HealthCare Voice

Can You Spell Bad Service? MICROSOFT

A year ago, as I worked to launch my new executive search firm, I experienced problems loading a customer/candidate database. I needed help in a hurry so I turned to the software company.  What a disaster in customer service.  It was if their motto was We make a lot of money selling software.  Don't bug us.  Visit our web site.

Welcome to Microsoft customer support.

If you are not a technical wizard, the Microsoft web page is as opaque as the complex Collateralized Debt Obligation instruments from the real estate debacle that were so complicated that the bankers who sold them didn't understand. Forget trying to find the right article, among hundreds, that will explain the issue and tell you how to fix it, assuming they were written in easy-to-understand English.   

They make it difficult to find their contact information and more difficult still to find a telephone number to technical support for the specific product.  When you finally get through the telephone decision decision tree, assuming you are not cut off, you are then connected -- using a system that is only marginally better than two orange juice cans and string -- to a technical support guru who is obviously not in the USA.  You struggle to hear. Understanding the representative is another struggle.  A pronounced accent and a bad connection is one definition of technical support hell.

Now compare that with Apple.  Today I had a question; I used their super fast Safari browser, easily found the technical support contact information, entered my product model number and filled in a quick form to explain the problem.  They gave me choices:

1. Immediate call.  They would call me.  The waiting time listed on the web was less than one minute.

2. I could schedule a call

3. I could use their knowledge base -- for the technically sophisticated among us

I chose the immediate call. Within seconds of entering my number, my telephone was ringing.  Apple was calling.  I also received a case number and explanation on my email. The technical support representative was friendly, eager to help and communication was not a problem... I will not ramble on.  Apple owners get it.  They know that this company is committed to making high quality products that surprise and wow their customers, and they back that up with what many think is best-in-industry customer service. No competition.  

Microsoft service is a long standing bad joke.  And given the mediocrity of some of their software, you would think they would take customer service a little more seriously. But what the heck, they are making a lot of money.  Too bad Apple just passed them in terms of market capitalization.

So now we come to hospitals.  We are not even in the same universe when it comes to customer service.  

A friend visited her physician who works in an integrated health system. They took x-rays, performed lab work and gave her two major injections to counter an infection.  She is a Medicare beneficiary.  Several weeks later, she received a bill, which she paid.  Then she received another much larger invoice, which was for her lab work.  Immediate payment was requested.  It seemed high, so my friend called Medicare to determine how much they had paid.

Guess what? Medicare had not been billed. Medicare's representative advised her to wait to pay that amount until the clinic filed a claim and Medicare determined how much they would pay.  The suggestion was clear -- that if my friend paid the clinic the full amount now, she might have to wait for months before receiving a refund. So she called the clinic billing office and dealt with someone whose name should have been: Ms. I Am Clueless. They discussed the situation but it was unclear to my friend if she made any progress, if anything was resolved, based on her conversation with the customer service representative. Hence the clueless moniker.

This week my friend received yet another bill for a different amount for the same test, but the amount -- $43 with another $4 tacked on as a late fee because the amount had not been paid in 30 days. She called the clinic back and talked to another customer service representative, Ms. Dismissive Indifference, who said she could not see why they had added a late fee since the payment due was not late.   In the end, however, my friend paid the principal amount and the late fee. She was told that it was just easier to do so.  I an era of tightening reimbursement, I guess that is just one small way to boost revenue. 

The big bill apparently is still rattling around in payment hell waiting for a settlement. 

This story, unfortunately, is fairly common. Not all hospitals and large clinics operate this way.  There are some great operators who get it right every day.  But many do not.

I work in healthcare and I am beginning to hate even thinking about going to my doctor. He is part of a big clinic whose centralized business office is run, I have come to believe, by some obscure, inept arm of the government.  Who needs the aggravation?  It is like dealing with Microsoft.  

The problem for most hospital CEOs is that they only hear about these incredible stories only if someone complains, which my friend will not do.  So absent an aggressive pro-actve customer service program that can identify problems before they alienate clients, nothing much changes.  Far too many are like Microsoft's leadership.  If they are profitable, the seem to say, don't sweat the small stuff.  I guess that means service, too.

Healthcare providers need to stop and take a page from Apple's playbook. They understand customer service and they love to exceed their customers' expectations.

