An Early Lesson in Leadership

Donna Sollenberger, EVP & CEO, UTMB Health SystemQuite a few years ago, my university alma mater asked me to speak on the topic of leadership and how, throughout the course of my career, I had honed my leadership skills. I began my presentation with an experience I had as a nine-year-old. Sharing this story that evening was especially significant because the main characters of the story, my brother and sister, were both sitting in the audience.

Growing up, my family lived in Paris, Illinois, which is a fairly small town in the central part of the state. There weren’t many organized activities for children, and my mother was often busy caring for my younger siblings, so I learned to keep myself entertained. This particular year, I had resourcefully used my time to orchestrate an illustrious plan—my sister, brother and I would put on a holiday variety show for my parents and grandparents. It would debut the evening of December 24.

I excitedly began production, armed with a hand crank Singer sewing machine and lots of crepe paper. I created costumes for my sister, brother and myself. Then, with a little construction paper and poster board, I built the scenery backdrop. I handcrafted the programs, wrote the script, selected songs we each would sing, and choreographed a dance number for the three of us to perform. I even made special invitations, which I mailed to my grandparents and hand-delivered to my parents.

With all of the groundwork for the project complete, I approached my brother and sister with my wonderful plan. Up until this point, I had not involved them in any of the preparation, so they had no idea what they were in for. It was at that moment that I learned something very important. Working by myself was easy. The hard part was engaging my sister and brother in the plan.

As I excitedly told them everything I had planned for the three of us, they did not seem especially thrilled with any of it, and they resisted my attempts to rehearse. After some unsuccessful attempts, however, I was able to entice them into participating. The price? I had to walk with them afterwards to the neighborhood store and buy them candy with my allowance. Having secured such a rewarding business deal, they were suddenly much more enthusiastic, and they put their heart and soul into the rehearsal. When we were finished, I fulfilled my end of the bargain. Maybe winning them over wasn’t so hard after all!

But on the night of the big performance, my sister dropped out. She claimed she was “sick”. To this day, I am not certain I believe that. Nonetheless, she sat in my mother’s lap the entire evening. I think she even fell asleep! Meanwhile, my brother participated but showed little enthusiasm for his role. I, on the other hand, delivered a stellar performance and ended with a rousing rendition of “Santa Claus is Coming to Town”.

Reflecting on this story many years later, I find amusement by the fact that it revealed several valuable lessons on leadership:

  1. Anyone has the capacity to lead. You don’t have to have a impressive title to be “authorized” to take the lead in situations that need attention or resolution. For example, if there is equipment that is not working properly, you can take the lead to report it and follow through to make sure it is fixed. If there is a patient that needs assistance, even if you are not the nurse, patient care technician or medical assistant assigned to the patient, you can still make sure that person gets what he/she needs. In most cases, leadership is really local and informal.
  2. Most acts of leadership require the engagement of others in the development of the plan, because you will need those individuals to execute the plan. I have often wondered what the outcome of my holiday production would have been if I had engaged my brother and sister in my plans. If I had involved them more, letting them help with the costumes, scenery and program, and if I had shown appreciation for their contributions, maybe they would have been more supportive and as excited as I was. Over the years, I have learned that the more leadership engages the individuals who are ultimately affected by a project during the planning process, the easier and more efficient the plan is to implement, and the stronger its end result. I believe this sort of inclusive thinking is important at UTMB, especially when projects impact our providers, clinicians and staff who work on the frontlines of patient care.
  3. Informal leaders rely on open communication, a shared vision, and often, charisma. Looking back on this experience from my childhood, I now know that my plans were not openly communicated. There was no shared vision, and as far as charisma to motivate the group goes, I failed miserably in that department, too.
  4. Informal leaders lead by example and through the strength of their character. In this instance, I wanted my brother and sister to enthusiastically perform, but the example with which I led was “I will develop the plans, and you will follow.” That is hardly a recipe for leadership success! Marshall Goldsmith, a noted speaker and writer on leadership who I also mentioned in last week’s report, reminds us that not only is it possible for leaders to sometimes add too much value, thus stifling group collaboration and creativity, but it is also important that they give everyone on the team a chance to stay informed of the plan’s status; otherwise, whatever is being planned is still only the leader’s vision, and those who are being asked to carry out the work may lose their enthusiasm.
  5. Informal leaders are often more strongly committed to the group, because they are part of it on a daily basis. As formal leaders, we rely on informal leaders at all levels of the organization in order to effectively execute big plans and help achieve high-level goals. As informal leaders, we have a responsibility to our group to align our work in a way that supports and helps achieve those organizational goals. That is one reason why the Weekly Relay messages are so important—they create a forum that provides important organizational information to all employees and faculty, and they also encourage feedback from staff that should be relayed back to leadership. Two-way communication is a vital part of successfully carrying out plans.

This childhood experience taught me the five leadership lessons above. In my experience as a nine-year-old planning a big holiday production for my family, I had thought I was being a great leader; however, my brother and sister have always been quick to point out that I was simply “bossy”. Oh my, what an eye-opener!

