Category: Health Angels

A better future for Health

Working under a Health Authority, such as Vancouver Coastal Health (VCH), presents specific challenges in terms of staff engagement and retention.  In its rigid corporate environment, there are many restrictions and limitations in terms of what the organization can do to engage and motivate health care workers.  One way to motivate staff is a reward system.  The rewards system is designed to align the goals of individuals with the goals of the organization (Galbraith, J. R., 2014).  With any government-funded organization, the spending by any department can be heavily scrutinized and held accountable to tax-payers.  This means spending on items outside of regularly mandated activities is highly discouraged.  In contrast, my wife is a supervisor at a private medical imaging clinic.  They often provide gift cards in small increments as a token of recognition for staff who did a good job.  Throughout the year, the company also host and paid for various events such as Christmas celebration and family activity day to increase team morale and create a tighter community.  These incentives appear small but can create a big impact in terms of engaging staff members and create a sense of ownership within the organization.  When our such spending is out of the question, the health authority will need to utilize strategic thinking to find creative ways to achieve the same outcome.  In one of my previous blog post, I mentioned one of the strategic ways to engage staff by making common sense with transparent communications, visioning collectively, and creating a culture of learning.  I would like to provide more concrete examples on how it can be applied specifically in my workplace.

There is a lot of distrust in union workers.  Like many government agencies, health care workers are unionized.   While there are many benefits for staff such as job security and fair employment process, the union can also create a lot of unnecessary tension and distrust when there is a conflict between the leadership team and staff members.  Union organizations tend to be skeptical of many directives from the leadership group and advise union members to always consider “what’s in it for me”.  This type of perspective foster a culture of selfishness and apathy when comes to organizational interests.  In terms of dealing with human resources in the health care setting, we must first establish trust by making common sense with transparent communications.  Our leadership team is faced with many challenges such as new directives from higher level agencies.  Often, these directives will translate to some less desirable changes to the frontline staff.  As strategic leaders, we must help others in the organization make common sense of the world around them, the challenges they collectively face, and how they will face them together (Hughes, Beatty, & Dinwoodie, 2014, p. 84).  Even when details of the directive is not relevant to the frontline staff, providing the information will help staff members understand why certain decisions are made.  As suggested by Hughes et al. (2014), “unarticulated knowledge can cause people to feel unclear or confused about the apparent disconnectedness between the priorities, policies, and processes of different teams, departments, or divisions in their organization” (pg. 85).

Corporate vision is just as mentioned, belongs to corporate.  There is no buy-in from staff members to the corporately developed vision.  As a strategic leader, we must be visioning collectively to allow staff members from all levels to participate in the vision-setting process.  This provides the opportunity for people to share personal versions of aspirations for the organization to create ownership of the organization’s vision (Hughes et al., 2014, p. 76).  The vision must also be meaningful to the entire organization and not just for the leadership team in order to reinforce the greater purpose of the organization.

The culture of learning is key to engage staff.  Achieving the enduring performance potential of the organization requires the hearts, minds, and hands of all to be engaged (Hughes et al., 2014, p. 41).  To do this, the strategic leaders must be willing to learn from others in all levels of the organization, including frontline staff.  The result of engaging staff members in different levels and departments is the creation of new connections and relationships that would foster higher levels of motivation and morality (Imbenzi, Williaume, & Page, 2013, para. 14).

Well, that didn’t work…but this might

Two years ago VCH conducted an employee engagement survey to assess the health of the workforce. The results of the survey were abysmal, with over 47% of health care workers stating dissatisfaction and disengagement with the organization.  The CEO of the organization has made it her priority in VCH to address these concerns.  Since then, many different initiatives have rolled out such as abolishing the employee absence program and promoting a learning series on change.  Yet, even though the idea of this initiative is good, not many changes have happened within the organization.  In fact, many staff members that I know are confused and not sure what is happening within the organization.  I believe this is because the initiative is missing a few key items:

