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August 10, 2019
You address it in the newsletter. You host a zillion small group meetings. You train trainers. You provide incentives. Haven’t you made it clear that jobs are on the line? Don’t they care that this is no longer about “improvement” but about survival? You’ve shouted the organizational imperative from the mountaintop . . . and still your workforce continues to do the same old things the same old way. Why won’t they do their part?
Lesson # 1: Mixed Messaging. We recently finished an audit for a client with a world class nursing workforce. This group had been told for years that if they improved their nursing satisfaction levels they would consequently improve their patient satisfaction scores and patient preference enhancements would drive the organization to new levels of success! It took some doing, but the message eventually was believed and this organization did the hard work of remediating processes, practices and even staffing levels to arrive at the pinnacle of professional excellence: a Magnet designation! They so greatly surpassed expectations that they had the highest nursing satisfaction and patient satisfaction of the 42 hospitals in their system (above 95 %tile in each)! The growth was uncomfortable and difficult, but when it was finally complete, the sense of accomplishment and pride was palpable at all levels of the organization! For about 8 months . . . That was when senior leadership announced that nursing would be required to reduce FTE’s because the hospital was no longer profitable. Of course they, like any good group of nursing leaders, immediately reduced their lowest skilled workforce. Still the profitability continued to erode. So they began an automation push in order to improve productivity. And productivity went down. Now comes the message that they need to revamp their scheduling methodologies, review their pay practices, reduce their agencyutilization and cut their overtime. And the resistance has begun! And why not? After all, this group did every single thing they were told to do and never saw anything but negative results and an increase in the requirements for change. They raised nursing satisfaction. They raised patient satisfaction. They reduced FTE’s. They even began the painful and arduous process of automating systems that weren’t broken and none of it produced the results the organization needed. It is safe to postulate that any workforce when told to “staff up” would resist a new suggestion of “reducing FTE’s” to improve financial standing. Weren’t they JUST TOLD that adding FTE’s and improving employee engagement WOULD DO THE SAME THING? Mixed messaging radically undermines a workforce’s belief that something actually IS an organizational imperative.
Lesson # 2: Faulty Assumptions. The mixed messaging described above clearly breeds resistance and reluctance to change. However, the mixed messaging itself derives from faulty logic directly attributable to consultants and 3 party vendors who each have something to gain by convincing an organization that THEIR assumptions are valid. All three of these faulty assumptions came into play in creating the shifting messaging and resistance to change the organization isn ow facing. Our lesson learned in this is, “to deeply explore the fundamental truths of change for each organization to ensure that the results derived from change are the ones targeted by leadership”. Further, we determined to be sure “we understand the difference between “correlation” and “causation” of each proposed solution”.