HealthCare Voice

Who Says Hotels Deliver Better Service Than Hospitals?

Tyler, Texas [November 27, 2008] – Hospitals get a bad rap for poor service and embarrassing cost shifting. We are ridiculed – deservedly, more often than not – for not being able to deliver quality service in the manner of luxury hotels. In addition, if that is not enough, we hear the inevitable stories about the $25 aspirin or the arrogance of some employees who believe that they are the reason patients are there.

Today, I want to turn the tables. As I enjoy this Thanksgiving Day at my “weekend” house in scenic Tyler, a small city about 110 miles east of Dallas, some recent experiences with hotels come to mind, particularly one famous New York establishment.

In the future, when I hear unflattering comparisons between hospitals and hotels, I will ask, what about the $9 orange juice or the two to six hours it took many guests to check in because housekeeping was behind. Or, the hundreds of pieces of luggage sitting on a Manhattan side street because the hotel’s luggage storage was overwhelmed, as were the bellhops, front desk personnel, the waiters, and, obviously, the management team.

I will not use the name of the hotel because I do not want my preferred customer status to revert to that of preferred rodent, but they do make a nice holiday salad. I am just not sure they can run a hotel.

Let’s cut to the chase. The orange juice. I was asked by a harried waiter if I wanted coffee. I did. And juice? Yes, I was dehydrated. The hotel’s heating system dried me out overnight. Wow, there was a lot of pulp in that OJ. This must be hand squeezed, I thought. Then that cautionary little voice in my head sounded the alarm: Be careful, hand-squeezed orange juice is expensive, especially from the hands of unionized New York kitchen workers. I was right. Nine dollars for an 8-ounce highball glass of not-from-concentrate vitamin C.

Now the kicker.

As I was walking from the restaurant I noticed on the counter, next to a carafe similar to the one from whence my juice was poured, a half gallon carton of orange juice -- Florida’s finest from the grove stand with lots of pulp. So much for that union worker in the kitchen diligently squeezing oranges. Then I did the math. A half-gallon contains eight servings, according to that manufacturer. At $9 a glass, that means the hotel was recording at least $72 of revenue per carton. Based on volume, I am thinking this enormous hotel property buys each half gallon for, at the most, $1.25 a unit. I do not even want to think about the $7.00 coffee, $19 for fresh berries, the $6 yogurt – probably not fresh – or the $20 scrambled eggs. Then you add the legendary New York taxes. The Big Apple, or at least in this case, a legendary hotel, suddenly becomes the big sucking sound as my wallet is assaulted by a juice carton masquerading as a unionized kitchen worker, sans juicer.

This is not meant to be another naive diatribe about New York’s high costs and ridiculous tax rates. About that there is no debate. Nope. This is a knock on a luxury hotel whose data processing capacity is suspect, whose customer service is worse than uneven, whose maintenance is sloppy, and indifferent executives who scurry about with their European-cut suits, cell phones in hand, with the conviction of an overwhelmed management intern who could not organize a three-car funeral.

The desk chair that was falling apart and that no one came to repair despite several calls to the hotel’s service hotline. The painfully slow service in the restaurants. The overwhelmed, plodding desk clerks and the smartly dressed housekeepers who could not clean the room before 2 PM. No wonder it took some QE2 passengers six hours to get a room while their luggage sat lined up on the sidewalk like the Northwest Airlines’ Detroit baggage claim following a snowstorm.

For those of us who toil in healthcare and have been made to believe that we are inferior humans because we cannot deliver service in a safe,timely, friendly, and cost effective manner, call me.

I will give you the name of a famous Park Avenue hotel where you can go and learn what NOT to do to your physicians and their patients.

John G. Self, Chairman and Founder of JohnMarch Partners, is the Firm’s senior client advisor. A 32-year veteran of the healthcare industry, he is a former investigative reporter and crime writer for a major daily newspaper. Candidates and clients say he is one of the most thorough executive recruiters working in the healthcare industry.

The A,B,Cs of Human Capital...

New York,NY [November 23, 2008] – So the price I paid for chatting up an unsuspecting healthcare consultant at Chicago’s O’Hare airport while awaiting the departure of a flight was to write an essay on what a search consultant should tell a hospital CEO who wants to transform his or her annual report language on human capital into action. It seemed such a small price to pay for the insights he shared regarding his biggest regrets as a hospital CEO.

