Marina Gorbis's Blog, page 785

How One Hospital Improved Patient Safety in 10 Minutes a Day

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Most modern health care improvements seem to involve expensive technology and an uncomfortable amount of change management. But clinical and nonclinical staff at the Rotterdam Eye Hospital have improved patient care and raised staff morale at a very modest cost: 10 minutes a day and a special deck of cards.

Members of the hospital’s design thinking team were inspired by something they saw when they boarded a KLM Airline flight: During a pre-flight huddle of the cabin crew, team members introduced each other and then asked each other two questions on flight safety.

When they got back to Rotterdam Eye Hospital, the managers asked themselves why couldn’t they add a similar feature to their own “team-start” huddles? After all, in some ways, the situations were similar: A group whose members may not have worked together before must form a close-knit team quickly and execute their duties in a way that meets the organization’s guidelines to the letter.

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To test the idea, hospital managers developed a special patient-safety card game that encouraged coworkers to work together more easily and reinforced their knowledge of core safety and patient care principles. (One of us, Roel, designed and ran the initiative; the other, Dirk, studied it.

Now, a number of other hospitals and long-term care organizations in the Netherlands have started playing the card game too. In 2016 and 2017, a nursing home and a rehabilitation center from Zorgpartners Midden Holland near Rotterdam also adopted the “team-start” huddle and card game and have seen similar improvements in patient care and staff morale.

Here’s how it works:

At the start of every shift, the team members get together for a brief “team-start.” Each team member rates his or her own mood as green (I’m good), orange (I’m okay but I have a few things I’m concerned about) or red (I’m under stress). The rest of the team doesn’t need to know that you’re under stress because you’re having a dispute with your landlord or you are worried about your ill toddler. How you feel, however, is important because it affects how you should be treated.

Next, the team leader asks if there is anything in particular the team needs to know to work more effectively together that shift: For example, “Is there a delay in public transport so we can expect patients to be late for their appointments?,” or “Is there a patient with some kind of special need coming in?”

Sharing the answers or results generated by the card questions and activities with the group ensures that the insights stick.

That’s it.

This routine might not sound like the makings of a significant advance, but Rotterdam Eye Hospital has experienced some significant improvements in service quality since it introduced the card game in 2015. First, the hospital’s performance on its patient-safety audits has risen, and caregiver job satisfaction has improved substantially, moving from 8.0 to 9.2 on a 10-point scale after staff began playing the game. The nursing home and rehabilitation center reported similar results.

The staffers have observed a variety of other gains as well. For instance, the game has encouraged team members to get to know each other better, and patients are reassured when team members are familiar with each other. (We conducted interviews with staff members in the hospital, nursing home, and rehabilitation center, and conducted an informal survey after the initial exercise.)

“The main advantage for me is that I know who I am working with today. Now I know their names and how they are doing,” one doctor said.

Other staff members gained a deeper understanding of the reasons behind certain protocols. “I now understand the importance of some patient safety measures more, and now I know how I contribute to them,” one cleaning person from the rehabilitation center said.

Finally, everyone gained a deeper understanding of the significance of their own job — not always easy in a centralized organization. “I now feel part of the caregiver team,” one nutrition assistant said. “I know now I am not only providing food but am part of making a patient feel safe.”

The game has also encouraged more sharing between members of the staff, particularly between people who often don’t have very many occasions to talk to each other such as cleaning people and doctors. One case in point: A question from the card game about what someone should do if he or she found medicine lying around prompted a cleaning person to mention that she kept finding pills in a patient’s bed, alerting the doctor to the fact that the patient was not taking the prescribed medicine.

Rotterdam Eye Hospital has also introduced the game to other members of the World Association of Eye Hospitals in the United Kingdom, Australia, and Singapore.

Although the game is not expensive to run, it does require management to do the following:

Design the particular card game you need. The card game must be tailor-made for your own culture and focused on your current challenges. A hospital, for example, might stress medication safety and hand hygiene, while a nursing home might focus on understanding the vulnerabilities of the elderly and end-of-life care. Each patient experience card game consists of at least six themes.

Make a commitment to the game. It won’t work if teams play only some of the time.

Require everyone on the team to participate. The game works because everyone knows that he or she is in the same boat and may be put on the spot tomorrow. And we mean everyone — not only the inpatient and outpatient teams but even people in HR and Finance.

We sometimes act as if health care organizations are big machines. But the fact is that the quality of health care depends ultimately on the collective performance of many small teams. The “team-start” huddle and patient experience card game suggests that performance can improve once we take into account the full perspective and emotional needs of the people who are actually delivering that care. The game is a great first step toward building that awareness.

Myths of the Gig Economy, Corrected

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Every day there are news stories about the so-called gig economy where workers contribute part or full-time labor — not as employees with benefits, but as independent contractors. Dara Khosrowshahi, the CEO of Uber, the ride-sharing giant, proudly declared on September 10 that “very few brands become verbs”. The same week Upwork, a platform for hiring freelancers, filed for an IPO, as did Fiverr, which boasts that it offers a “freelance services marketplace for the lean entrepreneur.” Indeed, the gig economy has not only turned millions of Americans into contractors, but it’s given the more successful entrepreneurs the tools to grow even faster. A fast-moving startup can secure talent as it needs it, outsource more quotidian tasks like payroll, and stay lean and mean; indeed, I see entrepreneurs employ this approach through my work at EY supporting creative, successful startups.

But there are lots of myths about gig work, whether full-time or part time. It’s growing, but not as much as you think, and in ways that may be very different than you imagine. It might even be better for older executives than recent grads. Here are a few myths worth dispelling.

Myth No. 1: Millennials love to gig. There is a common perception that somehow the millennial generation just loves part-time, gig employment. But a recent study by EY found a more complicated picture: Sixty percent of millennials — those born between 1981 and 1996 — were not involved in the gig economy at all, and only 24% report earning money from the gig economy. In fact, the percentage of millennials with full-time careers is rising at a brisk clip from 45% in 2016 to 66% in 2018, according to the data we collected. That reflects a growing economy that’s offering more full-time employment, but it also shows a generation that may want the same thing as their parents: Steady jobs with a clear advancement track and benefits such as health insurance and paid time off.

