Communications In Your Work Culture

By David L. Schreiner, Ph.D., FACHE

The room grew quiet. All of the executive team members had shared their thoughts on the topic. The only person not to speak was the CEO.

“He always encourages us to speak first, and then, and only then, will he share his perspective”, says one of the vice presidents. “By going last, he chooses to not initially sway the discussion in a particular direction.”

While studying CEO engagement in five different hospitals from around the country, I found three engagement core principles, which are central to my supercharged communications concept. Each contains five practices that, when used in combination, resulted in increasing communication with the people that matter the most: the board chairman or owner, the people that report to us, and entry-level employees. These principles can be applied to any business in any industry.

The first supercharged engagement principle: Engage and connect at a personal level

It’s easy for CEOs to get stuck in their office, dealing with various issues. That was me. But you’ve got to get out and connect with your people in order to supercharge your culture, and it starts with this principle.

The five practices for this principle:

1. Ask great questions and generate positivity. The example above in the introduction is one of those practices taken from my first supercharged engagement principle. The same CEO typically asks great questions and generates positivity. He says, “Tell me more about your opinion on this topic. Help me to understand exactly where you are coming from, and tell me not only what your perspective is, but why you feel the way you do.”

Specific, targeted, open-ended questions encourage team members to understand their perspectives at a deeper level and improve their ability to convey those opinions. Do you give people that report to you the freedom to express their opinions and understand those opinions are being heard?

• Develop outstanding listening skills and practice them regularly. Do you give people that report to you the freedom to express their opinions and understand those opinions are being heard? This practice generates positive engagement and increases the level of trust.
• Be accessible and show an interest in member concerns. Consider your personal standards of accessibility, and how you will listen and interact with your stakeholders. What can you do to show your people that you are invested in their concerns? Perhaps you cannot possibly respond to all your emails in a large company, but response time should still reflect your commitment to accessibility, whether that’s via an assistant or delegating the email to the proper department.
• Find ways to express gratitude. Regardless of the reasons someone works, we all like to be recognized for our efforts. But gratitude goes even beyond that. Gratitude is a mindset. You may think of gratitude as admiration for someone on your team: “I admire the way you thought about that and your unique perspective. Tell me more.” Gratitude should also involve recognition.
• Find ways to interact through rounding. Rounding is exactly what it sounds like – making rounds. In my case, I walk the hospital (and I also visit our satellite clinics, which entails driving to them off-site). You might walk the factory floor, or through various departments. In a large company you would obviously break it up, perhaps trying to get to each department once or twice a year, or once a quarter. But it’s important to be seen – this is about connecting. No more hiding in the office.

The second supercharged principle: Engage with intent through various mediums

So often as leaders we assume engagement occurs when we hit the “send” button. We worked hard on crafting the message, right? What could possibly occur to minimize the level to which that message was heard?

The answer: Everything. Competing priorities for the recipient, bad timing, technological challenges, etc. Here are some ways to increase the chances of your message being received.

The five practices for this principle:

1. Find a rhythm of regular communication with key constituents. Who is the intended audience? Are they expecting your communication because it comes out every Friday at noon, or is this a one-off message? Is the message easy to open and view on multiple devices? If the team members try initially without success, they may not give you a second bite at the apple to supercharge your message.
2. Be transparent with high frequency. Not sure how much to share on a sensitive subject? Err on the side of sharing too much. That line of oversharing is rarely crossed.
3. Use multiple channels to communicate your messages. Once upon a time, communication was fairly straightforward. That is not the case today. What I have discovered in my supercharged communications research is you need to use multiple channels. You need to meet your people and stakeholders where they are. Those channels include face-to-face (that includes Zoom), broadcast communications, mobile (including texts), phone, Slack and other instant messaging channels, social media, and of course email.
4. Look for ways to overcome engagement challenges. Employee engagement is the connection an employee feels, both emotionally and mentally, to their team and their workplace/organization, as well as the work they do. Engaged employees demonstrate enthusiasm. They also are more productive and willing to go that extra mile. Be clear on the mission, communicate consistently and don’t overload or repeat information.
5. In times of crisis be intentional about communicating differently. In crisis, it is important for nonessential communication to decrease for a time. Laser focus needs to be on the matter at hand. In order to communicate effectively in times of crisis, first, as a leader, you must identify your key messaging.

The third supercharged principle: Be mission-focused through united leadership

Leadership – whether by parents or a board of directors or the C-Suite – must offer a united front and lead from that strength. United leadership builds trust from the workforce as the employees learn that all leaders in the company have a shared vision and everyone’s role is aligned with it.

The five practices for this principle:

1. Keep your focus on the mission and know your audience – be prepared. As a hospital CEO I have learned that my message cannot be delivered in the same way to our medical staff and our housekeepers. Each group’s desire to understand specific items are different, and the amount of time one particular group is willing to allow me to share my message is highly variable. For example, while doctors may subscribe to the suggestion that time is money and sharing less is more, housekeepers are interested in different details that may influence their work, and they are willing to grant me more time.
2. Vocally support team members and encourage healthy debate. Draw key people into the conversation with great questions, asked in a manner respectful of their interest and free time. Connect the topic of the moment to the organizational mission. When you have trust in your leadership and your teammates, disagreements come from a place of “How can we all do this better?” not accusations or resentments.
3. Ensure team members feel informed and included. Leadership styles have evolved. Once upon a time, leadership was usually autocratic. It was a hierarchy, fairly linear, and top down.Now, leadership is more people-oriented and collaborative.

