A Culture of Service Excellence

By Arthur B. Cummings, MB ChB, FCS(SA), MMed(Ophth), FRCS(Edin

In modern cataract and refractive surgery, there is a saying: “Success equals Expectations minus Outcomes.” If your patient is expecting a 20/16 outcome but “only” achieves a 20/20 outcome, he or she may be disappointed. Conversely, a patient who was hoping to achieve driving standard (20/40) but ended up with 20/25 may be very happy because he or she got more than expected.

This example shows how someone with a less positive outcome could be happier than someone with an excellent outcome. As I deal with patients and their expectations and outcomes daily, I am acutely aware of how expectations frame our mindset and our references. Expectations, which are relative and subjective, have the power to influence the success of a practice. As any elite athlete or CEO can tell you, one’s expectations are a key driver of success. If you expect yourself to achieve something, the odds are higher that you will achieve that goal.

At the Wellington Eye Clinic, we have a culture of service excellence and mutual respect, and patient satisfaction—that is, matching patients’ expectations with performance—is our top priority. We hire team members for their attitude and then train them for aptitude.

The culture of a practice is determined by its leadership. Whatever is important to the leaders of the clinic will permeate into every team member’s psyche. If your underlying ethos is good, you have the foundations of a successful team.

The Wellington Eye Clinic is a flat structure with few managers and many active team members. Our general manager, Ed Toland, is responsible for human resources, the financial well-being of the clinic, general maintenance, oversight of all staff, and executing the clinic’s strategy. Our clinical manager, Lisa McLoughlin, is responsible for daily management, health care staff rosters, and teaching and furthering education, among other things. In this article, I ask to Ed give an overview from the general manager’s perspective and share some guidelines that he uses to help all of us achieve more. I ask Lisa to share tactics she uses to manage the clinical team.

As the owner and the Physician-CEO of the Wellington Eye Clinic, I would first like to share some thoughts of my own. It costs a lot of money to live in or around a European capital city such as Dublin, and hence salary is a fundamental starting point for incentivizing staff. Salary, however, will only get you so far. As the title of our article suggests, we want to exceed expectations.

In my view, other factors may weigh far more heavily on potential success: Is there opportunity for personal and professional growth? Do staff members feel respected and valued by their fellow team members? Do they enjoy their work, and do they realize the value that they bring, both to their team members and to our patients? Does each person on the team realize how important he or she is in the machine that provides our services? Are their personal needs considered, as far as is possible and fair to the rest of the team? Do they feel psychologically safe? That is, are their interpersonal relationships so solid that they feel free to speak and know that they will be heard but not judged?

Flexible work hours greatly improve working conditions for working parents, those who commute long distances and must navigate rush-hour traffic, and those for whom school holidays have high significance.

We hold regular team meetings where everyone is expected to participate and where we frequently teach, learn, share, troubleshoot, and think about challenges. I try as often as possible to emphasize the importance of teamwork and to show appreciation for the different roles that are covered throughout the 25 different job descriptions in the organization. Personally, nothing excites me more than seeing people develop and grow into successful and motivated professionals who establish new goals for themselves and for others to try to emulate. The adage “Attitude determines altitude” is one that I can personally attest to.

Ultimately, to incentivize a team to exceed expectations, one must seek to further develop the inherent personal attitude within each team member. They must be encouraged to set their own goals, preferably ones that are aligned alongside the collective goal, so that, in achieving their goals, the organization’s collective goal is achieved.

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A Multifaceted Approach

By Ed Toland

Motivating the staff of a medical practice requires effort on many levels. Motivational efforts should relate closely to the mission and values of the organization. Building a motivated team requires effective staff recruitment and a proper framework for staff members to grow and contribute. These individuals must understand their assigned task requirements and take cognizance of what is required to make the overall organization exceptional.

LEADERSHIP

A business will get from its team members the behavior it rewards. In any team, there are personalities that, if harnessed optimally, will make the whole far bigger than the sum of its parts.

It is the responsibility of those leading an organization to determine its mission, values, and culture. Hopefully, the team will understand and buy into these key principles. If they do not, or if the prospects of changing their attitudes are slim, they might be better off engaged elsewhere.

In recruiting new staff, the likelihood that a person will identify with the culture and values of the organization is of paramount consideration. In many instances, unless one is looking for specific requirements to fit a job description, attitude will trump experience and qualifications. Remember the old maxim: One should hire for attitude and train for skills.

SEEKING QUADRANT FOUR

There is a well-known mind map that is helpful for charting the performance of team members (Figure). Imagine a graph that quantifies attitude on the vertical axis and skill on the horizontal.

The leader should consider without bias each of his or her team members and think about where each member fits on this diagram:

Quadrant 1. Low on Skills, Low on Attitude

These are people who are likely poorly suited to your organization. Hopefully and probably, you do not have anyone on your team in this bracket. Put simply, these are staff members who might be better suited to employment elsewhere.

Quadrant 2. High on Skills, Low on Attitude

These are people who, at best, only go through the motions. Their contribution to making the organization stronger in the long term is likely to be limited. Sometimes Quadrant 2 can include staff members who have been in the business a long time and perhaps have become stale or bored. With some reenergizing and the right motivation, these individuals can move into Quadrant 4.

Quadrant 3. High on Attitude, Low on Skills

These are people with potential. It is possible to provide the training and the nurturing required to move these folks into Quadrant 4. These are people, after all, who aspire to be in Quadrant 4.

