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Title: The Impact of Team Development on Customer
Service
A Focus Paper
Katherine H. Beavers, CMPE
October 2, 2016
This paper being submitted in partial fulfillment of the requirements for election to Fellowship American College of
Medical Practice Executives
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Introduction
The purpose of this paper is to present a proven method to improve leadership and staff
relation and to show how it relates to improved customer service. The initial project goal was to
gain an awareness of and eliminate the deficiencies in customer service within the practice. The
quest for delivery of superior customer service may at times be an elusive one. In that quest, one
will quickly learn there are several different modalities used to gain the valuable information
entities may need to evaluate their current level of service delivery. Questions are asked of not
only the customers, accomplished through surveys and focus groups, but of the stakeholders and
staff who are delivering the service. Eventual measurements of data may include team attitudes,
satisfaction levels, S.W.O.T. (strengths, weaknesses, opportunities and threats) analysis and
emotional intelligence testing. With that, one can begin to develop a strategic customer service
plan. The plan must begin with team and leadership development. Only then can an action plan
be developed. The action plan needs to involve task functions based on solid research of
relationship and environmental functions. (Clark, 1995) Leadership must ensure the foundation
for team culture is not built on a sandy surface that could be washed away with the slightest
conflict.
“In order for an organization to be great, it has to have great leaders” (Studor, 2003).
Evaluation of leadership by self and the team must also be integrated in order to assure alignment
with the cultural and performance levels ultimately desired. The top ten leadership competencies
developed by James Kouzes and Barry Posner must be put into play during this process in order
to achieve success. Within this particular work, the focus will be upon Enabling Others to Act
and Modeling the Way. (Kouzes, 2007)
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Formal education and research as well of the use of known leadership principals formed the
basis of the process for this focus paper. The process, developed through the progression of trial
and experimentation within the practice setting, produced the methodology utilized. Although
time and personnel intensive, the enclosed steps are proven to lead to higher employee
satisfaction rates, increased retention of employees, employee empowerment and heightened
leadership capability. It is demonstrated that all of this translates to higher satisfaction rates for
the practice. Leadership may be challenged by a period of disharmony and misunderstanding
within the organization during this process. This project requires an investment of time and effort
for the entire team. The consequences of inaction however threaten the organization with higher
turnover, the placement of people in inappropriate roles and lower patient satisfaction that may
lead to loss of revenue.
Background
What do patients want? According to Kristin Baird in “Raising the Bar on Service
Excellence,” six principles are related to this question; Focusing on the patient experience; right
person; right job; standardization, facilities; technology and communication. How do we move
from a provider focus to a patient centered focus?
Routines and familiar surroundings can cultivate a breeding ground of complacency. The
“newness” of the routine wears off and slowly the policies and procedures of an office setting
can become redundant and forgotten. Negative impressions left on co-workers and the people
they serve can develop into “business as usual,” attitudes with enough day-to-day interactions.
Satisfied staff and customers are the basis of any successful organization, however written
policies alone do not create the culture that is needed for continued success.
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The goals of this project included movement towards superior customer service and
“Firms of Endearment” (Sisodia, 2007) qualities for the patients of ABC Medical (A fictitious
name). This was accomplished by aligning the interests of all stakeholder groups: physicians,
staff and patients. Through the engagement and development of staff, that attitude and culture
overflowed to the patient and back in a positive way. With outreach to patients, stakeholders
were better able to understand patient needs and how they could become more effective for them.
This was performed with several leadership competencies: people development which includes
temperament profiling for staff, team involvement, leadership evaluation, empowerment, the
guiding principal that “happy crew members make for happy customers,” (Sisodia, 2007) and
creation and the direction of a high performance climate. This was not a project to outline the
actual protocol of superior customer delivery but a project to evaluate current systems and most
importantly to examine what team development must take place in order to begin to deliver
superior customer service.
Success of any program starts with leadership support through the identification of
positive and negative issues and continues through a myriad of change until strategies and
execution come together. The goal with this project was to create a, “climate that is totally
focused on customer needs and responding to their requests” (Edmonds 2005).
This project followed a path: evaluation of current systems, identification of strengths
and weaknesses, evaluation of staff, emotional intelligence, decision-making, communication,
team dynamics and the impact of such on the service and impressions of the customers. The
project continued with evaluation of culture and leadership support, and the creation of systems
that gathered data and provided routine reporting with an action plan format.
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Simple tasks such as asking of questions, watching, listening, getting involved and
leading team meetings helped to form the basis for this project. Leadership developed a plan of
action after brainstorming with Physicians and staff. Questions were asked such as, why do we
do what we do? What keeps us here and who are our customers and why do they choose to come
to this office?
According to Larry Bossidy and Ram Charan, a strong strategic plan must address the
following questions:
What is the assessment of the external environment?
How well do we understand existing customers?
What are the obstacles to growth?
Who is our competition?
Can we execute the strategy for (improved quality customer service)?
What are the important milestones for executing the plan?
What are the critical issues facing the business?
Once the questions started to be answered a plan developed that covered all of the major
factors for the coming year such as training, personnel development, customer development and
marketing resulting in a benefit to the practice customers through better service and greater
knowledge.
Although the totality of good leadership involves many core components, there were two
main leadership competencies, which provided the focus for this project: Modeling the Way and
Enabling Others to Act. These leadership competencies facilitated the setting of clear goals,
philosophies, cooperative relationships and an improved atmosphere of trust for the staff and in
turn, for the customers. “The key to strategic management is to do the right thing, not just do
things right” (Swayne 2006).
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This project was executed in an actual medical office; however, for the purposes of this
paper the name has been changed to ABC Medical. ABC Medical, established 17 years ago is a
medical office that provides rehabilitation services to those who have disability because of injury
or illness. The office consists of 7 Physicians, 54 staff members and professionally trained
management totaling 65 people. Turnover in staff overall is approximately 11% with the
majority of turnover involving administrative staff.
