As we race to the end of yet another year, I am taking some time off to rest and recharge, and to reflect on a very successful 2011.
This is a great time of year; we are enjoying the fruits of our hard work and our considerable success. I am using the time to plan for the next business year. The is particularly exciting for me because we bare making some changes that are designed to significantly enhance customer value while accelerating our growth.
I spent some time this week reviewing my blog archive. I ran across the following blog entry that I wrote a year ago about my father's values in business. It seems particularly relevant for 2012 and so I want to share it with you again:
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Working for my father during my teenage years in his highly successful retail bakery in Tyler, Tex., I learned some of life's important rules and key lessons of business. He died in 1989 but today he remains my True North.
Here are Lloyd Self’s Five Rules. He never wrote them down; he just lived them.
1. Do what is right, even when no one is looking .
2. The customer comes first. Honor that. It is not just a rule; it is who you are.
3. The customer is not always right. See rule #2.
4. Quality counts.
5. We all make mistakes. We all get tired. We all want to cut corners because of time or fatigue. When that happens, remember rules #1 and #2.
In more than 16 years of interviewing and watching CEOs and other senior executives as a partner in an executive search firm, I have added another very important rule.
6. Respect your employees as if they were your customers. You will get more for your money. Do not yell at, bully, or criticize your employees, especially in public. There is no room in any company for an abusive leader.
We should pause and reflect throughout the year and measure how we are doing against these "rules." If we do that, we will become a better leader.
Happy New Year to you and your family.
© 2011 John Gregory Self
Words have consequences in job interviews.
Over my 18 years in executive search, I have heard hundreds of candidates describe their leadership style as “consensual -- I build consensus.” When a candidate gave that as an answer to a query regarding their leadership style in my earliest years, I would nod my head, as if I really understood what that term meant.
I learned my lesson, fortunately not at the client's expense. Now, I ask, “What does that really mean?” The truth is, candidates use that line because it sounds so collegial, so non confrontational. Considered in rapid time, consensual leadership sounds like the first cousin of a “collaborative” style. They are not.
Adam Bryant’s Corner Office column in Sunday’s New York Times provided an excellent case in point.
Consensus “...sounds wonderful but it was a very, very difficult way to manage anything, because to convince everybody to do one particular thing, especially if it was hard, [is] almost mpossible,” said Geoffrey Canada, President and CEO of the Harlem Children’s Zone, a non-profit which has offered education, social-service and community building programs to children and families since 1970. “Convincing people to give your way a try will work if you neutralize -- and sometimes you have to cauterize -- the ones who are really against change. They’re the kind of person who, if you tell them it is raining outside, they will fight you tooth and nail. You take them outside in the rain and they will say, ‘But it wasn’t raining five seconds ago’. I spent a year a year trying to convince those people to change and give me a chance. Then I realized it was a wasted year.”
Consensus leadership is a sure way for healthcare executives to get bogged down at a critical time in our history. The challenges in healthcare are significant. Most executives, employees and physicians inellectually comprehend what will transpire over the next five to 10 years as the result of out-of-control deficits and the national debt and Medicare’s central role in fueling the fire. Major cuts will occur. Healthcare delivery as we know it today will forever change. Getting people to actually undertake the necessary change is another matter. We might be able to collaborate on finding alternative strategies, but we will NEVER experience a time when everyone agrees to this kind of gut-wrenching change. Those who fear and resist change may nod their heads in agreement -- giving the consensual leader a false sense of hope or security -- but when the first sting of change pain occurs, they will dig in their heals and resist mightily.
So, as a healthcare leader, if you think a consensus building leadership styler is the answer, that it will help you through these tough times, perhaps you might want to rethink that proposition, because many of our leadership styles and techniques that worked 20 years ago, will not work in this new healthcare economy.
© 2011 John Gregory Self
Random observations from a week’s worth of traveling across America:
Most business organizations profess a commitment to understanding and delivering first class service to their customers. This implies a level of service is more than just being polite, helpful or customer-centric.
Most companies that make these claims are guilty of misleading statements. First-class customer service is indeed rare.
Exceptional service on the sales floor, in the first-class cabin on a long fight, from your bank, or the most sophisticated medical center, can be undone -- the brand damaged -- by the small details that go unnoticed or executed without care. These seemingly insignificant miscues include:
Great service is more than doing the obvious things right. It is simply not a catchy advertising slogan or an employee customer experience improvement campaign. It is about getting the small, seemingly insignificant details of what we do, perfectly. It is about the thousand moments of truth that happen every day and every time -- at the end of the day, when shifts are changing, when workers are tired, when airline executives make a calculated financial decision not to serve meals because they can get away with it with a captive travelers with few choices, or when management is just not paying attention.
