HealthCare Voice

New Website Launch, Blog Site

Editor's Note:  HealthCare Voice, John Self's healthcare blog, is moving this week to the website www.JohnGSelf.Com. The blog will run on the web and here  for a couple of weeks and then the content will be exclusively on www.JohnGSelf.Com.  Original plans to launch the site on Friday were delayed until some last minute glitches could be resolved.

John G Self is a frequent speaker and lecturer.  He has a new blog,  John G Self.  It features stories of hope, redemption, and humor of every day life.  His latest blog,  A Love Of My Life Is Dying is currently available.

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Most of the time I enjoy change.  Today we are rolling out our revamped web site and unveiling the transition of my healthcare blog, HealthCare Voice, to JohnGSelf.com . Making this change is something I have enjoyed a great deal.

As we launch this new site, I promise to make JohnGSelf.com more than an online brochure. We will provide daily healthcare news updates as well as an archive of stories on topics covering a wide array of subjects including healthcare reform, the country’s debt crisis, business model innovation, and career management.

My blog will continue on a twice-weekly basis – Tuesdays and Fridays. We will post special editions as events or ideas warrant.

New Offerings

Here is what the new site offers:

• Daily news briefings
• More in-depth analysis of important stories such as healthcare reform or the impact of inevitable debt reductions
• Career management resources, such as the highly regarded JGSA resume guide, as well as blogs on such topics such as managing references, strategies for personal brand management, and the ins and outs of background investigations and credit history

This is a work in progrtess and content will be added on an ongoing basis so check back from time to time. 

In addition to news updates with links to source documents, JohnGSelf.com will integrate video interviews and news stories. Beginning with a video display on the home page, the video content will be expanded over time. The emphasis of this programming will be on career management and talent acquisition.  Other topics such as healthcare reform and the various legal issues related to the Patient Protection and Affordable Care Act will also be featured on the site as video is made available.

The Blog

The blog will continue to be published at its old site during the transition. We are sticking with a twice weekly schedule even though I will admit to missing a couple of Fridays here and there with my busy project and travel schedule. The blog is one of the most enjoyable things I do, after candidate interviews. Most of you know, I am a recovering newspaper writer/reporter. The blog is part of my ongoing rehabilitation that began in 1977 when I left The Houston Post for greener pastures of hospital public relations and, over the years, many other interesting and challenging jobs, including helping implement the first fourteen hospital-based emergency helicopter systems. That was exhilarating, but nothing I did provided me the joy and reward of the news business until I began my recruiting career. I was back in my element. My interviewing skills, I am convinced, are one of the things that separates me from my able competitors. In more than 16 years of search work, I have had only six candidates who did not remain with the client organization through the 36-month C-suite guarantee.

Let me know what subjects you would like for me to cover and I will be happy to tackle the subject in one of my upcoming posts.

Your Input Is Invited

There will undoubtedly be some glitches for the first few weeks. If you identify issues, please let us know by sending an email to [email protected]. 

Finally, please let us know what you think of our expanding sections and content. We want to produce a site that not only promotes the value of retaining JohnGSelf Associates to lead your search, but provides useful information that will help you advance your career.

Thank you.

© 2011 John Gregory Self

Executive Search: The Model Is Broken

Editor's Note:  HealthCare Voice, John Self's  healthcare blog, will be moving to the web site, JohnGSelf.Com in two weeks. The blog will run on the web and here  for a couple of weeks and then the content will be exclusively on WWW.JohnGSelf.Com.

John G Self is a frequent speaker and lecturer.  He has a new blog,  John G Self.  It features stories of hope, redemption, and humor of every day life.  His latest blog, URBAN SNAPSHOT: We Assume, We Are Surprised posted on Monday.

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Candidates complain about recruiters – how they do not communicate effectively, how they do not provide real transparency, how they gloss over critical cultural, political and operational issues because to acknowledge them would complicate the search, or because the search consultant simply did not take the time to understand the underlying challenges.

