How to Lead and Inspire a Team
Emergency Department Directors Academy – Phase II How to Lead and Inspire a Team May 2011 5/9/2011 Building and Leading Teams in the Emergency Department Thom Mayer, MD, FACEP, FAAP Building, Leading and Inspiring Teams 1 5/9/2011 Huddle Up! Winners OWN Teamwork 2 5/9/2011 Teammates or Cowboys ? Our View of Ourselves? 3 5/9/2011 Teams – People Doing What I Want ? • “All I wanted was compliance with my wishes after reasonable discussion.” • The Second World War Teamwork itself is an End Result • Outcomes have their distinct “impact value” (Patients First) • The experience of the process itself “collaborative collaborative value” • (Value to the Team) 4 5/9/2011 3 Key Aspects of Team Building Integrity g y of the Data and the Leader Incentive Trust iin the h process To be an effective ff i team member Maslow’s Hierarchy of Needs and Your Emergency Department Best Practices A “Best in Class” learning organization Patient flow, Patient satisfaction, + Workforce Satisfaction Teams and Teamwork Effective leadership Is the ED Staffed? Right people, Right number, Right mix 5 5/9/2011 Leading Teams=Connecting Silos Silos Are Not ALL Bad • Training • Practice P ti • New knowledge and skills • Sense of identity • Culture • Familiarity and comfort 6 5/9/2011 Silos-The Patient’s View Triage Placement Triage and Registration In the ED MD Call for Bed or Discharge Exit ED Disposition Decision to Exit the ED Test and Treat Room Utilization Room Utilization Opportunity for Improvements within each Sub Cycle If You… • • • • • Establish silos Tolerate Silos Measure by Silos Punish by Silos Reward by Silos… 7 5/9/2011 You Will Inevitably Get… Don’t Let Life Be a Surprise to You! • We should never be surprised when people working in silos defend th i turf! their t f! 8 5/9/2011 Fill the Gaps with A Team Processes Leading Teams • Leveraging Capacity • “Give me a lever long enough and I can move the world.” Archimedes • Teams in a fundamentally capacity-constrained environment • Strategic Connectivity • My distinctness-What do I do to the exclusion of or different from others • Others distinctness-What I don’t but others do Connectivity/Flow-seeing seeing connections and capability • Connectivity/Flow where others may not • “I’m your doctor, even when I’m not in the room. Let the team know and they will let me know.” 9 5/9/2011 Beware of Old Habits • Anchoring • If you always l do d what h t you always l did, did you’ll ’ll always get what you always got. • One definition of insanity… • Anchoring Bias • “We can’t have the nurses attend our meetings!” • “We can’t ask the nurses to rank us!” • “Nurses aren’t trained to make treatment decisions-we are!” Team Work and the 5 “Whys” • • • • • • “We don’t need scribes in our ED.” Why? “I’m doing just fine without them.” Why? “Because I’ve worked 20 years without them.” Why? You also worked 20 years without angioplasty for AMI’s • ‘I’m uncomfortable with scribes.” • Why? • “I really don’t want someone watching me while I work!” 10 5/9/2011 How Do You Select Docs? The Problem of the Apostrophe Physicians/Nurses Physician/Nurse Leaders • “My job is to meet my patient’s needs.” d ” • “My job is to meet our patients’ needs.” d ” 11 5/9/2011 Stakeholder Analysis Boundary Mgt • Who are the key stakeholders in any given issue? • What do they view as their stake? • What do you view as their stake? • How can that stakeholder influence the change you are undertaking? • Healthcare is an infinite series of boundaries • Creating a boundaryless organization • Leading the charge in minimizing “boarder patrol” issues • Putting the patient first-ALWAYS !!!! Case Study Opening the Back Door of the ED • • • • You have made incredible progress on LOS for nonadmitted d itt d patients, ti t through th ha series of brilliant strategies on “Front End Flow.” However, boarding and decision to inpatient bed is still abysmal And now it is clearly causing your non-admitted LOS gains to erode How are you going to affect change? Who is critical to this change management effort? • • • • • Who are the key stakeholders in this issue? What do they view as their stake? What do you view as their stake? How can that stakeholder influence the change you are undertaking? How can y you let Rule #1 g guide the process? 