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Study Questions
The Florence
Prescription
Copyright © 2010, Values Coach Inc.
and
The Florence
Challenge
1
By taking The Florence
Challenge our organization
is telling the world that we:
2
Aspire to a culture of ownership
where people are committed to
the values of the
organization, are engaged in their
work and with their
coworkers, and take pride in
their work and in their
professions. 3
Encourage people to hold
themselves responsible and
accountable for their attitudes
and actions, and to empower
themselves to do the right
thing for patients.
4
Expect a workplace environment
that is free from finger-
pointing, cynicism, gossip, compl
aining, and other forms of toxic
emotional negativity.
5
The Florence Challenge for a
culture that is…
Emotionally Positive
Self Empowered
Fully Engaged
As a participant in
The Florence Challenge
we are asking you to:
7
Read The Florence Prescription
and think about how the 8
essential characteristics of a
culture of ownership apply to
your own work and life, and…
8
Take the seven simple promises
of The Self-Empowerment Pledge
to help you in your own life –
personally, professionally, finan
cially, and spiritually, and…
9
Refuse to participate in chronic
complaining, gossiping, and
other forms of toxic emotional
negativity, and replace the
words “Not my job” with “How
can I help?”
10
11
12
Are you willing to make
the commitment?
Are you ready to start?
13
Study Questions
for Chapter 1
14
Is this true?
You can‟t be cynical and negative sitting in
the cafeteria or break room and then
somehow flip an inner switch and become
genuinely caring and compassionate when
you walk into a patient‟s room. And
patients see right through the fraud.
The Florence Prescription
15
Is it possible to be cynical and negative
at work and then flip an inner switch and
become a genuinely nurturing and
empowering parent and loving spouse
at home?
16
If Carol Jean Hawtrey spent an hour
sitting in the cafeteria of your
hospital, what sorts of conversations
would she be likely to hear?
17
“Who cares for the caregiver?” is an
age-old question in healthcare.
But if we don‟t care for each other –
emotionally and spiritually – who will?
18
Is it important for people to know
and embrace the values of the
hospital they work for?
Do you know and embrace the values
of the hospital that you work for?
19
Study Questions
for Chapter 2
20
Do you agree with this?
You can hold people accountable for
showing up on time and for fulfilling the
terms of their job descriptions, but you
can‟t hold them accountable for being
committed and engaged. You can‟t hold
people accountable for caring. It takes a
spirit of ownership for those things to
happen.
The Florence Prescription
21
Do you agree with Connie O‟Dell
that negative attitudes increase
the stress level in a hospital – and
is the reverse true, that positive
attitudes can reduce the stress
level?
22
Florence Nightingale is surprised
when she hears someone use the
words “patient-centered care,” and
asks what other kind of care there is.
How dedicated is your hospital to
putting patients in the center of the
care matrix, and what more can be
done to put patients first?
23
Carol Jean says that the “Invisible
Architecture” is the soul of an
organization. Can organizations
have “a soul” in any meaningful
sense? Does yours? How would
you describe it?
24
Do you agree that accountability
alone is not enough to make a great
organization, that it takes a spirit
of ownership? How would you
define “accountability” and
“ownership”?
25
Carol Jean describes eight essential
characteristics of a culture of ownership:
Commitment, Engagement, Passion, Initiat
ive, Stewardship, Belonging, Fellowship
and Pride.
Are any of these superfluous, and has
anything important been left out?
26
Study Questions
for Chapter 3
27
Does this make sense to you?
Rules are of the left brain, values are
of the right brain. When people don‟t
share a common set of values you need
to have lots of rules.
The Florence Prescription
28
John Myerson described the “see-smile-
greet-help” rule of Memorial Medical
Center. How would your hospital be
perceived by a new employee or a lost
visitor?
Is it important that the
environment be friendly?
29
Carol Jean said, “When people don‟t share
a common set of values, you need to have
lots of rules.” Of course, as Myerson
replied, you need both – but there is a
continuum from rules-based to values-
based. Where does your hospital fall on
that continuum and what can be done to
move it further toward the values-based
end of the scale?
30
Myerson said that you cannot teach
people values if they didn‟t learn them at
home. Do you agree with him, or do you
agree with Carol Jean who said that not
only can values be taught, it‟s essential
that they be taught if you want to be a
great hospital?
31
Carol Jean said that core values define
what the organization stands for and what
it won‟t stand for. How clear are people at
your hospital about the behavioral
expectations created by your values
(both stated and implicit)?
32
Little Timmy tells Myerson that he should
give nurses a pay raise because he heard
them complaining in the hallways.
What are patients likely to overhear in
your hospital (keeping in mind that they
hear a lot more than you think they do)?
33
Study Questions
for Chapter 4
34
Do you agree?
When patients overhear caregivers
complaining and gossiping, it violates
the integrity of the caregiver and shows
a lack of respect for the patient, not to
mention the person who‟s being
complained or gossiped about.
The Florence Prescription
35
Timmy Mallory fights cancer by slaying
dragons in his imagination, and Myerson
suggests a dragon-slaying area on the
pediatric unit. How might a culture of
ownership encourage people to come up
with the sort of “crazy” ideas that can
make a hospital special?
36
“Just because the doctors have given up
hope doesn‟t mean there‟s no longer
hope.”
Read The Hope Diamond on the next
slide, then discuss Florence‟s comment –
both in the context of patient care and
of navigating a stressful healthcare
environment.
37
38
Most hospitals have a vibrant rumor
mill, but Florence states that gossip
violates the integrity of the caregiver and
shows lack of respect for the patient. How
active is the rumor mill at your
hospital, and what can individuals do to
help eliminate gossip?
39
Culture is to the hospital what personality
and character are to the individual. How
would you define the culture (personality
and character) of your hospital?
Are you proud to be part of it? What would
you change?
40
How wide is the gap between what the
hospital says it expects of people (e.g.
integrity, respect, initiative) and what it
tolerates (e.g. gossip, complaining, passive-
aggressive learned helplessness)?