By way of a reminder, this former hospital CEO said that his biggest disappointment was his failure to come to grips – to understand – the real importance of human capital issues, and how they directly related to his success or failure as a hospital leader. The number of hospital senior executives who focus on human capital issues with sufficient depth of understanding and passion as to make their employees a meaningful part of their market differentiation strategy, is miniscule, he believes. Now a Managing Director for a global consulting firm's human capital practice, this former hospital executive spends most of his time trying to convert healthcare leaders to the reality that having the best, most engaged workforce is one of the single most important pillars for achieving sustainable success.

As I started to write, I realized that my essay, save my first recommendation, was really a series of questions I would ask a hospital CEO, beginning with whether human capital is addressed in the organization’s long-range plan, and operationalized in the annual business strategy.

1. How many A, B, and C rated employees do you have? To get to this critical benchmark, complete a top down assessment of your workforce. Bring in a consultant – either an executive recruiter that you trust or a Topgrading© specialist – to collaborate with your team to complete this work.

2. If you have an abundance of C players, then it is time to ask why your employment team is spending dollars to recruit mediocrity. Is the problem the strategies your in-house recruiters use to source candidates, or the processes they use to screen them? Do you believe you are getting A candidates but far too many turn out to be Cs?

3. If you have too many Cs -- the employees who foul up service excellence, kill your productivity gains, or directly or indirectly contribute to an environment that jeopardizes patient safety -- why hasn’t your annual performance evaluation process caught this? Is anyone looking at the results on an enterprise-wide basis, or, are they more focused on the total financial impact of the raises each employee will receive?

4. If the majority of your employees are A and B players, with a small percentage of Cs, then look at other critical human capital metrics: rate of turnover, vacancies, and your orientation program.

5. Do you consider leadership development an expense or an investment? How much are you investing in your leadership/management development programs as well as employee education? Do you tie the effectiveness of your leadership and other education programs to performance improvement benchmarks?

6. Do you conduct a strategic assessment of your human capital – deciding who is ready for more responsibility or promotion, who needs additional attention and who should leave the organization? Or, is this performed on a division-by-division, department basis? If the latter is the case, how are you able to look at the human capital big picture?

7. How high is your organization’s accountability score? An 8 to 10 indicates that employees know that exceptional performance and accountability are critical to their survival; that there are consequences for everyone in the organization.

8. How often do you personally make rounds on all shifts? Do you require your senior leaders to make rounds? Your department managers? Is someone from your management team seeing every patient during his or her admission to monitor your human capital performance?

My O’Hare conversation just reconfirms what I have been trying to promote for years. The key to an organization’s success is its human capital. You cannot recruit and retain the best people without a comprehensive soup-to-nuts evaluation human capital development and assessment process that is constantly measuring where your organization stands.
This will not happen through best effort.

John G. Self, Chairman of JohnMarch Partners, is the Firm’s senior client advisor. He is a former investigative reporter and crime writer for a major daily newspaper. Candidates and clients say he is one of the most thorough executive recruiters working in the healthcare industry.

A Hospital CEO's Tough Lesson Learned

Dallas, Texas (November 16, 2008) -- The great thing about my job is that I get to meet and talk with a wide range of current and former health system and hospital executives.

Most of the time these encounters occur at ACHE events or other conferences. Occasionally they are chance meetings in hotel lobbies or airports. I am struck by how often these serendipitous encounters occur even though our industry is modest in size. However, in the interest of fairness and full disclosure, I have the ability, I am told, to chat up a brick wall. About that I am certain that my colleagues, my friends and, most assuredly, my family will agree.

The latest case in point was yesterday in Chicago. This unsuspecting "encounter" (read: victim) is a former hospital CEO who moved from the “daily grind” of running a hospital to the weekly travel grind of healthcare consulting, advising hospital executives on “tough lessons learned,” a term he used more than once.

OK, I bit. I am a former newspaper reporter who morphed over 15 years into the founder of a boutique search consultancy. You simply cannot drop a statement like that and not expect me to pounce. So, I asked, tell me, what was your toughest lesson learned?

“My biggest disappointment,” he explained, “was my failure to come to grips – to really understand – the real importance of human capital issues and how those directly related to my success or failure as a hospital leader. So many CEOs talk in platitudes, or business-speak, about how important their employees are, but the number of hospital senior executives who really get it, with sufficient depth of understanding and passion as to make their employees a meaningful part of their market differentiation strategy, is miniscule.

“They talk a good game but their actions do not support the words in their mission statements, strategic plans, or annual reports,” he lamented. “I guess you can say that I am recovering from a dangerous malady from which far too many CEOs suffer: Do as I say, not as I do. I talked but I did not really understand. I always found more traditional or convenient reasons for my successes and failures.”

Today, as a Managing Director for a global consulting firm's human capital practice, he spends most of his time trying to convert healthcare leaders to the reality that having the best, most engaged workforce is one of the single most important pillars for achieving sustainable success.

