Monthly Archives: July 2012

The Hard Dollar Costs of Not Investing in Our Nurses

A research study conducted by the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing and published in the American Journal of Infection Control links higher infection rates with nurse burnout.

If you’ve happened upon the media this morning, you may have heard yet another, peer-reviewed study has been published in a professional journal linking the care of our nation’s nurses with the care of our nation.  For nurses, this isn’t breaking news, but something that’s been thrust upon them for years.  When we were canvasing the research in 2009 while creating The Emotionally Resilient Nurse program we suspended our research once we had discovered more than two dozen research studies drawing similar conclusions regarding the value of cultivating emotional intelligence skills in nurses and the impact of nurse-to-patient staffing ratios.  The evidence is in.  Not caring for our nurses has serious economic and clinical repercussions throughout our health care system.

The study merged infection rates in Pennsylvania hospitals with research into the level of job-related stress with 7,000 Pennsylvania nurses practicing in 161 hospitals.  Jeannie P. Cimiotti, the study’s lead author was shocked to discover more than a third of the nurses tested (using  the Maslach Burnout Inventory, a recognized scale that tracks factors like emotional exhaustion, depersonalization and whether an individual feels any personal sense of accomplishment) displayed high levels of burnout.  The average staffing levels observed were 5.7 patients per nurse.  An increase in the average by just one patient was shown to increase actual infections in an additional 1,351 patients in the study’s population.

Just as importantly, the study also points to the tenor of the work environment as a driver of nurse burnout and resulting lapses in patient care.  The report identified if the level of nurse burnout in Pennsylvania hospitals is drawn down to 10%, they would prevent 4,160 cases of surgical site and catheter infections, two of the most common hospital-acquired infections, and save the health care system a minimum of $41 million annually.  From my experience working in the infection prevention field, this is a very conservative figure.  Surgical site infections can cost anywhere from $5,000 to more than $25,000 to treat in a hospital setting (annual surgical site infection rates average between 2% and 5%, depending on the hospital).

Commenting on the study, Nancy Foster, V.P. of Quality and Patient Safety Policy for the American Hospital Association said the research, “Raises an interesting question about exactly how can we look at nursing burnout and its impact on patient safety.”  Speaking to NBC News, Cimiotti added, “Now that we see that burnout is playing a role in this relationship, we have to look at more than just the staffing.  We have to look at the system, the organizational structure where the nurses provide care.  Ms. Cimiotti also commented on hospital leadership, “It doesn’t cost them anything to improve the organizational climate.”

In an earlier study published in March, 2012 in the British Medical Journal and conducted by lead author, Linda H. Aiken, who is the Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, demonstrated similar issues in both the U.S. and European health care delivery systems.  This study concluded, “Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.”

The conclusions are irrefutable.  Yes, improving the organizational culture and embracing a shift in leadership perspective from transactional to transformational, provides a remarkable return on investment.  When we looked into the impact of emotional intelligence training has on turnover rates alone (burnout is a key driver of turnover), we can demonstrate a 10% reduction in turnover leads to a 380% return on investment for the training.  The so-called soft skills in nursing are the key to saving hard dollars in our delivery system.

© 2012, Terry Murray.

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Insights into Cultivating and Sustaining an Inclusive, Creative Culture, Part III

Key Concept ~ Here’s part three in a series of excerpts from my book, “The Transformational Entrepreneur ~ Engaging The Mind, Heart & Spirit For Breakthrough Business Success”, that explore the nuanced challenge of cultivating a vibrant, inclusive organizational culture in today’s volatile world.

~ Empathy

The authentic expression of empathy contributes to our presence and is capable of re-engaging disaffected associates.  Most of us, at one time or another, have worked for companies and bosses that used us for their own personal gain.  I have.  Not a lot of fun.  The conditioned behavior of caution, of keeping our heads down and not fully and openly offering all of our gifts and talents to the endeavor is a natural result of these past experiences in the workplace.  Words alone cannot heal these wounds.  After all, language only represents approximately ten percent of how we communicate with other beings.  Empathy comes directly from the heart and radiates an unspoken energy that is felt by those we encounter, whether they are immediately conscious of it or not.  In a way, it’s the energetic acknowledgement that we’re all connected and share in a common human experience.  By being sensitive to the emotions of others, empathy communicates authentic concern for another person’s well being.

