HealthCare Voice

Career Management In Complicated Times

In a rapidly changing global economic environment with high long-term unemployment likely, regardless of who controls the levers of power in Washington, the value of career planning is in the spotlight. 

There are basically two schools of thought:

 1.  It is a waste of time.  No one can predict the future -- new technologies, business realignments and the resulting job losses, or opportunities that will emerge amidst the chaos.

 2. It is invaluable.  Career planning requires a sense of focus and discipline that is essential to navigate the opportunities and multiple pitfalls in the New Normal economy.

I vote for option number two.  I am not engaged in career coaching or outplacement businesses so I have nothing to gain from advocating for the value that is inherent in the career planning process.  In fact, I cannot imagine entering the workforce today without a plan for my professional life.

I freely admit that there are thousands upon thousands of stories of people who have enjoyed a rewarding, interesting, varied and prosperous career following what I call the opportunistic pathway; moving from job to job without knowing what new professional adventure next week, next month or next year will bring. But that was then and this is a competitive, unpredictable now.

As a matter of disclosure, I must that admit that I qualify for membership in the  “I Had No Plan Or Clue” class.  I began my career before I graduated from college, working for a daily newspaper.  From there, my career took me to Lubbock and Houston where I worked as an editor and writer.  I left the news business for public relations at Houston’s Hermann Hospital.  From there I became the first director of Life Flight, to the national marketing manager of the helicopter company, to acquisitions for an investor-owned hospital management company, back to Hermann to lead the start-up of a multi-hospital affiliated program, to a senior executive post responsible for business development for the hospital management company, to forming my own consulting firm, back to the town where I grew up to run home infusion pharmacy, correctional health businesses (not all at once), EMS, and then to be the general manager of an international nurse recruitment agency before leaving to form a recruiting firm and, finally, to forming my current executive search firm, JohnGSelf Associates, Inc.  And I did it all without a plan, an approach that I would not think about recommending in today.

My experiences – and my amazing luck – led me to the realization that career planning is no different than strategic planning for a business in which you are constantly adjusting strategy and tactics to address changing market threats and opportunities.

Career planning provides a framework for discipline and focus that will allow an individual to maximize their professional potential.

Is it a waste of time?  Not a chance. 

There are thousands upon thousands of people who trusted that everything would work out, professionally speaking.  It did not.

Not to sound glib, but luck is not a good career management strategy. 

© 2011 John Gregory Self

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How Important Is Your Human Resource Leader?

"If businesses managed their money as carelessly as they manage their people, most would be bankrupt."

That is the opening sentence in Bill Conaty's and Ram Charan's book The Talent Masters:  Why Smart Leaders Put People Before Numbers. If that does not make you uncomfortable as a healthcare CEO, then you must be in the above average category in terms of hiring, training and retaining the best talent.

Mr. Conaty, who was Jack Welch's Senior Vice President of Human Resources at GE, and Ram Charan, a top business advisor/author/speaker, have written one of the best, if not the best, books on talent management.  They argue that the best companies are those which excell in identifying and developing raw talent.

As healthcare providers enter a period of financial uncertainty and turmoil, the quality of an organization's talent will be the single most critical determinant of an their success; not their location, the stylishness of their big box facilities or their existing reputations.  Those will seem so insignificant when the fight for survival turns deadly serious. Less you think that all the big healthcare provider success stories of today will be around in five to 10 years, think about the hundreds of former market leaders in retail, services, computers, consumer products or even banking that are now but a distant memory, an "oh yeah, whatever happened to those guys?" They didn't find or keep the best people.

It always comes down to that fuzzy, soft concept of talent management. Organizations that fail to build their talent management around an exemplary CEO/Chief Human Resource Officer partnership, are running down a risky path.

The hospital Chief Financial Officer is the trustee of the financial resources. "The human resource function will only be as strong as the CEO wants it to be. If the CEO does not have high expectations for HR, then it will be second tier," even reporting to the COO or some other vice president, Charan and Conaty write.

"Why wouldn't the CEO want an HR function that is as important an managing the financial resources?  HR is, after all, the trustee of an organization's human capital."

Being a talent manager -- becoming a talent master -- is now an essential leadership comptency. 

© 2011 John Gregory Self

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Rethink Is Possible AND Necessary

There is a troubling strain of conventional wisdom that suggests that nurse-doctor relationships are dysfunctional, and that is one big reason for our unacceptable problems of quality of care.