Quadrant 4. High on Skills, High on Attitude

These are the stars of your organization. These are the people who will contribute the most. These are the people who can make your organization great.

REWARDS AND CURRENCY

Dealing with people is always a challenge. We are all different, and nature and the way we have been nurtured have profound effects on how we see the world and what motivates us.

The word currency in this context does not refer only to pecuniary rewards. Personal currency can vary from individual to individual. A list of what might motivate a staff member is a very long one.

In her section of this article, Lisa McLoughlin goes into detail regarding the essential infrastructure required to promote job satisfaction, as well as the importance of setting expectations. It is the responsibility of the employer to create the right framework for employee satisfaction and success.

Job satisfaction can come from a combination of many types of things:

• A simple pat on the back;
• A sincere “thank you”;
• Constructive feedback;
• Educational and career opportunities;
• A promotion;
• The opportunity to travel to conferences;
• A parking space;
• A new title; and so on.

Clearly, incentives are not limited to finance. During and after the recent global financial crisis, for many organizations there has not been much in the way of surplus to share. However, there is no doubt that financial and quasi-financial rewards are the most tangible ways to recognize outstanding achievement.

Should one reward the team collectively or reward individuals based on personal effort? A case can be made for either. However, to become truly world-class, in most cases I believe that those who are doing the outstanding work should be further encouraged by receiving the greatest rewards. An exception might be in task-specific circumstances, when a goal was reached collectively. Truly great organizations get to that point by having people who are exceptional and raise the collective bar.

RAISING THE BAR

Those who are raising the bar—setting new expectations on all—deserve better rewards. Outstanding performers might include those who exhibit these traits:

• They are prepared to go to exceptional lengths for a patient;
• They have a passion for the clinic;
• They understand that they are working in a service business;
• They understand the importance of the perceptions of each patient;
• They buy into and influence changes that will benefit all stakeholders in the clinic;
• They treat their colleagues with dignity and respect in person-to-person interactions;
• They excel in the quality of their contribution to the work of the collective;
• They are not clock-watchers longing for the minute that they can leave; and
• They understand the importance of attention to detail.

CONCLUSION

It is never prudent to reward someone in the vague hope that the recognition will lead to improved performance. This approach seldom delivers.

When a staff member leaves, it is an opportunity to bring someone in who can make the organization better. This can be challenging to achieve during periods of growth or when there is pressure to hire quickly. Nonetheless, it is imperative to select, not settle, when offering a position in your organization.

Ensure that the stars of your organization, the ones solidly in Quadrant 4, understand clearly why they are appreciated and why they are being rewarded.

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Creating an Environment for Success

By Lisa McLoughlin

Employees who believe their company supports them perform better. A well-trained and confident staff will be more secure and will do their jobs competently and with enjoyment.

As clinical manager of the Wellington Eye Clinic, part of my role is enabling staff to perform to their best abilities. This involves consideration of the environment, both physical and cultural; staff development efforts; and an understanding of each staff member’s personal commitments outside of work.

It is important for the line manager to encourage staff members to fulfill their roles to the best of their ability and skills, according to their experience. Employees who have clarity regarding their role and purpose perform better.

When new members join the team, they are introduced to the clinic vision, and clear performance goals are set. In order to perform to their maximum, staff members must also have the capability to perform their job; therefore, their induction must include training to ensure competence in all the skills required. They can see that their colleagues are well trained and educated, and this encourages them to work toward being part of our highly motivated multidisciplinary team.

ROLE OF MANAGEMENT

The ability of management personnel to fulfill their roles as leaders is vital in motivating staff. Staff members who feel respected, experience clear communication, and are positively supported will perform better.

From an operational point of view, we strive to develop a physical environment that enables staff members to work effectively and efficiently. Schedules are set up to be as fair as possible, to consider each employee’s personal challenges, and to ensure that all are comfortable with their workloads. Staff members are encouraged to do their jobs properly and in a timely fashion rather than rush through the work.

Designing the schedule can be challenging when there is a mix of requests from staff members with outside interests and commitments. Allocating a balanced mix of abilities when scheduling staff is a priority. If staff members see that management is willing to be flexible and consider their outside needs, they are more likely to be willing to help out when they are needed for busy clinics.

Giving feedback to staff members on an ongoing basis helps to address performance issues and to acknowledge our appreciation for work that is performed well. Receiving positive, constructive feedback benefits performance.

As the team grows and the more experienced staff members get involved in more complex aspects of the job, it is important also to acknowledge the efforts of less experienced employees who keep the basics of the day-to-day work going. Showing staff that they are appreciated and that they play a significant role in optimal patient care will in turn encourage them to go that extra mile to make the team stronger. All staff members have a role in ensuring that patients have a positive experience.

PERSONAL DEVELOPMENT

In order to encourage individuals to exceed expectations, personal development is vital. Education plays an important role in staff development. Giving staff members the opportunity to attend conferences shows that the clinic is investing in them as people.

Conferences also give staff members the opportunity to network with colleagues and learn from different experiences in other workplaces. On their return, the travelers can then share their new knowledge at staff meetings so that all can benefit. Opportunities to attend conferences are alternated so that everyone gets a turn.

The work environment is probably one of the most important factors in enabling staff to exceed our expectations and their own. An enjoyable and fun work environment, even at the most challenging times, is something I try as a manager to maintain, to ensure that we all perform to our best abilities. n