Talk Health and Care

If 'Disney' ran the NHS...

Following experts  is from "If Disney Ran Your Hospital - by Fred Lee (2004)

"About teamwork, I would ask the group  in a staff meeting to complete: I want to work for a manager who...I want to work with co-workers who...

About passion, I would ask each individual to privately complete: I would ask each individual to complete : I enjoy my work when... I wish there was less... I wish  there was more... When I am not at work , I enjoy...This process of probing for information, having frank conversations, taking corrective actions, and getting  feedback on performance , are the proven steps for continuous  improvement in the things  that cannot  be measured statistically. Anything done at the level of mediocrity is discouraging and a real drag.

Anything done at the level of excellence, or in the pursuit of excellence, is exciting and fun. Service should be changed to experience. We are not at a patient's bed-side to provide a service . We are there to provide a compassionate healing experience so the body  can mend itself. Accountability needs to be changed to responsibility. 

"A workplace focused primarily on compliance is a paternalistic (adult-child) culture because managers are like parents who lay down the laws to children who had better obey them or else. In terms of human motivation, it is the weakest, and places the responsibility for success on the shoulders of controlling , paternalistic authority. Great managers know that they are not judged by what they can do, but by what their teams can do without them...In the right atmosphere of teamwork, coaching, and learning, constant improvement is fun...An adult enters the mature world of marriage, family and work, he enters an interdependent reality. The competitive activities whereby people learn and establish their individual competencies and independence no longer work as they used to and are actually a hindrance to success in an interdependent reality. "The spirit of Win/Win cannot survive in an environment of competition. The system of recognition and working beautifully after 15 years - goes like this: Boxes ( like suggestion boxes) with compliment cards are placed conspicuously in key locations such as elevators and in waiting rooms. Anyone can use them, patients or employees. Someone is assigned to collect them at least once a week (more often if possible, and deliver them to the CEO. Top management reads all compliment cards and adds a note of thanks or just a signature indicating it was noticed. The cards are then routed through the chain of command to the employee. CEO's  might select a couple of cards once in a while to deliver personally by hand. No prizes are given. The integrity of the employee's intrinsic motivation is preserved.  Management has to stay involved because the cards keep coming. They can't opt just to quit reading them.And when the card is received, the employee feels the rush of appreciation, made more powerful because the appreciation arrives through management. A program like this is self renewing  and will go on successfully forever as long as someone keeps collecting the cards and sending them through management. There is no reason to game the system for rewards or leave it to individual managers to keep it going, and the only motive for both giver and receiver  is sincere appreciation. Since recognition is never at the expense of somebody else, there is no rivalry. And since there is no extrinsic reward, there is no cause for cynicism about people's motives. People want to be appreciated  for doing the right thing, not given a prize. Recruit the very best and get rid of the poor performers. Their spirit of teamwork was crucial to getting the work of our department done. To be forced by a arbitrary system to give some a higher raise than others whether it could be justified or not would ludicrous and demoralising. A typical eg might be an organisation decides to give a 3% increase across the board as a raise for employees, allowing managers to hit that average by giving differing amounts from 1% to 6% depending on the evaluations of a subordinate's performance. The problem comes when the system replaces the manager's judgment by demanding that some get less so that others get more. Why should people be paid the same if they do not perform the same? Doesn't it demoralise the hard workers and encourage laziness when you give everyone the same increase in pay? An individual  pay for performance system does not fit an organisation that is designed around processes and teams and that emphasises the importance of lateral relationships and co-operation. Individuals who need to co-operate and help each other should not be put in a position of competing for the same rewards. 

