Executives Warned: Know what you can and cannot change
Bangkok Hospital chief executive Chatree Duangnet believes in an "inverted pyramid" style of management, and says leaders should be "fussy".
"Leaders often think they're on the top of [an ivory] tower and they have no time to be fastidious. But being fastidious with staff is part of our job description," he said.
Speaking on "Leader's Roles in Promoting Quality" at a seminar held by the Healthcare Leader Development Association of Thailand (HeaLDAT) last week, Chatree said he had direct e-mail access to and from all his staff down to the fourth level from the top - those who work on the front line.
"There are many things that staff write in e-mail to me, and their bosses wonder how I could know those things," he said.
Bangkok Hospital is part of Bangkok Dusit Medical Services, the largest private healthcare group in Southeast Asia. It manages 17 hospitals under the Bangkok, Samitivej and BNH brands in Thailand, and two hospitals in Cambodia, with combined revenue of Bt22.2 billion in 2009.
Chatree said that as a chief executive he felt it was important for him to have direct contact with so-called N-4 level staff because they were the ones who faced up to the patients.
"Top executives are meaningless because we don't see the patients' faces. We can't simply wait for the normal reporting system [to filter down through the executive layers]. In addition to that, we have to bypass [the layers] and go to act as a 'tracer' by ourselves in the departments every week [following procedures to ensure that instructions are being followed].
"At peak time, the boss has to be in the 'battlefield'. He can't just stay in the meeting room.
"Even if the [hospital] director has 50 PhDs, if the front-line staff know nothing, there is no way [to achieve anything]. The [management] pyramid has to be inverted," he said.
Chatree said that every organisation looking to create a quality culture had to begin with a "window dressing" step in which the staff "acted" [the roles expected of them] because they knew their bosses expected them to be fastidious in their work. In the case of Bangkok Hospital, it took as long as three years before the staff adopted the desired culture and behaved accordingly.
"Our fastidious approach made the staff feel very annoyed. But we forced them to 'act' their roles repeatedly until they remembered it all," Chatree said.
He said there were four steps in the journey to a quality culture: setting up the team, setting the goals, implementing the plan and sustaining it. The "setting up the team" step requires a sia sang lui (decisive leader), and the "quality leader team" will earn full support from this sia sang lui to lead the change. The top and the second-to-top [N-1] executives also have to be very closely acquainted, he said.
In setting the goal, Chatree suggested that hospitals attempt to achieve local Hospital Accreditation (HA) or Joint Commission International (JCI) standards. They should conduct benchmarking with other hospitals and implement continuous quality improvement (CQI) tools in selected areas such as efficiency, hospitality, clinical practice and patient safety.
Where it comes to efficiency, for example, Bangkok Hospital applies a method adjusted from Toyota's famous "lean standard" system.
Because a culture-change project takes time, Chatree said leaders needed to stay long enough at their posts. A good leader also has to make sure he or she has followers.
"My personal experience is that I failed. My staff couldn't catch up with me, and you can't be a leader without followers. The pace [of change] must be set together," he said.
Leaders also need to invest in themselves or in their personal proficiency.
"For example, my boss, Khun Pongsak [Pongsak Viddayakorn, 76, the co-founder and executive director of Bangkok Dusit Medical Services, the parent firm of Bangkok Hospital], drinks vegetable juice every day as an elixir, and we are thinking of selling its recipe," joked Chatree.
To enhance employee engagement, Chatree said he used the "karma concept" of management, consisting of a cycle of action, reaction, synchronisation and appreciation.
"Whatever seeds you sow, that type of plant will grow. With every action you take, you will get the same kind of reaction. If, for instance, you're only thinking about taking their money or [you adopt the opposite approach and] you empathize [with your staff], they will respond in equal measure," he said.
By appreciating all the achievements of their staff without claiming any one achievement for their own credit, the positive cycle will return to the leaders, Chatree said.
Another important thing is to have the wisdom to know the difference between what can be changed and what cannot be changed. Chatree said he had on his desk a quote from theologian Reinhold Niebuhr, reading: "God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference."
"I came from being a rural kid in Chiang Rai, where I saw many people driving a Mercedes-Benz or BMW from Bangkok, running into, or being stopped, by buffaloes.
"Hold back on blowing your horn and driving the buffaloes away," he said.