I discovered a powerful metaphor for authentic presence while working with Linda Kohanov and the Epona herd of horses at her ranch in Arizona.  One of the early phases of the Epona Approach™ involves an exercise called the reflective round pen.  As prey animals, horses are natural empaths; they acutely feel the emotions and intention of those around them.  They sense emotion as information, information they receive from the intelligence centers in their enormous hearts and guts.  This is an evolutionary survival mechanism in prey animals.  They don’t stop to mentally analyze or judge these messages.  To pause and think about what they’re feeling may lead to their becoming a predator’s next meal.

Horses trust these messages and act without hesitation.  The empathic powers of horses are so finely tuned that when they encounter a human that is incongruent (displaying behavior that doesn’t match their intention) the horse will quietly walk away.  They feel beyond the masks we humans so often wear with each other.  Conversely, if the horse feels a person is congruent with their emotions, good, bad, or, indifferent, they will join up with them.  People are very similar.    Leaders that are capable of maintaining presence and radiate congruency of intention and emotion will see their constituents wanting to join up with them as well.

Linda prepares the person for the reflective round pen exercise with a horse by having the person conduct a body scan; a self-reflective process aimed at reconnecting the person with the intelligence centers that exist in their body as well as their head.  It is an exercise in presence that enables the participant to focus on what they are feeling within their entire being, reconnecting with the messages our body is continuously attempting to send us.  By connecting with our whole body intelligence we can begin to get out of our head and into our heart, recognizing what we are feeling and allowing the messages these emotions are attempting to convey to us.  It really is the first step in developing self mastery, being completely present within one’s self.  Self-awareness opens the mind to see through eyes of others.

My first experience with the reflective round pen offered several powerful revelations.  First, when I conducted my body scan (I actually envision a conscious form of an MRI scanning down my body) I noticed tension in my shoulders.

Linda instructed me to acknowledge and expand this feeling and to “breathe into that sensation, sending it oxygen and awareness.  Ask it what information it’s holding for you and be open to how your body may speak to you.”

Being a novice with horses I was a bit tense as I prepared to enter a sixty foot round pen with a 2,200 pound black Percheron named Kairos.  As I followed Linda’s instructions I sensed the tension in my shoulders inform me to just relax…just be.  The moment I acknowledge this message and spoke it out loud the tension dissipated instantly.  (This is a consistent occurrence using this practice.  My firm, Performance Transformation, employs this experiential learning approach in our various leadership, sales, and team building workshops.  We witness this release in more than 90% of our participants.)

I entered the round pen embodying this message, to relax and simply be present.  As I did, Kairos approached me, his giant hoofs gently puffing up dust as the physical and energetic space between us narrowed.  Before I knew it, his soft nose was touching my forehead, his deep, solemn breath washing over my face; in fact washing over my entire being.  We began to move together around the pen in delicate synchronization.  Neither he nor I was leading.  Neither he nor I was following.  Somehow we were perfectly connected in co-creative relationship, entirely in the moment.  Our movements anticipated one another’s as we stepped around the pen, side by side, without judgment or mental noise, profoundly connected in a place of peacefulness and trust.

What I had discovered was that by connecting with my embodied intelligence I had truly aligned with my self.  A moment of authentic presence emerged and my ability to empathically connect with another sentient being flowed effortlessly.  It seemed that Kairos and I felt each other’s presence so clearly we were able to connect on a majestically beautiful and inspirational level.  Neither of us attempted to dominate the other, we could simply move in the moment with grace and dignity.

The analogy of what I had experienced in leading the European business team those many years ago was not lost upon me.  I had entered into the leadership relationship with an open mind and, perhaps more importantly, an open heart.  I did not judge their ways of doing business as worse or better than corporate’s perspective.  It was simply their way of doing things that suited their markets and environment.  I genuinely cared about their success and empowered them to co-create the relationship resulting in a level of acceptance and respect that still resonates with me today.

