HealthCare Voice

Going Out On A Limb...Not Really

In one of the silliest of debates in the world of healthcare, challenging economic times and the inevitable cuts in reimbursement from healthcare reform and deficit reduction have fueled a renewal of the endless haggling over who is better: not-for-profit or investor-owned hospitals?

Let's cut to the chase:  the winner is/will be those hospitals that achieve superior results in terms of quality, safety and patient satisfaction.  Who cares about the ownership structure?

I have worked in the healthcare industry for more than 30 years.   When I first went to work for Hermann Hospital in Houston as a young PR director and the first director of Life Flight in early 1976, there were actually more investor-owned hospitals in the market than the staid non-profit behemoths of tertiary care.  While the big tertiary care facilities that took care of the sickest patients were tax-exempt, the hard-charging investor-owned community facilities reshaped the market dynamics in terms of competition, the speed with which business decisions were made, and their ground-breaking efficiency.

Today, the pros and cons of which ownership model is superior are once again being debated.  The truth is that both ownership structures are fraught with weaknesses that healthcare reform and the ongoing deficit/debt reduction efforts will challenge.  

Who will win?  To borrow a line from the late Molly Ivins, a newspaper columnist who covered Texas politics for decades, "I am going to go out on a limb and tell you that I haven't a clue."  That said, I do know what will be the deciding factor.  Quality people.  Organizations that recruit and retain the best talent and who understand the consequences of the "new normal" and the lower rates of reimbursement, will end up on top.  If you do not hire and retain the best people, it is impossible to compete in a hyper-challenging financial/business model transformation.

Eventually, when the financial squeeze reaches painful levels, ownership structure will certainly come into play.  I think I know how it will play out, but that is a conversation for a different day. There are so many policy/reimbursement issues about which hospital CEOs have so little control   For now, if you are a hospital CEO, pay attention to the most important variable you can control:  the quality of people you hire and the rate of retention. That is one of the most important things you will do as THE leader.

© 2011 John Gregory Self

Seed Newsvine

OK, Here's the Deal

Several months ago, I announced that I was going to shift from writing a blog exclusive to healthcare to more general interest issues. I promised that I would get back to you when my plans came together. All I can say is that best made plans are subject to change. So, here's the deal.

I am going to continue with HealthCare Voice. The focus will remain on healthcare leadership, strategy, career management, talent acquisition, retention, team development, etc.  My brand advisors and some of my valued readers encouraged me not to stray from my original intent. So, I changed my mind.  

HealthCare Voice will continue to appear at least twice a week.  In the near future it will be moved to my website, JohnGSelf.Com which is being expanded by my capable marketing team at Brandnu Marketing, a DFW firm that specializes in helping organizations enhance their brands and grow their businesses.  HealthCare Voice will feature a new design but will offer the same subscription and push distributition capabilities (which means RSS or email alerts). I will get back with you before the site is changed so that you can renew your subscription or RSS feed based on the new URL.

Plans for a general interest blog in support of my public speaking business are in full swing. This blog will focus on a variety of subjects about which I have a strong interest. More on this later.

© 2011 John Gregory Self

Seed Newsvine

Organizations Do Not Care About People...

Organizations do not care about people, only people care about people.

_{That was the theme of a recent Seth Godin blog.  It is the people, plain and simple.} 

_{For the record, Mr. Godin is a marketing innovator who pioneered “permission marketing.”  His daily blog is the 15th most popular in the Blogosphere world.}

Next month I am speaking to a national meeting of the association of imaging management which has decided to hold its annual conference on the sizzling skillet that is North Texas in August.  My seminar theme is how empowering employees is a strategic imperative in our “new normal” economy where unemployment remains excessively high and consumers are tapped out.  I am going to make the case that empowering people is more than a strategic necessity, it is a moral imperative.

I speak and write frequently about the importance of people in business and how they – our employees -- should be our most valuable asset, just as we advertise in our annual reports and recruitment brochures.  Of course today, for the most part, that is simply not true.  Today, far too many CEOs are unwilling, or unable, to walk their talk, a fact that is not lost on their employees.  From hospitals to airlines, carmakers to manufacturing and retails businesses still view their employees as not their most important asset, but their biggest expense. The consequences of that approach are all bad, and accepting the inevitable adverse impact this mindset inflicts on our customers/patients, is immoral.

