Accountability in the Small Hospital
Hardwired Results interviews Greg Paris, rural healthcare leader and expert
HR: Why is ED flow so important?
GP: It's both easier and it's harder than in large environments. There are a lot of universal things—you have to set expectations early, for example. And I consider it to be leadership malpractice in an organization of any size if you aren't sharing expectations or role modeling what to do. But in a small hospital, we have more access to each other. We're more nimble because of our size and we have very personal relationships with co-workers because we see them in the grocery store or at the ball game, and know their families.
Likewise, it's a curse when someone disappoints and you have to hold them accountable or let them go…because you see them in the grocery store or at the ball game, and know their families. It's not like in downtown Chicago.
HR: I hear you use storytelling to engage and hold people accountable?
GP: Yes, storytelling is a powerful way to teach and achieve buy-in. It helps employees understand why we ask them to do what we do.
I find that when I tell stories—say I want a nurse to "manage up" a doctor she works with— she'll be more likely to comply if she hears it from a patient perspective. I might share a story I heard from a patient by saying, "I was in your ER and was so appreciative that the nurse took a little extra time to explain to me what was going on. I was scared because I was having symptoms and I didn't know if I had cancer or something else. In the absence of information, I tend to make up my own story so when she told me what was going on, what the plan was, and why she had so much confidence in the doctor and his skills, I was a lot more at ease."
HR: How are leaders at Monroe accountable to employees?
GP: Well, one really important way is that we just made a commitment to not lay anyone off. Here's the thing: All along, we've told our employees that "you matter", we're a family, and we're all going the same direction. Now how authentic would it be if I tapped one of those individuals on the shoulder and said, "I know what I told you, but effective tomorrow you don't work here anymore." We asked our board to pass a resolution that says we don't lay off people. Now I may ask someone to do a different job or cross-train somewhere else, but I won't lay them off or send them home because of low census. You know, I just saw an ad in our state newspaper that offered a $20,000 sign-on bonus to physical therapists. You've got to realize that any physical therapist would pause before they turned that down. Your job is to create the kind of culture where it's not worth trading for a $20,000 bonus or a $2 per hour increase.
HR: Some say that small organizations just can't afford the journey from good to great. What's your response?
GP: Sometimes we tend to victimize ourselves in small hospitals. We get a defeatist attitude about all the reasons we can't do it…whether it's technology or service and operational excellence. The reality is, you can't afford not to do it. Seven years ago, when I looked around me at my competition, I was surrounded by hospitals that were bigger, enjoyed better reimbursement, better technology, and had deeper pockets. The only thing that was left for Monroe was to provide better service…which is all my patients wanted anyway. In fact, just the other day, we had a surgeon who told me he needed to make a surgery happen (that we don't normally do at Monroe) because the patient refused to go anywhere else! So we did.
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