Are You Asking What Matters Most to Caregivers?
Can we drive patient experience by focusing on caregiver experience? Join us as we discuss healthy teams, leader behaviors, empathic accountability, and more in a conversation with Linda McHugh, Chief Human Resource Officer at Cleveland Clinic.
Are You Asking What Matters Most to Caregivers?
Adrienne Boissy: Welcome to another episode of Studies in Empathy, a Cleveland Clinic podcast exploring empathy and patient experience. I'm your host, Adrienne Boissy, Chief Experience Officer here at the Cleveland Clinic in Cleveland, Ohio and I'm very pleased to have Linda McHugh here who is our Chief Human Resources Officer at the Cleveland Clinic. Linda, welcome to Studies in Empathy.
Linda McHugh: Thank you, happy to be here.
Adrienne Boissy: I've warned Linda in advance that I can ask any questions I want so she's really excited and super nervous. You will be at the Cleveland Clinic for 34 years in October.
Linda McHugh: Yes.
Adrienne Boissy: Tell me about where your journey began here and what keeps you here.
Linda McHugh: Yeah, so my journey began as a medical technologist in microbiology.
Adrienne Boissy: What?
Linda McHugh: Actually yes. I actually started my, right out of college at Marymount, so I was four years at Marymount and I kind of got bored there in the lab and a job came up with Cleveland Clinic and I said, "Well maybe I'll learn something different there." And the lab really was a great place. It kept me engaged for about nine years. I kept learning.
Adrienne Boissy: Wow.
Linda McHugh: The Cleveland Clinic is a national referral center, so you see a little bit of everything and you learn a little bit of everything. But I did go back to school and worked on my master's because I knew I couldn't spend the rest of my life in the lab.
Linda McHugh: And I think I was lucky to have opportunities to interact with some really special leaders who gave me opportunities across my career to grow myself and to develop into someone who could lead others as well as make a difference. Super committed to the mission of the Cleveland Clinic and all of the opportunities that it provides for all of our caregivers in addition to taking care of our patients of course.
Adrienne Boissy: Talk to me about some of that. You mentioned leaders who sort of created a platform for you to do something else or an opportunity. Give me an example or two.
Linda McHugh: I started when I was still in the lab volunteering on different committees. I worked on the United Way Committee, I worked on the American Heart Walk Committee. And through those committees I met other leaders. And when I told them that, I was thinking of when I completed my master's, leaving healthcare because I wasn't sure what I could do outside of the lab and they didn't want to stay in the lab.
Linda McHugh: I got a call from one of them saying, "Hey, you know, you should consider, we do hire administrators in the research area and it's an adjacency for you." And I did. I said, "I would love to talk to you." And I went over and talk to them and it certainly was my next learning opportunity. That I enjoyed, but I also had the opportunity to learn something new about both myself and about the clinic.
Adrienne Boissy: Well, that's a great story. I'd never realized that's where you started. And look at you now. It's totally amazing.
Linda McHugh: I've had seven different jobs.
Adrienne Boissy: Which is your favorite?
Linda McHugh: This one. It is.
Adrienne Boissy: Good answer.
Linda McHugh: It really is because I've learned something different in every single job and they were all somewhat different. The last job right before this, working with the CEO for almost 14 years, every day was different, but jobs before that also in operations were in different parts of the business. That gave me an opportunity to continue to learn and grow.
Adrienne Boissy: For those listeners who aren't aware, we have a new CEO as of about a little over a year ago, but you had worked very closely with the prior CEO as you said, for 14 years. What did you learn most from that 14 year experience about working with Toby?
Linda McHugh: Yeah, I think innovation and being open to new ideas is key and the idea around a culture of continuous learning is what made the Cleveland Clinic what it is. Innovation in learning and surrounding yourself with people who want that for themselves. To continuously look for ways to solve problems, whether it's patients' problems, operational problems, and that makes work fun. If you're standing still.
Adrienne Boissy: If you're Linda McHugh, you're really fun.