 © 2010 John Gregory Self                        

Health Systems, Hospitals Got It Right

Because I am not shy about criticizing or challenging my industry – healthcare – when we fail to live up to our mission of quality/safer patient care and support for the communities we serve, I owe it to my colleagues to voice my support when I believe they get it right.  They have in one very important area.

Executive compensation continues to be a hot subject both in the U.S. and Europe.  Not a week goes by without a news report, analysis or essay on the subject. While the current lightning rod is the large investment banks, there are far too many public corporations that are guilty of bad practices in how they pay their executives and how they explain it publicly.  

The central issues giving life to this continuing flow of coverage on the subject are the size of the base salaries and/or bonuses, the relationship between the pay for some easily understood performance metric, and the rights of shareholders – or the lack thereof – when the “owners” of the company are not happy with size or justification for the genrous awards.

Executive compensation issues and the financial community’s sense of entitlement, continues to irk regulators, millions of small business owners and “average Joes” everywhere.  The large banks single handedly drove this country to the verge of a global credit market contagion.  However, the continuing problems and lack of transparency in executive compensation are not confined to the banks.  There are hundreds of examples of corporations throughout the U.S. and Europe that treat shareholders as troublemakers of the worst sort if they deign to believe they are entitled to any rights  to have a meaningful say on this issue.

In healthcare delivery, we have kept our wits about us on executive compensation when other industrial and service sectors lost their way. We are not perfect, but our industry does remarkably well, all things considered. 

While there are health system and hospital CEOs who earn high six and low seven-figure incomes – and they are the exception – there are few examples where the size of compensation of a hospital CEO is inconsistent with the scope of responsibility and the complexity of the challenges these executives face.  In fact, there are examples aplenty of hospital CEOs of difficult-to-manage public and mid-sized community hospitals who are underpaid for the work they do and the results they produce. 

I am not going to discuss the payor or pharmaceutical segments because I lack the expertise.  My search firm does not work in those areas, but I believe there are certainly examples of these bad  compensation practices in the health insurance, technology, and pharmaceutical segments.

Health system and hospital boards, for the most part, are responsive to their communities and tend to be prudent in evaluating the CEO and how they pay him or her for the results they produce.  No, community boards are not as transparent as they should be in some markets, but even in the worst of cases, they are infinitely more responsive than the boards of far too many major public corporations who have created more rules and hurdles to block true shareholder input into how the company is run.  It is a maddening situation for many mom and pop investors, and increasing numbers of institutional investors, who are tiring of the corporate arrogance and greed.

Hopefully, as community healthcare organizations deal with the immense challenges that are part and parcel of our “new normal” economy, persistent high unemployment and anemic growth rates, their boards will become more transparent, not less, and more communicative, not less, regarding the size and scope of their community benefit which is how they justify their tax-exempt status.

Big corporations may have a legal requirement to be more forthcoming, but community healthcare providers have a moral and ethical duty.  And there is a big difference. 

 

© 2011 John Gregory Self

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Who Will Provide the Change We Really Need?

I don't know about you, but I am frustrated.  

We are at the start of another political season to "decide the fate of America."  But we all know, deep down, that when we listen to the two political parties nothing is going to change even though change is something we desperately need.  

I am not talking about "change you can believe in" or change that will "restore American values."  Those are just simplistic political talking points that clearly do not translate into real change that will help the American middle class, Main Street businesses, the healthcare industry or anyone else that really needs and wants their lot in life to improve.

This latest economic downturn has exposed deep structural problems in our society, according to David Brooks, a conservative columnist for The New York Times. He argues that the solutions by America's two-party system are not addressing the critical issues of our time:

• Unsustainable levels of debt
• Inability to generate middle class incomes
• Dysfunctional political system
• Steady growth in the dominance of special interests
• Gradual loss of national vitality

"The number of business start-ups per capita has been falling steadily since 1983.  Male wages have been stagnant for about 40 years. The American working class -- those without a college degree -- is being decimated, economically and socially.  In 1960, 83 percent of the working class were married. Now only 48 percent are," Mr. Brooks writes.

"Large majorities think the country is on the wrong track and have for years.  Large pluralities believe their children will have fewer opportunities than they do.