Great companies deliver exceptional service because it runs deep in their DNA, a passion to do the right thing for their customers, not just when it is convenient or they feel like it.
Sadly, truly great customer service is rare today because it is not in the DNA of most organizations When that is the case, we can only look to the CEO. Most things DNA within a company, most especially customer service, originates in the heart and the mind of the person at the top, not some expensive pre-packaged consulting product.
© 2011 John Gregory Self
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
© 2011 John Gregory Self
I have always believed that a good leader is a work of art, and that a bad leader is a tragedy -- for the organization and for the people with whom they interact.
There are far too many leaders who cannot see beyond their own office. They do not engage employees in a consistent and meaningful way. They offer any number of excuses for their lack of visibility and engagement, including that they do not feel "comfortable" communicating in that setting.
How senior executives interract with their teams -- their visibility and their ability to communicate the mission, vision and values of the organization in every-day conversation -- is an essential element in employee engagement.
At JohnGSelf Associates, we have an entire 45-minute block of questions in our comprehensive 3.5 hour face-to-face screening interview that zeroes in on this critical leadership issue. We believe that this competency is absolutely critical to the success of any organization.
When I tell people that our firm offers a three-year placement guarantee, my capable competitors ask how we can possibly make such an offer. They feel it is too risky. Actually, if you dig deep enough in the face-to-face candidate interview, there is virtually no risk. But it takes time and a great deal of research into relevant issues.
In 15 years, we have had only a small handful of candidates who did not work out in our C-suite and executive practice. Luck? Perhaps. Too risky? No. From my point of view, offering your clients a long placement guarantee is about taking ownership of what we do, recognizing the impact we can have on an organization and its employees if we do not get it right. Relying on video conference interviews to select which candidates to recommend to the client may save on the expense budget and make it easier for the recruiter, but it diminshes the quality of the screening and substantially elevates the risk of a miss-hire. I do not know one search firm that will offer their clients an extended placement guarantee when they cut corners.
I share this to encourage my colleagues in the search industry to look at what they are doing with their candidate screening process and seek meaningful ways to offer clients greater value.
As hospitals and physician practices experience significant reductions in funding and other disruptions that will surely occur as we navigate healthcare reform, executive recruiters and other consultants who work in this sector need to step up and own the the quality of the service we offer -- and the outcome.
© 2011 John Gregory Self
Why would you fire your chief executive officer over the telephone? Why would anyone want to work for a company that would treat its CEO so shabbily? Why would you do business with that company?
The sudden dismissal of Yahoo CEO Carol Bartz, reportedly an outspoken, combative, occasionally arrogant and sometimes profane executive, prompted me to think about how companies fire people, and the fact that how companies execute the termination can define an organization's corporate image and recruiting brand.
To be fair to the Yahoo board, Ms. Bartz was reportedly failing to meet performance expectations established by the Directors. There are many on Wall Street who argue that her termination was justified. Others say that her style made it inevitable. That said, the issue should be not the "why" but the "how."
There are reasons, justifications -- excuses -- as to why the board acted the way it did. Central among them was that Ms. Bartz was traveling and the board did not want word of their decision to leak before they had spoken to their CEO. Others speculate that she may have had a clause in her employment contract that required immediate notification of termination. Fine, those are important issues to consider. But here is another: if the intent was to rid the company of a leader who was failing in order to protect the interests of the brand and its shareholders, why would the board execute their plan of termination in a way that would cast a darker cloud over the already troubled company?
That Ms. Bartz fired off an email broadside to her employees explaining that she had been fired over the telephone should not have been a surprise to the board or its advisors. Nor should the resulting damage to the organization's image.
Boards frequently hire CEOs with fanfare for what they hope will be strong operating results, favorable press, and a strengthening of the corporate brand. They are almost always disappointed, frustrated, even angry when their best layed plans fall short. But there is no excuse for the board to make a bad situation worse with a poorly executed plan.
How an organization terminates employees says a lot about the real heart and soul of the company. Taking the high ground may not make the person or persons who have made the decision and who are notifying the employee feel less frustrated, but how they perform this important role will shape the image of the company.