At ABC Medical, examination took place concerning what was working and what was
not with team functions in regards to attitudes and relationships with co-workers. This began
with the Keirsey Temperament Sorter (Keirsey 2008). This tool was administered to staff and
physicians to better help leadership understand what, “makes them tick,” and facilitated the
understanding of specific work styles, levels of assertiveness and general temperament. Next, the
administration of an Emotional Intelligence test to all staff determined their social awareness,
self-management and self-awareness skills. Staff evaluated leadership performance as well and
the consolidated results from the Leadership Practice Inventory were included. Team meetings
were scheduled to facilitate further discussion and to help others realize the differences and
similarities in all, and to share information equally with the employees/physicians as a group.
The involvement of the entire group assisted in mitigating possible conflict as the strategic action
plan came together. Meetings with staff continued discussions in regards to the office vision,
purpose, and what they, (the staff) wanted to portray to their customers. The three key
components of an effective business strategy with a focus on customer service and exploration of
objective, scope and advantage was also explored and developed. Recognition of the seven
different service styles created by Bell and Paterson, and determination of how different
situations may be most effectively handled by each type of individual, were also studied.
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“Service is more than a process by which we get our needs met. It is an experience that
resonates with our heart; a rendezvous, which engages our emotion. The manner in which the
service provider manages these experiences can turn a routine encounter into a truly magical
moment. The emotional touch of service is the connection that can kindle a sense of kinship and
stimulate a bond of loyalty” (Bell 2007). The patients of ABC Medical were asked pointed
questions with a survey, and the resulting answers were used to base further exploration and
discussions with staff. Surveys were also administered to staff to measure their perceptions of the
quality of care they deliver.
Suspected Impact
The impact of this action study was realized by not only the staff and providers, but by
the business and the patients as a whole. Through the creation and implementation of an action
plan that was fluid and “slushy,” (Lux 2011) staff were able to practice what is espoused and
became clear on ABC Medical’s leadership philosophy. The creation of a vision allowed staff
involvement in the planning process, aided in development of cooperative relationships, and
facilitated the staff in ownership of the project. Leadership was able to communicate a message
of high expectation for customer service as well as a confidence in their ability to exceed in the
quest for superior customer service. Development of protocol for customer service and problem
solving was also explored.
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Leadership Development
Through the “Gap Theory” of curiosity (Heath, 2008) leadership’s job was to help the
staff understand that perhaps they did not know everything they needed to about customer
service. There was a need to spark the fire, create the knowledge gaps and, “give people enough
context about the game so they will start to care”… more (Heath 2008). The (LPI) Leadership
Practice Inventory allowed clear and unbiased feedback to leadership in relation to their
strengths and weaknesses.
There are several different kinds of leaders and leadership, Emotionally Intelligent
Leadership, Primal Leadership and Servant Leadership. In the book “Firms of Endearment,
Goleman states, “ A leaders primal task is an emotional one, to articulate a message that
resonates with their followers emotional reality, with their sense of purpose and so to move
people in a positive direction.” Without appropriate leadership, the strategic plan would never be
realized. “Leadership, after all is the art of getting work done” (Sisodia 2007). Leadership
encompasses the art of sharing the heart, managing change, chaos, the decline and fall of human
resources, dealing with investors and the developing social initiative. This all leads to the
development of a positive culture that promotes results, people development, big picture
awareness, team, flexibility and the creation of a high performance climate.
Initial General Goals
The ultimate project goal was to gain an awareness of and a way to eliminate deficiencies in
customer service within the practice. Key milestones included the completion of this project
plan, feedback from selective sources of testing, inquiry and feedback from staff and patient
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surveys. Additional milestones included learning how this practice was able to differentiate
themselves from other physician practices, and commitment to the project from staff. Finally,
managing the key for change and execution for the project and then creating a plan of action to
continue the momentum so that ABC Medical achieved not just change for improved customer
service but also a change of action in the culture of the organization. According to Rick Blizzard
in a 2003 Gallup article:
“analysis shows that there is a significant correlation over time between overall employee
engagement (as measured by the GrandMean score for the 12 questions in Gallup's standardized
employee engagement survey) and overall patient satisfaction (as measured by a single question
asking patients to rate their satisfaction with their hospital experience). More specifically,
employee engagement seems to influence patient satisfaction over time -- not vice versa --
implying that improving employee engagement can help hospitals improve patient satisfaction.”
Finally, the goal was not to, “get caught up in the details of running the business” (Lux 2011).
Leadership worked to, “utilize the building blocks of execution by knowing the people in the
business, insist on realism, set clear goals and priorities, follow through, reward the doers,
expand peoples capabilities and to know them self” (Lux 2011).
This section intentionally left blank.
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Project Goals
Goals to be accomplished during this study:
1) To develop enhanced cooperative relationships between staff and leadership, create a high
performance climate, involve others in planning and decisions (employee engagement), create an
atmosphere of trust and increase Emotional Intelligence.
2) Development of a strategy and plan for action or superb customer care.
3) Move from Managing to Leading; in that others are involved with planning and execution of
pre set goals.
4) Determine the source of distinctiveness for our company through vision creation.
5) Tie together the relationship between loyal employees and satisfied customers.
Anticipated Barriers
The success of the project relied heavily on several factors. Primarily would be the ability
of leadership to close knowledge gaps while effectively creating change. Second was the
question as to whether the present staff had a high enough emotional intelligence to realize that
the change was for the better and to buy in to the process. Finally yet importantly, much of the
feedback and information gained during this report was based on feedback of stakeholders and
patient survey. In an ideal world, a focus group of patients or referral sources would also be
added to the mix to provide additional valuable information. Branding may be an issue as well
that could be explored later. Critical questions were asked such as, what are we trying to
accomplish and do people know that we are here? Are there any ethical concerns to be
considered and is there a chance that the project will result in trying to do too much, too fast?
Does the medical office have anyone in the office that may not agree with the plan of action or
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lack personal commitment to the plan and if so, how can we, through appropriate conflict
resolution, bring him or her around to the new ideas?
Initial Research
Research was accomplished by first exploring the idea that, we do not know what we do
not know. What and who are the personalities involved and how did they affect the customer
service in the office? What have other companies done in the past? What are we capable of
doing? ABC Medical needed to take the obscure and nail it down to provide a plan. Research did
not happen all at once and cannot happen in a bubble. It was an ongoing gaining of knowledge
and information, finding new and better ways to handle situations and learning what works
through trial and error.
