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

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

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.

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

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

Seed Newsvine

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

Seed Newsvine

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

Seed Newsvine

Going Out On A Limb...Not Really

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

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

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

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

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

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

© 2011 John Gregory Self

Seed Newsvine

OK, Here's the Deal

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

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

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

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

© 2011 John Gregory Self

Seed Newsvine

Organizations Do Not Care About People...

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

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

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

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

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

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

“Our people are our most important slogan.”

 

© 2011 John Gregory Self

Five Reasons Hospital CEOs Get Fired

From Anchorage Alaska

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

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

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

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

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

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

© 2011 John Gregory Self

  Seed Newsvine

Can You Spell Bad Service? MICROSOFT

A year ago, as I worked to launch my new executive search firm, I experienced problems loading a customer/candidate database. I needed help in a hurry so I turned to the software company.  What a disaster in customer service.  It was if their motto was We make a lot of money selling software.  Don't bug us.  Visit our web site.

Welcome to Microsoft customer support.

If you are not a technical wizard, the Microsoft web page is as opaque as the complex Collateralized Debt Obligation instruments from the real estate debacle that were so complicated that the bankers who sold them didn't understand. Forget trying to find the right article, among hundreds, that will explain the issue and tell you how to fix it, assuming they were written in easy-to-understand English.   

They make it difficult to find their contact information and more difficult still to find a telephone number to technical support for the specific product.  When you finally get through the telephone decision decision tree, assuming you are not cut off, you are then connected -- using a system that is only marginally better than two orange juice cans and string -- to a technical support guru who is obviously not in the USA.  You struggle to hear. Understanding the representative is another struggle.  A pronounced accent and a bad connection is one definition of technical support hell.

Now compare that with Apple.  Today I had a question; I used their super fast Safari browser, easily found the technical support contact information, entered my product model number and filled in a quick form to explain the problem.  They gave me choices:

1. Immediate call.  They would call me.  The waiting time listed on the web was less than one minute.

2. I could schedule a call

3. I could use their knowledge base -- for the technically sophisticated among us

I chose the immediate call. Within seconds of entering my number, my telephone was ringing.  Apple was calling.  I also received a case number and explanation on my email. The technical support representative was friendly, eager to help and communication was not a problem... I will not ramble on.  Apple owners get it.  They know that this company is committed to making high quality products that surprise and wow their customers, and they back that up with what many think is best-in-industry customer service. No competition.  

Microsoft service is a long standing bad joke.  And given the mediocrity of some of their software, you would think they would take customer service a little more seriously. But what the heck, they are making a lot of money.  Too bad Apple just passed them in terms of market capitalization.

So now we come to hospitals.  We are not even in the same universe when it comes to customer service.  

A friend visited her physician who works in an integrated health system. They took x-rays, performed lab work and gave her two major injections to counter an infection.  She is a Medicare beneficiary.  Several weeks later, she received a bill, which she paid.  Then she received another much larger invoice, which was for her lab work.  Immediate payment was requested.  It seemed high, so my friend called Medicare to determine how much they had paid.

Guess what? Medicare had not been billed. Medicare's representative advised her to wait to pay that amount until the clinic filed a claim and Medicare determined how much they would pay.  The suggestion was clear -- that if my friend paid the clinic the full amount now, she might have to wait for months before receiving a refund. So she called the clinic billing office and dealt with someone whose name should have been: Ms. I Am Clueless. They discussed the situation but it was unclear to my friend if she made any progress, if anything was resolved, based on her conversation with the customer service representative. Hence the clueless moniker.

This week my friend received yet another bill for a different amount for the same test, but the amount -- $43 with another $4 tacked on as a late fee because the amount had not been paid in 30 days. She called the clinic back and talked to another customer service representative, Ms. Dismissive Indifference, who said she could not see why they had added a late fee since the payment due was not late.   In the end, however, my friend paid the principal amount and the late fee. She was told that it was just easier to do so.  I an era of tightening reimbursement, I guess that is just one small way to boost revenue. 

The big bill apparently is still rattling around in payment hell waiting for a settlement. 

This story, unfortunately, is fairly common. Not all hospitals and large clinics operate this way.  There are some great operators who get it right every day.  But many do not.

I work in healthcare and I am beginning to hate even thinking about going to my doctor. He is part of a big clinic whose centralized business office is run, I have come to believe, by some obscure, inept arm of the government.  Who needs the aggravation?  It is like dealing with Microsoft.  

