawhile and in many instances, our vice presidents, our managers knew there was a problem but didn’t know how to deal with it inthe past,” he says. “It’s not comfortable, andI don’t like people who find they enjoy firingpeople or disciplining people. It’s difficult todo, and they didn’t know how to do it.Therefore, people were sliding. But theyalready knew intuitively and by their measurements that certain employees were notas competent or were problem people.”

Results have so far been positive. Revenuein 2007 was up $18 million compared to2006. But Thomas knows that the work toimprove his organization will never be done.

“With any human organization ... it is anongoing effort, and you will never end thatjourney,” he says. “It is constant remindingand monitoring and participation. It’s participation at all levels.”

HOW TO REACH: The Washington Hospital, (724) 225-7000 orwww.washingtonhospital.org