In organizations, culture is defined by what we do. And just hoping that culture will evolve on its own is a recipe for disaster. To have a fluid, high-performing team, you must be intentional about developing the culture consistently.

One of the most important things you can do to shape your culture is to put time and thought into hiring the right people—people who will do the right things in alignment with your stated mission, vision, and values.

The bottom line is two-fold:

1. How do you make people want to work for you?
2. How do you attract the people you want?

When you have a clear understanding of your company’s values and desired culture, then identify where the role you are hiring for fits into that vision, you will hire individuals who have both the right skill set and the right cultural fit.

How can you tell if a candidate fits your culture?

“At Innovative Connections, we use a personality assessment to help determine how an employee might work within the culture of an organization as well as how they will meet the criteria for the role,” says Laurie Cure, Ph.D., president and CEO. “The assessment can indicate how a candidate’s personality, values, and potential blind spots might impact their individual performance as well as the way they might impact team dynamics and interactions.”

However, personality assessment should not be the sole criteria. “We also look at emotional intelligence (“EI”) in the hiring process. People with high EI scores are typically very self-aware, meaning they manage their own emotional experiences, handle conflict appropriately, are critical thinkers, can build trust, and are good at building strong relationships,” Laurie explains. There is a direct positive correlation between EI and leadership success.

“The research shows,” she says, “that, all other things being equal, a person’s emotional intelligence score dictates 80 percent of their success in a role. This tool identifies critical attributes for success.”

Using these two tools, in combination with a personal interview process, can be beneficial. Occasionally, a candidate’s personality profile in isolation may not indicate that they are a great fit for the company; however, further analysis through emotional intelligence profiles and interviews may reveal a more nuanced picture.

“We have had hires who, at first glance, would not have been identified as the ideal candidate based on their personality profile. But upon further discussion and assessment was determined their personality was right for the job,” she explains. “For instance, someone may have a strong ‘derailer’ (e.g., passive-aggressive or narcissistic behavior indicators, which can come across as unempathetic or uncaring). But if this same individual has high EI, they likely have a high level of awareness around their derailers and can effectively navigate and manage them to be a strength rather than a weakness.”

The interview process is also critical in deepening awareness of a candidate’s personality and EI traits. “It’s important to ask questions that will reveal the authenticity of a candidate, not just their technical skill set,” Cure says. Some key EI indicators that may predict a candidate’s potential for success include:

• Do they think about how others are affected by their actions?
• Do they think before they speak or act?
• Can they process their emotions internally before reacting to a situation?
• Can they use their own emotions to problem-solve?
• Are they adaptable in different situations?

To summarize, it is important to use more than one method or tool to make a judgement on the desirability of a candidate.

“Having a very strong sense of your company’s culture and vision prior to even beginning to write your job description is helpful in the process of making good hiring decisions,” Laurie recaps. “Then using a personality assessment in conjunction with EI indicators, as well as really honing your interviewing process, is a great way to ensure you are hiring the right person for the right reason for the right job.”

Next up? Once you have hired the perfect candidate, how do you keep them? Employee turnover is expensive.  In fact, according to statistics, it can cost employers up to 33 percent of the employee’s salary to replace them once they leave. Stay tuned for a future post with some insights into engagement and retention.

By David Quigley,MSW, PHR, Board-Certified Coach

How would you answer a physician who asked during new employee orientation, “Do you really expect us to smile all the time?” That question stimulated an interesting discussion in a group of newly-hired clinical and non-clinical hospital staff which resulted in clarifications and several key insights. I continue to reflect on it years later—more so recently, in light of my “deep dive” into patient experience with a loved one.

The physician who asked the question in orientation had not been born in the U.S. He went on to explain that, in his country of origin, if you walked around smiling all the time it might get you an all-expenses-paid full psychological assessment at the local mental health facility. In other words, smiling constantly could have been seen as unusual, concerning, and perhaps a sign of other issues.

What is the culture in your healthcare facility regarding smiling? And more to my point, does it make any difference? Is it simply a social pleasantry, or does smiling hold the potential to impact patients, families, other staff, and perhaps even the “smiling staff person” themselves? Farfetched? Perhaps; perhaps not.

