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CHAPTER HIGHLIGHTS Hardwiring Excellence by Quint Studer

Ch 1- Background Principles (Quint Studers experienceswhat he observed) o o o o Employees want: tools to do their job & to be rewarded/recognized Organizations achieve results thru hardwiring: agendas, communication., training leaders, evaluations, thank yous Observe causes of success & duplicate them (e.g., best practices) Successful leaders always asking: to make a better place to work, what do we (& they) need to do (do differently)?

Ch 2- Healthcare Flywheel (core values that drive health care professionals PURPOSE, WORTHWHILE WORK, MAKING a DIFFERENCE) o o o o To move and org from good-to-great goal is celebrating whats right (vs. whats wrong) To Dos (DEF: hardwired techniques that achieve Pillar results) e.g., emp satisfaction, quality, bottom line, turnover Apply the Roadmap (i.e., the 9 Principles of Service) Keeping staff motivated requires 2 things: a. Remind leaders connect actions asked of staff and results achieved to purpose, worthwhile work, making a difference b. Drive - the To Dos Consistently -invest in leadership training (i.e., build competencies so leaders can succeed) Employees want to align w/ leaders who have right purpose and intent #1 behavior leaders want to change - stop blaming others/system, take ownership of problems/opportunities Change (never easy) involves making adjustments Employees want: work where bad behavior is not accepted & people are accountable Leaders need to remember employee understanding comes last, staff need to see results/or do the behavior (until then, wont make sense) Change: all about the decision to act To get better - Spotlight the performers (something wonderful about recognizing employees doing right)

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Ch 3 Committing to Excellence (Principle1) o o o o o o Excellence is when employees feel valued Best organization award employee says, I work in a great place! With success credit should go to staff (not Sr Mgmt) Sustaining Excellence cannot be dependent on one or small group of individuals--everybody in the organization 5 PILLARS (DEF: step-by-step process of setting goals for service and operational excellence; systematic evaluation of short/long term objectives) Note Service goals often seen last. 3 Recommendations to hardwire Strategic Direction : 1. SET - agendas by pillar 2. USE - Leader Eval Tool by Pillar (creates accountability)

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USE - Communication Boards update staff on measurable progress

Rounding (3 types) Senior Mgmt, Unit , Support areas

Ch 4 Measure the Important Things (Principle 2) o Measurements effect on organizations: a. supports/reinforces desired behavior b. accountability for results c. determines if things are working d. aligns leadership and behavior what gets measured gets DONE! not about resources, its about spotting BPs & quickly adopting thru organization clear goals combined w/ consistent measurement = staff begin to understand importance of their behavior when to measure? often enough so you can reward quickly afterwards measuring important things shows where and where not making progress Remember: 1. focus on opportunities to create desired behavior 2. act fast 3. use data 4. push for results--not excuses (how many months do you allow staff to miss an assignment without action plan for change?) If you want change: 1. dont hide measurement (e.g., pt satisfaction) NO SECRETS!!! 2. results by Division/Unit (everyone has to see the dataidentify opportunities, units need to see improvement or theyll never change) tie purpose of measuring back to staff (and behaviors expected)

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STEPS ARE: action plans, re-measure, note improvement, celebrate/reward Ch 5 Building a Culture Around Service (Principle 3)connecting values to actions o o o o o o o o o o o define prescriptive actions/action plans (that will drive results) create systems/tools to hardwire focus on Service SERVICE TEAMS Standards (start with 1st), Pt Satisfaction, MD Satisfaction, Employer of Choice, Measurement, Communication, Reward and Recognition (immediate & short term rewards) Standards tied to questions on Patient, Employee, Faculty satisfaction survey (share draft w/ staff for feedback) staff have good ideas for improvementwe never give them opportunity once we ask poor performers to leaveDepartmental relationships improve Measurement Team focused on the important items of the satisfaction surveys harvest BPs - actions plans for whats not trending correctly, recognize performers TIP Focus on problem, Fix, Follow-up (time & again) w/ staff explaining what was done to correct Meetings identify a problem, focus on solution (input, discussion, action plan) INSANITY (def) doing same thing over & over, expecting different result

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Leaders need to develop own list of actions in their area Recognize the behavior you want repeated