John Quincy Adams once said, “If your actions inspire others to dream more, do more and become more, you are a leader.” As we go about our work, let’s be the best informal or formal leaders we can be so that we assure our patients and families always get the care and compassion they need. It is only through engaging everyone that UTMB can achieve the clearly articulated goals of the “The Road Ahead.”

holly

Simple solutions are seldom simple.

Donna Sollenberger, EVP & CEO, UTMB Health SystemAlfred North Whitehead, a noted English mathematician and philosopher, once said, “Simple solutions are seldom simple.” This quote resonates with me, particularly as I think about the work I have done throughout my career in health care. I am struck by how often something has sounded simple, but once I started digging a little deeper into the issue, I found that reaching a solution was not simple at all. In fact, solving the “simple” problem often involved days of work, discussions with many people, and a thorough review of what others had already done to ultimately solve the problem.

From my experience in solving many of these “simple” problems, a couple of effective strategies have surfaced over the years. These approaches have made reaching solutions easier and in the long run, have resulted in relatively successful outcomes. I hope that as an organization, we can apply these methods to solving a problem we face today: our quest to reduce hospital-acquired infections through the “simple” act of improving hand hygiene compliance.

It sounds like a pretty easy solution to use alcohol-based sanitizing gel or to wash our hands each time we enter and exit a patient’s room, doesn’t it? However, we have discovered that the act of washing our hands, just like our mothers always told us, is something easier said than done! UTMB is still struggling to get all of our physicians, nurses and staff to perform at the current target of 90% hand hygiene compliance, let alone reach 100% compliance. Although we all agree that we should be at 100%, we haven’t been able to move the needle—so what will that take?

So far at UTMB, we have attempted to solve the issue of hand hygiene using an overall institutional approach. Although we have made some considerable improvements from where we started several years ago, this year we have hit a plateau that continues to hover below our goal. Despite a new communications campaign and reinvigorated training efforts, we have made very little progress.

I have found that the best way to tackle a problem like this and find the best solution is to gather a strong representation of everyone who is affected, present the issue at hand, and through collaborative discussion, explore the various facets of the problem until a solution gradually emerges. The power of this synergistic process is that everyone brings different strengths and perspectives to the table, especially when they are not within the boundaries of their assigned department, unit or clinic—in other words, they are out of their silo and working in an integrated way. When people are allowed to freely collaborate, they arrive at some pretty practical, sometimes elegant, solutions to the problem(s) in front of them.

As a leader, it is important to realize that facilitating a collaborative discussion does not mean that we are expected to already have all of the answers immediately at our fingertips. In fact, sometimes if we know too much, it can actually inhibit the collaborative process. Marshall Goldsmith, a noted speaker and writer on leadership, suggests that the biggest mistake a leader can make is to “add too much value”. When a leader contributes too much too quickly, they can actually stifle discussion and collaboration. When that happens, the group does not get to the best solution, and sometimes they cannot reach a solution at all.

Instead, the role of the leader is to spearhead an exploration of the topic at hand. First, one simply needs a general understanding of the issue. The next important component is to possess the ability to recognize and bring the right group of people to the discussion—a proper representation of those who are impacted by the issue and who can champion change. Then, begin with effective, thought-invoking questions, and always keep the conversation focused so that a viable solution can be reached.

After giving considerable thought to the challenge of improving hand hygiene compliance at UTMB, and after having many conversations with others, I have determined that we can do better. I would like each clinic, led by the nurse manager and medical director, and each inpatient unit or department, led by the nurse or technical manager and the medical director, to develop their own approach—an approach that will work best for each area. By working together with Healthcare Epidemiology, for example, the Surgical Intensive Care Unit improved their performance over a nine-month period from ranking as one of the lowest performers to achieving a 91% compliance rate (read more on this achievement on page three of the October 2015 issue of Friday Focus Newsletter).

I encourage all of you to work together at your clinic, unit or department level on this topic. Discuss your performance to date, and once you see where you are in terms of that performance, develop an approach that you believe will work best for your area. Then, track and communicate the results. Hand hygiene results can be viewed at an overall level on the Hand Hygiene website and by unit/department level at http://scorecards.utmb.edu. I will be asking each of the managers at our December Health System Leadership Team meeting to develop an improvement approach by January 15, 2016 and then begin to implement it. Our goal is that all units, departments and clinics achieve a 90% or better outcome for hand hygiene by August 31, 2016.

I am confident that each of you can help us to move to a higher level in this area. Hand hygiene is one of the most important ways infection and the spread of germs can be prevented and is an integral part of infection prevention practices. Our patients deserve our careful attention to this matter so that we can assure them of the safest possible patient care environment.

Thank you for all you do every single day to contribute to “simple solutions” for the challenges we face. I am grateful to you all for your dedication to assuring that our patients are cared for in the best possible way!