12 5/9/2011 The number one sign of the health of an ED is the relationship between the physicians and the nurses MD • • • • • • • • Autonomous Authoritarian Hierarchical Intense, focused time Outcomes-driven Technical expertise Problem Solver Linear perspective RN • • • • • • • • Team-Dependent Collaborative Communications Expanded time Process-driven Interactive-service Critical thinking skills Circular perspective 13 5/9/2011 Biggest Teamwork Problems Nurses Only! Biggest Problems-Nurses Perspective • • • • • • • Lack of teamwork L k off collaboration Lack ll b ti Lack of appreciation Critical reasoning skills underutilized Too much charting p in new hires Too little experience Lack of accountability for results 14 5/9/2011 What Do Nurses Want? “Excellence is what we strive for-but consistency is what we demand.” Spinoza ED Docs and Nurses • • • • • • We are educated differently Our vocabulary is different We dress differently We spend our time differently Yet… We share the same space, the same goals, the same constraints, the same frustrations • We are “strapped to the mast” together, like it or not 15 5/9/2011 Key Issue-360 Degree Feedback • Great idea-you go first! • Do you value nursing? • Will you have nurses evaluate you? • Do you get to evaluate them? • Does it make us better clinicians? • Quality of the feedback • Ability to integrate feedback into action Do Your Nurses… • Interview physician candidates? • Have a voice in a 360 degree evaluation of the physicians? • Feel that their concerns will be used to hold physicians accountable? • Feel comfortable brining “gestalt” problems to you? • Hold their nurses accountable? • Is there a double standard? • Have a voice in ED operations decisions? 16 5/9/2011 What Makes a Great ER Nurse? 1. 2. 3. 4. 5. What Makes a Great ER Nurse? • • • • Talent Teamwork Leadership Execution 1) Customer Service 2) Communication 3) Flow PATIENT FIRST ANTICIPATION COVERS YOUR “SIX” NEVER SURPRISED LOVES INNOVATION… 17 5/9/2011 What are the biggest Nursing Problems Your ED Faces? • • • • • • • • Nursing Shortage (Vacancy rate) Lack of Experienced Nurses How many actually show up? Language issues Loss of “institutional memory” Lack of accountability Turnover “Pit Bull” Charge Nurse lacking Biggest Problems-Nurses Perspective • • • • • • • Lack of teamwork L k off collaboration Lack ll b ti Lack of appreciation Critical reasoning skills underutilized Too much charting p in new hires Too little experience Lack of accountability for results 18 5/9/2011 ED Docs Must Be… • Capable p of “playing p y g in the sandbox” • Team Leaders • Team Followers • The strongest advocate for nurses in the ED • The strongest advocates for nurses in the hospital • Servant Leaders ED Leadership Team-Monday Rounds • • • • • • • • Chair Medical Director Pediatric Medical Director Senior Patient Care Director Patient Care Directors Purpose-Where have we been ? Where are we going this week? Problems from the weekend 19 5/9/2011 ED Leadership Team-Department Mtg Senior PCD attends every Department Meeting g Keeps problems small Purpose Information flow with regard to nursing projects Manage “P and Moan” factor Direct communication for f all emergency physician with senior nursing leadership What can we do to make your job easier? ED Leadership Team- ED Ops and PI • • • • • • • • • • Emergency Physicians Nurses Lab Imaging Registration Scribes Bed Board Social Services EMS/Helicopter Purpose-Common Huddle for all ED Ops 20 5/9/2011 MD-RN Leaders • • • • • • • • Proactive, positive relationship MD as the strongest advocate for nurses Frequent meetings Supportive relationship Team goals, team results Empowerment, not autonomy S k and Seek d celebrate l b t small ll victories i t i Celebrate publicly The Huddle • • • • • • • Charge Doc Charge Nurse Nursing Supervisor Bed Board Proactive Positive Predictable 21 5/9/2011 If you could do three things to improve your Emergency Department, what would they be… 1. 2. 3. What Do You Want to See More Of? What Do You Want to Less Of? 22 5/9/2011 What Makes a Great ER? 1. 2. 3. 4. 