Webinar: Developing a Change Playbook: Tools for Leaders Navigating Change in the Healthcare Environment

Disclaimer: This transcript is intended to provide an overview of the main topics discussed in the webinar. Because it has been auto-generated, it might contain errors (including to proper names, industry terminology, and punctuation that result in altered meaning). To hear the webinar in full, please listen to the archived recording.

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Webinar Transcript

Thank you everyone for joining me today for this webinar about developing a change playbook. To play off of that really nice introduction, I want to give the audience a little more insight into what I do to add just a little more credibility to the speaker here. I work for a very large healthcare organization and the organization’s objective is growth. And so we have an acquisition and integration team, a team of individuals that go in and implement changes after a purchase of an agency. And I am in the home health and hospice industry. So we purchased these agencies and then I go in with my team and we have about eight or nine weeks to get that team turned around at them to change what they’re doing and adapt to our policies and procedures. And as you can imagine, I’m not the most popular individual when I first come on site and we deal with all kinds of struggles with regard to getting people to change.

And the main objective is to not lose any employees. It’s very expensive to hire employees and good healthcare employees are very hard to find. So that’s what I do for a living. And that is what I’m going to share with you today.

I’m going to share some tips tools that I use that I’ve used in the last six years in my job for us to be successful in integration. So that being said, I’m going to start off with a poll. I’m just curious as to who’s in the audience. If you could answer with one at one at these answers here, what area of healthcare is the audience currently working in? Just curious who we have and we’ll give it a little while for the poll response to come through. A lot in acute care. Karen, hospice. Great. When you give me a couple more. Oh, that’s good.

Okay. So we have a little bit of everything. Fantastic. We’ll give it a, a minute or a few more seconds here. Okay, great. Well, the answers are, we have 23% of you on the call here are in home care and hospice 32% and acute care, 11% skilled nursing long-term care, 28% in outpatient, and a tiny little portion of you are in private practice, but there’s a little bit of everything. So that helps me to know who the audience is. Regardless of what service line you’re in, we all have a common challenge and that is implementing change. The next poll question I have is what do you find the most challenging in getting your employees or staff to change? And if you could just take a moment to respond with what is your, I think your biggest barrier currently.

Negative attitudes, staff, retention, accountability, follow through resistance to letting go of old habits. Buy-In.

I got a good, a good majority of individuals applying. And so I’ll share the results of that.

So the biggest challenges are negative attitude, 10%, staff retention, 7%, accountability. I’m glad, I’m glad that people understand what that is. That’s 14% follow through, 7% resistance and letting go of old habits. And buy-in is the majority, 61%. And I have to agree in my travels, in what I do for a living. That is one of the biggest, that is the biggest barrier. Usually the individuals who are very resistant to change are the ones that are stuck in a rut. And I hope to have an opportunity to talk about ruts and in the future here.

So we all have a lot in common on this call today. So the objectives of this presentation, I want you to come away being able to identify the three methods of approach to employees who may be resistant to change. And essentially those three methods are the three chapters in this presentation today.

I want you to be able to apply lead and lag measures to the process of meeting goals. And I want you to be able to identify five precedent for developing a change playbook. So we’re going to work on your change playbook right now, starting with chapter one. And this chapter is all about kind of the mindset that you go in to a change environment, whether you’re implementing change small changes, maybe you’re going to implement a new billing system. There’s a few of you who work in home health. I think, you know, that there’s a radical change coming in just a few months, January one with PDGM and you know, how are you going to help your staff navigate that change? And I think the first thing to do is to identify that you are working with human beings. And that’s what I do when I go on site to implement some dramatic changes to a large group, maybe 200 individuals therapists and nurses.

I have to identify with each and every person at that. They are a human being and we all have a lot in common there. And this this slide is all about the hierarchy of needs. And it’s, it’s review for most of you because this is psychology one Oh one, but I want you to put it in your back pocket and I’m going to, I promise you that each and every day that I go to work, I think about the human element of the individuals that I am trying to get to change. And just as a review of the hierarchy here, you know, the bottom, the foundation of this pyramid is all about the psychological needs food air, water, clothing, rest not something that necessarily is going to be directly impacted by a lot of the change that we as healthcare providers, as leaders in the industry are doing, but the next rung up safety, I think a lot of individuals, particularly those who are resistant to change this wrong, this pier on the, the pyramid is really at the forefront of most everyone’s mind, whether you’re implementing something small, like trying to get individuals to boost productivity or whether you’re trying to Hey, you’re, you’re implementing a whole new billing reimbursement system people.