Linda McHugh: But he was someone especially who I think was really humble in terms of I don't know anything about that, let me go learn.
Adrienne Boissy: Exactly.
Linda McHugh: It was very striking.
Adrienne Boissy: Now you have the opportunity in one of the newest, and I might say biggest initiatives that really came out of new leadership and new ideas was around creating an office of caregiver experience. Talk to me about the genesis of that and then I know you've done a lot of listening over this past year to really understand what are our caregivers saying they need and want?
Linda McHugh: I will say creating the office shined a light on the subject, but work had been going on for many years around understanding where our caregivers were at, how they felt, what they needed. We actually started measuring engagement back in 2009 and action planning and trying to develop programs and initiatives to support them. While the office of caregiver experience certainly is focused directly on that and has some dedicated resources to that, it is not something brand new for us.
Linda McHugh: That's the good news. The listening tours, I think, actually after we had done town halls after our last engagement survey, we had primed the pump so to speak, on people understanding what it meant to come to together and give their opinions. That it was a safe space and we had 11,000 caregivers interact in one way or another. We gave them multiple ways to interact with us. Through electronically, in-person, in writing with suggestion cards. And we learned a lot. We asked some very specific survey questions around culture and how they felt.
Linda McHugh: The thing that came out the most was that caregivers want to be respected and they want to be supported and they want to have gratitude or recognition. They want to be thanked for the work that they do. And they also want to work in teams. They want the support that they feel that they need in stressful situations.
Linda McHugh: Burnout, and recognizing that caregivers are stressed and burned out is key. I think sometimes they feel like, and what we heard them say, is they feel like we ignore their stress when they're overworked and we have to really start recognizing and providing opportunities for them to alleviate their stress.
Adrienne Boissy: Yeah, so let's pause there for a second. Often, not oftentimes, but sometimes we have situations in the hospital, either challenging patient scenarios or people with mental health disorders or violence in the workplace. And that adds a whole new layer.
Linda McHugh: A whole new layer.
Adrienne Boissy: Of complexity and stress to our frontline caregivers. And what's always been amazing to me about that is when we've gone to the bedside and tried to just listen to the caregivers or give them a boost of support or check in with them, oftentimes what you hear them say is, "It is my team that is getting me through."
Adrienne Boissy: When you say, "How could you possibly be dealing with this? How can you show up the next day?" People invariably say, "It's my team or my manager." Is that your same reflection?
Linda McHugh: Absolutely. And the national data has shown that as well, that anyone who feels supported as part of a team, so much of the research, there's a new article that just came out in the Harvard Business Review about feedback, but it ties back to the idea of check-ins in teams so that you always have someone who's checking in about how you're feeling, not about how you're working or how you're doing, but how are you feeling? And that is where you get ...
Adrienne Boissy: Wait a second, wait a second. Let's talk about that. Because all the push you hear now and even some time things we've spent time on is how do we give feedback? This is a crucial conversation and you're going to keep doing this. You should adapt. This feels a little bit different.
Linda McHugh: And it is, and it's, I think, revolutionary, but it's going to be, you're going to hear more about it. You're going to hear it coming out.
Adrienne Boissy: You're not going to tell me now.
Linda McHugh: No, I'm going to tell. But Marcus, what's coming out, Marcus Buckingham, who is one of the architects, the research architects behind the Gallup Q12 is now working for ADP for their research institute and with the Harvard Business Review and with Stanford and Cisco and rolling out what I'm going to call an engagement platform. It's not a tool, it's a platform and it's about playing to people's strengths in the we in the me. Their strength as a team member and their strengths about themselves.
Linda McHugh: The research shows that humans are not good raters of other humans. They're only good raters of themselves. There's a bias when they rate others and it's proven time and time again in research. The idea is, really checking in with people about how they're feeling on their progress to their goals. They know what their goals are. 71% of our caregivers in our survey said they understood what their goals were, which is great. That's, I'm thrilled with that number. I want it to be 100% but 71 is great. The idea is that the leader checks in with them, not about how they're doing on the progress to their goals, but how they're feeling about where they're going towards the progress because they can only tell you how they're feeling. And they know it's empirical.