The problem for most hospital CEOs is that they only hear about these incredible stories only if someone complains, which my friend will not do.  So absent an aggressive pro-actve customer service program that can identify problems before they alienate clients, nothing much changes.  Far too many are like Microsoft's leadership.  If they are profitable, the seem to say, don't sweat the small stuff.  I guess that means service, too.

Healthcare providers need to stop and take a page from Apple's playbook. They understand customer service and they love to exceed their customers' expectations.

 © 2010 John Gregory Self                        

Health Systems, Hospitals Got It Right

Because I am not shy about criticizing or challenging my industry – healthcare – when we fail to live up to our mission of quality/safer patient care and support for the communities we serve, I owe it to my colleagues to voice my support when I believe they get it right.  They have in one very important area.

Executive compensation continues to be a hot subject both in the U.S. and Europe.  Not a week goes by without a news report, analysis or essay on the subject. While the current lightning rod is the large investment banks, there are far too many public corporations that are guilty of bad practices in how they pay their executives and how they explain it publicly.  

The central issues giving life to this continuing flow of coverage on the subject are the size of the base salaries and/or bonuses, the relationship between the pay for some easily understood performance metric, and the rights of shareholders – or the lack thereof – when the “owners” of the company are not happy with size or justification for the genrous awards.

Executive compensation issues and the financial community’s sense of entitlement, continues to irk regulators, millions of small business owners and “average Joes” everywhere.  The large banks single handedly drove this country to the verge of a global credit market contagion.  However, the continuing problems and lack of transparency in executive compensation are not confined to the banks.  There are hundreds of examples of corporations throughout the U.S. and Europe that treat shareholders as troublemakers of the worst sort if they deign to believe they are entitled to any rights  to have a meaningful say on this issue.

In healthcare delivery, we have kept our wits about us on executive compensation when other industrial and service sectors lost their way. We are not perfect, but our industry does remarkably well, all things considered. 

While there are health system and hospital CEOs who earn high six and low seven-figure incomes – and they are the exception – there are few examples where the size of compensation of a hospital CEO is inconsistent with the scope of responsibility and the complexity of the challenges these executives face.  In fact, there are examples aplenty of hospital CEOs of difficult-to-manage public and mid-sized community hospitals who are underpaid for the work they do and the results they produce. 

I am not going to discuss the payor or pharmaceutical segments because I lack the expertise.  My search firm does not work in those areas, but I believe there are certainly examples of these bad  compensation practices in the health insurance, technology, and pharmaceutical segments.

Health system and hospital boards, for the most part, are responsive to their communities and tend to be prudent in evaluating the CEO and how they pay him or her for the results they produce.  No, community boards are not as transparent as they should be in some markets, but even in the worst of cases, they are infinitely more responsive than the boards of far too many major public corporations who have created more rules and hurdles to block true shareholder input into how the company is run.  It is a maddening situation for many mom and pop investors, and increasing numbers of institutional investors, who are tiring of the corporate arrogance and greed.

Hopefully, as community healthcare organizations deal with the immense challenges that are part and parcel of our “new normal” economy, persistent high unemployment and anemic growth rates, their boards will become more transparent, not less, and more communicative, not less, regarding the size and scope of their community benefit which is how they justify their tax-exempt status.

Big corporations may have a legal requirement to be more forthcoming, but community healthcare providers have a moral and ethical duty.  And there is a big difference. 

 

© 2011 John Gregory Self

Seed Newsvine

Take The Time

Today I received a thank you card via PLAXO, one of a number of social networking sites, thanking me for being thoughtful.  It was from the CEO of a health system in the Mountain West who appreciated the fact that I remembered her birthday. "Thank you for your thoughtfulness."

Tough and challenging times lie ahead for healthcare leaders.  We will see unprecedented reductions in Medicare and Medicaid funding, the promises of the Patient Protection and Affordable Care Act notwithstanding.  These reductions will force providers to embark on structural reforms that most never imagined in their lifetime.  

There will be pain caused by our instincts to resist complicated reforms that upset our values. These changes will be especially hard on many of our key stakeholders such as our physicians and our employees.

