Monthly Archives: June 2011

How The Soft Skills In Nursing Can Save Hard Dollars For Hospitals

The subject of nurse retention and turnover came up during a recent conversation I was having with the HR director of a regional hospital system here in Florida.  We were discussing the Florida Center for Nursing report that identified the median turnover rate for RNs was 20% in 2007.  The HR director responded that prior to the recession they were running in the low to mid twenties, but it had dropped to just below twenty percent in the past two years.  As he said this, a look of trepidation came upon his face, as if he was waiting for the other shoe to drop.

The director added, “I hate to think what’s about to happen once hospitals begin hiring again.  The nursing shortage didn’t go away simply because the economy faded.”

Curious, I asked him to confirm if the American Hospital Association estimate that it costs an average of $64,000 to replace a single RN was realistic at his institution.

“Easily, and that doesn’t account for the increased stress an open position places on the remainder of the staff.”

A little short math reveals that a hospital with 200 nurses experiencing a 20% annual turnover rate is very likely expending $2.5 million a year in hard dollar costs associated with this phenomenon.  Extrapolated across the nation, this endemic turnover challenge may, in fact, be costing American hospitals more than $10 billion annually.  This doesn’t take into account the additional costs associated with patient length of stay, the risk for adverse events, cost at discharge, and patient-perceived quality of care, all of which are negatively effected by nursing staff shortages and exacerbated by nursing staff turnover.

A quick search of the peer-reviewed, published research on the subject reveals many of the underlying causes of endemic turnover in hospital nursing are rooted in the “soft skills” of nursing, leadership, and organizational culture.  Digging a bit deeper into the literature identifies some innovative, evidence-based suggestions and approaches to lowering costs and improving patient care as it relates to this front-line challenge.  More than two dozen studies document the positive role emotional intelligence and the cultivation of emotional resiliency can deliver in nursing and clinical leadership.  Fortunately, these are learned skills and competencies that can be developed over one’s lifetime.  The research clearly reveals that emotional intelligence in nursing:

Has a positive impact on nursing team cohesiveness and patient/client outcomes.

Minimizes the negative stress consequences of nursing.

Reduces nurse burnout.

Contributes to performance, career longevity, and job retention.

Builds successful nursing leadership.

Leads to more positive attitudes, greater adaptability, improved relationships, and increased orientation towards positive values.

Enables the expression of empathy through healthy, professional boundaries.

Nurses capable of a self-reflective process become aware of their own emotions.  When nurses recognize their own feelings they are more likely to manage them and communicate in appropriate ways.

The nursing profession exemplifies positive intention, a spirit of service, and compassionate behavior.  The daily interaction of nurses with their patients has a distinct impact on patient satisfaction, especially the emotional needs of patients and their families.  Yet constantly evolving technologies, severe economic constraints, and the chronic nursing shortage combine to challenge the ability of nurses to focus on patient care.  The very people that are in the position to have the most positive impact on critical patient perceptions also bear the brunt of many of today’s challenges.

The fact is, healthcare is entering a phase of unprecedented change, experiencing pressures from many sides simultaneously.  Like so many industries today, healthcare must adapt to a rapidly shifting economics, demographics, and expectations.  Investments in technology will undoubtably help contain costs and improve efficiencies, but technology can only go so far.  Of all industries and endeavors, healthcare is simply the most human.  Investing in the human aspects of care, in developing emotional intelligence, adaptability, engagement, and techniques in self-care should be a key consideration as administrators seek innovative ways to successfully lead their institutions through this period of uncertainty and change.

Learn more at or download a PDF of the Emotionally Resilient Nurse Seminar.

© 2011, Terry Murray

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Terry Murray Introduces an Innovative Approach to Leadership Development and Team Building at the ASTD

I had an opportunity to address members of the recent American Society for Training and Development conference regarding the use of Equine Facilitated Experiential Learning as a part of comprehensive, professional development programs.

