employees, and physicians. The physicians were the most difficult and most important change agents. At times they acted as desperate victims as the core of their power was diminished. Employees Another key to the process was the employee. Change at the staff level was crit- ical. Employees were rewarded for being caught caring. They were empowered to make things right when patients or their family members were upset. They were encouraged to go the extra mile when necessary. For the first two years this worked beautifully. As the bottom fell out of health care due to the shortage of registered nurses and the impact of the Balanced Budget Amendment, however, those employees who were motivated not to change began using the Planetree philosophy as a lever to get even with administration. Any time the employees, specifically nurses and laboratory technologists, were upset about pay raises or working conditions, they were less attentive to the patients, and told the patients and their families that they were overworked and underpaid. Both of these statements were true. The manner in which management corrected this problem involved sur- rounding the patients with volunteers and complementary care givers. A typi- cal patient would be seen by a massage therapist, aroma therapist, behavioral psychologist, clergy, volunteers with art carts, and, when desired, pets for pet therapy. FEEDBACK USE Planetree teams were put together to teach, train, and gather feedback from the employees. After the first two years of change, meaningful growth, and strong profits, during which time the employees enjoyed significant increases in salary, morale was at an all time high. During the following two years the finances were the driving force behind the primary unrest. These Planetree teams served an integral part of the cura- tive process for advancing the philosophy. Each meeting started with a venting session intended to allow the employ- ees in attendance the opportunity to express themselves. After each session the team would prepare anonymous debriefing reports to be read by senior leader- ship. This feedback began to bring light to the subject of the employee’s concerns. The Planetree team made sure that all participants had access to the sum- mary pages as well. The president discussed the findings with employees during his regular employee meetings. Due to these findings, employee satisfaction 430 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE cart_14399_ch18.qxd 10/19/04 1:20 PM Page 430 surveys, Lunch with the President, individual meetings, and newsletters were all forthcoming. In spite of all of these ongoing efforts, nothing changed until a windfall came to the hospital through a settlement with an insurance provider that enabled the hospital to give 30 percent raises to key caregivers. The reality here is that happy, well-paid employees were critical to the success of Planetree. DESIGN: PLANETREE PHILOSOPHY The core of the Planetree philosophy is as old as human healing and caring. It involves the holistic care that nurtures the mind, body, and spirit. It embraces the creation of an environment that recognizes a healing process that does not emanate purely from drugs or surgeries. It is a truth that has been known for thousands of years but has been overpowered during the past fifty years by modern medicines. Planetree embraces a philosophy that includes the creation of a healing envi- ronment through architecture, natural light, plants, music, aroma therapy, the presence and encouragement of loved ones, and the nurturing provided by clergy and psychologists. Each day bread is baked in the hallways, popcorn is popped in the lobby, music is played, and massage is offered to patients as they wait, to the employees at their workstations, and to the physicians in the hallways and in their offices. More important, the patients are empowered to ask, participate, and know. It is all about the belief that healing can occur in many ways. INTERVENTION: FUNDAMENTAL CHANGES The work of the Planetree teams, the senior leadership, the board and staff was all-inclusive and continues to this day. Each aspect of this change culture was carefully planned, executed, and managed. • Formal on-the-job training and classroom training from internal Plane- tree leaders, consultants from Planetree staff, and outside consultants • Annual refresher course for all employees • Employee training course for all new hires • Establishment of an anonymous telephone hotline for employees to identify any feelings of wrong doing toward them • Celebration of major accomplishments with parties, ice cream sundaes, dinner certificates, awards, trips to baseball games, and cash; recognition in written communication and gifts from senior managers WINDBER MEDICAL CENTER 431 cart_14399_ch18.qxd 10/19/04 1:20 PM Page 431 • Empowerment of employees with the authority to care for patients’ needs up to $300 in costs per incident • A portion of the employee compensation is tied to performance Success Factors 1. The extensive training by professionals and peers 2. Mention of Planetree in every communication to employees made it the single focus of the mission of the organization 3. Employee recognition by senior leadership 4. The president’s walk the talk approach 5. The humanistic approach to the removal of employees who would never be able to provide Planetree care 6. Recognition by local, regional, and national press for the unique patient-centered care, trademarked Windbercare, provided by the employees and volunteers at Windber Medical Center Together, these factors helped overcome the internal resistance and program obstacles. THE PLANETREE TEAMS The value of the Planetree teams cannot be discounted. It was because of their ongoing work and dedication that progress occurred. These employees worked dozens of hours on their own time at special meetings on and off campus to ensure that the Planetree sessions were meaningful. Because the sessions were peer to peer, they were much more effective. All employees were required to attend sessions where sensitivity training occurred. Role-playing of employees as patients was an important part of the programs. A SWAT team made up of social workers, psychologists, and clergy provides on-the-job