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					Nursing Leadership Academy

Senior Leadership Retreat
Instilling a Culture of Leadership

The Advisory Board Company

Washington, D.C.

Copies & Copyright
As always, members are welcome to an unlimited number of copies of the materials contained within this handout. Further, members may copy any graphic herein for their own internal purpose. The Advisory Board Company requests only that members retain the copyright mark on all pages produced. Please call the Delivery Services Department at 202-266-5920 for any help we may provide. The pages herein are the property of The Advisory Board Company. Beyond the membership, no copyrighted materials of The Advisory Board Company may be reproduced without prior approval.

Legal Caveat
The Advisory Board Company has worked to ensure the accuracy of the information it provides to members. This report relies on data obtained from many sources, however, and The Advisory Board Company cannot guarantee the accuracy of the information provided or any analysis based thereon, in all cases. Further, neither The Advisory Board Company nor any of its programs are in the business of giving legal, clinical, accounting, or other professional advice, and its reports should not be construed as professional advice on any particular set of facts or circumstances. In particular, members should not rely on any legal commentary in this report as a basis for action, or assume that any tactics described herein would be permitted by applicable law. Members are advised to consult with their medical staff with respect to matters that involve clinical practice and patient treatment, and with other appropriate professionals concerning legal, tax, or accounting issues, before implementing any of these tactics. Neither The Advisory Board Company nor any of its programs shall be liable for any claims or losses that may arise from (a) any errors or omissions in their work product, whether caused by The Advisory Board Company or any of its programs or sources, or (b) reliance on any graded ranking or recommendation by The Advisory Board Company.

Note to Members on Confidentiality of Findings
This document has been prepared by the Advisory Board for the exclusive use of its members. It contains valuable proprietary information belonging to The Advisory Board Company, and each member should make it available only to those employees and agents who require such access in order to learn from the profi les described herein, and who undertake not to disclose it to third parties. In the event that you are unwilling to assume this confidentiality obligation, please return this document and all copies in your possession promptly to The Advisory Board Company.

Nursing Leadership Academy

Senior Leadership Retreat
Instilling a Culture of Leadership

© 2004 The Advisory Board Company

Washington, D.C.

Nursing Leadership Academy
Instilling a Culture

I
Defining the Challenge Toward a Culture of Leadership Objectives
Why is a culture of leadership essential in today’s health care environment? What are the attributes of a culture of leadership? What do I want a culture of leadership to look like at my institution?

II
A Transformation Within Leadership Example
Why is my role as a senior leader so critical? What is the leadership example for senior nursing leaders? How do I assess whether I am serving as a leadership example to my staff?

Key Themes

Leadership in nursing is unique No place nursing can fail A culture of leadership is a conduit to success in a health care environment of unparalleled complexity

Stepping up as the leadership example Being a leader of leaders Serving as a leader in every interaction

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Senior Leadership Retreat
of Leadership

III
Building the Leadership Pool Talent Management
How do I encourage and support high potential managers? How do I promote managers with top leadership potential? What is the importance of limiting the negative impact of ineffective managers?

IV
Hardwiring Leadership Development Learning Infrastructure
Why is infrastructure important to instill a culture of leadership? What are the critical elements of an infrastructure around a culture of leadership? What planning and action steps am I responsible for in the short-and long-term?

V
Creating a Leadership Environment Coda
Committing to a culture of leadership Sustaining continued growth

Identify tiered growth challenges and individual derailers of nurse managers Leveraging current performance and developing skills Assessing existing staff on value and potential

Assigning roles and responsibilities to install a leadership infrastructure Planning the NLA year alongside internal leadership development efforts Reinforcing learning throughout the year through coaching and integration of leadership skills into daily practice

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I

Defining the Challenge
Toward a Culture of Leadership

1
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A Challenge Greater
Growing Challenges to the Patient Care Agenda…
Compliance with Government Regulation New Margin Imperative Deficit of Human Capital

?
On the Horizon
Government Regulation—Compliance with federal, state, and municipal legislation governing charges to the financial, legal, clinical, technological, and administrative aspects of health care delivery. New Margin Imperative—Accelerating growth and controlling cost levers to leverage the greatest future margin expansion. Deficit of Human Capital— Upskilling the nursing workforce amid an impending staffing shortage.

Source: Advisory Board interviews and analysis.

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Than Most
...Demanding Unique Leadership from Nursing
Life/Death Clinical Decisions Physician Challenge 24/7 Accountability

Su

STAFF SCHEDULE M T W T F

S

Source: Advisory Board interviews and analysis.

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No Dearth of
The Nursing Docket
Truly a Heavy Burden
1. Patient Safety on cacy & Satisfacti 2. Patient Advo ductivity 3. Finance & Pro tion 4. Talent & Reten ental/ Physician 5. Interdepartm Relations anning tegic Vision & Pl 6. Hospital Stra ottlenecks 7. Throughput B 8. JCAHO

Source: Advisory Board interviews and analysis.