Myth No. 2: We’re all going to be giggers. The size of the gig economy and how fast it’s growing also seem to be over-imagined at times. The measurements can vary a lot and so can the predictions for how much it’s likely to expand. Back in 2013, a much-touted survey suggested that by 2020 — just over a year from now — a whopping 40% of the workforce would be so-called contingent workers, a number that would include contractors, temps and the self-employed. But here are the facts: the best estimates according to the Gig Economy Data Hub, a joint project of Cornell University’s Institute of Labor Relations and the Aspen Institute, put the percentage at around 30%. That’s a lot and it’s growing. But don’t think the world as you know it is completely disappearing. Only about 10% of workers rely on gig arrangements for their full-time jobs. And on-demand services where you get your next gig from an app like Lyft or Task Rabbit represent an even smaller percentage of gig workers. In fact … less than 1% of workers have used online platforms to arrange work in the past month. Most workers are still grabbing extra hours the old-fashioned way — tending bar or temp work on the side — not by being digitally summoned.

Myth No. 3: Gig is better. In our 2018 EY Growth Barometer, an annual global survey of middle market company leaders, we found some movement away from part-time and gig hiring. Most companies are still committed to full-time hires for all of the advantages that bestows — loyalty, retained knowledge, institutional memory, stealing top talent from the competition. In many cases, you have jobs in which the worker is integral to a team or needs to be supervised. That’s why so many of the entrepreneurs I know use the gig economy where they can, but they also have a deep and abiding interest in hiring great, full-time talent. A gig-based businesses can’t transmit “a culture” in a traditional sense. “You have individuals doing things you have no supervision of, other than the work itself,” said D. Quinn Mills, a professor of business administration at Harvard Business School, in an interview. Mills noted that while the gig economy can benefit companies and is likely to expand, it’s not for every business.

Myth No. 4: Gig work is unfulfilling. There’s a perception that gig jobs are dead-end jobs. Not true. Consider Jody Greenstone Miller who has had a stunning career from the White House to the Walt Disney Company. The Los Angeles lawyer-turned-entrepreneur is the co-founder and CEO of Business Talent Group (BTG), which pairs high-end talent with high-end expertise in areas such as finance, operations, and mergers and acquisitions at companies such as Pfizer, Kraft, and MasterCard. Miller said in an interview that her that stable of top talent wants “to be able to choose who we work with and what we work on.” This lines up with EY’s recent findings. On a global basis, according to our 2018 Growth Barometer, a lack of skilled talent is a bigger headache for US companies than for those in other countries, with 25% of US survey respondents citing this as a challenge to growth compared to 10% of their counterparts elsewhere. With U.S. unemployment at a historic 40-year low, there just aren’t the numbers of suitably qualified people in the talent pool to hire.

Lisa Hufford, a consultant author of Navigating the Talent Shift, has worked with gig talent for years. She’s seeing first-hand that while the gig economy isn’t the answer to all problems, it can help startups meet their talent needs at lower costs and help mature companies grow. It can also be a surprising boon to baby boomers and Generation Xers. “We were raised at a time when there weren’t a lot of options, and now there are so many choices,” says Hufford, a member of Generation X, in an interview. “For people who didn’t grow up that way, it can feel overwhelming. I like to help people navigate that shift. They realize they have a lot of skills that companies want and a lot of options. It’s kind of cool.”

Power Sales Performance by Harnessing Analytics - SPONSOR CONTENT FROM TABLEAU

By Brian Selby, Senior Vice President, Worldwide Sales Operations, Tableau Software

How often is your sales team making important decisions based on gut feel? Are you sure that deal will close this quarter and was it optimally priced? Are your sales resources allocated properly to drive growth?

In my experience, when sales organizations make major decisions and plans based on gut feelings, there are costly consequences. One company missed its fourth-quarter forecast by a significant amount and had to reset all quotas for the next year, delaying quota distribution by several weeks. Another sales team relied too heavily on experience and judgment to make pricing decisions for large deals and left millions of dollars on the table. One company failed to leverage its data on relative productivity of sales reps across geographies and inefficiently allocated scarce sales resources to the right growth opportunities.

In a world where data is everywhere, too many companies fail to take advantage of the power of data and analytics to fuel sales performance improvement.

Why does this happen in so many companies? Historically, sales has been labeled an art. Selling revolves around people, and with that comes emotion, beliefs, opinion, and the careful management of relationships with customers, partners, and others within the sales organization. Accessing data, and figuring out what to do with it, has been a difficult endeavor. However, with more modern business intelligence platforms emerging, and easier access to sales performance data, the application of science to selling has become a key differentiator in managing the sales organization. Companies that embrace data and analytics as the foundation for sales planning and performance management will achieve breakthrough improvement in sales productivity.

What could this look like? I’ve seen several use cases where advanced analytics have been applied to sales:

• Improved pricing and discounting: Many sales reps and leaders are time-constrained and haven’t been trained to effectively apply data analytics to pricing decisions. Oftentimes, it’s faster and easier to just offer the same pricing to customers or use the floor of the discount matrix to speed up the customer buying process. Typically, sales reps don’t know that other reps in their organization have achieved higher prices for the same deals with similar customers. This is an area where data and analytics can yield several points of margin improvement. With an advanced analytics platform mining all historical sales data, sales leaders can see where they are pursuing suboptimal pricing and challenge sales teams to reconsider their deal structures.

• Better forecasting accuracy: Sales leader judgment can be an important ingredient in forecasting deals, but human judgment often fares far worse than analytical models in assessing the likely outcome of deals and sales teams. The data does not lie. By leveraging data points on opportunities (e.g., the customer’s historic buying behavior, sales rep performance, product type, and sales stage), a predictive model can actually deliver a more accurate forecast than traditional “roll-up” processes can. Using these types of analytical models can also save countless hours in management meetings trying to analyze human judgment and adding “manager overrides” to lower-level forecasts.

• Reduced customer churn: Armed with a comprehensive profile of customer behaviors (e.g., support incidents, attendance at training classes, and website engagement), sales reps and/or customer success managers can more accurately identify at-risk customers and take preventative actions to prevent churn. Marketing outreach can also be tailored to target at-risk customers and increase overall engagement.

Establishing data and analytics as a foundation within the sales organization isn’t easy. Getting there requires leadership to invest time and resources into acquiring the right data, systems, and people to build these new capabilities. In my experience, it’s vital to build the right Sales Operations function with the charter and resources necessary to prepare and analyze data, synthesize the analysis into effective action plans, and drive change management across sales. These leading Sales Operations teams bring deep insight into performance improvement opportunities and become trusted advisors to leaders throughout the company. All of this is built on a solid foundation of data, from governance to preparation to analytics and reporting.