5. What Makes a Great ER? • Leadership p • Service Excellence • Hardwiring Flow • Creating the Risk-Free ED • Teamwork 23 5/9/2011 Recruitment • What is the ED’s vision (Why?), mission (What?), strategies and tactics(How?) • Chris Argyris- Espoused Strategy versus Enacted Strategy • Why should a highly-talented young gun want to work here? • Why would anyone want to be led by you? • What will I be like in 3, 5, 10 years? • You say “team,” but do you play team? The Cold, Hard Reality of EM • I really don’t care how your ED works when you are there. • I care how it works when you’re not there. 24 5/9/2011 The Wisdom of Lou Holtz At a ffundamental d t l llevel, l thi this is i ALL Change Management. All Change Management requires LEADERSHIP. 25 5/9/2011 “People wish to be settled; but only as far as they are unsettled, is there any hope for them.” Ralph Waldo Emerson Leading Change… Change is an Art… R i t Resistance iis a S Science i 26 5/9/2011 Leading Change… Change is an Art Art… Resistance is a Science… M d l ti R Modulating Resistance i t iis L Leadership d hi Addressing Resistance: Four Steps to Remember 1. Bring the resistance to the surface “I’d like to hear your thoughts on this” “Tell me what concerns you about this” 2. Listen and empathize “You’re right that this will mean some inconvenience” “I can understand how that could be a problem for you” “Is there anything else that you see as a problem?” 3. Probe further and explore options “I want to understand yyour assumptions p about this and how it will affect you” “How can this be made to work from your point of view?” 4. Summarize what you have heard “Here’s what I’ve heard you say” “Let me review what we’ve covered 53 27 5/9/2011 A Wedge… And a Magnet… 28 5/9/2011 THE BEST MAGNET? • IT MAKES YOUR JOB EASIER ! 29 5/9/2011 Change Management The Change Model-Kurt Lewin 1. Unfreeze (shock a system out of stasis) 2. Transform (make purposeful adjustments) 3. Refreeze (engrain adjustments in system) – Change as a journey, not a destination – Communication is critical The Eight Stage Change Process-John Kotter 1. 1 Establish a sense of urgency 2 Create the guiding coalition 2. 3. Develop a vision and strategy 4. Communicate the change vision 5. Empower broad-based action 6. Generate short term wins 7. Consolidate gains and produce even more change 8. Anchoring new approaches in the culture John Kotter- Leading Change . 30 5/9/2011 Kotter & Lewin Unfreeze Change Freeze 1. Establishing a Sense of Urgency 2 Creating a Guiding Coalition 2. 3. Developing a Vision & Strategy 4. Communicating the Change Vision 5. Empowering Broad-based Action 6 Generating Short 6. Short-term term Wins 7. Consolidating Gains & Producing more Change 8. Anchoring New Approaches in Culture Kurt Lewin, "Frontiers of Group Dynamics", Human Relations, Volume 1, pp. 5‐41 How to Raise Urgency More honest Too much discussion of discussion of happy talk problems in from senior newsletter and management speeches Rewards for Busy/ stressed seizing future people tend opp. & current toward denial inability to pursue them Low Low‐ Use confrontation, consultants etc low‐candor, to force more kill‐the‐ honest messenger discussion culture Create a crisis Absence of a major and (allow visible crisis financial loss) Too many Too many Eliminate visible visible excess resources URGENCY Set targets Low overall that can’t be performance hit via standards business as usual Hold Narrow accountable functional for broad goals for measures, not employees subunits Require talking Lack of with external unsatisfied feedback on customers, performance unhappy suppliers Share more Focused on the results with wrong employees, performance esp. versus measures competitors Kotter, John P. Leading Change. Harvard Business School Press, 1996. 31 5/9/2011 2. Form a powerful guiding coalition • Change efforts often start with just 1-2 people. people • But they must continually ripple to include more and more who believe the changes are necessary. • The need in this phase is to gather a large enough initial core of believers (3 (3-5 5 people) people). • This initial group should be relatively powerful. • They help bring others on board with the new ideas. Kotter, John P. 1995. Leading Change: Why Transformation Efforts Fail. Harvard Business Review. 