HealthCare Voice

Taking Time For Others

Some days can provide an important reminder of the significance of taking time for others.

While waiting in my hotel for a candidate to arrive – stormy weather slowed air traffic into New York’s congested airports – I decided to check my email.  After reviewing and processing emails for 15 minutes or so, I ran across a message with an attached story from a former boss who I greatly admire.

Who knows or cares whether this particular story is true.  There are some stories where “the uplift” is far more important than the authenticity.  For years there have been stories with this theme that have been bouncing around on the Internet.  Periodically they emerge in various forms – irritating chain letters, personal testimonies, or even for political gain.  Naturally they are treated as if this is the first time the heart-warming facts have been shared. 

This story, in this telling, is uplifting, minus the cynicism.

It reminded me of an important point in my life.  I have been fortunate to be in a career position where I can help people -- providing support when they have been unexpectedly fired, when they cannot find a job, or to give some coaching advice that might help them find one.  The only requirement I have is that when the caller finds a new job, that they take the time to pay it forward, to help someone else.  Sure I like the money in the business, but it is the chance to help that makes my job so special.  I am sharing this story with you because if you do not get it, now is a good time to start.

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“One day, when I was a freshman in high school, I saw a kid from my class was walking home from school.

“His name was Kyle.

“It looked like he was carrying all of his books.  I thought to myself, Why would anyone bring home all his books on a Friday?  He must really be a nerd.

“I had quite a weekend planned (parties and a football game with my friends tomorrow afternoon), so I shrugged my shoulders and went on.

“As I was walking, I saw a bunch of kids running toward him...They ran at him, knocking all his books out of his arms and tripping him so he landed in the dirt.  His glasses went flying, and I saw them land in the grass about ten feet from him...

“He looked up and I saw this terrible sadness in his eyes.

“My heart went out to him.  So, I jogged over to him as he crawled around looking for his glasses, and I saw a tear in his eye.  As I handed him his glasses, I said, “Those guys are jerks.  They really should get lives.”

“He looked at me and said, “Hey thanks!”  There was a big smile on his face. It was one of those smiles that showed real gratitude.

“I helped him pick up his books, and asked him where he lived.  As it turned out, he lived near me, so I asked him why I had never seen him before.  He said he had gone to private school before now.

“I would have never hung out with a private school kid before. We talked all the way home, and I carried some of his books.  He turned out to be a pretty cool kid.

“I asked him if he wanted to play a little football with my friends .  He said yes.

“We hung out all weekend and the more I got to know Kyle, the more I liked him, and my friends thought the same of him.

“Monday morning came, and there was Kyle with the huge stack of books again.  I stopped him and said, Boy, you are gonna really build some serious muscles with this pile of books everyday!  He just laughed and handed me half the books.

“Over the next four years, Kyle and I became best friends.  When we were seniors we began to think about college.  Kyle decided on Georgetown and I was going to Duke.  I knew that we would always be friends, that the miles would never be a problem.

“He was going to be a doctor and I was going for business on a football scholarship.

“Kyle was valedictorian of our class.  I teased him all the time about being a nerd.

“He had to prepare a speech for graduation. I was so glad it wasn't me having to get up there and speak.

“On graduation day, Kyle looked great.  He was one of those guys that really found himself during high school.  He filled out and actually looked good in glasses.  He had more dates than I had and all the girls loved him.  Boy, sometimes I was jealous!

“Today was one of those days.

“I could see that he was nervous about his speech.  So, I smacked him on the back and said, 'Hey, big guy, you'll be great!'  He looked at me with one of those looks (the really grateful one) and smiled....

“Thanks,” he said.

“As he started his speech, he cleared his throat, and began ... “Graduation is a time to thank those who helped you make it through those tough years.  Your parents, your teachers, your siblings, maybe a coach, but mostly your friends.

“I am here to tell all of you that being a friend to someone is the best gift you can give them.  I am going to tell you a story.”

“I just looked at my friend with disbelief as he told the story of the first day we met.  He had planned to kill himself over the weekend.  He talked of how he had cleaned out his locker so his Mom wouldn't have to do it later and was carrying his stuff home.  He looked hard at me and gave me a little smile. 

“Thankfully, I was saved.  My friend saved me from doing the unspeakable.

