What Are We Learning From COVID-19?

This is my 100th blog entry. I couldn’t have predicted I’d still be writing after all this time, but it turns out I have a lot to say about how to care for patients and employees. 

Things have changed dramatically since COVID-19 hit and I’ve been thinking a lot about how to best care for staff who are showing up every day and working hard to save lives. 

The name Lorna Breen has been in the news a lot lately. She was an emergency medicine physician and the medical director of the emergency department at New York-Presbyterian Hospital in Manhattan. I never met her, never even heard her name until her story hit the news a few weeks ago. But I think it’s important to write about her. There is so much we as healthcare leaders can learn from her story. 

According to an April 27th New York Times article, Dr. Breen had contracted the coronavirus, stayed home for just a week and a half, returned to work, was sent home, then went to stay with her family in North Carolina to recuperate. Upon arriving, she was hospitalized for exhaustion for 11 days, and once discharged, went to stay with her mom, then her sister. Two days later, Dr. Breen died by suicide. 

By all accounts, Dr. Breen was a fun-loving extrovert who enjoyed skiing, salsa dancing, throwing parties, and volunteering at a home for older adults. She was well liked, well respected and was always looking out for her colleagues, making sure they had enough personal protective equipment and were doing okay. 

Her family said that working in the trenches with so many patients dying from the virus changed her. She would be at the end of a 12-hour shift and stay to continue helping. With patients dying in the waiting room before they could even get into the ER, Dr. Breen had said they couldn’t keep up, she couldn’t go home, she had to stay and help. 

When you go into a profession in healthcare, you are compelled to help. When you run in when others run away, it’s normal to think that if you don’t do it, it won’t get done. But we have to start helping these professionals see that there’s no shame in putting the oxygen mask on your own face before helping others with theirs. 

I’m not going to lay blame at anyone’s feet. I’ll just say that we have to look out for each other and insist that people go home. Rest. Recharge. I’ve worked in so many environments that just don’t allow for that. If someone admits they’re exhausted or struggling to keep going, others turn their backs and make them feel guilty. We as leaders have to change that. 

Right now, we have healthcare workers, physicians, nurses, food service workers, housekeepers, IT professionals, and patient experience teams who are feeling vulnerable, frightened, and tired. We have to reach out. We have to let them know how much they mean to us and we do that not by hanging banners that say Hero, but by spending time with them. Let them talk. Listen without interrupting. Insist they go home and not stay past the end of their shift. Create programs that nurture and support them. Give them hazard pay and additional sick days. Don’t just tell them, show them how much we care.

I feel terrible that Dr. Breen took her own life. I’m hopeful that we learn from this and start creating a culture that acknowledges that physicians and nurses aren’t superheroes. They’re people who care. Let’s care for them.

Shouldn’t You Call in Sick When You’re Sick?

How many of you work for an organization that rewards perfect attendance? 

I was at an awards ceremony at a hospital not long ago. They were giving service awards to employees who had been there for 5, 10, even 40 years. The chief nurse wanted to give a certified nurse’s assistant an award for never calling in sick once after working there for 35 years. I asked her if this was really a good thing. She looked at me in disbelief. “Of course it’s a good thing! She’s never called in, not once, in her whole time here. That’s amazing. That shows real dedication.”

I just stood there in stunned silence, wondering how she and I could be so far apart on this issue.  

As it happened, I was friendly with this CNA, so I asked her if she had ever been sick in those 35 years and came to work anyway. “Of course,” she said. “I got sick, everybody gets sick. I just put a mask on over my face and get to work.” 

Is this really what we want to celebrate?

As I write this, COVID-19, or coronavirus, is everywhere. There are over 250,000 cases and nearly 11,000 deaths globally. Industry conferences are being cancelled, cruise ships are being quarantined, and stores are selling out of toilet paper hand sanitizer all across the U.S. Do we really want to incentivize employees to come to work when they don’t feel well? Especially CNAs, who assist with feeding, bathing, and toileting people who are already sick?

Sick days exist for a reason. I understand not every company has them, but this one did. Generous sick leave, in fact. Part of me thinks this is a generational thing. My parents (and even me, to some extent) grew up believing that you keep your nose to the grindstone, work hard, and tough it out. I get it. 