The Project Begins
This project focused on coaching skills, not control skills along with facilitation of a self-
motivating work force of trust between management and workers based in part on the McGrath
critical leadership function (Northouse 2010). From the staff point of view, the project appeared
to be patient focused however, it was actually meant to be staff focused in an effort to bring them
together, working on a common project and for a common mission. This involved the smooth
progression of the group in accomplishing its tasks through:
Monitoring: both internal & external environments to create an accurate model of team
functioning, (tests - surveys - discussions), as well as defining the internal and external sources.
Action taking: selecting from competing courses of action to assist the team in developing a
system of organizing that facilitates quality decision making. (cumulation of information - brain
storming), action learning.
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For team success, leaders must:
• Remain open & objective (continual self-evaluation)
• Skillful in selection of appropriate action/inaction (utilization of resources)
The leader’s role is to monitor the following:
• Performance conditions (goals, structure, resources)
• Performance processes (effort, knowledge, strategies)
• Outcome states (satisfaction, performance)
Determine whether to continue monitoring function or take action based on current
information gathering. Determine what level of team process needs attention (internal
task, relational team dynamics, or environmental dynamics)
Decide most appropriate function or skill to be performed in the intervention (Northouse
2010) Table 1.
With the goal of delivering superior customer service in mind, the project outline was presented
to staff. In order to move ahead with a plan, leadership and staff created the ABC Medical action
list outlined in Table 2.
This action plan afforded the introduction of a solid base of new ideas, changes and
concepts for accountability and involvement that would carry into the future.
Status Report
To ensure proper execution of the strategy, to measure tracking and to ensure targets
were met, a status report was developed for weeks one through five. This status report will be
found in Table 3.
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Subsequent Research
Due to the nature of this project it was apparent early on that this action plan would
consist of two different sections; leadership development and the actual goal of the project.
When executing any project questions are raised such as, are we covering all of the topic areas?
What are we missing? Is there any place we have yet to explore and what tools do we need to
assure proper execution? Additional questions presented would be, How does one “Model the
Way and Enable Others to Act” (Kouzes, 2007) in the best way that is the most efficient and
effective? The second leadership model which was utlilized in addition to the McGrath
leadership function was be the Hill Leadership Model (Northouse, 2010) (Kouzes, 2007). In
“The Leadership Challenge” by Kouzes and Posner it is stated that, “ Leaders must forge an
agreement around common principals and common ideals…they must set the example…they
must work side by side with collegues and be highly visible during times of uncertantly.
Modeling the way is about earning the right and the respect to lead through direct involvment
and example. People follow first the person, then the plan.” Additionally, Kouzes and Posner
state that when enabling others to act it is important to use the word “we,” and that good leaders
make it possible for others to do good work. “Exemplary leaders strengthen everyones capacity
to deliver on the promises they make and when a leader makes people feel strong and
capable…they will give it their all and exceed their own expectations” (Kouzes, 2007). The plan
for superior customer service would ultimatley be executed by the team, and because of that,
leadership used the “Team Leadership Model”. “The team leadership model provided a mental
road map to help the leader diagnose team problems and take appropriate action to correct the
problems” (Northouse, 2010).
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Hill’s Team Leadership Model can be found in Table 4.
T h e F o u r L a y e r s i n t h e H i l l T e a m L e a d e r s h i p M o d e l
1. Top layer: Effective team performance begins with leader’s mental model of the
situation and then determining if the situation requires Action or just Monitoring.
2. Second Layer: Is it at an Internal or External leadership level?
3. Third layer: Is it Task, Relational, or an Environmental intervention? Select a
function depending on the type of intervention. See the next section for explanation of
Function Interventions.
4. Bottom layer: Correctly performing the above three steps creates high Performance
through Development and Maintenance functions.
T e a m L e a d e r s h i p F u n c t i o n I n t e r v e n t i o n s
I n t e r n a l T a s k F u n c t i o n s
Focus on goals by clarifying and/or getting agreement
Restructure plans, processes, roles, etc. in order to gain desired results (process
improvement)
Guide the decision-making process so that better information is obtained, coordination
is better, focusing on issues, etc.
Train members through both formal and informal means
Assess performance an confront when necessary
I n t e r n a l R e l a t i o n s h i p F u n c t i o n s
Coach team members
Use more collaborative methods to involve all team members (this survey includes
questions to determine if the environment is collaborative)
Manage conflict
Build commitment and esprit de corps through the use of ethos leadership
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Satisfy team members' needs
Model what you expect from your team members
E x t e r n a l E n v i r o n m e n t a l F u n c t i o n s
Network to increase influence and gather information
Advocate by representing your team so that it shows them at their best
Get support for your team by gathering resources and recognition for your team
Buffer the team from environmental distractions
Assess the environment through surveys and other performance indicators to
determine its impact on the organization
Share information with the team (Clark, 1995)
Subsequent Research
Customer Service
In reference to actual customer service, sources of literature included the books “Raising
the Bar on Service Excellence” by Kristin Baird and “Hardwiring Excellence” by Quint
Studer.
In her book “Raising the Bar on Service Excellence,” Krisitn Baird discusses the
importance of not only leadership development, but of setting and communicating priorities,
communication and the creation of a compelling vision for the work force” (Baird, 2008). She
goes on to discuss, “patient expectation, encounter, outcome, service recovery,” and says that
“one of the best ways to raise the bar in customer service is to ask the patients what they think
of the practice” (Baird, 2008).
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Quint Studer reinforces these concepts in the book “Hardwiring Excellence” as he discusses
the, “building of a culture around service and how to the use of measurments can align the
leader and employee behavior for increased patient satisfaction ratings” (Studer, 2003).