The first thing that goes through their mind is am I going to get paid? Am I going to have a job? How am I going to get benefits for my, and so there’s a lot of reaction and behavior associated with this particular tier on the pyramid of the hierarchy. The next one up is love and belonging. That sounds just like rainbows and sunshine, but it’s very important with my organization. One of the paramount features of my organization that keeps us together and keeps us very successful is culture. And when you’re going in to implement changes, whether big or small where you work it, it can in fact affect the culture of where you work has it affects relationships between individuals and when that is upset that can also illicit certain behaviors. So it’s something to keep in mind.

The next tier is esteem, that’s respect, status recognition, and freedom. We all need to keep this in the forefront of our minds, that we are working with skilled professionals, skilled individuals, and they need to be reminded that what they offer us in our healthcare organizations, what they offer patients is very valuable.

So when you are implementing change, I think what I do is I am constantly reminding individuals how valued they are, how they provide the skill that someone who works, you know, across the street at the McDonald’s can not provide. So I think it’s really important to keep reminding individuals and in meeting their needs here with regard to esteem, the last tier at the very top is self actualization and that’s achieving one’s potential. And we want all of our employees to get there. We want everyone to get there because once you, you find yourself there, that’s when the magic happens for your organization.

And it relieves the burden off of you because this individual essentially becomes pretty autonomous in working and their output is essentially more productive and everyone benefits. The patients benefit, patient satisfaction benefits, which affects the bottom line of your organization. And one more thing, with regard to this hierarchy, the first four, the bottom from the bottom up, the first four tiers are deficiency needs, meaning these needs arise usually due to a deprivation or a threat of deprivation. And that is what motivates people. With regard to these needs, the last one, the one on top self-actualization is a growth need, and it doesn’t STEM from a lack of anything. It really is a desire for that person to grow. So keep that in your back pocket. I know that’s a psychology 101 review, but I honestly use that every single day that I walk onto the job to try to implement a change.

The next little tool that I’ve come to a door is a little book called Who Moved My Cheese and it has been around forever. Most, everyone has heard that phrase who moved my cheese, or I’m going to move your cheese. And I’ll tell you, I am the cheese mover in my job. And this book was written about 30 years ago. It’s a business. It’s a business management book essentially written by Spencer Johnson. And it’s a story. He writes a story about a maze and there are four beings that live in this maze. Two of which are mice, and two are little people. And each of these beings have different personality traits and characteristics. And these traits, these characters they all react to change differently. And what happens in the maze is no they’re stuck in their rough. They have moved through the corridors that the maze every day, the same every day and one day somebody moves the cheese and they can’t find their cheese.

And it’s a story about how they react and whether they’re successful or unsuccessful in supervising that big change that happens with moving the cheese. It’s a book that I highly recommend for those cheese lovers. So who are the mice in the bays or mice and men, I should say. So there’s Scurry and Sniff. They are the mice and then there’s Him and Hall. And they are the little people. And I, the way I’ve used this in my job is I I’m not gonna say I pigeonhole people, but I can quickly identify who the Scurry and Sniffs are and who the Hem and Haws are. If you look at the list of characters, characteristics underneath each of these individuals, you’ll quickly see who’s the positive who I guess will be the successful ones with change and who will struggle and maybe be unsuccessful with change.