When I mentioned that I would like to use his comments in my blog, he asked that I not use his name to avoid any issues with his firm.

This healthcare leader said that he is continually amazed at CEOs who do not know how many of their hundreds or thousands of employees are A players, the best available talent for their respective positions. Or how many employees are Bs, those solid workers who are the heart and soul of any organization. Most alarming, he said, is the number of CEOs who do not have a clue how many of their employees are C players, those with whom you spend 80 percent of your time for a 20 percent return. These C employees, he maintains, crush productivity, foul up service and, in healthcare, contribute to an unsafe environment wherare patients are placed at risk.

“Listen, I think we are heading for some tough economic times... I am so busy and I hope that means that healthcare leaders are beginning to understand the importance of this issue. I really hope so because the upside is so great...This is truly not rocket science.

“You simply cannot be successful without focusing on the people, day in and day out,” this battle-tested former CEO said. "You may have gotten away with it in the past, but not anymore. If you are not zeroed in on your human capital issues, you cannot be the best in the market, and if you are number one, you will not stay as the market leader without an uncompromising focus on recruiting, training and retaining the best available senior leaders, managers, physicians, nurses and clinical support personnel – everyone, from the people who greet and register patients to the housekeeper polishing floors or cleaning patient rooms.

“For the sake of patient safety and to achieve enhanced operating performance, you have to elevate the performance of your workforce.”

I was amazed at his passion. I was impressed with his clarity of success. Before I realized it, my 90-minute wait for a flight to Dallas had passed. I was almost tempted to take a later flight to continue the conversation. As is the case with the best of leaders, he was so willing to share hard-earned insight.

Now, believe it or not, I have a homework assignment. He wants an essay outlining what a search consultant should tell a hospital CEO how to transform his or her annual report language on human capital into meaningful action.

Well maybe he was not serious about the essay, but I think I will give it a whirl. I think I will begin with the thesis that you do not have to be smartest or best paid CEO to embrace this maxim.

John G. Self, Chairman and Founder of JohnMarch Partners, is the Firm’s senior client advisor. A former investigative reporter and crime writer for a major daily newspaper, Mr. Self has been leading high profile executive search engagements for more than 15 years. Candidates and clients say he is one of the most thorough executive recruiters working in the healthcare industry.

3,800 Healthcare Jobs Lost - Just Like That....

BUFFALO, New York (Nov. 13, 2008) – The University of Texas Medical Branch (UTMB) in Galveston, the once mighty crown jewel of the UT health science center system announced yesterday that they were laying off 3,800 employees. The UT System Board of Regents confirmed the decision at a meeting in El Paso earlier in the day. As I travel working with clients to identify next-level leaders who can help their organizations weather this building storm of bad economic news, I was struck by the magnitude of the layoffs.

In making the decision, the UT Regents said they wanted to keep the medical school in Galveston but could not continue losing $40 million a month, according to The Houston Chronicle.

UTMB includes the medical school, John Sealy Hospital, a separate hospital to treat Texas prisoners and a network of clinics across Galveston County. It also has traditionally provided care for the uninsured from nearly 160 of Texas' 254 counties.

This is not a new issue. As the scope of healthcare delivery has changed in the Lone Star State, UTMB’s sphere of influence has been diminished by the health science centers in Houston, San Antonio and, of course, the famous UT Southwestern Medical Center in Dallas with its University Hospital, affiliation with Parkland Health and Hospital System, and the UT medical school with its massive research center.

There are two important take aways from this announcement.

First, this decision is NOT directly related to the rapidly deteriorating U.S. economy. It is a reflection more of the changing competitive environment in Texas and the effects of Hurricane Ike which devastated this island community.

Second, and perhaps more importantly, it does reflect the new economic realities for healthcare executives. Even a state university with massive financial resources, including the deep pockets of one of the largest endowments in the U.S., is not immune from making hard, heretofore unimaginable, decisions. This should be an alert for healthcare leaders across the country: get ready to make tough decisions. If the recession is deep, no one will be spared.

Leadership is not just about building an organization. Good leaders know when to make the right decisions to preserve financial integrity and patient care.

John G. Self, Chairman of JohnMarch Partners, is the Firm’s senior client advisor. He is a former investigative reporter and crime writer for a major daily newspaper. Candidates and clients say he is one of the most thorough executive recruiters working in the healthcare industry.

Videoconference Interviews and Marriage

JOHN G. SELF | Founder
& Chairman | JohnMarch Partners, Inc.

CHICAGO, November 5, 2008 -- Would you get engaged to marry a person who you met only through one or two video conference sessions?