Karen Bartholomew, RN, an international speaker and healthcare culture expert and Dr. Joseph Bujak, a speaker and consultant on physician relationships, clinical quality and patient safety, writing in Hospital Impact, claim “that the two most important people responsible for our patients’ care frequently never talk to each other, and when they do the interchange is often dysfunctional.

“No wonder 22 patients die an hour from avoidable harm.”

What makes this article more disturbing is their assertion that changes in medical practice over the past 20 years leave “physicians and nurses lamenting that it was ‘better’ in the old days.”

The authors point to structural changes in both the practice of medicine and hospital operations as reasons for this unacceptable breakdown in communication.

Physicians – “Physicians have progressively become more sub specialized, diffusing responsibility and challenging the ability to integrate care.  Coverage groups expanded, reducing the number of days on-call so that the primary attending physician is often unreachable.”  The authors point to physician rounding – sometimes before the patient is even awake – and the demands for improved productivity mean that there is little or no time for the physicians to locate the primary nurse.  “Sadly, physicians often don’t even know the names of the nurses who care for their patients.  How easy it is to be disrespectful of someone who remains anonymous – especially over the telephone.”

Nurses – The structural changes in hospital operations have also adversely impacted nursing.  “Twelve hour shifts make the continuity of care more difficult.  Only 40 percent of the nurse’s work is actually nursing – they are performing clerical duties, locating missing medications, trying to find equipment or on the telephone on hold.”  In a typical patient care cycle, the authors point out that “one nurse admits (the patient), another gives care, and yet another discharges in 48 hours – another example of why failed communication is the number one cause of medical error.”

But all is not lost.  Ms. Bartholomew and Dr. Bujak argue that structural changes can also make things better, a rethink of the physician-nurse relationship: 

1. The expansion of hospital intensivists and hospitalist physicians is reducing the number of doctors who are involved in complex cases
2. Team rounding is becoming more prevalent
3. Physician availability for an entire shift improves the frequency of nurse-physician communication
4. Situation-Background-Assessment-Recommendation/Request (SBAR) is “improving the nurses’ understanding, supporting their professionalism, and helping them prevent the entrapment of physicians when a lack of necessary information precludes good communication
5. Personalization of the nurse-physician relationship is essential.  Physicians should know the names of the nurses they deal with, and nurses should insist on identifying themselves before each encounter
6. Brief weekly – at least monthly -- education opportunities for nurses provided by a physician
7. Charge Nurse presentation of a case scenario at weekly physician rounds – an unheard of practice at most institutions, the authors say
8. Executives must lead what will amount to a cultural transformation at most hospitals “by insisting on daily communication, physicians knowing nurse names, creating joint education and celebratory venues and bedside rounding and actually living the values of the organization by zero tolerance of disruptive behavior -- same rules for all roles”

It has taken a long time for healthcare quality to slip to these disturbing levels in quality and safety, and our turnaround will not be “on a dime.”

The bigger question will be whether hospitals can sustain the focus that will be required to make these kinds of changes in an era of unprecedented cuts in funding that will prompt more focus on costs and productivity.

These valuable eight points are more of inside the box solutions. 

I wonder how we will manage the nurse-physician relationship outside the box – when we are forced to redesign how we deliver care because can we cannot sustain what we are doing now.

A healthcare system “rethink” is not only possible, it is necessary.

© 2011 John Gregory Self

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Integrity, Consistency and Walking the Talk

Integrity is a much admired and sought after characteristic in leadership.  When you ask board members or employees about the ideal characteristics for a new leader, integrity is almost always number one on the list, rarely lower than number three.  So since it so critical, what is it?  What does it really mean when a CEO or other leader is said to have great integrity?

Yes, it means telling the truth.  It also means doing the right thing, even when no one is looking.  It means giving credit to others when they deserve the recognition.  It means being authentic.  It means living your personal and professional life in balance, honoring your commitments.

It also means being consistent.  And for some leaders, that is where the rubber skids off the road.

Here is a classic example for healthcare: hospital leaders love to say that their employees are their most important asset.   These kinds of statements are a verbal tip-of-the-hat, an acknowledgement that it takes hundreds or thousands of employees to make a hospital operate.  The real question is whether a hospital can be successful without great employees?  As we grapple with the storms of change generated by impending reductions in reimbursement from deficit reduction programs, the answer is a resounding “no”!

Hospitals talk about the value and importance of their employees.  Rarely is a hospital annual report produced without that perfunctory claim.  More to the point is the question of how many CEOs walk the talk?  How many leaders tell their employees that they are truly the heart and soul of the organization and then back it up, day in and day out, with words and deeds to reinforce that claim?  How many CEOs make daily rounds, engaging their employees in meaningful ways?  How many come in overnight to bring coffee or cold drinks and snacks to the nurses and other support personnel who are there for the patients?  Not once or twice in their tenure, but on a regular basis?  How many leaders visit patients on a regular basis, to say hello and to ask how well the organization is doing to help them get better? 

