Hardwiring Accountability: An Interview with Cy Wakeman

To understand more about hardwiring accountability, two AONL members, Reynaldo R. Rivera, DNP, RN, NEA-BC, FAAN, and Laura Caramanica, PhD, RN, CENP, FAAN, interviewed Cy Wakeman, the author of two best sellers, Reality-Based Leadership and Reality-Based Rules of the Workplace. Cy Wakeman has helped leaders garner results in their organizations, assisting them to call on their direct reports to take ownership of their work. Wakeman’s “reality-based” philosophy has created heightened engagement and successful outcomes in spite of challenging circumstances. She has worked with more than 1,000 companies and organizations, including those that provide health care.

You are known for challenging people to think and act differently so that they can achieve the top results. What is your background and how did you develop your philosophy regarding “relationship-based leadership?”

I started my career as a marriage counselor, and as I worked with couples, I noticed some commonalities in the reasons that they sought help: they all wanted the same two things, better results in their lives and increased happiness in their marriages. Unfortunately, no matter how hard they worked to achieve these outcomes, they were unsuccessful because their thinking and their approaches were flawed. Most clients believed that in order to be happy and successful, they needed to change their circumstances, have a different spouse, better job, more money or an understanding boss, etc. So, I worked to help couples change their mindsets, to learn Reality-Based Rules, such as, “Suffering is completely optional and often self-imposed” and “Happiness is not correlated to one’s circumstances, but to the amount of accountability one takes for his or her circumstances.”

How then did this realization enable you to come up with your accountability-based model?

When I was promoted into my first health care leadership position, I learned that organizations had the same two common goals as well, and that most leaders and employees were using the same flawed thinking, leaving all frustrated and convinced that success just wasn’t possible in their current realities. I knew the truth to be different and began leading teams according to my philosophy and quickly had teams engaged and delivering results that they had previously believed to be impossible. I quickly realized that many of the techniques that were being taught in traditional leadership simply were not working and in fact, flew in the face of evidence in my field. My teams were practicing evidence-based medicine in their clinical lives but in leadership they were working off of conventional wisdom and worse yet, breeding learned helplessness, which is the opposite of accountability. Most leadership philosophy was focused on engaging employees but engagement without accountability creates entitlement, not results.

Can you explain your philosophy on personal accountability?

First and foremost, personal accountability is a mindset, not a skillset. It isn’t just about ownership—it is much bigger and it starts with one’s willingness and commitment to do whatever it takes to get the desired results.

Too many leaders hinder personal accountability in their staff on a daily basis. In an attempt to build engagement and loyalty, leaders often respond with sympathy rather than empathy coupled with a call to greatness. Sympathy is when leaders listen to staff complaints and concerns and feel sorry for them, begin colluding with them, and agree that they really are at the mercy of their circumstances. Empathy is hearing staff concerns and responding with a call to greatness, helping staff see each stressful moment as an indication of where they need to grow next in their capabilities and coaching them to be great.

We all have circumstances that are not what we expected or wanted but our circumstances are not the reasons we can’t succeed, they are the reality in which we must succeed. Leaders need to redirect the energy spent arguing with reality and focus it instead on delivering great care in our reality—focus on how we can, not why we can’t.

You use the term “reality check” often. How does this relate to your philosophy on ways leaders and staff can respond to challenges without drama?

I have discovered that the average health care worker spends two hours a day in drama, arguing with reality. Two hours a day of energy that could be recaptured and invested in patient satisfaction. While most of us are focusing on ways to eliminate waste from our organizations by focusing on processes, we are missing the most incredible opportunity to recapture two hours per day per person of emotional waste. This is what I actually believe is the role of a leader, eliminating emotional waste by holding people accountable to great mental processes.

It is vital to examine all of the ways in which your processes or systems fall short in the call for accountability. One example I found in my areas were the many forms that were to be used to report unsafe situations. The forms provided space to report what others had failed to do or did wrong but they were missing a huge section: What I did in the moment to help and ensure that all were safe and that patients were well-cared for. Even traditional engagement surveys sabotage a culture of accountability by treating every staff response as equal without differentiation and assuming that engagement drives results, when in fact accountability drives results.

I have created an engagement survey that allows organizations to sort the responses based upon individual accountability levels so that they can turn up the volume on what the highly accountable are saying and not be distracted by what “low accountable” staff are reporting.

“Reality Checking” is the call to stop believing everything you think and question it to get reality-based in our thinking. The stress in our lives is caused by our stories about reality, not our actual reality. Edit the story and lose the stress.