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Leadership Flashpoints
Constantly “Solving” Problems
Three RNs call in sick; holes filled in schedule Patient’s family upset about slow communication from nurses; concerns discussed and resolved Beds not ready on time, admissions delayed; housekeepers paged multiple times

Surgical Gloves

Hand Wash

Tests unable to be completed for next-day discharge; patient held in med/surg for extra day

First medications late again; medication room checked and pharmacy called

Backlog of patients waiting to be transported to 4B; placement arranged following negotiation with other managers

Jumping to Solutions
“Often, managers ask ‘I know what the answer is, so why do I have to [map out the problem]?’ They say ‘I just know it. I’m there every day, so I can feel it.’ Often, they’re right. But sometimes, after they give me their instinctual analysis, we go back to the data—budgets and patient days—and it says something different.” Director of Nursing

Source: Nursing Leadership Academy interviews.

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Barrier #1: Centralized Control

Where Is All
Being Left in the Lurch
Just get these vacancies filled—I don’t have time to think about our long-term recruiting strategy right now.

Source: Advisory Board interviews and analysis.

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the Leadership?
In the Hands of a Few
Unforeseen Consequences De-Prioritization of Critical Issues Absence of Back-Up

Survey Results

✓ ✓ ✓
HR Nursing Finance

Surprised by and unprepared for long-term effects of short-term decisions

Inability to address all issues equally

Fully dependent on oneself or few others

Source: Advisory Board interviews and analysis.

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Barrier #2: Lacking Ability

Managing with a
Coming Up Short on Effective Ideas
Brainstorm Session

?

?

?

?

?

?

Source: Advisory Board interviews and analysis.

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Critical Skill Deficit
Skills in Abeyance
Failure to Encourage Risk Failure of Infrastructure Failure of Application

CALENDAR
S M T 1 6 13 20 27 7 14 21 28 8 15 22 29 W 2 9 16 23 30 R 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26

Variance Analysis

Nurse executives fail to promote innovation; time not set aside for “consequence-free” idea exchange

Absent or inadequate support structure for training and development

Absent or inadequate implementation of learned skills

Source: Advisory Board interviews and analysis.

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Barrier #3: Absence of Accountability

Not Knowing
A Recurring Problem with No End in Sight
We didn’t meet our budget and our turnover is very high—I haven’t been able to work on the special project. We’ll try next month.

Director

VP

Source: Advisory Board interviews and analysis.

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What Is Expected
When Accountability Is Missing
No Expectations or Standards Set No Reward or Recognition Structure No Consequences

Project: Timeline:
0001
, 20
23-023/666

PROBATION REPORT

Expectations:

PAY TO THE ORDER OF

$ DOLLARS

MEMO
|

: 052366623 : 825428523 • 0001
| |

Nurse executives and managers fail to raise the bar and articulate clear objectives

No incentive for individual performance achievement; individual or group achievement not recognized publicly across department and hospital

Managers and staff not held responsible when expectations are not met

Source: Advisory Board interviews and analysis.

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On the Road to Renewal
A Culture of Leadership
Centralized Control Distributed Responsibility

Lacking Ability
? ? ? ? ? ?

Non-Stop Skill Development
January 2002
S M T 1 6 13 20 27 7 14 21 28 8 15 22 29 W 2 9 16 23 30 R 3 10 17 24 31 F 4 11 18 S 5 12 19 26

✗✗ ✗

25

Absence of Accountability

Hardwired Accountability

Error Rate

Source: Advisory Board interviews and analysis.

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Distributed Responsibility

Extending Leadership
Trying to Find Time to Breathe
Budget Analysis
Time of Day Direct Indirect Staffing & Patient Care Patient Care Scheduling Daily Operations Recruiting New Staff Assessing & Managing Current Staff Budget Activities Program Development Coaching, mentoring, education, and retention activities Hospitalwide meeting and initiatives Time of Day

Business Plan

5:30a-6a 6a-6:30a 6:30a-7a 7a-7:30a 7:30a-8a 8a-8:30a 8:30a-9a 9a-9:30a 9:30a-10a 10a-10:30a 10:30a-11a 11a-11:30a 11:30a-12p 12p-12:30p 12:30p-1p 1p-1:30p 1:30p-2p 2p-2:30p 2:30p-3p 3p-3:30p 3:30p-4p 4p-4:30p 4:30p-5p 5p-5:30p 5:30-6p 6p-6:30p 6:30p-7p 7p-7:30p 7:30p-8p 8p-5:30a
To tal Minutes

5:30a-6a 6a-6:30a 6:30a-7a 7a-7:30a 7:30a-8a 8a-8:30a 8:30a-9a 9a-9:30a 9:30a-10a 10a-10:30a 10:30a-11a 11a-11:30a 11:30a-12p 12p-12:30p 12:30p-1p 1p-1:30p 1:30p-2p 2p-2:30p 2:30p-3p 3p-3:30p 3:30p-4p 4p-4:30p 4:30p-5p 5p-5:30p 5:30-6p 6p-6:30p 6:30p-7p 7p-7:30p 7:30p-8p 8p-5:30a

Interview

Notes

Committee Agenda 1. II. III.

Nursing Department Care Model

Su

STAFF SCHEDULE M T W T F

S

Source: Advisory Board interviews and analysis.

