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Making Transparency Visible in Today's Healthcare Organizations

Today's integrated healthcare organizations are challenging from a leadership perspective, in part because they're formed by consolidating the varied and disparate cultures of regional hospitals, physician groups, labs, outpatient clinics, and other entities.

Today's integrated healthcare organizations are challenging from a leadership perspective, in part because they're formed by consolidating the varied and disparate cultures of regional hospitals, physician groups, labs, outpatient clinics, and other entities.

Each of these member entities brings its own cultural norms and ways of doing things to the new organization. How do you manage them and get them integrated and all working together in the name of cost-effectiveness and competition? How to you get employee buy-in to meet the organization's business objectives of high performance and profitability?

Start with Values

Creating a value-centric culture is how leadership can achieve the behaviours they desire from employees. That's because culture drives behaviour, not the other way around. Many leaders have this backwards.

People who work in healthcare already possess good and solid values -- but the organizations' culture prevents them from living these values at work. Surgeon Marty Makary offers an example of this in his excellent Wall Street Journal article, "How to Stop Hospitals from Killing Us." He says, "In a business where reputation is everything, doctors who call out other doctors can be targeted." So, the behaviour of looking the other way, which has become ingrained in the culture many doctors were accustomed to, may prevent them from doing what's right in the new, integrated organization. There are many examples of such carried-over behaviours in every facet of today's health systems.

Makary suggests a key to reducing poor performance in hospitals is finding ways to increase transparency.

Making Transparency Visible

Agreed -- transparency is an excellent place for leaders to begin healing their healthcare organizations. But transparency can be so vague, so...invisible. What exactly is it, and how can leaders translate this key value into everyday attitudes, operations, policies, and procedures that employees can see, experience, and internalize?

In order to instill values into the culture, leaders must break down broad concepts like transparency into smaller bite-size pieces. Here are some ways to do it.

Identify the Current State of Transparency

Get a sense of your baseline. Do your employees see transparency? How important is transparency to them at every level and function? Where do they see the barriers and obstacles to being transparent?

A values assessment will reveal the actual values embodied by your employees, the values they see in the current environment, and which values they feel are essential to be high performing and successful. This data, gathered through web assessments and interviews, also provides real, concrete evidence that will help leadership develop communication strategies to help employees adapt to the new realities of their organization.

Identify Behaviors that Support These Values

Makary recommends concrete steps to help employees "live" the value of transparency in hospitals, such as placing cameras in the operating room, publishing safety statistics and performance ratings, and rewarding employees who speak up on behalf of endangered patients.

However, before such interventions will be accepted and seen as a positive, leadership needs to lay a foundation of trust. Employees need to be part of the decision-making process. Leadership needs to communicate clearly why these changes are important and how they will benefit everyone. And they must also listen to employees' reservations and fears and present a detailed and specific plan for how those concerns will be addressed and overcome.

Require and Encourage Accountability

Find ways to strengthen teamwork -- where the performance of one affects the good of all. In a survey of 60 hospitals, those where 99 per cent of the staff reported good teamwork had the lowest infection rates and best patient outcomes. Being accountable to one's team translates into higher profits for the organization.

Accountability is built on two core foundations. The first is interpersonal relationships that focus on basic respect and on removing blame. The second is a strong sense of trust, in which everyone feels that leadership acknowledges inconsistencies and confusion -- and is seen as actively working to overcome these. In such an environment, employees are not only less skeptical of having their personal results publicized, but there's a positive sense of competition and camaraderie to achieve optimal results.

Make procedures logical.

If health system employees view new procedures as a waste of time, they'll never comply. Data is a good example. Under the new reform, healthcare organizations are now data-intensive in terms of number of surveys undertaken. Yet even though the industry is awash in data from reports, surveys, and evaluations, most employees agree that this new data isn't improving patient care.

Leadership can play a central role in aligning procedures with values by demanding a logical answer to the question, "How does this rule or requirement help us be more transparent and improve patient outcomes?" Reward employees who ask the same question. When a rule makes sense, employees embrace it.

Help employees live their values.

If the value is true patient care, then everyone has to be able to ask questions -- and speak the truth. Drill down to find out why anyone wouldn't be comfortable raising an issue. Bring it out in the open and address ways to remove each roadblock to transparency as it arises.

In organizations where employees feel there will be a witch hunt or unfair blame, they'll resist sharing their concerns. Find ways to encourage the airing of problems, solutions, and suggestions, whether it's through meetings or by rewarding whistle blowers. When employees have a sense of common goals and a desire for mutual improvement, fear of telling the truth dissipates.

Acknowledge inconsistencies.

Inconsistency shows itself in many ways--for example, a policy such as mandatory hand washing that's not enforced and therefore not taken seriously. That's an inconsistency between what management says versus what it does. Another type of inconsistency would be policies that seem to be unfairly imposed on one group but not another. Or a policy that's seen as not effectively addressing the issue that needs to be solved.

The leader's role is to sift through everyday operations and find practices that are inconsistent with the culture's core values. When a leader actively looks for an inconsistency and singles it out, employees see that leadership really cares.

Transparency Is Step One

Even if leadership makes the right decision about the importance of instilling transparency as a key value in their organization, they are only at step one. Transparency is the pinnacle of a series of actions that create a set of building blocks. These building blocks support the end goal of an integrated, cohesive, value-based culture.

To start, leaders must first understand and deal with fears and frustrations that block employees' ability to hear the messages and get on board. They then must address both the interpersonal barriers to transparency, namely a lack of trust, and then operational barriers to transparency, namely perceptions of bureaucracy, confusion, and inconsistent application of policies. Only then will the workforce be open to steps that enhance their sense of common purpose and mission, such as transparency in how everyone does their work.

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