Speaker 1 (14:47):

So Scurry and Sniff they’re positive, they’re proactive, they’re energetic, they’re helpful. They’re potential leaders or champions. And you can quickly identify who the scurry and sniffs are in your organization and who you can count on because we utilize the Scurry and Sniff in my job and for effective change, we utilize them to our advantage to help us drive change, particularly helping to support their peers, which are Hem and Haws. Now Hem and Haw, they’re negative. They’re indecisive, they’re led by fear, which is a big one. If you go back to the hierarchy of needs and the deficiency needs that are all behavior driven when there’s a threat that’s, that’s who him and ha are. They feel betrayed. They hold a grudge and they are the complainers. So I think we quickly identify in our, where we work, who is who and as I said, I use this information to quickly identify who I’m going to use as a potential you know, leader for change and who is going to need some extra attention.

And just as an additional little tip. It’s very typical for people when dealing with others. If you’ve got someone who’s negative, who’s very vocal, who’s the complainer, who always tends to voice their concerns publicly. It’s very typical to shy away from those individuals and ignore them because we think psychologically if I give them attention, they’ll just continue. But my take on it is I give these individuals extra attention. In fact, I make it. So they’re sick of hearing from me. I, I talk to them and have them talk to me until they’re all talked out. If you turn your attention to this, now, I’m not saying to completely disregard your positive people, but if you turn your attention to them, force yourself to attend to them. I think you’re going to find a change in at least the amount of negativity that’s voiced and especially publicly.

So I, I tend to call these people a lot. I meet with them a lot, whether they like it or not. And I, I make a real strong connection with the Hem and Haws in the groups that I work with. So lessons learned. So there’s a lot of lessons learned from this little book who moved my cheese and they are the first and foremost change happens. They keep moving the cheese. Those of us who’ve worked in healthcare as was mentioned, I’ve been in the business over 30 years and change happen all the time. In fact, in the last 10 years, it seems like every other week, there’s a change in policy change in reimbursement. So you just have to start to get the mindset that change is constant. And once the individuals that you work with understand that everything’s going to change, you’re going to change, and then everything’s going to change again.

I think that mitigates future struggles for you as a change leader, anticipate change, get ready for the cheese to move. As I said, it’s always gonna move. Somebody is going to move our cheese, especially in healthcare monitor, change, smell the cheese often. So, you know, when it is getting old and that’s it sounds funny, but those individuals who don’t have their eye on their horizon and don’t pay attention to what’s happening where they are in the present are going to be blindsided when it comes to change. I struggle with individuals who are stuck in their old ways, and that’s called a rut. And if you look at physically what a rut is, a rut in the road, and I think about the, the ancient roads in Rome or Pompei there were deep grooves in the stone streets carved out by chariots and physically for a chariot driver to turn a chariot out of a rut it takes an excessive amount of force.

And that’s, those are the horses, maybe the individuals it’s, you’re trying to get in your company to change. It takes a lot of force from those horses and momentum to get the wheels of that chariot out of the rut. Otherwise, if it’s not done right, the chariot will topple and it could kill the drive for it could enter the horses, it could break the chariot into pieces. So the drivers and that is you have to keep the momentum going in order to get the people out of the rut. Okay. So you know, that things are, the cheese was getting smelly, right? And so start proactively in, in getting the momentum, going with your team. So you can safely navigate that chariot out of that rut adapt to change quickly. The quicker you let go of the old cheese, the sooner you can enjoy the new cheese.

And I do try to get this message to the individuals I work with. I tell them, I know this is hard. I know that you’re used to doing things this particular way, and I’m not telling you that it’s wrong. I’m telling you it’s time for a new way. And I promise you that you’re going to see the fruits of your labor in the future change, move with the chiefs. So everybody needs to move together when the cheese moves you’ve already anticipated it. So it should be easier. As I said, in the future to it should be less of a struggle for you and your individuals to move with the cheese, enjoy change, savor the adventure, and enjoy the taste of the new cheese, be ready to change quickly and enjoy it again. Because as we all know, they keep moving the cheese, Spencer Johnson in his writing of this little book.

You know, as I mentioned before, we use the positive people to help promote, or I guess, empower the Hems and Haws. So we use the Sniff and Scurry to help guide and lead the negative individuals. And they do that by writing on the wall of the maze. So they have quickly figured out a way to navigate the change and figure out how to survive without cheese for a while. And then finally find a new cheese and along the way they share inspirational messages to Hem and Haw, which eventually gets them to change the way they do things and adapt to change. And here are just a few of the writings on the wall that I’ve, I really enjoy. If you do not change, you can become an extinct. The, and this is very true in healthcare.

