Orchestrating EVS staff operations

Many baby boomers can probably recall in their youth sitting directly in front of a TV set, dangerously close to what their mothers erroneously warned was radiation that would surely cause blindness.

Some of the best Saturday morning cartoons of that era featured huge symphony orchestras. During an operatic concert scene in a 1949 Warner Brothers cartoon short called “Long-Haired Hare,” Bugs Bunny poses as Leopold Stokowski, a famous, well-respected orchestra conductor of the early and mid-20th century. After receiving the conductor’s baton from an obsequious musician, Bugs snaps it in two and proceeds to conduct bare handed.

Celluloid and parody notwithstanding, a new health facility environmental services (EVS) manager should recognize that many important leadership principles may be gleaned from symphony orchestra conductors. There are many similarities between a conductor and an EVS leader because, in the final analysis, common themes are performance and creating an experience.  

It can also be appreciated that the orchestra itself exemplifies several key aspects of teamwork — from the nexus of the conductor’s first baton cue to the coalescence of tone, timbre, pitch and intensity, arriving at a single dramatic musical cadence — and is therefore a great analogy for EVS leaders.  

When a symphony orchestra is in sync, even the rows of violin bows move back and forth together in choreography. So, it comes as no surprise that the etymology of the word “concert” is “agreement, accord, harmony” ... essentially working together.

Leadership perspectives

To introduce a different approach to leadership perspectives through the juxtaposition of an otherwise unrelated vocation, following are eight leadership principles that can be learned from symphony orchestra conductors:

1. Have a plan. In health care, it is imperative to develop strategic, financial, capital and quality improvement plans to provide the underpinning ballast and road map to guide where an organization wants to go and by when. Written plans are the foundation upon which to overlay policies, procedures and ultimately performance activities. 

In symphonic music, the plan the conductor follows is called the “score.” A leadership imperative in health care is to know the score. In other words, know the plan intimately, and own it, communicate it, set the pace and follow it. 

Stokowski not only knew the scores intimately from which he conducted, but would continually mark them for reference, monitoring and changes. During performances, his flair for theatrics included grand gestures such as throwing the sheet music on the floor to show he did not need to conduct from a score. Histrionics aside, Stokowski really did know his plan that well, and so should health care leaders.

EVS leaders and administrators should participate in the development of the organization’s strategic business plan and become familiar with the organization’s plans, priorities, operating budgets, financial imperatives and policies. Then, they should align departmental management of operations accordingly. 

In addition to the development of departmental policies and procedures, the EVS leader should be consulted in the development of the hospital’s infection prevention and control plan and become very knowledgeable in inpatient nursing procedures as they pertain to isolation rooms, bed turnover, discharges and utilization as well as procedures for the perioperative services department pertaining to cleaning and preserving an aseptic surgical environment in accordance with Centers for Disease Control and Prevention and Association of periOperative Registered Nurses standards and recommended practices. 

2. Build a team. The imperatives of teams and team building are certainly not new to management in most organizations. In business, the air is awash with familiar expressions and catch phrases reinforcing the basic concept of working with one another, team commitment, integration, collaboration, benefiting from diversity and different strengths, and so on. But building the best EVS team starts with an understanding of the job and the core values, vision and strategy of the organization. From there, the leader can select and recruit the right balance of talent and experience.

Good performers beget good performances, so leaders must seek to build their teams and recruit the most promising candidates. This is evident in the orchestra as well as in business. Whether it is a department, management staff, committee or ad hoc group, one of the first signposts is to develop a team of individuals who will bring about success.

Equally important is that talent is revealed, harnessed and optimized by ensuring the right players are in the right roles. Getting the right people on the bus is a popular analogy and concept developed in the book Good to Great by James Collins. According to Collins, those who build great organizations make sure they have the right people on the bus and the right people in the key seats before they figure out where to drive the bus.

In context, how would an orchestra sound if all the musicians suddenly switched instruments just before a concert? It would be dreadful. Individually, they’re all great musicians, but not if the instruments and the parts are wrong.

It is imperative for EVS leaders to become very familiar with line staff and the management team. They should optimize individual strengths and passion, and motivate and enhance the team with training, recognition and inspiration. 