One Brand's Success in the "Science" of Selling

LinkedIn applied data and analytics to empower its sales teams with insights that drove success. Before, the company stored close to a petabyte or more of sales data using internal databases, Google Analytics, Salesforce.com, and third-party tools. One analyst serviced daily sales requests from over 500 salespeople, creating a reporting queue of up to six months, which left team members questioning their performance and the status of customer relationships.

The business analytics team adopted a new BI platform to centralize customer data and used dashboards to track performance and predict churn. To support even deeper analysis, they also leveraged predictive models in the BI platform to forecast churn—empowering sales to increase customer success within at-risk accounts. This has created a more proactive sales cycle and increased revenue. Michael Li, Senior Director of Business Analytics, said, “We decided to focus on how to scale the BI solution that we built and really provide the scalability and empower our sales team to get what they need in time. It became a one-stop shop for sales people to get what they need in a very self-service way.”

Today, 90 percent of LinkedIn’s sales force accesses the BI solution weekly. By tracking overall sales performance and digging deeper to understand the customer experience, sales now identifies when customers increase product usage and can proactively connect around opportunities to increase overall spend and avoid account churn.

Setting up the right processes, systems, and people to acquire, prepare, and analyze key sales data will enable better decision-making for any sales organization. By putting data at the center of your approach to sales planning and performance management, you will also be able to realize a breakthrough in growth and productivity.

Enabling the “Science of Selling”

Building a new capability to harness the power of analytics in sales begins with clean, prepared, and well-managed data. This data must come from a widely-adopted CRM system and should be analyzed by a robust, modern analytics platform. And as mentioned above, the right analytically-minded Sales Operations staff need to be in place to understand the data, glean insights from analysis, and recommend effective actions for sales leaders to take to improve performance.

1) Start with clean data

Enterprises already know the pain of disparate data sources, siloed departments, and legacy software—a broken infrastructure that hinders performance, growth, and development. Scaling advanced analytics enterprise-wide means having consistent definitions and sales practices. This also requires activating staff who will ask the right questions of data, perform analytics, and discern what must happen next.

2) Enable sellers with the right solutions

Globally, how is your CRM system being used? Is your account and opportunity hierarchy defined and structured the same way across teams—does “closed won” mean the same thing to your commercial sales team as it does to your enterprise team, to your teams in the UK and Australia, for example? Setting definitions and hierarchies within your CRM is a best practice that leads to cleaner data. Embrace an analytics platform with the capability to connect to your CRM and other data sources, which has intuitive data-prep tools and optimizes advanced analytics to provide a single source of truth. Then you can take advantage of modern business intelligence capabilities and scale quickly.

3) Hire inquisitive, driven, tech-savvy talent

Beyond standardization of data analytic definitions and processes, you need the right talent in place to set your organization up for success. Your sales operations staff are trusted advisors to the business and should have a seat at the table to support sales planning and resource optimization. For a true ROI in Sales Operations, they should not be relegated to back-office reporting but instead should have the organizational support and technology resources to apply advanced analytics. The right people, empowered with the right analytics platform, and backed by the right data, drives sale performance improvement.

To leverage data analytics to prosper as a modern sales organization and bring more science to your selling, visit the Tableau Sales Analytics Solutions page. This one-stop resource for all things data and sales, will support new and better possibilities for your sales operations.

Your Team Doesn’t Need a Data Scientist for Simple Analytics

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Arthur Nielsen, market research pioneer and founder of the Nielsen Corporation, once said, “The price of light is less than the cost of darkness.” As data proliferates across the enterprise, this observation by Nielsen is rendered even more relevant, because data represents the unlit fuel that has the potential to light the darkness, but which often lacks the spark of analytics that enables us to see.

The mission of enabling data analytics in today’s enterprise is hobbled by the lack of the requisite skills in the marketplace, including: advanced statistics/mathematics, new analytics methodologies, advanced systems analysis, business fundamentals, regulatory and legal understanding, and general IT technical and data architecture skills.

To cope with the shortfall in market supply, companies need to better leverage their existing talent. Having founded a data management company and worked with hundreds of organizations over the past 20 years to execute their information management and analytics initiatives, I’ve found the groups that are able to successfully utilize their company’s analytics technologies often take the following approaches:

Build a team. One strategy is to take the team approach to cross-pollinate and commingle the required skillsets; bringing together a diversity of skills and backgrounds from within your organization to achieve a common goal is a highly effective method.

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Start by identifying the characteristics and needs of your organization’s environment. For example, highly complex product and service environments will require domain experts or subject matter experts. Simpler product environments will require experts in operations, logistics, and supply chain. Formulate teams that reflect your particular needs, and consciously design your team’s framework and composition to transfer skills across functional or organizational boundaries.

Find the supporting players. I suggest going outside your department in order to lay the foundation for functional analytics initiatives. It will be productive to search across your organization for a few relevant skillsets that will enable your team to make use of the data available:

Data analytics experts: They understand the basics of analytics and can navigate between what’s possible and what’s relevant, using the latest methodologies and technologies available.
Data experts: They understand the data formats, the layout and content, especially the data schema and interrelationships.
Data architects: They know how data is stored and architected, including the plumbing that connects them. The perfect theoretical analytical approach can crash ignominiously when it takes an impossible amount of time to simply access the data. Particularly in these days of heady cloud adoption, one should be sensitive to latencies involved in moving data to and from the cloud.
IT technology and process experts: They understand the nature of the data flow and operational processes. They play an important role in leveraging available IT tools to access data while being aware of key issues.
Records managers: They are the curators of business records, both physical and digital. They know the locations of important documents and how they are categorized and catalogued.

Seek creativity and curiosity. The foregoing is a good start at convening a team of diverse skill sets in order to enable, if you will, “analytics for the rest of us.” However, there is one set of essential traits to be found in your team that will drive the initiative. Seek individuals who are innovative, frugal, and creative, who produce maximum results with minimal resources. In data analytics, such combinations of creativity and flexible thinking can make a huge difference in producing actionable results, while reducing time, effort, and costs.

For example, I spoke with one data analyst at a payments processor who claimed to predict riots with a high level of accuracy in the wake of the Ferguson unrest. One would have thought it was from comprehensive analyses of complex demographics and collections of red-flag news indicators of social discontent. It wasn’t. He simply tracked the sales of riot-related components such as crowbars and flammable fluids from major hardware outlets and looked for spikes in purchases that exceeded a certain threshold.