Some of us are natural empaths; capable of feeling the emotional energy of those we encounter.  This can be as much of a curse as it is a blessing.  Humans that are highly sensitive to these emissions can actually be overwhelmed by the emotions of those they encounter.  We’ve all experienced this on some level.  Think back to a moment when you may have encountered someone experiencing significant inner conflict; you most likely recoiled from that person without even being conscious as to why you reacted this way.  You simply knew you wanted to put space between you and that person.

While it can be challenging, natural empaths are well served by learning to discern the emotional energy of others from their own.  Conversely, those of us that are less aware of the emotional energy surrounding us are capable of learning how to calibrate our sensitivity to others.

I learned this while working on the empathy education company project I mentioned earlier in this book.  The company used scenario-based learning for clinical health care professionals to elevate their ability to express empathy towards people and family members experiencing a health crisis.

There is a significant difference between simply being present, expressing authentic empathy, and trying to fix the person or situation.  As we learned during this project, this is an exceptionally difficult delineation for health care providers and people drawn to serve others.  They are attracted to their profession by their desire to heal people, to ease their suffering by fixing their ailment.  It is difficult for them to accept there are certain situations they cannot fix, and attempting to do so beyond a certain point communicates a paternalistic, almost patronizing message to people in deep emotional pain.

What we discovered was the clinicians needed to learn to let go of this attitude and accept, what in their conditioned, well trained terms is considered defeat.  In other words, accept things exactly as they are.  The kindest and most conscientious expression they can offer at that point is empathy.  In certain situations they can no longer heal the body yet they can still help heal the spirit.

The lesson here is that empathy does not require action, only presence, authentic listening, and the allowance of space for emotional processing.  Simply being sensitive to the situations of those around us and quietly acknowledging what they may be experiencing is an expression of empathy.  We all experience ups and downs in our personal lives.  If leadership wants associates to be truly engaged, they must recognize these trials and tribulations will inevitably follow people into the workplace.  Authenticity recognizes emotions, both highs and lows, as part of being whole and present.

© 2011 – 2012, Performance Transformation, LLC™.  All Rights Reserved.

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Terry Murray Discusses Leading for Creativity on The Positive Business Show™

I had the great pleasure of recently being interviewed by renowned radio talk show host Patricia Raskin  We had the opportunity to explore how through the application and integration of Equine Facilitated Experiential Learning and Accretive Coaching can spark transformational change and creativity in business.  It was one of the most compelling interviews I’ve had the privilege of experiencing!

You’re welcome to listen to the podcast below:


© 2012, Terry Murray.

© 2012, Patricia Raskin, The Positive Business Show™.

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Speak with Author Terry Murray Live on Patricia Raskin’s Positive Business™ Radio Show

For Immediate Release

Entrepreneur, Author, and Business Strategy Architect Terry Murray will be appearing live on Patricia Raskin’s nationally syndicated, call-in radio program, Positive Business™, Friday, July 13th at 3:00 p.m., E.D.T.

Terry Murray, author of “The Transformational Entrepreneur ~ Engaging The Mind, Heart & Spirit For Breakthrough Business Success”, is scheduled for a live interview with renowned radio talk show host Patricia Raskin, Friday, July 13th, at 3:00 p.m., E.D.T.

“I’ve done many radio interviews, but this will be the first live show with callers participating in the conversation.” commented Mr. Murray.  “It should be a lot of fun!”

Terry’s book provides a step-by-step approach for creating and sustaining breakthrough performance in today’s volatile world.  Looking beyond conventional wisdom, Terry re-examines his entrepreneurial experiences to examine the human elements that consistently drive creativity, innovation and success.  The book was recently cited in the March, 2012 edition of the academic Journal For Economic Literature.