help. This crisis intervention team was an important aspect of providing support for employees when crisis situations arise. LOOKING BACK The transition of a small, 102-bed, urban hospital located in a community of less than four thousand people to national prominence was neither easy nor safe. The president of the organization was challenged numerous times by 432 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE cart_14399_ch18.qxd 10/19/04 1:20 PM Page 432 physicians, system executives, and employees. It was a passion for change that allowed the dream to become a reality. None of the goals could have been accomplished without hard work and commitment from the entire staff. The Change Circle The textbooks talk about unfreezing, changing, and refreezing a culture. In this case the refreezing of the culture is a never-ending task. The change circle for moving a traditional hospital to the Planetree model takes years. As the reputa- tion of the organization continued to grow, new physicians and employees attracted to the holistic, caring culture came seeking employment at the facil- ity. The addition of these special caregivers enabled the culture to change more dramatically and completely. It also began to balance the power of the medical staff. The organization was a typical Industrial Revolution model. Employees clocked in each day minutes before they were to be at their position within the hospital. They went to their workstations, and the day revolved around the physicians’ and employees’ schedules. In many cases, the staff did not recognize the patient as a customer. The patient was an inconvenience. Their presence was an interruption. In order to see the need for change, studies depicting the future demise of the organization were made available at employee meetings. These studies were not used as gospel but only as a warning signal that the organization had five years to make a significant change. The importance of making the patient the center of care was a difficult job. It was totally foreign to the culture of much of health care. Although the employees of Windber Medical Center and especially those of the palliative care unit were exceptionally caring individuals, the general rule of thumb was that the rules were the rules. Patients were scheduled at the convenience of the physician and the technician. This required the changes previously outlined. It Gets Worse Before It Gets Better The overall atmosphere of the organization was one of waiting for the wave to pass over. In fact, each aspect of the Planetree philosophy was undermined, ignored, and blatantly pushed aside while the employees waited for their fifth president to be fired or their sixth manager to be promoted or dismissed. It was the revolving door theory. If you ignore it, they will go away. When it became obvious that the change agents and the philosophy were, for the most part, going to stay, then positive reinforcement could begin to take hold. It was also a we-they relationship with the physicians and employees. One physician had all of the nurses on his group e-mail and used that e-mail to undermine the senior leaders on a regular basis. So those employees would cling to their protective physician for power as they ignored management. WINDBER MEDICAL CENTER 433 cart_14399_ch18.qxd 10/19/04 1:20 PM Page 433 I’m from the Government and I’m Here to Help As the program moved forward and received the positive attention of local politicians, federal, state, and local grants began to pour into the organization for special programs, research projects, and capital additions. Instead of pleasing the employees, making them happy and secure, these grants caused jealously between the departments that received them and those that did not. As new buildings came on line, the employees located in the older buildings were resentful and openly hostile. As new employees came on board, the long-time employees were disruptive and, many times, unkind toward them. It was a very interesting evolution that did not and could not work out until salaries, remodeling, and attention occurred housewide, five years into the transition. Getting Back on Track After several years of training, growth through increased census and patient numbers, grants, and national recognition, Planetree began to take hold as a way of life at Windber Medical Center. There are still physicians who do not want to allow patient empowerment, there are still not always care teams in place, there are days when patients don’t smell the bread, see the volunteers, or see the special complementary medicine specialists, but 95 percent of the time, things are as they should be. Because we wanted everyone to feel as though they were in the best five star hotel, a spa, and a healing garden, we hired a hotel manager to run our house- keeping, dietary, and maintenance departments and provide room service, fresh flowers, bread, live music, artwork, and fountains and invite loved ones to stay with their sick relatives. We have unlimited visiting hours. We also provide pajama bottoms and bathrobes. More like their home or better. A healing environment. In our birthing suites, we have midwives in room deliveries and use such complementary therapies as birthing balls, aromatherapy, music and massage therapy, infant massage, Jacuzzi tubs, and hand-held massagers. We also have double beds for the families to use after the baby is born. Mother, father, and baby occupy the same room. These birthing suites also contain computer hookups to the Internet, live music, and TV-VCR, and we bake fresh bread daily and offer tea and coffee. As part of our commitment to the community, we have added a “Center for Life.” This is the senior center for senior citizens. Seniors come each day and have access to our gym, our doctors, and trained staff. In this center, older citizens have access to social services and preventative health options. 