What can be done to close that gap?
41
“People would have a lot more time and
energy for compassion if they spent less
time and energy complaining and
gossiping.” Do you agree with Florence?
Or is “venting” and chatting about other
people a necessary feature of a healthcare
organization?
42
Especially in today‟s challenging healthcare
environment, hospitals cannot afford to
choose between compassion OR
productivity – they need both.
What ideas can you suggest for moving
from what Jim Collins calls “the tyranny of
OR” to “the genius of AND”?
43
Study Questions
for Chapter 5
44
Do you agree with this statement?
The cornerstones of Integrity are
honesty, reliability, humility and
stewardship. If people are not
committed to those behaviors, then
integrity is just a word on the back of a
name badge, not a core value
The Florence Prescription
45
Think about the core values of your
organization. Why do you think those
specific ones were chosen? If you were
made King or Queen for a day, what values
would you have chosen?
46
Think about your own personal values.
How well do they mesh with the statement
of values of your organization?
(If you haven‟t thought about your
personal values, this would be a good
time).
47
How can understanding the Values-
Behavior-Outcome Continuum influence
your personal life?
For example, if your desired outcome is
better health or financial
independence, what are the required
behaviors – and what core values would
inspire you to
take that action?
48
Discuss the 6-Es of Employee Engagement:
Expect, Educate, Enable, Energize,
Evaluate and Elevate
How much of a role can management play
in encouraging people to engage with their
work and with their coworkers, and how
much of it must come from within?
49
Florence Nightingale attributed her success
to the fact that she “never gave or took an
excuse.” What are some ways that you can
counter finger-pointing, buck-passing, and
blame game in your organization?
50
Study Questions
for Chapter 6
51
Do you find this provocative?
Taking care of the sick should be a
mission, not just a business. Being a
healthcare professional should be a
calling, not just a job. Our hospitals are
at risk of losing their souls.
The Florence Prescription
52
Long hours, changing shifts, and hard
work are often facts of life in healthcare.
No matter how tired or stressed we might
be, our patients still deserve our best.
How do we make sure that we
give it to them?
53
In the cafeteria, Carol Jean asked Sarah
what she would tell her CEO had he been
sitting there with them. What would you
tell your CEO if he or she were in the
room with you right now?
54
If Florence Nightingale showed up right
now (like she showed up in the MMC
cafeteria when Carol Jean was talking to
Sarah) what would you say to her?
What do you think she would say to you?
55
Nightingale said that caring for the sick
should be a mission and not just a
business, and that being a healthcare
professional should be a calling and not
just a job.
Still, hospitals and caregivers alike
must pay the bills. How do we
reconcile that tension?
56
Carol Jean tells Sarah that she‟s hiding
behind a mask of negativity and cynicism
because it hurts too much to care. Was
she being fair? Do you ever feel that way?
How can we support each other when it
hurts too much, or we‟re too tired, to
care?
57
As Sarah sat crying by Timmy‟s
bedside, CEO John Myerson was standing
in the doorway, also in tears, though
Sarah could not see him.
In what ways might this be a metaphor for
the big picture of healthcare today?
58
Study Questions
for Chapter 7
59
Are you just renting a job?
Any time someone says „not my job,‟
walks by a patient room where the call
light is on, or does not stoop down to
pick up a piece of paper on the
floor, that person is renting a space on
the organization chart, not taking
ownership for the work itself.
The Florence Prescription
60
Carol Jean says that corporate culture
is the only sustainable source of
competitive advantage for a
hospital, and that “cultural blueprinting”
is more important than designing
buildings.
Do you agree? Why or why not?
61
The culture of a hospital is really like a
patchwork quilt made up of the cultures
of individual areas.
What is the culture like in the area
where you work? What changes would
you like to see in that culture?
What actions could you and your
coworkers take to bring those
changes about?
62
Carol Jean distinguishes between
management (a job description) and
leadership (a life decision), and says that
today‟s hospitals need leaders in every
corner, not just the corner office.
How encouraging is your hospital of
informal leaders, and how much
influence do they have?
63
Carol Jean uses the fact that no one changes
the oil in a rental car as a metaphor for the
“not my job” attitude of people who are just
renting a space on the organization chart.
What is the difference between “owning the
work” and “renting the job”?
Not my job!
64
Carol Jean tells a skeptical John Myerson
that he should help people work on “soft
skills” like self-image and self-esteem
because a winning team is built around
people who know how to think and act like
winning players.
Do you agree that leaders (formal and
informal) should play this role?
65
Study Questions
for Chapter 8
66
How “real” is your picture?
We can make everyone go through customer
service training, and we can put billboards up on
the highway telling everyone how caring and
compassionate we are. But unless people change
how they think and act, all we‟ll have is a pretty
picture of an organization that exists only in our
dreams... To make the picture real, people have to
buy-in, to take ownership. That means they need
to change their attitudes and their behaviors. They
need to change the way they treat each other.
The Florence Prescription
67
Dr. Charlie Franklin tells Carol Jean that
he‟s skeptical about the latest “program of
the month”. How does a hospital infuse
new and innovative ideas and inspiration
without falling into “flavor of the month”
syndrome?
68
Carol Jean says that most hospitals are
very hierarchical and status-conscious.
How true is that of your hospital?
69
Put yourself in the shoes of Dr. Franklin
when he suddenly finds himself as Carlos
the housekeeper holding a mop at the
main intersection of the hospital.
How do you think you would be
treated at your hospital?
70
Carlos the housekeeper is reprimanded by
his supervisor for dancing with his mop in
the corridor. Would he have been
reprimanded at your hospital, or would
the supervisor have joined him in the
dance (at least metaphorically)?
71
Once he saw that the problem was
real, Dr. Franklin embraced the challenge
of chairing the hospital‟s new committee
to promote simple dignity.
If there were such a committee at your
hospital, what would you want it to do?
72
Florence tells Carol Jean that whether it‟s
the best of times or the worst of times
depends upon what we choose to see, and
that our perspective of today will shape
our reality of tomorrow.
