Study Guide for Joe Tye's book The Florence Prescription

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, compl
aining, and other forms of toxic
emotional negativity.
5

The Florence Challenge for a
culture that is…
Emotionally Positive
Self Empowered
Fully Engaged

As a participant in
The Florence Challenge
we are asking you to:
7

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…
8

Take the seven simple promises
of The Self-Empowerment Pledge
to help you in your own life –
personally, professionally, finan
cially, and spiritually, and…
9

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?”
10

Are you willing to make
the commitment?
Are you ready to start?
13

Study Questions
for Chapter 1
14

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
15

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?
16

If Carol Jean Hawtrey spent an hour
sitting in the cafeteria of your
hospital, what sorts of conversations
would she be likely to hear?
17

“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?
18

Is it important for people to know
and embrace the values of the
hospital they work for?
Do you know and embrace the values
of the hospital that you work for?
19

Study Questions
for Chapter 2
20

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.
21

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?
22

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?
23

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?
24

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”?
25

Carol Jean describes eight essential
characteristics of a culture of ownership:
Commitment, Engagement, Passion, Initiat
ive, Stewardship, Belonging, Fellowship
and Pride.
Are any of these superfluous, and has
anything important been left out?
26

Study Questions
for Chapter 3
27

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.
28

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?
29

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?
30

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?
31

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)?
32

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)?
33

Study Questions
for Chapter 4
34

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.
35

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?
36

“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.
37

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?
39

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?
40

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?
41

“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?
42

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”?
43

Study Questions
for Chapter 5
44

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
45

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?
46

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).
47

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?
48

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?
49

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 organization?
50

Study Questions
for Chapter 6
51

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.
52

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?
53

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?
54

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?
55

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?
56

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?
57

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?
58

Study Questions
for Chapter 7
59

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.
60

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?
61

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?
62

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?
63

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!
64

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?
65

Study Questions
for Chapter 8
66

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.
67

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?
68

Carol Jean says that most hospitals are
very hierarchical and status-conscious.
How true is that of your hospital?
69

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?
70

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)?
71

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?
72

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?73

Study Questions
for Chapter 9
74

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.
75

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?
76

“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?
77

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?
78

“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?
79

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?
80

Study Questions
for Chapter 10
81

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.
82

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?
83

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?
84

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?
85

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?
86

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?
87

Study Questions
for Chapter 11
88

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
89

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?
90

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?
91

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?
92

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?
93

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?
94

Study Questions
for Chapter 12
95

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.
96

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?
97

Do you agree with Carol Jean that caffeine
is the drug of choice for people of genius?
98

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?
99

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?
100

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?
101

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?
102

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?
103

Study Questions
for Chapter 13
104

638 readers of the Spark Plug
newsletter respond to the 12
questions in The Culture
Assessment Survey.
Two questions particularly pertain
to this chapter…

46% agree or strongly agree;
54% unsure or disagree

Only 8% of respondents strongly
agree that their coworkers reflect
positive attitudes, treat others
with respect, and refrain from the
behaviors of toxic emotional
negativity! Even worse >>>>>>>>

More than half of respondents
either disagree with or are
unsure whether their
coworkers have positive
attitudes, treat others with
respect, and refrain from toxic
emotional negativity!!!!!!!

Would our answer for this
organization be better – or
worse? Are we okay with
that?

Responses from the current survey

67% of respondents believe
that more than 10% (or more!)
of all paid hours where they
work are wasted on toxic
emotional negativity!!!

What is the cost of all that
toxic emotional negativity on:
 Productivity
 Patient experience
 Morale
 Innovation

How much more productive
would your organization
be, how much more engaged
would your people be, and how
much better would your
customer satisfaction be if…

All those many thousands of
paid hours now being wasted
on toxic emotional negativity
could be transformed into a
positive contribution?

Since culture doesn‟t change
until people change (culture
being the collective of their
behaviors), what can you do to
help your people change their
attitudes and behaviors?

Sarah Rutledge challenged her colleagues
to take The Pickle Pledge – should we?
116

How would we answer Sarah‟s questions:
 How much better off would we be in
our own lives if we were to take to heart
The Pickle Pledge?
 Would this be a better place to work
and would we do a better job of caring
for our patients if we all took to heart
The Pickle Pledge?
117

What creative ideas can we come up with
to promote The Pickle Challenge here?
118

Study Questions
for Chapter 14
119

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.
120

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?
121

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?
122

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?
123

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?
124

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.”
125

Study Questions
for Chapter 15
126

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.
127

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?
128

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?
129

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?
130

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?
131

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?
132

Study Questions
for Chapter 16
133

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?
134

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?
135

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?
136

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?
137

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
138

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?
139

Study Questions
for Chapter 17
140

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.
141

Sarah Rutledge described the recovery of
Timmy Mallory as a miracle.
Do miracles really happen in hospitals?
142

Let‟s do a quick
review:
The 8 Essential
Characteristics of a
culture of ownership
143

The Florence Commitment:
Refuse to participate in toxic
Replace the words “Not my job”
with “How can I help?”
145

Study Guide for Joe Tye's book The Florence Prescription

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Study Guide for Joe Tye's book The Florence Prescription