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From the Leaders Perspective: When Saying 'No' Adds Value

Tuesday, March 06, 2018
Sara M. Sluder, Program Director, Patient Experience
Legacy Health, Portland, Oregon

Sara M. Sluder

Early in my career, a leader I worked for told me that some of us are Teflon, and others are Velcro. She suggested that people who choose to do improvement work are often the latter of the two (people she dubbed “the pink collar,” those of us who will do the work regardless of the recognition or pay). Without realizing it, I adopted this Velcro mindset - attacking any job with a ‘yes’ mentality, demonstrating my worth through volume and hard work, regardless of recognition.

Eventually I was promoted to the system-level leader for Patient Experience at Legacy Health in Portland Oregon. Legacy Health is known for its commitment to improving the health of the community, and had a robust Patient Experience (PX) program.   We were not trying to go from bad to good, we were trying to go from ‘good to great,’ and this required me to build upon many successes, which is a very different then trying to fix something that is broken. 

At first, I drove programmatic and individual facility PX work with the ‘yes’ approach I had always used. I attended every meeting I was invited to, followed up on every individual unit and department request, and adapted my improvement recommendations to align with the organizational resources and needs. As a team of one, the ‘yes’ approach worked as well as you would imagine; I created a presence for PX, finding myself invited to participate in nearly every activity across the system even remotely related to patient experience, like the time I was invited to a meeting that appeared to be about physician communication. I found myself at this meeting and within the first 5 minutes I realized the meeting wasn’t about how physicians communicate, but how we develop a single source directory to communicate with physicians. That meeting was easily in my top 3 “longest hour of my life” meetings, however it did tell me I was putting physician communication on people’s radar.

I had built a reputation as a respected patient experience leader, however I still found that I was often checking the box for things I knew would be less effective than my original recommendations. I would check the box – trying to do everything possible - hoping it would show value and provide a platform to advocate for the work I wanted the system to prioritize.

I eventually realized that for every less effective ‘yes’ project I worked on, I was unintentionally eroding the foundation of our strategy. Stepping back for a minute, I realized that my actual job was to lead with purpose and direction – to provide guidance on what to do, not respond to every request with a ‘yes.”  In fact, it was not only my job to lead, but my responsibility to say ‘no’ when I recognized that something would not bring value to the overall strategy or when we were drifting off course.

So, I regrouped. I had to create some clarity for myself and for the organization. I needed to refine my approach to know when to say yes and when to say no. This is what I have learned so far:
  • Know Your Value: As the PX content expert for your organization, it is important to remember what you bring to the table. There is a reason your singular organizational purpose is patient experience. Don’t lose sight of the fact that your content expertise is valued, even when you don’t provide the preferred answer. Some of your value as a PX leader is knowing when to say no and how to use your unique knowledge and skill set to support not doing something.
  • Have a clear strategy: This comes back to volume verses value. I don’t believe I ever did the wrong work, but I do believe I didn’t always know if I was doing the most effective work. By developing a strategy, I am better equipped to help others understand how we identified our opportunities for improvement and how we are prioritizing the work to have the biggest organizational impact. Having a detailed strategy steeped in best practice recommendations and tactics has helped to respond to requests and determine if they aligned with the larger organizational focus.
  • Develop a PX “elevator speech”: Until recently I could not concisely articulate the direction of the PX program, nor could I concisely state the program tactics and goals in a way that resonated with all stakeholders. In this last year, I have refined how I talk about PX and the PX strategy. This does not mean I am rigid in my language or willingness to adapt. Rather, I have created an elevator speech that is becoming the programmatic drumbeat people can march to. Originally, I struggled with the chicken-egg issue: what comes first, the narrative or the plan?  What I have come to find is these two elements need to be developed in tandem – what is PX, why are we focused on it, what are our opportunities, and how are we going to practically and tactically make improvements?
  • Ensure PX is aligned: Both my strategy and my elevator speech now clearly address how PX is aligned with all major organizational initiatives. These days most of us are being asked to do more with less, whether we are running programs or providing direct patient care. One of the most value-added things you can do is demonstrate how your PX strategy can be integrated into and support the work teams are already doing.
  • Avoid the one-offs: I am not going to lie, this is the most difficult part for me! My natural instinct is to do that one-off staff meeting or that “special project” for that one manager I have worked with for almost a decade. My career has been built off saying yes and building relationships driven by the instinct to just do it now and question if it was strategic later. When I first started saying no I was convinced I would burn bridges left and right. I imagine if I had just said ‘no’ without an elevator speech and strategy those bridges would have come tumbling down, but I didn’t. I continue to stay with the drumbeat, which has maintained and strengthen my relationships.  
At this point my goal is to maintain consistency with my new approach. By doing so, I am helping Legacy keep its commitment to the people we serve. I am helping other leaders learn how to think about and speak to their teams about patient experience. I am able to validate whether the work I am leading is the ‘right work’, resulting in the desired outcomes. If I stay consistent, I am ensuring the patient and family will stay at the center of our work at Legacy, allowing us to actualize our organizational mission.   

Tags: best practices, leadership, perspective
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