Adrienne Boissy: You're an expert in your experience.
Linda McHugh: Yeah, exactly.
Adrienne Boissy: It sounds very similar of patients, like I'm an expert in my patient experience domain.
Linda McHugh: That's exactly it.
Adrienne Boissy: And then oftentimes we get into trouble when we think we're an expert in the patient's experience or how they should be feeling about where they're at.
Linda McHugh: Right. I think that's where you meet them where they're at and understand where they're at and then support them with what they say they need to get to that goal.
Adrienne Boissy: Sounds like an interesting new concept on the...
Linda McHugh: Yeah, I'm excited about.
Adrienne Boissy: I know, I can see. For those of you that can't see, she's smiling, raising her eyebrows. She's very excited. Something you and I have talked about sort of offline is just this idea that the way of capturing engagement in the past on this yearly basis, with these long complicated surveys, we have percentile rank performance for the rest of the country. Feel quite antiquated.
Linda McHugh: Absolutely.
Adrienne Boissy: Where are you heading? I mean I'm thinking about it in a patient experience world, where are you thinking about it? And how are you thinking it needs to change?
Linda McHugh: We're exactly in the same space now. Many of our agencies that accredit us have certain requirements of things that we have to measure. We're required to do a safety survey. We're required by Magnet to ask certain questions on an engagement survey. But our current biannual census survey could have up to 96 questions depending on whether you're a clinical caregiver or you're not.
Adrienne Boissy: Yeah, that's crazy.
Linda McHugh: Crazy. And it just, it's six weeks before you get the data. It's another two weeks before it gets put into a presentation and presented. And then there's action planning. It's not relevant or of the moment. Again, the research has shown measure as little as possible, as frequently as possible, as reliably as possible. Our goal would be to continue what we have to do for accreditation in a small survey and benchmarks. We know where we're at now. It's about year over year improvement. You don't always have to keep measuring teeny little increments. You want to see bigger.
Adrienne Boissy: Big change
Linda McHugh: Yeah, and so we're looking at technology to help us do more pulse surveys, get a more frequent measure of the sentiment around certain subjects. How is it to work here? Most of our caregivers say 90 something percent, It's a great place to work overall rating, but yet there's components of it when you break it down, that they don't like. And so those are what we need to get to. And not once every other year. It needs to be more frequent.
Adrienne Boissy: When you went on those listening tours, what kind of specific things were you hearing for people about they want?
Linda McHugh: Yeah, they want people to recognize that when they're overworked, they want their leaders to recognize when they feel stressed and overworked.
Adrienne Boissy: Gratitude or appreciation.
Linda McHugh: And they want respect between each other, between teams. They would never say that they're not respected on their team. It's often about the team of teams concept. Doctor to nurse nurse to...
Adrienne Boissy: Across teams.
Linda McHugh: Yes. Not within their own tribe.
Adrienne Boissy: Right, tribal things.
Linda McHugh: Yes. But it's a respect in tone and style and how we speak to each other. People's, I don't want to say feelings, but feelings are hurt often in the heat of the moment unintentionally. And then that stays with them. The other thing is we asked about physical environment. Some of our tools don't work all the time and they get frustrated. They're trying to take care of patients and their computers, networking, their communication device is not working. Their wand is not working. We have lots of technology to try to help them, but it has to work. We hear that consistently.
Adrienne Boissy: That's where that ease comes in, right?
Linda McHugh: Yes.
Adrienne Boissy: That idea we've been talking about, about trying to make patients' lives easier, but it's about making our caregiver's lives easier. Nothing more frustrating than trying to do the right thing, being super busy and then not having things work.
Linda McHugh: Exactly. Exactly.