Senior leaders who focus solely on strategy, the daily, weekly, and monthly metrics, and the month-end results, will not be as successful as those CEOs and their teams who keep their employees and customers front and center.  When the crunch hits, we must all resist the temptation to view maintaining these important relationships as an expense, a secondary priority, or something that can be all together forgotten in the name of "making the hard financial choices."

In the end, those healthcare organizations that thrive in an era of radical and painful change will be those who have employees who have been engaged and empowered to make their organization the best.  

To be a successful healthcare organization over the next 10 years means investing today in people and relationships. At the core of this effort must be developing a reservoir of goodwill with those stakeholders.

CEOs who understand that they must focus on their role as a strategist, resource coordinator, and chief relationship/communications officer will thrive, provided they delegate daily operations to a competent management team.

Leaders who focus on the big issues but remember the small things -- sending an employee a birthday card, a congratulatory note for going the extra mile, or making an unannounced visit to a department to recognize someone for a job well done is such a minor event in an otherwise busy day, but pays huge benefits. 

Effective, successful executives and thoughtful leaders are one in the same. Over the next 10 years, this leadership truth will become very apparent.

IMPORTANT QUESTIONS

1.  Do you regularly make rounds on all shifts?  Do you require your executives and managers to visit employees and physicians on a regular basis on all shifts?

2. Do you take the time to listen to what employees and physicians are telling you?  Do you follow up in a timely manner?

3. Are you promoting bottom-up innovation?  Top-down organizations will struggle to keep pace with sweeping changes over the next 10 years. You cannot turn this essential cultural orientation off and on like a light.

4. Are your employee-stakeholder communications leading edge and effective? Is there substance that engages employees, physicians and community stakeholders on important issues?  Do your distribution platforms connect with the age cohorts of your audience?  

5.  Do you have a weekly communications plan that always emphasizes the organization's core values, the more immediate key issues and performance targets, or do you work off the cuff?   Are you promoting real transparency or are you playing the transparency game?

© 2011 John Gregory Self

Seed Newsvine

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

Seed Newsvine

Leaders Who Are Bullies: No Excuse for Bad Behavior

Senior executives and managers who repeatedly castigate employees in front of their peers – yelling or humiliating them for whatever reason in whatever venue – prove only one thing: they are not leaders, they are bullies.

Physicians, the leaders in clinical care, who yell, curse and denigrate colleagues, nurses or other workers, are no different.  Their clinical brilliance, or lack thereof, is no excuse.  The problem of abusive physicians is well documented, so is the practice of far too many hospitals whose executives will look the other way when the offending party is a big admitter who drives significant profits to the bottom line.

It does not matter if the performance of the bully's target(s) is sub-par or whether the organization is in a turnaround crisis.  Physicians, executives and managers who employ all manner of lame excuses to justify their abusive behavior, are really just thugs masquerading as professionals. 

Boards or bosses who know that such behavior is occurring and allow it to continue for whatever rationalization, are no better than those who terrorize their employees. They act as if there are no consequences for tolerating such shameful actions. There are -- political, legal and economic.

Lest you think that I am angry about a relatively small issue – especially in healthcare – think again.  Let’s be fair.  This is not a problem that is limited to healthcare.  This unacceptable behavior touches every industry, in every corner of our nation. It is more widespread that anyone wants to acknowledge.

In my role as an executive recruiter, I hear of these stories far too often.  In my more than 30 years of executive experience, I have seen bosses shred employees in meetings and justify it as honest dialog about accountability.  I have seen CFOs shove employees against the wall “to get their attention.”  I have heard story after story of executives who blame their own mistakes on those who report to them.  I have seen leaders and managers misuse subordinates for no other reason because they can.

When I see this type of contemptible behavior, I often wonder what the bully’s home life is like.  

Being the victim of bullying -- emotional and verbal abuse -- brings with it a special shame. The victims often feel isolated, afraid to seek help. Notifying or asking for support from the wrong person -- the bully's ally or just another enabler -- may only aggravate the problem, especially if the bully's boss or the board believes the perpetrator is essential to the success of the organization. They rarely are, but that is part of the delusion. 

For the victim, quitting is not always an option.

I know victims who have risked exposure and called the hospital's compliance hotline because they simply could not take it anymore.  Some people have even tried notifying the Joint Commission because they did not trust the Chief Human Resource Officer to do the right thing or felt the internal process was compromised.  That failing is part of a larger story. When the chief of HR fails to investigate and protect, they are betraying the organization, themselves and their profession.  Being the HR advocate for an abused employee is not an optional job duty.