The statistics tend to support candidate concerns.  According to several industry studies, more than 50 percent of candidates recruited from outside an organization quit, are pushed out, or are fired within 24 months when you look at all sectors and all management levels. Heidrick & Struggles, the industry’s second largest executive search consultancy, admitted in 2009 that in an internal study of 20,000 assignments, 40 percent of their senior leadership placements were out the door within 18 months. 

The record of internal recruiters is not much better.  Apparently, the weaknesses that afflict search firms also infect the leadership talent acquisition function of many large corporations, health systems and not-for-profit organizations. 

Aside from these periodic studies and an occasional blog or article, the search industry is strangely silent on this dirty little subject. 

At the core of this industry failing is a broken business and process model which has existed for nearly 50 years. There are precious few industries in the world that have not undergone multiple transformations over the same period.  But not executive search.   Yes, there have been technological advances – the faxmachine, computerized databases, the Internet and email, but these developments have not changed the fundamental structure of this industry.

When you look at this problem, which has significant implications for a client's profitability or, in some cases, their actual survival, you have to consolidate the processes and results of both internal recruiters and outside search consultants.

Here is what the candidate’s are saying and have been saying for quite some time:

• There is a lack of transparency.  Search consultants rarely tell you the whole truth.

• Recruiters place the burden on the candidate to sort out things like corporate culture, how decisions are made, how success will be defined, and the hurdles to success.  The recruiters either were not perceptive and failed to ascertain this information or they made a financial calculation that to know and to tell would only delay the search and erode profitability of the engagement. Internal recruiters, like their external cousins, did not want to ask the tough questions regarding the search or share unflattering (but truthful) information for fear of rocking the boat. 

• There is poor communication between the candidate and the firm once a resume has been submitted.  That is perhaps the most common complaint and virtually everyone who practices in this profession is guilty as charged.  Weekly email updates should be the norm, candidates say.

• There is a lack of accountability for the quality of the service provided by the recruiters and for the outcome of their work, and candidates believe this contributes significantly to the problems they encounter in the recruiting process.  Here, corporate clients join the chorus of criticisms.  There are rarely any fee concessions if the client is unhappy with the quality of the panel of recommended candidates.  The placement guarantee -- the industry standard is 12 months at the executive level -- is really no guarantee since the vast majority of candidates do not leave an organization until the 18 to 24-month period, an insufficient length of time for the client to regain their investment.  Candidates and clients say the problem seems to be a focus on the process and filling a job order, rather than spending the time it should take to produce the right outcome. 

Now the good news:  These are problems that can be fixed.  These are not rocket science issues.  The real challenge will come in changing the culture of how talent acquisition -- external and internal recruiting -- works.  There is resistance to change, especially in the large firms where partners earn substantial six or seven figure incomes.  The people who should lead the change have a vested interest in protecting a business model that works well for them.  You can almost hear it now:  If it is not broken, don't fix it.

But the system is broken and in this period of business transformation spurred by prolonged financial uncertainty owing to world economic conditions and the debt crisis, corporations, especially healthcare providers, cannot afford business as usual.

© 2011 John Gregory Self

Medicare and the U.S. Financial Crisis: A Collision Course Is Set

Editor's Note: HealthCare Voice, John Self's  healthcare blog, will be moving to JohnGSelf.Com. in two weeks.  The blog will run on both sites for a couple of weeks and then the content will be exclusively on WWW.JohnGSelf.Com.

John G Self, his blog on stories of hope, redemption, and humor will continue to be featured on Typepad.  Later today he will publish "One Life to Live", thoughts on career management.  His blog, "Gingrich, Grizzard and Marriage" hit many reader's laugh button. 

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A former politically savvy county judge in Fort Worth reportedly once told a group of ambulance providers who were loudly opposing a new regional emergency medical authority designed to enhance service and improve quality:  The train is on the tracks.  You are either on the train, or on the tracks.

I have used that story before.  I am dragging it out again because it accurately reflects where we are in healthcare: The Medicare program as we know it today is on a collision course with the U.S. financial crisis.