But times are changing. Even before the coronavirus, I started to see signs in workplaces and elementary schools telling people to stay home if they didn’t feel good. And now, we’re socially isolating, sheltering in place, self-quarantining. And it makes good sense. Keep your germs to yourself.

The fact that this chief nurse was celebrating this CNA is incentivizing all the wrong things. I think people should take care of themselves and should be given time to rest, relax, and recover. The message she sent was the opposite of that. Maybe it’s generational, maybe it’s her set of values, but even after this virus passes, we need to tell our employees that their health and well-being is important to us as an organization and stop handing out perfect attendance awards. 

Thoughts from the Night Shift

A few years ago, I was working at a large medical center and decided to go out on the floors in an effort to connect with the night shift. As part of the leadership team I know it’s important to get out and talk with the direct-care staff, and it’s especially important to visit with the often overlooked night shift. 

My alarm went off at an hour when most college students are just going to bed. It was a time of night I haven’t seen in decades and I couldn’t imagine how anyone could be awake, let alone work. I dragged myself into the shower hoping the steady stream of hot water would bring me back into consciousness. It worked. I got dressed, put my face on, and headed out into the dark.

When I got to the hospital, I discovered one of the few perks of working nights: plenty of parking. Plus, it’s really quiet. That’s something we never experience during the day.

While I was able to get through most of the hospital, I spent the majority of my time in two different med/surg units and the differences between them were startling. In the first one, the nurses seemed genuinely happy to see someone from administration. When I walked up to them, they smiled and were very eager to talk about what they liked about working there. They had some suggestions about what could be improved but overall they were very positive. As I was leaving, I thanked them for taking time out of their very busy shift to talk to me. “No problem,” they answered. “We like seeing you guys up here. Thanks for not forgetting the night nurses.”

I walked toward the elevator smiling. “Wow,” I thought. “This is great. This is going to be a really good night.”

The other unit was completely different. I approached the small group of nurses at the desk and introduced myself. “Hi, my name’s Kate. I’m the director of patient experience and I’m out tonight visiting the units to…” 

“Ambush us?” said the tall one.

“Oh my goodness, no,” I said. “Is that what you think?” She shrugged and said, “Well, we never see you guys here. Something must be up.”

I spent the next several minutes trying to reassure her and the others that this was something the leadership team was committed to doing: getting out on the floors and talking to the people who are caring for patients, both days and nights. They seemed unconvinced. 

After some gentle prodding, they opened up a bit about what it’s like to work nights. The thing they liked best, they said, was the teamwork. They don’t have the same resources as the day shift so they pull together and help each other out. And while they complain that they never see anyone from administration, they like that they never see anyone from administration.

They said they feel more free to just be nurses without having management looking over their shoulder every minute. 

That struck a nerve. Free to be nurses without management looking over their shoulder? Wow. What had we done to make them feel this way?

I asked them to tell me more about that and, essentially, it all boiled down to one thing: their manager acted more like a taskmaster than a supporter. The relationship was less about re-engaging great nurses to continue doing great work and more about pointing out all the things they were doing wrong. We do ask a lot of our direct-care staff, that’s true, and for good reason: we want patients to be safe and feel well cared for. But there’s a way to ensure that all of those required steps – like asking a patient’s name and birthdate before giving a medication or foaming in and out of patient rooms – are done without it coming across as punitive.  

Until we give our leaders the right training on how to get the job done while still serving as an ally, a resource, a champion for the staff, we will hear things like I heard: just let us be nurses.

More Thoughts on Appreciative Coaching

Last time, I wrote about appreciate coaching and how it’s more effective for people to improve and learn. Well, this past week, quite by accident, I stumbled upon an article from the Harvard Business Review entitled “Why Feedback Fails.” In studying how people learn, thrive, and excel, they point to three core evidence-based learning theory tenets:

1.       Telling people what we think of their performance doesn’t help them thrive and excel, and telling people how we think they should improve actually hinders learning;

2.       Humans are highly unreliable raters of other humans. The feedback you give is more about you than the person receiving feedback;

3.       The only realm in which humans are an unimpeachable source of truth is that of their own feelings and experiences.