We now expect leaders to be inclusive. Instead of barking orders or commands, we inform and use our soft skills, like supercharged communication, to pull people together into a cohesive team.

• Build a structure to support key leaders. Since I am in the healthcare arena, I look at it a bit like the cardiovascular system. Leadership starts at the heart of what we need to do, and then pumps the principles and actions through the entire corpus of the hospital.

That structural model led to some amazing changes at our hospital. An employee engagement survey showed significant improvements in areas such as working well together as a team, being satisfied with the recognition they receive, different levels of the organization communicating effectively with each other, and feeling supported in work-life balance.

• The executive is part of the community – get involved. Many leaders are caught up in perception – how their employees perceive them. But I realized along the way that I didn’t need to be so concerned about how I present myself and what I have to say. It’s not about how the workplace community perceived me at all; it’s about me understanding what they have to say.

Leaders, take note: As I have discovered, you don’t have to be interesting; rather, you have to be interested. That’s what executive involvement is – it’s relationship.

Getting involved means being a learner, connecting with the stakeholders and the people most important to you, and being open to what they share.

What if I told you that understanding these supercharged engagement principles and 15 practices will allow you to increase employee and patient engagement, leading to a higher return on investment and a more dedicated workforce?

Take a quick look through the 15 practices I mentioned. How many are you using today, both intentionally and as a matter of how you currently communicate? Commit to trying something different today. Your leadership and your work culture will be better for it.

You own your own practice and the demands on your time leave you wishing you had more than 24 hours in every day. What if you could invest four minutes in reading this article to realize a rate of return that would allow you to engage in a more meaningful way with the people that matter the most?

Then let’s go!

As a physician, you sell the intellectual knowledge developed from your years of training and clinical experience. You are compensated for your time, so gaining the information you need quickly and efficiently will lead to improved clinical outcomes and increased compensation.

My interviews with CEOs at five high-performing rural hospitals and research I designed led to the following practices, which you can add to your daily interactions with your fellow physicians, hospital executive team members, and staff.

Ask great questions and generate positivity.

We gain clarity with improved understanding. You have likely heard of the five whys in clinical improvement. Adopt this method in dealing with others. Ask to understand and listen intently to the responses. By asking great questions, we can more quickly and deeply understand what is being requested of us.

Let’s look at an example. The throughput in your clinic is not as robust as you like. The old method is for you to determine where the bottlenecks exist and suggest solutions. A new approach would be to gather the team and get input from every member. Encourage each person to suggest three things that, if improved, would lead to better patient flow.

The people closest to the work often have the best answers, and if team members are responsible for generating ideas and solutions, the impact is more sustainable with improved results.

Be accessible and show interest in team member concerns

As a physician, you are the quarterback. Make sure you take time to listen to your team members. Carve out one-on-one time for your staff so you can ask how things are going for them. It’s their career, too, and retention of skilled employees is far easier than recruiting and training new staff.

In a busy practice, improvement suggestions often happen between patients at the nurse’s station. Your mind may be a thousand miles away on 20 things dominating your thoughts. A new approach would be to schedule time on a monthly basis for one-to-one meetings with staff members. Being proactive and addressing staff concerns will avoid disruption caused by staff leaving your practice. Find what matters to them and determine if changes implemented based on those issues benefit your practice.

Find ways to express gratitude

Your job as a physician and business owner is tough, and so is the job of your colleagues and staff. Tell them you appreciate them and be specific. Be creative in expressing your appreciation and use detail to describe how their actions positively impact your collective patients and your practice of medicine.
At your next team meeting, focus on one specific thing each staff member does, either large or small, that contributes to the success of your clinic. For example, Sara orders supplies, and Bob takes time to clean the nurses’ station for the benefit of all.

One CEO I interviewed has his executive team serve meals to all hospital employees on a quarterly basis. How much would lunch every three months cost compared to the expense of advertising for new staff, interviewing candidates, and beginning an extensive orientation program?

Be transparent with high frequency

The most effective physicians I work with as a hospital CEO remind me not to be paternal and “blow sunshine” on difficult topics. Physicians are used to complex environments and results that often are not ideal. Don’t sugarcoat the situation. Find reasons to interact frequently with people who are important to you and your practice. Repetition builds trust, and small, sincere interactions build trusting relationships.

Think about that one radiologist whose reports frequently require you to dig deeper, order additional tests that might be questionably appropriate, and cause concern for your patients. The old approach is to grumble and fight through it. The new approach is to request a 15-minute meeting every three months to review specific cases, share perspectives, and be transparent about how the report requires action on your behalf. The first three meetings might not result in improved radiology reports, but over time a symbiotic relationship just might emerge. The radiologist begins to understand what is important to you, and you understand at a higher level the intent of her findings.