Briefly explain the four elements of personal accountability which you believe are necessary for hardwiring accountability.

The four elements of personal accountability are: Commitment, which is the willingness to do whatever it takes to get results; Resilience is the ability to stay the course in the face of obstacles and setbacks; Ownership, which is acceptance of the consequences of our actions, good or bad; and Continuous Learning, whereby one sees success and failure as a learning experience to fuel future success.

Commitment is critical in your model. Explain how you see commitment as the foundation to achieving desired results.

Commitment is the willingness to do what it takes. Willingness is about buy-in, which is something only staff can do, not something leaders can create or bargain for. I advise leaders to work with the willing. Staff need to choose to engage, to stay and play fully or to leave in peace—but there isn’t a third option, to stay and hate, stay and complain, or stay and resist or sabotage.

In your work, you state that leaders should keep choices and consequences visible to ensure accountability. How does the leader go about doing this?

Staff tend to feel far removed from the results and at the mercy of their circumstances. To rid the team of learned helplessness, leaders need to make staff contributions to the results conscious and visible. The best way is to identify behaviors and accountabilities that are the key drivers to the desired outcomes and make them non-negotiable and measurable.

Rather than focusing on and reporting Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores to staff, identify the specific drivers to HCAHPS scores such as hourly rounding and being fully present with patients and make them measurable non-negotiables for staff. Create a visual dashboard that clarifies expected behaviors and lead indicators, the drivers that produce the results that are expected and review it often with individuals.

What are other ways managers can use to communicate expectations and give feedback?

As leaders, we work to keep our door open and to be available to coach staff through issues. Unfortunately, our own doorways become portals for drama—staff stop by, tattle or vent and ask us to take action to address the situation. This is not only an inefficient way to lead, but an ineffective one as well.

The issue is that most of the time, staff comes to the leader with “unprocessed work” and the leader spends a great deal of time listening and attempting to sort through the story and process the issue. The problem is that he who processes the issue is usually the one who then takes action on the issue, resulting in leaders who over-manage and under-lead.

Resist the urge to process the work for others and to race off to fix the circumstances and instead, coach the person in front of you. Tools make this easier. I like to employ a tool most nurses already are familiar with: Situation Background Assessment Recommendations (SBAR). I simply ask that prior to bringing an issue to me, that the staff member create an SBAR, outlining the situation in a single sentence, provide the relevant background, accompanied with their assessment of the root causes of the situation, along with their part in the issue and to deliver multiple recommendations to begin to improve the situation.

This gives us something concrete to coach on. I listen to SBAR for drama, judgment, assumptions, blame and lack of accountability and coach on critical thinking, mental flexibility, collaboration and innovation, the very competencies we should be evaluating our staff against.

How does the leader deal with resistance?

My research has revealed that change itself isn’t hard, as we are all preaching, it is only hard for the unready. So a huge piece of ensuring that staff isn’t resistant to change is to make sure that they are ready for what’s next. The best way to guarantee that staff is ready for what is next is to resist the urge to try and perfect their circumstances and instead grow them in ways that create immunity from their circumstances.

Why should leaders and staff engage more in self-reflection, which centers upon the strategic use of questions regarding what is working and what is not?

When I studied staff that rated high in accountability, one question I asked is how they got that way, how is personal accountability developed? Self-reflection was highlighted in all their answers. Based on this research, we advise leaders to keep feedback short and self-reflection long. Provide data or feedback in concrete short dialogues which outline expectations without apology and provide metrics on the performance and then give an assignment for self-reflection.

Feedback brings out the ego if it goes on too long. Giving an assignment allows the staff member some time and privacy to work through the emotional reaction and to plan for their own growth.

References

Wakeman, C. (2013). The reality-based rules of the workplace: know what boosts your value, kills yours chances, & will make you happier. San Francisco, CA: Jossey-Bass.

Wakeman, C. (2010). Reality-based leadership: ditch the drama, restore sanity to the workplace, and turn excuses into results. San Francisco, CA: Jossey-Bass.

About the Interviewers

Reynaldo R. Rivera, DNP, RN, NEA-BC, FAAN, is director of nursing research and innovation at the Center for Professional Nursing Practice at NewYork-Presbyterian Hospital, New York City.

Laura Caramanica, PhD, RN, CENP, FAAN, is associate professor of nursing, University of West Georgia, Carrollton. When this article ran in September 2015, she was vice president and chief nursing officer at WellStar Kennestone Hospital, Marrietta, Ga.