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Achieving Operational Excellence in Community Hospitals

Published on 5/13/2019
Estimated read time: 9 minutes

Our nation’s small, rural and community hospitals (I refer to the collective as “right-sized”) are experiencing a tidal wave of uncertainty and change. Some of it is desperately needed, and much of it is uncomfortable or even painful. No matter the speed or force of change, right-sized hospitals are working in overdrive with fewer available resources than those within large health care systems. The good news is that despite the inherent and familiar challenges, right-sized hospitals are overcoming the significant hurdles and weighty financial burdens of the business of health care.

Against the odds, right-sized hospitals are succeeding at innovation, increasing market share and recruiting and retaining talent. They are making headway on improving population health, community and patient engagement, and maintaining impeccable quality and safety. Perhaps not in all these areas, all at once, but enough to alleviate some of the pressures and foster a higher level of organizational optimism.

Overcoming the pressures of community health care

Yet, there is an alarming number of right-sized hospitals (along with their clinics, long-term skilled care facilities, home health divisions, etc.) that are teetering on the edge or have already fallen. According to a 2019 study by Navigant, one-in-five U.S. rural hospitals are at a high risk of closing unless their financial situation improves. This study also shows that 64% of the identified at-risk rural hospitals are considered highly essential to the health and economic well-being of their communities. Often lost in this conversation is the impact on employees.

The very people we are relying on to save lives are also expected to sprint their way through what feels like a daily marathon. The sustained pressures that are pummeling the right-sized sector are taking a visible toll. In over a decade, I’ve spent hundreds of hours observing hospital operations and interviewing hundreds of senior leaders, department managers and staff. Overwhelmingly the feedback is that of concern, frustration, fear and even anger. No matter how committed, experienced and professional a person might be, excellence in terms of patient care and outcomes are compromised when people are running on empty. 

A culture of emotional intelligence, trust is key to successful leadership

The current state of affairs for right-sized health organizations is complex, and the solutions to pull at-risk systems out of danger are multifaceted too. One critical facet is the need to assess and understand the organization’s emotional culture. If, as a health care leader, you truly have a hunger to achieve and sustain excellence (however defined), then you must also have a voracious appetite to effectively address burnout fueled by conflict, time pressures, poor relationships, broken communication and the erosive “us vs. them” dynamic.

In a constant state of fight or flight, the human factors that lead to disharmony are an overlooked albeit urgent priority. While working at improving culture and communication within your hospital will likely have no impact on say, legislation, policy and the broader economic matters distressing the industry, doing so significantly helps to establish and restore trust. Trust is the first step to accomplishing critical organizational goals.

Thankfully, there is a straightforward (not easy) way to grow and strengthen your organization’s emotional culture of trust to overcome the inevitable obstacle courses that lie ahead. The question to ask is, “does your leadership team have the will and the endurance to walk the longest mile on its journey to excellence, however long it may take?”

We know for sure that health care leaders are challenged most during times of organizational change. Depending on factors such as their personality type, communication style and how dialed-in they are to their emotional intelligence and responses, their approach to change falls into one of two categories.  Some manage change, while others deal with it. The latter tactic has greater potential to derail progress, and lead to employees becoming frayed; disengaged, distrustful and skeptical about management’s intentions. A leader that proactively manages what and how they relay impending change experiences more positive responses and behaviors from their team. 

Over the past decade, my team at Impact! Communications, Inc., has conducted multiple organizational culture assessments, which are different than job satisfaction or employee safety surveys. Within the average group of 50 respondents, 100% cite communications as the organization’s Achilles’ heel. Chief among our findings is that leaders who engaged their teams in early and frequent discussions about change, regardless of the progression of said change, reported that their teams grew closer, excelled at problem-solving and demonstrated new levels of enthusiasm and resiliency. Those who tend to react to change (deal with stuff as it unfolds) spend precious time and energy on cleanup. As a result, strategy takes a back seat, morale takes a hit and leaders (especially those in management positions) become hamstrung. 

Driving positive change through strategic internal communication

Will having an organization that communicates with high emotional awareness be spared from falling at the hands of those creating the conditions for chaos? Not likely. What a well-thought-out internal communication strategy can provide is essential infrastructure that facilitates organizational change; helping to transform disenfranchised staff into focused, engaged employees, inspiring them to deliver on the hospital’s mission, vision and goals. When leaders make the connection between culture and communication, shift happens.