In healthcare, the train represents said financial crisis and the profound impact that it will have on government spending for healthcare services at a time when there is an avalanche of new beneficiaries entering the program - one every 8 seconds, according to USA Today.  Over the next 18 years, Medicare's ranks -- those who qualify for government healthcare -- will increase by more than 40 million people, even when factoring in deaths, analysts estimate.                                                                                                                    

 Currently, we are borrowing about 30 cents on every dollar paid to physicians, hospitals and other healthcare providers for Medicare services.

Now, add these numbers to the mix:  The current annual deficit is about $1.27 trillion as of midnight last night (02/09/2012).  The national debt is more than $15.3 trillion. 

What is the difference between the deficit and the debt? 

The deficit is the annual shortfall of revenue to spending.  The national debt is the sum of all outstanding debt owed by the Federal Government.  Nearly two-thirds is the public debt, which is owed to the people, businesses and foreign governments who bought Treasury bills, notes, and bonds.  The rest is owed by the government to itself, and is held as Government Account securities. Most of this is owed to Social Security and other trust funds, which were running surpluses. These securities are a promise to repay these funds to Baby Boomers as they retire over the next 20 years. For now, they are unfunded liabilities. These unfunded liabilities represent a  substantial sum that the federal government has NOT included in its debt calculation. Everyone in Washington knows about this, including all the Presidential candidates, and yet no one is talks about it.

In business, corporations are required to count these unfunded liabilities when they are taken on — and report a big loss to shareholders.  Unlike businesses, however, Congress postpones recording spending commitments until it writes a check.  Those are the promises made for future payments in Social Security, veterans’ benefits, government retirement, healthcare for senior citizens, etc. 

If the deficit and debt numbers scare you, then the amount of unfunded liabilities -- the government's "off balance sheet" debt --  will drive you off a cliff.  That number is about $61 trillion, USA Today reported.  These "unfunded obligations amounts to $528,000 per household. That's more than five times what Americans have borrowed for everything else — mortgages, car loans and other debt. It reflects the challenge as the number of retirees soars over the next 20 years and seniors try to collect on those spending promises." 

The deficit, the debt, the unfunded liabilities – those are numbers so big that it is hard to get our arms around the extent of the problem.  So, lets cut it back to a basic number we can deal with.  How much is a $1 trillion?

The most graphic way to understand the size of this number is to use a time analogy.

If you started spending $1 million a day, every day, from 1 AD when Jesus Christ was born, through midnight last night (2/9/2012), you would still have about a quarter of a billion dollars left.

That is how big, how bad the $1 trillion number is. But remember, our national debt is now more than $15.3 trillion.  Now think about  the speed with which the government is incurring new liability -- the Baby Boomers who qualify for Medicare coverage at the rate of one every eight seconds.

Do you see the train? Can you begin to imagine how messy this collision will be?

There are way too many leaders who bristle when you suggest that the healthcare industry that we know today will be substantially different over the next five to 10 years.  It will never happen, they argue, the voters will never allow it.

When I hear that argument, two things come to mind:  the newspaper industry and the Greek government.

These dramatic changes may come incrementally, allowing us some time to adjust.  Or the European debt crisis could ignite a global disruption in the credit markets.  No one can be sure when or how fast this financial catastrophe waiting in the wings will occur.  I do know one thing for sure:  the train is on the tracks.

Today's career management tip: now is the least embarrasing time to learn how to adjust to dramatic change.

Sorry, perhaps I should not joke about something this bad.

© 2011 John Gregory Self

New Way to Look at Healthcare

Hospital Chief Executives and their boards, helped (aided and abetted) by their architects, have constructed some impressive hospitals and support facilities.  From humble community hospitals in small towns across America, to the big box medical centers in the regional centers of commerce, more often than not, the image of the hospital is defined by the quality (size) of the building, the technology inside and its medical staff.

Changes in the way healthcare is delivered, both from the Patient Protection and Affordable Care Act (PPACA) and also some rather draconian deficit reduction measures will most assuredly affect Medicare spending.  This could force us to stop looking at buildings as the center of our healthcare delivery universe and to begin to think about population groups and geographical territories.