73(2): 59‐67. Adopter Categories Innovators Early Majority Late Majority Early Adopters 2.5% 13.5% Laggards 34% 34% 16% Source: Rogers, 1995 32 5/9/2011 3. Create a vision • A picture of the future that is relatively easy to communicate and appealing to the stakeholders. – What will be better? How will I fit? • Helps clarify the direction in which an organization needs to move. • Useful rule of thumb: – If y you can’t communicate the vision to someone in 1 minute or less and get a reaction that signifies both understanding and interest, you are not yet done with this phase of the transformation process. Kotter, John P. 1995. Leading Change: Why Transformation Efforts Fail. Harvard Business Review. 73(2): 59‐67. 4. Communicate the vision • Estimate how much communication of the vision is needed, and then multiply that effort by a factor of 10-20 ! • Insufficient: – Holding a single meeting or sending out a single communication. – Making speeches to group of employees. – Newsletters • Walk the talk talk, nothing undermines change more than wrong behavior by important individuals. • Tip: – use every existing communication channel and opportunity. Kotter, John P. 1995. Leading Change: Why Transformation Efforts Fail. Harvard Business Review. 73(2): 59‐67. 33 5/9/2011 Beware Signal Loss CEO to VP: Today at 11:00 there will be a total eclipse of the sun. This is when the sun eclipse of the sun. This is when the sun disappears behind the moon for 2 minutes. This is something that cannot be seen everyday. Time will be allowed for employees to view the eclipse in the parking lot at ten till 11, when I will deliver a short speech introducing the eclipse and giving some introducing the eclipse and giving some background information. Safety goggles will be made available at a small cost. Contributed to Swenny's E‐mail Funnies by Ajay Ambastha, Mumbai, India Beware Signal Loss VP to Director: Today at 10 till 11 all staff should VP to Director: Today at 10 till 11 all staff should meet in the parking lot. This will be followed by a total eclipse of the sun, which will disappear for two minutes. For a moderate cost, this will be made safe with goggles. The CEO will deliver a short speech beforehand to give us all some background information. This is not something that can be seen every day. y y Contributed to Swenny's E‐mail Funnies by Ajay Ambastha, Mumbai, India 34 5/9/2011 Beware Signal Loss Director to Manager: Today the CEO will deliver a short speech to make the sun disappear for 2 minutes in an eclipse. This is something that cannot be seen everyday, so people will meet in the d l ill t i th parking lot at 10 or 11. This will be safe, if you pay a moderate cost. Contributed to Swenny's E‐mail Funnies by Ajay Ambastha, Mumbai, India Beware Signal Loss Manager to Supervisor: Ten or eleven staff are to go to the parking lot where the CEO will eclipse the sun for 2 minutes. This doesn’t happen every day. It will be safe, but it will cost you. f b t it ill t Contributed to Swenny's E‐mail Funnies by Ajay Ambastha, Mumbai, India 35 5/9/2011 Beware Signal Loss Supervisor to Employees: Some employees will go to the parking lot today to see the CEO disappear. It is a pity this doesn’t happen every day. Contributed to Swenny's E‐mail Funnies by Ajay Ambastha, Mumbai, India 5. Empower others to act on the vision • • • • People don’t resist their own ideas. Even if they y can’t p plan “what” they y can p plan “how”. Remove any key obstacles to the change. Nothing is more frustrating than believing in the change but not having the time, money, or support needed to effect it. • Potential obstacles for employees: – Narrow job definitions. – Compensation and appraisal systems. systems • The action is essential both to empower others and to maintain the credibility of change effort. Kotter, John P. 1995. Leading Change: Why Transformation Efforts Fail. Harvard Business Review. 73(2): 59‐67. 36 5/9/2011 Empowering People to Effect Change • • • • Communicate a sensible vision to employees M k structure Make t t compatible tibl with ith the th vision i i Provide the training employees need Align information and personnel systems to the vision • Confront supervisors who undercut needed change Kotter, John P. Leading Change. Harvard Business School Press, 1996. 