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

A Memory or A Legacy: What Kind of Leader Are You?

There are essentially two types of healthcare leaders.  Those who leave behind memories and those who build a legacy. 

Memories – good and bad – fade from consciousness.  Legacies are forever.  They are not formed by good executives.  They are built by dynamic leaders who are not afraid to take risks with big, transformational ideas.

Great leaders are like works of art.  They build a solid, patient/customer focused culture that is the organization’s heart and soul.  They develop centers of clinical and wellness excellence that are an integral part of the communities they serve.

Bad leaders – who are tragedies – leave behind second-class, dangerous hospitals, or abandoned buildings or, worse yet, a vacant lot where a hospital once stood. (Think Pittsburgh.)

A savvy Chief Executive, who engineered a stunningly successful turnaround of a New York hospital, once said that hospital boards and their CEOs lose money because they choose to.  Yes, they have a myriad of reasons/explanations why they lose, but more often than not those explanations amount to little more than lame excuses, he reasoned.  In the end, it was a matter of choice and the legacy they will leave behind – an inability to make the hard choices or to successfully execute -- that will be a tragedy for their communities

This nation’s hospital CEOs have one of the hardest jobs in all of business.  They run complex businesses that are highly regulated under the silly guise of being a free-market business model.  They have long struggled to balance reimbursement with the rising costs of doing business.  Now it is going to get tougher as Congress, whether its members want to or not, moves to reduce federal spending, which means that the reimbursement we receive from Medicare today is the most we will ever see in our lifetime.  But all is not lost.

As I travel around the country, I periodically lecture to healthcare management graduate students.  This new generation of future healthcare leaders is one of the best.  They "get" the grave challenges and the extent of the nation’s financial crisis, but they are eager to build a lasting legacy – with a radically transformed healthcare business model. 

They are works of art waiting in the wings.

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 the blog will be on the web page.

© 2011 John Gregory Self

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

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

Seed Newsvine

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

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

Seed Newsvine

4 Questions Physician Candidates Should Ask Recruiters

There are four critical questions I believe that physicians should ask before submitting to the wooing calls of a recruiter.

I need to disclose that I began my search career recruiting physicians. Secondly, while I no longer recruit physicians strictly for clinical practice, I am involved in recruiting physicians for C-Suite and executive leadership positions. 

The American College of Physician Executives' LINKEDIN site is currently featuring an interesting discussion on this very subject.  I made some comments there but I wanted to bring them across to my blog for your review and comment.  If you are a LINKEDIN member I urge to visit this page.

Physicians can quickly and effectively "qualify" the recruiter and the opportunity by asking these questions. 

1.  Is the recruiter working on an exclusive, retained basis or with a non-exclusive contingency contract?  

Be wary of the non-exclusive agreements. Success in the latter case comes by submitting as many "qualified" candidates as possible, as quickly as possible. In this scenario, it is primarily a metrics game -- if a recruiter submits more candidates before their competitor, they will have a better percentage of closing the deal.  With this approach the physician's interest typically becomes secondary. It is about the commission and recruiters working in this environment, and in a few of the big "mill" retained firms, are pressured to close deals. 

 2.  What type of placement guarantee is the recruiter offering the client?

As a candidate, this is one of the most important questions you can ask.  Why?  No placement guarantee, or anything less than a 1-2 year guarantee, means they do not have much skin in the game, except their reputation.  Research suggests that most physicians stay at least a year so equal or less time is not much of a guarantee. Physicians should care because the more risk the recruiter has, the more concerned he or she will be in ensuring the "fit" is right and that the physician candidates have a complete and accurate understanding of the opportunity. In other words, alignment of interests.

3.  Are you getting full disclosure?  

Every organization, from Mayo and the Cleveland Clinic to a multi-specialty clinic in rural Alabama, has issues that they would rather physicians not know about before they sign. I refer to this as the "good, the bad and the ugly." One clinic did not like to disclose their turnover rate -- it seems their attractive comp plan was attractive on paper, not in practice. The recruiter, who had a 6-month placement guarantee -- which is to say no guarantee -- was practicing the search equivalent of "don't ask, don't tell." In one year, 6 physicians left the practice. Their turnover was 50% at 24 months, according to the CEO of the neighboring hospital who quit providing income guarantees until the parnters in the practice agreed to full disclosure of their good, bad and ugly issues. 