In times of crisis, be intentional about communication differently

Whether a complicated clinical issue or a business challenge, make sure the person you are engaging with understands that this is a time of crisis. Through your language and non-verbal communication, leave no doubt that this is important and effective; crisp engagement is required.
The COVID pandemic forced all of us to implement change at the speed of light. Were there lessons learned during high-volume periods of time that you might apply to your practice in those seasons when your volume spike? Talk to team members about what they learned during the pandemic that might have been lost in the ensuing months when things calmed down. Let’s look for best practices we can retain.

Conclusion

Small changes in the way we engage with the people who matter the most, your physician colleagues and team members, can lead to meaningful improvements in your practice. And it might just get you out the door to your kid’s soccer game on time!

Dr. David L. Schreiner is the author of Be the Best Part of Their Day: Supercharging Communication with Values-Driven Leadership. He also is president/CEO of Katherine Shaw Bethea Hospital in Dixon, Ill. He is a passionate advocate for rural hospitals, having spent most of his life in small towns and working in small communities. A values-driven leader, Schreiner aims to be a missionary for excellent health and vibrant communities and spread love through generosity and healing. His research focuses on improving the health of others, with a particular emphasis on rural communities. Schreiner served on the American College of Healthcare Executives’ Board of Governors from 2016-2019. He is also the past chairman of the American Hospital Association Rural Health Task Force. He was the 2007 Dixon, Illinois Citizen of the Year and received the 2022 Distinguished Alumni Award from the University of St. Francis College of Business.

Originally published in Dixon Living Fall 2023

David Schreiner knows a few things about leadership. He’s in charge of an operation that employs nearly 1,000 people, a place where decisions can mean the difference between life and death. He’s even earned a degree in the subject.

You could say he wrote the book on leadership.

A little more than a year after the CEO and President of KSB Hospitals earned his doctoral degree in values-driven leadership, Schreiner has written “Be the Best Part of Their Day: Supercharging Communication with Values-Driven Leadership,” a book that shares his approach to leadership and the philosophy behind it.

Published by Advantage Media (the book publishing arm of Forbes), it will be released Jan. 16, beginning with online sales on Amazon; preorders are scheduled to begin in late November. An audiobook also is planned.

What led the way to adding “author” to his list of accomplishments? The book’s title pretty much sums it up: He wants to help make people’s day — and that, he said, can be accomplished through good leadership.

“We’ve all heard stories about ‘one smile,’ or ‘one kind comment,’ or, ‘some-body held the door open for me,’ and sometimes it gives people a little bit of hope, and that’s really what this book is about. How do we do that more of ten?” he said. “If I have time to spend with my son, I want to make sure I make his day better. We can add that to the people we work with, people who you go to church with. Can you say something uplifting, as opposed to jumping in with a lot of negative communication that’s out there — we hear a lot of that. Let’s take the opposite of that and be the best part of someone’s day.”

In his book, Schreiner identifies 15 different ways to improve leadership skills through three topics. Included are stories and examples that he person-ally has seen through his work at KSB, as well as his research for his dissertation through five other hospitals and their administrations.

“The premise of the book is based on how we engage and connect personally and to do that better. How do we listen better, and how do we ask better questions?” Schreiner said. “Engaging with intent. Everything from small group and large group presentations, video, email, all of the different ways we connect that weren’t available to us awhile ago. Then being mission focused and united in leadership. In our case, the hospital has a very specific mission and that’s why we’re here, and how do we keep that mission in the front of people’s minds when we are making decisions?”

While Schreiner’s experiences often involve interacting within a professional workplace, the concepts he details in his book also can apply to everyday situations. “If I can take these 15 things and go, ‘Here are five that I’m doing well, here are five that maybe I think about once in a while, and five that I’ve never really considered’ — and can I add more to that ‘do well’ list, or maybe bring one of those things that I’m not doing and maybe do it once in a while? The goal is to engage more effectively, and if these tips help with that, then the book did what it was supposed to do.”

A native of Crawfordsville, Indiana, Schreiner’s medical career began in 1986 as a radiology technician at Golden Valley Memorial Healthcare in Clinton, Missouri, a town of nearly 9,000 people southeast of Kansas City. He joined KSB in 1989 as its director of medical imaging, supervising its radiology department, and became President and CEO in 2011, having earned a master’s degree in health services administration from the University of St. Francis in Joliet leading up to his appointment.

Schreiner also became a Fellow of the American College of Healthcare Executives during his hospital leadership, adding “FACHE” to his post-nominal collection of letters before adding a few more — Ph.D — in 2022 with a doctorate in philosophy. He added doctor to his list of accomplishments after successfully defending his dissertation through Benedictine University in Lisle, titled “What CEO Practices help Rural Hospitals engage Constituents in Volatile, Uncertain, Complex, and Ambiguous Times?”

The answer: Be engaged and connectible at a personal level from top to bottom in the workplace, and focus and invest in the community.

“CEOs of independent, rural hospitals face increasingly challenging times for their organizations and patient communities,” Schreiner wrote to open the abstract of his dissertation. “The need to engage multiple stakeholders to sustain these hospitals is paramount. This inductive study explored how rural hospital leaders seek and maintain effective engagement with patients, employees, physicians, board members and community leaders.”