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Across the Line
Complete Role Elimination
Current Responsibilities: • Draft business plan for new imaging machine • Design “ideal” care model to distribute for employee training • Renegotiate vendor contracts for clinical supplies Could be managed by: 1. Ernest, 3N 2. Djuna, 4N 3. Alice, 3S

Source: Advisory Board interviews and analysis.

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Non-Stop Skill Development

A Commitment to
A Typical Approach
SUN No coaching 1.
Throughput Engagement

MON

TUE

WED THURS

FRI

SAT No follow-up

2. 9. 16. 23. 30.

3. 10.
Management Series I

. 11. 18. 25.

5. 12. 19. 26.

6. 13. 20. 27. Low priority

7. 14. 21. 28.

8. 15. 22.
Management Series II

17. 24.
Finance Practicum

29.

31.

Not aligned with department needs

Source: Advisory Board interviews and analysis.

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Continuous Learning
Development in Advance of Need
Abundance of Continuing Development Options
2004 Development Opportunities

Everyone Takes Part
Class Wait List

Broad and Comprehensive Development Areas

1
Jan/Feb Mar/Apr May/June

Jack Rachel Margaret Malcolm Carol

2 3 4 5

✓ Finance ✓ Problem Solving ✓ Diversity ✓ Throughput

Training sessions and development programs regularly scheduled throughout the year with repeat opportunities available

Attendance required of all relevant staff at training sessions and development programs

Training sessions and development programs address full range of Nursing competencies

Source: Advisory Board interviews and analysis.

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Hardwired Accountability

Setting Expectations
A Bar Too Low
Patient Complaints

Maybe we can all be more mindful of patient requests in the future. Let’s do the best we can.

May

June

Source: Advisory Board interviews and analysis.

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and Following Through
Rewards, Recognition, and Consequences
Expectations and Standards Rewards and Recognition Consequences

Project: Timeline:
, 20 PAY TO THE ORDER OF

PROBATION REPORT

0001
23-023/666

Expectations:

$ DOLLARS

MEMO
|

: 052366623 : 825428523 • 0001
| |

Managers and staff are provided clear objectives and expected to raise the bar for performance

Incentive structure in place to reward individual performance achievement; individual or group recognition publicly disseminated across department and hospital

Managers and staff held accountable when clear expectations are not satisfied

Source: Advisory Board interviews and analysis.

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Status Quo Assessment
Instructions
1. Read each question, considering the current performance of your nurse managers. 2. Record a “yes” or “no” response in the appropriate box for each question. 3. Subtotal the number of “yes” and “no” responses at the end of each section.

Distributed Responsibility 1. Do nurse managers allocate an appropriate amount of time for strategic, long-term planning and staff development? 2. Do nurse managers consistently look to grow the ability and confidence of staff nurses by delegating projects and tasks appropriate for them to undertake? 3. Have nurse managers identified assistants, or “nurse lieutenants,” who will stand in for the manager, completing all of his or her responsibilities on short notice, if necessary? 4. Are “nurse lieutenants” aware of and trained for the possibility of being called upon to fulfill the manager’s duties on short notice? Subtotal: Non-Stop Skill Development 5. Do training sessions or development programs map to the strategic needs of the nursing department? 6. Are training sessions and development programs available periodically, with repeat sessions available at least once throughout the year? 7. Do nurse managers themselves attend training sessions and development programs intended for staff nurses? 8. Do nurse managers meet with each staff nurse in a pull-up session following every training session or development program? Subtotal: Hardwired Accountability 9. Do nurse managers assure all staff have clear performance expectations that are measurable? 10. Do nurse managers establish definitive deadlines and checkpoint meetings for all assignments given to staff members? 11. Do nurse managers have an effective mechanism (e.g., bulletin board, staff meeting log, etc.) for applauding and showcasing the accomplishments of individual staff members? 12. Do nurse managers take immediate corrective/disciplinary action when a staff member has not met clearly specified expectations? Subtotal:
21

Yes

No

❏ ❏ ❏ ❏
Yes

❏ ❏ ❏ ❏
No

❏ ❏ ❏ ❏
Yes

❏ ❏ ❏ ❏
No

❏ ❏ ❏ ❏

❏ ❏ ❏ ❏

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Two-Year Blueprint

Creating a Design
Two Potential Destinations
EXCELLENCE AWARD

Budget Analysis
Time of Day Direct Indirect Staffing & Patient Care Patient Care Scheduling Daily Operations Recruiting New Staff Assessing & Managing Current Staff Budget Activities Program Development Coaching, mentoring, education, and retention activities Hospitalwide meeting and initiatives Time of Day

Business Plan

5:30a-6a 6a-6:30a 6:30a-7a 7a-7:30a 7:30a-8a 8a-8:30a 8:30a-9a 9a-9:30a 9:30a-10a 10a-10:30a 10:30a-11a 11a-11:30a 11:30a-12p 12p-12:30p 12:30p-1p 1p-1:30p 1:30p-2p 2p-2:30p 2:30p-3p 3p-3:30p 3:30p-4p 4p-4:30p 4:30p-5p 5p-5:30p 5:30-6p 6p-6:30p 6:30p-7p 7p-7:30p 7:30p-8p 8p-5:30a
To tal Minutes

5:30a-6a 6a-6:30a 6:30a-7a 7a-7:30a 7:30a-8a 8a-8:30a 8:30a-9a 9a-9:30a 9:30a-10a 10a-10:30a 10:30a-11a 11a-11:30a 11:30a-12p 12p-12:30p 12:30p-1p 1p-1:30p 1:30p-2p 2p-2:30p 2:30p-3p 3p-3:30p 3:30p-4p 4p-4:30p 4:30p-5p 5p-5:30p 5:30-6p 6p-6:30p 6:30p-7p 7p-7:30p 7:30p-8p 8p-5:30a

Interview

Notes

Bu

a ng il d i low

C

re u lt u

of L

er ead

s hi p

Infection Rate
Committee Agenda 1. II. III.