What are some of the ways
that healthcare today is in
“the best of times”?
best of times or
worst of times?73
Study Questions
for Chapter 9
74
Have you given yourself that power?
Empowerment isn‟t something that can
be given; it‟s a choice that must be
made. No one can empower you but
you, and once you‟ve given yourself that
power no one can take it away from you.
The Florence Prescription
75
The nursing leadership retreat that
Carol Jean planned with MMC‟s Chief
Nursing Officer Linda Martinez was
called “Empowering Caregivers.”
What are the implications of empowering
the caregivers for both patients and for
caregivers?
76
“Proceed until Apprehended” is another
way to saying “better to ask forgiveness
than permission.” What are some of the
ways that such a philosophy can improve
hospital operations and enhance patient
service, and what are some of the ways
that this philosophy might be
inappropriate?
77
Carol Jean describes the defining paradox
of Florence Nightingale as follows: She
was both a compassionate caregiver and a
tough manager.
How can we be compassionate without
being weak and be tough without being
hard-hearted?
78
“Empowerment is a choice. No one can
empower you but you, and once you‟ve
given yourself that power no one can take
it away from you.”
Do you agree or disagree with this
statement? Why?
79
Florence says that we overrate the
accuracy of our memories but underrate
the power of our vision.
How can collective memory sometimes
hold us back, and how can a shared vision
propel us forward?
80
Study Questions
for Chapter 10
81
Is it worth the effort?
If we each do our part, we will change
our lives for the better. If we all do our
parts, we will change our organizations
for the better.
The Florence Prescription
82
How would you rate your organization on
the empowerment scale, and how would
you rate your own behavior?
Do you think you‟d end up with the same
“Lake Wobegon Effect” that Carol Jean
found with the Memorial Medical Center
nursing leadership team?
83
When Carol Jean introduced The Self-
Empowerment Pledge at the nursing
leadership retreat, some were immediately
enthusiastic, some were renewed, and
some clearly thought it was a waste of
time.
What would you think? What would be
the distribution where you work?
84
Read the seven simple promises of The
Self-Empowerment Pledge. If you made a
good faith effort to live those
promises, what would be the impact on
your life –
personally, professionally, financially,
and spiritually?
85
If everyone in your work area made a
good faith effort to act on those seven
promises, would you do a better job of
supporting each other and serving your
patients and your community?
Would it be a better place
to work?
86
How much easier would it be for you to
act upon the seven promises of The Self-
Empowerment Pledge if the people in
your work area were to take on the
challenge as a group and support each
other?
87
Study Questions
for Chapter 11
88
Is this a valid metaphor?
Toxic emotional negativity is the spiritual
equivalent of cigarette smoke in the air –
as harmful to the soul as smoke is to the
body. Just as we once eradicated toxic
smoke from our hospital environments, it
is now our obligation to eradicate toxic
emotional negativity.
The Florence Prescription
89
After Sarah left the break room where two
nurses were passing a rumor about two
coworkers having an affair, she felt “like
some part of her soul had been spattered
with mud.”
What should someone do who overhears
other people spreading rumors and
passing gossip?
90
After the new nurse learns about the false
and malicious rumors, she bursts into
tears and runs out of the cafeteria.
Timmy says that the way people are
“always complaining about something or
talking about someone” is the same as
emotional cancer.
Do you agree, or is that putting it too
strongly?
91
When Timmy says hearing people
complain and gossip makes him feel even
worse than his cancer makes him
feel, Florence calls it “iatrogenic toxic
emotional negativity.” Since emotions
are contagious, do we really make our
patients even sicker with our bad
attitudes?
92
Imagine yourself as Sarah when she had to
listen to every negative conversation in
the hospital all at once, and then the
peace she felt when they all stopped.
How much effort would it be
worth to consistently achieve
the latter state?
93
Carol Jean calls toxic emotional
negativity “the spiritual equivalent of
cigarette smoke”, and calls upon us to
eradicate it in the way we once did
smoking.
People once thought a smoke-free society
was not achievable. Can we dare to hope
for a world that‟s free of toxic emotional
negativity?
94
Study Questions
for Chapter 12
95
Do you agree that this is a management
responsibility?
One toxically negative person can drag
down the morale and the productivity of
an entire work unit. It is a core
leadership responsibility to create a
workplace environment where toxic
emotional negativity is not tolerated.
The Florence Prescription
96
What was your reaction to reading
about members of the MMC Quality
Improvement Leadership Team (QILT)
reciting their mission statement aloud
at the beginning of their meeting with
Carol Jean? Did you think it was corny
or did it strike you as kind of cool?
97
Do you agree with Carol Jean that caffeine
is the drug of choice for people of genius?
98
Do you agree with Carol Jean‟s comment
that “left brain” statistical quality and
productivity tools are reaching a point of
diminishing returns, and that future
quantum leaps will be achieved by “right
brain” qualities like
enthusiasm, pride, passion and loyalty?
99
What has your hospital done, and what
more can be done, to move from the
fragmented and ultra-specialized system
that treats patients as a collection of body
parts, toward a more holistic “right brain”
system that recognizes the inter-
connection between body parts, and
between body, mind, emotions, and spirit?
100
When the MMC Maintenance Department
tried to “empower” people to perform
routine chores like changing light
bulbs, the project fell on its face. What
went wrong and what should have been
done differently?
101
Carol Jean points out that you can
measure left brain qualities but you can‟t
see them (what would ROI or the bottom
line look like?) while right brain qualities
can be seen but not measured.
How would you meet her challenge to
come up with new ways to assess the
things that can be seen but not
measured?
102
Carol Jean says it is not left-brain OR
right-brain, but how to find the right
balance or that continuum. Where does
your hospital fall on the continuum and
in which direction (if any) do you think it
should move?
103
Study Questions
for Chapter 13
104
638 readers of the Spark Plug
newsletter respond to the 12
questions in The Culture
Assessment Survey.