Buildings will always be central to healthcare delivery.  But instead of focusing on brick and mortar for how and where we should deliver care, CEOs and their employees should shift their focus to their customers, their markets and geographic territory.  This shift, a nuanced course correction in the eyes of some, will become, over time, a central article of faith in terms of how we design our system and allocate resources.  And over time, this rather radical transformation will play a significant role in reducing healthcare costs.

In the end, however, no one initiative will solve our massive and growing healthcare spending challenge.  There are literally hundreds, if not thousands, of transformative changes and tweaks that will have to occur, from the role of EMS in pre-hospital care, to treatment protocols and locale. 

These will be challenging, but exciting times.  Fortunately, we are an industry that has attracted some of the top graduate school talent over the past 10 years.

I am looking forward to this transformation a great deal.

© 2011 John Gregory Self

Editor's Note: HealthCare Voice, John Self's  healthcare blog, will be moving to JohnGSelf.Com, hopefully later this week.  The blog will run on both sites for a couple of weeks and then the content will be exclusively on WWW.JohnGSelf.Com

 

Deficit Reduction: A Threat to Publicly Owned Hospital Management Companies?

Healthcare reform and intense pressures related to this nation’s mounting deficit crisis are two forces that could dramatically alter the financial landscape for investor-owned hospital management companies.

There is a plausible scenario that suggests that over the next five to seven years all will not be well for the nation’s largest publicly owned hospital management companies. Their tribulations will occur not because they are bloated, inefficient operations. No, most are extremely efficient, a tribute to management’s laser focus on reducing costs and daily, if not hourly, scrutiny of performance metrics, mainly staffing. Because they are publicly owned, the real threat will come from their inability to meet Wall Street expectations for year over year growth in earnings.

As Medicare reimbursements are reduced -- most certainly to be followed by cuts in payments by the nation’s managed care providers -- hospitals all across America will get less money for the services they provide. Highly efficient investor-owned hospitals, which have for years bragged that they were lean machines, unlike, they say, the stodgy, poorly managed not-for-profits community medical centers will have less opportunity to reduce costs to maintain margins. This is not to say that investor-owned hospitals will suddenly begin losing money. They won’t. But -- and this is a big but -- they will not be able to sustain their historical performance in terms of growth in earnings, something Wall Street demands. There is only so much fat you can cut before you start hacking away at the bone, the core of your business.

There is an old story of two men flying in a remote region of the Andes Mountains when a vicious storm forced them to make a crash landing. One man was overweight -- some would stay fat. The other was a long-distance runner, the picture of good health. The overweight man survived while the fit man died -- because he had no excess body fat to burn when they ran out of food.

Investor-owned hospitals which depend on their growth in earnings to sustain investor confidence, which then paves the way for access to capital with the most favorable of rates, will face more skeptical lenders and less flexibility to acquire more hospitals in healthcare reform’s period of consolidation. Instead, look for some investor-owned companies to spin off their marginal performers to not-for-profit regional health systems or new, marginally capitalized start-ups. In the end, the losers will be the physicians and the communities who thought they had ensured the future of their hospital when they sold out years earlier.

Isn’t reality ironic?

What do you think?  Is this a plausible scenario or a misread of how deficit reduction cuts to Medicare will impact hospital management?

© 2011 John Gregory Self

 

EDITOR's NOTE:  In two weks, HealthCare Voice will move from this location to www.JohnGSelf.Com.  For two weeks, the blog will run on both sites and then we will close this URL and it will be on the web page.

Technology and Media: Remarkable Visions For The Future

As we cruise through the final days of 2011, the scribes of media and technology are busy laying their visions for the future.

Based on two articles in Monday morning’s New York Times, we should all fasten our seat belts, 2012 is going to be a fast and fascinating ride.  For healthcare organizations, many of which are struggling mightily just to implement and remain current with basic  information systems infrastructure to improve patient safety and operating efficiency, these predictions may evoke a dire question: How can we afford to keep up?  For an industry that trails other business sectors from five to 10 years in terms of information systems, that is a legitimate concern with some interesting consequences.  But that is a question for another day.  