As I travel around the country, I see signs posted in the hallways and employee work areas that are designed to boost morale and reinforce the corporate culture, as if clever, pretty signs will achieve the desired effect.  “Our People Are Our Most Important Asset,” is in the top 10 of popular postings.  But the sad truth is that if companies have to resort to hanging signs to remind their employees, they are truly in trouble.  What they are really telling their employees is: 

“Our people are our most important slogan.”

 

© 2011 John Gregory Self

EXECUTIVE RECRUITMENT: Can You Afford Average?

It is a recurring question -- how can I be sure that I am hiring the right executive and that once they join will they stay?

In all honesty, when dealing with people, there are no absolutes.  But with the right search consultant -- internal or with a firm -- and a gold-plated recruiting/candidate screening process, you can substantially mitigate the risks. However, let the buyer beware:  if your executive search firm uses terms like “job order”, “hiring authority” or “fill rate”, more than likely they are a placement agency or staffing company trying to move up the financial ladder.  

The real secret to success in executive search is to select a partner or search consultant who possesses some important skills.  First and foremost, success in executive search is not tied to the number of years of experience.  That is helpful, but if the consultant lacks a particular set of skills necessary for success, years of experience will ensure only that you are buying experienced mediocrity.  Nor is the size of the firm of any consequence unless your organization is a multinational operator and geographic reach is important.  No, the secret lies in the search consultant who will be doing the majority of the work.  Does this person possess a deep understanding of the culture of the organization -- the values, the rules governing interpersonal relationships, and how decisions are made?  Do they require complete transparency regarding performance expectations, details regarding the hurdles that must be overcome to achieve success, and identification of the always dangerous sacred cows?  The consultant must insist that the client lose their natural desire to put their best foot forward while obscuring important problems or challenges that will become the organizational equivalent of an IED - improvised explosive device -- with career-limiting consequences.

Is the consultant who will do most of the work on your search, save perhaps the candidate's final interview with the engagement partner, present for the all important site work, or are they closeted away in the Firm’s office working on other projects?  (That is the most common model in the search industry.)

If your consultant does not force you to deal with the tough issues, do not be surprised if the outcome is only average.  Executive search is like dating and marriage -- decisions are made after four or five dates.   If the search does not force the client to deal with always-present nasty little details in advance of the marriage, there is a good possibility that it will not be a long and productive relationship and the divorce will be messy and costly.  

The truth is that far too many executive recruiters practice what I call “don’t ask, don’t tell”  recruiting. The partner signs the engagement, a consultant who may, or may not have been present for the site work, prepares a superficial job description and if the candidate doesn’t ask about the culture or potential problems that could affect their success, the search firm does not tell.  Oh, the big firms deny that is the case, but I have interviewed far too many candidates who say otherwise.

How confident is the search firm in their ability to find a candidate who will deliver value to the organization?  To test a search firm's true mettle, ask the partner in charge if they will guarantee their work for an extended period of time and listen for the reasons they do not.  Most firms offer a 12-month placement guarantee.  That is average.  There are one or two firms competing in the healthcare provider segment who will offer an extended placement guarantee, but they are the exception.

So the answer to the question is, in the end, really this:  Given the cost of an executive search -- professional fees plus an overhead assessment and travel costs:  Can you afford average?

© 2011 John Gregory Self

Seed Newsvine

Quality and Safety: The Secret Ingredient for Success

I have had the pleasure of working with some great health system and hospital clients that have achieved national recognition for achieving meaningful and sustainable improvements in quality of care and patient safety.  These are not manufactured results for some national magazine survey or billboard campaign.  Their quality scorecards, based on national standards, are impressive.

Do you know what characteristic is evident in each of these star organizations?  A CEO with a laser-like focus who is passionate about quality and safety, a leader who is willing to stake his/her personal and professional reputation on achieving and sustaining excellence on these two deliverables, and every employee in the organization knows it.

A colleague, someone I personally admire and respect, works for a health system that is struggling with quality. The employees know it.  They all talk about it – outside of earshot of the patients, of course. He is seeking another job, determined never again to work for a CEO who does not put quality and safety ahead of all else, including his social calendar or vacation schedule. 