Yahoo is not the lone offender in American business. Thousands of times each day, someone is fired for a myriad of reasons, from poor performance to unethical or inappropriate conduct. There may be reasons to immediately remove the employee from the workplace. There may be ample justification to have security personnel available. Even when companies try to terminate someone in the right way, things can go wrong. Fortunately these incidents are the exception.
But companies who do not take the high road, protecting the dignity of the outgoing employee including complimenting the employee for their accomplishments and wishing them well while keeping security out of the room and the prying eyes of their colleagues at bay, are being short-sighted.
Miss-hires, at whatever level, are a costly mistake, but to make the matter worse by ending the employment relationship badly simply multiplies the problem.
© 2011 John Gregory Self
Hiring “nice” is a great idea, especially when you combine that with a healthy dose of passion.
That is the approach Andy Lansing takes. A recovering lawyer, Mr. Lansing is President and Chief Executive Officer of Chicago-based Levy Restaurants, a food service company with a diverse portfolio of operations that includes award-winning restaurants such as James Beard-winning Spiaggia and Bistro 110 in Chicago, Fulton’s Crab House, Portobello and Wolfgang Puck Grand Café at Walt Disney World Resort, renowned sports and entertainment venues like Lambeau Field in Green Bay, STAPLES Center in Los Angeles, and American Airlines Arena in Miami, and events including the Super Bowl, World Series, Kentucky Derby, NHL and NBA All-Star Games and the Grammy Awards.
If healthcare is one of the most complex businesses in the world, then leading a company of restaurants and food service operations all across the country can be more than just a challenge, especially in tough economic times. Mr. Lansing says give him people who are nice and passionate and he can teach them everything they need to know, and everyone can have fun doing it.
In healthcare we take ourselves very seriously. It is deeply baked in our industry’s DNA – we do very serious work, from brain surgery to delivering babies or suturing a child’s cut. We hire people with the appropriate credentials, technical expertise, and experience.
Our choices for leadership reflect that industry DNA. Sometimes we hire more for credentials and supposed track record with almost no emphasis on the candidate’s personality or leadership style. Then we are shocked when there is a CEO meltdown and an expensive severance agreement.
Mr. Lansing argues that there are two kinds of leaders – those with positional power and those with personal power. He describes positional power this way: “I have power over you because I am your boss. I am important. I am the CEO. You should fear me because of who I am.”
Personal power, Mr. Lansing explains, “is what is inside you. It is how you treat people and how you lead.”
Mr. Lansing’s leadership philosophy is a model that some hospital CEOs should take to heart. Employees will always work harder, go the extra mile and care more about what they are doing for the capable CEO who knows how to treat people.
Over the next several years, healthcare will face unprecedented challenges – from reimbursement to more scrutiny on quality of care and patient safety. CEOs will need every advantage they can muster to thrive in this type of turbulent environment.
The “screamers,” the “barkers” and the abusive, tough-guy senior leaders who think their way is the best way should sit in the time out chair and learn some important lessons from a very smart CEO who is passionate about his company and who is also a nice person.
Source: New York Times, “A Deal-Breaker Question for Job Interviews," Sunday, Aug. 28, 2011
© 2011 John Gregory Self
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
Success of a brand-name customer service/satisfaction initiative is not based on which pricey program a healthcare organization buys, but the commitment, the passion and the skills of the Chief Executive Officer.
Healthcare organizations looking for the magic silver bullet, should understand that it does not exist.
Quint Studer was a very successful President of Baptist Hospital in Pensacola, Florida, not because of some template or costly consulting package. No, he succeeded because of his commitment, his drive and deep understanding of common sense leadership principles. There is nothing magical about his very popular approach, or of those promoted by his able competitors. They provide a solid framework for cultural transformation. But without a strong CEO, no army of cosultants can produce an environement that fosters clinical excellence, patient safety and exceptional patient satisfaction scores.
There is no substitute -- none whatsoever -- for a dynamic leader who can craft and communicate their vision, and who can successfully build a strong leadership TEAM that, day in and day out, delivers exceptional results.
If you need to believe that there is a silver bullet, then there it is -- hard work and personal involvement by the CEO.
© 2011 John Gregory Self
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
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
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
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
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
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
Dominoes Pizza has taught us an important marketing lesson and along the way given us a better product. Perhaps there is a message for the healthcare industry somewhere in this remarkable and successful turnaround.
