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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.