All this talking in my friend's current organization has led to some amazing excuses and, sadly, inaction.  The leadership team just can’t seem to overcome their inertia on this critical subject.  Intellectually they want to do something but they cannot seem to see a clear pathway.  Their excuses run the gamut – take your pick from the usual suspects: poor leadership by the CEO; doctors who have grown complacent or more focused on financial returns than their patients; overworked nurses; the nasty, socially reprehensible financial costs associated with frivolous malpractice claims.

 We all know that there are causes for poor quality -- it is not always simply the physician or a nurse -- but many organizations adopt what I call “non-blame solutions.”  They spend a great deal of money on quality improvement in search of an easy answer where none exists instead of focusing on creating a culture of quality care that is real, and holds people accountable for improving the situation. 

All of this rationalization aside, I have come to believe that hospitals that suffer from continuing poor quality of care and patient safety do so because they choose to.  They could do something about the problem but they don’t.  What a damning statement, but the truth is that if you strip away all the excuses, the leaders and the physicians just cannot make the hard choices, ruffle feathers.  They say they do, because that is what people say who recognize that certain behaviors or outcomes or bad but lack the will or ability to drive change.

Sometimes it is just easier to do nothing or, worse, go through the motions – including meetings upon meetings, the engagement of consultants, the development of process improvement plans, and the investment in elaborate programs for collecting and plotting data.  The painful truth is that if the leadership team lacks the passion to fix the problem, if they are unwilling to stake their personal and career reputations on solving the situation, then most of what they say, the efforts they make, and the money they spend on equality improvement, is just the equivalent rearranging the deck chairs on the Titanic.

© 2011 John Gregory Self

Seed Newsvine

A New Type of CMO

Healthcare reform is extending beyond the Washington beltway.

You can see it in how health systems, hospitals and other providers are shifting their marketing strategies from the traditional wholesale approach -- physicians are the primary customer -- to retail marketing in which hospitals appeal directly to patients on the basis of quality, safety, technology, scope of services and access.  

As physicians shift their employment and business orientation from physician-owned practices to employment by hospitals and insurance companies -- yes, payors are beginning to acquire practices as well -- hospitals are turning their attention directly to the patients.

In the process, CEOs are creating yet another CMO position for their senior leadership team: Chief Marketing Officer. In the earliest days, marketing Vice Presidents or Directors were seen, more often than not, primarily as strategy, advertising and/or "sales" people.  

Providers now are quickly adjusting their perspective, acquiring sophisticated marketing information systems to aggregate and analyze a mountain of data hospitals have been collecting for years but never used in a meaningful way.

HealthLeaders.Com has published an excellent article, Image Makeover that is worthy of review. 

Read More.

© 2011 John Gregory Self

Seed Newsvine

Customer 2.0

The nation's hospitals, which have consistently lagged behind other industries in terms of management technology and service, will soon face a new demand for MIS innovation just as they are implementing new platforms, systems, and programs to deal with electronic health records and the concept of meaningful use.

It is called Customer 2.0.

It seems like only yesterday that some hospitals ventured timidly into the 20th century with call centers to assist clients navigate their way through a myriad of questions concerning unpaid balances, paying bills, scheduling and registration.  Now we learn that other industries are looking at innovative ways to meet consumer demands that want them to incorporate new media into the customer service mix.

This will not be a change that occurs overnight.  Thank goodness, since healthcare management information systems, which are today better than ever, are still far behind retail and manufacturing.  But this is a change that will come, and once the critical mass trigger is hit in other industries, it will sweep into healthcare.

Here is a post from Christopher Elliott writing in BNET, the excellent interactive business site from CBS:

"Brett Shockley, a senior vice president at Avaya, told a recent technology conference that businesses are just coming to terms with a new kind of consumer – he called it Customer 2.0 – and defined it like this:

They’re born with a keyboard. They’re born with an attitude.

Now that they’re graduating from college, they’ve got a disposable income and there’s about 80 million of them.

We’ve got to pay attention to all the different ways that they want to communicate. We’ve got totake all of this into consideration in our companies."

READ MORE.

If you are not a regular reader of BNET, I want to encourage to check in on this site from time to time.  They have some excellent articles. 

Now add to the mix that we will have less money for the whistles and bells – aka new technology – and the fact that we are change resistant, voila, you have yet another interesting confluence of competing interests that will make the CEO’s job – already one of the most difficult on earth – even more challenging.

 Have a great weekend.  I am staying indoors, if at all possible.  It is forecast to be 100+ again in Dallas.