As a CEO, or any leader for that matter, when you make grand statements statements regardiong your vision and values, then you must personally follow through.  That is called being consistent.  Employees pay attention to it because they know it reflects a leader’s integrity.    

© 2011 John Gregory Self

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Career Management: Married With Children

If you are female and married and aspire to have a big career and a big family, the odds that you will be successful are working against you.  Two children are OK, but when you have three, everyone assumes "you are home with the kids, right?"

That from Laura Vanderkam, a New York City author (168 hours: You Have More
Time Than You Think) who reported that when she mentions to people in social circles that "my prominent lump is baby number three, (people) either don't ask me about my job (while asking everyone else about theirs), or they say, 'kiss of death' for a career or that it will 'derail' your professional prospects."

Aside from Ms. Vanderkam's current state of pregnancy, she was motivated to focus on this issue in her BNET blog this week after reviewing an Australian study issued in July that reported that a mere 21 percent of the mothers under the age of 30 with three children worked outside the home.  Lord knows, with three children, working inside the home is no walk in the park; the demands of being a full-time COO of the home is an incredibly tough job. Older women with three or more children were a greater part of the workforce -- 55 percent versus 68 percent of that group who had only two kids, according to the survey.

As I speak at college campuses on career management, I am frequently asked by women graduate students about choices -- career and life -- and the prevailing mood in the marketplace about the so-called life balance issue. Will they derail their career path to the CEO spot, or one of the other C-suite posts if they take time out for a family?

In healthcare, the career versus having children question may become a more challenging for issue (choice) for women as hospitals and other providers face profound reductions in reimbursement over the next 10 years. Hospital leaders say they can see a day where they will have to do more with less, which could translate into longer hours at the office and an expanding workload for the after-hours time at home. That said, there are more than a few examples of successful women leaders who have managed to balance the rigors of two full-time jobs (their career and motherhood) while achieving impressive results in business.

Today, this is not an either or choice for women.  It does, however, require incredible discipline, enormous focus and physical and mental stamina, but there are some outstanding women executives who are able to do both, and do it well.

While it may get tougher for women executives to achieve the comfortable work-life compromise, there will always be opportunity for competent executives, regardless of their gender and number of children, the Australian study notwithstanding.

Many studies on this subject tend to reflect conventional wisdom and that is seldom right.

© 2011 John Gregory Self

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Bad Firing, Good Firing and the Company Brand

Why would you fire your chief executive officer over the telephone?  Why would anyone want to work for a company that would treat its CEO so shabbily?  Why would you do business with that company?

The sudden dismissal of Yahoo CEO Carol Bartz, reportedly an outspoken, combative, occasionally arrogant and sometimes profane executive, prompted me to think about how companies fire people, and the fact that how companies execute the termination can define an organization's corporate image and recruiting brand.

To be fair to the Yahoo board, Ms. Bartz was reportedly failing to meet performance expectations established by the Directors. There are many on Wall Street who argue that her termination was justified.  Others say that her style made it inevitable. That said, the issue should be not the "why" but the "how."  

There are reasons, justifications -- excuses -- as to why the board acted the way it did. Central among them was that Ms. Bartz was traveling and the board did not want word of their decision to leak before they had spoken to their CEO.  Others speculate that she may have had a clause in her employment contract that required immediate notification of termination. Fine, those are important issues to consider. But here is another:  if the intent was to rid the company of a leader who was failing in order to protect the interests of the brand and its shareholders, why would the board execute their plan of termination in a way that would cast a darker cloud over the already troubled company? 

That Ms. Bartz fired off an email broadside to her employees explaining that she had been fired over the telephone should not have been a surprise to the board or its advisors.  Nor should the resulting damage to  the organization's image.

Boards frequently hire CEOs with fanfare for what they hope will be strong operating results, favorable press, and a strengthening of the corporate brand.  They are almost always disappointed, frustrated, even angry when their best layed plans fall short.  But there is no excuse for the board to make a bad situation worse with a poorly executed plan.

How an organization terminates employees says a lot about the real heart and soul of the company. Taking the high ground may not make the person or persons who have made the decision and who are notifying the employee feel less frustrated, but how they perform this important role will shape the image of the company.