We are entering one of the most turbulent periods in the history of healthcare.  The impending challenges will require great leaders.  There is no place for bullies in the executive suite, as department managers or shift supervisors.  There never has been. 

© 2011 John Gregory Self

Seed Newsvine

Kicking the Can Down the Street, DeFacto Style

We hear a lot these days -- some would say 20-30 years too late -- that Congress can no longer kick the deficit/debt can down the road.  Of course, the clear and factually accurate implication of this statement is that Congress has seen this deficit/debt train wreck coming for a long time.  In their wisdom, they chose to put off the inevitable with year after year of highly touted cuts in spending which were actually cuts in the rate of increased spending, not net reductions leading to lower deficits, so we kept slipping further and further into debt.

What is going to happen now?  Since Medicare is and will continue to be the single biggest driver of federal spending, and future projected deficits, what role should healthcare providers play?

The healthcare industry’s normal response is to do nothing aside from complaining, and then adjusting to the significant reductions in reimbursement.  Spending more money, or even maintaining current funding levels, does not guarantee quality of care and service.  However, there is only so much money you can strip out of the current healthcare structure without causing irreparable harm to patients.  Major cuts, the size of which will be necessary to make a meaningful impact, will require a new business model.

I would argue that following our normal path of adapting is tantamount to kicking the can down the road.  

The Patient Protection and Affordable Care Act (PPACA) made an attempt to reduce the number of uninsured Americans but largely missed the boat in achieving material and sustainable reductions in healthcare spending.  Yes, I know what the Congressional Budget Office projected – important savings.  I know what the President and the Democrat leaders promised.  I am not accusing them of misleading the American people.  Rather, I am zeroing in on the phrase "sustainable reductions”.

The fact is that you cannot control healthcare spending over the mid-to-long term, whether it is for Medicare or commercial insurance, until you completely restructure the way patient care is delivered, how it is paid for and consumers are more financially responsible for the care they receive.  Tort reform should be included in the fix, as should improved accountability for quality and service, but those are not big drivers of the increased costs which this year doubled the rate of inflation and overall economic growth.

Congress, as I have said many times before, lacks the political will and moral courage in the current volatile political climate to revisit healthcare reform.  Democrats, some of whom understand the structural problems that contribute to higher costs, are of the view that any effort by Congress to lead a material restructuring will provide ample fodder for Republicans and Tea Party devotees to re-scream government takeover, socialism, the trashing of personal liberties... You get the point.  Republicans, while deserving much credit for the innovative ideas for Medicare reform in Rep. Paul Ryan's "Path to Prosperity", are seeing a rising tide of independent voters who are increasingly uncomfortable with, trending to outright opposition of, what is essentially privatization of a program that most Americans feel is a successful government program.  

This has all the makings of a black hole environment that will preclude Congressional action, must less leadership.

The most important business in Washington today is not the “people's business” unless you believe that average Americans today are focusing more on the next election rather than jobs and scrapping by to pay the bills.  The really depressing part is that when the 2012 election cycle is over, regardless of the outcome, the political operatives that create the red-hot, demonizing rhetoric, will begin thinking about the 2014 off-year election.  

So who is going to take the lead on this necessary restructuring?  Who will take the chance to design and promote a new approach -- from how hospitals are designed and operated to the role of physicians and other providers, to the payment mechanisms, economic alignments, and incentives?

Doing nothing, and adjusting to the marginal tweaks from Washington, is tantamount to kicking the can down the road.

What would you do?    

© 2011 John Gregory Self

Seed Newsvine

Principles, Integrity and Our Enabling Bad Habits

Principles are important.  Integrity matters.

We were once a nation that admired our leaders in politics and in business – who stuck to their principles and who conducted themselves in an ethical manner. 

Here is where I – and many of you – get frustrated.  For too long, the majority of our political and business leaders have not been true to their principles. Let's not talk about integrity when it comes  to politics or Wall Street.

This week we saw the conviction of a billionaire hedge fund manager who clearly broke insider trading rules to make – not earn – even more money.  In government, members of Congress have known for a long time that this nation’s slide deeper into debt – with more than $53 trillion in unfunded liabilities – would one day spark an economic crisis unlike anything this nation has ever experienced. But for years, no one spoke with any conviction about making material reductions in spending. Both political parties were more focused on the next election cycle, not in coming to grips with this very dangerous addiction to deficit spending. It was easier, and more convenient the dire consequences notwithstanding, to simply kick the can down the street.