For the past several years I have worked in the realm of patient experience. I have coached, taught, and observed delivery of care models in hospitals, medical clinics, hospices, home care agencies, and nursing homes across the country. Adding to the professional experience is my recent personal “deep dive,” spending 561 hours (and counting) witnessing care delivery to a loved one in hospitals and, now, a long-term care facility.

We, the patient and family, have benefited greatly and are deeply appreciative to have received some truly outstanding care from physicians, nurses, techs, food and nutrition staff, physical, occupational, and speech therapists, and housekeeping. Some has been subpar too, but for now I want to focus on two specific elements that have been present in every one of the individuals who delivered exceptional care to us. And I submit to you that these characteristics not only benefit the patient and family, but also the employee themselves.

• First, many of the outstanding care providers that I’ve had conversations with possess a positive attitude about their role, the work they do, and how their work benefits others. They believe in what they do and are committed to it. Although this is a small sample, every one of the high-performing staff that I’ve had a chance to visit with over time exhibits this “positive role perspective.”
• The next element is that they exuded a warmth, and nearly always presented with a smile. There was a felt sense of the unconditional positive human regard, a phrase developed by psychologist Carl Rogers.

These qualities could be considered essential engagement attributes that increase patient communication, patient compliance, and patient well-being. And they seem to be part of empathetic communication and a language of caring.

Of course, there are many other critical staff qualities such as competence and communication. Yet the care we receive that is delivered by staff who are intelligent and competent, but lack a smile and the accompanying warmth, empathy and compassion, feels like a lesser quality of care.

Now, what the potential benefits of positive attitude and smiles to the employees, themselves? Several years ago, Jim Collins in his book, Good to Great described a dynamic that is now being empirically demonstrated by neuroscience and positive psychology. At the “center of the flywheel” for all outstanding companies, he said, was the sense of meaning and purpose—doing worthwhile work and making a difference—embedded in the organizational culture and experienced by employees. This felt sense of meaning and purpose in and about one’s role can:

• Increase engagement
• Deepen fulfillment
• Enhance creativity and innovation
• Increase employee resilience and change hardiness
• Reduce turnover
• Propel the organization’s success

Given that healthcare is a complex, rapidly changing, and ambiguous environment these qualities might just be an excellent vaccine against burnout and compassion fatigue. So, go ahead…smile!

 

by David Quigley, MSW, PHR, Board-certified Coach

Have you ever had a loved one in a nursing home?

My spouse and I have both worked in hospitals and healthcare for the past several decades and I have been keenly interested in what constitutes exceptional care for the patient and family. We are currently in a situation where our work experience and life experiences have overlapped: for the first time we have a family member who has become a nursing home resident. It has been an emotional roller coaster with lots of inspirational highs and some sad and bitter lows.

As I experience the day-to-day care my loved one (let’s call him “Sam”) receives from the family member’s perspective, I’ve come up with the following short list of basic essential elements of quality patient care. I would coach caregivers in any hospital, clinic, or nursing home to communicate with their patients in this way:

• Connect first, then provide care. Take the time to get to know the patient and let him get to know you. His mentation varies from day to day, so take that into consideration. For example, you might introduce yourself by saying, “Hi Sam. You may not remember me but I met you yesterday.” (In one comedic moment during our experience, after an unintroduced doctor got done with his spiel, Sam asked him, “Are you a doctor?” Pretty relevant question isn’t it?)
• Always, always explain what you intend to do on this visit and ask his permission. I have seen caregivers walk in and begin to draw blood or give medications without saying a word.
• After you assess the patient’s mentation at the current moment, speak slowly and don’t “stack” your questions. Let him answer one question at a time and give him one instruction at a time.  For example, “Sam, first we are going to stand you up and then move you over into the wheel chair, okay? Here we go, first let’s stand you up. Good job, now over into the wheel chair.”

We have witnessed firsthand the difference that compassion and competence make, for both the patient and the family members, and we are deeply grateful to the caregivers out there doing this important work. Thank you for your competence, compassion, and empathy.

Now I would like to hear from you: What would you add to the above short list?

Interview with Pat Samples by Holly LeMaster

This is the third in a five-part series on physician leadership.