“We’re well past the Industrial Age, and in fact we’ve moved beyond the Information Age.  We now live in the Idea Age,” adds Terry.  “In today’s global economy, intellectual property is the driver of value creation.  The source of commercially viable ideas are people.  Highly engaged, talented, passionate people.  Human beings, and our remarkably creative and adaptive abilities, are the raw material for business in the 21st century.  The traditional, Industrial Age approach to leadership, strategy and organizational culture must also evolve in parallel with this evolutionary shift.”

Listeners are welcome to call into the show at (888) 345-0790.  The program is syndicated throughout the United States and will stream live at

Ms. Raskin has interviewed more nearly 2,000 guests on her show.  Her past guests include such luminaries as Dr. Mehmet Oz, Maya Angelou, Gay Hendricks, Debbie Ford and Dr. Andrew Weil.  In addition, she has written over 700 newspaper articles and produced and hosted 500 television programs and documentaries.

A podcast of the program will be posted on Terry’s blog site shortly after airing.

© 2012, Performance Transformation, LLC™.

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Insights into Cultivating & Sustaining an Inclusive, Creative Culture, Part II

Key Concept ~ Here’s part II in a series of excerpts from my book, “The Transformational Entrepreneur ~ Engaging The Mind, Heart & Spirit For Breakthrough Business Success”, that explore the nuanced challenge of cultivating a vibrant, inclusive organizational culture in today’s volatile world.

~ Reaping What Has Been Sown

Businesses have a difficult time addressing things they cannot measure, yet there are real costs associated with these veiled issues.  The greatest hidden cost that erodes organizational performance is employee disengagement.  Gallup®, Inc. has been measuring employee engagement levels since the beginning of the decade and reports on these surveys in the Gallup Management Journal.  The study indicates 29% of employees in America are engaged (meaning they work with passion, energy, and are emotionally connected to their organization), 56% of employees are not engaged (meaning they are physically present but do not work with passion or energy), and 15% are actively disengaged (meaning they actually are working at cross purpose with their fellow associates).  The study estimates the annual, aggregate cost of employee disengagement is anywhere between $237 and $270 billion in lost productivity.

  A recent study published in the Harvard Business Review® indicates that during what is now termed The Great Recession the percentage of actively disengaged employees has skyrocketed to 21%!

If we extrapolate these findings into a small business environment (even using the conservative numbers from Gallop), say one with twenty employees and payroll of $1 million, the impact of employee engagement becomes strikingly tangible.

In this scenario we can anticipate six employees are activity engaged, eleven are sleepwalking through their day, and three are actively working to undermine the company’s mission.  If we give the sleepwalkers the benefit of the doubt, that they’re perhaps contributing at 50% of their capabilities, we can assume that at a minimum, $425,000 of our million dollar payroll is providing no return on investment whatsoever.  This doesn’t take into account the value the actively disengaged employees are actually destroying through their efforts beyond the lost wages we are paying them.  Conversely, we are only enjoying a full return on investment on thirty percent of our annual payroll through our associates that are actively and passionately engaged with the mission!

Thankfully, the intentions and congruent actions of authentic leadership can re-engage many of the sleepwalkers by cultivating an atmosphere of trust and inclusion.

The fifteen  to twenty-one percent that are working to undermine their fellow associates simply need to go.  Their participation in the enterprise frustrates passionate associates and serves to foment further disengagement with the sleepwalkers. This is a great example of addition through subtraction.

Creating a shift in culture to one of trust and engagement begins with authenticity; the suspension of managerial ego in the daily interaction of the business.  Altruistic intentions combined with congruent actions resonates positive energy and engages associates to be fully present and contributory.  A genuine concern for the well being of associates that is consistently expressed will ignite the collective consciousness of a fully present team.

You’d be surprised how quickly leadership can turn around associate disengagement.  In the 1990’s I was working as the Vice President of International Marketing for a major medical device company.  My responsibilities brought me into close and frequent contact with the European managing directors for each country we operated in throughout the continent.  Moral was very low as the corporation historically had operated as a classic U.S. exporter into the region.  Products, services, pricing, and business methods were not tailored for the individual cultures and markets.  Everything was developed and dictated from the U.S. corporate office.  This situation was exacerbated by a veritable turnstile of senior management being assigned from the states that was not sensitive to the various cultural and operational nuances that existed country to country and quite often within the nation states themselves.