"Voters are in the market for new movements and new combinations, yet the two political parties have grown more rigid."

Mr. Brooks, who is protesting that he and his colleagues will have to cover yet another political season absent any new creative thinking, goes to the heart of the matter with his criticism of the current orthodoxy of Republicans and Democrats. 

The core belief of the Republican party that smaller government is the answer appears to be based on a belief that the American people will not do something really stupid en masse. But we did.  We may want to point our finger at Congress and recent Presidents, but we voters are just as guilty in terms of our deficit spending. As a nation we have lived above our means for years, from buying bigger houses than we could afford and taking on new home equity debt with the silly belief that real estate values would never fall, to purchasing a lifestyle we could just as easily do without.  All of it using borrowed money. All the while our government failed to use the regulations already on the books to make the mortgage loan industry and Wall Street bankers do the right thing.  Their bad behavior may have sparked the crisis, but if not this calamity, something else would have come along.  In looking over the last 10 years, if you take out the devastating real estate bubble, job growth in the U.S. has been essentially flat since 2000.

Today, "the Republican growth agenda offers tax cuts and not much else," Mr. Brooks contends, "...they do nothing to address the structural problems that are causing the working class crisis."  The GOP plan is "fiscally irresponsible and politically impossible. 

"They do not design policies to help their own working class voters," Mr. Brooks says. Rather, they use policy proposals as "signaling devices  -- as ways to assure the base that they are 100 percent orthodox and rigidly loyal.

"As for the Democrats, they offer practically nothing.  They acknowledge huge problems like wage stagnation and then offer...light rail! Solar panels!

"It was telling that the Democrats offered no budget this year even though they are supposedly running the country. That is because they are trapped in a bygone era.  

"Mentally, they are living in an era of affluence, but actually they are living in an era of austerity. They have these great spending ideas but there is no longer any money to pay for them and there won't be for decades. Democrats dream New Deal dreams, propose nothing and try to win elections by making sure nobody touches Medicare," Mr. Brooks writes

Mr. Brooks believes that covering the upcoming election will be akin to "covering competition between two Soviet refrigerator companies, cold-war relics offering products that never change."

I have come to believe that while we may be a nation of incredible thinkers who are capable to creating enormous economic growth, our political class, with only a few exceptions, is content with the new lows of group think that sucks the air right out of the room.  At a critical time when solutions are needed, solving problems is now secondary to re-election, and we all know it.

The American people want answers and action to deliver real solutions. Let's hope they will not settle for sound bites, clever disinformation, and political jingoisms that characterized our last three political campaigns. I sense that we are approaching a tipping point. I am just not sure what is going to happen when the tip occurs and that concerns me. 

As a former reporter, there are some questions I would like to ask the candidates if I were on the campaign trail.   

What about you?  What would you ask the President and the gaggle of Republicans who aspire to lead?  Remember, whatever they propose in the way of a solution, you will get the tab.

© 2011 John Gregory Self

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Take The Time

Today I received a thank you card via PLAXO, one of a number of social networking sites, thanking me for being thoughtful.  It was from the CEO of a health system in the Mountain West who appreciated the fact that I remembered her birthday. "Thank you for your thoughtfulness."

Tough and challenging times lie ahead for healthcare leaders.  We will see unprecedented reductions in Medicare and Medicaid funding, the promises of the Patient Protection and Affordable Care Act notwithstanding.  These reductions will force providers to embark on structural reforms that most never imagined in their lifetime.  

There will be pain caused by our instincts to resist complicated reforms that upset our values. These changes will be especially hard on many of our key stakeholders such as our physicians and our employees.

Senior leaders who focus solely on strategy, the daily, weekly, and monthly metrics, and the month-end results, will not be as successful as those CEOs and their teams who keep their employees and customers front and center.  When the crunch hits, we must all resist the temptation to view maintaining these important relationships as an expense, a secondary priority, or something that can be all together forgotten in the name of "making the hard financial choices."

In the end, those healthcare organizations that thrive in an era of radical and painful change will be those who have employees who have been engaged and empowered to make their organization the best.  

To be a successful healthcare organization over the next 10 years means investing today in people and relationships. At the core of this effort must be developing a reservoir of goodwill with those stakeholders.