What’s the impact of physician and nurse leaders partnering effectively—or not? Some of the literature is beginning to show that, since the advent of EMR, nurses and physicians are working more in parallel to one another versus in true collaboration. They don’t actually have to be in the same place at the same time anymore to “talk about” the patient. So a lot of the work I do with nursing leaders and physicians is about getting them back in the room together. We cannot deliver good care if the physician and the nurse aren’t partnering. That’s true at the front line, at middle management, and the executive level. Physicians and nurses must partner in the delivery of care. That’s all there is to it. We’ve let the EMR separate us, and we’ve got to get back to collaborating on patient care. There’s a lot of thinking outside the box and brainstorming about how to do this. What’s the vision? How are you going to get there? What behaviors are you willing to tolerate? How is the medical director going to support their nursing leader, and vice versa?

I recently went into an organization where the medical director was struggling with relationships and was highly frustrated. As I observed him go through his day, it became apparent to me that the nursing leader and the physician leader weren’t on the same page. As a result of understanding this, what I’ve come to do in most organizations is to ask the physician right away: who is your nursing leader and where are you two headed together? You must be going in the same direction, especially if you’re trying to drive a service line or a fast-paced procedure area. You must align your approaches to operational issues, skill mix, and strategic direction. It has to be an intentional conversation.

These relationships are often dysfunctional due to processes which aren’t ideal. But there’s a natural magnet between physicians and nurses that’s been depolarized by the EMR. We need to get back in there and fix it, for the best interest of the patient. Nurses spend more time with the patient, they know more about the social issues—information the physician needs. The two leaders need collaboration and role clarity. What you don’t want to happen is for the medical director to get bogged down in too much operational detail—it skews their perspective and they begin to have discussions with employees that they shouldn’t be having. The trick is learning how to use the power of the physician to leverage relationships and processes in the appropriate places. We do a lot of work around that.

Interview with Pat Samples by Holly LeMaster

Pat Samples, MS, RN, CENP

I recently sat down with Pat Samples, MS, RN, CENP, to talk about a topic that's close to her heart: physician coaching. Coming from her background as nurse, and then a nursing executive, Pat has a natural gift for coaching and developing physician leaders. If you're a physician who's curious about exploring a coaching relationship, or an administrator who is wondering about the benefits of coaching for members of your medical staff, you'll want to read all of these interviews.

This is the second  in a five-part series.

When we left off, you were talking about the physician leadership gap in healthcare organizations—about how there’s typically no effective peer support to help a physician who’s struggling with, say, behavioral or quality issues. What, exactly, is it that you do to fill this gap? It’s a process we call Observational Coaching. What I do that’s different is to spend time with them, watching in their natural habitats, and then give them feedback. I might follow them 4 - 6 hours at a time for 4 or 5 sessions, through every environment and practice setting—their offices, the O.R., on the units, with patients and families, with staff, in meetings—to see how they’re showing up in various settings and with various parties. As an objective party, a neutral “outsider,” I can then point out what I’m seeing and perceiving, and ask the physician to explain what’s happening for them. “Okay, here’s how I saw you show up here, and this is how I saw you show up there. Tell me the disconnect.”

Wow. Do other people know who you are and what’s going on? Sort of. The first session we spend one-on-one, just getting to know each other and laying the framework for the rest of the sessions. When I’m observing, we always get the patient’s permission (if there’s one involved) for me to be present. We tell others just that I’m a nurse who’s following the physician, which is factually accurate. They actually don’t know that I’m observing and coaching. It’s usually not until after they’re successful that they tell people, “remember that day in the O.R.? Pat really helped me!” In an O.R. setting, for example, I’m usually at the back of the room so they forget I’m there. I try to position myself behind them until they get comfortable, and then I move around so I can watch their facial expressions.

Under certain circumstances during the process, I might step up next to them and just cue them a few times, but only after I have asked their permission.

What kind of cues would you give? Once when one was sort of yelling and getting really frustrated…Wait, so you’re standing there; he knows you’re there, and he still misbehaved? They honestly forget I’m there, because I’m standing out of the way and they are focused on what they’re doing. I want to watch everybody. I want to see how the staff is showing up prepared or not prepared, take in the layout of the room—especially in the O.R. because it’s so multifaceted. In this particular case, it was the second time I’d followed this doctor into the O.R. And I observed him getting really frustrated, for all the right reasons: not the right equipment, the staff was not paying attention. So I just stepped up next to him and just whispered to him, “you’re yelling. That does not make them smarter.” I just cued him to stop yelling—that’s all I did.

