Dear Bahar
I manage a large staff of about seventy nurses. Where do I start to change a culture where there is no accountability to make it fully accountable?
This is not about patient care. The staff is excellent in that regard. What worries me is everything else! I'm talking about things like the reception desk being disorganized, or not attending mandatory trainings, or communication forms not being organized, or when something goes wrong in the department, it is not owned and ignored, or every issue is brought to me to "fix". It's as if the staff is only interested in their own area of work and doesn't take ownership of issues that they don't feel are their business, and this is detrimental to the patient experience. I'm getting worn out and I need help with this.
Thank you,
Tired Warrior
Dear Tired Warrior,
First of all, let me say that you are certainly not alone! Thousands of managers and employees feel exactly the same way. Whether you work with seventy nurses or just one person at the front desk, you will have accountability issues. And why is that? People are people and circumstances are complex. Sometimes you are confronted with a broken promise, a violated expectation or bad behavior.
Before answering your question, I would like to congratulate you. Your main job, patient care, is obviously going well. However, other things such as punctuality, paperwork and the working environment are not. The challenges you face are not as severe as those faced by people who have issues that affect the survival of their organization, such as quality or efficiency in their core business.
So to address your situation, I will first focus on what we might call expectation gaps in "non-core business" issues. An expectation gap is the difference between what is expected and what happens. I assume that at the root of your frustration and fatigue, you were very clear about what was expected. So you were clear about what a clutter-free desk looks like. You explained why this was important until your team felt like they were nagging. The same goes for paperwork and deadlines. Or the importance of contact forms being entered into the systems on time. But you saw that these issues were not being handled according to expectations or that performance was very low. And then this loud, insistent, and violent voice in your head started wailing, "It's so simple to get rid of clutter and get organized, and yet people can't do it? For God's sake, we're talking about simple things, how many minutes can it take!" Sometimes this voice inside you is so strong that it escapes you when you're talking to someone else. For many people, this cycle also occurs at home, with problems such as cleaning the room, getting home in time and using toothpaste correctly.
Assuming that this is the case, I will make a few suggestions.
- Make sure the expectation is clear and explain why it is important. Often managers or parents tell others what is expected, but don't take the time to help them understand why it is important or necessary. Unfortunately, when this happens, the message to the other person is "Because I say so!" or "Because I want it that way." This is not very motivating or mobilizing. Help the other person to understand what the positive consequences will be if they do what is asked and the natural negative consequences if they don't. When talking about potential negative consequences, you should want to help employees see how other employees, such as patients, families or colleagues, or even themselves, will be affected. What you don't want to do is talk about imposed consequences, such as "blacklisting them". Taking a few minutes to help others see the "what" and the "why" can make a significant contribution to performance.
- When assigning tasks, even something as simple as keeping a desk tidy, make sure you clearly explain who will do what, when, and follow up. Often one of these is not clear. Who will keep the desk tidy, what a tidy desk looks like, when tidying up needs to be done and when you will check on it, all need to be very clear. If you leave out one of these details, the task or assignment will be less effective.
- Do not simplify the issue. Treat it as a competence issue, not a motivation issue. We often assume that people don't want to do something when expectations are not met, and we try to motivate them by force, that is, by gentle or not so gentle threats. Even a raised eyebrow can carry many messages. If we treat the expectation gap as a competence issue and not as a motivational issue, we dialog with others and ask for their opinion. People who are close to the problem, close to the process they are in, often have good ideas about the solution. Ask, "What can be done to make this easier?" If others have good and feasible ideas, they are more likely to implement and follow them. They may also be able to point out some blockages, obstacles or difficulties that you are not aware of. As a result, you will have a better solution with increased commitment.
- Look at the example you and other leaders set. For example, let's imagine the following situation in a home setting. A mother is constantly asking her daughter to tidy and clean her room. The mother does not allow her to watch television until the room is clean. She also forbids her daughter from going out on weekends until the room is clean. When talking to her friends, this girl asks, "Does my mother think I'm blind?" Do you think she doesn't have to tidy her own closet or bedroom? The need for role modeling seems obvious, but sometimes parents, managers and leaders have a hard time seeing the negative example they themselves set in terms of messiness, punctuality, paperwork, civility, communication and even controlling costs. If accountability is suffering, take a look at what leaders are doing, including yourself.
ACCOUNTABILITY TRAINING
In summary, when expectation gaps persist, clarify what is actually expected and why; make sure you agree on who does what, when, and who follows up; ask for ideas; and pay attention to how you role model.
Best wishes
Spring