 © 2011 John Gregory Self

 

Seed Newsvine

What's In A Name?

What’s in a name?

A lot, it would seem, especially if you can find the humor in the law of unintended consequences in the child naming arena. And sometimes the last name is an indicator of the career choice of its owner.

When parents pick names for their children, they typically rely on family tradition, personal preferences, or what is currently popular. They do not think ahead to the implication of the awkward possibilities that a marriage or career choice might produce.

When I was growing up in East Texas, I had a friend. His last name was Fernley. He was cool. A lot of girls agreed, including the daughter of a local OB-GYN. Her name was Finley. Luckily, the romance ended in high school and we were spared  dealing with Finley Fernley.

In an earlier married life, I had a sister-in-law whose first name – her only name – was Morgan. She fell in love, got engaged and then, fortunately, the romance faded.  The good news is that the world was spared a woman whose name would have been Morgan Morgan.

In my days of reporting for The Houston Post, I frequently worked with a photojournalist – a photographer – whose last name was Click. He liked to hang out in a bar on Buffalo Speedway. Dave Press was a foreman in the press room of one of my former newspaper employers.

When I left the news business, I joined Hermann Hospital in Houston as their public relations director, and I met an aspiring Colon and Rectal surgeon whose last name was, no kidding, Dr. Butts. Fortunately his first name was not Seymour. 

BNET Blogger Steve Tobak wrote last week about a Wall Street Journal article that discussed aptonyms – when your name reflects your profession, like my teaching hospital acquaintance, Dr. Butts.

Mr. Tobak thoughtfully assembled a list from the WSJ as well as “reliable examples” from the comment section. Kudos to Mr. Tobak for bringing these wonderful examples to our attention:

• Personal injury attorney:  Patricia Boguslawski of Teanack, NJ. Her name is apparently pronounced Bogus–law-ski. Really
• Urologist:  Rick Chopp of Austin
• Doctors Toothman and Brush – two dentists from a location unknown
• Will Wynn – a former mayor of Austin
• Dr. Chu – an orthodontist
• Dr. Butcher – yes, a dental surgeon
• Dr. Jacqueline Hott – a sex therapist
• A urologist who did vasectomies – Dr. Harold Stop
• Laureen Light – a psychologist
• Soo Yoo – an attorney

Finally, apparently the founder of the University Of Rhode Island Graduate School Of Oceanography was Charles Fish. And then there was a family Realtors in West Virginia with the surname of Greathouse, Mr. Tobak wrote.

He asks us not to forget about the financial advisor whose name was actually Rich Widows.

I am John G. Self of Dallas and Tyler, Texas.  Clearly my name has nothing to do with recruiting or any of my earlier career pursuits.  I have been accused of being "self"-centered, but I will just ignore that for now.  My father was a very successful retail baker in Tyler. By ancestry we are Dutch by way of Arkansas. An earlier spelling of the family name, changed prior to my father's arrival in this world, was Selph.  No humor there, thank goodness. My grandfather, also a baker and later in life a city judge in Terrell, Texas, did ride his bicycle through Indian territory -- now known as Oklahoma -- when his family decided to forego the wilds of Arkansas for Texas. 

No, I do not have children with the names of “Him” or “Her” but my name does come up frequently in Sunday morning sermons.

 

© 2011 John Gregory Self

Seed Newsvine

Five Reasons Hospital CEOs Get Fired

From Anchorage Alaska

Hospital CEOs have their hands full.  They face a boiling cauldron of operational, financial and competitive challenges – any of which could prove career limiting.  Surprisingly, however, many CEOs fail not because they lacked knowledge or expertise in running a hospital or dealing with the myriad of threats.  Rather the fastest-track to a severance agreement, or unceremoniously escorted from the building, can be found in five major failings.

 The overarching principles on this subject are two-fold:  First, CEOs and senior executives should know themselves. The second “first” rule is that CEOs should do no harm to the employees they lead or the customers they serve.  CEOs who keep their eyes on these balls will typically do well, all other things equal – knowledge, talent, and expertise.

So why do CEOs get fired?  More often than not it is style, or lack of political sensitivity, that will be a CEO’s undoing.  In more than 30 years in healthcare leadership – 17 years in executive recruiting – I have seen senior executives run aground many times over because they lacked the sensitivity to read, understand and adjust to the shifting political and marketplace sands that exist in virtually every health system or hospital, from the governing board and medical staff to the hourly employees who do the really important work.

