By Valerie J. Dimond, Contributing Reporter

When managers fully understand the different ways in which individuals, including themselves, identify and communicate problems and solutions, also known as influencing styles, they’ll have a much better chance of achieving successful outcomes. This awareness also sets the stage for managers and staff to experience fruitful coaching experiences, which, according to Dr. David Munch, senior principal for Vizient Advisory Solutions, are critical to becoming an effective healthcare leader.

“Middle management is critically important to the design and execution of improvement and is responsible for seeing to it that the care is delivered as intended; that’s probably their most important role,” said Munch during a “Leading, Managing, and Coaching to Excellence” seminar he co-presented at the Institute for Healthcare Improvement’s 2019 National Forum, December 8-11 in Orlando, Florida. “Your time is much better spent coaching problem-solving than problem-solving itself — as a leader, as a manager.”

Munch began his discussion by describing how a good system works: “My best analogy of a well-written system is a symphony. Every one of those musicians has standard work in front of them; they have a process that they’re following. However, they have to coordinate with each other. The first violin has an ear for timing with the second violin to make sure the harmonies are going well. The second violin section actually has an ear toward percussion to make sure they’re on beat. There are all of these coordinations that occur between musicians, individuals, and departments, if you will — the wind sections, the percussion sections, the horn sections. And if it works as a system, it’s beautiful music. If it doesn’t, as maybe all of you have experienced, there’s some chaos and it doesn’t quite sound as good as you want it to.” To be an effective “healthcare conductor” you must motivate members and unleash their talents to grow and sustain a health system’s improvement initiatives.

Analyzing cost
“Most of the time when I review an improvement effort, I don’t see enough effort in the current-state analysis,” said Munch. “Every improvement effort should have as an initial analysis of the cost of poor quality — COPQ in Six Sigma terms — and based upon how we’re doing it now, what is it costing in respect to not only finance but possibly patient outcomes, or some other type of deficiency? Make sure you interview people within the issue, upstream and downstream, make sure you’ve observed it, make sure you’ve mapped it. Once you do that the cause will be much more likely to be found.”

Redeploy and delegate
One way to identify where changes can be made is to write down every task you do, including the length of time required, for three days, and ask yourself if they add value. If not, remove them from the schedule, but be mindful of what you do next with that time. “Be intentional about where you redeploy your [own] work; people have identified all kinds of things and started taking stuff off the schedule, but it didn’t fundamentally change what they did,” said Munch. “What happens is that other things creep into that time-saving spot. Fill it back with something more useful than you had before.”

Managers who feel overburdened also have the biggest work piles on their desk. “And the stack just gets bigger and bigger,” said Munch. “I’ve talked to a number of managers and they feel like they have to solve all the problems. No, use your team to help solve problems. Who on your team are people who show promise who might be able to eventually climb into a management position? Your role as a manager in creating an army of problem-solvers is to delegate and train so problem solving can occur on a grander scale than just yourself.”

Ask the right questions
Successful coaching involves asking powerful questions. Instead of telling people what should be done, allow them to arrive at their own solution, which is more likely to create enthusiasm for accomplishing goals and sustaining progress. What constitutes a powerful question? “Be very careful when starting a question with who, because that can get to blame and fear fairly quickly,” cautioned Munch. “The most effective questions are those that start with why, how or what. Why is that so? How would that work? What do you think should be our next step? Any question that can be answered with yes or no does not require any critical thinking skills to respond.”

Act in the moment
As Ben Franklin famously said, don’t put off until tomorrow what you can do today; the same goes for coaching. “The best coaching moment is at the moment of struggle for the employee or team member,” advised Munch. “If you can observe and coach right at the moment, it’s much more powerful than something happening a month later. It’s not about having the right answer, it’s about asking the right question. That can be very powerful in change management as well. Every coaching moment should result in action. Based upon this conversation, what will we do now, when can we expect that to be done, will you take responsibility, or will I take responsibility?”

Listen intently
Allowing employees to speak — for however long they need to — leads to the right solution. “Let’s say somebody did something wrong and you go up to them, they could be quite defensive, and as you start inquiring about it, they might unload on you,” Munch said. “What I would advise you to do, if there’s some tension there, is allow them to unload. Allow them to experience catharsis of all of the frustration they have until they’re done. Because then, and maybe only then, are they able to be in a position to listen to the next question or advice you may give them. Your job is not to win an argument. Your job is to come to a mutually agreed-upon solution going forward. I read a paper once that said the average amount of time that it takes before a physician interrupts a patient on the patient’s story is 17 seconds. I don’t know if I can describe anything in 17 seconds.”

Put it to the test
Later in the session, Munch asked people in the audience to pair up and practice working out a problem. One person played the coach and the other the coachee. After the exercise, many shared their experiences. “I’m actually a physician and I was the coachee,” said one person. “I got so frustrated because she kept on asking me questions. And I had no clue. And I kept saying we can’t do this, we can’t do this, and for these reasons. She said, ‘you tell me how, because we have to; at some point in time we will have to improve patient experience.’ Finally, she got three or four suggestions out of me — and I think that is a hallmark of a good leader.”

Another coach commented, “It was intense. In my situation I had an employee that has been doing this work for 20 years, so change is not always easy. But I validated her on the experience she had. I really wanted to hear the differences she had. I wanted to hear the important questions, the how, the why and the what. I wanted to hear what solutions she thought she could bring to the table, which I’m sure she could because she had 20 years of experience.” Munch said that was an excellent approach: “You were honoring her experience, her wisdom and knowledge to help generate the solutions.”

Allocating adequate time and a private place to talk is also important, as the coachee discovered. “I was being a difficult coachee because that’s the reality of when we’re having these conversations,” she said. “The takeaway for me is you need to make sure that you have an ample amount of time to have this conversation. We really didn’t get too far because I was being difficult, digging my heels in, and we needed more time for her to establish that trust so that I could start opening up, because maybe after 20 years my ideas have been shut down, and so it was going to take more time for her to get that wall down.”

Stay committed
The Hawthorne method works — people do what’s expected of them when they know you are watching. “You should be going to the floors on a weekly or monthly basis, said Munch. “And the agreement from the last coaching moment should be one of the first questions you ask on the next visit so that they know its important, that they know there’s going to be follow-up. If you don’t ask about it and follow up with it on the next visit, guess what they know they don’t have to do? It’s that periodic visit that never goes away that reviews all of these things on an ongoing basis. Early on in an improvement effort you may have to review things weekly or monthly. As it matures and is in control, you can pull back to maybe quarterly or every six months. The key here is to never drop it completely because once you do, entropy will deteriorate your work.”