Study Questions For The Florence Prescription

Study Questions

The Florence

Prescription

Copyright © 2010, Values Coach

Inc.

and

The Florence

Challenge

By taking The Florence

Challenge our

organization is telling

the world that we:

Aspire to a culture of

ownership where people are

committed to the values of the

organization, are engaged in

their work and with their

coworkers, and take pride in

their work and in their

professions.

Encourage people to hold

themselves responsible and

accountable for their

attitudes and actions, and

to empower themselves to

do the right thing for

patients.

Expect a workplace

environment that is free from

finger-pointing, cynicism,

gossip, complaining, and other

forms of toxic emotional

negativity.

As a participant in

The Florence Challenge

we are asking you to:

Read The Florence

Prescription and think about

how the 8 essential

characteristics of a culture of

ownership apply to your own

work and life, and…

Take the seven simple

promises of The Self-

Empowerment Pledge to help

you in your own life –

personally, professionally,

financially, and spiritually,

and…

Refuse to participate in

chronic complaining,

gossiping, and other forms of

toxic emotional negativity,

and replace the words “Not

my job” with “How can I

help?”

Are you willing to make

the commitment?

Are you ready to start?

Study

Questions for

Chapter 1

Is this true?You can’t be cynical and negative sitting

in the cafeteria or break room and then

somehow flip an inner switch and

become genuinely caring and

compassionate when you walk into a

patient’s room. And patients see right

through the fraud.

The Florence Prescription, page 30

Is it possible to be cynical and

negative at work and then flip an

inner switch and become a genuinely

nurturing and empowering parent and

loving spouse

at home?

Is it important for people to know

and buy into the values of the

hospital they work for?

Do you know and buy into the

values of the hospital that you

work for?

If Carol Jean Hawtrey spent an hour

sitting in the cafeteria of your

hospital, what sorts of conversations

would she be likely to hear?

http://www.flickr.com/photos/brykmantra/76765350/

“Who cares for the caregiver?” is an

age-old question in healthcare.

But if we don’t care for each other –

emotionally and spiritually – who

will?

Study

Questions for

Chapter 2

Do you agree with this?

You can hold people accountable for

showing up on time and for fulfilling

the terms of their job descriptions,

but you can’t hold them accountable

for being committed and engaged.

You can’t hold people accountable for

caring. It takes a spirit of ownership

for those things to happen.


Do you agree with Connie O’Dell

that negative attitudes increase

the stress level in a hospital –

and is the reverse true, that

positive attitudes can reduce

the stress level?

Florence Nightingale is surprised

when she hears someone use the

words “patient-centered care,”

and asks what other kind of care

there is.

How dedicated is your hospital to

putting patients in the center of

the care matrix, and what more

can be done to put patients first?

Carol Jean says that the

“Invisible Architecture” is the

soul of an organization. Can

organizations have “a soul” in

any meaningful sense? Does

yours? How would you describe

it?

Do you agree that accountability

alone is not enough to make a

great organization, that it takes

a spirit of ownership? How

would you define

“accountability” and

“ownership”?

Carol Jean describes eight essential

characteristics of a culture of

ownership:

Commitment, Engagement, Passion,

Initiative, Stewardship, Belonging,

Fellowship and Pride.

Are any of these superfluous, and has

anything important been left out?

Study

Questions for

Chapter 3

Does this make sense to you?

Rules are of the left brain, values are

of the right brain. When people

don’t share a common set of values

you need to have lots of rules.


John Myerson described the “see-

smile-greet-help” rule of

Memorial Medical Center. How

would your hospital be perceived

by a new employee or a lost

visitor?

Is it important that the

environment be friendly?

Carol Jean said, “When people don’t

share a common set of values, you

need to have lots of rules.” Of course,

as Myerson replied, you need both –

but there is a continuum from rules-

based to values-based. Where does

your hospital fall on that continuum

and what can be done to move it

further toward the values-based end of

the scale?

Myerson said that you cannot teach

people values if they didn’t learn them

at home. Do you agree with him, or do

you agree with Carol Jean who said

that not only can values be taught, it’s

essential that they be taught if you

want to be a great hospital?

Carol Jean said that core values define

what the organization stands for and

what it won’t stand for. How clear are

people at your hospital about the

behavioral expectations created by

your values

(both stated and implicit)?

Little Timmy tells Myerson that he

should give nurses a pay raise because

he heard them complaining in the

hallways.

What are patients likely to overhear in

your hospital (keeping in mind that

they hear a lot more than you think

they do)?