The chickens have come home to roost.  Next year, every penny of what U.S. residents pay in taxes – those 55 percent who actually pay anything at all – will go to fund entitlement programs and the interest on the debt.  The $1.65 trillion deficit spending for discretionary programs will simply be added to our long-term debt that is already $14,326.739.262.229 as of 1:55 AM GMT today.

No wonder our primary banker, China and several of the major fund managers, are nervous.  And you should be as well.

Now here is a bigger inconvenient truth: we are a population of enablers.  When fiscal responsibilities require that we give up a program, subsidy or benefit that impacts our lives – real or imagined– we are more likely to voice opposition with a wink of an eye or we chastise the politician who would dare cut a particular program that might be unpopular with their political base. We are enablers because while we drop phrases like “shared sacrifice” when we dish gossip at a cocktail party or church, sadly we no longer collectively understand the concept.

Over the next three to five years, many of these same politicians that we criticize today will be forced to make tough fiscal decisions that could save our nation, or send us into an irreversible not-so-slow, painful slide into the role of a debtor nation with the inevitable result that the U.S. will become a “second tier power”.  This is a very real possibility.

The key to our survival will be our ability to re-focus on those principles that made this nation great and support those political leaders who will do what is right with integrity, not necessarily what will endear them to their political base.  Finally we must be willing to passionately embrace shared sacrifice.

Forget about economic principles, the machinations of budgeting or government accounting.  Without our support of these three core principles, we will face a national financial calamity that will be more painful than anything we have known in modern history.  

© 2011 John Gregory Self

Seed Newsvine

Taking Stock of Your Brand

Our professional brand is defined in two ways:  The first is by the decisions we make, the actions we take and how we conduct ourselves. The second way is by how others perceive what we do, say or how we act.  

In today's rough and tumble "new normal" economy in healthcare, executives who ignore the importance of professional brand management do so at their own peril.  

In the coming months and years, CEOs and members of their senior leadership will be forced to make tough choices as payors place more pressure on health systems, hospitals and physicians to improve their performance in the crucial areas of quality, safety and satisfaction at the same time that Congress considers additional funding cuts because of the country's serious national debt crisis. These two events will produce some tough sledding for us all.

When I think of the worsening economic/reimbursement storm, and the impact it will have on executives in far too many healthcare organizations, the title of Marshall Goldsmith's wonderfully instructive book comes to mind:  "What Got You Here, Won't Get You There."

The first step for a CEO or other senior leaders is to take stock of their current professional brand.  Begin by talking to your Personal Assistant.  Not only do they interact with you as much -- or more -- than anyone else except your spouse, but they usually are good listeners to the organization's informal news channels.  They are a treasure trove of information, both good and bad, regarding how you are perceived. (A cautionary note: if you are a CEO with a reputation as someone who hates to hear the truth, then do not expect much honesty from your colleagues. Reach out for a professional coach who can help you get a handle on this very important issue. There are some outstanding people in the field who can help you sort this out as well as plot a successful branding strategy going forward.)

An important hint: while you can get away with this kind of candid conversation with your PA without much advance warning -- she is probably used to it -- develop a plan for talking with members of your senior leadership team.  Be mindful that a sudden burst of self-reflection might ignite panic or a wave of rumor regarding your or THEIR future.  Take the time to explain what you are doing and why you are doing it.

If you truly want to succeed in developing a gold plated professional brand, do not immediately reject as misguided those criticisms that surprise or irritate you. It is infinitely easier to point out the problems with someone else's leadership style or performance than it is to take stock of our own areas for improvement. Dismissing that with which you disagree can be a big mistake.

This process can and probably will be uncomfortable.  When I get negative feedback about elements of a speech --an idea or construct that I particularly liked, it frustrates me.  Like many of you, I start looking for the push back button. I know that if I am going to move into the top tier as a professional speaker (FYI: I plan to keep my day job as an executive recruiter) I must be willing to examine the good, the bad and irritating critiques and force myself to rethink the issues in question.   

So must we all.  We can no longer take for granted the importance of our professional brand. We will all need a full reservoir of good will and support.

© 2011 John Gregory Self

Seed Newsvine

Don't Look Now, But...