434 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE cart_14399_ch18.qxd 10/19/04 1:20 PM Page 434 The medical center has a palliative care unit for our hospice for pain control, respite for the family, and end-of-life care. We can accommodate a family of four in each patient room. The Joyce Murtha Breast Care Center is a model of breast care for women. It contains all state-of-the-art equipment for digital mammography, breast biopsy, osteoporosis, and 3D ultrasound, and even has a cosmetologist to assist women who are going through chemotherapy treatments. Quantifying the Results: Exhibits After several years of patient-centered care, some curious anomalies began to appear. Our patients had the lowest mortality rate for adjusted acuity, they had an extremely low length of stay, and our infection rate was well below the national average. (See Exhibits 18.1–18.3.) WINDBER MEDICAL CENTER 435 Exhibit 18.1. Average Length of Stay 0.5 1 1.5 2 2.5 3 3.5 4.5 4 0 1998 1999 2000 2001 2002 2003 2004 WMC Peer group Source: The Hospital Council of Western Pennsylvania. Reprinted with permission. cart_14399_ch18.qxd 10/19/04 1:20 PM Page 435 436 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE Exhibit 18.2. Nosocomial Infection Rate 2003–2004 Jan. 0 1 2 3 4 5 April July Oct. Average rate for 2003–2004 = 0.96 Jan. Exhibit 18.3. Mortality Comparison by Hospital 0.0 Risk-adjusted index is statistically significant at a confidence level of 95%. Oct. '99–Sep. '00 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 WMC Hospital A Hospital B Hospital C Hospital D Hospital E Hospital G Hospital F Source: The Hospital Council of Western Pennsylvania. Reprinted with permission. Source: The Hospital Council of Western Pennsylvania. Reprinted with permission. cart_14399_ch18.qxd 10/19/04 1:20 PM Page 436 Moving Ahead Again The Planetree philosophy is the future of health care. It embraces all aspects of holistic care. • We value Planetree as the medical center’s number-one priority • Patient-centered care is the center of the philosophy Windber, PA—David Klementik, Chairman of Windber Medical Center’s Board of Trustees, was named today by the prestigious publication Modern Healthcare as Trustee of the Year for hospitals and health systems with fewer than 250 beds or annual revenue of less than $75 Million. During a recent visit to Windber Medical Center, former Health and Human Services Secretary Donna Shalala summed up the WindberCare vision brilliantly, saying: “Close your eyes if you want to see health care in the future. Then open them, and see the extraordinary facility here at Windber. This is the future of health care, it focuses on prevention and research. Keeping people healthy and focusing on the end of life” (Modern Healthcare Magazine, January 22, 2001). Modern Maturity selected Windber Medical Center as one of the top 15 Hospitals with Heart in the United States. Its president was chosen as Outstanding Rural Health Leader of the year for Pennsylvania in 2001. LESSONS LEARNED Lesson #1—Work with the physicians first, last, and always. Lesson #2—Make sure that the right senior leadership is in place early and often. Lesson #3—Establish an effective employee screening and evaluation system. Some people never can or will be Planetree. Lesson #4—Be sure that the employees are taken care of first, last, and always. Happy employees make happy patients. Lesson #5—Recognition of team players by senior leadership on a regular basis is important and powerful. Lesson #6—Don’t give up. WINDBER MEDICAL CENTER 437 cart_14399_ch18.qxd 10/19/04 1:20 PM Page 437 ABOUT THE CONTRIBUTOR F. Nicholas Jacobs currently is president of Windber Medical Center and the Windber Research Institute. He has been with the Conemaugh Health System since August 1993 and before that was vice-president for administrative services at Mercy Medical Center for five years. Mr. Jacobs holds a master’s degree from Indiana University of Pennsylvania and Carnegie Mellon University, plus a health care certification from Harvard University and the Grantsmanship Center. He is a Fellow in the American College of Health Care Executives and was awarded the Community Rural Health Leader of the Year in 2001 by the Pennsylvania Rural Health Association. In addition, Mr. Jacobs served as an adjunct instructor for St. Francis University and has been a guest lecturer at Ohio State University, the Graduate School of Indiana University of Pennsylvania, Carnegie Mellon University, and other regional, state, and national conferences and workshops. 438 BEST PRACTICES INLEADERSHIPDEVELOPMENT AND ORGANIZATIONCHANGE cart_14399_ch18.qxd 10/19/04 1:20 PM Page 438 CHAPTER NINETEEN Conclusion Practitioner Trends and Findings To provide additional context for the practices presented in this book, we asked contributors to complete a survey to gain a more comprehensive view of their organizational change and leadershipdevelopment program. The survey comprised of five themed sections: (1) business diagnosis (including the type of initiative, business revenues, and costs and revenues associated with the initiative), (2) resistance to change, (3) design and implementation, (4) evaluating the initiative, and (5) summary. Though each organization differs with respect to area of expertise, amount of yearly revenues, and types of initiatives undertaken, each shares a similar goal of creating more successful and results-oriented organizations by way of organizational change and leadership development. COMPANY AND INITIATIVE BACKGROUND 440 BUSINESS DIAGNOSIS AND ASSESSMENT 440 Table 19.1: Top Five Reasons Organizations Made the Business Case for the Initiative, in Order of Frequency 441 Table 19.2: Assessment Methods by Frequency of Use 442 RESISTANCE TO CHANGE 442 Table 19.3: Types of Resistance Encountered, in Order of Percentage Frequency Encountered 443 REDUCING RESISTANCE 443 Table 19.4: Top Champions of Changein the Companies Initiative, in Order of Percentage Frequency 444 Table 19.5: Top Critical Success Behaviors of Senior Leadership for the Initiative, in Order of Percentage Frequency 444 Table 19.6: Challenges in Gaining Consensus During and for Best Practice Organizations’ Initiatives, in Order of Frequency 445 439 S S cart_14399_ch19.qxd 10/19/04 1:20 PM Page 439 . Initiative, in Order of Percentage Frequency 444 Table 19.6: Challenges in Gaining Consensus During and for Best Practice Organizations’ Initiatives, in Order. discussed the findings with employees during his regular employee meetings. Due to these findings, employee satisfaction 430 BEST PRACTICES IN LEADERSHIP DEVELOPMENT