HealthCare Voice

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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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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7 Vastly Overrated Business Books

BNet, the very interesting interactive web site from CBS, has just produced mini reviews of what they consider to be seven vastly overrated business books.  There were a few surprises.

BNet's contributor  Geoffrey James, who reviewed each of these seven books, begins his summary with the statement:  "Most business books are awful, some are mediocre and a (very) few are truly useful." 

1.  The One Minute Manager - "There is no panacea for good management, and it's certainly not going to be contained in a book that essentially treats management as being easy-peasy."

2.  Jack Welch:  Winning - In the past, business executives waited some time to allow for history and the markets to value a CEO's accomplishments.  Not any more..."Today, however, business leaders seem obligated to write self-congratulatory paeans that give new meaning to the word 'vomitable'." 

3.  The 7 Habits of Highly Successful People  - "The problem with Covey is that he alternates between the painfully sanctimonious and the painfully obvious."

4.  Atlas Shrugged - "As a novel, Atlas Shrugged isn't overrated, since most literary critics consider it one of the worst-written novels of all time. However, the book is highly influential in the executive suite because it espouses a philosophy of business that justifies the status quo and encourages executives to feel self-righteous... even when they're royally screwing the public or their employees." (Just think, the former Fed Chair, Alan Greenspan, who could not believe that the big banks wouldn't do the right thing and appropriate regulation was unnecessary, apparently admired this book.)

5.  Who Moved My Cheese - "The idea behind this book -- that you can't assume that what you're doing today will get the same rewards tomorrow -- is sufficiently obvious to encapsulate in a single sentence.  What's offensive about the idea is that it blames employees for not "getting" this concept, as if it should be their responsibility for resetting their goals and rewards." (Personal note:  I threw it in the trash after the second chapter.  Feeling guilty, given the numerous rave reviews from friends, I retrieved the book, got through one more chapter before pitching it back in the waste basket. There it remained until trash day.)

6. The Art of War -  "This book is NOT overrated if you're planning to play 'Shogun: Total War' or any other computer or board game that simulates medieval warfare.  However, as a guide to business behavior, it's seriously flawed..."(Personal note: Business is not war. The principles of war do not apply unless, of course, you think killing your customers is a good idea.)

7.  The Wealth of Nations - "While there's no question this book has been influential, it suffers from being treated as  scripture rather than a thoughtful work that reflected the state of business and government in the mid-18th century.  This limitation is particularly clear when Smith's work is cited in defense of a free market economy in the 21st century, nearly 250 years after the book was originally written."

For every business book I have read, there have been 10 or more for which I wish I had not wasted my money. However, since my agent, who arranges for my speaking engagements, has strongly encouraged me to write a book, it is hardly appropriate for me to be too critical.  

For daily reading, I thoroughly enjoy the BNet daily news feeds and I recommend this site. There are some great thoughtful articles.

About the reviewer:  Geoffrey James has sold and written hundreds of features, articles and columns for national publications including Wired, Men's Health, Business 2.0, SellingPower, Brand World, Computer Gaming World, CIO, The New York Times and (of course) BNET. He is the author of seven books, including Business Wisdom of the Electronic Elite (translated into seven languages and selected by four book clubs), and The Tao of Programming (widely quoted on the Web as a "canonical book of computer humor".)

© 2011 John Gregory Self

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Is Our Pizza THAT Bad?

Dominoes Pizza has taught us an important marketing lesson and along the way given us a better product.  Perhaps there is a message for the healthcare industry somewhere in this remarkable and successful turnaround.

Dominoes launched a nationwide television campaign 15 months ago that was more than just a little different. They began by admitting that their product was not that good.  To add some historical context, it had not been good for a very long time.  In the 1980s, working late at Hermann Affiliated Hospitals in Houston, we would frequently order a midnight pizza.  The standing joke was that when the pizza was delivered in 30 minutes or less, you threw out the pizza and ate the box. It had more taste. It was no surprise that when the company asked what was wrong with their product consumers repeatedly said the crust tasted like cardboard. The negative feedback from customers was brutal.  Their advertising campaign moved from pointing out that their product was not that good, to announcing they were making significant improvements to their crust, cheese and sauce. They began using better toppings, like real chicken, not a compressed version of various and questionable chicken parts.  Then the company ran ads asking customers to tell them how they were doing. 

Sales soared. This week Dominoes delivered another quarter of rising profits and revenues.  The company’s stock price has risen more than 150 percent since the company launched this risky campaign.  The public seems to like their candor and the product improvements. Moreover, the reservoir of goodwill that Dominoes is building will be invaluable as long as they do not forget these tough lessons learned.

Dominoes Pizza has proven that if you really want to stand out in the marketplace, you must be willing to take risks.  Smart risks, but risks nonetheless.  Harvard marketing professor Youngme Moon would agree.  With the Dominoes success in mind, hospital CEOs should watch this video promoting her book "Different" and think about your organization and how coming reforms will force healthcare organizations to re-examine their model and how they position themselves.