Study

Questions for

Chapter 4

Do you agree?

When patients overhear caregivers

complaining and gossiping, it

violates the integrity of the caregiver

and shows a lack of respect for the

patient, not to mention the person

who’s being complained or gossiped

about.


Timmy Mallory fights cancer by slaying

dragons in his imagination, and

Myerson suggests a dragon-slaying

area on the pediatric unit. How could

building a culture of ownership

encourage people to come up with the

sort of “crazy” ideas that can actually

make a hospital special?

“Just because the doctors have given

up hope doesn’t mean there’s no

longer hope.”

Read The Hope Diamond on the next

slide, then discuss Florence’s

comment – both in the context of

patient care and of navigating a

stressful healthcare environment.

Most hospitals have a vibrant rumor

mill, but Florence states that gossip

violates the integrity of the caregiver

and shows lack of respect for the

patient. How active is the rumor mill at

your hospital, and what can individuals

do to help eliminate gossip?

Culture is to the hospital what

personality and character are to the

individual. How would you define the

culture (personality and character) of

your hospital?

Are you proud to be part of it? What

would you change?

How wide is the gap between what the

hospital says it expects of people (e.g.

integrity, respect, initiative) and what it

tolerates (e.g. gossip, complaining,

passive-aggressive learned

helplessness)?

What can be done to close that gap?

“People would have a lot more time and

energy for compassion if they spent less

time and energy complaining and

gossiping.” Do you agree with

Florence?

Or is “venting” and chatting about other

people a necessary feature of a

healthcare organization?

Especially in today’s challenging

healthcare environment, hospitals

cannot afford to choose between

compassion OR productivity – they need

both.

What ideas can you suggest for moving

from what Jim Collins calls “the tyranny

of OR” to “the genius of AND”?

Study

Questions for

Chapter 5

Do you agree with this statement?

The cornerstones of Integrity are

honesty, reliability, humility and

stewardship. If people are not

committed to those behaviors, then

integrity is just a word on the back of

a name badge, not a core value


Think about the core values of your

organization. Why do you think those

specific ones were chosen? If you were

made King or Queen for a day, what

values would you have chosen?

Think about your own personal values.

How well do they mesh with the

statement of values of your

organization?

(If you haven’t thought about your

personal values, this would be a good

time).

How can understanding the Values-

Behavior-Outcome Continuum

influence your personal life?

For example, if your desired outcome is

better health or financial

independence, what are the required

behaviors – and what core values

would inspire you to

take that action?

Discuss the 6-Es of Employee

Engagement:

Expect, Educate, Enable, Energize,

Evaluate and Elevate

How much of a role can management

play in encouraging people to engage

with their work and with their

coworkers, and how much of it must

come from within?

Florence Nightingale attributed her

success to the fact that she “never

gave or took an excuse.” What are

some ways that you can counter finger-

pointing, buck-passing, and blame

game in your hospital?

Study

Questions for

Chapter 6

Do you find this provocative?

Taking care of the sick should be a

mission, not just a business. Being a

healthcare professional should be a

calling, not just a job. Our hospitals

are at risk of losing their souls.


Long hours, changing shifts, and hard

work are often facts of life in

healthcare. No matter how tired or

stressed we might be, our patients still

deserve our best.

How do we make sure that we

give it to them?

In the cafeteria, Carol Jean asked Sarah

what she would tell her CEO had he

been sitting there with them. What

would you tell your CEO if he or she

were in the room with you right now?

If Florence Nightingale showed up right

now (like she showed up in the MMC

cafeteria when Carol Jean was talking

to Sarah) what would you say to her?

What do you think she would say to

you?

Nightingale said that caring for the

sick should be a mission and not just a

business, and that being a healthcare

professional should be a calling and

not just a job.

Still, hospitals and caregivers alike

must pay the bills. How do we

reconcile that tension?

Carol Jean tells Sarah that she’s hiding

behind a mask of negativity and

cynicism because it hurts too much to

care. Was she being fair? Do you ever

feel that way?

How can we support each other when it

hurts too much, or we’re too tired, to

care?

As Sarah sat crying by Timmy’s

bedside, CEO John Myerson was

standing in the doorway, also in tears,

though Sarah could not see him.

In what ways might this be a metaphor

for the big picture of healthcare today?

http://www.flickr.com/photos/crookedteethhh/3259283202/

Study

Questions for

Chapter 7

Are you just renting a job?