Let’s start today with something as basic as the remote control for the television.  Respected media writer David Carr of the New York Times characterizes the current evolution of the remote as “...a little like hitting your television with a stick until it delivers what you want.  If things go as they should, we will spend less time looking under the couch for the remote and more time telling our television to get us the seventh episode of the second season of ‘Boardwalk Empire’.”  This month “Xbox 360 owners were already able to search TV shows by voice.  “...someday I should be able to walk into a hotel in Kansas, tell the television who I am and find [all the content that] I have [previously] bought and paid for, there for the consuming,” Carr writes.  This is one of the many promises of Cloud computing.  

“The iPad on your lap is a screen that makes it easy to navigate toward a completely personal experience.  That screen on your living room wall is going to have to perform the same way to remain relevant.”

Traditional content providers like the Wall Street Journal are already adding hours upon hours each month of video content to the web site to provide greater context for the stories in the morning business newspaper, still the largest daily circulation in the United States.  Venerable papers like Mr. Carr’s New York Times will either master the integration of video with written content, creating new value for paying subscribers, or they will perish.

Once news content providers with minimal presence in the U.S., like the BBC and Al Jazeera, “are no longer regional curios, they are here,” Mr. Carr explains. (FYI, current and former state department officers say Al Jazeera is a good source of information regarding developments in the Middle East, and the thinking of the Arab Street.  BBC broadcasts on numerous US NPR outlets.  This, too, is a great source of world news that most US TV networks and newspapers no longer cover.)

Most people do not know who Bernie Meyerson is and feel no compulsion to learn more about him.  They should.  He is the Vice President for Innovation at I.B.M. and a highly regarded researcher in advanced microprocessor design and computer systems.  It is Mr. Meyerson who ovrsees I.B.M.’s list of technological innovations that they think will come true in the next five years:

1. Small amounts of energy created by actions like people walking, or water running through a pipe, will be captured and stored in batteries and used to power things like phones, cars, or homes. ”You will see new ecosystems for generation and capture,”  the NY Times quoted Mr. Meyerson in its Monday morning BITS section.  “You [people] generate 60 to 65 watts [of energy] while walking.  You could easily use that to power your phone forever.”
2. Passwords as used today will disappear as increasingly powerful phones and sensors will store your personal biometric information.  This will enable computers and other machines to validate who you say you are.
3. Sensors on and inside the human brain will allow for the mental control of objects.  There are already experiments where the mind moves sensors, but Mr. Meyerson goes further: “You will observe thought patterns, which are highly personal.  You can use this to better understand stroke or disorders like autism,” Mr. Meyerson predicted.
4. Powerful mobile devices capable of precise language translation will belong to 80 percent of the world’s population.  Ubiquitous voice recognition and translation capabilities will make the phones useful to large segments of the population that are illiterate  or who use languages that are not easily written with keypads. (Does anyone think the world can become flatter?)
5. Personalized information filters and search will bring you only the information you want.  “This will invert the premise of marketing. The [smart] phones will start to be your advocate, recognizing what is near and dear to you and getting it.  Instead of companies speaking to you, you will reach out to companies.” (This makes Seth Godin’s Permission Marketing, a novel concept of the Fast Company era of the 90s almost irrelevant.)

A county judge in Fort Worth once said of major change:  “The train is on the tracks.  You are either on the train or on the tracks.”  

That seems to be remarkable guidance for those of us in healthcare as we scramble to adapt to these technological changes.

© 2011 John Gregory Self

Seed Newsvine

CEOs, Meet The Millennials

There is an age-old conflict in business:  the friction between the established leaders of today and the newest crop of the leaders of tomorrow. 

Meet the Millennials.