This combination of creativity and curiosity is difficult to teach but essential to effective analytics. Finding team members with such characteristics can make all the difference.

Make the data usable. Given that you’re unlikely to find an abundance of individuals with exceptional data management skills, it’s necessary to employ methodologies and technologies that present data in an accessible, visual, and intuitive fashion.

This has been demonstrated in our first-hand experience using internal enterprise data already under management for compliance and legal purposes to identify the “go-to” people in an organization. Rather than conducting complex analyses of high performance metrics, dictated by the type of role or function, and customized for each department or region, we used graphical analysis to discover a much easier proxy to get to the same approximate result: We analyzed individuals’ inbound communications to assess the frequency of questions and from how high up the organization they came, and then analyzed the outbound communications to assess the frequency of answers and to how high up the organization they went. The go-to people lit up like a fireworks display.

Note that this approach identified the top performers regardless of function or role, and took a fraction of the effort required in more traditional approaches. It is the technology that can make analytics tasks more intuitive and visual, thereby reducing the need for deep technical or statistical skills.

Consult legal and compliance stakeholders. Finally, in order to ensure that your analytics initiatives are in compliance with legal requirements and new privacy regulations such as GDPR and the California Consumer Privacy Act, it’s advisable to consult the right legal and compliance stakeholders:

Legal and Compliance Managers: They understand at a high level what data can be stored, and how they can be used, while minimizing the risk of running afoul of legal and regulatory guidelines.
Regulatory Data Managers: They understand which data is retained or deleted due to regulatory obligations, which can increase or reduce capabilities, and possibilities in data analytics projects.
Data Protection Officers: A new and timely role, these privacy experts can help analytics stay on the right path and avoid triggering penalties from incoming and expanding privacy regulations.

Lighting the Path Ahead

Data analytics is a powerful and promising source of competitive advantage. To enable such a strategy in the face of a difficult shortfall of the requisite talent in the marketplace, one must fall back on developing existing employees through cross-training and cross-pollination of team members and experts.

To embark on this strategy, we shouldn’t wait for that singular blazing torch-bearer to light the darkness. It is more pragmatic to help the rank-and-file member to become a candle, and from the collective light, illuminate the darkness.

4 Ways to Pressure-Test Strategic Decisions, Inspired by the U.S. Military

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Every leader wants to avoid major strategic mistakes, but, in a complex world, it’s hard to anticipate all the forces that might impact your goal. It’s vital to find weaknesses in your strategies before you implement them — and developing a rigorous process to do so.

The ability to poke holes in one’s own strategies is something the U.S. military has practiced and refined over centuries. Rick served in the U.S. Army for 35 years, retiring as a Lieutenant General, and has seen this firsthand. In the heat of battle, strategic planning that’s incomplete or simply wrong causes leaders to revert to on-the-spot decision making. While sometimes necessary, making it up as you go is more often associated with failure — and loss of life — and is often a symptom of ineffective or inaccurate anticipation of competitive moves or environmental shifts.

The same is true in business, and the techniques the military has honed can help executives anticipate problems and change course when necessary.

Build situational awareness

Simply put, situational awareness (SA) is achieved after a soldier has deliberately assessed an environment from various vantage points and has ensured that all potential perspectives have been captured.

In the business world, things are fuzzier — there are no landscapes, buildings, or troop movements to scan. But it’s still crucial to make sense of the environments in which we operate and foresee how different factors will affect our decisions.

One way to build one’s situational awareness is to talk through alternate realities. Although this sounds like science fiction, alternative realities are basically hypotheticals. We think X will happen, but what if Y or Z happens?

At Merck, where Jay served as Chief Strategy and Business Development Officer and President of Emerging Businesses, “alternate realities” were used to prevent “team think,” which frequently occurs when organizations believe the conventional view of a situation is the correct one.

To develop better situational awareness, start by forming  teams and tasking them to develop alternatives based on different views of the same situation. For example, what if a new competitor enters the market earlier than expected? What could they do that would surprise and/or outmaneuver us? What if they are delayed; what types of things might they do to try to recover and penetrate the market more quickly? Could any of their actions be extreme or desperate? What actions could and should our team consider mitigating or blunting the risk in these alternate scenarios?

The next step is to compare these hypotheticals collectively and then determine what counter measures will have the most impact.

 Most importantly, make sure to consider specific “triggers” that would indicate one or more of the alternative scenarios is unfolding. Agreeing on these triggers up front is useful because they prospectively define specific thresholds for change in action or direction. Once identified, you should track these triggers regularly on a dashboard that all senior team members see. This eliminates or greatly reduces debate when course changes become necessary and urgent. Then, make sure that group leaders complete an SA assessment regularly and discuss the alternate scenarios and triggers during each business review.

Small investments of time can result in new insights about your organization’s readiness, and your leaders’ acumen, that would have gone unnoticed until crisis.

Develop an outside-in perspective

This is another technique that’s routine in the military and can highlight unique but under-leveraged capabilities or untapped sources of competitive advantage. Think of aircraft. For a long time, the military used planes primarily to increase visibility of topography and troop movements, but starting in the early 1900s, the military began using planes to delivery ordinance and to conduct warfare. What are your organization’s aircraft?

Frequently, these are ancillary assets or capabilities that are often considered to be a “cost of doing business.” These could include a controlled global supply chain, unique abilities to test compounds, proprietary communication channels with key constituents, unique manufacturing machinery, etc. Think to yourself: In future scenarios, could any of these become new lines of business? If your environment changes unexpectedly could any of them help you to adapt?

In companies, an outside-in perspective can help shape an honest view of your organization’s strengths (and weaknesses). Customers can be a great source for this and forming a strategic advisory council is another option.

Game it out

Another practice is war-gaming, and there is often no substitute for putting real people into the mix to see how they react. Even complex AI simulation, while helpful, can lack the variability and ingenuity of human creativity. The US Military has become an expert in preparing for combat operations using war games.  Most notable is the establishment of the National Training Center in the Mohave Desert in California where the US Army conducts live, force-on-force battles to refine its capabilities.

At Merck, war-gaming exercises around critical decisions were used frequently. The best way to do this is to assign high performing managers to lead “opposing” teams, which should be made up of individuals with expertise across relevant functional areas. Before the exercise, make sure to prepare a background that  outlines the general challenge and provides specific information and data. A best practice is to task the line area most responsible for the situation with organizing and leading the overall exercise — and to make sure that each group presents their findings at the end. Incentivizing “opposing” teams for success will help ensure a robust simulation. For example, consider inviting a senior leader to judge the readout, and offering a cash bonus or team recognition for the winning team, or both.