6. Create short-term wins. • Change takes time. High risk for loss of momentum and the onset of disappointment. • Most people won’t go on a long march for change unless they begin to see compelling evidence that their efforts are bearing fruit. • Balance “preparing for” and “implementing” • PLAN short-term gains, hit them, celebrate them. Don’t just hope for them. them • Commitments to produce short-term wins help keep the urgency level up. Kotter, John P. 1995. Leading Change: Why Transformation Efforts Fail. Harvard Business Review. 73(2): 59‐67. 37 5/9/2011 7. Consolidate gains & create more change • Don’t declare victory too soon. That kills momentum. Old traditions reclaim ground. • Can take 5-10 years to sink deeply into a culture • New approaches are fragile and subject to regression. • Use the feeling of victory as the motivation: – to expose opportunities for more tuning – to move people committed to the new ways into key roles Kotter, John P. 1995. Leading Change: Why Transformation Efforts Fail. Harvard Business Review. 73(2): 59‐67. Anchoring Change in Culture • • • • • Culture comes last, not first Depends on results Requires a lot of talk May involve turnover Makes decisions on succession crucial Kotter, John P. Leading Change. Harvard Business School Press, 1996. 38 5/9/2011 Nothing so needs reforming as other people’s habits. Mark Twain Your Thoughts on Doc-RN? 39 5/9/2011 Integrating Administration into the Team • • • • • • • • • • Align strategic incentives. Define success –and its metrics Meet frequently-use time judiciously The power of the carbon copy, email, voice mail Frame questions cautiously Understand the language, philosophy, strategies Inform them of problems prospectively Public praise, private problems B responsive Be i If it’s an ED problem, it’s your problem “There’s a new Sheriff in Town” CMO • Relatively new addition to the leadership team • Deep joy/deep need or tired of clinical practice • Varied backgrounds • Varied training for the position • Friend or Foe? • Beware management by anecdote • Move upstream to his/her sources 40 5/9/2011 Negotiation Skills • Negotiation is a fundamental skill of all leaders • The best are highly nuanced • The best know they can often win big by not always winning • Negotiation is not exclusively an innate skill • There are excellent resources available for learning and enhancing negation skills The Role of the BATNA • • • • • Best Alternative To a Negotiated Agreement What are you left with if negotiations break down ? 41 5/9/2011 The BATNA • • • • • • • • Spend some time on it, know it, write it down Keep p it to yourself y (lots ( of p power in timing) g) The greater your BATNA, the greater your power Like all power, the strength is in not using it (until the time is right) However, if they know you can walk away, your power increases The Trip Wire (above the BATNA) Boost/grow your BATNA Know their BATNA BATNA Versus Best Agreement • Best Negotiated Agreement N Negotiate! ti t ! • • BATNA • Best Negotiated Agreement Don’t negotiate! • BATNA 42 5/9/2011 The ED Leader and the Medical Staff • • • • • • Align strategic incentives M t l respectt and Mutual d appreciation i ti Round on admitted patients Round in the MD lounge Focused, succinct clinical summaries g summaries on ALL Obtain discharge admitted patients • Inform leaders prospectively on inflammatory lesions Despite the elegance of the plans, one must occasionally look at the results. 43 5/9/2011 Of all the will toward the ideal in mankind only a small part can manifest itself in public action. All the rest of this force must be content with small and obscure deeds. The sum of these, however, is a thousand times stronger than the acts of those who receive wide public recognition. The latter, compared to the former, are like the foam on the waves of a deep ocean ocean. Albert Schweitzer, MD Out of my Life and Thought 44 5/9/2011 References References Berwick D. A primer on leading the improvement of systems. BMJ 1996; 312: 619 622 619-622. Langley J, Nolan K, Nolan T, Norman, C, Provost L. The Improvement Guide. (San Francisco: Jossey-Bass 1996) Sirkin, H., Keenan P., and Jackson A. The Hard Side of Change Management, Harvard Business Review, October 2005. Tufte, T ft E., E The Th Vi Visuall Display Di l off Quantitative Q i i Information, (Cheshire, CT:Graphics Press,1983) 45 5/9/2011 References Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, N.J.: Prentice Hall, Inc. 1986. Kotler P P., Roberto E.: Social Marketing: Strategies for Changing Public Behavior. New York, NY: Free Press, 1989. Prochaska J., Norcross J., Diclemente C. In Search of How People Change, American Psychologist, September, 1992. Rogers, E. Diffusion of Innovations. New York: The Free Press, 1995. Addressing the human side of change Heifetz, Ron: Leadership Without Easy Answers References • Edwards N, Kornacki MJ, Silversin J; Unhappy Doctors: what are the causes and what can be done? BMJ 2002; 324: 83538 • Derwick DM, Nolan TW; Physicians as Leaders in Improving Healthcare; Ann Inter. Med. 1998; 128 (4):289-292 • Silversin J, Kornaki MJ; Leading Physicians Through Change: How to Achieve and Sustain Results; American College of Physician Executive, 2000. • Heifetz R; Leadership Without Easy Answers; 1994 • Giuliani, R; Leadership; 2002 • Kotter J; What Leaders Really Do; 1999 • Galliour F; “Healthcare Transformation Parts I, II, III;” Health Leaders News; February 2003 • Reinertsen J, Pugh M, Bisognano M; Seven Leadership Leverage Points; Innovation Series 2005 whitepaper, www.ihi.org 46 5/9/2011 References - Developing Leadership 1. Augustine, NR: Managing the Crisis You Tried to Prevent. Harvard Business Review. November - December, 1995. 2. Fisher R and Brown S: Getting Together: Building Relationships as We Negotiate. Penguin Books, 1988. 3. Mayer T: Leadership, Management, Stewardship, and Motivation. In: Salluzzo R, Mayer T, Strauss R (Editors) Emergency Department Manager: Principles and Applications. St. Louis, Mosby, 1997. 4. Mayer T: Departmental Integration Strategies. In: Salluzzo R, Mayer T, Strauss R (Editors). Emergency Department Management: Principles and Applications. St. Louis, Mosby, 1997. 5. Mayer T: Managing Professionals in Organizations. In Salluzzo R, Mayer T, Strauss R (Editors). Emergency Department Management: Principles and Applications. St. Louis, Mosby, 1997. • • • • • 6. Zaleznik A: Managers and Leaders: Are they different? Harvard Business Review, March April 1992: 126-135. 7. Kotter JP: What Leaders Really Do. Harvard B i Business R Review; i M - June, May J 1990 103 1990: 103-111. 111 8. Farrell JR, Robbins MM: Leadership Competencies for Physicians. Healthcare Forum, July/August 1993. 9. Bennis W: On Becoming a Leader. Reading, Massachusetts, Addison-Wellesley; 1989. 10. Block P: Stewardship: Choosing Service Over SelfInterest. San Francisco, Berrett - Cohler Publishing, 1993. 47 5/9/2011 • • • • 11. Senge PM: The Fifth Discipline: The Art and Practice of the Learning Organization. New York; Doubleday: 1990. 12. Herzberg F: One More Time: How Do You Motivate Employees? Harvard Business Review; September - October 1987. 1987 13. Kohn A: Punished by Rewards: The Trouble With Gold Stars, Incentives Plans, A’s, Praise, and Other Bribes. Boston: Houghton Mifflin, 1993. 14. Kohn A: Why Incentive Plans Cannot Work. Harvard Business Review, September - October 1993. • 15. Allison EJ, Vawter JW: Strategic Planning and Missions Statements. In Salluzzo R, Mayer T, Strauss R, (Editors). Emergency Department Management: Principles and Applications Applications, St. St Louis, Louis Mosby, Mosby 1997 1997. • 16. Mayer TA: The Role of the Emergency Department Medical Director. In Salluzzo R, Mayer T, Strauss R, (Editors). Emergency Department Management: Principles and Applications, St. Louis, Mosby, 1997. • Kotter JP: John P. Kotter on What Leaders Really Do. Harvard Business School Press Press, Boston, Boston 1999. 1999 • Kotter JP: A Force for Change: How Leadership Differs from Management. Free Press, New York, 1990. 48 5/9/2011 • Stewardship • Block P: Stewardship: Choosing Service Over Self-interest. Berrett-Koehler. San Francisco, 1993. Frick DM, Spears LC (Editors): On Becoming A Servant Leader: The Private Writings g of Robert K. Greenleaf. Josseyy Bass, San Francisco, 1996. Block P: The Answer to How is Yes. Berrit-Koehler, San Francisco, 2002. • • • • • • • • Change Management Kotter JP: Leading Change, Harvard Business School Press, Boston, 1996. Kotter JP: Leading Change: Why Transformation Efforts Fail. Harvard Business Review, 1995; 73: 59-67. Kotter JP: The Heart of Change, Harvard Business School P Press, Boston, B t 2002. 2002 Lewin K: Field Theory and Social Science, Harper and Row, New York, 1951. Lewin K: Group Decision and Social Change. In: Maccoby EE, Newcomb TM, Harthy EL (Eds). Readings in Social Psychology (3rd Ed) Holt, Reinhardt, and Winston, New York, 1958. 