LEADING A CULTURE OF HIGH PERFORMANCE

2019 Annual ConferenceStrategic Leadership Track

LEADING A CULTURE OF HIGH PERFORMANCE

Jackie GainesSenior Director, National Speaker, Author

2©2018 Huron Consulting Group Inc. and affiliates. All rights reserved.

What Accountability Challenges are your organizations experiencing today?



1Discuss the role of leadershipas the DRIVER of accountability in your organization

3Share the impact of successful execution of accountability tactics in community-based health care

2Review leading practices in accountability as the anchor for achieving and sustaining organizational results

Session Objectives


Leaders in your life…

Hold that thought

• The best

• The worst



Characteristics of great leaders

• Cared about us

• Gave honest feedback

• Developed our skills

• Held us accountable for our performance

• Celebrated our success


Table Exercise: What is Accountability? What words or feeling come to mind?

“I am going to hold you accountable…”



Is Leadership Looking For a “Gotcha”?

FearThreat

Uh oh, now there are expectations

Punishment

Stress


AccountabilityDefinition

The obligation to demonstrate and take responsibility for performance in light of agreed upon expectations. There is a difference between responsibility and accountability; responsibility is the obligation to act; accountability is the obligation to answer for that action.



Accountability is both prospective and retrospective

WHAT IS PREVENTABLE? DID WE ACHIEVE WHAT WE SAID WE WOULD?


Accountability is introspective

WHAT DID I DO TO CONTRIBUTE TO SUCCESS? WAS I A BARRIER? AS A LEADER

WHAT DID I DO TO SUPPORT MY TEAM IN ACHIEVING RESULTS?

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Accountability has become a major issue in health care

Accountability entails the procedures and processes by which one party justifies and takes responsibility for its activities


“Desire is the key to motivation, but it's determination and commitment to an unrelenting pursuit of your goal – a commitment to excellence – that will enable you to attain the success you seek." ~Mario Andretti

• You have been on an amazing journey to excellence to improve the quality of care and service to your patients, workforce and community.

• With increased competition you must achieve top decile performance across all strategic objectives against national benchmarks.

• We still have a great deal of leader variance in execution and results.

Why is accountability an important success factor?



Performance Excellence

By holding ourselves and others accountable we will meet our strategic priorities; finance, staff,

service, quality and growth


We can not stand still and survive

“Being a leader in healthcare today is like continuously If one stands still they go backwards.”

— Quint Studer

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We must operate AT THE TOP OF OUR GAMECOMPETITIVE ADVANTAGES DICTATE WINNERS


Who’s accountable?OUR PATIENTS, OUR EMPLOYEES, OUR PROVIDERS, OUR COMMUNITIES

This Photo by Unknown Author is licensed under CC BY-NC-SA



What are they

accountable for?

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• Professional competence• Legal and ethical conduct• Financial performance• Adequacy of access, public health

promotion, and community benefit• Workplace culture• Quality of services rendered-

experience, health outcomes, follow-up

• Achieving strategic outcomes• Other?


High Level Goal: Measurable Outcomes

Create a better place to receive care, measured by your patients’ perception of their care. The emphasis will be to create a consistently positive experience for your patients, always.

Create

Create a better place to work and practice medicine, evidenced by improved team member engagement, reduced turnover and lower agency/contract labor expense.

Create

Build and sustain a foundation of alignment, accountability systems, and development of leaders so that optionality is reduced and results are hardwired across the organization

Build and

sustain

Achieve clinical, operational and financial targetsAchieve



5. Too many new behaviors introduced at once – need of sequenced approach

6. No process in place to re-recruit the high and middle performers and address low performers (HML)

7. Inability to take best practices and standardize across organization

8. Failure to have leaders “always” do desired behaviors

Why organizations today ARE not achieving results?1. Lack of balanced approach

2. Leaders do not have the training to be successful

3. Absence of an objective accountability system

4. Dots are not connected consistently to purpose, worthwhile work and making a difference


• Clear strategic goals and measurable outcomes to validate goal achievement

• High level of engagement- Board, leadership, providers, employees, patients

• Clear roles and responsibilities • Effective results-based evaluation methods- objective versus

subjective• Proactive communication strategies• High level of transparency• Inclusive decision-making• Tactics are aligned to achieving strategic goals

How Do we execute Accountability?