The most recent IBM CEO Survey indicated the single most important attribute CEOs are looking for in future leaders is creativity and the ability to cultivate creativity throughout the organization. Creativity, however, requires engagement; authentic engagement on both a cognitive and emotional level, or what we refer to as congruency.  The ability to cultivate this critical element requires heightened self-awareness and social awareness.  That’s what the horses help cultivate through our workshops.

As always, your thoughts and comments are welcome!

© 2011, Terry Murray

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The Quandary of Creativity in Leadership

As an executive coach I spend a fair amount of time working with clients to help them find a deeper understanding of themselves, their relationships, and their environments.  To discover the disconnects that may occur between their perceptions and their actions.  Through this process of cultivating self-awareness and social awareness, a new level of consciousness can emerge.  Step-by-step, the competencies of self management and relationship management open the door for self-mastery to take root in business leaders.  Leaders capable of inspiring, motivating, and fully engaging, both cognitively and emotionally, those they lead.  Leaders that refuse to be constrained by dogma and outdated thinking.  Leaders that have the courage to kindle and embrace not only their own creativity, but the creativity of their entire organization.

One of the most common disconnects I see is the one that occurs between our intentions and our behaviors.  It is part of our human nature.  How many of us intend to lose a few pounds but put off dieting or working out because we’re simply so busy?  A classic disconnect between our good intentions and the behaviors that would deliver the desired results.  This is why we incorporate the research from Applied Behavioral Economics in our process.  The fact is, we humans simply aren’t all that rational in our decision making processes.  How we feel about things, how we perceive things, strongly influences our corresponding behavior.  I recently saw an astounding example of this playing out from the results of a new, Cornell University research study and a relatively recent CEO survey conducted by IBM.

Early in 2010, IBM surveyed more than 1,500 CEOs operating in sixty-six countries, identifying the most critical leadership competencies companies need for future success.  The most important attribute identified was the need for creativity.  Not just in the leader, but in the leader’s ability to tap into the creativity of the entire organization.  In reading this survey I was greatly encouraged.  Finally, I thought, business leaders were beginning to see (and to paraphrase Albert Einstein) the level of thinking that got us here is not the same level of thinking necessary to move us forward.  Innovation demands creativity and the unique nature of the global economic climate we now find ourselves in demands it as well.  This recognition for the need of creativity is, perhaps, an early indicator that businesses are recognizing the old paradigms of command-and-control management are limited in a world that is shaped by the  rapid-fire development and commercialization of intellectual property.

Additional management research supports the CEOs’ desire for creativity in leadership.  A canvasing of the literature reveals nine studies that concur; creative leadership enables leaders to steward companies in profitable new directions.  Creative leadership is also proven to be more effective at championing positive change and inspiring associates than leaders that lack this attribute.

And then the disconnect was revealed…

In their study titled, “Recognizing Creative Leadership:  Can Creative Idea Expression Negatively Relate to Perceptions of Leadership Potential?”, Jennifer Mueller, Jack Goncalo, and Dishan Kamdar revealed a startling reality.  Through their research, they suggest the expression of creative thinking by up-and-coming executives could be derailing their opportunities for advancement.  Perceptions of prototypical leaders favors those that will sustain the status quo by maintaining the same level of thinking that created the status quo.  In Applied Behavioral Economics this is referred to as a heuristic, or rule-of-thumb perception people use when evaluating complex decisions.  To quote the study, “Indeed, this bias in favor of selecting less creative leaders may partially explain why so many leaders fail (Hogan & Hogan, 2001), and why so many groups resist change (Argyris, 1997), as the leaders selected may simply lack the openness to recognize solutions that depart from what is already known.”

We live in an age defined by adaptive challenges, a concept first put forth by Ronald A. Heifetz and Marty Linsky in their book, “Leadership on the Line, Staying Alive Through The Dangers Of Leading” (2001, Harvard Business School Press, Boston, MA).  Traditionally, companies faced technical challenges, fairly routine obstacles in which leadership had the answers at hand.  Adaptive challenges confront leadership with obstacles in which they do not have the answers.  These challenges emerge when seismic shifts (in technology, geopolitical influences, or macro-economic forces) occur that change the entire landscape.  This is the landscape we find ourselves in today and, I think we can agree, will most likely find ourselves in for the remainder of our careers.  The only way to address adaptive challenges is to discover the answers along the journey (there’s no pause button on a business) and to continuously seek innovative ways of staying ahead of the curve.  Discovery requires creativity.  Innovation demands it.