Dominoes launched a nationwide television campaign 15 months ago that was more than just a little different. They began by admitting that their product was not that good. To add some historical context, it had not been good for a very long time. In the 1980s, working late at Hermann Affiliated Hospitals in Houston, we would frequently order a midnight pizza. The standing joke was that when the pizza was delivered in 30 minutes or less, you threw out the pizza and ate the box. It had more taste. It was no surprise that when the company asked what was wrong with their product consumers repeatedly said the crust tasted like cardboard. The negative feedback from customers was brutal. Their advertising campaign moved from pointing out that their product was not that good, to announcing they were making significant improvements to their crust, cheese and sauce. They began using better toppings, like real chicken, not a compressed version of various and questionable chicken parts. Then the company ran ads asking customers to tell them how they were doing.
Sales soared. This week Dominoes delivered another quarter of rising profits and revenues. The company’s stock price has risen more than 150 percent since the company launched this risky campaign. The public seems to like their candor and the product improvements. Moreover, the reservoir of goodwill that Dominoes is building will be invaluable as long as they do not forget these tough lessons learned.
Dominoes Pizza has proven that if you really want to stand out in the marketplace, you must be willing to take risks. Smart risks, but risks nonetheless. Harvard marketing professor Youngme Moon would agree. With the Dominoes success in mind, hospital CEOs should watch this video promoting her book "Different" and think about your organization and how coming reforms will force healthcare organizations to re-examine their model and how they position themselves.
Healthcare is facing some of the toughest economic and regulatory challenges in its relatively short history as an industry. From the planned and very visible reductions in reimbursement contained in the Patient Protection and Affordable Care Act as well as additional cuts that are in the pipeline but are currently not so visible, to the looming deficit and long-term debt crisis, we face a future that, in the most understated of words, will be transformational.
The professional lives of healthcare leaders and the environment in which they work will be radically different. They will be forced to change. Change, not adapt. It is going to be the type of transformational change that will require a reconstruction of the entire business model. This change will mark an end of the big box hospitals of staggering size with a maze of hallways and poor signage will have to give way to a strategic focus on population groups while operating smaller, cost efficient facilities. The new economic model will be based on keeping people out of hospitals and providers will be paid not for how much they do, but for the quality of care and outcomes they achieve as well as customer/patient satisfaction.
Over the next 20 years the hospital industry will need to move from the wholesale marketing model that focuses on physicians, their patients and their poor health, to a retail model where there is real competition and where success will be based solely on performance.
It is easy to be critical. Let's face it, hospital executives and industry thought leaders are in a tough bind. It is hard to lead change when you are constrained by an existing business structure that is hopelessly complex, from a patchwork of payment systems to federal, state and local regulations that limit the ability of mainstream hospitals and entrepreneurs from leading the transformation.
Given that hospital executives are, for a variety of good reasons and some that are not so good, loathe to publicly confess their problems as Dominoes did, they may miss a marketing opportunity to drive the real structural change that the costly and uneven healthcare provider segment needs.
The GOP budget plan to privatize Medicare may save the federal government a lot of money and temporarily drive the bond market vigilantes away from the front door, but it will not solve the bigger problem. You cannot target one group and one program like Medicare and not expect a massive political push back as well as political consequences.
This approach will fail not because it reflects a political calculation to shrink the size of government, but the politicians have no real broad strategy to change and improve healthcare in America. Their current effort amounts to fiddling around the margins. Meanwhile, as the political debate gathers steam, the American public believes, alternatively, that either we have the greatest “system” in the world or that it is too expensive with questionable quality and hurts the nation's ability to compete globally.
Why don’t we at least think about the Dominoes approach?
© 2011 John Gregory Self
I started a new book over the weekend -- James B. Stewart's "Tangled Webs -- How False Statements Are Undermining America."
Based on my early reading, and the author's recent interview on Charlie Rose, this is going to be a fascinating read with disturbing issues to consider. Perjury and making false statements to investigators is apparently so common -- epidemic levels -- that law enforcement and financial regulatory agencies rarely prosecute these cases without other charges.
Stewart is a former Wall Street Journal Page One Editor and reporter who won a Pulitzer in 1988 for his reporting on the stock market crash and insider trading. In this new work, he focuses on cases involving people at the top of their fields -- Martha Stewart, I. Lewis "Scooter" Libby, Barry Bonds and perhaps the most notorious liar in the history of the financial industry, Bernard Madoff.