You know, it’s, it’s, we have to be on top of our game, no matter what our discipline is. Otherwise we become devalued and if we become devalued because we haven’t adapted and adopted to change eventually we will be replaced. So the next one, the fear you let build up in your mind is worse than the situation that actually exists. That is extremely true when you are fearful, you are thinking about the, what if, and, you know, we can’t be thinking all the time about what if we have to be thinking about the present and which is the change that has to happen right now. So get rid of the water. Being in the uncomfortable zone is much better than staying in the cheese list, situation, truth. What would you do if you weren’t afraid? So back once more time to the Maslow’s hierarchy of needs, and those first four tiers that are deficiency needs driven, you know, behavior that is, you know, driven from fear of not meeting those needs.

What if we weren’t afraid of meeting those needs, we would quickly elevate to the very top of that pyramid, that self-actualization, when you move beyond your fear, you feel free, see what you’re doing wrong, laugh at it, change and do better. And that is true. I worked for a phenomenal company and I am a phenomenal clinician. I’m great, but I’m not perfect. And the company I work for, isn’t perfect either. And so when we make mistakes, which we do we, we look at it very objectively and oftentimes we do laugh at it. Humor is a big part of my organization and, and of course my integration team, and then we adapt and adopt and we change it. So the next time we do it, we do better. And the last one is great. Life moves on. And so should we just get out of that rut, put it all together for your approach to change so established trust.

So this, this doesn’t come necessarily from Spencer Johnson’s book. This is just my little piece to add to this first chapter establish trust, be consistent, transparent and honest. I think it’s really important to have an open door policy to give the black and white of the situation, whatever you’re trying to change in individuals. And be honest about it. Don’t, don’t try that. There’s another book and I, I can’t recall the author, but it’s called crucial conversations and it’s really talks about how to have this upfront, honest discussion with individuals that’s not harming. But it is, it’s very honest. And especially with those individuals who may be the hems and Haws in your group but establishing trust is the very first and foremost thing that I do when I go on site when I work with individuals and part of that is listening and validating.

So as mentioned before, there’s a lot of fear associated with change, and there’s a lot of you know, obstinance, I guess people who are just stuck in their ways, stuck in their ruts and they don’t want to change. Or if you start to ask questions and listen and validate what they’re saying, it’s interesting. It’s almost like you’re mirroring what they’re saying, and they can listen to themselves. And sometimes they listen and, and they don’t like what they hear. So my team on the integration team, we do a lot of counseling, essentially, a lot of talking a lot of listening and validating, you understand what they’re going through. And you acknowledge the fear that they have clearly defined what is changing and why I, as I said, I’m a phenomenal clinician and I’ve been a great clinician. I’m very humble to I’ve been disgraced for 30 years, but I didn’t get to be great really until about 10 years ago when I started to take it upon myself, to learn about the business, to learn the, the, that what I do in, in health care, what I do with my patient, how that equals putting food on my table.

And I think at that time, when I started to really learn about the business, I became a much better clinician, a much better employee. So I recommend that your employees all understand how the system works in healthcare how, what they do with the patients relates directly to putting food on the table and keeping the electricity on meet team members where they are to a strategy of mine is that I if I have to meet with individuals now I’m an in home health care. So a lot of the individuals I work with are out on the road, right. But if I need to meet and have a discussion, instead of calling them into the office, which may be way out of the way I go and meet them at a Starbucks, you know, near their home, it makes them feel more comfortable.

It’s neutral territory. If we can have some very frank discussions there the same as such, if I’m working in an office and I need to talk to a director I will go to their office as opposed to calling them and summoning them to wherever I’ve set up my laptop. I think that helps to establish trust as well, find your champions and delegate. So use the, the positive mice those positive people. I think that there’s a lot to be said for peer learning. And I think that in an environment where there may be some resistance individuals, I think that they’re more likely to listen to and follow some of their peers as opposed to you as a leader. So we, we do that a lot in our organization using preceptors to teach and train and work alongside their coworkers to, to help guide change, keep telling the story.

