It’s not unusual for my hospital partners to tell me that some patient experience improvement tactic is mandatory only to find that it’s not really mandatory for everyone. The truth is that change is hard and when push-back occurs, it can be tempting to buckle and give in to the whining and excuses. The problem is that when leaders say one thing and permit another, they lose credibility and build resentment among those who comply.
I was doing a culture assessment a few years ago which started with a meeting with all the hospital executives. I was trying to learn why they had tried so many best practices and yet their scores never improved. When I asked about training and follow through, the CEO said, “It’s mandatory. No one has a choice.” But as he said the words I couldn’t help but notice the body language in the room. Sideways glances, furrowed brows and micro head shakes told a very different story. So like healthcare’s very own Sherlock Holmes I set out on a quest for the truth.
It turns out that their culture is one of making exceptions. The rules don’t really apply to all, and this became evident during the interviews and focus groups. Managers could continually excuse staff from attending training because they were too busy. Too busy for all 140 sessions offered throughout the day and all hours of the night over six months? Vice presidents excused managers from doing “mandatory” coaching conversations because they had over 100 direct reports. It’s not that these managers didn’t complete the conversations. They never even started them. As it turns out, the very departments and managers being excused have the lowest patient satisfaction scores. No surprise there.
It boils down to one thing; what you permit, you promote. My role in the organization I’ve just described was to help the senior leaders see the pattern and very consciously, put an end to their exception thinking. They had to change the question from “if” something would be done to “how” it would be done with a specific deadline.
Allowing a culture of excuses hinders patient satisfaction but also destroys the leaders’ credibility with their team members.