study questions for the florence prescription
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Study Questions
The Florence
Prescription
Copyright © 2010, Values Coach
Inc.
and
The Florence
Challenge
1
By taking The Florence
Challenge our
organization is telling
the world that we:
2
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. 3
Encourage people to hold
themselves responsible and
accountable for their
attitudes and actions, and
to empower themselves to
do the right thing for
patients.
4
Expect a workplace
environment that is free from
finger-pointing, cynicism,
gossip, complaining, and other
forms of toxic emotional
negativity.
5
As a participant in
The Florence Challenge
we are asking you to:
6
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…
7
Take the seven simple
promises of The Self-
Empowerment Pledge to help
you in your own life –
personally, professionally,
financially, and spiritually,
and…8
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?”9
Are you willing to make
the commitment?
Are you ready to start?
10
Study
Questions for
Chapter 1
11
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
12
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?
13
If Carol Jean Hawtrey spent an hour
sitting in the cafeteria of your
hospital, what sorts of conversations
would she be likely to hear?
14
“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?
15
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?
16
Study
Questions for
Chapter 2
17
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.
The Florence Prescription, page 3918
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?
19
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? 20
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?
21
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”?
22
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?
23
Study
Questions for
Chapter 3
24
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.
The Florence Prescription, page 45
25
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?
26
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?27
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?
28
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)?
29
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)?
30
Study
Questions for
Chapter 4
31
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.
The Florence Prescription, page 53
32
Timmy Mallory fights cancer by slaying
dragons in his imagination, and
Myerson suggests a dragon-slaying
area on the pediatric unit. How might
a culture of ownership encourage
people to come up with the sort of
“crazy” ideas that can make a hospital
special?
33
“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.
34
35
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?
36
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?
37
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?
38
“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?
39
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”?
40
Study
Questions for
Chapter 5
41
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
The Florence Prescription, page 62
42
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?
43
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).
44
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?
45
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?46
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?
47
Study
Questions for
Chapter 6
48
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.
The Florence Prescription, page 72
49
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?
50
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?
51
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?
52
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?
53
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?
54
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?
55
Study
Questions for
Chapter 7
56
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.
The Florence Prescription, page 79
57
Carol Jean says that 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?
58
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?59
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?
60
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!61
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?
62
Study
Questions for
Chapter 8
63
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.
The Florence Prescription, page 91 64
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 “flavor of the month” syndrome?
65
Carol Jean says that most hospitals are
very hierarchical and status-conscious.
How true is that of your hospital?
66
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?
67
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)?
68
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?
69
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?70
Study
Questions for
Chapter 9
71
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 Florence Prescription, page 104
72
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?
73
“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?74
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?
75
“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?
76
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?
77
Study
Questions for
Chapter 10
78
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.
The Florence Prescription, page 117
79
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?
80
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?
81
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?
82
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?
83
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?
84
Study
Questions for
Chapter 11
85
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.
The Florence Prescription, page 12786
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?
87
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?
88
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?
89
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?
90
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?
91
Study
Questions for
Chapter 12
92
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.
The Florence Prescription, page 14293
What was your reaction to reading
about members of the MMC Quality
Improvement Leadership Team (QILT)
reciting 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?
94
Do you agree that caffeine is the drug
of choice for people of genius?
95
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?
96
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?97
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?
98
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?99
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?
100
Study
Questions for
Chapter 13
101
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.
The Florence Prescription, page 155
102
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?
103
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?
104
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?
105
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?106
If you were a consultant, what advice
would you give 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.”
107
Study
Questions for
Chapter 14
108
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.
The Florence Prescription, page 166109
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?
110
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?
111
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?
112
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?113
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 could help
people cope with them?
114
Study
Questions for
Chapter 15
115
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?
The Florence Prescription, page 183
116
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?
117
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?
118
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 moonbeam119
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
120
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?
121
Study
Questions for
Chapter 16
122
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.
The Florence Prescription, page 190123
Sarah Rutledge described the recovery
of Timmy Mallory as a miracle.
Do miracles really happen in hospitals?
124
Let’s do a quick
review:
The 8 Essential
Characteristics of a
culture of
ownership
125
126
The Florence Commitment:
Refuse to participate in toxic
emotional negativity.
Replace the words “Not my job”
with “How can I help?”
127
128
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