Ch 6 Creating/Developing Leaders (Principle 4) o o I. Leadership Training the heart of why employees want to come to work and why they want to stay The Supervisor holds the key to employee retention PHASES OF ORG CHANGE: Phase 1 Honeymoon (excitement, hope, quick fixes) Key action steps: rounding/thank you notes hardwire key behaviors (build actions into the schedule) reward/recognize show the new accountability system roll-out behavior standards Phase 2 Reality (we/they, inconsistency, bigger than I thought, some getting it/some not)low, middle, high performers spread out Key action steps: focus training re-recruit high performers (profile them) increase substance of communication to staff * what systems/work habits do successful staff have hardwired the others do not? Share this. Phase 3 Uncomfortable Gap (more leaders - high/middle employees get it; others clearly dontproducing THE WALL) Low performers tougher decisions need to be made, inconsistencies more obvious, need for standardization obvious Key action steps: elevate & focus training continue to re-recruit high performers (promote them) ensure right people in right place 1st Priority - move high/middle to higher level of performance 2nd Priority - move low to higher level of performance or out (w/in specified timeframe) ** meeting deadlines reinforce as key expectation of leaders Phase 4 Consistency (system-wide results, right leaders in place, everyone understands keys to success, discipline people and processes, leaders take initiative to solve problems/suggest solutions)

Key action steps: push innovation (i.e., how do we continually get better?) standardize and repeat key behaviors Phase 5 Leading the Way - RESULTS (employees have purpose, what seemed impossible is occurring, staff want to work for you) Key action steps: push innovation (i.e., how do we continually get better?) standardize and repeat key behaviors How to Move Operational Performance ** Leaders biggest regret too much time w/ low performers, not enough time w/ high Step 1 - stratify high, middle, low performers Step 2 - meet w/ HIGH (thank, why their important, explain where org is going/anything you can do for them?) Step 3 - MIDDLE (good, solid employees to invest in) reassure their value, specifically why their important, share one idea for improvement, committed to themanything you can do to help them? Step 4 LOW (do not start mtg on positive note): DESK describe observations, evaluate how you feel, show what needs to be done, know consequences of same performance) Ch 7 Focus on Employee Satisfaction (Principle 5) - focus on positives, rounding for outcomes, employee survey action plans o o satisfied employees do a better job Employees want 3 things: org has right purpose; job is worthwhile; make a difference

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FOCUS ON POSITIVE (Hardwire staff mtgs) top of agenda is wins achieved this
week (or month); share examples of employees making a difference Employees want from bosses/leaders: relationship w/ you; approachability; willingness to work side-by-side; efficient systems; training/development; tools/equipment to do jobs, appreciation

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3 TYPES OF ROUNDING Unit Mgr, Sr. Leader, Support Dept on other Depts
ROUNDING FOR OUTCOMES (start w/ personal question): 1. whats working well today? 2. individuals who should be recognized? 3. anything we can do better? 4. tools/equipment to do your job? recognized behavior gets repeatedSuccess Builds Success Find something symbolic illustrate change being made (shows your listening) Rounding doesnt take long because its focused

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Rounding - can be overwhelmed by systems that havent been fixed in a long time (first, rounding creates more workover time becomes one of most enjoyable parts of job) Rounding Logs track outcomes and follow-up activities Unit Manager rounding do first, will have most impact

EMPLOYEE SURVEYS/SYSTEMATIC APPROACH TO EMPLOYEE SATISFACTION o key process after the survey is the most important!!! o Key WORDS - Im committed to making a better Dept, hope youll help me SHARING SURVEY RESULTS: 1. focus on TOP 3 issues 2. vote on actions to take & assign responsibilities 3. 90 Day Action Plan for Top 3 issues o employee satisfaction is not a quick fixits a process o whats the what? (what was bothering employees all along, but were never asked)

Ch 8 Building Individual Accountability (Principle 6) Peer Interviewing 30 and 90 day Interviewing (GOAL establish a relationship) 1. 2. 3. 4. how do we compare to what we said? what are we doing well? what people have been helpful? from your previous job, what could make us better? anything your uncomfortable with or would cause you to leave?

