Leadership Challenge
It had been only four months since I became the supervisor of my department and I was confronted with a major issue that hadn’t been addressed for many years. It was my first major challenge as a leader and I wanted to take this issue and make into an opportunity. I knew that if I was able to improve this process, I would gain my team and manager’s respect and trust.
Background
The echocardiography department at the royal jubilee hospital is primarily an outpatient lab. About 80% of our patients are outpatients while the rest are in-patients. Patients have their appointments booked at a specific time and they arrive about 15 minutes early to check-in. The procedure is performed by sonographers and can take anywhere from 45 to 60 minutes. If an outpatient does not show up for his scheduled appointment that slot is left empty and is labeled as a “No-show”.
In the past, a no-show spot was left empty and sonographers would take a break or use that time to catch up on previous patient reports. Hence, a no-show spot served as a benefit to the sonographers. However, only one or two the dedicated sonographers would go do an in-patient during a no-show spot.
There was no clear process in place of what staff was expected to do when there was a no-show. In addition, some of the sonographers felt that it was unfair that only some sonographers were scanning a patient during a no-show while others just relaxed. There was added pressure on the department to meet its acute inpatient needs and the no-show spots seemed like a perfect opportunity to utilize those spots for an inpatient.
What made matters complicated was that the sonographers, due to the nature of their job, have a high injury rate. Inpatients are more difficult to scan then outpatients. Hence, sonographers were less inclined to do an extra in-patient.
Challenge
As a leader my challenges were
a) Utilize these no-show spots and meet some of our inpatient needs
b) Create a fair process that staff will commit and adhere to.
c) Not to increase sonographer injury rates
As the new supervisor, I was under lot of pressure to address this long pending issue and find a solution. My initial reaction to this situation was to write out an email to everyone stating that we will now be utilizing the no-show spots and everyone was expected to scan an in-patient during a no-show spot. Then I realized that this may not be the best route to take as staff would react negatively to this abrupt change.
To get a different perspective on this issue I decided to consult the previous supervisor, who is retired and is also my mentor. I wanted to learn from his experience, what worked for him and why he did not choose to address this issue. His advice was to me was “Ali, you need the staff to take ownership of this issue! Or else you will be upsetting the entire department and you do not want that!”
Taking his advice, in the next staff meeting I announced that I will be creating a no-show committee made up of sonographers (junior and senior) and clerical staff (they are the ones who book and schedule the patients). Some staff volunteered themselves and I also asked two staff members to be part of this committee as I knew that, among the group, they would demonstrate the greatest resistance to this change. By having all the different stakeholders in the meeting and my goal was for the entire department to be united and buy-in to this change. I knew that if this committee was able to come up with good recommendations, each of these members will then help other team members to get on board and there will be less resistance to the change.
I setup an hour long meeting with this committee and using the “What, Why, Who, Where, and How” framework, all of us reviewed the current state of the no-show process. As a facilitator, I set clear expectations in the meeting, defined the goals, which were to a) reduce our no-show rates b) create a fair no-show policy c) not to increase staff injury rate, and asked the committee to remain future focused i.e. how can we make things better? I was a bit anxious that this committee may end up debating not come up with any pragmatic solutions. However, the committee surprised me as the sonographers and clerks discussed all the “what if “scenarios and came up with a list of changes and recommendations; some of them that even I hadn’t considered.
I wrote up the meeting minutes and asked the committee to review them, in the event if I missed any points. Afterwards, I presented these recommendations to my manager and solicited her guidance on how to implement this change.
Before the next staff meeting, I submitted a copy of the recommendations for all the staff to review. In the staff meeting, I gave staff the opportunity to ask questions, give feedback and clarify any points. As expected, I hardly had anyone raise any issues or concerns regarding the recommendations. The team was less resistance to this new no-show policy as they felt they were creating this change and they took ownership of the change. However, this was not the end; the implementation of this policy would have its own unique set of challenges.
Great story! I really enjoyed reading how you’ve made it this far, and I look forward to hearing the outcome. I have a few feedback questions:
1) Historically, do you know what was holding the department back from developing a no-show policy? Do you know how this practice developed (some scanning, others taking a break)?
2) Does something set apart those that we scanning inpatients as opposed to those who were not, such as social norms, personality, status, union position, motivation…?
3) What other risks did you personally face, other than your standing as supervisor, if any?
I really liked how you leveraged your mentor to advise you and included the greatest opponents in the working group, and acted as a facilitator rather than dictating practice.
Hi Ali
This is a great leadership story that encompasses features of leadership that makes it difficult. I will be brief as this is my second time writing this, I lost the first version somehow.
You described the main character: you and your role. I would like to know more about your relationships prior to becoming the supervisor–if it was the same facility. It would give me an idea of the culture. Were you good friends with the staff? Did they like you? Did they encourage you to take the position and were they supportive when you got it? For example, if I was hated as a peer and went into a position of leadership, I suspect that I would have a very challenging time making change and getting buy in.
You describe the goal well with supporting goals: utilize these spots fairly and don’t increase injuries doing so. This was well done and very succinctly. Staff will appreciate you considering fairness and workplace health.
For obstacles, you did describe what they would have been in your original plan by sending out an email. I would like what other obstacles you may face in this current plan. Is there going to be an increase in workload for the support staff scheduling appointments short notice? Will the cardiologists/radiologists make a fuss that there are more images to read? Will there be “enforcement” of utilizing these spots? IE, will anybody find loopholes to not utilize these spots?
Your initial action plan with the meeting was great. You being a facilitator was a great decision, you put yourself down with the staff and didn’t walk in and say “you will do this and that is that”. You engaged staff really well. Very clever using the “resisters”.
I would like to know more about risks you are taking with this plan. Is there any risk to credibility or influence that you have if you do not succeed? If things move slow, will the staff loose interest? If there is more reporting of injuries prior to implementation, will this cause a backlash? Will there be an increase in costs to doing more scans?
Thank you Ana and Julia for your feedback. I have tried to answer some of your questions.
My medical director and previous supervisor were the one that encouraged me to apply to the position. One of my strengths, which I believe helped me become the supervisor, was my inclusive personality. I never got involved in office politics or took sides. My neutrality aided me in building rapport with everyone as they considered me as a fair and reasonable person.
I believe it was for this reason that initially techs came to me complaining about how they found it challenging that not everyone on the team is working hard as they are. They felt I would be proactive in creating more fairness in the lab. Thus it was great to have support from some of the techs who were in favor of this policy.
One of the impacts of this no-show policy was that techs would be expected to scan an additional inpatient. In comparison to outpatients, inpatients are difficult to scan for several reasons:
a) Poor body habits (obesity, suture sites, drains, IVs etc.) making imaging difficult
b) Patients are loocated on wards thus techs have to incur travel time.
c) Greater pathology is observed in inpatients; hence reports are longer, which places greater demands on the tech.
d) Stretcher beds on wards have poor ergonomics for ultrasound scanning, putting techs risk for injury
On average the techs are expected to do 2 inpatients (in dedicated slots) out of a total 7 patient scans per shift. However, if a no-show occurs the techs would be scanning another inpatient.
During the committee discussion we realized that if there were 2 no-shows, techs would be scanning up to 4 or 5 inpatients per day, which will put them at risk for injury and lead to staff being unhappy. Hence to mitigate the risk of injury to techs we limited the maximum number of inpatients a tech can scan per shift to be 3.