Fo l
Su STAFF SCHEDULE M T W T F S

Actual

Target

Nursing Department Care Model

ing

t he

St a

t us

Qu

o

Today

2 Years

Source: Advisory Board interviews and analysis.

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for the Future
Beginning with the End in Mind
Hardwired accountability: clinical outcomes part of performance review
Budget Analysis
Time of Day Direct Indirect Staffing & Patient Care Patient Care Scheduling Daily Operations Recruiting New Staff Assessing & Budget Program Managing Activities Development Current Staff Coaching, mentoring, education, and retention activities Hospitalwide meeting and initiatives Time of Day

Business Plan

EXCELLENCE AWARD

5:30a-6a 6a-6:30a 6:30a-7a 7a-7:30a 7:30a-8a 8a-8:30a 8:30a-9a 9a-9:30a 9:30a-10a 10a-10:30a 10:30a-11a 11a-11:30a 11:30a-12p 12p-12:30p 12:30p-1p 1p-1:30p 1:30p-2p 2p-2:30p 2:30p-3p 3p-3:30p 3:30p-4p 4p-4:30p 4:30p-5p 5p-5:30p 5:30-6p 6p-6:30p 6:30p-7p 7p-7:30p 7:30p-8p 8p-5:30a
To tal Minutes

5:30a-6a 6a-6:30a 6:30a-7a 7a-7:30a 7:30a-8a 8a-8:30a 8:30a-9a 9a-9:30a 9:30a-10a 10a-10:30a 10:30a-11a 11a-11:30a 11:30a-12p 12p-12:30p 12:30p-1p 1p-1:30p 1:30p-2p 2p-2:30p 2:30p-3p 3p-3:30p 3:30p-4p 4p-4:30p 4:30p-5p 5p-5:30p 5:30-6p 6p-6:30p 6:30p-7p 7p-7:30p 7:30p-8p 8p-5:30a

Interview

Notes

2 Years 2 Years

Today Today

Committee Agenda 1. II. III.

Nursing Department Care Model

Su

STAFF SCHEDULE M T W T F

S

Non-stop skill development: interpersonal skills workshop A Blueprint for Leadership Success

Distributed responsibility: more than one person responsible

Source: Advisory Board interviews and analysis.

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© 2004 The Advisory Board Company

Two-Year Leadership Culture Blueprint

Drafting a
Instructions
• Using a series of discussion questions, draft a two-year leadership culture blueprint for the department. • In the boxes provided, describe the department as it will appear two years from today with respect to distributed responsibility, non-stop skill development, and hardwired accountability. Remember to strike a balance between what is realistic and idealistic. • To assist you, consider the questions below regarding the factors that might influence a two-year blueprint for the department’s leadership culture. • After drafting your blueprint, remove it from your handout and hand it in to the Recorder.

Questions to Consider: 1. In an ideal world, what will a culture of leadership in the department look like two years from today? Do not think solely in terms of problems that need to be solved or areas that need improvement, but also consider possibilities and opportunities. 2. When you think about the vision of the department, what image does that bring to mind? Is it the image of the department today? 3. Are there any organizations, either within health care or outside of the industry, after which you would like to model the department’s leadership culture? Of these organizations, what are the leadership characteristics that you find so compelling? How are these characteristics applicable to the work setting? 4. What are the best leadership qualities of the department today? Can these qualities be duplicated more widely throughout the department? What makes these qualities stand out? 5. Who are the department’s stakeholder groups? What do they value? How does the department provide value to these groups? 6. What are the major hospital leadership goals over the next two years? What major industry shifts are currently impacting the department? What changes in the department’s leadership culture could impact the unit?

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Desired Future
Two-Year Leadership Culture Blueprint
Distributed Responsibility

Non-Stop Skill Development

Hardwired Accountability

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Instilling a Culture of Leadership
Manifestation in Three Parts
Leadership Example Talent Management Infrastructure

CALENDAR
S M T 1 6 13 20 27 7 14 21 28 8 15 22 29 W 2 9 16 23 30 R 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26

✓ Role Modeling ✓ Decision Making ✓ Story Telling ✓ Teaching

✓ Selection ✓ Orientation/Training ✓ Align ✓ Termination

✓ Work Design ✓ Physical Environment ✓ Written Policies ✓ Organizational Structure

Source: Advisory Board interviews and analysis.

