By Joanna T. Smith, Founder and CEO of Hearts For Hearing
Contributing Authors: Dr. Jace Wolf and Dr. Mark Woods
Ten years ago, a team of 20 professionals left the security of a tertiary hospital in a step of faith to establish Hearts for Hearing in Oklahoma City to create life-changing opportunities for children and adults with hearing loss to listen for a lifetime. With the help from many supportive donors, charitable foundations, manufacturers, and a committed team of professionals with a passion to succeed, we launched in January 2007 and quickly realized we had a great deal to learn if we were going to build an organization that would stand the test of time and impact the lives of those touched by hearing loss.
Ten years later in November 2016 we moved into a new $10,000,000 state of the art facility that now reflects the quality of the care provided, as well as the research that is being conducted by our capable and committed employees. The original team of 20 has grown to a staff of 38 and we continue to learn and serve patients and their families who make us better every day. In celebration of ten years, in this installment of the Tot Ten, we share key takeaways from our experience. A special note of thanks to Dr. Teresa Caraway, a Co-Founder of Hearts for Hearing for her vision and leadership in those early days and Dr. R Stanley Baker, M.D. who recognized and continues to validate the value of our work.
1. Why Trumps What
None of the 20 professionals who joined Hearts for Hearing in 2007 had degrees in business, leadership, or finance. Instead, we all spent many years and dollars to obtain graduate degrees in speech-language pathology and/or audiology. To the person, we became students of leadership by seeking counsel from wise and successful business leaders both locally and nationally. Simon Sinek was one of those leaders who significantly impacted our work. In his TED talk, “How Great Leaders Inspire Action” he uses his “Golden Circle” model to explain how great leaders inspire action by focusing on the why rather than the what or how we do the work. We are convinced that our patients and their families don’t care so much about what or even how we operate. At Hearts for Hearing, the why drives our work and the meaning and power of what we do inspires us to continue to use every available tool to bring life-changing opportunities for children and adults with hearing loss to listen for a lifetime. When we focus on that heartfelt and constantly motivating purpose, all the equipment, products, processes and services we provide either make sense or they don’t. Our why is the foundation of our decision-making. Everything we do, invest money or human energy and passion in, must make life-changing opportunities for children and adults with hearing loss to listen for a life time happen or we don’t invest our precious resources.
2. Work ON The Business As Well As IN The Business
Another important takeaway from the first ten years is the importance of intentionally “working on the business” rather than just “in the business”. For most of us in the early years, we needed to be in the clinic doing the things we were trained to do. There is always work to be done and we were busy doing it. We were then challenged to discipline ourselves to “work on the business”, specifically regarding four different areas- team, financial, systems, and our patients and the families we serve. For donors, team members and our patients, we are constantly asking and articulating the answer to “what does success look like 5 years from now or even 10 years from now. Working on the business means our employees work as a team to build “future facts” which are word pictures of how things should work on the very best day at Hearts for Hearing. This simple tool helps us make choices about how to spend our valuable and limited resources to accomplish meaningful tasks. Future facts serve as a compass to keep us on course. We are always asking if an opportunity is in alignment with our future facts. For example, if an opportunity arises but it does not help us meet the future facts we’ve developed, then we would graciously decline. The future facts developed by each team member also help the employee know whether he/she is doing something that could be done by someone else and in fact may be a future fact for another team member.
3. Rules of The Game: BAM
Most of us are familiar with Maslow’s Hierarchy of Needs, the highpoints being that the first level of need is physical such as air, water and food and the second is safety, feeling secure and safe from the craziness around us. In a work setting, physical needs are most often satisfied through a paycheck, and safety needs are usually addressed by a safe working environment and benefits like health insurance. Beyond that, according to Maslow, everyone works for Belonging, Affirmation and Meaning or BAM. At Hearts for Hearing this meant that as we were establishing the rules of the game, we needed to make sure that that staff and families felt part of something bigger than themselves (belonging), individuals’ contributions were recognized (affirmation), and the work we are doing has greater significance (meaning). For stakeholders, whether a donor, employee, or client to be engaged, they must feel as if they are a part of something significant, receive affirmation for what they contribute, and produce something of value.
People feel a part of something bigger than themselves when they are recognized, which indicates to them and those with whom they have influence that what they are doing has greater significance. It connects to their hearts and minds. We utilize BAM stories to affirm individuals in our bi-weekly Huddle meetings, in weekly therapy appointments, and in all our parent groups. Our outcomes are better when employees want to belong, when there are many opportunities for affirmation, and when our work is drenched in meaning because the results that are obtained are life changing.
Salary is important but the power of BAM and the need to help team members and families feel that they belong, that they are affirmed, and that they are contributing meaningfully to something bigger than what can be done by one person has been powerful in our efforts to engage staff to better serve our patients. From affirming in a staff meeting our receptionist for the way she greets every family to meeting the physical needs of an audiologist who lost everything in a horrific tornado are examples of BAM at work.