Upon learning of his successful defense from his professors, he also took a piece of advice from them. Earning his doctorate has opened up opportunities for Schreiner to share his expertise, and not just locally. Fellow leaders from as far as Canada and Ireland have sought his expertise. That, in turn, led him to write his book.

“They said, ‘We think you got something, and something unique that’s not in the literature today,’” Schreiner said. “I wanted to take this to a broader audience. Not everybody wants to read 40 pages of academic articles, so I enjoyed writing the book.”

Schreiner’s determination to be a lifelong learner of all things leadership has made an impression on those he works with at KSB, including his chief of staff, Nancy Varga.

“It filters down through the executive team, and they embrace that same type of philosophy that’s in the book,” Varga said. “Certainly Dave is sharing it with our leader-ship team, and in turn, he pushes us to make sure that they share the same things with their departments. It’s cascading, and blows your mind, too. It has definitely made a difference.”

Schreiner’s dedication to improving and fine-tuning leadership skills also has made an impression on his fellow members of KSB’s board of directors. Board President David Hellmich, who’s also president of Sauk Valley Community College, was pleased to see Schreiner’s commitment to positive leadership.

“As the Chair of the KSB Board of Directors, I want to emphasize how proud I and the other directors are of Dr. Schreiner for his many accomplishments, not the least of which is his upcoming leadership book,” Hellmich said. “Dave has built a well-deserved national reputation as a thoughtful healthcare leader, and his book will help guide professionals as they navigate local challenges. It’s a wonderful bonus that Dave will denote a portion of the book’s proceeds to the KSB Hospital Foundation.”

Schreiner has also served in a leadership role on several statewide boards and task forces

focused on hospital and healthcare issues, including the Illinois Hospital Association. For 25 years, he’s also been a member of the adjunct faculty at St. Francis, teaching graduate courses on healthcare administration. In 2007, he was honored with the prestigious Citizen of the Year award by Dixon Chamber of Commerce and Main Street. Work isn’t the only place where his leadership skills come in handy — having them helps at home, too.

Schreiner and his wife, Stephanie, live in Dixon and have two children, Kaile of Dixon and Andrew of Chicago, and two granddaughters, Klara and Nova.“I think it works in a lot of different places,” Schreiner said. “I’ve found that it works in my personal life, so when I work with family and when I work with friends, some of the same concepts that come across in the book also translate into better personal interactions.”

“What I did was take my academic approach through my dissertation, and take those same concepts and add stories around it in my book,” Schreiner said. “I was looking for ways that I could engage more completely, engaging by connecting and communicating with different groups — people I report to, which are the KSB Hospital Board of Directors; our colleagues; people here at work and our KSB family; people in the community; our physicians — and taking a look at that group and finding out how to communicate better.”

What he found was a way to help people turn a page in their lives by turning a page in his own life, making the leap from academic to author and putting his approach to leadership into a book that he hopes will help today’s readers become tomorrow’s leaders.

Originally Published in Healthcare Executive NOV/DEC 2023

Written by: David L. Schreiner, PhD, FACHE, president/CEO of Katherine Shaw Bethea Hospital, Dixon, Ill. and Melanie M. Miller, Exceptional Student Education teacher

As we gain experience and become wiser with age, it’s important to reflect on the lessons we’ve learned and pass them on to the next generation. Grandparents and leaders share common goals for our grandchildren and employees: happiness, independence and productivity. The lessons we learn from children can help us lead more effectively, and we can pass these lessons on to others.

Too often, leaders overlook the power of appreciation and fail to ask the right questions. What if we used the same approach we use with children and applied it to our staff to encourage growth and development? Following are some leadership lessons to consider from that lens.

Ask Meaningful Questions

If you want to create a positive work environment, it’s essential to make sure your staff feels heard and appreciated. One way to do this is by asking them the right questions and listening intently to the responses.

When kids come home from school, we often ask them, “How was school?” When the standard answer is “nothing,” perhaps a better ques-tion is, “Can you tell me three things that made school fun today?” Research shows that we remember things in threes, and many indus-tries abide by this “rule of three” in their business and marketing prac-tices. But the real power of this question is that it gets kids talking and sharing. They don’t realize they’re communicating meaning-fully because they’re having fun with an appreciative audience.

This approach can also work with staff. Instead of asking, “What hap-pened at work today?” try saying, “Tell me three things that happened today that made you proud to work here.” For example, you could ask them to share three things they accomplished that day or three things they learned. This gets them talking and helps them focus on the positive aspects of their day. When people feel appreciated, they’re more likely to be engaged and motivated at work.

Let Them Finish Their Thought

Time constraints and impatience lead to one of the biggest things leaders should avoid doing: inter-rupting their staff. Children with slower processing speeds need more time to speak their thoughts, and some of these children become adults with slower processing speeds. Interrupting someone sends the message that you are uninterested in what they have to say. This can be demotivating.

Instead, always let your staff members finish their thoughts. This demonstrates that you value their input and are willing to listen. If the conversation turns negative, flip it back to thinking from a place of abundance. For example, instead of dwelling on what went wrong, ask them what could have happened to make it better.

Focusing on solutions rather than problems creates a positive environment that encourages creativity, innovation and efficiency. People are more likely to take risks and try new things when they feel supported and appreciated.