Two questions particularly pertain
to this chapter…
46% agree or strongly agree;
54% unsure or disagree
Only 8% of respondents strongly
agree that their coworkers reflect
positive attitudes, treat others
with respect, and refrain from the
behaviors of toxic emotional
negativity! Even worse >>>>>>>>
More than half of respondents
either disagree with or are
unsure whether their
coworkers have positive
attitudes, treat others with
respect, and refrain from toxic
emotional negativity!!!!!!!
Would our answer for this
organization be better – or
worse? Are we okay with
that?
Responses from the current survey
67% of respondents believe
that more than 10% (or more!)
of all paid hours where they
work are wasted on toxic
emotional negativity!!!
What is the cost of all that
toxic emotional negativity on:
 Productivity
 Patient experience
 Morale
 Innovation
How much more productive
would your organization
be, how much more engaged
would your people be, and how
much better would your
customer satisfaction be if…
All those many thousands of
paid hours now being wasted
on toxic emotional negativity
could be transformed into a
positive contribution?
Since culture doesn‟t change
until people change (culture
being the collective of their
behaviors), what can you do to
help your people change their
attitudes and behaviors?
Sarah Rutledge challenged her colleagues
to take The Pickle Pledge – should we?
116
How would we answer Sarah‟s questions:
 How much better off would we be in
our own lives if we were to take to heart
The Pickle Pledge?
 Would this be a better place to work
and would we do a better job of caring
for our patients if we all took to heart
The Pickle Pledge?
117
What creative ideas can we come up with
to promote The Pickle Challenge here?
118
Study Questions
for Chapter 14
119
Are you being treated like an owner and
a partner, and if not what‟s missing?
To foster a culture of ownership, you
must treat people like owners and not
just employees, like they are partners in
the enterprise and not just hired hands
doing the work.
The Florence Prescription
120
Did you have any “first day on the job”
experiences like the one Carol Jean had
where her patient coded and died, the
doctor called her a candy-striper, and the
head nurse told her (calling her by the
wrong name) to get over it?
How can such experiences be prevented
from being inflicted upon junior
employees at your hospital?
121
Florence reminds Carol Jean that she has
two ears and one mouth, and that this
should guide her proportion of listening
and talking. What is the listening culture
at your hospital?
122
Standing outside of the room for her
meeting with the union reps, Carol Jean
was subconsciously imagining a gang of
finger-popping Teamsters looking for an
excuse to rough her up.
How do the assumptions we make and the
stereotypes we draw distort the reality of
how we experience other people?
123
Shari Levenger complemented the CNO
Linda Martinez for not putting up with
slackers and for requiring people to do
their work “and cut out all the pettiness.”
Would Levenger make similar comments
about operations at your hospital, and
what recommendations would you
anticipate that a consulting team
might make in response?
124
If you were a consultant, what advice
would you give to John Myerson for
reducing we-they, management-staff
differences and remind everyone that,
as Bill Bristow put it:
“We‟re all in
this together.”
125
Study Questions
for Chapter 15
126
Do you agree with Sarah Rutledge?
We need to see opportunities where others
see barriers. We need to be cheerleaders
when others are moaning doom-and-gloom.
We need to face problems with contrarian
toughness because it‟s in how we solve
those problems that we differentiate
ourselves from everyone else.
The Florence Prescription
127
Sarah Rutledge did not let Timmy get by
with using the word “try” (“do or do not –
there is not try” she said, quoting Yoda).
What are some of the
words, phrases, similes and metaphors
commonly used in your hospital that can
create a disempowering environment?
128
Healthcare professionals are rarely
lectured on their lack of mental toughness
by 10-year old cancer patients. Did
Sarah, speaking for Timmy, have it right
when she said that we need to see
opportunities where others see barriers
and to face our problems with contrarian
toughness?
129
Carol Jean told the story of how Tom
Sawyer – who was accountable for white-
washing the fence, coaxed friends who
were not accountable to take ownership of
the work – and actually have fun doing it.
What is the lesson for us?
130
People with strongly negative and
cynical attitudes often find themselves,
metaphorically speaking, standing
outside throwing rocks when they‟d
be much more effective, and much
happier, coming in from the cold to
help with solutions.
What barriers prevent this from
happening and how can we bring
those barriers down?
131
Other than Sarah, no one noticed our
heroine Carol Jean crying on the patio;
she was expected to put on a happy face
and continue leading the retreat.
We all carry hidden hurts.
What are some of the ways
that your hospital could help
people cope with them?
132
Study Questions
for Chapter 16
133
Tough-loving leadership?
Some people aren‟t going to buy in to
a culture of ownership and a few will
actively seek to sabotage the effort. Are
you willing to raise your
expectations, lower your tolerance level
for deviation from those
expectations, and perhaps lose some
people who have good technical skills
but a bad attitude?
134
What do you think of the suggestion made
by CNO Linda Martinez that there be an
organization-wide training initiative on
values that would cover both the I-CARE
values of MMC and help people crystallize
and act upon their own person values?
135
Carol Jean asked why the hospital
workplace can‟t be more like a support
group environment, where at the end of
the day people leave physically tired but
emotionally uplifted.
Would Dale Prokopchuk‟s suggestion of
hospital-sponsored support groups help
this happen?
136
What are some of the ways that we can
encourage employees to share their
strengths and talents at work, even if it‟s
not part of their job description, like the
nurse Carol Jean mentioned who loved
poetry and wrote poems for her patients?
137
How would you answer the universal
icebreaker question “What do you do?” in
a way that conveys:
I love what I do
I‟m good at what I do
I‟m proud of what I do
What I do is important
138
Sarah Rutledge said that after she‟d
started bringing a more positive attitude
to work, some of her coworkers did not
like the “new me.”
How do we create an environment that
neutralizes peer pressure to be negative
and mediocre?
139
Study Questions
for Chapter 17
140
What do you take away as the
ultimate meaning of The Florence
Prescription?
That was the ultimate meaning of the
Florence Prescription… to foster a
culture of ownership that honors
victory of the spirit as much as it
celebrates healing of the body.