KEY FACTORS TO ACHIEVE HIGH PERFORMANCE


Results Triangle



Execution Triangle


THE HEALTHCAREFLYWHEEL®



NINE PRINCIPLES®

1. Commit to excellence

2. Measure the important things

3. Build a culture around service

4. Create and develop great leaders

5. Focus on employee engagement

6. Build individual accountability

7. Align behaviors with goals and values

8. Communicate at all levels

9. Recognize and reward success




Your Communications Must Be Crystal Clear!No one should have to read your mind…


Everyone Sees You!!!

You are not the Wizard of OZ…hiding behind a curtain

You are always “on” as a leader and highly transparent. Be a role model.



Beware of Signal Loss


The Snowflake Exercise

This Photo by Unknown Author is licensed under CC BY



• Ambiguity and generalizations lead to disappointment and confusion.

• Don’t use the “Glossary of Failure”

• Soon• ASAP• Right away• I’ll get right on it• The end of the day/week/month• Later• Try• Should• Best• Might• We• By the next time we meet

Specificity Is A Key Ingredient to Success


“The main reason why people do not live up to other’s expectations is because they mentally see a different result and assume their perspective is correct.”Henry Evans

• Leaders must take responsibility to describe the desired outcome and reflect understanding by asking for a reflection from the other person.

Without Clear Expectations, People are Being Paid to Guess

Teach Back



…rather than what they cannot ultimately control

Accountable leaders pour their energy into things they can control…

My Span of Control


Everyone thinks of changing the world, but no one thinks of changing himself.Leo Tolstoy



LAYING THE ACCOUNTABILITY FOUNDATION

Leading Practices


Strategy

Annual Goals & Results

Metrics• Perf. measures• Success

indicators

90 day focus• 3-4 areas• Joint action

planning

Identify tactics• Plan

deployment• Communicat

e in context

Process Must Move From Strategy Tactical Execution

• Know starting point

• Assess skill level


37Slide 37

©2018 Huron Consulting Group Inc. and affiliates. All rights reserved.

There should ALWAYS be a direct line of sight from tactics to the strategies they advance


Don’t Let the Tail Wag the Dog!

Strategy will direct tactics and

organizational annual plan,

not the reverse.



SAMPLE – CONVERTING STRATEGIC PLAN TO ORG GOALS

Strategy Annual Goal Weight RatingSenior Leader

Better Access

(Growth)

Strengthen loyalty of physicians to meet a larger share of each patient and family’s needs and care for more patients from our Service Area.

Increase internal referrals to Surgery practices by employed providers to 90%.

15%

5 = ≥95.0%4 = 93.0‐94.9%3 = 90.0‐92.9%2 = 85.0‐89.9%1 = ≤84.9% Steve, Nona &

Wendy

Increase internal referrals to Skilled Nursing Facilities to 60%.

10%

5 = ≥80.0%4 = 70.0‐79.9%3 = 60.0‐69.9%2 = 55.0‐59.9%1 = ≤54.9%

Decrease Readmission (AMI CHF Pneumonia

5 = ≤ 12.0%4 = 13.0‐12.1%3 = 15 0‐


Develop a Visible Timeline for Leaders

• Charts an annual cycle of deliverables for leadership

• Facilitates achieving benchmarks for performance by outlining clear expectations and “timeline”

• No surprises!This Photo by Unknown Author is licensed under CC BY-SA



• Identify which goals you will track for impact.

• Calculate impact results year to date (baseline to year-to-date)

• Create a flash report to validate and monitor performance (linear and using trend lines). Align with a balanced scorecard or other tracking methodology.

• Collect and present data monthly to executive leadership for review (Results Meeting). Note findings and red flag areas for action or follow-up.

RESULTS MUST DRIVE ACTIONS!

Identify and Track Key Impact Measures


Leaders must be held

accountable for results

and not just “working

hard” with no impact



Results are a leadership

differentiator

IT IS THEIR #1 JOB!

43


Leaders Primary Role is to Move Organizational Results!