Form diverse, strategic groups

Finally, form strategic initiatives groups, and populate them with people who can analyze problems from various perspectives.

At Merck, the strategic initiative group often came up with alternate decisions and actions on key business issues.  In one case, the choice to position a new product as second line treatment versus trying to displace a well-accepted initial therapy turned out to be uniquely advantageous, helping achieve a launch that far exceeded expectations.

When We Make All (or Most of) the Money

From the Women at Work podcast:

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Women are increasingly supporting our families financially. It can feel empowering to be the sole or primary earner, but many of us feel pressure to be both an ideal worker and an ideal mother. We hear from a woman who supports a stay-at-home husband and three sons.

Then, Alyson Byrne fills us in about the research on women as financial providers — for example, the more we financially contribute, the better our psychological well-being. (Yay.) She has tips on managing the professional side and the personal side of being the chief breadwinner. And Maureen Hoch, Women at Work’s supervising editor, shares her experience of being her family’s primary earner.

Guest:

Alyson Byrne is an assistant professor at the Faculty of Business Administration at Memorial University of Newfoundland.

Resources:

“Does a Woman’s High-Status Career Hurt Her Marriage? Not If Her Husband Does the Laundry,” by Alyson Byrne and Julian Barling
“Whether a Husband Identifies as a Breadwinner Depends on Whether He Respects His Wife’s Career — Not on How Much She Earns,” by Erin Reid

Fill out our survey about workplace experiences.

Email us here: womenatwork@hbr.org

Our theme music is Matt Hill’s “City In Motion,” provided by Audio Network.

When Companies Should Invest in Training Their Employees — and When They Shouldn’t

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According to one industry report, U.S. companies spent over $90 billion dollars on training and development activities in 2017, a year-over-year increase of 32.5 %. While many experts emphasize the importance and benefits of employee development — a more competitive workforce, increased employee retention, and higher employee engagement — critics point to a painful lack of results from these investments. Ultimately, there is truth in both perspectives. Training is useful at times but often fails, especially  when it is used to address problems that it can’t actually solve.

Many well-intended leaders view training as a panacea to obvious learning opportunities or behavioral problems. For example, several months ago, a global financial services company asked me to design a workshop to help their employees be less bureaucratic and more entrepreneurial. Their goal was to train people to stop waiting around for their bosses’ approval, and instead, feel empowered to make decisions on their own. They hoped, as an outcome, decisions would be made faster. Though the company seemed eager to invest, a training program was not the right way to introduce the new behavior they wanted their employees to learn.

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Training can be a powerful medium when there is proof that the root cause of the learning need is an undeveloped skill or a knowledge deficit. For those situations, a well-designed program with customized content, relevant case material, skill building practice, and a final measurement of skill acquisition, works great. But, in the case of this organization, a lack of skills had very little to do with their problem. After asking leaders in the organization why they felt the need for training, we discovered the root causes of their problem had more to do with:

Ineffective decision-making processes that failed to clarify which leaders and groups owned which decisions
Narrowly distributed authority, concentrated at the top of the organization
No measurable expectations that employees make decisions
No technologies to quickly move information to those who needed it to make decisions

Given these systemic issues, it’s unlikely a training program would have had a productive, or sustainable outcome. Worse, it could have backfired, making management look out of touch.

Learning is a consequence of thinking, not teaching. It happens when people reflect on and choose a new behavior. But if the work environment doesn’t support that behavior, a well-trained employee won’t make a difference. Here are three conditions needed to ensure a training solution sticks.

1. Internal systems support the newly desired behavior. Spotting unwanted behavior is certainly a clue that something needs to change. But the origins of that unwanted behavior may not be a lack of skill. Individual behaviors in an organization are influenced by many factors, like: how clearly managers establish, communicate, and stick to priorities, what the culture values and reinforces, how performance is measured and rewarded, or how many levels of hierarchy there are. These all play a role in shaping employee behaviors. In the case above, people weren’t behaving in a disempowered way because they didn’t know better. The company’s decision-making processes forbid them from behaving any other way. Multiple levels of approval were required for even tactical decisions. Access to basic information was limited to high-ranking managers. The culture reinforced asking permission for everything. Unless those issues were addressed, a workshop would prove useless.

2. There is commitment to change. Any thorough organizational assessment will not only define the skills employees need to develop, it will also reveal the conditions required to reinforce and sustain those skills once a training solution is implemented. Just because an organization recognizes the factors driving unwanted behavior, doesn’t mean they’re open to changing them. When I raised the obvious concerns with the organization above, I got the classic response, “Yes, yes, of course we know those issues aren’t helping, but we think if we can get the workshop going, we’ll build momentum and then get to those later.” This is usually code for, “It’s never going to happen.” If an organization isn’t willing to address the causes of a problem, a training will not yield its intended benefit.

3. The training solution directly serves strategic priorities. When an organization deploys a new strategy — like launching a new market or product — training can play a critical role in equipping people with the skills and knowledge they need to help that strategy succeed. But when a training initiative has no discernible purpose or end goal, the risk of failure is raised. For example, one of my clients rolled out a company-wide mindfulness workshop. When I asked a few employees what they thought, they said, “It was interesting. At least it got me two hours away from my cubicle.” When I asked the sponsoring executive to explain her thought process behind the training, she said, “Our employee engagement data indicated our people are feeling stressed and overworked, so I thought it would be a nice perk to help them focus and reduce tension.” But when I asked her what was causing the stress, her answer was less definitive: “I don’t really know, but most of the negative data came from Millennials and they complain about being overworked. Plus, they like this kind of stuff.” She believed her training solution had strategic relevance because it linked to a vital employee metric. But evaluations indicated that, though employees found the training “interesting,” it didn’t actually reduce their stress. There are a myriad of reasons why the workload could have been causing employees stress. Therefore, this manager’s energy would have been better directed at trying to determine those reasons in her specific department, and addressing them accordingly — despite her good intentions.

If you are going to invest millions of dollars into company training, be confident it is addressing a strategic learning need. Further, be sure your organization can and will sustain new skills and knowledge by addressing the broader factors that may threaten their success. If you aren’t confident in these conditions, don’t spend the money.