This large generation of rising adults, born since 1982, are starkly different from their older managers, teachers, and colleagues. Also known as Generation Y and the Echo Boomers, several million of them have joined the adult world since 2000, and they are entering the workforce faster than you can say “retiring Baby Boomers,” according to a research report from the former MillennialGeneration.Org site.

This group poses a unique set of hurdles for today’s leaders in terms of attitudes and practices in how they work and communicate.

Facing “big ticket” challenges, not the least of which are significant reductions in spending on Medicare and Medicaid over the next 10 years, CEOs and Chief Human Resource Officers aren’t always attuned to the nuances of a particular age group, most especially how to recruit, develop and retain the top talent from this working class.  This is a critical consideration.

The payor’s focus on customer service and the negative financial implications that will occur for those hospitals who do not achieve top scores in service and satisfaction, will require the leaders of today to harness the incredible intelligence and remarkable creativity of this new generation. 

For someone who frequently lectures to graduate management students, my only advice is to pay attention and engage your "up and comers" about what they think and believe, not what you want them to think.

© 2011 John Gregory Self

Seed Newsvine

In Interviews, Words Have Consequences

Words have consequences in job interviews.

Over my 18 years in executive search, I have heard hundreds of candidates describe their leadership style as “consensual -- I build consensus.”   When a candidate gave that as an answer to a query regarding their leadership style in my earliest years, I would nod my head, as if I really understood what that term meant. 

I learned my lesson, fortunately not at the client's expense.  Now, I ask, “What does that really mean?”  The truth is, candidates use that line because it sounds so collegial, so non confrontational.  Considered in rapid time, consensual leadership sounds like the first cousin of a “collaborative” style.  They are not.   

Adam Bryant’s Corner Office column in Sunday’s New York Times provided an excellent case in point.

Consensus “...sounds wonderful but it was a very, very difficult way to manage anything, because to convince everybody to do one particular thing, especially if it was hard, [is] almost mpossible,” said Geoffrey Canada, President and CEO of the Harlem Children’s Zone, a non-profit which has offered education, social-service and community building programs to children and families since 1970.  “Convincing people to give your way a try will work if you neutralize -- and sometimes you have to cauterize -- the ones who are really against change.  They’re the kind of person who, if you tell them it is raining outside, they will fight you tooth and nail.  You take them outside in the rain and they will say, ‘But it wasn’t raining five seconds ago’.  I spent a year a year trying to convince those people to change and give me a chance.  Then I realized it was a wasted year.”

Consensus leadership is a sure way for healthcare executives to get bogged down at a critical time in our history.  The challenges in healthcare are significant.  Most executives, employees and physicians inellectually comprehend what will transpire over the next five to 10 years as the result of out-of-control deficits and the national debt and Medicare’s central role in fueling the fire.  Major cuts will occur.  Healthcare delivery as we know it today will forever change.  Getting people to actually undertake the necessary change is another matter.  We might be able to collaborate on finding alternative strategies, but we will NEVER experience a time when everyone agrees to this kind of gut-wrenching change.  Those who fear and resist change may nod their heads in agreement -- giving the consensual leader a false sense of hope or security -- but when the first sting of change pain occurs, they will dig in their heals and resist mightily. 

So, as a healthcare leader, if you think a consensus building leadership styler is the answer, that it will help you through these tough times, perhaps you might want to rethink that proposition, because many of our leadership styles and techniques that worked 20 years ago, will not work in this new healthcare economy.

 

© 2011 John Gregory Self

Seed Newsvine

Missing the Little Things: When Service Is Not First Class

Random observations from a week’s worth of traveling across America:

Most business organizations profess a commitment to understanding and delivering first class service to their customers.  This implies a level of service is more than just being polite, helpful or customer-centric.  

Most companies that make these claims are guilty of misleading statements. First-class customer service is indeed rare.

