Studer / Collard Rewiring Excellence

Hardwired to Rewired
1. Auflage 2025
ISBN: 978-1-7370789-7-5
Verlag: The Gratitude Group Publishing
Format: EPUB
Kopierschutz: 0 - No protection

E-Book, Englisch, 114 Seiten

In 2003, Quint Studer wrote  . Now, more than 20 years later, the world has changed drastically. While some widely embraced behaviors and processes need to stay hardwired, others no longer work well (or, in some cases, at all). In many areas, it's time to rewire.

 is Quint's response to our rapidly shifting environment. Along with Dan Collard, who contributed to the book, he pinpoints the key areas that-at least in many organizations-most need rewiring. And he provides a wealth of practical how-tos for getting started. Here are just a few things leaders will learn:

• How to evaluate whether a process, practice, or behavior needs rewiring (or whether it's better left hardwired)

• Why the Human Capital Ecosystem™ Assessment is a good starting point for reimagining your organizationHow Emotional Onboarding™ helps new hires navigate uncertainty and accelerate the sense of belonging that makes them want to stay

• Why popular practices like patient and employee rounding have become too complicated and how to make them doable again

• Tactics for rethinking critical areas like selection and onboarding of talent, skill building, patient experience, employee well-being, and moreWhy a 'precision' approach to development is urgently needed in an industry with so many new leaders

• How a 'less-is-more' strategy helps close the saying/doing gap and builds trust throughout the organization

Here's the book's overarching message: The decision to rewire is as individual as the organization itself. Let outcomes lead the way. If it's working, great. Keep doing what's hardwired. But if you're not getting the results you want, don't be afraid to let go of the past. Rewire, move forward, and keep making healthcare better and better as the world evolves around us.

Autoren/Hrsg.

Studer, Quint

Collard, Dan

Leseproben

CHAPTER 1

Diagnosing the Need to Rewire

Years ago, in searching for a term to describe putting in place a tool, action, or method that would stick, the word “hardwired” came to mind. I am sure I read it somewhere. The word reminded me of projects my father worked on. He was a mechanic and a handyman. In some situations, he would put in a steel pipe and run wires through it. This protected the wires from various elements that could damage them. The pipe also held the wires steady and in place.

How can an organization create consistency and sustain high performance? There are some actions that should be hardwired, meaning not adjusted. The wire going through the pipe demonstrated that some systems are built to not be flexible and thus very hard to change. This is a good technique when the external environment stays the same, the workforce is very consistent, technology has little or no adjustments, and the hardwired actions and tools are achieving the desired outcomes. 

As mentioned earlier, the need to rewire does not mean that what was implemented was wrong or did not work at the time. If they didn’t work, the tools, processes, and actions would not have been put in place. The key is being willing and able to rethink things when circumstances change.

Bounce: The Art of Turning Tough Times into Triumph was written by Keith McFarland in 2009. It is a great book on how companies can bounce back after a financial downturn. In looking at late 2008/early 2009, the financial meltdown was very serious. Fast-forward to more recently and after the pandemic, organizations are experiencing even more challenges as they try to bounce back. The pandemic increased the acceleration of telehealth. It also increased the number of people who can work virtually. In Bounce, McFarland stated that two emotions that keep an organization from moving forward with the urgency needed are denial and nostalgia—denial of the depth and scope of the situation and nostalgia to go back to what once was. Denial is not the issue with the intense challenges facing all in healthcare. Nostalgia does rear up at times.

We receive calls from CEOs and others. We are grateful that people reach out. Many say, “It feels like we should just get back to the basics.” As part of diagnosing an organization whose performance isn’t where they want it to be, we’ll traditionally ask two questions: 1. “What if a leader (or group of leaders) wasn’t here when the basics were introduced?” and 2. “What if the basics have changed?”

In diagnosing, it is important to see why what worked in the past seems to not be working as well (or at all) in the present. Is it the tools that were put in place? Is it the process? Is it the frontline staff? Is it leadership? What other factors have impacted the outcomes?

Experience is a big one. The number of resignations that have taken place due to the pandemic means there are many people who are new to their roles. Even without the pandemic, the aging of the population meant there were going to be more retirements than normal. The pandemic increased the number of departures. Now we’re in what we call “the one-up world.” People tend to be in a role one up from where they were. It is not unusual for more than 20 percent of people in a leadership role to have less than three years’ experience leading. Then, there is another 20 percent of people who are experienced in leadership; however, they’re now in a different leadership role.