Watch Video

Healthcare is facing some of the toughest economic and regulatory challenges in its relatively short history as an industry.  From the planned and very visible reductions in reimbursement contained in the Patient Protection and Affordable Care Act as well as additional cuts that are in the pipeline but are currently not so visible, to the looming deficit and long-term debt crisis, we face a future that, in the most understated of words, will be transformational. 

The professional lives of healthcare leaders and the environment in which they work will be radically different.  They will be forced to change.  Change, not adapt.  It is going to be the type of transformational change that will require a reconstruction of the entire business model. This change will mark an end of the big box hospitals of staggering size with a maze of hallways and poor signage will have to give way to a strategic focus on population groups while operating smaller, cost efficient facilities. The new economic model will be based on keeping people out of hospitals and providers will be paid not for how much they do, but for the quality of care and outcomes they achieve as well as customer/patient satisfaction. 

Over the next 20 years the hospital industry will need to move from the wholesale marketing model that focuses on physicians, their patients and their poor health, to a retail model where there is real competition and where success will be based solely on performance.

It is easy to be critical.  Let's face it, hospital executives and industry thought leaders are in a tough bind.  It is hard to lead change when you are constrained by an existing business structure that is hopelessly complex, from a patchwork of payment systems to federal, state and local regulations that limit the ability of mainstream hospitals and entrepreneurs from leading the transformation.

Given that hospital executives are, for a variety of good reasons and some that are not so good, loathe to publicly confess their problems as Dominoes did, they may miss a marketing opportunity to drive the real structural change that the costly and uneven healthcare provider segment needs. 

The GOP budget plan to privatize Medicare may save the federal government a lot of money and temporarily drive the bond market vigilantes away from the front door, but it will not solve the bigger problem.  You cannot target one group and one program like Medicare and not expect a massive political push back as well as political consequences.

This approach will fail not because it reflects a political calculation to shrink the size of government, but the politicians have no real broad strategy to change and improve healthcare in America.  Their current effort amounts to fiddling around the margins.  Meanwhile, as the political debate gathers steam, the American public believes, alternatively, that either we have the greatest “system” in the world or that it is too expensive with questionable quality and hurts the nation's ability to compete globally.

Why don’t we at least think about the Dominoes approach?

© 2011 John Gregory Self

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Perjury: America's New Epidemic

I started a new book over the weekend -- James B. Stewart's "Tangled Webs -- How False Statements Are Undermining America."  

Based on my early reading, and the author's recent interview on Charlie Rose, this is going to be a fascinating read with disturbing issues to consider.  Perjury and making false statements to investigators is apparently so common -- epidemic levels -- that law enforcement and financial regulatory agencies rarely prosecute these cases without other charges.  

Stewart is a former Wall Street Journal Page One Editor and reporter who won a Pulitzer in 1988 for his reporting on the stock market crash and insider trading. In this new work, he focuses on cases involving people at the top of their fields -- Martha Stewart, I. Lewis "Scooter" Libby, Barry Bonds and perhaps the most notorious liar in the history of the financial industry, Bernard Madoff.  

These are interesting stories and that the subjects decided to lie when they did not have to -- with the exception of Mr. Madoff whose fraud was beyond comprehension -- is a disturbing commentary on American business. They were all rich, successful and well educated who were willing to cross the line and lie.

Why am I reading this book?  Mr. Stewart, who went to law school, is an accomplished story teller and promised to answer questions that puzzled many:

• Why would homemaking trendsetter Martha Stewart have lied about a relatively small stock trade when she was, by all accounts, a billionaire?  What caused her seemingly solid alibi to fall apart?
• Why was Mr. Libby, the chief of staff to the Vice President, the only high government official charged in the Valerie Plame-CIA leak scandal when he wasn't even the person who leaked her identify to columnist Robert Novak?
• Barry Bonds, a baseball star of epic proportions earning more than $15 million a year, was granted immunity from prosecution as long as he told the truth under oath about illegal steroid use in professional baseball? And yet he was convicted of obstruction of justice because there was a question of lying under oath.
• Was Bernie Madoff, who kept a ponzi scheme going for more than 20 years despite repeated inquiries and investigations, "an evil genius, a brilliant liar or something far more complex?" Until his scheme fell apart, he was one of the most admired people on Wall Street.

In researching cases for the book, Mr. Stewart said there were numerous examples.  He ruled out sexual scandals and divorce cases because they were among the most common. Apparently spouses trying to conceal wealth or other information from the prying eyes of matrimonial attorneys and judges, believe lying is perfectly acceptable.  

That this common practice floods into business is something that should concern us all.

© 2011 John Gregory Self

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What Am I Doing Wrong With Career Management? Nothing and Everything

An up and coming executive expressed angry frustration with the whole recruitment process.  Called twice for attractive positions that apparently represented career advancement, each opportunity ended with the job being awarded to internal candidates who were less qualified and lower paid.