Using Bundled Payments to Improve the Patient Experience

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In 2013, The Center for Medicare and Medicaid Innovation launched the Bundled Payments for Care Improvement (BPCI) initiative, a program that proponents hoped could rein in health care costs by “bundling” payment for the full gamut of services that comprise an episode of care. The model certainly seemed like a good bet, as it would reward hospitals for reducing the cost of soup-to-nuts care for any of 48 conditions and penalize them for overruns. Indeed, bundled care for hip and knee replacement has been a dramatic success with clear savings and no increase in emergency department visits, readmissions, or 30-day mortality.

However, our research suggests that bundles may not work as well for other types of conditions. That doesn’t necessarily mean that the problem lies with the bundled payment model itself. Rather, we think it could lie with the fragmented nature of the patient journey in a dysfunctional system, which is exposed by medical bundles’ lack of impact. But before delving into that diagnosis, let’s step back and look at the research.

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With our colleagues John Orav and Jie Zheng, we used Medicare claims from 2013 through 2015 to identify admissions for the five most common medical conditions covered under the Medicare bundled payment initiative: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease, and sepsis. We calculated the costs of each “episode” — the hospitalization plus all costs in the 90 days post discharge — for hospitals that joined BPCI as well as hospitals that didn’t join (our control group). We then looked to see whether costs dropped more in the BPCI hospitals than the control hospitals after the program started. Overall, the average Medicare payment per episode of care across the five conditions — about $24,000 — dipped just a few hundred dollars, a statistically insignificant amount. In addition, there was no difference in the change over time based on whether hospitals were or weren’t participating in the program. We also didn’t find any differences in clinical complexity, length of stay, emergency department use or readmission within 30 or 90 days after hospital discharge, or death within 30 or 90 days after admission between the intervention and control hospitals. In short, for these five common medical conditions, bundled payment had no impact on costs or clinical outcomes — at least in the program’s first year.

We don’t know exactly why bundles were successful for hip and knee replacements, but not for medical conditions. Perhaps all the hospitals that signed up for the hip and knee bundles were much more motivated than the hospitals that signed up for the medical bundles. Or perhaps we just need to wait longer to see an impact of bundling on a wider range of conditions.

However, we suspect that these patterns reflect the complexity and fragmentation of the patient journey for common medical conditions as a cause and shed light on not only how we might help hospitals succeed under bundles, but how we might also improve patient experience.

Hip and knee replacements are discrete, pre-planned events with a fairly standardized and consistent patient journey, from pre-operative evaluation to scheduled OR date to post-operative rehabilitation, and with a single “captain” of the ship. The surgeon performing the operation is ultimately responsible for the entirety of that patient’s clinical course. For the patient too, there is an obvious point person before the admission, during the hospitalization, and after discharge. Most patients who have had a total joint replacement could tell you the name of their surgeon even years after the procedure, often with great fondness.

Medical admissions follow an entirely different course. Consider what happens to a patient coming to the hospital with a heart failure exacerbation. She certainly did not plan the admission, and may have no pre-existing relationship with the clinician she sees in the hospital. She sees the emergency department physician who happens to be on duty that day, and depending on clinical severity, bed availability, and the call schedule of the residents and interns if she’s in a teaching hospital, could end up admitted to a general medical service, hospitalist service, cardiology service, medical intensive care unit, or cardiac intensive care unit. Her care team could change daily, including the nurses and nursing assistants. During her stay in the hospital she may see cardiologists, internists, and nephrologists, as well as physical therapists, pharmacists, social workers, and discharge planners. At discharge, she may or may not be scheduled to come back to see anyone that was involved in her inpatient care, depending on where she wishes to establish or maintain cardiovascular follow-up, and there is likely no post-discharge protocol for follow-up and rehabilitation, nor formal relationships with the nursing facility or home health agency to which she is discharged.

To improve this patient’s journey though the health care system — and increase the chance that bundled payments can help her achieve better outcomes and help the system lower its costs — we first need to understand the journey. Patterns of care are heterogeneous for medical conditions compared with discrete elective surgeries. And perhaps the overwhelming complexity and fragmentation of the patient journey for most unplanned medical admissions explains both why medical bundles are hard, and why they are so very important.

The early failure of medical bundles is a window into the disjointed, piecemeal health system most of our patients (and clinicians themselves) experience. Even the first step for hospitals electing to participate in BPCI for a medical condition — trying to figure out who needs to be around the table to discuss improving care across the clinical episode — is not an easy one.  But rather than discourage us from using bundles as a way to improve care, this complexity makes it all the more critical to use mechanisms like bundled payment programs to incent health systems to change the paradigm. Hospitals can and should design and implement standardized clinical pathways and provide more coordinated, efficient care for medical conditions, and bundling may be a powerful policy mechanism to help get us there.

The five years of experience we have had with BPCI seems like a sufficient time to have learned a lot about it. And perhaps with more time and greater incentives hospitals will be better able and more willing to make the changes needed in care delivery for medical bundles to be effective and to create a better experience for patients. But for now, we are only scratching the surface, and there is much more to learn about the use of bundling for different conditions and different patients. Indeed, bundling is just one in a series of policy innovations that Medicare and others are experimenting with to move us past traditional fee for service. The road to better policy will be long and winding.  We can only hope that on the way we will discover much about more efficient care, and most importantly, ways to both control costs and improve outcomes that matter to patients.

Higher Wages Aren’t Enough to Turn Mediocre Jobs into Good Ones

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Facing a tight labor market as the holiday shopping season approaches, many retail companies will undoubtedly consider following the lead of Amazon, which recently announced that it is raising its minimum hourly wage for all of its U.S. employees, including those working at Whole Foods stores, to $15 — $7.75 above the federal minimum wage.

Higher wages are good for retail and other low-wage service workers. So, we applaud Amazon’s decision and hope others will do the same. Higher wages are also necessary for many companies that are stuck in a vicious cycle of bad jobs, bad operations, bad customer service, low productivity, and high costs. But higher wages alone are not enough to break this vicious cycle. Unless accompanied by other changes, higher wages will likely reduce company profits and will not turn bad jobs into good ones.

Drawing on the concept of “efficiency wages,” some economists argue that higher pay can by itself improve performance by enabling companies to attract and retain better people and by motivating employees to work harder. But without other changes, we expect these benefits to be small. As one of us has witnessed first-hand while working at a large retailer, even highly skilled and motivated workers will not be able to be as productive as expected because the company’s operational systems got in their way, wasting rather than maximizing their skills and enthusiasm.