Build Trust

Trust is an essential component of any positive work environment. If you want to build trust with your staff, you need to make sure they feel safe and valued. One way to do this is to eliminate criticism from your rounding practice.

Instead of focusing on what people are doing wrong, focus on what they’re doing well and how they can challenge themselves. For example, consider an employee who has frequent tardiness. Rather than criticizing the staff member for their tardiness, a leader can ask what the employer can do to help the employee, such as adjusting schedules or seeking assistance from colleagues. By taking this approach, you create a positive learning environment that encourages growth and development.

Learning new things can be challenging—for kids and adults. Another way to build trust is responding to employees’ “I can’t” or “this is too hard” statements with “it’s hard because you haven’t learned it yet.” Allowing an employee the opportunity to step back to their own confident and independent performance level can establish trust. Work backward to their proficiency and then build skills from there.

Focus on the Learners

We should honor our team members as individuals. It’s important to remember that everyone learns differently. To be an effective leader, you need to understand your staff members’ learning styles and tailor your approach to meet their needs. Pay attention to the learners when observing a leader who is presenting to a team. What do the learners react to, and how do they react?

Understanding and facilitating to your staff’s learning style can create a positive learning environment that encourages growth and development. Present in a fun and interactive way. Try various mediums, such as employee forums, video, email and chat to engage employees around important issues. Remember the “rule of three.”

Leadership in Practice

Leadership is more than just telling people what to do. It’s about creating a positive environment that encourages growth and development. By asking the right questions, letting them finish their thought, building trust and focusing on the learners, you can create a culture of appreciation that will benefit everyone.

By incorporating these lessons into our leadership practices, we can help create a positive work environment where the staff feels valued, supported and motivated. These principles can help you become a more effective and compassionate leader while creating a better future for yourself and those who will follow in your footsteps.

Written by Chris Westfall and originally featured in Forbes

In 2022, turnover rates for segments of the healthcare industry ranged from 19.5% at hospitals to 65% for at-home care providers to 94% at nursing homes. According to a new report from software company Oracle, this level of turnover puts a huge financial and logistical burden on healthcare providers. Turnover in hospitals can cost up to $85,000 per clinician – and this number does not factor in future revenue for lost replacements, lost productivity, and other intangibles that hit the bottom line. While COVID-19 put additional stress on the healthcare labor force, the healthcare staffing crisis existed long before the pandemic. “There is an urgent need for healthcare organizations to proactively address the root causes of turnover, develop retention strategies, and invest in creating a supportive and engaging work environment,” explains Brian White, the CRO and Co-founder of software provider, Doorspace

Healthcare jobs are notorious for long hours and erratic schedules, and many are considered “deskless” jobs, meaning workers spend much of their time on the move. In fact, it’s estimated that nurses in hospitals walk about five miles a day. Hospitals operate at the intersection of high tech and high touch, when it comes to retention. “We focus on initiatives that are proven to be effective rather than continuing to invest in solutions that look good on paper but provide little, if any, real-world impact,” White says, referencing his company’s employee relationship management (ERM) software. But tech isn’t the only tool in the box, when it comes to keeping hospitals humming.

Focusing on impact and retention is David Schreiner’s business. Schreiner, a PhD, is the CEO of Katherine Shaw Bethea (KSB) Hospital in Dixon, Illinois. With nearly 1,000 employees, Schreiner leads an 80-bed rural facility 100 miles west of Chicago. While overall industry turnover stands at approximately 18%, Schreiner says his numbers hover around 11%. How is he tackling the challenge of retention in his hospital?

“Before our conversation today,” Schreiner shares from his office, overlooking the Rock River at sunrise, “I sent out six emails: three for work anniversaries, three for birthdays. We have an integrated reminder system so that we can stay connected with our team.” From high tech to high-touch, connection is the key, Schreiner says. “We have to earn the right for people to stay here. That means connecting with employees where they are, and recognizing their journey and their milestones,” he says. Here’s how Schreiner is making sure that those connections create better patient care:

1. Maintaining Gratitude: how well are you doing, as a leader, when it comes to expressing your appreciation? Schreiner is writing a book, published by Forbes, called Be the Best Part of Their Day. Launching in early 2024, the book identifies 15 leadership pillars (based on both his doctoral research and personal experience). According to Schreiner, it all starts with gratitude. “Leaders need to talk about [appreciation] every single time we get in front of our teams.” In healthcare, as in any business where caring and service are front and center, the key theme is the meaning of the work. That focus on individual impact is key to avoiding platitudes, when expressing gratitude. On a human level, we all see the value of appreciating others. Schreiner explains, “We have a local community college that pumps out 20 x-ray techs every year. It used to be a case that 15 of those would have to take part-time jobs until something opened up. Now they’re placed before they graduate.” It’s no secret that the current job market When employees understand that they have more options, leaders need to understand how to value the employees that choose your organization over others.
2. Transparency: With nearly 1,000 employees, the hospital doesn’t always lend itself to personal interaction with the CEO – but Schreiner goes out of his way to create a personal touch, inside a promise delivered. “When I get to meet with employees in the first hour of their first day at KSB Hospital, I give them my cell phone number. And I say, if within six months, KSB hospital isn’t the best place you’ve ever worked, please call me and talk to me about it.” When asked how often his phone rings, he replies, “Never. But I wish it would.” More than just a folksy offer, or a bold claim of an informal employee engagement survey, Schreiner means what he says. Walking the walk – and taking the tough calls – is part of transparency. What can you do, as a leader, to let people know that you possess that most valuable and rare leadership ability: the willingness to listen? For extra credit, consider how you might personalize your answer – and show that you mean what you say.
3. Do the Do-Able: If you improve just 1% per day, in 73 days you will double your results. Leadership, according to Schreiner, happens one step – and one conversation – at a time. “My journey started at a place where I felt like I was underdelivering. I was not engaging in the way that I wanted to with the people that matter the most.” The impulse led him to his doctoral research into advanced leadership, as a means to identify what was missing. In his journey, he recognized the importance of adding one thing at a time, instead of trying to arm wrestle the known universe. Can you relate? Does your leadership style feel like a scene from Everything, Everywhere, All at Once? Inside the frenzy of meetings and obligations, take the win for what you’re already doing right. From a place of encouragement, expand your possibilities. Schreiner calls his approach “Appreciative Inquiry” – offering a new kind of AI that doesn’t cause all of Hollywood to go on strike. “I wanna celebrate what’s already good, and from there: What are one or two or three of the things that are still outstanding that you might be willing to try?”

At its core, leadership is about humanity: connecting with people in a way that drives results. For effective leaders, those results come from appreciation, transparency and process. Leaders, and employees, have to realize that profitability and humanity must co-exist – one supports the other. When turnover can cost as much as 200% of a single workers’ salary, retention in healthcare is a profit-sucking obstacle for everyone – driving up healthcare costs, and reducing the quality of care. More than perhaps any other arena, healthcare is a people business. But hospitals are just one example among many, where people are making a difference. Maybe you’re not healing the sick or bringing babies into the world at your office, but anything of any value happens with the input of other human beings. At least, for now anyway. When you get right down to it, business exists for people, and with people, and because of (wait for it) people. In an era where the entire knowledge of the human race is just one prompt away, the information that leaders need isn’t coming from a ‘bot. We are already well-equipped to be better human beings. And in that regard, leadership is simply putting humanity into practice.

Imagine this.

As your health system’s CEO, you finish a meeting with a physician, stand to walk them to your office door, and present them with a handheld tablet on which they determine your compensation. The choices are 0%, 10%, 20%, and 25%. The process repeats throughout the day as you meet with your Board Chairman, a Vice President who reports to you, a housekeeping employee, and your Administrative Assistant.

As a servant leader, your organization has determined a portion of your compensation will be similar to that of a server in a restaurant. To keep the math simple, if you earn an annual salary of $100,000, your base pay will be reduced to $80,000, and you will have the opportunity to “make it up” through service to your key constituents. If you meet or exceed expectations, a generous gratuity will be granted. Leave them wanting, and no tip is given.

Non-profit leaders see themselves as stewards of the organizations who seek to grow the resources and reputation of the organizations entrusted to them (van Dierendonck et al., 2017). Servant leaders focus on the development of their followers.

Authentic leadership and servant leadership are closely aligned. Eva suggested that “servant leaders are authentic not for the sake of being authentic, but because they are driven either by a sense of higher calling or inner conviction to serve and make a positive difference for others” (Eva et al., 2019, p. 113). When considering the context of leadership in rural medicine, authentic leaders and servant leaders conform nicely to the space. Authentic leaders need and take opportunities to interact with their constituents. Servant leaders view hospital leadership as an opportunity to serve multiple constituents.

Let’s go back to that meeting with the physician. This doctor came to speak with you about her compensation. She feels she should be paid for taking call above and beyond the one-in-three medical staff bylaw requirements. You listen intently, processing the broader organizational impact of such a move. A commitment is made to consider the request and get back to her.

The handheld is offered. The physician looks you in the eyes and chooses 10%. You receive this message: “you heard me, now what are you going to do about it?”

How might this instant application of a gratuity impact your engagement? Would your decision be affected? Would the tone of your voice and your listening practices be modified in a more remarkable attempt to show interest and concern? Remember, when you return to this physician to report your decision, the handheld device will be presented for another gratuity round.

Gratuity is “something given voluntarily or beyond obligation, usually for some service” (Merriam-Webster, retrieved June 22, 2022). Leaders provide service in every interaction, and the concept of instant feedback is thought-provoking. A leader might claim they have little control over the mindset, agenda, or temperament of the people they serve, rendering the concept of tipping each encounter unfair. A server in a restaurant has no control over parking, the table where customers are assigned, the temperature of the food, or prices. Yet they are subject to the discretion of those they serve.

Why not leaders?

Peter Northouse describes servant leadership as the caring principle, with leaders as servants who focus on their followers’ needs to help these followers become more autonomous, knowledgeable, and like servants themselves (Northouse, 2018). (p. 24). Eva et al. (2019) expanded Greenleaf’s definition by including the success and prosperity of the broader community.