People tend to perform better by being given goals and results to achieve, when they receive positive feedback about what they are doing well, and by watching other people excel and receive validation for their excellence. The article went so far as to give examples on how to more effectively communicate with teams to elicit these principles:

Instead of:                                                            Try:

Can I give you some feedback?Here’s my reaction
Good job!Here are three things that really worked for me. What was going through your mind when you did them?
Here’s what you should doHere’s what I would do
Here’s where you need to improveHere’s what worked best for me and why
That didn’t really workWhen you did (x) I felt (y)  -or- That didn’t really work for me
You need to improve your communication skillsHere’s exactly where you started to lose me
You need to be more responsiveWhen I don’t hear from you, I worry we’re not on the same page
You lack strategic thinkingI’m struggling to understand your plan
You should do ____   (in response to being asked for advice)What do you feel you’re struggling with and what have you done in a similar situation? 

You might find that you’ve done a few things in the left column. That’s okay. We all have. But now we know better. Modelling and recognizing excellence is more effective in helping teams provide excellent care, everytime.

Reference: Marcus Buckingdall and Ashley Goodall. “The Feedback Fallacy.” Harvard Business Review, March-April 2019 edition. https://hbr.org/2019/03/the-feedback-fallacy

Appreciative Coaching

What’s the best way to help people improve? How do we work with staff members who do a good job and help them get even better?

Many of us came into leadership positions at a time when we focused on the gaps: what our employees needed to work on and where they were weakest. During annual evaluations, we centered the discussion around mistakes and weaknesses.

There’s a better way.

Appreciative coaching focuses on what people are doing well. It allows them to determine where they’d like to improve.

For example, when watching a nurse do hourly rounding, we might say, “I observed your interaction with Mrs. Jones. How do you think it went? I saw you do __ and __ really well, great job! What do you think could have gone better? Okay, how can I help you with that?”

When we use appreciative coaching, four things happen:

  • We build a road to improvement. Employees are more likely to make improvements when they identify the things they want to do better. We tend to follow through on things when they’re our own ideas.
  • We make it ‘safe’ to not be perfect as long as we’re still trying. Employees do better when they’re supported, not criticized. 
  • We foster a culture of recognition and appreciation. When we tell employees what they’re good at and how important those skills are, they do them more often and even better than before.
  • As leaders, we start to see our staff differently. When we look for the good, we tend to see more good. 

Of course, if there are some serious performance issues, that’s an entirely different conversation. But for your high-performing staff, try a little appreciative coaching. 

The Patient Experience Nurse

Earlier this month, we celebrated Nurse’s Week. Our Chief Nurse Executive had a whole week of wonderful things planned for the department including massages, root beer floats, a homemade meatball contest, and an awards ceremony. She had a few different categories but the one that caught my attention was the Patient Experience Award given to the nurse that consistently exemplified excellent patient experience.

The winner was someone I knew. I had spoken with him a time or two when I did patient rounds on his floor and had heard his name a lot as someone patients absolutely loved. The next time I saw him, I pulled him aside to congratulate him and I asked him what it was he did that earned him this award.

“I just talk to them.”

“Come on,” I said. “Lots of nurses talk to patients. What are you doing that’s making such a difference?”

His answer was not what I was expecting. I thought he’d go into some big thing about how he always does AIDET when he’s in a patient room and he always calls them by the name they wish to be called and he always manages up the other staff… Nope.

“I think it’s my job to help them understand their disease so they can better manage it,” he said. “Most of them don’t connect the dots between what they do and how they feel. If I can help them see how doing this thing makes them sick, they’re less likely to do that thing. If they understand that their health is something they can control, they usually do. But, too often, they come in, they get some meds, they go home, and then they’re right back here again in few weeks. I talk to them. I work with them. I encourage them. I help them.”

“Wow,” I answered. “That was not what I thought you were going to say.”

“I can see myself in everyone here. You got your life together? Great, me too. You got problems? Things in your life went sideways? I get it. I was there, too. You can’t judge people. If you judge, you can’t understand. If you understand, you can’t judge. You just talk to them so they know you’re on their side, you’re rooting for them. I think that’s what I do.”

I thanked him and left feeling so good that we had someone like that working at our hospital. Someone who connects with, roots for, and educates patients. Someone who doesn’t judge, but listens, informs, cares.

Maybe that’s the secret sauce.

I Said What?

Patients hear everything.

Whether they’re in a physician office, an imaging center, or a hospital, they hear just about everything we say to each other.

In every hospital I’ve worked, we’ve told staff that their personal conversations belong in the break room, not outside patient rooms, and they’ve done a good job of keeping the stories of their latest private adventures off the floor.