4.  Is the recruiter going to send you written information disclosing all the essential elements of the practice -- salary, benefits, and the good, the bad and the ugly?

If they can't or won't, run, do not walk, away. 

Some recruiters will argue this is an unrealistic model. I would argue that is exactly why this segment of the recruiting industry "enjoys" so much criticism.

Physicians, who were once at the top of the healthcare food chain in terms of earnings and importance when I began my career in the mid-1970s, should not be treated less appropriately in the recruiting process than other healthcare executives. But that is exactly what is happening in far too many cases day in and day out.

© 2011 John Gregory Self

Seed Newsvine

The Gospel of Service and Excellence

With all the pressures on a CEO, it is tempting to think that a consulting package can solve problems that essentially begin and end with people. Employees and physicians look to the boss.  If he or she is not walking the talk, it hits the informal employee news wire, spreads through the organization -- that the latest service initiative is nothing more than the latest customer initiative -- and the program fails.  The best approach I have seen is what I call the Gospel of Service and Excellence.  

Every day, the CEO talks about it and lives it. 

That is why verbal communications skills and leadership presence are shooting to the top of our chart of CEO critical competencies.  If you cannot personally communicate the value and importance of change, you cannot lead change.

On Sunday I am speaking to the national meeting of radiology/imaging professionals at the massive Gaylord convention center near DFW International Airport.  My focus will be on Employee Empowerment: A Strategic Imperative. I have spent a lot of time talking to hospital CEOs and other leaders who are on the cutting edge -- not necessarily in the spotlight -- for improving quality care and and building an environment of safety for the patients.  

Here is what I have learned:

1. Excellence in service and top patient satisfaction scores must go hand in hand but currently that is not necessarily the case even with some of the perennial industry leaders.

2. Landing on the Top 100 or the Top 50 lists is great PR but how are your HCAHPS scores? It is importnt to focus on processes and techniques in improving patient care and safety, but in your zeal to improve, do not forget the patient and their family.   

3. The unsung heroes, those CEOs who understand that improving quality and safety is much more important than securing a top ranking by some national magazine or consulting service, are more often than not those who use the Gospel of Service and Excellence technique.  Not a day goes by that they are not walking the halls, visiting with employees, physicians and patients, preaching the importance of adhering to best practices.  Yes, they invest in technology to measure and track performance.  Yes, they draw on outside expertise from time to time to get a fresh set of eyes for performance improvement opportunities.  But the CEO does the heavy lifting of driving the change, not a coach or team of consultants. He is walking the talk and asking for input at all levels.

© 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

Quality and Safety: The Secret Ingredient for Success

I have had the pleasure of working with some great health system and hospital clients that have achieved national recognition for achieving meaningful and sustainable improvements in quality of care and patient safety.  These are not manufactured results for some national magazine survey or billboard campaign.  Their quality scorecards, based on national standards, are impressive.

Do you know what characteristic is evident in each of these star organizations?  A CEO with a laser-like focus who is passionate about quality and safety, a leader who is willing to stake his/her personal and professional reputation on achieving and sustaining excellence on these two deliverables, and every employee in the organization knows it.

A colleague, someone I personally admire and respect, works for a health system that is struggling with quality. The employees know it.  They all talk about it – outside of earshot of the patients, of course. He is seeking another job, determined never again to work for a CEO who does not put quality and safety ahead of all else, including his social calendar or vacation schedule. 

All this talking in my friend's current organization has led to some amazing excuses and, sadly, inaction.  The leadership team just can’t seem to overcome their inertia on this critical subject.  Intellectually they want to do something but they cannot seem to see a clear pathway.  Their excuses run the gamut – take your pick from the usual suspects: poor leadership by the CEO; doctors who have grown complacent or more focused on financial returns than their patients; overworked nurses; the nasty, socially reprehensible financial costs associated with frivolous malpractice claims.

 We all know that there are causes for poor quality -- it is not always simply the physician or a nurse -- but many organizations adopt what I call “non-blame solutions.”  They spend a great deal of money on quality improvement in search of an easy answer where none exists instead of focusing on creating a culture of quality care that is real, and holds people accountable for improving the situation. 

