Supportive Accountability; A Cornerstone of Value Based Healthcare Presented by: Brad Zimmerman Chief innovation Officer I 3 Executive Coaching LLC brad@i3executivecoaching.com 1 P a g e
To succeed in the environment of value based healthcare, accountability must drill down to each person within your organization. However, the shortage of professionals in clinical and emerging key roles, makes it difficult to hold people accountable. A culture that is supportive of individual success, not punitive is imperative. In this highly interactive, experiential session explore how to create such a culture, rooted in inspiration, integrity and innovation. Learning Objectives: 1. Learn to inspire and empower staff to step up and take responsibility. 2. Develop an understanding of the building blocks for creating a culture of supportive personal accountability. 3. Access concepts that allow you to shift peoples resistance to change to a commitment to innovation. 4. Identify the barriers to such a culture and create strategies to overcome them. 2 P a g e
What challenges do you face in bringing this level of accountability to your organization? 3 P a g e
What is Accountability? 4 P a g e
What are the natural barriers to accountability? Given the barriers, why would anyone agree to being accountable? 5 P a g e
IT S PERSONAL! The first step in mastering the discipline of building shared visions is to give up traditional notions that visions are always announced from on high or come from an organization s institutionalized planning processes. The Fifth Discipline: The Art and Practice of the Learning Organization Peter M. Senge - author Doubleday/Currency - publisher Being personally committed to, or ON A MISSION is not the same as memorizing a Mission Statement. A Mission Statement represents the actual mission. The commitments that drive people in real-life organizations are much too complex to be fully defined in a short sound-byte. People need to fully understand and take personal ownership of the Grand Purpose that energizes and empowers, both internally and externally. The organization s purpose or Mission is a view of a future state that resides within the mind of each person that is on the mission. Such a mission can unite people in the enterprise; but only if leaders are successful at evoking it in the imagination of all team members. Such a mission can also clarify for people why they are being asked to do what is being requested. It provides an orienting point in the future, a guiding star for decision making. For a purpose/mission to be unifying and clarifying, it must inspire and motivate each team member. The purpose/mission must connect to each individual s personal purpose. The more personal accomplishment people can achieve through the mission, the more powerful the organization. For this reason there will be many individual perspectives of the purpose or mission. When individuals share their interpretation of the mission with others in the enterprise the mission becomes clarified and more inspiring. In the absence of an inspiring organizational purpose or Mission, the default motivation is people s comfort zone. When people s commitment to comfort is the motivating force, commitment to the status quo takes over and organizations languish and ultimately fail. The job of LEADERSHIP is to evoke the creation of an inspiring and motivating view of the FUTURE, in the minds of each member of the team, that they can adopt as their own. To have the desired effect, the mission must be continuously re-created, over and over and over again. 6 P a g e
The Triple Aim; a starting point for inspirational leadership. 7 P a g e
MISSION Reduce Cost Population Health Patient Experience 8 P a g e
BUILDING A CULTURE OF INTEGRITY What does it mean to have integrity? What is a Culture of Integrity? 9 P a g e
What part does accountability play in a culture of integrity? "The key to growth is to learn to make promises and to keep them." - Stephen R. Covey 10 P a g e
KEY PERFORMANCE INDICATORS A key performance indicator(kpi) is a management tool. Key performance indicators are not goals; they are measures used to gage the progress or advancement toward the organizations purpose; its mission, operational or department goals, and strategic goals. Key performance indicators, when not linked to the organizations purpose, can lead to, perverse incentives and unintended consequences as a result of people not understanding the real purpose behind the measures, or working to manipulate the specific measurements at the expense of the actual quality or value of their work. In other words, Leadership must precede Management. Although in some instances organizations use qualitative indicators the best, most precise KPIs are quantitative indicators that are both specific and measurable, they can be represented with a number, or a simple yes/no statement and therefore are not subject to human interpretation and disagreement. Many organizations use process indicators that measure compliance with, or the efficiency or effectiveness of a process. Process indicators can be very informative and powerful if used in conjunction with or in the context of outcome indicators that reflect the outcome or results. Measuring results is the only real gage of effectiveness, and informs users of their progress toward the organizations mission, departmental goals and strategic goals. Measuring only process goals may feel safer to some because people can be assured that I am doing it right but only outcome measures really inform users as to whether they are getting the job done. Any initiative to develop effective KPIs should always begin with outcome measures. Once the categories of KPI s have been established, future targets must be declared. Targeted KPIs have a timeframe in the future. They can be 5 years, 1 year, quarterly, monthly, weekly even hourly. In order for KPIs to be effective one individual must promise to be accountable for ensuring that the future targeted KPI is achieved. 11 P a g e
LINKING LEADERSHIP AND MANAGEMENT: The Leadership Dashboard MISSION Reduced Cost Population Health Patient Experience 12 P a g e
What KPI s might be used to measure the patient experience? 13 P a g e
How do you get people to promise to attain KPI s? 14 P a g e
