In Hardwiring Excellence, Studer examines what he has coined the Five Pillars for achieving excellence in health care People, Service, Quality, Finance and Growth and lays out the Nine Principles to service and operational excellence that every health care organization should follow in its quest to be the best.
You commit to excellence by setting measurable goals or desired results for each of the Five Pillars of Excellence. The best part of aligning goals this way is that the pillars work together synergistically. Say you have a goal under your Quality Pillar of reducing the occurrence of in-patient pressure ulcers. Your data shows that typically 5 percent of patients will acquire pressure ulcers during an inpatient stay and the cost to treat each pressure ulcer can exceed $20,000. So along with improving quality of care, a commitment to excellence in preventing pressure ulcers will result in substantial cost reductions under the Finance Pillar. Principle Two: Measure the Important Things
Simply stated, what gets measured gets done. Often, top management places greater emphasis on Finance than the other pillars. But Studer says that great CEOs focus as much on the People, Service, and Quality aspects of their organizations as they do on the Finance pillar. The more often you measure the important things like employee satisfaction, patient satisfaction, and clinical progress the more likely you are to reward successes and correct deficiencies. Principle Three: Build a Culture Around Service
Studer reminds excellence-oriented CEOs to teach their staff to “connect the dots” for people. For instance, incorporate “Key Words at Key Times” into your patient care protocol. If your hospital has curtains between beds and a nurse walks into a room and pulls the curtains closed without saying anything, the patient might think the nurse is either being rude or hiding something. If the nurse simply says, “Mrs. Medley, we want to make sure you have privacy here at our hospital. Let me close those curtains for you,” the patient will see you as a hospital that cares. Principle Four: Create and Develop Leaders
You no doubt know that great organizations must make leadership training a priority, but it’s a point that bears repeating. In his book Studer offers an anecdote about a CEO who was having trouble with employee turnover. Studer suggested taking leaders off-site for a couple of days every three months or so to train them on employee retention. When the CEO said the leaders didn’t have time to leave the hospital for that long, Studer asked exactly how high the turnover was. “It’s 33 percent,” said the CEO. “They may be too busy interviewing new employees!” Studer replied. “Sometimes, because we don’t deal with the cause, we get overwhelmed with the symptoms,” Studer writes. “Leadership training is at the heart of why employees want to come to work and why they want to stay. People don’t leave their jobs. They leave the work environment. The majority of employees leave their position because their relationship with their supervisor is not what they want it to be . . . The supervisor holds the key to high employee retention.” Principle Five: Focus on Employee Satisfaction
One of the most important things you can do to increase employee satisfaction is “Rounding for Outcomes.” This means walking around the hospital and interacting with your team. That means listening to employee problems and fixing them. During rounding at Holy Cross Hospital in Chicago, a nurse told Studer that her team needed a copy machine. So Administration got copy machines for every nursing unit, and, as a bonus, decided to get rid of the keys. In fact, they had a big key-smashing ceremony in the parking lot. “This wasn’t about getting rid of keys,” writes Studer. “It was about creating more trust in the organization. And it started with a simple question during rounding.” Principle Six: Build Individual Accountability
It’s no secret that the most desirable employees are the ones who act like owners. Studer points out that a hospital cafeteria is a great place to observe ownership. If employees leave trays on the table, they are renters, not owners. To foster a sense of ownership, he suggests that administrators:
- Involve employees in the interviewing process.
- Work on retention of new employees. Check in with them often over the first 90 days to gauge satisfaction and expectations and to help smooth the transition.
- Harvest intellectual capital through a Bright Ideas program that encourages employees to contribute innovative and quality ideas.
Principle Seven: Align Behaviors With Goals and Values
This principle speaks to taking a tough stance when it comes to raising your expectations of your organization’s leaders. In order to ensure that your employees have a great place to work, that physicians enjoy a supportive environment to practice, and patients receive exemplary care, you must take steps to ensure that the goals and values of the organization are aligned with the behavior of its leaders. In other words, walk the talk. And the place to begin is with your management team. To that end, you might consider:
- Adopting an objective, measurable leader evaluation tool and hold leaders accountable for the results.
- Being prepared to reward leaders for a job well done.
- Demonstrating a sustained commitment to training and coaching leaders; set them up for success.
Principle Eight: Communicate at All Levels
To achieve excellence, everyone in an organization from the vice presidents to the cashiers in the cafeteria must have the same information about the organization’s goals, direction, and progress. Studer suggests the following ways to rev up your communications:
- Manage up by communicating positively with your boss about his or her value and accomplishments, how well your staff is doing, and how well other departments are doing.
- Communicate with the entire organization staff through regularly scheduled employee forums. Use the forums as an opportunity to really engage, teach, and align the staff.
- Harness the power of storytelling. Learn about your own heroes and pass their stories along.
“When I talk to CEOs a year after they have started implementing our recommendations for Hardwiring Excellence, I like to ask them, ‘What’s the biggest lesson you have learned?'” writes Studer. “They always say, ‘The power of the Employee Thank You Notes.’ Too many, the thought of sending employee thank you notes seems too simple to actually make an impactor they consider it insincerebut it is neither. It is powerful.” A few tips:
- Send exemplary employees handwritten, personal thank you notes.
- Ask managers to send you regular e-mails pointing out employees who they think deserve a compliment. Send a few handwritten lines to the employee’s home.
- Recognize and reward physicians with a personal note of appreciation.