4. Home Grown
Because our professionals are our most valuable resources and there is not an abundance of pediatric audiologists and LSL professionals, one of the most effective ways we have learned to grow our staff with “cream of the crop” professionals is through the offering of 4th year externships for audiology and practicum experiences for speech-language pathology graduate students. We have been able to attract some of the strongest young professionals in the field by “dating” for a year so that they experience the Hearts for Hearing culture and learn best practices and protocols. Over the last 5 years, we have accepted 4th year audiology interns from the University of Oklahoma, University of Texas at Dallas, University of North Texas, Illinois State University, Texas Tech University, and Vanderbilt University. In the last 5 years, all our audiology hires have been following a 4th year externship and most of the speech-language pathologists were hired after completing an internship at Hearts for Hearing. This gifted cohort of young professionals is positioned to be leaders in the field for many years to come and we are grateful to the excellent university programs that are preparing the next generation.
5. Good Is The Enemy of Great
Jim Collins in his best-selling book, Good to Great states that “good is the enemy of great and that is one of the key reasons that we have so little that becomes great.” At Hearts for Hearing, we do not settle for good outcomes, instead we seek to utilize our scarce and precious resources to achieve excellent listening and spoken language outcomes. With every patient, task or project, we challenge each other with “could we have done better or worked harder?” The answer should never be “yes” because if it is, our job is not finished. Success can sometimes bring complacency and therefore it is important that we never rest on what we’ve accomplished but instead always seek to continually improve. Carol Flexer has frequently stated that families seeking information about hearing loss “do not seek our best 2001 opinion, instead they deserve our best 2017 opinion” and unless we are willing to do the work to excel, patients may still be getting an opinion from 2001. At Hearts for Hearing we study. We read and discuss articles. The Director of Research spends countless hours searching for the most current research to share with the team in order that our families can trust us to be giving them information to support great listening and spoken language outcomes.
6. Better Together
One of the most powerful tenants of the work at Hearts for Hearing is the way that we team to support our children and their families. Over half of our appointments especially in the first three years of a child’s life are scheduled with both a pediatric audiologist and a speech-language pathologist certified as a LSL Cert. AVT. Having both professionals working in sync with each other gives a family more resources and helps them to understand the impact of hearing loss on the development of speech-language skills. Clearly this model is a challenge financially as insurance reimbursement is complicated when more than one person is present during an appointment, but the why of our work is so powerful that we have been able to identify partners who donate to allow us to continue with this model of service delivery.
Additionally, when booth support is provided by the LSL professional who works with the child and family weekly, more information can be gathered in less time which helps offset the costs of having two professionals working together. When the “dance” between therapist and audiologist is done well, the family feels supported by a team of people who are committed to great listening and spoken language outcomes. Because wear-time of technology is so critical to auditory brain development in the first three years of a child’s life, a pediatric audiologist’s recommendations are supported by the LSL Cert AVT who is encouraging the family as they learn about the technology. A speech-pathologist who hears changes in speech production can immediately consult with the pediatric audiologist who may then adjust the hearing aid or cochlear implants. Having an additional set of eyes and the perspective of two different professionals has been welcomed by our families and it has made us all better in our specific roles.
7. Listening Is What We Do For A Living-Let’s Get It Right
As pediatric audiologists and speech-language pathologists we teach others to listen and talk. Listening is our business. Communication is our sweet spot yet when problems arise with a growing staff, often it is because of a breakdown in communication. If those who are involved are unwilling to talk about the issue, the problem usually gets worse. As we’ve shared before in the Tot 10 Pillars of an Effective Influencer for Good, our success is directly proportional to the number of difficult conversations we are willing to have. Unfortunately, what most often happens is that individuals avoid the difficult conversation and instead talk with everyone but the person with whom the breakdown occurred.
Realizing that anger and frustration are the result of unfulfilled expectations, it is critically important to speak directly with the persons involved and at Hearts for Hearing we take seriously the responsibility to hold each other accountable in this area. We must be better listeners by actively engaging with each other in conversation. As Stephen Covey wrote “we must seek to understand before being understood. It takes practice. It takes being fully present and is one of the primary reasons that we ask team members to keep cell phones out of staff meetings. If someone is reading e-mail, looking up information, even information pertinent to the topic of the meeting, he/she is not fully present and therefore not actively listening. This too requires discipline and as we learn to actively listen, there are even more opportunities for belonging, affirmation and meaning.