We see roadblocks like this all the time and, if you do any store shopping, so do you. For example:

Constant display changes that take hours to set up and break down — hours that could have been spent on much-higher-value work like helping customers and trying out process improvements.
Last-minute promotion or delivery changes that require managers to spend their time on last-minute schedule changes, which then disrupt employees’ lives and drive absenteeism, turnover, and understaffing, all of which increases the likelihood of errors.
Employees who are not empowered to improve their work or solve customer problems. They need management approval for even the smallest things, such as accepting a return or making a price change. When they have an idea for improvement, they are shut down by a manager who is already overwhelmed with all the firefighting she or he has to do.
Equipment and technology — such as scan guns, refrigerators, and training or scheduling software — that frequently breaks down, forcing employees to spend hours on the phone with help desks or just go without critical equipment for days or weeks.
Stores overwhelmed by a daily stream of directives from headquarters, dozens of sales reports to read, and 100+ management tools to use.

Raising the minimum wage won’t make any of these obstacles go away. It just means companies are wasting their employees’ time and paying more for it. In addition, these obstacles will likely hurt motivation and increase turnover by reducing workers’ sense of achievement, pride, and meaning.

Higher wages may not even allow companies to meet workers’ basic needs if companies are not offering livable take-home pay, predictable schedules, and clear career paths.

Take-home pay. More than hourly wages, workers care about take-home pay. The U.S. Bureau of Labor Statistics cited $23,210 as the median annual wage for a retail salesperson in 2017, but that assumes a regular 40-hour week. In service industries like retail and fast-casual dining, that’s rarely the case. It is not uncommon to have more than half the employees working part-time and even so-called full-timers aren’t usually guaranteed 40 hours a week. Part-time hours might make sense for high school or college students looking to make extra money, but in 2017, the median ages of a retail salesperson and a cashier were 36 and 26. These are people who need a living wage to support themselves and their families.

Companies don’t always realize how few hours their employees work; at one organization, executives told us that they were surprised that most of their hourly employees worked fewer than 15 hours per week and earned under $10,000 a year. So for companies thinking about raising wages, setting targets for actual take-home pay and tracking progress in that regard can help ensure that their workers are earning a living wage.

Predictable schedules. Apart from the instability that comes from not knowing what your pay will be week to week, it’s challenging trying to plan childcare, transportation, and the rest of your life when you get your schedule only a few days in advance, as is the case for many service workers. It’s also expensive. Companies known for offering good jobs provide schedules three to four weeks in advance and new legislation in places including California and Seattle is prompting others to follow suit. Companies that adopt this practice will not only be better employers; studies have shown that stable retail schedules can also drive sales and labor productivity.

Career paths. Today’s take-home is important to workers — but so is tomorrow’s. The best employers offer workers the opportunity to develop new skills, demonstrate their abilities, and move up the ranks, securing a better financial future for themselves and their families. For example, good jobs companies like Costco and QuikTrip promote almost exclusively from within for field positions, giving workers a clear path to higher pay and increased responsibility. Companies that want to attract and retain better workers will find that creating such paths is something their employees care a lot about.

Higher wages will not lead to higher performance for companies or good jobs for workers if companies do not fix their systems. If they create a system that increases the productivity, contribution, and motivation of employees, then higher wages will be one of the several forces driving high performance and good jobs. Luckily, we know a lot about the ingredients of that system.

Working with a Colleague Who Feels That the World Is Against Them

Some people love to play the victim. Nothing is ever their fault and everyone around them is out to get them. Having a coworker like this can take a toll on you. So what’s the best way to protect yourself? How can you help your colleague change their mindset? And how do you handle the emotional toll of working with this person? 

What the Experts Say

Working alongside someone who always feels like a victim “is an inherent downer,” says Holly Weeks, a lecturer at the Harvard Kennedy School and author of Failure to Communicate. “You feel stuck,” she says. “You see this person walking towards you and your heart sinks.” Perhaps the biggest challenge in dealing with a colleague who has this mentality is “the negativity” that this person exudes, says Amy Jen Su, managing partner of Paravis Partners and coauthor of Own the Room. “When you are busy, the last thing you need is to be around someone who views the world as glass half empty,” she says. Still, you’re not helpless. “The one thing you can control is your response,” Su says. Here’s some advice on how to deal with this decidedly difficult colleague.

Be empathetic

To begin, recognize that your colleague’s perpetual victimhood “is not about you,” says Su. “So don’t take it personally.” Try to reserve judgment. “Compassion helps,” she adds. “Notice that this person views the world differently than you do. And it must be hard to live every day in victim mode.” Weeks recommends trying to “shift how you see the person,” and then “adjusting your psychological reaction in any way that helps.” Be empathetic. Remember: your colleague is not purposely trying to make you crazy. “It’s like when you hear that your plane’s takeoff is delayed. You can dwell on it and get angry, or you can cool your jets and try not to let it bother you,” says Weeks. Your objective is not “necessarily to view your colleague with sympathy, but to be neutral.”

Be positive

Next, think about how you’ll “protect yourself from absorbing your colleague’s toxic behavior,” says Su. A little self-preservation is in order. She recommends spending time with colleagues who provide a “counterbalance” to this difficult one. “You need to surround yourself with people who bring you energy, lift you up, and who are positive forces.” When you have to spend time with this person, find ways to decompress afterward, whether it’s taking a walk, meditating, or listening to music. And, importantly, even if this particular colleague rubs you the wrong way, try to find something about this person to like, says Weeks. “Find different facets to them,” she advises. Don’t focus on their “freaked out, whiny, and paranoid side.” Look for commonalities — at the very least, you’re both committed to your organization.

Provide a counter narrative

Dealing with a colleague like this can be mentally exhausting — especially if you’re regularly listening to the person’s complaints. But you don’t have to “be passive in this recital of woe,” says Weeks. Instead, “shift this person’s focus away from the bogeyman” by “offering a counter narrative” to that version of reality. Say, for instance, your colleague grouses about a boss who they perceive as giving them more work than anyone else on the team. She suggests saying something like, “I know it’s stressful. I bet the boss is doing it because you’re so competent and reliable and doesn’t think it will put a strain on you.” Your response isn’t patronizing, rather it’s showing an alternative way of seeing the situation. Remember: your goal is to help the person “choose a different mindset.”