CEOs who understand that they must focus on their role as a strategist, resource coordinator, and chief relationship/communications officer will thrive, provided they delegate daily operations to a competent management team.

Leaders who focus on the big issues but remember the small things -- sending an employee a birthday card, a congratulatory note for going the extra mile, or making an unannounced visit to a department to recognize someone for a job well done is such a minor event in an otherwise busy day, but pays huge benefits. 

Effective, successful executives and thoughtful leaders are one in the same. Over the next 10 years, this leadership truth will become very apparent.

IMPORTANT QUESTIONS

1.  Do you regularly make rounds on all shifts?  Do you require your executives and managers to visit employees and physicians on a regular basis on all shifts?

2. Do you take the time to listen to what employees and physicians are telling you?  Do you follow up in a timely manner?

3. Are you promoting bottom-up innovation?  Top-down organizations will struggle to keep pace with sweeping changes over the next 10 years. You cannot turn this essential cultural orientation off and on like a light.

4. Are your employee-stakeholder communications leading edge and effective? Is there substance that engages employees, physicians and community stakeholders on important issues?  Do your distribution platforms connect with the age cohorts of your audience?  

5.  Do you have a weekly communications plan that always emphasizes the organization's core values, the more immediate key issues and performance targets, or do you work off the cuff?   Are you promoting real transparency or are you playing the transparency game?

© 2011 John Gregory Self

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Irony and Hypocrisy On Wall Street and Our Very Short Memory

There is no question that the United States has experienced a deep and profound recession.  Some economists argue that our nation was on the verge of a depression when decisive action by the Bush administration, albeit with some major gaffes and no small amount of good luck, halted the plunge and saved us from years of economic pain unlike anything this nation has ever seen.

A worldwide banking crisis caused by the bad behavior of some Wall Street bankers and mortgage loan originators and the interlocking mess of bad loans, collateralize debt obligations, and credit default swaps, was narrowly averted.

Credit markets locked up.  Even healthy companies like General Electric and Boeing, that had nothing to do with the home loan bubble or those incredibly complex financial instruments that the “bankers” on Wall Street bought and sold as if they actually understood them, had great trouble obtaining financing for daily operations.  Small companies like mine were completely shut out of the credit markets.  No problem, it only cost me 16 years of my life and a lot of hard work.  

The United States, indeed most of the free-market economies, were at the edge of the abyss.  Most Americans did not realize it at the time, but this nation and its financial system were on the verge of a series of events that would have plunged us into a depression far more devastating than the Great Depression.

Greed ruled the day.  All of this financial mayhem and pain was caused in no small part because some greedy executives and traders were more interested in earning big fees and enormous bonuses than doing what was right.  Even when the supply of crappy mortgages ran out, these bankers created investment facilities out of whole cloth.  They knew their behavior was risky, even in appropriate, but they took the money anyway and kept looking for more of the bad deals to do.  Even when they knew what they did was wrong, there was no remorse. 

Regulators, who had the power to stop or slow this crisis down, did nothing.  After the carnage, with thousands upon thousands of innocents losing their jobs, their retirements and self-respect, the former Chairman of the Federal Reserve, Allan Greenspan, was quoted as saying, in effect, that he could not believe that capitalism’s famous “market forces” did not force bankers to do the right thing. 

Angry Congressional leaders, who were asked to turnover billions of dollars of taxpayer money to the Treasury Department in an attempt to unlock the credit freeze, apparently were “surprised” that this whole mess happened. 

As the smoke cleared, Congress reasserted itself.  Determined not to let this type of crisis occur again, they created a wealth of new regulations in a major bill, Dodd-Frank Wall Street Reform and Consumer Protection Act.  This is not a perfect bill but imperfect legislation often emerges when free-market capitalists behave badly.  Over the next few years, it will need to be tweaked and revised to mitigate unintended consequences, which is a common quirk in many new laws.  

I do not believe that government can provide all the answers to our national challenges, our problems or even unusual events.  I do believe that government must provide moderate, even-keeled regulatory oversight to minimize any negative impact from those whose avarice propels them to irresponsible or illegal behavior – those who could care less about the “suckers on Main Street” who actually believe in following the rules.