The first thing I did as the new Vice President was to begin listening to the concerns of the managing directors and repositioning our portfolio to more closely align with their particular business needs.  This quickly escalated into my advocating with corporate the need to begin manufacturing products in Europe for Europeans and to expand our services within each market.  The European associates began to witness my actions matching my words and a new found faith in the future of the organization began to emerge.  For the first time in years the European associates began to feel the company aligning with their interests, markets, and corresponding opportunities for career success.

Within a few short months I found myself promoted to Vice President of Sales and Marketing for Europe, Africa, and the Middle East.  Not only was I faced with the challenge of relating to a wide spectrum of cultural perspectives but I was also twenty years younger than all of my direct reports (European hierarchies tend to move much slower than U.S. companies when it comes to promotions).  With my new level of authority I began empowering the managing directors to conduct business in the manner that best suited their opportunities and constraints.  I knew I had secured their trust when my managing director for Eastern Europe and the Middle East, Thanassis Bouzabardis, spoke up during a business dinner in Madrid with all of the managing directors, “Terry, I think I can speak for all of the directors when I tell you we don’t view you as another American coming here to manage our business…we view you as a fellow European.”

To this day I feel that was one of the greatest complements I’ve ever received regarding my leadership style and abilities.  By listening, expressing authentic empathy for their environments, and acting congruently I began shifting the culture of the business from a place of poor morale to re-engaging the European associates.  All of this took place within six short months.  The European team also increased sales by more than $16 million in that same timeframe!

Early stage companies have the advantage of starting with a relatively blank slate.  Enlightened hiring practices will attract enlightened talent.  Authentic leadership will attract authenticity.  Sharing the Vision during the hiring process will help in this regard as will following one’s intuition.

The compensation plan offered to new hires can also weed out people simply looking for immediate gratification versus people in search of being a part of something more meaningful and of greater significance in their lives.  The compensation package can reveal if a person is looking for remuneration based solely on their perceived individual value or if they are willing to work for a reasonable, competitive wage buoyed by incentives derived through team value creation and the tangible contribution of achieving shared goals.

The courage of visionary conviction will not miss out on what may appear to be the minimum talent threshold necessary for performance.  It will, in fact, reveal human beings capable of continuous growth and cooperation.  Fully engaged, eclectically talented associates,  build the creative bandwidth necessary for adaptive problem solving along the way.

Existing organizations are faced with a more challenging task in the cultivation of positive, collective consciousness.  It cannot be achieved overnight, but through the application of authenticity and consistent, conscious leadership it can happen in a surprisingly short period of time as my experience in Europe proved.  The expression of empathy combined with the vibrant cultivation of trust can rehabilitate the most disengaged workforce in a few short months.

Supported by honest accountability, starting with self-accountability, a conscious leader will begin to engage associates that have developed conditioned behaviors of self-preservation that dilute creative contribution.  The onus is on the leader to reach out and begin to display and communicate their dedication to the well being of each individual on the team.  Leadership that chooses to serve the team as a primary approach towards serving the business.

 © 2011 – 2012, Performance Transformation, LLC™

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Insights into Cultivating & Sustaining an Inclusive, Creative Culture, Part I

Key Concept ~ I’d like to share a series of excerpts from my book, “The Transformational Entrepreneur ~ Engaging The Mind, Heart & Spirit For Breakthrough Business Success”, that explore the nuanced challenge of cultivating a vibrant, inclusive organizational culture in today’s volatile world.

The most enlightened vision, the most elegant strategy requires the positive energy of a team in continuous alignment with the actions and intentions of aligned purpose.  In today’s world, where value creation emerges from intellectual property, human beings have never been more central to success.  The business community is slowly evolving in their understanding of the importance of human beings as the drivers of sustainable performance.

