Imagine the front porch of a country store in small town America with rocking chairs and friendly smiles. Just inside the front door, a large barrel full of crisp, delicious homemade pickles awaits. Aunt Mary's unique pickle recipe provides the special spicy yet sweet taste which permeates each aromatic bite. Departments are just like a pickle barrel when it comes to creating culture change. A good recipe, the right ingredients and patience all combine to create long term change. To play out the metaphor, let's look at the necessary components.
OK, you'll need to use your imagination...The pickle barrel represents the nursing department's future state. The cucumbers/pickles are the nurses and other employees within that department and the pickle juice is the vision for a new future of service excellence. The nursing managers' are the pickle "chefs" who create the unique recipe and create standards for continuity.
The culture change we are seeking here revolves around a ViewpointSHIFT(TM) regarding service excellence. Are patient satisfaction scores where you would like? Are you scoring in the top 10-15% of your peers nationwide? In my many years of working with healthcare organizations, I have found that many healthcare organizations make large investments in healthcare excellence, but they do not always provide the strategy and follow up to sustain long term change. Faced with flavor-of-the-month initiatives and lack of service accountability, raw talent is not enough and healthcare service suffers. Employees become numb to the announcements, new policies, and service programs. It is each nursing manager's responsibility to follow through with the strategies outlined below to avoid this lackadaisical attitude.
When it comes to service excellence, there are six key strategies for transforming the cucumbers in your department into pickles. Remember, in order to create long term change, this requires a good recipe, the right ingredients and patience.
Step 1: Strategize for service
Where does service fit in the strategic initiatives of your department? Defining your unique service culture is akin to having your own secret pickle recipe. What are the formal and informal leaders in your department saying (and more importantly doing) about service excellence. Does everyone in your department know how their job impacts patient satisfaction survey results?
I frequently see nursing managers who talk the talk, but don't walk the walk. If your department is not 100% supportive of a healthcare service excellence culture transformation - don't go any further. You will be wasting your time and money!
Step 2: Organize for service
From the physical layout of department to the use of technology, there are proven strategies for creating a culture of service excellence. Is signage well placed? Are chairs comfortable? Are your visiting hours customer friendly if applicable?
Other elements of organizing for service include policies & procedures, job descriptions, staff scheduling, service standards and scripting. A test to make sure your policies and procedures are written with the patient in mind involves asking this question. Can you replace "It's our policy" with "In the best interest of our patient, we..." Think about it- are the rules really in the best interest of the patient? You might ask your patients to find out, for sure.
Creating and agreeing upon universal service standards provides the unique spices and flavoring for your department. What behaviors can staff perform routinely to demonstrate to your patients the culture of healthcare service in your department?
Step 3: Select & train for service
Rotten cucumbers make rotten pickles. Hiring pickles who complement the staffing mix from the start is much easier than hiring a cucumber or worse yet a bell pepper. Remember back in the day, when folks said, "she's a great nurse, she's just not nice"? This is no longer acceptable.
Using behavior-based interviewing questions and validated pre-hire assessments allows nurse managers to select staff who already embrace the service standards of your department.
Orientation and on-the-job training provide important foundations for staff. Making sure there is congruence once the staff arrives in their department is trickier, but doable with strong management support. On-going training keeps the cucumbers immersed in the recipe long after the initial hoopla has died down and allows for service excellence over time.
Step 4: Deliver excellent service
This step is where the rubber meets the road or the pickle meets the customer. Well defined service behaviors which are competency based provide the foundation for service delivery. The expectation is that these behaviors are demonstrated daily and with ease.
Positive first impressions play a major role in setting the stage for service excellence. When problems do occur, service recovery procedures need to be set up to allow staff to solve service problems at the front line.
The delivery of excellent service is evidenced by positive attitudes, friendly smiles and high quality work output. Service efforts are not just about being "nice" - they involve a ViewpointSHIFT to match up safety and quality with caring and kindness.
Step 5: Manage for service
As steps one through four are being implemented, the nurse manager has a major responsibility for insuring the success of the process. Communicating strategic alignment (or the pickle recipe) is the first step toward culture change. Do staff members in your department really understand the service vision?
I frequently talk with front line service providers after training workshops and presentations and their concern is "will my manager really hold us all accountable?" Performance management, executed daily, will move the department towards the service vision.
In addition, regular contact with patients including surveys, focus groups and rounding provide real-time data for managers to use. On-going coaching lets staff know what is important on a regular basis.
Step 6: Sustain service momentum
Last, but not least, keeping the pickle recipe fresh requires the resources of time and money. Measuring patient satisfaction provides important data for making better decisions. Standardizing operations to decrease variation on the job is another key element.
Staff members who are providing excellent patient care want their managers to manage low performers - to get them to "shape up or ship out". Employee satisfaction is a key indicator of patient satisfaction so this is a good place to start. Keep your eyes open for fresh ideas from other types of service related businesses and see what might work in your organization.
So ponder that barrel of pickles in that country store. Imagine the friendly service and amiable folks who are running the place. These six strategies are a glimpse of what it takes to turn cucumbers into pickles so that your raw talent becomes excellent healthcare service providers.
Vicki Hess, RN, MS, Certified Speaking Professional, is an Escape Artist. She helps people escape from Professional Prison and provides a passport to Professional Paradise. To download free tools go to http://www.ProfessionalParadise.com . Vicki is passionate about working with forward-thinking organizations to develop fully engaged employees and leaders, who in turn deliver remarkable business results and ultimately create Professional Paradise! A highly-regarded speaker, author, facilitator and consultant, Vicki is an expert in employee engagement, team dynamics, and workforce and leadership development for healthcare leaders and employees. Vicki is a Certified Speaking Professional, the speaking profession's international standard for platform skill. She holds a Master's Degree in Human Resource Development from Towson University and was an adjunct professor at The Johns Hopkins University Graduate School of Business for five years. Vicki is the author of SHIFT to Professional Paradise: 5 Steps to Less Stress, More Energy & Remarkable Results at Work (CornerStone 2008). For more information please visit http://www.VickiHess.com .
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