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Impacting Change Through Challenge

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While talking with volunteers at the information desk, in walks the sweetest elderly couple. Both were in their mid to late 80s. The wife is using a cane with one hand and holding onto her husband for support with the other. 

“Leadership by Walking Around (LBWA) shows the vital link between accessibility and effectiveness - interacting throughout the day with patients, families and especially staff. In the ever-changing healthcare environment, our efforts should not simply be to survive, but working collaboratively to thrive. Embracing change to better care for the community. “ 

An early August day, outside temperatures were in the upper 90s. It was my first week working within a $40M health system as interim CEO and consultant. The facility offered a vast array of both general and specialized services. Without counting the licensed beds, one would never know it was not an urban health system, but rather a Critical Access Hospital.

As they approach, I greet them with a smile and ask if there’s anything I can do to help. The husband said they were here for some laboratory work. 

The long walk from the parking lot during the heat of the day had clearly taken its toll on them both, but thankfully, the Laboratory/Radiology department was nearby. The lab tech quickly came out, offering the husband a seat in the hallway and taking the wife back into the offices for her blood work. 

I looked around and noticed the “waiting area” consisted of a few hard-plastic chairs sitting in a major traffic area right off the main lobby. 

Little did I know what awaited me, as I told the husband I would get him some ice water and be right back. That is when the adventure began … 

Realizing I didn’t yet know where anything was, I asked a housekeeper where to find a cup for ice water. She pointed to a water fountain about 30 feet away from the lab, and then told me I would need to go to the cafeteria for ice and a cup.  

Trouble was, the cafeteria was not only downstairs, but on the opposite side of the rather large hospital campus.  Thankfully, I had already met with the Dietary (capturing the hearts of patients/families is far easier to do with a good meal), so I knew how to get there. By the time I made it back with the man’s ice water, the couple was heading out. Apologizing for the delay, I handed him the cup, introduced myself and thanked him for coming in to see us. 

I took that patient and family interaction as a failure. The lab folks were wonderful, taking great care of the wife, but I had a chance to care for the husband – clearly in need – and was unable to do so in a timely manner. The opportunity to increase engagement was lost. I took that as a personal challenge.  

I had a department head meeting the next morning. Sharing the story, I presented it as an opportunity to have an immediate impact for change. But the Laboratory Director presented a challenge of his own. He asked if the group to take on projects like this had to be department heads. He thought it better that front-line staff address this and many other issues - for they see these challenges daily. 

I did not yet appreciate the wisdom of his perspective - but having started in support services, I should have. Regardless, I will forever be grateful for what I would learn from his challenge of me, and the efforts that would follow. 

It was deemed an initiative of the culture committee, with discussions focusing entirely on issues and improvements to be made for patients, families, the community and especially staff. 

I welcome opportunities for effective collaborations at any level, so the invitation was extended to department heads, patient care employees and support services alike. It's important to have diverse representation with a willingness to contribute. I let it be known that it was not a requirement or even expectation, merely the possibility to impact change. 

What I saw within this group was incredible. The group was comprised of a housekeeper of 20+ years who said she felt empowered by finally "having a seat at the table;" a 10-year employee of Dietary that had recently been awarded Employee of the Year; an enthusiastic LPN, only a few months away from completing her BSN; and many others from virtually every department. The room resonated with ideas that longed to be heard.  

I presented the situation of the elderly couple outside the laboratory. Our task was to address an unmet need. To care for that husband - and family members like him - as he cares for his wife. 

Prior to opening up the session, I made one request. Whatever we came up with needed to be budget neutral.  

Many wonderful discussions ensued with the greatest difficulty being in keeping them from going down too many "rabbit holes" with their enthusiasm. It was encouraging to see the engagement--younger and older staff alike were sharing stories, ideas and, interacting with co-workers that had barely (if ever) met before. 

“Healthcare Leaders are to challenge staff, but do so in truth and encouragement. Lifting them up through delegation and empowerment. Enabling them to do better, be better, and improve quality of care for our community.” 

I did have one significant disappointment however - with a department head. It seemed her only intent was to be cantankerous. Wanting to be disparaging of any idea presented. Some of her points had validity, but her focus was on minor logistics. I gave her some grace, and reminded everyone we were there to brainstorm. 

But still, she continued. So, the next idea she shot down, I posed my own challenge to her - what was her proposal? Perfectly fair question. That is why we were there after all. But she offered nothing in response. 

After the meeting, I took the department head aside, and asked if she understood what we were trying to do and why. I can't expect her engagement if she doesn't align with the intent. It turns out, she didn't understand. Wanting the challenge to be meaningful, I asked specifically why she felt disconnected. Her response was perhaps my saddest moment as a leader. She claimed to want quality care for patients and families of course, and appreciated the "idea" of improving the culture - but did not recognize the value of my opening it up to front-line staff. Conjecture on my part, but it seemed her position of leadership was more about perception of power, rather than a responsibility of providing support. 

Likely, she did not understand that I myself had been one of those front-line staff members. Had I not been challenged and given the opportunity to have a voice, who knows whether I would ever obtain the positions I have.  

My first thought was to remind her the group was purely voluntary. Instead, I explained that as an Interim leader, I am seen as an outsider. I cannot go into any group and simply give directives. There would be no engagement. I can't know what I don't know, so these will not be my ideas. All I can do is bring diverse people together - it has been true of boards, staff and community members alike - and help facilitate a unifying shared focus.  

I assured her, we welcome her input, inviting her to bring ideas to the table. But, providing criticism of ideas, without offering alternatives, is simply being a barrier to quality improvement within an ever-changing healthcare environment. 

Through the effort of this culture committee, we were able to develop a miniature cafe of sorts. Volunteer Services already had a mobile cart that offered snacks and drinks throughout Outpatient Services, so the group decided to place the cafe off the main lobby, directly across from Laboratory/Radiology. Staffed by volunteers, this stand-alone station would offer coffee, tea, water, juice and even snacks.  

Of course, let us not forget that the biggest challenge was to make this budget neutral. It was suggested that we approach a local communications company (internet, phone cable) that had recently moved into town. 

Soon after I met with the Sales Director and Business Manager. As I walked into their offices, I see they are building a large version of exactly what the culture committee had envisioned. I admired their coffee bar, and mentioned how much we would like a miniature version of our own, and once again, began sharing the story of that elderly couple. 

Apparently, this company had a community engagement budget available, requiring only a simple grant application. But as with any collaboration, I am always looking for win-wins and long-term sustainability. The company- at their own cost - built our cafe station. A sponsorship sign with their company's logo provided a television playing local programming - an idea that also came from the committee - with all the drinks and snacks provided. There was even enough left over to purchase a few comfortable chairs, enabling us to remove those hard-plastic chairs.

It was such a big hit, the communications company asked how much was budgeted for those mobile carts within the clinics. Another grant and a sign on the side of those carts, the company provided funds to cover the snacks and drinks to clinic visitors for three years.  

Through the efforts of the culture committee, we not only increased engagement while providing better service to our patients and families, we surpassed the budget neutral challenge to actually save operating expenses. But perhaps the greatest success was beginning a culture shift, one of collaboration among all employees at every level.

As for that cantankerous department head, though I would like to say she became a beneficial contributor to the committee - once it was launched - her concern was that community members would come in just for free coffee. My response, was that if that were to happen, we simply turn it into another opportunity for community engagement.