Bringing FISH! To Temple University Hospital

Greg ForesterCOMM 560 Comm. Issues for LeadersRider UniversityCatching FISH! At Temple University HospitalAbout Temple Univ. Hospital (TUH)Major Philadelphia hospital and academic medical centerFlagship facility of Temple University Health System (TUHS)600 patient beds in cluster of buildings along N. Broad StreetSpecialty & tertiary care including Heart, Lung, Cancer, GI, Ortho, Neuroscience, BMT & more4000 FTEs & $600 million/year in annual revenue

Key Figures for Organizational ChangeTUHS CEO, TUSM Dean, & Senior Executive Vice President, Temple Health Sciences Larry Kaiser, MDIn 2011, brought established record of excellence at Penn Medicine & University of Texas Health System to TUHSWell-respected by physicians and staffTUH CEO Sandra L. Gomberg, RN, MSNRose through the ranks, with a nursing backgroundGenerally respected despite friction in 2009 nursing strikeGood grasp of leadership theory and strategy.Always willing to implement new, forward-thinking strategiesProblems Facing TUH in 2011 Structural budget deficit Poor payer mix of approx. 80% medical assistance (Medicare & Medicaid) Organizational Inferiority Complex But Were Only Temple 2009 Nursing Strike-related tensionsFirst FISH! Tenet: Be thereTo be there for another person has a powerful effect.Being there means giving someone undivided attention and focusing on needs and feelings vs. not being there, as in someone who barely looks at you.Includes listening but goes beyond that to Dialogue vs. Debate First FISH! Tenet: Be thereDebate: focused only on info. related to attack and retort & drowns out good listening.Dialogue: first step is actually listening to the person.Listening properly means discarding our own preconceived notions/judgments.Being there is not easy due to distractions of the modern world and workplace.First FISH! Tenet: Be therePutting in the effort pays dividends in better understanding, reduced mistakesMore valuable, profound relationships based on deep understanding.According to FISH!, being there requires awareness, commitment and practice.

Being there at TUHNursing Strike-related tension offers TUH leaders great opportunity.Implement the first tenet of FISH! and Be There for marginalized, adversarial stakeholders by mastering Be There focus and applying it to TUH.End of strike was not end of strife: Nurses union continues contentious relationship with management.Disparages TUH and its leaders in media and incendiary communications.Leadership recommendation: Be There for union members by proposing Retreat and/or series of sit-down meetings regarding ongoing grievances.Seek common ground, prepare to negotiate, but initially listen to union members about their genuine concerns regarding compensation, benefits, tuition remission..Go beyond FISH!...by pursuing shared meaning via dialogue.Potential areas of common ground include concern for patient safety and attention to hospitals long-term fiscal sustainability.Good Faith effort in listening & dialogue could yield results.Being there at TUH (cont.)Second FISH! Tenet: PlayFISH! advocates incorporating play into daily workplace environment.Invigorate work responsibilitiesLighten challenges with energy and enthusiasm.FISH!: Plays impact best innovations in the world are a result of playEven serious organizational environments with dire responsibilities benefit from playfulness.Second FISH! Tenet: Play (Cont.)Allows organizational stakeholders to tap into their inner, innovative beingPlay helps organizations with unearthing that which helps (us) fly forward into the future.FISH! Says play speaks to that kid we all still have deep inside of us.Results in engagement and involvement.Play draws out the Why? or How come? Second FISH! Tenet:Playing at TUHTUH leadership already has some success in incorporating play into daily workplace.Human Resources leadership understands value of invigorate work responsibilities and makes frequent attempts (Thanksgiving Build-A-Meal, Uniform Donations, Wellness Campaign).However, play opportunities are uneven in terms of departmental participation, especially between clinical units vs. support. Second FISH! Tenet:Playing at TUH (Cont.)Counteract disparity by asking support departments such as Environmental Science and Patient Transport to Play within initiatives that stimulate feedback, dialogue, and development of useful innovations.Apply to serious envts such as CT Surgery, Security, and Oncology.Key Leadership Idea: ensure Play opportunities tap into TUHs diverse workforce by ensuring participation of staff members at all levels, not only in actual Play events and initiatives but in their development.Third FISH! Tenet: Choose Your AttitudeCommon to attribute cause of the most negative attitudes and emotions to external forces.Negative emotions are often related to unpleasant experiences or negative people.FISH! states while external pressures may triggerfeelings, we (wear) those feelings. FISH! Presents a choice for stakeholders comprised of either being subservient to external events, few of which we have any control over, or we can take charge of our own response.

