Wednesday, September 30, 2015

Building resiliency

What's the secret of building resiliency, the ability to withstand unexpected challenges, into your organization?  Lots of leaders I know take this attitude: "When the crunch comes, we'll deal with it. I'll explain that we have a burning platform, and the team will respond."

Well, yes, they will, but to the extent that you succeed in handling the crisis?  If so, will the team respond in a way that creates the potential for future success, or will the effort just get you through the crisis?

A recent story [subscription required] in the UK Health Service Journal shows what happens when an administrative fiat is issued to deal with a budget shortfall.  Excerpts:

The financial ‘stretch targets’ and emergency measures imposed by NHS regulators will fail to make significant inroads into the total provider sector deficit, analysis by HSJ reveals.

Providers had forecast a combined year-end deficit of £2.1bn at the start of 2015-16, which prompted Monitor and the NHS Trust Development Authority to order them to revisit their financial plans for the year in August.

Emergency measures were announced, such as a recruitment freeze for non-clinical roles, while many trusts were asked to work to new stretch targets or control totals.

[HSJ[ findings revealed that at least 13 of these organisations were not given stretch targets, while at least seven have declined to alter their plans. For three organisations, their positions deteriorated.

Contrast that experience with the one at my former hospital when we faced a budget crunch in 2008-9 because of the financial crisis.  For several years, we had built a culture to support a learning organization, one in which the staff felt empowered and engaged and encouraged to redesign work flows.  When the bad numbers hit, we asked people to consider whether they would be willing to make sacrifices to save the jobs of others.  They did, willingly and enthusiastically.

Brian, from finance, said:

Obviously, I want to keep this job. I’m sure I echo most people’s thoughts when I say that no one wants anyone else to be laid off, and we are all willing to do whatever is necessary to make sure that as few as possible actually lose their jobs.

Catherine, a nurse, offered:

I would be more than happy to forgo a pay raise and reduce my earned time if that would mean another person in the hospital could keep their job. I think this is a great idea and I hope my colleagues feel the same.

And Bernice, an MRI technician, agreed:

I would rather take the loss of my yearly raise than see a fellow employee laid off.

And another:

I know the next few months will be extremely difficult for all of us. But it is so comforting to know that the people I work with are not just sitting back and letting things happen.

After this afternoon’s meeting, we had our own “post-town meeting meeting” to review what you had said, and to toss around suggestions. I know those little meetings are happening all over the medical center. I have never been prouder of the people I work with and the hospital I work for.

The challenge also enhanced our internal sense of community.

Lois, a manager in our Department of Medicine, said, “I think we will learn much from the process. I even dare to believe that we will become a community of healing for one another, just as we are for our patients.”

The end result of this entire process was that we were able to balance the budget with hardly any layoffs. And much to our amazement, we achieved national renown for our hospital. Readers emailed a Boston Globe story by Kevin Cullen detailing the events to over 14,000 other people around the world. The story was also posted on the Yahoo home page for an entire day, viewed there by hundreds of thousands of people. ABC news, NBC news, and PBS all came to do feature stories, seen by millions of viewers.

The pride among our staff was palpable. Patients, too, felt a part of the story and helped spread the word. Here’s a note from Bob, who had had cardiac surgery at our hospital:

I just watched the NBC clip about the employees of BI. I must tell you how much I appreciated the care that I received from all of the folks who attended to me while I was recovering from my surgery. This is most true of the ‘low-level’ employees. The folks who helped me wash, brought me my meals and took me for my x-rays were all professional and courteous. For this reason alone, I am so glad to hear of the efforts all of the BIDMC employees to ensure that everyone can keep their jobs.

About a year and a half later, we were able to restore the salary and benefits to our staff, and even pay a small bonus when our business improved. Jerry wrote a typical response: 

I’m sure you were inundated with thank you emails for this bonus, but I felt the need to add mine to the list. I also wanted to mention that when I told my wife about this she said, “What a wonderful place to work. That would have never happened at my company.”

I’m sure the five hundred dollars will come in handy, but the fact that our leadership even thought of this is what makes BIDMC such a great place to work. We came together when times were tough, and now we are sharing the wealth as finances improve. To me this sounds more like a family than a workplace.


Mike P-J said...

Whilst I applaud your example, my understanding is that a lot of staff in the UK NHS are on nationally agreed payscales, and so there's no option for taking voluntary pay cuts.

The broader idea that staff who are engaged will go the extra mile for the sake of the organisation is valid though.

Kashif Sheikh said...

Great piece. Lois's quote, "I think we will learn much from the process. I even dare to believe that we will become a community of healing for one another, just as we are for our patients," sounds like it could be the mission statement for any health organization.

gene lindsey said...

As an observer who was part of the senior management of an organization that was struggling through the same difficult times, I was encouraged by the show of community by the BIDMC family. That alone was enough to reassure our us that our organization and most importantly our patients would benefit greatly if we could have a closer relationship to the BIDMC. A culture of commitment can not be built easily or quickly and it is impossible without senior leadership that has empathy for its customers and everyone in the organization. I do believe that a culture like the one at BIDMC can be infectious and benefit those outside the organization. It always helps to have an example "of what good looks like".

Gene Lindsey, CEO emeritus, Atrius Health

Michael said...

Those Foundation Trust targets are significant and would require major changes in the way work is organized. Those that set those ‘stretch’ targets failed to spot (or maybe in their desperation chose to ignore) the major changes are required. Those that don’t properly understand how the NHS ‘system’ works are always going to fall prey to such tempting solutions. After all drawing a trajectory on a graph is very easy to do and can look very convincing even if it is based on thin air with a sprinkling of fairy dust.