So just, you don’t just come in there and say, this is, this is changed. This is what’s going to happen, make it happen. And then don’t talk about it anymore. You need to keep talking about it and be transparent and let your staff know how things are going and moving the dial towards change. Understand not everyone will get on board. This is a tough one to swallow, especially for me because we really want to retain staff, but there are people who are just not going to change. And eventually there comes a time when those individuals probably do need to leave the organization because that it can become toxic. And if somebody and where we are, somebody says, I’m going to resign. We take it very seriously and we allow them to, because there’s a study out there that once somebody submits a resignation eventually whether or not you, you, you convinced them to stay essentially they are going to leave.

So maybe better, sooner than later, establish a culture that accepts and understands change. So talk about change a lot and help your staff understand that change is going to happen all the time. If they’re going to continue to work in healthcare. Chapter two is about setting the precedent. And the majority of the information in this chapter, I got from a book called the four disciplines of execution. And it’s really about helping your team move your organization to meet goal. And I’m going to just kind of breeze through some of the highlights of the four disciplines of execution, understanding that there are two types of change strategies. You know, there’s a pen and paper stroke of the pen strategy. You know, those are the policies you have to implement.

Those are the billing procedures, reimbursement procedures that are going to happen. And that’s on paper. It’s the behavior change strategies that you implement that are really gonna move the dial and make and make growth, visible, positive changes in your organization like increased customer satisfaction, improved functional outcome measures, staff retention, reduce rehospitalization, behavior, change strategies. What makes the difference as opposed to the stroke of the pen? A behavior strategy means that people have to do something different, which is very hard to do. Talk about getting out of the rut, right? That’s takes a lot of force, a lot of energy and skill sets, a wildly important goal. So every organization, whether you’re a small individual private practitioner, or whether you work for a large company, we all have to have goals. And this book recommends you, you really laser in on just one or two goals, big goals for your company.

So you focus on less so that your team can achieve more, choose one or two goals to work towards a clear objectives will allow individuals to focus. And these are the overarching company goals. And I gave an example of, you know, increased patient referrals by 25% reduce hospital, hospitalization increase overall agency, star ratings. So these are your big wildly important goal. Then you develop a lead measures. Now the book talks about lead and lag measure, and there’s a difference between the two, the lead measures they’re measures about it measures the high end tech items. The team must do to reach a goal, new behaviors that will drive success. It’s predictive, influenceable and controllable. And when I say that, you know, that each individual employee has the control, and I’ll talk about that in a minute, it’s usually set and performed by inch of individual team members.

A lag measure is just the tracking of measurements towards your goals. It’s the performance that happened in the past, and it cannot change. The best example that I think is if a lead in a leg measure is weight loss. You have a wildly important goal that you’re going to lose 10 pounds in two months, right? So you step on the scale and that’s your leg measures. That’s the data that cannot be changed unless you’ve set or a limb immediately. And maybe then you could lose five pounds, but we’re not going to do that. And so you set these small goals, these lead measures small goals, one or two reduce calorie intake and increase exercise. And you have these individually. So I’m, I’m accountable to meet these lead measures. And hopefully the next time I step on the scale, my lag measure will illustrate a change, moving the dial toward my wig.

Some examples for healthcare, reduce Medicare denial rates increase in home documentation. That’s a big one in home healthcare. We’re trying to get individuals to get their documentation in, in a timely manner. I know that also when I worked in outpatient, that was an issue trying to get that documentation done at bedside or chairside and trying to move the dial and that respect getting timely documentation in that’s a good lead lag measure, increased patient satisfaction scores and decrease rehospitalization rates. So those are just some examples of lead and lag measures that that can be implemented with your organization, stick to the rules. So this is my take for the, the last part of chapter two. And it’s really just simpler points for you. You gotta memorialize your process, you gotta put it in writing. Okay. and it’s in writing it’s on stone tablets brought down from the mountain, all right.