 

POLITICO Breaking News
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WASHINGTON -- President Obama, House Speaker John Boehner and Senate Majority Leader Harry Reid didn't reach a deal on the budget after a Thursday afternoon meeting. Outside the White House, Reid told reporters that they would reconvene at 7 p.m. "We're going to continue to work to get this done," he said – or else face "the bad day tomorrow, which is the government shutdown."

JGS Comments:

While the national deficit continues to rise -- it  is $14.268 trillion as of this morning -- Congress remains deadlocked over about $7 billion in cuts -- an amount equivalent to what  the federal government spends in 17 hours.  

This is tantamount to arguing over a bar tab on the Titanic, says David Walker, a leading fiscal responsibility hawk who believes that our national deficit and debt crisis are much worse than advertised. You may remember him as the former Comptroller of the U.S. Public Accounts under President George W. Bush who appeared in 2007 on 60 Minutes to decry reckless government spending.  Four years later, Democrats and Republicans are nearly paralyzed by factions in their respective parties and an ongoing obsession with the next election cycle. 

Meanwhile, Congressman Paul Ryan's long awaited budget proposal is now on the record.  It is notable for what it includes -- entitlement reform.   Mr. Ryan's budget ideas will directly impact healthcare because his approach to reform assumes, in part, that we will markedly reduce our costs.

It is equally notable for what it does not address:  revenue and military spending. 

We enter this grave period in our history as a nation divided.  The only cuts in spending  that the majority of Americans agree on is foreign aid.  Too bad that accounts for only one percent of federal spending.

A cynical reading of those recent public opinion polls suggests that Mr. Ryan's proposal -- an honest effort worthy of public debate whether you agree with his ideas or not  -- will stir up the hornet's nest since America seems to be saying they want smaller government but do not touch Social Security, Medicare and defense spending. 

In addition to opposing cuts to the aforementioned programs, the voters  do not want any new taxes.  In other words, Americans want government services, they just do not want to pay for them.

This will really make our creditors happy.

If this rather sad disconnect with reality continues, and the bond markets lose confidence in this nation's ability to meet its financial obligations because of continued unchecked deficits, there will be dire consequences.  The bond markets who can, and will, impose their requirements for fiscal discipline,  will not care what the voters want or do not want.   They will not care what the healthcare industry says.   Our borrowing costs will soar and the U.S. will be left with no option but to comply with the demands of our" bankers".

How does that strike you?  The most powerful nation in the history of the world being bossed around by  China, which owns $1 trillion in U.S. debt, and other domestic and international bond funds who do not care what we think or want.  They will not care about the next election cycle -- who wins and who loses.

This is not a consequence for our next generation.  This is a crisis in the here and now.   Mr. Walker and others are warning that our debt smackdown could happen at any time -- when the people who hold U.S. debt give up on our government's abillity to solve this one very big, very threatening problem.  

If you like what is happening in Ireland, Greece and now Portugal, you will love this epic calamity in the making.  However, reaching a budget agreement before the government shutdown at midnight on Friday does nothing to solve our crushing debt problem. The larger debate will be game changing for the healthcare industry.

 

© 2011 John Gregory Self

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Can Bad Behavior Be Acceptable Behavior?

Should a business hire an executive with an impressive record of accomplishment in improving operations and financial performance who is "high profile, charismatic  and dynamic"  even though reference reports suggest that he  has a temper and that his personal assistants (PA) find him impossible: he had plowed through more than a dozen PA's in two years?  Do the positives outweigh his negatives?

That was the question posed in a recent "Dear Lucy" column in the Financial Times, the globally focused daily business newspaper based in London.

Lucy's example implied that the company in question was a public corporation, prompting one reader to respond that yes, the company should hire him since the executive "...has hit all the right numbers.  No PA (personal assistant) will be able to do that for you. Numbers speak for themselves." The reader continued, "If he was truly an unreasonable bully then he wouldn't have been able to achieve what he has."  The reader concluded that the real problem was with the employment agency who clearly was not providing good PA candidates.

Another reader wrote, "If Napoleon, Montgomery or Churchill had been judged by their abilities to control their tempers, they would have never become leaders."  This reader's suggestion:  "If he is good, hire him and hire an ex-Marine or ex-professional rugby player as a PA."  Another reader commented that while the board should hire that executive, they should tie his financial performance to his PA turnover rate.

