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Leadership in Long Term Care

Leadership in Long Term Care. Unlocking Strategic & Operational Success to Improve Patient Care Roberta L. Brofman, BSN, RN, MBA-HCM President, Five Star Clinical Solutions, LLC. Overview . Presentation Overview Elements of Successful Strategic Planning Prioritizing Goals & Managing Risk

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Leadership in Long Term Care

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  1. Leadership in Long Term Care Unlocking Strategic & Operational Success to Improve Patient Care Roberta L. Brofman, BSN, RN, MBA-HCM President, Five Star Clinical Solutions, LLC

  2. Overview Presentation Overview • Elements of Successful Strategic Planning • Prioritizing Goals & Managing Risk • Components of Organizational Behavior • Characteristics of Successful Leaders • Connecting Leadership & Strategy • Leading for Quality

  3. LEARNING OBJECTVES • Identify components of effective strategic planning & goal setting • Identify elements of organizational change • Describe how effective leadership influences organizational behavior • Define levels/styles of leadership & identify personal leadership style • Assess & improve performance of direct reports • Understand & apply Emotional Intelligence (EQ) to practice

  4. Strategy, Operations, Leadership GOALS = STRATEGY OPERATIONAL PERFORMANCE = PROGRAMS + PROCESSES + PEOPLE SUCCESS = STRONG LEADERSHIP Therefore, measurable strategic goals coupled with targeted programs & processes implemented by the right people & driven by strong leaders yields operational success!

  5. Strategy, Operations, Leadership • Goals • This is the vision of the leadership based upon organizational needs & market demands & stakeholder input.

  6. Prioritizing Goals Measuring Risk CMS Five Star Status All nursing home ratings & citations are available for public review on https://www.medicare.gov/nursinghomecompare/search.html • Used by referral sources • Potential residents/patients & their families • Risk managers/insurers • Potential care partners

  7. CMS Rating Components • Health Inspections • Survey Process • Staffing • Payroll Based Journaling • Quality Measures • Provides a snapshot view of the quality provided. • Physical & Clinical Measures as well as antipsychotic medications

  8. Value Based Purchasing • Required by the Affordable Care Act (ACA); as of Oct 1, 2018 • Rewards Skilled Nursing Facilities with motivational payments for performance on reducing hospital re-admissions known as the Skilled Nursing Facility 30-Day All-Cause Readmission Measure (SNFRM).  • Provides strong incentives to coordinate care with discharging hospitals. • What is your demographic looking for in a facility?

  9. Strategic Planning The Vision “Strategic planning is an organization's process of defining its strategy, or direction, & making decisions on allocating its resources to pursue this strategy”. (Bryson, 2018) The leader’s responsibility is to create the vision & keep the plan moving toward the goal(s). A strategic plan is not a document; it is a set of goals & actions requiring supervision & accountability through strong leadership.

  10. Strategic Planning Process • Strategy & Vision are not an end in themselves. Must be accompanied by ACTION & ACCOUTABILITY. • Create a written ACTION PLAN that drives the PROCESS • Consider use of LEAN Process Improvement – input from all levels • Identify the right people who are committed to the success of the project • UPDATE the Action Plan at least monthly • Does the team have authority to remove obstacles? • Hold responsible parties ACCOUNTABLE • Who has authority to hold responsible individuals accountable?

  11. Strategy, Operations, Leadership • How do you know that the PROGRAMS, PROCESSES & PEOPLE are achieving as expected? • Data drives outcomes or goals. Each department should have SMART goals with outcomes that are tracked & trended. • Data must be reported at established regular intervals • Data without analysis is without value • Analysis without response & process improvement leads to frustration

  12. Strategy, Operations, Leadership • Operations • Operations are based upon PROGRAMS & PROCESSES implemented by the right PEOPLE with the proper TRAINING. • PROGRAMS • Standardized written systems or protocols. • PROCESSES • Financial, Clinical, Political, Service, Risk Management, Quality, Regulatory, Dietary, Facility Management • PEOPLE • Hire the right people who share your beliefs • TRAINING • Invest in your people & they will take care of your clients!

  13. Strategic Process

  14. Strategic Planning Process-Accountability *Used with permission of David Mustin

  15. Strategic Action Planning Process

  16. Strategic Action Planning Process

  17. Organizational Behavior • “Organizational Behavior (OB) is the study & application of knowledge about how people, individuals, & groups act in organizations”. • OB encompasses the whole organization, team & society. • The purpose is to build better relationships & communication between internal & external clients. • Employee & Patient/Family Satisfaction • Key factors include managing: personalities, skills, values, motivation, communication styles, change, culture & leadership

  18. Change Management Dale Carnegie

  19. Change Management-Step 1 • Step 1-Establish a Motivation for Change • Economic conditions • Demand from clients/employees • Desire to be the BEST.