“I heard the gasp go through the crowd as this handsome, popular boy told us all about his weakest moment.  I saw his Mom and dad looking at me and smiling that same grateful smile.

“Not until that moment did I realize the depth of importance of a kind act or the friendship you share.  Never underestimate the power of your actions.  With one small gesture you can change a person's life.

“For better or for worse.”

© 2011 John Gregory Self

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Leadership and Executive Search

I have always believed that a good leader is a work of art, and that a bad leader is a tragedy -- for the organization and for the people with whom they interact. 

There are far too many leaders who cannot see beyond their own office. They do not engage employees in a consistent and meaningful way.  They offer any number of excuses for their lack of visibility and engagement, including that they do not feel "comfortable" communicating in that setting.

How senior executives interract with their teams -- their visibility and their ability to communicate the mission, vision and values of the organization in every-day conversation -- is an essential element in employee engagement.

At JohnGSelf Associates, we have an entire 45-minute block of questions in our comprehensive 3.5 hour face-to-face screening interview that zeroes in on this critical leadership issue. We believe that this competency is absolutely critical to the success of any organization.

When I tell people that our firm offers a three-year placement guarantee, my capable competitors ask how we can possibly make such an offer. They feel it is too risky. Actually, if you dig deep enough in the face-to-face candidate interview, there is virtually no risk. But it takes time and a great deal of research into relevant issues. 

In 15 years, we have had only a small handful of candidates who did not work out in our C-suite and executive practice. Luck? Perhaps. Too risky? No. From my point of view, offering your clients a long placement guarantee is about taking ownership of what we do, recognizing the impact we can have on an organization and its employees if we do not get it right.  Relying on video conference interviews to select which candidates to recommend to the client may save on the expense budget and make it easier for the recruiter, but it diminshes the quality of the screening and substantially elevates the risk of a miss-hire.  I do not know one search firm that will offer their clients an extended placement guarantee when they cut corners.

I share this to encourage my colleagues in the search industry to look at what they are doing with their candidate screening process and seek meaningful ways to offer clients greater value. 

As hospitals and physician practices experience significant reductions in funding and other disruptions that will surely occur as we navigate healthcare reform, executive recruiters and other consultants who work in this sector need to step up and own the the quality of the service we offer -- and the outcome.  

© 2011 John Gregory Self

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Texas Provider Shows Local Innovation, Not Congress, Will Lead Real Reform

Healthcare reform -- I am talking about true, structural reform that actually saves real money (versus CBO estimates) -- is not going to come from Washington.  It will come one hospital, one provider, one community at a time, led by CEOs who are willing to take risks and empower their physicians and employees to rethink how care should be delivered.

The irony in this scenario is that it will be the blunt force of the federal government's biggest and most compelling weapon -- the power of the purse -- that will be needed to unleash the creative forces necessary to craft innovative new models.  Unfortunately, we are an industry that does not like to consider game-changing reform until forced to do so. 

Here is one interesting example of where a creative group of healthcare executives conceived a plan to improve quality and access while saving real-world dollars.  MedStar, the Fort Worth/Tarrant County emergency medical services authority which operates 911 and non-emergency transports without subsidy from its member cities or the county, is in the midst of a program trial designed to reduce the unnecessary transport of patients with chronic illnesses such as diabetes and pulmonary disease.  By making house calls when the advanced paramedics were available in the area where one of the study patients resided, MedStar recorded significant reductions in the number of unnecessary transports that clogged the county trauma center and added big costs to the taxpayers who provided for indigent care through ad-valorem taxes.  MedStar is now preparing to launch a nurse triage program to direct patients who do not need emergency transport, to more appropriate and cost-effective patient care settings.  This, too, should help reduce costs to the taxpayer and free up valuable resources at the public hospital to care for those who need a higher level of treatment. By some estimates this limited trial program has saved hospitals, primarily the public trauma center where many of these patients would have ended up, millions of dollars.

While showing great promise, this approach cannot be easily replicated in America's largest cities, regardless of the savings or benefits to the patients. Why?  Because the vast majority of the big-city EMS services are operated by fire departments, organizations with union bargaining agreements and work rules.