Any time someone says ‘not my job,’

walks by a patient room where the

call light is on, or does not stoop

down to pick up a piece of paper on

the floor, that person is renting a

space on the organization chart, not

taking ownership for the work itself.


Carol Jean says the corporate culture

is the only sustainable source of

competitive advantage for a hospital,

and that “cultural blueprinting” is

more important than designing

buildings.

Do you agree? Why or why not?

The culture of a hospital is really like

a patchwork quilt made up of the

cultures of individual areas.

What is the culture like in the area

where you work? What changes

would you like to see in that culture?

What actions could you and your

coworkers take to bring those

changes about?

http://www.flickr.com/photos/patchworkpottery/153896467/

Carol Jean distinguishes between

management (a job description) and

leadership (a life decision), and says

that today’s hospitals need leaders in

every corner, not just the corner

office.

How encouraging is your hospital of

informal leaders, and how much

influence do they have?

Carol Jean uses the fact that no one

changes the oil in a rental car as a

metaphor for the “not my job” attitude of

people who are just renting a space on

the organization chart. What is the

difference between “owning the work”

and “renting the job”?

Not my job!

Carol Jean tells a skeptical John Myerson

that he should help people work on “soft

skills” like self-image and self-esteem

because a winning team is built around

people who know how to think and act

like winning players.

Do you agree that leaders (formal and

informal) should play this role?

Study

Questions for

Chapter 8

How “real” is your picture?

We can make everyone go through customer

service training, and we can put billboards up

on the highway telling everyone how caring and

compassionate we are. But unless people

change how they think and act, all we’ll have is

a pretty picture of an organization that exists

only in our dreams... To make the picture real,

people have to buy-in, to take ownership. That

means they need to change their attitudes and

their behaviors. They need to change the way

they treat each other.


Dr. Charlie Franklin tells Carol Jean that

he’s skeptical about the latest

“program of the month”. How does a

hospital infuse new and innovative

ideas and inspiration without falling

into “program of the month”

syndrome?

Carol Jean says that most hospitals are

very hierarchical and status-conscious.

How true is that of your hospital?

Put yourself in the shoes of Dr. Franklin

when he suddenly finds himself as

Carlos the housekeeper holding a mop

at the main intersection of the

hospital.

How do you think you would be

treated at your hospital?

Carlos the housekeeper is reprimanded

by his supervisor for dancing with his

mop in the corridor. Would he have

been reprimanded at your hospital, or

would the supervisor have joined him

in the dance (at least metaphorically)?

Once he saw that the problem was

real, Dr. Franklin embraced the

challenge of chairing the hospital’s

new committee to promote simple

dignity.

If there were such a committee at your

hospital, what would you want it to do?

Florence tells Carol Jean that whether

it’s the best of times or the worst of

times depends upon what we choose to

see, and that our perspective of today

will shape our reality of tomorrow.

What are some of the ways

that healthcare today is in

“the best of times”?best of times or worst of times?

Study

Questions for

Chapter 9

Have you given yourself that power?

Empowerment isn’t something that

can be given; it’s a choice that must

be made. No one can empower you

but you, and once you’ve given

yourself that power no one can take

it away from you.


The nursing leadership retreat that

Carol Jean planned with MMC’s Chief

Nursing Officer Linda Martinez was

called “Empowering Caregivers.”

What are the implications of

empowering the caregivers for both

patients and for caregivers?

“Proceed until Apprehended” is

another way to saying “better to ask

forgiveness than permission.” What

are some of the ways that such a

philosophy can improve hospital

operations and enhance patient

service, and what are some of the

ways that this philosophy might be

inappropriate?

Carol Jean describes the defining

paradox of Florence Nightingale as

follows: She was both a

compassionate caregiver and a tough

manager.

How can we be compassionate without

being weak and be tough without

being hard-hearted?

“Empowerment is a choice. No one

can empower you but you, and once

you’ve given yourself that power no

one can take it away from you.”

Do you agree or disagree with this

statement? Why?

Florence says that we overrate the

accuracy of our memories but

underrate the power of our vision.

How can collective memory sometimes

hold us back, and how can a shared

vision propel us forward?

Study

Questions for

Chapter 10

Is it worth the effort?

If we each do our part, we will

change our lives for the better. If we

all do our parts, we will change our

organizations for the better.


How would you rate your organization

on the empowerment scale, and how

would you rate your own behavior?

Do you think you’d end up with the

same “Lake Wobegon Effect” that Carol

Jean found with the Memorial Medical

Center nursing leadership team?