These are interesting stories and that the subjects decided to lie when they did not have to -- with the exception of Mr. Madoff whose fraud was beyond comprehension -- is a disturbing commentary on American business. They were all rich, successful and well educated who were willing to cross the line and lie.
Why am I reading this book? Mr. Stewart, who went to law school, is an accomplished story teller and promised to answer questions that puzzled many:
In researching cases for the book, Mr. Stewart said there were numerous examples. He ruled out sexual scandals and divorce cases because they were among the most common. Apparently spouses trying to conceal wealth or other information from the prying eyes of matrimonial attorneys and judges, believe lying is perfectly acceptable.
That this common practice floods into business is something that should concern us all.
© 2011 John Gregory Self
Words matter. Actions fulfill the promise of those words. When a leader’s actions do not match his or her words, he/she is creating an environment that will compromise their achievements, damage their brand and, worse, limit the success of the enterprise.
At the core of what makes a talented executive a great leader is authenticity. When a leader is perceived to be anything less than authentic, the consequences can be far reaching.
In healthcare, that environment can trickle down – actually it cascades – to such deeply important issues as quality of care, patient safety and customer satisfaction.
Why would anyone want to be admitted to a hospital where the work environment is dysfunctional, where the leader is seen in less than favorable terms – an executive fraught with inconsistency, yearning to be liked at the expense of respect, a shouter, an abuser or a bully?
These characteristics may be the extreme, but it is surprising how little it takes for the culture of the leadership to reach an unhealthy tipping point. In challenging times, with financial, regulatory, and competitive pressures accelerating at breath-taking speeds, CEOs must be mindful of not only many complex issues and relationships, they must also ensure that their authenticity gauge is working correctly.
© 2011 John Gregory Self
I have just finalized my lecture on leadership and career management for the Health Management and Policy graduate students at the University of Michigan School of Public Health in Ann Arbor. I enjoy speaking to students because it allows me a chance to stay connected with emerging trends and a robust source for new ideas. In other words, I learn as much from them as, hopefully, they learn from me.
One very positive trend is that this generation -- the Millennials -- seems less focused on consumption than their elders. That is a good thing since they are the generation that must deal with the very serious consequences of more than 40 years of excessive government and consumer spending, much of it financed with mountains of debt. While consumer spending has slowed, the federal government continues to spend more than it takes in. The national debt as of 1:30 PM GMT on Tuesday, Feb. 15 is $14,097,682,614,097, or $45,471 for each U.S. citizen. The bad news is that since Feb 28, 2007 the national debt has been increasing by $4.12 billion per day.
In 2010, 68 percent of our debt was financed by foreign sources. They are warning us that they are increasingly frustrated with our inability or unwillingness to tackle this debt problem. At the current pace, in 10 short years, the interest on the national debt will be $1 trillion a year. Coincidentally, that is equal to the amount of our national debt held by the Chinese government.
A trillion dollars is a big number. David Cote, Chairman and Chief Executive Officer of Honeywell and a member of the President's bi-partisan deficit reduction commission, has provided us with the best illustration of how stunningly large this number really is. This is a must watch Video. (When you arrive at the page, scroll down to start the video.)
If that explanation doesn't take your breath away, you are either already dead or just beyond help.
In my youth, my father’s ultimate punishment for not doing well in school or for not following the house rules was to ask for my car keys until he felt I had learned my lesson. Frankly, I am surprised (shocked) that the Millennials haven't collectively and figuritively asked us to surrender the car keys.
What does the debt crisis have to do with my lecture to the graduate students of this great University? Plenty. The financial mess that they must clean up means that their lives -- and their careers -- will be markedly different than those of their parents and grandparents. For these future healthcare executives, it means that the industry they are preparing to enter today will be substantially different within 10 short years because the current trajectory for federal spending, if not substantially reduced, will create a sovereign debt crisis the likes of which will dwarf the current problems in the Euro zone -- Greece, Ireland and Portugal. That will trigger catastrophic consequences for this nation and its expensive healthcare delivery system, most economists agree.
So these students of today will be forced to deal with dramatic change, and more than their fair share of gut-wrenching decisions. Managing their careers will be more challenging than for any generation over the last 50 years. The rules of personal brand management, job searching, resumes and interviewing will change.
The pressures on future leaders to perform -- reduce costs and improve quality, safety and service -- will be more intense than at any time in our industry's history.
