Slide 1

Report
Improving Organizational Performance
with Bus Stop Conversations
E
A
August 7, 2009
L
Learning Objectives
• Prepare OU Medicine leaders for next steps required
to align behaviors, and build the EXCEL culture,
throughout the enterprise by…..
– Closing the Performance Gap!
– Re-recruiting Excelling and Achieving performers
– Moving Lagging performers up or out
• You will learn to…..
– Differentiate and identify Excelling, Achieving and Lagging Performers
– Conduct EAL (or Bus Stop) conversations with direct reports
– Use effective strategies to overcome the challenges that may occur
during these conversations
– Successfully implement Bus Stop Conversations to achieve intended
results
2
Why Organizations Do Not Sustain Excellence
• Do not achieve critical
mass - Lack of balanced
approach
• Too many new behaviors
introduced at once – need
sequenced approach
• Leaders do not have the
training to be successful
• No process in place to rerecruit the high and middle
performers and address low
performers
• Absence of an objective
accountability system
• Dots are not connected
consistently to purpose,
worthwhile work and
making a difference
• Inability to take best
practices and standardize
across organization
• Failure to have physician
leaders “always” do desired
behaviors
3
Evidence-Based
Rev 11.08
LeadershipSM
Foundation
STUDER GROUP®:
Objective
Evaluation
System
Leader
Development
Aligned Goals
Implement an
organizationwide staff/
leadership
evaluation
system to
hardwire
objective
accountability
(Must Haves®)
Must
Haves®
Performance
Gap
Aligned Behavior
Create
Agreed upon
processes
tactics and
and assist
behaviors to
leaders in
achieve goals
developing
 Rounding for
skills and
Outcomes:
leadership
 Thank You Notes:
competencies
necessary to  Physician
Selection,
attain desired Selection and the
results
First 90 Days
 Key Words at Key
Times AIDET
 Post Phone Calls
Re-recruit
excelling
and
achieving
performers
Move
lagging
performers
up or out
Standardization Accelerators
Aligned Process
Processes
that are
consistent
and
standardized
throughout
the
enterprise
Leader Eval
ManagerTM
Staff Eval
ManagerTM
Discharge Call
ManagerTM
Rounding
ManagerTM
Idea ExpressTM
4
Where Do Bus Stop Conversations Fit?
• Goals are outlined in LEM
• Behavior Standards are in place
• Rounding on Employees and Physicians is hardwired to assure
that everyone has tools and equipment to take care of our
patients
• Critical Conversation Training helps us as leaders have
conversations in real time regarding goals and behaviors for
those that report to us
• Coffee Cup conversations help us have conversations in real
time regarding goals and behaviors with colleagues
• Bus Stop Conversations are structured coaching and
performance conversations that are based on patterns of
behavior and they re-recruit, retain and make expectations clear
5
highmiddlelow® Survey Design & Response
• July 2008 – a personal email invitation was sent to 43
Studer Group hospital partners identified by Studer
Group coaches that conducted highmiddlelow®
conversations at their organization.
• Interviews were scheduled and completed with
participants by telephone.
• A total of 30 surveys were completed for a response
rate of 69%.
Source: 2008 highmiddlelow® Research Study
6
highmiddlelow® Respondents
• All respondents worked for a hospital and full time
equivalent employees ranged from 40 to 15,000;
average number of employees = 2,112; median
(midpoint) number of employees = 1,000.
• From 30 organizations surveyed, an average of 92% of
employees received an HML conversation.
• Almost half (46%) of organizations surveyed,
conducted HML conversations in 2007 or 2008.
Source: 2008 highmiddlelow® Research Study
7
highmiddlelow® Organizational Results
How would your rate your organization's ability to:
(1=Very Poor, 10=Excellent)
10
9
8
7
6
5
4
3
2
1
0
7.9
5.7
Retain High Performers
7.7
7.4
5.2
Before implementing HML
4.0