Third FISH! Tenet: Choose Your Attitude (Cont.)Important note:Choosing your attitude does not mean adopting false external emotions and dispositions that do not reflect true sentiment.FISH! Accepts genuine anger or sadness, using it as a jumping point to emphasize the importance of choosing ones attitude.With attitude awareness, stakeholders are less likely to externalize emotions.Choose your attitude helps stakeholders shape emotions more productively and more satisfactorily.You control your attitude, not the other way around.

TUH inferiority complex stimulates widespread externalization of attitudes, related to organizational dysfunction & self-fulfilling prophecy of cultural attitude infecting effort and reducing value of results.Negative emotions at TUH are usually linked to other physicians and staff or faraway bureaucratic departments and entities.Leadership Idea: Develop FISH! Workforce program to instill FISH! Ideas into all levels of the organization, especially attitude tenet.Helping Staff Choose Their Daily Attitudesand Improve TUH (Cont.)Helping Staff Choose Their Daily Attitudesand Improve TUH (Cont.)TUH physicians and staff must understand negative attitudes and mediocre work and customer service impact all areas of the organization, especially those in direct contact with patients.Negative staff emotions incite negative patient emotions that may very well end up on Patient Satisfaction surveys.Pat/Sat surveys soon linked to insurance reimbursement, providing strong incentive to TUH to grasp attitude choice and enhance Patient Satisfaction scores.Leadership Idea: Following attitude seminars, offer Play opportunities linked to Pat/Sat scores that encourage collaboration and offer prizes/recognition. Make Everyones Day at TUH Make their day runs the full spectrum of larger events and productions of showing appreciation and kindness to simple actions (with) potential to brighten someones day. Tenet means taking a genuine interest in..gifts of others. Regardless of planning, Make Their Day actions denote those in which stakeholders make the effort to brighten someones day without reference to the potential for punishment or reward. Two-way process, because doer receive(s) an internal gift that makes lifemore meaningful . FISH labels a making their day-type action as a win-win. Make Everyones Day at TUHTUH has recently taken up the mantle of Make their day on an organization-to-employee basis via Service Awards.Program recognizes staff members for five-year employment milestones and retirements after a lengthy tenure at TUH.Other organizational recognitions include lauding efforts of specific clinical units within Pat/Sat and Env. Safety programs.Less organized recognitions include opportunities for staff to recognize colleagues at Town Hall meetings.However, TUH has room to institute a more widespread culture of Making Everyones Day via educational seminars and more stakeholder collaboration on new programs.

Make Everyones Day at TUHWith taking a genuine interest in the unique gifts of others in mind, TUH could encourage clinical & support departments to develop their own programs for recognition.One idea: propose a program of Secret Shoppers who perform Direct Observations of staff members, with employees who perform good deeds eligible for every-changing recognition.Plan removes transactional nature by using different rewards and recognition, which could be slowly phased out if either culture changes or the program fails.In the event of success, the hope is that recognized staff members gain the internal gift that makes lifemore meaningful that encourages continued Make Their Day actions in the future, and among other staff.Conclusions.FISH! tenets offer attractive addition to TUH initiatives aimed at closing the structural deficit and ensuring sustainability: cost-cutting, smart purchasing and staffing, directed marketing and expansion, and talent recruitment.Beyond these additions, FISH! Tenets could harness potential of dormant employee groups and enhance organizational culture.FISH! features like Play and Make Their Day promise a more engaged workforce more likely to go beyond work duties.Choose Your Attitude offers opportunities in enhancing staff relationship with patients and visitors, as well as other emps.Be There offers an opportunity to put to rest the key conflict remaining between nursing staff members and management.