Extreme Ownership – How to Lead and Educate Patients and Employees

Jun 19, 2017
10 min read

Anyone who has ever had a patient who did not follow the treatment plan, raise your hand.

Anyone who has ever had a staff member make a mistake under your watch, raise your hand.

Chances are, a lot of hands are in the air right now.

Now raise your hand if you think you’re responsible for all of those outcomes.

I’m guessing fewer hands went up this time. But guess what? It is.

“Extreme Ownership,” is a concept detailed in a recent book by the same name authored by former Navy SEALS Leif Babin and Jocko Willink. In the book, the authors describe how leadership lessons in the military apply to leadership in business or any other context.

The prevailing message is a simple one.

If a mistake is made by anyone you oversee, you – to some degree – are responsible for it. Regardless of circumstances, the fact that you’re the leader requires you to take ownership of the outcome. And, you are then responsible for making a change to ensure it doesn’t happen again.

By accepting responsibility and vowing to pursue options to fix the problem, you communicate that your ego is not superior to the mission. As a result, you earn significantly more respect from those you’re leading. You teach them a lesson about responsibility through example, not by pointing fingers or finding a scapegoat.

Others will follow your example.

Those you lead will be more willing to come forward and accept responsibility for mistakes they’ve made and look for solutions. Ultimately, it’s about building trust, solving problems, and avoiding blaming others.

At this point, you’re probably thinking to yourself, “How can I control what others do? It wouldn’t be fair that I be liable for their mistakes.”

It’s true that you can’t control what you’re patients and employees ultimately do.

And, you don’t really want to.

There is a certain amount of autonomy needed for the individual to do any task efficiently. What you can control is how you communicate to them what the task/goal is and what tools and strategies would be useful for completing it.

Whether you’re instructing a patient or an employee, it’s your responsibility that they understand what you want them to do. More importantly, they need to understand WHY you want them to do those things.

“Duh” is probably the response that comes to your mind. But, I’m amazed at how often we don’t give an explanation as to why we do the things we do.

Top take the explanation of WHY a step further; it’s more important to explain HOW it all fits into the bigger picture.

For a patient, explaining the effects of a treatment on their daily lives will help give it more meaning.

For example, you’re starting someone on latanprost at bed time. No one says, “Take these drops before bed” and leaves it that, at least I hope not.

The best patient education involves a brief overview of the problem and the treatment followed by an explanation of WHY in a context that is meaningful in their lives.

Consequently, you can’t use the exact same script with every single patient, but you can use the template in every interaction.

Here’s an example:

“Taking these drops is very important and here’s why. They lower the pressure in your eye and that lowered pressure helps prevent or slow the progression of peripheral vision loss that results from glaucoma (I’m assuming you’ve explained glaucoma at this point). This way we keep your visual field as wide as possible. We want to make activities like driving/navigating your house/keeping an eye on multiple grand kids, anything where you rely on your side vision, as easy as possible for you. One thing you have to keep in mind is that glaucoma is a slow and painless condition; chances are you won’t notice any improvements in your vision from taking them. That doesn’t mean you get to stop whenever you want! With these drops, consistency is the key so make it part of your evening routine, brush your teeth, take your drops. One drop, each eye. Are you comfortable putting drops in your own eyes? (if not, teach them.) Easy enough? If you feel like you want to stop taking them FOR ANY REASON. Call the office. If you’re about to run out and need a refill; call the office. Even if you’re coming to see me a few days later. I want to know what your pressures after you’ve taken the drop the night before. If they burn, make you sleepy, give you headaches, etc., we can make change. If you forget anything, have more questions, or just want to chat. Don’t hesitate to call.”(Additional follow up info and pharmacy details should be discussed as well).