It requires:

Skill

Will

Tools and processes to facilitate focus and consistent execution

Data - quantitative (the numbers) and qualitative (subjective analysis)

Effective and efficient methods of communication, oversight and follow-up



Tool Why

Leader EvaluationSets clear expectations with objective measures.Establishes priorities with weights. RESULTS DRIVEN

Report CardTo monitor and track progress and communicate results. KEY METRICS

Meeting ModelA structured process for coaching performance throughout the FY. EFFECTIVE COMMUNICATION

90-Day PlanManage dialogue on progress and actions being taken to achieve goals. TACTICS & FOLLOW-UP

Recommended Accountability Tools


Impact on Operational Outcomes

Mis

sio

n

Gro

wth

Clin

ical

Ou

tco

mes

Cu

sto

mer

Exp

erie

nce

Em

plo

yee

En

gag

emen

t

Op

erat

ion

al P

erfo

rman

ce

Fin

anci

al P

erfo

rman

ce



Performance dashboards offer a visual review of progress toward strategic priorities, targeted goals and a platform for discussion and oversight.

Performance dashboards


Sample



Sample


DIAGNOSIS TREATMENT

Employee Engagement Rounding on Staff Skill Development

Staff Responsiveness Rounding® on Patients

No-Shows Pre-Visit Calls

Readmissions Post-Visit Phone Calls

Physician Engagement Rounding on Physicians Physician Preference Cards

Turnover 30/90 Day Meetings Peer Interviewing

Tactical approach depends on the diagnosis



Making the Right Diagnosis to Drive Results


Driving performance



Alignment

Are your actions aligned with operational results?


Or, Did you really want to build a house?

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This Photo by Unknown Author is licensed under CC BY-SA

• You must have the right action plans in place to move you closer to your desired results

•Look back at results to date, trend lines (quantitative data) and validating current data through continued dialogue with all stakeholders (qualitative data)

Identify who’s responsible for creating and executing those actions to impact the outcomes; and monthly follow-up to assure compliance and movement in the right direction.



Action Plan: Stay the course- current action plans are working! Reward and Recognize. Use accelerators (new tools and tactics) to advance success.

Action


NEW ACTION PLAN REQUIRED! Don’t tweak! Current actions are not working. You need a new plan.

Action



Action Plan: This reflects variance in execution. Before you can design an action plan you have to do some additional homework to determine if your results reflect a “skill issue”, “will issue” or combination of both. For skill- Are you challenged with a couple of staff or across a whole department? Your approach may be focused on the individual or a whole group. Think skills labs, seminars, elevate the subject matter in huddles, validation and follow-up. For will- think “crucial conversations”, reinforce employee expectation and discipline if non-compliance continues.

Action


Accountability takes place

when leaders INSPECT

what they EXPECT

Arm Chair Leadership is not enough!

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Action Plan: Before any action plan can be created, complete a root cause analysis to diagnose what caused the event. Without some diagnosis, we are destined to have a repeat occurrence.

Action plans should include how to mitigate the impact related to the identified cause.

Action


Are you an owner or a renter?

ARE YOUR STAFF MEMBERS OWNERS OR RENTERS?



Use Monthly Supervisory Meeting to recalibrate as needed for Success

• Both parties come prepared

• Results drive the discussion-80/20 rule

• Plans are realistic and inclusive of all stakeholders

• Clarity in expectations and next steps before meeting close


“I don’t have time”

“My plate is too full”

Competing priorities (too many #1’s)

Executive leaders do not role model expectations

So how do leaders spend their time if their #1 job is to move organizational results?

Push Back



Best Practice Criteria

• Patient Experience results above 85th percentile

• Quality indicators benchmarking above 25% of outcomes

• Operating income: 6%+

• Growth higher: 5%+

• Turnover less: <12%

• Sustained results: Minimum of 3 years


Celebrating What’s Right in Health Care®

Highest Performing Community Health Center

41st

percentile

80th

percentile

2017

2018

Tom Bowman, CEOFire Starter Hall of Fame Inductee

Employee EngagementTop Performer

85th

percentile

2019



Do you have opportunities for improvement?

So, How would you rate Your Organization on accountability on a 1-10 scale (10 = Best)


Which leading practices would you like to implement within the next 90 days to impact accountability? Top 3

• Strategic alignment• Effective goals and 90 day action

plans• Effective measurement

processes and tools• Results driven leadership

evaluations• Monthly supervisory meetings• Effective communication

strategies

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Questions/key take-aways


Marcie [email protected]

How to contact us

Jackie [email protected]

LEADING A CULTURE OF HIGH PERFORMANCE

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