Mary J. Boustani, MHA, Consulting Practice Leader
When I served as CEO of a hospital, allowing employees to be involved in decision-making was usually about as easy as plugging that oil leak off the Louisiana coast. Why? For almost 20 years, I was part of leadership teams moving at warp speed. We weren’t trained in grad school to seek input from staff in decisions. The pressure on us was intense to achieve a positive bottom line, provide quality care, improve patient satisfaction and maintain Joint Commission accreditation. In most cases, ceding authority for important decisions to physicians or employees was out of the question. Let’s face it; there have always been a lot of type A personalities and control freaks in the C-suite – not a bad thing.
Making the change to more inclusive decision-making is hard, but nowadays, forward-looking organizations realize that they won’t stay competitive if they don’t create partnerships with their key internal stakeholders—physicians and employees. Leaders need to overcome their fear of losing control and their lack of trust and take the time needed to consistently and effectively involve physicians and employees in decisions that affect their work. How many times have you seen a new process or policy introduced in your organization only to have it dropped or changed after the end users became involved? Probably more than some of us want to admit. If we added up the wasted time, money and resources and the damaged relationships and trust that result from excluding most of the people who work at an organization from decisions, the result would not be pretty. You can trace back the fault lines that lie beneath many failed organizational initiatives to the lack of conversations with those required to implement change.
The job of leaders is to create a time and space for conversation to occur. Conversation requires that we use all of our senses, most importantly listening. Conversation is the place where problem-solving moves from one isolated option to a collection of diverse, innovative and effective solutions generated by the end users – our employees and physicians.
It might take more time and trust for senior leaders and managers to step back and give up control to a team of staff and/or physicians and allow them to make decisions or, at a minimum, give feedback before decisions are final, but it’s something our employees and physicians want and need. In 2009, Press Ganey’s Employee Partnership database results reported that two of the top five priorities involve the employees’ lack of participation in decision-making and not being asked their opinion before decisions are made – in other words, they want to have healthy conversations with their leaders.
A few things to remember when trying to start the dialogue:
- Healthy conversations stem from healthy relationships
- Healthy relationships require that both parties contribute equally
- Contributing to a relationship requires time
- Meetings create the time for healthy conversations
Oops, I must go now. … I am running late for my next healthy conversation!
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