The Florence Prescription
141
Sarah Rutledge described the recovery of
Timmy Mallory as a miracle.
Do miracles really happen in hospitals?
142
Let‟s do a quick
review:
The 8 Essential
Characteristics of a
culture of ownership
143
144
The Florence Commitment:
Refuse to participate in toxic
emotional negativity.
Replace the words “Not my job”
with “How can I help?”
145
146

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Study Guide for Joe Tye's book The Florence Prescription

  • 1. Study Questions The Florence Prescription Copyright © 2010, Values Coach Inc. and The Florence Challenge 1
  • 2. By taking The Florence Challenge our organization is telling the world that we: 2
  • 3. Aspire to a culture of ownership where people are committed to the values of the organization, are engaged in their work and with their coworkers, and take pride in their work and in their professions. 3
  • 4. Encourage people to hold themselves responsible and accountable for their attitudes and actions, and to empower themselves to do the right thing for patients. 4
  • 5. Expect a workplace environment that is free from finger- pointing, cynicism, gossip, compl aining, and other forms of toxic emotional negativity. 5
  • 6. The Florence Challenge for a culture that is… Emotionally Positive Self Empowered Fully Engaged
  • 7. As a participant in The Florence Challenge we are asking you to: 7
  • 8. Read The Florence Prescription and think about how the 8 essential characteristics of a culture of ownership apply to your own work and life, and… 8
  • 9. Take the seven simple promises of The Self-Empowerment Pledge to help you in your own life – personally, professionally, finan cially, and spiritually, and… 9
  • 10. Refuse to participate in chronic complaining, gossiping, and other forms of toxic emotional negativity, and replace the words “Not my job” with “How can I help?” 10
  • 11. 11
  • 12. 12
  • 13. Are you willing to make the commitment? Are you ready to start? 13
  • 15. Is this true? You can‟t be cynical and negative sitting in the cafeteria or break room and then somehow flip an inner switch and become genuinely caring and compassionate when you walk into a patient‟s room. And patients see right through the fraud. The Florence Prescription 15
  • 16. Is it possible to be cynical and negative at work and then flip an inner switch and become a genuinely nurturing and empowering parent and loving spouse at home? 16
  • 17. If Carol Jean Hawtrey spent an hour sitting in the cafeteria of your hospital, what sorts of conversations would she be likely to hear? 17
  • 18. “Who cares for the caregiver?” is an age-old question in healthcare. But if we don‟t care for each other – emotionally and spiritually – who will? 18
  • 19. Is it important for people to know and embrace the values of the hospital they work for? Do you know and embrace the values of the hospital that you work for? 19
  • 21. Do you agree with this? You can hold people accountable for showing up on time and for fulfilling the terms of their job descriptions, but you can‟t hold them accountable for being committed and engaged. You can‟t hold people accountable for caring. It takes a spirit of ownership for those things to happen. The Florence Prescription 21
  • 22. Do you agree with Connie O‟Dell that negative attitudes increase the stress level in a hospital – and is the reverse true, that positive attitudes can reduce the stress level? 22
  • 23. Florence Nightingale is surprised when she hears someone use the words “patient-centered care,” and asks what other kind of care there is. How dedicated is your hospital to putting patients in the center of the care matrix, and what more can be done to put patients first? 23
  • 24. Carol Jean says that the “Invisible Architecture” is the soul of an organization. Can organizations have “a soul” in any meaningful sense? Does yours? How would you describe it? 24
  • 25. Do you agree that accountability alone is not enough to make a great organization, that it takes a spirit of ownership? How would you define “accountability” and “ownership”? 25
  • 26. Carol Jean describes eight essential characteristics of a culture of ownership: Commitment, Engagement, Passion, Initiat ive, Stewardship, Belonging, Fellowship and Pride. Are any of these superfluous, and has anything important been left out? 26
  • 28. Does this make sense to you? Rules are of the left brain, values are of the right brain. When people don‟t share a common set of values you need to have lots of rules. The Florence Prescription 28
  • 29. John Myerson described the “see-smile- greet-help” rule of Memorial Medical Center. How would your hospital be perceived by a new employee or a lost visitor? Is it important that the environment be friendly? 29
  • 30. Carol Jean said, “When people don‟t share a common set of values, you need to have lots of rules.” Of course, as Myerson replied, you need both – but there is a continuum from rules-based to values- based. Where does your hospital fall on that continuum and what can be done to move it further toward the values-based end of the scale? 30
  • 31. Myerson said that you cannot teach people values if they didn‟t learn them at home. Do you agree with him, or do you agree with Carol Jean who said that not only can values be taught, it‟s essential that they be taught if you want to be a great hospital? 31
  • 32. Carol Jean said that core values define what the organization stands for and what it won‟t stand for. How clear are people at your hospital about the behavioral expectations created by your values (both stated and implicit)? 32
  • 33. Little Timmy tells Myerson that he should give nurses a pay raise because he heard them complaining in the hallways. What are patients likely to overhear in your hospital (keeping in mind that they hear a lot more than you think they do)? 33
  • 35. Do you agree? When patients overhear caregivers complaining and gossiping, it violates the integrity of the caregiver and shows a lack of respect for the patient, not to mention the person who‟s being complained or gossiped about. The Florence Prescription 35
  • 36. Timmy Mallory fights cancer by slaying dragons in his imagination, and Myerson suggests a dragon-slaying area on the pediatric unit. How might a culture of ownership encourage people to come up with the sort of “crazy” ideas that can make a hospital special? 36
  • 37. “Just because the doctors have given up hope doesn‟t mean there‟s no longer hope.” Read The Hope Diamond on the next slide, then discuss Florence‟s comment – both in the context of patient care and of navigating a stressful healthcare environment. 37
  • 38. 38
  • 39. Most hospitals have a vibrant rumor mill, but Florence states that gossip violates the integrity of the caregiver and shows lack of respect for the patient. How active is the rumor mill at your hospital, and what can individuals do to help eliminate gossip? 39
  • 40. Culture is to the hospital what personality and character are to the individual. How would you define the culture (personality and character) of your hospital? Are you proud to be part of it? What would you change? 40