Exceptional service on the sales floor, in the first-class cabin on a long fight, from your bank, or the most sophisticated medical center, can be undone  -- the brand damaged -- by the small details that go unnoticed or executed without care.  These seemingly insignificant miscues include: 

• A dirty, smelly public bathroom near the dining room of a state-of-the art hospital
• A financial decision not to serve first class passengers a meal because the flight time is 10 minutes under the airline’s three-hour threshold for meal service
• An airline squeezes the leg room in first class so they cram in another row of seats in coach; there is more leg room in an exit row in coach class
• The broken desk chair in a famous New York luxury hotel room that is reported to the management three times but never repaired
• The very profitable “money-center” bank which accepts your deposit from a tripple “A” rated insurance company drawn on a larger money center bank but does not give you access to your funds for up to 15 days even though the transaction will electronically clear at midnight on the date of deposit

Great service is more than doing the obvious things right.  It is simply not a catchy advertising slogan or an employee customer experience improvement campaign.  It is about getting the small, seemingly insignificant details of what we do, perfectly.  It is about the thousand moments of truth that happen every day and every time --  at the end of the day, when shifts are changing, when workers are tired, when airline executives make a calculated financial decision not to serve meals because they can get away with it with a captive travelers with few choices, or when management is just not paying attention.

Great companies deliver exceptional service because it runs deep in their DNA, a passion to do the right thing for their customers, not just when it is convenient or they feel like it. 

Sadly, truly great customer service is rare today because it is not in the DNA of most organizations  When that is the case, we can only look to the CEO.  Most things DNA within a company, most especially customer service, originates in the heart and the mind of the person at the top, not some expensive pre-packaged consulting product.

© 2011 John Gregory Self

Seed Newsvine

Video Summaries of Candidate Interviews Leads To Greater Success

Video Summaries of your search firm’s recommended candidates can help organizations avoid a costly leadership miss-hire; not video conferencing, which is widely overused in executive search, but edited video summaries of your recruiter’s in-depth face-to-face interview with the candidate.

Using videoconference technology to conduct the defining interviews that will be used to select their recommended candidates is a big mistake, the purported cost expense savings notwithstanding.  Reviewing an edited version of the interview allows the client to make an informed decision as to which of the four or five candidates on the panel should be invited for a site interview.

The proof is in the record of success.  Clients who have used search firms that incorporate video summaries as part of their candidate presentation say that it is “incredibly helpful” in selecting the right candidates .  “In the past, we had to rely solely on the recruiter’s judgment, and in many larger firms, the partner has only limited exposure to the candidate in the screening process,” one CEO said who asked that I not use his name out of concern that there might be negative repercussions.  Anyone who understands how most large consultancies work -- and search firms are consultancies -- knows that the partner is a rainmaker first, a client relationship manager second, and a working consultant a distant third. 

Providing clients video summaries is a game changer in the client-search firm relationship.

The CEO continued that over a seven-year period and 12 searches, “having the videos helped us avoid some big mistakes.  Over that period of time we only had one candidate who did not work out and that individual left after two years and the search firm provided a replacement.”  He is not alone in his assessment.

The cost of a miss-hire at the executive level is extraordinarily costly, from 50 to 500 times the failed executive’s annual base compensation, depending on the size of the company and the that individual’s scope of responsibility.

Using videoconference interviews between the recruiter and candidates for the final panel is penny wise and pound foolish.

© 2011 John Gregory Self

Seed Newsvine

Humbled By Connectivity

A couple of years ago I lectured to graduate students at a major university on career strategies and personal brand management. As the students entered the lecture hall, a significant number opened their laptops. I told my son who is a graduate student (SMU) that they thought enough of my lecture that they were taking notes. 

He laughed. Out loud. 

"Dad, they were surfing the web, looking at email, or on Facebook, and those that weren't on their computers were probably texting on their phones." 

Humbled by a lack of understanding of how connectivity has changed our lives and our attention spans.

© 2011 John Gregory Self

Seed Newsvine

Four Things A Manager Should Never Say

As I have reported on more than one occasion, I am a fan of the CBS MoneyWatch (formelry BNet) web site.  They have excellent content, particularly in the area of career management.  As an executive recruiter I spend a lot of time evaluating leaders -- their styles and personality -- and I spend even more time researching the mayriad of concepts written about leadership. 