Many hospital administrators I’ve worked with over the years have bemoaned the fact that they’re putting lots of information out there but getting less enthusiasm and support for what they want to do. This is the crux of the problem – confusing information sharing with communication. Telling someone something doesn’t necessarily mean the information is received or understood.  Words are wasted if all we’re doing is talking.

Strategic internal communication is a purposeful approach to interpreting organizational strategies and issues for your employees and developing messages, methods and systems to reach, engage and gather support from internal audiences. To maximize internal communications, health care executives need to define the role of internal communications beyond disseminating information. This requires a focused alignment of internal communication to hospital goals. Managers at all levels must serve as ambassadors in the communication process, and experts who understand the organization must provide objective feedback from a strategic perspective. Done correctly, internal communications can:

  • Provide employees with clear standards, information and expectations for their work roles
  • Help employees maintain a shared vision and sense of belonging in the organization
  • Provide feedback on organizational performance, patient perspectives and community perceptions
  • Provide support during challenging times – mainly induced by external drivers
  • Suggest new ideas to improve team dynamics across all areas of the organization
  • Be the vehicle that helps to steer accountability toward positive and away from the punitive reputation the word has taken on   

An internal communication plan is best when it is built into the framework of the organization. Every initiative from facility upgrades to the launch of a new electronic health record platform warrants a deliberate communications plan.

Even the smallest hospitals, whether it’s a staff of 90, 200 or 500 can quickly evolve into a disjointed collection of employees working individually to achieve their own goals. With effective internal communication, your hospital becomes a powerful, cohesive unit that can successfully handle change and cycles of transformations. 

5 tips for effective communication

Individuals and groups communicate using different styles and with varying perspectives and assumptions. People’s gender, age, experience, cultural background, personality type, emotional intelligence and education, all shape how we send, receive and interpret communication. Sniff test your communications methods. Is what you put out for consumption right for every appetite? Despite differences in communication styles, these core principles of communication are always worth applying:

1. Communication is two-way. If information isn’t understood or comprehended the way you meant it, then you haven’t communicated effectively. An excellent communicator must understand how to empathize with the audience and try to anticipate what they will think and how they will feel about the message they receive.

2. Communication isn’t just about words. It can include facial expressions, body language, tone of voice and overall attitude. A dismissive or condescending attitude or an impatient demeanor may be stronger than the positive message being sent by words.  Say the word “fine” out loud with a smile on your face and an upbeat tone.  Now, repeat it with your teeth clenched. Sound different?

3. Communication preferences are different for the generations. Some prefer email, while others would rather receive a text or read about it in an e-community. Survey your team and use multiple ways to deliver the news and receive feedback aligned with their liking.

4. Communication can be direct (going directly from the source to the recipient of the message) or indirect (going through a third, fourth or fifth party). Keep in mind that while indirect communication is often necessary, it always carries the risk of being distorted as it passes through your system or network. Be sure to check-in with how your leaders are conveying news.

5. Communication via email is easily misconstrued. How many times have you been the recipient (or culprit) of copying others who are not relevant to the conversation? Internal communication is one of the most critical aspects of managing change in any health care organization. Make sure information flows in all directions and ensure that employees learn immediately about things that interest or affect them. Be open and sensitive to others’ style of communication and check your communication systems and channels regularly to make sure that internal communication is relevant and timely for your employees. 

Building a solid foundation for high quality care

Many years ago, I worked with the founder and facilitator of a high and low ropes course who was also a finalist on the hit TV show Survivor. Her writing and subsequent teaching work focused on the alignment of actions with intentions. As I carry the knowledge, she taught me forward in my work, I encourage teams in pursuit of excellence to avoid the costly, and potentially corrosive misstep, of having a flavor-of-the-month approach to improving organizational culture.

Excellence is born from behavior which requires self-work and reflection. Amassing tools and training in the race to reach excellence often becomes a band-aid to cover unattended wounds.  A resilient, just and authentic culture of safety and accountability is built on a solid foundation of strategic, honest, consistent and emotionally intelligent communication.

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