Friday, August 24, 2012

Good Leadership, Poor Leadership, Well Designed Systems and Random Behavior

I spend a lot of time thinking about how to move our health system faster towards its vision and I often reflect on incidents that happen to me in my life outside of GBMC and try to learn from them. I would like to share three episodes from my life over the past few days.

I do a lot of traveling on Southwest Airlines, I choose Southwest generally because they are the best at getting me to where I want to go safely and on time and they usually have the best price.  (This is the definition of value). They have been recognized historically for being very customer friendly, sharing GBMC’s value of respect, but I have been concerned lately that Southwest is losing its customer focus.

Last week I was waiting at the gate at BWI and sitting facing the Southwest Airlines counter and observed an employee who was talking on a cell phone obviously having a non-business related conversation. A woman came up to the counter, looking frantic standing in front of her, obviously trying to get the attention of this employee, who put her cell phone down.  The woman said, “Is this where Flight 396 is leaving from?” The employee turned, and pointed to the board that showed it indeed was the gate for flight 396, and the woman rushed off to get on the boarding line.  The Southwest employee then got back on her cell phone and complained to the person on the other end about the woman who asked if she was in the right place for her flight -  as if the customer was an annoyance.  Southwest, historically, has not operated like this. As I witnessed this I asked myself:  “What is the vision of Southwest Airlines?” “Does this employee know what Southwest’s vision is?” “Where is her supervisor? What would her supervisor say to her, if anything, if she witnessed this behavior?”

This past weekend, I was driving on the highway and I stopped at a rest stop to get something to eat. Ok, I must sheepishly admit I wanted a Nathan’s hot dog. The rest stop food concessions are all run by private companies. I was standing there waiting to order and there were several employees moving behind the counter and back and forth through a door that went to the kitchen. The line of customers was short, but it was taking a long time for anyone to get served. It wasn’t clear to me that there was any design to the work. It seemed almost that the people were working independent of each other and with no regard for meeting the needs of the people in line.  I then noticed two people who I later realized were the supervisors standing off to the side and chatting.  At one point they called one of the workers over and I heard them engage her in a conversation that was unrelated to the workflow. I finally ordered my hot dog and enjoyed it but the process to simply get something to eat was very challenging and by the time I left there was a long line of frustrated customers. Again, I started thinking: “Who is responsible for focusing on the customer in a business?” “What were the employees thinking?” “What was up with the two managers?” There did not appear to be a designed system for meeting the customers’ needs and leadership was truly lacking.

Compare these two situations with what I experienced earlier this week – taking my car for a required emissions test at the state facility in Owings Mills.

I looked online and saw that the wait time was just nine minutes and the on-line cameras validated that there were only a few customers waiting.  By the time I got there, there was actually zero wait, and I pulled in just behind a car that was leaving.  The young man took my sheet that I had received in the mail, checked my VIN number and hooked up the machine.  He asked how I wanted to pay, I swiped my card, I signed my name and he gave me the results sheet and credit card receipt, telling me I needed to come back in two years.  The whole thing took less than five minutes.

Not only was this system designed, but it looked like it had gone through multiple sequences of improvement to drive all the waste out of the process.  Through the eyes of this customer, the emissions inspection station performance surpassed my wildest expectation. There were no managers visible yet leadership was evident.

The characteristics that separated the two poorly functioning systems through the eyes of the customer from the one that delighted the customer were good leadership, true customer focus, and a well-designed system operated by a team of individuals who are empowered to make further changes to improve the system.

That is what we are striving for in our GBMC HealthCare System.

What can we do to get more customer-focused and design things better at GBMC? How can we use metrics better, get better teamwork, or make our staff more empowered?


  1. The reason it's so quick at the emissions testing center is because they've perfected the money grab. That's all it's about!

  2. The last time I went to Emmissions (last year) I had one of my kitties with me. Normally they don't allow animals in the car. But I explained we'd just come from the vet (kitty had cancer) and if we could keep her where she was (she was sleeping on passenger's lap, so comfortable) would they do it? So sweet, he let her stay on passenger's lap and just did it, in and out. That's a little outside the box and I thought excellent customer service (ability to see things not just in terms of standard work but when there's a fly in the ointment). That can also be a mark above in customer service.
    FYI... kitty did pass away following Monday but even that small moment of not being disturbed is remembered.