Project Execution/Results
Week One: Temperament Testing, Emotional Intelligence Testing for ABC Medical
Project execution was performed using the S.M.A.R.T Goals action list (Table 2). Week one
included the execution of Tempermant Profiling based on the Keirsey Temperament Sorter
(Keirsey, 1984). The study of temperament is based on the fact that people are obviously
different. They act differently and work differently. “They have different wants, skills, values
and interests. Jobs that interest one may have the opposite effect on another” (Keirsey, 1984) and
that concept will affect subsequent customer service. Temperament Theory “tells us the "why" of
behavior, our motivators, and sources of stress. Intoversion/Exrovertion, Sensing/Intuativeness,
Thinker or Feeler, Task Oriented/Or not. Knowing our temperament patterns tells us our core
needs and values as well as the talents we are more likely to be drawn to develop” (Keirsey,
1984)
Temperament testing and sharing of information with existing staff not only facilitated
improved understanding of eath other, but opened new doors to retraining to increase job
satisfaction and productivity. Linda Berens (2001), an author of several books and articles on the
subject of temperament profiling states that, “Effective teamwork starts with understanding
ourselves and ways we are different from each other, temperament and the job or the
temperament of the new worker and those around them.” The staff were able to better
understand why their coworkers do what they do. This was helpful to not only prevent conflict,
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but during conflict and when working with patients. For the purpose of this paper the
temperaments were consolodated in commonality. Table 5 represents the results of the ABC
Medical staff temperament testing:
ABC Medical exhibited a typical representation of the temperaments in a medical office.
Studies have shown that a a great majority of health care workers are feelers; this office, with
72% of the staff testing as feelers, is in line with other medical offices.
Response and Action
The temperament testing action was an internal realtionship function that facilitated
coaching, collboration, help to manage conflict and build esprit de corps (Clark, 1995). Looking
at Table 5, the first measure of temperament relates to introversion and extroversion. It was clear
that a majority of staff had at least some qualities of extrovertism. This is an important factor
when working with patients, as an extrovert enjoys the talking and interaction that comes with
communicating with patients. This is important when staffing front desk, patient scheduling and
nursing. On the other hand, introverts typically work to avoid personal contact with people with
whom they are not familier, often the case in back office, records, transcription or insurance
personel. The second measurement, sensing and intuitiveness, is based on how people conduct
their decision making. Sensing styles make decisions based on past experiences while intuatives
base their decisions on their “gut” (Keirsey, 1984). Next and perhaps near the top of importance
when it comes to temperament evaluation is the thinker – feeler category. The majority of health
care workers, doctors and nurses are feelers, and most are glad they are. Conversely, with fifteen
thinkers in the group it was plain to see there is plenty of room for conflict. Thinkers often have
the tendancy to be perceived as “cold” or “unfeeling.” They often do not realize that they have
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this affect on others and that is when the feeler’s feelings are hurt, often creating communication
difficulties between the two temperament types. The last temperament catagory, the judging and
perceiving type is based on how people perform their tasks. There are judging types and
perceiving types that, for instance will make a list of items to do for the day, however a judger
will methodically check the list off as tasks are accomplished, as they like structure. The
perceiver on the other hand, will lose the list as they typically do not appreciate structure, are
curious and prefer to keep their options open. Due to the highly organizational nature of the
medical field, it may be adventagious to employ staff who have a higher level of judging than
perceiving.
How did this translate into increased customer service? Once each staff member learned
and understood the concept of temperaments, they were able to get along with each other more
effectively by understanding the clues that help to indicate the value set (temperament) of each
customer. This information was shared with all staff during a staff meeting. Many staff were
surprised to see how similar and/or different they were from each other. There were many
comments such as, “Now I know why you do that!” which also made for a lively staff meeting
full of laughter and discussion. This topic was be placed on future agendas to discuss the tie in
between temperaments and particular issues at hand. A new action list was posted in the staff
lounge so that staff was given the opportunity to write down particular problem situations with
patients or each other to discuss as a group in staff meetings. This ensured that the topic of
temperaments was always near the front of the offices value creations.
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Emotional Intelligence
According to the author in Psychology Today, “Emotional Intelligence (E/I) is the innate
potential to feel, use, communicate, recognize, remember, describe, identify, learn from, manage,
understand and explain emotions” (Cherry). So how was this important to customer service?
Without the proper amount of E/I staff would not only have difficulty communicating with each
other but also have a difficult time with the customers. Social awareness with clear, concise
communication and an ability to recognize when someone is upset, in pain, frustrated or
emotional is paramount with patient centered service. Additionally, it is crucial that staff is not
only aware of tempering their own emotions but to “manage (their) emotional reactions to all
situations and all people” (Czesniuk, 2011). Table 6 represents the results of ABC Medical
emotional intelligence testing and has been divided into ranges.
Response and Action
Emotional intelligence testing was another internal relationship function that allowed
leadership to model their expectations (Clark, 1995). “Current interest in emotional intelligence
has raised the question of whether it is possible to improve the emotional competence of
customer service employees. Research in training, development and behavior changes suggests
that this is possible. Strong evidence highlights the enormous impact that high emotional
intelligence can have in a customer service enviornment” (Kaizen Consulting Group). Learning
about ones emotional intelligence first can give them a starting point on the scale, and then
further training in ways to increase emotional intelligence can be explored. Increase in E/I
equates to increase in patient satisfaction. Leadership carefully formed a group of emotional
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intelligence mentors in order to gently guide and direct those who have lower E/I’s. Barrries that
were encountered were withdrawal because of hurt feelings or feelings of inadequecy from
lower E/I staff. It was critically important that this action was approached in a sensative,
nonthreatening and nonauthoratative manner by all involved so that the atmosphere remained
one of trust.
LPI Testing of Leadership for ABC Medical (Leadership Practices Inventory)
It was important to determine which part of what leadership was doing on a daily basis
was really management and which part was really leadership. This was accomplished by looking
at a typical day/week and making a list of things they do or things that happen. It was also
important for leadership to look at their own awareness and personal values to ensure they are
appropriately in line with the culture of the organization. An exercise like this would renew
leadership’s commitment to their team as well as enhance leadership skills. Upon starting the
process, leadership met with the staff and explained to them the current observations and intent
while asking questions about different issues that affect them and the office. Staff was informed
that the goal is to gather information to create a strategic plan and vision for the office in
reference to patient care and customer service. “For many of us who work, there is an
exasperating discontinuity between how we see ourselves as persons and how we see ourselves
as workers. We need to eliminate that sense of discontinuity and to restore a sense of coherence
to our lives" (Mulhern, 2003). To do that, leadership needed to examine not just themselves, but
staff was asked to evaluate leadership. The staff was asked to rate the leader on their leadership
skills with a pre formatted LPI test. The leader also evaluated themselves with a preformatted
LPI for leaders only. The results of the self-assessment and staff assessment for ABC Medical
practice are in Table 7.