49 5/9/2011 • Boundary Management • Hirschhorn L, Gilmore T: The New Boundaries of the Boundaryless Company. Harvard Business Review, 1992; 70: 104-115. Gilmore T, Leadership and Boundary Management. Journal of Applied Behavioral Sciences Sciences, 1991; 18: 343-356 343-356. Schein EH: How Can Organizations Learn Faster? The Challenge of Entering the Green Room. Sloan Management Review. Winter 1993: 85-92. • • • Negotiation • Fisher R, Ury W, Patton B: Getting to Yes: Negotiating Agreement Without Giving In. Pennwooden Books, NY, 1991. Shell GR: Bargaining for an Advantage: Negotiation Strategies for Reasonable People. Viking, New York, 1999. Ury W: Getting Past No: Negotiating Your Way From Confrontation to Cooperation. 1991, New York, Bantam Books. Sebenius JK: Six Habits of Merely Effective Negotiators. Harvard Business Review 2001; 74: 87-95. • • • 50 5/9/2011 • Teams and Teamwork • Katzenbach JR, Smith DK: The Wisdom of Teams: Creating the High Performance Organization. Harvard Business School Press, Boston, 1993. Oncken W, Wass DL: Management Time: Whose Got the Monkey? Harvard Business Review, November-December 1999: 179-186. Lee TH: Turning Doctors into Leaders. Harvard Business Review, April 2010: 3-10. • • • Leadership Styles • Goleman D: Leadership that Gets Results. Harvard Business Review, March-April 2000: 78-90. Execution Bossidy L L, Charan R: Execution: The Discipline of Getting Things Done. Crown Business, New York, 2002. Charan R: Profitable Growth is Everyone’s Business, Crown, NY, 2004. • • • 51 5/9/2011 Meta-Leadership and Systems • • • Marcus LJ, Dorn BC, Henderson JM: Meta-leadership and national emergency preparedness. Biosecurity and Bioterrorism, 2006, 4 (2), 128134, 134 Marcus LM, Ashkenazi I, Dorn BC, Henderson J: The Five Dimensions of Meta-Leadership, 2007 Schein EH: Organizational Culture and Leadership 2004, San Francisco, Jossey-Bass References • • • • • • • • • • Fitzsimmons J., and M. Fitzsimmons. 2006. Service Management: Operations, Strategy, Information Technology. 5th ed. Boston: McGraw-Hill. G Goldratt, E. 1986. 1986 The Goal. G G Great Barrington: North River Press. Institute for Healthcare Improvement (IHI). Optimizing Patient Flow: Moving Patients Smoothly Through Acute Care Settings. Innovation Series 2003. “Bursting at the Seams: 2004. Improving Patient Flow to Help America’s Emergency Departments.” Urgent Matters Learning Network Whitepaper. www.gwhealthpolicy.org accessed September 17, 2005. Building the Clockwork ED: Best Practices for Eliminating Bottlenecks and Delays in the ED. HWorks. An Advisory Board Company. Washington D.C. 2000. Bazarian J. J., and S. M. Schneider, et al. Do Admitted Patients Held in the Emergency Department Impair Throughput of Treat and Release Patients? Acad Emerg Med. 1996; 3(12): 1113-1118. Full Capacity Protocol. www.viccellio.com/overcrowding.htm Kelley, M.A. The Hospitalist: A New Medical Specialty. Ann Intern Med. 1999; 130:373-375. Holland, L., L. Smith, et al. 2005. “Reducing Laboratory Turnaround Time Outliers Can Reduce Emergency Department Patient Length of Stay.” Am J Clin Pathol 125 (5): 672-674. Husk, G., and D. Waxman. 2004. “Using Data from Hospital Information Systems to Improve Emergency Department Care.” SAEM 11(11): 1237-1244. Christensen, Grossman, and Hwang,-The Innovator’s Prescription, 2009 52 5/9/2011 The Psychology of Waiting • Maister, D. (1985). The Psychology of Waiting Lines. In J. A. Czepiel, M. R. Solomon & C. F. Surprenant (Eds.), The Service encounter: managing employee/customer interaction in service businesses. Lexington, MA: D. C. Heath and Company, L i t B Lexington Books. k • Norman, D. A. (2008) -- The Psychology of Waiting Lines The PDF version is an excerpt from a draft chapter entitled "Sociable Design" for a new bookwww.jnd.org/dn.mss/the_psychology_of_waiting_lines • Norman, D. A. (2009). Designing waits that work. MIT Sloan Management Review, 50(4), 23-28. • Christine M M. Meade Meade, PHD PHD, Julie Kennedy Kennedy, RN RN, BSN BSN, TNS TNS, and Jay Kaplan Kaplan, MD MD, FACEP-The Studer Group- JEM 2008 • Fitzsimmons J., and M. Fitzsimmons. 2006. Service Management: Operations, Strategy, Information Technology. 5th ed. Boston: McGraw-Hill. 53
© Copyright 2024