  20. Change Management-Step 2 • Step 2-Analyze the Current Situation • What is the reason or catalyst for change? • What are the risks? • What are the benefits? • Who is onboard & who is not? • Who are the “unofficial leaders” or influencers in the organization?

  21. Change Management-Step 3 • Step 3-Plan the Direction • This is the Strategic Plan Process • Determine who will be most impacted & anticipate their responses. • Create a step by step approach to implementation.

  22. Change Management-Step 4 • Step 4-Implement the Change • Impact may be great or small • Announce the change • Maintain open communication • Define responsibilities • Promote the positive benefits of change

  23. Change Management-Step 5 • Step 5-Review the Direction • Review progress & effects of changes implemented • Course correct as needed • Stay positive

  24. Change Management-Step 6a • Step 6a-Adapt • How well are goals being met? • How well are people adapting to change? • How could you improve?

  25. Change Management-Step 6b • Step 6b-Adjust • Engage key leaders to determine where & why goals are not being met. • Ensure lines of communication are open. • Implement changes to review process & change implementation.

  26. WHAT MAKES A LEADER? • What is your definition of a leader? • Who are the leaders you have looked up to in your career? • What are the characteristics of your favorite leader? https://www.youtube.com/watch?v=e-VjisHm4sw

  27. LEADERSHIP • “The one thing you need to know about leadership is there is more than one thing to know about leadership”—John C. Maxwell • 1.5 TRILLION articles & books written about leadership in past 10 years!

  28. LEADERSHIP • What is leadership? • Leadership is a verb, not a noun. • Real leaders add value to people. • Leadership is influence! • How can you become a person of influence?

  29. WHERE and WHY? • Where are you going and why should I follow? • “People don’t buy what you do they buy why you do it”. • Simon Sinek • Those who lead INSPIRE US. • Leaders have a RESPONSIBILITY TO LEAD.

  30. HOW GREAT LEADERS INSPIRE • Simon Sinek’s Golden Circle:

  31. The Golden Circle + Human Brain-Simon Sinek Neocortex Responsible for all of our rational and analytical thought, and language. Limbic System Responsible for all feelings, like trust and loyalty. It’s also responsible for all human behavior and decision-making, yet it has no capacity for language. 31

  32. GREAT LEADERS MAKE YOU FEEL SAFE Circle of SAFETY DANGER DANGER DANGER DANGER

  33. THE FIVE LEVELS OF LEADERSHIP • John C. Maxwell identified 5 levels of leadership: Level One Position – Key word is RIGHTS Level Two Permission – Key word is RELATIONSHIPS Level Three Production – Key word is RESULTS Level Four People Development – Key word REPRODUCTION/GROWTH Level Five The Pinnacle/Personal – Key word is RESPECT

  34. LEVEL ONE-POSITION: RIGHTS • Position & title does not make you a leader. • Upside: you have a position & can work on becoming a true leader. • Downside: the people who follow you are only following you becausetheyhave to. They give you the very least, energy, mind & effort. People don’t like to follow people because they HAVE TO. • What does the office of a positional leader look like?

  35. LEVEL TWO-PERMISSION: RELATIONSHIPS • People follow you because they want to. • They follow because they like you. • Relationships are the foundation of leadership because leadership is influence& you cannot influence someone who does not like you. • A leader at this level -Listens well -Observes & knows what his/her people do -Has an attitude of servanthood

  36. LEVEL THREE: PRODUCTION • RESULTS! You start to become effective as a leader because you produce. • High morale & credibility • Problem solving • Productive • Momentum

  37. LEVEL FOUR: PEOPLE DEVELOPMENT • Growth • Loyalty • Key to development is recruitment • Positioning---Successful leaders position others well • Equip well: • I do it, • I do it & you are with me, • You do it & I’m with you, • You do it alone, • You do it & someone is with you.

  38. LEVEL FIVE: THE PINNACLE-PERSONAL • Respect • You’ve done this so well, with so many, for so long, that people follow you because of what you have accomplished & done.

  39. PERSONAL ANALYSISBRING HOME THE LEADERSHIP LEVELS • Leadership is a dynamic process • You may be on different levels with different people • Think about the people you lead—what level are you on with each of them & how does that effect your outcomes? • What do you need to do to improve? • What do you do to make staff feel safe?

