ESSAY ONE

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Course Learning Outcomes for Unit IV

Upon completion of this unit, students should be able to:

4. Relate the concepts of work design, motivation, and information flow.

Reading Assignment

Chapter 5: Leading with Strategic Intelligence and Profound Knowledge, pp. 61-76

Unit Lesson

Healthcare delivery is very procedure-driven and has a high degree of human touch. Unlike some industries where a product is produced, in health care we are providing care for people who are often in their greatest time of need. To create an organization where compassionate care is provided by a motivated team, we must foster a collaborative environment, and we must have great support systems. In this unit, we will focus on motivation, workflow design, and information flow.

Motivation

Any department or facility can have great systems, but what happens if the team lacks motivation? It is often said that people leave bad bosses, not bad jobs. With that in mind, let’s explore practical ways you can create a highly motivated team:

Believe in others: There is a term called the looking glass self, coined by early sociologist Charles Cooley (1902), who put forth that people will often behave as they perceive others perceive them. In other words, we tend to perform to the level we think others think we are capable. To put it differently, people often “play their part.” When you think back to great leaders or coaches in your life, are they not the people who believed in you the most and saw your greatest potential? People often put a lot of stock into what they perceive their manager thinks of them, so believing in others is absolutely critical to bringing out the best in your employees.

Understand that input = output: People in management positions cannot have favorites, giving that positive energy to some and only casually noticing others. Imagine seeing two staff members in the hallway, asking the one warmly how she is doing and providing praise from about her, then briefly saying to the other, “Oh hi.” The employee given the cold reception was given a low energy input, and that is likely the same type of low energy output she will show in her work (i.e., she is more likely to have low productivity and morale). The energy managers input into their staff is usually the type of energy and output they will bring about.

Understand hygiene (extrinsic) versus higher level (intrinsic) motivators: Some base-level factors such as pay or unsafe working conditions can prevent an employee from feeling a sense of satisfaction, while higher level factors such as recognition, achievement and advancement lead to higher motivation. In other words, when base level and extrinsic factors that affect motivation are present (good pay, safe work environment), higher levels of motivation (intrinsic) are more likely to come about (productivity, engagement, etc.). Base-level motivators are often called hygiene factors, a concept coined by Maslow (1942) in his famous “Hierarchy of Needs” pyramid, which shows physiological and safety needs at the base (extrinsic factors), while love, esteem and self-actualization (intrinsic factors) are at the higher levels. Extrinsic factors are things that happen to us (the environment to which we are exposed), while intrinsic factors come from within and represent the care and compassion we give. One of the roles of healthcare managers should be to promote an environment of care, therefore it is vitally important to make sure employees’ base-level (extrinsic)

UNIT IV STUDY GUIDE

Motivation, Workflow Design

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Title needs (pay, equipment, safety) are met, so their higher level (intrinsic) motivation can blossom (compassion, caring, etc.).

Create a learning organization: Health care is so complex and procedure-driven that it is important to have continual education for staff. Learning leads to satisfaction in health care.

Create opportunities for advancement: Many frontline jobs in health care are restricted in by what that certified or licensed person can provide. For example, if a person only has a Certified Nursing Assistant (C.N.A.) or Certified Medical Assistant (C.M.A) certification, he or she is limited in scope of practice of what he or she can do by nature of the certification or license he or she holds. However, this should not limit managers from creating opportunities to advance and be recognized. Consider, for example, creating a “Skills Star” or other type of recognition program where a person can earn more Skills Stars for each level he or she attains. Consider tying that to pay or other types of reward. For example, a C.M.A can earn one star for becoming phlebotomy certified, another star for becoming IV certified, or another for becoming a Licensed Practical Radiology Technician (LPRT).

Encourage innovation: When you want something which requires creativity and something cerebral, the best method is to be clear with the objectives and allow autonomy. It is actually found that bonuses and incentives do not work as well for creative-type (cerebral) tasks, but they do work well for tasks that are more procedure-driven (do this, do that).

Be the example: It is important for managers to work alongside their team to earn their trust. Actions speak louder than words, and the best way for people to see that they are cared about is if they see their managers doing their same work. This is a good way to grain employees’ trust in management.

The employee has a choice: Realize that even as managers are doing all of the above and more, ultimately it is the employee’s choice to engage and be satisfied.

Workflow Design

Let’s examine two aspects of workflow design, systems workflow design and human resource workflow design.