“What am I doing wrong?”  Nothing and everything.

Nothing in the sense that his resume was an excellent reflection of his career progression, his performance, and the value creation for each prior employer.  In each case, the recruiters expressed great interest and assured the candidate that he would be a perfect fit – just what the client was looking for.  He interviewed exceedingly well – no apparent mistakes.  He received assurances from several of the interviewers that, in fact, he was just what they were looking for, but in the end, the jobs were awarded to internal candidates who were less skilled, less experienced but with a lower salary target.  This leads me to the “everything” part of my answer.

The young executive had no career plan, no targeted industry on which to focus, no concept of career brand management, a narrow list of networking contacts, and a lack of understanding of how the talent acquisition process really works.  Ten years ago, his list of “have nots” would have been largely inconsequential.  Today, those deficiencies are huge.

Here are some important career management points to consider:

1.   Recruiters are focused on building a credible panel of candidates for their client – whether as a search consultant working for an external firm or as an internal headhunter.  That is how they are compensated or evaluated.  They may, or may not, have your best interests at heart.  They certainly do not work for the candidate, regardless of how friendly the relationship.  They are probably unaware, or do not care, how not being selected for a position can subtly impact your personal brand.  Candidates who look at numbers of positions are naïve if they do not believe that the “always the bridesmaid, never the bride” image will ultimately affect their career brand.
2.  Always ask if there is an internal candidate.  Recruiters do not always like to divulge that information, but you are entitled to know.  Push the envelope and try to find out if that candidate is credible or if their involvement in the search is more “political” or “for show.”  If the candidate is a strong contender, or if the recruiter is evasive, it is time to hit the brakes.  In this troubled economy, employers are less likely to take a risk with a more expensive outside hire for non C-suite positions.  Candidates can always tell the recruiter to call them back if something cannot be worked out with the internal person.  Or better yet, just decline consideration.  This can be a smart, brand-enhancing move but timing and style are everything.  However, be forewarned that it is not a good idea to treat a recruiter badly.  They have memories like elephants, and they share information internally with notes to the candidate database.
3.  Develop a career plan – the sooner the better – focusing on a specific job or a type of work that brings joy and satisfaction.  Focus on a sector or an industry segment, if possible, and begin building your networking of contacts across this spectrum.  Do not focus building relationships only with external recruiters since they handle less than 35 percent of all management and executive recruiting projects.  Keep an open mind given there is a good chance you will not end your career doing the job you thought you would always have.  Finally, allocate time every week to focus on career networking and industry research.  This is as important as staying relevant with new ideas and technological developments in your current field. This is not “your parents” job market and it is only going to become more challenging. 

© 2010 John Gregory Self

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"Rain" - Lessons From A First Business

As I was flipping through the Dallas Morning News this morning, a small book review caught my eye. "Rain," is a new business parable that uses paperboys and the business of newspaper delivery as a case study. The author's 10 Customer Service Commandments are worthy of review in this rotten economic environment, where companies must compete more aggressively for the available business.

On a personal note, this review resonated with me. In my junior high and high school years, I, too, delivered newspapers for the Tyler Morning Telegraph in Tyler, Texas, a small city 1.5 hours east of Dallas. This was a time when kids on bicycles were a key part of the news distribution system. Not anymore. This is just another part of Americana that has faded from view.

Today, as Chairman of JohnMarch Partners, an international executive search consultancy based in Dallas, we have developed our own customer commandments. Our commandments govern our service, the quality of our work product and being accountable for the tenure and performance of our recommended candidates. Most search firms brag about service and quality. Few mention the word accountability.

With credit to the Dallas Morning News and the reviewer, Jim Pawlak, I want to share the book review with you:
_________________________

This business parable takes many of us back to our first job – paperboy. We didn't just deliver newspapers; we ran a business. We had to increase our customer base if we wanted to make more money. We learned and practiced customer service skills.

We dealt with our supplier (the newspaper) and knew the importance of on-time delivery (especially in bad weather). We managed delivery schedules around customer needs. We learned accounting and collected money.

Rain, the paperboy in this tale, reminds us of what should be done to build any business. Rain's 10 Customer Commandments provide the key to customer satisfaction: 1. Thou shalt not fail to deliver. 2. Thou shalt not be late. 3. Thou shalt not be sick. 4. Thou shalt not be on vacation. 5. Thou shalt not be at camp. 6. Thou shalt not deliver wet, damaged or incomplete papers. 7. Thou shalt not have bike trouble. 8. Thou shalt not get lost. 9. Thou shalt not be tired. 10. Thou shalt not make excuses.

Think about how these apply to your business.
_____________________________________________

In a final personal note, I must confess that at 4 AM, I struggled with Commandment number 9.

Jim Pawlak reviews business books for The Dallas Morning News.

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