Now, remarkably, some of the same bad-boy bankers who created this havoc, and who profited handsomely, are whining about excessive regulation, predicting all manner of dire consequences for the U.S. economy.  These Wall Street leaders would have you forget their near miss and just trust them – again – to do the right thing. 

Some members of Congress, well-intentioned small government conservatives who decry regulations, and others who are more interested in maintaining their political fundraising pipelines to the Wall Street titans, are clamoring for repeal of the entire bill – the good, the bad and the ugly.

As I watch this extraordinary mix of irony and hypocrisy, I am reminded of an ugly story of marital infidelity with a similar outcome.

A wife arrives home early from an out-of-town trip.  She catches her husband in their marital bed with a neighbor’s wife.  The shocked wife understandably explodes in anger, hurt and shame.  She storms off into another part of their large home to regroup.

The neighbor’s wife beats a quick retreat out the side door.  The offending husband calmly goes to his bathroom, takes a shower, and changes clothes.  He retires to his study to smoke a cigar, drink a single malt Scotch and read his Wall Street Journal. 

Meanwhile, his wife has been noisily cleaning the house.  Her anger has driven her to the edge.  She is stunned by her husband’s callous bad behavior.  Cleaning the house, she reasons, is a safe and non-violent, stay-out-of-jail way to work off her rage.  After several hours of work she finally barges into her husband’s study to complete her work.  She loudly launches into vacuuming and dusting.

Her husband looks up from his paper, cigar in hand, takes a sip of scotch, and asks, “What are you so upset about?”

Sound familiar?

 

 

© 2011 John Gregory Self

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Leaders Who Are Bullies: No Excuse for Bad Behavior

Senior executives and managers who repeatedly castigate employees in front of their peers – yelling or humiliating them for whatever reason in whatever venue – prove only one thing: they are not leaders, they are bullies.

Physicians, the leaders in clinical care, who yell, curse and denigrate colleagues, nurses or other workers, are no different.  Their clinical brilliance, or lack thereof, is no excuse.  The problem of abusive physicians is well documented, so is the practice of far too many hospitals whose executives will look the other way when the offending party is a big admitter who drives significant profits to the bottom line.

It does not matter if the performance of the bully's target(s) is sub-par or whether the organization is in a turnaround crisis.  Physicians, executives and managers who employ all manner of lame excuses to justify their abusive behavior, are really just thugs masquerading as professionals. 

Boards or bosses who know that such behavior is occurring and allow it to continue for whatever rationalization, are no better than those who terrorize their employees. They act as if there are no consequences for tolerating such shameful actions. There are -- political, legal and economic.

Lest you think that I am angry about a relatively small issue – especially in healthcare – think again.  Let’s be fair.  This is not a problem that is limited to healthcare.  This unacceptable behavior touches every industry, in every corner of our nation. It is more widespread that anyone wants to acknowledge.

In my role as an executive recruiter, I hear of these stories far too often.  In my more than 30 years of executive experience, I have seen bosses shred employees in meetings and justify it as honest dialog about accountability.  I have seen CFOs shove employees against the wall “to get their attention.”  I have heard story after story of executives who blame their own mistakes on those who report to them.  I have seen leaders and managers misuse subordinates for no other reason because they can.

When I see this type of contemptible behavior, I often wonder what the bully’s home life is like.  

Being the victim of bullying -- emotional and verbal abuse -- brings with it a special shame. The victims often feel isolated, afraid to seek help. Notifying or asking for support from the wrong person -- the bully's ally or just another enabler -- may only aggravate the problem, especially if the bully's boss or the board believes the perpetrator is essential to the success of the organization. They rarely are, but that is part of the delusion. 

For the victim, quitting is not always an option.

I know victims who have risked exposure and called the hospital's compliance hotline because they simply could not take it anymore.  Some people have even tried notifying the Joint Commission because they did not trust the Chief Human Resource Officer to do the right thing or felt the internal process was compromised.  That failing is part of a larger story. When the chief of HR fails to investigate and protect, they are betraying the organization, themselves and their profession.  Being the HR advocate for an abused employee is not an optional job duty.

We are entering one of the most turbulent periods in the history of healthcare.  The impending challenges will require great leaders.  There is no place for bullies in the executive suite, as department managers or shift supervisors.  There never has been. 

© 2011 John Gregory Self

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