29
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II

A Transformation Within
Leadership Example

31
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Instilling a Culture of Leadership
Manifestation in Three Parts
Leadership Example Talent Management Infrastructure

CALENDAR
S M T 1 6 13 20 27 7 14 21 28 8 15 22 29 W 2 9 16 23 30 R 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26

✓ Role Modeling ✓ Decision Making ✓ Story Telling ✓ Teaching

✓ Selection ✓ Orientation/Training ✓ Align ✓ Termination

✓ Work Design ✓ Physical Environment ✓ Written Policies ✓ Organizational Structure

Source: Advisory Board interviews and analysis.

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All Eyes on
A Leader in Every Interaction
Nursing’s Voice at the Table A Leader of Leaders
Let’s congratulate our two new Nurse Directors.

COO

CFO

CEO

CNO

CIO

Redmont

MEDICAL CENTER

Source: Advisory Board interviews and analysis.

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the Senior Leadership
All Behavior Has Meaning
Communication Action

Sorry, Doc, no time!

I should be more firm when I talk with persistent physicians.
Y

I guess this meeting isn’t very important.
Nurse Patient Relations Committee Session III

?
Oncology
Gynecology

Nurse Director
RN

MD

Source: Advisory Board interviews and analysis.

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Leading with Symbols
Signaling a New Era
Continental’s CEO Calls for Greater Autonomy
Case in Brief
• Prior to 1994, employee creativity stifled • 800-page, 9-inchthick rule book an obstacle to innovation • Book burning signals importance of proactive, innovative employees

C

Continental Airlines in brief
• Continental Airlines, headquartered in Houston, Texas, is an air carrier of passengers, cargo, and mail • Goal: To improve customer service constantly through improved customer service, innovation and creativity

Source: Lipton M, Guiding Growth: How Vision Keeps Companies on Course, Boston: Harvard Business School Press, 2003: 144–149; Schuch B, Van De Mark D, “Continental’s Comeback,” CNNfn: Business Unusual, originally aired March 9, 1998.

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and Daily Practice
Actions, Not Just Words
Motorola Chairman Demonstrates What’s Important

1) Goals 2) Progress 3) Awards

Quality Improvement

1) Revenue 2) Income 3)

Financial Reports

Motorola in brief
• Motorola, based in Schaumburg, Illinois, is a manufacturer and marketer of electronic equipment and components • Goal: To make things smarter and life better by placing value on quality improvement, creativity, innovation, ethics, and customer service

Source: Collins J, Porras J, Built to Last: Successful Habits of Visionary Companies, New York: HarperBusiness, 1994: 115–121, 213.

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Setting an Example “Across the Board”

Leadership Culture Attribute:

Distributed Responsibility

Non-Stop Skill Development

Hardwired Accountability

PROBATION REPORT PROBATION REPORT R A R

Leadership Example:

Delegation

Professional Development

Performance Review/ Probation Report

Source: Advisory Board interviews and analysis.

39
© 2004 The Advisory Board Company

Distributed Responsibility

Sharing Power
The All-Too-Common Approach
Taking Everything on Oneself

To Do: Monday Revise staff schedule Tuesday Prepare committee agenda Wednesday Update interviewing guide Thursday Create supply order Friday Prepare physician meeting

Source: Advisory Board interviews and analysis.

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© 2004 The Advisory Board Company

Throughout the Rank
The Leadership Example
Delegating Across the Staff

To Do: Monday Revise staff schedule Tuesday Prepare committee agenda Wednesday Update interviewing guide Thursday Create supply order Friday Prepare physician meeting Delegated to Jonas Delegated to Cheryl

Delegated to Rebecca

Source: Advisory Board interviews and analysis.

41
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A Three Step Process
Segment Match Delegate

Task

Task

Task

Task

Task

Task

Identify all the distinct tasks that can be isolated and therefore delegated to staff

Link task responsibilities with individual skill sets, interests, and development goals

Provide staff member with opportunity to perform the task

Source: Advisory Board interviews and analysis.

43
© 2004 The Advisory Board Company

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Role Elimination Planning
Instructions
1. List the ten major task-specific job responsibilities on your agenda, (for example, items found on your “to do” list). 2. Consider who among your staff will assume responsibility for each task should you urgently need to be away for three months. Note: Do not list the same manager for more than two tasks. 3. Indicate “yes” or “no” in the boxes depending on whether the manager is properly trained for the task and whether you expect resistance from the manager.

Job Responsibilities

Manager to Fill In

Trained? Yes No

Expect Resistance? Yes No

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.
Source: Advisory Board interviews and analysis.

45
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Non-Stop Skill Development

Time and Commitment
The Leadership Example
A Conscious Investment
Every senior leader needs to make this development program a top priority. 1.

Meeting Agenda Staff Development Program

2. Patient Education 3. Physician Satisfaction 4. Recruiting 5. Staff Party

Source: Advisory Board interviews and analysis.

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© 2004 The Advisory Board Company

to Skill Development
Building Ability at Every Turn
Directors Participating as Students
Continuous Learning Programs Regularly Scheduled Support Sessions Daily Application Class Participation

Source: Advisory Board interviews and analysis.

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© 2004 The Advisory Board Company

Management Leadership

sing Nur

Hardwired Accountability

Up-Front Confidence
Always Checking Up; Never Letting Go
Martita, I was just checking in again on how the project is going. Well, not much new to report since yesterday!