Some of the world’s leading corporations have adopted servant leadership practices, including Starbucks, Southwest Airlines, Ritz-Carlton, Marriott, and Intel (Eva et al., 2019). In the seminal work on servant leadership, Greenleaf (1977) stated, “Servants by definition are fully human. Servant leaders are functionally superior because they are closer to the ground—they hear things, see things, know things, and their intuitive insight is exceptional. Because of this, they are dependable and trusted.”

As servant leaders, we are motivated for reasons far beyond financial returns to care for those we serve. I interviewed CEOs, board chairpersons, hospital executives, physicians, and staff members at five health systems to determine effective engagement methods. Three themes emerged from the research.

This qualitative research determined that all three best practices for engagement must be implemented.

Engage and Connect at a Personal Level

Ask great questions and generate positivity

• Develop outstanding listening skills and practice them regularly
• Be accessible and show an interest in member concerns
• Find ways to express gratitude
• Find ways to interact through rounding

Engage with Intent through Various Mediums

• Find a rhythm of regular communication with key constituents
• Be transparent with high frequency
• Use multiple channels to communicate your message
• Look for ways to overcome engagement challenges
• In times of crisis, be intentional in communicating differently

Be Mission-Focused

• Keep the focus on the mission and know your audience – be prepared
• Vocally support team members and encourage healthy debate
• Ensure team members feel informed and included
• Build a structure to support key leaders
• The Executive is part of the community – get involved

If your compensation depends upon the evaluation of others defined at the moment of interaction, these best practices give you the best chance of reaching and exceeding your previous salary.

And who is to say our compensation and career success do not, directly and indirectly, revolve around how we engage with our key constituents?

References

• Eva, N., Robin, M., Sendjaya, S., van Dierendonck, D., & Liden, R. C. (2019). Servant leadership: A systematic review and call for future research. The Leadership Quarterly, 30(1), 111–132. https://doi.org/10.1016/j.leaqua.2018.07.004
• Gratuity Defined. (n.d.). Merriam-Webster. Retrieved June 21, 2022, from https://www.merriam-webster.com/dictionary/gratuity
• In-text citation
• Greenleaf, R. K. (1977). Servant leadership: A journey into the nature of legitimate power and greatness. Paulist Press.
• Northouse, P. G. (2018). Leadership: Theory and practice (8^th ed.). Sage Publications.
• Schreiner, D. L. (2022). What CEO practices help rural hospitals engage constituents in volatile, uncertain, complex, and ambiguous times?
• van Dierendonck, D., Sousa, M., Gunnarsdóttir, S., Bobbio, A., Hakanen, J., Pircher Verdorfer, A., Cihan Duyan, E., & Rodriguez-Carvajal, R. (2017). The cross-cultural invariance of the servant leadership survey: A comparative study across eight countries. Administrative Sciences, 7(2), 1–11. https://doi.org/10.3390/admsci7020008

Published in The Governance Institute, December 2021

I tell our senior leaders that we have twelve Super Bowls every year. These big moments are when we get together to have hospital board meetings, and I want each one to be special for everyone involved.

Board members want to make valuable contributions to the organizations and communities they serve, and rural hospital CEOs want their board members engaged. What is important to board members, and how do we, as executives, show them the love they deserve?

I came up with a novel idea:  Ask them.

I surveyed the eleven board members from the independent, rural health system I serve and received input from six. I did not finish at the top of my class in my doctoral program statistics class, but I’m going with the basis that a 54% response rate is pretty solid. I asked four questions:

1. Think of a time when you felt fully engaged as a Hospital board member. Describe in vivid detail what was going on at the time. What was it about the moment?

• When thinking of our board meeting agenda, do certain items catch your attention?  Describe a category(s) you find interesting and why.

• Is there anything about your board work that is a de-energizer for you? Do certain topics leave you feeling less engaged?

• What could I do to increase your feeling of engagement and accomplishments as a Hospital Board member?

The answers funneled towards five themes that may help to lead your board members with love.

Make Sure All Voices Are Heard

Break into small groups and tackle a complicated topic. Ask the question from a curious perspective. Have each group elect a spokesperson and reconvene the full board and share key takeaways. Small groups offer some of our quieter members the opportunity to express their opinions in a safe manner.

Connect Board Members with Employees

Any chance to connect board members with those closest to our patients is a win. Invite them to serve lunch at Hospital Week and bring board members in as participants in staff retirements and other celebrations. Ask key hospital personnel to present information at board meetings and allow board members to ask questions and express gratitude for the work. This practice represents a growth opportunity for the employee as well. Board education has a role in many of our board meetings. Bring internal talent onto this stage.

Connect Board Members with Each Other

Our board meetings finish with a roundtable chance for each member to share something personal or professional. We call this segment “Inquiring Minds.” New grandchildren, job accomplishments, patient stories, and times when something they learned at a hospital board meeting was operationalized in their own business have all been topics of conversation. This process takes less than ten minutes and helps to personalize the experience.

Balance Out Heart Versus Head Agenda Items

Some of us are numbers people, while some of us feed on emotion. Find a balance during your board meetings to connect with both kinds of board members. If the meeting needs to be finance-heavy, find a way to weave in an appreciative inquiry moment, inviting board members to dream about the organization’s future. If a portion of the meeting needs to address hospital billing issues, balance the topic by asking members what it might feel like to have a near-perfect billing experience with hospital and physician services.