Nurses - think of the variation in performance that is beyond their control. Every patient is different. No two situations are alike and individual care cannot be standardised as on an assembly line. Even patient flow cannot be controlled. Physicians can have radically different ways of doing things and make differing demands on individual staff members. A dozen departments must work closely with the patient-care team to deliver maximum results for each individual patient. Should a nurse manager base pay for performance on how well the paperwork is done because that is a fairly objective and individual activity? Then there is the effect of the nurse on the morale of the nursing team. Would we want a system that ignores  what is subjective and rewards only what is objective?  If the system lends itself to favouritism, how effective is it? How demeaning it would be to rate  them all as average  when they have worked with dedication  and achieved  a stature and recognition far above average. With the grade comes a difference in pay! Where is the logic or fairness in that?  How long can you keep such talented individuals if they felt unappreciated by their organisation with no sensible justification based on their actual work? What would this do to their energy and motivation? To their self-confidence? To their morale? The negative consequences of this arbitrary system can be disastrous. To the one winner it will feel like a reward. But to the losers, it will end up feeling like a punishment. Employees at Disney were not rewarded in a competitive  system. Instead, everyone got raises based on longevity. Annual raises for frontline members and their supervisors encouraged synergy, longevity, and cross- functional learning instead of competition. A culture characterised by subjective performance evaluations coupled with competitive individual rewards is significantly different from one in which people are not put through such a demoralising process that is fraught with secrecy, suspicion, politics, accusation of favouritism, and the inability to explain why one person receives more than the other...doubted that hospitals would ever be able to achieve the level of service and teamwork so evident at Disney without changing the compensation system  to one that is more like Disney's. 

In the division of Disney, each member wrote up a personal development plan. This plan was reviewed periodically with the person's manager. The member would evaluate his or her own progress and indicate areas for improvement  and personal growth. The manager, seen as a supporter and coach to help the member reach his or her own goals within the context of the team 's goals. Management by fear...nourishes short - term performance, annihilates long- term planning, builds fear, demolishes teamwork, nourishes rivalry  and politics. It leaves people bitter, crushed, bruised, battered, desolate despondent, some even depressed, unfit for work for weeks. It is unfair, as it ascribes to the people in a group differences that may be caused totally by the system that they work in...Merit rating rewards people that do well in the system. It does not reward attempts to improve the system. Eliminating pay for individual performance and empowering teams = incredible performance. The difference is the management culture. Western managers were enamoured with the statistical charts and tools to better measure quality, but they could not turn substantial power and decision making over to the process teams, the very  strength that fuels exceptional performance. Instead of educating workers to take ownership and think and act for themselves, they second - guess recommendations of teams, instilled more "carrots" and "sticks" to maintain a culture of compliance and competition, which saps the energy of intrinsic  motivation with compensation systems that make people feel resentful instead of supported. Bureaucracies grow out of top management's distrust of the ability of managers and supervisors to make decisions, including those about employee performance and compensation. The arbitrariness of the system left little room for manager discretion or judgement. Unintended consequence is that it also discourages employees from taking initiative and performing tasks outside their rigid job descriptions. This in turn, provides little  motivation for teamwork and collaboration. Workers become focused only on their own jobs instead of the quality of the service produced by their team, which decreases commitment, enthusiasm, and pride- all compelling motivators.

When extrinsic rewards become the focus of an organisations attempt to motivate  the work force , the result is a culture of hierarchy and compliance. It creates a work environment of competition, fear, and defensiveness. Compliance is the weakest of all motivations because it does not tap into the power of our intrinsic desire to to constantly do better. I am spending my energies on covering my backside, not making any mistakes, or being envious of rewards given to others, there is not much left in the well for me to go for personal growth. And this applies to managers as well.

Disneys unique knowledge about what the customer's want. It is Disney's consistency in the day-to-day execution of universally shared values and commonly desired behaviours. Managers have never been held  accountable  for the results of satisfaction surveys of patients and employees. Two major ways to improve performance: through systems and through behaviours. Action comes from doing, not by planning, listening or talking. Learning by doing there is no gap between knowing and doing. When problems become conspicuous and distort the delivery systems, the normal reaction is to do a formal assessment of the problem and write a proposal  for its solution. Yet how many of these activities turn into action that eliminates the problem or improves the system. As long as managers can stave off accountability under the guise of getting more information, many of them will. The reason customer and employee satisfaction so often escape accountability is that they are rarely  framed as life or death requirements in the same way we frame cost containment and clinical quality.

Sam DHSC 8 months ago

Thanks for sharing Patricia - please keep engaging on the platform.

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