So how do we go about reconciling this disconnect?  The first step towards resolution lies in awareness.  The quote above points to the solution, “…simply lack the openness to recognize…”.  By elevating executive self-awareness and social awareness, professionals can begin to set down their limiting perceptions and rules-of-thumb.  As the competencies of self management and relationship management emerge, leaders can more fully engaged both their own creativity and begin to cultivate the creative talent that is often lying dormant throughout their organization.

While management fads may come and go, the professional and personal development reflected in presence and awareness is constant to the human condition.  Companies are beginning to recognize the need for creativity in leadership.  Those that move decisively to cultivate these competencies are positioning themselves to win in the twenty-first century.

© 2011, Terry Murray

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Leadership Development For Transformational Times

Having spent the past ten years working as a consultant, coach, and start-up business strategist I am continuously researching market drivers, environmental influences, and emerging management imperatives.  I cast a wide net, looking to divine what on the surface may appear to be independent currents that often coalesce into a confluence of sweeping change.  Having just completed a new book on entrepreneurship, I had some time to reflect on several threads of real-world, market research that warrant further exploration.

Every year over the past decade or so, The Gallup Company conducts research on employee engagement levels.  Their most recent report demonstrates the continuous slide companies continue to experience in this critical arena.  Today, a little more than a quarter of employees are fully engaged with their employer, meaning they show up with passion and enthusiasm for their work.  More than half are disengaged, simply going through the motions, contributing the minimal required effort, keeping their heads down, and voices low.  Essentially sleepwalking, if you will.  And strikingly, approximately one out of six employees is activity working at cross-purpose with their employers.  The aggregate cost of this engagement crisis to businesses in the U.S. exceeds a quarter of the trillion dollars annually.  More importantly to many individual businesses, however, is the fact that more than fifty percent of their payroll may be contributing little or no return on investment to the firm.

Interestingly, another recent study published in the Harvard Business Review demonstrated the next productivity breakthrough will come through cultivating the emotional engagement of both employees and customers.  Also conducted by Gallup, the study explored the implications of Applied Behavioral Economics in actual enterprises.  What they saw was the fact that creating rationally satisfied customers was no longer enough.  The research showed that rationally satisfied customers purchased no more and were no more likely to continue doing business with a firm than dissatisfied customers.  The difference in wallet share, future purchases, and customer loyalty was found to lie in creating emotionally satisfied customers.  The study went on to demonstrated that companies that engage both their employees and customers on an emotional level enjoy a 240% improvement in financial performance.  Apple immediately comes to mind as a company that fully understands and leverages this perspective.  Their customers literally line up to buy their next product offering.

Here’s the final thread.  IBM’s biennial Global CEO Study issued in 2010 indicated that creativity was selected as the single most important factor for success in the future.  Not managerial discipline, integrity, or even vision.  The more than 1,500 CEOs from sixty countries interviewed pointed to creativity as the critical success factor going forward.  Less than half of those surveyed felt their firms were prepared to handle the increasingly complex, volatile environments in which they operated.  More than sixty percent of CEOs reported that industry transformation is the top factor contributing to their uncertainty.  They described an imperative need to discover innovative ways to manage structure, strategy, talent, and finances.

So let’s break these critical elements down and see if we can roll them up into a plausible solution.  First, the majority of human talent is sitting idle on the sidelines in many firms.  In light of the fact that we live in transformational times in which intellectual property is the driver of value creation, employee disengagement represents an astounding scrap rate of industrial raw material.  How many firms would purchase millions of dollars of raw materials only to let fifty percent of it go to waste?  But that’s exactly what is happening today in many firms when it comes to leveraging their talent.

