The Most Important Question

In healthcare, Medicare patients are surveyed about their experience in hospitals.  They are asked questions about the doctors, the medications, the nursing staff, and they are asked about the quality of the food and service of the Dietary staff.  The survey results are used to determine Medicare reimbursement; if the facility does well on the surveys, they will be reimbursed the full allowable Medicare rates.  If the facility doesn’t do well, they can experience a reduction in reimbursement rates.  Patient Satisfaction is a huge motivator to improving the quality of our service.

In the last year, I have implemented several changes that have had a huge impact on processes within my Dietary department. We implemented a new menu program that provides more variety of choice for every meal. We took on a new acute long-term care hospital in our facility, which increased our daily meal production. And I implemented a hostess process that gives face to face assistance to each and every patient to ensure they are able to make food choices that best satisfy them.

I started observing some behavior issues with a long-term employee in my Dietary Department. Initially she made complaints to her co-workers about the changes; she didn’t see why we needed to have more than one choice for each meal, she didn’t see the value in the face to face interaction between patients and our hostess position.  Both myself and the Dietary supervisor would meet with her to see what the issues were, and she would say that the workload was too much, that there wasn’t enough help for all of the prep that was now required with the new menu program. I would ask her for examples of actual issues that caused her to feel this way, and rarely was she able to articulate exactly what was causing her frustration. I had added additional staff to accommodate both the new menus and the patient interaction, so it was hard for me to validate the statement of overwork. I observed processes on more than one occasion, just to be sure that my understanding of the workload was accurate.

As time progressed, her behavior and work performance continued to suffer, eventually resulting in a patient issue that required me to perform a written corrective action with this employee.  I was having a hard time sympathizing, as I had watched the processes and concluded that time management was more of the issue than work load. I was struggling to find a way to get to the root of the issues, while also getting this staff member back on track.

But as life happens, learning experiences present themselves at the exact time that we most need them!

During an Organizational Leadership class, the instructor stated that the most important question you can ever ask is “Why?” It is applicable to any situation, and always allows the receiver to tell you exactly what it is that is causing the issue.  The very next morning, I met with my Dietary staff member.  I started the meeting with a synopsis of why we were meeting, outlining the patient issue that prompted the intervention, and then I asked “Why do you come to work everyday?”  Out of context, this may sound like a harsh question, however I know from long-term interaction this employee has a true heart for our patients and their well-being. Her reaction was not one I expected, and it caught me totally off guard; she started crying.  She started to recount that she loves the patients, the people she gets to work with, the ability to do something creative with food.  With all of these positives, I asked her why she had been exhibiting such negative behaviors.  This really caused an emotional response, but once she composed herself, she said that she was no longer sure she could perform all of the duties required. She had some significant health issues the year before, and she was still figuring out her work abilities. She hadn’t voiced these physical concerns with anybody, which made it impossible to know what the root cause was for the behavior.

All of the behavior issues were due to the fact she was worried whether she could do the job, but it was easier for her to blame the system than it was to admit she had this fear. I also missed the opportunity to identify the issue early on, because I was focused on actual task data, but not on the emotions. Once she had voiced her fear, and realized that my mission was to fix things so that she could complete her daily tasks, her whole demeanor changed. We made some modifications to work load, moved some duties around, and agreed to meet in two weeks to see if the changes made a difference.

The change in demeanor and behavior was immediate. My employee was relieved to find that we support her as a person first and foremost, and that she is a valued member of the team. She was able to verbalize her fear about her abilities, and she saw that we were willing to make accommodations to ensure her success. Because the changes were implemented immediately, she was able to complete her daily tasks as well as provide support to her co-workers.

I was amazed that such a simple question was able to identify, define and provide a solution that met everyone’s expectations. And I was able to maintain a trust relationship with a long-term, passionate employee.

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