To make matters worse for these future hospital executives, many medical schools seem oblivious to the need to immediately change the way they educate the physicians of tomorrow. Without this change the sometimes nasty conflicts between hospitals and physicians that occurred when hospitals converted to the DRG payment system and the physicians did not, will seem like child's play. But then that is whole other story.
Another positive trend is that my experience/interactions with the Millennials suggests that they are bright, responsible and most are keenly aware of the challenges they face ahead. I am betting they will do what my generation failed to do -- make tough choices, act responsibly and deliver safer, better healthcare at a lower cost.
What are your thoughts?
© 2011 John Gregory Self
Hospital executives across America are warily eying the new Congress which will take over the first week in January.
The House of Representatives is now solidly in GOP control and its members are decidedly more conservative and adamant that the size of government be reduced, that annual budget deficits be eliminated, and that future spending policies be geared to reducing the national debt. That could spell big trouble for hospitals, physicians and other providers since deficit reduction/elimination will require spending cuts, probably including further reductions in Medicare reimbursements.
This nation's drive toward fiscal responsibility will be tumultuous. As a nation, shared sacrifice and common good are no longer high on the list of admirable American values. We are also a nation of well-financed special interests which means there will be great temptation for Congress, yet again, to kick the can down the road again. Except, now that we have already entered the dead-end section of road to fiscal responsibility, we do not have much room to wiggle around. Many economists and political leaders from both parties believe that further delays will only result in a financial crisis of epic proportions.
So how do we cut the spending and avert this crisis? We talk about sacrifice for the common good, but what does that really mean? Significant reductions in spending will be necessary, but what programs will be affected?
Do you think you can make the tough choices that will be necessary to solve the problem?
The New York Times crafted a budget cutting exercise in its Sunday's Week In Review Section. It provides readers with budget cutting alternatives to cut $1.345 trillion from the 2030 budget, the year where many believe that the full impact of baby boomers will be felt in terms of spending on Social Security and Medicare. The Times scenarios include almost triple the revenue cuts and tax increases needed to solve this mounting financial crisis, allowing you the option to ignore choices you do not want to make. Of course, Congress will have more alternatives at their disposal, including their now famous creative accounting, but the Social Security surplus which enabled President Clinton to achieve budget surpluses, will be long gone at that point and Medicare and Social Security will be major contributors to deficit spending.
Here is the link. Click Here or cut or paste this address in your browser. http://www.nytimes.com/interactive/2010/11/13/weekinreview/deficits-graphic.html.
I was able to do it without capping Medicare spending at GDP plus one percent, but it took deep cuts in spending from other programs, including defense, along with some tax increases. It is important to remember that as I made the tough choices we hear so much about, that I didn't have any lobbyists or political contributors beating me over the head while I did it.
Finally, you must remember that these tough choices only limit future annual deficits, they do not address the overall national debt which as of 7:30 AM Monday, November 15 is $13,738,736,868,863.89. If you want to see how much it has increased since this writing, click the U.S. National Debt Clock. And if you want to write a check for your share, they will provide that amount to you as well. But be warned, it is a depressingly large number.
Building bench strength --assessment, investment and consistency -- is an important human capital strategy for healthcare organizations. It is a strategy that will be an important foundation for an organization's future success. Or survival.
The assessment piece is easy -- evaluating senior leaders, managers, and all those hourly workers who are the heart and soul of whether an organization is great or mediocre, successful, or on the road to crisis and failure. A CEO who is not engaged in this process, who is not familiar with top, middle and low performers is missing an important leverage point for success.
Investment is a little tougher to master. Far too many hospitals and other providers by thought, word and deed treat their human capital as an expense that is tangential to success. In a time of Medicare reductions, those we know about today and those we will learn about as this nation's debt crisis continues over the next 15 to 20 years, it is counterintuitive to make investments in leadership, management and performance development initiatives, especially if an organization has always skimped in the past. Most human capital specialists who work in the healthcare arena argue that this is no longer a discretionary investment but essential spending.
Consistency. This is truly the hardest hurdle to overcome. CEOs who do not see talent acquisition and development as a critical part of their job struggle with this the most. They begin with great intentions but then slip back to duties and issues about which they are more comfortable, or about which they believe are more critical to the success of day-to-day operations. Changing innate patterns takes time, energy and a trusted coach. Randy Guttenberger, CBA, a JGSA associate and founder of CEROS, an executive coaching and team building consultancy, says that CEOs must rewire how they look at their role as a leader, their priorities as well as the underlying beliefs that drive daily behavior. Building a great team is not something that just happens. It takes a focused effort and a willingness to adjust core values regarding how CEOS view their jobs along with a willingness to delegate operational matters that other team members can easily handle.
