During my graduate program in the spring of 1999, I conducted a research project. In doing so, I used the work of Kouzes and Posner and their Five Practices of Exemplary Leadership to analyze interviews I conducted with 13 women in senior management positions.
The behaviors demonstrated by these women (all in Jacksonville Florida, where I was living at the time) mirrored the Five Practices so closely and resonated with me so profoundly, that I adopted this framework. Soon after, I made the decision to found Healthassist with a simple mission: To empower healthcare consumers to take control of their own healthcare through leadership.
In short, I was inspired by my desire for individual healthcare consumers to take control over the only thing we really can: Ourselves. In addition, I wanted each of us to take a leadership role in directing our healthcare experiences, something that requires a change in our own behavior.
The Five Practices of Exemplary Leadership
These five practices, explained in more detail below, are:
- Inspire a Shared Vision
- Challenge the Process
- Model the Way
- Enable Others to Act
- Encourage the Heart
Each of these can be applied in different healthcare settings, the most common of which are:
- Outpatient. This includes accessing care; seeing primary care and specialist physicians; having diagnostic tests completed; participating in outpatient rehabilitation utilizing physical, occupational and speech therapies.
- Inpatient. This includes hospitalization because of an emergency from the development of an acute illness; the exacerbation of a chronic illness; an injury from an accident, such as a fall.
- During transitions. This includes moving from an inpatient acute hospital setting to an acute rehab hospital or a skilled nursing facility; to home with in-home care; to an alternative living arrangement when a return home is not physically possible.
For each of these healthcare settings, what follows are examples of how we encourage our clients to use the Five Leadership Practices…
Inspire a Shared Vision
You can have a mutually respectful relationship with your physician in which you embark on shared decision making. The use of a written agenda that outlines your objective for a meeting and defines the agenda items you wish to discuss is a great example of this.
In the event communication with your physician is strained, you can use the agenda item of “Our relationship / Communication” to bring up the topic, so you can describe your experiences and work together to improve it.
For example, immediately upon admission, make plans for discharge. If a loved one is hospitalized, seek out the case manager/discharge planner right away so you can work together towards a mutually satisfying discharge. You can say:
“I know you are responsible for preparing for my loved one’s discharge. Let me share some information with you about their baseline level of functional abilities and the home setting we’d like him/her to return to, so we can all be working toward the same goals.”
When discharged to home with in-home services that include care from a nurse and physical therapist, ask that they conduct an assessment and outline quantifiable goals. Offer to participate in that process:
“As you know, I’ve received in-patient rehab services and worked hard to be discharged to home, but I know I have a long way to go. I’d like to share in the goal setting process and plan to work very hard toward achieving those goals. For me, I’d like to progress from using a walker to walking with just a cane. Can we achieve that together?”
Challenge the Process
When asked to change into a hospital gown prior to meeting a physician for the first time, we suggest you do not. Instead, respond by saying:
“I know it promotes efficiency to have me change, but I’ve never met this physician before and it’s important to me that I have a conversation with her/him before I change. Being in a hospital gown is uncomfortable for me right now.”
For example, when someone is admitted to a skilled nursing facility, within 72 hours, assessments must be completed by a physician, nurse, physical and occupational therapist. A plan of care is outlined with quantifiable goals and a duration of stay is predicted. Unfortunately, that information is not routinely shared with the patient or family members.
A way to challenge the process is to request a family meeting within 72 hours of the admission. Here’s what you can say upon admission:
“I know that for insurance purposes, you are required to do an assessment of my loved one, outline goals that are quantifiable and set a discharge date. So that we all have the same expectations and so we can assist our loved one with working toward those goals, I’d like to schedule a family meeting for approximately three days from now.”
Sometimes, in a rush to transition a patient out of an in-patient setting, a suggestion is made for a loved one to transition to a skilled nursing facility for a week or two. Negotiating for an extra day or two in the in-patient setting instead, so that your loved one can go directly home, may be possible:
“I came in to have this knee replacement with the intention of returning directly home and availing myself of in-home care, and supplementing that with my son staying with me to help me out. You’re suggesting I leave tomorrow. Can you explain what I have to demonstrate so I can go directly home? Could I stay one extra day to attempt to achieve that goal?”
Model the Way
Be gracious and treat all you encounter within the healthcare system with a smile and politeness, even when you may be anxious and stressed. This models the behavior you expect in return.
For example, when a loved one is hospitalized, a team of professionals generally sees him or her every morning, reviews the outcome of the previous day’s interventions and creates a treatment plan for the day.
Upon admission, seek out the physician in charge and state that while you appreciate the time constraints she/he has in their schedule, you have constraints as well. Request a daily phone call at a set time to touch base. This demonstrates respect for each other’s time while modeling the communication you expect to have.
When a loved one is in a memory facility for progressing dementia, and it is thought that a transition to a higher level of care such as a long-term care facility might be in their future, rather than resisting that possibility, bring up the topic with the current team to collaborate on the criteria that would necessitate a change. Ask for recommendations of other facilities you can visit so that you are prepared if the need arises. This models a collaborative approach and promotes cooperation and negotiation.
Enable Others to Act
When working with a physical therapist, tell him/her that you know they have vast knowledge to share and you hope to be a good student as they teach you how to care for yourself.
When in an inpatient setting and a nurse asks that you not get out of bed without assistance, follow the recommendation and allow him/her to promote your safety.
When a loved one is feeling a bit discouraged about their physical progress while obtaining rehabilitation care, offer to attend a Physical Therapy session with them so that you can learn what is being asked of them and practice with them in-between formal sessions.
Encourage the Heart
Remember to thank the medical assistant who greeted you at the beginning of your appointment and helped to schedule your follow-up testing.
Attempt to introduce yourself to all you encounter in inpatient settings and try to remember their names. That includes physicians, nurses, aides, dietary personnel, transport and cleaning staff. Smiling and greeting them by name acknowledges their contribution to your loved one’s care and can make being in a stressful situation much more pleasant for everyone.
Demonstrate how much you appreciate those caring for your loved one. When someone does a great job, thank them. In addition, seek out their supervisor and give them a call or write a letter of appreciation to let them know how you felt about the quality of the care.
Using this framework can be hard, especially when you are challenging processes that have been in place forever. Remember, however, many of these processes were born out of convenience for the professionals who care for you and your loved one, but not necessarily the patient.
In a world of patient-centered care — a world that is recognized by more and more health care organizations every day — inspiring a shared vision is necessary, challenging is okay, modeling behaviors you expect in others is welcomed, enabling others to act is inspiring, and encouraging the heart is the right approach.
After all, all of this is what leaders do.