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Response and Action
The scores in Table 7 show areas of strength and areas that need improvement. LPI testing is
also a relationship function that will assist leadership in determining if the environment is
collaborative. Trust and team buy-in for future projects were facilitated with this tool. Human
nature tells us that we usually feel we are doing a better job that we are. As vision creation is on
this action list, facilitation of improvement in this role is expected. The next step was to gain
endorsement from physician partners, which is crucial for a project of this size and type. If
leadership has their hands tied in regard to exploring optimal leadership concepts, it may be time
to examine if they are a good fit for the organization. ‘…those who lead others to greatness seek
and accept challenge” (Gallos, 2008). Accepting this challenge was not the issue. Execution of
the challenge was a potential roadblock that had to be managed and overcome.
In Business Leadership, it states, “Psychologically hardy executives felt the strong need for
challenge, believing that personal fulfillment and improvement come through the continual
process of learning through both negative and positive experiences.”
S.W.O.T. Analysis for ABC Medical (Strengths, Weaknesses, Opportunities and Threats)
“In a S.W.O.T. analysis one identifies strength, weaknesses, and market opportunities for the
company, and threats to the business. One way to use the analysis is to develop marketing
strategies that will minimize the effect of the weaknesses on the business while maximizing the
strengths” (Porter, 2008). For ABC Medical the goal was to ensure improved patient satisfaction,
an internal marketing function. Brainstorming sessions with staff helped to define areas that they
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saw as strong or weak. This action served a dual role as buy in was created by staff involvement.
The results are recorded in Table 8.
Development of a Vision
Modeling the Way
According to Kouze & Pozner (2007), “Part of the source of power in really great leaders
flows directly out of their clarity about what they stand for. "The way" in the best of all worlds is
a consciously chosen way, around which a culture is built and sustained. "The way" is the how-
things-get-done-around-here that characterizes the culture.”
A leader who models the way is:
• Clear on leadership philosophy
• Breaks projects into steps
• Ensures values are adhered to
• Lets others know beliefs/values
• Practices what is espoused
• Sets clear goals and milestones
The next step in the creation of a vision was to determine what leadership stands for.
Using the book “Finding your True North” (George B, 2008) leadership at ABC Medical
examined these questions by identifying values, principles and ethical boundaries. Because
leadership included the staff in this process, staff was given a list of twenty-seven values from
this book and upon giving them the list, staff was asked to identify their own values. They were
then to choose their top ten values from the list. Then, they were to choose the top ten values
they wanted to see in their leader. Leadership chose this methodology even though there is
conflicting information regarding its value. According to Leadership (2008), “Surveying all
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employees about what values they believe the company should adopt is a bad idea for two
reasons. First, it integrates suggestions from many employees who probably don’t belong at the
company at the first place. Second, it creates the false impression that all input is equally
valuable.”
Overall, the staff was reasonably satisfied with the present working environment, their
hopes for the future, and what drives them to do the very best they know how. This is a result, in
part, of accidental values, which - “reflect common interest or personalities that form over time”
(Leadership 2008). The results lead leadership to believe that quizzing the staff on what values
they found were the most important was a useful exercise that held many more positives than
negatives. Additionally, in the book “Leadership,” (Northouse, 2010) states, “It is axiomatic that
people who have a say in the vision underlying any endeavor will naturally be more committed
to carrying it out than those who are simply handed a mandate. Indeed, if a vision is handed
down from the top, employees may have a good reason for resisting if it does not incorporate
local concerns”.
Response and Action
Upon determining the ten most important values for the staff, the top ten most important
values the staff wanted to see in their leader, and the top ten most important values to the leader,
results were cross-referenced to examine similarities. Duplications were discarded and another
list of top ten values was created from the original three lists. The final top ten values were then
brought once again before the staff who was asked to look at them as a group and to brainstorm
24
and number the values in order of most importance. The following list became known in
chronological order:
Teamwork (overwhelmingly #1)
Compassion
Happiness
Achievement
Fulfillment
The progress report outlined in the Table 3 action plan shows the continual development of
the vision for this practice.
Meeting with Staff, Further Development of the Vision
Armed with all of the information from questionnaires and tests, leadership was finally
able to meet with staff to share, brainstorm and discuss the meaning of the copious amounts of
information that was gathered. “Frontline workers at Firms of Endearment (FoE) companies
often have the opportunity to interact directly with the CEO. The marketplace is now dominated
by conversations. People talk to each other as never before… (that) forces companies into a
greater transparency” (Sisodia, 2007). Due to the volume of information, it was disseminated in
bites. A plan was formulated to meet regularly and to create an action plan once this and
additional information was gathered. The tie in between vision, emotional intelligence,
temperament styles were discussed and the S.W.O.T. analysis was included always keeping a
patient centered focus. Difficulties emerged with the abundance of information, time and the
concept of how all of the information ties together. It was important for leadership of ABC
Medical to create an atmosphere of trust and transparency in order to overcome the “zero-sum”
mindset of a few staff members (Sisodia, 2007). One of the ways this was accomplished was to
25
set up a board in the staff lounge that showed visually the progress that was made by the office.
This board held the results of all testing as well as graphs or progress and action plans to follow.
Response and Action
As stated in Business Leadership, (Gallos, 2008), the path to change and had begun with the
gathering of information, understanding needs and expectations of the organization, the keeping
of an open mind and the awareness that the original idea may change. That included the attitudes
and reactions of all involved staff. All of this information further facilitated the development of
the vision. Further action plans involved clarification of the vision as questions are asked that
will result in the identification of a “few higher-order values” (Kouzes, 2007). This process
moved staff from “frozen” to “change ready” (Lux, 2011), however some were still skeptical. It
was important for leadership to facilitate the movement from “comfort to readiness by using
“push” methods, and then use “pull” methods to help staff see that a better situation lies in the
vision of the future (Lux, 2011).