  3. Jeff Olsons book "The Slight Edge" states "Your philosophy creates your attitude, your actions, your results...creates your life". Meaning, your philosophy is what you know, how you hold what you know and how it affects what you do. Example: "Do the thing, and you shall have the power"- Ralph Waldo Emerson. Nike, the MTV generation simplifies it "Just do it". My personal favorite by John Wooden "Don't let what you cannot do interfere with what you can do".

    Unless, we embrace the philosophy (personal and/or GBMC, Southwest Airlines, Nathan's Hot Dog....etc ) and act upon it for the good of the customer service. We will not perform at our very best.

  4. Emmission testings does one only thing and has finally learned to it fairly well.People,unlike vehicles,are as varied as snowflakes.GBMC's ED is a source of long waits and therefore,dissatisfaction.We get cases of homeless men covered w/parasites to puzzling infections in children to massive MI's.Each case has thoughtful care tailored to it and this takes time.Cookie cutter care can be fast and easy but is this really what you want for your critically ill family member?This is a hospital not McDonalds

    1. Thanks very much, A. Mcisaac. I agree that our work at GBMC is much more complex and difficult than any of the three pursuits that I mentioned in the blog. People coming to the Emergency Department are all different but we should treat everyone with respect.

      If by "cookie cutter care" you mean that everyone with the same disease should get what the evidence says is best, than yes, I believe in "cookie cutter care". We have made great progress in putting central lines in everyone the same way. I don't think you want the chef changing the recipe on your favorite dish every time she makes it.

      I also realize, since I took care of patients for many years, that no two patients are exactly alike. It is in doing the things that should be standardized in a standardized way that we free up the time to really think about the differing needs of individual patients.

  5. If you want to know about some bad management practices all you need to do it look around GBMC. There are managers here who should not be in the position and yet they are. They are demeaning and demoralizing to their staff and make the staff feel as if it is their fault. One unit in particular suffered for years with a tyrant as a manager only to get it changed to a passive-aggresive borderline personality disorder for a manager. Staff does not respond to people like this. This has been bought to many peoples attention and still they are here. You will lose more good people as they tire of being made to feel like they don't exist.

    1. Thank you for sharing your thoughts. As you know, no organization is perfect, no manager is perfect and we all make mistakes. The Senior management team at GBMC works very hard to assess our managers and help them to grow and improve. An example of this is that the leadership team has a full day of training three times a year dedicated solely to becoming a better leader. I am very proud of our managers and I know that we have an excellent management team.
      I agree with you that employees do not respond well to people who are not good leaders. What I expect is that our employees speak directly and openly with their manager. If you believe that your manager is not listening, then you should bring it to your manager's boss or to the human resources person who is assigned to your department. I encourage you to do this. You should also provide your feedback in the annual employee opinion survey that is taking place right now. The Senior management team looks very closely at the results of this survey for their areas and they are looking for patterns of dissatisfaction and concern. I hold the senior team directly accountable to develop action plans to assure improvements take place where needed.
      I get it that we must all work to retain our good people.

  6. Great leadership and effective management is not consistently demonstrated within GBMC. What tools are used to motivate employees to do their best? What training is provided to educate people to perform at their best and to get the most out of our systems?

    If you are in a technical or non-clinical professional role here, the opportunities for training, recognition, and career advancement are almost non-existent. Even reviews are not handled consistently. And, reviews without peer and external management input are ineffective. Plus with no rewards built in for excellent work performance, where's the incentive to continue performing at a high level? There are no rewards tied with excellent performance and little to no management recognition after a job well done. There is rarely anything positive that comes after a large project is done except more work added to the growing TO DO list. How can this NOT be impacting our front end clinical personnel that care for our patients? It's a team effort -- systems and people supporting one another.

    I have personally seen top performers and my well respected peers consistently leaving the ranks of GBMC. Yet no one really listens to the reason they leave. No one follows up on exit interviews. Nothing changes. Except one thing remains constant... more work and no positive reinforcement or rewards.