And it’s never changed. Well, it can’t be changed, but it should not be changed very often. I should say, all employees should have access to this process. That’s your standard operating procedure manual. And you empower them to do that themselves. You empower them to look at it instead of spewing information, throwing data at them, throwing information at them, empower them to go look for the data and look for the answers that goes a long way. And don’t stray from the process. You can’t have a process in place and you allow Susie Q to fudge, okay. You can’t say, well, we’re going to implement this dress code policy, but I know that, you know, Susie Q can’t afford purple scrubs that we’re going to let her wear sweat pants that that would kind of just blows your whole culture. So the processes in place, and it applies to everyone, including yourself, help employees understand the consequences of straying from the process.

Once again you know, just like children, you don’t tell them what to do. You tell them the why’s and that helps them behave better. Always refer to the rules and regulations and process manual when teaching and training employees. And finally, the third chapter is about accountability. It’s pretty simple, but I love this quote, keep your promises and be consistent, be the kind of person others can trust. And it all comes from accountability. So your accountability starts with you and it will trickle down to your employees. So being an accountable leader helps establish trust, and you’ve got to follow the rules, just like everyone else. Each employee, including yourself, should be part partnered with an accountability partner. So in my organization, we’re all partnered with somebody and we have our lead and lag measures. And we meet with our accountability partner to talk about, are we moving the dial or not?

And my partner helps me problem solve what could be happening or what I can do to next time to help move the dial, or what am I doing, right. What am I doing wrong? Everybody’s accountable in my organization to somebody else, check in with the accountability partner to review the progress. Being accountable also means admitting you’ve made a mistake and you know, we’re not perfect. And yeah, there are times we’re not gonna meet that lead measure. Sometimes we’re not gonna meet our wildly important goal. But that’s okay too. And it just means that you need to problem solve and change behaviors so that you can continue to move forward. Get that chariot out of the rut employees must clearly understand consequences for actions taken or not taken. Policy must be adhered to, with regard to consequences, making personal commitments to the entire team, to move the scores forward, and then following through in a disciplined way. So we report on our last week commitment, we review what it is now, our leg measures, and we make commitments for the coming week.

Examples of some of this in health care, you can use this for employees that don’t adhere to dress code policy not completing or submitting timely documentation employees don’t follow the CMS regulations for developing and documenting an appropriate care plan. Employees don’t follow company policies regarding still technique or hand-washing employees don’t take responsibility for timely license renewals. So those are just some examples of lead measures.

Remember following the rules and being accountable for our actions as a healthcare professional allows us to feel secure with ourselves and our respective professions. Following the rules is not always the easy path to take. And I tell you, you know, when it comes to getting your documentation done you know, changing the way you do something so that you’re more efficient, you’re more productive is not an, it’s not easy to turn that bus around. It’s not easy to convince people to do it because it’s not easy, but in the long run, if individuals understand the end result and what the end result can be by doing your documentation at bedside, you’re going to have all this extra time in the evening for your family. So trying to getting them to understand what the consequences are, is really key there, but it’s not an easy, it’s not always the easy path to take.

Finally, I want to give you five precedents for, for successful change and understand and connect with people. Remember what I said instead of very beginning of this presentation, we have to understand that we’re connecting with human beings and we need to know what their basic needs are and understand that when there’s a threat to those needs, and sometimes those negative people, the hems and Haws they’re negative. I mean, baby, maybe that’s your character and you’re not going to change all that negativity, but a lot of times their responses are because they feel threatened. And there’s a deficiency in one of those areas tiers on that pyramid, get to know who you’re dealing with, you know, are they the Hems and Haws? Are they the Sniffs or Scurries set, clear objectives, use wildly important goals, use lead and lag measures?

I liked the lead measures because it individualizes the goals and it might lead measure is going to be different than my coworkers lead measure. And we all are accountable and we take ownership for change that has to occur and understanding what the consequences are. If those changes do not occur communicate often check in often. All right. You know, make a point to check in with your negative Nancy, your ham and your hall check in a lot, B, B I don’t want to say in their face, but be present and, and let them know you’re there to support them, but you’re also you’re keeping an eye on, on what’s happening and their progress or lack of progress, communicate the possibility of future change. So I would really let your, your staff know, but individuals know that change is going to be constant.