Roadblock Evaluation
Leadership and staff self assessment was performed in week two. Leadership found that the
staff who they expected to be resistant, have been the ones who were resistant to these courses of
action. As stated in the original action plan, time was a significant restraint as was overcoming
the “Gap Theory” (Heath, 2008). Many staff automatically assumed they gave the best care
possible to patients. This way of thinking resulted in overconfidence that was not justified or
valid. This overconfidence was mitigated by the use of the patient and employee survey results
and comments. Another way that leadership would continue to work on reducing the gap theory
26
is by “unsticking” certain staff through value development and spelling out the “benefit of the
benefit” (Heath, 2008).
According to Lewins model for change, “ even at the psychological level, (change) is a
journey rather than a simple step. Often people may need to go through several stages of
misunderstanding before they get to the other side”. Based on the LPI and the current action
plan, leadership was also experiencing change and gaining the understanding that it is as
important as ever to remain ethical and transparent. This was an important time to model the way
and enable others others to act.
Enabling Other to Act
This project was a large undertaking. Not only did the close knit “family” of staff and
Physicians need to be examined but the external forces that have shaped the present culture. The
group at ABC Medical collaborated fairly well on a daily basis, however uncertainty about
coming change introduced an atmosphere of conflict. Identification of obstacles that created
conflict was important because it has been found that the “memory of a negative experience in a
previous conflict clouded the subsequent realtionships between parties” (Folger, 2009). It was
important for leadership to “manage the climate” in regard to the “prevailing temper, attitude and
outlook of the group” (Folger, 2009). “Leadership is a relationship” (Kouzes, 2007) and
leadership must foster the atmosphere of trust in order to help relationships grow stronger and to
be more effective in execution of the plan of action. “After all, if you could do it alone, why
would you need a team?” (Kouzes, 2007) Enabling others to act gets the team to work. It was
not a case of “I” but “we.” Enabling others to act meant that leadership would involve others in
planning, treat them with respect, allow them to make decisons, create an atmosphere of trust and
27
use pursuasion to help staff own the project at hand. Everyone was invloved in the process and
leadership had to portray “teamwork, trust and empowerment as essential elements of their
efforts” (Kouzes, 2007).
Customer Service Survey
In order to create a “service culture,” we have to make sure we know what the patients want
and don’t want” (Studer, 2003) Customer service surveys were e-mailed to 1500 patients. As of
August 12, 2015 (15 days), ABC Medical had received a response rate of 18%. 88% of the
responses were favorable however it was determined that the office should have a goal of no less
than a 99% favorable response. The action plan involved the development of a patient
satisfaction team, which used as a tool the development of the vision and monthly action
planning. Ideas were developed to “continually improve service and best practices in order to
help other staff learn how to give WOW service” (Studer, 2003).
Staff Survey – Perception of Customer Service
In order to create a service culture, staff and Physicians in the office were asked how they
perceive the level of care they provide. Responses were quite varied. 97% of the respondents
believed that team dynamics impacts customer service and 60% felt that the office could improve
the current level of customer service. When queried about the overall level of customer service in
the office however, 89% of the staff gave themselves a score of eight, (with ten as the best).
Leadership challenged staff to predict the outcome of each of these surveys because “as we gain
information we are more likely to focus on what we don’t know” (Heath, 2008). The action plans
anticipated involved the new patient satisfaction team’s use of all surveys, sharing of results with
staff, and development of a customer service action list.
28
Summary
Between the dates of 2013 and 2015, this exercise was implemented in two separate medical
practices. It took time and much planning to not only set up and execute the plan, but to
maintain the momentum and spirit of importance. Employee and physician buy in was the single
most important key factor for success. Through a project such as this, staff could be empowered;
their voices heard and in turn have an effect on their work environment. Although time intensive
it was found that in both instances subsequent surveys resulted in increases in not only patient
satisfaction percentages but also increased employee satisfaction and retention for both practices.
Patient satisfaction resulted in natural internal and external marketing which positively affected
the bottom line of the practice. In both of these instances, with all other factors being the same
over a six month period, patient visits increased by an average of 6%. Patients also reported an
increase of over 5% in patient satisfaction scores.
Conclusion
The initial project goal was to gain an awareness of and eliminate deficiencies in customer
service within the practice. As the gap of knowledge opened, it became clear that more and
ongoing research was required to complete the fluid overall action plan. In the effort to facilitate
progress, action teams formed to continue work on areas of ongoing concern or deficiencies.
Staff now understands why satisfied staff members equal happy customers. Staff now has a place
to voice problem situations and is armed with the ability to tie solutions into the temperaments of
those involved. Staff now understands the correlation between superior customer service and
emotional intelligence. There will be ongoing development and training for those with low E/I.
Leadership will continue to ask for feedback and perform self- analysis as they lead the way, for
29
staff. The execution of a S.W.O.T. analysis enabled a look at external and internal forces that
effect the practice and a team has been created to examine and take action with these forces.
With all of this information, the team developed a vision for the practice. An ongoing task for
the team will be roadblock evaluation. Few projects are executed without some difficulties,
therefore by brainstorming a plan of action was developed to handle problems as they arise.
Action plans included identifiable strategies that clearly and consistently identify the personal
values and aspirations of the staff. These action plans also constituted a clear stimulus to
organizational effort and commitment, are socially responsible and exploit major opportunities.
Furthermore, ongoing strategies were put in place to avoid, reduce, or mitigate the major threats,
establish short and long-term goals as well as establish expectations for responsibility
Key Learning’s
Through the execution of this project, management gained improved and increased
leadership skills that have facilitated discussion, transparency, growth and empowerment. After
testing and further query issues were uncovered that, if left unaddressed, could have lead to
strategic difficulties for the company. “Through first the development of staff, one can facilitate
the creation of a better-quality patient centered team” (Studer, 2003).
Strategy is the “laying out, in specific terms, the direction of the unit: where it is now, where
it will be going in the future and how it will get there” (Bossidy, 2002). Strategy starts with a
mission and a vision and ends with the execution of the plan. Strategy includes the assessment of
the external environment, markets, short and long-term goals, milestones and critical issues.
Strategy takes into consideration whether the business is even able to execute the strategy. For
example, it may be useful when developing a strategy to use Porters Five Forces for Industry
30
Analysis (Porter, 2008) in order to consider strategically all threats of competition. Strategy also
includes taking steps to ensure that one has the right people in place to carry out the plan of
action.