Herein lies an interesting twist to the local reform concept.  Fire department EMS providers are often the most inefficient providers of EMS services, even though the quality of care data does not conclusively justify their high costs. For example, there are typically the same number of fire department operated ambulances on duty at 3 AM on Sunday morning as there are on a payday Friday night. By contrast, MedStar flexes their unit hours and staffing based on computer models that forecast demand by time of day, day of week. Moreover, the paramedics do not sit around at a fire station waiting for a call.  Dispatchers, using the demand forecasts, "post" the ambulances in an area where calls are likely to come. That eliminates overhead costs that are almost always born by the taxpayers and improves response times.  There are fire departments that are experimenting with innovative programs but these, too, are underwritten by taxpayers.  

MedStar's fees for service may be higher than a typical fire department charges for a similar service, but consumers can join a membership program to protect against out-of-pocket expenses.  Moreover, indigent patients are never denied care. Even without taxpayer support, he system is currently financially self-sufficient, but they are not resting on their laurels.  They know that cuts in reimbursement will be painful.  "We will either innovate or become irrelevant," one senior MedStar exectuve said recently.

The healthcare industry is going to change. To remain relevant, providers, and the companies who provide services or products, must innovate and then redeploy technology to rewrite the rules for how we will all operate in the future.

© 2011 John Gregory Self

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Hospital Golden Rule: Simple Innovation for Quality, Safety

When I moved from the news business, writing about crime and investigating corrupt politicians and police officers, to the healthcare industry in the mid-1970s, we measured only the basic hospital performance indicators -- including census, staffing, inventory, days in accounts receivable and average length of stay.  The data was not in real time by any stretch of the imagination.  By the time the information was produced and distributed to managers, the horse was already out of the barn and in the next county.

Today, we measure almost everything.  The question is: are we getting any better in terms of quality and safety?  Are we now paying too much attention to the numbers and not enough to the people?

We are certainly better at collecting and producing data in a timely manner. Financially, most hospitals are better.  But what about the quality and safety issues?  Are our patients safer? Do they receive better care?  

It is not like we don't have a multiple of compelling reasons, including financial survival. Quality, safety, and patient satisfaction will drive future levels of reimbursement from the government and commercial payors.  It is imperative that we get on top of this problem once and for all.  

Before we start talking about the costs of achieving success, we should remember that it all revolves around people and process.  As an industry we have spent hundreds of millions of dollars trying to address quality and safety issues and we are still not even close to where we need to be. Maybe it is time to try a new approach.

A leading chemical industry safety expert who consulted with several hospitals on quality and safety said she was stunned to see how little transparency there was in the hospital quality improvement process.  After the attorneys and risk managers charged into the breach, scrubbed the scene and admonished the participants, there was very little honest discussion about what went wrong and how it could be fixed so the events did not happen again.  Her overarching theme is startlingly simple: what we have been doing is not working and the outcomes will not change unless we rethink our entire quality improvement approach, sans the lawyers and risk managers. It is not that difficult, she said. Do what other industries are doing.

Proctor & Gamble Chairman and CEO Bob McDonald emphasized in a recent speech that innovation was the way of the future.  Only 10 of American's Fortune 50 companies in 1955 are still in business today.  The rest failed to innovate, he said.  Hospital leaders, especially those who feel invincible, should take note.  The speed of change is moving at a significantly faster pace today, especially in healthcare, and the demise of organizations will come much sooner. 

If we cannot innovate to solve our troubling quality, safety and cost challenges, who will be around in 10 years?  What can we do now that successfully changes our current performance trajectory and inevitable failure rate?

Maybe we should start by making it mandatory for every nurse, doctor, pharmacist, patient care aide, and housekeeper to think of each patient as a member of their family, someone they love and want to protect -- a new hospital Golden Rule.  The other obstacles to quality and safety that we have created – complexity, cost, alignment – are just excuses for not trying to innovate. Often, doing the simple stuff is the better way to care for our patients.

Maybe it is all about people, process, and a willingness to innovate. 

© 2011 John Gregory Self

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Steve Jobs' Legacy For Healthcare

If you are a hospital CEO who touts customer service -- the customer experience -- and you have not heard about Apple's remarkable product innovation, their laser commitment to service, and their remarkable out-of-the box retail experience, you are probably so far inside the box that you are immerdiately vulnerable to competitive market forces.

Apple redefined the customer service experience. Not just for the computer industry or the technology sector. Steve Jobs and his colleagues raised the bar for everyone in business. From their technical support access, which is far and away the best in any industry, to the amazing Apple retail experience, this company is about delighting the customer. They thrive on that sense of accomplishment.                                   