All of this rationalization aside, I have come to believe that hospitals that suffer from continuing poor quality of care and patient safety do so because they choose to.  They could do something about the problem but they don’t.  What a damning statement, but the truth is that if you strip away all the excuses, the leaders and the physicians just cannot make the hard choices, ruffle feathers.  They say they do, because that is what people say who recognize that certain behaviors or outcomes or bad but lack the will or ability to drive change.

Sometimes it is just easier to do nothing or, worse, go through the motions – including meetings upon meetings, the engagement of consultants, the development of process improvement plans, and the investment in elaborate programs for collecting and plotting data.  The painful truth is that if the leadership team lacks the passion to fix the problem, if they are unwilling to stake their personal and career reputations on solving the situation, then most of what they say, the efforts they make, and the money they spend on equality improvement, is just the equivalent rearranging the deck chairs on the Titanic.

© 2011 John Gregory Self

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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

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

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

Now We Move to the Main Event: Serious Spending Reductions

 

By DAVID ROGERS | 4/8/11 8:32 PM EDT Updated: 4/9/11 9:49 AM EDT

The bottom line to Friday night’s spending deal is a record $40 (sic) billion cut in domestic and foreign aid appropriations – and a hard lesson in the tough and almost permanent disorder of Washington’s budget politics.

Read more: http://www.politico.com/news/stories/0411/52836.html#ixzz1J2CXmcaG

Impressive -- Republicans and Democrats actually agreed to the largest cut in spending in U.S. history. However, sadly, there is a staggering counterpoint to this moment of accomplishment and political credit taking:

 

We experienced weeks of high drama and threats of a government shutdown over spending cuts that are equivalent to about nine days of budget deficit neutral spending.  Yes, our deficit increases on average about $4.08 billion each day.  That is how big, that is how bad, our deficit crisis has become.

Now, we move on to the real battle -- serious reductions in spending in a way that hopefully will not wreck the fragile economic recovery and severely cripple the healthcare delivery industry. 

Rep. Paul Ryan, Chair of the House Budget Committee, has defined this debate with the submission of his budget proposal.  As I have written in the past, you may not agree with Mr. Ryan's budget plan -- Paul Krugman, Princeton's Nobel Laureate in economics and New York Times columnist certainly does not -- but he at least has had the political courage to acknowledge the problem and to propose a correction.

 

As healthcare leaders, we must now focus on this problem because it is not healthcare reform that will change or wreck our lives as we know them today, but the deficit crisis and the fact that Medicare spending will be the biggest issue in this seminal debate over our country's future.

Consider this:  two 56-year-olds with average earnings will pay $140,000 in dedicated Medicare taxes over their lifetimes.  They will receive $430,000 in benefits,  conservative columnist David Brooks wrote in the Friday New York Times.  It is not important whether you agree with Mr. Ryan's approach, the math simply does not work, and that leaves us with only one course of action: we must reform this entitlement program in a way that we cure this acturial imbalance.

I do not have the answers, but I do believe that healthcare leaders -- physicians, hospital executives and insurers -- can craft a solution that will work far better than anything that comes from Congress, which took weeks of high drama just to agree on cuts that will yield only nine days of deficit neutral spending over the next six months.

This was, as Politco reported, "a hard lesson in the tough and almost permanent disorder of Washington’s budget politics."

© 2011 John Gregory Self

Seed Newsvine

Don't Look Now, But...

 

POLITICO Breaking News
-------------------------------------------------

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

Seed Newsvine

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.

 

Seed Newsvine

BLOG SPECIAL: THE IDITAROD - A Unique, Grueling Alaska Experience

ANCHORAGE.   I am in Anchorage advising a client in connection with a senior executive placement.  It was my good luck to arrive in time to witness the ceremonial start of the 39th Iditarod -- the last great race on earth -- in downtown Anchorage.

Saturday's festivities, attended by thousands in one big tailgate party and winter carnival, was an exciting, and very cold build up, to the real race which began Sunday in Willow, AK.

"Today is a winter festival," an announcer boomed over the public address system. "Tomorrow begins a big old sweaty dog race." 