  • 41. How wide is the gap between what the hospital says it expects of people (e.g. integrity, respect, initiative) and what it tolerates (e.g. gossip, complaining, passive- aggressive learned helplessness)? What can be done to close that gap? 41
  • 42. “People would have a lot more time and energy for compassion if they spent less time and energy complaining and gossiping.” Do you agree with Florence? Or is “venting” and chatting about other people a necessary feature of a healthcare organization? 42
  • 43. Especially in today‟s challenging healthcare environment, hospitals cannot afford to choose between compassion OR productivity – they need both. What ideas can you suggest for moving from what Jim Collins calls “the tyranny of OR” to “the genius of AND”? 43
  • 45. Do you agree with this statement? The cornerstones of Integrity are honesty, reliability, humility and stewardship. If people are not committed to those behaviors, then integrity is just a word on the back of a name badge, not a core value The Florence Prescription 45
  • 46. Think about the core values of your organization. Why do you think those specific ones were chosen? If you were made King or Queen for a day, what values would you have chosen? 46
  • 47. Think about your own personal values. How well do they mesh with the statement of values of your organization? (If you haven‟t thought about your personal values, this would be a good time). 47
  • 48. How can understanding the Values- Behavior-Outcome Continuum influence your personal life? For example, if your desired outcome is better health or financial independence, what are the required behaviors – and what core values would inspire you to take that action? 48
  • 49. Discuss the 6-Es of Employee Engagement: Expect, Educate, Enable, Energize, Evaluate and Elevate How much of a role can management play in encouraging people to engage with their work and with their coworkers, and how much of it must come from within? 49
  • 50. Florence Nightingale attributed her success to the fact that she “never gave or took an excuse.” What are some ways that you can counter finger-pointing, buck-passing, and blame game in your organization? 50
  • 52. Do you find this provocative? Taking care of the sick should be a mission, not just a business. Being a healthcare professional should be a calling, not just a job. Our hospitals are at risk of losing their souls. The Florence Prescription 52
  • 53. Long hours, changing shifts, and hard work are often facts of life in healthcare. No matter how tired or stressed we might be, our patients still deserve our best. How do we make sure that we give it to them? 53
  • 54. In the cafeteria, Carol Jean asked Sarah what she would tell her CEO had he been sitting there with them. What would you tell your CEO if he or she were in the room with you right now? 54
  • 55. If Florence Nightingale showed up right now (like she showed up in the MMC cafeteria when Carol Jean was talking to Sarah) what would you say to her? What do you think she would say to you? 55
  • 56. Nightingale said that caring for the sick should be a mission and not just a business, and that being a healthcare professional should be a calling and not just a job. Still, hospitals and caregivers alike must pay the bills. How do we reconcile that tension? 56
  • 57. Carol Jean tells Sarah that she‟s hiding behind a mask of negativity and cynicism because it hurts too much to care. Was she being fair? Do you ever feel that way? How can we support each other when it hurts too much, or we‟re too tired, to care? 57
  • 58. As Sarah sat crying by Timmy‟s bedside, CEO John Myerson was standing in the doorway, also in tears, though Sarah could not see him. In what ways might this be a metaphor for the big picture of healthcare today? 58
  • 60. Are you just renting a job? Any time someone says „not my job,‟ walks by a patient room where the call light is on, or does not stoop down to pick up a piece of paper on the floor, that person is renting a space on the organization chart, not taking ownership for the work itself. The Florence Prescription 60
  • 61. Carol Jean says that corporate culture is the only sustainable source of competitive advantage for a hospital, and that “cultural blueprinting” is more important than designing buildings. Do you agree? Why or why not? 61
  • 62. The culture of a hospital is really like a patchwork quilt made up of the cultures of individual areas. What is the culture like in the area where you work? What changes would you like to see in that culture? What actions could you and your coworkers take to bring those changes about? 62
  • 63. Carol Jean distinguishes between management (a job description) and leadership (a life decision), and says that today‟s hospitals need leaders in every corner, not just the corner office. How encouraging is your hospital of informal leaders, and how much influence do they have? 63
  • 64. Carol Jean uses the fact that no one changes the oil in a rental car as a metaphor for the “not my job” attitude of people who are just renting a space on the organization chart. What is the difference between “owning the work” and “renting the job”? Not my job! 64
  • 65. Carol Jean tells a skeptical John Myerson that he should help people work on “soft skills” like self-image and self-esteem because a winning team is built around people who know how to think and act like winning players. Do you agree that leaders (formal and informal) should play this role? 65
  • 67. How “real” is your picture? We can make everyone go through customer service training, and we can put billboards up on the highway telling everyone how caring and compassionate we are. But unless people change how they think and act, all we‟ll have is a pretty picture of an organization that exists only in our dreams... To make the picture real, people have to buy-in, to take ownership. That means they need to change their attitudes and their behaviors. They need to change the way they treat each other. The Florence Prescription 67
  • 68. Dr. Charlie Franklin tells Carol Jean that he‟s skeptical about the latest “program of the month”. How does a hospital infuse new and innovative ideas and inspiration without falling into “flavor of the month” syndrome? 68
  • 69. Carol Jean says that most hospitals are very hierarchical and status-conscious. How true is that of your hospital? 69
  • 70. Put yourself in the shoes of Dr. Franklin when he suddenly finds himself as Carlos the housekeeper holding a mop at the main intersection of the hospital. How do you think you would be treated at your hospital? 70
  • 71. Carlos the housekeeper is reprimanded by his supervisor for dancing with his mop in the corridor. Would he have been reprimanded at your hospital, or would the supervisor have joined him in the dance (at least metaphorically)? 71
  • 72. Once he saw that the problem was real, Dr. Franklin embraced the challenge of chairing the hospital‟s new committee to promote simple dignity. If there were such a committee at your hospital, what would you want it to do? 72
  • 73. Florence tells Carol Jean that whether it‟s the best of times or the worst of times depends upon what we choose to see, and that our perspective of today will shape our reality of tomorrow. What are some of the ways that healthcare today is in “the best of times”? best of times or worst of times?73