1. Set clear strategic priorities.  Even though the CEO has started the initiative in the attempt to engage staff, there are really no priority changes to the existing work demands to allow this to happen.  VCH is currently rolling out a series of workshops to help staff develop new skills in managing change and establishing a culture of curiosity.  However, without prioritization of existing workload and other projects, after staff have taken the workshop, there is no opportunity to implement or practice such learning.  Once staff returns back to their care site, the urgent matters quickly come rushing back to their attention and the newly acquired skills are soon to be forgotten.  If staff engagement is the main focus and priority for VCH, then every project and tasks must be properly aligned by setting clear strategic priorities, which is one of the key strategic acting competencies (Hughes et al., 2014, pg. 120).
2. Keeping leaders accountable.  Our top executive leader, the CEO, has been very visual with this new initiative and priority for VCH and it has been very refreshing for the frontline staff to see her level of commitment.  However, this cannot be said the same for the local department leadership.  It appears there is a disconnect the CEO and other leadership groups.  When our direct leadership group is nonchalant about a project initiative or decides that is it not important for the department, it is very difficult for staff members to engage.  For example, in my own department, this initiative to engage staff was never brought up in our staff meetings or senior strategic meetings.  Because of my current position, it is difficult for me to determine why the disconnect exist.   I do believe one way to increase the effectiveness of this initiative is to hold people accountable.  As suggested by Lepsinger, R. (2010), “high level of accountability will take initiative to ensure the success of a project, provide early warning of potential problems, and take action to resolve a problem”.  Our immediate leaders and supervisors must be seen to have buy-in and continue to promote this initiative in order for it to succeed.  Otherwise, it is destined to fail and things will go back to the way it was.
3. Implement initiatives at the right time.  When this initiative first rolled out, the project team was very enthusiastic and together with a third-party strategic management company has begun to introduce a two-day workshop on change management and to encourage staff to embrace change.  My leadership team has identified me as one of the emerging leaders of the department and I was invited to participate in the pilot workshops.  Together with approximately 30 people, we represented the emerging middle and frontline leaders that are motivated and passionate about what we do.  However, the outcome of the pilot was confusion and disengagement.   The overall sense of the workshop was it lacked the purpose and vision of the initiative.   After attending the two-day pilot, many people in the group felt the workshop was delivered in an inappropriate time and many people did not understand how this workshop relate back to the original purpose of the initiative.  These workshops well thought-out and useful for staff members, but it must be implemented at the right time before it can be effective.  When most of the organization were still uncertain as to the direction of this new initiative, rolling out additional projects and training only adds to stress and create even more confusion.

The three things I can do…

…to promote the positive renewal, execution, and organization design principles:

1. Engage my staff to create shared direction, alignment, and commitment (Hughes et al., 2014, pg. 41).  The organization is currently attempting to establish a collective vision for VCH.  It is important for me as a leader to work with my staff members and determine how we can align ourselves to achieve the organizational purpose in a way that is meaningful to my team.
2. Foster agility by making strategy a learning process (Hughes et al., 2014, pg. 129).  In the next three years, we anticipate major organizational changes to our leadership team.  It is important for me, as a strategic leader, to continue to be agile in being ready for the uncertainty of what is to come.  These challenges can only be overcome by collective problem-solving processes which require strategic learning (Hughes et al., 2014, pg. 129).
3. Creating systems of accountability (Lepsinger, 2010).  People who have a high level of accountability will take initiative to ensure the success of a project, provide early warning of potential problems, and take action to resolve a problem even when it is not their fault (Lepsinger, 2010).  I will use the three techniques as suggested in Lepsinger (2010)
   • Clarifying actions and expectations
   • Agreeing on due dates for deliverables
   • Establishing checkpoints

…to promote the negative practice of these principles:

1. I will not do it alone.  Leadership is often demonstrated by collectively as a group.  In the upcoming challenging times, success is dependent on the intelligence of the entire team.  As suggested by Hughes et al. (2014), “the must crucial work of a strategic leader is to engender strategic leadership in others by igniting the power and potential of the entire organization in service of its performance potential (pg. 42).
2. I will not make excuses when things do not go the way I have planned.  In addition to creating a system of accountability for my staff, I also need to hold myself accountable and take ownership of mistakes being made.  Making mistakes is a part of learning and I cannot shy away from making them.
3. I will not expect things will work right away.  From the point prior to this one, it is naive to believe things will work correctly right away.  We must extend grace to others as the team is adapting collectively to new changes.  In the same way, I must also extend grace to myself.  But more important, I must not give up on if things go awry.

…to correct behaviours not conducive to your career health and the principles required to promote health strategic practice:

1. Be intentional in listening to people that are different.  It is easy to get along with people who are similar to me.  But a strategic leader will consider people from all parts of the organization in order to create a shared direction, alignment, and commitment.  To do so, I must not only listen to the people around me but to also go to the people are distant from me but still part of the organization.
2. Demonstrate more empathy as a servant leader.  Because of my nature of thinking in terms of processes and being more analytical, I often neglect to consider how other’s feelings could come into the matter.  Empathy is one of the ten characteristics of servant leadership as suggested in Northhouse (2016).
3. Focus on the growth of others.  A transformational servant leader can effectively engage followers to achieve the organizational purposes by attending to the needs to the followers (Imbenzi et al., 2013, para. 34).  I want to prioritize my focus on helping others fulfil their potential instead of focusing on my own.  By doing so, we can collectively lift each other up to fulfill an even higher calling.