Here is an example: We were at an organization that is very well respected. All those in a leadership position were attending an off-site session. The CEO led off the day sharing the number “1,185,” asking the group what they thought it represented. People had fun guessing. The answer turned out to be the number of days since they had all been together in person in a system-wide leadership session. In working with the human resource department, we learned that 43 percent of those in attendance had not been at the session 1,185 days ago. Some were brand new to the organization. Some had gone from an hourly staff position to a leadership role. What this meant was 57 percent of the attendees had a recollection of what being a leader at the organization used to be like. The other 43 percent did not. Imagine being at an event where people are sharing what a great time they had four years ago. While fun to hear, there’s a different perception for those who were not at the event. This is the reality for leaders who became leaders after March 2020: Many could end up feeling like they’ll eternally be three years behind everyone else.

It could be that what worked in the past may not work as well now due to the experience level of the workforce, including those in leadership roles. In most instances when a person is new, it is understood it will take them time to gain the skills those with more experience have. Yet the (often unspoken) expectation is the person new in leadership will pick up where the person they replaced left off, with performance expectations and more. For example, a new manager is still expected to achieve the labor budget and so on. Our work with people new in leadership shows that skills like working with staff scheduling and financial tools are not easy to manage day one. It is not that the tools are not good; it just takes time. Items like training and development need to be rewired. There is more to come on that in the following chapters. 

What are some specific things to diagnose? When it comes to patient experience and the measure often used for inpatient care (HCAHPS), the questions, methodology, etc. can be debated; however, it is national data, so it is comparing apples to apples. Even before the pandemic, patient perception of experience had been stagnant since 2016. This was not due to lack of passion, dedication, or resources. As a matter of fact, there are more resources focused on patient experience now than in the past. We can’t blame the pandemic as the only reason for the stagnation as results had been flat prior to COVID. The question then is, “What are some explanations for the stagnation?”

Here are some observations.

Due to so much complexity, helping people understand the connection between patient experience and clinical outcomes may have lessened. Connecting patient experience to clinical outcomes connects to values. Once an action is linked to values in employees’ minds, that action is more likely to be taken. In fact, it cannot not be taken. Our experience is that when the connection is made that a patient will have a better clinical outcome when listened to, when the facility is clean, when medications and treatment plans are understood and so forth, the patient and family rates the experience highly. When patient experience measurement was relatively new, people thought it was more focused on hospitality. Hospitality is important. However, for healthcare professionals, connecting patient experience to clinical outcomes created a deeper understanding of experience. Due to the work of many, today very few people, if any, question the need for patient experience. However, due to so many new people, the connection to clinical outcomes may not be as understood as it needs to be. It is always a good time to reconnect experience to clinical outcomes.

Another factor is that our attempts to improve the patient experience have gotten too complex. Even the best intentions can have negative consequences. In 1993, at Holy Cross Hospital in Chicago, when we first experienced rounding to improve the patient experience, we learned from a nurse leader named Michelle Walsko. Her patient care area had better results than the other areas. We met with her to find out what she did differently. It turned out that she visited all the new admits, introduced herself, shared her card, and explained how to reach her. She assured the patient that everyone was committed to making sure they received very good care. She asked how things were. She mentioned items she wanted the patient to be aware of. She would write down things to remember on a note card, like people to recognize, or an item to follow up on, or a patient she wanted to follow up with. And her unit’s patient experience was in the top percentiles.

Michelle was our benchmark. Her approach was scaled throughout the hospital. It was a great experience. There were lots of people to recognize, and, at times, there were items to follow up on or fix. It was inspiring.

Over the years, the one question Michelle asked became two and then more questions—all with good intentions. Today nurse managers might be tasked with asking from 5 to 11 questions. The record is 17 questions expected to be asked. The note card or census sheet became an iPad. At times, there was more than one tool to use in documentation. What started out as a few actions meant to build relationships slowly moved into a process that can feel like a transaction. Now the inpatient rounding practice on new admits has moved to all patients every day. “Did you receive very good care?” and “How are we doing?” kept growing. The approach of “more questions and more patients” has at times led to worse, not better, outcomes.

In meeting with a nurse manager, I asked her how many patients are usually on the unit. The answer was 42. We then asked how many patients she was expected to see each day. The answer was all of them. And she was expected to document them all in a software tool. I asked her, “What are the chances that you will ask 210...