  • 75. Have you given yourself that power? Empowerment isn‟t something that can be given; it‟s a choice that must be made. No one can empower you but you, and once you‟ve given yourself that power no one can take it away from you. The Florence Prescription 75
  • 76. The nursing leadership retreat that Carol Jean planned with MMC‟s Chief Nursing Officer Linda Martinez was called “Empowering Caregivers.” What are the implications of empowering the caregivers for both patients and for caregivers? 76
  • 77. “Proceed until Apprehended” is another way to saying “better to ask forgiveness than permission.” What are some of the ways that such a philosophy can improve hospital operations and enhance patient service, and what are some of the ways that this philosophy might be inappropriate? 77
  • 78. Carol Jean describes the defining paradox of Florence Nightingale as follows: She was both a compassionate caregiver and a tough manager. How can we be compassionate without being weak and be tough without being hard-hearted? 78
  • 79. “Empowerment is a choice. No one can empower you but you, and once you‟ve given yourself that power no one can take it away from you.” Do you agree or disagree with this statement? Why? 79
  • 80. Florence says that we overrate the accuracy of our memories but underrate the power of our vision. How can collective memory sometimes hold us back, and how can a shared vision propel us forward? 80
  • 82. Is it worth the effort? If we each do our part, we will change our lives for the better. If we all do our parts, we will change our organizations for the better. The Florence Prescription 82
  • 83. How would you rate your organization on the empowerment scale, and how would you rate your own behavior? Do you think you‟d end up with the same “Lake Wobegon Effect” that Carol Jean found with the Memorial Medical Center nursing leadership team? 83
  • 84. When Carol Jean introduced The Self- Empowerment Pledge at the nursing leadership retreat, some were immediately enthusiastic, some were renewed, and some clearly thought it was a waste of time. What would you think? What would be the distribution where you work? 84
  • 85. Read the seven simple promises of The Self-Empowerment Pledge. If you made a good faith effort to live those promises, what would be the impact on your life – personally, professionally, financially, and spiritually? 85
  • 86. If everyone in your work area made a good faith effort to act on those seven promises, would you do a better job of supporting each other and serving your patients and your community? Would it be a better place to work? 86
  • 87. How much easier would it be for you to act upon the seven promises of The Self- Empowerment Pledge if the people in your work area were to take on the challenge as a group and support each other? 87
  • 89. Is this a valid metaphor? Toxic emotional negativity is the spiritual equivalent of cigarette smoke in the air – as harmful to the soul as smoke is to the body. Just as we once eradicated toxic smoke from our hospital environments, it is now our obligation to eradicate toxic emotional negativity. The Florence Prescription 89
  • 90. After Sarah left the break room where two nurses were passing a rumor about two coworkers having an affair, she felt “like some part of her soul had been spattered with mud.” What should someone do who overhears other people spreading rumors and passing gossip? 90
  • 91. After the new nurse learns about the false and malicious rumors, she bursts into tears and runs out of the cafeteria. Timmy says that the way people are “always complaining about something or talking about someone” is the same as emotional cancer. Do you agree, or is that putting it too strongly? 91
  • 92. When Timmy says hearing people complain and gossip makes him feel even worse than his cancer makes him feel, Florence calls it “iatrogenic toxic emotional negativity.” Since emotions are contagious, do we really make our patients even sicker with our bad attitudes? 92
  • 93. Imagine yourself as Sarah when she had to listen to every negative conversation in the hospital all at once, and then the peace she felt when they all stopped. How much effort would it be worth to consistently achieve the latter state? 93
  • 94. Carol Jean calls toxic emotional negativity “the spiritual equivalent of cigarette smoke”, and calls upon us to eradicate it in the way we once did smoking. People once thought a smoke-free society was not achievable. Can we dare to hope for a world that‟s free of toxic emotional negativity? 94
  • 96. Do you agree that this is a management responsibility? One toxically negative person can drag down the morale and the productivity of an entire work unit. It is a core leadership responsibility to create a workplace environment where toxic emotional negativity is not tolerated. The Florence Prescription 96
  • 97. What was your reaction to reading about members of the MMC Quality Improvement Leadership Team (QILT) reciting their mission statement aloud at the beginning of their meeting with Carol Jean? Did you think it was corny or did it strike you as kind of cool? 97
  • 98. Do you agree with Carol Jean that caffeine is the drug of choice for people of genius? 98
  • 99. Do you agree with Carol Jean‟s comment that “left brain” statistical quality and productivity tools are reaching a point of diminishing returns, and that future quantum leaps will be achieved by “right brain” qualities like enthusiasm, pride, passion and loyalty? 99
  • 100. What has your hospital done, and what more can be done, to move from the fragmented and ultra-specialized system that treats patients as a collection of body parts, toward a more holistic “right brain” system that recognizes the inter- connection between body parts, and between body, mind, emotions, and spirit? 100
  • 101. When the MMC Maintenance Department tried to “empower” people to perform routine chores like changing light bulbs, the project fell on its face. What went wrong and what should have been done differently? 101
  • 102. Carol Jean points out that you can measure left brain qualities but you can‟t see them (what would ROI or the bottom line look like?) while right brain qualities can be seen but not measured. How would you meet her challenge to come up with new ways to assess the things that can be seen but not measured? 102
  • 103. Carol Jean says it is not left-brain OR right-brain, but how to find the right balance or that continuum. Where does your hospital fall on the continuum and in which direction (if any) do you think it should move? 103
  • 105. 638 readers of the Spark Plug newsletter respond to the 12 questions in The Culture Assessment Survey. Two questions particularly pertain to this chapter…
  • 106. 46% agree or strongly agree; 54% unsure or disagree
  • 107. Only 8% of respondents strongly agree that their coworkers reflect positive attitudes, treat others with respect, and refrain from the behaviors of toxic emotional negativity! Even worse >>>>>>>>
  • 108. More than half of respondents either disagree with or are unsure whether their coworkers have positive attitudes, treat others with respect, and refrain from toxic emotional negativity!!!!!!!