 

References

Galbraith, J. R. (2014). Designing organizations: Strategy, structure, and process at the business unit and enterprise levels.

Hughes, R. L., Beatty, Collarelli-Beatty, K., & Dinwoodie, D. L. (2014). Becoming a strategic leader: Your role in your organization’s enduring success. San Francisco, CA: Jossey-Bass.

Imbenzi, G., Williaume, D. & Page, D. (2013). Transformational servant leadership. Unpublished manuscript, Master of Arts in Leadership. Trinity Western University: Langley, Canada.

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Francisco: Jossey-Bass.

Northouse, P. G. (2016). Leadership: Theory and practice. Los Angeles, Calif: SAGE.

 

We’re the Health Angels!

This is the Health Angels first post! Who are the Health Angels you ask?  We are a dedicated group of health care professionals who are pursuing their passion in becoming strategic leaders in our fields.  The Health Angels name is actually a word play of one of the notorious motorcycle gang that is prominent in Canada and United States where members typically ride Harley-Davidson motorcycles (https://en.wikipedia.org/wiki/Hells_Angels).  But not to lose focus, we are the Health Angels, strategic leaders in health care!

Transformational Servant Leadership in Health Care

Transformational servant leadership (TSL), is a concept consisting of the ideologies of transformational leadership and servant leadership (Imbenzi, Williaume, & Page, 2013, para. 11).  The combination of these two concepts is strategic in nature to effectively engage followers to achieve the organizational purposes by attending to the needs to the followers (Imbenzi et al., 2013, para. 34).   When considering strategic leadership direction for health care, TSL greatly shifts the focus of a predominantly service-centric industry to learning-centric in order to focus the most important asset, which is the personal and intellectual property of the organization (Imbenzi et al., 2013, para. 38).  In other words, the paradoxical shift of the focus from patients (outward focus) to staff (inward focus) is a strategic way to increase staff engagement and improve health care for patients.

Health care professionals are overworked.  Speaking from personal experiences of working in Canada under a government-funded health care system, we have some of the most caring and dedicated staff members who decided to enter into the field because of their passion to serve and to help others.  However, the challenges with the Canadian universal health care system is the lack of accessibility and availability of care in a timely manner.  For example, recent studies have illustrated access to family physicians in Canada is becoming increasingly difficult due to physician shortages and increase rates of chronic illness (Ansell, Crispo, Simard, & Bjerre, 2017, p.2).  One of the results of this is patients turn to urgent care in the hospitals for non-urgent health issues which contribute to the long wait times.  CTV News Vancouver (2017) reported emergency room wait times are the worse in the province of British Columbia compared to other areas in Canada with about ninety percent of emergency visits were complete after 8.4 hours in the 2016-17 fiscal year (Miljure, B. and Mangione, K., 2017). Waiting for health care appointments can often impose a physical and emotional burden on individuals who are in pain or worried about serious health conditions.  However, the excessive wait times not only puts a burden on patients but to health care workers as well.  With patients lining for hours at hospitals, health care professionals are in extremely high demand, resulting in staff being overworked, missing necessary meal breaks and working in overtime shifts constantly.  Many professionals that talked to mentioned burn-out as one of the factors of job dissatisfaction.

Creating a culture of learning is the key.  In many organizations, including health care, there is a great disconnect with the people who are running the organization and the people who are in the front lines providing care to patients.  Achieving the enduring performance potential of the organization requires the hearts, minds, and hands of all to be engaged (Hughes, Beatty, & Dinwoodie, 2014, p. 41).  To create a culture of learning, the TSL utilizes strategic thinking and acknowledge it is a collective process that includes diverse perspectives from both inside and outside of the organization (Hughes et al., 2014, p. 54).  The result of engaging staff members in different levels and departments is the creation of new connections and relationships that would foster higher levels of motivation and morality (Imbenzi et al., 2013, para. 14).

Tools for TSL in Health Care

Approximately one month ago, my wife and I visited our elderly grandmother who was admitted to the hospital due to a kidney failure.  Grandma was sharing a room with three other patients who are also in care.  During this nighttime visit, two of the patients in the room require assistance and had called for help on numerous occasions but to no avail.  They groaned and call the alarm for help until eventually, a nurse came in.  The nurse was busy and her hands already full, running and hustling about.  The nurse told them they will have to wait as one of her colleague called in sick and unable to work.  She later added there were six other patients that are waiting for her assistance as well.  I felt bad for this nurse, who sighed and walked away, didn’t even bother to apologize or make an excuse.  Our health care professionals work tirelessly to care for those who are in need.  This question comes up often: who will care for those who care for us?