Here are the five sure-fire issues that will get a CEO fired.

1. Micromanage your team - Micromanagers are like amateurs masquerading as "in-the-know" leaders. Let's be honest, if you have to get that involved in the operations of the enterprise, you are not hiring the right people.  When you micromanage, you destroy morale, and disrupt service.  You show me a hospital CEO or COO who is a micromanager and I will show you an organization that is, or will, suffer quality and  patient safety problems, and, eventually, poor financial performance.
2.  Be a Bully - There is no place in leadership for bullies/abusive leaders.  If you have to use anger, intimidation, or abuse to achieve targeted results, or if you enjoy calling out subordinates and humiliating them in front of their peers, you might want to reconsider changing careers. Your employees -- and your customers --  will be delighted you have left. In short, if you think that approach to management is smart leadership, you do not belong in healthcare.  Management and employee turnover is dangerous for your patients and it is very expensive.  The only way a CEO with this particular mortal sin can hold on to their job is if they work for an incredibly toxic board or a ridiculously misguided corporate entity that equates this type of boorish behavior with “tough” leadership.  There is no accounting for stupidity that manifest itself in this type of misguided and misinformed corporate or governing board oversight.
3. Ignore Your Customers – That is perhaps one of the biggest – and most common – sins in healthcare today.  Take care of your customers. They will take care of you (and your career).  Steve Jobs and Apple blew past Microsoft in terms of market cap, not because they treated their customers with dismissive indifference, but because they were passionately focused on offering an extraordinary customer experience – exceptional quality and best-in-industry service.  Day in and day out, Apple employees focus on their customers – meeting their needs with enthusiasm that is fueled by a belief that they are working for an outstanding company “that gets it.”  Fighting with your customers (read: physicians) – even though they may also be your competitors at some point in the day – is a bad idea.  It demonstrates, without equivocation, that you do not get it.  As a savvy politician once said, never fight with a man who buys printer’s ink by the barrel.  Taking a my-way-or-the-highway posture with the people who admit patients and generate revenue or the board members who evaluate your performance is a really bad idea.  As CEO, you are supposed to be on top of the emerging trends.  If your physicians are concerned with their revenue, be a partner, not an adversary. That point is not rocket science but you would be surprised how many CEO terminations can be traced to an arrogant belief that you can fight with your customers and still be a winner.
4. Excel in self-importance – CEOs, you should (read: must) check your ego at the front door.  It is not about you.  It IS about the people you serve.  In a crummy economy, the smart leaders are the ones who walk the floors and talk to their employees – on all shifts, all the time – looking for ways to improve quality and service, how they can make a meaningful difference in the lives of those who, day in and day out, actually do the work.  CEOs should regularly visit their physicians – all of them – on their turf.  Listen, learn.  This is not for show.  The employees and the physicians know when they are being taken seriously and they appreciate the effort.  So many CEOs fail to build this reservoir of goodwill that will be essential to survive the inevitable crisis that will occur during a standard tenure of five to seven years.  CEOs have all sorts of excuses why they can’t do this (I have heard most of them), but when the board makes the decisions to terminate, remember your lame excuses and then decide if you like the feeling of getting the boot.
5. Be a Phantom CEO -- You cannot lead from behind closed doors and a cadre of assistants who shield you from your customers and those who actually do the work that generates the revenue.   Stop trying.  In plain terms, do not build walls or a honking big silo of reinforced concrete around yourself.  CEOs should not let their fears or insecurities make them a prisoner of the executive suite, venturing out only for the weekly manager’s meeting or occasional hospital-wide event.  A CEO once told me, “I just do not feel comfortable interacting with the employees without others being with me.”  Insecurity is the stuff that walls and silos are made of.  Get a coach and get over it. Or get an outplacement adviser.  You will need one

Bonus Reason:  Avoid Accountability. Blame others for your failings.  Your       subordinates will really love you for that one.  Do the opposite.  Be accountable.         No one likes a leader who is full of excuses, who dodges accountability.  Revel in       being responsible for the success of the organization. Take joy in the challenge.         Talk about it constantly and hold others accountable.  That is a powerful       message.  No one likes a dodger who is better at excuses than results

© 2011 John Gregory Self

  Seed Newsvine