Sixty-three contestants -- Mushers and their dog teams -- will endure grueling conditions for the next 10 to 17 days over a more than 1,000 mile course to Nome through regions of this vast state that only dog sled teams go.  Even with GPS technology on each sled, Mushers face daunting challenges, including getting lost in nasty snow storms. This sport is not for the faint of heart or  weak of body and spirit.  Racers will experience bitter cold, brutal headwinds, and hallucinations resulting from loss of sleep. Truth is that the Mushers will take better care of their dogs than themselves during this 10+ days of the race. Before the race the dogs, which are bred to run and get stronger as the race progresses, are thoroughly evaluated by veterinarians.  That does not stop critics from labeling this event as animal cruelty.  

At race time on a cloudless Saturday morning, the temperature was about 2 degrees in downtown. I won't kid you, I was cold. Really cold. But judging by the elbow-to-elbow crowds in the bars, coffee houses and restaurants, I wasn't the only one who needed a break to warm up.

For me, this was a fascinating experience and an opportunity to learn more about this unique state.  Here are some race facts about this race and dog sledding that I found interesting:

• Iditarod is a ghost town that is located on the southern course. Each year the race alternates between the longer northern course and the southern route which is known for its bitter headwinds. This year the race is using the southern course.
  
• This year's entrants include Mushers from Stonehaven, Scotland; Aukland, New Zealand; St. Anne, Jamaica; a funeral director known as the "Mushing Mortician" from Anchorage; and a 62-year-old physician from Chattanooga, TN.
• There are 11 women in this year's field of entrants.  The first woman to win was Libby Riddles in 1985.  Susan Butcher, perhaps the best known woman to win the race, won her first time in 1986 and was the first racer to win four out of five sequential years. She is the second four-time winner. Ms. Butcher died of a virulent form of Leukemia in 2003. 
• DeeDee Jonrow, a fan favorite and breast cancer survivor, entered the 2003 Iditarod, three weeks after completing chemotherapy. A 27-race veteran, this native of Frankfurt, Germany has not been out of the top 25 since 1984.  In her 27 races, she has won more than $472,128.
• The ceremonial route is 11-miles long.  Because there has been no recent snow, and given the city's excellent snow removal program, snow that was stockpiled for weeks, is brought in to create a manicured course. Mushers invite friends to ride with them in the sled for the Saturday run, or they tow another sled, to add weight to keep the dogs for going too fast.
  
• Each Musher is required to carry the following equipment in the actual race: An ax with a handle at least 22 inches long, snowshoes, promotional materials provided by the race committee (yeah, believe it or not), eight booties for each dog on the team, cooker and pot capable of boiling at least three gallons of water at one time, veterinarian notebooks that are reviewed by a veterinarian at each checkpoint, fuel and a cable gang line capable of securing a dog team.
• A 1925 Diphtheria epidemic in Nome was ravaging children.  A train delivered the needed serum to the town of Neema, the end of the rail line.  Dog sledding teams carried the drug the last 674 miles in 24-hour shifts. Thousands of lives were saved, and dog sledding earned an important part of this state's extraordinary history.
  

I have uploaded additional photographs on my Facebook page.  http://on.fb.me/hy19hN

 © 2011 John Gregory Self

Seed Newsvine

That Other Potential Calamity for Healthcare

When some public policy calamity strikes, people tremble with fear or anger and they cry out:  "Why didn't someone warn us?  Why didn't someone tell us that there were bad consequences?  We do not want this pain!"

That is a reasonable request, especially for healthcare leaders who are already facing unprecedented challenges that threaten to dramatically change the way we do business. In responding, let me borrow a quote from Mike Moncrief, Fort Worth's mayor and a former county judge, who once said about a major change in EMS service for his community, "The train is on the tracks.  You are either on the train or on the tracks."

Now, which train are we talking about -- the Patient Protection and Affordable Care Act (PPACA) -- the so-called Obamacare plan -- or something far more sinister.  The answer to that question is easy:  something far more sinister. It is the fat, smelly elephant in the room that no one wants to look at, much less talk about: the skyrocketing and soon-to-be catastrophic debt crisis.  Healthcare executives -- it is time to step up to the leadership plate to prepare to deal with this very real possibility.