Especially in healthcare, it just get used to it. If you want to stay in the healthcare business for right now, keep telling the story, be transparent in results and how things are going with regard to change. There’s no closed door policy on anything it’s black and white, very transparent, make everyone accountable. So stick to your process. And you know, that you’re accountable to yourself as well, but stick to the process, no fudging, no. In a special deals, we, I deal a lot with that. And in my business, I come into an agency that we just purchased and there’s been all these special deals for everyone. Nobody is treated equally. And these little agencies that we purchase, whereas in my organization, we stick to process and I can feel comfortable knowing that the speech language pathologist that works in Las Vegas at one of our agencies there is treated the same as I’m treated.

And that’s very comforting and sure everyone is aware of the process and the consequences, and finally celebrate progress and be ready for more change to come. But we do a lot of celebrations find something to celebrate. Even if nobody meets their lead measures or if nobody is able to follow the, the process to the letter this week, we know what’s going to happen next week. Well, let’s celebrate that. We all came together to discuss it. So we always try to find something to celebrate, to make people feel good. There’s gotta be humor. And we got a value. We have to value our employees and remind them that, that they’re appreciated for the skill and the care that they give our patients.

So that was a lot of information. But we’re going to go to Q and A right now and have a couple of questions. Let me get to the first one.

Often the complaining and negative chatter goes on behind my back. You know, when I meet with them individually, however, they do not share with me anything, tell me everything they tell me everything’s okay. How do I get to the real feeling of my staff? Wow. That’s a fantastic question. And it is, and that’s from Lorraine, Lorraine. Thank you. And that, I think that happens to everyone. Let’s look at it forget from the human element perspective. Obviously there’s, there’s Jesus being moved or there’s a, one of those tiers on that needs pyramid is things threaten, right. And you can’t force them. First of all, I definitely wouldn’t say, I know you guys are talking about, or I know, I know you’ve got issues. I hear it behind my back. Because that that is a problem with trust, right? That there’s a trust issue because maybe then there’s this cultivation of this feeling of this trust, somebody knocking on me and I, somebody told the boss, you know, that I’ve got this problem, so I wouldn’t do that.

But number one, if you can identify what the issue is, then you don’t have to, you don’t have to point fingers or call anyone out in a room. You can bring up the issue with the group of individuals to discuss that particular situation or item that’s being discussed. And I don’t know what the details of it is, but I would go back to being transparent, being honest, get them the facts and teach them, teach them how to go and get the facts on their own. IE the policy and procedure manual. And it’s really hard to argue. When you’re, when you’re given facts, factual data, I find it’s really hard to argue unless it’s a, you know, a personality issue, but hopefully that answered that question. I second the above question about employees not being honest, or what’s holding information in our private conversation, how can I encourage them to come to me instead of complaining or letting it brew?

So that’s a tough one, but I would establish who’s the direct supervisor. And, and, you know, this, this situation has come up in my past before too. And I had a supervisor who in, in the group said first of all, she validated concerns that were going on in the department. And secondly, she valued. She made sure that we each felt valued. Not just, not just a blanket value statement, you’re all great clinicians, you know, identifying individually each person’s skillset or value. And that, that immediately let us know this boss knows who I am. I think a lot of the problem is the bosses don’t know their employees. And I’m not saying you got to go out for a beer, you know, every Friday with your employees, but get to know who they are. And what drives these individuals, you know, and where are, what, what areas their pyramid are disruptive.

So that’s what she did what she valued each and every one of us. And then she let us know, you know, this there’s a mutual trust that has to go on here. I am your direct supervisor. I encourage you to come to me if you have an issue, because going to your counterpart with an issue isn’t going to solve the problem and I want to solve the problem. That’s, that’s a very I think that’s a common thing that happens in departments and you’ve got some hymns and hogs. I’m sure that you’re working with individuals who for some reason are negative and maybe they’re always going to be negative. There are people who love to gossip and who loves to stir the pot. So I just personally I never play into it. I just, I like to see a lot of facts at people, but I also like to get to know exactly who I’m dealing with.