  40. COMMUNICATION, CONNECTION, INFLUENCE • Communication is the ability to relate to people in such a way that it increases your influence over them. • Everyone communicates but few connect. • Connecting is all about others-if you get people what they want they will help you get what you want. • Leaders do not think of themselves but others first; this takes maturity. • Leaders serve those whom they lead. • Only those who are secure can stoop. • Connecting requires energy & work. • Connectors find common ground & lift others up. Common ground is respect.

  41. LEADERSHIP IS INFLUENCE • People with a great attitude are more likable • Teachable spirit (can honestly self-assess) • Take responsibility (good thoughts=good actions) • Take the high road during difficult times (pack a good sandwich) • Control your response • Understand the value of a great attitude • What we appreciate will appreciate

  42. GUARD YOUR THOUGHTS • As a Man Thinkith by James Allen 1902 “Every man is where he is by the law of his being; the thoughts which he has built into his character have brought him there, & in the arrangement of his life there is no element of chance, but all is the result of a law which cannot err. This is just as true of those who feel “out of harmony” with their surroundings as of those who are contented with them…..man is where he is that he may learn that he may grow; & as he learns the spiritual lesson which any circumstances contains for him, it passes away and gives place to other circumstances”.

  43. How to Win Friends and Influence People Dale Carnegie Ways to Make People Like You • Principle #1: Become Genuinely Interested in Other People! • Principle #2: Smile! • Principle #3: Remember that a person’s name is to that person the sweetest & most important sound in any language. • Principle #4: Be a good listener. Encourage others to talk about themselves. • Principle #5: Talk in terms of the other person’s interests. • Principle #6: Make the other person feel important-& do it sincerely.

  44. HOW TO WIN FRIENDS AND INFLUENCE PEOPLE – DALE CARNEGIE Fundamental Techniques in Handling People • Principle #1: Don’t Criticize, Condemn or Complain! • Principle #2: Give Honest & Sincere Appreciation • Principle #3: Arouse in the other person an eager want.

  45. How to Win Friends and Influence People Dale Carnegie An effective leader should remember these things: • Be sincere. Do not promise anything you cannot deliver. Concentrate on the benefits to the other person. • Know exactly what it is that you want the other person to do. • Be empathetic & ask yourself what the other person really wants. • Consider the benefits that the other person will receive from doing what you suggest. • Match those benefits to the other person’s wants. • When you make your request, put it in a form that will convey the idea that he personally will benefit.

  46. John C. Maxwell’s 21 Irrefutable laws of leadership • The Law of Navigation: • Anyone can steer but it takes a leader to chart the course. Controlling your direction is better than being controlled by your direction. • The Law of E.F. Hutton: • When a real leader speaks people listen. Who do people look at when a question is asked in a board room? • Seven key areas of leaders: 1. character; 2. relationships; 3. knowledge; 4. intuition; 5. experience; 6. past success; 7. ability. • The Law of Solid Ground: • Key word-trust! Leaders build credibility with followers; to build trust leaders must have competence, be connected, character. Character makes trust possible & trust makes leadership possible.

  47. John C. Maxwell’s 21 Irrefutable laws of leadership • Law of Respect: • People follow leaders stronger than themselves. • Law of Intuition: • Leaders can read people/themselves. Connect people with solutions. • Law of Magnetism: • Who are you attracting? Good leaders staff to their weakness. • Law of Connection: • Leaders touch hearts first.

  48. John C. Maxwell’s 21 Irrefutable laws of leadership • Law of the Inner Circle: • Potential is determined by those around them. Bring in potential, positive, personal, production, proven value. • Law of Empowerment: • Secure leaders give power to others. • Law of Reproduction: • It takes a leader to raise up a leader. • The Law of Buy In: • People first follow worthy leaders & then worthy causes.

  49. John C. Maxwell’s 21 Irrefutable laws of leadership • The Law of Victory: • Leaders find a way to win. Components: Unity of vision, diversity of skills & a leader who raises players to their potential • Law of the big MO; • Momentum is a leaders best friend!- Keys: preparation & motivation. • Law of Priorities: • Activity is not necessarily accomplishment. Two guidelines to prioritize: Pareto principle (80/20 rule), the three R’s: What is Required, What brings the best Return, what brings the best Rewards. • Law of Sacrifice: • Must give up to go up the ladder; requires constant change/work

  50. John C. Maxwell’s 21+2 Irrefutable laws of leadership • Law of Timing: • Timing is everything! Wrong action at the wrong time disaster, right action at wrong time will lead to resistance, wrong action at right time is mistake, right action at right time is success. • Law of Explosive Growth: • To add growth lead followers, to multiply growth lead leaders. • Law of legacy: • Succession planning. Lead with long view. • The Law of Addition: • We add value to people by serving them. • The law of the Picture: • People do what they see. Be the best example with character & live out the values. What you say matches what you do.

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