The essence of servant leadership is putting others first.  Attending to the needs of others first will allow them to produce their best by meeting their personal needs and supporting them in the workplace (Imbenzi et al., 2013, para. 39).  A TSL need to engage our health care workers first and address their concerns.  When staff members are given the opportunity to be heard and recognized, they feel valued and honoured to be a part of something bigger than themselves.  In addition, staff members will focus on generating solutions to a problem rather than complaining or waiting to be told what to do (Lepsinger, 2010, Bridge 3: Employee involvement in decision making).

Visioning collectively is an important process for an organization that is servant leadership focused.  Many organizations have an established vision which provides direction and purpose of its existence.  However, often the vision is created at the higher leadership level and seldom consulting with the front line staff.  Allowing health care workers from all levels to participate in the vision-setting process allows an opportunity for people to share personal versions of aspirations for the organization to create ownership of the organization’s vision (Hughes et al., 2014, p. 76).

Making common sense with transparent communications is vital in creating a culture of trust.  TSL is to help others in the organization make common sense of the world around them, the challenges they collectively face, and how they will face them together (Hughes et al., 2014, p. 84).  Developing a shared understanding is important in terms of being transparent because people often rely on implicit knowledge and fill start to fill in the gaps when information is not known.  Unarticulated knowledge can cause people to feel unclear and even more disconnected to the organization (Hughes et al., 2014, p. 85).  This is less likely to happen when people share a common understanding of their vision and strategy for the organization.

“Staying above the line” is a reframing mindset, focused on creating a culture of learning and being curious.  Appreciative inquiry is one method of staying above the line, where the goal is to encourage others to focus on working collaboratively in solving problems versus finding faults.  A TSL who is focused on creating a culture of curiosity and learning will result in better collaboration, creativity, innovation, and connection.

Critical Thinking

In 2012, all health authorities in British Columbia faced a budget cut mandated by the federal government.  In the efforts of reducing the overtime costs and excessive sick-time, many health authorities went through a dramatic change in health care worker’s scheduling.  The result of this change led to many dissatisfied workers having to work shift times that are unfavourable to their lives.  Many committed individuals felt this schedule change was unnecessary and they provided various alternative strategies that would help fulfil the budget mandate without having taken this step.  In subsequent surveys that were conducted of the staff in Vancouver Coastal Health indicated job satisfaction and engagement is at an all-time low, with much to do with this imposed change.

There is no money.  With various constraints and mandates from higher levels of government, a TSL must utilize critical thinking in order to continue to support our health care workers.  When monetary incentives are out of the question, the TSL will need to utilize critical thinking and consider alternative means to motivate staff members such as providing additional learning and development opportunities.

Health care and governments are rigid.  Unlike organizations from private sectors and businesses, many health care organizations and government groups are stuck doing things the same way for many years.  Another way where critical thinking is essential in health care is for the TSL to consider the current landscape and how to best deliver care to the public.  The needs of the public shifts with culture.  Consider the accessibility of technology and internet connectedness, creative thinking can provide new strategic direction in how people can access care without waiting at the emergency room for non-urgent medical attention.

 

References

Ansell, D., Crispo, J. A. G., Simard, B., & Bjerre, L. M. (2017). Interventions to reduce wait times for primary care appointments: a systematic review. BMC Health Services Research, 17(1), 295. https://ezproxy.student.twu.ca:2420/10.1186/s12913-017-2219-y

Hughes, R. L., Beatty, Collarelli-Beatty, K., & Dinwoodie, D. L. (2014). Becoming a strategic leader: Your role in your organization’s enduring success. San Francisco, CA: Jossey-Bass.

Imbenzi, G., Williaume, D. & Page, D. (2013). Transformational servant leadership. Unpublished manuscript, Master of Arts in Leadership. Trinity Western University: Langley, Canada.

Lepsinger, R. (2010). Closing the execution gap: How great leaders and their companies get results. San Franciso, CA: Jossey-Bass.

Miljure, B. and Mangione, K. (2017, November 30).  B.C. emergency wait times worse than most in Canada: report. CTV News Vancouver. Retrieved from https://bc.ctvnews.ca/b-c-emergency-wait-times-worse-than-most-in-canada-report-1.3701287