I sure hope that I could do a whole webinar just on that one, Pam. Here’s another question when starting to talk about productivity, numbers and changes, are there topics you approach first to better help with staff understanding the change? Beautiful question. Yes. it goes back to understanding the business and I’m not sure what service line you are in with this question, but I go back to, I used to be the first one to complain about productivity. I thought, Oh my God, it’s the, it’s the points, what shop here? And I’m so sick of it being, you know, thrown down my throat. But then I started to, you know, as I said, research on my own how the business works and I started to research exactly what the reimbursement is. And I I’m in home health and it’s Medicare for my company.

And so I started researching, you know, what goes into reimbursement from Medicare and started crunching the numbers. And I did because I’m not a mathematician or a statistician at all. I did asked my supervisor to help me understand and to help me and to look at some of the financial sheets so that I understood that in order to keep the lights on and to keep people paid at the salaries that they’re paid, which were very generous, I really did need to produce. So I think I start by talking about facts and we’ve got a lot of changes coming up in home health care, as I mentioned before, and I know my company is very transparent and talks about very specific details about cuts and very specific details about reimbursement for PDGM that are coming. So that’s what I talk about first.

And if you can dumb it down if you need to, to, to help your staff understand, but like I said, I became less of a negative Nancy when I started to understand how the business actually works. That was a great question. Any suggestions for dealing with in-house barriers to supporting change such as too few resources for streamlining updated, updating HR formats that would allow field staff to be more productive. We can’t keep asking staff to do more if we’re not facilitating that, I completely agree 110%. If you’re going to ask, I mean, and I, I’m not pointing, I am going to point fingers pointing fingers at, for me, I’m pointing fingers at Medicare and our reimbursement system, our reimbursement system healthcare reimbursement as historically drives our behavior. Right. And so they have been there are so many more requests and so many more things that we have to do in the healthcare field and in home health care in particular in order to be billable, right?

So when Medicare changes the conditions of participation, which they just did and they added, you know, 20 more things that we have to be responsible for your company has got to step up and understand and, and also make changes to how things operate. And it’s really easy for me to say it’s kind of a no brainer, but once again, go back to the facts and gather your facts. Very you know time data for what, how much time individuals are spending with drive time with documentation time, with non-visible activity time, gather the time data and bring that to your CEO or, or to the leaders to have a discussion about it. I I’m in complete agreement with you, you can’t evoke change.

You can’t force these individuals to change if the leaders in the company aren’t about change as well. I was more on a soapbox than anything really answering your question, Cindy, but hopefully that gives you a little bit of fuel. You can feel free to reach out to me on that particular topic. And that’s in my wheelhouse, I find here’s one from Doug. I find holding people accountable is challenging. What is the best way to address staff don’t who don’t follow the process and goals that have been outlined? Well, accountability also is linked with consequences and I, this is challenging for the leader, right? Because we can all put out these rules and these processes and things that have to happen. But if we don’t follow up with consequences and why is anyone going to bother the change? So they have to see what the consequences are.

And that sometimes is very tough. And that’s, once again, I’m going to recommend the book, Crucial Conversations. It’s a, it’s an easy read, and it’s a really great guidebook for leaders to have these very Frank conversations with individuals regarding behavior. And yes, I hold these people accountable and I blamed them for not following the rules. However, I hold the leader accountable as well. If you don’t follow up with consequences, I know you don’t want to lose staff or maybe you don’t want to lose staff. And, and that is a challenge, but honestly, if you’ve got one person who’s being allowed to not be accountable and what does that do for everyone else? I think that creates a, a very negative culture in the work environment. So go find crucial conversations. And the lead measures are really that four disciplines of execution is a great tool and it helps each individual be accountable.

And you have an accountability partner who you can trust to be an accountability partner to help move the dial. I’m hoping that helps. I think that’s about all we have time for, and I am very grateful and very appreciative to everyone for your attention today. I hope that some of you just came away from this, with this one little pearl of wisdom to help you navigate through difficult change is difficult people. I make it sound super easy and super fun, and it’s not that’s just my speaker voice. So thanks again, everyone for joining me and hope to see you again on another MedBridge webinar.