When Carol Jean introduced The Self-

Empowerment Pledge at the nursing

leadership retreat, some were

immediately enthusiastic, some were

renewed, and some clearly thought it

was a waste of time.

What would you think? What would be

the distribution where you work?

Read the seven simple promises of The

Self-Empowerment Pledge. If you

made a good faith effort to live those

promises, what would be the impact on

your life – personally, professionally,

financially,

and spiritually?

If everyone in your work area made a

good faith effort to act on those seven

promises, would you do a better job

of supporting each other and serving

your patients and your community?

Would it be a better place

to work?

How much easier would it be for you

to act upon the seven promises of The

Self-Empowerment Pledge if the

people in your work area were to take

on the challenge as a group and

support each other?

Study

Questions for

Chapter 11

Is this a valid metaphor?

Toxic emotional negativity is the

spiritual equivalent of cigarette smoke

in the air – as harmful to the soul as

smoke is to the body. Just as we once

eradicated toxic smoke from our

hospital environments, it is now our

obligation to eradicate toxic emotional

negativity.


After Sarah left the break room where

two nurses were passing a rumor

about two coworkers having an affair,

she felt “like some part of her soul had

been spattered with mud.”

What should someone do who

overhears other people spreading

rumors and passing gossip?

http://www.flickr.com/photos/khushroo/215150486/

After the new nurse learns about the

false and malicious rumors, she bursts

into tears and runs out of the

cafeteria. Timmy says that the way

people are “always complaining about

something or talking about someone”

is the same as emotional cancer.

Do you agree, or is that putting it too

strongly?

When Timmy says hearing people

complain and gossip makes him feel

even worse than his cancer makes him

feel, Florence calls it “iatrogenic toxic

emotional negativity.” Since emotions

are contagious, do we really make our

patients even sicker with our bad

attitudes?

Imagine yourself as Sarah when she

had to listen to every negative

conversation in the hospital all at once,

and then the peace she felt when they

all stopped.

How much effort would it be

worth to consistently achieve

the latter state?

Carol Jean calls toxic emotional

negativity “the spiritual equivalent of

cigarette smoke”, and calls upon us to

eradicate it in the way we once did

smoking.

People once thought a smoke-free

society was not achievable. Can we

dare to hope for a world that’s free of

toxic emotional negativity?

Study

Questions for

Chapter 12

Do you agree that this is a

management responsibility?

One toxically negative person can

drag down the morale and the

productivity of an entire work unit. It

is a core leadership responsibility to

create a workplace environment

where toxic emotional negativity is

not tolerated.


What was your reaction to reading

about members of the MMC Quality

Improvement Leadership Team (QILT)

reading their mission statement

aloud at the beginning of their

meeting with Carol Jean? Did you

think it was corny or did it strike you

as kind of cool?

Do you agree that caffeine is the drug

of choice for people of genius?

Do you agree with Carol Jean’s

comment that “left brain” statistical

quality and productivity tools are

reaching a point of diminishing

returns, and that future quantum

leaps will be achieved by “right brain”

qualities like enthusiasm, pride,

passion and loyalty?

What has your hospital done, and what

more can be done, to move from the

fragmented and ultra-specialized

system that treats patients as a

collection of body parts, toward a more

holistic “right brain” system that

recognizes the inter-connection

between body parts, and between

body, mind, emotions, and spirit?

When the MMC Maintenance

Department tried to “empower”

people to perform routine chores like

changing light bulbs, the project fell

on its face. What went wrong and

what should have been done

differently?

Carol Jean points out that you can

measure left brain qualities but you

can’t see them (what would ROI or the

bottom line look like?) while right

brain qualities can be seen but not

measured.

How would you meet her challenge to

come up with new ways to assess the

things that can be seen but not

measured?

Carol Jean says it is not left-brain OR

right-brain, but how to find the right

balance or that continuum. Where

does your hospital fall on the

continuum and in which direction (if

any) do you think it should move?

Study

Questions for

Chapter 13

Are you being treated like an owner

and a partner, and if not what’s

missing?

To foster a culture of ownership, you

must treat people like owners and

not just employees, like they are

partners in the enterprise and not

just hired hands doing the work.


Did you have any “first day on the job”

experiences like the one Carol Jean had

where her patient coded and died, the

doctor called her a candy-striper, and

the head nurse told her (calling her by

the wrong name) to get over it?

How can such experiences be

prevented from being inflicted upon

junior employees at your hospital?