  • 109. Would our answer for this organization be better – or worse? Are we okay with that?
  • 110. Responses from the current survey
  • 111. 67% of respondents believe that more than 10% (or more!) of all paid hours where they work are wasted on toxic emotional negativity!!!
  • 112. What is the cost of all that toxic emotional negativity on:  Productivity  Patient experience  Morale  Innovation
  • 113. How much more productive would your organization be, how much more engaged would your people be, and how much better would your customer satisfaction be if…
  • 114. All those many thousands of paid hours now being wasted on toxic emotional negativity could be transformed into a positive contribution?
  • 115. Since culture doesn‟t change until people change (culture being the collective of their behaviors), what can you do to help your people change their attitudes and behaviors?
  • 116. Sarah Rutledge challenged her colleagues to take The Pickle Pledge – should we? 116
  • 117. How would we answer Sarah‟s questions:  How much better off would we be in our own lives if we were to take to heart The Pickle Pledge?  Would this be a better place to work and would we do a better job of caring for our patients if we all took to heart The Pickle Pledge? 117
  • 118. What creative ideas can we come up with to promote The Pickle Challenge here? 118
  • 120. Are you being treated like an owner and a partner, and if not what‟s missing? To foster a culture of ownership, you must treat people like owners and not just employees, like they are partners in the enterprise and not just hired hands doing the work. The Florence Prescription 120
  • 121. Did you have any “first day on the job” experiences like the one Carol Jean had where her patient coded and died, the doctor called her a candy-striper, and the head nurse told her (calling her by the wrong name) to get over it? How can such experiences be prevented from being inflicted upon junior employees at your hospital? 121
  • 122. Florence reminds Carol Jean that she has two ears and one mouth, and that this should guide her proportion of listening and talking. What is the listening culture at your hospital? 122
  • 123. Standing outside of the room for her meeting with the union reps, Carol Jean was subconsciously imagining a gang of finger-popping Teamsters looking for an excuse to rough her up. How do the assumptions we make and the stereotypes we draw distort the reality of how we experience other people? 123
  • 124. Shari Levenger complemented the CNO Linda Martinez for not putting up with slackers and for requiring people to do their work “and cut out all the pettiness.” Would Levenger make similar comments about operations at your hospital, and what recommendations would you anticipate that a consulting team might make in response? 124
  • 125. If you were a consultant, what advice would you give to John Myerson for reducing we-they, management-staff differences and remind everyone that, as Bill Bristow put it: “We‟re all in this together.” 125
  • 127. Do you agree with Sarah Rutledge? We need to see opportunities where others see barriers. We need to be cheerleaders when others are moaning doom-and-gloom. We need to face problems with contrarian toughness because it‟s in how we solve those problems that we differentiate ourselves from everyone else. The Florence Prescription 127
  • 128. Sarah Rutledge did not let Timmy get by with using the word “try” (“do or do not – there is not try” she said, quoting Yoda). What are some of the words, phrases, similes and metaphors commonly used in your hospital that can create a disempowering environment? 128
  • 129. Healthcare professionals are rarely lectured on their lack of mental toughness by 10-year old cancer patients. Did Sarah, speaking for Timmy, have it right when she said that we need to see opportunities where others see barriers and to face our problems with contrarian toughness? 129
  • 130. Carol Jean told the story of how Tom Sawyer – who was accountable for white- washing the fence, coaxed friends who were not accountable to take ownership of the work – and actually have fun doing it. What is the lesson for us? 130
  • 131. People with strongly negative and cynical attitudes often find themselves, metaphorically speaking, standing outside throwing rocks when they‟d be much more effective, and much happier, coming in from the cold to help with solutions. What barriers prevent this from happening and how can we bring those barriers down? 131
  • 132. Other than Sarah, no one noticed our heroine Carol Jean crying on the patio; she was expected to put on a happy face and continue leading the retreat. We all carry hidden hurts. What are some of the ways that your hospital could help people cope with them? 132
  • 134. Tough-loving leadership? Some people aren‟t going to buy in to a culture of ownership and a few will actively seek to sabotage the effort. Are you willing to raise your expectations, lower your tolerance level for deviation from those expectations, and perhaps lose some people who have good technical skills but a bad attitude? 134
  • 135. What do you think of the suggestion made by CNO Linda Martinez that there be an organization-wide training initiative on values that would cover both the I-CARE values of MMC and help people crystallize and act upon their own person values? 135
  • 136. Carol Jean asked why the hospital workplace can‟t be more like a support group environment, where at the end of the day people leave physically tired but emotionally uplifted. Would Dale Prokopchuk‟s suggestion of hospital-sponsored support groups help this happen? 136
  • 137. What are some of the ways that we can encourage employees to share their strengths and talents at work, even if it‟s not part of their job description, like the nurse Carol Jean mentioned who loved poetry and wrote poems for her patients? 137
  • 138. How would you answer the universal icebreaker question “What do you do?” in a way that conveys: I love what I do I‟m good at what I do I‟m proud of what I do What I do is important 138
  • 139. Sarah Rutledge said that after she‟d started bringing a more positive attitude to work, some of her coworkers did not like the “new me.” How do we create an environment that neutralizes peer pressure to be negative and mediocre? 139
  • 141. What do you take away as the ultimate meaning of The Florence Prescription? That was the ultimate meaning of the Florence Prescription… to foster a culture of ownership that honors victory of the spirit as much as it celebrates healing of the body. The Florence Prescription 141
  • 142. Sarah Rutledge described the recovery of Timmy Mallory as a miracle. Do miracles really happen in hospitals? 142
  • 143. Let‟s do a quick review: The 8 Essential Characteristics of a culture of ownership 143
  • 144. 144
  • 145. The Florence Commitment: Refuse to participate in toxic emotional negativity. Replace the words “Not my job” with “How can I help?” 145
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