You’ve explained how the treatment works (drop the pressure, prevent vision loss), you’ve explained how it fits into the larger context of their life (how peripheral vision is important to everyday activities) you’ve explained why it might feel drops aren’t making a difference, you’ve confirmed they know how to get drops in (or don’t know how to), you’ve suggested ways to incorporate the act into their routine, you’ve reinforced that questions are encouraged and that the line of communication is open.

They no longer have an excuse for non-compliance.

It may take some time to get through everything; but, you’ve spent a significant amount of time coming up with your plan.

Why risk blowing it with a poor explanation? A comprehensive script reduces that risk. Often, it will feel like you’re explaining painfully obvious bits of information. But, many patients won’t speak up if they don’t understand or will simply ignore your advice if they don’t think it’s important. You have to be clear and provide context to ensure they are getting the best possible care.

Fortunately, you can use the same communication strategies with your employees.

When one inquires as to why they have to do a certain job, saying “because I said so” is the fastest way to ensure that task doesn’t get done.

If you can’t articulate the reason, it must not be that important. Either that or you’ve never taken the time to figure out how the tasks connect with the bigger goals of your practice. That’s why having a clear mission statement and practice values are so critical.

For example, one of your employees might be responsible for keeping the exam lanes cleaned up. You instruct them to clean the sink, wipe down the chair and equipment, take the trash out, etc. Another item that is probably on the list is to wipe down the top of the mirror frames if your lane is mirrored.

With no explanation, most employees will nod and smile. But, they may be thinking, “That seems a bit excessive, no one can even see up there. I’ll probably have to get a step stool to do it, that’s a lot of work.” Eventually, you might find yourself collecting dust as you move your finger over the mirror. Instead, communicate why it’s important.

“…..and I want to wipe down the frames of the mirrors to get the dust off. I know no one under 6 foot 7 can see up there, but guess what happens when the little old lady waiting for the doctor is in here? She looks for places that collect dust. She’s been hunting for the stuff for longer than you’ve been alive. She might even reach up and run her finger across it. When her finger comes back clean, she’ll know she picked the right office. And when she tells her friends and family about what a wonderful experience she had, it will start with ‘The office was so clean….’ It sounds a little excessive, but the little things are the big things. You doing your job helps everyone in the office create the best experience for the patient. And without them, none of us would be here.”

Yes, the example is dramatized for effect; but, you get the idea.

You’ve given the seemingly trivial and annoying task context in the bigger mission. If the task still doesn’t get done, the chance it is a subordination issue is much more likely than a communication issue.

Now that’s not to say you’re going to be hitting homeruns every single time. People won’t listen to you no matter how skillfully you provide them with the necessary information. That’s just human nature. But, I think these cases are much rarer than we care to believe.

The first person you should be questioning when something doesn’t go quite right is yourself. Did you truly communicate the ideas and instructions to the best of your ability? Or did you omit some seemingly trivial information that proved to be essential.

Patients that I have educated to “take these drops four times a day”, put four drops in each eye first thing in the morning and called it good for the day. I could have blamed them, but they truly followed my directions. Now my previous instruction is followed by, “BREAKFAST, LUNCH, DINNER, BEDTIME!”

Most patients laugh or roll their eyes, but it gets the point across. Chances are you’ve had similar experiences and if you haven’t made changes to prevent it from happening again, you haven’t fully taken responsibility. By not doing so, you’ll only become frustrated and defensive when the issue arises again.

Here’s what we have to remember.

Are patients not following your instructions to personally spite you?

Are employees doing things incorrectly because they purposefully want the business to do poorly?

Is your boss making you fill out more paperwork to intentionally make your job harder?

Even though it may feel like the answer is sometimes yes, it isn’t. The reason any of this situations occur is almost always that the person you’re communicating with doesn’t understand what, why, or how. It truly is on you to make sure they get it. More often than not, a little extra effort to connect will make the difference.

About Steven Turpin, OD

Newest member of Cascadia Eye, an OD/MD group practice in Washington. Currently building a specialty lens practice from the ground up. Myopia control and contact lens design are my guilty pleasures.

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