While reader comments were surprisingly evenly divided as to whether the board should hire or pass on the candidate, Lucy offered what I thought was a unique perspective, one that the whole of the healthcare industry should take to heart. If the executive was running a hedge fund, making vast amounts of money for his investors and himself, while making sizeable donations to a wide array of charities with his personal profits, then his mammoth temper tantrums might be "just about OK" given the line of work he was in. "The world would have been a poorer place had his beastly PA habit barred his advance."

But Lucy draws a line in hiring a volatile leader for other types of businesses.  "If your company makes ball bearings or sells groceries, I wouldn't even consider him.  The job of a chief executive isn't just to be dynamic, and charismatic and high profile.  It is to set the tone in the organization.  It is to recruit the right people and make them stay."  She concludes that when there is a revolving door in the PA's office, it is clear that the CEO has no idea how to begin to set the right tone for the enterprise.  I agree.

As financial pressures on healthcare organizations mount, and as some hospitals plunge into a dark abyss requiring an extraordinary executive to lead a rescue, boards must exercise great caution in vetting the performance of the CEO they choose. They must pay particular attention to the candidate's reputation and leadership style.

While CEO bullies have succeeded in the past, we are entering a new era in healthcare, an era that will be characterized by changes in traditional relationships, financial incentives, and serious challenges that will be exacerbated by anticipated sharply lower rates of reimbursement.  This important shift requires a new type of executive with a leadership style that can bring sustainable change.

When a hospital is in trouble and its future is in the balance, it is tempting to hire the toughest turnaround leader available, regardless of their personality and/or reported prior bad behavior.  Health systems need leaders with a healthy attitude to achieve sustainable success.  That is something yelling bullies cannot do.   

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My post on Tuesday -- the third in a series of articles -- will focus on techniques for executives who have yet to master the fundamentals of professional networking. \

Have a great weekend. I am off to the weekend home where I will attempt to achieve life balance:  completing the "honey dos", getting caught on work, and R&R.

© 2011 John Gregory Self

Seed Newsvine

Very Bad Polling Data on Spending Cuts

New polls concerning the voter's diminishing appetite for making the hard choices to curb deficit spending and pay down the debt are not encouraging.  In fact, they are scary. 

Take this report from Politico in Monday morning's news brief:  "Govs face budget blowback"   Alexander Burns reports on the findings of  several polls.

"It was supposed to be one of the clearest messages of the 2010 elections: Voters were finally fed up with government spending.

"It felt like the usual rules had changed, and that Americans were worried enough about the size of  government to support a new era of belt-tightening. They wanted leaders to make the tough choices – and would stick by the ones who did.

"Now, a new wave of polling has challenged that consensus, raising serious questions about whether voters really are yearning for a grown-up conversation about the cost of government — or would simply rather keep punting the problem down the road, just like in the past.

"Almost every governor who’s tried to deliver a take-your-medicine message has paid a price. And widespread polling data suggests a chasm between what Americans say they want and the price they’re prepared to pay to get there."

Read more: http://www.politico.com/news/stories/0311/52002.html#ixzz1HtvS2XSW

These latest polls reaffirm what some political observers have believed for a long time -- that Americans want big government service, they just not want to pay for it.

This is indeed a very bad sign for the healthcare industry.

Congress, badly divided on the depth and scope of spending cuts with both political parties dancing around the possibility of another government shutdown, could very well fold their cards -- yet again -- without producing a meaningful solution to this growing crisis. 

This is not the time for healthcare leaders to sit on the sideline.

The LAST THING healthcare providers should want is for the bond markets to impose fiscal discipline on us.  Given that Medicare is the single biggest driver of the deficit, we probably will face devastating consequences. We will be much better off if we force Congress to address this matter, even if it is the adoption of the  deficit reduction strategy set out in the report from the  bi-partisan National Commission on Fiscal Responsibility and Reform.   This plan would probably placate the bond markets who are becoming increasingly restive with our bi-partisan lack of fiscal discipline.  If Congress fails to raise the deficit limit, given the hard-line approach of many of the Tea Party members, all bets are off. It is possible that could trigger a market response akin to the austerity measures forced on Greece.

Whether a massive health system, a thriving community hospital, physician group practice or a small business like JohnGSelf Associates, we all have a major stake in what happens in Washington over the next several weeks.