LEADERSHIP is the first step; engendering in each person s imagination a unifying and compelling vision, mission and goals for the future (as well as generating an aligned view of the current reality). The power of creative tension causes all team members to create good ideas and actions that overcome the inertia of the status quo. Current Reality Mission Goals Promises from people for achieving Key Performance Indicators, tasks or specific actions are required to create progress toward the Mission & Goals. MANAGEMENT must follow leadership; creating a structure of accountability and integrity (requests, promises and accounting for actual performance vs. promises) is required to transition from vision to action. This transition to action is what moves the current reality forward, toward the future state and is produced step by step; promise by promise. People are willing to make promises and be held to account because they are committed to the mission and goals. Current Reality Mission Goals COACHING creates a culture of support; for the organization to grow beyond the current reality, each person must grow beyond their default success strategy and be willing to request support; and support must be readily available. When people are committed to the future state, and have made promises that require behaviors or knowledge beyond their current capabilities, they must grow in order to fulfill the promise. This creates the demand for coaching. The conscious and skillful application of leadership, management and coaching together produce a culture of personal growth, a learning organization, an organization that produces breakthrough results. Your personal challenge is to develop both the conscious awareness of when they are needed and the skill to apply them. 15 P a g e
Supportive Accountability Feedback How would you rate the value you gained in this workshop? (Circle one) 1 2 3 4 5 6 7 8 9 10 None Exceptional How would you rate your ability to apply the concepts you gained in this workshop. (Circle one) 1 2 3 4 5 6 7 8 9 10 None Exceptional If you would like to receive 2 hours of personal phone coaching over the next 60 days, please fill in your contact info below or give us a business card. Name Title Organization Phone E-mail 16 P a g e
SUPPORTIVE ACCOUNTABILITY By Brad Zimmerman Chief innovation Officer, i 3 Executive Coaching If only people around here were more accountable for results... Managers don t hold people accountable here This is one of the complaints we hear frequently from both organizational leaders and staff. We all know that accountability is a key ingredient to the success of any organization. Why then does there seem to be such a widespread absence of accountability? A large part of the answer lies in the frequent misunderstanding of the word and the concept itself. Accountability is often equated with blame when things go wrong. Often when the cry is heard someone needs to be held accountable it really means someone needs to be fired. Equating accountability with blame, subjecting people to negative feedback that undermines their sense of pride in their work, is counterproductive. Recent studies have shown that performance reviews that focus principally on blame for performance problems are demotivational, productivity has been shown to suffer for months after such a review. This explains why people dread reviews and why many managers avoid doing them. Another factor in the absence of accountability is the theme that they (not I) aren t accountable. Accountability seems to be something that other s are lacking. It is rare indeed, that an individual thinks that they themselves are lacking in accountability. The root of the word, account gives us the first clue to the most productive definition of accountability. Accountability involves simply keeping an account of results produced compared to results promised. That is it, the basic act of acknowledging actual performance. Nothing more. If an accounting is to be done, there must be clearly agreed upon Key Performance Indicators (KPIs) that measure a person s effectiveness in their job. Reviewing the accounting of actual performance compared with promised performance reveals that the person is succeeding in some areas, and failing in some areas. Black and white; no blaming, no excuses. This objective review, of the promises a person has made should lead to a coaching discussion. The question; How can I improve in the areas in which I am failing? is a request for coaching and can lead to a root cause analysis, which can examine factors such as Policies, Procedures and systems that are lacking or counterproductive, interpersonal or interdepartmental breakdowns (others are not keeping their promises to me), etc. None of which excuses the lack of performance, but instead points out where the person needs to direct attention to solve the root cause, or ask for appropriate assistance in doing so. That said, a system of rewards (for better than promised performance) and consequences (for worse than promised performance) can be an effective mechanism to reinforce accountability by individuals sharing in the proceeds of both successes and failures but such a system by itself will not bring accountability about. All the above defines and describes accountability. But what about the supportive aspect? What is it that is being supported? The simple and superficial answer is the person but the deeper answer is that person s commitment. 17 P a g e
Frequently people agree to Key Performance Indicators to pacify their manager s demands. This is not a genuine promise, but an act of compliance in the face of force. They are agreeing to something that someone else is committed to, not what represents their commitment. What is important and compelling for them is what they are committed to. In order for managers to really manage effectively, they must first lead; inspiring a personal commitment to the organizations mission, goals and purpose of the individual s job. The more inspiring the purpose, the more people engage at a level that is truly meaningful to them, the more power is generated. A leader who engages people in a purpose that allows them to make a difference, to contribute to the lives of others, will generate more power than one who engages people in an exercise in avoiding domination or simply being in it for the money. When leadership engenders this level of commitment from and within people, they will embrace being held accountable for results. Effective management then becomes a natural support for the attainment of each person s commitment. They want to make the promise because the result is important to them, and they know that having someone hold them accountable is a good way to support their personal success. If a person is consistently failing to meet the KPIs that they promise, and they are either not asking for coaching or not putting the coaching received into action, they are demonstrating that they are more committed to the status quo than to performing on the job. A team is a group of people who share a commitment to a common purpose that is superior to each individual s agenda or comfort zone. Therefore a person who is demonstrating a lack of commitment to the common purpose is, by definition, not on the team. In this situation, leaders have three options available: 1. Inspire the individual to commit to the larger purpose. Put them in a coaching structure such as a plan of correction. 2. Acknowledge that the person is not sufficiently committed to the team s purpose, and therefore not really on the team, and replace them with someone who does share the commitment. 3. Continue to accept substandard performance (and probably complain about it and blame the person). If you are truly being accountable for the performance of your team, these difficult choices must be made. Supportive accountability is simple, but certainly not easy. Combined with inspirational leadership and insightful coaching it is one of the keys to creating a highly successful, sustainable organization. 18 P a g e