Source: Advisory Board interviews and analysis.

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© 2004 The Advisory Board Company

with Back-End Accountability
The Leadership Example
Sticking to Your Word
This is not what we agreed to…

Re p o r

t

E xpec

tation

s

Source: Advisory Board interviews and analysis.

51
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Guiding the Way
A Structured Process
Project: Timeline:
$

PROBATION REPORT
0001
, 20
/666 23-023

DOLLAR

S

Expectations:

THE PAY TO OF ORDER

MEM
|

O

: 052366

623

|

: 825428

523

|

• 0001

Clearly Articulated Expectations

Comparing Expectations and Outcomes

Rewards, Recognition, and Consequences

Source: Advisory Board interviews and analysis.

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Hardwiring Accountability Self-Test
Instructions
1. Read each question, considering how you currently manage daily tasks and responsibilities, including your interactions with nurse managers. 2. Record a “yes” or “no” response in the appropriate box for each question. 3. Subtotal the number of “yes” and “no” responses at the end of each section.

Clearly Articulated Expectations 1. I provide my direct reports with clear guidelines of what is expected from their leadership roles. 2. I provide my direct reports with well-defined goals and deadlines for each task or initiative I assign to them. 3. The expectations I set for direct reports are measurable. 4. I am always clear with my direct reports about the skills, knowledge, and abilities they will need to complete assigned tasks successfully. Subtotal: Comparing Expectations and Outcomes 5. I set and adhere to milestone checkpoints with staff to be sure they are meeting specified expectations. 6. I maintain a rigorous performance measurement in order to assure accurate assessment of outcomes. 7. My staff understands and accepts how performance for any assignment will be measured. 8. My staff knows and accepts that performance will be based on results rather than effort. Subtotal: Rewards, Recognition, and Consequences 9. I routinely praise my direct reports for good performance. 10. I maintain a public forum for praising success in order to assure that all staff understand the value placed on superior performance. 11. When I detect a performance problem, I immediately discuss it with the staff member involved and plan a strategy for correction. 12. I always apply appropriate consequences for failure to perform to expectations. Subtotal:
55

Yes

No

❏ ❏ ❏ ❏
Yes

❏ ❏ ❏ ❏
No

❏ ❏ ❏ ❏
Yes

❏ ❏ ❏ ❏
No

❏ ❏ ❏ ❏

❏ ❏ ❏ ❏

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III

Building the Leadership Pool
Talent Management

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Instilling a Culture of Leadership
Leadership Example Talent Management Infrastructure

CALENDAR
S M T 1 6 13 20 27 7 14 21 28 8 15 22 29 W 2 9 16 23 30 R 3 10 17 24 31 F 4 11 18 25 S 5 12 19 26

✓ Role Modeling ✓ Decision Making ✓ Story Telling ✓ Teaching

✓ Selection ✓ Orientation/Training ✓ Align ✓ Termination

✓ Work Design ✓ Physical Environment ✓ Written Policies ✓ Organizational Structure

Source: Advisory Board Interviews and Analysis.

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Integrating Talent
A Filter at Sun Microsystems
Getting It Right from the Start
Ideal Candidate Application Process Working Environment
To Do
1 2 3 4 5 6 7

• • • •

Hardworking Quick-Thinking Confident Creative

• Lengthy (7+ interviews) • Challenging • Competitive • Complex

• Demanding • Unpredictable • Competitive • Fast-Paced

Sun Microsystems in Brief
• Sun Microsystems, headquartered in Santa Clara, California, is a provider of products, services, and support for network computing • Culture of Leadership: Fast-paced and busy, values independent self-starters, innovation, cooperation, commitment

Source: Lipton M, Guiding Growth: How Vision Keeps Companies on Course, Boston: Harvard Business School Press, 2003: 214– 215; “Sun Microsystems,” available at: http://www.sun.com/ company, accessed March 4, 2003.

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and Cultural Fit
Providing the Tools (and Leeway)
Nordstrom Employee Manual
WELCOME TO NORDSTROM We’re glad to have you with our Company. Our number one goal is to provide outstanding customer service. Set both your personal and professional goals high. We have great confidence in your ability to achieve them. Nordstrom Rules: Rule #1: Use your good judgment in all situations. There will be no additional rules. Please feel free to ask your department manager, store manager or division general managers any question at any time.

Nordstrom in Brief
• Nordstrom, headquartered in Seattle, Washington, is a high-end retailer of apparel, shoes, and accessories for men, women, and children • Culture of Leadership: Excellence in customer service, hard work and productivity, continuous improvement, excellence in reputation

Source: Collins J, Porras J, Built to Last: Successful Habits of Visionary Companies, New York: HarperBusiness, 1994: 115–121.

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Baptism
Most Managers Promoted from Within
Path to Current Position
Lateral Move Within Institution n=1,540

Star nurse promoted to manager

23% 63% 14%
Promoted Internally from Staff RN Position

Clinical experts, charge nurses

Hired from Outside Institution

Great Nurses Not Always Great Nurse Managers
“One thing that I’ve recognized and I’ve always faulted nursing for, we’ve always felt that we could just take a nurse and make her a manager, and that’s not the case. And just like for any other business, it takes a special skill. It takes something within yourself to know that you have the ability to manage, to make change, to be that force that can be reckoned with, and stand on the front line even when you’re being fired at.” Nurse Manager, Philadelphia

Source: Advisory Board interviews and analysis.