 

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Businesses Oppose Repeal of Healthcare Reform: Poll

Depending on your source of news and information, you either believe that the Patient Protection and Affordable Care Act (PPACA) is destined for repeal or almost  certainly will be overturned by the Supreme Court, or that this hallmark legislation was a much needed, albeit imperfect, first step in helping improve healthcare delivery in the nation.

Regrettably, the news reporting and opinion “analysis” fail to provide a full picture.  We tend to listen to what we agree with – when we have a choice. At the core, I am really no different, but as a former reporter, I tend to visit the other side.  I rather enjoy pushing myself out of my safe zone.  Safe can produce amazing mediocrity and more often than not I am pleasantly surprised with what I find -- at times, new facts or a different perspective that helps shape my point of view.

There is one survey that you may find surprising if you are pro-business conservative:  Only three percent of business leaders surveyed by the HR Policy Association favored repeal of the PPACA.  The HR Policy Association consists of over 300 of the largest corporations doing business in the United States and globally. Collectively, their members employ more than 20 million employees worldwide and have a market capitalization of more than $7.5 trillion.

Writing in Human Resource Executive, Jared Shelly, benefits columnist for that publication, reported that businesses did offer several suggestions on how to make the bill better:

• Remove the 1099 reporting requirement for vendors paid more than $600 or more.  They argue that large businesses could be forced to issue millions of 1099s each year. 
• Create limiting stipulations for PPACA’s provisions for coverage of children on their parent’s benefit plan up to the age of 26, excluding those who get coverage from their own employer or those who are married.  Businesses feel this provision will increase their health benefit costs.
• Move away from the hospital/physician fee-for-service model, a system that fuels dysfunction.  “There is a lot of care that isn’t needed and can be downright harmful,” said Helen Darling, President of the Washington-based National Business Group on Health. “We are paying for services whether they are needed or not, whether they are effective or not.  It’s a mess," she told Mr. Shelly.

It is a fool’s errand to make firm predictions regarding what Congress and the Supreme Court will or will not do.  Unless there is a major shift in political power or the Supreme Court rules that the use of the commercial clause of the Constitution to support mandates for insurance purchase is unconstitutional, PPACA, while not perfect, is apparently better in the eyes of business than doing nothing.

© 2011 John Gregory Self

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Talent Academy Summit Focuses on Critical Issues for Healthcare HR Professionals

As the nation’s overwhelming debt crisis looms, and as the immediacy of healthcare reform’s reimbursement reductions come into focus, healthcare human resource executives are zeroing in on strategies to acquire and retain the best talent ahead of their competitors.  As they begin this battle for the best people, most understand that they will have to do more with less, no small feat when you consider the organization that captures the top talent will be the market winner.

Meeting in a talent management summit this week in Houston sponsored by Talent Management Academy, participants from San Diego to New York and Boston listened to presentations on a wide range of issues -- healthcare reform; the potential for a cataclysmic debt crisis that will force dramatic reductions in Medicare; recruiting; and  leadership development and the need for retaining the best talent. 

 Here are some important takeaways:

• Healthcare reform and the potential for a debt crisis that could severely cripple Medicare reimbursement rates making hiring and retaining top talent – now more than ever -- a strategic imperative
• More non-executive hiring is moving to cloud recruiting
• In-house recruitment databases that include features for automated candidate messaging and options that empower qualified candidates to schedule convenient interview times rather play telephone tag with a recruiter, are gaining traction
• Tracking top performing employees who leave the organization through an “alumni” web portal in the hopes they will achieve “boomerang” status – return to the fold – is but one strategy that some leading healthcare systems are implementing to enhance their talent brand and to double down on their commitment to recruit and retain the best possible people.  Consulting firms and non health-care corporations have been doing these things like this for years.  For hospitals and other service delivery providers, this strategy will be a talent management imperative
• Recruiting support firms are incorporating these types of connectivity features, integrating with comprehensive employee communications and onboarding programs

In a time when healthcare executives are fiercely scrutinizing costs in anticipation of severe reductions in payments from the government, this type of expensive investment seems counter-intuitive, but nothing could be further from the truth.  Many leaders in the field believe the longer that hospitals delay in developing best-in-class onboarding, recruiting and retention programs, the bigger disadvantage they will face in the area where it counts the most:  Finding and keeping the best, from the most highly skilled clinicians to the people who cook the food and clean the building.

© 2011 John Gregory Self

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