Find A Way To Close The Loop On Key Issues

Here’s a quote from the survey that caught my attention:

“The board hears a lot about strategic partnerships when we are considering the opportunity or first entering into them, but we hear little about how those partnerships are progressing until there is an issue that causes us to exit the strategy. We often invest a substantial amount of money in infrastructure to accommodate a partnership, and it would be beneficial to know how successful these initiatives are periodically.”

When the board makes a key decision, create a placeholder three months or six months away that provides the board with an update on how that decision is progressing. Good or bad, close the loop, reevaluate the decision, and learn from the process.

Closing Thoughts

A high level of engagement between hospital board members and senior leadership contributes to organizational success. Positive engagement is wonderful when things are going well and our health systems are firing on all cylinders. I suggest engagement is even more important in challenging times when CEOs need support, advice, and love from the board members they are blessed to serve.

Building positive connections with our hospital board members has proven to be one of the most rewarding aspects of my career. Try one or more of these suggestions, and let me know if and how the change impacts the meetings with this most important constituency group.

I believe all Americans deserve access to a medical professional to make them feel better when they’re sick or hurt. In my experience, that access feels even more important when the hurting person is my spouse, a young child or an elderly parent. In situations like these, should healthcare be considered an inalienable right? I say yes.

More proactive services – such as wellness programs, mammography tests and annual physicals – are important, too. Are these rights? And, if so, who should pay for services?

Some politicians argue the government is responsible. “Medicare-for-All,” which continues to pick  up some momentum this election cycle, is built on the premise that healthcare is a right. The proposal would replace private insurance, Medicare and Medicaid.

According to an article on Politifact.com titled “Medicare-for-All: What it is, and what it isn’t,” “Medicare for All would be a single, national health insurance program that would cover everyone who lives in the United States… It would pay for every medically necessary service, from routine doctor visits to surgery to mental health to prescription drugs. Dental and vision care are part of the package, too.”

Studies have shown that so-called “social determinants of health” – things like access to healthy food, shelter, safety, education and clean air – have a huge impact on a person’s wellbeing. Should these be included under things that are “medically necessary”?

Is it one person’s right to live in a large house with acreage while others live in more modest settings? If everyone has the right to be educated, does that include primary school, undergraduate, graduate and doctoral studies?

If public transportation is not available in certain areas, should the government provide automobiles to citizens that live in those places?

The Congressional Budget Office estimates the cost of Medicare-for-All at upwards of $34 trillion. That’s “trillion” with a “T”. A suggested method of payment would come in the form of new taxes, perhaps increasing taxes by as much as 20 to 25 percent (The Atlantic, October 2019).

My area of expertise is in healthcare, and I intentionally veer somewhat out of my lane to challenge you to think about what Medicare-for-All might look like if our elected leaders are encouraged to continue down that path.You may have noticed that I’ve posed many more questions than answers. Here’s what I know: America’s community hospital’s are fighting every day to make needed services available to the people in the communities we serve. Hospitals are fighting to keep down costs, regardless of whether the entity paying is the employer, the government, or the patient. The healthcare payment process, as it exists today, is inappropriately complex and confusing and adds unnecessary costs for everyone.

I believe we owe it to our patients to work within today’s framework to find realistic solutions, rather than overhauling the entire system. I also believe healthcare is an inalienable right, which is why many hospitals are holding more open-to-the-community health programs, seminars and health events than ever before.  But I’m particularly proud of the great work the hospital community is doing to educate and improve the services offered to our communities, especially in rural areas,  in hopes of keeping our friends and neighbors out of the hospital and free from the high bills that our current system requires.

It may not be a perfect, immediate solution. But I believe we are making a difference in people’s lives,  and I’ve yet to see a realistic federal proposal that fixes our problems any better.

The COVID-19 pandemic is surging across our country, and true heroes are emerging. America’s healthcare workers are tirelessly caring for those patients that exhibit symptoms of the virus (fever, dry cough, or shortness of breath).

When I see our team members staffing a drive-thru screening clinic dressed in full personal protective equipment, it reminds me of firefighters running into burning buildings.

These people are heroes.

I witness our physicians, nurses, and technicians caring for our patients, knowing that their personal risk of exposure is exponentially higher. These people understand the risk and still come to work every day because they care about their patients.

These people are heroes.

Housekeepers clean dirty rooms. Maintenance workers fix what needs to be fixed, regardless of the location. Supply chain professionals work tirelessly to make sure the scarce supplies are obtained and distributed. Dietary workers feed not only our patients but our hungry, tired, staff members as well.

These people are heroes.

Lab Professionals do their jobs, Radiologic Technologists continue to perform their examinations, and Respiratory Therapists will continue to be key performers in the COVID-19 drama.

Nurses, Nurse Aides, and Medical Assistants in our physician offices are often the first point of contact in communication with our patients. They answer the phones, provide advice, schedule appointments, and care for our patients in the clinics.

These people are heroes.

All of them know they signed up for, and they do run towards the danger because that is what they were trained to do. And they still worry about taking home the virus to their own family members.

They go home exhausted and frustrated that they didn’t do enough and worried that they made a mistake.

And they come back the next day and do it again.