Yahoo is not the lone offender in American business. Thousands of times each day, someone is fired for a myriad of reasons, from poor performance to unethical or inappropriate conduct. There may be reasons to immediately remove the employee from the workplace.  There may be ample justification to have security personnel available.  Even when companies try to terminate someone in the right way, things can go wrong. Fortunately these incidents are the exception.

But companies who do not take the high road, protecting the dignity of the outgoing employee including complimenting the employee for their accomplishments and wishing them well while keeping security out of the room and the prying eyes of their colleagues at bay, are being short-sighted.  

Miss-hires, at whatever level, are a costly mistake, but to make the matter worse by ending the employment relationship badly simply multiplies the problem.

© 2011 John Gregory Self

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Leadership Check-Up

The leadership team that you have today may not be the team that can help you move to the next level of performance, a new peak that may mean the difference between success or selling to a competitor.

The road ahead for healthcare providers is fraught with unprecedented challenges.  Today, more than any other time in the last 30 years, CEOs realize that waiting too long to fine tune their leadership resources could lead to serious consequences.

There is an emerging trend  -- CEOs are giving their organizations a “leadership checkup” using their internal organization development team or an outside consultant.

This is a dicey proposition, especially if you have a stable team that, up to now, has consistently produced good results.  You do not want to embark on a assessment strategy that will put valued members of the team "in play" – sampling the job market in an over abundance of caution because the leadership assessment could cost them their job security.   

To succeed – that is to say to produce a realistic assessment that provides insight while valuing the contributions of the team – you must begin by selecting the right consultant, one who offers a balanced set of skills, from diplomacy and compassion to operational insight and a keen understanding of the challenges ahead.  But more importantly, you must have a consultant that, in the privacy of the CEO’s office, will tell them what they need to hear, not what they want to hear, free of financial motives.

Most consultants come to the table with a set of built-in weaknesses – most of which are built around the desire to secure additional add-on consulting or a future engagement.  Not everyone in the market is concerned with doing the right thing, particularly if their performance and financial incentives favor the art of winning add-on business.

Subject matter expertise is also important.  Healthcare is a complex and unique industry.  Legendary management guru Peter Drucker posited that hospitals are among the most complex of human organizations every created.  Leadership experts or coaches that lack a depth of knowledge of healthcare delivery and the impact that budget deficit reductions will have on healthcare providers are not ideally suited for this work. 

The game is changing for executive recruiters as well.  The traditional transactional model of “order placement” will not work.  CEOs need more than an “order taker.”  They need a leadership consultant who understands the issues, and who is as obsessed with the results as their Client.

The solution for CEOs is to look for executive recruiters who understand that their 50-year-old business model has changed and that it is not just about the fee.

In the end, we will all change.

 

© 2011 John Gregory Self

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All Is Well

Poosted  from Tyler, Texas

On the day we are born, scientists tell us, we begin to die.

Death at an early age is a tragedy.  The death of a baby with an irreparable defect is heart wrenching.  A teenager who dies in an accident is shocking, filling us with a consuming grief of wonderful memories and sadness for a future that will never be.

We all react to death in a different way, personally and professionally.  The healthcare industry is unique among all others because we are there at the start of life and, frequently, we are there at the end.  We tend to see this as the inevitable, albeit very expensive, part of the natural order.  That does not spare us the grief and sadness when a friend dies, but it is such an ever-present element of our profession. 

For teenagers, the death of a friend evokes a raw outpouring of sadness and confusing disbelief, but at the same time there is a certain detachment that restores balance; death is an anomaly.  They are reassured by the belief that something this tragic could never happen to them.  As we move into the last 10 to 20 years of life, death takes on a new meaning.  It is now more than the obscure concept of existential inevitability.  It is a real part of our lives and we understand that death can come at any time. 

In the last quarter of our own life, the death of a friend, especially one so full of life, is startling, but we do not waste time asking how something so sudden, so shocking could happen because we know.  

When the person who dies is a successful and beloved physician -- and a friend -- the news may feel surreal but the understanding that comes with our own advancing age typically mitigates the disbelief and shock.  We know there are only two choices: retreat into grief or double down on the joy of life.  Death is inevitable, but what we do with our remaining days in this life is not.

In Henry Scott Holland's 1910 sermon on death at St. Paul's Cathedral as King Edward VII lay in state, he wrote:

"Life means all that it ever meant.  It is the same that it ever was.  There is absolutely unbroken continuity. Why should I be out of mind because I am out of sight?

"I am waiting for you, for an interval, somewhere very near, just around the corner.

"All is well."

Happy Trails my friend.

© 2011 John Gregory Self

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