Developing bench strength is a more cost effective and less risky approach to meeting management or leadership needs. This is not rocket science but you must be willing to assess, invest and then be the type of consistent leader who says -- and who is a true believer -- that people are an organization's most important asset.
© 2010 John Gregory Self
The higher you move up in an organization, the less control and absolute power you have, or so goes an old business adage. You are forced to depend on others to do the work, to make responsible decisions. When it comes down to affecting relationships with employees, you cannot command loyalty and respect. Those are earned.
A health system CEO I know and respect once remarked that he never made patient room visits and certainly not employee rounds by himself because he was uncomfortable in that role. He preferred the familiar surrounds of the executive suite and the structure of department manager meetings and carefully organized town hall meetings. That surprised me given that he was seen as a very successful CEO, reducing costs, enhancing service, improving accountability and building the balance sheet. Yet, he was uncomfortable "mixing it up" -- casual interactions -- with the people who made his success possible. Not enjoying making rounds and getting to know his workforce while reinforcing the organization's values and strategic vision, felt incongruous to me.
Fast forward to today's complex tough operational and hyper-competitive market. It is more important than ever for CEOs to cultivate and store the vital "capital" of employee support, if not loyalty, and goodwill. There will always be bad times ahead and CEOs will need to draw from this reservoir of support.
The complexity of change, and the pace at which it occurs, is accelerating thanks to technology, connectivity and high-speed customer and workforce expectations. Together, they can create some formidable speed bumps, and CEOs will need all the available employee communication tools at their disposal to achieve success.
Gone are the days when so-called phantom hospital administrators could operate successfully from the confines of the executive office, making use of a private entrance that made their comings and goings almost invisible to employees and physicians and rarely seen walking the halls or taking lunch in the cafeteria. That leadership style began to disappear in the late 1970s. By the late 1980s it had almost vanished even though today, there are still some executives who have not made the transition.
A personalized approach to employee communication, supported by state-of-the-art integrated web-based platforms that draw in employees, who increasingly include physicians, is an essential investment -- and a critical tool -- for hiring and retaining top talent. As usual, other industries are way out in front of healthcare organizations in developing this medium.
This is one investment healthcare cannot afford to put off.
© John Gregory Self
Michael Lewis: Boomerang: Travels in the New Third World
Next up on my reading list. Lewis, author of Liar's Poker, The Big Short and Money Ball, is a great story teller. I am looking forward to beginning this soon.
Bill Conaty & Ram Charan: The Talent Masters: Why Smart Leaders Put People Before Numbers
Just started this over the weekend. Great, engaging read. (***)
Frederick Kempe: Berlin 1961
Kennedy, Khrushchev and the most dangerous place on earth. Mr. Kempe provides an extraordinary inside look at the Genesis of the cold war. This is a great leadership book as well as a historical expose. (*****)
Michael Lewis: The Big Short: Inside the Doomsday Machine
This is an excellent inside look at the financial crisis that nearly brought the U.S. economy to its knees, and how a few very smart people made millions in profits. from the foolish decisions of mortgage originators and investment bankers.
(*****)
Atul Gawande: The Checklist Manifesto: How to Get Things Right
A good read from a physician in the forefront of improving healthcare safety and quality.
Youngme Moon: Different: Escaping the Competitive Herd
A wonderful read. Exciting stuff. Visit Amazon for a wonderful and creative new media promotion for this book. It is one of the best I have seen.
http://www.youtube.com/watch?v=26PVrm4iLA0
Helpful hint: if you do not run a company, simply substitute your name for the references to companies. (****)
Matthew Stewart: The Management Myth: Why the "Experts" Keep Getting it Wrong
If you have ever had a bad experience with consultants, this books will explain the dirty little secrets of management consulting. (*****)
Marshall Goldsmith: What Got You Here Won't Get You There: How Successful People Become Even More Successful
An extraordinary book! As you move through his unsettling examples, be ready for self-reflection. Embrace change. We are experiencing unprecedented changes in our economy. It is not logical to assume that the management style that brought success in the 1970s or 1980s will be as effective today.
(*****)
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