8. Embrace The Hard
There have been some hard seasons in our first 10 years. There will be more. As difficult as it is to acknowledge, we have learned as much, or more from the most difficult days, as we have from the best. The downturn of the economy in 2008-2009 and the impact it had on the organization’s financial health changed the trajectory of the organization significantly. Changes in key leadership positions were also hard. In the economic downturn, we were forced to reduce staff and change the direction of the building campaign. Yet in that season, because “the why” trumped “the what”, the team explored creative ways to diversify our revenues, reduce expenses, and invite partners in the community to step up in new ways.
Confronting the brutal facts whether they be financial, systems, or personnel issues is the only way solutions can be generated. Additionally, when the brutal facts are addressed, it is an excellent opportunity to identify whether issues are truly problems that need to be solved or tensions that need to be managed. A problem is something that can be solved but tensions are necessary for a healthy organization and are always needing to be managed. The tension of quality vs. cost, work-life balance, autonomy vs.? and of course, income vs. expenses. At Hearts for Hearing, we believe that all team members need to be familiar with the tension of the organization’s finances and we offer financial literacy opportunities so that everyone can offer solutions that allow the why of our work to continue. Some of the best solutions for generating additional revenue as well as cost-cutting measures have come from those who are understanding the tension for the very first time. We seek to maintain a culture of solutions.
9. What Gets Measured Gets Done - Use Scoreboards
Without measurement, improvement or failure is just a feeling. Without measurement, we do not know whether we are gaining or losing weight, winning or losing a game, or solving or making a problem worse. In the field of speech and hearing, it seems we measure just about everything in order to document progress: speech detection thresholds, receptive language skills etc.. In our organizations, we all track a great deal of information but are we using that information? Because what gets measured gets done, it is important to measure the right things to get the right things done. For example, because we depend on charitable donations to provide quality care, it is important for us to manage donor dollars well. We track donations and expenses to know if we are hitting the mark. To reduce the number of missed appointments, we track those appointments to determine if the investment of our energy, time, and passion resources is having an impact. The determination of what needs to be tracked is constantly changing because people, situations, and technology change.
Football is a big deal in Oklahoma and if a fan happened to get to a game late, the first thing he/she would likely do is glance at the scoreboard to know the score. So beyond measuring, it is important to create a scoreboard for the organization so that every leader, i.e. every employee, can look at the scoreboard and know where we stand on all the items we’ve determined as a team are important to measure. Competitive? Perhaps. Yet, competition is healthy when the score is an indication of performance against a benchmark or even our best efforts. Certainly, poorly conceived scoreboards can be demotivating but purposefully built and carefully nurtured scoreboards are critically important to allocating our scarce and precious resources for the highest good. Measuring the right stuff helps get the right stuff done. The use of scoreboards has also been an invaluable tool for building BAM, belonging, affirmation, and meaning, by uniting a group of people to work toward a goal, recognizing people when they win and allowing team members to contribute their gifts, abilities, talents, and knowledge to creating life-changing opportunities for children and adults with hearing loss to listen for a lifetime.
10. Create a culture of gratitude
Gratitude generates generosity. We have seen this time and time again but it wasn’t until hearing Andy Stanley share in a leadership podcast that “unexpressed gratitude is the same as ingratitude” that the power of gratitude became clearer. There have always been those in our organization who modeled gratitude through words and notes yet it has now become a focus to take the time to thank those who help us create life-changing opportunities for children and adults with hearing loss to listen for a lifetime. When gratitude is expressed, belonging, affirmation, and meaning can be experienced by those being thanked whether it is a staff member who has gone above and beyond or a parent who pours her heart into every therapy session. The expression of gratitude through hand-written notes on EVERY year-end request letter resulted in a near double total from previous year-end appeals. Gratitude generates generosity. Although it may sound manipulative to say that we respond better when we are thanked and affirmed, all of us are motivated by authentic words of gratitude. The cumulative effect of working in an environment where gratitude abounds is transforming.
Because most successful organizations focus on the future it requires leaders to be intentional about modeling gratitude and celebrating the accomplishments of the days, weeks or year. At Hearts for Hearing, we have found that it is critically important to pause at least annually to celebrate the achievements of the past year. Although these days that are set aside to celebrate, dream and laugh together are certainly expensive due to the lost revenue from clinical services, the return on the investment far outweighs the cost. Remembering and laughter are good for the soul.
In closing, as we mark our first ten years, we would like to thank all the leaders in the field of hearing health who have improved the lives of babies who are yet to be born through their perseverance and passion to develop miraculous technology that improves listening and spoken language outcomes. We thank the educators who are preparing the next generation of pediatric audiologists and speech language pathologists. We are grateful for the local and national donors and philanthropists who have supported our why and for going above and beyond to make it possible for us to have a new facility where excellent outcomes will be achieved for years to come. Lastly thank you to the amazing Hearts for Hearing team of professionals and the families we serve. Without them, there would be no why.