I try to stay away from politics in this space, but this issue is too important for me not to comment.  Hopefully, you will agree that this is truly a bipartisan train wreck.  The proposed GOP  House plan, which many know will probably never see the light of day, is more about ideology and a political principle than good policy.  Their proposed $61 billion in budget cuts comes from about 12 percent of the annual budget that is known as discretionary spending.  While $61 billion is serious money, and many in the GOP would argue that it represents a good start, it is woefully inadequate given the size of the deficit and our long-term debt.  In other words, this approach, without commitments to a sustainable policy of reduced spending over the long term will not keep the bond vigilantes away from our door. You simply cannot balance the budget by reducing discretionary spending.

The Democratic position is equally ludicrous.  Democratic defenders argue that the White House's initial plan was only a starting point for prolonged negotiations to craft a meaningful spending plan.  That line of defense of the President's approach is akin to a timid man whistling while passing a graveyard. You knew we were in trouble from a leadership perspective when the President said that he and the Republicans had "to step in the boat at the same time."  If a hospital CEO tried that approach with his medical staff when it came to a critically tough decision, there would be blood on the floor.

If the bond market decides that the U.S. is unable or unwilling to come to grips with the deficit and debt crisis, the consequences will be "abrupt, swift and painful beyond our wildest projections," argues David Walker, former Comptroller of the U.S. Public Accounts under George W. Bush.  Recently, while serving as a guest host on CNBC's Squawk Box morning show, he predicted that the crisis, now challenging debtor nations in the Euro zone, will visit the U.S.  shores within the next three to five years, if not sooner.  When it occurs, he posits, and it could happen at any time, the U.S. government's ability to continue borrowing, and refinancing existing debt, will become so expensive -- assuming anyone will lend to us at all -- that it will wreck our way of life as we know it today.

Healthcare providers will be at the nexus of this calamity. Regardless of what we say, the excuses we use and the promises we make, it will be too late.  Our economy, our industry will face an immediate restructuring, the type that is found only in the the most desperate of bankruptcies: It will be "abrupt, swift and painful beyond our wildest projections."

So why aren't we hearing more about this potential calamity from the healthcare trade press?  For the same reason that most futurists/after dinner speakers, and others who know better, are avoiding the subject.  Perhaps it is that we cannot imagine a system of care that is not like the one we have today, or perhaps it is simply that people will not pay good money for speeches who produce more heartburn than good feelings and laughs.   

This is a time when leadership must rise to the surface.  Leadership is not only about leading an organization for today, it also about the ability to anticipate how market and financial forces will shape its future, and to prepare the business to adapt.

© 2011 John Gregory Self

Seed Newsvine

What Would You Do?

So, here is the $64 million dollar question for hospital CEOs.  You learn that in the next 12 months the federal government is planning substantial cuts in Medicare reimbursement. Big cuts to balance the budget.  Moreover, CMS announces that all Medicare payments in 2012 will be tied directly to quality of care, patient safety, and customer satisfaction performance measures. Managed care payors announce that they will follow the government's lead. They, too, will join in the plan to bundle payments to providers, forcing immediate financial collaboration between physicians and hospitals.

This reflects a potentially devastating change for hospitals and physician practices, the perfect storm. This is the REAL sea change that consultants have been harping about for years.

To survive, hospital CEOs must take dramatic action including reducing costs by at least 7 to 10 percent below current Medicare rates. Quality of care -- using a variation of pay for performance formulas -- will be the key driver for all future payments. If hospitals do not measure up, they will get less, a lot less.

What will you do?   How will you restructure your organization?

This is no hypothetical scenario.  Today it may be just a fear, fodder for blogs, subject matter for futurists, and the inevitable journal articles about the doom and gloom future of healthcare.  But just around the corner, much sooner than later, it will be a reality.  

I have incredible confidence in the quality of U.S. healthcare leadership.  I know that, if challenged in this way, the vast majority of healthcare executives and physicians will respond in a dynamic and productive way. There is, in most executive suites, an untapped reservoir of extraordinary ideas and creativity that will lead to a new vision for the U.S. healthcare system.

However, most CEOs today are reluctant to advance these extraordinary ideas because we are an industry that is not comfortable with sudden change. Consequently we focus on what is safe in terms of strategy and innovation. But we are nearing that economic/reimbursement tipping point.

This is a subject worth thinking about.  What will you do?

© 2011 John Gregory Self

Seed Newsvine