Second, solid research coming out of Applied Behavioral Economics points to the emotional aspects of economic decision making.  Most behavioral economist concur that upwards of seventy percent of economic decisions are emotionally driven with the remaining thirty percent based in rational thought.  This is true in business-to-business environments as well as in business-to-consumer environments.  It comes down to our human nature.  Emotional gain matters to us.  Emotions are part of our primary survival mechanisms. Core Emotional Systems are present in all mammals; it is how we evolved in nature.  Genetically speaking, we haven’t changed all that much over the past fifty thousand years.  To rule out emotions as a messy bi-product and ignore their economic implications disengages human beings from being human.  The road to creating emotionally engaged customers is paved by emotionally engaging employees.  The fact is, passion and intention resonates with others.  This not only speaks to how we should view leadership but also to how we must take organizational culture into consideration as a strategic imperative as well.

Third, the consensus amongst a statistically significant number of chief executives is creativity is the single most important factor for driving success going forward.  Creativity in leadership, but also in leadership’s ability to cultivate creativity throughout the entire firm.  This is a far cry from the demands for conformity and standardization that emerged out of our heavy manufacturing past.

So here’s the challenge.  Leadership must find a way to cultivate creativity with a highly disengaged workforce.  In addition, leadership must find ways to emotionally satisfy customers in order to maintain wallet share, growth, and profitability.  That sounds like some pretty heavy lifting is in order.  The solution, however, isn’t so far out of hand as it may appear on the surface.

To paraphrase Albert Einstein, the problems of today cannot be solved by the same thinking that created them.  A shift in perspective must occur.  I’d like to reference an important book that Ronald A. Heifetz and Marty Linsky published in 2002 called “Leadership On The Line” (Harvard Business School Press, Boston, MA) to help frame a possible solution.  In this book, Heifetz and Linsky point to two types of challenges companies typically face.  The first are “technical challenges”.  Relatively straight-forward challenges that are not terribly unfamiliar.  Familiar enough that we already know the solutions.  Such challenges require “technical change”, which is relatively low risk and easily negotiated.  The second type of challenge is “adaptive” in nature.   Challenges in which we do not have all the answers.  Challenges that represent a landscape fraught with uncertainty in which we must, in many instances, discover the answers along the way.  These challenges require “adaptive change”, which, by definition, requires creativity.  This is what we face today.

The traditional path for leadership development, team building, et. al. is limited in its ability to solve these challenges.  After all, as Einstein might have pointed out, these historical modalities are a part of the thinking that got us here.  Traditional coaching models also fall short.  They are built on a premise that all of the answers must come from the person being coached.  This may have been effective for executives facing technical challenges, but by definition, this approach is incapable of guiding leaders attempting to navigate adaptive change.  In these circumstances, the answers have yet to be discovered.  What is needed is a transformational process for development that will instill a fresh perspective, tap into dormant creativity, and fully engage both associates and customers.

A new, integrated, developmental approach for addressing these adaptive challenges is the Accretive Coaching Process™.  The term accretive refers to the growing together of separate parts into a single whole of greater value.  The evidence-based approach integrates education, experiential learning, and coaching methods evolved from traditional modalities.  The process delivers a positive shift in perspective while imparting tools grounded in emotional and social competencies, Applied Behavioral Economics, and recent discoveries from performance psychology and neurophysiology.  This comprehensive approach elevates self-awareness and social awareness leading to competencies in self management, relationship management, and empathy; all keys to rekindling employee engagement.  It also cultivates both non-verbal and verbal communication skills and an understanding and respect for individual boundaries.  The accretive nature of the process enables leaders to fully connect and align their cognitive and emotional talents and attributes, tapping into their creative power.  From this position of authentic, creative, and connective power, leaders can begin to inspire and motivate associates without dominating or coercing them.  This approach is fully capable of igniting associate passion and cultivating a fresh, creative culture in organizations.

By aligning integrated, professional development processes with the challenges and opportunities companies face in today’s transformational economy, adaptive solutions can emerge.  The key is to cultivate leaders, culture, and strategies that continue to fully engage associates, customers, and stakeholders.  Technology will only take us so far.  At the end of the day, it is the human element that will create, adapt, and shape the future of our success.

© 2011, Terry Murray

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