3. Engender trust. Leading others should not be based upon the fact that the leader simply occupies a particular position on a corporate organizational chart. International management consultant and author Ken Blanchard once said, “In the past, a leader was a boss. Today’s leaders must be partners with their people ... they no longer can lead solely based on positional power.”

Orchestral conductors, by the very nature of their position, provide several incontrovertible reasons why it would be best to trust them and to follow them. So why would folks want to follow the conductor? Conductors like Stokowski have the full score and hence see the full panoply of where things should be going, how to get there, and how the bits and pieces are spliced together to make music.  

The conductor’s metronomic baton gestures ensure everyone is rhythmically on the same page. Without this leadership, the music could degrade into an improvised aleatoric jam session.

Position or title on the organizational chart notwithstanding, the reality is that authority is a two-way understanding and, at best, fleeting without a bedrock of trust. To that end, EVS leaders must be clear about performance expectations, consistent in their management, fair in decision-making and devoid of bias to the furthest extent possible. 

4. Drive accountability. It is imperative that orchestra conductors help create an organization that holds individuals, sections and the entire ensemble accountable to their portion and contributions to the given endpoint: a great experience. This precept has far-reaching application across the spectrum of fields and organizations into the health care environment.

In his books The Accountability Revolution and Creating the Accountable Organization, author Mark Samuel first debunks the myth that accountability is a way to blame someone for making mistakes and then suggests that it is the key to increasing trust and improving morale and performance. However, Samuel states that one simple way to drive accountability is to “not allow (individuals to) perform poorly without making it clear that their performance is unacceptable ...”.

In a symphony orchestra, musicians must own the results, be responsible for the outcome and embrace their contributions to the outcome, whether it is met with cheers or jeers. As the orchestra conductor must foster individual and team accountability, so should an EVS leader. It starts with a clear understanding of what is expected of teams and individuals. 

5. Recognize interdependence. The dictionary defines interdependence as the quality or condition of being mutually reliant on each other. 

Several authors and leaders have referenced the concept of interdependence throughout history. In a 2009 publication, Stephen Covey said, “ ... we live in an interdependent reality. Our most important work, the problems we hope to solve or the opportunities we hope to realize require working and collaborating with other people in a high-trust, synergistic way …”.

For the symphony orchestra to pull together, the confluence of all layers, sounds, tones and rhythms must coalesce into a mellifluous cohesive musical amalgam with all of the musicians participating interdependently — but mutually dependent on each other. That said, as the score is interpreted, the conductor must not only imagine how the music will sound but also how each instrument’s capabilities, range, dynamics, tone and timber contribute to the whole form.

The concept of connection is much deeper than the integration of orchestral players or departments along the care pathway. The conductor (and the EVS leader) must first know how to connect and then to make the connection with people. To optimize the potential synergy harnessed through interdependence, EVS leaders must realize that their “orchestras” get a little bit bigger. In addition to the EVS worker, mutual reliance and collaboration should also include, at the very least, infection control practitioners, nursing and other clinical staff, and facilities professionals. 

As stated earlier, the importance of team building cannot be overstated, but from there, different interdependent teams relying on each other and the underpinning foundation of trust go hand in hand. 

6. Encourage innovation. Just because leaders work from a score or a plan doesn’t mean they should allow themselves to hold fast to a needlessly narrow view of procedure and execution. Stokowski not only made alterations to scores but altered the seating arrangements of the sections as well as the acoustics of the hall to create better sound. Late in the 1929-30 season, he actually started conducting without a baton (like the cartoon), and his free-hand manner of conducting became one of his trademarks.  

This is an important example for EVS leaders. Fred Lee, acclaimed author of one of the definitive books on quality and service culture — If Disney Ran Your Hospital — stated that “… if necessity is the mother of invention, dissatisfaction must be the father of improvement ...”.

EVS leaders should recognize that this way of thinking is in lockstep with basic principles of a high-reliability organization — in particular, preoccupation with failure and deference to expertise. Encouraging innovation starts with an appreciation for and willingness to yield to and optimize the expertise of staff. 

If a staff member is an expert in floor care, let this person take the lead. If another has infection prevention experience, listen and allow this person to advise on new surface disinfection procedures. 

7. Count. Leaders must set and keep the pace, and account for the finances, performance data, and anything else meaningful and quantifiable.