Here’s what we didn’t expect: nurses do a lot of talking about patients’ bowel movements and dressing changes and patients are just as put off hearing about it. While they understand things like that need to be discussed, many of them told us they came to know other patients by their bathroom habits and it was unsettling.  

Most of the time, however, patients are listening to what we’re saying to each other about each other.

Although it was years ago, I remember like it was yesterday waiting in my doctor’s office and overhearing the front desk staff say to one another, “Oh, stay away from Dr. X today. He’s in a bad mood.” I was waiting to see Dr.X and I couldn’t help but worry that he’d snap at me, try to rush me out, or roll his eyes if I asked a question. He didn’t. He treated me just as he’d done every time before, but hearing that statement caused all kinds of unnecessary anxiety. Not only should I not have heard it for my sake, but for Dr. X’s. A new patient might have gotten a very different impression of him based on what they’d overheard.

And in an inpatient unit where they may have limited mobility, patients often feel anxious about the kind of care they’re going to receive. When they hear us speaking unfavorably about the physicians or the other nurses on the unit or the phlebotomists from the lab or the techs from radiology, it makes them feel less and less safe. Even something seemingly innocent like, “Man, I can’t believe how busy we are today,” can make a patient wonder if they’ll be forgotten.

Most of us don’t realize it. When we point it out, the response is often, “I said what? Really? I don’t even remember that.” I’m guilty of it, myself. I was admiring a new baby in the postpartum unit and said, “Look how much hair it has. So cute!” When the person with me said, “It?” I had no idea what she was talking about. I called the newborn it? Really? I felt awful. I can’t imagine how I made the new mom feel.

Sometimes, just knowing that patients are listening intently to us is enough to help us remember to watch our words, but sometimes we need a gentle reminder. Being open to that kind of feedback will help create a safer and kinder environment for everyone.

Continued Employee Engagement

A few months ago, I wrote a piece about employee engagement. I said that employees are never more excited to be at your organization than on the first day. Over time, as their excitement begins to wane and they become bored and even cynical, we tend to blame them rather than looking at all the ways we drained their enthusiasm from them.

Instead of frustrating and demotivating our employees in ways we probably don’t even realize, what can we do instead?

  1. Periodically have your team reflect on what they enjoy about their role. When they can tell you what they like about what they do, they won’t lose sight of it.  
  2. Remember to tell them you appreciate them. For me, it’s important to mix in professional achievements in with personal attributes. I don’t want to be acknowledged only when I produce for the boss. I like to be recognized for who I am, as well.
  3. Give them as much freedom as they can handle. Some employees, especially ones in new roles, prefer more structure and assistance. Others prefer – and do well with – less oversight. Know who’s who and adjust your management style appropriately.
  4. Go to bat for them. Sometimes, there are conflicts between departments that require leadership to get involved. Show your employees that you have their backs by listening to their side of the story before confronting them. If it truly was their fault, help them come up with ways to avoid the same problem in the future.
  5. Encourage the team to work together. One of the worst things we can do as leaders is to create competition within the department. Showing obvious favoritism doesn’t encourage staff to work harder to win your favor; it makes them resent the favorite – and you.  
  6. Let them know what you’re up to. Many leaders keep their employees in the dark about things they’re planning or changes that are coming in the company. Certainly, keep confidential and sensitive information out of bounds, but if you’re working on important things that will affect the team, tell them. Keeping them in the dark only frustrates them, especially when they hear rumors they know nothing about.
  7. Plan something fun. Better yet – let them plan something fun. If you’re able to go off-site, give them some options and let them choose where they’d like to go and what they’d like to do. If that’s not possible, bring in lunch for everyone every so often and eat with them.  
  8. Keep tying the work of the department to the larger mission of the organization. When there’s conflict or disagreement about how to move forward, bring them back to why we’re here and what we’re trying to do.
  9. Set clear expectations not only about the work but about behavior. When you hear people speaking ill of others, whether in your department or not, put a stop to it right away. Stay consistent.
  10. Recognize that motivation will wax and wane over time. Be aware of what your team members may be going through and don’t overreact if someone doesn’t look as cheerful today as usual. Be accessible if they want to talk and continue to recognize and appreciate them.