Offer validation

Offering validation can also be helpful in these circumstances, says Su. “Validation is often the missing link for people like this,” she explains. “They don’t feel seen or heard and so they think, ‘If I complain” — or play the victim — “I will get some acknowledgment and some appreciation.” She says that sometimes these people just need positive reinforcement that they’re not getting elsewhere. Don’t be disingenuous, of course, but “if the compliment is well-deserved it might quell the noise.” This doesn’t mean that you endorse their complaints, rather that you recognize their positive accomplishments. 

Propose solutions

Another possible response to your colleague’s litany of complaints is to offer solutions to problems, says Su. “This person may be complaining because they have an unspoken need that’s not being addressed,” she says. In this case, you should “go into coach mode. Say, ‘Are there expectations you have that others may not be aware of?’ Or: ‘I hear you are upset about XYZ, let’s brainstorm ways to resolve it.’” Your goal, according to Weeks, is to focus “not on your colleague’s feelings,” but on the professional challenges. Empower your colleague and “brace yourself around the issues,” she says. Whatever you do, don’t “encourage the dynamic” of constant carping. If nothing more, your colleague will realize that you’re not fun to grumble to and will likely lose interest in the conversation.

Be direct with your colleague

The prospect of confronting a colleague about their behavior can invoke profound feelings of dread. “But if this person is taking a toll on business results, you need talk to them about the impact they’re having,” says Su. Be gracious and considerate. “Say: ‘You are a leader on this team. I can see you’re under stress, but when you complain, it brings the team down. Can you be more mindful of what you’re telegraphing?’” Your aim is to show your colleague that “their mood has a ripple effect.” Your tone and word choice are critical here, according to Weeks. “If you say, ‘You’re paranoid and you whine a lot,’ your colleague is not going to hear it.” Instead, focus on the behavior they should be exhibiting not the behavior you wish they’d stop.

Talk to your boss

It might also be worthwhile to talk to your manager about the situation. The decision to go to your boss, however, is not straightforward, says Su. “In some ways, if you complain to the boss, you’re becoming this person,” she says. But if you believe that your colleague’s conduct is “taking a toll on the team or having a negative impact on the business,” you need to speak up. Don’t center the conversation around “personalities,” says Weeks. Rather, “talk in terms that are useful” to your boss. “Make it about the work.” You might say, for instance, that this person is distracting. The goal is to “frame the issue in a way that your boss realizes this is not the dynamic they want in the office.”

Set limits

Finally, make your boundaries clear. “If this person is always coming by your desk to vent, you need to set new rules of engagement,” says Su. Don’t be rude or disrespectful. But be upfront about your limits. “Go quiet and use you your body language to signal that you don’t want to get into it.” Even if “you feel like you can’t fix the situation, you can at least contain it,” adds Weeks. “As soon as you see the person coming, say, ‘I have about six minutes to talk.’” It’s not a perfect strategy, but “at least you won’t have to suffer very long.” Your goal is to be “neither a doormat nor an enabler.”

Principles to Remember

Do

Demonstrate empathy and compassion for your colleague.
Try to shift your colleague’s focus away from complaining by offering solutions to their problems.
Talk to your colleague about their behavior and the effect it’s having on the team. Your aim is to show your colleague that their mood has a ripple effect.

Don’t

Encourage the dynamic with a colleague who is constantly carping. When you don’t join in, this person will realize you’re not fun to grumble to.
Let the negativity drag you down. Surround yourself with colleagues who bring you energy, lift you up, and who are positive forces.
Be a doormat. Be upfront about your boundaries and set limits on how much time you’re willing to spend with this person.

Case Study #1: Find something to like about this person and focus on solutions

Duke Greenhill, Vice President of Creative & Strategy at J.O., an advertising agency in Fort Worth, Texas, once worked closely with someone who lived in perpetual victimhood. The employee — we’ll call him Sam — worked in the account services department.

Sam whined a lot, recalls Duke. “The world, fate, God, Yaweh, chance, luck, you name it…they were all conspiring against him. Sam also felt everything was personal, and probably had a healthy dash of narcissism. His every response began with ‘But.’”

In the beginning, Duke tried to be compassionate. He reflected on the things he liked and admired about Sam. “Sam wasn’t bad [at his job] by any stretch of the imagination,” he says. “He was driven and tenacious.”

But Duke admits that this initial approach was maybe a little too soft. “I was, perhaps, overly empathetic — read: enabling — at first, and so Sam began bringing his woes directly to me.”

Duke felt he needed to take action, especially because he knew all too well the dangers of playing the victim. “I used to be [like] Sam in some ways and so I told him about my own similar experiences,” he says. “I also showed him at every opportunity that people/life/the world are not black or white. Through metaphor and everyday examples, I think I helped him see things differently.”

Duke also focused on helping Sam change his perspective by asking him to think about possible solutions to the challenges he faced. “I told him: ‘Don’t come to me with problems and complaints unless you also come to me with at least one potential solution/reframing,’” he says.

Over time, Sam complained less and also proactively began to try to solve his own problems. He also stopped playing the victim as often. He has since moved on to another company. “I hear that Sam is doing well,” says Duke.

Case Study #2: Talk to your colleague about the impact his mood has on the team

Christian Rennella, the CEO of oMelhorTrato — a South American company that helps customers find and compare prices of credit cards and insurance services — has recent experience working with someone who felt the world was out to get them.

About six months ago, his company hired an engineer in the field of artificial intelligence. In many ways, the employee — we’ll call him Ethan — has worked out very well. “The progress he has made has been spectacular,” he says. “Thanks to Ethan, we have been able to automate a large part of our processes and that has helped us grow.”

But Ethan has also proved to be a challenging personality. “It always seemed that he was the victim and that he was never to blame — whether the imagined culprit was within the company or in the larger world of AI,” says Christian. “He had a constant tendency to focus on what happened around him rather than his own work.”

At first, Christian wasn’t sure what to do. But upon reflection, he realized that the behavior was having a negative impact on others. “I saw that the rest of the team also noticed Ethan’s complaints and it was an uncomfortable situation at times.”

Christian decided to talk to Ethan. He wanted to show him that his negativity and victim mindset affected others. “So, in a one-on-one meeting, I highlighted the various times in which he played the victim,” he says.

Christian’s tone was respectful and considerate. “I told him that instead of looking for excuses, what we need from him is to look for solutions.” He also explained that he was making the team uncomfortable.

Ethan didn’t realize that he was having that kind of impact, according to Christian. “He took what I said to heart — and he’s made many adjustments,” he says. “His personality has changed for the better.”