Adrienne Boissy: One of the things I read about teams a long time ago, there was this article about what makes teams work and it was this study of Google. I think Google had tried to study teams to engineer what their teams needed to look like and they were trying to figure out who needs to be on it, what needs to be dynamic, and they ultimately found that it's really about norms. Social norms that a team has, which got me thinking about almost values. Do we value the same things? And how does that translate then to our behavior? That that glue for a team can be incredibly powerful. Maybe even more so than who's on it or what their background is or how they function.
Adrienne Boissy: And you've spent an incredible amount of time thinking about values and leadership behaviors and how those tie to performance. Talk to me about how your thinking around that has evolved and what we've most recently done.
Linda McHugh: And I will first say though that I think all of those things play into the base of what is a healthy team, which is trust. You're going to trust someone who displays the behaviors that we've said we value and displays the behaviors around our actual values. When we were doing our strategic plan this year, we had the opportunity to re-look at our stated values and our leadership behaviors. We had not looked at those since I think Toby became CEO in 2004 and we realized that there was overlap between our leadership behaviors in the six values that we had before. And also that we were missing something around inclusion. And that compassion and service didn't really describe what we wanted to get across relative to empathy.
Linda McHugh: We were lucky that our CEO and the executive team were open to the idea of really building out behaviors underneath some refreshed values and new leadership behaviors that include now some accountability because we did not have anything in our leader behaviors around driving results in holding people accountable for results.
Linda McHugh: What you value, what you say you value and the behaviors that you reward around those values define your culture. And if we want our culture to be that of a family in a team of teams, that trust base ties all together with the values and the leader behaviors. I will say too though that healthy teams also have conflict. It's not a bad thing to have people on teams who may have different personalities as long as they have the same values.
Adrienne Boissy: Right. Somebody sent me a quote recently because I think we had some conflict on our own team and somebody sent me a quote and said, "Conflict was really important for teams in a healthy way. What we didn't want to have was apathy."
Linda McHugh: Right, exactly.
Adrienne Boissy: Right? Which conflict at least implies you think it's a safe space to have that conflict. You're happy to share a dissenting opinion versus just sitting there and shutting down. I thought it was interesting. I still think healthy conflict on teams is real hard work.
Linda McHugh: It's hard work and it's important when you're developing a team or say a project team, to get a specific task completed. There's four different types of personalities that you would want on a team. You have the ideator or you have the executer. If everyone's in ideation and you have no executer on the team.
Adrienne Boissy: You're in trouble.
Linda McHugh: You're not going to get anywhere. It's important to understand people's strengths, which is part of what the Marcus Buckingham platform is, is understanding everyone's strengths. Because when you're putting a team together, you want to know who you can rely on for what part of that equation to get things done.
Linda McHugh: When we were thinking about values for the enterprise, as you said, we combined service and compassion into empathy. We combined quality and safety, which were already existing. And then we added inclusion.
Adrienne Boissy: Let's spend a moment on why it was important to create a separate value around inclusion.
Linda McHugh: Yeah, diversity and inclusion has always been a core base belief for us and part of our strategy. We have an office of diversity and inclusion. We strive to make sure that our leadership as well as our overall caregiver population, percentage wise, match what's in the market so that we really are both matching our patients in the market for diversity in race, gender, sexual orientation, religion and abilities. And that we felt it was time to call that out in a more specific way because sometimes people don't understand the difference between diversity and inclusion.
Linda McHugh: You start with diversity, but inclusion really is letting them have a voice as well. A seat at the table is diversity of voice at the table and being asked to participate is inclusion.
Adrienne Boissy: I remember we were trying to articulate it as diversity is what makes us different. And yet inclusion is about the behaviors that we need to demonstrate to bring other diverse opinions in.
Linda McHugh: Exactly.
Adrienne Boissy: Or people in for that matter. Is that fair?
Linda McHugh: Yeah, absolutely.
Adrienne Boissy: Capitulation. I think one of the biggest challenges is for us to align what we say we value, the values and behaviors. Because as you said, culture is everybody watching to make sure that we're actually living and breathing and rewarding what we say. And there is a lot of eyes on whether or not we're holding people accountable for them. I think even at the Clinic I've seen in my own work that when we can convert, for example, a single known, perhaps ineffective communicator to an effective communicator that has more ripples than any communication I ever sent out.