You would be crazy.

That is exactly what an increasing number of top-tier executive search firms are asking their clients to accept. With increasing frequency, some name brand recruiters are relying on videoconference interviews – and in some cases only telephone calls – to make a critical decision concerning which candidates they plan to submit for client consideration.

I find this alarming.

The central problem with the executive search process is that it requires a client – and the candidate – to make life-changing, career-changing decisions based on three or four face-to-face meetings. Historically, this meant a face-to-face interview with the firm’s engagement partner following several telephone screening interviews with search associates and then one or two site interviews with the client.

At its best, the executive search process is a somewhat risky business when you consider the myriad of professional/organizational, and personality issues, as well as the enormous financial risks, that surround the selection process. It is about cramming a massive exchange of information into a relatively short, defined process and, in the end, coming up with a correct assessment.

Executive search is anything but a scientific process. Oh yes, there are firms with a boatload of tests they ask you to take, psychologists they ask you to meet, impressive and comparative graphs they create. And these can be useful tools. However, at the end of the day, executive search is no more a science than a high stakes poker game. In fact, you could make the argument that executive search is really a black art. Success will always be based on sound, experienced judgment and good information.

As a search partner with more than 10 years of senior level search experience, I have always felt executive search is best described as the process of getting married after four or five dates. Now that is risky. In marriage, as in search, the only way to mitigate the risks is through the exchange of information and the evaluation of leadership style, attitudes, values and a thorough vetting of past performance which is the best predictor of future success.

Let’s focus on the importance of information for a minute. Information about the client – and about the candidate – is at the heart of the process. The quality of the information is critical to a successful search.

Candidates need clients to make full disclosure – the good, the bad and the ugly. Every organization has those charactertistics. Clients need recruiters who will drill deep into a candidate’s background, evaluating credentials, background issues and past performance to provide in-depth dossiers. Without a robust exchange of information, the search process is flawed.

Following several recent HealthCare Voice blogs, I have talked with increasing numbers of candidates who are eager to share their experiences (and frustrations) concerning executive recruiters. There is a recurring theme: candidates say that they get minimal information about the client, their challenges and opportunities, and almost nothing about performance expectations or the cultural DNA of the organization. Let’s be honest, it is hard to describe these issues as well as the community in a 7 to 12 page document which seems to be the average these days.

At JohnMarch Partners, the average length of our Position Prospectus varies from 24 to 60 pages, depending on the complexity of the engagement. We do not want our candidates to be surprised or feel sandbagged.

With an increasing number of horror stories in which the recruiter, the client, or both, withheld important information that was material to the decision to accept an employment offer, candidates are justified with their concerns over this lack of disclosure.

And now the alarming trend: candidates say that more and more, their contact with recruiters is limited to the telephone or one or two videoconference sessions. For senior level executive assignments, this is a very bad practice that will result in an increasing number of bad matches.

The real cost of an executive level mis-hire has been estimated at 100 times the candidate’s annual salary. That can be a staggering financial loss for a client organization. If using videoconference interviews is about saving money, then someone is being penny wise and pound foolish. Or is this trend of videoconferencing candidate interviews more for the convenience of the recruiter? Is the search process becoming more about candidate inventory and filling client orders? Where does judgment fit in that formula?

I am not anti-technology. JohnMarch Partners was one of the first firms to use videoconference technology in the early 1990s when searching for clinical physicians. There is no question that technology is a great thing. It can contribute to the search process. But technology cannot replace the all important face-to-face interview between a well prepared search consultant and a potential recommended candidate. A probing two or three hour interview by the engagement partner is as much about the nuance of a candidate’s responses and reactions as are his or her answers to the questions. You simply cannot achieve that level of insight through videoconferencing.

Make no mistake, the engagement partner’s interview is critical in deciding which candidates should be submitted to the client for their review. Here is a more personal way to look at this practice: using videoconference interviews to select candidates is like seeing your new grandchild for the first time. You are delighted for the picture but there is absolutely no substitute for the experience of holding that grandchild for the first time.

When a client pays the recruiter a fee that is equal to one-third of the successful candidate’s first year cash compensation, they are entitled to every advantage, every bit of value that a search firm can deliver. A convenience for the search consultant should not be a factor.

Videoconferencing the key interviews in lieu of meeting the candidate personally is a poor substitute for good recruiting.

Or for deciding who to marry.

John G. Self, Chairman of JohnMarch Partners, is the Firm’s senior client advisor. He is a former investigative reporter and crime writer for a major daily newspaper. Candidates and clients say he is one of the most thorough executive recruiters working in the healthcare industry.