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Leadership and Improvement Conference-Toronto 2017 Series: Part 3 of 5

Connecting to the Why of Healthcare During Times of Crisis, and in Everyday Practice

Defining, communicating and maintaining a clear and relentless focus on the why is fundamental to Evidence-Based LeadershipSM.

The why reminds us of the core purpose of all we do in healthcare. It is typically expressed in statements of mission, vision and values. It varies according to the history and mandates of each organization, but is always grounded in providing the best possible care for patients and families.

Understanding the why is essential to achieving and sustaining success. In practice, this extends well beyond commitments in principle to the hard work of translating the why into measurable goals, and connecting it to everything the organization does, from strategic planning to performance measurement and evaluation.

The why was a prominent theme at this year’s Healthcare Leadership and Improvement Conference, and speakers focused in particular on the role it plays in two critically important and closely interrelated leadership challenges – engaging staff and managing change.

Managing change at the personal level

Mitch Hagins, Studer Group senior coach and speaker, looked at the why from the perspective of individuals confronting an endless stream of new demands.

He outlined the process we all go through as we acquire skills and competencies. We move from “unconsciously unskilled” (when we don’t know what we don’t know), to “consciously unskilled” (when we first become aware of our incompetence, often with some discomfort), to “consciously skilled” (when we gain proficiency through learning and practice), to “unconsciously skilled” (when we are competent and confident).

The challenge in our fast-moving world is that we are constantly becoming aware of things we don’t know, and confronting this process repeatedly. Whenever we talk about change we are talking about individuals cycling through states of competence and incompetence, along with the anxiety, disruption and uncertainty this can entail.

These personal challenges are amplified in healthcare because whenever there is incompetence, there is risk. Our skills and competencies are respected and critically important, yet today we are frequently asked to become incompetent, almost certainly causing discomfort and potentially creating risk to our patients, staff or communities.

“We need something bigger and deeper than ourselves to make all of that worthwhile,” according to Mitch Hagins. “This is the importance of the why in what we are trying to accomplish in change and transformation – the why being mission, vision, values and strategic plan.”

Connecting to the why in practice

Individuals can find the motivation and support they need in organizations that have systems in place to engage staff and physicians, and connect everyone to a common why.

Dr. Lucas Chartier, an emergency physician at Toronto’s University Health Network (UHN), described proven tactics for engaging physicians through communication, recognition, capacity-building, measurement and identifying champions (Insight No. 5). All are supported by a communication protocol that begins with the why before moving to the what and the how, and helps to build trust, buy-in and a common understanding of goals.

Ron Gagnon, president and CEO at Sault Area Health, discussed how his organization structures its entire strategic plan around its mission – “exceptional people working together to provide outstanding care in Algoma” – and applies tactics to bring this mission to life. These include extensive use of staff and patient testimonials, award and recognition programs, and robust patient relations processes.

Eric Hanna, president and CEO of Arnprior Regional Health, characterized rounding as “the single most powerful tool to engage employees”. He showed how rounding drives engagement and performance, and how these practices are closely linked to the why. Survey results show strong correlations between employee engagement scores and agreement with statements about sharing values with the organization and understanding how the work relates to the organization’s vision.

Meeting the needs of patients, families, staff, physicians and the community

Bonnie Adamson, executive leadership consultant and speaker, told two very different but equally compelling stories about confronting change, challenge and crisis.

The first recalled her experience as CEO of North York General Hospital (NGH) in 2003, when this major health centre in a highly urbanized part of the Toronto region became the epicentre of the SARS epidemic. Hospital staff struggled to deliver care while managing mandatory quarantines and the strictest possible infection control protocols.

As the epidemic intensified, fear and panic spread throughout the community. Signs on local stores warned “do not enter if you work at NGH”.  Many healthcare workers were terrified; some died in the line of duty. There were “battle-hardened clinicians with tears in their eyes”.

There were also countless demonstrations of empathy, courage and exceptional leadership, and the hospital and community ultimately survived the crisis. NGH eventually emerged as one of Canada’s top-performing community hospitals. “We had to heal our way to a new future,” says Bonnie Adamson of that difficult transition.

Her second story recounted her personal journey as caregiver for her husband during a 2 ½-year battle with terminal cancer. She spoke of the emotional turbulence families endure in these situations, and the degree to which they rely on each and every contact with the health system, from a major procedure to a simple voicemail message.

In this new role, she learned about issues like “healthcare silos” and “patient experience” from a much different perspective. Seemingly small actions by frontline staff become profoundly important when viewed through the lens of patients and families.

Bonnie Adamson’s challenging and provocative advice got to the very core of what health leaders must do to deliver on the why.

She urged leaders to “expect the unexpected”. In times of adversity, leaders and their teams “have to be in this together,” and leaders have to be present on the front lines.

She also spoke about developing a “leadership style that overflows with humility, humanity and compassion”. This is critical during periods of stress, but also essential for truly patient-centred care and something that must always be there, through countless small actions, sensitive statements and personal touches that can leave a positive long-term impact.

She advocates a positive approach to our current health system challenges. “If we truly want a patient-centred system, we cannot throw up our hands. Patients deserve better. Now, more than ever, we need bold, committed, courageous leaders.”

She recalled, during the SARS crisis, “a gut-wrenching, relentless drive to meet the needs of patients, families, staff, physicians and the community.” “Excellence in leadership,” according to Bonnie Adamson, “comes from the same place.”

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