Trust Part 2: It's about what you do
Dave Sneddon
Transforming Life for Vulnerable Populations | COO | CEO | Building Financially Sustainable Cultures | Developing People from CNA to C-suite
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You can’t buy trust when you need it – you need to earn it long before.
It is about who you are (empathy and sincerity) and what you do (competence and integrity)
Trust comes from demonstrated competence and integrity.
In nursing home world nothing is more stressful than state survey. A survey is an inspection of every detail of your operation. A team of 4-12 inspectors will spend anywhere from 2 weeks to 6 months digging into every file, observing every action, and ensuring compliance with thousands of pages of state and federal regulations over the past year.
They often work in overlapping shifts meaning the managers have to be there sometimes 20 hours per day to respond to requests immediately.
Failing a survey can mean millions of dollars of fines and for the administrator loss of a license that took years to obtain and an end to your career.
It is high stress for everyone.
Citations for non-compliance range in scope and severity from A to L. A-C are very minor, D-F have potential for serious harm and must be addressed with a detailed plan of correction and evidence of compliance, G means you caused actual harm and is an automatic failure of the survey. Higher than that is “Immediate Jeopardy” (IJ) and must be corrected ?with an abatement plan before any inspector or manager leaves the building. IJs are a really big deal but can be triggered by something as simple as a fire extinguisher in the wrong place.
Deficiency free is the gold standard. Most people go their whole career and never have a deficiency free survey.
Deficiency free is about how you run the facility all year and about the trust you earn from surveyors.
One former surveyor told me “Every building has a G if you look hard enough. But if the nha and Director of nursing get what I want right away (and don’t hide in their office for an hour “finding” the paperwork) and the residents are clean and happy - I don’t look too hard” that’s building trust that gets you to zero.
When you hand them 7 months of documentation of facility wide monitoring and QA in a fall with fracture before they ask? That’s the trust that gets you to zero.
When a surveyor asked me to “go for a smoke” at a building we had just taken over management of and told me what she had seen in the kitchen and how she knew if I had seen it on any day it would have been fixed - so maybe I could check before they looked “officially” that afternoon. That’s the trust you earn that gets you to zero.
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The inspection supervisor who told me and the regional nurse that what she had seen didn’t look like an IJ …….yet? And raised her eyebrows until we rattled off an immediate abatement plan and sprang into action. She smiled and said - I knew you two would handle it. That’s the trust that gets to zero.
In all the zero deficiency surveys that I have had – we were never perfect. No one is. What we did have was a record of competence and integrity.
Every industry and profession has it’s challenges and high stress moments. A chap I met at a hotel in Pittsburg recently told me that running a sawmill was the most complicated and high pressure job in the world (who knew?)
But competence and integrity will build the trust you need with your team, your clients, your regulators, and your boss.
1.?????Show you care about the people all the time – not just when you need something and don’t mean it.
2.?????Own up to mistakes. If you can do it and develop a culture without fear your team will as well.
3.?????Create systems to identify and correct mistakes – and document how you keep improving to prevent similar issues.
4.?????Constantly refine the system to improve. Don’t make it up, don’t pretend everything is fixed forever. Every failure is a data point to identify what and where to improve. Failures should be celebrated in this kind of system.
5.?????Do what you say you will. Not just in a plan of correction but on everything. Those surveyors knew if we said we would do it – it would be done.
Don’t hold people accountable. Create a culture of accountability.
This is where people feel safe enough to own up to their mistakes and supported enough to build systems of improvement. Holding someone accountable incentivizes them to “fix” the problem so you will go and hold someone else accountable instead of them. Creating a culture of accountability incentivizes people to find mistakes before you do and get your help to make it better.
Be good to people and be good at what you do – at least be better than every single yesterday.