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by Fire
Recognizing the need for training…
Top Nurse Manager Supports Needed as Ranked by Nurse Executives
n=209

1. Cooperation of other hospital departments 2. Technological support 3. Ongoing management-focused training 4. Interaction with senior nursing leaders 5. Access to dedicated secretarial support

6. Provision of timely and accurate benchmarking data 7. Having an assistant 8. Interaction with finance 9. Clerical support from unit clerk

…but not following through

Percentage of Managers Reporting That They Receive Ongoing Management Training
n=1,607

Preparing for the Worst
“My director is really focused on leadership and she had us read The Flight of the Buffalo. It’s about leadership style. And my director said, “That’s what you want to create, that type of environment, so that everybody doesn’t go off the cliff when you do.” Nurse Manager Nursing Executive Center National Nurse Manager Focus Groups Fall 2000

Yes

60.7%
No

39.3%

Source: Nursing Executive Center.

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Building the Talent Pool
1 2 3

Value

Potential

Managing Next-Generation Leaders

Promoting Top Potential

Identifying Underperformers

Source: Advisory Board Interviews and Analysis.

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Managing Next- Generation Leaders

Building
Trial by Fire Yields Uncertain Results
I really need someone to head up the unit policy committee. That’ll be a good way for Sue, who’s new, to get to know people.

Great. Well, first I’d better learn what the committee does!

Why did they choose her?

Will this be a waste of time?

Source: Advisory Board analysis.

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Bench Strength
Tiered Growth Challenges
A Steady Progression
Difficult

Leadership Ability

Complexity of Challenge

Easy

Time

A Hierarchy of Challenges
Skills Tested Level I Level II Level III • Basic ability to demonstrate ownership, “get the job done” • Conflict management • Ability to work in groups, get things done through others • Teaching • Dealing with difficult interpersonal relations; complex organizational skills Typical Challenge • Solo project or task • Resolving difficult interactions with peers, physicians, patient families • Unitwide committees; precepting

Level IV

• Unit scheduling; charge role; intra-unit committees

Source: Advisory Board analysis.

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Addressing Trouble
Can’t Argue with These Results
QI Committee Goals met: ✓ Decrease in patient falls ✓ Decrease in patient ulcers ✓ All new grads trained on key practices I’m pleased to report great results from the committee’s work this quarter. Jane’s getting great results. How do I let her know her staff is upset with her forceful attitude?

Source: Advisory Board analysis.

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Spots Early On
Overcoming Critical Derailers

Manager discusses identified derailer, provides data to demonstrate impact of derailer on other employees, organization; recommends books, practices to curb negative behavior

Employee implements manager’s suggestions

Manager observes candidate’s efforts and improved behavior

Manager conducts follow-up meetings with candidate to discuss improvement, reinforce positive behaviors

Case in Brief
• Choice Hotels International has identified a list of “derailers” known to negatively impact a leaders’ performance: – Overly ambitious – Arrogant – Insensitive to others – Betrayal of trust – Lacking integrity – Pushing the limits of tolerance – Lacking trust in others – Disrespectful of the customer base

• Derailers, while important, are viewed as fi xable if caught and addressed early on • However, rising leaders are expected to have no more than one derailer; individual with two or more generally deemed unsuitable for leadership roles

Source: Advisory Board interviews.

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Individual Action Plan
Name of Nurse Manager:

Planning the Cultivation of Next- Generation Leaders
Tiered Growth Challenges
• How will I help the manager with his/her development needs? • How can I provide the manager with opportunities to build skills?

Overcoming Critical Derailers
• What two derailers does the manager have? • Have I addressed the derailers with the manager?

Next Development Need: 1. _________________________________

Derailers 1. ____________________________

Yes/No ______

2. _________________________________

2. ____________________________

______

3. _________________________________ • What is my plan to help the manager overcome the derailers? Development Opportunity: 1. _________________________________ Coaching Plan

2. _________________________________

3. _________________________________

3–6 Months

6 Months–1 Year

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Promoting Top Potential

Beyond Clinical
Average Performance in Average Units
Supervisor Rating of Nurse Manager’s Performance
All Nurse Managers Managers on Superior Units

Proficient

Proficient

Superior

47.9%

28.2%

Superior

23.9%

74.4%

20.3% 1.7% 3.6%
Fair n=5,483 Poor n=1,137 Poor to Fair

Source: Advisory Board interviews and analysis.

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Skill Alone
Utilizing Promotion Screens
Distributed Responsibility
& Influencing
r po Pu

Bu ild in g

nsh tio ela R
a Te

ips

Lead

ing
se

S ho

w in

g Su

pp o

rt

January 2002
S M T 1 6 13 20 27 7 14 21 28 8 15 22 29 W 2 9 16 23 30 R 3 10 17 24 31 F 4 11 18 S 5 12 19 26

ping People velo De

✗✗ ✗

25

Non-Stop Talent Development

Developing & Retaining Top Talent

Ma

C (v omm er ba u n l a ic a nd t i w r ng C it t le en a r ly ) Act iv e Lis ten in g

R g& y in nt if nt Ide Ta le Top

ecr

Culture of Leadership Screen

Leadership Focus Screen

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Com mu n

ica tio

Hardwired Accountability

Source: Advisory Board Interviews and Analysis.