Afterward, when we were debriefing the experience, we referred to his Hogan Personality Assessment (a tool we use that provides powerful insights into personality, behaviors, and values). And based on who he was as a person, it was clear he really derails when he does not have the right equipment in the room. From there, we were able to strategize: what control do you have to make sure that you always have the right equipment? They key is in teaching them to get to know themselves, what they need to be successful, and what they can impact and influence. Instead of allowing other people’s poor choices to negatively impact his surgery, ask what’s within his control and what’s within his influence? And then, own it. Once you’re in that place, you can verbalize your frustrations differently and more productively.

This must have impact way beyond the single physician. Yes. We also organically uncover operational issues as a result of this observation process. When that happens, I can report the problems back to leadership and recommend resolutions. In one case, we ended up doing some extended work with my physician client’s whole team to support them in being more effective overall. It’s never just one thing, is it? No. If we can address those operational barriers that are elevating the frustration, we can improve the dynamics from multiple angles. That’s why physicians appreciate this process so much. They learn to become accountable for their own behaviors while we simultaneously identify and address the areas where they need help from others—their team, their leaders, the organization.

To address the personal dynamics with the coached physician following observation, we use the Hogan Personality and Emotional Intelligence Assessments for self-discovery, and then we really talk about the physician as a human being—how their personality traits, behaviors, and values are serving them and how they’re getting in the way. Who do you want to be? How do you want to grow? What do you want to master? And, I tell them directly, “you actually can’t act like this anymore. We don’t yell at people, we don’t call them names; you can’t create that kind of culture anymore.” We know that the real reason most physicians resort to these kinds of bad behaviors it is that it gets them what they want; it gets somebody’s attention. My job is to teach them to find their voice and express it in a mature way that serves the team and the patient.

Okay, so that accounts for an individual physician and the areas he or she touches. What about the rest of the medical staff and physician leadership. How do you address that next level?  Good question. The physician leaders in that organization might not have the skill sets to help them  integrate the learning and sustain the new  and improved behaviors. Once I’ve done the work with the frontline practicing physician, we go to their leader or medical director together. The physician explains, “here’s what I’ve learned about myself and here’s what I need from you.”  Then we make a plan together to move forward and keep the behaviors in check. This process teaches the medical director how to help and support all of his frontline physicians. They just need the awareness, intention, and skills to be able do that. At the medical director level, I can teach them crucial conversations, addressing behavior in the moment, conflict resolution ability, and how to learn about their colleague as a person (why they are behaving the way they are). To address a colleague’s behavior doesn’t mean they aren’t providing quality care. And that’s a new concept for physicians. It doesn’t mean they are a bad physician or don’t know how to provide the care. But if you don’t have the right behavior in delivering the care, you’re part of the problem in healthcare.

"If you, as my medical director, see me lose my cool and don’t say anything, that silence is affirmation."

To summarize, why would an organization hire Innovative Connections for physician coaching? Their pain is, more often than not, a physician that’s causing chaos or disruption in an environment that’s having a downstream effect on other people. Physician leadership is a fairly new concept in healthcare at a very disruptive time. Appropriate support, education, and coaching will allow physicians to be more successful with fewer casualties, and have a higher impact quicker to support them, their colleagues and their teams. Trickle down leadership!

We’ve experienced great success with our observational physician coaching, I believe, because it’s really focused and intentional. Because we’re there, watching, we experience firsthand through an objective viewpoint what’s working and what’s not working. Then we create a totally individualized learning plan for the physician based on their specific obstacles and circumstances.

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We're committed to practicing what we preach at Innovative Connections. So we regularly build in time to pause, reflect, and connect as a team. Yesterday we had an extended team meeting and holiday celebration together to enjoy one another's company, review the past year, and imagine our way into 2018.

Our reflections consistently bring forward this undeniable truth: we are profoundly grateful for the opportunity to partner with and serve you--individuals and organizations with the courage and vision to intentionally create and grow.

So whatever you're celebrating this holiday season, we send great joy and abundant blessings to you and yours. May 2018 bring much love, deeply satisfying adventures, and grand successes your way.

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