Bright Ideas Program choose someone to champion 1. set a focus for ideas (perhaps under Pillars) and communicate action plans 2. establish a process for Bright Ideas (centralized submission & review) 3. Reward in 3 phases on submission of idea, when implemented, when a few ideas implemented 4. Acknowledge idea with thanks (assess based on: worth piloting, impact, cost, timing, low-hanging fruit) 5. Track ideas employee acknowledged, whether reviewed, # ideas implemented, $ saved/impact 6. Continually refine the Program - (e.g., perhaps make it a Pillar-specific focus at times) Ch 9 Align Behaviors with Goals and Values (Principle 7) MUST HAVE objective, measurable Leader Eval Tool (& reward leaders based on results) o Set division goals and weights for each item under a Pillar; weights > 5%/item..totaling 100%. Rate on 1-5 scale. o a clear plan on how the tool will implemented and driven by sr mgmt is needed o if the item is on the toolits here to stay!!!

2 Tools that Support 1. Monthly Progress Report - communicate results, hardwire a focus, identify areas of performance/non-performance 2. 90-Day Plan annual goals, 90-day goals, and specific Action Steps, Manage Up levels (13) , and Results ** once the Leader Eval Tool , 90-Day Plan and monthly reports in place leaders appreciate them Ch 10 Communicate at All Levels (Principle 8) o o o Communicating at ALL levels is critical! When everybody understands whats important = tremendous growth (employees take charge of their own development and feel fulfilled) We need to connect the dots for employees (via the breadth and depth of what we communicate)

4 Prescriptive To Dos of Communication 1. Managing Up (when things going well; good news to share; direction needed on how to achieve specific goals) 2. Employee Forums 3. Communication Boards 4. Storytelling MANAGING UP (focus is on the POSITIVE): Your boss - communicate what you appreciate, misc info boss might need to know (personal or work-related). Your Staff (i.e., blowing the horn of your staff to your boss/sr. leaders) - celebrate w/ pizza parties, spotlight an employee at mtgs,) organization doesnt dont know about the good things if you dont tell themnot mind readers. Yourself and Skill Set introducing yourself w/ background on what you do (can help with) Coworkers and other Depts. tell the boss whats going well & people to be complemented EMPLOYEE FORUMS (Quarterly Mtgs led by Sr. leaders) o Benefits to staff communicate consistent message; learn about and celebrate their workplace.

Hardwiring Employee Forums requires: 1. 2. 3. 4. Predetermined agenda tied to Pillars A theme that supports the mission and creates and enjoyable opportunity for teamwork attended by ALL employees structured OUTCOME for the meeting

Suggestions for how to Plan, Implement, and Evaluate Employee Forums:

Planning 1) choose theme/key concept; 2) solicit questions from staff prior - answer at mtg 3) have fun!!! Implementation - 1) Pre-session w/ leaders on what will be presented 2) hold at a time people can attend Evaluations 1) complete evals at end of mtg (to be shared at next mtg 2) additional questions COMMUNICATION BOARDS (so everyone in organization knows how their Division is contributing to the organizational goals) o organized by Pillar (monthly progress reports, Employee of Quarter, thank you letters)

TIPS select high performers to help manage (provide the good news); evaluate best format to communicate on the boards; identify standard info that should appear on ALL Division boards ** Employees define Quality Communication by: quick wins re what they really need to know about STORYTELLING (leaders need to seek inspirational stories out from employees) Ch 11 Recognize and Reward Success (Principle 9) (i.e. hardwiring the acknowledgement of great work) o o o o o 1. 2. 3. 4. 5. 6. o o o Do staff feel overly rewarded each dayNO!!! people appreciate SPECIFIC feedback more than youd expect 3 compliments for every criticism Create a Reward and Recognition Team (hardwire it!!)create a Toolkit and build it into the system The most important way to demonstrate recognition good supervisor current/in-depth information opportunities for development systems that work tools to do job de-selection of low performers dont be afraid to recognize consistent performancenot just above/beyond performance Biggest Lesson Learned power of Thank You notes_ Thank you notes hardwire a new leadership behavior Focusing on the POSITIVES!!!

KNOW Rounding for Outcomes and Employee Thank You notes are the 2 most important actions needed in the first 3 months of Excellence Churchill extraordinary times create extraordinary leadersthere are EXTRAORDINARY times in health care.