The most important thing to remember is that it’s a lot easier to keep a team motivated than it is to try and re-motivate one that’s lost its enthusiasm. So instead of being upset with employees that aren’t nearly as excited as they were on their first day, try not to beat that enthusiasm out of them in the first place.

Will doing all these things keep your staff from losing their fire? I can’t guarantee it, but I can guarantee that they’ll enjoy working for you a lot more than if you don’t.

What other things do you do to keep your team engaged?

 

We Already Do This!

In the many years I’ve been leading service training classes across the country, I have yet to teach a class that didn’t have at least one person who truly resents being there. Sometimes, those people are the ones who think what you’re teaching is nonsense: all that touchy-feely stuff, that’s not what I do, I do my job, I don’t have to be nice about it.

I know how to handle those folks; they don’t bother me. I’ll gently cajole, end a lot of sentences with, “Don’t you think?” or, “Right?” and try to let the members of the class be the ones to drive the message home.

It’s the ones who feel they already know all this, they already do all this, and this training is a waste of time. Those ones are harder because they believe in delivering great service and I don’t want to talk down to them and cause them to disengage. But with so many others in the class for whom these are new skills, I have to slow it down and make sure they understand and feel comfortable using these new skills.

So how do you teach a class full of people who believe they already know all this stuff?

  1. Tell them that this is a new experience for them. The information may be things they’ve already heard, but this class is designed to help them see service in a new way, reinforce what they already know, and keep service top-of-mind.
  2. Tell them that the training is to get everyone in the organization to perform at a certain level, a level that some of them are already achieving. I talk about how someone can do a beautiful job working with a patient or visitor and one knucklehead can undo all that great work in just one interaction. Each person’s great work lasts when everyone delivers great service.
  3. Tell them that many of us believe we do this all the time when we probably only do it most of the time. I always use myself in this example. I know I’m a nice person but am I always nice? Maybe not. Always is a high bar to clear and consistency is what separates great organizations from good ones.
  4. Do some role playing. Involve everyone in the process and allow your ‘star students’ an opportunity to show what they know. It’s especially helpful if you can give them a scenario that is outside their normal process. If they’re nurses, give them a scenario that applies to IT or environmental services.
  5. Involve them in the process. When I get to a new talking point, I look at them and say, “You do this all the time right? Tell me how this works in your department.” Asking them to give examples of what they do demonstrates that I know they do great work and allows them to act as the expert. Now, we are teaching the class, not just me.

The goal, of course, is to not have people in the class sit there with their arms folded, resenting the fact that they had to sit through this stupid class where they already knew everything. The goal is to get everyone to engage, participate, and actually enjoy the class.

Sure, there will be some who think the whole thing is nonsense, but for those who believe in the message and try to live it everyday, do everything you can to involve them in the process and let them be your biggest champions.

The Craft and Cider Project

Along with Patient Experience, part of my current role under the Service Excellence umbrella is Healing Arts. I’m fortunate to be working in an organization that recognizes the impact that visual arts and music has on a person’s well-being and we have a number of programs for patients and their visitors.

I realized we had an opportunity to offer the same kinds of programs for our employees.

My fabulous intern and I decided to put together an event that featured acrylic paint, small canvases and easels, a variety of brushes, non-alcoholic apple cider, and a harpist playing in the background. Employees were welcome to spend some time painting, creating, sipping apple cider and relaxing. For those who insisted they didn’t know how to paint, we even hired a professional artist to come and help them tap into their inner Van Gough.

It was a hit.

We held the event in a very public space, allowing guests and visitors a chance to stop in and participate, as well. People seemed genuinely impressed that we were offering this kind of free event.

  • A young woman who was visiting her husband came by looking for a way to pass the time while he slept.
  • An older man with his granddaughter painted a seascape and told us he had never held a paintbrush or painted anything before. He was so grateful to be able to experience that, especially with his granddaughter.
  • Two little girls visiting their grandma stopped by to paint for a while. Their parents were so thankful they had something new to do after spending so much time in our hospital.
  • Several nurses and other staff members popped in on their lunch break and said they felt refreshed with renewed energy after spending 30 minutes painting with us.

A very well-received event and it didn’t cost a ton of money; what more could you ask for? If you’re looking for a way to do something for your staff, consider bringing the arts to them. Even those who don’t feel confident in their abilities can benefit from 30 minutes of time spent away from their department creating. We know the impact art has on patients. It can do the same for your employees.