This is reflected in the jargon.  What were once Personnel Departments became Human Resources, and HR is now evolving towards Talent Management.  While this line of thinking shows promise there often still exists a disconnection between posturing and jargon and the actions of leadership.

This slow march still leaves many organizations far from embracing the complex, nuanced, and multi-dimensional nature of human beings.  We are much more than an amalgamation of our cognitive abilities, education, and accumulation of experiences.  And yet, for the most part, that’s exactly the criteria most commonly associated with recruitment and hiring.

The fact is, there is something accretive about our very nature.  A fully actualized human being represents a sum that is greater than his or her individual attributes, talents, experiences, and education.  There is something beyond this mere accounting, something mysterious and beautiful.  Something that sparks the creativity that lies within us all!

Our ability to connect, engage, and authentically motivate others emerges through our emotional competencies, often referred to as emotional intelligence.    This refers to our self-awareness, social awareness, self-management, and relationship management skills.  Research reveals that more than 80% of success in life can be attributed to the level of emotional self mastery that emerges through the development of these abilities.  The remaining 20% relates to our native intelligence and cognitive abilities.

Perhaps the single most important sensor-connector in the human experience (and one critical to effective leadership) is our ability to express empathy.      Again, an ability that emerges through our emotional attunement.  Contemporary business culture tends to ask us to leave our emotions at home.  Yet, in doing so, they are disconnecting us from our very nature.  Leaving our hearts on the sidelines disengages us from both our employers and our authentic selves.

This leads us to consider the mysterious source of human creativity.  What is the source of inspiration in human beings?  I venture to say it emerges from a place far beyond the mere components of our physical existence.  There is something Divine in our ability to create.  Something that relates to our accretive nature, of how our mind, heart, and spirit intertwine and create the essence of our being.  To compartmentalize our gifts, to ask us for one while discounting another leaves us fragmented, less than what we are meant to be.

As I write this IBM® just released their 2010 Global CEO Study.  In canvasing more than 1,500 CEOs from around the world, a revelation came to light.  According to these business leaders, the single most important leadership competency necessary for success in the future is creativity.  Not managerial discipline, mental rigor, integrity, or vision…but creativity.  They go on to identify the solution to this challenge lies in cultivating creativity throughout the entire organization.  This is a hopeful sign.  An acknowledgement that the driver of success going forward must embrace the creative nature of human beings.

Unfortunately, the mindset in today’s workplace is often one of fear.  Fear from leadership to acknowledge our authentic nature.  Fear with associates to take risks with positive intention.  Fear based in a lack of trust and the insecurities rooted in ego-driven behavior.

The historical lack of commitment from many businesses towards associates has instilled an incessant, negative expectation.  Waiting for the other shoe to drop.   Leading associates to hedge their emotional and energetic contributions, protecting their themselves by projecting a false façade.  Managers defend territory and take issues personally.  Doesn’t feel like a creative place, does it?

Fortunately, it is not imperative to speak of the authentic nature of humans to acknowledge, embrace, and cultivate the creative potential of human beings.  However, in many environments, a conscious break in the perspective and behavior of leadership needs to occur for creativity to emerge.  Creativity is tough to manufacture…it needs to be cultivated.  I think you can see how it takes a different mindset and perspective to spark a creative environment.

The philosophy of winning at any cost has become deeply rooted in many corporate settings.  The attitude of if we’re not growing, we’re dying has always befuddled me to a certain degree.  I’m not speaking of small, growing businesses trying to build traction or mid-size companies moving quickly to leverage capabilities.  I mean some of the really large businesses I’ve worked for in the past.  Growth tells one part of the story, but I’ve seen some areas where less would have been more, both in the near term and strategically for the organization.  Moving forward isn’t always a linear process.

Be smart here.  Learn to measure your steps towards progress in the tangible motion of the business.  Are you positioning your talent, capabilities, and culture in a position poised for adaptability?  This is what the CEOs in the survey are concerned about…finding the creative thinkers that can navigate this new horizon.

to be continued…

© 2011 – 2012, Performance Transformation, LLC™.

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