    It's time we start paying attention to those profesionals that care for the people and systems that care for our patients. It's a team effort and takes team influence to make a difference. GBMC offers exceptional patient care and I've been a patient on more than one occasion and have always been very satisfied with the care received. However, as an employee and health care IT professional for nearly 20 yrs, my experience here has been quite different.

    And I can't comment with my name because of fear of reprisal by management. But I hope someone reads this and wants to make a change. Or, I can guarantee that more professionals will leave out of frustration, lack of training, no advancement, no recognition, no rewards for a job well done.

    Thank you.

    1. Thank you for taking the time to post a comment on the blog. Your feedback is helpful. I am sorry that you have the opinions that you shared. I encourage you to speak with your supervisor or your supervisor’s manager directly about your concerns. You can also share your concerns via the employee opinion survey that is currently taking place. Remember, all responses on the employee opinion survey are held in the highest of confidence. There will be no reprisal by management as a result of sharing honest and thoughtful opinions. Many people who comment anonymously to the blog say something about being concerned about reprisal. I always ask them to come forward with evidence of reprisal and I will investigate the case thoroughly and deal with it if it is found. So far, no one has come forward with a case of reprisal.

      Many of our people are concerned that raises to base salary are not tightly linked to an individual's performance. We are working on improving this merit pay system for the future.
      Maybe you don’t know how many opportunities for training, recognition and advancement we have at GBMC. Among them are things like: the tuition reimbursement program offered to our employees is one of the most generous of the hospitals in the area; additionally the T. Rowe Price Family Education Fund is available to cover not only tuition expenses but fees, books, uniforms and class supplies may be covered as well; our Nurse Education program is robust (although I acknowledge that you are specifically talking about training for non-clinical employees); next month we will hold our annual Employee Recognition event, where more than 500, nearly 15% of our employees will be recognized for their loyal and dedicated service of five years or more to GBMC; another example is that every month at the Leadership Conference we start the meeting off by recognizing a handful of employees (Clinical, administrative and support staff) who are providing outstanding service or our patients, visitors and each other. Every member of the Senior Team sends thank you notes to the home of employees and medical staff members. In July and August to date, I have sent 37 well deserved thank you notes to our colleagues.

      Could we do more recognition? Sure! I look forward to hearing the types of recognition that you believe would be inspirational and motivational to our people.

  7. While these incentives are good, going back to school to get an advanced degree to leverage the tuition reimbursement program doesn't make financial sense to do so. The ROI just isn't there in this tight economy for earning MBA or MS degrees at over $30k. Plus with no advancement incentives inside GBMC this incentive really can't be used to its fullest extent. And 2% raises hardly consitute a cost of living increase and have no incentive to earn more degrees. Regarding the Employee Recognition dinner -- well this event is only welcome to employees celebrating 5 yr increments of service. And my experience is that the 'prize' is a pin or GBMC engraved pen to go along with the nice meal. Again, employees are only eligible to go every 5 yrs. Our senior executive hasn't even stopped by to comment on our project... so I doubt he'll even take the time to write a thank you note. And after many months of exhausting work with no outside help or budget, a thank you note is hardly an incentive. This is nothing but a line item on a KPI that he will earn bonus money on and the workers won't get a dime let alone recognition. So, while I appreciate your feedback, it's token at best for the ample dollars associated in savings and efficiency gained by the organization. Dissatisfied doesn't even begin to cover my personal level of stress and dissatisfaction. And additional off hours (FREE) support is my 'reward' for all my hard work.

    Frustrated and looking for work outside of GBMC where professionals are respected and valued.

  8. Your comments about going to Human Resources show just how out of touch you are. I have been to human resources for issues only to be asked when the last time I took a class was. HR has no idea how nurses work and have no idea how to deal with our issues. Talk about reprisal. After going to HR the issue was exacerbated to the point of me having to leave a unit due to this manager. I have had to escalate to EEOC due to your HR not understanding what the issues were and what the reprisals were. I have also had to contact a lawyer due to the relatitory behavior of management here. Open your eyes because you have lost some great nurses and will lose more if something isn't done to reign in some of these managers. Even if this manager is leaving the complaint will stand as written. I have beens subject to slander and libel and I will not tolerate it.


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