When I think about the  average hospital admission process and the endless waits in the ER that can be made worse by, in many cases, the absolutely terrible customer service and non-existent communication from the staff, I wonder why the healthcare industry seems so afraid to explore game-changing innovations.   

When we talk about Apple it is easy to say, "Oh, computers, that is different. That industry is not anything like healthcare," as if to say that Apple wanted to emulate the mediocrity that has come to define Microsoft. The beauty of Apple is that Steve Jobs empowered his people to redefine the customer satisfaction experience from a standard that said satisfactory was OK to one in which anything less than delightful was unacceptable. Outsourcing his customer support through terrible telephone connections to some  remote outpost in India, which is how so many companies attempt to maxmize profitability, was not in the Jobs' playbook.  He drove profits by doing the opposite -- spending money on taking care of his customers.

Apple became a bigger company than the once invincible Microsoft in terms of market cap as the result of its passionate commitment to focus on game-changing design and a level of service that delighted their customers.  

As we mourn the loss of such an incredible innovator, it behooves those of us in healthcare to pause and to think how our industry can bring a little of Steve Jobs' keen insight for innovation and a customer-centered delight into our complex organizations, and to think how we can offer our customers -- doctors and patients -- service that delights and surprises. 

He showed that it can be done.  And he offered some compelling words during a Stanford commencement speech in 2005 to help guide the way.

"Follow your heart...Your time is limited so don't waste time living someone else's life. Don't be trapped by dogma which is living with the results of other people's thinking. Don't let the noise of others' opinions drown out your own inner voice..." 

What are we waiting for?

© 2011 John Gregory Self

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Are These The Good Old Days?

Our lives are changing at such a rapid pace that it is hard to comprehend what is actually taking place.  We are being swept along by an avalanche of innovation, information, and connectivity that, together, are shaking some of society’s long-standing norms.

Everything is faster, bigger, more connected.

Gone is the simple way of life that many retiring Baby Boomers fondly remember, a time in which we lived our lives sheltered from the avalanche of information, the good and the bad, the true and the fiction.  In this era, the flow of information depended on radio, the arrival of the afternoon or morning newspapers or the start of the nightly network news. 

Today the news is free flowing from the Internet – sometimes reliable, sometimes not.  It can be hard to tell the difference.

Connectivity has become a lifestyle essential.  Almost everyone has a cell phone.  Many have smartphones to check their email, surf the web, or to remotely watch television.  Texting has become the preferred method of communication among people under the age of 30.  Some would rather send a terse text message than to talk on the telephone. 

When not texting, this new younger generation is busy growing up much faster than their Baby Boomer parents, participating in risky behavior, from underage drinking to recreational drug use, or engaging in sexual relations at an earlier age than their parents. 

The wealthy are wealthier, the poor are poorer, and our country is more heavily in debt.  Our politicians are more divided than ever, pursuing rhetorical assaults that are frequently more self-serving and reckless than helpful.

Some executives have pushed the envelope of what is right and wrong in business to make more and more money, amounts that were hard to imagine less than 20 years ago, regardless of the impact their questionable acts might have on the company or their most valuable asset, the employees.

The pace of change, with all of its good and bad implications, has invaded our leisure time.  In sports, our favorite athletes are bigger and faster.  Their sheer size, their strength, and speed, has produced new physical hazards that equipment makers cannot accommodate.  The number of head and spinal injuries is up sharply in pro football, prompting the NFL to insert new rules to protect the players.  In professional basketball, the players are taller and bigger.  When compared to our bygone heroes like Guard Bob Cousy (Boston:  6’1”), Center Bill Russell (Boston: 6’9”), Guard Calvin Murphy (Houston: 5’9”) or Center Moses Malone (Houston: 6’10”), today’s stars seem like giants. At the current pace, the National Basketball Association will need to raise the basket from 10 to 12 feet and lengthen the court. 

Some of this change is just a natural evolution.  We can’t do anything about it, nor should we try.  The question is whether these forces of nature and the values of society can be separated to avoid a gigantic explosion because, at the speed of our current times, we are overheated?

Or, are these the “good old days” about which our kids will tell stories to their grandchildren? 

© 2011 John Gregory Self

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