In the book “Firms of Endearment, Goleman states “ A leaders primal task is an emotional
one, to articulate a message that resonates with their followers emotional reality, with their sense
of purpose and so to move people in a positive direction” (Sisodia, 2007). Without appropriate
leadership, the strategic plan would never be realized. “Leadership, after all is the art of getting
work done.” (Sisodia, 2007) Leadership encompasses the art of sharing the heart, managing
change, chaos, the decline and fall of human resources, dealing with investors and the
developing social initiative. This all leads to the development of a positive culture that promotes
results, people development, big picture awareness, team, flexibility and the creation of a high
performance climate. Strategic leadership is a global entity that encompasses many activities,
standards, commitments, emotions and skills. Strategic leadership involves the ability to manage
change while seeing the big picture, identifying realistic options and making hard choices.
Because all business has competition, the strategic leader must understand the forces that shape
strategy (Porter, 2008) and be able to exploit the changes in the forces. Questions must
constantly be asked in relation to competitive or differentiation advantage, value creation and
uniqueness, corporate responsibility and ethical concerns within the strategic relationships?
Strategic leadership can provide the ability to unfreeze people and make them change ready
(Lux, 2011). It can be the development of values disciplines and basic philosophies of
operational, product or customer excellence.
Strategic leadership means asking poignant questions and constantly understanding that any
strategic plan is a dynamic one, which must be monitored on a regular basis for needed
31
adjustments. Strategic leadership is about execution, the ability to get things done.
Execution is when the real excitement starts. The risk and project is commenced and
everything depends on the foundation that has been previously laid. This is when it all comes
together: the idea, plan, research, goals, mission and vision. This is when everything is put into
action.
.
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32
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34
Table 1: Monitoring vs Taking Action
MONITOR EXECUTIVE ACTION
INTERNAL Diagnosing group deficiencies Taking Remedial Action/ or
No Action
EXTERNAL Forecasting Environmental
Changes or Influences
Preventing Delirious Changes
or Coaching/Influencing the
Changes
Notice how many weeks overlap as multiple projects are executed at the same time.
Table 2: S.M.A.R.T. Goals
Specific –Measurable –.Assignable- Realistic -Time-related
Week Task
Who is
Involved?
Requirements
Constraints
Benefits Possible
Barriers
Goals Measure/How
will we know it
has been
accomplished?
1 Temperam
ent
Testing
Leader/Staff/
MD
Testing Materials
Time
Instructions
Determine
interests
skills and
work style
temperament
Questioning
staff/Time/
MD Time
Trust or
lack thereof
for
leadership
Complete
testing by
week’s
end
Compilation of
all information.
Maintenance of
Action List
Weeks End
1 E/I
Testing
Leader/Staff Testing Materials
Time
Instructions
Determine
social/self
awareness
and relation
management
Questioning
staff/time
Trust or
lack thereof
for
leadership
Complete
testing by
week’s
end
Compilation of
all information
Weeks End
2 LPI
Testing
for
Leadershi
p
Leader/Staff/
MD
Testing Materials
Time
Instructions
Creating
atmosphere
of trust for
staff/
evaluation of
leadership
Staff not
being
honest/worr
y about
retribution
Clearer
picture of
where
leadershi
p needs
to
Compilation of
all information.
Weeks end.
Maintenance of
Action List
35
MD Time
improve
2 SWOT Leader/Staff/
MD
Time/ feedback Enabling
others to act
Knowledge
about
factors
involved in
a SWOT
MD Time
To
determin
e
perceived
strengths
&
weakness
es
By week 4-
others are
owning the
project/
resolution
Week Task
Who is
Involved?
Requirements
Constraints
Benefits Possible
Barriers
Goals Measure/How
will we know it
has been
accomplished?
1-12 Vision Leader/Staff/
MD
Hitting a
roadblock/ no
new ideas
Determine
where we
want to go/
develop co-
op
relationship.
Asking what
is our
objective/sco
pe/advantage
?
Knowledge,
influence
from
leadership,
fear of
change/
How are we
different?
Involves
all in
planning,
decisions,
& gets
others to
own
project
Set weekly
meetings/open
dialogue/
continued
planning and
change.
3-4 Discuss
all testing
results
with staff
Leader/Staff/
MD
Time Knowledge
gaps / self
awareness/
camaraderie
Resulting
poor
attitudes
Respect
for
opinions,
developin
g
philosoph
y
Set weekly
meetings/open
dialogue/
continued
planning
4-5 Roadblock
evaluation
Leadershi
p self
assessmen
t
Leader/Staff Time Evaluation of
current
systems that
are not
working. Is
leadership
modeling the
way and
enabling
others to act?
None Increased
Awarene
ss
Maintaining
Action Plan/
Adding new
subjects as they
arise
36
5 Survey
Patients/C
ustomer
Service
Leader/
appointed
staff
Development of
questions and
posting of survey
to e-mails
Learn what
our
customers
think of us.
Involvement
of process
with staff
Time/
compiling
results
Stakehol
der
Opinion/
knowledg
e gaps
End of week 5
compile
information
Week Task
Who is
Involved?
Requirements
Constraints
Benefits Possible
Barriers
Goals Measure/How
will we know it
has been
accomplished?
5 Survey
Staff/Cust
omer
Service
Leader/
appointed
staff
Development of
questions and
posting of
confidential
survey
Determine
our
interpretation
of our cust.
Service.
Involvement
of process
with staff
Biased
Opinions of
self
Knowled
ge gaps
End of week 5
compile
information
6 Discussio
n of all
survey
results
Leader/Staff/
MD
Time/
attitudes/getting
others to own
project
Project
ownership/
setting of
goals.
Involvement
of process
with staff
Resistance
to change/
conflict
Coaching
/
Modeling
/
Empower
ing
Action Plan
development
with clear set
goals and
timelines
10 Team
meeting
plan
developm
ent
Bell and
Patterson
Service
Style Eval
Leader/Staff Set time aside for
meeting with
agendas/ action
plans and
accountability
Involves
others in
planning/
develops
cooperative
relationship/
help with
change
Education/
not knowing
what they
don’t know
Who are
our
customer
s?
Better
customer
service
for our
patients
Regular
dialogue/ follow
up surveys,
encouragement/
buy- in.