& ng ng ki ni Ma on

ntion Preve t fl ic t C on emen anag &M g in i ld Bu

s& ard ty nd tabili Stacoun Ac

n&

Motivating

em ag an M n t y t io a l i nt a Q u r ie l ic a e O i n ic Cl S er v & bi lit y counta Ac

na

gin

gV

u it

ing
Init

Pr
Financial Savvy
i at

isio

en

t

m

ob

Plan ni ng Ti me M , Pr iorit iz at ion, anagem & ent le m So lv i ng & In no va t io n

ive

De Pla cis n i

n

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Culture of Leadership Screen

Testing for Cultural Capability
Distributed Responsibility Non-Stop Skill Development Hardwired Accountability

January 2002
S M T 1 6 13 20 27 7 14 21 28 8 15 22 29 W 2 9 16 23 30 R 3 10 17 F 4 11 18 S 5 12 19 26

✗✗ ✗
24 31

25

Is the candidate able to delegate tasks and empower others?

Is the candidate proficient in identifying areas of improvement in others and developing their skills?

Does the candidate set clear guidelines and expectations for projects and tasks and follow through on results?

Source: Advisory Board interviews and analysis.

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Leadership Focus Screen

Finding the
A Comprehensive Skills Portfolio
Clinical Quality Management & Service Orientation Accountability Planning, Prioritization, & Time Management Problem Solving & Innovation
sh ion lat Re
ips
& Influencing

Lead

Initiative
ing
se

Bu ild in g

Pu

rpo

Financial Savvy
s& ard ty nd tabili Stacoun Ac
n me t

Show

ing

Sup

Ma

tion even ic t Pr t Confl agemen an &M g in i ld Bu am Te

n&

Motivating

por

t

g People lopin

Developing & Retaining Top Talent
ec &R ru it ing

e ag an M n t y t io a li nta Qu ie a l Or nic ice Cli Ser v & ity ntabil Accou

na

g in

Active Listening Communicating Clearly (verbal & written) Identifying & Recruiting Top Talent Developing & Retaining Top Talent Showing Support Team Building Conflict Prevention & Management Motivating & Influencing Managing Vision & Purpose

gV

C (v omm er ba u n l a ica nd t in wr g C it t le en a r ly ) Ac tiv e Liste ni ng

ve De

ing tify nt Iden Ta le Top

Pr

isio

ob

Pla nn ing Time Ma , Pr ior itiz ation, nagem & ent lem So lv in g& In no va t io n

Init iati ve

& ng ng ki n i Ma on

Financia l Savvy

De Pla cis n i

Com

mu n

ica tio

n

Source: Nursing Leadership Academy 360º Leadership Audit.

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Right Match
Multiple Opportunities for Growth for Good Candidates
Clinical Track Education Track Management Track

Source: Nursing Executive Center analysis.

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Making Many Career Changes,

Clinical Track

Education Track
Perri Hopper, RN, MSN • Promoted to RN4 through combination of education and clinical skills • Receives pay increase

Level 4 Receives master’s degree in advanced practice

Level 3 Maintains RN3 status by completing clinical criteria

Continues to work in bedside nursing and to improve skills

Promoted to RN3 (Educator); receives pay increase

Level 2

Promoted to RN2 (Clinical), receives pay increase, transfers to CCU U

Chooses to explore Educator track, while remaining in bedside nursing

Achieves RN2 (Educator) status

Becomes interested in charge nurse position

Level 1

Perri Hopper, RN • New BSN graduate • Starts work in med/surg

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All Within One Hospital

Management Track
Facing Reality
“[A multi-track career ladder] fits the reality that nurses want to experience different areas of nursing throughout their careers, and allows us to keep them in the hospital system. If we really invest in our nurses and help them realize that nursing is a career, I think a lot of the frustrations they have now will disappear. The nurse can stay at the bedside and be promoted, and still have opportunities for growth in other areas of interest.” Assistant Vice President East Jefferson General Hospital

Decides management is not a good fit, begins work on master’s degree

Achieves RN2 (Management) status

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Insert Front of Pullout Here

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Insert Back of Pullout Here

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With Compounding Effect
The Power of the Multiplier
Sharon

1

Ineffective Manager

71

Ineffective Nursing Staff Members

Weak Managers Contribute to Turnover
Percentage of Nurses Who Considered Leaving Hospital Nurses Very Dissatisfied with Direct Manager
16% 57% 84%
Considered Leaving Hospital n=1,576
Source: Nursing Executive Center National RN Survey; Advisory Board interviews and analysis.

Nurses Very Satisfied with Direct Manager

43%

Considered Leaving Hospital

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The Choice Is
Two Ways Out
Improve Reassign

OR

Or

Develop skills to improve effectiveness of manager

Find a more appropriate fit and replace manager

Source: Advisory Board interviews and analysis.

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Description: Nursing Leadership Instilling a Culture of Leadership