Florence reminds Carol Jean that she

has two ears and one mouth, and that

this should guide her proportion of

listening and talking. What is the

listening culture at your hospital?

http://www.flickr.com/photos/edwindejongh/3514965253/

Standing outside of the room for her

meeting with the union reps, Carol

Jean was subconsciously imagining a

gang of finger-popping Teamsters

looking for an excuse to rough her up.

How do the assumptions we make and

the stereotypes we draw distort the

reality of how we experience other

people?

Shari Levenger complemented the CNO

Linda Martinez for not putting up with

slackers and for requiring people to do

their work “and cut out all the

pettiness.”

Would Levenger make similar

comments about operations at your

hospital, and what recommendations

would you anticipate that a consulting

team

might make in response?

If you were a consultant, what advice

would you give to Carol Jean – and to

John Myerson – for reducing we-they,

management-staff differences and

remind everyone that, as Bill Bristow

put it, “we’re all in this together”?

Study

Questions for

Chapter 14

Do you agree with Sarah Rutledge?

We need to see opportunities where

others see barriers. We need to be

cheerleaders when others are moaning

doom-and-gloom. We need to face

problems with contrarian toughness

because it’s in how we solve those

problems that we differentiate

ourselves from everyone else.


Sarah Rutledge did not let Timmy get

by with using the word “try” (“do or do

not – there is not try” she said, quoting

Yoda).

What are some of the words, phrases,

similes and metaphors commonly used

in your hospital that can create a

disempowering environment?

Healthcare professionals are rarely

lectured on their lack of mental

toughness by 10-year old cancer

patients. Did Sarah, speaking for

Timmy, have it right when she said

that we need to see opportunities

where others see barriers and to face

our problems with contrarian

toughness?

Carol Jean told the story of how Tom

Sawyer – who was accountable for

white-washing the fence, coaxed

friends who were not accountable to

take ownership of the work – and

actually have fun doing it. What is the

lesson for us?

People with strongly negative and

cynical attitudes often find

themselves, metaphorically

speaking, standing outside throwing

rocks when they’d

be much more effective, and much

happier, coming in from the cold to

help with solutions.

What barriers prevent this from

happening and how can we bring

those barriers down?

Other than Sarah, no one noticed our

heroine Carol Jean crying on the patio;

she was expected to put on a happy

face and continue leading the retreat.

We all carry hidden hurts. What are

some of the ways that your hospital

would help people cope with them?

Study

Questions for

Chapter 15

Tough-loving leadership?

Some people aren’t going to buy in

to

a culture of ownership and a few will

actively seek to sabotage the effort.

Are you willing to raise your

expectations, lower your tolerance

level for deviation from those

expectations, and perhaps lose some

people who have good technical

skills but a bad attitude?


What do you think of the suggestion

made by CNO Linda Martinez that there

be an organization-wide training

initiative on values that would cover

both the I-CARE values of MMC and

help people crystallize and act upon

their own person values?

Carol Jean asked why the hospital

workplace can’t be more like a support

group environment, where at the end

of the day people leave physically tired

but emotionally uplifted.

Would Dale Prokopchuk’s suggestion of

hospital-sponsored support groups

help this happen?

What are some of the ways that we can

encourage employees to share their

strengths and talents at work, even if

it’s not part of their job description,

like the nurse Carol Jean mentioned

who loved poetry and wrote poems for

her patients?Breathing there inside youLike a mermaid on

a moonbeam

How would you answer the universal

icebreaker question “What do you do?”

in a way that conveys:

I love what I do

I’m good at what I do

I’m proud of what I do

What I do is important

Sarah Rutledge said that after she’d

started bringing a more positive

attitude to work, some of her

coworkers did not like the “new me.”

How do we create an environment that

neutralizes peer pressure to be

negative and mediocre?

Study

Questions for

Chapter 16

What do you take away as the

ultimate meaning of The Florence

Prescription?

That was the ultimate meaning of

the Florence Prescription… to

foster a culture of ownership that

honors victory of the spirit as

much as it celebrates healing of

the body.


Sarah Rutledge described the recovery

of Timmy Mallory as a miracle.

Do miracles really happen in hospitals?

Let’s do a quick

review:

The 8 Essential

Characteristics of a

culture of

ownership

The Florence Commitment:

Refuse to participate in toxic

emotional negativity.

Replace the words “Not my job”

with “How can I help?”

Study Questions For The Florence Prescription

Business

cno linda

toxic emotional

carol jean

nursing leadership

good faith

people dont

hold people

carol jean