Three Core Beliefs, Part II:

Top Performance Requires Daily Performance Feedback Systems

Regardless of how much campaigning executives do to try to change performance, there must be in place a system of daily performance feedback so that folks can see how well they did individually compared to their team and to the standards of the past and the future every day, and every shift.

Without such a system in place, people are left to a subjective evaluation of daily events. Now, that is actually very important. But without an anchor in objective measurement, it can become skewed badly. The day that felt great may have been a day of very bad delays and some errors for patients. The day that felt very difficult may have been the day that remarkable service levels were achieved. When the two pieces of information - subjective evaluation and objective metrics - are combined in real time, you have the basis of the best possible analysis of what happened, and the best information is the basis of the best performance.

When individuals try to interpret hard data without actually having been there to also get the subjective evaluation, or when that evaluation is made days after the event, subject to the failings of memory, you get suppositions, conclusions that are personally convenient, though erroneous, and at best a demand for more data and analysis. It becomes an endless exercise with no actual behavior change.

But when that evaluation and analysis takes place on the very day of the performance, or the next day...with hard data on quality, service and productivity, then the memories are fresh, the data keeps people honest, and you get a high level and objective result, and some honest dialogue: No amount of months of dry data recording and remote review can equal it.

And the evaluation is much faster, and the consensus about what happened and what to do tomorrow much easier to build.

One of the most important facets of daily performance feedback and analysis among the team is that the team which once thought they did a 100% perfect job every day now learns they don't. Sometimes they provide a less than great service. And other days, for reasons that no one can understand, they exceed all possible benchmarks and something close to a miracle happens on behalf of patients. Along with these new learnings are several  important lessons:

1. We don't perform consistently every single day.
2. Some of the things that cause great or poor performance are right on this team, and not something requiring new construction or new equipment, or a commandment from the CEO....some of it is human performance that can be improved immediately. Only open discussion and mentoring among this team, including our sacred MDs; with this hard data and these people here right now; every day; can result in not simply an adequate job immediately but also the best possible performance overall.
3. Now peers are partners with management in helping provide that feedback and acknowledgement, so that accountability isn't merely vertical, but horizontal. The hard metrics provide a foundation and a basis for team members to open up...and a protection and justification for them to do so.
4. Daily review is the opportunity for management to give directly, face to face, positive recognition. And for peers with a grudge to let go and do the same when they see their rivals perform literally miracles for patients.. Yes, miracles happen in Hospitals. God works through these very people you have doubts about.

Recognition is generally lacking in hospitals because most of the time most folks are doing their job. But management isn't recognizing them that often. They don't have the objective data to do so, and management doesn't want to be accused of having favorites. The daily metrics are crucial for opening up a world of positive and real acknowledgement.

Recognition, and correction, are not annual, semi-annual, quarterly or even weekly events. They are daily events in a number One Hospital. And not just the duty of front-line management, but of each professional on the team.

And front line management knows that while they have many, many other duties, this is their principle duty--review metrics and team discussion and problem-solving, and recognize the team every....single.....day.....and every shift.