In this digital age we are all overwhelmed with information -- the most commonly used phrase to describe this tidal wave of data is "taking a drink of water from a fire hose." From time to time, as I review articles that I think of interest to my readers and subscribers, I will share them with you.  Let me know what you think.

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"People listen to leaders. It's one of the qualities that helps define them as leaders -- and their followers as followers.

"But because of this, leaders need to mind what they are saying, and avoid knee-jerk responses.  A leader's brain must always work things out ahead of his mouth speaking them,"

"Patrick Alain, author of The Leader Phrase Book: 3000+ Phrases That Put You In Command. To help wannabe leaders cement their status, Alain has compiled a shortlist of four phrases that a good leader will never, ever say. Avoid these lines and people will be more likely to follow your lead."

In a nutshell here are the four no nos.

1.That's impossible

2. John Doe is a jerk

3. My way or the highway

4. I am always right

Read More

 

 

© 2011 John Gregory Self

Seed Newsvine

Executive Search: It Is Time for Change

As the business climate experiences dramatic changes in our new normal economy, one industry will face dramatic upheaval:  executive search.

The record of the executive search industry is mediocre even under the best of economic conditions. The time has come for fundamental change and those firms who understand this trend will thrive.  Those who do not, like the vast majority of Fortune 50 companies over the past 50 years, will disappear.

Here is the problem: the search firm business model is more than 50 years old and, unlike most other industries, little has changed from its inception. There are few other business sectors in the world today that have not undergone at least several transformations over their lifetime, but executive search has not changed because there has been no reason: their business grew and recruiters prospered.  Yes, technology like computerized databases, the fax machine, internet connectivity, and video conferencing have facilitated the timeliness of the process, but overall the model is the same: you hire a firm, pay them a retainer and a professional fee based on the successful candidate’s first year base salary or the first year total cash compensation.  When it came to accountability for the quality of a firm’s work, there was either no guarantee that the candidate would be successful and remain with the client, or the recruiter offered a limited one-year guarantee.

There are today some star performers both in the large and regional search firms, but the real creative work that is transforming how the executive search process works, and how you should hold a recruiter accountable for tenure and performance, is occurring in smaller companies  that have greater flexibility to innovate.

Today, the search industry is beginning to see some long overdue transformation. Some of the more introspective firms, including global giant Heidrick & Struggles, realized the changing business climate was upsetting the industry’s long-held and highly profitable business model.  Heidrick & Struggles examined 20,000 of their searches and found that 40 percent of the candidates they placed across all sectors on a global basis quit, were forced out or were fired within 18 months.  Other studies show that 50 percent of the candidates recruited from outside an organization are gone within 24 months. Anecdotally, a large east coast health system which had paid a major global traditional search firm nearly $1 million in professional fees plus expenses in less than 18 months, saw their new executives, save one, leave the organization because of performance or poor match within three years.

Businesses, particularly health systems and hospitals, cannot afford this level of value. 

 There are strategies and processes to dramatically improve the rate of success in recruiting from outside the organization.  Friday, I will share with you how to improve the process and enhance the value -- from search firms and your internal recruiters.

© 2011 John Gregory Self

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5 Things Successful People Don't DO

I found this interesting article on the new CBS Money Watch site that replaced one of my long time favorite information venues, BNet. The BNet brand is no more but the edgy and interesting content lives on.  You may not agree with everything you read, but it reflects an emerging point of view among younger executives.

The author, Penelope Trunk,  is the founder of Brazen Careerist, a social network for young professionals.

"There are no formulas for who is successful. But there are statistical probabilities. For example, you are equally as likely to succeed if you go to Harvard as if you apply to Harvard and get rejected, according to Alan Krueger, Princeton economist. And you are more likely to be successful at work if you were a cheerleader than if you get a Ph.D.

"So you can be proactive, and do things that successful people do. But you can also think the other way, and avoid doing things that only losers do. Here are five of those..."

Read More

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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.

-------------------------------------- 

“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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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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