Adrienne Boissy: Holding everyone accountable for those things. And there's also instances where I think we've let people go because they weren't a cultural fit and those have sent a very strong message.
Linda McHugh: Strong message.
Adrienne Boissy: Across the institution. Do you think that's an important piece of accountability? Or how do you think about accountability?
Linda McHugh: And I think, I want to use the words that one of our coaches used with us, which is in a loving, caring, productive way to hold them accountable. It's back to the feedback conversation. Here's how I felt about what just happened. How did you feel about it? I think there's ways to be productive and hold accountable to goals.
Linda McHugh: When we look at our, how we're going to managing performance this year, it's around the behaviors we've built out around those values and leader behaviors, and then the goals that people individually set for themselves with their leader in OKR format. That's it. Those two things. And they can't produce the goals at the expense of their behavior. Their behavior has to match our values and the goals need to be achieved. There's a way to do that in a supportive way. That's the key word is support.
Adrienne Boissy: Yeah. I hear what you're trying to do there. And yet this idea you said loving, supportive way. At times, the most loving, supportive thing you could do is...
Linda McHugh: Off board.
Adrienne Boissy: Is tell somebody this is not working or say this isn't working. It's time for a transition. And yet at the same time, I think that's a constant challenge for leaders of being, people equate being loving or empathic with not holding people accountable. There's some softness that gets lost there. Do you see people struggle with that loving support and accountability?
Linda McHugh: Absolutely. Sometimes this is the hardest decision for a leader to have someone that they know is not going to be successful where they're at and have that honest conversation with them. If you're having continuous check-in conversations, it's not going to be a surprise that the role's not the right fit and it's oftentimes the best thing for both parties to be open and honest about that in a psychologically safe way and support them in finding something else. Now, on the flip side, if their behavior is toxic or completely inappropriate, there's a way out the door.
Adrienne Boissy: Right, right. Well, you can't possibly enable that and create the culture you're aspiring to create.
Linda McHugh: Exactly.
Linda McHugh: Right. Since we've started this year with our harassment training and tracking complaints for discrimination, bullying or harassment, which is one of the other things we heard from caregivers is about hostile work environment or bullying, of the 300 or so allegations that we had, almost 70% of them when investigated were unfounded, but we did end up terminating 24 people. We take it seriously and we tried to make sure that we are enforcing what we believe around our values and behaviors, particularly in extreme cases, very visible, but also fully investigate.
Adrienne Boissy: People are definitely watching. You referenced leader behaviors and a little bit of accountability. Can you talk to me how leader behaviors differ from behaviors we're expecting of all of our caregivers?
Linda McHugh: There's two leader behaviors in particular that are new this year that I think are very important is the connecting teams. When we talk about the importance of teams and team of teams, it's up to the leaders to be able to connect the teams that they work with, to the other teams across the organization that they also need to interact with to produce the right results. I love using Taussig cancer as the example. The oncologist and hematologist can't work in isolation. They need the surgeons, they need pathology, they need nursing on the floor. When we talk about taking, let's say a breast cancer patient, there's a big cross functional team that takes care of that patient and the leader is responsible for making sure those connections happen.
Linda McHugh: The other is drive results. We did not have that before as one of our leader behaviors. And I think when we talk about what our caregivers want, they want to know what's expected of them and they want to know what their goals are. And that ties right into driving results. If the people don't know what you expect of them and what the goals are, how can you drive the results that you need to drive?
Linda McHugh: I think those are two key behaviors that are new on our list. We had teamwork on there, but we didn't have connect.
Adrienne Boissy: Connect across.
Linda McHugh: Exactly.
Adrienne Boissy: You also referenced, OKRs, which I want to spend a moment on. Terminologies, there's a great book about OKRs, what they are and how they're created. Are those new to healthcare and is that different than strategic management?