Further Develop Middle
Performers
After implementing HML
Move Out Low Performers
Source: highmiddlelow Research Study 8/08
Before HML, N=26; After HML, N=25 for Retaining High Performers
Before HML, N=25; After HML, N=25 for Further Developing Middle Performers
Before HML, N=25, After HML, N=25 for Moving Out Low Performers
8
highmiddlelow® & Organizational Results
Source: highmiddlelow Research Study 8/08
Before HML, N=26; After HML, N=25 for Retaining High Performers
Before HML, N=25; After HML, N=25 for Further Developing Middle Performers
9
highmiddlelow® & Organizational Results
Source: highmiddlelow Research Study 8/08
Before HML, N=24; After HML, N=24 for Moving Up Low Performers
Before HML, N=25; After HML, N=25 for Moving Out Low Performers
10
highmiddlelow® & Organizational Results
Source: highmiddlelow Research Study 8/08
Before HML, N=25; After HML, N=25
11
highmiddlelow® & Employee Satisfaction
Top Scores
Those rating a 4 or 5 on
5-point scales
Source: highmiddlelow Research Study 8/08
Before HML, N=16; After HML, N=15
This is a blended score of different types of employee satisfaction questions
across 16 different hospitals; scores above reflect
Top Box scores - % of employees that gave a 4 or 5 rating on a 5-point scale 12
highmiddlelow® and Annualized Turnover Rates
Source: highmiddlelow Research Study 8/08
N=24 for Turnover rates before and after HML conversations;
N=15 for Current Turnover Rate
13
HML Impact
Line of service
Before HML
After HML
Advocate Good Samaritan, Downers Grove, IL
Beds = 303, Admissions = 17,486, Employees = 2500
Employee satisfaction
Month before - 65
6 months after - 81
Inpatient satisfaction
2 months before - 74
4 months after - 87
Outpatient satisfaction
2 months before - 86
4 months after – 98
United Regional Health Care, Wichita Falls, TX
Beds=357, Admissions = 15,995, employees=1,788
Inpatient satisfaction
1st Quarter - 61
4th Quarter - 91
Outpatient satisfaction
1st Quarter - 45
4th Quarter - 69
ED satisfaction
1st Quarter - 50
4th Quarter - 83
Homestead Hospital, Florida
Employee engagement as
measured by Gallup
7.9
14.2
Positive Results of highmiddlelow®
• “I do not use an agency anymore. I attribute this to
highmiddlelow® working so successfully.”
Houshang Falahatpour
Inova Fairfax Emergency Care Center - Fairfax, VA
• “We discontinued using agency nurses as of July
2006 and this adds up to more than $1 million dollars
in savings.”
Elizabeth Parsons
Palmetto Health Baptist Easley – Easley, SC
Source: highmiddlelow Research Study 8/08
15
Positive Results of highmiddlelow®
• “We have a LEM goal to retain high performing
nurses and this resulted in reducing RN turnover
from 21% to 15% (2006 to 2007). This also produced
a return on investment of $1 million dollars!”
Kristi Faulkner
United Regional Health Care System – Wichita Falls, TX
Source: highmiddlelow Research Study 8/08
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Dartmouth Hitchcock IOP Distribution
“We moved our performance curve!”
17
Results That Last
…Spending 92 percent of your time retaining the 92
percent of your employees who want to be on board,
and 8 percent of your time dealing with the 8 percent
who don’t. The outcome is results that last.
Results That Last, Quint Studer, Chapter 1, Pg 4
18
What Are Your Supervisors Doing?
19
Who Are You Spending Time With?
20
V-TACH
Underlying Cause: Several
Treatment: ACLS
21
• PATIENT SATISFACTION V-TACH
• Underlying Cause: Inconsistency
• Treatment: Bus Stop Conversations
Ja
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Patient
GoalSatisfaction
= 90%
October 25, 2004
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
95%
90%
18%
21%
22
Performance Curve
Excelling-Achieving-Lagging
L
A
8%
58%
E
34%
23
24
Tool Five: Excelling
E
25
1/3 clinical skills
1/3 team work
1/3 service skills
26
Tool Five: Achieving
A
27
28
Tool Five : Lagging
L
29
Phase 1:The Honeymoon
What to expect:
Key Action Steps:






Sense of excitement
Right “to do” list
Things will get better (hope)
Quick fixes are implemented
Skeptics






Provide more communication
(information)
Acquire tools and improve systems
Start to hardwire selected behaviors
Roll out Behavior Standards
Implement new accountability system
(LEM)
Begin Leadership Development
Sessions
Start Teams
30
Excelling, Achieving, and Lagging Performer
E
A
L
31
Phase 2: Reality Sets In
What to expect:
Key Action Steps:
 We/they
 Inconsistency
 Leadership training gets more focused
 Re-recruit excelling performers
 Increase substance of communication
to stakeholders
 Prepare to have conversations with
excelling-achieving-lagging performers
 Increase reward and recognition
 Bigger than I thought
 This will impact me
 Some are getting it
 Some are not
32
The Gap Becomes Evident
E
A
E
A
L
Hoping that:
• More time will help
• More coaching will help
• More focus will help
• A transfer will help
• They will leave
Gap is
uncomfortable
L
33
The Gap is Intolerable
E
E
E
The
Wall
A
A
A
Gap is
uncomfortable
L
L
Gap is
Intolerable
L
34
Results Decline (look familiar?)
E
E
E
E
E
E
A
A
LL
A
A
A
M
A
Gap is
intolerable
Gap is
uncomfortable
LL
E
The
Wall
A
Results
Decline
L
L
L
35
Phase 3: The Uncomfortable Gap
What to expect:
Key Action Steps:




 Tough questions are responded
The performance gap is evident
Tougher decisions must be made
Process improvement increases
Inconsistencies become obvious
to and hardwired by leaders
 EAL Completed
 The “right people” are in the “right
places”
36
Over the Wall
E
A
E
E
E
A
L
A
The
Wall
A
Gap is
intolerable
Gap is
uncomfortable
L
L
37
Over the Wall
E
A
E
E
E
A
L
A
The
Wall
A
Gap is
intolerable
Gap is
uncomfortable
L
L
38
Phase 4: Consistency
What to expect:
Key Action Steps:
 High performing results
 Everyone understands the keys to
success
 Push for innovation
 Disciplined people and disciplined
processes
 Proactive leadership
 Standardize and repeat key
behaviors
 Next generation of
tools/techniques
39
Moving the Excelling Performers
GAP
L
A
E
Performance
40
Start at the Top…
41
Bus Stop Conversation Toolkit
42
Tool Six: Tracking Tool
43
Excelling Performance Conversation
• ENGAGE: Tell them where the organization is going
• APPRECIATE: Thank them for their contribution and
articulate the specific value of their work
• SUPPORT: Outline why they are so important
• Ask them what they need to be a long-term employee and
what you can do for them
44
Excelling Performance Conversation
Kay and Cheryl
45
Role Playing Exercise Outline
• Participants break into groups of 2
• Role play scenarios are in your packets
• One person will have an Excelling performer
conversation
• Role play begins (5-7 minutes)
• Feedback (5 minutes)
46
Moving the Achieving Performers
GAP
L
A
E
Performance
47
Achieving Performance Conversation
Reassure individual goal is to retain
• S : Support
– Describe what they do well – be specific
• C : Coach
– Identify one thing they can improve, provide specifics
and benefit of doing this. Ask for their ideas for
training or support
• S : Support
– Ask them how you can assist or support them in
developing this skill. Reaffirm good qualities.
48
Achieving Performance Conversation
Tim and Darnell
49
Role Playing Exercise Outline
• Participants break into groups of 2
• Role play scenarios are in your packets
• One person will have an Achieving performer
conversation
• Role play begins (5-7 minutes)
• Feedback (5 minutes)
50
Clear Expectations for Lagging Performers
GAP
L
A
E
Performance
51
Lagging Performance Conversation
Do not start meeting on a positive note
• D : Describe
– Describe what has been observed.
• E : Evaluate
– Evaluate how you feel.
• S : Show
– Show what needs to be done.
• K : Know
– Know consequences of continued same performance.
• Schedule follow up conversation within the
improvement time frame
52
Lagging Performance Conversation
Karen and Cyndi
53
Role Playing Exercise Outline
• Participants break into groups of 2
• Role play scenarios are in your packets
• Each person will have a Lagging performer
conversation
• Role play begins (5-7 minutes)
• Feedback (5 minutes)
54
Tool Seven
Remember to be
prepared for the
conversations!
55
What Has Been Accomplished?
• Leader demonstrates concern and care for those that
report to them
• Leader demonstrates commitment to team member
professional development
• Leader affirms and shows appreciation for excelling and
achieving
• Leader lets people with sub-par performance know
exactly where they stand and next steps for their
performance
• Leader role models value driven leadership
56
Excelling!
NEW
OLD
Performance
57
Key word …….CHOICE
Studer Group® : Nuts and Bolts of Service and Operational Excellence in the ED
58
Linkage Grid
59
We have learned that the reluctance to
address low/sub-par performance keep an
organization from being the best.
Quint Studer
60

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