Music can be broken down to math — intervals between notes, rhythm, even the tones themselves are vibrations that are differentiated by the unit of frequency. The orchestra conductor is literally immersed in math ideas. The conductor, of course, realizes the importance of counting. 

Similarly, the progressive EVS leader must track, monitor and improve performance by the numbers as a conductor would continually refer to the score; this includes performance-related goals, objectives and their corresponding metrics, performance data, financial statements, invoices and material requisitions, charts, graphs and other effective tools of monitoring performance, quality, and statistical analysis.

Among the tools to help EVS managers gauge and quantify patient perspectives is the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. According to the Centers for Medicare & Medicaid Services, the HCAHPS survey is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. Garnered from patient feedback, these data can be effective in helping EVS leaders to quantify performance, benchmark, and establish meaningful performance dimensions and goals. 

EVS leaders should avail themselves of the HCAHPS results and continually review and monitor these scores as they pertain to their facility and department.One of the specific HCAHPS questions concerning the hospital environment is, “During this hospital stay, how often were your room and bathroom kept clean?” While this number may appear quite specific, it is indicative of how the patient perceives overall cleanliness, attention to detail and service. 

8. Communicate. With all that said, not everything that counts is necessarily counted. While the conductor’s baton provides the beat and tempo, the other hand typically cues dynamics, feelings and that intangible “passion.” Both are extremely important aspects of communication. Good communication doesn’t necessarily have to take the form of official formal meetings, emails or memos.

In leadership, the importance of good communication and an effective style of communicating and engaging others should never be marginalized. A good leader must effectively communicate the core values of the organization and the vision, long-term strategy, objectives, tactical plans, and proper procedures and techniques like a conductor continually communicates the score. 

Renowned composer and conductor Leonard Bernstein once said, “Technique is communication: the two words are synonymous in conductors.” In a film of Leonard Bernstein conducting his own work, he sometimes stopped the baton gestures and cues and would only listen for a few measures, gracefully bouncing with his arms down as if dangling on a single string like a marionette. 

The learning is that there are times when the EVS leader should take a step back, stop directing, and simply listen and pay attention to what the EVS team has to say. A good, healthy dialogue often will move the team forward better than a soliloquy.  

Written communication is effective and will deliver the right message when the text is succinct, grammar and syntax are correct, and the intent and direction are clear and understandable. EVS leaders must always be objective, balanced and transparent in their communications and, like Bernstein, willing to listen. 

In communicating to staff, the technique of health care EVS leaders must keep staff apprised; talk often through huddles, staff meetings and other gatherings; be open to ideas, honest and unafraid to broach the tough subjects; and be transparent, direct, respectful, supportive and timely. 

One example of leadership communication with front-line EVS staff is through the performance evaluation process. The Joint Commission Human Resources Standard HR.01.07.01 stipulates that
“(T)he hospital evaluates staff based on performance expectation that reflect their job responsibilities.” The operative words here are “performance expectation.”

The first step in direct and honest dialogue between the manager and the employee is making sure there is a clear understanding of performance expectations. This also factors into the notion of driving accountability, as explored earlier. 

The EVS leader must effectively convey what is expected of the employee in terms of quality, productivity, safety, infection prevention and efficiency; and, during the same initial conversation, the employees should be made to feel comfortable communicating their expectations in terms of the support, guidance and tools they need to do the job.

This type of communication is the cornerstone of individual and team performance dimensions set for the ensuing performance year and should be monitored with periodic follow-up communication. The results of year-end performance evaluations should never be a surprise.

In health care, a communication breakdown is a harbinger of systemic breakdown. For the new EVS leader, this somewhat silly admonition underscores the importance of effective, consistent communication: “Communicate and you’ll be great. If you don’t … you won’t.”

All about performance

In the final analysis, it’s all about performance. This means the manner in which or the efficiency with which something reacts or fulfills its purpose. Simply put, performance is the way that EVS departments and symphony orchestras execute their jobs and deliver satisfaction. 

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Lloyd Duplechan is a retired hospital chief operating officer and is owner and principal of the health care environmental consulting firm Duplechan & Associates. He has also studied classical music and orchestral conducting. Duplechan can be contacted at duplechanlloyd@gmail.com.