Linda McHugh: They're not necessarily new to healthcare. They've been in the business world for awhile. Measure What Matters is the name of the book and you know it really is about creating a framework for your goal. That's all. It's simple. You put the high level objective and what are the tactics that you have to do? Or the key metrics to get there.
Linda McHugh: We've been doing this. When we looked at our goals from last year, 80% of our caregivers had good goals in the system that would have translated into an OKR. It's just writing them in a different format and really understanding it makes you think a little more about what do I need to do to achieve this objective? And how can I measure it? Because sometimes we don't always write that down. We know in our head what it is, but it's not specifically written in the system.
Linda McHugh: The other thing is, we've been collecting everything in Workday, so Workday is actually going to help us try to figure out how to put it in that format for next year to make it easier for everybody to put them in. But it really is not a new concept. I consider it a different framework that's a little simpler for people to think about the tactics to get to their goal.
Adrienne Boissy: Yeah and we've emphasized it really organizationally this year in a way that we never have before, even though we've been doing goal planning, but OKRs has really been a constructive format for us to get all that in. You recently set up gratitude trees in our lobbies. Talk to me about the impetus for that. You mentioned obviously gratitude before, but there was nervousness about doing that, right?
Linda McHugh: Yeah.
Adrienne Boissy: Whether that was a good idea.
Linda McHugh: Yeah, we had seen it at a meeting we went to, it was a gratitude station where you could go and log in and send gratitude to someone for anything because we wanted to make it a little different from the caregiver celebrations and we thought the time between Thanksgiving and Christmas was the right time to do that. The interesting thing is that we expected less than half the first day. We were overwhelmed with the number of people that came in wanting to express gratitude to their coworkers. And in addition, they found out that they could do it online. We never even advertised that there was an online link and it's still up and running. People are still sending. We were going to shut it down, but then two more came through the other day. It was like, oh my gosh. I said, "Well let's just leave it up and running."
Linda McHugh: But people, it feels good when you say thank you to someone or you express gratitude to them for what they did. It's a little different than the caregiver celebrations. We were happy with the outcome.
Adrienne Boissy: Yeah, and you have people make.
Linda McHugh: Yeah, we had them do ornaments for the holiday tree.
Adrienne Boissy: Just on a closing note, many people across the country trying to drive patient experience often ask me what the first thing they should do, especially if they feel like their caregivers are all stressed and burned out while they're having crucial conversations about their scores. And oftentimes I find myself saying, "Well, if that's the situation you're in, then the most important thing to do is to focus on your caregivers." Would you agree with that?
Linda McHugh: Absolutely.
Adrienne Boissy: There's this constant dialogue about which is more important.
Linda McHugh: That's where the check in and the support comes from. What can we do to help you make these scores better? What are the barriers? What are your barriers in front of you? Because it can't be just about putting the numbers up there and saying make these better because if they could have made them better, they would have. Something is a barrier. Whether it's staffing, whether it's the tools, whether it's the leader not recognizing that they're stressed and overworked, or that the wrong people are in the wrong roles. Something is a barrier. And that's where you have to have those open conversations in small groups to really get at what's driving this?
Adrienne Boissy: Right. And we know, of course, that if our people are struggling with the basics of that Maslow's hierarchy, they're never going to deliver this exceptionally complex, high quality, high experience that we want to deliver and are going to be able to treat other people like family when they're not in a good place. I appreciate everything you've done around gratitude. Personally, I have to say as somebody who's had their office next to you for a number of years, the counsel you've provided me personally as a well-respected leader in our organization, is just invaluable. I'm very grateful for you.
Linda McHugh: Oh, thank you. I'm grateful for you.
Adrienne Boissy: Aw, tell me more. Well Linda, thank you for spending so much time with us today, I really appreciate it. This concludes Studies In Empathy podcast. You can find additional podcast episodes on our website, my.ClevelandClinic.org/podcasts. Subscribe to Studies In Empathy podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcasts. Thank you for listening. Please join us again soon.