Systems Workflow Design: Consider that preventable medical mistakes are the third leading cause of death (Sanders, 2014), and one can quickly see why having standardized workflows and clinical decision-making matrixes are so vitally important. There is a big push in health care towards standardized workflow, and clinical decision making, or the idea of doing things in an organized way to decrease variability and errors, and to increase decisions made with scientific information and recommended best practices.

As an example, consider a patient who presents at the clinic with a chief complaint of chronic obesity. Using the table below from the National Heart, Lung, and Blood Institute (2010), the doctor will assess the patient’s history and measure the person’s body mass index (BMI), as shown in steps 2-4. Then, based on that information, the doctor will make a decision for the patient’s treatment plan. As you see from the diagram, if the patient does not have a BMI > 25, the recommended treatment plan will flow downward from step 5 and result in education and periodic weight checks (steps 15-16). If the patient does have a BMI > 25, the recommended treatment plan will flow rightward from step 5 and result in goal setting (step 8), dietary therapy, behavior therapy, and physical activity (step 11). These types of clinical decision-making algorithms are embedded into most major electronic medical records (EMRs) and make it very easy for the clinician to know the recommended treatment plan. Click on the image below to view a larger version of the algorithm.

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Common examples of systems workflow design in health care are the standardized order sets in the EMR. For example, a doctor will have a pre-formed order set of diagnostic labs or radiologic studies for a given problem, so that all he or she has to do is click Order. These order sets are based on the most up-to-date science and recommended treatment algorithms. Let’s say a patient with diabetes is presenting in the clinic and he or she has an A1c lab value > 7.0, a hard stop order set will appear for the doctor and have the recommended orders pre-built. All the doctor has to do is click Order and the lab orders will populate, as well as a referral to the Registered Dietician for dietary counseling.

This push toward workflow standardization is largely based in the “Triple Aim” to:

1. Improve the Health of Populations 2. Improve the experience of customers 3. Reduce per capita (per person) healthcare costs

The Triple Aim was authored by the Institute for Health Improvement (IHI) and is frequently referred to and utilized by different healthcare quality improvement organizations.

Human Resource (HR) Workflow Design: There are two aspects of HR workflow design that will be discussed in this section, helping employees excel, and promoting teams of inter-dependence.

Regarding helping employees excel, talented people tend to find themselves in valuable positions in an organization and they are often turned to by colleagues for help (regardless of their position on the company’s organizational chart). This is often known as the informal organization, or the concept that work gets done through the path of least resistance and by those who are the most expert. Managers’ focus is to help employees excel and have the right person for the right job. Managers should have the sagacity to know someone’s talent, and the creativity to find the best work possible for that person. They should always be invested in someone’s growth, rather than in their own interests. Leadership is about the employee, not the manager, and it is about helping people to find their gifts and to be their best.

Regarding promoting teams of inter-dependence, the sign of a good healthcare manager is that things run well when he or she is not there. If everything has to go through the manager, it is a bureaucracy and a crutch of co-dependence. In contrast, the sign of inter-dependence is that the team trusts each other and holds each other accountable, and they are empowered with information and systems such that they can make their own decisions without the manager present. This skill of creating inter-dependence is so important in health care, as operations are a symphony of inter-disciplinary teams (IDTs) of various people with varying licenses and certifications, each working together in harmony for the patient’s outcome.

A few practical tips for healthcare managers to encourage IDT collaboration include:

National Heart, Lung, and Blood Institute algorithm for obesity (National Heart, Lung, and Blood Institute, 2010)

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 provide information and training,

 empower people to solve issues at the most frontline level possible,

 encourage communication and a learning organization, where it’s safe to make mistakes and to speak out (silence kills in health care), and

 hire capable people, delegate, and encourage trust.

Information Flow

Withholding information is a form of control, yet often in management, we are bound to not share too much information. Employees are usually more motivated and productive when they are given the information about why what they are doing is important, or what is sometimes called “sharing the whys.”

Share as much information as you can with your team, and be sure to paint the picture of mission and importance.

References

Cooley, C. H. (1902). Human nature and the social order. New York, NY: Scribner.

Maslow, A. H. (1943). A Theory of Human Motivation. Psychological Review (50), 370-396.

National Heart, Lung and Blood Institute. (2010). Assessment and treatment algorithm for overweight and obesity [Image]. Retrieved from https://commons.wikimedia.org/wiki/File:Assessment_and_treatmentalgorithm_for_overweight_and_o besity.png

Sanders, B. (2014). Medical mistakes are third leading cause of death in U.S. [Press release]. Retrieved from http://www.sanders.senate.gov/newsroom/press-releases/medical-mistakes-are-3rd-leading-cause- of-death-in-us