Possible other
new ways of
outreach
37
6-12 Tie in of
all
informatio
n
Developm
ent of
Customer
Service
protocol
Leader/Staff Time Tie in
between
employee
satisfaction
and customer
satisfaction
Knowledge,
influence
from
leadership,
fear of
change
Increased
awarenes
s/ team
building/
customer
service
Action Plans
with clear goals
and timelines
Week Task
Who is
Involved?
Requirements
Constraints
Benefits Possible
Barriers
Goals Measure/How
will we know it
has been
accomplished?
10-12 Re-
evaluation
of process
Leadership Time and
Feedback
Is this action
plan
developing
the way
leadership
had planned?
What are
new
barriers/const
raints?
Time/ Lack
of
commitment
To be on
track,
have
systems
develope
d and
tracked
with
feedback.
Attitude
for
change
ready.
Check action
plan. Ask
questions of
leadership-
what would you
change?
12 Developm
ent of a
patient
focus
group/
outreach
to referral
sources/
re-survey
of patients
Leadership Time Greater
awareness of
patient needs
and desires.
Time/feedba
ck
Improved
policies
and
procedur
es for
greater
customer
satisfacti
on
Continued
Monitoring/Acti
on plans.
Has feedback
from patients
changed?
Conti
nuing
Monthly
Data
Collection
and
Tracking
Leadership/St
aff
Time Attaching an
importance
to the task,
accountabilit
y, tracking,
Change in
staff-
retraining
Improved
employee
buy in,
increased
customer
Set regular
accountable
monthly
reporting to all
staff.
38
measuring,
making mid
course
corrections
of
adjustments
satisfacti
on and
employee
retention
Table 3: Project Status Report
1 Period Covered July 13, 2015 – August 17, 2015
2 Tasks Completed Temperament & E/I testing of staff, LPI Survey from staff, SWOT
3 Tasks in Progress Vision statement, staff survey in regards to perceived level of patient
care, patient survey.
4 Issues Encountered Time and staff being suspicious as to what is going on. They wonder
what will become of this information, “Are they being tested? Can they
pass or fail? Why is this information being gathered?”
5 Variance Analysis
(planned steps /
actions against actual
steps / actions. In
other words, what
happened differently
than you expected?
How did you
compensate / adjust to
new (and unplanned)
contingencies?)
Staff was leery (unplanned) - Assurance to staff that they cannot pass or
fail, information will be shared; they will be part of the process.
Apparent that several staff members have the perception that there is
superior customer service and there is no room for improvement
(unplanned-surprised). Time was a factor so arrangements were made
for each to cover the other during testing. Staff was reluctant/afraid to be
honest (unplanned) to share information - more assurance. Interesting
information with E/I testing and perception of priorities - seems to be a
generational issue, (unplanned) so leadership will discuss differences and
how they can benefit the group, set the desired office culture, and
facilitate uniqueness with staff. The staff voiced interesting feedback
with development of vision. Leadership is learning who is "buying into"
the process, and who has/will not (unplanned). LPI assessment- one staff
member very angry with leadership (unplanned). Leadership plans to
discuss information openly with staff without divulging names.
Leadership will focus on Modeling the Way and Enabling Others to Act.
Leadership was able to accomplish more than planned and is ahead of
schedule with action list. Learning change is difficult for many; people
39
like things the way they are. Leadership needs to move the group into
“change ready" mode, especially once feedback from patient surveys
come in.
6 Future Tasks / Next
Steps
Continuation of vision development / await feedback of staff / patient
survey. Leadership will discuss results of surveys with staff. Next, steps
will involve the development of action list and development of customer
service protocol involving new issues as they are discussed as outlined in
weeks 6-12 in the S.M.A.R.T. goals timeline.
Table 4: Hill's Team Leadership Model-Provided with permission by Don Clark
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40
Table 5: Results of ABC Medical Temperament Testing
Extro/Intro Sensing/Intuitive Thinker/Feeler Task Oriented (J) or Not (P)
# of Staff
8 E S T J
4 E/I S T J
33 E S F J
6 I I F J
5 E/I I F J
4 I S T J
2 E S F P
1 E/I S F J/P
1 E/I S T J
1 E/I I T J
Table 6: Results of ABC Medical Emotial Intelligence Testing
Number of People Score
14 130-150
19 120-129
24 110-119
5 100-109
2 90-99
1 80-89
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41
Table 7: Results -LPI Testing for Leadership for ABC Medical
Below are ranges in scores from different departments, not number of people.
Leadership Clinical Front Desk Billing Total
Model the Way 29 49 48 54 180 Inspire a
Shared Vision 21 32 50 34 137 Challenge the
Process 16 40 42 35 133 Enable Others
to Act 24 54 52 46 176 Encourage the
Heart 22 54 44 53 173
Table 8 Results of S.W.O.T.
What do we do well? What are our weaknesses?
Efficient with Tasks Community Awareness
Teamwork (all) Size of Office
Communication Ancillary Services
Workflow design Communication w hospital staff
Completion of Projects
Having to share space and resources
with hospital
Care of our patients/customers Illusion that we are part of the hospital
Accommodation of referrals Familiarizing people about Physiatry
Good Physicians Relationship with rehab
Leadership – too many chiefs
What opportunities are we
missing? What threats are out there?
Performing more procedures Rehab mentality
Advertising/ Exposure Other physiatrist moving into town
Not in a stand-alone facility-
Ability to network/location
Insurance reimbursement/ healthcare
reform
Fundraising Economy
Other services Loss of employment
Lack of awareness
42
Key words for search:
Patient, employee, satisfaction, leadership, action plan, goals, S.M.A.R.T, temperament,
Emotional Intelligence, strategic, Leadership Practices Inventory, Modeling the Way, team
development, customer service
Main Idea Paragraph:
This project was developed to evaluate current systems and most importantly to examine
what team development must take place in order to begin to deliver superior customer service.
Satisfied staff and customers are the basis of any successful organization, however written
policies alone do not create the culture that is needed for continued success. The enclosed steps
are proven lead to higher employee satisfaction rates, increased retention of employees,
employee empowerment and heightened leadership capability. It is demonstrated that this
translates to higher satisfaction rates for the practice.